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Specific Objectives:
To enumerate the classification of
urinary tract infection
To determine the appropriate
diagnostics and management of each
type
Demographics
• E.G.V.
• 39 year old Female
• Filipino
• Married
• Born on December 10, 1979
• San Agustin Kanluran, Isla Verde,
Batangas City
• First time to seek consult in our
institution – March 7, 2019
Dysuria
Chief Complaint
History of Present Illness
1 week PTC
Persistence of
Symptoms
• Terminal Dysuria
• Low back pain- 5/10, Consult
intermittent, non-radiating,
non-aggravated.
• No febrile episodes
• No vomiting
• No loss of appetite
• No consult was done
• Patient took sambong capsules
TID for 10 doses- NO RELIEF
Patient is a S/P Dilatation and Curretage-
August 2018
UTI- approx. 2x per year (august 2018) Father- Hypertension
No Hypertension, DM, Heart Disease, Asthma
PTB, COPD, Cancer No known family history of Heart Diseases,uti
Asthma, Pulmonary Tuberculosis, Thyroids
No known allergies to food and drugs. disease, Stroke and Renal Diseases.
No other previous hospitalizations and
surgeries.
LMP: February 20, 2019 Born and raised in Isla Verde, Batangas
G3P2 (2012)
Works as a SPED Teacher
Menarche: 12 years old
Interval: monthly, regular Non-alcoholic beverage drinker
Duration: 4-5 days Non-smoker
Amount: 2 napkins/day Coffee intake of 3 to 4 cups per day
Symptoms: No dysmenorrhea Water intake of approximately 4 glasses per day
Patient had 2 sexual partners. One is previous husband, now separated. No food preference
Presently in monogamous relationship with live-in partner. No dyspareunia.
Daily perineal hygiene 2x a day, use of PH care,
Coitus approximately 1-2x per week.
Contraceptive: Oral Contraceptive pills wipes from front to back
(-) Weight change, Fatigue,
Easy fatigability, Chills, Loss of
Appetite
(-) hematemesis, no dysphagia,
no heartburn, no abdominal
pain, no change in bowel
(-) Rashes, pruritus, habits, no diarrhea, no
discoloration constipation, no melena, no
hematochezia
Vaginitis (STI)
RULE IN RULE OUT
(+) Terminal Dysuria (-) Foul smelling vaginal
discharge
(-) vulvar pruritus/ irritation
UTI
RULE IN RULE OUT
(+) Terminal Dysuria Cannot totally rule out
(+) low back pain, 5/10,
intermittent, non-radiating,
non-aggravated
(+) Bilateral CVA tenderness
Diagnostics
• Uncomplicated Cystitis:
use of a diaphragm with spermicide
frequent sexual intercourse
history of UTI
• Pyelonephritis
frequent sexual intercourse
new sexual partner
UTI in the previous 1 2 months
maternal history of UTI
Diabetes
incontinence
Etiology
HISTORY
• At least 1 symptom of UTI (dysuria, frequency, hematuria or back
pain) = 50 % probability
• plus absent vaginal discharge and complicating factors + risk factors
present= 90% probability
URINALYSIS
• Nitrite
• Leukocyte Esterase Test
• Pyuria
URINE CULTURE
• “gold standard”
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2015 Update
Asymptomatic Bacteriuria: SCREENING
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2015 Update
Asymptomatic Bacteriuria: SCREENING
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2015 Update
Asymptomatic Bacteriuria: SCREENING
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2013 Update
Asymptomatic Bacteriuria: TREATMENT
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2013 Update
Asymptomatic Bacteriuria: ALGORITHM
Recurrent UTI
Recurrent UTI: DEFINITION
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2013 Update
Recurrent UTI: PREVENTION
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2013 Update
Recurrent UTI: PREVENTION
Behavioral Measures
• Post-defecation and anal cleansing antero-posteriorly in women to
avoid contaminating the periurethral area with fecal flora
• Post-coital douche or post-coital urination
• Liberal fluid intake especially after intercourse
• Avoidance of tight-fitting underwear
• Use of alternative form of contraception for women using spermicide-
containing contraceptives
Recurrent UTI: PREVENTION
Cranberry Products
• Cranberry juice and cranberry products
• The recommended dose for UTI prevention is daily
consumption of 300 mL of cranberry juice cocktail or 500
mg capsules containing 36 mg PACs) taken twice a day.
Recurrent UTI: TREATMENT
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2013 Update
Acute Uncomplicated Cystitis: MANAGEMENT
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2013 Update
Acute Uncomplicated Cystitis: ALGORITHM
Acute Uncomplicated Pyeloneph
ritis
Acute Uncomplicated Pyelonephritis:
DEFINITION
• symptomatic infection of the kidneys
1. Mild pyelonephritis can present as low-grade fever with or
without lower-back or costovertebral-angle pain, whereas
2. Severe pyelonephritis can manifest as high fever, rigors, nausea,
vomiting, and flank and/or loin pain.
• Fever is the main feature distinguishing cystitis and pyelonephritis.
The fever of pyelonephritis typically exhibits a high spiking "picket-
fence" pattern and resolves over 72 h of therapy.
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2013 Update
Acute Uncomplicated Pyelonephritis:
MANAGEMENT
Philippine Clinical Practice Guidelines on the Diagnosis and Management of Urinary Tract Infections in Adults 2013 Update
Acute Uncomplicated Pyelonephritis:
MANAGEMENT
Acute Uncomplicated Pyelonephritis:
DEFINITION
Complicated Urinary
Tract Infection
cUTI: DEFINITION
• A urine sample for gram stain, and culture and sensitivity testing
must always be obtained before the initiation of any treatment.
• CT-scan is generally preferred over KUB ultrasound as it can better
identify and localize the presence of urinary tract abnormalities or
multiple lesions such as abscesses
cUTI: TREATMENT
• For mild to moderate illness (symptoms of fever and
lower or upper UTI without urosepsis, circulatory
failure and/or organ dysfunction/failure), oral
fluoroquinolones or amoxicillin/clavulanic acid
• For severely ill patients, broad-spectrum parenteral
antibiotics should be used, choice of which would
depend on the following:
a) The expected pathogens,
b) Results of the urine gram stain,
c) The current susceptibility patterns of
microorganisms in the area, and,
d) Risk factors for the acquisition of drug-resistant
organism
SUMMARY
REFERENCES