Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and...
Transcript of Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and...
![Page 1: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/1.jpg)
Diagnostic approach and microorganism
resistance pattern in UTI
Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman Bela
Microbiology Department
Medical Faculty, University of Indonesia
![Page 2: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/2.jpg)
Urinary Tract Infection (UTI)
Upper urinary tract : ureters and kidneys
Lower urinary tract: bladder and urethra
urinary tract inflammation that results
from any one of a number of distinct
syndromes
It is most commonly caused by a
bacterial infection
![Page 3: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/3.jpg)
Urinary Tract Infection Lower urinary tract : bladder and urethra
![Page 4: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/4.jpg)
![Page 5: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/5.jpg)
The bladder wall is covered with a surface mucopolysaccharide that inhibits the attachment of bacteria via their adhesins
![Page 6: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/6.jpg)
Uropathogenic strains of bacteria can attach to the cell wall of the bladder
![Page 7: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/7.jpg)
![Page 8: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/8.jpg)
Diagnostic approach in UTI Symptom UTI: localization of the site of infection 1. Acute bacterial pyelonephritis: - Fever, loin pain - Significant bacteriuria
2. Acute bacterial cystitis: - Frequency, & dysuria syndrome - Significant bacteriuria
3. Acute prostatitis - Perineal pain after sitting, a tender prostate, & fever - Significant bacteriuria
4. Symptomatic patients without significant bacteriuria urethritis, subacute or chronic bacterial prostatitis
![Page 9: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/9.jpg)
UTIs INTO PERSPECTIVE
Upper urinary tract : ureters and kidneys
Lower urinary tract : bladder and urethra
150 million UTIs
(uncomplicated and complicated)
occur yearly in the world
UNCOMPLICATED UTIs are
the most frequent
BACTERIAL INFECTION
IN WOMEN
Stamm and Norrby, CID, 2005
![Page 10: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/10.jpg)
The shorter urethra is a predisposing factor for Cystitis in women
![Page 11: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/11.jpg)
Women lack the bacteriostatic properties of prostatic secretions: UTI >>
Risk factors for UTI: In females:
pregnancy, spermicidal contraceptives,
diaphragm, estrogen deficiency.
In males:lack of circumcision, prostatic hypertrophy,
use of catheter.
![Page 12: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/12.jpg)
old age, obstruction, vesicoureteric reflux,
instrumentation, neurogenic bladder, renal
transplantation.
UTI frequency is roughly equal in women and men among the elderly
Men: an enlarged prostate in older men obstructs the urethra, leading to increased
frequency of urinary retention UTI
Menopause women: the loss of estrogen will be thins the lining of the urinary tract, which increases susceptibility to bacterial infection.
![Page 13: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/13.jpg)
Struthers, Clinical Bacteriology, 2005
![Page 14: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/14.jpg)
Epidemiology of UTI
Overview by sex and age
![Page 15: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/15.jpg)
![Page 16: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/16.jpg)
Diagnostic approach in recurrent bacterial cystitis :
• Someone who have had one bacterial cystitis have a risk recurrences, which follow the resolution of a previous treated or untreated episode
• Recurrent: at least 2 infections of the bladder in 6 months, or 3 infections in 1 year
![Page 17: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/17.jpg)
Risk Factor for Recurrent UTI:
• Patients who do not empty their bladder completely
• Some large kidney stones
• Other foreign objects in the urinary system
![Page 18: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/18.jpg)
Methods of urine collection :
No Methods Comments
1. MSU (main method) If possible, collect 2 specimens
to increase the percentage confidence of
organisms detection 2. a. Adhesive bags-infants
b. Clean-catch
specimen (CCS)-
infants
3. Suprapubic aspiration occasionally necessary in infants
4. Catheterization of urethtra - should never occur just to obtain a urine
specimen introducing infection
- If already catheterized, collected from the
catheter into a syringe and needle before
- it enters the drainage bag
5. Ureteric catheterization during operation
![Page 19: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/19.jpg)
![Page 20: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/20.jpg)
20
Transport to laboratory
• Urine sample in sterile container should reach the microbiology laboratory for culture within 2 h of collection
• The following methods can be used in delay transportation:
1. Refrigeration at 4 0C (24 - 48 h)
2. Dip-slide technique
3. Boric acid (1.8% boric acid in the urine)
![Page 21: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/21.jpg)
21
Microscopic, Culture urine and determination of bacterial counts:
1. The white cells are counted
2. A. Surface viable count
B. Semi-quantitative
- Filter paper screening method
- Standard loop method
- Dip-slide method
![Page 22: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/22.jpg)
![Page 23: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/23.jpg)
23
Mid-stream, clean-catch, & adhesive bag urine samples
No Interpretation Comments
1. Significant bacteriuria - >105 bacteria per ml
- usually a pure growth of one organism
- confidence ~ symptoms & pyuria
2. No evidence of infection - <104 bacteria per ml & not receiving
antibiotic
3. Equivocal results - 104 -105 bacteria per ml, especially if
Proteus or staphylococci are present
- Suggest repeat culture
4. Probable contamination - mixed growths in MSU sample
- < 104 bacteria per ml
- epithelial cells in microscopy
suggesting vaginal contamination
![Page 24: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/24.jpg)
24
Catheter or suprapubic urine samples:
Evidence of infection:
>105 bacteria per ml when infected urine
two organisms common when indwelling catheter
< 104 -105 bacteria per ml, may still be significant
![Page 25: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/25.jpg)
25
Interpretation of sterile pyuria: No Interpretation Comments
1. Possible
tuberculosis - consider early morning specimen of urine (EMSU)
X 3 for acid fast bacilli culture esp.if persistent pyuria
2. Treatment / non-
infective causes - antibiotic therapy; tumours or foreign bodies incl.
catheters; recent surgery; analgesic nephrophaty
3. Urethritis /
abacterial cystitis
- pus cells from ‘urethritis’ & ‘abacterial cystitis’
if low to moderately high counts of white cells
4. Vaginal discharge - pus cells from vaginal contamination
5. Other possible
causes
- due to a fastidious organism such as M. hominis,
Ureaplasma urealyticum
- look at Gram-stain of urine deposit. If numerous
short bacilli are present, infection due to diphtheroids
or anaerobes is a possibility
![Page 26: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/26.jpg)
ESSENTIAL OF DIAGNOSIS:
Acute Cystitis-Urethritis
– Women and girls older than 2 years
– Acute onset dysuria, increased frequency of urination
– Pyuria: more than 10 leucocytes (high power field of centrifuged urine) or positive leukocyte esterase test
– Positive urine culture : 1,000-100,000 CFU/ml urine
![Page 27: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/27.jpg)
ESSENTIAL OF DIAGNOSIS:
Acute Pyelonephritis
Fever, chills, costovertebral angle pain
Pyuria
Positive urine Gram stain
Positive urine culture (> 100.000 CFU) or blood culture
![Page 28: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/28.jpg)
ESSENTIAL OF DIAGNOSIS:
Acute Prostatitis (subjects older than age 35)
◦ Fever, chills, dysuria, increased frequency of urination, low back or pelvic pain
◦ Pyuria
◦ Positive urine culture for gram-negative bacilli or enterococci
Chronic urinary tract infection
◦ persistence or frequent re-infection of the kidney, bladder, or prostate
![Page 29: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/29.jpg)
• To know the most common bacteria-causing cystitis
• Resistance pattern to be able to perform adequate therapy
![Page 30: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/30.jpg)
![Page 31: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/31.jpg)
![Page 32: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/32.jpg)
![Page 33: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/33.jpg)
Microbial Pattern of UTI
0
5
10
15
20
25
30
35
40
45
E. coli (%) K. pneumoniae (%) Proteus mirabilis (%) Staphylococcus aureus(%)
Pseudomonasaeruginosa (%)
2009
2010
2011
2012
![Page 34: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/34.jpg)
Resistance Pattern
• E.coli Antibiotic 2009
%S
2010
%S
2011
%S
2012
%S
Fosfomycin 92 92.3 90 73
Ciprofloxacin 32.3 42.9 40 27
Trimthoprim/ Sulfamethazole
45.2 21.4 40 35
Piperacilin/
Tazobactam
85.7 85.7 92 66
Imipenem 96.7 100 90 78
LMK Mikrobiologi FKUI,
2009-2012
![Page 35: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/35.jpg)
![Page 36: Diagnostic approach and microorganism resistance pattern ... · Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana , Anis Karuniawati, Yulia Rosa, Budiman](https://reader030.fdocuments.net/reader030/viewer/2022040206/5e05df2a5b11dc4e913a0734/html5/thumbnails/36.jpg)