1. Urinary tract infection

2. UTI
 One of the commonest infections in
ambulatory, commonest in bed-ridden
 Upper- pyelonephritis;
Lower- urethritis, cystitis, prostatitis
 Acute or chronic
 Asymptomatic or symptomatic
 Uncomplicated or complicated
 Recurrence- reinfection or relapse

3. Risk factors for symptomatic UTI
 Female sex
 Age
 Pregnancy
 Sexual intercourse
 Use of spermicide
 Menopause
 Vesicoureteric reflux
 Obstruction-
 Congenital, calculi
 Residual urine-
 Neurogenic bladder,
stricture, BPH
 Instrumentation-
 Catheterization,
dilatation, cystoscopy

4. Clinical presentation
 Lower UTI- mostly acute
 Frequency, dysuria, urgency, suprapubic pain,
fever uncommon
 Significant bacteriuria
 Pyelonephritis- acute or chronic
 Systemic symptoms- fever with chills
 Hematuria, pyuria, renal angle tenderness/fullness
 Edema, HT, anemia-erythropoietin deficiency
 May lead to sepsis/septic shock or
acute/chronic renal insufficiency

5. Significant bacteriuria
>1 lakh CFU of bacteria per ml
Suprapubic collection- any
growth

6. Causative organism
Uncomplicated- majority E.coli
Complicated- other G –ve bacteria,
staph., enterococcus, candida

7. Evaluation
CBC, RFT
US, IVP, CT-scan
Endoscopic procedures

8. Treatment
 Antibiotics-
 Oral- co-trimoxazole, nitrofurantoin, quinolones
 IV- quinolones/3rd
generation cephalosporin + aminoglycoside
 Duration- LUTI-1-3 days, UUTI-14 days
 Asymptomatic bacteriuria is treated in
pregnancy, DM, post-transplant, VUR
 With catheter, stone, obstruction-
treat only symptomatic bacteriuria
 Frequent UTI- Relapses
 r/o underlying pathology
 Abx based on sensitivity
 Long-term suppressive therapy- co-trimoxazole/NFT

9. Indwelling urinary catheters
 Use when required, remove when not
 Aseptic insertion, properly secured
 Sterile closed drainage system
 Continuous non-obstructed gravity flow
 Once inserted, can be used for 2 weeks
 Chronic indwelling catheter- change if
malfunction or obstruction

10. Indwelling urinary catheters
 Use when required, remove when not
 Aseptic insertion, properly secured
 Sterile closed drainage system
 Continuous non-obstructed gravity flow
 Once inserted, can be used for 2 weeks
 Chronic indwelling catheter- change if
malfunction or obstruction