MALEMALE FEMALEFEMALE2

Condition in which microorganisms actively multiply and persist in the genitourinary tract.Acute infection of the urinary tract falls into two general anatomic categories.

Lower Tract Infection - Urethritis And Cystitis.Upper Tract Infection - Acute Pyelonephritis, Prostatitis , Intrarenal and Perinephric Abscess.

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Most common infectious disease.Affects all ages

Males predominate in the newborn periodBeyond this age, females predominate

Most Numerous specimens are received in the Laboratory

Appropriate clinical information gives many clues for better diagnostic evaluations.

Specimen collection is the primary objective in getting an ideal sample.

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More common in adults than in children. Infections in children are more likely to be serious than those in adults and should not be ignored.Physical contact with an infected partner.Waiting too long to urinate.Pregnancy.Diabetic /Immunosuppressed individualsCalculi.Men with an enlarged prostate. 5

Any medical conditions that cause incomplete bladder emptying (spinal cord injury) or bladder decompensation after menopause.

The most common cause of UTIs are bacteria from the bowel that live on the skin near the rectum or in the vagina, which can spread and enter the urinary tract through the urethra

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Frequent urination, but very little urine may come out.Painful burning sensation before, during, and after urinating.Urinating blood.Urgent need to urinate, and in serious cases,

unable to control bladder and leaks urine.Cloudy or foul smelling urine.Fever.Malaise or the general feeling of unwell.Severe pain in the lower abdominal region.

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Mainly caused by colonic bacteria

E.coli – most commonKlebsiellaProteusStaphyloccus saprophyticusPseudomonas aeruginosaCandida- infections in Diabetic or imunocompromised patients.

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Acute PyelonephritisAcute PyelonephritisInvolvement of renal parenchyma.Characterized by:

Early Onset Fever.Abdominal Pain or Flank Pain.Malaise.Nausea and Vomiting.

Diarrhea.CystitisCystitis

Involves bladder .Characterized by:

Dysuria . Urgency. Frequency. Suprapubic Pain. Incontinence . Malodorous Urine. No fever and does not result in renal injury

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UrethritisUrethritisSuspected in growth/ culture negative symptomatic

cases.Symptoms similar to Cystitis.Caused by Sexually Transmitted infections .

Asymptomatic bacteriuriaAsymptomatic bacteriuria+ urine culture without any manifestation of infection.Occurs exclusively in girls, elderly men and women.Benign and does not cause renal injury.

Catheter associated UTIsCatheter associated UTIsFemale SexUnsterile procedure while insertion Prolonged CatheterizationSevere underlying DiseasesLack of catheter care 10

Routine Blood InvestigationsBlood Urea & Serum Creatinine.Routine urine

Simple microscopic examination of wet films of unconcentrated urine for detection of Polymorphonuclear leucocytes & pus cells gives leading clues.

Semi-quantitative culture of urine to determine whether urine contain potentially pathogenic bacteria in Numbers sufficient to identify it as causative agent causing infection.Urine culture and antibiotic sensitivity.

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Radiological EvaluationRadiological EvaluationGuidelines for selection of patients with UTI for radiologic evaluation:

All neonates with 1st UTI All males with 1st UTI at any age All patients with recurrent UTI All patients with Pyelonephritis

Intravenous Pyelography (IVP)Intravenous Pyelography (IVP)Information about renal size, renal scars and state of pelvocalyceal system

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VCUG (voiding cystourethrogram) VCUG (voiding cystourethrogram) Definitive test to document VURIndicated in children younger than 5 yr with UTI, any child with febrile UTI, school-aged girls who had 2 or more UTIs Any male with UTI

UltrasoundUltrasound of the kidney and urinary bladderScreening Procedure Of ChoiceShould be obtained to rule out Hydronephrosis and renal or perirenal abscesses,calculi.

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Specimen CollectionSpecimen Collection

The urine collected in a wide mouthed sterile container sterile container A mid stream mid stream specimen is the most ideal for processing. Do not collect spontaneously Do not collect spontaneously collected urine collected urine , which can Lead to contamination with commensal bacterial colonies on urethral orifice and perineum.

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All collected specimens of urine to be transported to laboratory with out delay

Delay of 1-2 hour lowers the quality of diagnostic evaluations.

If the delay is anticipated the specimens are to be preserved at 40c.

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Urinalysis Urinalysis > 10 WBC /hpf In A Centrifuged Urinary Sediment Hematuria + Nitrite Test Absence Of Pyuria Does Not Rule Out UTI

Urine culture Urine culture Gold Standard Midstream Urine Sample: > 100,000(105) Colonies/ml of a Single Pathogen 10,000 Col/ml If Symptomatic Catheterized Urine > 105 Colony Count Suprapubic Aspirate = Any Bacterial Growth

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Symptomatic Cases attending OPDs should be started on Broad-Spectrum Antibiotics.Ideally urine samples to be sent for examinations prior to Antibiotic administration.

DRUGS:DRUGS: Trimethoprim Sulfamethoxazole Nitrofurantoin Penicillin Quinolone Aminoglycosides Cephalosporins

Conservative:Conservative: Increased oral fluids intake.Acidification of urine.Regular and complete bladder emptying.Good personal hygiene.

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