URINARY TRACT INFECTIONS 3 rd Y Med Students Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan

Urinary Tract Infections-1  Normal urine is sterile.. It contains fluids, salts, and waste products, but it is free of microorganisms such as bacteria, viruses, or fungi.  UT infection occurs when microorganisms, usually bacteria from the intestinal tract, adhere to the opening of the urethra and begin to multiply.  UTI is defined as a significant bacteriuria in the presence of Signs & Symptoms.  UTI's associated with Inflammation of any part of Urinary tract System.

Urinary Tract Infections-2 -Dysuria / Bacteriuria.. burning, frequent & painful urination.. Presence of pus cells (WBCs) & Bacteria in urine, fever, abdominal pain..urgency of urination.. Pyuria.. Presence of pus cells  Cystitis :Inflammation of the lower urinary tract mucosa.. This infection is related to urethra and Bladder.. not invasive.. It is Frequently associated with voiding small volume urine.. Fever.. Burning, abdominal pain.. Rarely Septicemia   Pyelonephritis: Infection of upper part of UT ureter mucosa & kidneys.. High fever.. may result in blood sepsis & kidney failure.

Urinary Tract Infections-3  The bacteria most often seen in UTIs are of fecal origin.. Between % of acute community UTIs of patients with normal anatomic structure and function are caused by certain strains of E. coli  Coagulase-negative Staphylococcus..caused %.. other G-ve Klebsilla, Enterobacter, Proteus or G+ve Enterococci fecalis and others (5%)  Hospitaized patients acquired often infection with multidrug resistance bacteria: P. aeruginosa, Proteus spp., Kelbsiella-Enterobacter spp. Enterococcus sp.. Due to accumulation MDR bacteria in intestine & Hospital environment.

Urinary Tract Infections-3  Hemorrhagic cystitis is characterized by large quantities of visible blood in the urine. It can be caused by an infection & other causes  Pyelonephritis - This infection usually results from ascending of the bacteria to the Ureter.. Kidney from the lower urinary tract.. It also can arise by hematogenous spread (sepsis, pneumonia).. In contrast to cystitis.. Pyelonephritis is an invasive disease.. With severe consequences.  Sepsis/Bacteriamia may complicate UTI.. Common in Children & Women, Older.. Compromised Patients.

Urinary Tract Infections-4  UTI's.. rank second only to respiratory infections in their general incidence. The majority of the cases seen in outpatients clinics..Female/male ratio (30:1)  90% of all women have at least one episode of a UTI at some time during their productive years  Pregnancy & women sexually activity increase UTIs 10 times.  Up to 20 % of young women with acute cystitis develop recurrent UTI's.  Males exposed increasing to UTI's after > 50s. This is mostly due to prostate gland hypertrophy..underlying diseases, catheterization, diabetes mellitus, of the immune system.  In children..congenital abnormalities

Risk factors  Catheterization by placing  Catheterization by placing Foleys catheters in the urinary bladder is one of the most common sources of infection.. Nosocomial UTI % Worldwide  Diabetes mellitus and Immunosuppressed patients  Most common Klebsiella pneumoniae, Proteus mirabilis, Enterococcus sp., P.aeruginosa.  Rarely Strict anaerobic bacteria or Candida spp. can cause UTI.  kidney stones in any part of the urinary tract can form a blockage, creating the conditions for a UTI.

Lab Diagnosis-1  Routine Microscopic Fresh Urine analysis: - Midstream Urine should be collected.. Early morning - Midstream Urine should be collected.. Early morning - Urine Should be examined with one hour of collection or refrigerated for < 24h. - Urine Should be examined with one hour of collection or refrigerated for < 24h. - Presence > 8 WBSc /phf.. Most probable Infection - Presence > 8 WBSc /phf.. Most probable Infection - Presence few Red Blood Cells.. Women.. Men ? - Presence few Red Blood Cells.. Women.. Men ? - Presence of Bacteria.. Rare Candida.. Normal flora. - Presence of Bacteria.. Rare Candida.. Normal flora. - Protein, Sugar, pH, Casts, specific gravity etc. - Protein, Sugar, pH, Casts, specific gravity etc. - Symptomatic UTI.. Acute Infection/ Significant Bacteriuria: 100,000 colony-forming units (10 5 CFU) per ml.. Plus Numerous WBCs ( > 10 WBSc /phf) - Symptomatic UTI.. Acute Infection/ Significant Bacteriuria: 100,000 colony-forming units (10 5 CFU) per ml.. Plus Numerous WBCs ( > 10 WBSc /phf)

Lab Diagnosis-2  Asymptomatic /Chronic Infection: ,000 CFU/ ml.. Midstream Urine.. 99% Pure Growth.. One Facultative Anaerobic Bacteria species..  Community UTIs: 80-90% E. coli, Less Staph., Others.  Hospital UTIs: 50% Klebsilla-Enterobacter, Proteus, Pseudomonas aeruginosa, Enterococcus  Presence Less than No WBCS.. Mostly Not significant..  Mixed Bacterial Cultures are mostly Contamination  Suprapubic Urine.. Any Bacterial Count.. Infant & Young children..  Urine culture on Blood & MacConkey agar,35-37C Incubation Hrs..

E. coli – Lactose Fermenter Gram-stain & Culture on MacConkey agar E. coli – Lactose Fermenter Gram-stain & Culture on MacConkey agar

Antimicrobial Treatment -1  The clinical manifestations determine the initial step in Antimicrobial Therapy.  Community acquired infection /outpatients –A febrile patients experiencing first time uncomplicated symptomatic.. acute cystitis and/or urethritis are usually treated for three days with Augumentin,trimethoprim- sulfamethoxazole, nitrofurantoin, nalidix acid,Norfloxacin/ Ciprofloxacin. –Long-term studies have shown antibiotic prophylaxis to be effective for up to five years with trimethoprim, trimethoprim- sulfamethoxazole or nitrofurantoin..

Antimicrobial Treatment -2 -Recurrence of UTI's within 3 months require performing Urine Culture and Antimicrobial Susceptibility Test. Often infection associated with R- bacteria strains. -Hospital acquired UTI's is often associated MTD-R bacteria.. require culture and susceptibility test.  Pyelonephritis is more serious & difficult to cure.. reoccurrence due to relapse (treatment failure) or reinfection.. Mostly with the same bacteria spp. or mixed culture.. 2 bacteria spp.  Patients experiencing high fever, shaking chills and flank or abdominal pain, in addition to symptoms of lower UTI, should be hospitalized and treated with intravenous drugs.

Treatment & PREVENTION  A large number of pregnant women develop asymptomatic bacteriuria. Up to 30% of pregnant women with asymptomatic bacteriuria will develop acute pyelonephritis if not treated.  Drug treatment of asymptomatic bacteriuria in pregnant women decreases the risk of pyelonephritis.. preterm birth or baby low birth weight.  Urine samples should be obtained periodically from pregnant women to determine if they have bacteriuria.  Augmentin, Co-trimoxazole, Amoxacillin, Ciropfloxcin / levofloxacin, Nitrofurantioin, Nalidixic acid, Ceftriaxion