Urinary Tract Infections UTI. Diagnosis1

Common UTIs and treatment.

1. URINARY TRACT INFECTIONS BY: MAGOBA CHRISTINE, BSN & KASADHA NASSER BSc, MSc 24/8/2023 1

2. Outline Definition Classification Causes Risk factors Clinical manifestations Management Prevention Definition : UTIs are defined as Infection of any part of the urinary tract 2

3. Classification and examples Upper UT: Kidneys, and ureters Lower UT: Bladder, and urethra Upper UTI: acute pyleronephritis Lower UTI: Cystitis, Urethritis 3

4. Classification Cont ’ Can be complicated or uncomplicated Uncomplicated; normal renal tract structural and function. Complicated; structural/functional abnormality of GUS e.g. obstruction, stones and abscess formation 4

5. CAUSATIVE AGENTS Usually anaerobes and gram negatives from bowel and vaginal flora. Gram negatives: E. coli main cause in community 75-95% Klebsiella Proteus mirabilis Enterococci Gram positives: Staphylococcus 5

6. RISK FACTORS History of recent UTI Use of diaphragm Use of spermicide Indwelling urethral catheters Dehydration Obstructed UT Urinary incontinence Faecal incontinence Increased sexual activity Increased bacterial over growth DM Immunosuppression Obstruction Stones Catheter Pregnancy Old age 6

7. Risk factors cont ’ NB UTIs common in women due to; Short urethra Close proximity of anal opening with urethral opening. Males are protected due to; Long urethra Prostate secretions( bacteriostastic ) 7

8. CLINICAL MANIFESTATION SYMPTOMS: LOWER UTI Cystitis; Increased urinary frequency Dysuria Urgency Suprapubic pain Polyuria Hematuria 8

9. CLINICAL MANIFESTATIONS cont ’ UPPER UTI: ACUTE PYELONEPHRITIS; Fever Rigors Vomiting and nausea Loin pain, lower abdominal pain Associated cystitis symptoms Septic shock Foul smelling urine 9

10. CLINICAL MANIFESTATION cont ’ Signs: Fever Supra pubic tenderness loin tenderness Examine for distended urinary bladder Examine for prostate enlargement Renal angle tenderness 10

11. INVESTIGATIONS/DIAGNOSIS Urinalysis: Urine dipstick; WBC and nitrites suggest UTI Do not use urine from the catheter or urine bag, sample collection technique? Urine microscopy; pus cells, how many ? ≥ 5 per HPF Urine culture; mid stream urine 11

12. Cont ’ Blood tests: if systemically unwell; FBC, Blood culture in case of failure to respond to treatment Electrolytes panel RFTs Imaging : USS; kidneys, prostate Cystoscopy, CT Intravenous urography: persistent upper UTI , recurrent UTI(>2 years), persistent hematuria and obstractive uropathies 12

13. Diagnosis Symptoms + or – leucocytes and or nitrates at urine analysis 13

14. TREATMENT Cystitis Ensure high fluid intake First line; tabs nitrofurantoin 100mg 12hourly for 5-7 days. Trimethoprim sulfamethoxazole 160/800 g 12 hrly for 3 days Fosfomycin tremetamol 3 g once for one day 2 nd line; tabs ciprofloxacin 500mg 12hourly5-7days 14

15. TREATMENT CONT’ Levofloxacin 250-500 mg daily for 3 days Alternative agents Cephalexin 500 mg 6-12 hrly for 7 days Amoxicillin/ clavulanate 500/125 mg every 12 hrs for 3 days Cefpodoxime 100 mg every 12 hrs for 3 days 15

16. TREATMENT CONT’ Pyelonephritis Ensure adequate fluid intake PCM 1g 8hrly, for pain & fever Hospitalised Ampicillin 1 g 6 hours, plus gentamycin 1 mg/kg every 8 hrs IV for 14 days Ceftriaxone 1 g daily for 14 days Ciprofloxacin 12hrly 400mg for 14 days 16

17. Cont ’ Non hospitalized Ceftriaxone 1 g once Ciprofloxacin 400 mg once Gentamycin 5mg/kg Followed by Ciprofloxacin 500 mg 12 hrly for 7 days Or Levofloxacin 750 mg daily for 5 days Trimethoprim- sulfamethoxazole 160/800 mg one tablet every 12 hrs for 14 days 17

18. Acute bacterial prostatitis Hospitalized Ampicillin 2 g every 6 hrs plus gentamycin 1.5 mg/kg every 8 hrs IV until afebrile Followed by one of these Trimethoprim- sulfamethoxazole 160/800 mg ever 12 hrs for 3 weeks Ciprofloxacin 250-500 mg every 12 hrs for 3 weeks 18

19. Chronic prostitis First line Ciprofloxacin 500 mg every 12 hrs for 1-3 months Levofloxacin 750 mg daily for 28 days Second line Doxycline 100 mg twice daily for 4-12 weeks Azithromycin 500 mg daily for 4-12 weeks Clarithromycin 500 mg daily for 4-12 weeks 19

20. COMPLICATIONS Renal calculi Peri -nephric abscess Septic shock 20

21. PREVENTION Improving perineal hygiene Taking plenty of fluids Completely empting the bladder frequently Avoid bad vaginal practices like vaginal steaming, dounching , application scents, herbal medicines etc 21

22. DIFFERENTIAL DIAGNOSIS Vulvovaginitis Gonococcal and non- gonococcal urethritis Bladder tumor Chemical induced cystitis Drug induced cystitis Cholecystitis Salpingitis appendicitis 22