Urinary Tract Infection: Symptoms, Diagnosis, Prevention, and Treatment

Last updated date: 17-Jul-2022

General HealthUrinary Tract InfectionUTI
CloudHospital

15 mins read

Overview

A urinary tract infection (UTI) affects 40% of women in the United States at some point in their lives, making it one of the most frequent illnesses among women. Bacterial infections of the bladder and surrounding tissues are classified as uncomplicated urinary tract infections, sometimes known as cystitis or lower urinary tract infections.

Uncomplicated urinary tract infections occur in female individuals who do not have any anatomical abnormalities or comorbidities, such as diabetes, advanced age, pregnancy, or immunocompromised state. In individuals with anatomical defects or comorbidities such as diabetes, advanced age, pregnancy, or immunocompromised condition, complicated urinary tract infections arise.

 

Urinary tract infections definition 

Urinary tract infections are common and are also called UTIs. UTIs describe microbial colonization and infection of the structures of the urinary tract. UTIs are categorized by infection site as pyelonephritis (kidney), cystitis It can also be classified as uncomplicated or complicated. UTI is the most common bacterial infection, affecting 150 million people each year worldwide. UTIs are most common in women. more than men

 

Epidemiology

Urinary tract infections are among the most common bacterial illnesses in women. They often occur between the ages of 16 and 35 years, with 10% of women contracting an infection each year and more than 40% to 60% contracting an illness at least once in their lifetimes. Recurrences are common, with almost half of those infected acquiring another infection within a year. Females are at least four times more likely than males to get urinary tract infections.

 

Pathophysiology

A simple UTI generally just affects the bladder. When germs infiltrate the bladder mucosal membrane, an inflammatory response known as cystitis occurs. The majority of organisms that cause a UTI are enteric coliforms, which live in the periurethral vaginal introitus. These germs enter the bladder through the urethra and produce UTI. Sexual activity increases the migration of germs into the bladder, which is a typical cause of a UTI. People who often void and clear their bladders are less likely to develop a UTI.

Urine is an excellent bacterial growth medium. A pH less than 5, the presence of organic acids, and high amounts of urea are all factors that make it unfavorable for bacterial development. It is also known that frequent urination and large urine volumes reduce the incidence of UTI.

Bacteria that cause UTIs contain adhesins on their surface that allow them to connect to the urothelial mucosal membrane. Furthermore, a small urethra makes it simpler for the uropathogen to enter the urinary system. Premenopausal women have high lactobacilli concentrations in the vagina and an acidic pH, which inhibits uropathogen colonization. Antibiotics, on the other hand, can negate this protective effect.

 

Pediatric UTI

The urinary tract is a common source of infection in children and infants and is the most common bacterial infection in children < 2 years of age in both community and hospital settings. Acute UTIs are relatively common in children. By age seven, 8 percent of girls and 2 percent of boys will have at least one episode.

Common uropathogens include Escherichia coli (accounting for 85% of pediatric UTIs), Klebsiella, proteus, enterobacter, citrobacter, staphylococcus saprophyticus, and enterococcus.

 

The clinical signs and symptoms of a UTI depend on the child's age.

A newborn with a UTI may have symptoms such as infectious jaundice, failure to thrive, vomiting, or fever.

In infants and young children, common signs and symptoms include fever, strong-smelling urine, hematuria (blood in the urine), abdominal or pelvic pain, and urinary incontinence.

School-age children may have symptoms similar to those of adults, including dysuria, frequency or urgency.

Boys are at increased risk of a UTI if they are less than six months old or if they are less than 12 months old and unchecked. Women are generally at increased risk of a UTI, especially if they are less than one year old.

 

Urinary tract infection (UTI) in females

Clinical signs and symptoms of a female UTI.

  • Dysuria, urinary frequency, and urgency.
  • Possible suprapubic pain and hematuria.
  • Urine may smell unpleasant and cloudy.

For more information see : Urinary-disorder-facts-viewpoints-from-expert-doctors

 

Risk factors for recurrent urinary tract infections (RUTI) in pre-sexually active postmenopausal women are:

  • Onset of symptoms shortly after intercourse
  • Use of sperm for contraception, new sexual partners, age of first UTI,
  • Maternal history of UTI and voiding disorders

 

Medical conditions such as pregnancy, diabetes mellitus (DM), and immunity increase a woman's risk of recurrent UTI (RUTI) by facilitating access to uropathogens overcoming normal host defense mechanisms.

 

Acute cystitis Bladder (bladder) and UTI in women:

Most urinary tract infections (UTI's) in women are uncomplicated acute cystitis caused by Escherichia coli (80%) (E. coli), 100 years old. To uncomplicated lower UTI in non-pregnant premenopausal women with unknown urinary tract abnormalities or co-morbidities.

Classic lower urinary tract symptoms include dysuria, urinary frequency, urgency, and sometimes hematuria. Physical examination is usually normal or positive for suprapubic tenderness.

 

Pyelonephritis (kidney) and UTI in women:

In such a complex UTI pyelonephritis (kidney). Symptoms of a lower UTI persist for more than a week with systemic symptoms of persistent fever, chills, nausea, and vomiting.

 

Urethritis (urethra) and UTI in women:

Urethritis is an inflammation of the urethra. Pain with urination is the main symptom of urethritis. Urethritis is usually caused by a bacterial infection.

 

Bacteria that commonly cause urethritis include:

  • Gonococcus, which is sexually transmitted and causes gonorrhea
  • Chlamydia trachomatis, which is sexually transmitted and causes chlamydia.
  • Bacteria in and around the stool
  • Herpes simplex viruses (HSV-1 and HSV-2) can cause urethritis. Trichomonas (sexually transmitted) are another common cause of urethritis.

 

Urinary tract infection (UTI) in men

Urinary tract infections are uncommon in men due to the long length of the male urethra, antibacterial properties of prostate fluid, and less frequent periurethral colonization in men. Dysuria is the most common chief complaint in men. with UTI

 

Risk factors for recurrent UTIs in men are:

  • Enlarged prostate
  • colovesical fistulas associated with colon cancer or inflammatory bowel disease
  • congenital abnormalities of the urinary tract
  • instrument for measuring the urinary tract (during endoscopy or gardening
  • Conditions that inhibit immune function, such as diabetes, human immunodeficiency virus infection.

For more information about HIV see : Freddie-mercury-a-long-fight-against-aids

 

Lower urinary tract infection (UTI) in men [urethritis, cystitis, and prostatitis]

Lower urinary tract infections are usually caused by intestinal bacteria that enter and contaminate the urinary tract from below, usually spreading from the skin to the urethra and then to the bladder.

Urethritis:

Symptoms of urethritis in men usually include urethral discharge, penis itching or tingling, and dysuria. The main pathogens associated with urethritis are chlamydia, trachomatis, and gonorrhea neisseria.

The symptoms and management of urethritis in men are markedly different from those in women. Although there is an infectious and non-infectious etymology. But most studies have focused on urethritis as a sexually transmitted infection (STDs). 

 

Cystitis:

The resulting infection can cause uncomfortable symptoms such as a sudden urge to urinate. It may also cause pain while urinating and abdominal pain. Cystitis is more common in men who practice anal intercourse and in those who are not circumcised.

 

Prostatitis:

Prostatitis is a common problem in men causing dysuria and urinary frequency in middle-aged and younger men more often than urinary tract infections do in the glands. Acute prostatitis patients often appear acutely ill with sudden onset of chills and fever, urinary frequency and urgency, perineal dysuria and low back pain.

 

Upper urinary tract infection in men (Pyelonephritis)

Upper tract infections usually occur because bacteria have traveled up the urinary tract from the bladder to the kidneys or because bacteria that have accumulated in the bloodstream have collected in the kidneys.

 

Urinary tract infections diagnose

A clean urine (UA) specimen is critical to the diagnosis. It is preferable to have a clean catch specimen in non-obese women. Most obese women are unable to provide a clean specimen, and the presence of epithelial cells in the UA indicates that the urine sample was exposed to the vaginal surface and did not exit the urethra directly. Obtain a clean sample with few epithelial cells. This may necessitate a rapid catheterization.

In uninfected women, in-and-out catheterization of the bladder causes UTI around 1% of the time. Men should begin the urine stream to clear the urethra before collecting a midstream sample. Urine should be delivered to the lab promptly or frozen since bacteria multiply fast at room temperature, creating an overestimation of the severity of the infection.

A UTI should not be diagnosed based just on a visual examination of the urine. Cloudy urine can be aseptic; the cloudiness may be caused by protein or calcium phosphate detritus in the sample, rather than an infection. Urine can be contaminated even though it is crystal clear. All urines are tested with a dipstick, which may be done at the patient's bedside. pH, nitrites, leukocyte esterase, and blood are all useful readings.

Remember that in patients with UTI symptoms, a negative dipstick does not rule out the possibility of a UTI, but positive results might imply and aid in the diagnosis. On microscopic urinalysis, look for the presence of bacteria and/or white blood cells (WBC) in the urine.

The pH of normal urine is somewhat acidic, with typical readings ranging from 6.0 to 7.5, while the normal range is 4.5 to 8.0. A urea-splitting organism, such as Proteus, Klebsiella, or Ureaplasma urealyticum, is often found in urine with a pH of 8.5 or 9.0. An alkaline urine pH may indicate struvite kidney stones, sometimes known as "infection stones."

The nitrite test is the most reliable dipstick test because bacteria must be present in the urine to convert nitrates to nitrites. This takes 6 hours, which is why urologists frequently request first-morning pee for testing, especially in men. This test has a sensitivity of better than 90%. In individuals with symptoms, this is direct proof of bacteria in the urine, which is a UTI by definition. Several bacteria do not convert nitrates to nitrites, yet they are commonly seen in complex UTIs including Enterococcus, Pseudomonas, and Acinetobacter.

The presence of WBCs in the urine is detected by leukocyte esterase (LE). The LE is likely released by the WBCs in reaction to germs in the urine. This is why the dipstick LE is just a secondary test for UTI, with a specificity of approximately 55%. Although LE is effective in detecting WBCs in urine, WBCs can also be found in the bladder for other causes, such as inflammatory illnesses.

Hematuria can be beneficial because bacterial infections of the bladder's transitional cell lining can induce bleeding. This distinguishes UTI from vaginitis and urethritis, both of which do not result in blood in the urine.

Many laboratories will immediately do a microscopic examination of the urine for microorganisms, WBCs, and RBCs if nitrites or leukocyte esterase are present. Because there should be no bacteria in uninfected pee under high field microscopy, any bacteria on Gram-stained urine is substantially linked with UTIs. In symptomatic individuals, an excellent urine sample with more than 5 to 10 WBC/HPF is atypical and strongly suggests a UTI.

Urine cultures are not normally required in simple UTIs, however they are advised owing to rising antibiotic resistance and to assist distinguish recurring from relapsing infections. Urine should be cultured in all men, as well as all patients with diabetes mellitus who are immunocompromised and pregnant women. The gold standard for infectious pee is larger than 10 colony forming units, according to traditional urine culture instruction .

According to recent research, a patient who arrives with symptoms and more than 10 CFU is infected. Except in the case of recurring UTI, urine cultures are rarely useful in the emergency room, although they can make following therapy easier if patients do not react to the first antibiotic given.

Urine collection is critical. Midstream voided specimens are fairly precise if the proper procedure is used. Contamination is indicated by the presence of lactobacilli and squamous cells, and a catheterized specimen may be required. Suprapubic aspiration may be required to obtain a urine specimen in young children and people with spinal cord injury.

 

Treatment of UTIs

Historically, the therapy lasted anywhere from 3 days to 6 weeks. With "mini-dose therapy," which consists of three days of treatment, there are good cure rates. E. coli resistance to conventional antimicrobials varies by region of the country, and if the resistance rate exceeds 50%, pick another treatment.

Trimethoprim/sulfamethoxazole for three days is an effective mini-dose treatment, however resistance is common in many places. It should not be utilized if local resistance is more than 20%. Mini-dose treatment is best served by first-generation cephalosporins. Nitrofurantoin is an effective treatment for uncomplicated UTI, however it is bacteriostatic rather than bacteriocidal and must be taken for 5 to 7 days.

Fluoroquinolones have significant resistance yet are popular among urologists because to their high tissue penetration levels, particularly in the prostate. As a result, fluoroquinolones are not recommended unless the illness is severe or involves the prostate. The FDA's recent warnings concerning fluoroquinolone adverse effects should be taken seriously.

The FDA has authorized fosfomycin as a single-dose treatment for uncomplicated E coli UTIs. Adjunctive phenazopyridine medication for a few days may assist give additional symptom alleviation.

Even without therapy, most UTIs will cure on their own in around 20% of women, especially if greater hydration is employed. A healthy girl has an extremely low chance of developing acute pyelonephritis. Asymptomatic bacteriuria is fairly frequent and does not require treatment, except in pregnant women, immunocompromised individuals, those who have had a transplant, or those who have just undergone a urological, surgical operation.

 

Treating UTIs in Children

A follow-up assessment to confirm an appropriate clinical response should be done 48 to 72 hours after initiation of antimicrobial therapy in all children with UTIs.

Culture results and susceptibility may indicate that antibiotic change is necessary. Constipation should be addressed in infants and children with UTIs to help prevent subsequent infections.

The effectiveness of cranberry juice in children is less certain, and the high drop-out rate in studies indicates that cranberry juice may not be acceptable for long-term prevention. A systematic review concluded that regular circumcision in boys did not reduce the risk of UTI enough to demonstrate the risk of surgical complications.

 

Prevention of UTIs

The easiest strategy to deal with UTIs is to avoid them completely. Staying clean and avoiding urethral discomfort is especially important if you have a history of urinary tract infections. Keep germs at bay with these preventative methods to reduce your risk and say goodbye to the unpleasant symptoms of UTIs:

  • Stay hydrated

Throughout the day, drink lots of water. This will increase your need to pee more frequently, clearing germs from your urinary system. Avoid dehydrating drinks such as tea, coffee, and other caffeinated beverages. When it comes to hydration, water is the greatest option. Make an effort to drink at least eight glasses of water every day.

  • Avoid holding your pee

Make sure you urinate whenever you feel the need to. Bacterial growth might be aided by holding your pee. Don't go to the restroom for longer than 4 hours. This is especially critical for pregnant women.

  • Wipe from front to back

A bacteria called E. coli, which is typically present in the rectum, is the most prevalent cause of UTIs. After using the restroom, always clean your genitals from front to back. This reduces the possibility of germs from the anus entering the urethra.

  • Urinate before and after sex

Because we know that sexual activity raises the chance of a UTI, particularly in women, it's critical to flush out any germs that may cause UTIs before and after sex. Pee promptly before and after intercourse to lessen your risk. If possible, carefully wash before and after to reduce the chance of germs spreading.

  • Avoid irritating feminine hygiene products

The vagina naturally contains around 50 good bacteria germs that help to maintain the pH level regulated. Scented feminine products can disturb beneficial bacteria, putting you at greater risk of hazardous bacteria development. Douches, scented pads or tampons, deodorant sprays, scented powders, bath oils, soaps, and any other potentially irritating goods should be avoided.

  • Talk to your OB-GYN about your birth control options

In certain situations, your birth control techniques may be to blame for your recurrent UTIs. This is due to the fact that some forms of birth control stimulate the growth of dangerous bacteria in the urinary system. Diaphragms, non-lubricated condoms, spermicides, and spermicide condoms have all been identified as potential sources of contamination. If you suspect that your birth control methods are causing recurrent UTIs, consult your doctor to discuss your choices.

  • Take a probiotic

Probiotics are live microorganisms sold over the counter that help to enhance beneficial gut flora. They have also been shown to encourage the formation of beneficial bacteria in the urinary system, hence preventing UTIs. Probiotic supplements are widely available at most drug and supermarket stores.

  • Avoid taking baths

Shower instead of bathing if at all feasible. Sitting in unclean tub water has been linked to an increased risk of UTI.

  • Increase your intake of cranberries

Cranberries are a well-known traditional treatment for urinary tract infections. This is because the berries contain proanthocyanidins, which are known to inhibit E.coli from sticking to urinary tract tissues. The finest alternatives are pure cranberry juice or fresh or frozen cranberries. Cranberry supplements are also available at most grocery shops. Increasing your cranberry consumption at the first indication of UTI symptoms can be very beneficial in stopping the infection before it worsens.

  • Talk to your doctor about chronic UTIs

Long-term therapy alternatives are required in some circumstances. Your doctor may prescribe a low-dose antibiotic once a day for six months or longer. After having sex, you may also need to take a single dosage of antibiotics.

 

Prognosis

Even when treated with antibiotics, most UTI symptoms might remain for several days. The quality of life is low among women who have recurrent UTIs. Such recurrences affect around 25% of women. The following factors imply a bleak future:

  • Poor overall health
  • Advanced age
  • Presence of renal calculi
  • Diabetes (especially if poorly controlled)
  • Sickle cell anemia
  • Presence of malignancy
  • Catheterization
  • Ongoing chemotherapy
  • Incontinence
  • Chronic diarrhea

While UTI mortality is modest, the morbidity is significant. Aside from the vexing symptoms, the expense of care is too high. Missing work and school are typical causes, and hospitalization is occasionally necessary due to severe symptoms.

 

Conclusion

Urinary tract infections (UTIs) are infections of the urinary tract, which include the bladder (cystitis), urethra (urethritis), and kidneys (kidney infection). Antibiotics can be used to treat UTIs, however, they are not always necessary.

UTI is best handled collaboratively, and most nurses, in addition to physicians, will encounter a patient with a UTI. The key to reducing recurrences is patient education. When a UTI is detected, the patient should be advised to consume more water. Sexually active women should try to urinate immediately after sexual encounters to help wash the germs out of the bladder.

Prophylactic antibiotic usage may assist some women with recurring UTIs. Several more non-medical therapies may be beneficial to certain ladies suffering with UTI. According to anecdotal evidence, cranberry juice and probiotics may help lower the severity and frequency of UTI in certain women. Patients with recurrent UTI should be referred to a urologist to rule for reflux and anatomical problems.

Clinicians and pharmacists should collaborate closely to ensure the optimum antibiotic options for therapy, with the pharmacist confirming proper coverage, dose, and duration. Patient and community safety are influenced by providing the optimal antibiotic prescription and drug adherence.

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