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
9 3 1 2 1
Nosocomial
55
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 Kuwait Inpatient (%) 35 Kuwait Outpatient (%) 56.7
Proteus mirabilis CNS Other GNB Other GPB Candida albicans
1.2 1.1 29.6 12.1 5.5
2 1.9 16.8 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
(% of Resistance)
1
4
Cefotaxime Ciprofloxacin Piperacillin
Tazobactam-piperacillin
5 6 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