Infecciones de vías urinarias tratamiento y diagnóstico

1. Infección de vías urinarias
Urología 903
Isaac Méndez Ruiz
Dr. Salas Foglia Abel

2. Presentación muy variada, desde un
curso asintomático de bacterias en la
orina hasta una fuerte infección del
riñón con septicemia resultante.
Puede requerir sólo un antibiótico
específico mientras que en otros
requiere el curso más largo de un
antibiótico de amplio espectro.
Generalidades

3. 14000:100,000H
53000:100,000M
Epidemiología
1.12%
Mayor
incidencia
En hombres sin
circuncisión primeros
6 meses de vida
2.4-
2.8%
En niños
Es la incidencia
que se presenta
Al menos el 50% de todas las
IVU no reciben atención médica.
Prevalencia
general
Las mujeres tienen la mayor incidencia
10-20% tienen al menos 1 episodio
en su vida

4. Patogénesis
01

5. Entrada bacteriana
1
Suele aceptarse como la
principal causa de las IVU.
Ascenso de bacterias
2
Puede ocurrir en
inmunocomprometidos y
neonatos.
Dispersión hematógena
3
Pacientes con abscesos
intraperitoneales de fístulas
vesicointestinal o vaginal.
Extensión de órganos
adyacentes
4
A partir de un foco en
próstata o riñón tratado
inadecuadamente.
Reincidencia de infección
Hay 4 modos posibles de entrada bacteriana en las vías
genitourinarias:

6. Defensas del huésped
Factores de susceptibilidad
Características de la orina
Osmolaridad, urea, ácidos orgánicos y
pH son factores protectores.
Glucoproteína de
Tamm-Horsfall
Inhibe la adherencia bacteriana
Patologías específicas
Retención urinaria, estasis o
reflujo de la orina promueven IVU.
Anomalías
anatómicas/funcionales
Trastornos obstructivos,
enfermedades neurológicas,
presencia de cuerpos extraños, etc.
Recubrimiento epitelial
de vías urinarias
Expresan receptores tipo Toll los cuales
producen mediadores inflamatorios.
Otras: Selectividad en adherencia bacteriana, relacionado a la
colonización e infección. Microbiota urinaria. Envejecimiento.

7. Características especiales:
● Mayor adherencia
● Resistencia bactericida por
el suero humano.
● Producción de hemolisina.
● Mayor expresión de
antígeno capsular K.
Patógenos causantes
80% de las cistitis
y pielonefritis son
causada por E. coli
(serogrupo O)
Otros: Klebsiella, Enterobacter spp (niños), Proteus, Pseudomonas (hospital), S.
aureus (diseminación), Estreptococos beta-hemolíticos B (embarazadas).

8. Diagnóstico
02

9. Se irriga la vejiga, se coloca
una sonda ureteral y se
recolecta una muestra de la
pelvis renal.
Estudios de
localización
Búsqueda de esterasa leucocitaria
y nitritos, más confiables cuando
la cifra de bacterias es de 100,000
UFC/ml. >3 leucocitos por campo
sugiere infección.
Análisis de orina
Es la prueba de referencia para
la identificación de IVU. Se
cuenta la cantidad de colonias
por mililitro de orina.
Urocultivo
Depende del análisis de orina y el urocultivo, en ocasiones
se puede necesitar estudios de localización.
Disura, dolor suprapúbico,
abdominal o lumbar. Disuria,
polaquiuria, tenesmo vesical,
urgencia miccional y dolor
suprapúbico, con o sin fiebre.
Signos y síntomas

10. Tratamiento
03

11. Ineficaz contra Enterococcus
y Pseudomonas spp. No usar
en el embarazo y otros
estados.
TMP-SMX
Amplio espectro, sobre todo Gram-,
poca efectividad contra
estreptococos y bacterias
anaeróbicas. Costosas. Empíricas.
No usar en el embarazo.
Fluoroquinolonas
Buena actividad contra la
mayoría de Gram-, estafilococos
y enterococos, excepto
Pseudomonas y Proteus. Muy
efectiva y económica.
Nitrofurantoína
La elección del antibiótico suele ser difícil y no están bien definidas las dosis
efectivas más bajas ni la duración. Depende del patógeno infeccioso, paciente
y el sitio de infección, tomar en cuenta enfermedades renales y hepáticas.

12. Suelen usarse en IVU
complicada. Efectivas
contra casi todas las
Gram-, efectivas contra
enterococos cuando se
combina con ampicilina.
Aminoglucósidos
Buena actividad contra la
mayoría de uropatógenos.
Tratamiento empírico en
no complicada, niños con
IVU febril, pielonefritis o
ambas.
Cefalosporinas
Amoxicilina y ampicilina tienen
buena actividad contra
enterococos, estafilococos, E.
coli y Proteus, en conjunto con
inhibidores de beta-lactamasa
son efectivas contra Gram-.
Penicilinas

13. GPC IVU en niños

14. Resistencia a
los antibióticos
Ha aumentado drásticamente en los
últimos años. Se relaciona con
S.aureus y C. difficile resistentes a
meticilina. E. coli ha resultado con
alta resistencia a ampicilina y TMP-
SMX. Avanza la resistencia a
nitrofurantoína y fluoroquinolonas.
Probióticos
Probióticos como bacterias del
ácido láctico y las bifidobacterias
restauran la microbiota y promueven
las defensas del huésped. Evitarse
en enfermedad crítica o
inmunocomprometidos.

15. ● McAninch J, Lue T. Smith y Tanagho: Urología general. 18a ed. Mc Graw Hill: México; 2014.
● Generalidades de las siete principales causas de morbilidad en México 2005-2012 [Internet].
Secretaría de Salud: México; 2013 [Fecha de acceso 28 de agosto del 2022]. URL disponible en:
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&ved=2ahUKEwipn6K3wur
5AhWeKUQIHWCzD_sQFnoECBkQAQ&url=https%3A%2F%2Fwww.gob.mx%2Fcms%2Fuplo
ads%2Fattachment%2Ffile%2F12855%2Fsem43.pdf&usg=AOvVaw02446d0esfUu1CjWR0kcT
k
● Resistencia bacteriana y comorbilidades presentes en pacientes urológicos ambulatorios con
urocultivos positivos [Internet]. IMSS: México; 2017 [Fecha de acceso 28 de agosto del 2022].
URL disponible en:
http://revistamedica.imss.gob.mx/editorial/index.php/revista_medica/article/view/1149/3042
● Diagnóstico y tratamiento de la infección de vías urinarias no complicada en menores de 18
años en el primer y segundo niveles de atención [Internet]. Secretaría de salud: México; 2021.
[Fecha de acceso 28 de agosto del 2022]. URL disponible en:
https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=&cad=rja&uact=8&ved=2ah
UKEwiJ7cmk6Or5AhVmMEQIHSUSCM0QFnoECAgQAQ&url=http%3A%2F%2Fwww.cenetec-
difusion.com%2FCMGPC%2FGPC-SS-027-
21%2FER.pdf&usg=AOvVaw3bbzh0zt2FJIfnSLKyL6oZ
Fuentes consultadas

16. You can describe the
topic of the section here
TABLE OF CONTENTS
OBJECTIVES
01 You can describe the
topic of the section here
METHODOLOGY
02
You can describe the
topic of the section here
RESULTS
ANALYSIS
03 You can describe the
topic of the section here
CONCLUSIONS
04

17. OBJECTIVES
You can enter a subtitle here if you need it
01

18. INTRODUCTION
You can give a brief description of the topic you
want to talk about here. For example, if you
want to talk about Mercury, you can say that it’s
the smallest planet in the entire Solar System

19. Mercury is the closest
planet to the Sun
BACKGROUND
MERCURY
Venus is the second
planet from the Sun
VENUS
Despite being red, Mars is
actually a very cold place
MARS
It’s a gas giant and the
biggest planet
JUPITER
The Sun is the star at the
center of the Solar System
SUN
Neptune is the farthest
planet from the Sun
NEPTUNE

20. 130,000
Big numbers catch your audience’s attention

21. Mercury is the closest
planet to the Sun and the
smallest one
GOALS
MERCURY
Neptune is the farthest
planet from the Sun. It's
really cold there
NEPTUNE
Venus has a beautiful
name and is the second
planet from the Sun
VENUS

22. METHODS
MERCURY
Mercury is the closest
planet to the Sun
VENUS
It’s the second planet
from the Sun
NEPTUNE
Neptune is the farthest
planet from the Sun
MARS
Despite being red,
Mars is actually a cold
JUPITER
Jupiter is a gas giant
and the biggest planet
PLUTO
It’s now considered a
dwarf planet

23. AWESOME
WORDS

24. RESEARCH AND PUBLICATIONS
“Despite being red, Mars is actually a
cold place. It's full of iron oxide dust,
which gives the planet its reddish cast”
BY MARS
“Venus has a beautiful name and is the
second planet from the Sun. It’s terribly
hot, even hotter than Mercury”
BY VENUS

25. ● You can list your reference websites or publications here
● You can list your reference websites or publications here
● You can list your reference websites or publications here
● You can list your reference websites or publications here
● You can list your reference websites or publications here
● You can list your reference websites or publications here
● You can list your reference websites or publications here
● You can list your reference websites or publications here
● You can list your reference websites or publications here
RESEARCH RESOURCES

26. Mercury is the closest
planet to the Sun and the
smallest one
FACTORS TO CONSIDER
MERCURY
Neptune is the farthest
planet from the Sun. It's
really cold there
NEPTUNE
Venus has a beautiful
name and is the second
planet from the Sun
VENUS
It has several rings. It's
composed of hydrogen
and helium
SATURN

27. “This is a quote, words full of
wisdom that someone important
said and can make the reader
get inspired.”
—SOMEONE FAMOUS

28. CLINICAL TRIAL
PRECLINICAL Mars is a actually a
very cold place
Human safety
PHASE 1
Venus is the second
planet from the Sun
Expanded safety
PHASE 2
Mercury is the
smallest planet
Efficacy & safety
PHASE 3
Lab studies

29. TRIAL TIMELINE
1
Mercury is the closest planet
to the Sun and the smallest
one in the Solar System
RESEARCH
2
Despite being red, Mars is
actually a cold place. It's full
of iron oxide dust
EXPERIMENTAL
3
Venus has a beautiful name
and is the second planet from
the Sun. It’s terribly hot
RESULTS
4
Neptune is the farthest planet
from the Sun. It's also the
fourth-largest object
CONCLUSIONS

30. 80%
PHASE 1
20%
MERCURY
It’s the closest
planet to the Sun
80%
MARS
Mars is a very
cold place
Success rate
Despite being red, Mars is
actually a cold place. It's full
of iron oxide dust
RESULTS
Young healthy people
20 - 80 Participants

31. TREND
PHASE 1
Despite being red, Mars is a cold
place. It's full of iron oxide dust
PHASE 2
Neptune is the farthest planet from
the Sun. It's really cold there
PHASE 3
Saturn is a gas giant. It’s composed
of hydrogen and helium Follow the link in the graph to modify its data and then paste the new
one here. For more info, click here

32. RESULTS
OUTCOME
TREATMENT 123 42 397
GROUP 1 256 - 423
GROUP 2 90 89 190
GROUP 3 - 245 99
EXPERIMENT A
OUTCOME
TREATMENT - 36 93
GROUP 1 315 70 150
GROUP 2 777 - -
GROUP 3 375 - 36
EXPERIMENT B

33. A PICTURE IS
WORTH A
THOUSAND WORDS

34. RESULTS ANALYSIS
JUPITER
Jupiter is the biggest planet in the
entire Solar System
15%
Venus has a very
beautiful name
30%
Mercury is the
smallest planet
55%
Mars is a very
cold place
SATURN
Saturn is a gas giant and is
composed of hydrogen and helium
EARTH
Earth is the third planet from the
Sun and the only one with life

35. SUCCESS RATE
Neptune is the farthest
planet from the Sun. It's
really cold there
NEPTUNE
10%
Despite being red, Mars is
actually a cold place. It's
full of iron oxide dust
MARS
30%
Jupiter is the biggest
planet in the Solar System.
It’s a gas giant
JUPITER
60%

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