The document discusses uncomplicated urinary tract infections (UTIs), including risk factors, common causative agents, diagnosis, and treatment. It notes that uncomplicated UTIs most often involve the lower urinary tract and are caused by bacteria like E. coli entering the bladder. A short course of antibiotics is usually sufficient to treat uncomplicated cystitis or pyelonephritis.
The document discusses uncomplicated urinary tract infections (UTIs), including risk factors, common causative agents, diagnosis, and treatment. It notes that uncomplicated UTIs most often involve the lower urinary tract and are caused by bacteria like E. coli entering the bladder. A short course of antibiotics is usually sufficient to treat uncomplicated cystitis or pyelonephritis.
The document discusses uncomplicated urinary tract infections (UTIs), including risk factors, common causative agents, diagnosis, and treatment. It notes that uncomplicated UTIs most often involve the lower urinary tract and are caused by bacteria like E. coli entering the bladder. A short course of antibiotics is usually sufficient to treat uncomplicated cystitis or pyelonephritis.
The document discusses uncomplicated urinary tract infections (UTIs), including risk factors, common causative agents, diagnosis, and treatment. It notes that uncomplicated UTIs most often involve the lower urinary tract and are caused by bacteria like E. coli entering the bladder. A short course of antibiotics is usually sufficient to treat uncomplicated cystitis or pyelonephritis.
Department of Internal Medicine Udayana School of Medicine/Prof Ngoerah General Hospital 2023 ▪ It is the presence of microorganisms in the urinary tract that cannot be accounted for by contamination. ▪ The organisms have the potential to invade the tissues of the UT and adjacent structures. ▪ A UTI can manifest as several syndromes associated with an inflammatory response to microbial invasion that range from asymptomatic bacteriuria to pyelonephritis. ANATOMIC SITE DEGREE
▪ Uncomplicated UTI ▪ Occur in individuals who lack ▪ Lower tract infection: cystitis, urethritis, prostatitis structural or functional abnormalities ▪ Upper tract infection: ▪ Mostly in healthy females pyelonephritis, involving the kidneys ▪ Complicated UTI ▪ Predisposing lesion of the UT such as congenital abnormality or distortion of the UT, a stone a catheter, prostatic hypertrophy, obstruction, or neurological deficit COMPLICATED UTI Increase the risk of complication or treatment failure. Different pre and post evaluation, type and duration of antibiotic compared to uncomplicated UTI. Hooton, T. In: Feehally et al. Comprehensive Clinical Nephrology. 6th ed. Philadelphia: Elsevier; 2018. p. 626-37
uncomplicated
uncomplicated ▪ Recurrent: ▪ Two separate culture proven episodes of acute bacterial cystitis and associated symptoms within six months or three episodes within one year ▪ 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. ▪ Asymptomatic Bacteriuria: ▪ Presence of bacteria in the urine that causes no illness or symptoms Uncomplicated UTI commonly occurred → Incidens of cystitis in young sexually active female : 0,5 per 1 person-year
Complicated UTI → nosocomial → occurred in 5% of hospitalization → most common: catheter related infection
Bacteriuria asymptomatic → 5% of young female Bacteriuria asymptomatic → may develop into UTI with symptoms→ may cause serious complication Kodner MC. Recurrent Urinary Tract Infections in Women: Diagnosis and Management. Am fam physician. 2010 sep 15;82(6):638-643. HOST
ENVIRONMENT AGENT ▪ Early step that may cause non-complicated UTI, also occurred in complicated UTI ▪ Factors that may lead to UTI → causing risk of complicated due to obstruction or urine flow obstruction → facilitating the entry of uropathogen to bladder by penetrating body defense mechanism ▪ Causing infection nodes that not ready to treat with antimicroba ▪ Diabetes mellitus patients → related to renal abses and perineal, pyelonephritis and emphysematous cystitis, papillary necrosis, and xanthogranulomatous pyelonephritis. ▪ Most uncomplicated UTIs in healthy women result when uropathogens (typically E.coli) present in the rectal flora enter the bladder through the urethra after an interim phase of periurethral and distal urethral colonization
▪ Colonizing uropathogens also may come from a sex partner’s
vagina, rectum, or penis ▪ Hematogenic spread of the urinary tract by uropathogens → usually Staphylococcus aureus → can be a source of UTI → occurs if there is persistent bloodstream infection or urinary tract obstruction ▪ Majority of uncomplicated UTI in healthy women occur when uropathogen (commonly E.Coli) in rectum enter bladder through urethra ▪ Hematogenic spread urinary tract by uropathogen → usually Staphylococcus aureus → may become source of UTI → occur if there is persistent blood stream infection or urinary tract obstruction PREDISPOSE FACTORS PROTECTING FACTORS
▪ Host’s immune response;
▪ Maintenance of normal vaginal flora, which protects against colonization with uro-pathogens; ▪ and removal of bladder bacteriuria by micturition. • Uncomplicated upper and lower UTI are most often caused by E. coli, Uro- pathogenic E. coli (UPEC), present in 70% to 95%, and • Staphylococcus saprophyticus, 5% to more than 20%.
Hooton, T. In: Feehally et al. Comprehensive Clinical
Nephrology. 6th ed. Philadelphia: Elsevier; 2018. p. 626-37 Mireles et al. Nat Rev Microbiol. 2015 May ; 13(5): 269–284 ▪The greater distance between the anus and the urethral meatus, ▪The drier environment surrounding the male urethra, ▪And the greater length of the male urethra. The diagnosis of a UTI is based on the combination of symptoms and laboratory findings 1. Effective therapeutic response 2. Prevention of recurrence 3. Reduce the development of resistance of bacterial strains ▪ Cystitis is the most common UTI, involving only the lower urinary tract, and is seen in both pre- and postmenopausal women. There is no fundamental difference in the principle of treatment. ▪ In sporadic UTI, empiric treatment can be initiated on the basis of symptoms without any further workup. A short treatment of 3–5 days is sufficient. No clinical or microbiological follow-up is usually required. ▪ A more thorough diagnostic evaluation is indicated for women with evidence of uncomplicated pyelonephritis. ▪ This workup includes a urine analysis, urine culture and susceptibility testing, blood samples, and, radiological evaluation. ▪ Involving the renal parenchyma, this infection is more serious and requires a 7–14-day treatment. ▪ Clinical and microbiological follow-up is recommended. Asymptomatic Bacteriuria ▪ Screening and treatment of asymptomatic bacteriuria is generally not warranted ▪ In young women with recurrent UTI, asymptomatic bacteriuria may be protective against symptomatic recurrence and treatment may increase the risk for such recurrences. ▪ However, patients at high risk for serious complications warrant a more aggressive approach to diagnosis and treatment, including pregnant women and patients undergoing urologic surgery ▪ Patients with anatomic or functional abnormalities of the urinary tract, diabetic patients, and patients with urea-splitting bacteria (e.g. P. mirabilis, Klebsiella spp) ▪ Dysuria with acute onset, frequency, urgency, or suprapubic pain. ▪ Pyuria → often occur → no presence of this signs strongly suggest for other diagnosis ▪ Hematuria ▪ Definitive diagnosis: Significant bacteriuria (105 or more of uropathogen per milliliter from mid stream urine) → Definition from Infectious Diseases Society of America (IDSA) 103 cfu/ml or more ▪ E. Coli as etiology → often resistant to trimethoprim, TMP-SMX, and cotrimoxazole in US, Canada, Europe ▪ Fever >= 38OC, shivering, flank pain, nausea and vomiting, pain in CVA ▪ Cystitis may occur ▪ Pyuria may occur ▪ Urine culture → 104 cfu/ml or more of uropathogen (in 95% of patients) ▪ Indication for hospitalization ▪ Unable to maintain hydration or oral medication ▪ Uncertain social situation → treatment adherence ▪ Unsure of diagnosis → further workup ▪ Severe symptoms → high fever, severe pain ▪ Symptoms may mimic cystitis and pyelonephritis, buat also unspecific (weakness, nausea, headache, back or abdominal pain ) ▪ Complicated UTI → related to pyuria and bacteriuria ▪ Urine culture should always perform in individuals suspected for complicated UTI ▪ IDSA definition for complicated UTI → 105 cfu/ml in female or 104 cfu/ml in male
However, lower amount of bacteria in smymptomatic individuals → marked as
significant bacteriuria → especially if sample collected from urinary catheter
103 cfu/ml uropatogen
▪ Need for adequate drug concentration in urine to sterilize urine ▪ Adequate drug concentration in tissue to treat pyelonephritis ▪ Concentration of serum antimicroba correlated with drug concentration in renal tissue ▪ In patients with low GFR and pyelonephritis or cystitis, drug recommendation in table depicted above has been proven as adequate ▪ Duration of catheter insertion is an important risk factors → > 30 days → bacteriuria with resistance to various antibiotics ▪ Sample collected from newly inserted catheter → if inserted long enough → biofilm in catheter may lead to spurious ▪ Duration for antibiotic → 7 days if symptoms improve → 10-14 days if response slower ▪ Preventive measurement → sterile catheter insertion, immediate removal of catheter ▪ Occur in 25% of male ▪ Most commonly found organism → E.Coli, Proteus spp., Klebsiella spp, P. Aeruginosa, dan may found (although rare) enterococci and S.aureus ▪ Pathogenesis --< urine reflux from urethra to prostatic ducts ▪ Symptoms that may occur: dysuria, frequency, urgency, fever, shivering, myalgia ▪ May be treated as outpatient ▪ Patients with more severe symptoms → parenteral antibiotics ▪ Treatment duration: 14-30 days ▪ Commonly benign ▪ Pyuria often occur, particularly in elderly population ▪ Screeing and treatement usually not needed CONCLUSION • Urinary tract infection showed significant bacteriuria • Principle of treatment of urinary tract infection including adequate choice of antibiotics • Proper choice and duration of antibiotics may decrease resistency in the future
