In The Name Of God URINARY TRACT INFECTIONS - PowerPoint Presentation

Slide1

In The Name Of God

Slide2

URINARY TRACT INFECTIONS

Slide3

These are the

most common bacterial infections during pregnancy.

:

Its prevalence is

(

5-6 %

)

asymptomatic

bacteriuria

1 - 2 %)

)

cystitis

(

0.5 - 2 %

)

Pyelonephritis

Slide4

Microbiology

 

Organisms that cause urinary infections are from the normal

perineal

flora

.

E. coli

is the predominant

uropathogen

found in both asymptomatic

bacteriuria

and urinary tract infection (70 % )

Klebsiella

and

Enterobacter

species (3 % each),

Proteus

(2 %),

gram-positive organisms, including

group B Streptococcus

(10 %).

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Asymptomatic

Bacteriuria

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Asymptomatic

Bacteriuria

persistent, actively multiplying bacteria within the urinary tract in asymptomatic

women

is typically present at the

first prenatal visit

.

risk Factors:

---a history of prior urinary tract infection

---pre-existing diabetes mellitus

---increased parity

---low socioeconomic status

Slide7

Significance

Without treatment

, 30-40 % of pregnant women will develop a symptomatic

urinary tract infection during pregnancy .

This risk is reduced by 70-80 % if

bacteriuria

is eradicated

Slide8

In some studies

, covert

bacteriuria

Has been associated with:

---low-

birthweight

infants

---preterm delivery

---hypertension

---anemia

Pregnancy associated Benefits of treatment for asymptomatic bacteria are limited to the reduction of the incidence

pyelonephritis

Slide9

Screening

recommend

screening

for

bacteriuria

at the first prenatal visit.

Rescreening every4-6 w

:

urinary tract anomalies hemoglobin S preterm labor

Diabetes

mellituse

Nephropathy

Immmunodeficiency

Neurologic dysfunction

Calculi

Genitourinar

instrumentation

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Diagnosis

 

The diagnosis of asymptomatic

bacteriuria

should be based on

culture of a urine

specimen of a clean-catch voided)

An initial

positive

urine culture result prompts

treatment

, after A clean-voided specimen containing more than

100,000

organisms/

mL.

It may be prudent to treat when lower concentrations are identified, because

pyelonephritis

develops in some women despite colony counts of only

20,000 to 50,000

organisms/

mL

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Treatment

Bacteriuria

responds to

empirical

treatment with any of several antimicrobial regimens

listed in Table.

Regardless of regimen given, the

recurrence

rate is

30%

.

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Management

After antibiotic therapy ,

urine culture

;

must be

sterilise

.

with

persistent or recurrent

bacteriuria

, prophylactic or suppressive antibiotics may be warranted in addition to retreatment .

nitrofurantoin

,100 mg orally at bedtime.

Cephalexin

250 mg orally at bedtime.

This drug may rarely cause an acute pulmonary reaction that dissipates on its withdrawal

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Cystitis And

Urethritis

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Cystitis And

Urethritis

Cystitis is characterized by:

---

dysuria

---urgency

---Frequency

---few associated systemic findings.

---

Pyuria

,

bacteriuria

and microscopic

hematuria

are usually found

.

Lower urinary tract symptoms with

pyuria

accompanied by a

sterile urine

culture may be from

urethritis

caused by Chlamydia

trachomatis

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Almost

40 % of pregnant women with acute

pyelonephritis

have preceding symptoms of lower tract infection .

Most of these regimens are usually

90% effective

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Acute

Pyelonephritis

Slide20

Renal infection is the

most common

serious medical complication of pregnancy leading cause of septic shock during pregnancy

urosepsis

may be related to an increased incidence of

cerebral palsy

in preterm infants .

Fortunately, there appear to be

no

serious

longterm

maternal

sequelae

Develops more frequently in the

second trimester,

Pyelonephritis

is unilateral and right-sided

in more than half of cases, and it is bilateral in a fourth

.

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Increased Risk Of :

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Clinical Findings

There is usually a rather abrupt onset with:

---fever

---shaking chills

---aching pain in one or both lumbar regions

---Anorexia

---

nausea,and

vomiting

---Tenderness in one or both

costovertebral

Angle

---

Pyuria

&

bacteruria

& microscopic

hematuria

.

---

Bacteremia

is demonstrated in 15 -20 %

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Differential Diagnosis

Labor

Appendicitis

Chorioamnionitis

placental abruption

infarcted

leiomyoma

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Management

----

hospital admission

electrolytes, CBC , Cr , urine and blood cultures

----Intravenous

hydration

to ensure adequate urinary output (

cornerstone

of treatment)

.

----

Monitor

by serial determination of urinary output, BP, PR,

BT,and

oxygen saturation.

----High fever should be lowered with a cooling blanket or

acetaminophen

. (because of possible

teratogenic

effects of hyperthermia).

----

Antimicrobials

are

begun promptly (they may initially worsen

endotoxemia

from bacterial

lysis

) Antimicrobial therapy usually is

empirical

, and

ampicillin

plus

gentamicin

;

cefazolin

or

ceftriaxone

;

an extended spectrum antibiotic were all 95%

effectiv

.

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response

is usually prompt, and 95 % of women are

afebrile

by

72 h

.

After

discharge

, most recommend

oral therapy

for a total of 7 -14 d

If

cesarean

or

NVD

is indicated delay until patient is

afebrile

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Persistent Infection

With persistent

spiking fever

or lack of clinical improvement by

48 to 72 h

,

urinary tract obstruction or another

complication

or both are considered.

persistent infection can be due to an

intrarenal

or

perinephric

abscess

or

phlegmon

Renal

sonography

is recommended to search for obstruction manifest by abnormal

ureteral

or

pyelocaliceal

dilatation

Slide29

If stones are strongly suspected despite a

nondiagnostic sonographic

examination, a

plain abdominal radiograph

will identify nearly 90 %.

Another option is the modified

one-shot intravenous

pyelogram

—a

single radiograph obtained 30 min after contrast injection.

MRI

may disclose the cause of persistent infection .

Slide30

Obstruction relief is important, and one method is

cystoscopic

placement of a double-J

ureteral

stent

surgical

removal of stones may be required in some women

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Surveillance

Recurrent infection—either covert or symptomatic—is common and develops in 30-40 % of women after

pyelonephritis

therapy .

nitrofurantoin

,

100 mg orally at bedtime

given for the remainder of the pregnancy

mg orally at bedtime

250

cephalexin

U/C

in 3

rd

trimester

Slide32

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