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Urinary Tract Infection

Urinary Tract Infection. Dr.Shervin Shokouhi Infectious Disease Specialist & Associate Professor of Shaheed beheshti University of Medical Sciences. Definitions. Significant Bacteriuria. Asymptomatic Bacteriuria. Cystitis. Pyelonephritis (Acute & Chronic). Uncomplicated UTI.

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Urinary Tract Infection

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  1. Urinary Tract Infection Dr.Shervin Shokouhi Infectious Disease Specialist & Associate Professor of Shaheed beheshti University of Medical Sciences

  2. Definitions • Significant Bacteriuria. • Asymptomatic Bacteriuria. • Cystitis. • Pyelonephritis (Acute & Chronic). • Uncomplicated UTI. • Complicated UTI. • Relapse & Reinfection.

  3. Routes of invasion • Ascending. • Hematogenous. • Lymphatic Pathways.

  4. Infecting Organisms • Gram negative mic.: Ecolie,klebsiella, Proteus, Pseudomonas,Enterobacter. • Gram positive mic.:Enterococci, Staph.aureus,epidermidis,saprophyticus, Corynebacterium group D2. • Candida • Virus: Adenovirus(type 11),BK & JC Virus. • Others: Gard.vaginalis, Myco.hominis, Ureap.urealyticum, Nanobacteria

  5. Clinical Manifestations • Clinical manifestations in children. • Clinical manifestations in old age. • Clinical manifestations in adulthood: 1. Lower UTI. Frequency,Urgency,Dysuria,and sometimes Suprapubic pain,(Occasionally bloody urine). 2. Upper UTI. Fever(sometimes with chills),Flank pain (Tenderness,Discomfort) , and frequently lower tract symptoms, and sometimes JUST lower tract symptoms.

  6. DIGNOSIS • Acceptable methods for urine collection: 1.Midstream clean catch. 2.Catheterization. 3.Suprapubic aspiration. • Microscopic examination of urine (U/A): 1.WBC. 2.RBC. 3.Casts. 4.Pro. 5.S.Gravity. 6.Bacteria. 7.Nitrite • Urine Culture. 1.Technic. 2.Criteria for calling a culture (Significant) “Enterobacteriaceae” -In asymptomatic persons (Midstream clean catch & Catheterization) -in symptomatic women -In men 3.Criteria for calling a culture (Significant) “Non Enterobactericeae” • False negative urine cultures: -Use of Abx. –Soap .. -Total obstruction below infection. -TB -Diuresis

  7. Exclude Vaginitis and Herpes Genitalia Urine Culture Significant Bacteria 50% <10* Bacteria/mi *=5 Acute Urethral Synd 40%. UTI with low bacterua 18% Urethritis 8% Unknown 14% Dysuriaand Frequency In a normal woman

  8. Management of Uncomplicated Urinary Tract Infection • Nonspecific Therapy. -Hydration -Urinary PH -Analgesics • Lower UTI. (U/A) (Trimethoprim, Trimethoprim-Sulfamethoxazole, Amoxicillin-Clauvonic acid,Fluoroquinolones,…) -Conventional Therapy -Single Dose Therapy -Short-Course Therapy • Acute Pyelonephritis. (U/A & U/C) -In patient (Third Generation Ceph.,AMG,Ampi-Sulbactam, Fluoroquinolone(IV),Ampicillin?,Cefazolin?,…..) -Out patient (Trimethoprim, Trimethoprim-Sulfamethoxazole,Cephalexin, Amoxicillin-Clauvonic acid,Fluoroquinolones,….)

  9. Dysuria,frequency urgancy U/A PYORIA+ PYORIA- Treatment for lower UTI Search for A.U.S Causes Clinical Response Doesn’t Respond U/C and Doxy. for 7 days if Sexual+ if Sexual - : U/C Clinical Response but relapse U/C and Treat for 14 days Office Strategy

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