This document discusses urinary tract infections (UTIs), including pyelonephritis. It defines UTIs as inflammation of the renal pelvis and kidney parenchyma. E. coli is the most common causative organism, entering the urinary tract via the urethra or hematogenously. Risk factors include female anatomy, catheterization, neurological conditions, pregnancy, and diabetes. Symptoms range from asymptomatic to fever and flank pain. Diagnosis involves urine culture and microscopy. Treatment consists of antibacterial therapy and fluid intake. Prevention focuses on proper catheter care and hygiene.

1. Nur Amalina Aminuddin Baki
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2.  Definition
 Etiology
 Pathogenesis
 Clinical feature
 Lab diagnosis
 Treatment

3.  inflammation of the
parenchyma and
lining of renal pelvis
of kidney

4.  Epidemiological viewpoint
 Community acquired ( common)
 hospital acquired (catherization)(40%)

6. ASCENDING ROUTE
 Gram negative organism
 E.coli (common)
 Proteus mirabilis,
Citrobacter, klebsiella,
enterobacter, proteus
pseudomonas aeruginosa
 Gram positive organism
 Staph.saprophyticus,
Staph. Epidermidis
enterococcus,
Corynebacteria and
lactobacilli
BY HEMATOGENOUS
SPREAD
 Salmonella typhi,
staphylococcus aureus and
mycobacterium
tuberculosis

7. VIRUS
 Rare
 Virus Human
polymaviruses , JC and BK
 Cytomegalovirus and
rubella
 Korean hemorrhagic fever
virus
 Mumps and HIV
 Recovered in urine in
absence of UTI
PARASITE
 Fungi : candida spp and
histoplasma capsulatum
 Protozoa : trichomonas
vaginalis
 Helminth: schistosoma
haematobium

9.  Female :Shorter urethra
 Male : uncircumcised infant  bacterial
colonization inside prepuce and urethra
 Catherization
 DIRECT: Bacteria carried directly into bladder
during insertion
 INDIRECT:Facilitation of bacterial access via
▪ lumen of catheter
▪ Tracking up between outside catheter and urethral wall

11. • Normal urine flow
disruption ( obstruction )
Incomplete bladder
emptying  > 2-3ml
residual urine infection
 ascent of infection 
pyelonephritis
 Pregnancy
 Prostatic hypertrophy
 Renal calculi
 Tumor
 Stricture
 Loss of neurological
control of bladder and
sphincter( spina bifida ,
paraplegia, multiple
sclerosis)
 Vesicourethral reflux
( urine reflux from bladder
to ureter, renal pelvis and
parenchyma)
 Diabetes Mellitus 
diabetic neuropathy
interfere with bladder
function

12.  Uropathogenic E. Coli (UPEC)
 Pyelonephritis associated pili (PAP) adhesion to
urethral and bladder epithellium in
 K antigen that help E coli to be phagocytosis-
resistant
 Hemolysin ( membrane damaging toxin)
 Proteus spp
 Urease

14.  Asymptomatic infection
 Pregnant woman and young
children
 The elderly and those with
diabetes
 People undergoing
instrumentation of urinary
tract
 Detect only by urine
screening
 Lower UTI symptoms :
 Dysuria
 Urgency
 Frequent micturition
 Fever
 Hematuria
 Pyuria ( M. TB)
 Renal hypertension renal
damage
 Renal tract obstruction
 Septicemia

15.  Sample collection
 Sample transport
 Laboratory investigation

16.  Collected before start of antimicrobial therapy
 State on request form if patient received therapy
within previous 48 hours
 Adult: Midstream urine sample
 Children : Bag Urine, Suprapubic aspiration
 Sample from catheter

17.  MidStream Urine
 Clean labia/ glans with non-antiseptic soap and
water
 Void first part of urine stream
 Collect midstream sample into sterile wide
mouthed container
 difficult in babies and young children

18.  Bacteriuria considered SIGNIFICANT when
 Properly collected
 > 105 organism /ml
 Only a single bacterial species
 Not apply to urine specimen not contaminated by
periurethral flora
 Contaminated urine of MSU
 < 104 organism /ml
 Contain > 1 bacterial species

19.  BAG URINE :
 Stick plastic bag to perineum/ penis
 Frequent heavy contamination
 Suprapubic aspiration
 Collected directly from bladder by needle
insertion
 No contamination
 Significant bacteruria not applied

21.  M. Tuberculosis
 3 early morning urine sample
 Do not require precaution as MSU
 Culture technique inhibit other organism’s growth
 S. haematobium
 Last few ml of late morning sample after exercise

22.  Only in patient undergoing catherization
 Withdraw using a syringe and needle from
catheter tube
 Do not take urine from catheter drainage bag
( bacterial multiplication)
 Significant bacteruria not applied

24.  Immediate with minimum delay
 Multiplication of organism in specimen alters
result

25.  Macroscopic :
 appearance
 colour
 turbidity
 Microscopic : enable Rapid preliminary report
 Presence of
▪ RBC
▪ WBC
▪ pus

26. PRESENCE OF RBC
 Hematuria:
 Infection of urinary tract
and elsewhere ( bacterial
endocarditis)
 Renal trauma
 Calculi
 Urinary tract carcinoma
 Clotting disorder
 Thrombocytopenia
 RBC contamination of
menstruating women
PRESENCE OF WBC
 Normal : <10/ml
 Abnormal : > 10/ml
 Not always associated
with bacteruria
 Confused with renal
tubular cell in urine of
aspirin-misuser

27.  An important finding and may reflect :
 Concurrent antibiotic therapy
 Other diseases( neoplasm, urinary calculi)
 Infection with organism not detected by routine
urine culture method

28.  Based on factor:
 Collection- carried out properly
 Storage
▪ cultured within one hour of collection
▪ Stored at 4 Celsius not > 18 hour before culture
 Antibiotic treatment – smaller number of
organism may be significant
 Fluid intake - influence quantitative result
 Specimen – for MSU specimen

29.  Colony Morphology on Mc Conkey agar:
 LF : E.coli, Klebsiella, Enterobacter
 NLF: Proteus mirabilis, Pseudomonas, Staph.
Aureus, S. Typhi
 Colony morphology on Blood agar:
 Gamma: E.coli, proteus mirabilis
 Beta: Staph. Aureus, Pseudomonas

30.  Gram Stain
 Positive:
▪ Staphylococcus saprophyticus ,Staph. Epidermidis and
enterococcus, Corynebacteria and lactobacilli
 Negative:
▪ E.coli,Proteus mirabilis, Citrobacter ,Klebsiella,
enterobacter, proteus and pseudomonas aeruginosa

31. Catalase Coagulase Acid , Gas
production
Staph.
Epidermidis + - AG
Staphylococcus
aureus + + A
Corynebacteria
+ - A
Enterococcus
- X A
Lactobacilli
- X AG

32. IMViC Acid , Gas production
Klebsiella,
--++ AG
Enterobacter,
--++ AG
Pseudomonas
aeruginosa ---+ A
Salmonella typhi,
-+-- A
E.Coli
++-- AG
Proteus mirabilis
-+-+ AG
Citrobacter ,
V+-+ AG

33.  Specific antibacterial therapy
 Drink large volume of fluid
 Continued systemic treatment till sign and
symptom subsides
 Usually 10 days
 > 10 days to sterilize kidney

34.  Regularly emptying bladder in healthy
women
 Prevention of hospital-acquired infection in
catheterized patient by :
 Avoid catherization whenever possible
 Minimize duration of catheterization
 Insert catheter with good aseptic technique
 Use closed sterile drainage system
 Maintain a gravity drain
 Use topical antiseptic around meatus in women
 Wash hand before and after inserting catheter,
collecting specimen and emptying drainage bags

35.  Inflammation of pelvis and kidney
 Complication from UTI
 Mainly by E. coli
 Collection: MSU, bag urine, suprapubic
aspiration, catheter
 Treatment based on infection

36.  Textbook of Microbiology, 4th
Edition, Dir. Prof. C
P Baveja, 2013, Arya Publications
 Mims’ Medical Microbiology, 4th
edition, Mims,
2008 , MOSBY Elsevier