INFECTIONS OF THE URINARY TRACT from kidney to urethra

This is a lecture on urinary tract infection

1. INFECTIONS OF THE URINARY TRACT

2. DEFINITION Presence of infective agent in the urinary tract Excluding the distal urethra in sexually active women

3. Syndromes Asymptomatic bacteriuria Cystitis Prostatitis pyelonephritis

4. classification Asymptomatic/symptomatic Upper UTI/Lower UTI Complicated/Uncomplicated Community acquired/Catheter associated

5. Asymptomatic UTI: no symptoms despite presence of bacteria in the UT Symptomatic UTI: symptoms and/or signs accompanying the presence of bacteria in UT

6. Upper UTI: involves infection of kidneys, prostate gland Lower UTI: involves infection of the bladder, urethra

7. Uncomplicated UTI: episode of UTI in an individual with normal UT and no factor that predisposes to delayed therapy Complicated UTI: UTI in the setting of structural abnormality of the UT or systemic disorder that predisposes to UTI eg DM, HIV, steroid

8. Catheter associated UTI: UTI developing in a patient after catheter insertion.

9. Risk Factors Sex F>M Age neonatal M>F, >50 Yrs M>F Spermicides Diaphragm Frequent sex Incontinence Diabetes mellitus

10. Past UTI Lack of circumcision Non secretors of ABO blood group antigens HIV

11. etiology E coli Klebsiella Proteus Enterococcus spp Citrobacter spp Pseudomonas aeruginosa Staph aureus Staph saphrophyticus

12. Candida Herpes viruses

13. Pathogenesis Ascending infection invasion of the UT by bacteria from the urethra. Coliforms are the usual organisms involved. Abnormalities of urine flow and large residual urine assist passage of bacteria.

14. Haematogenous spread to the kidney follows overwhelming systemic infection with salmonella, staph aureus

15. Clinical Features ABU no local or systemic features Cystitis: dysuria , frequency, suprapubic pain, cloudy urine, suprapubic pain Acute pyelonephritis : abrupt onset of symptoms, fever, chills & rigors, nausea, vomiting, loin pains, renal angle tenderness Catheter associated UTI: develops after catheter insertion, bacteria ascends through intra catheter lumen into the bladder or on the biofilm on the catheter surface

16. Prevented by use of sterile closed collecting system, topical application of antibiotics, and addition of antibiotics to urine bags.

17. Investigation Urinalysis: nitrites, leukocyte esterase, and protein Urine microscopy: presence of bacteria 10⁵/ml, WBC, WBC cast, and culture E/U/Cr may be deranged in acute pyelonephritis FBC: leucocytosis

18. Imaging USS; stones, cysts, obstruction, abscess, features of pyelonephritis IVU CT MRI

19. TREATMENT General measures Fluid intake 3 to 3L/day Void after sexual intercourse Good hygiene

20. Specific Trimethoprim / Sulphamethoxazole Amoxicilin Ciprofloxacin Short course 3-5 days for uncomplicated UTI Acute pyelonephritis may require intravenous fluids and parenteral antibiotics

21. Complications Abscess Sepsis Stone formation Recurrence