URINARY TRACT INFECTIONS

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URINARY TRACT INFECTIONS

• Sandra del Mundo, M.D.

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How does a UTI start?

• Ascending infection
• Bacteria in perineal area ascends through the
  urethra, enters the urinary bladder and
  multiplies
• This is the most common route of infection
• Systemic infection
• In a patient with bacteremia, bacteria may be
  seeded into the kidneys from the blood

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What parts of the urinary tract can get infected?

• Urethra - Urethritis
• Urinary bladder Cystitis
• Ureters Ureteritis
• Kidneys - Pyelonephritis

(Most common)
(Most serious)
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What are the signs and symptoms of UTI?

• Cystitis
• Frequency
• Urgency
• Dysuria painful voiding
• Pain or discomfort in suprapubic or perineal area
  or lower back
• Cloudy or foul-smelling urine

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• Acute pyelonephritis
• Fever
• Nausea and vomiting
• More pronounced malaise
• Pain in the back
• () CVA tenderness

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Who are at higher risk for UTI?

• People with any abnormality of the urinary tract
  which interferes with normal flow of urine
• Enlarged prostate
• Kidney stones
• Vesicoureteral reflux

• People with indwelling urinary catheters

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Who are at higher risk for UTI?

• People with compromised immune function
• People with diabetes
• People taking immunosuppressive drugs

• Women in general
• Pregnant women
• Sexually active women

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What tests do you need to order if you suspect a
UTI?

• If likelihood of simple cystitis is very high
  nothing

• If you are not so sure of the diagnosis
• Urinalysis
• Urine dipstick for leukocyte esterase or nitrites

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How do you treat a UTI? What antibiotic should
you choose?

• Ampicillin
• Amoxicillin

NO!

• Cotrimoxazole

Yes

• Quinolones

Yes
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How do you treat a UTI? How long should you
treat?

• Single dose of antibiotic

• Three day course

• Seven day course

A three day course provides the best compromise
between effectiveness and cost and side effects
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When should you refer a patient with UTI to a
nephrologist ?

• Most patients will not need a referral. Only
  special cases need to be referred .

• Recurrent UTI More than three UTIs per year

• When UTI symptoms are accompanied by fever or
  blood in the urine

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When should you refer a patient with UTI to a
nephrologist ?

• UTI symptoms in a pregnant woman, or a diabetic
  individual

• Any one whose symptoms do not resolve after one
  course of antibiotics

• A second UTI episode in an adult male or child of
  either sex

• A first UTI episode in an infant

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Take home messages

• Most cases of acute cystitis will resolve with a
  3-day course of quinolones

• Ampicillin and amoxicillin are not recommended
  choices for the treatment of UTI because of the
  high incidence of resistance

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Take home messages

• Complicated cases need to be referred