URINARY TRACT INFECTION.pptx-causes,complications

uti in pregnancy

1. Dr.Chippy URINARY TRACT INFECTION

2. DEFINITION UTI is defined either as a lower Urinary tract (acute cystitis) or upper Urinary tract (acute pyelonephritis) infection.

3. Asymptomatic bacteriuria-ASB Asymptomatic bacteriuria is used when a bacterial count of the same species over 10 5 / ML in mid stream clean catch specimen of urine on two occasions is detected without symptoms of urinary infection.

4. ASB Factors that have been associated with a higher risk of bacteriuria H/O Prior urinary tract infection P re-existing diabetes mellitus Low socioeconomic status

5. ASB INCIDENCE 2-8% CAUSES E. coli >90 % cases. Klebsiella pneumonia Proteus ,Enterobacter 25% of these women are likely to develop acute pyelonephritis if left untreated Asymptomatic bacteriuria if recurrent is associated with high incidence of urinary tract abnormality (20%), congenital or acquired . The woman runs a greater risk of developing chronic renal lesion in later life. WHY SHOULD IT BE TREATED?

6. Others   Preterm Birth, Low Birth Weight Perinatal Mortality Preeclampsia

7. DX Bacteriuria is defined as two consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts of ≥10 5  colony-forming units ( cfu )/mL or a single catheterized urine specimen with one bacterial species isolated in a quantitative count of ≥10 2   cfu /mL At 12 to 16 weeks

8. TREATMENT Ampicillin (500 mg qid) Nitrofurantoin (100 mg qid ) Cephalexin (500 mg tid) Amoxycillin–clavulanic acid ( 375mg tid ). A course of 10–14 days will cure 70–100% of cases ACOG guidelines state that follow-up urine culture after treatment of asymptomatic bacteriuria is recommended in the literature

9. SCREENING URINE CULTURE IN FIRST TRIMESTER RESCREENING IN Past UTI Presence of urinary tract anomalies Diabetes mellitus Hemoglobin S Preterm labor

10. CYSTITIS

11. DIAGNOSIS Urine Complete Urine Culture ≥10 3   cfu /mL in a symptomatic pregnant woman as an indicator of symptomatic UTI. If bacteria that are not typical uropathogens (such as lactobacillus) are isolated, then ≥10 5   cfu /mL

12. TREATMENT

13. FOLLOW UP AND RECCURRENCE As long as symptoms have resolved with treatment- do not routinely check a follow-up culture For individuals who have three or more episodes of recurrent cystitis during pregnancy-antimicrobial prophylaxis for the duration of pregnancy to prevent additional episodes Daily or postcoital prophylaxis with low-dose Nitrofurantoin (50 to 100 mg orally postcoitally or at bedtime) or Cephalexin (250 to 500 mg orally postcoitally or at bedtime) can be used.

14. ACUTE PYELONEPHRITIS Fever (>38°C or 100.4°F) Flank pain Nausea Vomiting Costovertebral angle tenderness Pyuria is a typical finding USUALLY IN SECOND AND THIRD TRIMESTERS

15. COMPLICATIONS Septic shock syndrome-20% ARDS Anemia Renal dysfunction Acute renal failure Preterm Labour (Hemolysis -mediated By Endotoxin –ANEMIA)

16. DD CHORIOAMNIONITIS ABRUPTIO PLACENTAE TREATMENT Hospitalization and intravenous antibiotics until the woman is afebrile for 24 to 48 hours and symptomatically improved Then switched to oral therapy 7 to 10 days of treatment

17. Nitrofurantoin and Fosfomycin are not appropriate for treatment of pyelonephritis due to inadequate tissue level If symptoms and fever persist beyond the first 24 to 48 hours of treatment, a repeat urine culture and renal ultrasound should be performed to rule out persistent infection and urinary tract pathology.

18. Recurrent Pyelonephritis Recurrent pyelonephritis during pregnancy occurs in 6 to 8 percent of women Use postcoital prophylaxis in pregnant women who have recurrent UTIs that appear to be temporally related to sexual intercourse. Recurrent urinary tract infection (UTI) refers to ≥2 infections in six months or ≥3 infections in one year

19. E COMPLETE URINE MACROSCOPY-COLOR AMBER URINE MACROSCOPY-TRANSPARENCY CLEAR CHEMICAL ANALYSIS-PROTEIN TRACE Negative(<15 mg/dl) CHEMICAL ANALYSIS-GLUCOSE NEGATIVE Negative (<25 mg/dl) CHEMICAL ANALYSIS-KETONES TRACE Negative(<5 mg/dl) CHEMICAL ANALYSIS-BILIRUBIN NEGATIVE Negative CHEMICAL ANALYSIS-UROBILINOGEN ++ Negative(<2 mg/dl) CHEMICAL ANALYSIS-NITRITES NEGATIVE Negative CHEMICAL ANALYSIS-LEUCOCYTE + Negative(<25/ microlitre CHEMICAL ANALYSIS-BLOOD(Hb/RBCs)/MYOGLOBIN +++ Negative(0.5 mg/dl) CHEMICAL ANALYSIS-pH 5.5 4.6 - 8 CHEMICAL ANALYSIS-SPECIFIC GRAVITY 1.03 1.001 - 1.035 URINE MICROSCOPY-RBC 36 0 - 2cells/ hpf URINE MICROSCOPY-WBC 19 0 - 5cells/ hpf URINE MICROSCOPY-EPITHELIAL CELLS 12 0 - 9cells/ hpf URINE MICROSCOPY-NON SQUAMOUS EPITHELIAL CELL 1 0-2 URINE MICROSCOPY-CASTS URINE MICROSCOPY-HYALINE CAST 0 0-2 URINE MICROSCOPY-CRYSTALS CALCIUM OXALATE PRESENT

20. URINE CULTURE SPECIMEN URINE PUS CELLS 1-2/HPF BACTERIA + COLONY COUNT 10^4CFU/ML FINAL REPORT PROBABLY SIGNIFICANT BACTERIURIA ORGANISMS:KLEBSIELLA PNEUMONIAE (ESBL PRODUCER) {} ANTI-BIOTICS: AMIKACIN - SUSCEPTIBLE GENTAMICIN - SUSCEPTIBLE NETILMICIN - SUSCEPTIBLE TOBRAMYCIN - SUSCEPTIBLE CEFUROXIME - RESISTANT CEFTAZIDIME - RESISTANT CEFTRIAXONE - RESISTANT CEFOTAXIME - RESISTANT CEFEPIME - RESISTANT ERTAPENEM - SUSCEPTIBLE IMIPENEM - SUSCEPTIBLE NITROFURANTOIN - SUSCEPTIBLE CEFOPERAZONE+SULBACTAM - SUSCEPTIBLE COLISTIN - INTERMEDIATE MEROPENEM - SUSCEPTIBLE PIPERACILLIN+TAZOBACTAM - SUSCEPTIBLE TIGECYCLINE - RESISTANT CIPROFLOXACIN - RESISTANT NORFLOXACIN - SUSCEPTIBLE NALIDIXIC ACID - SUSCEPTIBLE CO - TRIMOXAZOLE - RESISTANT

21. QUIZ