Uti Urinary Tract Infection

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Urinary Tract Infections

MLAB 2434 Clinical Microbiology Cecile Sanders & Keri Brophy-Martinez

Definitions

UTI = Urinary Tract Infection Upper UT includes renal parenchyma (pyelonephritis) and ureters (ureteritis) Lower UT includes bladder (cystitis), urethra (urethritis), and, in males, the prostrate (prostatitis) Bacteriuria = presence of bacteria in urine; may be symptomatic or asymptomatic

Urinary System

Except for urethral mucosa and renal medulla, the urinary tract efficiently and rapidly eliminates microorganisms Conditions such as high ammonia concentration, hyperosmolarity, lowered pH, and sluggish blood flow in renal medulla can contribute to reduced leukocyte chemotaxis and bactericidal activity of WBCs

Risk Factors

Age

Infants to Pre-school age


Girls infected more than boys Most renal damage due to UTI at this age

School-age children
Presence of bacteria in urine defines population at higher risk for development of UTIs in adulthood Girls more prone to develop UTI upon sexual activity

Risk Factors (contd)

Age (contd)

Adults to 65
UTIs in men extremely low, except with anatomic abnormalities or prostate disease or as a result of instrumentation 20% of women in this age group experience symptomatic UTI

Risk Factors (contd)

Age (contd)

Over age 65 and residence in longterm care facility


UTIs increase dramatically in both genders Males prostate changes and increased catherization Women fecal soiling, neuromuscular disease, and increased catheterization

Risk Factors (contd)

Inpatient Care
Hospitals and nursing homes More prone to UTIs due to pathologic conditions and higher probability of urinary tract instrumentation

Clinical Signs and Symptoms


Infants and children < 2 years age have nonspecific symptoms > 2 years are more likely to have localized symptoms (dysuria, frequency, abdominal or flank pain) Adults with lower UT infections have dysuria, frequency, urgency, and sometimes suprapubic tenderness

Clinical Signs and Symptoms (contd)

Upper UTIs, especially with acute pyelonephritis, include LUTI symptoms along with flank pain and tenderness and fever AGN (Acute Glomerulonephritis) results from immune response to S. pyogenes (Group A) infections, either respiratory or pyodermal

Edema around eyes Hematuria RBC and WBC casts

Etiology of UTIs

Pathogenesis of UTI

Three access routes


Ascending (most significant) Hematogenous Lymphatic

UTI Agents
G- Bacilli E. coli Pseudomonas, Proteus, Klebsiella, & Enterobacter sp. G+ Cocci Enterococcus more commonly in

older men

S. saprophyticus sexually active


young women

UTI Agents (contd)

G+ Bacilli Bacillus is a contaminant Others (Mycobacterium, Listeria, Clostridium) Fungi Some powerful STIs will produce UTIs (Ex. N. gonorrhoeae, C. trachomatis, Gardenella vaginalis) Viruses

Specimen Collection
Need to collect specimen to prevent normal vaginal, perianal, and urethral flora Mid-stream clean catch if self collected, patient needs GOOD instructions Catheterized Suprapubic aspiration

Specimen Collection (contd)


Additives even with additive, time from collection to processing should not exceed 24 hours Dip-slide urine collection better for physician offices Transport if not refrigerated or preserved, urine should be refrigerated

Specimen Screening

Manual screening

5 to 10 WBC/hpf is upper limit of normal Chemical screening


Leukocyte Esterase and Nitrate on urine dipstick

Automated methods expensive, except in large volume labs 24 hour urines and Foley catheter tips must be rejected for culture

Culture and Interpretation


Inoculation using either a 0.001 ml (x1000) OR a 0.01 ml (x100) loop Interpretation of urine cultures is determined by medical staff of hospital

Culture and Interpretation (contd)

Textbook algorithm

Specimen with three organisms is probably contamination and should not be identified unless specifically requested by physician One or two pathogens 100,000 CFU/ml should be identified and sensitivities done One or two pathogens 100 CFU/ml should be identified only if clinical situation warrants or specimen is catheterized or suprapubic aspiration

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