Professional Documents
Culture Documents
Infections
Dr. Sameh Ahmad Muhamad abdelghany
Lecturer Of Clinical Pharmacology
Mansura Faculty of medicine
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OBJECTIVES
Describe pathogenesis & clinical
characteristics of Urinary tract infections
Identify most likely etiologic organism(s)
Review appropriate drug therapy
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CONTENTS
INTRODUCTION
Classification
RISK FACTORS
Infections
Diagnosis
Treatment
INTRODUCTION
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INTRODUCTION
Urinary tract infection is one of the most
common bacterial infection managed in
general medical practice
Accounts for 1‐3% of consultations
Up to 50% of women will have a UTI at
some point in their life
UTI uncommon in men except over the
age of 60 when urinary tract obstruction
due to prostatic hypertrophy may occur
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INTRODUCTION
Symptomatic presence of
micro-organisms within
the urinary tract i.e.,
kidney, ureters, bladder
and urethra.
Associated with
inflammation of urinary
tract.
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INTRODUCTION
Significant bacteriuria:
o presence of at least 105 bacteria/ml of
urine.
Asymptomatic bacteriuria :
o bacteriuria with no symptoms.
Urethritis: infection of anterior urethral
tract.
Cystitis: infection to urinary bladder
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UTI - Terminology
Acute pyelonephritis:
o infection of one/both kidneys.
Chronic pyelonephritis:
o particular type of pathology of kidney;
may/may not be due to infection.
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UTI - Terminology
Uncomplicated: UTI without underlying renal
or neurologic disease.
Complicated: UTI with underlying structural,
medical or neurologic disease.
Recurrent : > 3 symptomatic UTIs within 12
months following clinical therapy.
Reinfection: recurrent UTI caused by a
different pathogen at any time
Relapse: recurrent UTI caused by same species
causing original UTI within 2 wks after therapy
CLASSIFICATION
Classification Of UTI
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A. Upper UTI:
Acute pyleonephritis
Chronic pyleonephriitis
Interstitial pyleonephritis
Renal abscess
Perirenal abscess.
B. Lower UTI:
Cystitis
Prostatitis
Urethritis
Complicated UTI:
Pseudomonas aeruginosa, Enterobacter &
Serratia
Isolated in hospital acquired infections
and catheter associated UTI.
Viruses : Rubella, Mumps and HIV
Fungi : Candida, Histoplasma capsulatum
Protozoa : T. vaginalis, S. haematobium
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RISK FACTORS
Risk Factors
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1. Aging:
diabetes mellitus
urine retention
impaired immune system
2. Females:
shorter urethra
incomplete bladder emptying with age
3. Males:
prostatic hypertrophy
bacterial prostatitis
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PRESENTATION
Clinical manifestations depends on
i. site of infection
ii. age of patient.
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I. Clinical manifestations
depending on site of infection
Urethritis:
Discomfort in voiding
Dysuria
Urgency
frequency
I. Clinical manifestations
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I. Clinical manifestations
depending on site of infection
Pyleonephritis:
Invasive nature
Suprapubic tenderness
Fever and chills
White blood cell casts in urine
Loin pain
Nausea and vomiting
Complications :
sepsis, septic shock and death.
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SYMPTOMS OF PYELONEPHRITIS
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Investigations
Laboratory examination
Laboratory findings
Normal Findings Abnormal findings
Urinalysis
Urine culture
For pyelonephritis
Not a rapid diagnostic tool
>105 bacteria /ml
Differential leukocyte count
(increased neutrophils)
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UTI - management
Symptomatic UTI: antibiotic therapy
Asymptomatic UTI: no treatment
required except in special situations.
Non- specific therapy:
more water intake.
Maintaining acidity of urine by fluids
like cranberry juice or use of ascorbic
acid.
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Anti-microbial therapy
Goals of therapy:
Elimination of infection
Relief of acute symptoms
Prevention of recurrence
and long term
complications
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Anti-microbial therapy
Principles of anti microbial therapy :
o Levels of antibiotic in urine but not in
blood
o Blood levels of antibiotic –important in
pyelonephritis
o Penicillins and cephalosporins –drugs of
choice for UTI with renal failure.
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Anti-microbial therapy
Treatment duration:
Single dose therapy
3 day course
7 day course
10 – 14 day course
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Anti-microbial therapy
Single dose therapy:
Trimethoprim- sulfamethaxole
Amoxicillin- clavulnate 500mg
Amoxcillin 3gm
Ciprofloxacin 500mg
Norfloxacin 400mg
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Anti-microbial therapy
3 day therapy:
Efficacy same as 7 day therapy with
less adverse effects
Drugs used include
o quinolines
o TMP-SMZ
o betalactam antibiotics
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Anti-microbial therapy
7 day therapy:
Used less for uncomplicated UTI
Useful in :
a. recurrent cases
b. pregnancy
c. UTI with other risk factors
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Anti-microbial therapy
14 day therapy:
For complicated UTI
High risk of mortality and morbidity
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Conclusion
Urinary tract infections are the 2nd most
common bacterial infections.
Women are the most infected subjects in
the population.
Development of resistance to antibiotics
by the bacteria result in problems during
the treatment and lead to relapse or
recurrence.
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thanks
Fo r W at ching