UTI

-Common to WOMEN

[10-20% they tend to have UTI in their life] why: syempre bukas kasi ang pekpek so mas malaki
ang surface na pedeng pasukan: no malice pero realtalk.

Etiology

INFECTION: acquired by ascending route from urethra to the bladder

*It may proceed to kidney

*May also lead to SEPTICEMIA (Blood inf.)

CAUSATIVE AGENTS

A.) Most Common

-E. Coli

B.) Other causes

-Proteus mirabilis

-Enterobacter

-Pseudomonas aeuruginosa (Hospital acquired)

-Klebsiella

-Serratia spp.

C.) Gram (+) spp.

-Staph. Saphrophyticus [Young pokpok womensz]

-Staph. Epidermidis and enterococcus spp. [Associated with UTI in the hospital]

-Obligates anaerobes-rare

-Salmonella typhi, Staph. Aureus, mycobacterium tuberculosis [hematogenous spread]

D.)Viral causes UTI- RARE

*human polyomaviruses – Respiratory Tract- spread through the body and kidney tubules and ureter

[CYTOMEGALOVIRUS (CMV)]

E.) Parasites

-Schistosoma haematobium

F.) Protozoan

-Trichomonas vaginalis

G.) Fungi

-Candida spp

-Histoplasma capsulatum

Pathophysiology

 Anything that disrupts the normal urine flow or complete emptying off bladder
 Facilitate access of organism to the bladder- inf.
 Nakukuha sa kantutan
 Kapag supot pa ang isang lalaki

Causes of obstruction to complete bladder emptying

 Pregnancy
 Prostatic hypertrophy
 Renal calculi
 Tumors

Predisposing Factor
A.) Catheterization
-Bacteria may be carried into the bladder during insertion either

Via:
-Lumen of catheter
 -tracking up between the outside of the catheter and the urethral wall

Acute lower UTI’s

Clinical Features
-dysuria
-urgency
-frequency of micturation
-asymptomatic [elderly with indwelling catheter]

Diagnosis

-Urinalysis

+ pus

-Urine culture

-Pyuria

[In the absence of (+) urine culture can be due to Chlamydia or tuberculosis

Recurrent Inf. Lower UT

-Relapse

-caused by the same strain of organism

-Reinfection

-caused by diff. organism

UTI’s

-Bladder (lower UTI)

-Upper UT and kidney

Pyelonephritis

-inf. Of the kidney

Sign and symptoms

-fever and lower UTi

Common cause

-staphylococci and renal abscesses are generally present

Recurrent episodes

-Lead to loss of function of renal tissue which may cause hypertension

-Obstruction and septicaemia if inf. Is associated with stone form.

Tx

Uncomplicated UTI

 Oral anti-bac. agent as a single dose or for 3 days

 The choice of agent should be based on the results of susceptibility
 Follow culture to check eradication of organism
 Drink large of fluids to help flushing out process
 Children and pregnant women with asymptomatic bacteuria- treat with anti-bac and followed up to check
for eradication of inf.

Complicated UTI

 Should be treated with systemic anti-bac agent

 Susceptible of organism should be known
 Tx should continue until pt. is (-) for signs and symptoms
 Usual tx. Is 10 days but longer is necess. To sterilize kidney
 Hospital-acquired inf. Or recurrent inf. i.e

-catheterized Px may be caused by antibiotic-resistant organism

-if possible catheter should be removed

Antibacs for UTI

 Ampicillin
 Amoxicillin
  Augmentin
 Cephalexin
 Cefaclor
 Co-trimoxazole
 Nitrofurantoin
 Nalidixic acid
 Ciprofloxacin

*Nitrofurantion and nalidixic acid- uncomplicated UTI

Prevention

-Regular emptying of bladder [flushes out the bacteria out of the bacteria and is important following intercourse]

-Prophylactic use of antibiotic to prevent recurrent inf.

-Catheter care procedures or avoid catherization if possible or keep in minimum duration