SEARCH RESULTS FOR: lower-urinary-tract-infection-pathogenesis-and-clinical-findings

lower-urinary-tract-infection-pathogenesis-and-clinical-findings

Predisposing Factors: Immunocompromised state, diabetes, elderly, female (short urethra), stagnant urine (anatomical variant, obstruction, neurogenic bladder, urinary reflux) Bacterial entry (Less Common): Indwelling catheter, surgical inoculation, hematogenousspread, trauma (Staphylococcus, Enterococcus, Candida) Fecal bacteria access urethra (E. coli, Proteus, Klebsiella) Impairment of body's natural defense systems, or stagnant urine, allow for bacterial accumulation Portal of entry bypasses body's physical defenses (gravity and repetitive outward urine flow) Bacterial fimbriae and pili allow them to ascend urethra and adhere to epithelium Lower Urinary Tract Infection (LUTI): Pathogenesis and clinical findings Suprapubic Tenderness Bacterial colony irritates urinary epithelium Urgency: Sensation of need to urinate quickly or impending incontinence Stimulation of inflammatory response Stimulation of urinary reflex Pathogens use enzymes to reduce nitrate to nitrite Delirium in Elderly Frequency: Repetitive need to urinate Unique response of altered fluid status, electrolytes and mental status, likely as a result of increased inflammatory cytokines Lower Urinary Tract Infection (“Cystitis”): Infection of bladder or distal tract by capable bacteria colonizing epithelium and causing symptoms Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published March 16, 2014 on www.thecalgaryguide.com Author: Brett Edwards Reviewers: Riley Hartmann Jan Rudzinski Haotian Wang Steve Vaughan* * MD at time of publication Usual Pathogens (“KEEPS”): K – Klebsiella E – E. coli (90%) E – Enterococcus, Enterobacteriaceae P – Proteus, Pseudomonas S – Staph. saprophyticus, Serratia Urine Findings: ↑ Colony Count (>107 CFU/L) ↑ WBC (>10 WBC/μL) (+) Bacterial culture (+) Nitrites, Leukocyte Esterase (+) Foul, turbid urine +/- Hematuria (rare) WBCs onsite release enzymes Cytokines released systemically Fever, Malaise, ↑WBC (>11 x 109 cells/L) (Rare in LUTI)