Urinary Tract Infections (UTIs)

Microbiological Investigation
Prof. Yuwono
Dept. Clinical Microbiology Moh. Hoesin
General Hospital/Sriwijaya University School
of Medicine Palembang Indonesia
yuwonodr@gmail.com
3MED666 Laboratory
Investigation of UTIs

Predisposing factors
Sexual activity in females
Elderly males: prostatic hypertrophy
Young children with inherited defect, e.g.
vesico-uretic reflux
Pregnancy
Catheterisation
Surgery, e.g. prostatectomy
Diabetes mellitus
3MED666 Laboratory
Investigation of UTIs

Genito-Urinary tract

3MED666 Laboratory
Investigation of UTIs

Human kidney

3MED666 Laboratory
Investigation of UTIs

Types of UTI
Non- sexually transmitted!
Cystitis: inflammation of bladder wall;
accompanied by dysuria and frequency
Cystitis is much the commonest,
discomforting but not serious
Upper tract infections, e.g. pyelonephritis,
are much more serious
Accompanied by fever and risk of
complications
3MED666 Laboratory
Investigation of UTIs

Causative agents: mainly faecal bacteria

COMMUNITY
-ACQUIRED
Escherichia coli
Proteus mirabilis
Klebsiella
pneumoniae
Enterococcus faecalis
Staphylococcus
species

HOSPITAL
ACQUIRED
Pseudomonas
aeruginosa
Candida albicans
AND
Mycobacterium
tuberculosis (renal TB
will be a sterile
pyuria

3MED666 Laboratory
Investigation of UTIs

Investigation: the specimen

Mid-stream Urine (MSU) is the specimen
of choice
Suprapubic urine
Catheter urine
In all cases, urine must be examined
immediately or stored at 4oC
Contamination of urine is a big problem!!
3MED666 Laboratory
Investigation of UTIs

Standard procedures
Investigation of UTI involves the detection
of bacteriuria together with evidence of an
inflammatory response
Microscopy for pyuria and haematuria
(can also reveal other structures, e.g.
crystals, other cells, casts
Culture for detection of bacteria
Sensitivity testing to advise on antibiotic
treatment
3MED666 Laboratory
Investigation of UTIs

Microscopy
Not always performed as it is time
consuming
The finding of a rise in WBCs (pyuria)
should be linked to a bacteriuria
May also see RBCs (haematuria); this is
potentially an important finding
Microtitre plate and an inverted
microscope enables many urines to be
simply screened
3MED666 Laboratory
Investigation of UTIs

White cells in urine

In normal state, there is a continuous
secretion of WBCs into urine
In a UTI caused by bacteria, neutrophils
may be secreted in large numbers
Labs may report >200/l (>200 x 103/ml)
and will suggest this as significant pyuria
Lower numbers: < 103/ml are regarded as
not significant
3MED666 Laboratory
Investigation of UTIs

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Culture: procedure
Cystitis is usually caused by a single
species of bacterium present at >10 5/ml
Standard loopful of urine is streaked onto
a selective medium, e.g. CLED
Typically 1l
Incubate overnight and count the colonies
If a genuine UTI, should see >100
colonies; this = >100 bacteria/l or >10 5/ml
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Investigation of UTIs

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Culture: interpretation
>105/ml of a single species strongly suggests a
UTI
104-105/ml of a single species is equivocal
needs repeat specimen for testing
<104/ml is regarded as no significant growth
>1 species in any numbers suggests
contamination
Catheter and suprapubic urines should be
interpreted differently
3MED666 Laboratory
Investigation of UTIs

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Sensitivity testing
Clinical isolates are tested against antibiotics
that a) are filtered by kidneys and b) are usually
effective against common agents
Since UTIs are common, drugs should be
cheap!
Typical course of treatment: 5-7 days orally,
resulting in sterile urine
Nitrofurantoin, nalidixic acid, trimethoprim,
ampicillin + gentamicin, cephalosporins
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Investigation of UTIs

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Antibiotic sensitivities

3MED666 Laboratory
Investigation of UTIs

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TERIMA KASIH

3MED666 Laboratory
Investigation of UTIs

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