Urinary Tract Infection Types Causes Diagnosis

Urinary Tract Infection Types Causes Diagnosis

Urinary Tract Infection is an infection that occurs in the urinary tract, often caused by bacteria such as Escherichia. Coli

UTI Epidemiology

About 60% of women suffer a UTI  in their life.

Symptomatic infections are more common in young women after the onset of sexual activity ( 20 to 50 years old) and it is uncommon in males < 50 years old

The incidence of UTI infection increase in both sexes over 50 years, but the female, male ratio decrease due to increased frequencies of prostate disease in males

Why do women have a greater incidence of UTI than men?

Women’s urethras are shorter, which makes it easier for bacteria to make their way to the body & cause infections

Women’s urethras are also located closer to their rectums which makes it easier for bacteria to travel to the urethra & gain entry into the body.

In addition, urine is stagnant in women forming a good medium for the growth of microorganism

Types of Urinary tract infection

UTI can be classified according to the section of urinary tract affected into lower UTI

Cystitis (bladder)

-urethritis ( urethra)

Upper UTI

Pyelonephritis (kidney & renal pelvis ) more serious

Urethritis

UTI is also classified into

Uncomplicated UTI

Affects mainly healthy females of age 15-45 years

Complicated UTI

UTI’s that are associated with metabolic disorders & anatomic or functional abnormalities that impair urinary tract drainage

Complicating factors include

  • Immunosuppressant
  • Urologic structural
  • Functional abnormality
  • Nephrolithiasis present
  • Recent hospitalization
  • Nursing home
  • Catheter
  • Symptoms for > 7 days

Causes of Urinary tract

For uncomplicated UTI – for uncomplicated UTI

Escherichia coli is responsible for 85% of UTI

Staph. saprophyticus 5 -15%

Klebsiella, proteus,

Pseudomonas 5-10%

Pathophysiology of Urinary tract infection

Bacterial entry into the urinary tract can occur through one or more of the following routes

Ascending from the urethra. (mainly from the GIT; the easiest in treatment)

  • Through bloodstream
  • Through lymphatic system
  • During bladder catheterization

UTI risk factors

  • Obstruction of the urinary tract

( e.g. presence of kidney stones )

  • Female gender
  • Pregnancy
  • Sexual intercourse
  • Bladder catheterization (the longer it’s used) the more infection
  • Dm
  • Genitourinary malformation
  • Prostatic hypertrophy inmates

Signs & symptoms

Lower UTI-

Dyouria, urgency, frequency, nocturia, suprapubic, heaviness, gross hematuria.

Upper UTI –

Flank pain, fever, nausea, vomiting, malaise

Diagnosis of Urinary tract infection

Lab tests for UTI including

Urinalysis is done through dipstick tests or microscopic examination of urine

Urine culture & sensitivity which is a quantitative test that is not recommended to diagnose or verify uncomplicated UTI

Dipstick tests-

leukocytes esterase enzyme

nitrile- the presence of bacteria that produce nitrate reductase

protein (proteinuria) – indicates upper UTI, as the kidney is passing large molecules as protein

microscopic examination of urine

WBC counts (pyuria) indicates urothelial inflammation

RBC counts (hematuria) – especially in cystitis

Treatment of Urinary tract infection

Goals

  • Eradication of the invading micro-org
  • Prevent recurrence of infection
  • Resolve symptoms
  • Avoid permanent kidney damage
  • Avoid side effects from treatment
  • Antibiotics for urinary tract infection

Uncomplicated UTI

1st line therapy for uncomplicated UTI is trimethoprim/sulfamethoxazole / double strength (Ds) tablet (160/800mg) twice daily for 3 days

2nd line therapy include

Quinolones as ciprofloxacin 250mg twice daily for 3 days

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