PREDISPOSING FACTORS

1. GENDER – women. AGE: 60&

above ; school-aged girls
2. MECHANICAL FACTORS –
catheterization, sexual intercourse,
kidney stones, improper use of
tampons & douches
3. METABOLIC DISORDER- increased
sugar content or urine in diabetes,
making it conducive to bacterial
growth
4. ANATOMIC ABNORMALITY OF
URINARY TRACT – cause
obstruction or incomplete voiding of
urine or reflux of urine.
Symptoms of Urinary Tract
Infection
Dysuria
Increased frequency
Hematuria
Fever
Nausea/Vomiting
(pyelonephritis)
Flank pain
(pyelonephritis)
Findings on Exam in UTI
Physical Exam:
• CVA tenderness
(pyelonephritis)
• Urethral discharge (urethritis)
• Tender prostate on Digital and
Rectal Exam (DRE) (prostatitis)
Labs: Urinalysis
• + leukocyte esterase
• + nitrites
• More likely gram-negative rods
• + WBCs
• + RBCs
Culture in UTI
• Positive Urine Culture =
• Most common pathogen for
cystitis, prostatitis,
pyelonephritis:
• Escherichia coli
• Staphylococcus saprophyticus
• Proteus mirabilis
• Klebsiella
• Enterococcus
• Most common pathogen for
urethritis
• Chlamydia trachomatis
• Neisseria Gonorrhea
PROTEUS MIRABILIS

 GRAM (-) bacilli of

Enterobacteriaceae.
 Produces urease –
causes alkalinization of
urine –
 2nd common cause of
community – acquired
UTI; major cause of
HEALTH CARE
ASSOCIATED
INFECTIONS
SERRATIA SP.
Gram (-) bacilli of
Enterobacteriaceae.
Most frequent is Serratia
marcescens
Associated w/ outbreaks of
UTI, wound infections,
pneumonia & septicemia
 ENTEROCOCCUS FAECALIS

Part of enteric normal flora

Belongs to Enterobacteriaceae
Most common among the
Enterococci. Frequent cause of
HAI.
Transmitted from 1 patient to
another primarily on the hands
of hospital personnel
Most common site of infection :
urinary tract, wounds, biliary
tract and blood
ENTEROCOCCUS FAECALIS:
PATHOGENESIS
Microorganism Derived from
own fecal flora.
2 routes bacteria reaches
kidney:
through bloodstream
ascending infection from
Lower urinary tract. – most
common cause of clinical
pyelonephritis
Urine Stasis- urinary retention
CYSTITIS
Uncomplicated (Simple)
cystitis
In healthy woman, with
no signs of systemic
disease
Complicated cystitis
In men, or woman with
comorbid medical
problems.
Recurrent cystitis
CYSTITIS  inflammation of urinary
bladder
 Most common type of UTI
 Most commonly caused by
E. Coli
 Other causes: Proteus,
Klebsiella, Enterococcus,
Pseudomonas, Enterobacter,
Staphylococcus
saprophyticus,
Staphylococcus epidermidis
& Candida albicans
Uncomplicated (simple) Cystitis
Definition
Healthy adult woman (over age 12)
Non-pregnant
No fever, nausea, vomiting, flank pain
Diagnosis
Dipstick urinalysis (no culture or lab tests
needed)
Treatment
Trimethroprim/Sulfamethoxazole for 3 days
May use fluoroquinolone (ciprofoxacin or
levofloxacin) in patient with sulfa allergy,
areas with high rates of bactrim-resistance
Risk factors:
Sexual intercourse
May recommend post-coital voiding or
prophylactic antibiotic use.
Complicated Cystitis
Definition
Females with comorbid medical
conditions
All male patients
Indwelling foley catheters
Urosepsis/hospitalization
Diagnosis
Urinalysis, Urine culture
Further labs, if appropriate.
Treatment
Fluoroquinolone (or other broad
spectrum antibiotic)
7-14 days of treatment (depending on
severity)
May treat even longer (2-4 weeks) in
males with UTI
 Special cases of Complicated
cystitis
Indwelling foley catheter
Try to get rid of foley if possible!
Only treat patient when symptomatic (fever,
dysuria)
Leukocytes on urinalysis
Patient’s with indwelling catheters are frequently
colonized with great deal of bacteria.
Should change foley before obtaining culture, if
possible
Candiduria
Frequently occurs in patients with indwelling
foley.
If grows in urine, try to get rid of foley!
Treat only if symptomatic.
If need to treat, give fluconazole (amphotericin if
resistance)
Recurrent Cystitis
is usually defined
as three episodes of
urinary tract
infection (UTI) in the
previous 12 months,
or two episodes in
the previous six
months.
It is common in
young, healthy women