Urinary tract infection

Kurniyanto
Introduction
• UTIs  financial burden on society.
• 15% of all community-prescribed antibiotics in the US and
Europe are dispensed for UTI
• At least 40% of all hospital acquired infections are UTIs and the
majority of cases are catheter associated
• Bacteriuria develops in up to 25% of patients who require a
urinary catheter for one week or more with a daily risk of 5-7%
Definition and epidemiology
• UTI  bacterial or fungal infection of the normally sterile urine
• Clinical presentation
• Asymtomatic bacteriuria
• Cystitis, urethritis
• Pyelonephritis
• Urosepsis
• Prevalence of community acquire UTI  0,7%
• Hospital acquire UTI  12,9% (US), 19,6% (Europe), 24% (developing
country)
• Women > men
• Category of UTI in adults :
• young women with acute uncomplicated cystitis
• young women with recurrent cystitis
• young women with acute uncomplicated pyelonephritis
• adults with acute cystitis and conditions that suggest occult renal or
prostatic involvement
• Complicated UTI
• Asymptomatic bacteriuria
• Bacterial count that are clinical relevant
• > 103 cfu/mL of uropathogens in a mid-stream sample of urine (MSU)
in acute uncomplicated cystitis in women.
• > 104 cfu/mL of uropathogens in an MSU in acute uncomplicated
pyelonephritis in women.
• > 105 cfu/mL of uropathogens in an MSU in women, or > 104 cfu/mL
uropathogens in an MSU in men, or in straight catheter urine in women,
in a complicated UTI
• Uncomplicated UTI
• Acute, uncomplicated UTIs in adults include episodes of acute cystitis
and acute pyelonephritis in otherwise healthy individuals.
• These UTIs are seen mostly in women without structural and functional
abnormalities within the urinary tract, kidney diseases, or comorbidity
that could lead to more serious outcomes and therefore require
additional attention
• Asymptomatic bacteriuria
• Complicated UTI
• Infection associated with a condition, such as structural or functional
abnormalitiesof the genitourinary tract or the presence of an underlying
disease, which increases the risks of acquiring an infection or of failing
therapy.
• Two criteria are mandatory to define a complicated UTI: a positive
urine culture and one or more of the factors
Classification of UTI (European association of urology, 2013)
Etiology
Pathogenesis
Pathogenesis
• Uncomplicated UTI
• In healthy woman uropathogen (typically E.colli) in rectal 
urethra  bladder
• In male, uropathogen come from sex partner vagina or rectum
• Complicated UTI
• Risk factors :obstruction or stasis of urine flow, facilitating entry
of uropathogens into the urinary tract by bypassing normal host
defense mechanisms, providing a nidus for infection that is not
readily treatable with antimicrobials, or compromising the host
immune system
• UTIs likely occurred in : indwelling cathteter, vesicoureteral reflux,
obstruction, neutropenia, and immune deficiency
Clinical symptoms of UTI
Clinical syndrome of UTI
• Acute uncomplicated cystitis in woman
• Acute onset of dysuria, frequency, urgency, or suprapubic pain.
• Acute dysuria in a young sexually active woman is usually caused by
acute cystitis;
• Pyuria  acute cystitis as well as in most women with urethritis
caused by N. gonorrhoeae or C. trachomatis, and its absence strongly
suggests an alternative diagnosis.
• Hematuria (microscopic or gross) is common in women with UTI but
not in women with urethritis or vaginitis.
• Recurent acute uncomplicated cystitis  persistence of the
initially infecting strain in the fecal flora
• Acute uncomplicated pyelonephritis in women
• Fever (temperature =38.5°C), chills, flank pain, nausea and vomiting,
and costovertebral angle tenderness.
• Cystitis is variably present
• Pyuria almost common
• Adults with acute cystitis and conditions that suggest occult renal or
prostatic involvement
• Symptoms, signs, and laboratory findings in this group are the same as
those in uncomplicated cystitis.
• Complicated UTI
• May present with classic signs of cystitis and pyelonephritis
• may also be associated with vague or nonspecific symptoms, such as
fatigue, irritability, nausea, headache, and abdominal or back pain.
• Signs and symptoms may exist for weeks to months before diagnosis.
• Complicated UTI associated with pyuria and bacteriuria
• Asymptomatic bacteriuria
• common and generally benign infection.
• Pyuria is often present, especially in elderly people, and is a predictor
for subsequent symptomatic UTI in some groups.
• Causative uropathogens are the same as those causing UTIs in the
same population
Diagnosis
• Urinalysis
• Urine culture  identification of bacteria is hallmark of UTI
• Laboratory : complete blood count, urea, creatinine, GFR,
electrolyte, procalcitonin
• Blood culture  if urosepsis suspected
• Imaging
• Ultrasound
• Computed tomography
• Urography
Treatment
Treatment
Treatment
Treatment
Thank you