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单击此处编辑母版标题样式,*,Urinary Tract Infections,UTI,UTI-common affliction for which patients seek medical attention,UTI can occur from infancy through old age,more common in females than males 20%of all females will experience a UTI during their lifetime,UTI,Definitions,The term,“,UTI,”,represents a wide range of clinical syndromes,Bacteriuria:the presence of bacteria in urine -does not necessarily imply infection,Asymptomatic bacteriuria:presence of bacteria in the urinary tract in the absence of symptoms,-clinical significance controversial outside certain patient populations,-pregnant women,-patients undergoing invasive procedures of the urinary tract,UTI,Definitions,Cystitis:UTI presumed to be confined to the bladder -painful/burning urination -urgency or frequency -absence of symptoms or physical signs suggesting inflammation at other sites within the urinary tract,Note:clinical criteria are notoriously inaccurate in identifying the actual anatomic site of infection,UTI,Definitions,Pyelonephritis:clinical diagnosis which implies a more invasive infection-inflammation of the kidney and renal pelvis is assumed to be present when patients have pain or tenderness involving the flank,together with other clinical or laboratory evidence of UTI-fever,nausea,chills,malaise,headache,etc,UTI,Definitions,Prostatitis:inflammation/infection of the prostate gland -may present as acute or chronic,Intrarenal abscess/perinephric abscess:collection of pus in the kidney or in the soft tissue surrounding the kidney,UTI,Definitions,Complicated infections,-underlying abnormality that predisposes patient to UTI or makes UTI more difficult to treat effectively,Recurrent Infections Relapse-recurrence of infection by same organism after discontinuation of treatment Reinfection-recurrence of infection by a different organism after discontinuation of treatment,UTI,Pathogenesis,UTI usually due to patients own intestinal flora -ascending route of infection -organisms enter the urinary tract in a retrograde fashion via the urethra,Complicating factors such as catheters,nephrostomy tubes,surgery,urinary stones,etc -allow organisms to enter and persist in urinary tract -alter the typical spectrum of organisms -may have multiple etiologies,UTI,Pathogenesis,Elderly patients -incontinant -functionally impaired -postmenopausal changes -neurological alterations,Pregnant women -altered anatomy,Hematogenous route -endocarditis,bacteremias,tuberculosis -disseminated infections,UTIEtiology,Majority of UTI are due to a single pathogen,The Enterobacteriaceae responsible for 90%of all UTI-gram negative bacilli-facultatively anaerobic-common intestinal flora,Escherichia coli,most commonly isolated pathogen 80%of all UTI,Community-Acquired UTI,E.coli,K.pneumoniae,Proteus,S.saprophyticus,S.epi&,gm-enterics,Enterococcus,Uro-pathogens,E.coli,Klebsiella spp.-intrinsic gut organisms-highly motile-produce fimbriae(pili)attachment,Proteus,Morganella,Providencia-Urease producing organisms-increases urinary pH-leads to crystal formation biofilmscolonization of catheterprotects bacteria from host defenses&antibiotics,Nosocomial UTIcatheter associated,Short Term,Long Term,E.coli,E.coli,Pseudomonas,Pseudomonas,Proteus,Proteus,Enterobacter,Candida,Providencia,Morganella,S.aureus,Enterococcus,Urinalysis,usually have increased numbers of WBC,leukocyte esterase test is often positive,nitrate test is often positive,Urinalysis,Urine culture:significant bacteriuria usually defined as 10,5,bacteria/ml.(10,8,/litre),lower numbers may be significant in children and in catheter collected specimens,Specimen collection,Should all patients with a suspected UTI be cultured?,Community acquired vs nosocomial?,Should all isolates be identified?Susceptibility testing?,Specimen collection,Clean catch mid stream specimens,-most frequently used method -urethra cleaned prior to collection -first void urine allowed to pass to clear urethra -mid-stream collected in sterile container,Collection bags(children),-used in young children lacking bladder control -often contaminated -most meaningful result is a negative culture,Specimen collection,Suprapubic aspiration/straight catheters,-invasive -specimen obtained directly from bladder,Indwelling catheters,-urine obtained by inserting needle into catheter or through diaphram -preferable to obtain specimen from new catheter,rather than old catheter,Specimen transport,Sent to and processed by lab as quickly as possible-Require:method of collection time of collection patient,s antibiotics,Specimens not received by lab in 1-2 hours,MUST,be refridgerated,Urines not received within 24 hours or not refridgerated will be rejected by laboratory,Antimicrobial Therapy,Empiric Therapy -based on most probable pathogens -local rates of resistance -acute infection vs chronic -reinfection or relapse -indwelling catheter etc,Management of UTI,Anatomical/Functional Predisposition to UTI,Impaired bladder emptying,Dysfunction,Neuropathy,VUR,BOO,Diverticulum,Management
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