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Urinary tract infections among the patients of southren Punjab. Presented by: Aneeqa hayat Ghauri’s clinical laboratory Multan . INTRODUCTION:.
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Urinary tract infections among the patients of southren Punjab Presented by: Aneeqa hayat Ghauri’s clinical laboratory Multan
INTRODUCTION: • A urinary tract infection (UTI) is a condition where one or more parts of the urinary system (the kidneys, ureters, bladder, and urethra) become infected. UTIs are the most common of all bacterial infections and can occur at any time in the life of an individual. Almost 95% of cases of UTIs are caused by bacteria that typically multiply at the opening of the urethra and travel up to the bladder. Much less often, bacteria spread to the kidney from the bloodstream
Urine is normally sterile, that is, free of bacteria, viruses, and fungi.) • In healthy women, the vagina is colonized by lactobacilli, beneficial microorganisms that maintain a highly acidic environment (low pH) that is hostile to other bacteria. Lactobacilli also produce hydrogen peroxide, which helps eliminate bacteria and reduces the ability of Escherichia coli (E. coli) to adhere to vaginal cells. (E. coli is the major bacterial culprit in urinary tract infections.)
UTI is established by counting the bacteria in urine. The bacterial count in excess of 100,000/ml of urine is indicative of UTI. Chronic infection can lead to distortion and scarring of the kidneys.
Types of UTIs : • Uncomplicated or complicated, depending on the factors that trigger the infections • Primary or recurrent, depending on whether the infection is occurring for the first time or is a repeat event
Uncomplicated UTIs are due to a bacterial infection, most often E. coli. • Cystitis, or bladder infection, is the most common urinary tract infection. It occurs in the lower urinary tract (the bladder and urethra) and nearly always in women. In most cases, the infection is brief and acute and only the surface of the bladder is infected. Deeper layers of the bladder may be harmed if the infection becomes persistent, or chronic, or if the urinary tract is structurally abnormal
Pyelonephritis (Kidney Infection). Sometimes the infection spreads to the upper tract (the ureters and kidneys). This is called pyelonephritis, or more commonly, a kidney infection. • Complicated infections, which occur in men and women of any age, are also caused by bacteria but they tend to be more severe, more difficult to treat, and recurrent (Catheter use in the hospital setting or chronic indwelling catheter , Bladder and kidney dysfunction, or kidney transplant )
Signs and symptoms • The most common symptoms of a bladder infection are burning with urination (dysuria), frequency of urination, an urge to urinate, significant pain. An upper urinary tract infection may additionally present with fever. Discomfort or pressure in the lower abdomen. The abdomen can feel bloated. • Pain in the pelvic area or back.
The symptoms of urinary tract infections may vary with age and the part of the urinary system that was affected. In young children, urinary tract infection symptoms may include diarrhea, loss of appetite, nausea and vomiting, fever and excessive crying that cannot be resolved by typical measures. Older children on the other hand may experience abdominal pain, or incontinence. Lower urinary tract infections in adults may manifest with symptoms including hematuria (blood in the urine )
The urine often has a strong smell, looks cloudy, or contains blood. This is a sign of pyuria, or a high white blood cell count in the urine, and is a very reliable indicator of urinary tract infections.
Risk Factors • Women are more prone to urinary tract infections than men, and these infections tend to recur. One reason is that the urethra (the tube that carries urine away from the bladder) is shorter in women than in men. • When women reachmenopause, the loss of estrogen thins the lining of the urinary tract, which increases susceptibility to bacterial infections.
Diagnosis: • If a patient is susceptive with UTI than its mid stream urine is collected for urine routine examination and if p/s >5 are present than it shows UTI. RBC,s different casts shows chronic infection of UTI. • This sample is now cultured for the causative agent (pathogen) and checked for the sensitivity of different antibiotics.
It involves incubating and growing the bacteria contained in the urine. A urine culture can help identify the specific bacteria causing the infection, and determine which type of antibiotics to use for treatment. • Clean-Catch Sample. To obtain an untainted urine sample, doctors usually request a so-called midstream, or clean-catch, urine sample. To provide this, the following steps are taken :
Patients must first wash their hands thoroughly, then wash the penis or vulva and surrounding area four times, with front-to-back strokes, using a new soapy sponge each time. • The patient must then begin urinating into the toilet and stop after a few ounces. • The patient then positions the container to catch the middle portion of the stream. Ideally, this urine will contain only the bacteria and other evidence of the urinary tract infection.
Causes : • Escherichia (E.) coli is responsible for most uncomplicated cystitis cases in women, especially in younger women. E. coli is generally a harmless microorganism originating in the intestines. If it spreads to the vaginal opening, it may invade and colonize the bladder, causing an infection. The spread of E. coli to the vaginal opening most commonly occurs when women or girls wipe themselves from back to front after urinating, or after sexual activity.
Staphylococcus saprophyticus accounts for 5 - 15% of UTIs, mostly in younger women. • Klebsiella aerogenes, Alcaligenes feacalis, Enterococci bacteria, Pseudomonas aeruginosa and Proteus mirabilis account for most of remaining bacterial organisms that cause UTIs. They are generally found in UTIs in older women.
Treatment: • Antibiotics are the main treatment for all UTIs. A variety of antibiotics are available, and choices depend on many factors, including whether the infection is complicated or uncomplicated or primary or recurrent • Treatment decisions are also based on the type of patient (man or woman, a pregnant or non-pregnant woman, child, hospitalized or non-hospitalized patient, person with diabetes).
Treatment should not necessarily be based on the actual bacteria count. For example, if a woman has symptoms, even if bacterial count is low or normal, infection is probably present, and the doctor should consider antibiotic treatment. • In laboratory diagnosis in vitro condition pathogens which cause UTI are grown on cultures under optimum conditions and then these bacterial colonies are checked for the response of different antibiotic discs.
Sometimes numerous p/s are seen in the urine but the culture fails to give any growth mainly due to excretion of antibacterial drugs which affect the culture. These types of findings are mainly due to the liberal misuse of antibiotics. • It is well recognized that indiscriminate use of antibiotics has worssoned the problem of antibiotics resistance. Anti-microbial agents are very effective weapons against infection, but at the same time their misuse not only adds enormously to
Expenditure of the patient’s treatment but it is harmful to the health of the patient. • The patients who get infection in the hospitals, respond to antibiotics in a different way as compared with those who catch infections outside in 5the community. • Culture is made on cysteine lactose electrolyte deficient (CLED) medium. Minimum 50 colonies shows significant growth equivalent to 100,000 organisms/ml shows UTI.
These bacterial colonies were than tested by different biochemical or differential methods (TSI etc) and physical characters (gram staining). After the identification of bacteria their sensitivity to various antibiotics must be looked for and it is inoculated on “Sensitivity agar” to study antibiogram. Proper selection of antibiotics is very important in the treatment. • We use different antibiotics from different groups like cephalosporins 1st 2nd and 3rd generation penicillins,
Macrolides, quinolones, miscellaneous, aminoglycosides, carbapenem etc. our study clearly indicates that it is the prolonged use or misuse of drugs which over a period of time producers resistant strains of organisms. That’s why all those drugs which are sensitive against maximum number of organisms and example is ESBL (extended spectrum B-lactamase) producing organisms. There is no precise definition of ESBLs. A commonly used working definition is B-lactamases capable of conferring bacterial resistance to the
Pencillines, 1st, 2nd and 3rd generation cephalosporins and aztreonam( but not the cephamycins or carbapenems e.g. MEM,IMP) • ESBLs destroy the beta lactum ring of beta lactum antibiotics. They bind and prevent the action of pencillin binding proteins (PBPs). ESBLs are the commonest cause of resistance in gram negative bacteria.
