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URINARY TRACTURINARY TRACT
INFECTIONINFECTION
DR MAHTABDR MAHTAB
GMSGH 16 CHDGMSGH 16 CHD
URINARY TRACT INFECTIONURINARY TRACT INFECTION
• URINE IS STERILEURINE IS STERILE
• URINE IS EXCELLENT CULTUREURINE IS EXCELLENT CULTURE
MEDIUM FOR BACTERIAMEDIUM FOR BACTERIA
PREVALENCE ANDPREVALENCE AND
ETIOLOGYETIOLOGY
• GIRL: 1-3%GIRL: 1-3%
• BOY: 1%BOY: 1%
• 11STST
YR =M:F=2.8-5.4:1YR =M:F=2.8-5.4:1
• AFTER 2YR- M:F 1:10AFTER 2YR- M:F 1:10
ORGANISMORGANISM
• CAUSED MAINLY BY COLONICCAUSED MAINLY BY COLONIC
BACTERIABACTERIA
• E.COLIE.COLI
• KLEBSIELLAKLEBSIELLA
• PROTEUSPROTEUS
• STAPHYLOCOCCUS SAPROPHYTICUSSTAPHYLOCOCCUS SAPROPHYTICUS
• VIRUS(ADENO VIRUS MAINLYVIRUS(ADENO VIRUS MAINLY
RESPONSIEBLE FOR CYSTITIS)RESPONSIEBLE FOR CYSTITIS)
CLINICAL MANIFESTATION ANDCLINICAL MANIFESTATION AND
CLASSIFICATIONCLASSIFICATION
3 BASIC FORM OF UTI3 BASIC FORM OF UTI
• PyelonephritisPyelonephritis
• CystitisCystitis
• Asymptomatic bacteriuriaAsymptomatic bacteriuria
Other less common are focal pyelonephritis (nephronia)Other less common are focal pyelonephritis (nephronia)
renal abscessrenal abscess
Clinical pyelonephritisClinical pyelonephritis
• Abdomen ,back and flank painAbdomen ,back and flank pain
• Malaises ,nausea ,vomatingMalaises ,nausea ,vomating
• Occasional diarrhoea and fever may beOccasional diarrhoea and fever may be
the only manifestationthe only manifestation
NEONATESNEONATES
• NON SPECIAFIC SYMPTOMNON SPECIAFIC SYMPTOM POOR FEEDINGPOOR FEEDING
IRRITABILITY,JAUNDICE,WT LOSSIRRITABILITY,JAUNDICE,WT LOSS
CYSTITISCYSTITIS
• DYSURIA,URGENCY,FREQUENCY,SUPRAPUDYSURIA,URGENCY,FREQUENCY,SUPRAPU
BIC PAIN,INCONTINENCE ANDBIC PAIN,INCONTINENCE AND
MALODOUROUD URINEMALODOUROUD URINE
• CYSTITIS DOES NOT CAUSE FEVER ANDCYSTITIS DOES NOT CAUSE FEVER AND
RENAL INJURYRENAL INJURY
-ACUTE HEMORRHAGIC CYSTITIS-ACUTE HEMORRHAGIC CYSTITIS
E COLI ,ADENO VIRUS 11,21E COLI ,ADENO VIRUS 11,21
EOSINOPHILIC CYSTITISEOSINOPHILIC CYSTITIS
INTERSTITIAL CYSTITISINTERSTITIAL CYSTITIS
RARE FORM FORM OF CYSTITISRARE FORM FORM OF CYSTITIS
ASYMPTOMATICASYMPTOMATIC
BACTERIURIABACTERIURIA
• POSITIVE URINE CULTURE WITHOUTPOSITIVE URINE CULTURE WITHOUT
ANY SYMPTOMANY SYMPTOM
• MOST COMMON IN GIRLS ,SCHOOLMOST COMMON IN GIRLS ,SCHOOL
AGE GIRLSAGE GIRLS
• IF LEFT UNTREATED CAN RESULTIF LEFT UNTREATED CAN RESULT
INTO SYMPTOMATIC UTIINTO SYMPTOMATIC UTI
RISK FACTOR FOR URINARYRISK FACTOR FOR URINARY
TRACT INFECTIONTRACT INFECTION
• FEMALE GENDERFEMALE GENDER
• UNCIRCUMCISED MALEUNCIRCUMCISED MALE
• TOILET TRAININGTOILET TRAINING
• VOIDIND DYSFUCTIONVOIDIND DYSFUCTION
• OBSTRUCTIVE UROPATHYOBSTRUCTIVE UROPATHY
• URETHRAL INSTRUMENTATIONURETHRAL INSTRUMENTATION
• NEUROGENIC BLADDERNEUROGENIC BLADDER
• SEXUAL ACTIVITYSEXUAL ACTIVITY
• PREGNENCYPREGNENCY
• CONSTIPATIONCONSTIPATION
PATHOLOGY ANDPATHOLOGY AND
PATHOGENESISPATHOGENESIS
• MOST UTI ARE ASCENDINGMOST UTI ARE ASCENDING
INFECTIONINFECTION
DIAGNOSISDIAGNOSIS
• BASED ON SYMPTOM OR FINDING ONBASED ON SYMPTOM OR FINDING ON
URINOLYSISURINOLYSIS
• URINE CULTURE IS NECESSARY FORURINE CULTURE IS NECESSARY FOR
CONFIRMATIONCONFIRMATION
WAYS TO COLLECT URINEWAYS TO COLLECT URINE
SAMPLESAMPLE
• TOILET TRAINED CHILDREN –MIDTOILET TRAINED CHILDREN –MID
STREAM URINESTREAM URINE
• NOT TOILET TRAINED CHILDREN---NOT TOILET TRAINED CHILDREN---
CATHETERISED URINE SAMPLECATHETERISED URINE SAMPLE
SHOULD BE COLLECTED ORSHOULD BE COLLECTED OR
APPLICATION OF SEALEDAPPLICATION OF SEALED
,ADHESIVE,STERILE,COLLECTION BAG,ADHESIVE,STERILE,COLLECTION BAG
• PYURIA ( LEUKOCYTE IN URINE ) SUGGESTPYURIA ( LEUKOCYTE IN URINE ) SUGGEST
UTIUTI
• STERILE PYURIA - POSITIVESTERILE PYURIA - POSITIVE
LEUKOCYTE ,NEGATIVE CULTURE ,OCCURLEUKOCYTE ,NEGATIVE CULTURE ,OCCUR
IN PARTIALLY TREATED BACTERIAL UTIIN PARTIALLY TREATED BACTERIAL UTI
,VIRAL INFECTION ,RENAL,VIRAL INFECTION ,RENAL
TUBERCULOSIS,RENAL ABSCESSTUBERCULOSIS,RENAL ABSCESS
• NITATES AND LEUKOCYTE ESTERASE +VENITATES AND LEUKOCYTE ESTERASE +VE
IN INFECTED URINEIN INFECTED URINE
• WHITE BLOOD CELL CASTE IN URINARYWHITE BLOOD CELL CASTE IN URINARY
SEDIMENT SUGGEST RENAL INVOVLEMENTSEDIMENT SUGGEST RENAL INVOVLEMENT
• IF CULTURE SHOW >100,000 COLONIES OFIF CULTURE SHOW >100,000 COLONIES OF
SINGLE PATHOGEN OR IF THERE IS >10,000SINGLE PATHOGEN OR IF THERE IS >10,000
COLONIES +CHILD IS SYMPTOMATICCOLONIES +CHILD IS SYMPTOMATIC
- CONSIDER UTI- CONSIDER UTI
• IN BAG SAMPLE IF URINOLYSIS IS +VEIN BAG SAMPLE IF URINOLYSIS IS +VE
,CHILD SYMPTOMATIC ,SINGLE ORGANISM,CHILD SYMPTOMATIC ,SINGLE ORGANISM
CULTURE WITH COLONIES COUNT >100,000CULTURE WITH COLONIES COUNT >100,000
THERE IS PRESUMED UTITHERE IS PRESUMED UTI
• BLOODBLOOD
LEUKOCYTOSIS,NEUTROPHILIA,INCREASEDLEUKOCYTOSIS,NEUTROPHILIA,INCREASED
ESR,RAISED C-RPESR,RAISED C-RP
CHILDCHILD
 ASYMPTOMATIC ,URINALYSIS -VEASYMPTOMATIC ,URINALYSIS -VE
…. NO UTI…. NO UTI
SYMPTOMATIC ,URINALYSIS –VESYMPTOMATIC ,URINALYSIS –VE
…………POSSIBLE UTIPOSSIBLE UTI
TREATMENT OF UTITREATMENT OF UTI
• ANTIBIOTICS ARE RECOMMENDED IN ALLANTIBIOTICS ARE RECOMMENDED IN ALL
PROVEN CASES OF UTIPROVEN CASES OF UTI
• TREATMENT SHOULD BE BEST GUIDED BYTREATMENT SHOULD BE BEST GUIDED BY
ANTIMICROBIAL SUSCEPTIBILITY TESTANTIMICROBIAL SUSCEPTIBILITY TEST
• IF SYMPTOM IS SEVERE PRESUMPTIVEIF SYMPTOM IS SEVERE PRESUMPTIVE
TREATMENT IS STARTED PENDING RESULTTREATMENT IS STARTED PENDING RESULT
OF CULTURE .IF SYMPTOM IS MILD OROF CULTURE .IF SYMPTOM IS MILD OR
DIAGNOSIS IS DOUBTFUL TREATMENT CANDIAGNOSIS IS DOUBTFUL TREATMENT CAN
BE DELAYED UNTIL RESULT OF CULTURE ISBE DELAYED UNTIL RESULT OF CULTURE IS
KNOWNKNOWN
• BEFORE THE RESULT OF CULTURE ANDBEFORE THE RESULT OF CULTURE AND
SENSITIVITY TRIMETHOPRIM-SENSITIVITY TRIMETHOPRIM-
SULFAMETHOXAZOLE (TMP-SMX) 3-5 DAYSSULFAMETHOXAZOLE (TMP-SMX) 3-5 DAYS
COURSE –EFFECTIVE IN MOST OF E-COLICOURSE –EFFECTIVE IN MOST OF E-COLI
• NITROFURANTOIN 5-7mg/kg/days 3-4 dividedNITROFURANTOIN 5-7mg/kg/days 3-4 divided
dose HAS ADVANTAGE ACTIVE AGAINSTdose HAS ADVANTAGE ACTIVE AGAINST
KLEBSIELLA AND ENTEROBACTERKLEBSIELLA AND ENTEROBACTER
• AMOXYCILLIN 50mg/kg/day BUT HAVING NOAMOXYCILLIN 50mg/kg/day BUT HAVING NO
ADVANTAGES OVER SULFONAMIDE ORADVANTAGES OVER SULFONAMIDE OR
NITROFURANTOINNITROFURANTOIN
DURATIONDURATION
• NEW BORN UTI -14 DAYSNEW BORN UTI -14 DAYS
• PYELONEPHRITIS -14 DAYSPYELONEPHRITIS -14 DAYS
• CYSTITIS -3-7DAYS,PER AGECYSTITIS -3-7DAYS,PER AGE
Urinary tract infection dr.m - copy

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Urinary tract infection dr.m - copy

  • 1. URINARY TRACTURINARY TRACT INFECTIONINFECTION DR MAHTABDR MAHTAB GMSGH 16 CHDGMSGH 16 CHD
  • 2. URINARY TRACT INFECTIONURINARY TRACT INFECTION • URINE IS STERILEURINE IS STERILE • URINE IS EXCELLENT CULTUREURINE IS EXCELLENT CULTURE MEDIUM FOR BACTERIAMEDIUM FOR BACTERIA
  • 3. PREVALENCE ANDPREVALENCE AND ETIOLOGYETIOLOGY • GIRL: 1-3%GIRL: 1-3% • BOY: 1%BOY: 1% • 11STST YR =M:F=2.8-5.4:1YR =M:F=2.8-5.4:1 • AFTER 2YR- M:F 1:10AFTER 2YR- M:F 1:10
  • 4. ORGANISMORGANISM • CAUSED MAINLY BY COLONICCAUSED MAINLY BY COLONIC BACTERIABACTERIA • E.COLIE.COLI • KLEBSIELLAKLEBSIELLA • PROTEUSPROTEUS • STAPHYLOCOCCUS SAPROPHYTICUSSTAPHYLOCOCCUS SAPROPHYTICUS • VIRUS(ADENO VIRUS MAINLYVIRUS(ADENO VIRUS MAINLY RESPONSIEBLE FOR CYSTITIS)RESPONSIEBLE FOR CYSTITIS)
  • 5. CLINICAL MANIFESTATION ANDCLINICAL MANIFESTATION AND CLASSIFICATIONCLASSIFICATION 3 BASIC FORM OF UTI3 BASIC FORM OF UTI • PyelonephritisPyelonephritis • CystitisCystitis • Asymptomatic bacteriuriaAsymptomatic bacteriuria Other less common are focal pyelonephritis (nephronia)Other less common are focal pyelonephritis (nephronia) renal abscessrenal abscess
  • 6. Clinical pyelonephritisClinical pyelonephritis • Abdomen ,back and flank painAbdomen ,back and flank pain • Malaises ,nausea ,vomatingMalaises ,nausea ,vomating • Occasional diarrhoea and fever may beOccasional diarrhoea and fever may be the only manifestationthe only manifestation NEONATESNEONATES • NON SPECIAFIC SYMPTOMNON SPECIAFIC SYMPTOM POOR FEEDINGPOOR FEEDING IRRITABILITY,JAUNDICE,WT LOSSIRRITABILITY,JAUNDICE,WT LOSS
  • 7. CYSTITISCYSTITIS • DYSURIA,URGENCY,FREQUENCY,SUPRAPUDYSURIA,URGENCY,FREQUENCY,SUPRAPU BIC PAIN,INCONTINENCE ANDBIC PAIN,INCONTINENCE AND MALODOUROUD URINEMALODOUROUD URINE • CYSTITIS DOES NOT CAUSE FEVER ANDCYSTITIS DOES NOT CAUSE FEVER AND RENAL INJURYRENAL INJURY -ACUTE HEMORRHAGIC CYSTITIS-ACUTE HEMORRHAGIC CYSTITIS E COLI ,ADENO VIRUS 11,21E COLI ,ADENO VIRUS 11,21 EOSINOPHILIC CYSTITISEOSINOPHILIC CYSTITIS INTERSTITIAL CYSTITISINTERSTITIAL CYSTITIS RARE FORM FORM OF CYSTITISRARE FORM FORM OF CYSTITIS
  • 8. ASYMPTOMATICASYMPTOMATIC BACTERIURIABACTERIURIA • POSITIVE URINE CULTURE WITHOUTPOSITIVE URINE CULTURE WITHOUT ANY SYMPTOMANY SYMPTOM • MOST COMMON IN GIRLS ,SCHOOLMOST COMMON IN GIRLS ,SCHOOL AGE GIRLSAGE GIRLS • IF LEFT UNTREATED CAN RESULTIF LEFT UNTREATED CAN RESULT INTO SYMPTOMATIC UTIINTO SYMPTOMATIC UTI
  • 9. RISK FACTOR FOR URINARYRISK FACTOR FOR URINARY TRACT INFECTIONTRACT INFECTION • FEMALE GENDERFEMALE GENDER • UNCIRCUMCISED MALEUNCIRCUMCISED MALE • TOILET TRAININGTOILET TRAINING • VOIDIND DYSFUCTIONVOIDIND DYSFUCTION • OBSTRUCTIVE UROPATHYOBSTRUCTIVE UROPATHY • URETHRAL INSTRUMENTATIONURETHRAL INSTRUMENTATION • NEUROGENIC BLADDERNEUROGENIC BLADDER • SEXUAL ACTIVITYSEXUAL ACTIVITY • PREGNENCYPREGNENCY • CONSTIPATIONCONSTIPATION
  • 10. PATHOLOGY ANDPATHOLOGY AND PATHOGENESISPATHOGENESIS • MOST UTI ARE ASCENDINGMOST UTI ARE ASCENDING INFECTIONINFECTION
  • 11. DIAGNOSISDIAGNOSIS • BASED ON SYMPTOM OR FINDING ONBASED ON SYMPTOM OR FINDING ON URINOLYSISURINOLYSIS • URINE CULTURE IS NECESSARY FORURINE CULTURE IS NECESSARY FOR CONFIRMATIONCONFIRMATION
  • 12. WAYS TO COLLECT URINEWAYS TO COLLECT URINE SAMPLESAMPLE • TOILET TRAINED CHILDREN –MIDTOILET TRAINED CHILDREN –MID STREAM URINESTREAM URINE • NOT TOILET TRAINED CHILDREN---NOT TOILET TRAINED CHILDREN--- CATHETERISED URINE SAMPLECATHETERISED URINE SAMPLE SHOULD BE COLLECTED ORSHOULD BE COLLECTED OR APPLICATION OF SEALEDAPPLICATION OF SEALED ,ADHESIVE,STERILE,COLLECTION BAG,ADHESIVE,STERILE,COLLECTION BAG
  • 13. • PYURIA ( LEUKOCYTE IN URINE ) SUGGESTPYURIA ( LEUKOCYTE IN URINE ) SUGGEST UTIUTI • STERILE PYURIA - POSITIVESTERILE PYURIA - POSITIVE LEUKOCYTE ,NEGATIVE CULTURE ,OCCURLEUKOCYTE ,NEGATIVE CULTURE ,OCCUR IN PARTIALLY TREATED BACTERIAL UTIIN PARTIALLY TREATED BACTERIAL UTI ,VIRAL INFECTION ,RENAL,VIRAL INFECTION ,RENAL TUBERCULOSIS,RENAL ABSCESSTUBERCULOSIS,RENAL ABSCESS • NITATES AND LEUKOCYTE ESTERASE +VENITATES AND LEUKOCYTE ESTERASE +VE IN INFECTED URINEIN INFECTED URINE
  • 14. • WHITE BLOOD CELL CASTE IN URINARYWHITE BLOOD CELL CASTE IN URINARY SEDIMENT SUGGEST RENAL INVOVLEMENTSEDIMENT SUGGEST RENAL INVOVLEMENT • IF CULTURE SHOW >100,000 COLONIES OFIF CULTURE SHOW >100,000 COLONIES OF SINGLE PATHOGEN OR IF THERE IS >10,000SINGLE PATHOGEN OR IF THERE IS >10,000 COLONIES +CHILD IS SYMPTOMATICCOLONIES +CHILD IS SYMPTOMATIC - CONSIDER UTI- CONSIDER UTI • IN BAG SAMPLE IF URINOLYSIS IS +VEIN BAG SAMPLE IF URINOLYSIS IS +VE ,CHILD SYMPTOMATIC ,SINGLE ORGANISM,CHILD SYMPTOMATIC ,SINGLE ORGANISM CULTURE WITH COLONIES COUNT >100,000CULTURE WITH COLONIES COUNT >100,000 THERE IS PRESUMED UTITHERE IS PRESUMED UTI
  • 16. CHILDCHILD  ASYMPTOMATIC ,URINALYSIS -VEASYMPTOMATIC ,URINALYSIS -VE …. NO UTI…. NO UTI SYMPTOMATIC ,URINALYSIS –VESYMPTOMATIC ,URINALYSIS –VE …………POSSIBLE UTIPOSSIBLE UTI
  • 17. TREATMENT OF UTITREATMENT OF UTI • ANTIBIOTICS ARE RECOMMENDED IN ALLANTIBIOTICS ARE RECOMMENDED IN ALL PROVEN CASES OF UTIPROVEN CASES OF UTI • TREATMENT SHOULD BE BEST GUIDED BYTREATMENT SHOULD BE BEST GUIDED BY ANTIMICROBIAL SUSCEPTIBILITY TESTANTIMICROBIAL SUSCEPTIBILITY TEST • IF SYMPTOM IS SEVERE PRESUMPTIVEIF SYMPTOM IS SEVERE PRESUMPTIVE TREATMENT IS STARTED PENDING RESULTTREATMENT IS STARTED PENDING RESULT OF CULTURE .IF SYMPTOM IS MILD OROF CULTURE .IF SYMPTOM IS MILD OR DIAGNOSIS IS DOUBTFUL TREATMENT CANDIAGNOSIS IS DOUBTFUL TREATMENT CAN BE DELAYED UNTIL RESULT OF CULTURE ISBE DELAYED UNTIL RESULT OF CULTURE IS KNOWNKNOWN
  • 18. • BEFORE THE RESULT OF CULTURE ANDBEFORE THE RESULT OF CULTURE AND SENSITIVITY TRIMETHOPRIM-SENSITIVITY TRIMETHOPRIM- SULFAMETHOXAZOLE (TMP-SMX) 3-5 DAYSSULFAMETHOXAZOLE (TMP-SMX) 3-5 DAYS COURSE –EFFECTIVE IN MOST OF E-COLICOURSE –EFFECTIVE IN MOST OF E-COLI • NITROFURANTOIN 5-7mg/kg/days 3-4 dividedNITROFURANTOIN 5-7mg/kg/days 3-4 divided dose HAS ADVANTAGE ACTIVE AGAINSTdose HAS ADVANTAGE ACTIVE AGAINST KLEBSIELLA AND ENTEROBACTERKLEBSIELLA AND ENTEROBACTER • AMOXYCILLIN 50mg/kg/day BUT HAVING NOAMOXYCILLIN 50mg/kg/day BUT HAVING NO ADVANTAGES OVER SULFONAMIDE ORADVANTAGES OVER SULFONAMIDE OR NITROFURANTOINNITROFURANTOIN
  • 19. DURATIONDURATION • NEW BORN UTI -14 DAYSNEW BORN UTI -14 DAYS • PYELONEPHRITIS -14 DAYSPYELONEPHRITIS -14 DAYS • CYSTITIS -3-7DAYS,PER AGECYSTITIS -3-7DAYS,PER AGE