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Urinary Tract

Infection
(Infeksi Saluran
Kemih)Sp.PD-KGH
dr. Sahala Panggabean,
Departement of Internal Medicine
RSU FK UKI
Learning Objectives:
After listening to this lectures, participents will be
better able to:
• Define Urinary Tract Infection
• Recognize Symptoms and Signs of UTI
• Diagnose UTI
• Recognize the Etilogies of UTI
• Recognize the Risk Factors of UTI
• Plan the Tretment of UTI
• Plan the Prevention of UT I
• Understand the Terminologies in relation to UTI
Introduction and Definition
• Urinary Rract Infection (UTI) is the presence and
multiplication of antimicrobial pathogens within the
normally sterile urinery tract.

• UTI can be limited to the bladder (cystitis) can be


painful and annoying. But serious consequences can
occur if the infection spreads to the kidneys (acute
pyelonephritis).

• Women are most at risk of developing a UTI. About


half of all women will develop an UTI episode during
their lifetimes, and many will experience more than
one.
Anatomic categoties of UTI

UTI can be subdivided into two general anatomic


categories:
– Lower Tract Infections ( Urethritis
and Cystitis )
– Upper Tract Infection ( Acute
Pyelonephritis, Intrarenal and Perinephric
abscesses).
Types UTI
UTI usually develop first in the lower urinary tract
(urethra, bladder) and, if not treated, progress
to the upper urinary tract (ureters, kidneys).
• Bladder infection (cystitis) is by far the most
common UTI.
• Infection of the urethra is called urethritis.
• Kidney infection (pyelonephritis) requires
urgent treatment and can lead to reduced kidney
function and possibly even death in untreated
due to septicemia in severe cases.
Epidemiologic categories of
UTI
Epidemiologically UTI’s are sub divided
into:
2.Cathether-associated or nosocomial
infections
3.Community-aquired infections
Acute community-aquired infections are very common
and a ccount for more than 7 million office visits
annually.
Asymptomatic bacteriuria is more common among
elderly men and women.
The Urinary Tract
Bacterial Etiology of UTI
Pathogenesis of UTI
• The urinary tract can be infected from below,
bacteria entering the urethra and trevelling
upwords (ascending infection).
• Some UTI ocuurs by bacteria entering the kidneys
from the bloodstream (hematogen spread).
• Infection from hematogen spreads are most often
seen in newborns with sepsis and
immunocompromized older patients.
• In older children and adults infection most often
starts from below (ascending infection)
Pathogenesis ascending
infection
• In many cases, bacteria first travel to the urethra
from the perineum. Bacteria multiply and
infection can occur.
Infection limited to the urethra is called
urethritis.

• If bacteria move to the bladder and multiply, a


bladder infection or cystitis results.

• If the infection is not treated promptly, bacteria


may then travel further up the ureters to multiply
and infect the kidneys result in kidney infection is
called acute pyelonephritis.
Risk Factors for UTI
• A woman's urethra is shorter than a man's, which is one reason
why women are much more likely than men to get UTI's.
• For many women, sexual intercourse seems to trigger an infection.
• Any abnormality of the urinary tract that obstructs the flow of
urine;
kidney stones for example sets the stage for an infection.
• Enlarged prostate gland also can slow the flow of urine, thus
raising the risk of infection.
• Common source of infection is catheters, or tubes, placed in the
urethra and bladder.
• People with diabetes have a higher risk of a UTI because of
changes in the immune system.
• According to some reports, about 2 to 4 percent of pregnant
women develop a urinary infection
Risk Factors for UTI
Conditions affecting
Pathogenesis
• Gender and sexual activity
• Pregnancy
• Obstruction
• Neurogenic Bladder Dysfunction
• Vesicoureteral Reflux
• Bacterial Virulence Factors
• Genetic Factors
Signs and Symptoms in
young children
Symptoms of urinary tract infections (UTIs)
in young children include the following:
– Diarrhea
– Excessive crying that cannot be
resolved by typical measures (e.g.,
feeding, holding)
– Loss of appetite
– Fever
– Nausea and vomiting
Signs and Symptoms in
adults
Older children or an adult may experience the
following symptoms with UTI:
– Flank or lower back pain (with a kidney
infection)
– Frequent urination
– Inability to produce more than a small
amount of urine at a time
– Incontinensia urinae
– Pain in the pelvic area
– Painful urination (dysuria)
– Cloudy urine or with unusual smell
Clinical Presentations
Cystitis
• Patients with cystitis usually report
dysuria, frequency, urgency, and
suprapubic pain.
• The urine often becomes grossly cloudy
and malodorous, and it is bloody in 30%
of cases.
• Physical examination generally reveals
only tenderness of the suprapubic area.
Clinical Presentations
Acute Pyelonephritis
• Symptoms of acute pyelonephritis
generally develop rapidly over a few
hours or a day and include a fever,
shaking chills, nausea, vomiting, and
diarrhea. Besides fever, tachycardia, and
generalized muscle tenderness.
• Physical examination reveals marked
tenderness on deep pressure in one or
both costovertebral angles or on deep
abdominal palpation.
Clinical Presentations
Urethritis

• Approximately 30% of women with acute


dysuria, frequency, and pyuria have midstream
urine cultures that show either no growth or
insignificant bacterial growth.

• In this situation, a distinction should be made


between women infected with sexually
transmitted pathogens, such as C. trachomatis,
N. gonorrhoeae, or herpes simplex virus, and
those with low-count E. coli or staphylococcal
Complications of UTI
• The most serious consern in a UTI is if to
avoid its progress to acute pyelonephritis.

• This can result in scarring and damage to


the kidney tissue and Sepsis

• Fortunately acute uncomplicated


pyelonephritis in adults rarely progresses
to renal functional impairment and chronic
renal disease.
Diagnostic Testing
• Proteinuria, pyuria, hematuria microskopis and/or macroskopis are
ususally found in urinalysis. Glomerular cast is a sign for kidney
infection (pyelonephritis)
• Determination of the number and type of bacteria in the urine with
the urine culture is an important diagnostic procedure.
• Microscopic bacteriuria which is best assessed with Gram-stained
urine seiment, is found in 90% of specimens from patients whose
infections are associated with colony counts of at least 105/mL,
and this finding is very specific.
• Urine culture and antimicrobial susceptibility testing.
• Ultrasound exam to look for stones and obstruction.
• BNO – IVP to look for structural abnormality.
TREATMENT-1
• Severely ill patients with
vomiting should be hospitalized
and given the IVFD until they can
take fluids and drugs orally.

• Drinking plenty of water helps


cleanse the urinary tract of
bacteria.
TREATMENT-2
Following principles underlie the treatment of UTIs:
• Except in acute uncomplicated cystitis in women,
quantitative urine culture should be oredered to
confirm infection before empirical treatment is begun.
• When culture results become available, antimicrobial
sensitivity testing should be used to further direct
therapy.
• Factors predisposing to infection, such as obstruction
and calculi, should be identified and corrected if
possible.
Treatment-3
Oral regimen for acute uncomplicated
cystitis:
Parenteral regimens for acute
uncomplicated and
complicated UTI
PREVENTIONS-1
• Women who experience frequent symptomatic
UTIs (3 per year on average) are candidates for
long-term administration of low-dose antibiotics
directed at preventing recurrences.
• Such women should be advised to avoid
spermicide use and to void soon after intercourse.
Daily or thrice-weekly administration of a single
dose of TMP-SMX (80/400 mg).
• Prophylaxis should be initiated only after
bacteriuria has been eradicated with a full-dose
treatment regimen.
• All pregnant women should be screened for
bacteriuria in the first trimester and should be
Preventions-2
• Drink plenty of liquids, especially water.
• Wipe from front to back. Doing so after
urinating and after a bowel movement
helps prevent bacteria in the perineum
from spreading to the vagina and urethra.
• Voiding as soon as possible after
intercourse
• Avoid potentially irritating feminine
products.
References:
• Thomas Hooton: Urinary Tract Infection in
Adults.
In Richard Johnson and John Feehally (eds.):
Comprehensive Clinical Nephrology. Mosby,
New York, 2nd.ed. 2003; 695-729.

• Lindsay Nicole: Urinary Tract Infection.


In: Arthur Greenberg (Ed.) Primer on Kidney
Diseases. National Kidney Foundation, 4th.ed.
2005; 411-417.

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