1. URINARY TRACT INFECTIONS Sandra del Mundo, M.D.

2. How does a UTI start? Ascending infection Bacteria in perineal area ascends through the urethra, enters the urinary bladder and multiplies This is the most common route of infection Systemic infection In a patient with bacteremia, bacteria may be “seeded” into the kidneys from the blood

3. What parts of the urinary tract can get infected? Urethra - Urethritis Urinary bladder – Cystitis Ureters – Ureteritis Kidneys - Pyelonephritis (Most common) (Most serious)

4. What are the signs and symptoms of UTI? Cystitis Frequency Urgency Dysuria – painful voiding Pain or discomfort in suprapubic or perineal area or lower back Cloudy or foul-smelling urine

5. Acute pyelonephritis Fever Nausea and vomiting More pronounced malaise Pain in the back (+) CVA tenderness

6. Who are at higher risk for UTI? People with any abnormality of the urinary tract which interferes with normal flow of urine Enlarged prostate Kidney stones Vesicoureteral reflux • People with indwelling urinary catheters

7. Who are at higher risk for UTI? People with compromised immune function People with diabetes People taking immunosuppressive drugs • Women in general • Pregnant women • Sexually active women

8. What tests do you need to order if you suspect a UTI? If likelihood of simple cystitis is very high – nothing • If you are not so sure of the diagnosis • Urinalysis • Urine dipstick for leukocyte esterase or nitrites

9. How do you treat a UTI? What antibiotic should you choose? Ampicillin Amoxicillin NO! • Cotrimoxazole Yes • Quinolones Yes

10. How do you treat a UTI? How long should you treat? Single dose of antibiotic • Three day course • Seven day course A three day course provides the best compromise between effectiveness and cost and side effects

11. When should you refer a patient with UTI to a nephrologist ? Most patients will not need a referral. Only special cases need to be referred . • Recurrent UTI: More than three UTI’s per year • When UTI symptoms are accompanied by fever or blood in the urine

12. When should you refer a patient with UTI to a nephrologist ? • UTI symptoms in a pregnant woman, or a diabetic individual • Any one whose symptoms do not resolve after one course of antibiotics • A second UTI episode in an adult male or child of either sex • A first UTI episode in an infant

13. Take home messages • Most cases of acute cystitis will resolve with a 3-day course of quinolones • Ampicillin and amoxicillin are not recommended choices for the treatment of UTI because of the high incidence of resistance

14. Take home messages • Complicated cases need to be referred