01. urinary tract infection - kuliah mahasiswa.ppt

8/18/2019 01. Urinary tract Infection - KULIAH MAHASISWA.ppt

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URINARY TRACT INFECTION


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Clinical Presentation of Renal Disease

• Chronic renal failure (CRF)

• Acute renal failure (ARF)

• Hyertension

• Asy!to!atic roteinuria an" ersistent urinary

a#nor!alities

• Nehrotic syn"ro!e (N$)

• Urinary tract infection (UTI)

• Acute nehritis (Acute %lo!erulonehritis)

• O#structi&e nehroathy

• Renal stones

• Renal tu#ular "efects


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Urinary Tract Infections (UTI)Urinary Tract Infections (UTI)

Fre'uent clinical ro#le!Fre'uent clinical ro#le!

Any site in the urinary tract !ay #e in&ol&e" the urethra rostateAny site in the urinary tract !ay #e in&ol&e" the urethra rostate

#la""er ureter *i"ney an" erinehric sace+#la""er ureter *i"ney an" erinehric sace+

,acterial infection is !ost co!!on #ut fun-i chla!y"ia &iruses,acterial infection is !ost co!!on #ut fun-i chla!y"ia &iruses

an" arasites !ay #e resonsi#le in so!e atientsan" arasites !ay #e resonsi#le in so!e atients

.o!en /// 0en.o!en /// 0en


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Ter!inolo-y of Urinary Tract Infections (1)

Bacteriuria : Presence of bacteria in the urine.

Asymptomatic bacteriuria : 105 CFU/ml urine ith or ithout pyuria! in a patient

ithout symptoms of U"#.

Cystitis : inflammation of the bla$$er

• Bacterial cystitis• Abacterial cystitis %urethral syn$rome&

Acute pyelonephritis: acute bacterial infection of the 'i$ney characteri(e$ by

chills an$ fe)er %often hi*h& an$ flan' pain %usually unilateral&! as ell as

ten$erness.

Ribeiro RM, et al. Int Urogynecol 2002;13:1

Chronic pyelonephritis : +a$iolo*ical $ia*nosis here there is e)i$ence of focal

scarrin* of the 'i$neys ith associate$ calyceal abnormality in$icatin* renal

$ama*e $ue to a combination of reccurent infection ith obstruction of the

pel)iocalyceal system %chronic obstructi)e nephropathy& or )esicoureteral

reflu, %reflu, nephropathy&.


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+einfection : An infection ith a $ifferent strain of microor*anism or a $ifferent

serolo*ical type after %en$ of therapy& era$ication of pre)ious infection.

-ost li'ely represent infections of the bla$$er! occur ee's to months after-ost li'ely represent infections of the bla$$er! occur ee's to months after

treatment of the pre)ious infection! response ell to therapy!treatment of the pre)ious infection! response ell to therapy!

usually associate$ ith a normal urinary tractusually associate$ ith a normal urinary tract

+elapse : A consecuti)e urinary infection cause$ by the same strain or serotype of

bacteria! usually represent infection of the 'i$ney or prostat! often recurusually represent infection of the 'i$ney or prostat! often recur

ithin 1 ee's after antimicrobials ha)e been $iscontinue$! some casesithin 1 ee's after antimicrobials ha)e been $iscontinue$! some cases

represent persistent infection! anatomic abnormalities or renal insuficiencyrepresent persistent infection! anatomic abnormalities or renal insuficiencyare more common ith relapsin* or persistent infection! a lon* course ofare more common ith relapsin* or persistent infection! a lon* course of

antimicrobials or sur*ery may be reuire$ if the urine is to be permanentlyantimicrobials or sur*ery may be reuire$ if the urine is to be permanently

sterili(e$sterili(e$

Ribeiro RM, et al. Int Urogynecol J 2002;13:



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+ecurrent U"#: patients ith at least to infections ithin months or three or

more $urin* a sin*le year! in hich the initial episo$e is resol)e$ an$

is folloe$ by another infection.

Ribeiro RM, et al. Int Urogynecol J 2002;13:


Persistence : the continue$ presence of the microor*anisms isolate$ at the be*innin*

of the treatment! oin* to resistance to antimicrobial therapy! ina$euate

$ru* $osa*e! or a urolo*ical abnormality. "hese unresol)e$ infections may

be also in conseuence of the patients non2compliance in ta'in* me$ication!

mi,e$ infections ith to $ifferent bacterial strains ith mutually e,clusi)esusceptibilities! or renal insufficiency %lea$in* to an ina$euate $ru*

concentration in the urine&.


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Classification

• Upper UTI = Pyelonephritis

• Lower UTI = Cystitis

• Complicated UTI

• Uncomplicated UTI


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I+ Unco!licate" urinary tract infectionI+ Unco!licate" urinary tract infection

• 3ccurs in in$i)i$uals ith structurally an$ functionally normal *enitourinary

tracts

• -ost common bacterial infection that occurs in omen! but is uncommon in

men• -ay in)ol)e the bla$$er or the 'i$neys an$ may be symptomatic or

asymptomatic

II+ Co!licate" urinary tract infectionII+ Co!licate" urinary tract infection

• As acute or chronic parenchymal infection associate$ ith a functional orstructural urinary tract abnormality

Classification of Urinary Tract InfectionClassification of Urinary Tract Infection


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Un"erlyin- factors associate"4ith 5co!licate"6 urinary tract infection

$yste!ic Con"itionsDia#etes !ellitusPaillary necrosis (e+-+ anal-esic nehroathy)I!!uno"eficient states (inclu"in- i!!unosuressi&e

"ru- theray)

A#nor!al "raina-e of urineRenal calculiUrinary o#struction7esicoureteric reflu8

Pel&ioureteric 9unction o#structionInstru!entation of the urinary tract (inclu"in- catheters)Pre-nancy


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Clincial UTI

Patterns of In&esti-ation in Urinary Tract Infection

Urinalysis

Urine !icroscoy culture an""eter!ination of anti#iotic sensiti&ity

Further in&sti-ation

A"ult fe!ale

(lo4er UTI)

Treat 4ithoutfurther

in&esti-ation

0ale

(Any UTI)

Ultrasoun": CystoscoyChec* renal

cunction

Chil"ren

(Any UTI)

Ultrasoun": 0CU

Uer UTIor

Co!licate" UTI

,loo" culturesUltrasoun"

: I7PChec* renal function


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Dia-nosis Urinary Tract InfectionDia-nosis Urinary Tract Infection

1+1+ $y!to!s $y!to!s • Lower UTILower UTI• Upper UTIUpper UTI

2+2+ UrinalysisUrinalysis

3+3+ CultureCulture

• "he presence of ≥ 10 4BC / mm fresh un2spun mi$stream urine• "he presence of ≥ 10 4BC / hi*h2poer fiel$ se$iment mi$stream

urine

;+;+ Ra"iolo-ical e&aluationRa"iolo-ical e&aluation• Ultrosoun$• Plain ab$ominal ra$io*raphy• #ntra)enous uro*raphy• C" scannin*


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Clinical features of acute lo4er an"uer urinary tract infection in a"ult

Lower UTI Upper UTI

Dysuria

Frequency

Suprapuic pain

!alodorous urine

"aematuria

#ormal temperature

Systemically unwell

Fe$er % ri&ors

Loin pain and tenderness

#ausea and $omitin&

"ypotension and shoc'

Features of lower urinarytract infection


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(ariation in the si&nificant acterial count in urine

accordin& to the technique used for urine collection

Type of collectionSignificant bacterial

count (cells/ml)

!idstream urine ) *++,+++

Slide-hole catheter ).+,+++

/pen % end catheter *+++

Suprapuic aspiration *


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Criteria for "ia-nosis of si-nificant #acteriuriaCriteria for "ia-nosis of si-nificant #acteriuria

$y!to!atic 4o!en $y!to!atic 4o!en

• ≥≥ 101066 coliform or*anisms/ml urine plus pyuria! orcoliform or*anisms/ml urine plus pyuria! or

• ≥≥ 101055 of any patho*enic or*anism/ml urine! orof any patho*enic or*anism/ml urine! or

• Any *roth of a patho*enic or*anism from urine obtaine$ byAny *roth of a patho*enic or*anism from urine obtaine$ by

suprapubic aspirationsuprapubic aspiration

$y!to!atic !en $y!to!atic !en

• ≥≥ 1010 patho*enic or*anism/ml urinepatho*enic or*anism/ml urine

Asy!to!atic atients Asy!to!atic atients

• ≥≥ 101055 patho*enic or*anism/ml urine in to consecuti)e samplespatho*enic or*anism/ml urine in to consecuti)e samples


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,acterial etiolo-y of urinary tract infection,acterial etiolo-y of urinary tract infection

• E+ coliE+ coli : 702859 %uncomplicate$ U"#&! 61259 %complicate$&: 702859 %uncomplicate$ U"#&! 61259 %complicate$&

• ;. ;aprophyticus : 52609 %uncomplicate$&! 129 %complicate$&;. ;aprophyticus : 52609 %uncomplicate$&! 129 %complicate$&

• 19 %uncomplicate$&! 62189 %complicate$&


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Clinical Classification of Urinary Tract Infection

1+ Acute unco!licate" cystitis in 4o!en

6. Acute uncomplicate$ pyelonephritis in omen

. Complicate$ U"# in both se,es

. +ecurrent infections in omen

5. Asymptomatic bacteriuria

McBryde C, Redington. Primary Care Case Rev 2001 ;


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Acute uncomplicated cystitis in women

;in*le $ose or 2$ay course of treatment

Follo2up urine culture 721 $ays later

Cure$%sterile urine&

Failure or relapse%i$entical patho*ens&

+einfection%ne patho*en&

?o in)esti*ation Ultrasono*raphy urinary tract=UB ra$io*raph

Catel WR. Clin Drug Invest 199 ; 9 !"#$$l 1% :

"reatment for 6 ee's


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1. Acute uncomplicate$ cystitis in omen

2+ Acute unco!licate" yelonehritis in 4o!en






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0o"erate se&erity$e&ere illness

3utpatients an$ oraltherapy possible

"reatment 1 $ays

@ospitali(ation ith initialparenteral therapy

3ral treatment 1 $ays orlon*er as reuire$

Acute unco!licate" yelonehritis in 4o!en

?o resolutionin 5 $ays

?o resolutionin 5 $ays

Urolo*ic e)aluation

+a$iolo*ic e)aluation

+esolutionin 5 $ays


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3+ Co!licate" UTI in #oth se8es





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@ospitali(e! urine culture! bloo$ culture@ospitali(e! urine culture! bloo$ culture


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;+ Recurrent infections in 4o!en




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Recurrent infections in 4o!en

+eccurent U"# in omen

ia*nosis+elapse +einfection

Con)entional antibiotictherapy 62 ee's

D × year E 6 × year

;e,ually acti)e PostmenopausalCon)entional antibiotic

therapy 27 $ays


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Dru- re-i!ens for lon- !-

Tri!ethori!Tri!ethori! 1>> !-1>> !-

Co+2; -

Norflo8acinNorflo8acin 2>> !-2>> !-

Ciroflo8acinCiroflo8acin 12= !-12= !-

Cehale8inCehale8in 12= !-12= !-( useful if renal insufficiency)( useful if renal insufficiency)

He8a!ine hiurateHe8a!ine hiurate 1 -1 -

* Treatment is effective if taken each night, alternate nights, three times a week,* Treatment is effective if taken each night, alternate nights, three times a week,

or just after intercourseor just after intercourse


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=+ Asy!to!atic #acteriuria



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In"ication for the treat!ent of atients 4ith

asy!to!atic #acteriuria

Definiti&e Possi#le Not in"icate"

Pre*nancy iabetes mellitus


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T H A N KT H A N K

Y O UY O U

01. urinary tract infection - kuliah mahasiswa.ppt

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