a lecture presentation about urinary tract infection

lecture

2. MALE
FEMALE
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3. Condition in which microorganisms actively multiply
and persist in the genitourinary tract.
Acute infection of the urinary tract falls into two general
anatomic categories.
Lower Tract Infection -Urethritis And Cystitis.
Upper Tract Infection -Acute Pyelonephritis,
Prostatitis , Intrarenal and Perinephric
Abscess.
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4. Most common infectious disease.
Affects all ages
Males predominate in the newborn period
Beyond this age, females predominate
Most Numerous specimens are received in the
Laboratory
Appropriate clinical information gives many clues for
better diagnostic evaluations.
Specimen collection is the primary objective in getting
an ideal sample.
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5. More common in adults than in children. Infections
in children are more likely to be serious than those in
adults and should not be ignored.
Physical contact with an infected partner.
Waiting too long to urinate.
Pregnancy.
Diabetic /Immunosuppressed individuals
Calculi.
Men with anenlarged prostate.
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6. Any medical conditions that cause incomplete
bladder emptying (spinal cord injury) or bladder
decompensation aftermenopause.
The most common cause of UTIs are bacteria from the
bowel that live on the skin near the rectum or in the
vagina, which can spread and enter the urinary tract
through the urethra
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7. Frequent urination, but very little urine may come
out.
Painful burning sensationbefore, during, and after
urinating.
Urinatingblood.
Urgent need to urinate, and in serious cases,
unable to control bladder and leaks urine.
Cloudy or foul smelling urine.
Fever.
Malaise or the general feeling of unwell.
Severe painin the lower abdominal region.
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8. Mainly caused by colonic bacteria
E.coli–most common
Klebsiella
Proteus
Staphyloccussaprophyticus
Pseudomonas aeruginosa
Candida-infections in Diabetic or imunocompromised
patients.
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9. Acute Pyelonephritis
Involvement of renal parenchyma.
Characterized by:
Early Onset Fever.
Abdominal Pain or Flank Pain.
Malaise.
Nausea and Vomiting.
Diarrhea.
Cystitis
Involves bladder .
Characterized by:
Dysuria . Urgency.
Frequency. Suprapubic Pain.
Incontinence . Malodorous Urine.
No fever and does not result in renal injury9

10. Urethritis
Suspected in growth/ culture negative symptomatic cases.
Symptoms similar to Cystitis.
Caused by Sexually Transmitted infections .
Asymptomatic bacteriuria
+ urine culture without any manifestation of infection.
Occurs exclusively in girls, elderly men and women.
Benign and does not cause renal injury.
Catheter associated UTIs
Female Sex
Unsterile procedure while insertion
Prolonged Catheterization
Severe underlying Diseases
Lack of catheter care
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11. Routine Blood Investigations
Blood Urea & Serum Creatinine.
Routine urine
Simple microscopic examination of wet films of
unconcentrated urine for detection of Polymorphonuclear
leucocytes & pus cells gives leading clues.
Semi-quantitative culture of urine to determine whether
urine contain potentially pathogenic bacteria in Numbers
sufficient to identify it as causative agent causing infection.
Urine culture and antibiotic sensitivity.
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12. Radiological Evaluation
Guidelines for selection of patients with UTI for radiologic
evaluation:
All neonates with 1st UTI
All males with 1
st
UTI at any age
All patients with recurrent UTI
All patients with Pyelonephritis
Intravenous Pyelography (IVP)
Information about renal size, renal scars and state of
pelvocalyceal system
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13. VCUG (voiding cystourethrogram)
Definitive test to document VUR
Indicated in children younger than 5 yr with UTI, any child
with febrile UTI, school-aged girls who had 2 or more UTIs
Any male with UTI
Ultrasoundof the kidney and urinary bladder
Screening Procedure Of Choice
Should be obtained to rule out Hydronephrosis and renal or
perirenal abscesses,calculi.
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14. Specimen Collection
The urine collected in a wide
mouthed sterile container
A mid stream specimen is
the most ideal for processing.
Do not collect spontaneously
collected urine , which can
Lead to contamination with
commensal bacterial colonies
on urethral orifice and
perineum.
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15. All collected specimens of
urine to be transported
to laboratory with out delay
Delay of 1-2hour lowers the
quality of diagnostic
evaluations.
If the delay is anticipated the
specimens are to be preserved
at 4
0
c.
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16. Urinalysis
> 10 WBC /hpf In A Centrifuged Urinary Sediment
Hematuria
+ Nitrite Test
Absence Of Pyuria Does Not Rule Out UTI
Urine culture
Gold Standard
Midstream Urine Sample:
> 100,000(10
5
) Colonies/ml of a Single Pathogen
10,000 Col/ml If Symptomatic
Catheterized Urine > 10
5
Colony Count
Suprapubic Aspirate = Any Bacterial Growth
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17. Symptomatic Cases attending OPDs should be started on Broad-
Spectrum Antibiotics.
Ideally urine samples to be sent for examinations prior to Antibiotic
administration.
DRUGS:
Trimethoprim SulfamethoxazoleNitrofurantoin
Penicillin Quinolone
Aminoglycosides Cephalosporins
Conservative:
Increased oral fluids intake.
Acidification of urine.
Regular and complete bladder emptying.
Good personal hygiene.
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