MDS Urinary Tract Infection Dr Noura

Urinary Tract infections DR. Noura AL-Sweih Laboratory Definitions Bacteriuria: Significant Bacteruiria  Bacteria in MSU  > 105CFU/ml  One type of Bacteria  Pyuria : Many WBC or pus cells in urine  No micro-organism  Causative Organisms  Bacteria and fungi are the main organisms infect UT Bacterial causes of urinary tract infection UTI % ----------------------------------------------Organism  E-coli  S epidermidis & S saprophyticus  Proteus  E faecalis  Klebsiella spp  Pseudomonas aeruginosa Community 82 Nosocomial 55 9 3 1 2 1 4 12 3 13 7 Other causative organisms Sample collection Laboratory Tests Routine and Microscopy Culture and Sensitivity Methods of urine collection  Urine samples should be collected before antibiotic therapy  Contamination is reduced if collection of MSU (explain to the patient) Suprapubic sample, Catheter Sample  Sample collection Laboratory Tests Routine and Microscopy Culture and Sensitivity Routine Urinanalysis RBC WBC Yeast Sample collection Laboratory Tests Routine and Microscopy Culture and Sensitivity Culture E.coli Laboratory Diagnostic Criteria Culture  Significant bacteriuria   MSU ≥ 100,00 CFU/ml (105 CFU/ml) Indicative of UTI of 80% if one sample & it increase to 95% if two samples  Type of Urine Samples Laboratory Reports Culture Report Percent(%) Outpatient Inpatient 38 56.9 No growth No significant growth Mixed growth Significant growth 21.5 28 9.8 13 23 6.3 Causative Organisms Type of Organism Escherichia coli Proteus mirabilis CNS Other GNB Kuwait Inpatient (%) Kuwait Outpatient (%) 35 1.2 1.1 29.6 56.7 2 1.9 16.8 Other GPB Candida albicans 12.1 5.5 20.1 0.9 Sensitivity Pattern of E.coli Community Hospital (% of Resistance) (% of Resistance) Antibiotic Ampicillin 63 76 Augmentin 45 53 Cephalothin 33 42 Cefuroxime 8 14 Cotrimoxazole 51 44 Nitrofurantoin 5 6 Norfloxacin 8 21 Naladixic acid 16 25 Sensitivity Pattern of E.coli Hospital Antibiotic Amikacin Gentamicin Cefotaxime Ciprofloxacin (% of Resistance) 1 4 5 6 Piperacillin Tazobactam-piperacillin 62 8 A Case  A 2 yr old boy visited his GP according to his mother C/O Fever on and off  Not eating well, not feeling well  No vomiting  No nasal discharge or sore throat  May had abdominal pain this is why not eating  Predisposing factors  Congenital anomalies  Instrumentation [ Nosocomial UTI] Diabetes mellitus Immunosuppression   Case 2  A 26 yr old pregnant lady during her ANC visit at 28 wks. Her Dr. requested for her urine test “R&M and C&S” as routine screening she had no specific complaints Laboratory Report  R& M Glucose ++, Pr +, Nit ++, WBC +++, RBC +, Bacteria +++  Report C&S Group B streptococci > 105 CFU/ml  S ( AM, CF, NIT)  A 74 yr old man admitted to the hospital with history of fever, confusion and lower abdominal pain for the last 3 days, he is known to be diabetic for the last 30 yrs