Urinary Tract Infection

- A urinary tract infection (UTI) is an infection of the urinary tract. An infection anywhere from the kidneys to the ureters to the bladder to the urethra qualifies as a urinary tract infection. - microbial invasion of any tissues of the tract from the renal cortex to urethra - presence of significant bacteriuria - bacteriuria + bacterial invasion of tissue of urinary tract
kidney - pyelonephritis bladder - cytitis urethra - urethritis

although N urine is sterile, it is an excellent medium for bacteria Bacteriuria: presence of bacteria in the urine Only 51% of symptomatic women with UTI grew 100,000 bacteria/ml

Causative agents
Common organisms that cause UTIs include: Escherichia coli and Staphylococcus saprophyticus. Less common organisms include Proteus mirabilis, Klebsiella pneumoniae, Enterbacter spp, and Enterococcus spp.

PYURIA presence of PMN cells in urine indicates inflammation infectious or non-infectious in etiology if (-) entertain TB What is significant pyuria? at least 3 WBC/hpf only 50% of patients with UTI will have significant pyuria Significant bacteuria is a laboratory finding, not a disease. correlate clinically expect low count in low proportion of individuals with tissue infection low bacterial counts in males are easily interpreted, as compared with females high count may be due to contamination

Age group Neonatal Premature Full-term Pre-school School Reproductive Elderly

Prevalence (%) Approx. sex ratio (m:f) 1 29

Prevalence of UTI (according to age & sex)

1.5:1

0.7 2-3 1-2 2.5 20-30 1:10 1:30 1:50 1:10

Routes of Infection

Ascending - most common female urethra short tendency for rectal bacteria to colonize perineum & vaginal vestibule Hematogenous Lymphatic Direct extension

Bacterial Virulence Factors ability of E. coli to adhere to vaginal & uroepithelial cells mediated by bacterial fimbriae or pili that protrude from the cell surface like tiny hairs Causative organisms in Hospitalized patients: Pseudomonas E. coli Serratia marcescens Klebsiella Proteus

Diagnosis
A patient with dysuria (painful voiding) & urinary frequency generally has a spot midstream urine sample sent for urinalysis, specifically the presence of nitrites, leukocytes or leukocyte esterase. If there is a high bacterial load w/o the presence of leukocytes, it is most likely due to contamination. Pyelonephritis is ruled out by checking for costovertebral angle tenderness (CVAT).

 The diagnosis of UTI is confirmed by a urine culture. If the urine culture is negative: symptoms of urethritis may point at Chlamydia trachomatis or Neisseria gonorrheae infection. symptoms of cystitis, may point at interstitial cystitis. in men, prostatitis may present w/ dysuria. In severe infxn, charac. by fever, rigors or flank pain, urea & creatinine measurements may be performed to assess whether renal function has been affected.

Symptoms & Signs

Urethritis: discomfort or pain at the urethral meatus or a burning sensation throughout the urethra w/ micturition (dysuria). Cystitis: pain in the midline suprapubic region &/or frequent urination Hematuria (bloody urine) Cloudy and foul-smelling urine

 High temperature lasting for more than 3 days should be a trigger to get the urine culture done to ascertain whether the fever is d/t UTI or not. UTI is very harmful especially in infants since it can cause permanent renal damage. Nausea & vomiting, accompanied by high fever may indicate a more complicated UTI in w/c the kidney is infected

Prevention
Not resisting the urge to urinate. Taking showers, not baths, or urinating soon after taking a bath. Practicing good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by fecal pathogens.

 Cleaning genital areas prior to and after sexual intercourse. For sexually active women, and to a lesser extent men, urinating w/in 15 mins. of sexual intercourse to allow the flow of urine to expel the bacteria before specialized extensions anchor the bacteria to the walls of the urethra. Having adequate fluid intake, especially water.

 Most uncomplicated UTIs can be treated w/ oral antibiotics i.e. trimethoprim, cephalosporins, Macrodantin, or a fluoroquinolone (e.g. ciprofloxacin, levofloxacin). (Whilst co-trimoxazole was previously used (and
continues to be used in the U.S.),

Treatment

the additional benefits of the sulphonamide gave little additional benefit compared to the trimethoprim component alone, but was responsible for its both high incidence of mild allergic reactions & rare but serious complications).