Download - URINARY TRACT INFECTION - MICROBIOLOGY
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Urinary Tract Infection
Dr. Ashish Jawarkar, M.D.
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Urinary tract
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Urinary Tract Infection
Upper urinary tract Infections: Pyelo-nephritis Ureteritis
Lower urinary tract infections Cystitis (“traditional” UTI) Urethritis (often sexually-transmitted)
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Ascending UTI
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Descending infection
Hematogenous spread Chronically ill or immunosuppressed
patients
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Causes
Stasis of urine (enlarged prostate etc.) Sexual activity Pregnancy Catheterisation Stones
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5-7% pregnant women may present without symptoms
May lead to prematurity and perinatal death
Hence mandatory to screen all pregnant women
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Symptoms of Urinary Tract Infection
UPPER UTI Dysuria (burning micturition) Increased frequency
LOWER UTI Fever Flank pain
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Agents of UTI
Most common – E coli Community acquired
E. coli Enterobacter
Hospital acquired Klebsiella S. aureus Pseudomonas
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Lab diagnosis
Urine can get contaminated while passing
Sterile wide mouthed containerMid stream clean catch specimen First portion – bacteria from distal
urethra Processed within 2 hours
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Significant bacteriuria
>1,00,000 bacteria per ml Counts <1000 are due to contamination Counts between 1000 and 1,00,000 may
be significant, have to be co related clinically and by repeat culture
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Other methods for collection
Suprapubic aspiration
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Percutaneous nephrostomy
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catheter
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Culture
Blood agarMc conkey agar
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Antibiotic susceptibility testing
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Screening tests
Nitrite test TTC test Demonstration of bacteria in wet film
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Wet mount
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Strips
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Family enterobacteria
Include E. coli Klebsiella Proteus
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Escherichia Coli
Named after Escherich who first discovered the colon bacillus
Lives in intestine, passed in feces
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Test for contaminated water supply
E coli testing in water
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Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
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Morphology
Gram negative rod Singly or in pairsMotile
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Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
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Growth characteristics
Good growth on ordinary media Hemolytic on blood agarMac conkeys agar, pink colonies
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Blood agar
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Mac conkey’s medium
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Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
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IMViC test
I - IndoleM - Methyl red Vi - Voges-Proskauer C - Citrate utilisation
To differentiate between enterobacteria
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Klebsiella IMViC
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Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
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Resistance
Resistant to multiple antibiotics Due to production of beta lactamase
which inactivates penicillin and cephalosporins
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Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
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Pathogenicity and virulence
Surface antigens O and K O antigen – prevents phagocytosis,
endotoxic activity K antigen – also protects against
phagocytoisis Fimbria – important in UTI Toxins – beta lactamase
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Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
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Epidemiology
Inhabit the colon Spread via contaminated water/food
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Diseases caused
UTI Precipitated by
Prostate enlargement Pregnancy Calculi
Peritonitis and bowel abcessesMeningitis in new born Septicemia
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Morphology Growth characteristics Biochemical reactions Resistance Pathogenicity and virulence Epidemiology Diseases caused Laboratory diagnosis Treatment
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Treatment
Ampicillin + clavulanic acid ImipenemMeropenem
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