Empfohlen
Weitere ähnliche Inhalte
Was ist angesagt?
Was ist angesagt? (20)
Ăhnlich wie A B C of URINARY TRACT INFECTION, Dr. Sharda Jain Lifecare Centre
Ăhnlich wie A B C of URINARY TRACT INFECTION, Dr. Sharda Jain Lifecare Centre (20)
Mehr von Lifecare Centre
Mehr von Lifecare Centre (20)
KĂźrzlich hochgeladen
KĂźrzlich hochgeladen (20)
A B C of URINARY TRACT INFECTION, Dr. Sharda Jain Lifecare Centre
- 1. A B C of URINARY TRACT INFECTION Dr. Sharda Jain Dr. Jyoti Agarwal Dr. Jyoti Bhaskar
- 2. Our Team dedicated for giving knowledge & skill to doctors
- 4. Overview ⢠Understanding Urinary Tract Infection ⢠How Big is theProblem ⢠What is UTI ⢠Why UTI is more Common in Woman ⢠Pathogenesis ⢠Classification ⢠Risk Factors ⢠Causative Organisms ⢠Clinical Manifestation ⢠Diagnosis
- 5. Ann Clin Micr Anti 2007; 6: 4-12 Urinary Tract Infection (UTI) ⢠UTI is the 2nd most common infectious presentation in community practice. ⢠World wide, about 150 million people are diagnosed with UTI each year.
- 6. Urinary Tract Infection (UTI) UTI is an inflammatory response of the urothelium to bacterial invasion. UTI is usually associated with bacteriuria and pyuria. Campbells Urology 2007; 9th Ed
- 7. Urinary Tract Infection (UTI) Bacteriuria Presence of bacteria in the urine â usually growth ⼠103 cfu/ml of urine Pyuria Presence of white blood cells (WBCs) in urine â usually 10 WBC/ml of urine is an indicative of an inflammatory response of the urothelium to bacterial invasion. Bacteriuria can be symptomatic or asymptomatic. Campbells Urology 2007; 9th Ed
- 8. Prevalence ⢠50% of women experience at least one episode of UTI at some point in their lifetime.1 ⢠One in every 3 women will have had atleast one episode of UTI by the age of 24 years.2 ⢠Recurrent UTI occur in 20-40% of women.1 ⢠50% of women experience at least one episode of UTI at some point in their lifetime.1 ⢠One in every 3 women will have had atleast one episode of UTI by the age of 24 years.2 ⢠Recurrent UTI occur in 20-40% of women.1 Common in women 1. Indian J. Community Med 2012; 37(1): 39-44 2. EAU Guidelines on Urological Infections 2015
- 9. Why greater susceptibility of UTI in women? The female urethra ⢠short length (~4cm) ⢠proximity to anus Urethra is prone to colonization with fecal bacteria.Urethra is prone to colonization with fecal bacteria. Medicine 2007; 35: 423-427
- 10. Prevalence ⢠Rare in Males ⢠Anatomical or functional abnormality of the urinary tract ⢠Rare in Males ⢠Anatomical or functional abnormality of the urinary tract ⢠8% of girls and 2% of boys will have UTI in childhood. ⢠8% of girls and 2% of boys will have UTI in childhood. ⢠Incidence of UTI increases markedly in the elderly. ⢠Bacteriuria is found in 21% of women and 12% of men over 65 yrs of age. ⢠Incidence of UTI increases markedly in the elderly. ⢠Bacteriuria is found in 21% of women and 12% of men over 65 yrs of age. BMJ 1999; 319: 1173-1175 Medicine 2007; 35: 423-427
- 11. Prevalence Pregnancy ⢠UTIs are detected in 2 to 8% of pregnant women ⢠UTIs are detected in 2 to 8% of pregnant women Diabetes ⢠Prevalence of UTI is 26% in women with DM as compared to 6% in those without DM ⢠Prevalence of UTI is 26% in women with DM as compared to 6% in those without DM Catheter ⢠8.5% of patients acquired UTI following indwelling bladder catheterization ⢠8.5% of patients acquired UTI following indwelling bladder catheterization Am J Med 1991; 19: 65-71 Medicine. 2007; 35: 423-427 BMJ 1999; 319: 1173-1175
- 12. Pathogenesis Most UTI occur in women who are healthyMost UTI occur in women who are healthy Interaction occurs between the bacterial virulence and host defense Interaction occurs between the bacterial virulence and host defense Increase in virulence Decrease in host defense Infection Medicine 2007; 35: 423-427
- 13. UTI - Classification Infections acquired in the community Infections acquired in the community Infections acquired in the hospital Infections acquired in the hospital
- 14. UTI - Classification Infection involving normal urinary tract Infection involving normal urinary tract Presence of metabolic, anatomic and functional abnormalities Presence of metabolic, anatomic and functional abnormalities ⢠Healthy non-pregnant women ⢠Healthy non-pregnant women ⢠Pregnancy ⢠Catheterization ⢠Diabetes ⢠Infection stones ⢠Pregnancy ⢠Catheterization ⢠Diabetes ⢠Infection stones
- 15. UTI - Classification Depending on the site of origin
- 16. Risk Factors Associated with UTIs ⢠Sexual intercourse ⢠Spermicide creams ⢠Diaphragm ⢠Previous UTI ⢠Pregnancy ⢠Catheterization ⢠Diabetes ⢠Infection stones ⢠Male ⢠Elderly Uncomplicated Complicated Medicine.2007; 35: 423-427
- 17. Common symptomatic infection in young non-pregnant women is acute uncomplicated cystitis.
- 18. Causative Organisms of Acute Uncomplicated Cystitis Arch; 1Intern Med.200767: 2207-12 ⢠Escherichia coli: 70 - 95% ⢠Staphylococcus saprophyticus: 10 - 15% ⢠Klebsiella spp. ⢠Proteus mirabilis
- 19. Symptoms of Acute Uncomplicated cystitis If both dysuria and frequency are present in the absence of vaginal discharge, the chance of UTI is ~90%. ⢠Dysuria ⢠Frequency ⢠Urgency ⢠Hematuria ⢠Suprapubic pain Campbells Urology 2007; 9th Ed
- 20. Diagnosis of Acute Uncomplicated cystitis History ⢠Symptoms of UTI ⢠Other history (e.g. Vaginal discharge or irritation) Examination Pelvic examination to rule out other causes like urethritis and vaginitis EAU Guidelines on Urological Infections 2015
- 21. Diagnosis of Acute Uncomplicated cystitis Urine analysis ⢠Dipstick method ď Nitrite ď Leukocyte esterase ⢠Microscopic analysis ď Bacteriuria ď Pyuria ď Hematuria EAU Guidelines on Urological Infections 2015
- 22. Diagnosis of Acute Uncomplicated cystitis Urine culture Not recommended in case of cystitis but done if acute pyelonephritis is suspected or complicated UTI. Ultrasonography CT scan EAU Guidelines on Urological Infections 2015
- 23. Treatment for Uncomplicated Cystitis Short term antibiotics recommended by EAU guidelines as drug of first choice. Drug Dose Duration Fosfomycin trometamol 3 g SD 1 day Nitrofurantoin macrocrystals 100 mg bid 5 days Pivmecillinam 400 mg tid 3 days Choice of antibiotic should take into account not only the spectrum of activity but also resistance. Choice of antibiotic should take into account not only the spectrum of activity but also resistance. EAU Guidelines on Urological Infections 2015
- 24. Treatment for Uncomplicated Cystitis Short term antibiotics Drug Dose Duration CefpodoximeCefpodoxime 100mg, bid100mg, bid 3days3days TMP-SMXTMP-SMX 160/800mg, bid160/800mg, bid 3days3days NitrofurantoinNitrofurantoin 100mg, bid100mg, bid 5-7days5-7days CiprofloxacinCiprofloxacin 250mg, bid250mg, bid 500mg, od500mg, od 3days3days 3days3days LevofloxacinLevofloxacin 250mg, od250mg, od 3days3days NorfloxacinNorfloxacin 400mg, od400mg, od 3days3days OfloxacinOfloxacin 200mg, bid200mg, bid 3days3days PivmecillinamPivmecillinam 200mg, bid200mg, bid 7days7days EAU Guidelines 2006
- 25. Treatment for Uncomplicated Pyelonephritis Long term antibiotics Drug Dose Duration CiprofloxacinCiprofloxacin CiproXRCiproXR 500mg, bid500mg, bid 1000mg, od1000mg, od 7days7days 7-10days7-10days CefpodoximeCefpodoxime 200mg,bid200mg,bid 10days10days GatifloxacinGatifloxacin 400mg, od400mg, od 10days10days LevofloxacinLevofloxacin 250mg, od250mg, od 10days10days LomefloxacinLomefloxacin 400mg, od400mg, od 10days10days TMP-SMXTMP-SMX 160/800mg, bid160/800mg, bid 14days14days EAU Guidelines 2006
- 26. In severe cases of pyelonephritis ⢠Hospitalization ⢠Parenteral antibiotics (Quinolones and beta lactamase inhibitor) ⢠With improvement switch to oral therapy to complete the course EAU Guidelines 2006
- 27. Choice of antibiotics should take into account not only the spectrum of activity but also resistance
- 28. Resistance ⢠Infecting organisms are not susceptible to antimicrobial agent selected ⢠Invariably patient has received recent antimicrobial therapy which produces resistance Campbells Urology 2007; 9th Ed
- 29. EAU Guidelines on Urological Infections 2015 ⢠In ALL Women - routine post-treatment urinalysis or urine cultures in asymptomatic patients ⢠If symptoms do not resolve by the end of treatment and if symptoms recur within 2 weeks, urine culture and antimicrobial susceptibility tests should be performed. ⢠Retreatment with a 7-day regimen using another agent should be considered.
- 30. TAKE HOME MESAGE Acute bacterial urinary tract infection are among the most common bacterial infection treated by doctors. CYSTITIS account for most of these, only 1-2% are admitted to hospital for acute pyelonephritis treatment TREATMENT COURSES longer than 3 days result in almost twice the number of adverse events & not more effective in treating uncomplicated cystitis , are more costly , & have higher rates of non compliance.