Urinary Tract Infection
Overview
Understanding Urinary Tract Infection
How Big is theProblem
What is UTI
Why UTI is more Common in Woman
Pathogenesis
Classification
Risk Factors
Causative Organisms
Clinical Manifestation
Diagnosis
4. Overview
• Understanding Urinary Tract Infection
• How Big is theProblem
• What is UTI
• Why UTI is more Common in Woman
• Pathogenesis
• Classification
• Risk Factors
• Causative Organisms
• Clinical Manifestation
• Diagnosis
5. Ann Clin Micr Anti 2007; 6: 4-12
Urinary Tract Infection (UTI)
• UTI is the 2nd
most common infectious
presentation in community practice.
• World wide, about 150 million people are
diagnosed with UTI each year.
6. Urinary Tract Infection (UTI)
UTI is an inflammatory response of the
urothelium to bacterial invasion.
UTI is usually associated with
bacteriuria and pyuria.
Campbells Urology 2007; 9th Ed
7. Urinary Tract Infection (UTI)
Bacteriuria
Presence of bacteria in the urine – usually growth ≥ 103
cfu/ml
of urine
Pyuria
Presence of white blood cells (WBCs) in urine – usually 10
WBC/ml of urine is an indicative of an inflammatory response
of the urothelium to bacterial invasion.
Bacteriuria can be symptomatic or
asymptomatic.
Campbells Urology 2007; 9th Ed
8. Prevalence
• 50% of women experience at least
one episode of UTI at some point in
their lifetime.1
• One in every 3 women will have had
atleast one episode of UTI by the age
of 24 years.2
• Recurrent UTI occur in 20-40% of
women.1
• 50% of women experience at least
one episode of UTI at some point in
their lifetime.1
• One in every 3 women will have had
atleast one episode of UTI by the age
of 24 years.2
• Recurrent UTI occur in 20-40% of
women.1
Common in women
1. Indian J. Community Med 2012; 37(1): 39-44
2. EAU Guidelines on Urological Infections 2015
9. Why greater susceptibility of
UTI in women?
The female urethra
• short length (~4cm)
• proximity to anus
Urethra is prone to colonization with fecal bacteria.Urethra is prone to colonization with fecal bacteria.
Medicine 2007; 35: 423-427
10. Prevalence
• Rare in Males
• Anatomical or functional
abnormality of the urinary tract
• Rare in Males
• Anatomical or functional
abnormality of the urinary tract
• 8% of girls and 2% of
boys will have UTI in
childhood.
• 8% of girls and 2% of
boys will have UTI in
childhood.
• Incidence of UTI increases markedly in the
elderly.
• Bacteriuria is found in 21% of women and 12%
of men over 65 yrs of age.
• Incidence of UTI increases markedly in the
elderly.
• Bacteriuria is found in 21% of women and 12%
of men over 65 yrs of age. BMJ 1999; 319: 1173-1175
Medicine 2007; 35: 423-427
11. Prevalence
Pregnancy • UTIs are detected in 2 to 8% of pregnant
women
• UTIs are detected in 2 to 8% of pregnant
women
Diabetes • Prevalence of UTI is 26% in women with DM
as compared to 6% in those without DM
• Prevalence of UTI is 26% in women with DM
as compared to 6% in those without DM
Catheter • 8.5% of patients acquired UTI following
indwelling bladder catheterization
• 8.5% of patients acquired UTI following
indwelling bladder catheterization
Am J Med 1991; 19: 65-71
Medicine. 2007; 35: 423-427
BMJ 1999; 319: 1173-1175
12. Pathogenesis
Most UTI occur in women who are healthyMost UTI occur in women who are healthy
Interaction occurs between the bacterial
virulence and host defense
Interaction occurs between the bacterial
virulence and host defense
Increase in
virulence
Decrease in
host defense
Infection
Medicine 2007; 35: 423-427
13. UTI - Classification
Infections acquired
in the community
Infections acquired
in the community
Infections acquired
in the hospital
Infections acquired
in the hospital
14. UTI - Classification
Infection involving normal
urinary tract
Infection involving normal
urinary tract
Presence of metabolic,
anatomic and functional
abnormalities
Presence of metabolic,
anatomic and functional
abnormalities
• Healthy non-pregnant
women
• Healthy non-pregnant
women • Pregnancy
• Catheterization
• Diabetes
• Infection stones
• Pregnancy
• Catheterization
• Diabetes
• Infection stones
19. Symptoms of Acute
Uncomplicated cystitis
If both dysuria and frequency are present
in the absence of vaginal discharge, the
chance of UTI is ~90%.
• Dysuria
• Frequency
• Urgency
• Hematuria
• Suprapubic pain
Campbells Urology 2007; 9th Ed
20. Diagnosis of Acute
Uncomplicated cystitis
History
• Symptoms of UTI
• Other history (e.g. Vaginal discharge or irritation)
Examination
Pelvic examination to rule out other causes like
urethritis and vaginitis
EAU Guidelines on Urological Infections 2015
22. Diagnosis of Acute
Uncomplicated cystitis
Urine culture
Not recommended in case of cystitis but done if acute
pyelonephritis is suspected or complicated UTI.
Ultrasonography
CT scan
EAU Guidelines on Urological Infections 2015
23. Treatment for Uncomplicated
Cystitis
Short term antibiotics recommended by EAU
guidelines as drug of first choice.
Drug Dose Duration
Fosfomycin
trometamol
3 g SD 1 day
Nitrofurantoin
macrocrystals
100 mg bid 5 days
Pivmecillinam 400 mg tid 3 days
Choice of antibiotic should take into account not only
the spectrum of activity but also resistance.
Choice of antibiotic should take into account not only
the spectrum of activity but also resistance.
EAU Guidelines on Urological Infections 2015
24. Treatment for Uncomplicated
Cystitis
Short term antibiotics
Drug Dose Duration
CefpodoximeCefpodoxime 100mg, bid100mg, bid 3days3days
TMP-SMXTMP-SMX 160/800mg, bid160/800mg, bid 3days3days
NitrofurantoinNitrofurantoin 100mg, bid100mg, bid 5-7days5-7days
CiprofloxacinCiprofloxacin 250mg, bid250mg, bid
500mg, od500mg, od
3days3days
3days3days
LevofloxacinLevofloxacin 250mg, od250mg, od 3days3days
NorfloxacinNorfloxacin 400mg, od400mg, od 3days3days
OfloxacinOfloxacin 200mg, bid200mg, bid 3days3days
PivmecillinamPivmecillinam 200mg, bid200mg, bid 7days7days
EAU Guidelines 2006
25. Treatment for Uncomplicated
Pyelonephritis
Long term antibiotics
Drug Dose Duration
CiprofloxacinCiprofloxacin
CiproXRCiproXR
500mg, bid500mg, bid
1000mg, od1000mg, od
7days7days
7-10days7-10days
CefpodoximeCefpodoxime 200mg,bid200mg,bid 10days10days
GatifloxacinGatifloxacin 400mg, od400mg, od 10days10days
LevofloxacinLevofloxacin 250mg, od250mg, od 10days10days
LomefloxacinLomefloxacin 400mg, od400mg, od 10days10days
TMP-SMXTMP-SMX 160/800mg, bid160/800mg, bid 14days14days
EAU Guidelines 2006
26. In severe cases of
pyelonephritis
• Hospitalization
• Parenteral antibiotics (Quinolones and
beta lactamase inhibitor)
• With improvement switch to oral therapy to
complete the course
EAU Guidelines 2006
27. Choice of antibiotics should
take into account
not only the spectrum
of activity but also resistance
28. Resistance
• Infecting organisms are not susceptible to
antimicrobial agent selected
• Invariably patient has received recent
antimicrobial therapy which produces resistance
Campbells Urology 2007; 9th
Ed
29. EAU Guidelines on Urological Infections 2015
• In ALL Women - routine post-treatment
urinalysis or urine cultures in asymptomatic
patients
• If symptoms do not resolve by the end of
treatment and if symptoms recur within 2
weeks, urine culture and antimicrobial
susceptibility tests should be performed.
• Retreatment with a 7-day regimen using
another agent should be considered.
30. TAKE HOME MESAGE
Acute bacterial urinary tract infection are among
the most common bacterial infection treated by
doctors.
CYSTITIS account for most of these,
only 1-2% are admitted to hospital for acute
pyelonephritis treatment
TREATMENT COURSES longer than 3 days result
in almost twice the number of adverse events &
not more effective in treating uncomplicated
cystitis , are more costly , & have higher rates of
non compliance.
