Urinary tract infection

UTI One of the commonest infections in

ambulatory, commonest in bed-ridden Upper- pyelonephritis;

Lower- urethritis, cystitis, prostatitis Acute or chronic Asymptomatic or symptomatic Uncomplicated or complicated Recurrence- reinfection or relapse

Risk factors for symptomatic UTI Female sex Age Pregnancy Sexual intercourse Use of spermicide Menopause

Vesicoureteric reflux Obstruction- Congenital, calculi Residual urine- Neurogenic bladder,

stricture, BPH Instrumentation- Catheterization,

dilatation, cystoscopy

Clinical presentation Lower UTI- mostly acute Frequency, dysuria, urgency, suprapubic pain,

fever uncommon Significant bacteriuria Pyelonephritis- acute or chronic Systemic symptoms- fever with chills Hematuria, pyuria, renal angle tenderness/fullness Edema, HT, anemia-erythropoietin deficiency May lead to sepsis/septic shock or

acute/chronic renal insufficiency

Significant bacteriuria

>1 lakh CFU of bacteria per mlSuprapubic collection- any

growth

Causative organism

Uncomplicated- majority E.coliComplicated- other G –ve bacteria,

staph., enterococcus, candida

Evaluation

CBC, RFTUS, IVP, CT-scan

Endoscopic procedures

Treatment Antibiotics- Oral- co-trimoxazole, nitrofurantoin, quinolones IV- quinolones/3rd generation cephalosporin + aminoglycoside Duration- LUTI-1-3 days, UUTI-14 days Asymptomatic bacteriuria is treated in

pregnancy, DM, post-transplant, VUR With catheter, stone, obstruction-

treat only symptomatic bacteriuria Frequent UTI- Relapses r/o underlying pathology Abx based on sensitivity Long-term suppressive therapy- co-trimoxazole/NFT

Indwelling urinary catheters Use when required, remove when not Aseptic insertion, properly secured Sterile closed drainage system Continuous non-obstructed gravity flow Once inserted, can be used for 2 weeks Chronic indwelling catheter- change if

malfunction or obstruction

Indwelling urinary catheters Use when required, remove when not Aseptic insertion, properly secured Sterile closed drainage system Continuous non-obstructed gravity flow Once inserted, can be used for 2 weeks Chronic indwelling catheter- change if

malfunction or obstruction