1. Urinary tract infections are usually caused by bacteria like E. coli entering the urinary tract and multiplying. Risk factors include anatomical abnormalities, catheters, diabetes, and pregnancy. 2. Symptoms depend on the location of infection, ranging from painful urination with cystitis to fever and flank pain with pyelonephritis. Diagnosis involves urine tests and culture. 3. Treatment involves antibiotics, with uncomplicated cystitis typically treated for 3 days and pyelonephritis requiring longer courses in hospital. Prevention focuses on personal hygiene and drinking plenty of fluids.

1. URINARY TRACT INFECTIONS
(Urethritis, Cystitis,
Pyelonephritis)
3rd year class of 2015

4. ETIOLOGY
UTI defined as “Significant bacteriuria” in the
presence of symptoms.
Bacteria of Fecal origin.
• Bacteriuria is presence of 100,000 bacteria /ml
of Urine.
• 80-90%. Acute UTI in anatomically normal Urinary
tract caused by E. coli.
• 10% to 20% by coagulase-negative Staphylococcus
saprohyticus in females.
• 5 % Enterbacteriaceae organisms or enterococci.

5. • IN U.T.I `s RESULTING FROM ANATOMIC
OBSTRUCTIONS OR FROM CATHETERIZATION
–E. coli, Klebsiella pneumoniae,
Proteus mirabilis
–Enterococcus sp,
Pseudomonas aeruginosa.
–In rare cases Candida albicans can cause UTI
(diabetic patients).
–Staph. saprophyticus second most common
cause in young sexually active women.

7. EPIDEMIOLOGY
• Female/Male ratio = 30 :1
• Males experience rapid increase
in incidence UTI's sometime in
their 40s.
• About the time that males are
experiencing prostate gland
hypertrophy and experiencing
midlife crisis.
``Men become naughty after
40 ``
• Women generally don't have
many problems with UTI's until
they become sexually active.

10. RISK FACTORS
• Abnormality of the urinary tract : STONES, enlarged
prostate etc.
• Catheters, or tubes, placed in bladder.
• Diabetes mellitus.
• Immunosuppressed patients
• Coitus in females precipitates UTI's.
• Neurogenic bladder or diverticulum's.
• Postmenopausal with bladder or uterine prolapse.
• Pregnant women more susceptible to UTI's.

12. • Sexually active women more prone to
U.T.I. so are sedentary workers.
PATHOGENESIS
Entry is normally by ascent from the urethra.
Blood borne infections are infrequent usually
leading to renal abscesses.
HOST FACTORS important in protection are:
Normal flow, presence of the ureterovesical
valves. and constant peristalsis of the ureters.

13. BACTERIAL FACTORS –
• Pilli
• Polysaccharide which inhibits phagocytosis.
• Hemolysins that can cause tissue damage
directly.
• Endotoxin from Gram negative. contribute to
inflammation and damage of renal
parenchyma.

14. SPREAD TO THE KIDNEY - Ascending infection
1. Reflux to kidney - due to incomplete
development of ureterovesical valves.
2 .Physiological malfunctions - disorders leading to
poor emptying of bladder. Pregnancy leading to
dilatation and decreased peristalsis of the ureters.
3 Urethral catheters - can serve as a
conduit for the bacteria to ascend into the
bladder and a source of bacteria for
Persistent infection.
4. Urinary tract stones - Stones make bacteria
escape antibiotics and cause further infections.

15. • Proteus sp. ex of organism
which cause stones to form.
produces an enzyme called
urease that can split urea to
ammonia and carbon dioxide.
• This raises pH of the urine and
facilitate the formation of
"struvite" calculi.
Struvite (ammonium magnesium
phosphate) is a phosphate
mineral with formula:
((NH4)MgPO4·6H2O).
A high pH of the
urine is
indicative of a
Proteus sp.
infection.

18. CLINCAL SYMPTOMS
A. Urethritis - Most of the cases of purulent Urethritis
without cystitis are sexually transmitted and will be
discussed later. i.e.
Chlamydia trachomatis,
Non gonococcal urtheritis (NGU)
Ureaplasma urelyticum,
Neisseria gonorrhoeae, or Trichomonas vaginalis common
causes of uretheritis.
In men and women, discomfort during voiding, but there
are usually no symptoms of post void suprapubic pain
or urinary frequency.

19. B. Cystitis - Results from an irritation of the lower
urinary tract mucosa. This infection as such is
not invasive.
1. Dysuria (painful urination)
2. Urgency (the need to urinate without delay)
3. Increased frequency of urination
4. Suprapubic tenderness, pelvic discomfort especially pre-
and immediately
post void occurs in 20% of women with uncomplicated
UTI.
5. Small volume voiding.
6. Increased number of white blood cells in the urine
(pyuria)
• Symptoms 1-4 are sometimes called irritative
voiding symptoms.

20. C. Hemorrhagic cystitis is characterized by large
quantities of visible blood in the urine. It can be
caused by an infection radiation, cancer
chemotherapy etc.
• Clinical presentation ``irritative voiding
symptoms typically``.
• Hemorrhagic cystitis is often confused with
glomerulonephritis, but hypertension and
abnormal renal function are absent in
hemorrhagic cystitis.

21. D. Pyelonephritis
• Ascending infection
or
Hematogenous spread (ex. from lungs in
patients with pneumonia).
1. Suprapubic tenderness
2. Urinary urgency and
frequency may be present
or absent.
3. Fever with Shivering!
4. Flank pain and tenderness (back pain)

22. D. Pyelonephritis (Contd..)
5. Costovertebral angle
tenderness (CVA tenderness)
6. Nausea and vomiting
7. Peripheral leukocytosis
8. Urine contains white blood cell casts
(elongated structures) composed of cells
that were tightly packed in the tubules
and excreted in a proteinaceous matrix.

24. Complications can include:
• 1. Sepsis
• 2. Septic shock (if a Gram-
negative organism).
• 3. Death

25. DIAGNOSIS
• Urinary Tract infection can be diagnosed
through a urine sample test.
• In recurrent cases, cystoscopy and
ultrasound scan are performed to check the
status of the internal organs.
• Antibacterial drugs are the most effective
medication

26. • SPECIMEN COLLECTION
– clean voiding wide mouth bottle. Mid stream
specimen. Transported to lab. Within one hour or
stored at 2-8oC.
1. Direct microscopic examination:
• Place 1 drop of uncentrifuged urine dry on a microscope
slide and Gram stain it.
• If you see >1 bacterium per oil immersion field the
specimen has >105 bacteria/ml.
• Centrifuged urine: a finding of 5-10 WBCs or >/= 15
bacteria per HPF in the urine sediment is consistent with
UTI.

27. Urine Specimen Container

28. URINE LAB. EXAMINATION
• Dip stick to look for sugar proteins nitrites, pH,
Sp. gravity, blood, urobilinogen etc.
• Microscopy: Direct examination, centrifuged
urine, grams stain are performed
• Culture: Mac Conkeys medium or CLED
medium

29. CLED Medium
(Cystiene Lactose Electrolyte Deficient Medium)

30. • The diagnosis of UTI in normal cases is based on
a quantitative urine culture yielding greater than
100,000 colony-forming units (105 CFU) per
milliliter of urine, which is termed :
• Low-coliform-count infections). It is also known
that a bacterial count of 100 CFU can also cause
persistent cystitis.

31. THERAPY
• The clinical manifestations determine the initial
step in therapy.
• Febrile patient experiencing symptoms of lower
UTI are treated on an outpatient basis.
• Patients experiencing high fever, shaking chills
and flank pain, in addition to symptoms of lower
UTI, are usually hospitalized.

32. General guidelines
• 1. Uncomplicated symptomatic acute cystitis
and/or Urethritis are usually treated for three
days (TMP-SMX), Ofloxacin, or ciprofloxacin.
• 2. Pyelonephritis is more difficult to cure than
urethritis-cystitis and reoccurrence due to
relapse (i.e. treatment failure) or reinfection is
more common.

33. PREVENTION & CONTROL:
• Blot or wipe gently from front to back after urinating or having a
bowel movement.
• This will avoid spreading bacteria from your rectum to the vagina
or urethra.
• Do not use colored toilet paper, bubble bath, perfumed soaps,
douches, feminine hygiene deodorants, tampons and napkins.
• Wear cotton underwear. Avoid wearing tight clothing, such as
bodysuits, tight pants and nylon panty hose without cotton
liners.
• Avoid using strong soaps and bleaches when washing
underclothes.
• Drink six to eight glasses of water or fluids a day atleast

34. • Urinate when you feel the urge - do not hold
urine for long periods of time.
• Urinate before and after having intercourse.
• Avoid prolonged activities that can aggravate
bladder infections, such as bicycling,
horseback riding, motorcycling and traveling.