Thursday, March 10, 2011

Urinary tract infection

Urinary tract infection is the most common bacterial infection managed in general medical practice and accounts for 1-3% of consultations. Up to 50% women have a UTI at some time. In male UTI is uncommon. Most common presentation of UTI is acute urethritis and cystitis.

Spectrum of presentation:

1) Asymptomatic bacteriuria
2) Acute pyelonephritis
3) Symptomatic acute urethritis & cystitis
4) Acute prostatitis
5) Septicaemia

Common causes:

1) E. coli
2) Klebsiella
3) Proteus
4) Pseudomonus
5) Streptococci
6) Staphylococci epidermidis
7) In Hospitals- E. coli , Klebsiella and streptococci

Risk factors:

1) incomplete bladder emptying :

a) bladder outflow obstruction
b) neurological problems-
multiple sclerosis
diabetic neuropathy
c) gynaecological abnormalities-
uterine prolapse
d) vesico ureteric reflux

2) foreign body-

a) urethral catheter
b) ureteric stent

3)loss of host defence-

a) diabetes mellitus
b) atrophic urethritis and vaganitis in post menopausal women

Differential diagnosis:

1) urethritis
2) vaginitis

Clinical feature :

1) abrupt onset of frequency of micturation and urgency
2) dysuria
3) supra pubic pain during and after voiding
4) stranguary
5) urine may appear cloudy and have an unpleasant odur
6) microscopic or visible heamaturia
7) fever, rigor, vomitting

Investigations :

1) Dipstick examination - nitrite, leucocyte esterase and glucose
2) urine R/E - for pus cell and epithelial cell ( > 5-6)
3) urine culture (midstream urine)
4) CBC
5) Blood culture
6) USG
7) Serum urea ,electrolytes, creatinine
8) Cystoscopy

Management:

1) fluid intake at least 2 litre per day
2) regular complete emptying of bladder
3) good personal hygiene
4) emptying of bladder before and after sexual intercourse
5) if vesico ureteric reflux is present practice double micturation
6) antibiotics according to the report of urine culture
  • ciprofloxacin - 500mg 12 hourly for 3 days
  • trimethoprim - 200 mg 12 hourly for 3 days
  • nitrofurontion - 50 mg 6 hourly for 3 days
  • coamoxiclav - 500/ 125mg 8 hourly for 3 days
Seriously ill patient I/V cefuroxime -750 mg 8 hourly for 3-14 days
In pregnancy - penicillin and cephalosporins

Edited by ImAn NoOr




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