Definition

UTI means infection of any part of urinary tract

(Kidney, Ureter, Bladder or Urethra)

Infections of the urethra and bladder are often

considered superficial (or mucosal) infections

While pyelonephritis, and renal suppuration

signify tissue invasion

Asymptomatic bacteriuria, acute cystitis, and

acute pyelonephritis are common renal disorders

in pregnancy.

Asymptomatic bacteriuria- is defined as the

presence of actively multiplying bacteria in

the urinary tract excluding the distal urethra

in a patient without any obvious symptoms

Incidence during preg.is 10%.

The diagnosis is based upon isolation of

microorganisms with a colony count > 105

organisms per milliliter of urine in a clean-

catch specimen.

If asymptomatic bacteriuria is left untreated in pregnancy, up to 40% of patients will develop symptoms of UTI.

Approximately 25–30% of women will develop acute pyelonephritis. With treatment, the rate is 10%

The increased risk is due to:

decreased ureteral tone,

decreased ureteral peristalsis,

temporary incompetence of the vesicoureteral valves,

Bladder catheterization

Escherichia coli ( 80% ).

The Klebsiella-Enterobacter-Serratia group,

Staphylococcus aureus,

group B Streptococcus,

enterococcus

Proteus are responsible for the remainder

of the case

Dysuria, urgency and frequency-the

symptom.

Pyuria,bacteriuria and microscopic

hematuria.

Frequency, urgency, dysuria ,pyuria but

urine culture with no growth may be

urethritis caused by C.trachomatis.

The bacteria causing acute cystitis are

similar to those in asymptomatic bacteriuria

Acute pyelonephritis is the infection of the

renal pelvis and the kidneys.

It is one of the most common causes of

hospitalization and serious medical

complication of pregnancy.

Complicates 1-2% of pregnancies.

Develops more frequently in second

trimester.

Isolates from urine or blood are-E.coli(75-

80%),others K .pnuemonia, enterobacter or

proteus

Asymptomatic bacteruria-the single most

important risk factor.

aprevious history of pyelonephritis,

Gravidity(primi)

urinary tract malformation,

urinary calculi.

Maternal DM

Sickle cell trait

Fever(usually > 390C)

shaking chills,

bilateral flank pain,

Nausea, vomiting and possibly diahrrea

headache,

increased urinary frequency, and dysuria

CVA tenderness.

chorio-amnionites,

appendicites,

labor,

placental abruption,

red degeneration of myoma

Renal caliculi

maternal fetal bacterial endotoxemia,

endotoxic shock

renal insufficiency(ARF)

anemia,

leukocytosis,

thrombocytopenia,

Pulmonary dysfunction

(mild cough,rispiratory

infiltrat to sever ARDS)

low birth weight(small

for GA)

premature delivery

neonatal death

CBC(Hct,Hgb,WBC(leukocytosis),pletlet)

Blood group and RH

Serum HCG

Blood sugar level

U/S,IVP

Urine culture:

Significant bacteriuria= 105 cfu/ml

symptoms: 1 +ve cuture = infection

Symptoms: 102 cfu/ml = propable infection

Asymptomatic: 2 +ve cultures = infection

False negative : antibiotics, antiseptics, renal

TB, diuresis.

Microscopy of urine

Assessed with Gram-stained uncentrifuged urine

Microscopic bacteriuria is found in >90% of specimens with colony counts of at least 105 /mL

The detection of bacteria by urinary microscopy constitutes firm evidence of infection, but the absence of microscopically detectable bacteria does not exclude the diagnosis

Pyuria (WBC > 5/HPF) is demonstrated in nearly all acute bacterial UTIs and its absence calls for the diagnosis of UTI in question

Look also for RBCs, WBC casts

Associated hematuria may indicate urinary calculi.

Sterile pyuria

Pyuria in the absence of bacteriuria

Indicate infection with unusual agents such as C.

trachomatis, U. urealyticum, or Mycobacterium

tuberculosis or with fungi

May also occur in noninfectious urologic

conditions such as calculi, anatomic abnormality,

vesicoureteral reflux, interstitial nephritis, or

polycystic disease

1. Hospitalization

2. Urine and blood cultures,RFT,electrolyte

3. Monitor vital signs frequently, including

urinary output; consider indwelling catheter

4. Intravenous crystalloid to establish urinary

output to 30 mL/hr

5. IV antimicrobial therapy(sulfonamides and

cephalosporin are reasonable choices.)

6. Chest radiograph if there is dyspnea or

tachypnea

7. Repeat hematology and chemistry studies in

48 hours

8. Change to oral antimicrobials when afebrile

9. Discharge when afebrile 24 hours; consider

antimicrobial therapy for 7 to 10 days