URINARY TRACT

INFECTIONS (UTIs)
Prepared by
Dr Alia Abdel Monaem
Lecturer of Medical Microbiology & Immunology
Zagazig university
Learning objectives

How to collect urine sample

Enumerate common causes of UTIs
Define sterile pyuria & explain causes of it
Interpretation of bacterial count of urine specimen
Definitions
 Pyelonephrit
Urethritis Cystitis
is

Anterior
Urinary
urethral kidney
bladder
tract

Dysuria Lion pain

Dysuria
frequenc pyuria
urgency
y pyuria rigors
frequenc
hematuri fever
y
a
Causative agents
 Bacteria
E. Coli: 1st most common (60- 90%)

Staphylococcus saprophyticus: 2nd most common in

sexually active young female (10- 30%)

Staph. Epidermidis (catheterization)

Staph. Aureus (upper UTI)

Hospital acquired infections:

Proteus (renal stones)

Klebseilla pneumonia (catheterization)

Pseudomonas aeruginosa (renal stones,

catheterization)
Immunocompromised patients
Enterobacter
Enterococcus faecalis (catheterization)

Mycobacterium tuberculosis
Anaerobes (e.g. Bacteroides fragilis)
Chlamydia, Neisseria gonorrhea, Mycoplasma
(urethritis)
 Other agents
Viral: rubella, mumps, adenovirus

Fungal: Candida, Histoplasma

capsulatum

Protozoal: T. vaginalis
 Diagnosis of UTIs
1) Specimen Collection & transport
2) Wet film of urine deposit
3) Direct smears with Gram & Z.N. stains ( if
indicated)
4) Bacterial count within 1h from uncentrifuged
urine
5) Cultivation of centrifuged urine
6) Identification of isolated colonies
7) Antibiotic susceptibility tests
Diagnosis of UTIs
1) Specimen collection

Mid-stream morning urine

Sterile wide mouth screw capped container
 Urine collection in babies

Sterile adhesive plastic

Suprapubic needle
bags
aspiration
Specimen transport

Transport to laboratory
immediately otherwise
refrigeration at 4-60c

Delay > 2hrs add Boric

acid (bacteriostatic)
Wet film of urine deposit( 2

WBCs (Pus cells)

RBCs
Crystals
Casts
Bilharzial ova
WBCS (PUS CELLS)
 WBCS (PUS CELLS)

WBCs (arrowheads) are larger,

colorless and more granular
RBCs (arrows), which have no
internal texture (although
appear slightly biconcave).
WBCs (arrowhead) are smaller and more
uniformly round
Epithelial cells (likely of transitional origin)
larger that have more angular or flatter
borders (arrow).
WBCS (PUS CELLS)
Crystals
Casts
 Sterile pyuria
Pus cells in urine
without bacterial
growth on
ordinary media
 Causes of sterile pyuria

1) Antibiotic therapy
2) Anaerobes
3) Mycobacterium tuberculosis
4) Chlamydia, Neisseria gonorrhea, Mycoplasma , ureaplasma, L-
forms
5) Viruses
6) Prostatitis
7) Non infectious causes e.g. renal stones, tumor
3) Direct smears with gram stain

(1) Gram ve bacilli

(2) Gram +ve cocci
Direct smears with Z.N. stain
( if requested)
4) Bacterial count within 1h from
uncentrifuged urine by calibrated loop on
nutrient agar
Interpretation of bacterial count of
urine specimen

100,000 bacteria/ml Significant

bacteriuria

<10,000 bacteria/ml Contamination

10,000 bacteria/ml Significant (G+ve, one

type )
5) Cultivation of centrifuged urine
overnight incubation at 37C

Blood agar MacConkey

CLED
6) Identification of isolated colonies

1- Macroscopic examination (colony

morphology).

2- Microscopic examination of stained films.

3- Biochemical reactions.
Identification of gram +ve isolates

Staphylococcus aureus
Staphylococcus
saprophyticus
Staphylococcus epidermidis
Enterococcus fecalis
Identification of gram +ve isolates

The minimal tests to differentiate Gram + cocci

include
1) Catalase
2 ) Coagulase test
3) Hemolysis on blood agar
Catalase test
Identification of gram -ve isolates

E. Coli
Klebseilla pneumonia
Enterobacter
Proteus
Pseudomonas
aeruginosa
 Identification of gram -ve isolates

Lactose fermentation on MacConkey agar

Oxidase test
IMVC test to differentiate between
enterobacteriacae
TSI
Urease test
MacConkey agar
 MacConkey agar

(A) Lactose fermenting , gram negative rods producing pink

colonies
(B) Non lactose fermenting , gram negative rods producing
colorless colonies
Oxidase test
IMVC of E.coli & Klebsiella
 Click icon to add picture

Triple sugar iron (TSI)

TSI of Pseudomonas( A)
TSI of Proteus( B)
(A) TSI of E.coli & Klebseilla pneumonia
 Cultural characters of Proteus

55

Nutrient agar Blood agar

 Cultural characters of Pseudomonas
aeruginosa

Metallic greenish , hemolytic

Greenish exopigment
colonies
on nutrient agar
7) Antibiotic susceptibility tests