A Therapeutic topic on Urinary Tract Infection, covering various subtopics like the causative organism, clinical features and more importantly, the laboratory diagnosis.

1. Urinary Tract
Infection
BY- SATYAM PANDEY
PHARM.D III YEAR
CASE PRESENTATION OF

2. Introduction
• Urinary tract lined by epithelium –
Protection
• Microorganism enter thro’ epithelial
surface.
• Affected areas:
• Bladder – Cystitis
• Renal pelvis
• Kidneys - Pyelonephritis

3. Types
Upper UTI
Acute Pyelitis
Acute
Pyelonephritis
Lower UTI
Urethritis
Cystitis
Prostatitis

4. Predisposing Factors
• Age
• Sex
• Pregnancy
• Structural and functional abnormality
of kidney
• Metabolic
• Intervention
• Bacterial Virulence

5. Clinical Presentation
• Asymptomatic:
• 5-7% pregnant women
• May lead to complications-untreated
• Symptomatic:
• Common symptoms
• Pyelonephritis (Upper UTI)
• Fever, flank and loin pain
• Cystitis (Lower UTI)
• Dysuria, fever with chills

6. Symptoms of UTI

7. Etiology
• Community acquired UTI:
• Infection contracted outside the
healthcare settings
• Hospital acquired UTI:
• Catheter associated
• Poor aseptic insertion

8. Causative Organism
• Gram -ve Bacilli
• E.Coli
• Proteus
• Gram +ve Cocci
• Staphhylococcus
• Enterococcus
• Gram –ve cocci
• N. gonorrhoea
• Others
• M. Tuberculosis
• Salmonella
Bacteria
• Adenovirus
Virus
• Candida albicans
Fungi
• Trichomonas vaginalis
• Schistosoma
haematobium
• Enterobius
vermicularis
Parasites

9. Lab Diagnosis
• Collection and transport of specimen
• Microscopy
• Screening
• Culture
• Antibiotic Sensitivity Test

10. Collection of Specimen
Collectio
n
Midstream urine
Male
Female
During cystoscopy
Catheter sample
urine
Early morning
Urine
Suprapubic
Aspirate
Initial Flow
TB of urinary
tract
Children, infant
and older women
Urethritis,
Prostatitis

11. Transport of Specimen
• At room temp - half an hour
• Refrigerated at 4⁰- 4 hrs
• Not processed beyond this time
• No immediate access – Spl. container
with 1.8% boric acid
• Contamination-False +ve

12. Microscopy
• Urine centrifuged and deposit
examined under microscope
• The following can be seen:
• Pus cells ( > 5/hpf)
• Bacteria
• Epithelial cells
• RBC

13. Culture:
• Semi-quantitative cultures
• Standard loop technique
• Involves a ‘standard calibrated loop’ –
transfers fixed, small quantity of urine
• Culture Media:
• Mac Conkey Agar
• Blood Agar
• Mac Conkey- quantitative measurement
• Blood- presumptive diagnosis

14. • Colony count of 105/ml – Significant
• 104/ml – 105/ml – Doubtful significance
• < 104/ml – Significant only if:
• On prior antibiotics
• Obstruction in UT
• Fungal infection/pyelonephritis
• Specimen is suprapubic aspiration
• ≥ 3 types of organism - Contaminants
Fixed and small amount
of uncentrifuged urine
is transferred to
BLOOD and
MacCONKEY AGAR
Incubate at 37⁰ C for24
hours
Next day, the number
of colonies grown is
counted and total count
per ml is calculated

15. Screening
• Necessity:
• UTI is a common problem
and facilities are not always
available
• Used for presumptive
diagnosis
Catalase
Test
Griess
Nitrite
Test
TTC
(Triphenyltet
razolium
chloride)
Gram Stain
Dip Slide
Culture
Glucose
Paper Test

16. 1. Griess Nitrite Test:
• Normal urine does not contain nitrite
• Is based on nitrate reducing enzyme produced by bacteria
during infection
2. Catalase Test
• Certain bacteria have catalase enzyme which acts on
hydrogen peroxide to release oxygen
• +ve rection evident by formation of
bubble
• Only in catalase +ve organism

17. 3. Triphenyl tetrazolium chloride:
• Is based on production of pink red precipitate in the reagent
• Caused by respiratory activity of growing bacteria
4. Gram stain:
• Microscopic demonstration of bacteria in gram stained
films of urine

18. 3. Glucose Paper Test:
• Is based on utilization of minute amount
of glucose in the normal urine utilized by
the bacteria causing infection
4. Dip Slide Culture:
• CLED agar on one side and MacConkey on another coated
slide →immersed in urine → incubated at 37⁰C → growth
estimated by colony counting or color change

19. Antibiotic Sensitivity:
• E. coli and other urinary pathogens –
multi drug resistance; transferable variety
• Necessary to administer proper
antibiotics
• Primary susceptibility test with urine
specimen is done
• Confirmed by AST using bacteria
recovered in culture

20. SOAP STUDY

21. PATIENT PROFILE
 CR No. : 8621/18
 Age : 22 years
 Sex : F
 DOA : 28/08/18
 DOD : 03/09/18

22. PATIENT COMPLAINT
 Fever with Headache
(since last 03 days). Vomiting (2-3 episodes)
 Burning Micturition

23. PAST HISTORY AND FOOD HABITS
 Social history : No history of addiction.
 Vegetarian.
 Non-smoker.
 Medical
 Surgical
 Medication
 ADR history
NIL

24. Pulse : 76 bpm
B.P : 120/90
R. Rate : 22 cpm
Temp. : 98.6 C
CVS : S1,S2 normal
CNS : Intact
VITAL CHART Observation as on ( 28/08/2018)

25. DIAGNOSTIC TESTS
 URINE MICROSCOPIC EXAMINATION
Presence of E-Coli in urine culture

26. ASSESSMENT AND TREATMENT PLAN........
Based on the reports of routine urine examination and microscopy,
the present case was diagnosed as that of Urinary tract infection .

27. THERAPEUTIC GOAL
 To lower the body temp.
 To provide the relief from headache and Burning micturition
 Prevention of vomiting.
 To eradicate the infection of Urinary tract

28. PROVISIONAL/FINAL DIAGNOSIS
 Urinary tract infection

29. TREATMENT PLAN
DRUGS/BRAND NAME GENERIC NAME DOSE ROUTE FREQUENCY DAY
1
DAY
2
DAY 3 DAY 4 DAY 5
Inj. DIFNAPAR DICLOFENAC 25 mg IV √ √ √ √
Inj. EMSET ONDANSETRON 04 mg IV TDS √ √ √ √
Inj. PANTOP PANTOPRAZOLE 40 mg IV OD √ √ √ √
Tab. CALPOL PARACETAMOL 650 mg P/O √ √
Tab. BACTRIM SULPHAMETHOXAZOLE
+
TRIMETHOPRIM
P/O BD √ √ √ √

30. Condition of the patient improved and prescription revised
for discharge.
Discharge summary is as follows:
DAY OF DISCHARGE (03/09/2018) –
1. Tab. Bactrin BD
2. Tab. Calpol 650 mg BD
3. Tab. Protene 40 mg BD
*Advice to repeat Routine Urine Examination & Microscopy tests and follow up
after 10 days.

32. Thank You !