UTI

Urinary tract infection

Dr.Nariman Fahmi

Objectives

Define Urinary Tract Infection (UTI)
Diagnosis of UTI
treatment for UTI

Relationship of the Kidneys to Vertebra and Ribs

Figure 23.1b

They are retroperitoneal and are located in the abdominal cavity.

They are at the level of T12 to L3, so they are at the costal margin, and the ribs protect them a little.

Even though they are protected by thoracic ribs, they are NOT in the thoracic cavity because they are below the diaphragm.
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Case history

A 9 year old girl with a 2 days history of loin pain ,fever and vomiting, clinically she appears ill.

a full blood count shows a Hb 12 mg/dl,

WBC of 14x10( cells/L
You send of a midstream urine sample for culture.

prescribed paracetol and ask the patient came next day. The next day you find that she has been reported urine culture of more than 100 000colonies of E-Coli.

What is the most probable diagnosis ??

Which part of renal tract is most likely infected and why??
What choice of antibiotics??
investigations that are needed

Urinary Tract Infections Yes, it is a bacteriuria

Urinary Tract
Female Male

A UTI can happen anywhere along the urinary tract.

UTI have different names, depending on what part of the urinary tract is infected.

Bladder -- an infection in the bladder is also called cystitis or a bladder infection

Kidneys -- an infection of one or both kidneys is called pyelonephritis or a kidney infection
• Definition of UTI

Bacteriuria

Presence of bacteria in the urine


Dysuria
Pain or difficulty in urinating

Pyuria

Presence of/increased numbers of white blood cells in the urine
Terminology

Most UTIs are from ascending bacteria

E. coli (60-80%), Proteus, Klebsiella, Enterococcus, and coag. neg. staph.

forms of UTI are

1-pyelonephritis
2-Cystitis
3- urithritis
4- prostitis



Cystitis (bladder involvement )
clinical fatures

dysuria,

urgency,
frequency,
suprapubic pain,
incontinence,
malodorous urine.
Cystitis does not cause fever and does not result in renal injury s












General urine exam

Microscopical exam

Pus cells in urine

DIAGNOSIS

urine culture

Imaging of the Renal tract

* Renal U/S
* KUB
* DMSA
* IVU


* Cystogram
VCUG/RNC
The goal of imaging studies in UTI is to identify
Anatomic abnormalities that predispose to infection and identify scarring

Reflux Seen on Voiding Cystourethrogram (VCUG) using transurethral contrast

Urinary Tract Infection
Upper urinary tract Infections:
Pyelonephritis


Lower urinary tract infections
Cystitis (“traditional” UTI)
Urethritis (often sexually-transmitted)
Prostatitis

Symptoms of pyelonephritis

Hematuria
Fever
Nausea/Vomiting (pyelonephritis)
Flank pain (pyelonephritis)

Findings on Exam in UTI

Physical Exam:
Costo Vertebral Angle tenderness (pyelonephritis)
Urethral discharge (urethritis)
Tender prostate on PRE (prostatitis)
Suprapubic tenderness (cystitis)
Labs: Urinalysis
Positive + WBCs
Positive + RBCs


Culture in UTI
Positive Urine Culture = >105 CFU/mL
Most common pathogen for cystitis, prostatitis, pyelonephritis:
Escherichia coli
Staphylococcus saprophyticus
Proteus mirabilis
Klebsiella
Enterococcus
Most common pathogen for urethritis
Chlamydia trachomatis
Neisseria Gonorrhea

Pyelonephritis

Infection of the kidney
Associated with constitutional symptoms – fever, nausea, vomiting, headache
Diagnosis:
Urinalysis, urine culture, CBC, Chemistry
Treatment:
2-weeks of Trimethroprim/sulfamethoxazole or fluoroquinolone ,cephalosporins
Hospitalization and Intravenous antibiotics if patient unable to take orally .


Question
A 24-year old woman presents with fever, chills, nausea, vomiting, flank pain and tenderness. Her temperature is 40°C, pulse rate is 120/min., and blood pressure is 100/60 mm Hg.

Question

What further studies do you want in this patient?
How would you treat this patient?
What might you do if she does not improve after 3-4 days?