Urinary Tract Infection

Urinary Tract
Infection
Dr Chimezie Okwuonu
Gregory University Umuahia Campus
Definition
 REFERS TO AN
INFECTION
OCCURING
ANYWHERE ALONG
THE URINARY
TRACT FROM THE
KIDNEY TO THE
URETHRAL MEATUS
 Accounts for 1-2% of
hospital visit
CLASSIFICATION
1. Based on aetiologic agent eg bacterial,
fungal, or mycobacterial
2. Based on location in the genitourinary tract
Lower urinary tract - cystitis, urethritis,
prostatitis and epididimytis
Upper urinary tract – pyelonephritis
3. Based on duration eg acute or chronic
pyelonephritis
4. Based on complexity :
Uncomplicated UTI
- Commonest type
-infection occuring in non- pregnant adult female
without structural damage or renal dysfunction
Complicated UTI
-infection of sites other urinary bladder
-infections occuring in men, in pregnancy,
immunosuppressed patients, abnormal renal tract,
outflow or voiding difficulty, impaired renal function,
virulent organism e.g staph aureus
Risk factors
1. Previous UTI
2. Female- because of short urethra and proximity to vagina
and anus
3. Sexual intercourse especially a new partner
4. Pregnancy
5. Menopause
6. Spermicide exposure in female (by diaphragm or condom)
7. Impaired host defence ( DM, immunosuppression)
8. Urinary tract obstruction (prostate enlargement, stones ,
catheter, malformation)
9. Instrumentation. NB; Urine in catheterized bladders
isalmost always infected.
Organisms
1. Escherichia coli ( 70-95%)
2. Staphylococcus saphrophyticus (5-20%)
3. Proteus mirabilis (complicated UTI)
4. Klebsiella spp
5. Enterococcus
6. Pseudomonas aeruginosa
7. Others : TB, candida, enterobacter, serratia,
staph. aureus
1st three are the common organisms isolated in urine
PATHOGENESIS
 Symptomatic UTI occurs when balance
between virulence and number of infecting
organism and host defences is distrupted
 Infection by 2 major routes:
1. Ascending transurethral route – bacteria

colonising anus, distal urethra,or vagina can
enter and invade the proximal urethra and
bladder
2. Haematogenous route
3. Via lymphatics
4. Direct extension eg vesicocolic fistula
CLINICAL FEATURES
Clinical presentation of UTI include;
 Asymptomatic bacteriuria
 Symptomatic acute urethritis and cystitis
 Acute prostatitis
 Acute pyelonephritis
 Septicemia (gram negative)

Acute urethritis and cystitis
 Abrupt onset of frequency and dysuria
 Scalding pain felt in the urethra
 Systemic symptoms slight or absent
 Urine may have unpleasant odour and may
appear cloudy
 Gross haematuria may occur
Pyelonephritis
 Acute or chronic
 Combination of high fever, loin pain with tenderness and
significant bacteriuria implies infection of the kidney
(acute)
 nausea and vomiting, haematuria ± dysuria, frequency,
and nocturia
 Features of sepsis (fever, tarhycardia, tachypnea) &
septic shock
 Features of underlying structural or functional
abnormalities of the urinary tracts.
 Positive punch tenderness during abdominal examination
Pyelonephritis CTD
 Histologically- focal infiltration by
polymorphs and polymorphs in tubular lumina
 Investigation –CT show wedged shaped areas
of inflammation in the renal cortex
 Treatment – antibiotics depending on
sensitivity
Cystitis
 Supra pubic pain during and after voiding
 Frequency, dysury, urgency
 Desire to void after bladder is emptied due
spasm of bladder wall
 Treatment – trimethoprim 200mg bd for 5
days or cephalexin
Prostatitis
 Flu-like symptoms
 Low back ache
 Few urinary symptoms
 Swollen or tender prostate on DRE
Asymptomatic Bacteriuria
 The presence of > 105 CFU/mL of bacteria with
no symptoms
 Diagnosis: 2 consecutive voided urine specimens

with isolation of the same bacterial strain >105 or
a single catheter urine specimen
 The following category of patient will benefit
from treatment.
 Pregnant
 Renal transplant
 Pt who are about to undergo urinary tract procedures.
DIAGNOSIS
Depends on
1. Characteristic clinical features
2. Demonstration of a significant growth of

organism in a MSU
3. The presence of neutrophils in urine
INVESTIGATIONS
1. Mid-stream urine (MSU) for microscopy and dip-stick
testing for proteinuria, leucocytes, nitrites and RBCs
 Send fresh urine for m/c/s
 >105 colony forming units is diagnostic
 If <105 CFU and pyuria (>20 WBCs), result is still

significant
2. Ultrasound , IVU,Cystoscopy – considered for UTI in
men, infants, children, recurrent UTI,
pyelonephritis,and unusual organisms
TREATMENT
 Advice fluid intake – 2L/day
 Antibiotics depending on sensitivity
Single isolated attacks, treat for 5 days with

amoxycillin, nitrofurantoin, trimethoprim or
oral cephalosporins
 Treatment can be modified base on culture and
sensitivity
 For complicated UTI, 10-14 days of treatment
with antibiotics is allowed
 Recurrent UTI
- More than once
- pre and post treatment urine cultures are mandatory to
identify whether due to relapse or reinfection
 Relapse is
- recurrence of bacteriuria with same organism within 7

days of completion of antibacterial Rx implying failure
to eradicate infection usually in conditions such as
stones, scarred kidneys, polycystic kidneys etc
 Reinfection means
-recurrence of bacteriuria with the same or
different organisms after 14 days of
completion of treatment
- It implies predisposition to periurethral
colonisation or poor bladder defences
- Contraceptive practices should also be
reviewed
PREVENTION
 2L daily fluid intake
 Voiding before bedtime and after inter course
 Avoidance of spermicides, bubble baths or

other chemicals in bathwash
 Avoidance of constipation which may impair

bladder emptying

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Urinary Tract

1. Ascending transurethral route – bacteria

 Symptomatic acute urethritis and cystitis

 Septicemia (gram negative)

 Diagnosis: 2 consecutive voided urine specimens

2. Demonstration of a significant growth of

 >105 colony forming units is diagnostic

 If <105 CFU and pyuria (>20 WBCs), result is still

Single isolated attacks, treat for 5 days with

- recurrence of bacteriuria with same organism within 7

 Voiding before bedtime and after inter course

 Avoidance of spermicides, bubble baths or

 Avoidance of constipation which may impair

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