Bacterial Urinary Tract Infection

(UTI)

Riyani Wikaningrum
Bag. Mikrobiologi
FKUY

Terminology Used in UT
infections

Upper Urinary Tract Infection

the urinary tract above the level of the bladder; that is, the
ureters, kidneys, and peri-renal tissues.
pyelonephritis.
Upper UTI also encompasses
intrarenal abscess (renal carbuncle)
perinephric abscess.

Renal papillary necrosis refers to infarction of the papillae

(sometimes with sloughing into the ureters) caused by
pyelonephritis or analgesic abuse
diabetes mellitus
sickle cell disease
ureteral obstruction.

Acute bacterial pyelonephritis

clinical syndrome
Fever
flank pain
often with constitutional symptoms

Laboratory findings:
Leukocytosis
leukocyte casts in the urine
bacteriuria with or without signs of
concomitant inflammation in the bladder

Lower Urinary Tract Infection

Lower urinary tract infection refers to infection at
or below the level of the bladder. In clinical
practice, lower UTI is often used synonymously
with cystitis, a syndrome characterized by
dysuria, frequency, urgency, and variable
suprapubic tenderness. Because one cannot say
with certainty that infection involves mainly or
exclusively the urinary bladder, some authorities
suggest that cystitis should be abandoned.
Lower UTI also encompasses prostatitis,
urethritis, and infection of the periurethral glands.

Chronic bacterial pyelonephritis

long-standing infection with active bacterial
growth in the kidney, or the presence of
residual lesions in the kidney caused by such
infection in the past.
Chronic interstitial nephritis
in which evidence for an etiologic role for
bacterial infection is lacking.
Etiology : Drugs (not only prescription drugs but
also non-prescription drugs as in analgesic
nephropathy)

Introduction
20 30% females have recurrent urinary
tract infection (UTI)
Men less common and primary occur
after 50 years old
Acute infection

Common
cused
of UTI

Acquisition and Etiology

Bacterial infection is usually acquired by
the ascending route from the urethra to
bladder
Community acquired
Hospital acquired catheterization

Etiology
E. coli and P. mirabilis
Klebsiella, Enterobacter, Serratia sp, P
aeruginosa hospital acquired
Ureaplasma

 Gram-positive S. saprophyticus, S.
epidermidis, and Enterococcus
Hematogenous spread S. enterica
Serotype Typhi, S. aureus and M.
tuberculosis

Viral cause of UTI rare but certain virus

can be recovered from the urine in the
absent of UTI, e.g. CMV, rubella,
adenovirus, hantavirus
Very few parasites cause UTI Candida;
H. capsulatum; Trichomonas vaginalis;
Schistostoma haematobium

Pathogenesis
Predisposing factors:
Disruption of urine flow
Short female urethrae
Sexual intercourse
In male infants uncircumcised
Pregnancy
Prostatic hypertrophy
Catheterization

Pathogenesis

Risk Factor in Female

Clinical Features
Acute lower UTIs cause
Dysuria burning pain on passing urine
Urgency the urgent need to pass urine
Frequency on micturition

The urine is cloudy due to pyuria and

bacteriuria
Pyuria in the absence of positive culture
chlamydial; mycobacterial infections
Pyelonephritis causes a fever and lower
urinary tract symptoms

 Asymptomatic infections
Pregnant women
Young children
Catheterization may proceed to bacteremia
Elderly persons
Diabetes

Laboratory Diagnosis
Specimens:
MSU
Suprapubic aspiration of urine
bag urine
Urine in catheterized patients ..

Quantitative culture methods

Infections bacterial count >= 105/ml urine
Contaminated less than 103/ml urine

Sample Collection (supra pubic puncture)

Sample collection (in situ cathether)

Pyuria

Interpretation of Quantitative
Culture

 Interpretation of the significant bacterial

cultures depends upon a variety factors:
Collection of specimen
Storage
Antibiotic treatment
Fluid intake

Special urine samples:

Three early morning urine samples on
consecutive days for M. tuberculosis
The last few milliliters of morning urine
sample collected after exercise for detection
of S. haematobium

Treatment
Uncomplicated UTI oral antibacterial as
single dose or 3 days
Complicated UTI (pyelonephritis)
systemic antibacterial agents

Prevention
Reccurent infection in healthy women
Regularly emptying the bladder
Avoid catheterization if possible or keep to
minimum duration

GUIDELINES FOR CATHETER

CARE
avoid catheterization whenever possible
keep duration of catheterization to a minimum
use intermittent rather than continuous catheterization
when feasible
insert catheters with good aseptic technique
use a closed sterile drainage system
maintain a gravity drain
use topical antiseptics around the meatus in women
wash hands before and after inserting catheters and
collecting specimens, and after emptying drainage bags.

Escherichia coli

Escherichia coli
Flora normal pada usus manusia & hewan
Manifestasi klinis:
Infeksi saluran kemih: penyebab 80%
kasus; kuman hemolisin (+), tahan serum,
faktor virulensi pili P
Septisemia: asal infeksi adalah infeksi saluran
kemih atau penjalaran kuman dari usus
Meningitis pada neonatus: E. coli K1
Gastroenteritis (Diare) karena E. coli

 Pathogenesis factors of bacteria:

Somatic serotype O1, O2, O4, O6, O7,
O75
Capsular serotype K1, K2, K3, K5, K12,
K13
Pili P Uropathogenic E. coli (UPEC)

The healthy urinary tract is resistant to

bacterial colonization, due to:
pH, chemical content and flushing mechanism
of urine

UPEC (Uropathogenic E. coli)

BACK

Proteus, Providencia, Morganella

Spesies penting: P. vulgaris, P. mirabilis
Pertumbuhan: menjalar, H2S (+), urease
(+)
Manifestasi klinis: infeksi sal. kemih,
bakteremia, pneumonia, infeksi
nosokomial (P.vulgaris; Morganella)
Terapi: ampisilin, trimetoprim. Perlu tes
sensitivitas kuman

Proteus

BACK

Klebsiella
Morfologi Kuman: batang, Gram (-), gerak
(-), mempunyai kapsul tebal
Faktor virulensi:
Kapsul menghambat fagositosis
Ag.O menghambat lisis oleh komplemen

Manifestasi Klinis:
infeksi saluran kemih, bronkhopneumoni,
infeksi nosokomial

Enterobacter
Serupa dengan Klebsiella, hanya gerak (+)
Spesies penting: E. aerogenes & E.
cloacae
Penyebab infeksi nosokomial, dan infeksi
saluran kemih
Umumnya resisten terhadap penisilin
Terapi: gol. aminoglikosida

BACK

Family: Mycoplasmataceae
Genus: Mycoplasma
Species: M. pneumoniae
Species: M. hominis
Species: M. genitalium

Genus: Ureaplasma
Species: U. urealyticum

Diseases Caused by Mycoplasma

Organism

Disease

M. pneumoniae

Upper respiratory tract disease,

tracheobronchitis, atypical
pneumonia, (chronic asthma??)

M. hominis

Pyleonephritis, pelvic
inflammatory disease,
postpartum fever

M. genitalium

Nongonococcal urethritis

U. urealyticum

Nongonococcal urethritis,
(pneumonia and chronic lung
disease in premature infants??)

Morphology and Physiology

Smallest free-living bacteria (0.2 - 0.8 m)
Small genome size
Require complex media for growth
Facultative anaerobes
Except M. pneumoniae - strict aerobe
Lack a cell wall

Grow slowly by binary fission

Fried egg colonies
M. pneumoniae colonies have a granular
appearance

Fried Egg Colonies of

Mycoplasmas

Morphology and Physiology

Ureaplasma - T strains
Require sterols for growth

Differentiation of Species

M. pneumoniae - glucose
M. hominis - arginine
U. urealyticum - urea
M. genitalium - difficult to culture

M. hominis, M. genitalium and

U. urealyticum
Clinical syndromes
M. hominis - pyleonephritis, pelvic inflammatory
disease and postpartum fever
M. genitalium - nongonococcal urethritis
U. urealyticum - nongonococcal urethritis

Epidemiology

Colonization at birth - usually cleared

Colonization with M. hominis - 15%
Colonization with U. urealyticum - 45% -75%
Colonization with M. genitalium - ??

M. hominis, M. genitalium and

U. urealyticum
Laboratory diagnosis
Culture (except M. genitalium)

Treatment and prevention

Treatment
Tetracycline or erythromycin

Prevention
Abstinence or barrier protection
No vaccine

BACK

INFEKSI pada PROSTAT

Sampling Technique

Three-glass Procedure

Meares and Stamey localization techniq

1. Approximately 30 minutes before taking the specimen,

the patient should drink 400 ml of liquid (two glasses).
The test starts when the patient wants to void
2. The lids of four sterile specimen containers, which are
marked VB1, VB2, EPS and VB3, should be removed.
Place the uncovered specimen containers on a flat
surface and maintain sterility
3. Hands are washed
4. Expose the penis and retract the foreskin so that the
glans is exposed. The foreskin should be retracted
throughout
5. Cleanse the glans with a soap solution, remove the
soap with sterile gauze or cotton and dry the glans
6. Urinate 1015 ml into the first container marked VB1

7. Urinate 100200 ml into the toilet bowl or vessel and

without interrupting the urine stream, urinate 1015 ml
into the second container marked VB2
8. The patient bends forward and holds the sterile
specimen container (EPS) to catch the prostate
secretion
9. The physician massages the prostate until several
drops of prostate secretion (EPS) are obtained
10. If no EPS can be collected during massage, a drop may
be present at the orifice of the urethra and this drop
should be taken with a 10 ml calibrated loop and
cultured
11. Immediately after prostatic massage, the patient
urinates 1015 ml of urine into the container marked
VB3.

Prostatitis:
Akut - Disebabkan oleh:

E. coli
P. aeruginosa
Serratia sp.
Klebsiella sp.
Proteus sp.
Enterococci
Staphylococcus

Kronik
dibagi menjadi 3 sindrom:
Chronic bacterial prostatitis
Chronic abacterial prostatitis/CPPS-inflammatory
Chronic abacterial prostatitis/CPPS-non-inflammatory

Disebabkan S. aureus, S. faecalis, Enterococcus, difteroid

Prostatitis
Pemeriksaan laboratorium:
MSU
EPS (expressed prostatic secretion digital rectal
massage):
Lepas antibiotik selama 1 bulan
Tidak mengalami ejakulasi selama 2 hari

Epididymo-orchitis
Penyebab:

Mumps virus
Coxsackievirus
N. gonorrhoeae
C. trachomatis
E. coli
Koliform lainnya