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Urinary tract infections (UTIs)
The urinary tract is one of the most common sites of bacterial infection, particularly in
females
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Severe infections result in a loss of renal
function
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UTIs may be community acquired or
nosocomially acquired due to catheterization
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Citrobacter, Klebsiella, Enterobacter, Proteus and
Pseudomonas aeruginosa, are frequently found in hospital acquired UTIs as their resistance
to antibiotics favours their selection in hospital patients
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Viral causes of UTI appear to be rare, although there are associations with hemorrhagic
cystitis and other renal syndromes
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the human polyomaviruses JC and BK
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Very few parasites cause UTIs
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And
Histoplasma capsulatum, the protozoan Trichomonas vaginales, and infections with
schistosoma haematobium
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The shorter female urethra is a less
effective deterrent to infection than the male urethra
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UTIs are common in uncircumcised male infants
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increased volumes if post-void
residual urine are associated with a greater likelihood of infection
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Catheterization is a major
predisposing factor for UTI
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The duration of catheterization is directly associated with increased
probability of infection, due in part to the formation of biofilms
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Uropathogenic E
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fimbriae
(pyelonephritis-associated pili), which allows uropathogenic E
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Clinical features
Acute lower UTIs case dysuria, urgency and frequency
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The urine is cloudy owing to the
presence of pus cells (pyuria) and bacteria (bacteriuria), and may contain blood
(haematuria)
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Recurrent infections of the lower UT occur in a significant number of patients
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Acute bacterial prostatitis causes systemic symptoms (fever) and local symptoms
(perineal and low back pain, dysuria, and frequency)
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Staphylococci are a common cause and renal abscesses are present
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Pyuria in the absence of positive urine cultures can
be due to chlamydia or tuberculosis
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Laboratory diagnosis
Infection can be distinguished from contamination by quantitative culture methods
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Urine specimens may
become contaminated with periurethral flora during collection
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Infected urine usually contains a single predominant bacterial
species
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In urine collected from catheters any number of organisms may be
significant because the specimen is not contaminated by periurethral flora
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An MSU sample should be
collected into a sterile wide-mouthed container after careful cleansing of the labia or glans,
and after allowing the first part of the urine stream to be voided, as this helps to wash out
contaminants in the lower urethra
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For
patients with a catheter, a catheter specimen of urine is used for microbiological
examination
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tuberculosis and schistosoma
haematobium
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tuberculosis,
the last few milliliters should be collected early afternoon after exercise for detection of
S
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Microscopic examination of urine allows a rapid preliminary report
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However, they
are not necessarily indicative of infection, but may indicate that the specimen has been
poorly collected or left at room temperature
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hematuria may be present in
association with; infection of the UT and elsewhere, renal trauma, calculi, UT carcinomas,
clotting disorders, or thrombocytopenia
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A laboratory diagnosis of significant bacteriuria requires quantification of
the bacteria
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Direct
antibiotic susceptibility tests may be initiated upon detection of abnormal numbers of white
blood cells or bacteria on microscopy, so that both culture and susceptibility results are
available within 24h
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These factors relate to; collection- specimen collection must be
carried out correctly, storage- the urine must be cultured within 1h of collection or held at 4
degrees celsius for no more than 18h before culture, antibiotic treatment- in s patient

receiving antibiotics smaller numbers of organisms may be significant and may represent an
emerging resistant population, fluid intake- the patient may be taking more or less fluid than
usual and this will influence the quantitative result, and the specimen- the quantitative
guidelines are valid for MSU specimens
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Nitrofurantoin a urinary antiseptic
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Initial treatment of
complicated UTI (pyelonephritis) usually involved a systemic antibacterial agent
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the prophylactic use of
antibiotics may also prevent recurrent infections
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