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In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International Branch

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Urinary Tract Infection

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Page 1: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

In the name of God

Tara MottaghiHabibollah Amini

Bacterial infections of Urinary tract

Mazandaran University of Medical Sciences – Ramsar International Branch

Page 2: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Quick View

UTI

DefinitionImagingTreatmentRecurrent UTIApproach to acute Cystitis

Renal InfectionsAcute PyelonephritisChronic PyelonephritisEmphysematous PyelonephritisXanthogranulomatous PyelonephritisRenal Abscess Prostatitis

UTI during pregnancy UTI in children

Page 3: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Urinary Tract Infection

Page 4: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Definition

Random urine samples Wbc > 10U/A

Page 5: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Definition

Random urine samples

Mid stream urine samples + Dysuria & Frequency

Wbc > 10

Colony count > 10²

U/A

U/C

Page 6: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Definition

Random urine samples

Mid stream urine samples + Dysuria & Frequency

Mid stream urine samples + Asymptomatic urinary tract

Wbc > 10

Colony count > 10²

Colony count > 105

U/A

U/C

Page 7: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Definition

Random urine samples

Mid stream urine samples + Dysuria & Frequency

Mid stream urine samples + Asymptomatic urinary tract

Urine samples obtained by catheter

Wbc > 10

Colony count > 10²

Colony count > 105

Colony count > 10²

U/A

U/C

Page 8: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Definition

Random urine samples

Mid stream urine samples + Dysuria & Frequency

Mid stream urine samples + Asymptomatic urinary tract

Urine samples obtained by catheter

Urine samples obtained through suprapubic aspiration

Wbc > 10

Colony count > 10²

Colony count > 105

Colony count > 10²

A number of gram-negative bacteria

U/A

U/C

Page 9: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Definition

Random urine samples

Mid stream urine samples + Dysuria & Frequency

Mid stream urine samples + Asymptomatic urinary tract

Urine samples obtained by catheter

Urine samples obtained through suprapubic aspiration

Wbc > 10

Colony count > 10²

Colony count > 105

Colony count > 10²A number of gram-negative bacteria

A few gram-positive bacteria

U/A

U/C

Page 10: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Imaging

KUB

IVP

Sonography

CT Scan

Page 11: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Treatment

Treatment for 7 days

Simple uncomplicated UTI in womenTreatment for 3-5 days

Thesigns and symptoms been persist for more than a week

Age > 65 yrs

History of diabetes

Cystitis in pregnant

Recent UTI

Page 12: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Recurrent UTI

Reinfection Persistant Unresolved

Causes

• Chronic protatitis• Urinary fistulas• Infectious stones• Congenital anomalies of the urinary• Chronic pyelonephritis• Foreign body• Diverticulitis urethra• Ureteral stump after nephrectomy

Causes

• Bacterial resistance to antibiotics used• The creation of resistant strains during treatment• Renal failure• Renal abscess• Staghorn renal calculi• Obstruction in the urinary tract• Inadequate dose treatment• Inadequate treatment period

Page 13: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Staghorn renal calculi

Page 14: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Approach to acute Cystitis

در افراد دارایRisk factor مانند،آنومالی و دیابت سنگ و سپس شروع U/Cاول

AB

U/A قدم : اول

و Pyuriaعدم وجود Bacteriuria

و Pyuriaوجود Bacteriuria

شروعAB

& Vaginitisبررسی از نظر Urethritis

اگر عالئم بهبود نیافت

بهبود عالئم

اقدام دیگری حین U/Cالزم نیست

درمان

منفی

مثبت

ارزیابی بیشتر الزم نیست

بررسی نتایج Antibiogram

اگر در آنتی بیوگرام مقاومت مطرح شد

و بررسی ABتعویض U/Cحین درمان با

تجویزی ABدرصورتی که میکروب به حساس باشد و بیمار دارو را خوب

مصرف کرده باشد

Unresolved

شروع عالئم با قطع درمان

Persistant bacteriuria Reinfection

Page 15: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Unresolved Persistant bacteriuria

Reinfection

Approach to recurrent UTI

Urologicارزیابی R/Oبرای ،انسداد و سنگ

آنومالی ها

و ارزیابی ABشروع Urologic و رفع

کانون عفونت

Riskفاقد factor

Risk factorدارای مانند ،حاملگی،دیابت

ضعف ایمنی،سنگ و آنومالی های

ساختمانی

ارزیابی Urologic

درمان پروفیالکتیک ماه6به مدت

Tab co-trimoxazole , ½ , Qhs

Tab nitrofurantoin , 50-100mg , Qhs

Tab nalidixic acid , 250-500mg , Qhs

Tab cephalexin 250mg , Qhs

Page 16: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Pyelonephritis

Page 17: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

PyelonephritisAcute pyelonephritis

Chronic pyelonephritis

Emphysematous Pyelonephritis

Xanthogranulomatous Pyelonephritis

Common sign & symptom :(Except chronic pyelonephritis)

FeverShaking chills Flank pain Nausea & vomiting

Page 18: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Acute pyelonephritis

Signs & symptoms :

• Fever• Shaking chills• Flank pain• Dysuria• Frequency• Cloudy urine• Vomiting

Laboratory tests results :• Pyuria• Hematuria• high ESR and CRP levels• Leukocytosis

The most common cause : Ecoli

Page 19: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Approach to Acute Pyelonephritis: قدم اول

U/A , U/C و رنگآمیزی گرمتأیید

عفونت

اگر عالئم سپسیس نداشت . حال عمومی خوب و تهوع و استفراغ

نداشت ABدرمان خوراکی با

روز14-10به مدت Choice : Fluocinolone

هفته2در پایان هفته پس از 4-6

اتمام درمان

تکرار کشت

اگر عالئم سپسیس و

تهوع و استفراغ داشت

B/C , Imaging (sonography or CT scan)IVبستری و درمان

پاسخ مناسب IVبه درمان

ادامه تب و درد پهلو علیرغم

درمان وریدی به 72hمدت

ادامه درمان وریدی روز برای کشت 7-10

خون مثبت روز برای کشت 2-3

خون منفیو در ادامه

14-10درمان به مدت خوراکیABروز با

CT یا Sonographyو کشت و

اسمیر مجدد

DDx: Bacterial resistance to

antibiotics usedorAbscess

Page 20: In the name of God Tara Mottaghi Habibollah Amini Bacterial infections of Urinary tract Mazandaran University of Medical Sciences – Ramsar International

Chronic pyelonephritis


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