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GENITOURINARY TRACT INFECTION

GENITOURINARY TRACT INFECTION. Anacta, Klarizza Andal, Charlotte Ann Ang, Jessy Edgardo Ang Joanne Marie Ang, Kevin Francis. a term applied to a variety of clinical conditions in the urinary tract ranging from the asymptomatic presence of bacteria in urine to severe infection of the kidney

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GENITOURINARY TRACT INFECTION

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  1. GENITOURINARY TRACT INFECTION Anacta, Klarizza Andal, Charlotte Ann Ang, Jessy Edgardo Ang Joanne Marie Ang, Kevin Francis

  2. a term applied to a variety of clinical conditions in the urinary tract • ranging from the asymptomatic presence of bacteria in urine to severe infection of the kidney • accurate diagnosis and treatment is essential to limit morbidity & mortality Urinary Tract Infection • a term applied to a variety of clinical conditions in the urinary tract • ranging from the asymptomatic presence of bacteria in urine to severe infection of the kidney • accurate diagnosis and treatment is essential to limit morbidity & mortality

  3. Epidemiology Smith’s Urology, 17th ed.

  4. need to understand: • bacterial entry • host susceptibility factors • bacterial pathogenic factor Pathogenesis • need to understand: • bacterial entry • host susceptibility factors • bacterial pathogenic factor

  5. Modes of entry: 1. periurethral bacterial ascend - most common cause 2. hematogenous spread - immunocompromised & neontes ( S. aureus, Candida sp. & M. tuberculosis) 3. lymphatogenous spread 4. adjacent organs - intraperitoneal abscesses or fistulas Bacterial Entry • Modes of entry: 1. periurethral bacterial ascend - most common cause 2. hematogenous spread - immunocompromised & neontes ( S. aureus, Candida sp. & M. tuberculosis) 3. lymphatogenous spread 4. adjacent organs - intraperitoneal abscesses or fistulas

  6. Factors: • unobstructed urinary flow • urine itself - Tamm-Horsfall glycoprotein • anatomic functional abnormality-obstructive condition, neurologic disease, diabetes or pregnancy • presence of foreign bodies-stones, catheters and stents • aging (men: increase in obstructive uropathy; women: alteration in vaginal and periurethral flora) Host Defense • Factors: • unobstructed urinary flow • urine itself - Tamm-Horsfall glycoprotein • anatomic functional abnormality-obstructive condition, neurologic disease, diabetes or pregnancy • presence of foreign bodies-stones, catheters and stents • aging (men: increase in obstructive uropathy; women: alteration in vaginal and periurethral flora)

  7. Defenses • Inflammatory mediators • Blood group antigens • Periurethral normal flora (in women: lactobacillus) • Prostate secretion (in men: fluid containing zinc) • Vesicoureteral reflux (in children) Host Defense • Defenses • Inflammatory mediators • Blood group antigens • Periurethral normal flora (in women: lactobacillus) • Prostate secretion (in men: fluid containing zinc) • Vesicoureteral reflux (in children) • Defenses • Inflammatory mediators • Blood group antigens • Periurethral normal flora (in women: lactobacillus) • Prostate secretion (in men: fluid containing zinc) • Vesicoureteral reflux (in children)

  8. Bacterial Pathogenic Factor • Escherichia coli (common) • increased adherence to uroepithelial cells • resistance to bactericidal activity • production of hemolysin • increased expression of K capsular antigen • Recurring infection • bacteria matured in biofilms and create pod-like bulges on urothelial surface

  9. Common(80%): E.coli (O serogroups) • Less Common: Klebsiella, Proteus and Enterobacter spp., and enterococci • Hospital setting: pseudomonas and staphylococcus sp. • Children: Klabsiella and Enterobacter spp. more common • Pregnant: Group B beta – hemolytic streptococci • Normal flora: Anaerobic bacteria, lactobacilli, corynebacteria, streptococci & S. epidermidis Causative Pathogens • Common(80%): E.coli (O serogroups) • Less Common: Klebsiella, Proteus and Enterobacter spp., and enterococci • Hospital setting: pseudomonas and staphylococcus sp. • Children: Klabsiella and Enterobacter spp. more common • Pregnant: Group B beta – hemolytic streptococci • Normal flora: Anaerobic bacteria, lactobacilli, corynebacteria, streptococci & S. epidermidis • Common(80%): E.coli (O serogroups) • Less Common: Klebsiella, Proteus and Enterobacter spp., and enterococci • Hospital setting: pseudomonas and staphylococcus sp. • Children: Klabsiella and Enterobacter spp. more common • Pregnant: Group B beta – hemolytic streptococci • Normal flora: Anaerobic bacteria, lactobacilli, corynebacteria, streptococci & S. epidermidis

  10. Urinalysis • Urine Culture – gold standard for identification of UTI • Localization studies • Ultrasound, MRI or CT Scan Diagnosis • Urinalysis • Urine Culture – gold standard for identification of UTI • Localization studies • Ultrasound, MRI or CT Scan

  11. Goal: to eradicate the infection by selecting the appropriate antibiotic that would target specific bacterial susceptibility • Consider the following in choosing: • Infecting pathogen • The patient • Site of infection Antibiotic Treatment • Goal: to eradicate the infection by selecting the appropriate antibiotic that would target specific bacterial susceptibility • Consider the following in choosing: • Infecting pathogen • The patient • Site of infection

  12. Antibiotic Treatment

  13. urinary infection of the lower urinary tract, principally the bladder • women > men • Mode of infection: ascending from periurethral/vaginal and fecal flora Acute Cystitis • urinary infection of the lower urinary tract, principally the bladder • women > men • Mode of infection: ascending from periurethral/vaginal and fecal flora

  14. Presentation • Irritative voiding (dysuria, frequency & urgency) • Low back and suprapubic pain • Hematuria • Cloudy / foul – smelling urine • Work – up • Urinalysis: WBCs in urine with hematuria • Urine culture: confirm diagnosis and identify causative orgnanism • Management • Short course of oral antibiotic (TMP – SMX & nitrofurantoin) • Treatment of 3 – 5 days Acute Cystitis • Presentation • Irritative voiding (dysuria, frequency & urgency) • Low back and suprapubic pain • Hematuria • Cloudy / foul – smelling urine • Work – up • Urinalysis: WBCs in urine with hematuria • Urine culture: confirm diagnosis and identify causative orgnanism • Management • Short course of oral antibiotic (TMP – SMX & nitrofurantoin) • Treatment of 3 – 5 days • Presentation • Irritative voiding (dysuria, frequency & urgency) • Low back and suprapubic pain • Hematuria • Cloudy / foul – smelling urine • Work – up • Urinalysis: WBCs in urine with hematuria • Urine culture: confirm diagnosis and identify causative orgnanism • Management • Short course of oral antibiotic (TMP – SMX & nitrofurantoin) • Treatment of 3 – 5 days

  15. Presentation: • Bacterial persistence or reinfection with another organism • Work – up: • Urine culture: to identify for management of bacterial persistence • Ultrasonography: screening evaluation of the GUT • Pyelogram, Cystoscopy and CT Scan • Management: • Surgical removal of source • Prophylactic antibiotic Recurrent Cystits • Presentation: • Bacterial persistence or reinfection with another organism • Work – up: • Urine culture: to identify for management of bacterial persistence • Ultrasonography: screening evaluation of the GUT • Pyelogram, Cystoscopy and CT Scan • Management: • Surgical removal of source • Prophylactic antibiotic • Presentation: • Bacterial persistence or reinfection with another organism • Work – up: • Urine culture: to identify for management of bacterial persistence • Ultrasonography: screening evaluation of the GUT • Pyelogram, Cystoscopy and CT Scan • Management: • Surgical removal of source • Prophylactic antibiotic

  16. Management: • Intermittent self – start antibiotic – treat recurrent antibiotic • Sexual activity: frequent bladder emptying and single does of antibiotic taken after sexual intercourse reduces incidence • Alternatives: • Intravaginal estriol • Lactobacillus vaginal suppositories • Cranberry juice taken orally Recurrent Cystits • Management: • Intermittent self – start antibiotic – treat recurrent antibiotic • Sexual activity: frequent bladder emptying and single does of antibiotic taken after sexual intercourse reduces incidence • Alternatives: • Intravaginal estriol • Lactobacillus vaginal suppositories • Cranberry juice taken orally • Management: • Intermittent self – start antibiotic – treat recurrent antibiotic • Sexual activity: frequent bladder emptying and single does of antibiotic taken after sexual intercourse reduces incidence • Alternatives: • Intravaginal estriol • Lactobacillus vaginal suppositories • Cranberry juice taken orally

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