Urinary Tract Infection

Definisi
UTI and ASB connote the presence of bacteria
in the urinary tract, usually accompanied by
white blood cells and inflammatory cytokines
in the urine.
 Epidemiologi
Neonatal period : Male > Female
Infants and elderly : Male = Female
1 year 50 years of ages = Male < Female
50% 80% of women acquired at least one
UTI during their life time
 Etiologi
E. coli accounts for 7590%
Staphylococcus saprophyticus for 515% (with
particularly frequent isolation from younger
women)
Klebsiella, Proteus, Enterococcus, and
Citrobacter species, along with other
organisms, for 510%.
Gram-positive bacte- ria (e.g., enterococci and
Staphylococcus aureus) and yeasts
Patogenesis
 Clinical Syndrome
Asymptomatic Bacteriuria
does not have local or systemic symptoms
Cystitis
dysuria, urinary frequency, and urgency
Nocturia, hesitancy, suprapubic discomfort, and
gross hematuria
 Pyelonephritis
Mild : low-grade fever with or without lower back or
costovertebral angle pain
Severe : high fever, rigors, nausea, vomiting, and flank
and/or loin pain.
Prostatitis
dysuria, frequency, and pain in the prostatic pelvic or
perineal area
Complicated UTI
symptomatic episode of cystitis or pyelonephritis
with an anatomic predisposition to infection
 Dianostic Tools
The Urine Dipstick Tes & Urinalysis
point-of-care information
Urine Culture
Retrospectively confirm a prior diagnosis
 Treatment
Uncomplicated
UTI
 Pyelonephritis
fluoroquinolones the first-line (orally or parenterally)
ciprofloxacin (2 x 500mg for 7 days, with or without an
initial IV 400mg)
TMP-SMX
Uropathogen is suspecibility known (2 x double strength
tablet for 14 days)
Pathogen is suspecibility unknown (plus initial IV 1g dose
of ceftriaxone)
Parental therapy
fluoroquinolones, an extended spectrum cephalosporin
with or without an aminoglycoside, or a carbapenem.
Combinations of a -lactam and a -lactamase inhibitor
(e.g., ampicillin-sulbactam, ticarcillin- clavulanate,
piperacillin-tazobactam) or imipenem-cilastatin can be
used in patients with more complicated histories
 UTI in pregnant women
Nitrofurantoin, ampicillin, and the
cephalosporins are considered relatively safe
in early pregnancy
Pyelonephritis in pregnancy
parenteral -lactam therapy with or without
aminoglycosides is the standard of care
 UTI in men
Uropathogen is susceptible
fluoroquinolone or TMP-SMX for 7 to 14 days
Acute bacterial prostatitis
Antimicrobal according the culture for 2-4 weeks
Chronic bacterial prostatitis
Antimicrobal according the culture for 4-6 weeks
Recurrences
Antimicrobal according the culture for 12 weeks
 Complicated UTI
Prior urine culture data that can be used to
guide empirical therapy
Xanthogranulomatous pyelonephritis is
treated with nephrectomy
Percutaneous drainage can be used as the
initial therapy in emphysematous
pyelonephritis
 Asymptomatic Bacteriuria
Treatment of ASB in pregnant women and
patients undergoing urologic procedures
should be directed by urine culture results
 Catheter Associated UTI
Eradication of a catheter-associated biofilm is
difficult without removal of the device itself
7- to 14-day course of antibiotics is
recommended
 Candidauria
Fluconazole (200400 mg/d for 14 days)
Oral flucytosine and/or parenteral
amphotericin B (Resistance to fluconazole)
 Prevention of Recurrent UTI in
Women
Patient Lifestyle
Continuous prophylaxis and postcoital
prophylaxis : low doses of TMP-SMX, a
fluoroquinolone, or nitrofurantoin
 Prognosis
Cystitis is a risk factor for recurrent cystitis and
pyelonephritis.
use of a long- term indwelling bladder
catheter is a well-documented risk factor for
bladder cancer