1. BY DR WAQAR MBBS, MRCP ASSISTANT PROFESSOR
UTI BY
DR WAQAR
MBBS, MRCP
ASSISTANT PROFESSOR

2. URINARY TRACT

3. UTI * Pyelonephritis ( infec. In the kidney) Cystitis Urethritis
prostatitis
COMMONEST IS CYSTITIS & URETHRITIS, specially in women
Cystitis is uncommon in young men.

4. NATURAL DEFENCES Factors which prevent infection
Free flow of urine ( no stasis)
Acidic urine ( acidity kills bacteria)
Complete bladder emptying (no stasis)
Urinary tract epithelium secretes substances which are anti-bacterial.

5. DEFENCES (contd.)
ANY BREAK IN THIS CHAIN CAN CAUSE UTI

6. HOW THE PROCESS STARTS
In most cases, bacteria from the GI tract ( anal canal) reach the urethra go up
cause UTI so
Mostly an ascending infection

7. RISK FACTORS Female sex Old age ( even males)
Anatomic abnormality of urinary tract
Obstructive uropathy like stone, BPH.( causes
urine stasis, so more chance of UTI)
Poor perineum hygiene

8. RISKS (contd.) Pregnancy( stasis)
Urethral instrumentation (Foley’s cath)
Immunocompromised states (DM)

9. PATHOGENS CAUSING CYSTITIS
E.Coli : Most common cause.
Proteus( 12%) Klebsiella (4%), Pseudomonas
Staph. Saprophyticus(10%)
* Normal flora of the female genital tract
but can cause UTI also
Candida Albicans ( fungus): Causes UTI if
immunity is low.

10. S/S OF CYSTITIS Dysuria, increased frequency, nocturia
Suprapubic pain & tenderness
Cloudy & very foul urine odour
Fever uncommon in young females
In children fever more common

11. S/S IN OLD PATIENTS Typical S/S often absent Common S/S are:
* Confusion, drowsy
* Change in behavior
* Not feeling well, anorexia, weakness
* Incontinence

12. INVESTIGATIONS
Urine analysis Urine C/S Imaging

13. INVESTIGATIONS
1) Urinalysis : Take a clean, midstream, freshly voided sample ( or catheter sample) * Bacteria: ~ In females, 10-5 /ml of urine ~ In males, 10-2 /ml of urine * Nitrite: + (produced by bacteria) * WBCs : more than 8-10/ high power field * Leucocyte Esterase: + (an enzyme in WBCs)

14. Contd. * Blood : +/- Quick urine test by dipstick
leucocyte esterase, nitrite detected

15. DIPSTICK TEST

16. 2) Urine C/S
* Not recommended in every case
* Takes hrs
* Recommended in DM, recurrent UTIs,
old patients( > 65), failure to respond
to RX

17. 3) IMAGING : i.v.Pyelogram, u/s, CT (with
contrast)
Not done routinely
Done in the following :
* Recurrent UTIs
* Suspected abnormality in the urinary tract
(stone, BPH, Diverticulum)
* In children & males

18. i.v. pyelogram (I.V.P)

19. MANAGEMENT OF UTI (MAINLY CYSTITIS)
1) Antibiotics
2) High fluid intake
3) Cranberry juice( ?)
4) Remove/replace catheter or stent, if
present
Antibiotics are started empirically, then modified according to culture reports, if needed

20. MANAGEMENT ( contd.)
1) IN OTHERWISE HEALTHY FEMALES WHO ARE NOT PREGNANT * First choice : Tmp/Smx ( Bactrim )DS ,1 tab. bid. * Second choice : Quinolones ( eg. Ciprofloxacin), Fosfomycin ANY OF THEM FOR 3 DAYS

21. Management ( contd)
2) MALES : * Bactrim or Cipro * 7 day Rx ( not 3 days) In 1) & 2) no need to do a urine C/S after treatment.

22. UTI IN PREGNANCY pyelonephritis ( maternal & fetal complic.)
1) 6% of preg. females have significant bacteria
in urine. If not treated can cause
pyelonephritis ( maternal & fetal complic.)
2) Routine urine C/S is done in the 1st trimester
3) Rx is given even if no symptoms (asymp. bacteriuria)
4) Rx of choice : * Amoxicillin * Nitrofurantoin
5) Urine C/S is done before & after treatment
TREAT FOR 7 DAYS ( NOT 3 DAYS)

23. DURATION OF CYSTITIS TREATMENT
Non-pregnant female: 3 days
Males
Pregnant female Days DM

24. SPECIAL SITUATIONS
1) Asymptomatic bacteriuria Treated only in pregnancy or if the patient is going to have any urologic surgery.

25. PROPHYLAXIS FOR RECURRENT UTI
If a patient gets recurrent UTI, do the following:
Advise increased fluid intake
Frequent urination
Investigate for any urinary tract pathology &
treat it.
Some patients may require long term prophylactic antibiotics.

26. Special situations
Chronic indwelling Foley’s catheter * WBC & bacteria are almost always present * Treat w/antibiotics only if symptoms present * Change Foley’s catheter

27. ACUTE PYELONEPHRITIS It is infection of the renal parenchyma
Mostly due to ascending infection from below
S/S : Same as lower UTI + fever, loin pain
Invest. : * Urine analysis * Urine C/S * Blood C/S, Imaging studies if needed
Rx : 1) Co-amoxiclav (Augmentin)
2) Cipro/levofloxacin
3) i.v. gentamycin, 3rd gen. cephalosporins
Depending on the severity, patient may need oral or iv antibiotics.

28. SUMMARY Commonest bacteria: E.Coli UTI more common in females
Treatment with antibiotics usually for 3 days
Treatment for 7 days in males and in pregnancy
In pregnancy, if bacteria are present in urine, treat it, even if asymptomatic
Obstruction in the urinary tract increased risk of UTI
Antibiotics used:
* Non-pregnant female: Bactrim, ciprofloxacin
amoxicillin
* Males: Bactrim, Cipro * Pregnancy: nitrofurantoin

29. NEXT SLIDE IS VERY IMPORTANT !

31. THANK YOU
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