بسم الله الرَحمن الرَحيم
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بسم الله الرَحمن الرَحيم. Urinary Tract Infections (UTIs). Introduction. * UTIs are common, especially among women * UTIs in men are less common and primarily occur after 50 years of age * UTIs infection usually occur by ascending route (urethra to bladder)

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Introduction l.jpg
Introduction

* UTIs are common, especially among women

* UTIs in men are less common and primarily

occur after 50 years of age

* UTIs infection usually occur by ascending route (urethra to bladder)

* UTIs infection is less common by haematogenous spread (kidney)

* UTIs occur in two general settings: community-acquired and hospital (nosocomially) acquired


Definitions l.jpg
Definitions

* Urethritis : Infection of anterior urethral tract

dysuria, urgency

and frequencyofmicturition

- Dysuria (burning pain on passing urine)

- Urgency (the urgent need to pas urine)

- Frequency of micturitionتعدد مرات التبول

* Cystitis : Infection of urinary bladder

dysuria, frequency, pyuria and

haematuria

* Bacteriuria: Presence of bacteria in urine

A count of 10 organisms/ml or more in urine

* Pyuria : Presence of pus in urine

(more than 10 cells/HPF)

  • Pyelonephritis: Infection of kidney(lion pain, pyuria,

    rigors زفزفةورعشة

    , fever


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Etiology Of Urinary Tract Infections

*Causative organisms:

Escherichia coli

Klebsiella, proteus and pseudomonas

1- Bacterial S. aureus, S. epidermidis and S. saprophyticus

Enterococci (Strept. faecalis)

Mycobacterium tuberculosis

Chlamydia trachomatis, Mycoplasma

2- Viral Rubella, Mumps and HIV

3- Fungal Candida, Histoplasma capsulatum

4- Protozoal T. vaginalis,S. haematobium


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Notes on pathogens

* Escherichia coli : the commonest urinary pathogen

causing 60-90 % of urinary infections

* Pseudomonas, Proteus, Klebsiella and S. aureus

are associated with hospital acquired infections because their resistance to antibiotics favor their selection in hospital patients

(catheterization, gynaecological surgery)

* Proteusinfections are associated with renal stones

Proteus produce a potent urease which act on ammonia, rendering the urine alkaline

* S. saprohyticus infections are found in

sexually active young women


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Notes on pathogens

* Candida urinary infection is usually found in diabetic patients and immunosuppression

* Infection of the anterior urinary tract (urethritis) is mainly caused byN. gonorrhoae, staphylococci, streptococci and chlamydiae

* M. tuberculosisis carried in blood to kidney from another site of infection

(e.g. respiratory T.B.)


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Mechanical And Functional Factors Predispose to UTI

* Disruption of urine flow or complete emptying of bladder

- Pregnancy - Renal stones -Tumor

- Prostate hypertrophy - Strictures = narowing of ureter

* Loss of neurologic control of bladder and sphincters

Paraplegia, and multiple sclerosis

Paraplegia شلل نصفى فى الرجلين

multiple sclerosis تكوين طبقة على العصب تقلل قدرته

* Vesicouretral reflux

(reflux of urine from bladder up the ureter)

Anatomic abnormalities in children

* Catheterization facilitate bacterial access to bladder

- During insertion

- In situ, bacteria access to bladder


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Virulence Factors of Causative Organisms

- Fimbriae enable adherence to urethral epithelium

- Capsular polysaccharide inhibite phagocytosis

- Haemolysin production by E. coli

-Membrane damaging toxin

- Production of urease enzyme (proteus spp.)


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Healthy Urinary Tract

Bacterial colonization in urinary tract is

prevented by:

- pH of urine (acidic)

- Chemical content of urine

- Flushing mechanisms اندفاع البول


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Clinical Features

Acute lower UTIs (Urithritis and cystitis):

Rapid onset of:

- Dysuria (burning pain on passing urine)

- Urgency (the urgent need to pas urine)

- Frequency of micturition

Upper UTIs (Pyelonephritis):

- Fever

- Chills

- Dysuria

- Urgency

- Frequency of micturition


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Difference between infected and contaminated urine

Infection Contamination

More than 105 Organisms/ml less than 104Organisms/ml

A single bacterial spp. More than one organism


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Diagnosis of Urinary Tract Infections

* Specimen : Urine

- An aseptic collection technique essential to prevent contamination

- The first urine passed by patient in the morning

- A ”mid stream” urine sample under a septic precaution

- Boric acid is used as a preservative for urine specimens

* Special urine specimens are required to detect:

a- Mycobacterium tuberculosis :

Three early morning urine samples on 3 consecutive days

b- S.haematobium :

The last few milliliters of a morning urine sample after exercise


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Diagnosis of Urinary Tract Infections

* Detection of significant bacteruria

a- Microscopic examination :

- Wet film to detect :

. Pus cells, red cells, casts, yeasts

. Bacteria T.vaginalis, S. haematobium

b- Viable bacterial count :

- A measured volume (calibrated loop 0.002 ml)

of urine is spread on surface of a solid medium

- Incubation of the solid medium at 37°C for

18-24 hours

- Enumerate the number of colonies


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Diagnosis of Urinary Tract Infections(cont.)

c- Cultures :

- Culture is required when urine contain bacteria, cells, casts, protein,nitrite

- Nutrient agar, CLED agar, Blood agar and MacConkey’s medium at 37°C

- Isolated colonies are identified in a systematic way:

1- Microscopical examination :

Gram staining to differentiate between Gm negative and Gm positive

Shape, size and arrangement

2- Biochemical reactions :

- For Gm negative organisms: Sugar fermentation, Indol test,

Oxidase, MR, VP and urease tests

- For Gm positive organisms : Coagulase test, catalase test

3- Serological identification : Detection ofmicrobial Ag by specific Ab


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Sterile Pyuria

- Presence of pus in urine in absence of bacterial growth

- Causes :

a- Infection with: Chlamydia trachomatis

M. tuberculosis

Ureaplasma

Anaerobic bacteria

Mycoplasma and L-forms

Viruses

b- Previous antibiotic therapy

(Suppress growth of bacteria)


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Treatment

* Uncomplicated UTI:

An oral antibacterial as a single dose or for 3 days

* Complicated UTI (Pyelonephritis):

Treatment with a systematic antibacterial agent

e.g. Beta-lactam (Ampicillin, amoxicillin, cefalexin)

Quinolone (Ciprofloxacin, levofloxacin)