|Urinary Tract Infection|
Multiplication of organisms in urinary tract and is associated with >10^5 organisms/ml in midstream sample of urine.
Organisms – E.coli, Klebsiella, Proteus, Enterococcus, Pseudomonas aeuroginosa, Chlamydia trachomatis, N. gonorrhea.
- Ascending Infection Route – This is the most common route. The organism enter the bladder via the urethra and ascend towards the kidney.
- Hematogenous and Lymphatic Pathways – Less common. The spread of the organism occur from the adjacent organs.
Females are more prone due to following reasons:-
- Short urethra – 4cm
- Absence of prostatic secretion
- Sexual intercourse may cause minor urethral trauma and transfer bacteria from perineum into bladder.
- Gram negative organisms residing near the anal region colonies the periurethral region.
Risk Factors of UTI
- Prostatic Cancer
- Urethral Stricture
- Posterior Urethral Valve
- Spina Bifida
- Tabes Dorsalis
- Diabetic Neuropathy
- Uterine Prolapse
- Urinary Catheter
- Fever with chills and rigor
- Suprapubic Pain
- Loin pain, guarding and vomiting in case of acute pyelonephritis
- Midstream urine sample collection for leukocytes, cast cells and red cells
- Dipstick Test – Nitrite and leukocyte esterase test
- Culture and sensitivity of urine
- Full blood count
- Urea and Creatinine
- Renal Ultrasound – To see obstruction
- DMSA renal scan
- Micturating Cystourethrogram – To identify reflux
- Fluid intake >2 L/day
- Regular complete bladder emptying
- Analgesic and antispasmodic agents
- Remove the catheter if symptomatic
- Maintain perineal hygiene
- Empty bladder before and after the intercourse
- Antibiotic – Trimethoprim (3 days), Nitrofurantoin (7 days)
- If asymptomatic no need for treatment unless pregnancy, renal transplant or urological surgery.
- If complicated UTI then hospitalization and IV treatment needed.