2. Urinary Tract Infections
Is an infection of the urinary tract caused by the
presence of pathogenic microorganism in the
urinary tract with or without signs & symptoms
The most common sites of infections
Urethra – Urethritis
Bladder – Cystitis Lower UTI
Prostate – Prostatitis
Ureter – Ureteritis
Renal pelvis– Pyelonephritis Upper UTI
Kidney-Interstitial nephritis
Renal abscess
By: Belete N 2
3. Urinary Tract Infections…
Risk factors
Iatrogenic/Drugs
Indwelling catheter
Antibiotic use and spermicides
Behavioral
Voiding dysfunction
Frequent or recent sexual intercourse
Anatomic/physiologic
Vesico-urethral reflux
Female sex and Pregnancy
By: Belete N 3
4. Urinary Tract Infections…
Genetic
Susceptible uroepithelial cells(secrete less
IgA)
Vaginal mucus properties
Etiology
Ascending infections (that enter via urinary
meatus)
Obstructive abnormalities (strictures,
prostatic tumors or hyperplasia)
Upper urinary tract disease may occasionally
cause recurrent bladder infections
By: Belete N 4
5. Urinary Tract Infections…
Pathophysiology
The bacteria causing UTIs usually originate from
bowel flora of the host acquired via three
possible routes
Ascending
Hematogenous or
Lymphatic pathways
Three factors determine the development of
UTIs
The size of the inoculum
Virulence of the microorganism, and
Competency of the natural host defense
By: Belete N 5
6. Urinary Tract Infections…
An important virulence factor of bacteria is their ability
to adhere to urinary epithelial cells by fimbriae
Other virulence factors include hemolysin, a cytotoxic
protein produced by bacteria
Lyses a wide range of cells including
erythrocytes, polymorphonuclear leukocytes, and
monocytes ; and aerobactin
★Facilitates the binding and uptake of iron by
Escherichia coli
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7. Urinary Tract Infections…
The most common cause of uncomplicated UTIs is E.
coli
Accounting for more than 85% of community
acquired infections
Sign and symptoms
Dysuria, frequency, urgency, and nocturia
Suprapubic pain and discomfort
Hematuria and back pain
Syndromes of urosepsis- If complicated
Diagnosis
1. Urine dipstick-may react positively for blood WBC
2. Urine microscopy- shows RBC and many WBC-
HPF By: Belete N 7
8. Urinary Tract Infections…
Other Classification
Uncomplicated UTI
UTI that occurs in individuals who lack
structural or functional abnormalities in the UT
that interfere with the normal flow of urine
★Mostly in healthy females of childbearing
age
Complicated UTI
UTI that occurs in individuals with structural
or functional abnormalities i.e. congenital
distortion of the UT, a stone, a catheter,
prostatic hypertrophy, obstruction, or
neurological deficit
★UTI in men are usually complicated-why?
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9. Urinary Tract Infections…
Recurrent UTI
Refers to multiple symptomatic UTIs with
asymptomatic periods in between
It is considered significant when there is two
or more symptomatic episodes per year or it
interferes with patient’s quality of life
It is usually a reinfection than a relapse
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10. Urinary Tract Infections…
Management
The management of a patient with a UTI includes
Initial evaluation
Selection of an antibacterial agent and
duration of therapy, and
Follow-up evaluation
Selection of antimicrobial agent for the treatment
of UTI is based on
The severity of the presenting signs and
symptoms
The site of infection
Whether the infection is complicated or
uncomplicated
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11. Urinary Tract Infections…
The general Management principle includes
1. Relieve discomfort and provide rest
(catheterization if needed)
2. Antibiotic
3. Follow up culture to prove treatment
effectiveness
4. Increase fluid intake- water is best
5. Avoid irritants - Coffee, tea, alcohol, cola
drinks
6. Promote urinary output- Q 2 to 3 hrs
By: Belete N 11
12. Urinary Tract Infections…
Antibiotic therapy according to ESTG
Acute, uncomplicated UTI in women
First line:
★Ciprofloxacin, 500mg P.O., BID, for 3 days
or
★Norfloxacin, 400mg P.O.,BID, for 3 days.
Alternatives:
★Nitrofurantoin 50mg P.O., QID for 7 days or
★Cotrimoxazole 160/800mg P.O, BID for 3
By: Belete N 12
13. Pyelonephritis
Pyelonephritis is an inflammation of the renal pelvis,
calyces, and medulla
The infection usually arises in the lower urinary tract
with organisms ascending into the renal pelvis
Begins in the interstitium & rapidly extending to
involve the tubules, glomeruli & blood vessels
Classifications
Acute pyelonephritis
Chronic pyelonephritis
By: Belete N 13
14. Pyelonephritis…
Acute pyelonephritis
It is sudden onset & self-limited bacterial disease
of the kidneys.
Etiology
Bacteria: E-coli (80%), Proteus, Pseudomonas,
S. aures, Strep. faecalis (entrococcus)
Procedures: Catheterization, Cystoscopy,
Urologic surgery
Systemic infections (such as tuberculosis)
Other causes: Urinary obstruction, Neurogenic
bladder (Vesicourethral reflux)
By: Belete N 14
15. Pyelonephritis…
Acute pyelonephritis is an active bacterial infection
that can cause:
Interstitial inflammation
Tubular cell necrosis
Abscess formation in the capsule, cortex, or
medulla
Temporarily altered renal function, and may
rarely progresses to renal failure
By: Belete N 15
16. Pyelonephritis…
Risk Factors
Women over 65 years of age
Older men with prostate problems
Chronic urinary stone disorders
Spinal cord injury
Pregnancy
Congenital malformations
Bladder tumors
Chronic illness (diabetes mellitus,
hypertension, chronic cystitis)
By: Belete N 16
17. Pyelonephritis…
Clinical Manifestation
Flank pain
Low back pain
Costovertebral angle tenderness
Dysuria (Painful or difficulty of urination)
Nocturia, hematuria, cloudy urine with fishy
odor
Burning, urgency, frequency, nocturia
Shaking chills, generalized fatigue
Fever, tachycardia, tachypnea
Anorexia, nausea and vomiting, headache,
malaise By: Belete N 17
18. Pyelonephritis…
Diagnosis
Appropriate history taking, & Physical
examination
Urinalysis:
Dark color, cloudy appearance, foul odor
Proteinuria, glycosuria, rarely ketonuria
Leucocytes, Few red blood cell
Casts, decreased urine specific gravity
Positive leukocyte esterase (85 to 90%
specific)
Positive nitrate (95% specific)
Urine culture reveals the causative organism
By: Belete N 18
19. Pyelonephritis…
Diagnosis…
CBC
Elevated WBC (>10,000mm3), elevated
neutrophils
Erythrocyte sedimentation rate (ESR) will be
elevated
Intravenous pyelogram
If functional and structural renal abnormalities
are suspected (calculi, structural, or vascular
abnormalities)
Ultrasound or CT scan
Radionuclide imaging
May be useful to identify sites of infection that
By: Belete N 19
21. Pyelonephritis…
Medical Management
According to ESTG
Acute uncomplicated Pyelonephritis in non-pregnant
women:
Mild and moderate acute uncomplicated
pyelonephritis (able to tolerate oral therapy with no
vomiting, no dehydration, no evidence of sepsis):
First line
★Ciprofloxacin, 500mg P.O., BID, oral for 7-10
days
Alternatives
★Cotrimoxazole(Trimethoprim-
sulphamethoxazole), 160/800mg P.O, BID for 14
days
By: Belete N 21
22. Pyelonephritis…
Severe acute uncomplicated pyelonephritis
(high fever, high white blood cell count, vomiting,
dehydration, or evidence of sepsis) or fails to
improve during an initial outpatient treatment
period
Intravenous therapy should be started and
continued until the patient improves (usually
at 48–72 hours)
On discharge oral therapy is continued to
complete 10-14 days course
Antibiotics should be started after urine
culture sample is collected
By: Belete N 22
23. Pyelonephritis…
First line
Ciprofloxacin, 400mg, I.V, BID till patient
improves and continue oral ciprofloxacin
500mg, PO, BID to complete 10-14 days
course
Alternatives
Ceftriaxone, 2gm, I.V, daily or 1gm, I.V, BID
till patient improves and continue oral
ciprofloxacin 500mg, PO, BID to complete 10-
14 days course
If no response in 48-72 hrs. ultrasound is
warranted therapy to evaluate for obstruction,
abscess, or other complications of pyelonephritis
By: Belete N 23
24. Pyelonephritis…
Complicated UTIs and UTI in men-similar to
uncomplicated UTIs but needs prolonged duration
Recurrent UTI in women
First line: Cotrimoxazole, 240mg, P.O., daily or 3x
per week or postcoital
Alternatives:
★Cephalexin, 125–250mg, P.O., once daily or
postcoital or
★Norfloxacin, 200mg, P.O., once daily or
postcoital or
★Ciprofloxacin, 125mg, P.O., once daily or
postcoital
Duration of antibiotics-for six months followed by
observation
If recurrent UTI comes again the prophylaxis can be
prolonged for 1-2years By: Belete N 24
25. Pyelonephritis…
Nursing interventions
Administer antipyretic & Antibiotics
Fluids (2-3 L/d) to empty the bladder of
contaminated urine & prevent calculus formation
Catheterize with strict sterile technique
Instruct the patient to perform appropriate perineal
care
Teach proper technique for collecting a clean catch
urine specimen
Emotional support
Personal hygiene
Advice routine checkups for patient with history of
UTIs By: Belete N 25
26. Pyelonephritis…
Chronic pyelonephritis
It is a persistent inflammation of kidneys
Repeated infections that cause progressive
inflammation & scarring
Etiology:
Bacteria
Urinary obstruction
Vesicourethral reflux
By: Belete N 26
27. Pyelonephritis…
Clinical manifestations
Usually have no symptoms of infection
Noticeable signs
★Fatigue
★Headache
★Poor appetite
Polyuria /Low specific gravity of urine/
Excessive thirst
Weight loss
Flank pain
By: Belete N 27
28. Pyelonephritis…
Diagnosis
History taking & physical examination
Laboratory investigations
Urinalysis
Proteinuria (Albuminuria)
Intermittent bacteriuria
Leukocytes in urine
Low specific gravity of urine
Urine culture to identify the pathogen
Blood
Decreased Hgb
Measuring BUN & creatinine/may increase
Decrease HCI
Radiologic IV Urogram
By: Belete N 28
29. Pyelonephritis…
Complications
End-stage renal disease (from progressive
loss of nephrons secondary to chronic
inflammation and scarring)
Hypertension
Formation of kidney stones (from chronic
infection with urea-splitting organisms)
Management
The same as acute pyelonephritis (Long-term
use)
Monitor HTN
Monitor intake and out put
By: Belete N 29
The vaginal flora is the bacteria that live inside the vagina. The normal vaginal flora is dominated by various lactobacillus species. Lactobacilli help to keep the vagina healthy by producing lactic acid, hydrogen peroxide, and other substances that inhibit the growth of yeast and other unwanted organisms
The five primary classes of immunoglobulins are IgG, IgM, IgA, IgD and IgE. These are distinguished by the type of heavy chain found in the molecule. IgG molecules have heavy chains known as gamma-chains; IgMs have mu-chains; IgAs have alpha-chains; IgEs have epsilon-chains; and IgDs have delta-chains.
Human urine is composed primarily of water (95%). The rest is urea (2%), creatinine (0.1%), uric acid (0.03%), chloride, sodium, potassium, sulphate, ammonium, phosphate and other ions and molecules in lesser amounts
Congenital malformations
One kidney may be missing (renal agenesis).
One or both kidneys may be abnormally small (renal hypoplasia).
One or both kidneys may have formed abnormally (renal dysplasia).
The kidneys may be joined to form a single arched or horseshoe kidney.
The kidneys may be in the wrong position.
One or both kidneys may have fluid-filled cysts (polycystic kidney disease or multicystic kidney disease