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1. URINARY TRACT INFECTIONS
DR UMER RASUL AWAN
PGR 1 GDH

2. DEFINITION
• IT is the infection of urinary tract that includes urethra, bladder,
ureters and kidneys.
• It is further classfied into 2 groups
• Upper urinary tract infections and lower urinary tract infections.
• Most infections involve the lower urinary tract,bladder and urethra
• Females are more prone to UTI due to short urethra.

3. INTRODUCTION
• In women most UTI’S are
cystitis or pyelonephritis
• In men most UTI’S are
urethritis or prostitis.
• Incidence of UTI is increased in patients aged more than 50
years,pregnant women, children, hospitalized patients.

4. • ACUTE PYELONEPHRITIS: It is the upper urinary tract
infection of kidneys causing inflammation due to
complication of uti.
• Cystitis: inflammation of bladder
• Prostatitus: inflammation of prostate.
• Urethritis: inflammation of urethra

5. Anatomy

6. Risk factors
• .
Iatrogenic/drugs behavioural anatomic genetic
RISK FACTORS
• Indewelling
catheters
• Antibiotics
• spermicides
• Voiding
dysfunction
• Frequent
intercourse
• Vesicoureteric reflux
• Females
• pregnancy
Familial tendency

7. Pathophysiology

9. CLINICAL CLASSIFICATION
UTI
complicated uncomplicated recurrent relapse

11. Simple VS Complicated UTI

12. RESISTANT UTI
• Risk factors for resistant organisms include recent
broad-spectrum antimicrobial use,
• health care exposures,
• and travel to parts of the world where multidrug-
resistant organisms are prevalent

13. ADMISSION CRITERIA
• Patients are septic or otherwise critically ill.
• Persistently high fever (eg, >38.4°C/>101°F) or pain,
marked debility, or inability to maintain oral hydration
or take oral medications.
• when urinary tract obstruction is suspected

14. ETIOLOGY

15. CLINICAL PRESENTATION

16. COMPLICATIONS
• patients with acute complicated UTI can also present with
• bacteremia,
• sepsis,
• multiple organ system dysfunction, shock, and/or acute renal failure.
• urinary tract obstruction
• renal corticomedullary abscess,
• perinephric abscess,
• emphysematous pyelonephritis,
• or papillary necrosis

17. DIAGNOSIS
• Physical exam
• costovertebral angle, abdominal, and suprapubic tenderness.
TLC COUNT
Microscopic exam:
• urine dipstick
• urine complete exam
• urine culture:
The presence of bacteriuria (≥105 colony-forming units/mL of a uropathogen)
with or without pyuria in the absence of any symptom that could be
attributable to a UTI is called asymptomatic bacteriuria.
• Imaging:
ultrasound kub, CT

19. CT SCAN
PYELONEPHRITIS

20. DIPSTICK

21. WHEN TO DO URINE CULTURE TEST?

22. TREATMENT
BASIC:
• Increase hydration
• Maintaine hygiene
• Cranberry juice
• Fosfomycin sachet

23. ACUTE COMPLICATED UTI
• Antipseudomonal:
carbapenems
• Imipenem 500 mg IV every 6 hours infused over 3 hours or
• Meropenem 1 g IV every 8 hours infused over 3 hours
• PLUS
• Vancomycin 15 to 20 mg/kg IV every 8 to 12 hours with or without a loading
dose
• ”OR."
• Ceftriaxone 1 g IV once daily or
• Piperacillin-tazobactam 3.375 g IV every 6 hours or

24. • ALTERNATIVES:
• Levofloxacin 750 mg IV or orally daily
• Ciprofloxacin 400 mg IV twice daily
• Ciprofloxacin 500 mg orally twice daily
• Ciprofloxacin extended-release 1000 mg orally once daily
• If Enterococcus or Staphylococcus species are suspected piperacillin-
tazobactam is preferred.

25. IF PSEUDOMONAS IS SUSPECTED
piperacillin-tazobactam or a fluoroquinolone is preferred.
• tanzo 3.375 g IV every 6 hours or
• Cefepime 2 g IV every 12 hours.
• IF VRE OR MRSA ARE SUSPECTED ,
vancomycin (for MRSA) or daptomycin or linezolid (for

26. • For patients with low risk of fluoroquinolone
resistance/toxicity:
• Ciprofloxacin 500 mg orally twice daily for 5 to 7
days or
• Ciprofloxacin extended-release 1000 mg orally once
daily for 5 to 7 days or
• Levofloxacin 750 mg orally once daily for 5 to 7 days

27. ALLERGIC TO QUINOLONES
• FOR PATIENTS WHO CANNOT USE A FLUOROQUINOLONE:
• Ceftriaxone 1 g IV or IM once or
• Gentamicin 5 mg/kg IV or IM once or
• Tobramycin 5 mg/kg IV or IM once
• FOLLOWED BY ONE OF THE FOLLOWING:
• TMP-SMX one double-strength tablet orally twice daily for 7 to 10 days or
• Amoxicillin-clavulanate 875 mg orally twice daily for 7 to 10 days or
• Cefpodoxime 200 mg orally twice daily for 7 to 10 days.

28. • Enterococcus – If Enterococcus is isolated,
• amoxicillin (500 mg orally every eight hours or 875 mg twice daily)
●Staphylococcus –
• trimethoprim-sulfamethoxazole (one double-strength [160 mg/800
mg] tablet orally twice daily
• for methicillin-susceptible Staphylococcus species, cefadroxil (500 mg
twice daily).

29. • Duration — Total duration of antimicrobial therapy generally ranges
from 5 to 10 days, depending on the rapidity of clinical response and
the antimicrobial chosen to complete the course.
• For individuals who have an appropriate clinical response
(symptomatic improvement within the first 48 to 72 hours of
therapy), we give fluoroquinolones for 5 to 7 days,

30. This Photo by Unknown Author is licensed under CC BY-NC