InstituteInstitute forfor Microbiology, Medical Faculty of Masaryk UniversityMicrobiology, Medical Faculty of Masaryk University and St. Anna Faculty Hospitaland St. Anna Faculty Hospital in Brnoin Brno Agents of urinary tractAgents of urinary tract infectionsinfections UUrinary tract infectionsrinary tract infections (UTIs)(UTIs) FrequencyFrequency of UTIs:of UTIs: 2nd most common2nd most common infectionsinfections In adults: the most commonIn adults: the most common infectionsinfections AfflictingAfflicting mainly femalesmainly females (shorter urethra)(shorter urethra) CystitisCystitis - the- the most commonmost common UTI:UTI: -- developsdevelops ascendentlyascendently caused bycaused by intestinalintestinal microfloramicroflora -- ssymptomymptoms:s: dysuriadysuria (difficult urination with sharp(difficult urination with sharp burning pain)burning pain) pollakisuriapollakisuria (urgent need to urinate(urgent need to urinate accompanied by urination ofaccompanied by urination of aa smallsmall amount of urine only)amount of urine only) PyelonephritisPyelonephritis -- more seriousmore serious - origin: ascendent or hematogenous- origin: ascendent or hematogenous - symptom- symptoms:s: fever, chills, flank pain, or costovertebralfever, chills, flank pain, or costovertebral tenderness,tenderness, urinary frequency, dysuria,urinary frequency, dysuria, hematuriahematuria ......urethritisurethritis – will be dealt with STD– will be dealt with STD EtiologyEtiology ofof UTIsUTIs DiffersDiffers inin:: • non-complicatednon-complicated UTIsUTIs • structuralstructural abnormalitiesabnormalities (prostatic hypertrophia,(prostatic hypertrophia, urinary stones, strictures, pregnancy,urinary stones, strictures, pregnancy, congenital defects, permanent catheters)congenital defects, permanent catheters) • functionalfunctional disordersdisorders (vesicoureteral reflux,(vesicoureteral reflux, neurological disorders, diabetes mellitus)neurological disorders, diabetes mellitus) Etiology of non-complicated UTIsEtiology of non-complicated UTIs 1.1. 80 %80 % Escherichia coliEscherichia coli 2. 10 % enterococci2. 10 % enterococci ((Enterococcus faecalisEnterococcus faecalis)) 3. 5 %3. 5 % Proteus mirabilisProteus mirabilis -- otherother enterobacteriaenterobacteria ((Klebsiella pneumoniae,Klebsiella pneumoniae, Kl. oxytoca, Ent. cloacae, C. freundiiKl. oxytoca, Ent. cloacae, C. freundii etc.)etc.) -- Streptococcus agalactiaeStreptococcus agalactiae -- coagulase neg.coagulase neg. staphylococcistaphylococci -- yeastsyeasts (mainly(mainly Candida albicansCandida albicans)) http://biology.clc.uc.edu Etiology of complicated UTIsEtiology of complicated UTIs 80 %80 % Escherichia coliEscherichia coli Klebsiella pneumoniaeKlebsiella pneumoniae Proteus mirabilisProteus mirabilis Pseudomonas aeruginosaPseudomonas aeruginosa enterococcienterococci other enterobacteriaother enterobacteria acinetobactersacinetobacters other G-neg. non-fermenting rodsother G-neg. non-fermenting rods candidaecandidae Lege artisLege artis taking a urine sampletaking a urine sample • after a thorough cleaningafter a thorough cleaning incl. externalincl. external oriforiffficium of urethra by soap and watericium of urethra by soap and water • middle stream of urinemiddle stream of urine • sterilesterile vesselvessel • sterilesterile tubetube & stopper& stopper promptlypromptly • process it within 2 hoursprocess it within 2 hours, or place into 4 °C for, or place into 4 °C for 18 hours at most18 hours at most http://www.naturalnews.com/cartoons/Expensive_Urine_600.jpg SemiSemi--quantitative examination – Iquantitative examination – I • the kind of microbethe kind of microbe in the urine samplein the urine sample • the amountthe amount of the microbeof the microbe BecauseBecause • high numbershigh numbers only stand for theonly stand for the UTIUTI • low numberslow numbers mean usuallymean usually contaminationcontamination acquired during urinationacquired during urination SemiSemi--quantitative examination – IIquantitative examination – II TheThe urine is inoculatedurine is inoculated on culture media byon culture media by aa calibrated loopcalibrated loop takingtaking 11 μlμl of urineof urine In this caseIn this case 1 colony means 101 colony means 1033 CFU/mlCFU/ml 10 colonies mean 1010 colonies mean 1044 CFU/mlCFU/ml 100 colonies mean 10100 colonies mean 1055 CFU/mlCFU/ml (CFU = colony(CFU = colony--forming unit = 1 cell)forming unit = 1 cell) Significant concentrations ofSignificant concentrations of bacteria in urinebacteria in urine Type ofType of specimen,specimen, symptomssymptoms Type of microbeType of microbe SignificantSignificant numbernumber (CFU/ml)(CFU/ml) Middle stream,Middle stream, symptomssymptoms presentpresent Primary urinePrimary urine pathogenpathogen 101033 Dubious urineDubious urine pathogenpathogen 101055 Middle stream,Middle stream, no symptomsno symptoms AnyAny 101055 SuprapubicSuprapubic punctionpunction AnyAny 101011 TherapyTherapy • TTrimethoprimrimethoprim • NitrofurantoinNitrofurantoin • CephalexinCephalexin • AmoxicillinAmoxicillin • in complicated UTIs ATB sensitivity assessmentin complicated UTIs ATB sensitivity assessment • ESBL strainsESBL strains Paulus Peeter Rubens (1577-1640): Goddess of health Hygiene (1615)Paulus Peeter Rubens (1577-1640): Goddess of health Hygiene (1615) DetailDetail Paulus Peeter Rubens (1577-1640): Goddess of health Hygiene (1615)Paulus Peeter Rubens (1577-1640): Goddess of health Hygiene (1615)