The document outlines the definition, pathophysiology, risk factors, and types of urinary tract infections (UTIs), emphasizing their prevalence and causative organisms, particularly E. coli. It details the distinctions between lower and upper tract infections, including conditions like cystitis and pyelonephritis, along with their symptoms and treatment options. Risk factors include age, gender, urinary tract obstructions, and anomalies, and the document highlights the significance of proper diagnosis and antibiotic treatment.

1. Pre by lect. ZAHID REHMAN
IPMS(KMU)
Urinary tract infection

2. Lecture objective
At the end of this lecture the student will be able to know
Definition of urinary tract infection
Pathophysiology
Risk factors
Pyelonephritis
Urethritis
Cystitis

5. Second most common infection followed respiratory infection.
UTI occur when bacteria (E. coli) from the digestive tract get
into the opening of the urinary tract and multiply
Bacteria first infect the urethra, then move to the bladder and
finally to the kidneys
UTI tend to occur more in women than men

6. URINARY TRACT INFECTION
TYPES
LOWER TRACT INFECTION UPPER TRACT INFECTION
URETHRITIS
PROSTATITIS
CYSTITIS
PYELONEPHRITIS
PERI NEPHRIC ABSCESS

8. Background
Common causative organisms
Escherichia coli (gram-negative enteral bacteria)
causes most community acquired infections
Staphylococcus, gram-positive organism causes 10 –
15%
Catheter-associated UTI’s caused by gram-
negative bacteria: Proteus, Klebsiella, Seratia,
Pseudomonas

9. Normal mechanisms that maintain sterility of urine
 Adequate urine volume
 Free-flow from kidneys through urinary meatus
 Complete bladder emptying
 Normal acidity of urine
 Peristaltic activity of ureters and competent ureterovesical
junction
 In males, antibacterial effect of zinc in prostatic fluid

10. Pathophysiology
1. Pathogens which have colonized urethra, vagina, or perineal
area enter urinary tract by ascending mucous membranes of
perineal area into lower urinary tract
2. Bacteria can ascend from bladder to infect the kidneys
3. Classifications of infections
a. Lower urinary tract infections: urethritis, prostatitis, cystitis
b. Upper urinary tract infection: pyelonephritis (inflammation
of kidney and renal pelvis)

11. Risk Factors
1. Aging
a. Increased incidence of diabetes mellitus
b. Increased risk of urinary stasis
c. Impaired immune response
2. Females: short urethra, having sexual intercourse, use of contraceptives
that alter normal bacteria flora of vagina and perineal tissues; with age
increased incidence of cystocele, rectocele (incomplete emptying)
3. Males: prostatic hypertrophy, bacterial prostatitis, anal intercourse
4. Urinary tract obstruction: tumor or calculi, strictures
5. Impaired bladder innervation

12. Cystitis
1. Most common UTI
2. Remains superficial, involving bladder mucosa, which becomes
hyperemic and may hemorrhage
General manifestations of cystitis
 Dysuria
 Frequency and urgency
 Nocturia
 Urine has foul odor, cloudy (pyuria), bloody (hematuria)
 Suprapubic pain

13. Diagnosis
Urinalysis, Urine culture
Further labs, if appropriate.
Treatment
Fluoroquinolone (or other broad spectrum antibiotic)
7-14 days of treatment (depending on severity)
May treat even longer (2-4 weeks) in males with UTI

14. Pyelonephritis
1. Inflammation of renal pelvis and parenchyma (functional kidney tissue)
2. Acute pyelonephritis
Results from an infection that ascends to kidney from lower urinary tract
Risk factors
 Pregnancy
 Urinary tract obstruction and congenital malformation
 Urinary tract trauma, scarring
 Renal calculi
 Polycystic or hypertensive renal disease
 Chronic diseases, i.e. diabetes mellitus
 Vesicourethral reflux

15. Pathophysiology
 Infection spreads from renal pelvis to renal cortex
 Kidney grossly edematous; localized abscesses in cortex surface
 E. Coli responsible organism for 85% of acute pyelonephritis; also Proteus,
Klebisella
Manifestations
 Rapid onset with chills and fever
 Malaise
 Vomiting
 Flank pain
 Urinary frequency, dysuria

16. Chronic pyelonephritis
Involves chronic inflammation and scarring of tubules
and interstitial tissues of kidney
Common cause of chronic renal failure
May develop from chronic hypertension, severe
vesicourteteral reflux, obstruction of urinary tract
Asymptomatic
Mild behaviors: urinary frequency, dysuria, flank pain

17. Prostatitis
 Symptoms:
 Pain in the perineum, lower abdomen, testicles, penis, and with
ejaculation, bladder irritation, bladder outlet obstruction, and
sometimes blood in the semen
 Diagnosis:
 Typical clinical history (fevers, chills, dysuria, malaise,
pelvic/perineal pain, cloudy urine)
 The finding of an edematous and tender prostate on physical
examination
 Will have an increased PSA
 Urinalysis, urine culture

18. Treatment:
Trimethoprim/sulfamethoxazole, fluroquinolone or
other broad spectrum antibiotic
4-6 weeks of treatment
Risk Factors:
Trauma
Dehydration

21.  Cystoscopy
Direct visualization of urethra and bladder through
cystoscope
Used for diagnostic, tissue biopsy, interventions
Client receives local or general anesthesia
Manual pelvic or prostate examinations to assess
structural changes of genitourinary tract, such as
prostatic enlargement, cystocele, rectocele

22. THANK
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