| ID | 395 |
|---|---|
| Name | U TI (Urinary Tract Infection) |
| Cause | A previous UTI. Sexual activity. Changes in the bacteria that live inside the vagina, or vaginal flora. ... Pregnancy. Age (older adults and young children are more likely to get UTIs) Structural problems in the urinary tract, such as enlarged prostate. Poor hygiene, for example, in children who are potty-training. |
| Signs Symptoms | Pain or burning while urinating. Frequent urination. Feeling the need to urinate despite having an empty bladder. Bloody urine. Pressure or cramping in the groin or lower abdomen. |
| Diagnosis | UTIs can be found by analyzing a urine sample. The urine is examined under a microscope for bacteria or white blood cells, which are signs of infection. Your health care provider may also take a urine culture. This test examines urine to detect and identify bacteria and yeast, which may be causing a UTI |
| Investigations | Laboratory Investigations: A. Primary Investigations -For UTI- 1. Urine: R/E, C/S with colony count. 2. Blood: routine count- TC, DC, ESR Hb% & platelet. For urinary tract anomaly (if any) - if infection persists, inspite of appropriate drug therapy- 1. Blood-Urea nitrogen, S.creatinine. 2. Plain X~ray abdomen (KUB). 3. Ultrasonogram of renal system. 4. I.V.U. 5. M.C.U (micturating cysto-urethrogram) best test for VUR. 6. Excretory urography. B. Secondary investigations- 1. Radio-isotope scanning by using Tc 99 (Tech-netium 99). 2. DMS scans (2,3 dimercaptosuccinic acid scan)- in Europe it is commonly done to exclude renal scars, but involve significant radiation exposure to kidney. |
| Management | Management of UTI: A. General management- 1. Adequate fluid intake. 2. Adequate nutrition. B. Specific treatment- Except for the asymptomatic bacteriuria, every UTI patient should be treated with appropriate antibiotic. The choice of antibiotic therapy must be verified by prior culture and sensitivity if possible. But in case of UTI where treatment to be started immediately, following regimens can be given: 1. For uncomplicated cases of urethritis or cystitis, a single 3 to 5 day course of oral therapy with co-trimoxazole is effective against most strains of E.coli; Or, nitrofurantoin, which is effective against E.coli and also active against Klebsiella-Enterobacter organisms. After receiving culture and sensitivity reports, this course can be continued or can be changed if needed. 2. In case of suspected complicated or febrile UTI, such as, pyelonephritis or cystourethritis- a 10 to 14 day course of broad-spectrum antibiotic capable of reaching significant tissue levels should be given. Parenteral treatment with- 1. Ceftriaxone 50-75mg/kg/day (not exceeding 2gms); Or, 2. Ampicillin lOOmg/kg/day in 6 hourly divided doses with an aminoglycoside such as gentamicin (particularly effective against pseudomonas spp.) 3-5mg/kg/day in 1 to 3 divided doses is preferable. Oral 3rd-generation cephalosporins such as cefixime are as effective as parenteral ceftriaxone against a variety of gram-negative organisms other than pseudomonas, and these medications are considered as the treatment of choice for oral therapy. Nitrofurantoin should not be used routinely in children with a febrile UTI because it can’t reach significant renal tissue levels. Oral quinolone derivative such as, ciprofloxacin is an alternative agent for resistant microorganisms, particularly pseudomonas, in patients older than 17 years. The safety and efficacy of ciprofloxacin in children is under study. But, in some centres it is used occasionally for short-course therapy in young children with pseudomonas UTI. A loading dose of ceftriaxone injection followed by oral therapy with a third generation cephalosporin (e.g cefixime) is found effective. After receiving culture and sensitivity reports, the ongoing course can be continued for 10-14 days or can be changed if needed. Drugs of choice with their dosages schedule- Drug of choice Dose in mg/kg/day No. of doses 1. Co-trimoxazole 24mg/kg/day 2 (TMP-4mg, SMZ-20mg) 2. Ceftriaxone (injection) 50-75mg/kg/day 1 (not esceeding 2gms) 3. Cefixime (oral) 8mg/kg/day lor 2 4. Nitroftirantoin 5-7mg/kg/day 3-4 5. Ampicillin lOOmg/kg/day 3 6. Gentamicin 3-5mg/kg/day 1-3 Duration: Cystourethritis- 3 to 5 days, maximum 7 days - approx. 90% cured. Acute pyelonephritis- 10-14 days - approx. 90% cured. Longer treatment does not have any advantage in children with non-obstructive UTI (short or ultra-short therapy for 1 day or with only one dosage, although well established in the treatment of adult woman with non-obstructive UTI, can not be recommended for children). For every case wth acute pyelonephritis, early start of Rx is one of the most important factor in the prevention of renal scarring every child wth fever without evident cause other than UTI should have an immediate urinealysis. If pyuria & bacteriuria are documented, antibiotic therapy should be initiated immediately. Recurrence of UTI are re-infection in more than 95%, particularly in children relapses are very rare C. Antibiotic prophylaxis: Aim: to prevent intracanalicular ascending re-infections arising from the perigenital area & the distal urethra. Indications for prophylaxis: a. Recurrent acute pyelonephritis. b. Persistent VUR. c. Very frequent hyperacute cystourethritis. Choice of drugs: Choice of drug Dose in mg/kg/day No. of dose Co-trimoxazole 6mg (5-10mg)/kg/day 1 (TMP-lmg, SMZ-5mg) Nitrofurantoin lmg(l-2mg)/kg/day 1 Cephalexin 10-12mg/kg/day 1 One single dose at bedtime will be sufficiently effective & will improve compliance. The prophylaxis should not be interrupted before control of urine analysis. Incase of recurrence, inspite of prophylaxis, the future can be doubled or to improve spectrum by adding another antibiotic. Duration of prophylaxis should be adopted to the individual situation such as, VUR until 3 months after surgical treatment or after spontaneous disappearence of reflux. Recurrent acute pyelonephritis without reflux- 6 months. Very frequent hyperacute cystourethritis- 3 months. If any resistance (e.g with E. coli, proteus) or recurrence with prophylaxis no interruption of prophylaxis should make before control examination & to be continued as it with single dose at bedtime. D. Treatment of recurrent infection- If there is recurrent infection see under prop-hylaxis. E. Treatment of urinary tract anomalies, such as- VUR- by surgical method (if needed). Obstruction- removal of obstruction by catheterization or surgical measure. Stone- removal of stone. F. Follow up - Check for further UTI Investigation for metabolic cause of stone. Renal function (if kidney involved). Hypertension. |
| Introduction | n 7-11 years old age group) Boys- 0.5-2% Bacteriology of UTI: Infections are caused mainly by colonic bacteria (source is generally the patients fecal flora). In female- 75-90% infections are caused by- - E. col. (most common) - Klebsiella - Proteus - Staph. albus - Pseudomonas In male- - Proteus (most common) - E. Coli - Klebsiella - Staph. albus. - Pseudomonas. Viral infections may rarely occur. |
| History | |
| Etiology | Bacteria, often from the skin or rectum, enter the urethra, and infect the urinary tract. The infections can affect several parts of the urinary tract, but the most common type is a bladder infection (cystitis). Kidney infection (pyelonephritis) is another type of UTI. |
| Clinical Features | Pain or burning while urinating. Frequent urination. Feeling the need to urinate despite having an empty bladder. Bloody urine. Pressure or cramping in the groin or lower abdomen. |
| Preventions | Urinate after sexual activity. Stay well hydrated. Take showers instead of baths. Minimize douching, sprays, or powders in the genital area. Teach girls when potty training to wipe front to back. |
| Treatment | Trimethoprim and sulfamethoxazole Fosfomycin Nitrofurantoin Cephalexin Ceftriaxone |
| Complications | Persistent lower urinary tract symptoms. Staghorn urinary calculi. Pyelonephritis. Emphysematous pyelonephritis and cystitis. Incontinence. Focal renal nephronia. Renal abscess. Chronic prostatitis. |
| Prognosis | Most UTIs can be cured. Bladder infection symptoms most often go away within 24 to 48 hours after treatment begins. If have a kidney infection, it may take 1 week or longer for symptoms to go away |
| Types | cystitis – infection of the bladder. Cystitis is the most common lower urinary tract infection. urethritis – infection of the urethra. pyelonephritis – infection of the kidneys. vaginitis – infection of the vagina. |
| Classification | Classification of UTI: A. General classification- 1. Asymptomatic bacteriuria 2. Symptomatic bacteriuria. B. Clinical clasification- 1. Systemic infection. 2. Acute pyelonephritis (may become ch.pyelo-nephritis). 3. Acute cystitis. 4. The frequency-dysuria syndrome. 5. Asymptomatic bacteriuria. C. Operational classification- 1. Uncomplicated UTI (radiologically normal) 2. Complicated UTI (i.e presence of vesicoureteral reflux or other abnormalities). Significance of UTI: 1. Ascending infection. 2. Kidney infection. 3. Kidney damage (may be renal damage upto 7 years of age, later on no chance of damage). 4. Development of CRF. 5. Associated with developmental anomalies. 6. Associated with VUR 7. Recurrent UTI can develop reflux. |
| Observation | |
| Pathology |
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