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MICROBIOLOGY OF URINARY TRACT INFECTION

Alfred H L Toruan Nugroho S.S M. Fatikh Nanda

INTRODUCTION
Epidemiology of UTI by age group and sex
Age
<1 1-5 6-15 16-35 36-65

Female
0,7 4,5 4,5 20 35

Male
2,7 0,5 0,5 0,5 20

Risk factor
Foreskin,anatomic GU abnormalities Anatomic GU abnormalities Functional GU abnormalities Sexual intercourse,diaphragm use Surgery, prostate obstruction, catheterization Incontinence, catheterization, prostate obstruction

>65

40

35

  Urine factor : Urea concentration and high osmolarity Low pH of urine  kill bacteria 2.DEFENSE MECHANISM OF THE URINARY TRACT 1.    Hydrokinetic factor : Periodic urinary flow Dilution of rest urine cause of urinary flow from kidney Bladder emptying .

Mucosal factor :      Mucosa of the bladder consist of more than one layer cells Mucosa of the urinary tract and bladder covered by mucus  prevent microorganism attachment Prostatic secretion : has an antibacterial effect Secretion of local IgA  prevent attachment of microorganism on uroepithelium later and neutralize toxin produce by microorganism Perioxidase on the mucosal layer  has a bactericidal effect .3.

PATHOGENESIS • Urine : steril • Modes of bacterial entry : • Ascending • Hematogenous • Lymphatogenous • Direct extension .

Entry is normally by ascent from the urethra Bacteria invade the urinary tract by ascending route through the urethra to infect the bladder and renal pelvis is the most common.PATHOGENESIS A. Occasionally with hematogenous spread .

B. or neurological disorder leading to the failure to completely eliminate the urine can lead to UTI  Men in their 40's have problems with the prostate gland enlarging resulting in obstruction of the urethra followed by incomplete elimination of urine from the bladder and UTI's . Host factors  The larger number of UTI's present in women than in men is probably 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  Any anatomic obstruction.

>Pseudomonas infections are both invasive and toxinogenic >S. Aureus expresses many potential virulence factors such as proteins.C. Bacterial factors >The most important virulence factor of bacteria is the enhanced ability to adhere to uroepithelial cells. enzymes and toxins .

Such factors include: 1. 3. Reflux of urine to the kidney Physiological malfunctions Urethral catheters Urinary tract stones .D. 2. 4. 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.

CLINICAL MANIFESTATION LOWER URINARY TRACT INFECTIONS Acute cystitis : a superficial inflammation of the bladder and urethra Acute prostatitis occurs when bacteria invade the prostate UPPER URINARY TRACT INFECTIONS Acute pyelonephritis is due to bacterial invasion of the renal tissue with inflammation and swelling. sometimes cause renal dysfunction .

and Staphylococcus epidermidis are more resistant. Enterobacter. and Proteus spp.ETIOLOGY -Escherichia coli. are relatively common. and other Gram positive bacteria such as Enterococcus faecalis. Pseudomonas aeruginosa. each accounting for 3 to 5 % of infections -Within the hospital environment. . which is responsible for 80 % of infections that are acquired outside of hospitals -Other Gram-negative rods such as Klebsiella. common hospital-acquired phatogens. Serratia marscesens.

particularly coagulase-negative staphylococci and enterococci.Gram-positive organisms.. particularly if diabetes is present . cause some infections -Staphylococcus saprophyticus causes about 10 % of UTI in young women -Candida albicans is also a frequent pathogen in hospitalized patients.

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particularly mumps virus. cytomegalovirus.ETIOLOGY Anaerobes and fastidious organisms rarely cause urinary infections A number of viruses.g. and coxsackieviruses. Chlamydia trachomatis and herpes simplex can present with symptoms that mimic acute cystitis in both men and women . but rare A number of sexually transmitted pathogens (e. Neisseria gonorrhoeae) may invade the urethra.. can be present in the kidneys and urine.

coli typically produce hemolysin .URINARY TRACT INFECTION Escherichia coli .UTI can result in bacteremia with clinical signs of sepsis .The most common cause of UTI .Accounts approximately 80 % of first UTI in young women .Nephropathogenic E.

E. possess polysaccharide capsule Grow on nonselective media Red colonies on Mac Conkey agar An isolate from urine can be identified by its hemolysis on blood agar Temperature for growth : 15 – 450C Some strains more resistant to heat viable at 600 C 15 minutes .550 C 60 minutes . coli Member of the normal intestinal flora Motile.

Klebsiella pneumoniae -The most clinically important species This bacterium produces large sticky colonies when plated on nutrient media .K. pneumoniae is second only to E. K. . coli as a urinary tract pathogen.In fact. pneumoniae urinary tract infections are common in catheterized patients .Klebsiella's pathogenicity can be attributed to its production of a heat-stable enterotoxin .

differ in motility  The organisms has small capsule  E.living as well as in the intestinal tract  E. aerogenes may be found free. cloacae causes UTI & sepsis . similar characteristics to Klebsiella.ENTEROBACTER  Previously : Aerobacter. aerogenes & E.

PROTEUS  Infection in humans only when bacteria leave the intestinal tract  Found in UTI. vulgaris & M. focal lesions in debilitated patients or receiving i. produce bacteremia.v infusions  P. morganii important nosocomial pathogens .

leading to urinary tract  .PROTEUS P. mirabilis  UTI. occasionally other infection    Produces a typical “swarming” growth on blood agar Is primarily an opportunist. transmitted via catheters Produces a powerfull urease that hydrolyzes urea to ammonia and CO2 Results in stones and calculi.

marscescens : is common opportunistic pathogen in hospitalized patient  Causes pneumonia.SERRATIA S. meningitis. wound infections. bacteremia & endocarditis specially in narcotics addicts & hospitalized patients Often multiply resistant to aminoglycosides & penicillins Infections can be treated with 3rd generation cephalosporins . UTI.

aeruginosa produces two types of soluble pigments. pyocyanin and (fluorescent) pyoverdin.Pseudomonas aeruginosa  Opportunistic pathogen of humans. yet there is hardly any tissue that it cannot infect.  Pyocyanin (from "pyocyaneus") refers to "blue pus" which is a characteristic of suppurative infections caused by Pseudomonas aeruginosa. aerobic rod. if the tissue defenses are compromised in some manner  Pseudomonas aeruginosa is a Gram. . belonging to the bacterial family Pseudomonadaceae  P.  The bacterium almost never infects uncompromised tissues.negative.

can grow at a temperature range of 15 to 450C and at NaCl concentrations as high as 15 % .Staphylococcus Staphylococci are Gram-positive spherical bacteria that occur in microscopic clusters resembling grapes Taxonomically. the genus Staphylococcus is in the bacterial family Micrococcaceae Staphylococci are facultative anaerobes The bacteria are catalase-positive and oxidase.negative.

often hemolytic on blood agar Nearly all strains produce the enzyme coagulase S. coagulase-negative.Staphylococcus   S. Lacks protein A   . aureus forms a fairly large yellow colony on rich medium. nearly all strains lack the coagulase enzyme S. epidermidis has a relatively small white colony. non hemolytic. novobiocin-resistant. saprophyticus Is non hemolytic if culture on blood agar.

positive is a typical presentation for Enterococcus  Microscopically. weakly catalase. produce a small gray colony after 24 hour incubation at 35°C on sheep blood agar  A small gray colony that is slightly  or hemolytic and sometimes β-hemolysis. Gram-positive cocci occurring in chains or pairs with individual cells being somewhat elongated can be presumed to be streptococci or enterococci .Enterococcus faecalis  The enterococci are facultative anaerobes.

 Urine must be chilled and processed within 2 hours . urine is taken by renal catheter.Microbiological diagnosis  Specimen has to be taken under strict precautions as lower part of urethra is colonized by fecal flora  Thus catheterization is forbidden  Midstream urine is the primary choice. while suprapubic puncture are alternatives  In special cases after surgery on the kidney.

was termed "significant bacteriuria.DIAGNOSIS The diagnosis of UTI : based on a quantitative urine culture : > 100. even in asymptomatic persons.000 colony-forming units (105 CFU) per ml of urine. They have also shown that a bacterial count of 100 CFU per mL of urine has a high positive predictive value for cystitis in symptomatic women ." This value was chosen because of its high specificity for the diagnosis of true infection. However. several studies have established that one third or more of symptomatic women have CFU counts below this level (low-coliform-count infections).

Bacteriuria with quantitative >100.000 cfu/ml 2. If the result of culture is > 1000 cfu of fungus/ ml  indicate fungal infection .Bacteriuria indicate UTI Criteria of UTI 1. Bacteriuria with quantitative <100.000 cfu/ml in repeated culture. only one species of bacteria.000 cfu/ml. Bacteriuria with quantitative <100. and same kind of bacteria was found 4. Bacteriuria with quantitative <100. with definite clinical symptoms 5.000 cfu/ml and lekocyturia 3.

TERIMA KASIH .