1. This lecture was conducted during the Nephrology Unit Grand Ground by Medical Student under Nephrology Division under the supervision and administration of Prof. Jamal Al Wakeel, Head of Nephrology Unit, Department of Medicine and Dr. Abdulkareem Al Suwaida, Chairman of Department of Medicine and Nephrology Consultant. Nephrology Division is not responsible for the content of the presentation for it is intended for learning and /or education purpose only.

2. Urinary tract infection
An overview
Presented By:
Dr. Nasser Al Faqih
Medical Student
2009

3. Definitions
UTI : is currently defined as the inflammatory response of the urothelium to bacterial invasion it is usually associated with lower or upper urinary tract infection symptoms
Bacteriuria: is the presence of the bacteria in the urine
Pyuria : is the presence of white blood cell (pus cell) in urine
Uncomplicated UTI: is the one occurring in a patient with a structurally and functionally normal urinary tract
Complicated UTI: is the one occurring in the presence of an underling anatomical or functional abnormality
UTI may be isolated , recurrent or unresolved

4. Prevalence of urinary tract infections (UTI)
Females are much more affected than males
It is estimated that half of all women will have at least one UTI in their live.
the risk of UTI in women increases after menopause
after a UTI % will have a recurrence
the recurring infections are usually reinfections.
asymptomatic bacteriuria in women occurs in
2.7% of years old
9.3% of over 65 years old and
% of over 80 years old

5. Prevalence of UTIs UTI is rare in young and middle-aged men
UTI in men is often associated with :
underlying pathology
catheterisation
urological procedures.
urinary catheter increases the risk of UTI
- because it may introduce infection or the bacteria colonise the catheter
- pseudomonas is commonly encountered organism

6. Route of infection Ascending infection Haematogenous infection
Bacteria in perineal area ascends through the urethra, enters the urinary bladder and multiplies
This is the most common route of infection
e.g. E.coli to the bladder
Haematogenous infection
In a patient with bacteremia, bacteria may be “seeded” into the kidneys from the blood
e.g. staph .aureus , T.B

7. Causative agents of UTIs

8. Risk factor Women in general Pregnant women Sexually active women
abnormality of normal flow of urine
Enlarged prostate
Kidney stones
Vesicoureteral reflux
Neurogenic bladder
indwelling urinary catheters
compromised immune function
diabetes
immunosuppressive drugs

9. Clinical features of UTI
Cystitis
Frequency
Urgency
Dysuria – painful voiding
suprapubic Pain
Cloudy or foul-smelling urine

10. Clinical features of UTI
Acute pyelonephritis
Loin pain and tenderness
High Fever and chills
Nausea and vomiting
malaise

11. microscopy for WBCs & RBCs
INVESTIGATION OF UTI
Midstream urine (MSU) for:
dipstick for nitrite
microscopy for WBCs & RBCs
urine culture
If sterile pyuria is detected then T.B has to be considered in the differential diagnosis

12. INVESTIGATION OF UTI cnt ..
Further investigation if underlying cause is suspected :
- symptoms of upper UTI
- recurrent infection
- pregnant women
- unusual infected organism e.g. proteus

13. INVESTIGATION OF UTI cnt ..
Further investigations include , as indicated by the clinical condition of the patient ,the following:
- CBC
- Blood culture
- Plain KUB
- Ultrasound
- IVU or CT urogram
- Cystoscopy

14. Treatment of UTI Antimicrobials are the mainstay of treatment
The choice of antimicrobial depend on the diagnosis, the clinical condition of the patient and the organism isolated .
Dose , route and duration of antimicrobial depend on the diagnosis and severity of infection
Treatment of underlying cause if present
- e.g. stones , obstruction , reflux ….etc

15. Treatment of UTI Commonly used antimicrobials include : - trimethoprim
- cotrimoxazole
- quinolones
- nitrofurantoin
- cephalosporin
- ampicillin , amoxicillin
- aminoglycosides
- fluconazole for fungi

16. Treatment of UTI Acute uncomplicated cystitis:
trimethoprim for 3 days
Cotrimoxazole for 3 days
Quinolones for 3 days
nitrofurantoin for 7 days
Acute Uncomplicated pyelonephritis:
Ciprofloxacin for days
Cephalosporin for days
Amoxicillin for 7-10 days
Aminoglycosides 7-10 days

17. UTI IN CHILDERN A common pediatric problem
Girls are more affected than boys
May indicate an underlying cause
Reflux and other abnormalities need to be excluded
Treatment :
- treat the infection
- investigate for possible underlying cause
- ? Need for prophylaxis
- treat the underlying cause if present