1/23/2012 urinary tract infection by
manish kumar 1
NIMS University ,Jaipur ,Rajasthan
This
report is submitted in partial fulfilment of the requirement for the degree of
MSc in
[Microbiology]
2012
1/23/2012 urinary tract infection by
manish kumar 2
Attestation
I understand the
nature of plagiarism, and I am aware of the University’s policy on this.
I certify that
this dissertation reports original work by me during my University project .
Manish kumar
Signature Date-02/02/2012
1/23/2012 urinary tract infection by
manish kumar 3
Signed declaration
All sentences or passages quoted in this dissertation from other
people's work have been specifically acknowledged by clear cross-referencing to
author, work and page(s).
Any
illustrations which are not the work of the author of this dissertation have
been used with the explicit permission of the originator WHERE POSSIBLE and are
specifically acknowledged. I understand that failure to do this amounts to
plagiarism and will be considered grounds for failure in this dissertation and
the degree examination as a whole.
Name: MANISH KUMAR MEENA
Signature: manish kumar
Date: 02/02/2012
1/23/2012 urinary tract infection by
manish kumar 4
Contents
•
General Goal
•
Specific Educational Objectives
•
Etiology
•
Manifestations
•
Epidemiology
•
Pathogenesis
•
Diagnosis
•
Urinary Tract Infections in Adults
•
Therapy and Prevention-
• A. The
clinical manifestations determine the initial step in therapy.
• B. B.
General guidelines
• References
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General Goal
Know the major cause(s) of these diseases, how they are
transmitted, and the major manifestations of each disease.
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Specific Educational Objectives
The student should be able to:
1.
Recite the common cause(s) of these disease.
2.
Describe the common means of transmission.
3.
Describe the major manifestations of this infection.
4.
Describe how you diagnose, treat and prevent this infection.
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Etiology
UTI’s are defined as a significant bacteriuria in the presence of
symptoms. The bacteria most often seen in UTI’s are of fecal origin. These
organisms are a subset of the organisms found in the feces. Strict anaerobic
bacteria rarely cause UTI’s. More than 90% of
acute UTI’s in patients with normal anatomic
structure and function are caused by certain strains of E coli. Ten
to 20% of acute UTI’s are caused by
coagulase-negative Staphylococcus saprophyticus (young sexually
active females) and 5% or less are caused by other Enterobacteriaceae or
enterococci.
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In complicated cases of UTI, such as UTI's resulting from anatomic
obstructions, or from catheterization the most common causes of UTI are E.
coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus sp.,
Pseudomonas aeruginosa. In rare cases Candida albicans can
cause UTI (e.g., diabetic patients).
Staphylococcus saprophyticus is a common
inhabitant of the gastrointestinal tract.
Young women are more susceptible than other ages of women. Sexual intercourse
promotes colonization and infections are more common in the late summer to fall
seasons. S saprophyticus is the second most common cause of uncomplicated urinary tract infections (UTI) in sexually
active young (13-40 years of age) women following E coli.
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Causes of UTI's in
Outpatients
Inpatients
ALLPatients
(%) (%)
Escherichia coli
|
53-72
|
18-57
|
Coagulase
|
2-8
|
2-13
|
negative Staphylococcus
|
|
|
Klebsiella
|
6-12
|
6-15
|
Proteus
|
4-6
|
4-8
|
Morganella
|
3-4
|
5-6
|
Enterococcus
|
2-12
|
7-16
|
Staphylococcus
aureus
|
2
|
2-4
|
Staphylococcus
saprophyticus
|
0-2
|
0.4
|
Pseudomonas
|
0-4
|
1-11
|
Candida
|
3-8
|
2-26
|
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Manifestations
Urethritis - Most of the cases
of purulent urethritis without cystitis are
sexually transmitted and will be discussed later. The inflammation and
infection is limited to the urethra. It is usually a sexually transmitted
disease. Pathogens such as Chlamydia trachomatis , Neisseria
gonorrhoeae, Ureaplasma urealyticum or
Trichomonas
vaginalis are the common causes of urethritis. The disease is present in
men and women. Complaints include discomfort during voiding, but there
areusually no symptoms of postvoid suprapubic pain or urinary frequency.
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Cystitis - Results from an
irritation of the lower urinary tract mucosa. This infection as such is not
invasive. Frequently, one will see (symptoms 1-4 are sometimes called
irritative voiding symptoms.):
1. Dysuria (painful urination)
2. Urgency (the need to urinate without
delay)
3. Increased frequency of urination
4.
Suprapubic tenderness, pelvic discomfort especially pre- and
immediately postvoid. Occurs in 20% of women with uncomplicated UTI.
5. Small volume voiding.
6. Increased number of white blood cells in
the urine (pyuria)
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Hemorrhagic cystitis- is characterized by
large quantities of visible blood in the urine. It can
be caused by an infection (bacterial or adenovirus types 1-47) or as a result
of radiation, cancer chemotherapy, or immunosuppressive medication. Clinical
presentation usually depends on its origin. All causes result in irritative
voiding symptoms typically. When infectious in origin, signs and symptoms of
infection may also be encountered. Adenovirus is a common cause and is
self-limiting in nature. Hemorrhagic cystitis is often confused with
glomerulonephritis, but hypertension and abnormal renal function are absent in
hemorrhagic cystitis. Hemorrhagic cystitis may develop months after cessation
of radiation therapy.
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Pyelonephritis
- This
infection usually results from ascension of the bacteria to the kidney from the
lower urinary tract, but also can arise by hematogenous spread (e.g., from
lungs in patients with pneumonia). In contrast to cystitis, pyelonephritis is
an invasive disease. Blood cultures are positive in up to 20% of women who have
this infection. The patient will experience many of the symptoms of cystitis as
well as:
1. Suprapubic tenderness
2.
Urinary urgency and frequency may be present or absent.
3.
Fever
4.
Flank pain and tenderness (back pain)
5.
Costovertebral angle tenderness (CVA tenderness)
6.
Nausea and vomiting
7.
Peripheral leukocytosis
8.
Urine contains white blood cell casts- elongated structures composed
of cells that were tightly packed in the tubules and excreted in a
proteinaceous matrix.
Complications of pyelonephritis
can include:
1.
Sepsis
2.
Septic shock
3.
Death
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Epidemiology
•
UTI's rank second only to respiratory infections in their incidence in
the U.S. UTI’s account for over 6 million physician visits per year.
•
Males during the neonatal time of life are slightly more likely than
females to present with UTI’s and are oftentimes septic due to infection with
gram-negative bacteria (E coli).
•
The incidence in preschool children is approximately 2% and is 10
times more common in females.
•
About 5% of school-aged females experience UTI’s. These infections are
rare in school-aged males.
•
The large majority of the cases seen in the doctor's office are in
adult females (30:1, female:male ratio). Forty percent of all females have at
least one episode of a UTI at some time in their lives. Up to 20% of young
females with acute cystitis develop recurrent UTI's. Incidence of infection
increases with age and sexual activity.
•
Women generally don't have many problems with UTI's until they become
sexually active.
•
Postmenopausal women have higher rates of infection because of bladder
or uterine prolapse, loss of estrogen that causes a change in the vaginal
flora, loss of lactobacilli in the vaginal flora which results in periurethral
colonization with gram-negative aerobes (E coli) and higher likelihood of
concomitant medical illness (diabetes).
•
Males experience a rapid increase in the incidence UTI's sometime in
their 50’s. This is about the time that males are more likely to experience
benign prostatic hypertrophy (BPH).
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Risk factors that
increase a patient’s chances of getting a UTI include:
•Any abnormality of the urinary tract that obstructs or slows the flow
of urine makes it easier for bacteria to grow in the bladder. A stone in the
kidney or any part of the urinary tract can form such a blockage, creating the
conditions for a UTI. In men, an enlarged prostate gland can obstruct urine
flow and make infection difficult to treat. •One of the most common sources of
infection is catheters placed in the bladder. •People who have diabetes.
•Immunosuppressed patients.
•UTI's occur in a
small percentage of infants due to congenital abnormalities that sometimes
require surgery.
•For many women,
sexual intercourse seems to precipitate UTI's.
•Women who use the
diaphragm and spermicides are more likely to develop a UTI than women who use
other forms of contraception.
•Patients with a
neurogenic bladder or bladder diverticulum. •Postmenopausal women with bladder
or uterine prolapse •Pregnant women are more susceptible to UTI's.
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Pathogenesis
Entry is normally by ascent from
the urethra. The organisms that cause UTI’s are usually
fecal organisms. Blood borne infections are infrequent usually leading to
renal abscesses.
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Host
factors - Host factors
important in protection from cystitis include the normal flow of
urine and the constant sloughing of the epithelial cells lining the urinary
tract. The kidneys are protected due to the presence of the ureterovesical
valves that prevent reflux of urine from the bladder, and constant peristalsis
of the ureters.
The larger number
of UTI's seen in women is due to the much shorter urethra and the much closer
association of the urethra to the anus. Sexual intercourse contributes to the
increased number of UTI's seen in women. Celibate women have a lower frequency
of bacteriuria.
Some women have been shown to have a much higher
number of bacterial receptors on their uroepithelial cells leading to recurrent
UTI’s. Any anatomic obstruction or neurological disorder leading to failure to
completely eliminate urine from the bladder can lead to UTI. Men in their 50's
and above have problems with prostate gland enlargement resulting in
obstruction of the urethra followed by incomplete elimination of urine from the
bladder and UTI's.
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Bacterial factors - The ability of an organism to produce
fimbriae (Type 1, P, S, and Dr) is important in that
it enables the bacteria to attach to the uroepithelial cells and thereby avoid
elimination. Uropathogenic strains of E coli can also resist killing by
complement.
Human epithelial
cells of the bladder and the kidney can internalize E coli cells. The
Type 1 fimbriae are important in attachment of the bacteria to the host
epithelial cells and in promoting reorganization of the epithelial cell’s
intracellular cytoskeleton to then internalize the bacteria. Internalization of
the bacterial cells in epithelial cell vacuoles enhances bacterial cell
survival by providing protection from host immune defenses and allows the
pathogen greater access to deeper tissues. Once internalized the bacteria can
grow in the epithelial cell and form pod-like structures. Intracellular E
coli can form a reservoir within the bladder mucosa that may serve as a
source for recurrent acute infections (20% of all UTI’s).
The Type 1 fimbriae mediated internalization of E coli is
rather slow and the rate of internalization can be increased by 10 fold if the
bacteria have first been opsonized by complement component C3. Since
uropathogenic E coli are resistant to killing by complement they can
then use C3 to gain entry into the host epithelial cells. Not much complement
is in the urine in normal conditions. However, during infection LPS from E
coli may induce the production of cytokines in the kidney that then causes
increased amounts of C3 to gain entrance into the bladder. C3 binds to the
surface of the bacterial cells. This surface bound C3 then binds to human
complement regulatory protein, CD46, on the surface of the epithelial cell. The
CD46 protein then mediates internalization of E coli.
1/23/2012 urinary
tract infection by manish kumar 19
Spread
to the kidney - Infection of the kidney is due to ascent from the lower urinary tract and
so any factor leading to retrograde flow of the urine to the kidney will
predispose the host to pyelonephritis. Such factors include:
1.
Cystitis due to a strain of E coli that produces the mannose
resistant pili that binds to the receptor for the P blood group found on
epithelial cells and red blood cells.
2.
Internalization of E coli in the proximal tubular epithelial
cells of the kidney can also occur helping the bacteria avoid the immune
response of the host. C3 bound to the surface of E coli cells appears to
also be important in internalization of the bacteria in the kidney epithelial
cells.
3.
Reflux of urine to the kidney - usually due to incomplete development
of
ureterovesical
valves.
4.Physiological malfunctions - disorders leading to poor emptying of
the bladder. Changes during pregnancy leading to dilatation and decreased
peristalsis of the ureters.
5. Urethral
catheters - can serve as a conduit for the bacteria to ascend into the bladder
and a source of bacteria for persistent infection.
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6. Urinary tract stones - These
stones serve as a place in which bacteria can escape antibiotics and cause
further infections. Proteus sp. is an example of an organism, which can
cause stone formation. Proteus sp. produce an enzyme called urease that
splits urea to ammonia and carbon dioxide. This raises the pH of the urine and
facilitates the formation of "struvite" calculi. A high pH in the urine is indicative of a Proteus infection.
Kidney damage is due to the ability of the organism to produce
polysaccharide
(which inhibits
phagocytosis), alpha hemolysin and cytotoxic necrotizing factor 1
(causes tissue
damage directly), endotoxin that contributes to inflammation and damage of
renal parenchyma and internalization of the bacterial cells in kidney
epithelial cells.
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Diagnosis
The diagnosis of UTI was based on a quantitative
urine culture yielding greater than 100,000 colony-forming units (105 CFU) per
milliliter of urine, which was termed "significant bacteriuria." This
value was chosen because of its high specificity for the diagnosis of true
infection, even in asymptomatic persons. However, several studies have
established that 30% or more of symptomatic women have CFU counts below this level
(low-coliform-count
infections). They have also shown that a bacterial count of 100 CFU/ml of urine
has a high positive predictive value for cystitis in symptomatic women.
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Since very few organisms cause UTI in acute uncomplicated cystitis in
young women and since their antibiotic sensitivity is relatively predictable,
urine cultures and susceptibility testing add little to the choice of
antibiotic. Therefore, urine cultures are no longer advocated as part of the
routine work-up of these patients. Instead, these patients should undergo an
abbreviated laboratory work-up in which the presence of pyuria is confirmed by
traditional urinalysis (wet mount examination of spun urine), the cell-counting
chamber technique (looking for more than 8 white blood cells per mm3) or a
dipstick test for leukocyte esterase. A positive leukocyte esterase test has a
reported sensitivity of 75 to 90% in detecting pyuria associated with a UTI.
Gram stains of
urine can be used to detect bacteriuria. In this semiquantitative test, one
organism per oil immersion field correlates with 100,000 CFU/ml by culture.
Because the procedure is time-consuming and has low sensitivity, it is not
routinely performed in most clinical laboratories unless it is specifically
requested.
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In today's office practice, the dipstick test for nitrite is used as a
surrogate marker for bacteriuria. It should be noted that not all uropathogens
reduce nitrates to nitrite. For example, Enterococcus, S
saprophyticus and
Acinetobacter species do not and therefore give false-negative results.
1/23/2012 urinary tract infection by
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M1
Urinary Tract Infections in Adults
Category
|
Diagnostic
|
Principal
|
First-line
|
Comments
|
|
criteria
|
pathogens
|
therapy
|
|
|
|
|
|
|
Acute
|
Positive urinalysis
|
Escherichia coli
|
TMP-SMX DS
|
Three-day course is
|
uncomplicated**
|
for pyuria or
|
Staphylococcus
|
(Bactrim, Septra)
|
best.
|
cystitis- women
|
bacteriuria (culture
|
saprophyticus
|
Trimethoprim
|
Quinolones may be
|
|
not required)
|
Proteus mirabilis
|
(Proloprim)
|
used in areas of
|
|
|
Klebsiella
|
Ciprofloxacin
|
TMP-SMX
|
|
|
pneumoniae
|
(Cipro)
|
resistance or in
|
|
|
|
Ofloxacin (Floxin)
|
patients who
|
|
|
|
|
cannot tolerate
|
|
|
|
|
TMP-SMX.
|
|
|
|
|
|
Acute cystitis in
|
Urine culture
|
Same as for
|
Same as for
|
Treat for seven
|
young men
|
with a bacterial
|
acute
|
acute
|
to 10 days.
|
|
count of 1,000
|
uncomplicated
|
uncomplicated
|
|
|
to 10,000 CFU
|
cystitis
|
cystitis.
|
|
|
per mL of urine
|
|
|
|
1/23/2012
|
urinary tract infection
by manish kumar
|
25
|
SLIDE 25
M1 MANISH, 1/22/2012
Acute
|
Urine culture
|
Same as for
|
If gram-neg
|
Switch from
|
uncomplicate
|
with a
|
acute
|
organism,
|
IV to oral
|
d
|
bacterial
|
uncomplicate
|
oral
|
administratio
|
pyelonephriti
|
count of
|
d cystitis
|
fluoroquinolo
|
n when the
|
s
|
10,000 CFU
|
|
ne.
|
patient is
|
|
per mL of
|
|
If gram-pos
|
able to take
|
|
urine
|
|
organism,
|
medication
|
|
|
|
amoxicillin.
|
by mouth;
|
|
|
|
If parenteral
|
complete a
|
|
|
|
administratio
|
14-day
|
|
|
|
n is required,
|
course
|
|
|
|
ceftriaxone
|
|
|
|
|
(Rocephin) or
|
|
|
|
|
a
|
|
|
|
|
fluoroquinolo
|
|
|
|
|
ne.
|
|
|
|
|
If Enterococc
|
|
|
|
|
us species,
|
|
|
|
|
add oral or IV
|
|
|
|
|
amoxicillin
|
|
|
|
|
|
|
1/23/2012 urinary tract infection by
manish kumar 26
Complicated UTI
|
Urine culture
|
Escherichia coli
|
Gram-negative
|
Treat for 10-14
|
(women and
|
with a bacterial
|
Klebsiella
|
organism, oral
|
days
|
men)
|
count of 10,000
|
pneumoniae
|
fluoroquinolone
|
|
|
CFU per mL of
|
Proteus mirabilis
|
Enterococcus sp
|
|
|
urine
|
Pseudomonas
|
ecies, ampicillin
|
|
|
|
aeruginosa
|
or amoxicillin
|
|
|
|
Enterococcus sp
|
with or without
|
|
|
|
ecies
|
gentamicin
|
|
|
|
Frequently
|
(Garamycin)
|
|
|
|
multi-drug
|
|
|
|
|
resistant
|
|
|
|
|
organisms are
|
|
|
|
|
present
|
|
|
|
|
|
|
|
Asymptomatic
|
Urine culture
|
Same as for
|
Amoxicillin
|
Avoid
|
bacteriuria in
|
with a bacterial
|
acute
|
Nitrofurantoin
|
tetracyclines
|
pregnancy
|
count of more
|
uncomplicated
|
(Macrodantin)
|
and
|
|
than 10,000 CFU
|
cystitis
|
Cephalexin
|
fluoroquinolone
|
|
per mL of urine
|
|
(Keflex)
|
s.
|
|
|
|
|
Treat for three
|
|
|
|
|
to seven days
|
|
|
|
|
|
1/23/2012 urinary tract infection by
manish kumar 27
Catheter-
|
Symptoms and a
|
Escherichia
|
Gram-negative
|
Remove the
|
associated
|
urine culture
|
coli Proteus,Pseu
|
organism, a
|
catheter if
|
urinary tract
|
with a bacterial
|
domonas,Entero
|
fluoroquinolone
|
possible, and
|
infection
|
count of more
|
bacter, Serratia,E
|
Gram-positive
|
treat for seven to
|
|
than 100 CFU per
|
nterococcus, Can
|
organism,
|
10 days
|
|
mL of urine
|
didaspecies.
|
ampicillin or
|
Patients with
|
|
|
Oftentimes is
|
amoxicillin plus
|
long-term
|
|
|
polymicrobic in
|
gentamicin
|
catheters and
|
|
|
long-term
|
Candida- remove
|
symptoms, treat
|
|
|
indwelling
|
catheter and no
|
for five to seven
|
|
|
catheter patients.
|
treatment
|
days
|
|
|
|
needed if the
|
|
|
|
|
patient is not
|
|
|
|
|
high risk (high-
|
|
|
|
|
risk= neonates
|
|
|
|
|
and neutropenic
|
|
|
|
|
patitents) If
|
|
|
|
|
catheter cannot
|
|
|
|
|
be removed or
|
|
|
|
|
the patient is
|
|
|
|
|
high risk treat
|
|
|
|
|
with Fluconazole
|
|
|
|
|
for 14 days
|
|
1/23/2012
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urinary
|
tract infection by manish
|
kumar
|
28
|
|
|
|
|
|
TMP-SMX=trimethoprim-sulfamethoxazole;
CFU=colony-forming unit; IV=intravenous.
*--Patient is given
a prescription for an antibiotic to take if symptoms develop.
**--Complicated UTI- UTI's that occur due to anatomic, functional or
pharmacologic factors and predispose patients to persistent infection,
recurrent infection or treatment failure (e.g., anatomic= benign prostate
hypertrophy in older males).
Information from Stamm WE, Hooton TM.
Management of urinary tract
infections in adults. N Engl J Med
1993;329:1328-34.
1/23/2012 urinary tract infection by
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If culture of the
urine is required it must be preformed using a mid-stream catch (clean catch
specimen). If the patient can't or won't comply, use percutaneous bladder
aspiration or ureter catheterization. Bacteria grow rapidly in urine therefore
urine samples should be processed immediately or refrigerated. Cultures
refrigerated for more than 2 hours are usually of no value in making the
diagnosis.
Diagnosis should also involve the determination
of the site of infection (i.e., kidney or bladder-urethra). This may be
suggested by the clinical manifestations and preliminary lab tests.
1/23/2012 urinary tract infection by
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There are a number
of tests that may help in establishing the site(s) of infection.
1.
An antibody-coated bacterium in urine test is based upon the principal
that bacteria originating in the kidney are coated with specific antibody
(detect by fluorescent microscopy following staining with FITC-conjugated, goat
anti-human gamma globulin) but those bacteria originating from the bladder are
not coated with antibodies. Not always reliable.
2.
Presence of white blood cell casts indicates the patient has
pyelonephritis.
3.
Ureteral catheterization under cystoscopic visualization to culture
urine directly obtained from each kidney.
If a patient is experiencing recurrent UTI's, the causative organism
should be identified by urine culture and then documented to help differentiate
between relapse (infection with the same organism) and recurrence (infection
with different organisms). Multiple infections caused by the same organism are,
by definition, complicated UTIs and require longer courses of antibiotics
(e.g., 7 to 10 days) and possibly further diagnostic tests.
1/23/2012 urinary tract infection by
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Between 10 and 20% of patients who are hospitalized receive an
indwelling Foley catheter. Once this catheter is in place, the risk of
bacteriuria is approximately 5% per day. With long-term catheterization,
bacteriuria is inevitable. Catheter-associated urinary tract infections account
for 40% of all nosocomial infections and are the most common source of
gram-negative bacteremia in hospitalized patients.
Asymptomatic
bacteriuria is defined as the presence of more than 10,000 CFU/ml of voided
urine in persons with no symptoms of urinary tract infection. The largest
patient population at risk for asymptomatic bacteriuria is the elderly. Up to
40% of elderly men and women may have bacteriuria without symptoms.
Aggressively screening elderly persons for asymptomatic bacteriuria and
subsequent treatment of the infection has NOT been found to reduce either
infectious complications or mortality. Consequently, this approach currently is
not recommended.
1/23/2012 urinary tract infection by
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Three groups of
patients with asymptomatic bacteriuria have been shown to benefit from
treatment:
• Pregnant women-
Between 2 and 10% of pregnancies are complicated by UTI’s. If left untreated,
25 to 30% of these women develop pyelonephritis. Pregnancies that are
complicated by pyelonephritis have been associated with low-birth-weight
infants and prematurity. Thus, pregnant women should be screened for
bacteriuria by urine culture at 12 to 16 weeks of gestation. The presence of
10,000 CFU of bacteria per mL of urine is considered significant.
•
Patients with renal transplants
•Patients who are
about to undergo genitourinary tract procedures.
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Therapy and Prevention
A.
The clinical manifestations determine the initial step
in therapy.
Afebrile patients experiencing symptoms of lower UTI are treated on an
outpatient basis.
Patients experiencing high fever, shaking chills and flank pain, in
addition to symptoms of lower UTI, may need to be hospitalized.
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B.
General guidelines
·Uncomplicated
symptomatic acute cystitis and/or urethritis are usually treated for three days
with trimethoprim-sulfamethoxazole (TMP-SMX), norfloxacin, or ciprofloxacin.
·Pyelonephritis
is more difficult to cure than urethritis-cystitis and reoccurrence due to
relapse (i.e., treatment failure) or reinfection is more common.
•
Three day
therapy is inappropriate.
•
Give intravenous antibiotics until 24 hr after the fever breaks, and
then give oral antibiotic for a total treatment time of 14 days.
• Oral 14-day therapy
can be considered in women with mild to moderate symptoms that are compliant
with therapy and can tolerate oral antibiotics but do not have other
significant conditions, including pregnancy and gastrointestinal upset.
•
Do bacteriologic culturing as a follow-up to insure treatment success.
•
Candida and torulopsis yeast infections of the urinary tract are treated with
flucytosine.
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Underlying
uropathies requiring surgical correction are much more common, particularly in
males with pyelonephritis, so a more extensive workup is required to prevent
reoccurrence.
1.
A seven-day course should be considered in pregnant women, diabetic
women and women who have had symptoms for more than one week and thus are at
higher risk for pyelonephritis because of the delay in treatment.
2.
Women who have more than three UTI recurrences documented by urine
culture within one year can be managed using one of three preventive
strategies:
•
Acute
self-treatment with a three-day course of standard therapy.
•
Postcoital prophylaxis with one-half of a
trimethoprim-sulfamethoxazole double-strength tablet (40/200mg) if the UTIs
have been clearly related to intercourse.
• Continuous daily
prophylaxis with one of these regimens for a period of six months: trimethoprim-sulfamethoxazole,
one-half tablet per day (40/200 mg); nitrofurantoin, 50 to 100 mg per day;
norfloxacin, 200 mg per day; cephalexin (Keflex), 250 mg per day; or
trimethoprim, 100 mg per day.
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Long-term studies have shown antibiotic prophylaxis to be effective
for up to five years with trimethoprim, trimethoprim-sulfamethoxazole or
nitrofurantoin, without the emergence of drug resistance. Antibiotic
prophylaxis does not appear to alter the natural history of recurrences since
40 to 60% of these women reestablish their pattern or frequency of UTI's within
six months of stopping prophylaxis.
3. Complicated
UTI's occur in patients due to anatomic, functional or pharmacologic factors
that predispose the patient to persistent infection, recurrent infection or
treatment failure. These factors include conditions frequently seen in elderly
men, such as enlargement of the prostate gland, blockages and other problems
necessitating the placement of indwelling urinary devices, and the presence of
bacteria that are resistant to multiple antibiotics. Even though
antibiotic-susceptible E coli strains cause more than 80% of
uncomplicated UTI's, it accounts for less than 33% of complicated cases.
Clinically, the spectrum of complicated UTI's may range from cystitis to
urosepsis with septic shock.
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If the patient has
urinary tract infections urge them to:
•
Maintain a high fluid intake to be sure you have good urine output-at
least one to two quarts of fluid in 24 hours.
•
Drink cranberry juice. It may be helpful. Tannins in the juice appear
to prevent binding of the bacteria to the uroepithelial cell surfaces. Recent
•
Empty their bladder as soon as they feel the urge to urinate, even if
it does not feel full.
•
Avoid foods that may irritate the bladder, such as spicy foods,
alcohol, or beverages containing caffeine.
•
Take medications prescribed by the doctor exactly as instructed, and
be sure to take all of the medication prescribed.
•
Call the doctor or clinic if signs and symptoms of your infection do
not subside after two or three days.
A large number of pregnant women develop asymptomatic bacteriuria. Up
to 30% of pregnant women with asymptomatic bacteriuria will develop acute
pyelonephritis if not treated. Asymptomatic bacteriuria may also have a role in
preterm birth, or it may be a marker for low socioeconomic status and thus, low
birthweight. Drug treatment of asymptomatic bacteriuria in pregnant women
substantially decreases the risk of pyelonephritis. Urine samples should be
obtained periodically from pregnant women
to determine if they have bacteriuria.
1/23/2012 urinary
tract infection by manish kumar 38
Long-term low dose
antibiotic treatment may be necessary in women with frequent reinfections to
prevent future UTI’s.
Sexually active women with recurrent UTI’s can prevent recurrences by
not using spermicide-containing contraceptives and taking a prophylactic
antimicrobial agent around the time of intercourse. Postmenopausal women with
recurrent UTI’s can prevent recurrences by taking oral or vaginal estrogen
which will shift the vaginal flora from uropathogens to Lactobacillus
and will lower the vaginal pH and protect them from an ascending infection.
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References
Theses/Dissertations
Hatzis, A. (1999) Optical Logo-Therapy (OLT): Computer-Based
Audio-Visual Feedback Using Interactive Visual Displays for Speech Training.
PhD, University of Sheffield.
Online Journal Articles
Crave, T.C. (1998) Human creation of abstracts with selected computer
assistance tools. Information Research [Online], 4(3), 46 paragraphs.
Available:
http://www.shef.ac.uk/~is/publications/infres/paper47.html [25/8/1999]
Web References
Note that where an author name or date are not
known, then the citation in the main text should take the form of a tag which
clearly identifies the correct reference in the bibliography, e.g. for a
World-Wide Web reference for which the author(s) is not known, the citation
could take the following form (WWWn) where n are consecutive numbers.
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