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Urinary Tract Infection

Dr. Ashish Jawarkar, M.D.
Urinary tract
Urinary Tract Infection


Upper urinary tract Infections:
Pyelo-nephritis
 Ureteritis




Lower urinary tract infectio...
Ascending UTI
Descending infection
Hematogenous spread
 Chronically ill or immunosuppressed
patients

Causes
Stasis of urine (enlarged prostate etc.)
 Sexual activity
 Pregnancy
 Catheterisation
 Stones

5-7% pregnant women may present
without symptoms
 May lead to prematurity and perinatal
death
 Hence mandatory to screen...
Symptoms of Urinary Tract Infection


UPPER UTI
Dysuria (burning micturition)
 Increased frequency




LOWER UTI
Fever...
Agents of UTI
Most common – E coli
 Community acquired


E. coli
 Enterobacter




Hospital acquired
Klebsiella
 S. ...
Lab diagnosis
Urine can get contaminated while
passing
 Sterile wide mouthed container
 Mid stream clean catch specimen
...
Significant bacteriuria
>1,00,000 bacteria per ml
 Counts <1000 are due to contamination
 Counts between 1000 and 1,00,0...
Other methods for collection


Suprapubic aspiration


Percutaneous nephrostomy


catheter
Culture
Blood agar
 Mc conkey agar

Antibiotic susceptibility testing
Screening tests
Nitrite test
 TTC test
 Demonstration of bacteria in wet film

Wet mount
Strips
Family enterobacteria


Include
E. coli
 Klebsiella
 Proteus

Escherichia Coli
Named after Escherich who first
discovered the colon bacillus
 Lives in intestine, passed in feces

Test for contaminated water supply


E coli testing in water










Morphology
Growth characteristics
Biochemical reactions
Resistance
Pathogenicity and virulence
Epidemio...
Morphology
Gram negative rod
 Singly or in pairs
 Motile











Morphology
Growth characteristics
Biochemical reactions
Resistance
Pathogenicity and virulence
Epidemio...
Growth characteristics
Good growth on ordinary media
 Hemolytic on blood agar
 Mac conkeys agar, pink colonies

Blood agar
Mac conkey’s medium










Morphology
Growth characteristics
Biochemical reactions
Resistance
Pathogenicity and virulence
Epidemio...
IMViC test
I - Indole
 M - Methyl red
 Vi - Voges-Proskauer
 C - Citrate utilisation




To differentiate between ent...
Klebsiella IMViC










Morphology
Growth characteristics
Biochemical reactions
Resistance
Pathogenicity and virulence
Epidemio...
Resistance
Resistant to multiple antibiotics
 Due to production of beta lactamase
which inactivates penicillin and
cephal...










Morphology
Growth characteristics
Biochemical reactions
Resistance
Pathogenicity and virulence
Epidemio...
Pathogenicity and virulence


Surface antigens O and K
O antigen – prevents phagocytosis,
endotoxic activity
 K antigen ...










Morphology
Growth characteristics
Biochemical reactions
Resistance
Pathogenicity and virulence
Epidemio...
Epidemiology
Inhabit the colon
 Spread via contaminated water/food

Diseases caused


UTI


Precipitated by
Prostate enlargement
 Pregnancy
 Calculi


Peritonitis and bowel abcesses
 M...










Morphology
Growth characteristics
Biochemical reactions
Resistance
Pathogenicity and virulence
Epidemio...
Treatment
Ampicillin + clavulanic acid
 Imipenem
 Meropenem

URINARY TRACT INFECTION - MICROBIOLOGY
URINARY TRACT INFECTION - MICROBIOLOGY
URINARY TRACT INFECTION - MICROBIOLOGY
URINARY TRACT INFECTION - MICROBIOLOGY
URINARY TRACT INFECTION - MICROBIOLOGY
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URINARY TRACT INFECTION - MICROBIOLOGY

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This is a series of lectures on microbiology, useful for undergraduate medical and paramedical students

Published in: Health & Medicine

URINARY TRACT INFECTION - MICROBIOLOGY

  1. 1. Urinary Tract Infection Dr. Ashish Jawarkar, M.D.
  2. 2. Urinary tract
  3. 3. Urinary Tract Infection  Upper urinary tract Infections: Pyelo-nephritis  Ureteritis   Lower urinary tract infections Cystitis (“traditional” UTI)  Urethritis (often sexually-transmitted) 
  4. 4. Ascending UTI
  5. 5. Descending infection Hematogenous spread  Chronically ill or immunosuppressed patients 
  6. 6. Causes Stasis of urine (enlarged prostate etc.)  Sexual activity  Pregnancy  Catheterisation  Stones 
  7. 7. 5-7% pregnant women may present without symptoms  May lead to prematurity and perinatal death  Hence mandatory to screen all pregnant women 
  8. 8. Symptoms of Urinary Tract Infection  UPPER UTI Dysuria (burning micturition)  Increased frequency   LOWER UTI Fever  Flank pain 
  9. 9. Agents of UTI Most common – E coli  Community acquired  E. coli  Enterobacter   Hospital acquired Klebsiella  S. aureus  Pseudomonas 
  10. 10. Lab diagnosis Urine can get contaminated while passing  Sterile wide mouthed container  Mid stream clean catch specimen  First portion – bacteria from distal urethra  Processed within 2 hours 
  11. 11. Significant bacteriuria >1,00,000 bacteria per ml  Counts <1000 are due to contamination  Counts between 1000 and 1,00,000 may be significant, have to be co related clinically and by repeat culture 
  12. 12. Other methods for collection  Suprapubic aspiration
  13. 13.  Percutaneous nephrostomy
  14. 14.  catheter
  15. 15. Culture Blood agar  Mc conkey agar 
  16. 16. Antibiotic susceptibility testing
  17. 17. Screening tests Nitrite test  TTC test  Demonstration of bacteria in wet film 
  18. 18. Wet mount
  19. 19. Strips
  20. 20. Family enterobacteria  Include E. coli  Klebsiella  Proteus 
  21. 21. Escherichia Coli Named after Escherich who first discovered the colon bacillus  Lives in intestine, passed in feces 
  22. 22. Test for contaminated water supply  E coli testing in water
  23. 23.          Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
  24. 24. Morphology Gram negative rod  Singly or in pairs  Motile 
  25. 25.          Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
  26. 26. Growth characteristics Good growth on ordinary media  Hemolytic on blood agar  Mac conkeys agar, pink colonies 
  27. 27. Blood agar
  28. 28. Mac conkey’s medium
  29. 29.          Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
  30. 30. IMViC test I - Indole  M - Methyl red  Vi - Voges-Proskauer  C - Citrate utilisation   To differentiate between enterobacteria
  31. 31. Klebsiella IMViC
  32. 32.          Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
  33. 33. Resistance Resistant to multiple antibiotics  Due to production of beta lactamase which inactivates penicillin and cephalosporins 
  34. 34.          Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
  35. 35. Pathogenicity and virulence  Surface antigens O and K O antigen – prevents phagocytosis, endotoxic activity  K antigen – also protects against phagocytoisis  Fimbria – important in UTI  Toxins – beta lactamase 
  36. 36.          Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
  37. 37. Epidemiology Inhabit the colon  Spread via contaminated water/food 
  38. 38. Diseases caused  UTI  Precipitated by Prostate enlargement  Pregnancy  Calculi  Peritonitis and bowel abcesses  Meningitis in new born  Septicemia 
  39. 39.          Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
  40. 40. Treatment Ampicillin + clavulanic acid  Imipenem  Meropenem 

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