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Urinary tract infection
Dr.Nariman Fahmi
Objectives
• Define Urinary Tract Infection (UTI)• Diagnosis of UTI• treatment for UTI
Relationship of the Kidneys to Vertebra and Ribs
Figure 23.1b
They are retroperitoneal and are located in the
abdominal cavity.
They are at the level of T12 to L3, so they are at the costal margin, and the ribs protect them a little.
Even though they are protected by thoracic ribs, they are NOT in the thoracic cavity because they are below the diaphragm.
4
Case history
• A 9 year old girl with a 2 days history of loin pain ,fever and vomiting, clinically she appears ill.
• a full blood count shows a Hb 12 mg/dl,• WBC of 14x10( cells/L• You send of a midstream urine sample for culture.
• prescribed paracetol and ask the patient came next day. The next day you find that she has been reported urine culture of more than 100 000colonies of E-Coli.
• What is the most probable diagnosis ?? • Which part of renal tract is most likely infected
and why??• What choice of antibiotics?? • investigations that are needed
Urinary Tract Infections
Yes, it is a bacteriuria
Urinary Tract
Female Male
A UTI can happen anywhere along the urinary tract. UTI have different names, depending on what part of the
urinary tract is infected.
Bladder -- an infection in the bladder is also called cystitis or a bladder infection
Kidneys -- an infection of one or both kidneys is called pyelonephritis or a kidney infection
Definition of UTI
Bacteriuria
Presence of bacteria in the urine Dysuria Pain or difficulty in urinating
Pyuria Presence of/increased numbers of white blood cells in the urine
Terminology
• Most UTIs are from ascending bacteria
– E. coli (60-80%), Proteus, Klebsiella, Enterococcus, and coag. neg. staph.
forms of UTI are
1-pyelonephritis 2-Cystitis
3 -urithritis 4 -prostitis
Cystitis (bladder involvement )clinical fatures
• dysuria,• urgency, • frequency, • suprapubic pain,• incontinence, • malodorous urine. • Cystitis does not cause fever and does not result in
renal injury s
General urine exam
Microscopical exam
Pus cells in urine
DIAGNOSIS
urine culture
Imaging of the Renal tract
* Renal U/S
* KUB
* DMSA
* IVU
* Cystogram
•VCUG/RNC
The goal of imaging studies in UTI is to identify
Anatomic abnormalities that predispose to infection and identify scarring
Reflux Seen on Voiding Cystourethrogram (VCUG) using transurethral contrast
Urinary Tract Infection
• Upper urinary tract Infections:– Pyelonephritis
• Lower urinary tract infections– Cystitis (“traditional” UTI)– Urethritis (often sexually-transmitted)– Prostatitis
Symptoms of pyelonephritis
• Hematuria• Fever • Nausea/Vomiting (pyelonephritis)• Flank pain (pyelonephritis)
Findings on Exam in UTI
• Physical Exam:– Costo Vertebral Angle tenderness (pyelonephritis)– Urethral discharge (urethritis)– Tender prostate on PRE (prostatitis)– Suprapubic tenderness (cystitis)
• Labs: Urinalysis Positive + WBCs Positive + RBCs
Culture in UTI• Positive Urine Culture = >105 CFU/mL• Most common pathogen for cystitis, prostatitis,
pyelonephritis:– Escherichia coli– Staphylococcus saprophyticus– Proteus mirabilis– Klebsiella– Enterococcus
• Most common pathogen for urethritis• Chlamydia trachomatis• Neisseria Gonorrhea
Pyelonephritis• Infection of the kidney• Associated with constitutional symptoms – fever,
nausea, vomiting, headache• Diagnosis:
• Urinalysis, urine culture, CBC, Chemistry• Treatment:
• 2-weeks of Trimethroprim/sulfamethoxazole or fluoroquinolone ,cephalosporins• Hospitalization and Intravenous antibiotics if
patient unable to take orally .
Question
• A 24-year old woman presents with fever, chills, nausea, vomiting, flank pain and tenderness. Her temperature is 40°C, pulse rate is 120/min., and blood pressure is 100/60 mm Hg.
Question
• What further studies do you want in this patient?
• How would you treat this patient?• What might you do if she does not improve
after 3-4 days?