This document provides an overview of urinary tract infections (UTIs). It discusses the epidemiology, etiology, classification, pathogenesis, risk factors, clinical presentation, diagnosis, and management of UTIs. UTIs are common, especially in women, and are usually caused by bacteria entering the urinary tract and ascending to the bladder or kidneys. Symptoms vary depending on the location and severity of infection. Diagnosis involves urinalysis and culture. Treatment involves antibiotics targeted to the specific pathogen.

2. Contents
• Introduction
• Epidemiology
• Etiology
• Classification of UTI
• Pathogenesis
• Risk factors
• Clinical presentation
• Diagnosis
• Conclusion
• References

3. INTRODUCTION
• A urinary tract infection (UTI) is an
infection in any part of urinary system
— kidneys, ureters , bladder and
urethra. Most infections involve the
lower urinary tract — the bladder and
the urethra.

4. Epidemiology
• Seen in all age groups
• Infants up to 6 months – 2/1000
Women – at greater risk than men;
prevalence 40-50% in women and 0.04% in
men.
• 10% women have recurrent UTI in their life
• 7 million new cases of lower UTI / year
• 1 million hospitalizations / year
• Incidence of UTI increases in old age; 10%
of men and 20% of women are infected.

6. Etiology
• Acute uncomplicated UTI:
• Escherichia coli – cause about 80% of UTI
• 20% of UTI caused by-
1. Gram negative enteric bacteria – Klebsiella,
Proteus
2. Gram positive cocci – Streptococcus Faecalis
Staphylococcus saprophyticus
• S.saprophyticus – restricted to infections in
young sexually active women.

8. CLASSIFICATION OF UTI
Site of Infection
Upper
•Acute pyleonephritis
•Chronic pyleonephriitis
•Interstitial pyleonephritis
•Renal abscess
•Perirenal abscess
•Both upper & lower UTI are further divided
into complicated and uncomplicated.
Lower
•Cystitis
•Prostatitis
•Urethritis

9. 2. UTI
1. Community aquired (non catheter
associated)- uncomplicated
2. Nosocomial uti (catheter associated) –
complicated

10. 3. UTI
Uncomplicated UTIs Complicated UTIs
• Infection involving Presence of metabolic,
normal urinary tract. Functional and anatomical
• Healthy non pregnant abnormalities.
1.Women
2.Pregnancy
3.Catheterization
4.Diabetes
5.Infecton stone

11. Pathogenesis
• 4 routes of bacterial entry to urinary
tract.
1) Ascending infection
2) Blood borne spread
3) Lymphatogenous spread
4) Direct extension from other organs

12. Ascending Infection
 Most common route.
 Organisms ascend through urethra into
bladder.
Organism
Colonize in perineal , periurethral areas
Ascend to bladder and kidney
UTI

13. Hematogenous spread:
• Blood borne spread to kidneys.
• Occurs in bacteraemia.

14. • Lympathogenous spread
• Men- through rectal and colonic
lymphatic vessels to prostrate and
bladder.
• Women- through periuterine lymphatics
to urinary tract.
Direct extension from other
organs:
• Pelvic inflammatory diseases
• Genito-urinary tract fistulas

15. RISK FACTORS
1. Aging: diabetes mellitus
• urine retention
• impaired immune system
2. Females: shorter urethra
• sexual intercourse
• contraceptives
• incomplete bladder emptying with age
3. Males: prostatic hypertrophy
• bacterial prostatis
• age

16. UTI-CLINICAL
PRESENTATION
• Clinical manifestations depending on site of
infection
• Clinical manifestations depending on age of
patient

17. Clinical manifestations
depending on site of infection
 Urethritis:
• Discomfort in voiding
• Dysuria
• Urgency
• frequency
• pyuria

18. Cystitis:
• Dysuria, urgency and frequent urination
• Pelvic discomfort
• Suprapubic pain
• Abdominal pain
• Pyuria
• Urine is cloudy,
Malodorous and bloody

19. Pyelonephritis
• Invasive nature
• Suprapubic tenderness
• Fever and chills
• White blood cell casts in urine
• Back pain
• Nausea ,vomiting and diarrhea.
• Complications include sepsis, septic shock
and death.

20. Clinical manifestations depending on age
 Babies and infants:
1. Failure to thrive
2. Fever
3. Apathy
4. Diarrhoea
 Children:
1. Dysuria, urgency, frequency
2. Haematuria
3. Acute abdominal pain
4. Vomiting

21.  Adults:
1. Lower UTI- frequency, urgency ,
dysuria, haematuria
2. Upper UTI- fever, rigor and loin pain
and symptoms of lower UTI.
 Elderly patients:
• Mostly asymptomatic
• Not diagnostic as the symptoms are
common with age.

22. INVESTIGATION
• Microscopic examination of urine
• Urinalysis
• Urine culture
• Imaging techniques – CT scan and
MRI

23. Laboratory findings
Normal finding
• pH - 4.6 – 8.0
• Appearance- clear
• Color – pale to amber
yellow
• Odor – aromatic
• Blood – none
• Leukocyte esterase –
none
• WBC- absent
• Bacteria- absent
Abnormal finding
• •pH – Alkaline
(increases)
• Appearance – cloudy
• Color - deep amber
• Odor – foul smelling
• Blood – maybe present
• Leukocyte esterase -
present
• WBC- present
• Bacteria- present

24. Urinalysis :
• Presence of pus, white blood cells, red
blood cells
• Bacterial count > 105 /ml – significant
bacteriuria
• Leukocyte esterase dipstick test – WBC in
urine
• Nitrite dipstick test- pink colour

25. Urine culture
• For pyelonephritis
• Not a rapid diagnostic tool >105 bacteria
/ml
• Differential leukocyte count increased
neutrophills.

26. UTI - management
• Symptomatic UTI- antibiotic therapy
• Asymptomatic UTI- no treatment
required
except in special situations.
• Non- specific therapy:
1. more water intake.
2. Maintaining acidity of urine by fluids
like canberry juice.

27. TREATMENT
PATHOGEN SPECIFIC TREATMENT

28. Conclusion
• Urinary tract infections are the 2nd most
common bacterial infections.
• Women are the most infected subjects in the
population.
• Development of resistance to antibiotics by
the bacteria result in problems during the
treatment and lead to relapse or recurrence.
• Recent advances such as development of
immunologicals like intranasal vaccines may
result in life time cure of the infection in
future.