Transcript GENITOURINARY TRACT INFECTION

GENITOURINARY TRACT
INFECTION
Anacta, Klarizza
Andal, Charlotte Ann
Ang, Jessy Edgardo
Ang Joanne Marie
Ang, Kevin Francis
Urinary Tract Infection
• a term applied to a variety of clinical
conditions in the urinary tract
• ranging from the asymptomatic presence
of bacteria in urine to severe infection of
the kidney
• accurate diagnosis and treatment is
essential to limit morbidity & mortality
Epidemiology
Smith’s Urology, 17th ed.
Pathogenesis
• need to understand:
– bacterial entry
– host susceptibility factors
– bacterial pathogenic factor
Bacterial Entry
• Modes of entry:
1. periurethral bacterial ascend - most common cause
2. hematogenous spread - immunocompromised &
neontes ( S. aureus, Candida sp. & M. tuberculosis)
3. lymphatogenous spread
4. adjacent organs - intraperitoneal abscesses or fistulas
Host Defense
•
1.
2.
3.
Factors:
unobstructed urinary flow
urine itself - Tamm-Horsfall glycoprotein
anatomic functional abnormality-obstructive
condition, neurologic disease, diabetes or pregnancy
4. presence of foreign bodies-stones, catheters
and stents
5. aging (men: increase in obstructive uropathy; women:
alteration in vaginal and periurethral flora)
Host Defense
• Defenses
– Inflammatory mediators
– Blood group antigens
– Periurethral normal flora (in women: lactobacillus)
– Prostate secretion (in men: fluid containing zinc)
– Vesicoureteral reflux (in children)
Bacterial Pathogenic
Factor
• Escherichia coli (common)
– increased adherence to uroepithelial cells
– resistance to bactericidal activity
– production of hemolysin
– increased expression of K capsular antigen
• Recurring infection
– bacteria matured in biofilms and create pod-like
bulges on urothelial surface
Causative Pathogens
• Common(80%): E.coli (O serogroups)
• Less Common: Klebsiella, Proteus and
Enterobacter spp., and enterococci
• Hospital setting: pseudomonas and
staphylococcus sp.
• Children: Klabsiella and Enterobacter spp. more
common
• Pregnant: Group B beta – hemolytic streptococci
• Normal flora: Anaerobic bacteria, lactobacilli,
corynebacteria, streptococci & S. epidermidis
Diagnosis
• Urinalysis
• Urine Culture – gold standard for
identification of UTI
• Localization studies
• Ultrasound, MRI or CT Scan
Antibiotic Treatment
• Goal: to eradicate the infection by selecting the
appropriate antibiotic that would target specific
bacterial susceptibility
• Consider the following in choosing:
– Infecting pathogen
– The patient
– Site of infection
Antibiotic Treatment
Drugs
Trimethoprim –
Sulfamethoxazole
Fluoroquinolones
Features
For most UTI except Enterococcus and
Pseudomonas spp.
Best vs gram – negatives, Staphylococcus
sp. not Streptococci
Nitrofurantoin
Good bs gram – negative bacteria.
Straphylococci and enterococci spp., except
Pseudomonas and Proteus spp.
Aminoglycosides
For complicated UTI; vs gram – negative
+ ampicillin – vs enterococci
Cephalosporins
Aminopenicillins
Most uropathogens
Good vs Enterocicci, Staphylococci, E.coli
and Proteus mirabilis
+ clavulanic acid – vs gram - negative
Acute Cystitis
• urinary infection of the lower urinary tract,
principally the bladder
• women > men
• Mode of infection: ascending from
periurethral/vaginal and fecal flora
Acute Cystitis
• Presentation
–
–
–
–
Irritative voiding (dysuria, frequency & urgency)
Low back and suprapubic pain
Hematuria
Cloudy / foul – smelling urine
• Work – up
– Urinalysis: WBCs in urine with hematuria
– Urine culture: confirm diagnosis and identify causative
orgnanism
• Management
– Short course of oral antibiotic (TMP – SMX & nitrofurantoin)
– Treatment of 3 – 5 days
Recurrent Cystits
• Presentation:
– Bacterial persistence or reinfection with another
organism
• Work – up:
– Urine culture: to identify for management of bacterial
persistence
– Ultrasonography: screening evaluation of the GUT
– Pyelogram, Cystoscopy and CT Scan
• Management:
– Surgical removal of source
– Prophylactic antibiotic
Recurrent Cystits
• Management:
– Intermittent self – start antibiotic – treat recurrent
antibiotic
– Sexual activity: frequent bladder emptying and single
does of antibiotic taken after sexual intercourse
reduces incidence
– Alternatives:
• Intravaginal estriol
• Lactobacillus vaginal suppositories
• Cranberry juice taken orally