2. Urinary Tract Infections
- Definition: Infection of any part of the urinary tract
- Presence of more than 105 organisms/ml in
midstream sample of urine(MSU)
5. “Asymptomatic bacteriuria”
Presence of bacteria(>105/ml on 2 occasions in females and 1
occasion in males) without any symptoms
- It is common in pregnancy
- There are no symptoms
- Does not usually require treatment
6. Causes of UTI
Causative organism:
Majority(85%) of UTIs are due to gram-negative bacilli
- Most common: E. coli, Proteus, Klebsiella, Enterobacter,
Pseudomonas
- Less common” Streptococcus faecalis, viruses
7. Pathogenesis
Route of infection:
- Bacteria reaches urinary tract via: bloodstream, lymphatics or
directly
- Most common: ascending route, via urethra - called “transurethral
route”
- Ascending infection: infection ascends from lower urinary tract
into the renal parenchyma
8. Risk factors
UTIs are more common in females, due to the following:
- Shorter urethra(4 cm)
- Absence of prostatic fluid, which has antibacterial effect
- Hormonal changes in females
- Trauma to urethra during sexual intercourse makes it
easier for bacteria to enter the bladder
- Gram-negative organisms living around the anal region
colonise the periurethral region
9.
10. Clinical features of UTI
- Fever with chills and rigor
- Problems with micturition, such as:
- Increased frequency
- Painful micturition - “dysuria”
- Burning micturition
- Urgency
11. - Desire to pass more urine after bladder has been emptied
- “strangury”
- Suprapubic pain
- Hematuria
- Cloudy urine with unpleasant odour
12. Investigations
Urine examination:
- Dipstick tests: positive nitrite test and leukocyte esterase
test
- Microscopic examination: WBCs, WBC casts and RBCs
seen
- Urine culture: using MSU specimen
14. Treatment of UTI
Antibiotic therapy
● Antibiotic depends on result of urine C&S
● Cotrimoxazole(trimethoprim and sulfamethoxazole) 1
double strength tablet two times daily
● Ampicillin 250 mg three times daily
● Amoxicillin 250 mg three times daily
● In uncomplicated cases: taken for 2-5 days
● In complicated cases: taken for 7-10 days
15. ● Hospitalised patients:
● Ceftriaxone 1 g iv once daily
● Or piperacillin-tazobactam 3.375 g iv every 6 hours
Fluid intake should be high - 2 litres per day to maintain high
rate of urine flow
Regular complete emptying of bladder at 2- to 3-hour
intervals
16. - Alkalinisation of urine
- Analgesics, antispasmodics e.g: hyoscyamine
- Perineal hygiene, empty the bladder before bedtime
17. Honeymoon cystitis or Honeymoon disease
- Cystitis as a result of frequent or prolonged sexual activity,
typically expected in the honeymoon period of marriage
21. Definition
Acute infection of the upper urinary tract, affecting the tubules,
interstitium, and renal pelvis.
● Can be acute or chronic
● Bacterial infection commonly
22. Etiology
Causative organisms:
● Gram-negative bacilli
● E.coli, Klebsiella, Enterobacter
Route of infection:
● ascending infection from lower urinary tract
● Less common: hematogenous spread
24. Pathogenesis
● Bacteria from perineum spread to lower urinary tract due to poor
hygiene and colonise it
● spread from lower tract to upper tract via catheterisation/trauma/reflux
● Multiply in upper urinary tract and cause infection(acute
pyelonephritis)
● Leads to Acute kidney injury(AKI)
25. Clinical features
● Fever
● Sudden onset of pain in abdomen
● Dysuria, frequency and urgency
● Cloudy urine
● Tenderness and guarding in the renal angle
26. Investigations
- Total leukocyte count(TLC): increased
- Urine analysis: pus cells, WBC casts
- Bacterial C/S: to find out organism and which antibiotic
it is sensitive to
- USG
30. Chronic pyelonephritis
Chronic inflammation of tubulointerstitial tissue leading
to scarring of calyces, pelvis and renal parenchyma.
● important cause of end-stage renal disease
31. Types
2 types
1. Reflux nephropathy (chronic reflux-associated
pyelonephritis)
2. Chronic obstructive pyelonephritis
● Develops due to recurrent infections superimposed on
obstructive lesions, which lead to renal inflammation,
parenchymal atrophy and scarring.
36. Treatment
- Treat risk factors
- Control of infection - antibiotics for 7 days
- Complete emptying of bladder
- Double micturition of bladder: empty the bladder and after
10-15 minutes, try to empty the bladder a second time
40. Diagnosis
● Urine analysis to check for UTI
● Cystoscopy may be needed
Treatment:
Antibiotics for infection
41. Questions:
LE:
SE:
- Mention causes, Mx and prevention of UTI
- Mx of lower UTI in males
- asymptomatic bacteriuria
- Types of UTI with symptoms
SA:
- define cystitis and pyelonephritis
- organisms causing UTI
42. For notes, click here
or scan:
References:
● Archith Boloor, Ramadas Nayak - Exam
Preparatory Manual
Questions:
salman.s.ansari92@gmail.com
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