Urinary Tract Infection

Urinary Tract Iinfection Description

A urinary tract infection (UTI) is an infection of the urinary tract. An infection anywhere from the kidneys to the ureters to the bladder to the urethra qualifies as a urinary tract infection.

Infections of the urinary tract are the second most common type of infection in the body. Urinary tract infections (UTIs) account for about 8.3 million doctor visits each year.* Women are especially prone to UTIs for reasons that are not yet well understood. One woman in five develops a UTI during her lifetime. UTIs in men are not as common as in women but can be very serious when they do occur.

Urinary Tract Infection Symptoms & Signs

Urethritis: discomfort or pain at the urethral meatus or a burning sensation throughout the urethra with micturition (dysuria).

Cystitis: pain in the midline suprapubic region and/or frequent urination

Hematuria (bloody urine)

cloudy and foul-smelling urine

High temperature lasting for more than 3 days should be a trigger to get the urine culture done to ascertain whether the fever is due to UTI or not. UTI is very harmful especially in infants since it can cause permanent renal damage.

Nausea and vomiting, accompanied by high fever may indicate a more complicated UTI in which the kidney is infected

Some urinary tract infections are asymptomatic.

Increased confusion and associated falls are common presentations to Emergency Departments for elderly patients with UTI.

Diagnosis

Not everybody with a UTI has symptoms, but many people have at least some symptoms. These may include a frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination

A patient with dysuria (painful voiding) and urinary frequency generally has a spot mid-stream urine sample sent for urinalysis, specifically the presence of nitrites, leukocytes or leukocyte esterase. If there is a high bacterial load without the presence of leukocytes, it is most likely due to contamination. Pyelonephritis is ruled out by checking for costovertebral angle tenderness (CVAT). The diagnosis of UTI is confirmed by a urine culture.

If the urine culture is negative:

symptoms of urethritis may point at Chlamydia trachomatis or Neisseria gonorrheae infection.

symptoms of cystitis, may point at interstitial cystitis.

in men, prostatitis may present with dysuria.

In severe infection, characterised by fever, rigors or flank pain, urea and creatinine measurements may be performed to assess whether renal function has been affected.

Causative agents

Common organisms that cause UTIs include: Escherichia coli and Staphylococcus saprophyticus. Less common organisms include Proteus mirabilis, Klebsiella pneumoniae, and Enterococcus spp.

A mnemonic that can be used to remember the bacteria that cause UTIs is SEEK PP (Staph saprophyticus, E. coli, Enterococcus, Klebsiella, Proteus, Pseudomonas).

Prevention

In the future, scientists may develop a vaccine that can prevent UTIs from coming back. Researchers in different studies have found that children and women

The following are a list of things that can be done to avoid a urinary tract infection. As many people, especially women, experience recurrent infections some commonly recommended preventative measures are:

Having adequate fluid intake, especially water.

Not resisting the urge to urinate.

Taking showers, not baths, or urinating soon after taking a bath.

Practising good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by faecal pathogens.

Cleaning the urethral meatus (the opening of the urethra) after intercourse has been shown to be of some benefit; however, whether this is done with an antiseptic or a placebo ointment (an ointment containing no active ingredient) does not appear to matter.^[1]

Cleaning genital areas prior to and after sexual intercourse.

For sexually active women, and to a lesser extent men, urinating within 15 minutes of sexual intercourse to allow the flow of urine to expel the bacteria before specialized extensions anchor the bacteria to the walls of the urethra.

It has been advocated that cranberry juice can decrease the incidence of UTI. A specific type of tannin found only in cranberries and blueberries prevents the adherence of certain pathogens (eg. E. coli) to the epithelium of the urinary bladder (studies referenced in External Links section)

Treatment

Most uncomplicated UTIs can be treated with oral antibiotics such as trimethoprim, cephalosporins, Macrodantin, or a fluoroquinolone (e.g. ciprofloxacin, levofloxacin). (Whilst co-trimoxazole was previously used (and continues to be used in the U.S.), the additional benefits of the sulphonamide gave little additional benefit compared to the trimethoprim component alone, but was responsible for its both high incidence of mild allergic reactions and rare but serious complications).

If the patient has symptoms consistent with pyelonephritis, intravenous antibiotics may be indicated.

The choice of drug and length of treatment depend on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine, uncomplicated UTIs are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin (Omnipen, Polycillin, Principen, Totacillin). A class of drugs called quinolones includes four drugs approved in recent years for treating UTI.

Recurrent UTIs

Patients with recurrent UTIs may need further investigation. This may include ultrasound scans of the kidneys and bladder or intravenous urography (X-rays of the urological system following intravenous injection of iodinated contrast material).

Often long courses of low dose antibiotics are taken at night to help prevent otherwise unexplained cases of recurring cystitis.

Acupuncture has been shown to be effective in both treating urinary tract infections, (sometimes along with chinese herbs with antibiotic compounds) as well as preventing new infections in chronic cases^{[2] [3] [4]} . A study published in October 2002 in the American Journal of Public Health showed that urinary tract infection occurrence was reduced by 50% for 6 months^[5] . Acupuncture appears to reduce the total amount of residual urine in the bladder.

If there is no response to treatments, Interstitial cystitis may be a possibility.