3. INTRODUCTION
• Symptomatic
presence of micro
organisms within the
urinary tract
i.e., kidney, ureters,
bladder and
urethra.
• Associated with
inflammation
of urinary tract.
5. • Significant bacteriuria: presence of at least
105
bacteria/ml of urine.
• Asymptomatic bacteriuria : bacteriuria with
No symptoms.
• Urethritis: infection of anterior urethral tract
*dysuria, urgency and frequency of urination.
• Cystitis: infection to urinary bladder
*dysuria, frequency and urgency, pyuria and
haematuria.
6. • Acute pyelonephritis: infection of
one/both kidneys; sometimes lower tract
also *pyuria, fever, painful micturition
• Chronic pyelonephritis: particular type of
pathology of kidney; may/may not be
due to infection.
7. UTI - TERMINOLOGY
• Uncomplicated: UTI without underlying renal
or neurologic disease.
• Complicated: UTI with underlying
structural, medical or neurologic disease.
• Recurrent : > 3 symptomatic UTIs within
12 months following clinical therapy.
• Reinfection: recurrent UTI caused by a
different pathogen at any time
• Relapse: recurrent UTI caused by same species
causing original UTI within 2 wks after therapy.
8. EPIDEMIOLOGY
Seen in all age groups
Women – at greater risk than men; prevalence
40-50% in women and 0.04% in men.
10% women have recurrent UTI in their life
7 million new cases of lower UTI / year
1 million hospitalizations / year
Incidence of UTI increases in old age; 10% of
men and 20% of women are infected.
9. ETIOLOGY
• Acute uncomplicated UTI:
• Escherichia coli – cause about 80% of UTI
• 20% of UTI caused by-
Gram negative enteric bacteria – Klebsiella,
Proteus
Gram positive cocci – Streptococcus
faecalis,Staphylococcus saprophyticus.
10. • COMPLICATED UTI:
Pseudomonas aeruginosa, Enterobacter
& Serratia
Isolated in hospital acquired infections and
catheter associated UTI.
Viruses - Rubella, Mumps and HIV
Fungi - Candida, Histoplasma
capsulatum
Protozoa - T. vaginalis, S.
11. PATHOGENESIS
• 4 routes of bacterial entry to urinary
tract.
1) Ascending infection
2) Blood borne spread
3) Lymphatogenous spread
4) Direct extension from other organs
12. • Ascending Infection:
most common route.
organisms ascend through urethra into
bladder.
organism
Coperineal and
periurethral areas
Ascend to bladder,
Kidneys
UTI
14. • Lymphatogenous spread:
Men- through rectal and colonic
lymphatic vessels to prostrate and
bladder.
Women- through periuterine lymphatics
to urinary tract.
• Direct extension from other organs:
Pelvic inflammatory diseases
Genito-urinary tract fistulas
15. • The organism:
E.coli – many strains present but only few
cause infection.
Virulence factors:
1. fimbriae
2. resistance to serum bactericidal
activity
; increased amounts of capsular K antigen
activity
3. toxin production
4.production of urease enzyme (proteus
19. UTI – RISK FACTORS
1. Aging: diabetes mellitus
urine retention
impaired immune system
2. Females: shorter urethra
sexual intercourse
contraceptives
incomplete
bladder emptying
with age
3. Males: prostatic
hypertrophy
31. UTI
URINALYSIS
Urine microscopy and culture
Male
Any UTI
Ultrasound
cystoscopy
Adult female
Lower UTI
Treat without
further
investigation
Children
Any
UTI
cystourethro
graphy
pyelonephriti
s
Complicated
Blood
cultures
CT
scan
Further investigation
32. UTI- MANAGEMENT
• Symptomatic UTI- antibiotic therapy
• Asymptomatic UTI- no treatment required
except in special situations.
• Non- specific therapy:
• more water intake.
• Maintaining acidity of urine by fluids like
canberry juice.
33. PRINCIPLES OF ANTI MICROBIAL THERAPY
• Levels of antibiotic in urine but not in
blood
• Blood levels of antibiotic – important in
pyleonephritis
• Penicillins and cephalosporins – drugs of
choice for UTI with renal failure.
35. SINGLE DOSE THERAPY
a. Trimethoprim- sulfamethaxole
bactrim–DS : TMP–160mg + SMZ–
800mg
co-trimoxazole-DS :TMP-160mg + SMZ-800mg
b. Amoxicillin- clavulnate 500mg
aceclav tab
acmox- AG tab
c. Amoxcillin 3gm
d. Ciprofloxacin
500mg –
36. For uncomplicated UTI
• Not for patients with
1. past history of complicated UTI
2. history of antibiotic resistance
3. history of relapse with single dose
• advantages: compliance, cost, less side
effects, less resistance
• Disadvantages: increased recurrence or
relapse
37. 3 DAY THERAPY
• Efficacy same as 7 day therapy with less
adverse effects
• Drugs used include
1. quinolines
2. TMP-SMZ
3. betalactam antibiotics
• Extended release ciprofloxacin
500mg for uncomplicated UTI
1000mg for complicated UTI
38. 7 DAY THERAPY
• Used less for uncomplicated UTI
• Useful in 1. recurrent cases
2. pregnancy
3. UTI with other risk factors
14 day therapy
• For complicated UTI
• High risk of mortality and morbidity
• Cefuroxime –For 7 & 14 day therapy
42. PROPHYLAXIS FOR UTI
• Single dose of trimethoprim 100mg /
nitrofurantion 50mg
• Long term low dose prophylaxis
beneficial
• Women- single dose of antibiotic after
sexual intercourse.
43. CATHETER ASSOCIATED UTI
• Asymptomatic UTI develop in
catheterized patients after 10-14 days.
• Antibiotic treatment - eradicate
organism but high chance of relapse.
• Catheter removal before treatment is
beneficial.
44. SURGICAL TREATMENT
a) Surgical removal of renal calculi,
bladder calculi
b) Ureteroplasty
c) Reimplatation of ureters if
VUR present
45. CONCLUSION
Urinary tract infections are the 2nd most
common bacterial infections.
Women are the most infected subjects in
the population.
Development of resistance to antibiotics
by the bacteria result in problems during
the treatment and lead to relapse or
recurrence.
Recent advances such as development of
immunologicals like intranasal vaccines may
result in life time cure of the infection
