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Management of uti
1. Javed Iqbal
FCPS, FRCS,
Professor Of Surgery
Quaid-e-Azam Medical College, &
Iqbal Minimal Invasive Surgery Center
Bahawalpur
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3. Introduction
Most common type of bacterial infections
Although the urinary tract, unlike the
respiratory tract or the gastrointestinal
tract, is not exposed to the outside
world, and is normally sterile.
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4. Definition
Urinary tract infection is diagnosed
when bacteria and pus cells are
recovered from the urine with or
without symptoms.
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5. UTI
Women during the reproductive years
Old age
Post-operative period
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6. “complicated” UTI
Long-term foreign bodies such as indwelling
urinary catheters and stents.
Urinary tract stones.
Congenital or anatomic anomalies.
Obstructive uropathy
Vesicoureteric reflux, or structural urologic
abnormalities, including surgically created
structural changes, such as ileal loops;
Neurogenic bladder disorder
Renal transplantation.
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7. Why is the Concept of
'Complicated' Urinary
Tract Infections Useful in
Practice?
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8. Complicated UTI
More chances of infection with bacteria
that are resistant to first-line antibiotics
Less likely to respond to a short course
(<7 days) of antibiotics; and
More likely to require microbiologic
laboratory testing, follow-up
assessment, and consideration of imaging
procedures
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9. Pre-menopausal
Women
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10. Premenopausal Women
Nosocomial pathogens --recent hospitalization
Diabetes mellitus
Pregnancy
Recent instrumentation or surgery
Uremia from renal causes
Anatomic abnormalities of the urinary tract
Urinary tract stones
Urinary stents or other foreign bodies
Immunocompromised or
immunosuppressed, including from the use of
immunosuppressive drugs; and a history of renal
transplantation.
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11. Why are Women so Prone
to Urinary Tract
Infections?
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12. Short urethra.
Close proximity to the anus, vulva and
perineal area.
In adults the UTIs have been shown to be
strongly and independently associated
with recent sexual activity
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14. In infants below the age of three
months
hematogenous spread
After this age
The route of entry of pathogens is by
ascending through the urethra, as in
adults
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15. The organism most
commonly associated with
UTI in children, as in
adults, is E. coli
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16. Diagnosis is not always as straightforward
as in adults, especially in neonates and
very young children;
The risk of recurrence is relatively high
The risk of complications, or long-term
sequela is relatively high, a risk that can
be significantly reduced with timely
diagnosis and prompt treatment.
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17. More extensive diagnostic investigations
Greater emphasis on prompt and
appropriate treatment
Longer follow-up after apparent cure
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18. What is Required for the
Diagnosis of a Pediatric
Urinary Tract Infection?
Urine Culture is must
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20. Again, women outnumber
men as far as incidence is
concerned
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21. Urinary Tract Infections in
the Elderly should always
be Considered
'Complicated'
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22. 1
Non-specific, vague, or
atypical clinical presentation
Decline in mental status
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23. 2
The sensitivity of standard
urinalysis for leukocyte esterase
as a marker of infection is low.
Urine cultures
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24. 3
Non-first-line antibiotics
short-course antibiotic therapy is
much less likely to be effective.
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25. 4
Wide variety of both Gram-negative and
Gram-positive bacteria, and polymicrobial
infection is relatively common.
E. coli accounts for less than 50% of
bacterial isolates in the elderly
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26. Treatment failures and
recurrences, despite what would
be considered appropriate and
adequate therapy, are common
in the elderly
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27. Why elderly are more prone to UTI
Oestrogen
Anatomical changes due to
gyaenacological surgery
Some degree of BOO in male
Debilitating diseases resulting in
decreased immunity
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29. More than 100,000 colony-
forming units (CFU)/mL of
voided urine in a person
with no symptoms of UTI
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32. Asymptomatic bacteriuria
Itshould be treated
E-coli is the common bug
First line treatment is the choice
Duration should be short
Recurrence should be monitored
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33. Patients with Anatomic
Abnormalities of the
Urinary Tract
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34. Patients with congenital developmental or
anatomic anomalies;
Patients with surgically created anatomic
changes in the urinary tract;
Patients with any kind of obstructive uropathy;
Patients with urinary tract stones; and
Patients with long-term foreign bodies in the
urinary tract, such as stents or indwelling
catheters
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35. Infected with a wider range of bacteria
They sustain renal damage and scarring
as a result of infection
They have a high risk of poor response to
antibiotic therapy.
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37. Risk Factors
longer duration of catheterization
female sex
poor catheter care
inadequate use of antibiotics
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38. Can Urinary Tract Infection be Prevented in
Catheterized Patients?
Minimal duration
Close system
Intermittent cathetrization
Supra-pubic cystostomy
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39. Should Asymptomatic
Bacteriuria in
Catheterized Patients be
Treated?
NO
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42. UTI was first treated with
sulfonamides during the
Second World War in 1939
by the Nobel Prize Winner
Gerhard Domagk
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43. Non specific therapies
Hydration and increased fluid intake;
E. coli do not grow in a low osmolar
(dilute) urine.
Alkalinization of the urine: dissolves urate
and oxalates crystals and less growth of
E.coli
Urination after intercourse.
Analgesia.
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45. General Considerations
Concentration in the urine
Concentration in vaginal secretions
Spectrum of activity against infecting
organisms
Half-life
Safety and adverse effect profile
Cost
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46. Traditional First-line Agents for
Uncomplicated Urinary Tract
Infections
Amoxicillin
Ampicillin
Trimethoprim
Trimethoprim–sulfamethoxazole
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47. First-line Agents
No role in Complicated UTI
Very little role when the isolate is E-Coli
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53. Classification of Fluoroquinolones
Whatis the Anti-bacterial Activity of the
Fluoroquinolones?
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54. Which Fluoroquinolones
are Suitable as First-line
Agents for Treatment of
Complicated Urinary
Tract Infections?
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