Download Urinary tract infec

Urinary tract infections among
the patients of southren
Punjab
Presented by: Aneeqa hayat
Ghauri’s clinical laboratory
Multan
INTRODUCTION:
A urinary tract infection (UTI) is a condition
where one or more parts of the urinary
system (the kidneys, ureters, bladder, and
urethra) become infected. UTIs are the most
common of all bacterial infections and can
occur at any time in the life of an individual.
Almost 95% of cases of UTIs are caused by
bacteria that typically multiply at the opening
of the urethra and travel up to the bladder.
Much less often, bacteria spread to the
kidney from the bloodstream
Urine is normally sterile, that is, free of
bacteria, viruses, and fungi.)
In healthy women, the vagina is
colonized by lactobacilli, beneficial
microorganisms that maintain a highly
acidic environment (low pH) that is
hostile to other bacteria. Lactobacilli
also produce hydrogen peroxide,
which helps eliminate bacteria and
reduces the ability of Escherichia coli
(E. coli) to adhere to vaginal cells. (E.
coli is the major bacterial culprit in
urinary tract infections.)
UTI is established by counting the
bacteria in urine. The bacterial count in
excess of 100,000/ml of urine is
indicative of UTI. Chronic infection can
lead to distortion and scarring of the
kidneys.
Types of UTIs :
Uncomplicated or complicated,
depending on the factors that trigger
the infections
Primary or recurrent, depending on
whether the infection is occurring for
the first time or is a repeat event
Uncomplicated UTIs are due to a
bacterial infection, most often E. coli.
Cystitis, or bladder infection, is the
most common urinary tract infection.
It occurs in the lower urinary tract (the
bladder and urethra) and nearly
always in women. In most cases, the
infection is brief and acute and only
the surface of the bladder is infected.
Deeper layers of the bladder may be
harmed if the infection becomes
persistent, or chronic, or if the urinary
tract is structurally abnormal
Pyelonephritis (Kidney Infection).
Sometimes the infection spreads to the
upper tract (the ureters and kidneys).
This is called pyelonephritis, or more
commonly, a kidney infection.
Complicated infections, which occur in
men and women of any age, are also
caused by bacteria but they tend to be
more severe, more difficult to treat,
and recurrent (Catheter use in the
hospital setting or chronic indwelling
catheter , Bladder and kidney
dysfunction, or kidney transplant )
Signs and symptoms
The most common symptoms of a bladder
infection are burning with urination
(dysuria), frequency of urination, an urge to
urinate, significant pain. An upper urinary
tract infection may additionally present with
fever. Discomfort or pressure in the lower
abdomen. The abdomen can feel bloated.
Pain in the pelvic area or back.
The symptoms of urinary tract infections may
vary with age and the part of the urinary
system that was affected. In young children,
urinary tract infection symptoms may include
diarrhea, loss of appetite, nausea and
vomiting, fever and excessive crying that
cannot be resolved by typical measures.
Older children on the other hand may
experience abdominal pain, or incontinence.
Lower urinary tract infections in adults may
manifest with symptoms including hematuria
(blood in the urine )
The urine often has a strong smell,
looks cloudy, or contains blood.
This is a sign of pyuria, or a high
white blood cell count in the urine,
and is a very reliable indicator of
urinary tract infections.
Risk Factors
Women are more prone to urinary
tract infections than men, and these
infections tend to recur. One reason
is that the urethra (the tube that
carries urine away from the bladder)
is shorter in women than in men.
When women reach menopause, the
loss of estrogen thins the lining of the
urinary tract, which increases
susceptibility to bacterial infections.
Diagnosis:
If a patient is susceptive with UTI than its
mid stream urine is collected for urine
routine examination and if p/s >5 are
present than it shows UTI. RBC,s different
casts shows chronic infection of UTI.
This sample is now cultured for the
causative agent (pathogen) and checked
for the sensitivity of different antibiotics.
It involves incubating and growing the
bacteria contained in the urine. A urine
culture can help identify the specific
bacteria causing the infection, and
determine which type of antibiotics to
use for treatment.
Clean-Catch Sample. To obtain an
untainted urine sample, doctors
usually request a so-called midstream,
or clean-catch, urine sample. To
provide this, the following steps are
taken :
Patients must first wash their hands
thoroughly, then wash the penis or
vulva and surrounding area four times,
with front-to-back strokes, using a new
soapy sponge each time.
The patient must then begin urinating
into the toilet and stop after a few
ounces.
The patient then positions the
container to catch the middle portion of
the stream. Ideally, this urine will
contain only the bacteria and other
evidence of the urinary tract infection.
Causes :
Escherichia (E.) coli is responsible for most
uncomplicated cystitis cases in women,
especially in younger women. E. coli is
generally a harmless microorganism
originating in the intestines. If it spreads to
the vaginal opening, it may invade and
colonize the bladder, causing an infection.
The spread of E. coli to the vaginal opening
most commonly occurs when women or
girls wipe themselves from back to front
after urinating, or after sexual activity.
Staphylococcus saprophyticus
accounts for 5 - 15% of UTIs, mostly
in younger women.
Klebsiella aerogenes, Alcaligenes
feacalis, Enterococci bacteria,
Pseudomonas aeruginosa and
Proteus mirabilis account for most of
remaining bacterial organisms that
cause UTIs. They are generally found
in UTIs in older women.
Treatment:
Antibiotics are the main treatment for all
UTIs. A variety of antibiotics are available,
and choices depend on many factors,
including whether the infection is
complicated or uncomplicated or primary or
recurrent
Treatment decisions are also based on the
type of patient (man or woman, a pregnant
or non-pregnant woman, child, hospitalized
or non-hospitalized patient, person with
diabetes).
Treatment should not necessarily be
based on the actual bacteria count.
For example, if a woman has
symptoms, even if bacterial count is
low or normal, infection is probably
present, and the doctor should
consider antibiotic treatment.
In laboratory diagnosis in vitro
condition pathogens which cause UTI
are grown on cultures under optimum
conditions and then these bacterial
colonies are checked for the response
of different antibiotic discs.
Sometimes numerous p/s are seen in
the urine but the culture fails to give
any growth mainly due to excretion of
antibacterial drugs which affect the
culture. These types of findings are
mainly due to the liberal misuse of
antibiotics.
It is well recognized that
indiscriminate use of antibiotics has
worssoned the problem of antibiotics
resistance. Anti-microbial agents are
very effective weapons against
infection, but at the same time their
misuse not only adds enormously to
Expenditure of the patient’s treatment
but it is harmful to the health of the
patient.
The patients who get infection in the
hospitals, respond to antibiotics in a
different way as compared with those
who catch infections outside in 5the
community.
Culture is made on cysteine lactose
electrolyte deficient (CLED) medium.
Minimum 50 colonies shows significant
growth equivalent to 100,000
organisms/ml shows UTI.
These bacterial colonies were than
tested by different biochemical or
differential methods (TSI etc) and
physical characters (gram staining).
After the identification of bacteria their
sensitivity to various antibiotics must
be looked for and it is inoculated on
“Sensitivity agar” to study antibiogram.
Proper selection of antibiotics is very
important in the treatment.
We use different antibiotics from
different groups like cephalosporins 1st
2nd and 3rd generation penicillins,
Macrolides, quinolones, miscellaneous,
aminoglycosides, carbapenem etc. our
study clearly indicates that it is the
prolonged use or misuse of drugs which
over a period of time producers resistant
strains of organisms. That’s why all those
drugs which are sensitive against
maximum number of organisms and
example is ESBL (extended spectrum Blactamase) producing organisms. There is
no precise definition of ESBLs. A
commonly used working definition is Blactamases capable of conferring bacterial
resistance to the
Pencillines, 1st, 2nd and 3rd generation
cephalosporins and aztreonam( but
not the cephamycins or carbapenems
e.g. MEM,IMP)
ESBLs destroy the beta lactum ring
of beta lactum antibiotics. They bind
and prevent the action of pencillin
binding proteins (PBPs). ESBLs are
the commonest cause of resistance
in gram negative bacteria.
%age of organisms among gram
negative and ESBL
Organisms
Escherichia
coli
Klebsiella
aerogenes
Pseudomonas
aeruginosa
Proteus spp.
% gram
%ESBL
negative rods
60.5%
38.5%
20.1%
18.9%
12.8%
11.3%
4.3%
0.9%
Sensitivity pattern of ESBL
producing organisms:
Antibiotics
Imipenem (IMP)
Meropenem (MEM)
Sulzone (SCF)
Tazocine (TZP)
Gentamicin (CN)
Norfloxacin (NOR)
Novidat (CIP)
Augmentin (AUG)
sensitivity
96%
96%
94%
76%
55%
49%
52%
41%