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Classification
Lower UTIs: Infections of the bladder (cystitis) ,infections of the urethra (urethritis) and prostate
(prostatitis)
Upper UTIs: Infections of the kidneys (pyelonephritis)
Both upper and lower UTI are further divided into complicated and uncomplicated
Urethritis:
Cystitis:
Infection to urinary bladder *dysuria, frequency and urgency, pyuria and hematuria.
Acute pyelonephritis:
Infection of one/both kidneys; sometimes lower tract also. *pyuria, fever, painful micturition
Chronic pyelonephritis:
Epidemiology
• 20% of women between ages 20-65 suffer one attack per year
90 cystitis,
10% pyelonephritis
75 sporadic
25 recurrent
2% complicated
urine retention
sexual intercourse
contraceptives
bacterial prostatitis
age
Etiology
E.coli (gram-ve)
Staphylococcus saprophyticus(gram+ve)
Uncomplicated UTI:
Pseudomonas aeruginosa(gram-ve)
Most are caused by single organisms except in patients with stones, indwelling urinary catheters or chronic
renal abscesses
• frequent urination;
• fatigue;
• in elderly patients, subtle symptoms such as altered mental status (confusion) or decreased activity
may be signs of a UTI.
• frequent or persistent urge to urinate without much urine passing when you go;
fever or chills;
Vaginal itching is not a typical symptom of a UTI. It may be a sign of bacterial vaginosis or a vaginal yeast
infection.
If one is experiencing fever or back pain, this may be a sign of a kidney infection (pyelonephritis), which can be
a serious medical issue. Seek medical attention immediately.
1) Ascending infection
3) Lymphatogenous spread
Ascending infection
Hematogenous spread:
• Occurs in bacteraemia
• Men- through rectal and colonic lymphatic vessels to prostrate and bladder.
UTI- DIAGNOSIS
Urinalysis to examine the urine for red blood cells, white blood cells and bacteria (The number of
white and red blood cells can indicate an infection.)
Urine culture to determine the type of bacteria in the urine. This is important to help determine
the appropriate treatment.
If your infection does not respond to treatment or if you get repeated infections, your doctor may use the
following tests to examine your urinary tract for disease or injury:
Intravenous pyelogram (IVP), a series of X-rays of the bladder, kidneys and ureters after a special
dye is injected (The dye helps the structures to show up better on the X-ray.)
Ultrasound, a test that uses sound waves to form images of internal organs
Cystoscopy, a test that uses a special instrument fitted with a lens and a light source (cystoscope)
to see inside the bladder from the urethra
CT scan, a type of X-ray that takes cross sections of the body (like slices) – much more precise
than typical X-rays
Laboratory examination
1. stick on bags
2. catheterization
Laboratory findings
Normal Findings
• pH - 4.6 – 8.0
• Appearance- clear
• Odour – aromatic
• Blood – none
• WBC- absent
Bacteria- absent
Abnormal findings
• pH – Alkaline ( increases)
• Appearance – cloudy
Urethritis:
• Discomfort in voiding
• Dysuria
• Urgency
• frequency
Cystitis:
• dysuria, urgency and frequent urination
• Pelvic discomfort
• Abdominal pain
• Pyuria
Haemorrhagic cystitis:
Pyelonephritis:
• Invasive nature
• Suprapubic tenderness
• Back pain
Elimination of infection
ORAL THERAPY
1. FLUOROQUINOLONES; CIPROFLOXACIN NORFLOXACIN LEVOFLOXACIN
2. PENCILLINS: AMOXICILLIN + CLAVULANATE [25mg +62.5mg]
3. TRIMETHOPRIM + SULPHAMETHAZOLE [1:5 dose]
4. NITROFURANTOIN [SPECIFIC DRUG FOR UTI]
5. CEPHALOSPORINS
PARENTRAL THERAPY:
1. AMINOGLYCOSIDES: AMIKACIN
2. PENCILLIN: AMPHICILLIN+SULBACTUM, PEPERICIN+TAZOBACTUM
3. CEPHALOSPORIN: CEFTRIAXONE, CEFTAZIDIME
4. CARBAPENAMS/MONOBACTAMS: IMIBENAM+CELESTINE, MEROPENAM
5. FLUROQUINALONES: CIPROFLOXACIN, NORFLOXACIN, LEVOFLOXACIN
TREATMENT REGIMEN: