in the name of god tara mottaghi habibollah amini bacterial infections of urinary tract mazandaran...
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Urinary Tract InfectionTRANSCRIPT
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In the name of God
Tara MottaghiHabibollah Amini
Bacterial infections of Urinary tract
Mazandaran University of Medical Sciences – Ramsar International Branch
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Quick View
UTI
DefinitionImagingTreatmentRecurrent UTIApproach to acute Cystitis
Renal InfectionsAcute PyelonephritisChronic PyelonephritisEmphysematous PyelonephritisXanthogranulomatous PyelonephritisRenal Abscess Prostatitis
UTI during pregnancy UTI in children
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Urinary Tract Infection
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Definition
Random urine samples Wbc > 10U/A
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Definition
Random urine samples
Mid stream urine samples + Dysuria & Frequency
Wbc > 10
Colony count > 10²
U/A
U/C
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Definition
Random urine samples
Mid stream urine samples + Dysuria & Frequency
Mid stream urine samples + Asymptomatic urinary tract
Wbc > 10
Colony count > 10²
Colony count > 105
U/A
U/C
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Definition
Random urine samples
Mid stream urine samples + Dysuria & Frequency
Mid stream urine samples + Asymptomatic urinary tract
Urine samples obtained by catheter
Wbc > 10
Colony count > 10²
Colony count > 105
Colony count > 10²
U/A
U/C
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Definition
Random urine samples
Mid stream urine samples + Dysuria & Frequency
Mid stream urine samples + Asymptomatic urinary tract
Urine samples obtained by catheter
Urine samples obtained through suprapubic aspiration
Wbc > 10
Colony count > 10²
Colony count > 105
Colony count > 10²
A number of gram-negative bacteria
U/A
U/C
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Definition
Random urine samples
Mid stream urine samples + Dysuria & Frequency
Mid stream urine samples + Asymptomatic urinary tract
Urine samples obtained by catheter
Urine samples obtained through suprapubic aspiration
Wbc > 10
Colony count > 10²
Colony count > 105
Colony count > 10²A number of gram-negative bacteria
A few gram-positive bacteria
U/A
U/C
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Imaging
KUB
IVP
Sonography
CT Scan
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Treatment
Treatment for 7 days
Simple uncomplicated UTI in womenTreatment for 3-5 days
Thesigns and symptoms been persist for more than a week
Age > 65 yrs
History of diabetes
Cystitis in pregnant
Recent UTI
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Recurrent UTI
Reinfection Persistant Unresolved
Causes
• Chronic protatitis• Urinary fistulas• Infectious stones• Congenital anomalies of the urinary• Chronic pyelonephritis• Foreign body• Diverticulitis urethra• Ureteral stump after nephrectomy
Causes
• Bacterial resistance to antibiotics used• The creation of resistant strains during treatment• Renal failure• Renal abscess• Staghorn renal calculi• Obstruction in the urinary tract• Inadequate dose treatment• Inadequate treatment period
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Staghorn renal calculi
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Approach to acute Cystitis
در افراد دارایRisk factor مانند،آنومالی و دیابت سنگ و سپس شروع U/Cاول
AB
U/A قدم : اول
و Pyuriaعدم وجود Bacteriuria
و Pyuriaوجود Bacteriuria
شروعAB
& Vaginitisبررسی از نظر Urethritis
اگر عالئم بهبود نیافت
بهبود عالئم
اقدام دیگری حین U/Cالزم نیست
درمان
منفی
مثبت
ارزیابی بیشتر الزم نیست
بررسی نتایج Antibiogram
اگر در آنتی بیوگرام مقاومت مطرح شد
و بررسی ABتعویض U/Cحین درمان با
تجویزی ABدرصورتی که میکروب به حساس باشد و بیمار دارو را خوب
مصرف کرده باشد
Unresolved
شروع عالئم با قطع درمان
Persistant bacteriuria Reinfection
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Unresolved Persistant bacteriuria
Reinfection
Approach to recurrent UTI
Urologicارزیابی R/Oبرای ،انسداد و سنگ
آنومالی ها
و ارزیابی ABشروع Urologic و رفع
کانون عفونت
Riskفاقد factor
Risk factorدارای مانند ،حاملگی،دیابت
ضعف ایمنی،سنگ و آنومالی های
ساختمانی
ارزیابی Urologic
درمان پروفیالکتیک ماه6به مدت
Tab co-trimoxazole , ½ , Qhs
Tab nitrofurantoin , 50-100mg , Qhs
Tab nalidixic acid , 250-500mg , Qhs
Tab cephalexin 250mg , Qhs
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Pyelonephritis
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PyelonephritisAcute pyelonephritis
Chronic pyelonephritis
Emphysematous Pyelonephritis
Xanthogranulomatous Pyelonephritis
Common sign & symptom :(Except chronic pyelonephritis)
FeverShaking chills Flank pain Nausea & vomiting
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Acute pyelonephritis
Signs & symptoms :
• Fever• Shaking chills• Flank pain• Dysuria• Frequency• Cloudy urine• Vomiting
Laboratory tests results :• Pyuria• Hematuria• high ESR and CRP levels• Leukocytosis
The most common cause : Ecoli
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Approach to Acute Pyelonephritis: قدم اول
U/A , U/C و رنگآمیزی گرمتأیید
عفونت
اگر عالئم سپسیس نداشت . حال عمومی خوب و تهوع و استفراغ
نداشت ABدرمان خوراکی با
روز14-10به مدت Choice : Fluocinolone
هفته2در پایان هفته پس از 4-6
اتمام درمان
تکرار کشت
اگر عالئم سپسیس و
تهوع و استفراغ داشت
B/C , Imaging (sonography or CT scan)IVبستری و درمان
پاسخ مناسب IVبه درمان
ادامه تب و درد پهلو علیرغم
درمان وریدی به 72hمدت
ادامه درمان وریدی روز برای کشت 7-10
خون مثبت روز برای کشت 2-3
خون منفیو در ادامه
14-10درمان به مدت خوراکیABروز با
CT یا Sonographyو کشت و
اسمیر مجدد
DDx: Bacterial resistance to
antibiotics usedorAbscess
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Chronic pyelonephritis