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
In pregnancy - penicillin and cephalosporins
Edited by ImAn NoOr
