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Urinary Tract Infection

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Urinary Tract infection

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Urinary Tract Infection

  1. 1. By Belete N(Bsc, Msc in AHN) DBU By: Belete N 1
  2. 2. Urinary Tract Infections Is an infection of the urinary tract caused by the presence of pathogenic microorganism in the urinary tract with or without signs & symptoms The most common sites of infections Urethra – Urethritis Bladder – Cystitis Lower UTI Prostate – Prostatitis Ureter – Ureteritis Renal pelvis– Pyelonephritis Upper UTI Kidney-Interstitial nephritis Renal abscess By: Belete N 2
  3. 3. Urinary Tract Infections… Risk factors Iatrogenic/Drugs Indwelling catheter Antibiotic use and spermicides Behavioral Voiding dysfunction Frequent or recent sexual intercourse Anatomic/physiologic Vesico-urethral reflux Female sex and Pregnancy By: Belete N 3
  4. 4. Urinary Tract Infections… Genetic Susceptible uroepithelial cells(secrete less IgA) Vaginal mucus properties Etiology Ascending infections (that enter via urinary meatus) Obstructive abnormalities (strictures, prostatic tumors or hyperplasia) Upper urinary tract disease may occasionally cause recurrent bladder infections By: Belete N 4
  5. 5. Urinary Tract Infections… Pathophysiology The bacteria causing UTIs usually originate from bowel flora of the host acquired via three possible routes Ascending Hematogenous or Lymphatic pathways Three factors determine the development of UTIs The size of the inoculum Virulence of the microorganism, and Competency of the natural host defense By: Belete N 5
  6. 6. Urinary Tract Infections… An important virulence factor of bacteria is their ability to adhere to urinary epithelial cells by fimbriae Other virulence factors include hemolysin, a cytotoxic protein produced by bacteria Lyses a wide range of cells including erythrocytes, polymorphonuclear leukocytes, and monocytes ; and aerobactin ★Facilitates the binding and uptake of iron by Escherichia coli By: Belete N 6
  7. 7. Urinary Tract Infections… The most common cause of uncomplicated UTIs is E. coli Accounting for more than 85% of community acquired infections Sign and symptoms Dysuria, frequency, urgency, and nocturia Suprapubic pain and discomfort Hematuria and back pain Syndromes of urosepsis- If complicated Diagnosis 1. Urine dipstick-may react positively for blood WBC 2. Urine microscopy- shows RBC and many WBC- HPF By: Belete N 7
  8. 8. Urinary Tract Infections… Other Classification Uncomplicated UTI UTI that occurs in individuals who lack structural or functional abnormalities in the UT that interfere with the normal flow of urine ★Mostly in healthy females of childbearing age Complicated UTI UTI that occurs in individuals with structural or functional abnormalities i.e. congenital distortion of the UT, a stone, a catheter, prostatic hypertrophy, obstruction, or neurological deficit ★UTI in men are usually complicated-why? By: Belete N 8
  9. 9. Urinary Tract Infections… Recurrent UTI Refers to multiple symptomatic UTIs with asymptomatic periods in between It is considered significant when there is two or more symptomatic episodes per year or it interferes with patient’s quality of life It is usually a reinfection than a relapse By: Belete N 9
  10. 10. Urinary Tract Infections… Management The management of a patient with a UTI includes Initial evaluation Selection of an antibacterial agent and duration of therapy, and Follow-up evaluation Selection of antimicrobial agent for the treatment of UTI is based on The severity of the presenting signs and symptoms The site of infection Whether the infection is complicated or uncomplicated By: Belete N 10
  11. 11. Urinary Tract Infections… The general Management principle includes 1. Relieve discomfort and provide rest (catheterization if needed) 2. Antibiotic 3. Follow up culture to prove treatment effectiveness 4. Increase fluid intake- water is best 5. Avoid irritants - Coffee, tea, alcohol, cola drinks 6. Promote urinary output- Q 2 to 3 hrs By: Belete N 11
  12. 12. Urinary Tract Infections… Antibiotic therapy according to ESTG Acute, uncomplicated UTI in women First line: ★Ciprofloxacin, 500mg P.O., BID, for 3 days or ★Norfloxacin, 400mg P.O.,BID, for 3 days. Alternatives: ★Nitrofurantoin 50mg P.O., QID for 7 days or ★Cotrimoxazole 160/800mg P.O, BID for 3 By: Belete N 12
  13. 13. Pyelonephritis Pyelonephritis is an inflammation of the renal pelvis, calyces, and medulla The infection usually arises in the lower urinary tract with organisms ascending into the renal pelvis Begins in the interstitium & rapidly extending to involve the tubules, glomeruli & blood vessels Classifications Acute pyelonephritis Chronic pyelonephritis By: Belete N 13
  14. 14. Pyelonephritis… Acute pyelonephritis It is sudden onset & self-limited bacterial disease of the kidneys. Etiology Bacteria: E-coli (80%), Proteus, Pseudomonas, S. aures, Strep. faecalis (entrococcus) Procedures: Catheterization, Cystoscopy, Urologic surgery Systemic infections (such as tuberculosis) Other causes: Urinary obstruction, Neurogenic bladder (Vesicourethral reflux) By: Belete N 14
  15. 15. Pyelonephritis… Acute pyelonephritis is an active bacterial infection that can cause: Interstitial inflammation Tubular cell necrosis Abscess formation in the capsule, cortex, or medulla Temporarily altered renal function, and may rarely progresses to renal failure By: Belete N 15
  16. 16. Pyelonephritis… Risk Factors Women over 65 years of age Older men with prostate problems Chronic urinary stone disorders Spinal cord injury Pregnancy Congenital malformations Bladder tumors Chronic illness (diabetes mellitus, hypertension, chronic cystitis) By: Belete N 16
  17. 17. Pyelonephritis… Clinical Manifestation Flank pain Low back pain Costovertebral angle tenderness Dysuria (Painful or difficulty of urination) Nocturia, hematuria, cloudy urine with fishy odor Burning, urgency, frequency, nocturia Shaking chills, generalized fatigue Fever, tachycardia, tachypnea Anorexia, nausea and vomiting, headache, malaise By: Belete N 17
  18. 18. Pyelonephritis… Diagnosis Appropriate history taking, & Physical examination Urinalysis: Dark color, cloudy appearance, foul odor Proteinuria, glycosuria, rarely ketonuria Leucocytes, Few red blood cell Casts, decreased urine specific gravity Positive leukocyte esterase (85 to 90% specific) Positive nitrate (95% specific) Urine culture reveals the causative organism By: Belete N 18
  19. 19. Pyelonephritis… Diagnosis… CBC Elevated WBC (>10,000mm3), elevated neutrophils Erythrocyte sedimentation rate (ESR) will be elevated Intravenous pyelogram If functional and structural renal abnormalities are suspected (calculi, structural, or vascular abnormalities) Ultrasound or CT scan Radionuclide imaging May be useful to identify sites of infection that By: Belete N 19
  20. 20. Pyelonephritis… Complications Secondary arteriosclerosis Calculi formation Renal damage Renal abscess ★Metastasize to the other organs Septic shock Chronic pyelonephritis Chronic renal failure Hypertension By: Belete N 20
  21. 21. Pyelonephritis… Medical Management According to ESTG Acute uncomplicated Pyelonephritis in non-pregnant women: Mild and moderate acute uncomplicated pyelonephritis (able to tolerate oral therapy with no vomiting, no dehydration, no evidence of sepsis): First line ★Ciprofloxacin, 500mg P.O., BID, oral for 7-10 days Alternatives ★Cotrimoxazole(Trimethoprim- sulphamethoxazole), 160/800mg P.O, BID for 14 days By: Belete N 21
  22. 22. Pyelonephritis… Severe acute uncomplicated pyelonephritis (high fever, high white blood cell count, vomiting, dehydration, or evidence of sepsis) or fails to improve during an initial outpatient treatment period Intravenous therapy should be started and continued until the patient improves (usually at 48–72 hours) On discharge oral therapy is continued to complete 10-14 days course Antibiotics should be started after urine culture sample is collected By: Belete N 22
  23. 23. Pyelonephritis… First line Ciprofloxacin, 400mg, I.V, BID till patient improves and continue oral ciprofloxacin 500mg, PO, BID to complete 10-14 days course Alternatives Ceftriaxone, 2gm, I.V, daily or 1gm, I.V, BID till patient improves and continue oral ciprofloxacin 500mg, PO, BID to complete 10- 14 days course If no response in 48-72 hrs. ultrasound is warranted therapy to evaluate for obstruction, abscess, or other complications of pyelonephritis By: Belete N 23
  24. 24. Pyelonephritis… Complicated UTIs and UTI in men-similar to uncomplicated UTIs but needs prolonged duration Recurrent UTI in women First line: Cotrimoxazole, 240mg, P.O., daily or 3x per week or postcoital Alternatives: ★Cephalexin, 125–250mg, P.O., once daily or postcoital or ★Norfloxacin, 200mg, P.O., once daily or postcoital or ★Ciprofloxacin, 125mg, P.O., once daily or postcoital Duration of antibiotics-for six months followed by observation If recurrent UTI comes again the prophylaxis can be prolonged for 1-2years By: Belete N 24
  25. 25. Pyelonephritis… Nursing interventions Administer antipyretic & Antibiotics Fluids (2-3 L/d) to empty the bladder of contaminated urine & prevent calculus formation Catheterize with strict sterile technique Instruct the patient to perform appropriate perineal care Teach proper technique for collecting a clean catch urine specimen Emotional support Personal hygiene Advice routine checkups for patient with history of UTIs By: Belete N 25
  26. 26. Pyelonephritis… Chronic pyelonephritis It is a persistent inflammation of kidneys Repeated infections that cause progressive inflammation & scarring Etiology: Bacteria Urinary obstruction Vesicourethral reflux By: Belete N 26
  27. 27. Pyelonephritis… Clinical manifestations Usually have no symptoms of infection Noticeable signs ★Fatigue ★Headache ★Poor appetite Polyuria /Low specific gravity of urine/ Excessive thirst Weight loss Flank pain By: Belete N 27
  28. 28. Pyelonephritis… Diagnosis History taking & physical examination Laboratory investigations Urinalysis Proteinuria (Albuminuria) Intermittent bacteriuria Leukocytes in urine Low specific gravity of urine Urine culture to identify the pathogen Blood  Decreased Hgb  Measuring BUN & creatinine/may increase  Decrease HCI Radiologic IV Urogram By: Belete N 28
  29. 29. Pyelonephritis… Complications End-stage renal disease (from progressive loss of nephrons secondary to chronic inflammation and scarring) Hypertension Formation of kidney stones (from chronic infection with urea-splitting organisms) Management The same as acute pyelonephritis (Long-term use) Monitor HTN Monitor intake and out put By: Belete N 29
  30. 30. The End By: Belete N 30
  • OmSomwanshi

    Jun. 25, 2021
  • NaseefMohammed9

    Jun. 1, 2021
  • mukukaKatongo

    Apr. 26, 2021
  • KalyaniRamisetty

    Mar. 19, 2021
  • BeleteNegese

    Jan. 22, 2021

Urinary Tract infection

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