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.

4

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?