Urinary Tract Infections

Urinary Tract Infections
By: Charles S. Bryan, M.D.

Overview of UTI by age and sex
Terms
* Urinary tract infection
* Significant bacteriuria
* Asymptomatic bacteriuria
* Acute pyelonephritis
* Chronic pyelonephritis
* “Upper” versus “lower” UTI
* Urethral syndrome
* UTI: the finding of microorganisms in bladder urine with or without clinical symptoms and with or without renal disease
* Significant bacteriuria: the finding of > 105 cfu/ml of urine (but lower counts can be significant)
* Asymptomatic bacteriuria: Significant bacteriuria without clinical symptoms or other abnormal findings.
* Acute bacterial pyelonephritis: a clinical syndrome of fever, flank pain, and tenderness, often with constitutional symptoms, leukocyte casts in the urine, and bacteriuria; or histologic findings thereof
* Chronic bacterial pyelonephritis: Long-standing infection associated with active bacterial growth in the kidney; or the residuum of lesions caused by such infection in the past
* Chronic interstitial nephritis: renal disease with histologic findings resembling chronic bacterial pyelonephritis but without evidence of infection
* “Upper UTI”: infection above the level of the bladder
* “Lower UTI”: infection at or below the level of the bladder
* “Urethral syndrome”: clinical manifestations of lower UTI (dysuria, frequency, urgency) without significant bacteriuria
* Pyuria: the presence of pus (WBC’s [leukocytes] in urine, which may or may not be caused by UTI. The preferred method for quantitation is enumeration in unspun urine using a counting chamber. The leukocyte esterase nitrite test has a sensitivity of between 70% and 90% for symptomatic UTI

Asymptomatic bacteriuria
Frequency of significant bacteriuria
Screening for significant bacteriuria
Urinary tract bacteriology
Etiology of community-acquired UTI
Etiology of nosocomial UTI
Urease-producing microorganisms
UTI in children
UTI in adults
Role of bacterial virulence in UTI
The role of bacterial virulence (2)
Host defenses: antibacterial properties of urine
Host defenses: anti-adherence mechanisms
Host defenses: miscellaneous
Routes of urinary tract infection
Mechanisms of lower UTI
Mechanisms of upper UTI
Localization of upper versus lower UTI
Acute uncomplicated cystitis in young women
Acute uncomplicated pyelonephritis in young women
White blood cell casts
Recurrent UTIs in women
Complicated UTIs
Catheter-associated UTI
Long-term bladder catheterization
Prostatitis

Urinary Tract Infections.ppt