Urinary tract infection

Dr. Crisbert I. Cualteroshttp://

crisbertcualteros.page.tl

Urinary tract infectiono Condition in w/c microorganisms actively multiply

and persist in the genitourinary tracto Affects all ages > males predominate in the newborn period > beyond this age, females predominate (3.5 % of

girls and 1% of boys)

Etiology:o Mainly caused by colonic bacteria > E.coli – most common > Klebsiella > Proteus > Staphyloccus saprophyticus

Clinical Manifestation3 basic forms: 1. Acute Pyelonephritis - involvement of renal parenchyma - characterized by fever, abdominal pain or

flank pain, malaise, NAV, diarrhea2. Cystitis - involves bladder and symptoms of

dysuria, urgency, frequency, suprapubic pain, incontinence and malodorous urine

- no fever and does not result in renal injury

3. Asymptomatic bacteriuria - + urine culture w/o any manifestation of

infection - occurs exclusively in girls - benign and does not cause renal injury

Pathogenesis route of infection: - ascending infection - anatomic abnormalities - uroepithelial adherence - bacterial virulence

Risk factors for UTI

female uncircumcised male vesicoureteral reflux toilet training voiding dysfunction obstructive uropathy urethral instrumentation wiping from back to front bubble bath tight underwear pinworm infestation constipation P fimbriated bacteria anatomic abnormallity neuropathic bladder sexual activity pregnancy

Diagnosiso Urinalysis - > 10 WBC /hpf in a centrifuged urinary sediment - hematuria - + nitrite test - absence of pyuria does not rule out UTI

o Urine culture - gold standard - midstream urine sample: > 100,000 colonies/ml of a single pathogen 10,000 col/ml if symptomatic - catheterized urine > 105 colony count - suprapubic aspirate = any bacterial growth

Diagnosis….o Radiological EvaluationGuidelines for selection of pxs w/ UTI for radiologic

evaluation: - all neonates w/ 1st UTI - all males w/ 1st UTI at any age - all pxs w/ recurrent UTI - all pxs w/ pyelonephritis

o Intravenous Pyelography (IVP) - information about renal size, renal scars and

state of pelvocalyceal system

o VCUG (voiding cystourethrogram) - definitive test to document VUR - indicated in children younger than 5 yr w/ UTI,

any child w/ febrile UTI, school-aged girls who had 2 or more UTIs

- any male w/ UTI

o Ultrasound of the kidney and urinary bladder - screening procedure of choice - should be obtained to rule out hydronephrosis

and renal or perirenal abscesses

Treatment - Trimethoprim Sulfamethoxazole - Nitrofurantoin - Ampicillin - Amoxicillin - Aminoglycosides - Cephalosporins

Conservative: - Increased oral fluids intake - Regular and complete bladder emptying - Increased dietary fiber intake

Prognosis -difficult to determine - especially if with significant renal scarring

» at risk for developing chronic renal insufficiency

Thank you!!!