• asymptomatic bacteriuria
• cystitis
• acute pyelonephritis
• chronic pyelonephritis (doesnt exist EXCEPT in TB)
• recurrences
  • relapse
  • reinfection

• more common in women (10-30 x)
• 10-20% of women have UTI in lifetime
• kids with bacteriuria are more likely to have bacteriuria as adult
• most common nosocomial infection
• elderly (majority female, but only twice as much as men)

• short urethra in females
• obstruction
  • extrarenal
    • BPH
    • pregnancy
    • indwelling catheters
    • calculi
    • extrinsic compression on ureter
  • intrarenal (any stricture)
    • nephrocalcinosis
    • renal stones
    • polycystic kidneys
    • sickle cell disease

recurrence of bacteriuria with a new microogranism (often predisposing condition)

• DM
• urinary incontenance
• neurogenic bladder
• vesicouretal reflux

• history of UTI
• difficulty holding urine
• family history of UTI in mother
• sexual intercourse (frequency, number of partners)
• spermicide use
• pregnancy (pressure on urethra by uterus)
  • increase reflux
  • increase likelihood of infection
• instrumentation/catheterizations (Foley catheters)(nosocomial nature of infection)

• bladder washout
• urine has antibacterial properties
  • low pH
  • high urea
  • high osmolality
• vagina
  • low pH
  • IgA and flora as well
• Tamm Horsfall protein
  • binds to E coli and prevents epithelial cell attachment
• bladder mucopolysaccharides
• TLR11- recog. bacterial polysaccharides
  • if absent, increase incidence of pyelonephritis

1. starts in rectal flora
2. perineal colonization
3. vaginal colonization
4. introital colonization
5. urethra
6. bladder
7. kidney

• women w/UTI's have greater incidence of introital colonization with enterobacteria (E fecalis)
• no evidence of inflam. associated with introital colonization
• vaginal pH correlate with introital colonizations (higher pH equal higher colonization)
• colonization not related to vaginal glycogen content or local IgA
• bacterial adherance to vaginal epithelium is greater in women with recurrent UTI's
• antibiotics increase introital colonization

• adhesins
  • mannose sensitive- bladder
  • manose resistant and X adhesins- pyelo
• serum bactericidal resistance (can't survive in blood stream)
• increased K antigen (evade phagocytes)
• presence of aerobactin (bind Fe)
• presence of hemolysins

• 95% females
• 16-35 age at risk
• at risk:
  • healthy outpatients
  • normal UTI's 90% symptomatic
• sensitive to most antibiotics
• relapse rare

• equal affect on males and females
• age at risk is over 50
• at risk population
  • hospital patients
  • complicated UTI's
• presentation- 90% asymptomatic
• therapy- this is a multidrug resistant pathogen
• outcome- relapse common

• pre-existing Ab to organism doesnt protect
• high levels of IgG against lipid A correlate with severity of infection
• upper tract infection, NOT lower tract, associated with Ab response
• no increased incidence of UTI in patients with humoral or cellular immune systems
  • this is anatomical in nature

• clinical syndrome
• microscopic examination of urine
• biochemical tests
• culture

• fever
• vomitting
• failure to thrive

• dysuria
• urgency
• frequency
• suprapubic pain

• fever
• dysuria
• urgency
• frequency
• flank pain

• fever
• change in mental status (they act young)

• absence of pyuria strongly suggest non-infectious cause for symptoms
• at least 10 WBC's/high powered field (400 power) is abnormal
• WBC casts are diagnostic of upper tract infections
• presence of one organism/unspun hpf correlates with (greater than 10^5 cfu/mL)

DONE WITH DIPSTICK (takes 2 minutes, but much less reliable)

• presence of leukocyte esterase (if greater than 10 WBC's/hpf)
• nitrite tests
  • detect reduction of nitrate to nitrite by Enterobacteriaceae
  • less sensitive when less than 10^5 cfu bacteria present

• bacteremia
• perinephric abcess (located along renal papilla)
  • if abcess occuring hematogenously is a renal carbuncle (in periphery of kidney)
• emphysematous pyelonephritis (gas in kidney)
• xanthogranulomatous pyelonephritis
• papillary necrosis
• chronic pyelonephritis (aka interstitial nephritis)

• bacterial infections do not cause intersitial nephritis unless there is obstruction, but it can contribute to it

• most infections casued by E coli
• culture often not necessary in healthy women
• short course (3 days) usually effective

• E coli, Klebsiella, Proteus
• cultures should be obtained
• treat 10-14 days
• hospitalize for GI symptoms or if severely debilitated

• sulfonamides (most resistant)
• ampicillin
• TMP/SMX
• cephalosporins
• quinolones
• aminoglycosides

Bolded ones are most popular ones

• DO NOT TREAT UNLESS:
  • pregnant women (high incidence of pyelonephritis if bacteruria)
    • if dont treat, can cause prematurity
  • before a urologic procedure
  • young children when there is high incidence of vesicouretal reflux

• incomplete bladder emptying
  • pelvic relaxation with cystocele
  • bladder diverticula
  • neurogenic bladder
• urinary obstruction
  • meatal stricture
  • urethral stricture
  • prostatic enlargement
  • bladder neck obstruction
• vesicoureteral reflex
• stones

Main cause unknown

• hematogenous
• asceding infection from urethra
• reflex of infected urine into prostatic bed
• risk with:
  • urethral instrumentation
  • foley catheters
  • surgery

• symptoms
  • high fever
  • chills
  • perineal and back pain
  • UTI symptoms

• examination
  • warm, swollen, very tender
• microbiology
  • N. gonorrhoeae
  • E coli
  • other gram negative rods

• symptoms
  • asymptomatic to perineal discomfort
  • lower back pain
  • dysuria
• examination- normal to mild tenderness

• bacterial- enterococci, E. coli, other gram negative rods
• nonbacterial- Chlamydia, ureaplasma

• difficuly is antibiotic penetration
• frequently require prolonged treatment
• usually tetracyclines, quinolones have good penetration