K - 9 Urinary Tract Infection (Ilmu Penyakit Dalam)

7/23/2019 K - 9 Urinary Tract Infection (Ilmu Penyakit Dalam)

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Urinary Tract InfectionsUrinary Tract InfectionsLecture 2: Genito-urinary system.



Sherwood Fig. 12-6a, p.530

Renal

vein

(a)

Ureter

Aorta

idne!

Renalarter!

Urethra

Urinar!

"ladder

#n$erior

vena %ava



Figure 26.1

An introduction to the Urinary System An introduction to the Urinary System



Getting Clear on theGetting Clear on the

TerminologyTerminology

UTI

Asymptomatic

Bacteriuria

Symptomatic

UTI

Cystitis

Urosepsis

Asymptomatic

UTI

Pylonephritis

Pyuria



5

#n$e%tion#n$e%tion

Infection is defined as the entry and

multiplication of microorganism(s) in the

tissues of the host that produces injuriouseffects.



6

&!'titi'&!'titi'

Infection of the urinary tract limited to the

bladder, usually inoling only the mucosal

surface ! Most common type of UTI in the long-term care

setting



"

!elonephriti'!elonephriti'

Infection of the #idney usually resulting from

trael of the infection from the $ladder to the

ureter and then to the kidney. (ascending



%

Uro'ep'i'Uro'ep'i'

&epsis occurs 'hen $acteria hae entered the

bloodstream and lead to a 'idespread

(systemic) inflammatory response.rosepsis means the infection has stemmed

from an infection of the urinary tract



A'!ptoati% *a%teri+riaA'!ptoati% *a%teri+ria

*he presence of $acteria in the urine of a

person without symptoms of infection.

! Should not be called a UTI ! Should not be treated with antibiotics



1+

!+ria!+ria

*he presence of white blood cells in the urine.

! The bodys reaction to in!asion by bacteria"

! #ne of the key differentiating points betweenUTI and assymptomatic bacteriuria



Getting Clear on theGetting Clear on the

TerminologyTerminology

Pollakisuria

Pollakisuria$dysuria

syndrome

Anuria

%ysuria

Polyuria

#liguria

Cylindruria

&ematuria



!! The ris" of uti in #omenThe ris" of uti in #omen $%&$%& men.men.

'hy'hy

the shorter distance between anus andthe shorter distance between anus and

meatus urethrae externum.meatus urethrae externum.

!! almost half of allalmost half of all woenwoen #ill ha)e at least#ill ha)e at least

one UTI in their li)es.one UTI in their li)es.!! the ris" of UTI in #omen increases afterthe ris" of UTI in #omen increases after

meno*ausemeno*ause

U.T.I.



!! after a UTI 2% - +% , #ill ha)e aafter a UTI 2% - +% , #ill ha)e a recurrencerecurrence

!! the recurring infections are usuallythe recurring infections are usually

re-infections.re-infections.!! asym*tomatic acteriuria in #omen occurs inasym*tomatic acteriuria in #omen occurs in

2., of $/ - 2+ year olds2., of $/ - 2+ year olds

0.1, of o)er / year olds and0.1, of o)er / year olds and

2% - /%, of o)er 3% year olds2% - /%, of o)er 3% year olds

U.T.I.



U# i'U# i' rarerare in !o+ng and iddle-aged enin !o+ng and iddle-aged en

U# in en i' o$ten a''o%iated withU# in en i' o$ten a''o%iated with %atheteri'ation%atheteri'ation oror

+rologi%al pro%ed+re'+rologi%al pro%ed+re'..

"a%teri+ria in elderl! en o%%+r' in"a%teri+ria in elderl! en o%%+r' in

4 a"o+t 10 o$ tho'e living at hoe,a"o+t 10 o$ tho'e living at hoe,

4 a"o+t 20 o$ tho'e living in n+r'ing hoe' anda"o+t 20 o$ tho'e living in n+r'ing hoe' and

4 30 o$ tho'e who are in-patient' in ho'pital'30 o$ tho'e who are in-patient' in ho'pital'

+rinar! %atheter in%rea'e' the ri' alo't ten-$old in+rinar! %atheter in%rea'e' the ri' alo't ten-$old inho'pitali'ed patient' and tho'e in other %are hoe'.ho'pitali'ed patient' and tho'e in other %are hoe'.

p!elonephriti' i' %oon in patient' who have "eenp!elonephriti' i' %oon in patient' who have "een

%atheteri'ed $or over a onth.%atheteri'ed $or over a onth.

R/A/&/



Urinar! tra%t in$e%tion o%%+r' when "a%teria whi%hUrinar! tra%t in$e%tion o%%+r' when "a%teria whi%h%oloni'e the anal area%oloni'e the anal area ascend ascend thro+gh +rethra to thethro+gh +rethra to the

"ladder "ladder

5is" factors include5is" factors include

4 reduced resistance offered y the mucous memranes (e.g.reduced resistance offered y the mucous memranes (e.g.after meno*auseafter meno*ause

4 se&ual intercoursese&ual intercourse

4 disturances in ureteral functioningdisturances in ureteral functioning

4 in children the re-entering of urine ac" into the uretersin children the re-entering of urine ac" into the ureters

()esicoureteral reflu&6 #hich *redis*oses them *articularly()esicoureteral reflu&6 #hich *redis*oses them *articularly

to u**er UTI7sto u**er UTI7s

8athogenesis



8athogenesis

ther ri' $a%tor'4ther ri' $a%tor'4

enign *rostatic hy*ertro*hyenign *rostatic hy*ertro*hy

any illness6 such as diaetes6 #hich affects theany illness6 such as diaetes6 #hich affects theem*tying of the ladder em*tying of the ladder

s*inal in9ury (associated #ith disturances ins*inal in9ury (associated #ith disturances inladder em*tying or urinary catheterladder em*tying or urinary catheter

catheterisation in hos*ital or residential carecatheterisation in hos*ital or residential care

other urological *roceduresother urological *rocedures



&a+'ative agent' o$ U#'

Escherichia coli Escherichia coli

4 o't %oono't %oon

4 aout 3%, of *rimary care infectionsaout 3%, of *rimary care infections

4 aout /%, of hos*ital-acuired infectionsaout /%, of hos*ital-acuired infections

;thers:;thers:

4 enterococci enterococci

4 Staphylococcus saprophyticusStaphylococcus saprophyticus andand

4 klebsiellasklebsiellas 4 )arious ty*es of)arious ty*es of pseudomonas pseudomonas andand proteus proteus areare

more raremore rare



&opli%ated or +n%opli%ated

77Un%opli%atedUn%opli%ated urinary tract infections areurinary tract infections are

4 o%%a'ional lower +rinar! tra%t in$e%tion' in woeno%%a'ional lower +rinar! tra%t in$e%tion' in woen #ith#ith

no *redis*osing factors to infectionsno *redis*osing factors to infections

77&opli%ated&opli%ated infections areinfections are all other U#'all other U#' including lo#erincluding lo#er

UTIs inUTIs in

4 *regnant #omen*regnant #omen

4 menmen

4 childrenchildren

4 and catheter-induced infectionsand catheter-induced infections

4 The in)estigations and treatment of these entail s*ecialThe in)estigations and treatment of these entail s*ecial

featuresfeatures



S!pto' o$ U#' 1

&!'titi'4&!'titi'4

ty*ical sym*toms include freuency andty*ical sym*toms include freuency and urning sensationurning sensation

#hen *assing urine.#hen *assing urine.

!elonephriti'4!elonephriti'4

only some *atients ha)eonly some *atients ha)e difficulties in micturitiondifficulties in micturition

tem*erature (< 13tem*erature (< 13ooC and flan" or ac" *ainC and flan" or ac" *ain

nausea in the elderly or sudden colla*se in health status (=off-nausea in the elderly or sudden colla*se in health status (=off-

legs=legs=



Sym*toms of UTIs 2Sym*toms of UTIs 2

incontinence or offensi)e urine inincontinence or offensi)e urine in the elderl!the elderl! should not eshould not e

consideredconsidered as UTI as such> e)en though they may e indicati)eas UTI as such> e)en though they may e indicati)e

signs of an infectionsigns of an infection

almost any signs of infection inalmost any signs of infection in in$ant'in$ant' may e indicati)e of amay e indicati)e of aUTIUTI (&)(&)

inin a 'all %hilda 'all %hild a tem*erature alone6 #ithout any other signs ofa tem*erature alone6 #ithout any other signs of

an infection6 should raise a sus*icion of a UTIan infection6 should raise a sus*icion of a UTI

UTI in children and the elderly may manifest itself asUTI in children and the elderly may manifest itself asincontinence or retention.incontinence or retention.



8iagno'i' o$ U#'

*a'ed on the '!pto'*a'ed on the '!pto' othoth

a %lini%al diagno'i'a %lini%al diagno'i' of a UTI andof a UTI anda di$$erentiationa di$$erentiation et#een lo#er (cystitis oret#een lo#er (cystitis or

u**er (*yelone*hritis UTI should e madeu**er (*yelone*hritis UTI should e made



&olle%ting a 'aple

in adults and older children ain adults and older children a id 'trea +rineid 'trea +rine(9SU)(9SU) sam*le usually relialy re*resents the urine insam*le usually relialy re*resents the urine inthe ladder.the ladder.

sam*les collected from urinary ags or ed*anssam*les collected from urinary ags or ed*ansshould not e used to diagnose UTI as they in)arialyshould not e used to diagnose UTI as they in)arialy#ill e contaminated#ill e contaminated

thethe most relialemost reliale sam*le is otained )ia asam*le is otained )ia a su*ra*uicsu*ra*uic

*uncture*unctureurine in ladder <+ hours (any shorter time #illurine in ladder <+ hours (any shorter time #illincrease the ris" of false negati)e findingsincrease the ris" of false negati)e findings



Clinically significant *athogen concentrationsClinically significant *athogen concentrations

&lini%al 'tat+' or ethod' o$ 'apling

Signi$i%ant%on%entration(i%ro"e' : l)

?SU> sym*tomatic *atient or urine in-ladder @+ h

<$%1

?SU> urine in -ladder <+ h <$%+-/

?ale *atient6 catheter s*ecimen sam*le <$%1

emale *atient6 catheter s*ecimen sam*le <$%+

Asym*tomatic -acteriuria <$%/

Su*ra*u-ic *uncture sam*le any gro#th



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K - 9 Urinary Tract Infection (Ilmu Penyakit Dalam)