UTIs (1)

Urinary Tract Infections
(UTI)
Dr. Saboohi Irfan

MBBS, FCPS (Medicine)
Consultant Physician
Senior Registrar
Department of Medicine
ATMC, Karachi
Learning objectives
At the end of session final year participants will be
able to:
• Define urinary tract infection (UTI)
• Discuss the pathophysiology of UTI
• Classify UTI
• Explain all the spectrum of presentations of UTI
• List the risk factors for UTI
• Explain the symptoms & signs of UTI
• Justify an outline for the management of UTI
Introduction
• Most common bacterial infections
• More common in females
• 20% of women develop at least one UTI
• 80% of nosocomial UTI...uretheral catheterization
• 5-10 % cases….genitourinary manipulation
Definition
Defined as significant bacteriuria in the

setting of symptoms of cystitis or
pyelonephritis
Classification/terminology
• Uncomplicated
– UTI without underlying renal or neurologic disease
• Complicated
– UTI with underlying structural, medical or
neurological disease
Recurrent
>3 symptomatic UTIs within 12 months
following clinical therapy
Reinfection
Recurrent UTI caused by a different pathogen
at any time
Relapse
Recurrent UTI caused by same species causing
original UTI within 2 weeks after therapy
Organisms for UTI
• E coli - 70%-90% of both upper &lower UTI
• Staphylococcus saprophyticus
• Proteus mirabilis
• Klebsiella pneumonia
• Enterococcus faecalis
Acute pyelonephritis
History taking
History taking
Physical examination
Investigations
CBC
Dipstick test --- leukocyte esterase 94-98%

specificity
Urine DR --- > 10 WBCS /ml pus ,

proteinuria , hematuria
Nitrite test --25% of patients

Contd.
Urine CS
 Ultrasound
 Cystoscopy
 CT scan : if pyelonephritis, recurrent infections,

or anatomic abnormalities are suspected
Spectrum of presentations
• Asymptomatic bacteriuria
• Symptomatic acute urethritis and cystitis
• Acute pyelonephritis
• Acute prostatitis
• Septicaemia (usually Gram-negative bacteria)
Definitions on the basis of Urine CS
• Cystitis: > 1000 colony forming units (CFU)/ml
• Pyelonephritis: > 10,000 CFU/ml
• Asymptomatic bacteriuria: in a female >

100,000 CFU/ml in an asymptomatic individual
Treatment
Prevention
Women who have >3 episodes of cystitis/ year are
considered candidates for prophylactic antibiotic
1. Trimethoprim sulfamethoxazole (40 mg/200 mg),
2. Nitrofurantoin ( 100 mg),
3. Cephalexin (250 mg) single dose
• Maintaining proper catheter insertion techniques
• Utilizing alternatives such as intermittent
catheterization
Best choice questions
A 35-year-old female presents with symptoms of
a urinary tract infection. Urine culture reveals the
presence of a gram-negative rod that is lactose-
fermenting.
What is the most likely causative organism?

A) Staphylococcus saprophyticus
B) Proteus mirabilis
C) Escherichia coli
D) Klebsiella pneumoniae
C) Escherichia coli
A 25-year-old female presents with dysuria,
frequency, and urgency for the past two days.
She has no history of fever, flank pain, or any
prior similar episodes. On examination, she is
afebrile, and there is no costovertebral angle
tenderness.
What is the most appropriate classification of

this urinary tract infection?
A) Uncomplicated cystitis
B) Complicated cystitis
C) Pyelonephritis
D) Asymptomatic bacteriuria
A) Uncomplicated cystitis
A 60-year-old male with a history of recurrent UTIs
presents with symptoms of lower urinary tract
infection. Despite multiple courses of antibiotics, his
symptoms persist. A recent ultrasound shows no
structural abnormalities.
When should this patient be referred to a urologist?

A) After the first episode of UTI
B) Only if the UTI is complicated
C) If symptoms persist despite appropriate antibiotic
therapy
D) Only if there are structural abnormalities on
imaging
C) If symptoms persist despite
appropriate antibiotic therapy
A 30-year-old pregnant woman presents
with her first episode of UTI. She
complains of dysuria and frequency but
has no fever or flank pain. Urinalysis
confirms the diagnosis.
What is the most appropriate antibiotic

treatment for her?
A) Ciprofloxacin
B) Trimethoprim-sulfamethoxazole
C) Nitrofurantoin
D) Tetracycline
C) Nitrofurantoin
A 28-year-old pregnant woman at 16 weeks of
gestation is found to have significant bacteriuria on
routine screening during her antenatal visit. She has
no symptoms of a urinary tract infection.
What is the most appropriate management for this

patient?
A) Observation and follow-up in 4 weeks
B) Immediate antibiotic therapy
C) No treatment required unless symptomatic
D) Referral to a urologist for further evaluation
B) Immediate antibiotic therapy
70-year-old female with a history of type 2 diabetes
mellitus is found to have bacteriuria on routine
screening. She denies any symptoms such as
dysuria, frequency, or urgency. Urinalysis shows
significant bacteriuria, but she is otherwise
asymptomatic.
Which of the following is the most appropriate

management for this patient?
A) Immediate antibiotic therapy
B) Repeat urine culture in 2 weeks
C) No treatment required unless symptomatic
D) Referral to a urologist for further evaluation
C) No treatment required unless
symptomatic
QUESTIONS?
THANK YOU

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Urinary Tract Infections

Dr. Saboohi Irfan

Defined as significant bacteriuria in the

Dipstick test --- leukocyte esterase 94-98%

Urine DR --- > 10 WBCS /ml pus ,

Nitrite test --25% of patients

 CT scan : if pyelonephritis, recurrent infections,

• Pyelonephritis: > 10,000 CFU/ml

• Asymptomatic bacteriuria: in a female >

What is the most likely causative organism?

What is the most appropriate classification of

When should this patient be referred to a urologist?

What is the most appropriate antibiotic

What is the most appropriate management for this

Which of the following is the most appropriate

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