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Urinary Track Infection Pathopysiology 1

Urinary Track Infection Pathopysiology 1

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Published by: rraven16 on Feb 07, 2011
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01/29/2013

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Pathophysiology:
The urinary tract, from the kidneys to the urethral meatus,is normally sterile and resistant to bacterial colonizationdespite frequent contamination of the distal urethra withcolonic bacteria. Mechanisms that maintain the tract's sterilityinclude urine acidity, emptying of the bladder at micturition,ureterovesical and urethral sphincters, and various immunologicand mucosal barriers.About 95% of UTIs occur when bacteria ascend the urethra to thebladder and, in the case of acute uncomplicated pyelonephritis,ascend the ureter to the kidney. The remainder of UTIs arehematogenous. Systemic infection can result from UTI,particularly in the elderly. About 6.5% of cases of hospital-acquired bacteremia are attributable to UTI.A urinary tract infection is an infection of any of the organsin the urinary tract, which consist of the bladder, the ureter,the urethra, and the kidneys.A urinary tract infection (UTI) may occur in the: Bladder -
Cystitis
is an infection of the bladder. This is the most commonform of UTI; it can be aggravated if the bladder does not emptycompletely when you urinate. Urethra -
Urethritis
isinfection/inflammation of the urethra. This can be due to otherthings besides the organisms usually involved in UTI¶s; inparticular, many sexually transmitted diseases (STD¶s) appearinitially as urethritis. Ureter ±
Ureteritis
is infection of aureter. This can occur if the bacteria entered the urinary tractfrom above, or if the ureter-to-bladder valves don¶t workproperly and allow urine to ³reflux´ from the bladder into theureters. Kidney ±
Pyelonephritis
is an infection of the kidney
 
itself. This can happen with infection from above, or if refluxinto the ureters is so bad that infected urine refluxes all theway to the kidney.Commensal colonic gram-negative aerobic bacteria cause mostbacterial UTIs. In relatively normal tracts, strains of E. coliwith specific attachment factors for transitional epithelium ofthe bladder and ureters are the most frequent causes. Theremaining gram-negative urinary pathogens are otherenterobacteria, especially Klebsiella
,
Proteus mirabilis, andPseudomonas aeruginosa. Enterococci (group D streptococci) andcoagulase-negative staphylococci (eg, Staphylococcussaprophyticus) are the most frequently implicated gram-positiveorganisms.E. coli causes > 75% of community-acquired UTIs in all agegroups;
S.
saprophyticus
accounts for about 10%. In hospitalizedpatients, E. coli accounts for about 50% of cases. The gram-negative species Klebsiella
,
Proteus, Enterobacter, andSerratia account for about 40%, and the gram-positive bacterialcocci
nterococcus
aecalis
and
S.
 
saprophyticus
and
taphylococcus
 
aureus
account for the remainder.People more susceptible to UTI¶s:
y
 
Diabetics because of changes in the immune system
y
 
Infants who are born with abnormalities of the urinarytract
y
 
A woman has shorter
length of the urethra.
 
y
 
W
omen whose partners use a condom with spermicidal foam
y
 
A person who has already had a UTI
y
 
Pregnant women
y
 
Post-menopausal women

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