Urinary tract infections (UTIs) are caused by the presence of microorganisms in the urinary tract. UTIs can be uncomplicated or complicated depending on whether there are underlying medical issues. Common symptoms include burning during urination, frequent urination, and abdominal pain. Diagnosis involves urine testing and culture. Treatment depends on whether the infection is uncomplicated or complicated but generally involves antibiotic therapy for 3-14 days depending on severity. Single dose antibiotics are often used for uncomplicated infections while longer courses are needed for complicated or recurrent UTIs.

1. Urinary Tract
Infection
Dr. Iqra Muzaffar

2. Definition
Symptomatic prescence of
microorganisms within the
urinary tract i-e kidneys ,
ureters, bladder and urethra .

3. Terminologies
– Uncomplicated : UTI without underlying renal and neurological disease.
– Complicated : UTI with underlying structural , medical or neurological disease.
– Recurrent : Greater than 3 symptomatic UTI within 12 months following clinical
therapy
– Re-Infection : Recurrent UTI caused by a different pathogen at any time.
– Relapse: Recurrent UTI caused by same species causing original UTI within 2
weeks after therapy.

4. Classification
Upper
• Acute pyelonephritis
• Chronic pyelonephritis
• Interstitial pyelonephritis
• Renal Abscess
• Peri-renal Abscess
Lower
• Cystitis
• Prostatitis
• Urethritis

5. – Both Upper and lower UTI are further divided into complicated and
uncomplicated.

6. Epidemiology
– Seen in all age groups.
– Infants upto 6 months (2/1000)
– More common in boys than girls.
– WOMEN
are at greater risk than men (40-50% prevelance in women ,
0.04% in men)
Incidence of UTI increases in old Age (10 % men & 20% women are infected )

7. ETIOLOGY
– ACUTE UNCOMPLICATED UTI :
E. Coli – 80%
20% of UTI caused by
Gram negative enteric Bacteria – Klebsiella , Proteus
Gram Positive Cocci – Streptococcus feacalis
Staphylococcus Saprophyticus – restricted to infections in
young sexually active women .

8. – COMPLICATED UTI
– Pseudomonas aeruginosa, Enterobacter & Serratia .
– Hospital Acquired

9. Pathogenesis
– Routes of infection
– Ascending ( most common route )
– Blood borne ( S. Aureus)
– Lymphatogenous ( in men through rectal and colonic
lymphatic vessels to prostate and bladder ; in women through periuterine
lymphatics to urinary tract )
– Direct extension from organs
( Pelvic Inflammatory disease,
Genitourinary fistulas )

10. Risk Factors
– Aging
Diabetes ,
Urine retention,
Impaired immune system
– Females
shorter urethra
sexual intercourse
contraceptives
– Males
Prostatic hypertrophy
Bacterial prostatitis

11. UTI CLINICAL
PRESENTATION
– Depends on site of infection
& Age of the patient

12. Signs & Symptoms
Mostly
asymptomatic
Elderly
Frequency
Urgency
Dysuria
Hematuria
Fever e rigors
Loin pain
AdultsChildren
Failure to
thrive
Fever
Apathy
Diarrhea
Infants
Dysuria
Frequency
Urgency
Vomiting
Acute
Abdominal
Pain

13. Diagnosis
– Microscopic Examination of Urine
– Urinanalysis
– Urine Culture
– Imaging Techniques – CT Scan , MRI

14. Laboratory Examination
– Uncontaminated , MSU
– Methods of urine Collection
– Sticks on bag
– catherization
– Supra-pubic Aspriation 9 Gold Standard)

15. Diagnostic Tests for
RECURRENT UTI in ADULTS
– IVP
– Excretory
– Voiding Cystourethrography
– Cystoscopy
– Manual Pelvic and prostatic Examination

16. MANAGEMENT
Non specific
Therapy
Asymptomatic –
No Antibiotics
Symptomatic –
Antibioyic
therapy

17. Goals of therapy
– Elimination of infection
– Relief of acute symptoms
– Prevention of recurrent and long term complications.

18. Ideal ANTIBIOTIC for UTI
– Adequate coverage over E.coli
– Concentration in urine
– Duration of therapy
– Low resistance
– Cost effective
– Low adverse effect profile

19. Single dose therapy
(Uncomplicated UTI)
– Trimethoprim-Sulfamethoxazole (160+800 mg )
– Amoxicillin-culvulnate 500mg
– Amoxicillin 3G
– Ciprofloxacin 500mg
– Norfloxacin 400mg

20. 3 Day therapy
(Complicated UTI)
– Extended release ciprofloxacin
– 500mg for uncomlicated
– 1000mg for complicated

21. 7 DAY THERAPY
– Recurrent cases
– Pregnancy
– UTI with other risk factors

22. 14 DAYS THERAPY
– For complicated UTI
– High risk of mortality and morbidity