DR K TAMILSELVAN

Urinary Tract Infection

Urinary tract infection (UTI) is defined as microbial colonization of urine and tissue invasion along the urinary tract. A part from bacteria,yeast, fungi and viruses may produce urinary infection.

Significant Bacteriuria is said to exist when a bacteria count is over 100,000 organisms / ml in a fresh “clean catch” midstream specimen of urine.However women with acute cystitis may have > 10³ but < 10⁵ bacteria per ml midstream urine cultures.

Aymptomatic Bacteriuria refers to large numbers of bacteria in the urine without producing symptoms.

Acute urethral syndrome refers to dysuria and frequency in the absence of significant bacteriuria in young women, often caused by ureaplasma Chlamydia trachomatis.

Cystitis and pyleonphritis are symptomatic infections of the bladder and kidney respectively.

Causative organisms

Escherichia coli in 90% cases

Other gram Negative bacilli (e.g. Proteous, klebsilla, enterobactor, serratia, pseudomonas).

Gram positive cocci (Enterococci, staphaureus)

Fungus (e.g. Candida, Cryptococcus)

Chlamydia trachomatis

Clinical features of UTI

Urinary Tract Infection

Frequency, dysuria, burning pain on urination

Suprapubic discomfort, fever.

Rigors in urethral syndrome, cystitis, pyelonephritis.

Passage of cloudy and occasionally blood-tinged urine.

Renal angle tenderness of flank pain.

Diagnosis of UTI

Urine in a container for analysis

Microscopic examination of an unspun, clean voided urine bacteriuria diagnosed if > 1 organism / oil immersion field. Pyuria diagnosed if > 8-10 puscells / high-power field.

Gram stain of urine specimen showing bacteria in centrifused or uncertrifused specimens.

Urine quanitiative culture showing > 100,000 bacteria/ml organism identified.

Intravenous Urography (IVU)

Men : should have IVU after first infection

Women : should have IVU for a genitourinary evaluation if :

i. Persistent enuresis in child hood.

ii. Proteinuria in between infections

iii.More than two recurrences in one year

iv.Increased blood urea, cretinine

v.Relapse after an adequate antibacterial therapy

vi.3 definite episodes of UTI in adult life

Complications like papillary necrosis, perinephric abscess, renal carbuncle or tumor suspected.

viii. Renal ultrasonnography

Treatment for UTI

A. Asymptomatic bacteriria : is to be treated if

i.Pregnant patient in 3^rd trimester, diabetic

ii.With polycystic kidneys

iii.With anatomic or neurologic abnormalities

iv.Immune compromised

v. To undergo urologic manipulation

1. Symptomatic U.T.I is to be always treated.The regimens are

1.Single dose regimen : A moxycillin 3 gm orally; cortimoxazole 320 – 600 mg orally.

2.5 day regimen : Norfloxacin 400 mg twice daily very effective.

3.7-10 day regimen

Ampicillin 500 mg six hourly, Cotrimoxazole 160mg – 800mg twice daily, nalidixic acid 1 gm six hourly.

Acute prostatis needs 2 weeks of treatment but chronic prostatitis be treated for 1 month. The drug of choice is ciproflozacin 500 mg bid.

Complicated UTI to be treated with amikacin 7.5 mg / kg in two divided doses for 10 days, tobramycin 3-5 mg/ kg daily in 3 divided doses for 10 days or third generation cephalosporin i.e. cefoperazone 1 gm IV id or cetizoxime 1 gm iv BID.

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