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Urinary Tract

Infection
(Infeksi Saluran
Kemih)Sp.PD-KGH
dr. Sahala Panggabean,
Departement of Internal Medicine
FK UKI
May 11, 2011
Learning Objectives:
After this lectures, participants will be able to:
Define Urinary Tract Infection
Recognize Symptoms and Signs of UTI
Diagnose UTI
Recognize the Etilogies of UTI
Recognize the Risk Factors of UTI
Plan the Tretment of UTI
Plan the Prevention of UT I
Understand the Terminologies in relation to UTI
Introduction and Definition
Urinary Rract Infection (UTI) is the presence and
multiplication of antimicrobial pathogens within the
normally sterile urinery tract.

UTI can be limited to the bladder (cystitis) can be painful


and annoying. But serious consequences can occur if the
infection spreads to the kidneys (acute pyelonephritis).

Women are most at risk of developing a UTI. About half


of all women will develop an UTI episode during their
lifetimes, and many will experience more than once.

UTI is the second most common type of infection in


human, accounts for 8.3 million doctor visits per year.
Anatomic categoties of UTI

UTI can be subdivided into two general anatomic


categories:
1. Lower Tract Infections ( Urethritis and
Cystitis )
2.Upper Tract Infection ( Acute
Pyelonephritis, Intrarenal and Perinephric
abscesses).
Types UTI
UTI usually develop first in the lower urinary tract
(urethra, bladder) and, if not treated, progress to
the upper urinary tract (ureters, kidneys).
Bladder infection (cystitis) is by far the most
common UTI.
Infection of the urethra is called urethritis.
Kidney infection (pyelonephritis) requires
urgent treatment and can lead to reduced kidney
function and possibly even death in untreated
due to septicemia in severe cases.
Epidemiologic categories of
UTI
Epidemiologically UTIs are sub divided
into:
1.Cathether-associated or nosocomial
infections
2.Community-aquired infections
Acute community-aquired infections are very common and
account for more than 7 million office visits annually.
Asymptomatic bacteriuria is more common among elderly
men and women.
The Urinary Tract
Bacterial Etiology of UTI
Pathogenesis of UTI
The urinary tract can be infected from below,
bacteria entering the urethra and trevelling
upwords (ascending infection).
Some UTI ocuurs by bacteria entering the kidneys
from the bloodstream (hematogen spread).
Infection from hematogen spreads are most often
seen in newborns with sepsis and
immunocompromized older patients.
In older children and adults infection most often
starts from below (ascending infection)
Pathogenesis ascending
infection
In many cases, bacteria first travel to the urethra from
the perineum. Bacteria multiply and infection can
occur.
Infection limited to the urethra is called urethritis.

If bacteria move to the bladder and multiply, a


bladder infection or cystitis results.

If the infection is not treated promptly, bacteria may


then travel further up the ureters to multiply and
infect the kidneys result in kidney infection is called
acute pyelonephritis.
Risk Factors for UTI
A woman's urethra is shorter than a man's, which is one reason
why women are much more likely than men to get UTI's.
For many women, sexual intercourse seems to trigger an infection.
Any abnormality of the urinary tract that obstructs the flow of
urine;
kidney stones for example sets the stage for an infection.
Enlarged prostate gland also can slow the flow of urine, thus
raising the risk of infection.
Common source of infection is catheters, or tubes, placed in the
urethra and bladder.
People with diabetes have a higher risk of a UTI because of
changes in the immune system.
According to some reports, about 2 to 4 percent of pregnant
women develop a urinary infection
Risk Factors for UTI
Conditions affecting
Pathogenesis
Gender and sexual activity
Pregnancy
Obstruction
Neurogenic Bladder Dysfunction
Vesicoureteral Reflux
Bacterial Virulence Factors
Genetic Factors
Signs and Symptoms in
adults
Older children or an adult may experience the
following symptoms with UTI:
Flank or lower back pain (with a kidney
infection)
Frequent urination
Inability to produce more than a small
amount of urine at a time
Incontinensia urinae
Pain in the pelvic area
Painful urination (dysuria)
Cloudy urine or with unusual smell
Clinical Presentations
Cystitis
Patients with cystitis usually report
dysuria, frequency, urgency, and
suprapubic pain.
The urine often becomes grossly cloudy
and malodorous, and it is bloody in 30%
of cases.
Physical examination generally reveals
only tenderness of the suprapubic area.
Clinical Presentations
Acute Pyelonephritis
Symptoms of acute pyelonephritis
generally develop rapidly over a few
hours or a day and include a fever,
shaking chills, nausea, vomiting, and
diarrhea. Besides fever, tachycardia, and
generalized muscle tenderness.
Physical examination reveals marked
tenderness on deep pressure in one or
both costovertebral angles or on deep
abdominal palpation.
Clinical Presentations
Urethritis

Approximately 30% of women with acute dysuria,


frequency, and pyuria have midstream urine
cultures that show either no growth or insignificant
bacterial growth.

In this situation, a distinction should be made


between women infected with sexually transmitted
pathogens, such as C. trachomatis, N.
gonorrhoeae, or herpes simplex virus, and those
with low-count E. coli or staphylococcal infection of
the urethra and bladder.
Complications of UTI
The most serious consern in a UTI is if to
avoid its progress to acute pyelonephritis.

This can result in scarring and damage to the


kidney tissue and Sepsis

Fortunately acute uncomplicated


pyelonephritis in adults rarely progresses to
renal functional impairment and chronic
renal disease.
Diagnostic Testing
Proteinuria, pyuria, hematuria microskopis and/or
macroskopis are ususally found in urinalysis.
Glomerular cast is a sign for kidney infection
(pyelonephritis)
Determination of the number and type of bacteria in
the urine with the urine culture is an important
diagnostic procedure.
Microscopic bacteriuria which is best assessed with
Gram-stained urine seiment, is found in 90% of
specimens from patients whose infections are
associated with colony counts of at least 105/mL, and
this finding is very specific.
Urine culture and antimicrobial susceptibility testing.
Ultrasound exam to look for stones and obstruction.
BNO IVP to look for structural abnormality.
TREATMENT-1
Severely ill patients with vomiting
should be hospitalized and given
the IVFD until they can take fluids
and drugs orally.

Drinking plenty of water helps


cleanse the urinary tract of
bacteria.
TREATMENT-2
Following principles underlie the treatment
of UTIs:
Except in acute uncomplicated cystitis in
women, quantitative urine culture should
be oredered to confirm infection before
empirical treatment is begun.
When culture results become available,
antimicrobial sensitivity testing should be
used to further direct therapy.
Factors predisposing to infection, such as
obstruction and calculi, should be identified
and corrected if possible.
Treatment-3
Oral regimen for acute uncomplicated
cystitis:
Treatment-4
Parenteral regimens for acute
uncomplicated and complicated UTI
PREVENTIONS-1
Women who experience frequent symptomatic UTIs (3 per
year on average) are candidates for long-term
administration of low-dose antibiotics directed at
preventing recurrences.
Such women should be advised to avoid spermicide use
and to void soon after intercourse. Daily or thrice-weekly
administration of a single dose of TMP-SMX (80/400 mg).
Prophylaxis should be initiated only after bacteriuria has
been eradicated with a full-dose treatment regimen.
All pregnant women should be screened for bacteriuria in
the first trimester and should be treated if bacteriuria is
demonstrated.
Preventions-2
Drink plenty of liquids, especially water.
Wipe from front to back. Doing so after
urinating and after a bowel movement
helps prevent bacteria in the perineum
from spreading to the vagina and urethra.
Voiding as soon as possible after
intercourse
Avoid potentially irritating feminine
products.
References:
Thomas Hooton: Urinary Tract Infection in
Adults.
In Richard Johnson and John Feehally (eds.):
Comprehensive Clinical Nephrology. Mosby,
New York, 2nd.ed. 2003; 695-729.

Lindsay Nicole: Urinary Tract Infection.


In: Arthur Greenberg (Ed.) Primer on Kidney
Diseases. National Kidney Foundation, 4th.ed.
2005; 411-417.