URINARY TRACT INFECTIONS

Urinary Tract Infection
Definition

Multiplication of organisms in urinary tract and is associated with >10^5 organisms/ml in midstream sample of urine.

Etiology

Organisms – E.coli, Klebsiella, Proteus, Enterococcus, Pseudomonas aeuroginosa, Chlamydia trachomatis, N. gonorrhea.

Pathogenesis
  1. Ascending Infection Route – This is the most common route. The organism enter the bladder via the urethra and ascend towards the kidney. 
  2. Hematogenous and Lymphatic Pathways – Less common. The spread of the organism occur from the adjacent organs.

Females are more prone due to following reasons:-

  1. Short urethra – 4cm
  2. Absence of prostatic secretion
  3. Sexual intercourse may cause minor urethral trauma and transfer bacteria from perineum into bladder.
  4. Gram negative organisms residing near the anal region colonies the periurethral region.
But during the neonatal period, the incidence of UTI is slightly higher in males than females because infant more commonly have congenital urinary tract anomalies.

Risk Factors of UTI

  1. BPH
  2. Prostatic Cancer
  3. Urethral Stricture
  4. Calculi
  5. Posterior Urethral Valve
  6. Spina Bifida
  7. Tabes Dorsalis
  8. Diabetic Neuropathy
  9. Uterine Prolapse
  10. Urinary Catheter

Clinical Features
  1. Fever with chills and rigor
  2. Frequency
  3. Dysuria
  4. Urgency
  5. Hematuria
  6. Suprapubic Pain
  7. Strangury
  8. Loin pain, guarding and vomiting in case of acute pyelonephritis

Investigations
  1. Midstream urine sample collection for leukocytes, cast cells and red cells
  2. Dipstick Test – Nitrite and leukocyte esterase test
  3. Culture and sensitivity of urine
  4. Full blood count
  5. Urea and Creatinine
  6. Renal Ultrasound – To see obstruction
  7. Cystoscopy
  8. DMSA renal scan
  9. Micturating Cystourethrogram – To identify reflux

Treatment
  1. Fluid intake >2 L/day
  2. Regular complete bladder emptying
  3. Analgesic and antispasmodic agents
  4. Remove the catheter if symptomatic
  5. Maintain perineal hygiene
  6. Empty bladder before and after the intercourse
  7. Antibiotic – Trimethoprim (3 days), Nitrofurantoin (7 days) 
  8. If asymptomatic no need for treatment unless pregnancy, renal transplant or urological surgery.
  9. If complicated UTI then hospitalization and IV treatment needed.



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