urinary tract infection

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urinary tract infection

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urinary tract infection

  1. 1. Urinary tract infection Dr. Crisbert I. Cualteros http://crisbertcualteros.page.tl
  2. 2. <ul><li>Urinary tract infection </li></ul><ul><li>Condition in w/c microorganisms actively multiply and persist in the genitourinary tract </li></ul><ul><li>Affects all ages </li></ul><ul><li>> males predominate in the newborn period </li></ul><ul><li>> beyond this age, females predominate (3.5 % of girls and 1% of boys) </li></ul><ul><li>Etiology: </li></ul><ul><li>Mainly caused by colonic bacteria </li></ul><ul><li>> E.coli – most common </li></ul><ul><li>> Klebsiella </li></ul><ul><li>> Proteus </li></ul><ul><li>> Staphyloccus saprophyticus </li></ul>
  3. 3. <ul><li>Clinical Manifestation </li></ul><ul><li>3 basic forms : </li></ul><ul><li>1. Acute Pyelonephritis </li></ul><ul><li>- involvement of renal parenchyma </li></ul><ul><li>- characterized by fever, abdominal pain or flank pain, malaise, NAV, diarrhea </li></ul><ul><li>2. Cystitis </li></ul><ul><li>- involves bladder and symptoms of dysuria, urgency, frequency, suprapubic pain, incontinence and malodorous urine </li></ul><ul><li>- no fever and does not result in renal injury </li></ul>
  4. 4. <ul><li>3. Asymptomatic bacteriuria </li></ul><ul><li>- + urine culture w/o any manifestation of infection </li></ul><ul><li>- occurs exclusively in girls </li></ul><ul><li>- benign and does not cause renal injury </li></ul>
  5. 5. <ul><li>Pathogenesis </li></ul><ul><li>route of infection: </li></ul><ul><li>- ascending infection </li></ul><ul><li>- anatomic abnormalities </li></ul><ul><li>- uroepithelial adherence </li></ul><ul><li>- bacterial virulence </li></ul>
  6. 6. <ul><li>Risk factors for UTI </li></ul><ul><li>female </li></ul><ul><li>uncircumcised male </li></ul><ul><li>vesicoureteral reflux </li></ul><ul><li>toilet training </li></ul><ul><li>voiding dysfunction </li></ul><ul><li>obstructive uropathy </li></ul><ul><li>urethral instrumentation </li></ul><ul><li>wiping from back to front </li></ul><ul><li>bubble bath </li></ul><ul><li>tight underwear </li></ul><ul><li>pinworm infestation </li></ul><ul><li>constipation </li></ul><ul><li>P fimbriated bacteria </li></ul><ul><li>anatomic abnormallity </li></ul><ul><li>neuropathic bladder </li></ul><ul><li>sexual activity </li></ul><ul><li>pregnancy </li></ul>
  7. 7. <ul><li>Diagnosis </li></ul><ul><li>Urinalysis </li></ul><ul><li>- > 10 WBC /hpf in a centrifuged urinary sediment </li></ul><ul><li>- hematuria </li></ul><ul><li>- + nitrite test </li></ul><ul><li>- absence of pyuria does not rule out UTI </li></ul><ul><li>Urine culture </li></ul><ul><li>- gold standard </li></ul><ul><li>- midstream urine sample: </li></ul><ul><li>> 100,000 colonies/ml of a single pathogen </li></ul><ul><li>10,000 col/ml if symptomatic </li></ul><ul><li>- catheterized urine > 10 5 colony count </li></ul><ul><li>- suprapubic aspirate = any bacterial growth </li></ul>
  8. 8. <ul><li>Diagnosis…. </li></ul><ul><li>Radiological Evaluation </li></ul><ul><li>Guidelines for selection of pxs w/ UTI for radiologic evaluation: </li></ul><ul><li>- all neonates w/ 1st UTI </li></ul><ul><li>- all males w/ 1 st UTI at any age </li></ul><ul><li>- all pxs w/ recurrent UTI </li></ul><ul><li>- all pxs w/ pyelonephritis </li></ul><ul><li>Intravenous Pyelography (IVP) </li></ul><ul><li>- information about renal size, renal scars and state of pelvocalyceal system </li></ul>
  9. 9. <ul><li>VCUG (voiding cystourethrogram) </li></ul><ul><li>- definitive test to document VUR </li></ul><ul><li>- indicated in children younger than 5 yr w/ UTI, any child w/ febrile UTI, school-aged girls who had 2 or more UTIs </li></ul><ul><li>- any male w/ UTI </li></ul><ul><li>Ultrasound of the kidney and urinary bladder </li></ul><ul><li>- screening procedure of choice </li></ul><ul><li>- should be obtained to rule out hydronephrosis and renal or perirenal abscesses </li></ul>
  10. 10. <ul><li>Treatment </li></ul><ul><li>- Trimethoprim Sulfamethoxazole </li></ul><ul><li>- Nitrofurantoin </li></ul><ul><li>- Ampicillin </li></ul><ul><li>- Amoxicillin </li></ul><ul><li>- Aminoglycosides </li></ul><ul><li>- Cephalosporins </li></ul><ul><li>Conservative: </li></ul><ul><li>- Increased oral fluids intake </li></ul><ul><li>- Regular and complete bladder emptying </li></ul><ul><li>- Increased dietary fiber intake </li></ul>
  11. 11. <ul><li>Prognosis </li></ul><ul><li>- difficult to determine </li></ul><ul><li>- especially if with significant renal scarring » at risk for developing chronic renal insufficiency </li></ul>
  12. 12. Thank you !!!

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