(UTI) presentation.pptx
- 1. Urinary tract infection (UTI) UoD - college of medicine
- 3. Introduction • urinary tract infection (UTI) is an infection in any part of the urinary system —kidneys, ureters, bladder and urethra • UTI may be asymptomatic (subclinical infection) or symptomatic (disease). Thus, the term UTI encompasses a variety of clinical entities, including asymptomatic bacteriuria (ABU), urethritis, cystitis, prostatitis, and pyelonephritis.
- 4. • Urinary tract infection (UTI) is a common and painful human illness that, fortunately, is rapidly responsive to modern antibiotic therapy. In the preantibiotic era, UTI caused significant morbidity.
- 5. Classification UTI Upper • Acute pyelonephritis • Chronic pyelonephritis • Interstitial pyelonephritis • Renal/ perirenal abscess Lower • Cystitis • Prostatitis • Urethritis Both are further divided into complicated and uncomplicated
- 6. UTI terminology • Uncomplicated : UTI without underlying renal or neurologic disaese • 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 weeks after therapy
- 7. Epidemiology • Except among infants and the elderly, UTI occurs far more commonly in females than in males. • During the neonatal period, the incidence of UTI is slightly higher among males because male infants more commonly have congenital urinary tract anomalies. • After 50 years of age, obstruction from prostatic hypertrophy becomes common in men, • Between 1 year and ∼50 years of age, UTI and recurrent UTI are predominantly diseases of females. • As many as 50–80% of women in the general population acquire at least one UTI during their lifetime— uncomplicated cystitis in most cases.
- 8. Etiology • In acute uncomplicated cystitis in the United States, the etiologic agents are highly predictable: -E. coli accounts for 75–90% of isolates; -Staphylococcus saprophyticus for 5–15% -Klebsiella species, Proteus species, Enterococcus species, Citrobacter species, and others for 5– 10%. Similar etiologic agents are found in Europe and Brazil. • The spectrum of agents causing uncomplicated pyelonephritis is similar, with E. coli predominating.
- 9. Etiology cont.. • In complicated UTI (e.g., CAUTI), E. coli remains the predominant organism, but other aerobic gram-negative rods, such as Klebsiella species, Proteus species…..etc, also are frequently isolated. • Gram-positive bacteria (e.g., enterococci and Staphylococcus aureus) and yeasts are also important pathogens in complicated UTI.
- 10. Pathogenesis • 4 routes of bacterial entry to urinary tract: 1) Ascending infection: most common pathway 2) Blood borne spread: accounts for <2% of documented UTIs and usually results from bacteremia caused by relatively virulent organisms, such as Salmonella and S. aureus 3)Lymphatogenous spread 4)Direct extension from other organs f
- 11. The interplay of host, pathogen, and environmental factors determines whether tissue invasion and symptomatic infection will ensue
- 12. • For example, bacteria often enter the bladder after sexual intercourse, but normal voiding and innate host defense mechanisms in the bladder eliminate these organisms. • Any foreign body in the urinary tract, such as a urinary catheter or stone, provides an inert surface for bacterial colonization. • Abnormal micturition and/or significant residual urine volume promotes true infection. • In the simplest of terms, anything that increases the likelihood of bacteria entering the bladder and staying there increases the risk of UTI.
- 14. Clinical features cystitis and urethritis : • abrupt onset of frequency of micturition and urgency • burning pain in the urethra during micturition (dysuria) • suprapubic pain during and after voiding • intense desire to pass more urine after micturition, due to spasm of the inflamed bladder wall (strangury) • urine that may appear cloudy and have an unpleasant odour • non-visible or visible haematuria. • Systemic symptoms are usually slight or absent. acute pyelonephritis: • This is suggested by prominent systemic symptoms with fever, rigors, vomiting, hypotension • loin pain, guarding or tenderness, and may be an indication for hospitalisation. • Only about 30% of patients with acute pyelonephritis have associated symptoms of cystitis or urethritis Prostatitis • perineal or suprapubic pain, • pain on ejaculation • prostatic tenderness on rectal examination.
- 16. Treatment • Cystitis Drug Regimen Duration Comment First choice Trimethoprim Nitrofurantoin 200 mg BID 50 mg QID 3 days 3 days 7-10 days in men 7-10 days in men Second choice Cefalexin Ciprofloxacin Pivmecillinam 250 mg QID 250 mg BID 400 mg TID 3 days 3 days 3 days 7-10 days in men 7-10 days in men 7-10 days in men In pregnancy Nitrofurantoin Cefalexin 50 mg QID 250 mg QID 7 days 7 days Avoid trimethoprim and quinolones during pregnancy, avoid nitrofurantoin at term
- 17. • Prophylactic therapy Drug Regimen Duration First choice Trimethoprim 100 mg at night continuously Second choice Nitrofurantoin 50 mg at night continuously
- 18. • Pyelonephritis Drug Regimen Duration Comment First choice Cefalexin Ciprofloxacin 1 g QID 500 mg BID 14 days 7 days Admit to hospital if no response within 24 hours Second choice Gentamicin cefuroxime According to renal functioin and serum level 750-1500mg TID 14 days 14 days Switch to appropriate oral agent as soon as possible
- 19. • References • HARRISONS NEPHROLOGY AND ACID BASE BALANCE, 2nd edition • DAVIDSONS PRINCIPLES AND PRACTICE OF MEDICINE , 23rd edition • Slideshare website
- 20. Thank you