The document discusses urinary tract infections (UTIs). It notes that UTIs can affect people of all ages but are more common in females, especially younger girls. The main causes are E. coli and other bacterial infections that enter the urinary tract. Symptoms vary depending on whether the infection involves the bladder (cystitis) or kidneys (pyelonephritis). Risk factors, diagnosis through urinalysis and culture, treatment with antibiotics or conservatively, and potential long-term issues like renal scarring are covered.

1. Urinary tract infection Dr. Crisbert I. Cualteros http://crisbertcualteros.page.tl

2. Urinary tract infection Condition in w/c microorganisms actively multiply and persist in the genitourinary tract Affects all ages > males predominate in the newborn period > beyond this age, females predominate (3.5 % of girls and 1% of boys) Etiology: Mainly caused by colonic bacteria > E.coli – most common > Klebsiella > Proteus > Staphyloccus saprophyticus

3. Clinical Manifestation 3 basic forms : 1. Acute Pyelonephritis - involvement of renal parenchyma - characterized by fever, abdominal pain or flank pain, malaise, NAV, diarrhea 2. Cystitis - involves bladder and symptoms of dysuria, urgency, frequency, suprapubic pain, incontinence and malodorous urine - no fever and does not result in renal injury

4. 3. Asymptomatic bacteriuria - + urine culture w/o any manifestation of infection - occurs exclusively in girls - benign and does not cause renal injury

5. Pathogenesis route of infection: - ascending infection - anatomic abnormalities - uroepithelial adherence - bacterial virulence

6. Risk factors for UTI female uncircumcised male vesicoureteral reflux toilet training voiding dysfunction obstructive uropathy urethral instrumentation wiping from back to front bubble bath tight underwear pinworm infestation constipation P fimbriated bacteria anatomic abnormallity neuropathic bladder sexual activity pregnancy

7. Diagnosis Urinalysis - > 10 WBC /hpf in a centrifuged urinary sediment - hematuria - + nitrite test - absence of pyuria does not rule out UTI Urine culture - gold standard - midstream urine sample: > 100,000 colonies/ml of a single pathogen 10,000 col/ml if symptomatic - catheterized urine > 10 5 colony count - suprapubic aspirate = any bacterial growth

8. Diagnosis…. Radiological Evaluation Guidelines for selection of pxs w/ UTI for radiologic evaluation: - all neonates w/ 1st UTI - all males w/ 1 st UTI at any age - all pxs w/ recurrent UTI - all pxs w/ pyelonephritis Intravenous Pyelography (IVP) - information about renal size, renal scars and state of pelvocalyceal system

9. VCUG (voiding cystourethrogram) - definitive test to document VUR - indicated in children younger than 5 yr w/ UTI, any child w/ febrile UTI, school-aged girls who had 2 or more UTIs - any male w/ UTI Ultrasound of the kidney and urinary bladder - screening procedure of choice - should be obtained to rule out hydronephrosis and renal or perirenal abscesses

10. Treatment - Trimethoprim Sulfamethoxazole - Nitrofurantoin - Ampicillin - Amoxicillin - Aminoglycosides - Cephalosporins Conservative: - Increased oral fluids intake - Regular and complete bladder emptying - Increased dietary fiber intake

11. Prognosis - difficult to determine - especially if with significant renal scarring » at risk for developing chronic renal insufficiency

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