urinary tract infection UTI, infection, urinary

urinary tract infection

1. Urinary Tract Infection Ariff Rosli

2. Introduction One of the commonest bacterial infections in adults and women Lower (urethritis, cystitis) or upper UTI (pyelonephritis) Risk factors: Females Behavioural factors eg : MSP STD Obstetric history: multiparous Unhygiene (ascending infection) Previous UTI, calculi, previous instrumentation or surgery (foreign body) Renal Stone (urine stasis) Congenital defects (single kidney, horshoe -kidney) Comorbids

3. Terminology Anatomy : Lower: Urethritis, cystitis Upper: ureteritis , pyelonephritis Uncomplicated : young, healthy , non pregnant women normal urinary tracts Complicated : Infection in patient with structural abnormality or with u/l disease Obstruction Instrumentation Immunodefeciency Asymptomatic bacteriuria: >100,000 CFU/ml Recurrent UTI : >2 cultures positive in 6/12 or >3 in last 12 months Relapse UTI : similar organism in 2 consecutive cultures

4. Causative agents Bacteria E. Coli (80%) Proteus mirabilis * urea splitting organism Klebsiella Staph Saprophyticus TB Rare, following Pulmonary TB Often cause TB proctitis Suspected in sterile pyuria cases (78%) Fungal Candida sp Seen in immunocompromised ptn

5. Clinical Features Generally: fever, dysuria, frequency, urgency, hesitancy, cloudy urine Specific: Cystitis: suprapubic pain Pyelonephritis: flank pain, fever with chills & rigors, nausea and vomiting, Renal Punch: + ve Urethritis: discharge from urethra Prostatis : tender prostate + LUTS sx

6. Investigation Blood investigation FBC RP CaMgPo4: stone work-up Urine *MSU, clean catch, SPA, indwelling catheter UFEME: leu , nitrite (specificity >90%) Urine C&S: significant if >10 5 CFU/ml Radiological X ray KUB: radio-opaque stone USG KUB: visualize renal parenchymal, follow up for paeds CTU: visualize stone, abnormalities in urinary tract, find cause of obstructive uropathy

7. Management Prevention: ↑fluid intake, cranberry juice, avoid ‘hold-on’ Antibiotics: (2 nd gen cephalosporin) T Cefuroxime 250mg BD x 7-10 days (1 st gen cephalosporin) T Cephalexin 33mg/kg (max 500mg) TDS x 7-10 days T augmentin 625mg BD x 7 days (2 nd line) T Bactrim 200mg BD or T Nitrofurantoin 50mg QID (1 st line) Urine alkalizer : ural sachet I/I TDS CBD change 2-weekly Indication of admission: intractable vomiting, poor oral intake, AKI, urosepsis etc

8. THANK YOU