7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦...
-
Upload
moses-mckinney -
Category
Documents
-
view
214 -
download
4
Transcript of 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦...
![Page 1: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/1.jpg)
Urinary Tract Infections
![Page 2: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/2.jpg)
I would like to tell you something…Will you listen to me…?
![Page 3: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/3.jpg)
![Page 4: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/4.jpg)
Overview of UTI
7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women
◦ 40% to 50% of women have UTI at some point during their lives
Important complications of pregnancy, diabetes mellitus, polycystic disease, renal transplantation, conditions that impede urine flow (structural and neurologic)
![Page 5: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/5.jpg)
Terms
Urinary tract infection Significant bacteriuria Asymptomatic bacteriuria Acute pyelonephritis Chronic pyelonephritis Chronic interstisial nephritis Pyuria Urethral syndrome
![Page 6: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/6.jpg)
UTI: the finding of microorganisms in bladder urine with or without clinical symptoms and with or without renal disease Women: Presence of at least 100,000 colony-forming units (cfu)/mL in a pure culture of voided clean-catch urine.
Men: Presence of just 1,000 cfu/mL
Significant bacteriuria: the number of bacteria in the voided urine exceeds the number that can be expected from contamination (i.e. ≥ 10⁵ cfu/ml)
![Page 7: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/7.jpg)
Asymptomatic bacteriuria: Significant bacteriuria (>105 cfu/ml) without clinical symptoms.
Acute bacterial pyelonephritis: a clinical syndrome of fever, flank pain, and / or tenderness
![Page 8: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/8.jpg)
Chronic bacterial pyelonephritis: Long-standing infection associated with active bacterial growth in the kidney; or the residum of lesions caused by such infection in the past
Chronic interstitial nephritis: renal disease with histologic findings resembling chronic bacterial pyelonephritis but without evidence of infection
![Page 9: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/9.jpg)
Pyuria: the presence of pus (WBC’s) in urine, which may or may not be caused by UTI. The preferred method for quantification is enumeration in unspun urine. The leukocyte esterase nitrite test has a sensitivity of between 70% and 90% for symptomatic UTI
Urethral syndrome: characterized by frequency, dysuria, and suprapubic discomfort without demonstrable infection
![Page 10: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/10.jpg)
Some Classifications of
UTI
![Page 11: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/11.jpg)
11
Presentation of UTIs Urethritis
o The inflammation and infection is limited to the urethrao It is usually a sexually transmitted disease.o Present in men and women
Cystitiso Irritation of the lower urinary tract mucosa (i.e. bladder)o Dysuria (painful urination)o Urgency & frequency but smallo Suprapubic tendernesso Pyuria
Haemorrhagic cystitiso Large quantities of visible blood in the urineo Caused by an infection (bacterial or viral)o Irritation when voiding
Pyelonephritiso Kidney infection from lower UTI infectiono Complications – Sepsis, septic shock and death
![Page 12: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/12.jpg)
Uncomplicated vs Complicated UTI
Uncomplicated UTI: infection that occurs in a structurally and neurologically normal urinary tract
Females > Males
Complicated UTI: infection in a urinary tract with functional or structural abnormalities (including indwelling catheters and renal calculi)
Females = Males In elderly men are always considered complicated In women are complicated when:
Hx of recurrent UTI Secondary to structural abnormalities Catheters Stones Urinary retention Abscess formation or urosepsis
![Page 13: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/13.jpg)
Primary Vs. Recurrent
Primary UTI Infection that occurs in the urinary
tract for the first time. No previous episodes of infections.
Recurrent UTI Presence of past history of urinary
tract infection
![Page 14: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/14.jpg)
RecurrentRelapse Vs. Reinfection
Relapse Recurrence within 2 weeks of
treatment and mainly due to treatment failure, the initial organism is not totally cleared.
The Same Organism
Occurs in case of:• Acute Upper UTI.• Presence of obstruction like stone
disease.
![Page 15: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/15.jpg)
ReinfectionRecurrence within several weeks after
the antibiotic therapy has cleared up the initial episode.
Different Organisms
![Page 16: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/16.jpg)
Lower Urinary Tract Infection(Urethritis and Cystitis)
Vs
Upper Urinary tract Infection(Pyelonephritis)
![Page 17: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/17.jpg)
Acute Uncomplicated Cystitis Acute bacterial cystitis is usually
characterized by sudden onset, multiple urinary symptoms, pyuria, and sometimes hematuria
Acute dysuria in young women usually indicates: acute bacterial cystitis; the urethral syndrome; or vaginitis
Although most patients have lower urinary symptoms only, 30% to 50% may have subclinical renal involvement
Causes: E. coli (80%), S. saprophyticus (10% to 15%), and occasionally Klebsiella, Proteus mirabilis, and other microorganisms.
![Page 18: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/18.jpg)
Acute Uncomplicated Pyelonephritis Largely a clinical diagnosis Pyuria is usually present; about 20%
have positive blood cultures; causative organisms the same as with cystitis
Predisposing factors: structural abnormalities; strains of E. coli with unique markers; genetically-determined carbohydrate receptors on uroepithelial cells
Highly significant! Presence of WBC casts suggests pyelonephritis
![Page 19: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/19.jpg)
Physiologic changes with aging in the urinary tractAge-Related Changes Men WomenDecreased bladder capacity and increased urine production (especially at night)
Decreased voided volume
Decreased estrogen w/menopause leads to thinning of vaginal & urethral mucosa
Decreased lower urinary tract sensory threshold
√
√
√
√
√
√Palmer, 2004
Urinary Tract InfectionPhysiologic Changes
![Page 20: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/20.jpg)
Physiologic changes with aging in the urinary tract
Age-Related Changes Men Women
Problems of urinary storage & emptying
↑incidence of overflow incontinence from urethral obstruction or stricture
Decreased estrogen levels leads to pH changes in vagina, favoring colonization of E. coli, ↑risk of UTI
Prostatic enlargement can lead to urinary obstruction, increased residual urine & infection
√
√
√
√
√
√
Palmer, 2004
![Page 21: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/21.jpg)
Risk Factors Organisms Rout of Infection Symptoms - History Signs – Physical Exam Differential Diagnosis Investigation Treatment Complications
Urinary Tract Infections
![Page 22: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/22.jpg)
Risk Factors
??????
![Page 23: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/23.jpg)
Risk Factors
General Conditions Diabetes Previous urinary tract infection Kidney Problems Immunosuppression Sickle Cell Disease Functional or mental impairment Urinary Stone Disease Urinary Tract Anomalies Neurogenic Bladde
Urologic instrumentation or surgery Urethral catheterization Renal transplantation spinal injury
![Page 24: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/24.jpg)
![Page 25: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/25.jpg)
Risk Factors
Specific for Females
Structure of Urinary Tract. Sexual Behavior. It is not STD Contraception. Pregnancy Menopause
![Page 26: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/26.jpg)
Risk Factors
Specific for Males
Benign Prostatic Hypertrophy
Prostatitis
![Page 27: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/27.jpg)
Risk Factors
Specific for Children
Uncircumcised Males
Vesicoureteral Reflux Disease.
![Page 28: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/28.jpg)
Frequency distribution of symptomatic UTI and prevalence of asymptomatic bacteriuria by age and sex
)Male – shaded area; Female – line(
![Page 29: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/29.jpg)
Organisms
??????
![Page 30: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/30.jpg)
OrganismsGram Negative Organisms
E.Coli In Acidic Urine (most common)
Proteus In Alkali Urine
Klebsiella
Citrobacter
Pseudomonas
![Page 31: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/31.jpg)
OrganismsGram Positive Organisms
Staphylococcus Aureus
Staphylococcus Epidermidis
Streptococcus Feacalis
![Page 32: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/32.jpg)
OrganismsFungal Infections
Mainly in Diabetic Patients.
Candida Species
![Page 33: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/33.jpg)
Rout of Infection
??????
![Page 34: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/34.jpg)
Rout of Infection
Ascending Infection.◦ The common route of nearly all forms of urinary
tract infection (bacteria initially colonize periurethral tissues)
◦ Common in females than in males because of shorter urethra
◦ Single bladder catheterization can result in UTI in 1% of the ambulatory population
Lymphatic Spread. Increase bladder pressure can cause lymphatic flow
to be directed toward the kidney
Local Spread.
![Page 35: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/35.jpg)
Rout of Infection
Hematogenous Spread.• Frequently seen with Staphylococcus aureus
bacteremia or endocarditis• Also seen to occur in experimental models with
Candida• Infections with gram negative bacilli rarely occurs
by this route Descending From the Kidneys Local Spread.
![Page 36: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/36.jpg)
Symptoms - History
??????
![Page 37: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/37.jpg)
Symptoms - History
Lower Urinary Tract Infection
Frank Hematurea.
Painful Micturation.
Discomfort in the lower abdomen.
Urinary Frequency.
Urinary Urgency.
![Page 38: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/38.jpg)
Symptoms - History
Upper Urinary Tract Infection
High Grade Fever, chills and rigor.
Flank Pain.
Nausea and Vomiting
Lower UTI Symptoms.
![Page 39: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/39.jpg)
Signs – Physical Exam
??????
![Page 40: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/40.jpg)
Signs – Physical Exam
Vital Signs
Suprapubic Tenderness
Flank Tenderness
![Page 41: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/41.jpg)
Based on the symptoms both
a clinical diagnosis of a UTI and a differentiation between lower (cystitis) or upper (pyelonephritis) UTI should be made
![Page 42: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/42.jpg)
Differential Diagnosis
??????
![Page 43: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/43.jpg)
Differential Diagnosis
Lower UTI
Stones.
Vaginitis and STD
Interstitial Cystitis.
Menopausal Changes.
Prostate Disease.
![Page 44: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/44.jpg)
Differential Diagnosis
Upper UTI
Pneumonia.
Cholecystitis.
Appendicitis.
Kidney Stones.
![Page 45: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/45.jpg)
Investigation
??????
![Page 46: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/46.jpg)
Investigation
Dipstick Test
Nitrites Test
Leukocyte Esterase Test.
Blood.
Proteins.
![Page 47: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/47.jpg)
Investigation
Microscopic Examination
WBC’s Count.
RBC’s Count.
Cellular and Hyaline Casts.
![Page 48: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/48.jpg)
Investigation
Clinical Symptoms
Plus
Suggestive Dipstick
Plus
Suggestive Microscopic ExamEqual
Urinary Tract Infection (75%)
![Page 49: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/49.jpg)
Investigation
Gram Stain and Urine Culture
Urine culture is gold standard.
Used in every positive dipstick and urinalysis.
Used in negative dipstick and urinalysis if:
- Age less than 2 Years.
- UTI symptoms (25%).
![Page 50: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/50.jpg)
![Page 51: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/51.jpg)
Investigation
Helpful Laboratory Tests
CBC
Serum Electrolytes
KFT
Blood Culture.
![Page 52: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/52.jpg)
Investigation
Imaging Studies
Recurrent cases of pyelonephritis
Structural abnormalities are suspected.
No response to treatment.
Suspicion of obstruction.
Children: age 2 - 24 months
![Page 53: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/53.jpg)
Investigation
Ultrasound
Screening for hydronephrosis.
Kidney Stones.
Kidney Abscess.
![Page 54: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/54.jpg)
Investigation
Nuclear Scan
Kidney Scar.
![Page 55: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/55.jpg)
InvestigationX-rays
Stones. Structural Abnormalities. Urethral Narrowing. Incomplete Bladder Emptying. Examples:
- MCUG- IVP and KUB
![Page 56: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/56.jpg)
Symptomaticpatient
Uncomplicated cystitisin a woman,
no risk factorsnot a relapse
Typical symptoms, < 2 infections / year,
patient familiar withher illness
Bacterial culture,"on the spot" testingto confirm diagnosis
Starttreatmentbased onresults
Antibiotictherapy
Yes
No
No
Yes
![Page 57: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/57.jpg)
![Page 58: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/58.jpg)
TreatmentUpper UTI
Good Hydration.
Oral TMP-SMX or Quinolones for 2 weeks.
Oral amoxicillin and clavulanic acid for 2 weeks.
![Page 59: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/59.jpg)
TreatmentLower UTI
Good Hydration.
Oral TMP-SMX or Quinolones for 1 week.
Relapses are best treated with the same AB, long period.
![Page 60: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/60.jpg)
![Page 61: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/61.jpg)
![Page 62: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/62.jpg)
![Page 63: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/63.jpg)
Treatment
Reinfections
Long term AB prophylaxis.
Surgical reimplantation of the ureters >>> VUR disease
![Page 64: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/64.jpg)
Treatment
Failure of Treatment
Compliance and AB Dose. Bacterial Resistance. Polymicrobial UTI. Azotemia. Papillary Necrosis. Staghorn Calculi.
![Page 65: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/65.jpg)
Prophylaxis of recurrent cystitis with antimicrobial agents
prophylaxis should be considered when more than 3 infections per year
prophylaxis to continue for 6 months if infections recur after prophylactic
treatment, the prophylaxis is re-commenced for 6 – 12 months
![Page 66: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/66.jpg)
Drugs of choice in UTI prophylaxis
First choice: trimethoprim 100 mg in the evenings nitrofurantoin 50 - 75 mg in the eveningsSecond choice: methenamine hippurate 1 g twice daily norfloxacin 200 mg daily or on 3 evenings per week nitrofurantoin (not if serum creatinine is above 150 μmol/l) quinolones (in cases where there is no response with other
prophylactic medication or tolerance to other medications is poor)
During pregnancy: nitrofurantoin 50 mg daily or methenamine hippurate 1 g daily for the rest of the
pregnancy particularly if recurrent bacteriuria is diagnosed in early
pregnancy
![Page 67: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/67.jpg)
![Page 68: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/68.jpg)
Complications
??????
![Page 69: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/69.jpg)
Complications
Spread of Infection
- Sepsis.- Prostatitis.- Epididymitis.
Persistence of Infection
- Perinephric Abscess.- Chronic Infection.
![Page 70: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/70.jpg)
Complications
Obstruction.
Kidney Scar.
Kidney Stones
![Page 71: 7 million office visits yearly 1 million hospitalizations About 2/3rds of patients are women ◦ 40% to 50% of women have UTI at some point during.](https://reader035.fdocuments.in/reader035/viewer/2022062516/56649da55503460f94a90c4d/html5/thumbnails/71.jpg)
That will be all … thanks for not falling asleep ;)Bye Bye