The document discusses urinary tract infections (UTIs). It defines UTIs as the presence of microorganisms in the urinary tract that can invade tissues and cause inflammation. The most common causes are E. coli, S. saprophyticus, K. pneumoniae, Proteus species, P. aeruginosa, and Enterococcus species. UTIs can occur in the lower urinary tract (urethra and bladder) or upper urinary tract (ureters and kidneys). Common symptoms depend on the infected area and can include burning with urination, frequent urination, and abdominal or back pain. Diagnosis involves urine tests and cultures. Treatment involves antibiotic therapy.

1. URINARY TRACT
INFECTION (UTI)
Presented By:
Breeha sana (1925546009)
Khusbhu Akram (1925546028)
Mahnoor Khalid (1925546033)
Sobia Shafqat (1925546059)
Pharm-D Fourth Professional.
Lahore College for women university

2. DEFINITION
Presence of micro-organisms in the urinary tract, that may have potential to invade the
tissues of urinary tract and may cause inflammation.
• The most common cause of UTI
• Escherichia coli
• Staphylococcus saprophyticus
• Klebsiella pneumoniae
• Proteus spp.
• Pseudomonas aeruginosa
• Enterococcus spp.

3. ANATOMY OF URINARY TRACT
• Urinary tract is body’s drainage system for removal of urine.
• It consists of:
a) Kidney
b) Ureter
c) Bladder
d) Urethra
• Length of male urethra is 20cm,
• while that of female is 4.8-5.1cm
• LOWER URINARY TRACT INFECTION(urethra, Bladder).
• UPPER URINARY TRACT INFECTION( ureter, Kidney).

4. TERMINOLOGIES
• Cystitis: Infection of bladder.
• Pyelonephritis: Infection of kidney.
• Prostatitis: Infection of prostate .
• Relapse: Relapse is recurrence caused by the same organism that caused the original infection within 2
weeks.
• Reinfection: Reinfection is recurrence caused by a different organism, and is therefore a new infection
after 2 weeks.
• Complicated urinary tract: Structural or functional abnormality and obstruction of urine flow.
• Non-Complicated urinary tract: is usually considered to be Cystitis or pyelonephritis that occurs in
premenopausal adult women with no structural and functional abnormality of urinary tract.

5. PATHOPHYSIOLOGY

7. CAUSES AND RISK FACTORS
• Males: Urinary tract blockage due to prostate enlargement
• Children: Urinary tract does not develop properly, or due to use of catheter or may
be due to diapers.
• Elders: With age muscles tends to weaken that causes urine retention.
• Diabetic Patients
• Pregnant females

8. CAUSES AND RISK FACTORS

9. CLINICAL MANIFESTATIONS DEPENDING ON
AGE
INFANTS AND BABIES
• Fever
• Apathy
• Diarrhea
CHILDREN
• Abdominal pain
• Vomiting
• Dysuria
• Hematuria
ELDER
• Mostly asymptomatic
• Not diagnostic as symptoms are common with age
ADULTS
• Upper UTI
Fever lion pain and symptoms of lower UTI
• Lower UTI
• Dysuria ,hematuria ,frequency ,urgency etc

10. SIGNS AND SYMPTOMS OF UTI
• Symptoms of a UTI depend on what part of a urinary tract is infected:
Lower Urinary Tract Infection:
 Increased frequency of urination without passing much urine
 Burning with urination
 Increased urgency of urination
 Bloody urine
 Cloudy urine
 Urine that looks like cola or tea
 Urine that has a strong odor
 Pelvic pain in women
 Rectal pain in men

11. SIGNS AND SYMPTOMS OF UTI
• Part wise Infection and their Respective Symptoms:
• 1. Kidneys (acute pyelonephritis)
 Upper back and side (flank) pain
 High fever
 Shaking and chills
 Nausea and vomiting
• 2.Bladder (cystitis)
 Lower abdomen discomfort
 Frequent, painful urination
 Blood in urine
• 3.Urethra (Urethritis)
 Burning with urination

13. UTI-DIAGNOSIS
 Urine dipstick test
 Urinalysis
 Urine culture
 Imaging techniques-CT scan and MRI
URINALYSIS:
(physical, chemical, microscopic examination)
 Presence of pus, white blood cells, red blood cells
 Bacteria count>10^5/ml – significant bacteriuria
URINE CULTURE:
 For pyelonephritis
 Not a rapid diagnostic tool
 >105 bacteria/ml
 Differential leukocyte count(increased neutrophils)
 Gold standard for detection of UTI
URINE DIPSTICK TEST
• Nitrite dipstick test , Leukocyte esterase dipstick test .

14. LABORATORY FINDINGS:
LABORATORYFINDINGS:
Normal Findings Abnormalfindings
 pH 4.6-8.0 Alkaline(increases)
 Appearance Clear Cloudy
 Color Pale to amber yellow Deep amber
 Odor Aromatic Foul smelling
 Blood None Maybe present
 WBC Absent Present
 Bacteria Absent Present

15. UTI’S IN CHILDREN
8% of girls and 2% of boys will have at least one episode by seven years of age
Of these children, 12–30% will experience recurrence within one year

16. ALGORITHM FOR UTI MANAGEMENT IN CHILDREN -
NATIONAL INSTITUTE FOR HEALTH AND CARE
EXCELLENCE AND KIDNEY HEALTH AUSTRALIA
GUIDELINES

20. UTI’S IN ADULTS
• Adults (30–65 years) Male -0.1% Female - 10%
• Urinary tract infections in men complicated because they result from an
anatomic or functional anomaly or instrumentation of genitourinary tract
• Conditions like prostatitis, chlamydial infection and epididymitis should
be considered in the differential diagnosis with acute dysuria or frequency
and appropriate diagnosis test should be considered
• In all men with symptoms of UTI a urine sample should be taken for
culture.

21. Antibiotic treatment

22. UTI’S IN PREGNANCY
• URINARY TRACT INFECTIONS are the most common bacterial infections during
pregnancy.
• It can occur as:
 Asymptomatic Bacteriuria
 Acute Cystitis
Acute Pyelonephritis
EPIDEMOLOGY
Asymptomatic Bacteriuria 10-13%
Acute Cystitis 1 - 4%
Acute Pyelonephritis 0.5% - 2%

23.  Though, incidence of bacteriuria in pregnant women is only slightly higher than non pregnant women, the
chances of progression to pyelonephritis is significantly higher i.e. 40%*
WHY UTI IS MORE COMMON
IN PREGNANCY?
The answer lies in the physiological changes occurring in the
Urinary Tract during pregnancy?
PHYSIOLOGICAL CHANGES IN KIDNEYS
 Kidney size increases approximately by 1.5 cm.
 Increase in urinary stasis (due to pressure of uterus on bladder and progesterone release causes relaxation of
smooth muscles)
 There is increase in GFR ( increase in glucose level in urine and provide environment for bacteria growth)
 Immunse suppression in end of pregnancy
 Difficult hygiene due to a distended pregnant belly is also one of the cause of increase incidence of UTIs in
pregnancy

24. CLINICAL PRESENTATION:
 The most common form recurrent UTI is recurrent or persistent Asymptomatic Bacteriuria.
 However, it may also present as Acute Cystitis or Acute Pyelonephritis after an untreated primary Asymptomatic
Bacteriuria.
ASYMPTOMATIC BACTERIURIA IN PREGNANCY
When a bacterial count of same species over 10^5 CFU/mL in mid stream clean catch urine on Two occasions is
detected without symptoms of urinary infection this is known as ASB
SCREENING : Recommend screening for bacteriuria at the first prenatal visit or at 12 weeks,
whichever is earlier.

25. SIGNIFICANCE :If asymptomatic bacteriuria is not treated, approximately 40 percent of infected women will
develop symptomatic infection during pregnancy
ACUTE CYSTITIS IN PREGNANCY
Acute cystitis affects approximately 1% of all pregnant women.
ACUTE PYELONEPHRITIS IN PREGNANCY
It is the most common serious medical complication of pregnancy.
Pyelonephritis was the leading cause of septic shock during pregnancy

26. MANAGEMENT
Antibiotics For 7 to 10 days (for asymptomatic and acute cystitis)
ANTIBIOTICS DOSE
Fosfomycin
Ampillicin 500 mg qid
Ampoxicillin - clavulanic acid 375 mg tid
Cephalexin 500 mg tid

27. • In case of recurrent infection, Nitrofurantoin 50mg or Amoxycillin 250mg at night
to continue till delivery

28. Antibiotics to avoid during pregnancy
•Ciprofloxacin (bone development problem) – 1st Trimester
•Nitrofurantoin ( it could cause problems with your baby's
red blood cells) – 3rd Trimester
•Sulphamethoxazole (increases bilirubin)
– 1st & 3rd Trimester of pregnancy
•Trimethoprim ( it may affect your levels of folic acid, which is
important in the early stages of your baby's development).
-1st & 3rd Trimester of pregnancy

29. PREVENTION:
 Drink plenty of liquids especially water
 Drink cranberry juice or carrotjuice
 Proper hygiene
 Wipe from front to back.
 Empty your bladder soon after intercourse.
 Avoid potentially irritating feminine products.