URINARY TRACT INFECTION

UTI is the common term for conditions in which there is growth of bacteria within the urinary tract Bacteriuria is presence of bacteria in bladder urine Growth of > 100.000 colony forming units significant

AETIOLOGY
Escherichia coli (80-90% acute UTI) (70-80% recurrent UTI) Proteus, Staphylococcus epidermidis & aureus, Enterococcus, Pseudomonas, Klebsiella.

CLASSIFICATION
1. Clinical Problem -Non complicated UTI (Non obstructive) -Compilcated UTI (Obstructive) - Abnormality urinary tract - Abnormality immunology system - Renal impairment

With or without symptom

- Symptomatic Frequent syndrome Acute pyelonephritis Acute prostatitis -Asymptomatic

PATHOGENESIS
1. Ascenderen (95%) 2. Hematogen (3%) 3. Lymphogen

LABORATORY
PYURIA A. urine sedimen, leucocytes 5/HPF B. urine leucocytes (non centrifuge) 2. BACTERIA IN URINE (non centrifuge)
2 bact/10 HPF or 5 bact/HPF 3. CHEMICAL TEST a. Nitrite test b. Methylen blue reductase test

URINE SAMPLE LABORATORY

1. Perineal bag steril
2. Urine mid stream 3. Catheterization 4. Suprapubic aspiration

INTERPRETATION OF THE RESULT URINE CULTURE Sample Midstream Colony Culture >100.000 1 >100.000 2 Catheterization >100.000 1 Supra pubic > 1 bact Gr - 1 > 1000 bact Gr+ 1 UTI 80% 96% 95% 99% 99%

DIAGNOSIS
- SYMPTOMS
- PYURIA - TRUE BACTERIURIA

CLINICAL PRESENTATIONS
- The symptoms of children with UTI depend on the level of the infections as well as the age of child - Neonatal : anorexia, lethargy, feeding difficults, body tenderness, hypothermia - Infants : non toxic - Childhood : classical symptoms

Management of Acute Symtomatic

1. Eliminate infection 2. Establish clinical and microbiological survailence to ensure 3. Prevent further infection

ANTI BACTERIAL TREATMENT

Depend : culture & resistensi test
1. Bactericid & Bacteriostatic 2. No side effect 3.After treatment increase therapeutic level 4. Easy 5. No resistance

COMPLICATION
- Evaluate ---- Anomaly. VUR and other obstruction
ren & CRF damage If + 1. Prophylactic antibiotic a. Complicated UTI, recurrence 3 X or more in one year ( 1-2 years)

 B. Uncomplicated UTI recurrence 3X or more in one year (3-6 months) Drugs : Nitrofurantoin, cotrimoxazol Radiology : PIV, MSU, USG, Cyntigrahpy, Cistography, Tomography computer, after 4-6 weeks no infections. Urology intervention