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URINARY TRACT INFECTIONS. Sandra del Mundo, M.D. How does a UTI start?. Ascending infection Bacteria in perineal area ascends through the urethra, enters the urinary bladder and multiplies This is the most common route of infection Systemic infection
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URINARY TRACT INFECTIONS Sandra del Mundo, M.D.
How does a UTI start? Ascending infection Bacteria in perineal area ascends through the urethra, enters the urinary bladder and multiplies This is the most common route of infection Systemic infection In a patient with bacteremia, bacteria may be “seeded” into the kidneys from the blood
What parts of the urinary tract can get infected? Urethra - Urethritis Urinary bladder – Cystitis Ureters – Ureteritis Kidneys - Pyelonephritis (Most common) (Most serious)
What are the signs and symptoms of UTI? Cystitis Frequency Urgency Dysuria – painful voiding Pain or discomfort in suprapubic or perineal area or lower back Cloudy or foul-smelling urine
Acute pyelonephritis Fever Nausea and vomiting More pronounced malaise Pain in the back (+) CVA tenderness
Who are at higher risk for UTI? People with any abnormality of the urinary tract which interferes with normal flow of urine Enlarged prostate Kidney stones Vesicoureteral reflux • People with indwelling urinary catheters
Who are at higher risk for UTI? People with compromised immune function People with diabetes People taking immunosuppressive drugs • Women in general • Pregnant women • Sexually active women
What tests do you need to order if you suspect a UTI? If likelihood of simple cystitis is very high – nothing • If you are not so sure of the diagnosis • Urinalysis • Urine dipstick for leukocyte esterase or nitrites
How do you treat a UTI? What antibiotic should you choose? Ampicillin Amoxicillin NO! • Cotrimoxazole Yes • Quinolones Yes
How do you treat a UTI? How long should you treat? Single dose of antibiotic • Three day course • Seven day course A three day course provides the best compromise between effectiveness and cost and side effects
When should you refer a patient with UTI to a nephrologist ? Most patients will not need a referral. Only special cases need to be referred . • Recurrent UTI: More than three UTI’s per year • When UTI symptoms are accompanied by fever or blood in the urine
When should you refer a patient with UTI to a nephrologist ? • UTI symptoms in a pregnant woman, or a diabetic individual • Any one whose symptoms do not resolve after one course of antibiotics • A second UTI episode in an adult male or child of either sex • A first UTI episode in an infant
Take home messages • Most cases of acute cystitis will resolve with a 3-day course of quinolones • Ampicillin and amoxicillin are not recommended choices for the treatment of UTI because of the high incidence of resistance
Take home messages • Complicated cases need to be referred