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Urinary Tract Infections (UTIs)

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Urinary Tract Infections (UTIs) Introduction * UTIs are common, especially among women * UTIs in men are less common ... – PowerPoint PPT presentation

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Title: Urinary Tract Infections (UTIs)


1
  • ??? ???? ??????? ???????

2
  • Urinary Tract Infections (UTIs)

3
Introduction
  • UTIs are common, especially among women
  • UTIs in men are less common and primarily
  • occur after 50 years of age
  • UTIs infection usually occur by ascending
    route (urethra to bladder)
  • UTIs infection is less common by haematogenous
    spread (kidney)
  • UTIs occur in two general settings
    community-acquired and hospital (nosocomially)
    acquired

4
Definitions
  • Urethritis Infection of anterior urethral
    tract
  • dysuria, urgency
  • and frequency of
    micturition
  • - Dysuria (burning
    pain on passing urine)
  • - Urgency (the urgent need to
    pas urine)
  • - Frequency of micturition ???? ???? ??????
  • Cystitis Infection of urinary bladder
  • dysuria, frequency, pyuria
    and
  • haematuria
  • Bacteriuria Presence of bacteria in urine
  • A count of 10? organisms/ml or more in urine
  • Pyuria Presence of pus in urine
  • (more than 10 cells/HPF)

5
Etiology Of Urinary Tract Infections
  • Causative organisms
  • Escherichia coli
  • Klebsiella,
    proteus and pseudomonas
  • 1- Bacterial S. aureus, S.
    epidermidis and S. saprophyticus
  • Enterococci
    (Strept. faecalis)
  • Mycobacterium
    tuberculosis
  • Chlamydia
    trachomatis, Mycoplasma
  • 2- Viral Rubella, Mumps and
    HIV
  • 3- Fungal Candida, Histoplasma
    capsulatum
  • 4- Protozoal T. vaginalis, S.
    haematobium

6
Notes on pathogens
  • Escherichia coli the commonest urinary
    pathogen
  • causing 60-90 of urinary infections
  • Pseudomonas, Proteus, Klebsiella and S. aureus
  • are associated with hospital acquired
    infections because their resistance to
    antibiotics favor their selection in hospital
    patients
  • (catheterization, gynaecological surgery)
  • Proteus infections are associated with renal
    stones
  • Proteus produce a potent urease which act on
    ammonia, rendering the urine alkaline
  • S. saprohyticus infections are found in
  • sexually active young women

7
Notes on pathogens
  • Candida urinary infection is usually found in
    diabetic patients and immunosuppression
  • Infection of the anterior urinary tract
    (urethritis) is mainly caused by N. gonorrhoae,
    staphylococci, streptococci and chlamydiae
  • M. tuberculosis is carried in blood to kidney
    from another site of infection
  • (e.g. respiratory T.B.)

8
Mechanical And Functional Factors Predispose to
UTI
  • Disruption of urine flow or complete emptying
    of bladder
  • - Pregnancy - Renal stones -Tumor
  • - Prostate hypertrophy - Strictures
    narowing of ureter
  • Loss of neurologic control of bladder and
    sphincters
  • Paraplegia, and multiple sclerosis
  • Paraplegia ??? ???? ?? ???????
  • multiple sclerosis ????? ???? ??? ????? ????
    ?????
  • Vesicouretral reflux
  • (reflux of urine from bladder up the ureter)
  • Anatomic abnormalities in children
  • Catheterization facilitate bacterial access to
    bladder
  • - During insertion
  • - In situ, bacteria access to bladder

9
Virulence Factors of Causative Organisms
  • - Fimbriae enable adherence to urethral
    epithelium
  • - Capsular polysaccharide inhibite
    phagocytosis
  • - Haemolysin production by E. coli
  • -Membrane damaging toxin
  • - Production of urease enzyme (proteus spp.)

10
Healthy Urinary Tract
  • Bacterial colonization in urinary tract is
  • prevented by
  • - pH of urine (acidic)
  • - Chemical content of urine
  • - Flushing mechanisms ?????? ?????

11
Clinical Features
  • Acute lower UTIs (Urithritis and cystitis)
  • Rapid onset of
  • - Dysuria (burning pain on
    passing urine)
  • - Urgency (the urgent need to
    pas urine)
  • - Frequency of micturition
  • Upper UTIs (Pyelonephritis)
  • - Fever
  • - Chills
  • - Dysuria
  • - Urgency
  • - Frequency of micturition

12
Difference between infected and contaminated urine
  • Infection
    Contamination
  • More than 105 Organisms/ml less than
    104 Organisms/ml
  • A single bacterial spp.
    More than one organism

13
Diagnosis of Urinary Tract Infections
  • Specimen Urine
  • - An aseptic collection technique essential to
    prevent contamination
  • - The first urine passed by patient in the
    morning
  • - A mid stream urine sample under a septic
    precaution
  • - Boric acid is used as a preservative for
    urine specimens
  • Special urine specimens are required to detect
  • a- Mycobacterium tuberculosis

  • Three early morning urine samples on 3
    consecutive days
  • b- S.haematobium
  • The last few milliliters of a morning
    urine sample after exercise

14
Diagnosis of Urinary Tract Infections
  • Detection of significant bacteruria
  • a- Microscopic examination
  • - Wet film to detect
  • . Pus cells, red cells, casts,
    yeasts
  • . Bacteria T.vaginalis, S.
    haematobium
  • b- Viable bacterial count
  • - A measured volume (calibrated loop
    0.002 ml)
  • of urine is spread on surface of a
    solid medium
  • - Incubation of the solid medium at
    37C for
  • 18-24 hours
  • - Enumerate the number of colonies

15
Diagnosis of Urinary Tract Infections (cont.)
  • c- Cultures
  • - Culture is required when urine contain
    bacteria, cells, casts, protein,nitrite
  • - Nutrient agar, CLED agar, Blood agar and
    MacConkeys medium at 37C
  • - Isolated colonies are identified in a
    systematic way
  • 1- Microscopical examination
  • Gram staining to differentiate
    between Gm negative and Gm positive
  • Shape, size and arrangement
  • 2- Biochemical reactions
  • - For Gm negative organisms Sugar
    fermentation, Indol test,

  • Oxidase, MR, VP and urease tests
  • - For Gm positive organisms Coagulase
    test, catalase test
  • 3- Serological identification
    Detection of microbial Ag by specific Ab

16
Sterile Pyuria
  • - Presence of pus in urine in absence of
    bacterial growth
  • - Causes
  • a- Infection with Chlamydia trachomatis
  • M. tuberculosis
  • Ureaplasma
  • Anaerobic
    bacteria
  • Mycoplasma and
    L-forms
  • Viruses
  • b- Previous antibiotic therapy
  • (Suppress growth of bacteria)

17
Treatment
  • Uncomplicated UTI
  • An oral antibacterial as a single dose or
    for 3 days
  • Complicated UTI (Pyelonephritis)
  • Treatment with a systematic antibacterial
    agent
  • e.g. Beta-lactam (Ampicillin, amoxicillin,
    cefalexin)
  • Quinolone (Ciprofloxacin,
    levofloxacin)

18
  • Thank you
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