UTI Nebras Abu Abed

Definition & CLASSIFICATION

GENERAL CHARACTERISTICS Female VS male Prevalence in F ? Causes of this characteristic predominance ?  Most common source of bacteremia caused by G(-) organisms !

pathogens Most common IS E.Coli ….80% Other organisms ??? Risk : men / recurrent UTIs /urinary cath Non –infectious causes of UTI symptoms ? Radiation /cytotoxic drugs(cyclophosphamide)/interstitial cystitis

Risk factors Gender Certain birth control types Pregnancy ??? Cath Hx of UTI DM ??? Especially upper Spinal cord injury?? Immunocompromised Anything that impedes urinanry flow …BPH Male risk factos (uncircumcised/ IC with male / IC with F carrying uropathogens )

COMPLICATED VS NON Acute non-complicated : UTI in healthy non- pregnant ,pre-menopausal with no history of UT abnormalities . Otherwise , considered complicated ! Ex : men, pregnant , diabetic , renal faliure , Hx of pyelonephritis , cath , AB resistant organism , immunocompromised ,recent hospotalization , recent AB exposure

Clinical features Dysuria … expressed ? Frequency Urgency VS hesitation Tenderness …site ?? Sometime …gross hematuria What is characteristically ABSENT ?

diagnosis 1)Dipstick urine analysis Look for leuko est and nitrite (+) leuko est menas ? (+)nitrites mean ?

diagnosis 2)Urinalysis Clean catch midstream specimen ? Criteria : *Bacteruria : >1 organism/oil immersion field Bacteruria without pyuria isn’t reliable *pyuria : greater than or equal 10 leuko/micro L

Urine culture Acute non complicated ?? Indicated in : 1)Asymptomatic bacteruria ??? When diagnosed ? In which patients ??? 2) Suspected pyelonephritis , complicated , recurrent UTI , suspicion of resistant organism *criteria : >= 10^5 CFU/mL , 2 to 4 is enough if symptoms & signs are present !

Complications 1)Upper spread (pyelonephritis / prostaties / urosepsis ) Risk factors : pregnancy , DM , VUR ! 2)During pregnancy : preterm labor , LBW . 3)Recurrence

Treatment In acute uncomplicated : Bactrim 3 days ( oral TMP/SMX) & Nitrofurantoin 5-7 days We can also use : fosfomysin single dose or Fluroquinolones ( cipro 3 D regimen ) Urinary analgesic : phenazopyridine 1-3 days Don’t use nirtofurantoin or fosfomycin if PN is suspected !! If didn’t respond for short AB , treat for PN

Treatment Pregnancy : Amicillin , amoxicillin or oral cephalosporins for 7- 10 days Avoid fluoroquinolones , fetal arthropathy

treatment Men : as in uncomplicated but for 7 days

Pyelonephritis Farah al-hjouj

Organisms : e.Coli G(-) : proteus , klebsiela, enterobacter, psudomonous G(+) : s.aureus

Clinical features Symptoms ??? Signs ???

Diagnosis 1)Urinalysis 2)Urine culture 3)Blood culture 4)CBC 5)Renal function 6)imaging

complications 1)Sepsis 2)Emphesematous PN 3)Chronic PN

Treatment ?????