UTI’s risk factors

Done by Anas Hindawi

 UTI’s risk factors
• Gender and Sexual Activity
• Pregnancy
• Obstruction
• Neurogenic Bladder Dysfunction
• Vesicoureteral Reflux
• Bacterial Virulence Factors
• Genetic Factors
 Gender and Sexual Activity
• The female urethra more prone to colonization because
of its proximity to the anus, its short length (~4 cm), and
its termination beneath the labia

• Spermicidal condoms or diaphragms

• Diabetes
• Prostatic hypertrophy and obstruction
• Heterosexual or homosexual activity
• lack of circumcision has been identified as a risk factor
for UTI
 Pregnancy
• UTI’s are detected in 2–8% of pregnant women

• Predisposition to upper tract infection during

pregnancy results from decreased ureteral tone,
decreased ureteral peristalsis, and temporary
incompetence of the vesicoureteral valves

• Bladder catheterization during or after delivery

causes additional infections
 Obstruction
• T ,S ,S ,PH

• Infection superimposed on urinary tract

obstruction may lead to rapid destruction of
renal tissue

• Intervention in such cases has to be immediate

and if surgical has to be much more carefully not
to administer an INFCTION
 Neurogenic Bladder Dysfunction
• Spinal cord injury
• Tabes dorsalis
• Multiple sclerosis
• Diabetes

• Catheter induced infection further alleviated

by abnormal bladder drainage and prolonged
stasis of urine
 Vesicoureteral Reflux
• DEF … …
• anatomically impaired vesicoureteral junction
facilitates reflux of bacteria and thus upper tract
infection

• Common in children
• Renal damage in this group of children seen to
be caused by ??!?!?!?! VUR rather than infection
 Bacterial Virulence Factors

• Most E. coli strains that cause symptomatic

UTIs in noncatheterized patients belong to a
small number of specific O, K, and H
serogroups
Bacterial adherence to uroepithelial cells is a critical
first step in the initiation of infection
 Genetic Factors

• The number and type of receptors on

uroepithelial cells to which bacteria may
attach are, at least in part, genetically
determined
 Clinical Presentation
• Localization of Infection

• Cystitis
• Acute Pyelonephritis
• Urethritis
• Catheter-Associated UTIs
• Prostatitis
 Localization of Infection

• Cystitis rarely cause fever

• Parenchymal infection is attributed as a main

cause for fever
 Cystitis
• Dysuria
• Frequency
• Urgency
• suprapubic pain

• The urine often becomes grossly cloudy and malodorous

and is bloody in ~30% of cases

• Fever > 38.3 Cs ,nausea ,vomiting are indicative for

concomitant renal infection
 Acute Pyelonephritis
• Symptoms generally develop rapidly over a few hours or a day and
include :

• Fever
• Shaking chills
• Nausea
• Vomiting
• Abdominal pain
• Diarrhea

• Symptoms of cystitis are sometimes present. Besides fever,

tachycardia, and generalized muscle tenderness
 Acute Pyelonephritis ctd.
• physical examination reveals marked tenderness on deep
pressure in one or both costovertebral angles or on deep
abdominal palpation

• significant leukocytosis
• Leukocyte casts

• Hematuria during the acute phase of the disease

• if it persists after acute manifestations of infection have
subsided, a stone, a tumor, or tuberculosis should be
considered.
 Urethritis
• Acute dysuria
• Frequency
• Pyuria

• ~30% have midstream urine cultures with either no growth or

insignificant bacterial growth

• Clinically, these women cannot always be readily distinguished from

those with cystitis

• It is useful to distinguish among sexually transmitted dis. UTI’s and E

coli induced UTI’s
 Catheter-Associated UTIs
• Factors associated with an increased risk of catheter-
associated UTI include :

• Female sex
• Prolonged catheterization
• Severe underlying illness
• Disconnection of the catheter and drainage tube

• other types of faulty catheter care, and lack of systemic

antimicrobial therapy
 Catheter-Associated UTIs ctd.
• Clinically cause minimal symptoms without
fever and often resolve after withdrawal of the
catheter

• The catheterized urinary tract has repeatedly

been shown to be the most common source of
gram-negative bacteremia in hospitalized
patients in ~30%
 Prostatitis

NGU, nongonococcal urethritis

 Upper versus lower UTI’s
• Usually, no alterations of acute phase reactants are found in patients with lower
UTI ,body temperature is below 38°C.

• Upper UTI causes elevation of C-reactive protein or leukocytosis and fever.

• Diagnostic procedures to accurately localize UTI are invasive and not without risk
(bladder and/or ureteral catheterization).

• A variety of non-invasive methods have been proposed to distinguish between

lower (urethra, bladder) and upper (kidney) UTI, particularly recent contributions
of renal nuclear medicine 

• Urinary NAG excretion was significantly higher in patients with upper than lower
UTI or healthy adults