URINARY TRACT INFECTION
Presented By - Reeta sharma Moderator- Dr. .....
DEFINITION
I
Infection of urinary tract called UTI. UTI may be defined as the presence of bacteria undergoing multiplication in urine within urinary drainage system. The presence of detectable bacteria in the urine is termed as BACTERIURIA. The presence of pus cells in urine PYURIA.
SIGNIFICANT BACTERIURIA :
If proper collected specimen urine is examined Colony count 105 organism/ml is
significant.(Kass)1957. 104 organism is encountered under contamination. Count of 103 organism per ml may be significant in pure growth.
CLASSIFICATIONDivided in two categories:
LOWER UTI
Cystitis(bladder) Urethritis(urethra) Prostatitis(prostate) Lower UTI is due to ascending infection caused by faecal coliforms.
UPPER UTI
Pyelonephritis(infectio n of parenchyma of kidney) It is due to haematogenous infections.
FACTORS PREDESPOSING
1.AGE-:Incidence increases greatly with age. 2.SEX-:Sexually active females are more prone
because of-: Short Urethra Proximity to anus Urethral trauma during intercourse
3.PREGNANCY-:It disposes to upper UTI. 4.DIABETES MELLITUS 5.INSTRUMENTATION AND SURGERYCatheterization Surgical procedure
CAUSTIVE ORGANISM
A. 1. 2.
BACTERIA-:
GRAM POSITIVE COCCI Enterococci Staphylococci Haemolytic streptococci GRAM NEGATIVE BACILLI E.coli Proteus spp. Pseudomonas Klebsiella
B. C. D.
MISCELLANEOUS.
M. tuberculosis Citrobacter Salmonella Streptococcus pyogenes Mycoplasma
PARASITES FUNGUS
RISK OF UTI INFECTIONS
Enlarged Prostate. Common to patients with catheters & tube. Diabetic patients
SYMPTOMS
Urgency, Frequency & burning micturition. Loose milky cloudy urine. Vomiting, Nausea. In children, only fever present.
LABORATORY DIAGNOSIS
SPECIMEN COLLECTION 1. Mid stream urine specimen(MSU)
Collected in sterile container. Before collecting the sample genitalia should be cleaned with soap and water. Male-instructed to retract the foreskin of glans penis. Female-should keep the labia apart. The first portion of urine is allowed to pass then without interrupting the urine flow,mid portion of stream is collected. The first portion of urine adequately flushes out the normal urethral flora.
2. Catheter specimen
Urine should be collected from the cathetar and not from the collection bag. Catheter should not touch the container.Although catheter specimen yields excellent results but catheterisation to obtain urine is not justified because of risk of introducing infections.
3. Infants Specimen
Collecting specimen in infants is suprapubic aspiration.
TRANSPORTATION
Well labelled specimen with the request form must be immediately sent. If delay occur preserving substance like boric acid to be added and can be refrigerated at 40C.
GROSS EXAMINATION
Include matching of sample and form. Colour Turbidity Deposits
MICROSCOPIC EXAMINATION
Centrifuged sample Bacteria,Pus cells,Epithelial cells,Casts & crystals. Budding yeast cells & Pseudohyphae.
CULTURE
Uncentrifuged sample Inoculated on CLED Blood & MacConkey agar also used.
STANDARD LOOP METHOD
A standard calibrated loop is used to culture a fixed volume of uncentrifuged urine. CLED are used and incubated at 370C for 24 hrs. Next day, the number of colonies is counted and the total count per ml is calculated.
The fixed volume loop is 4mm in diameter & can hold 0.001ml urine, the total bacterial count per ml will be number of colonies multiplied by 1000. Single bacterium would form a single colony, therefore the number of colonies shall be equal to number of bacteria present.
Identification of Organism
CLED
LF
GPC
NLF
GNB OXIDASE
Staphylococcus Catalase-pos.
E.Coli,kleb. Proteus
If pos. pseudomonas If neg. Vibrio,proteus etc.
Coagulase-pos.in Staph.aureus.
Streptococcus Catalase-neg.
OTHER METHODS-:
1. DIP SLIDE METHOD It consists of media coated over disposable plastic slides. Inoculation by immersing slide in urine container or by allowing flow of urine to pass over it. This method is relatively expensive.
2.Pour plate method-:Quantitative method.
3.Catalase test-:Presence of catalase is evident
by bubbles formation on addition of hydrogen peroxide.
4.Glucose oxidase test-:The test is based on
utilization of small amount of glucose present in normal urine by bacteria causing UTI.
4. Griess nitrate test: The test is based on rapid
reduction of nitrate to nitrite by nitrate reducing enzyme-nitrate reductase-an enzyme present in gram negative bacilli commonly involved in UTI.
5. Leukocyte esterase test: This is a dip stick
method used for the detection of pyuria.
6. FILTER PAPER STRIP METHOD:
In this method the filter paper strip is dipped into urine and transferred to agar plate and after incubation colonies are counted.
IDENTIFICATION & SENSITIVITY TEST
Antibiotic sensitivity tests are best done with appropriately detected inoculum of pure sub culture. Susceptibility is determined by Kirby Bauer disc diffusion method using 6 drugs on 9 cm plate .
ANTIBIOTICS:
1. ORAL ADMINISTRATION Amoxycillin or Ampicillin Cephalexin Ciprofloxacin, Norfloxacin Nitrofurantoin 2. PATIENT IN HOSPITAL Cefuroxime Gentamicin
THANKS
