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UTI- Urinary Tract Infection


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Published in: Health & Medicine

UTI- Urinary Tract Infection

  2. 3. <ul><li>Condition in which microorganisms actively multiply and persist in the genitourinary tract. </li></ul><ul><li>Acute infection of the urinary tract falls into two general anatomic categories. </li></ul><ul><li>Lower Tract Infection - Urethritis And Cystitis. </li></ul><ul><li>Upper Tract Infection - Acute Pyelonephritis, Prostatitis , Intrarenal and Perinephric Abscess. </li></ul>
  3. 4. <ul><li>Most common infectious disease. </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 </li></ul><ul><li> </li></ul><ul><li>Most Numerous specimens are received in the Laboratory </li></ul><ul><li>Appropriate clinical information gives many clues for better diagnostic evaluations. </li></ul><ul><li>Specimen collection is the primary objective in getting an ideal sample. </li></ul>
  4. 5. <ul><li>More common in adults than in children. Infections in children are more likely to be serious than those in adults and should not be ignored. </li></ul><ul><li>Physical contact with an infected partner. </li></ul><ul><li>Waiting too long to urinate. </li></ul><ul><li>Pregnancy. </li></ul><ul><li>Diabetic /Immunosuppressed individuals </li></ul><ul><li>Calculi. </li></ul><ul><li>Men with an enlarged prostate. </li></ul>
  5. 6. <ul><li>Any medical conditions that cause incomplete bladder emptying (spinal cord injury) or bladder decompensation after menopause. </li></ul><ul><li>The most common cause of UTIs are bacteria from the bowel that live on the skin near the rectum or in the vagina, which can spread and enter the urinary tract through the urethra </li></ul>
  6. 7. <ul><li>Frequent urination, but very little urine may come out. </li></ul><ul><li>Painful burning sensation before, during, and after urinating. </li></ul><ul><li>Urinating blood . </li></ul><ul><li>Urgent need to urinate, and in serious cases, unable to control bladder and leaks urine. </li></ul><ul><li>Cloudy or foul smelling urine . </li></ul><ul><li>Fever . </li></ul><ul><li>Malaise or the general feeling of unwell. </li></ul><ul><li>Severe pain in the lower abdominal region. </li></ul>
  7. 8. <ul><li>Mainly caused by colonic bacteria </li></ul><ul><ul><li>E.coli – most common </li></ul></ul><ul><ul><li>Klebsiella </li></ul></ul><ul><ul><li>Proteus </li></ul></ul><ul><ul><li>Staphyloccus saprophyticus </li></ul></ul><ul><ul><li>Pseudomonas aeruginosa </li></ul></ul><ul><ul><li>Candida- infections in Diabetic or imunocompromised </li></ul></ul><ul><ul><li>patients. </li></ul></ul>
  8. 9. <ul><li>Acute Pyelonephritis </li></ul><ul><li>Involvement of renal parenchyma. </li></ul><ul><li>Characterized by: </li></ul><ul><li>Early Onset Fever. </li></ul><ul><li>Abdominal Pain or Flank Pain. </li></ul><ul><li>Malaise. </li></ul><ul><li>Nausea and Vomiting. </li></ul><ul><li>Diarrhea. </li></ul><ul><li>Cystitis </li></ul><ul><li>Involves bladder . </li></ul><ul><li>Characterized by: </li></ul><ul><li>Dysuria . Urgency. </li></ul><ul><li>Frequency. Suprapubic Pain. </li></ul><ul><li>Incontinence . Malodorous Urine. </li></ul><ul><li> No fever and does not result in renal injury </li></ul>
  9. 10. <ul><li>Urethritis </li></ul><ul><li>Suspected in growth/ culture negative symptomatic cases. </li></ul><ul><li>Symptoms similar to Cystitis. </li></ul><ul><li>Caused by Sexually Transmitted infections . </li></ul><ul><li>Asymptomatic bacteriuria </li></ul><ul><li>+ urine culture without any manifestation of infection. </li></ul><ul><li>Occurs exclusively in girls, elderly men and women. </li></ul><ul><li>Benign and does not cause renal injury. </li></ul><ul><li>Catheter associated UTIs </li></ul><ul><li>Female Sex </li></ul><ul><li>Unsterile procedure while insertion </li></ul><ul><li>Prolonged Catheterization </li></ul><ul><li>Severe underlying Diseases </li></ul><ul><li>Lack of catheter care </li></ul>
  10. 11. <ul><li>Routine Blood Investigations </li></ul><ul><li>Blood Urea & Serum Creatinine. </li></ul><ul><li>Routine urine </li></ul><ul><li>Simple microscopic examination of wet films of unconcentrated urine for detection of Polymorphonuclear </li></ul><ul><li>leucocytes & pus cells gives leading clues. </li></ul><ul><li>Semi-quantitative culture of urine to determine whether urine contain potentially pathogenic bacteria in Numbers sufficient to identify it as causative agent causing infection. </li></ul><ul><li>Urine culture and antibiotic sensitivity. </li></ul>
  11. 12. <ul><li>Radiological Evaluation </li></ul><ul><li>Guidelines for selection of patients with UTI for radiologic evaluation: </li></ul><ul><ul><li>All neonates with 1st UTI </li></ul></ul><ul><ul><li>All males with 1 st UTI at any age </li></ul></ul><ul><ul><li>All patients with recurrent UTI </li></ul></ul><ul><ul><li>All patients with Pyelonephritis </li></ul></ul><ul><li>Intravenous Pyelography (IVP) </li></ul><ul><li>Information about renal size, renal scars and state of pelvocalyceal system </li></ul>
  12. 13. <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 with UTI, any child with febrile UTI, school-aged girls who had 2 or more UTIs </li></ul><ul><li>Any male with 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,calculi. </li></ul>
  13. 14. <ul><li>Specimen Collection </li></ul><ul><li>The urine collected in a wide </li></ul><ul><li>mouthed sterile container </li></ul><ul><li>A mid stream specimen is </li></ul><ul><li>the most ideal for processing. </li></ul><ul><li>Do not collect spontaneously </li></ul><ul><li>collected urine , which can </li></ul><ul><li>Lead to contamination with </li></ul><ul><li>commensal bacterial colonies </li></ul><ul><li>on urethral orifice and </li></ul><ul><li>perineum. </li></ul>
  14. 15. <ul><li>All collected specimens of </li></ul><ul><li>urine to be transported </li></ul><ul><li>to laboratory with out delay </li></ul><ul><li>Delay of 1-2 hour lowers the </li></ul><ul><li>quality of diagnostic </li></ul><ul><li>evaluations. </li></ul><ul><li>If the delay is anticipated the </li></ul><ul><li>specimens are to be preserved </li></ul><ul><li>at 4 0 c . </li></ul>
  15. 16. <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(10 5 ) 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>
  16. 17. <ul><li>Symptomatic Cases attending OPDs should be started on Broad-Spectrum Antibiotics. </li></ul><ul><li>Ideally urine samples to be sent for examinations prior to Antibiotic administration. </li></ul><ul><li>DRUGS: </li></ul><ul><li>Trimethoprim Sulfamethoxazole Nitrofurantoin </li></ul><ul><li>Penicillin Quinolone </li></ul><ul><li>Aminoglycosides Cephalosporins </li></ul><ul><li>Conservative: </li></ul><ul><li>Increased oral fluids intake. </li></ul><ul><li>Acidification of urine. </li></ul><ul><li>Regular and complete bladder emptying. </li></ul><ul><li>Good personal hygiene. </li></ul>