URINARY TRACT INFECTIONS B.Pharmacy 2nd Semester 2023 (2022-2023) Previous Year's Question Papers/Notes Download - HK Technical PGIMS

URINARY TRACT INFECTIONS

UTI
Definition
Gross presentation
UTI-def
• Presence of microorganisms in the
urinary tract
• Occurs when a microbial agent, usually
bacterial, invades and colonizes the
urinary tract.
• The organisms are potent to invade the
tissues of the UT and adjacent
structures.
UTI
Occurs when a microbial agent, usually
bacterial, invades and colonizes the
urinary tract.
Gross Presentation of UTI
• The organisms can produce inflammatory
response
• Manifest several syndromes
Pyelonephritis
Range
From - TO
Asymptomatic
Bacteriuria
Gross Presentation of UTI
• Asymptomatic bacteriuria
• Symptomatic abacteriuria
• Cystitis (“traditional” UTI) bladder )
• Urethritis (often sexually-transmitted)
• Prostatitis
• Pyelonephritis
– Infection of the kidney Associated with
constitutional symptoms
What is Bacteriuria / abacteriuria
• Bacteriuria :
– the presence of bacteria in the urine with the
presence /or absence of both pyuria and symptoms.
• Asymptomatic bacteriuria
– Common among the elderly
– Bacteiruria > 105 bacteria/ml of urine without
symptoms
• Symptomatic abacteriuria:
– Symptoms of frequency and dysuria in the
absence of significant bacteriuria
UTI
Agent factors
UTI-Causative organisms
• Most common pathogen for cystitis,
prostatitis, pyelonephritis:
–Escherichia coli
–Staphylococcus saprophyticus
– Proteus mirabilis
–Klebsiella
–Enterococcus
• Most common pathogen for
urethritis
• Chlamydia trachomatis
• Neisseria Gonorrhea
UTI-Causative organisms
• The majority of UTIs are caused by a
single organism
• In patients with stones , indwelling
catheter, or chronic renal abscesses
multiple organisms may be isolated
• E. Coli responsible organism for 85%
of acute pyelonephritis; also Proteus,
Klebisella
UTI
Host factors
The normal bladder is capable of
clearing itself of organisms
within 2 to 3 days of their
introduction.
HOW?
UTI-Host factors
Normal mechanisms that maintain
sterility of urine
• Adequate urine volume
• Free-flow from kidneys through
urinary meatus
• Complete bladder emptying
• Peristaltic activity of ureters and
competent ureterovesical junction
UTI-Host factors
Normal mechanisms that maintain sterility
of urine
• Normal acidity of urine-antibacterial
properties of urine and its constituents
• The intrinsic mucosal bladder
defensemechanisms
• In males, antibacterial effect of zinc in
prostatic fluid
• An acid vaginal environment (female)
UTI-Host factors
Abnormalities that interfere with
natural defenses
• Obstruction-/-incomplete emptying
Condition that result in residual urine volumes
e.g. Prostatic hypertrophy,
• Mechanical instrumentation
– Urinary catheter
• Pregnancy,
• Use of spermicidies and diaphragms
UTI
Riskfactors
UTI-Host Risk Factors
1. Aging
Increased risk of urinary stasis
Impaired immune response
2. Females: short urethra, use of
contraceptives that alter normal bacteria
flora of vagina and perineal tissues
3..Males: prostatic hypertrophy, bacterial
prostatitis,
4.Urinary tract obstruction: tumor or
calculi, strictures
5.Impaired bladder innervation
Ex spinal injuries
UTI-Host Risk Factors
DM & UTI
• DM Complications
– diabetic nephropathy, papillary necrosis,
renal artery stenosis, and diabetic
cystopathy.
• Bacteriuria is twice as common in
glycosuric and diabetic patients.
• Morbidity and potential mortality is
greater in diabetic patients with UTIs.
UTI
Two potential Routes
of entry
UTI –routes of entry
Two potential routes
• The ascending route
• Hematogenous route
UTI –routes of entry
• Ascending route : most commonly,
bacteria enter the bladder via the
urethra.
– Large bowel commensal organisms, the
perianal region
– the prepuce in the male
UTI –routes of entry
• Hematogenous and lymphatic pathways : far
less common, the spread of bacteria from
adjacent organs. The major causes of
hematogenous infection are S. aureus,
Salmonella species, P. aeruginosa, and Candida
species.
UTI
Pathophysiology
• To produce a UTI agent should
– Adhere
– Multiply
– Colonize
– Invade the urinary tract
Bacterial virulence
x
Host defense
UTI-Pathophysiology
Bacteria get access from urethra and ascends
Colonized Pathogens at urethra or perineal
area enter urinary tract by ascending mucous
membranes into lower urinary tract
Bacteria can ascend from bladder to infect the
kidneys
Females are more prone due to:
• Small urethra
Gram negative organism radiate from
perianal area to urethra
Sexual intercourse
• Susceptibility of epithelium
Whether bladder infection
ensures it, depends on the
following:
• Flushing and diluting of micurition and
voiding
• Antibacterial properties of bladder
mucosa and urine
• Size of inoculum
UTI
Varieties
•Types according to anatomical
region affected
•Simple,complicated,recurrent
TYPES
LOWER TRACT INFECTION UPPER TRACT INFECTION
URETHRITIS
PROSTATITIS
CYSTITIS
PYELONEPHRITIS
PERI NEPHRIC ABSCESS
Urinary Tract Infection
Uncomplicated UTIs (simple UTIs) :
Complicated UTIs
Recurrent UTI
Urinary Tract Infection
Uncomplicated (Simple)
– In healthy non pregnant woman, with
no signs of systemic disease
– normal urinary tract
(structurally and functionally)
– no history of recent antimicrobial use.
Eg :most isolated or recurrent lower
UTIs
and acute pyelonephritis in female
patients.
Urinary Tract Infection
Complicated
– In men, or woman with comorbid medical
problems.
– abnormal urinary tract
( structurally and/or functionally)
eg. UTI secondary to
– urinary tract catheterization/Instrumentatio
– urolithiasis
– obstructive uropathy,
– diabetes mellitus,
– pregnancy
Recurrent UTIs
• Multiple symptomatic infections with
asymptomatic periods
• Reinfection: caused by a different
organism than originally isolated and
account for the majority of recurrent
UTIs.
• Relapse: repeated infections with the
same initial organism and usually
indicate a persistent infectious source.
UTI
Symptoms
Symptoms of Urinary Tract
Infection
• Fever
• Nausea/Vomiting
(pyelonephritis)
• Flank pain (pyelonephritis)
• Hematuria
Voiding dysfunction secondary to a
UTI
is characterized by some or all of
the following
Urgency-frequency
Dysuria(pain while passing urine)
Hesitancy
( inability to completely empty the
bladder)
dribbling of urine
overt incontinence