Urinary Tract Infections UTI

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Urinary Tract Infections (UTI)

• Anatomical ( urethra, bladder, ureters, kidney)
• Cystitis bladder dysuria burning
• frequency
• Pyelonephritis kidney loin and back pain
• fever and rigors
• Pyuria - pus (white cells) in urine
• Haematuria - blood in urine
• Bacteruria - bacteria in urine (sympt or asymp)

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Mechanisms of Transmission

• Reservoir of infection endogenous bowel flora.

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Host versus Microbe

• Bacterial entry into bladder
• Symptomatic infection transient bacteruria

whether bacterial entry into the bladder results
in infection or is a transient event, depends on
the dynamics of host defenses and microbial
virulence factors.
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Host Factors

• Flushing - complete and frequent.
• Susceptibility to colonisation - external
• - bladder
• Facilitate ascent - intercourse
• Catheterisation - insertion
• - loss of flushing
• - pooling
• - ascent

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Host Factors

• Flushing - complete and frequent.
• Susceptibility to colonisation - external
• - bladder
• Facilitate ascent - intercourse
• Catheterisation - insertion
• - loss of flushing
• - pooling
• - ascent

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Microbial factors

• E. coli is the most common cause of UTI
• NOT all E. colis are the same
• Numbers and types of adhesins that the organism
  is able to express.

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Incidence of infection

• Are bacteria male chauvanists?
• 10 - 25 of women have UTI in lifetime.
• Higher rates during pregnancy.
• Some women have lifetime recurrences.
• UTIs are very UNCOMMON in males.

• More easily colonised (anatomical)
• Easier access (shorter urethra)
• Prostatic fluid (antibacterial)

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Special considerations

• Hospitalisation - multifactorial
• - catheterisation
• Pyelonephritis
• Bacteraemia and septicaemia
• Stone formation
• Asymptomatic bacteruria - benign
• - PREGNANCY

Increased risk of Pre term labour and low birth
weight. Increased risk of UTI - Pyelonephritis -
complicates pregnancy
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Diagnosis

• Symptoms / cloudy urine - sex and age group
• Ward dipsticks - leucocytes and nitrite
• Laboratory urine analysis
• Microscopy (pyuria)
• Culture (quantitative)

UTI
CONT
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Urine specimens (Must reflect bladder urine

• Midstream urine - avoid external contamination
• - cleaning with swabs/water
• - patient instruction
• Minimise impact of contamination - transport
• OTHER SPECIMENS
• Catheter collection (per se or indwelling)
• Suprapubic aspirate
• Bag urine

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Management

• Further investigate - all children / children
• - females persistent
• recurrent
• Treatment pyeloneph
• CYSTITIS - encourage hydration
• - analgesics / alkalinisers
• - antibiotic therapy
• Pyelonephritis - hospital / antibiotics
• Recurrent - prophylactic antibiotics
• - post coital voiding / antibiotics
• Catheter - MUST remove catheter