Presentation is loading. Please wait.

Presentation is loading. Please wait.

URINARY TRACT INFECTIONS URINARY TRACT INFECTIONS By By Dr Dave Maharajh MD Dr Dave Maharajh MD.

Similar presentations


Presentation on theme: "URINARY TRACT INFECTIONS URINARY TRACT INFECTIONS By By Dr Dave Maharajh MD Dr Dave Maharajh MD."— Presentation transcript:

1 URINARY TRACT INFECTIONS URINARY TRACT INFECTIONS By By Dr Dave Maharajh MD Dr Dave Maharajh MD

2 Bacteria Preparing to Attack Bacteria Preparing to Attack

3 URINARY TRACT INFECTIONS MISURY

4 MISURY MISURY

5

6

7 PREGNANCY PREGNANCY

8 CLASSIFICATIONS CLASSIFICATIONS UPPER URINARY TRACT UPPER URINARY TRACT Complicated and Uncomplicated Complicated and Uncomplicated LOWER URINARY TRACT LOWER URINARY TRACT Complicated and Uncomplicated Complicated and Uncomplicated COMBINED UPPER AND LOWER TRACTS COMBINED UPPER AND LOWER TRACTS Complicated and Uncomplicated Complicated and Uncomplicated

9 Epidiemiology Epidiemiology Adults: F>M 18-60 yrs (11%/yr) Adults: F>M 18-60 yrs (11%/yr) Children: F>M 5-Puberty Children: F>M 5-Puberty Approx. 50-60% of Adult Women report a urinary tract infection during lifetime Approx. 50-60% of Adult Women report a urinary tract infection during lifetime Adult Female: 3UTI/yr. > refer and inv. Adult Female: 3UTI/yr. > refer and inv. Adult Male: 1 infection. Refer and inv. Adult Male: 1 infection. Refer and inv. Children: M(1) and F(>3 refer and inv.) Children: M(1) and F(>3 refer and inv.) Children: F>M except neonates M except neonates < 5yrs refer

10 WHEN LENGTH MATTERS WHEN LENGTH MATTERS

11 MECHANISMS OF ACTION MECHANISMS OF ACTION Direct Contamination:invasive procedures Direct Contamination:invasive procedures Migration Migration Hematogenous ( TB and Staph. ) Hematogenous ( TB and Staph. ) Ascending Infection Ascending Infection Foreign Bodies ( Catheters and others) Foreign Bodies ( Catheters and others) Coexisting Conditions Coexisting Conditions Fistulas, Crohn’s/UC, Diverticular disease Fistulas, Crohn’s/UC, Diverticular disease IBS, DM, Neurogenic bladder, Calculi. IBS, DM, Neurogenic bladder, Calculi. Immunosuppression, Immunosuppression, Nonsecretors of blood group substances (Toll-like receptors (TLR-1 and TLR-4> Chemokines CXCL8 Nonsecretors of blood group substances (Toll-like receptors (TLR-1 and TLR-4> Chemokines CXCL8

12 URINARY TRACT INFECTIONS CLINICAL VARIATIONS Asymptomatic Bacteruria Septic Shock Trivial Voiding Irritation

13 Clinical Symptoms Clinical Symptoms Upper Tract: Upper Tract: Flank Pain, Fever, Chills, nausea/vomitting Flank Pain, Fever, Chills, nausea/vomitting Lower Tract: Lower Tract: Frequency, Urgency, Dysuria, Hematuria, Odour, Cloudy urine, Suprapubic pain, Sense of incomplete emptying. Frequency, Urgency, Dysuria, Hematuria, Odour, Cloudy urine, Suprapubic pain, Sense of incomplete emptying. Constitutional symptoms: Malaiase, lack of energy and appetitite, confusion. Constitutional symptoms: Malaiase, lack of energy and appetitite, confusion.

14 DIFFERENTIAL DIAGNOSIS DIFFERENTIAL DIAGNOSIS Vulvovaginitis ( Yeast, Trichomonas etc) Vulvovaginitis ( Yeast, Trichomonas etc) Urethritis ( Chlamydia, GC) Urethritis ( Chlamydia, GC) STD’s STD’s Sterile Pyuria Sterile Pyuria Postmenopausal atrophic vaginitis Postmenopausal atrophic vaginitis

15 LABORATORY INVESTIGATIONS Urinalysis: Urinalysis: Urine dipstick Urine dipstick MSU MSU Urine Culture and Sensitivity Urine Culture and Sensitivity Catheterized urine Catheterized urine Suprapubic aspirate Suprapubic aspirate Nephrostomy tube collection Nephrostomy tube collection

16 DIAGNOSTICS DIAGNOSTICS Urine dipstick: RBC/ WBC and Nitrites Urine dipstick: RBC/ WBC and Nitrites Usually detects >10/`5 colony/ml Usually detects >10/`5 colony/ml Beware of sterile pyuria, age of sticks Beware of sterile pyuria, age of sticks Evaluate with clinical scenario Evaluate with clinical scenario Must do MSU or centrifuged urine Must do MSU or centrifuged urine Treat and await culture/sensitivity Treat and await culture/sensitivity Repeat MSU not dipstick after Rx. Repeat MSU not dipstick after Rx.

17 DIAGNOSTICS DIAGNOSTICS MSU: MSU: Colony count > 10`5 or 10`8 Colony count > 10`5 or 10`8 Culture and Sensitivity to follow Culture and Sensitivity to follow Contamination (Multiple bact. Identified) Contamination (Multiple bact. Identified) Fungi and Chlamydia need different media, suspect if neg. culture and symptomatic Fungi and Chlamydia need different media, suspect if neg. culture and symptomatic

18 Diagnostics Diagnostics Radiological Investigations: Radiological Investigations: Ultrasound ( Kidney and Bladder) Ultrasound ( Kidney and Bladder) CT Scan ( Abd/Pelvis) CT Scan ( Abd/Pelvis) VCUG VCUG MRI MRI Non Radiological: Non Radiological: Cystoscopy Cystoscopy Urodynamics and Uroflow Urodynamics and Uroflow

19 ORGANISMS COMMONLY FOUND E. Coli >70% E. Coli >70% Klebsiella Pneumoniae Klebsiella Pneumoniae Proteus Mirabilis Proteus Mirabilis Enterococcus Fecalis Enterococcus Fecalis Staphylococcus Saprophyticus Staphylococcus Saprophyticus Enterobactae Enterobactae

20 URINARY TRACT INFECTIONS Non Antimicrobial Therapies Personal Hygiene Personal Hygiene Avoid Bubble Baths and Hot Tubs Avoid Bubble Baths and Hot Tubs Beware of Spermicide Use Beware of Spermicide Use Cranberry Juice Cranberry Juice Increased daily Fluid Intakes Increased daily Fluid Intakes Development of a Vaccine Development of a Vaccine

21 Strategies to Prevent UTI Strategies to Prevent UTI Simple measures Simple measures Increase Fluid intake Increase Fluid intake Void before and after intercourse Void before and after intercourse Personal Hygiene (wipe front to back) Personal Hygiene (wipe front to back) Avoid feminine hygiene sprays Avoid feminine hygiene sprays Take showers instead of baths Take showers instead of baths Cranberries / Juice Cranberries / Juice Assess voiding pattern Assess voiding pattern Cranberries Cranberries

22 TREATMENT Uncomplicated UTI TREATMENT Uncomplicated UTI Young Woman first episode Young Woman first episode Single dose Single dose Young Male first episode Young Male first episode Treat, investigate and refer Treat, investigate and refer TMP-SMZ TMP-SMZ 320/1600mg, 2 double strength tabs 320/1600mg, 2 double strength tabs Amoxicillin 3gm Amoxicillin 3gm Cephaloridine 2gm Cephaloridine 2gm Gentamycin 5mg/kg Gentamycin 5mg/kg Doxycycline 300mg Doxycycline 300mg Quinolones Quinolones

23 TREATMENT Uncomplicated UTI TREATMENT Uncomplicated UTI Young woman first episode Young woman first episode Short course 3-5days Short course 3-5days 10-14 days 10-14 days Treat according to sensitivity Treat according to sensitivity Repeat urine culture after treatment Repeat urine culture after treatment TMP-SMZ TMP-SMZ Nitrofurantoin/ Macrobid Nitrofurantoin/ Macrobid Ciprofloxacin Ciprofloxacin Noroxin Noroxin Amoxil Amoxil Quinolones Quinolones

24 TREATMENT COMPLICATED UTI TREATMENT COMPLICATED UTI Specific Pharmacotherapy Specific Pharmacotherapy Investigate with Radiology Investigate with Radiology Refer to appropriate specialty Refer to appropriate specialty Consider low dose prophylaxis while awaiting referral and diagnostics Consider low dose prophylaxis while awaiting referral and diagnostics Admit patient if not responding to treatment and refer Admit patient if not responding to treatment and refer

25 Common Scenarios Common Scenarios Young female with recurrent UTI and relapses after treatments >3 Young female with recurrent UTI and relapses after treatments >3 Simple measures as discussed Simple measures as discussed Do U/S kidney and bladder with PVR Do U/S kidney and bladder with PVR May need VCUG May need VCUG Refer to Specialty Refer to Specialty Consider low dose prophylaxis Consider low dose prophylaxis

26 COMMON SCENARIOS COMMON SCENARIOS Young Females (Pediatric age group) Young Females (Pediatric age group) Avoid excessive baths Avoid excessive baths Treat and eliminate constipation Treat and eliminate constipation Encourage frequent voids Encourage frequent voids Proper Potty Training Proper Potty Training Proper Genital Hygeine Proper Genital Hygeine Recurrent UTI (Investigate and refer) Recurrent UTI (Investigate and refer) U/S, VCUG U/S, VCUG

27 Common Scenarios Common Scenarios Postmenopausal woman with recurrent UTI. Postmenopausal woman with recurrent UTI. Simple measures as discussed Simple measures as discussed Treat constipation and avoid baths Treat constipation and avoid baths Use Premarin/ estrogen cream locally Use Premarin/ estrogen cream locally Consider low dose prophylaxis Consider low dose prophylaxis Do U/S kidney and Bladder with PVR Do U/S kidney and Bladder with PVR Refer to Specialty Refer to Specialty

28 Common Scenarios Common Scenarios Chronic indwelling catheters Chronic indwelling catheters No need for Rx. Unless symptomatic No need for Rx. Unless symptomatic Change catheter every 4-6 weeks Change catheter every 4-6 weeks Use of Silastic catheters less infection Use of Silastic catheters less infection Local hygiene to the catheter and Urethral meatus helpful Local hygiene to the catheter and Urethral meatus helpful Irrigation of the Catheter helpful in certain situations. ( Mucus production and sediments) Irrigation of the Catheter helpful in certain situations. ( Mucus production and sediments)

29 Common Scenarios Common Scenarios Pregnancy Pregnancy Treat all Asymptomatic Bacteruria with the appropriate antibiotic for trimester of Pregnancy Treat all Asymptomatic Bacteruria with the appropriate antibiotic for trimester of Pregnancy Always do and U/S Kidney and bladder with PVR Always do and U/S Kidney and bladder with PVR Refer to specialty if needed Refer to specialty if needed

30 Common Scenarios Common Scenarios Young and Old Males Young and Old Males Treat with appropriate antibiotics Treat with appropriate antibiotics Always do diagnostic Imaging (U/S or CT) Always do diagnostic Imaging (U/S or CT) Examine Genitalia and Prostate Examine Genitalia and Prostate Refer to Specialty Refer to Specialty

31 Common Scenarios Common Scenarios Patients with Neurogenic Bladders Patients with Neurogenic Bladders Do appropriate Imaging Do appropriate Imaging Personal Hygiene Personal Hygiene Techniques of Clean Intermittent Catherizations) Techniques of Clean Intermittent Catherizations) Treat with culture sensitive antibiotics Treat with culture sensitive antibiotics Refer to Specialty as needed Refer to Specialty as needed Beware Autonomic dysreflexia Beware Autonomic dysreflexia

32 References References Update in Adult Urinary Tract Infection Update in Adult Urinary Tract Infection Lindsay Nicolle Curr. Infect. Dis.Rep Lindsay Nicolle Curr. Infect. Dis.Rep (2011) 13:552-560 (2011) 13:552-560 Dept. Of Internal Medicine and Medical Microbiology. U. Of Manitoba Dept. Of Internal Medicine and Medical Microbiology. U. Of Manitoba An Update on Uncomplictaed UTI in Women An Update on Uncomplictaed UTI in Women Current Opinion in Urology 2009 19:368-374 Florian. M. Wagenlehner Current Opinion in Urology 2009 19:368-374 Florian. M. Wagenlehner

33 Urinary Tract Infections Urinary Tract Infections QUESTIONS QUESTIONS

34 Structural and functional abnormalities of the genitourinary tract associated with complicated urinary infection Structural and functional abnormalities of the genitourinary tract associated with complicated urinary infection ObstructionUreteric or urethral stricturesTumours of the urinary tractUrolithiasisProstatic hypertrophyDiverticulaePelvicalyceal obstructionRenal cystsCongenital abnormalitiesInstrumentationIndwelling urethral catheterIntermittent catheterizationUreteric stentNephrostomy tubeUrological proceduresImpaired voidingNeurogenic bladderCystoceleVesicoureteral refluxIleal conduitMetabolic abnormalitiesNephrocalcinosisMedullary sponge kidneyRenal failureImmunocompromisedRenal transplant ObstructionUreteric or urethral stricturesTumours of the urinary tractUrolithiasisProstatic hypertrophyDiverticulaePelvicalyceal obstructionRenal cystsCongenital abnormalitiesInstrumentationIndwelling urethral catheterIntermittent catheterizationUreteric stentNephrostomy tubeUrological proceduresImpaired voidingNeurogenic bladderCystoceleVesicoureteral refluxIleal conduitMetabolic abnormalitiesNephrocalcinosisMedullary sponge kidneyRenal failureImmunocompromisedRenal transplant

35

36 The diagnosis of symptomatic urinary tract infection in patients without indwelling urological devices should be considered only when localizing genitourinary signs or symptoms are present (AII). The diagnosis of symptomatic urinary tract infection in patients without indwelling urological devices should be considered only when localizing genitourinary signs or symptoms are present (AII). For patients with indwelling urological devices, systemic symptoms, such as fever in the absence of localizing genitourinary signs and symptoms, may be consistent with symptomatic urinary tract infection (AII). For patients with indwelling urological devices, systemic symptoms, such as fever in the absence of localizing genitourinary signs and symptoms, may be consistent with symptomatic urinary tract infection (AII). A urine specimen should be obtained for culture and susceptibility testing before institution of antimicrobial therapy for every episode of complicated urinary tract infection (AI). A urine specimen should be obtained for culture and susceptibility testing before institution of antimicrobial therapy for every episode of complicated urinary tract infection (AI). –A single urine specimen with a quantitative count of at least 108 cfu/L (at least 105 cfu/mL) is consistent with urinary infection in symptomatic subjects (AII). –A quantitative count of at least 108 cfu/L (at least 105 cfu/mL) on two consecutive specimens is the appropriate diagnostic criteria to identify asymptomatic bacteriuria in women (BII). –Any quantitative count of organisms is consistent with bacteriuria for individuals with urine specimens obtained by bladder catheterization (AII).


Download ppt "URINARY TRACT INFECTIONS URINARY TRACT INFECTIONS By By Dr Dave Maharajh MD Dr Dave Maharajh MD."

Similar presentations


Ads by Google