The document discusses urinary tract infections (UTIs). It defines different types of UTIs including asymptomatic bacteriuria, cystitis, prostatitis, and pyelonephritis. Escherichia coli is the most common bacteria responsible. Diagnosis requires a urine culture showing over 105 colony-forming units per mL or symptoms present with a lower count. Treatment duration depends on the infection location, with tissue infections requiring longer therapy. Risk factors include anatomical abnormalities, foreign bodies, and loss of host defenses.

1. URINARY TRACT
INFECTION
By – Dr A. C. GUPTA
PROFESSOR, KPS INSTITUTE
MEDICINE

2. Introduction
• Urinary tract infections are among the most common entities
encountered in medical practice
• Coliform bacteria are responsible for most uncomplicated urinary
tract infections, with Escherichia coli being the most common.
• A urine culture is recommended for patients with suspected
urinary tract infection. Previously, a colony count greater than
105/mL was considered the criterion for urinary tract infection,
though up to 50% of women with symptomatic infections may have
lower counts. In addition, the presence of pyuria correlates poorly
with the diagnosis of urinary tract infection, and thus urinalysis
alone is not adequate for diagnosis.
• With respect to treatment, tissue infections (pyelonephritis,
prostatitis) require therapy for 1-2 weeks, while mucosal infections
(cystitis) require only1-3 days of therapy.

3. DEFINITIONS
• UTI may be asymptomatic (subclinical infection) or
symptomatic (disease).
• Thus, the term urinary tract infection encompasses a
variety of clinical entities, including asymptomatic
bacteriuria (ASB), cystitis, prostatitis, and pyelonephritis
• ASB occurs in the absence of symptoms attributable to the
bacteria in the urinary tract and usually does not require
treatment
• the term urinary tract infection denotes symptomatic
disease;
• cystitis,symptomatic infection of the bladder;
• pyelonephritis, symptomatic infection of the kidneys.

4. • Recurrent urinary tract infectionis not
necessarily complicated; individual episodes
can be uncomplicated and treated as such.
• Catheter-associated bacteriuria can be either
symptomatic (CAUTI) or asymptomatic.

5. PATHOPHYSIOLOGY-
• Urine is an excellent culture media for
bacteria.
• Urothelium of susceptible person may have
more receptor to which virulent strains of
E.Coli become adherent.
• In women ,the ascent of organisms into the
bladder is easier than in men

6. RISK FACTOR FOR UTI
• Bladder outflow obstruction- Benign prostatic enlargement
Urethral stricture
Prostate cancer
• ANATOMICAL ABNORMALITIES-VESICO-URETERIC REFLUX
• LOSS OF HOST DEFENCE - Diabetes mellitus,
Atrophic urethritis
vaginitis
• FOREIGN BODIES- Urethral catheter
Suprapubic catheter
Urolithiasis
Ureteric stent

22. Acute Cystitis
DIAGNOSTIC FEATURES
► Irritative voiding symptoms (frequency,
urgency, dysuria) and suprapubic discomfort
► Patient usually afebrile. Urinalysis shows
pyuria, bacteriuria, and varying degrees of
hematuria.
► Positive urine culture; blood cultures may
also be positive.

23. Acute Bacterial Prostatitis
• DIAGNOSTIC FEATURES
• ► Fever.
• ► Irritative voiding symptoms.
• ► Perineal or suprapubic pain
• ► Positive urine culture.

24. Clinical Findings
• Perineal, sacral, or suprapubic pain, fever, and
irritative voiding complaints are common. Varying
degrees of obstructive symptoms may occur as
the acutely inflamed prostate swells, which may
lead to urinary retention.
• High fevers and a warm and often exquisitely
tender prostate are detected on examination.
Care should be taken to perform a gentle rectal
examination, since vigorous manipulations may
result in septicemia.

25. . Acute Pyelonephritis
• Acute pyelonephritis is an infectious
inflammatory disease involving the kidney
parenchyma and renal pelvis. Gram negative
bacteria are the most common causative
agents including E coli, Proteus, Klebsiella
• The infection usually ascends from the lower
urinary tract—with the exception of S aureus,
which usually is spread by a hematogenous
route

26. Clinical Findings
• Symptoms include fever, flank pain, shaking
chills, and irritative voiding symptoms
(urgency, frequency, dysuria).
• Associated nausea and vomiting and diarrhea
are common.
• Signs include fever and tachycardia.
•

27. . Laboratory Findings
• Complete blood cell count shows leukocytosis
and a left shift.
• Urinalysis shows pyuria, bacteriuria, and
varying degrees of hematuria.
• White cell casts may be seen.
• Urine culture demonstrates growth of the
offending organism, and blood culture may
also be positive.