Urinary tract infection
Name = Urinary tract infection
ICD10 = ICD10|N|39|0|n|30
ICD9 = ICD9|599.0
Caption = Multiple rod-shaped bacteria shown between
white cells at urinary microscopy from a patient with urinary tract infection.
MedlinePlus = 000521
eMedicineSubj = emerg
eMedicineTopic = 625
eMedicine_mult = eMedicine2|emerg|626
DiseasesDB = 13657
MeshID = D014552
A urinary tract infection (UTI) is a bacterial
infectionthat affects any part of the urinary tract. Although urinecontains a variety of fluids, salts, and waste products, it usually does not have bacteria in it. [cite web |url=http://www.med.umich.edu/1libr/aha/aha_asybac_crs.htm |title=Adult Health Advisor 2005.4: Bacteria in Urine, No Symptoms (Asymptomatic Bacteriuria) |accessdate=2007-08-25 |format= |work=] When bacteria get into the bladder or kidneyand multiply in the urine, they cause a UTI. The most common type of UTI is a bladder infection which is also often called cystitis. Another kind of UTI is a kidney infection, known as pyelonephritis, and is much more serious. Although they cause discomfort, urinary tract infections can usually be quickly and easily treated with a short course of antibiotics. [cite web |url=http://www.braithwaite.yourmd.com/ypol/user/userMain.asp?siteid=1713982&content=userCustomPage&bcx=My%20Doctor^TAB~Web%20Site^MNU~Dr%20S.%20Braithwaite^PST^1713982~UTI^CAT^9&pageid=336989&rndm=0.2728092846502904 |title=Urinary Tract Infections |accessdate=2007-08-25 |format= |work=] Studies have shown that breastfeeding can reduce the risk of UTI's in infants. [cite journal |last=Hanson |first=LÅ |year=2004 |title=Protective effects of breastfeeding against urinary tract infection |journal=Acta Pædiatr |issue=93 |pages=154–156 |issn=0803-5253 |url=http://www.cirp.org/library/disease/UTI/hanson1/ |accessdate=2008-08-10]
For bladder infections
Frequent urinationalong with the feeling of having to urinateeven though there may be very little urine to pass.
Nocturia: Need to urinate during the night.
Urethritis: Discomfort or pain at the urethral meatus or a burning sensation throughout the urethra with urination( dysuria).
Painin the midline suprapubic region.
Pyuria: Pus in the urine or discharge from the urethra.
Hematuria: Blood in urine.
Pyrexia: Mild fever
* Cloudy and foul-smelling urine
* Increased confusion and associated falls are common presentations to Emergency Departments for elderly patients with UTI.
* Some urinary tract infections are
Proteinfound in the urine.
For kidney infections
* All of the above symptoms.
Emesis: Vomiting is common. [ [http://www.askdrsears.com/html/8/T080800.asp askdrsears.com] ]
* Back, side (flank) or groin pain.
* Abdominal pain or pressure.
* Shaking chills and high spiking fever.
* Extreme fatigue.
UTIs are most common in sexually active women and increase in people living with diabetes and people with
sickle-cell diseaseor anatomical malformations of the urinary tract.
Since bacteria can enter the urinary tract through the
urethra(an ascending infection), poor toilet habits can predispose to infection, but other factors ( pregnancyin women, prostateenlargement in men) are also important and in many cases the initiating event is unclear.
While ascending infections are generally the rule for lower urinary tract infections and
cystitis, the same may not necessarily be true for upper urinary tract infections like pyelonephritiswhich may be hematogenous in origin.
Allergies can be a hidden factor in urinary tract infections. For example, allergies to foods can irritate the bladder wall and increase susceptibility to urinary tract infections. Keep track of your diet and have allergy testing done to help eliminate foods that may be a problem. Urinary tract infections after sexual intercourse can be also be due to an allergy to latex condoms, spermicides, or oral contraceptives. In this case review alternative methods of birth control with your doctor.
urinary catheters in women and men who are elderly, over placement of a temporary Prostatic stentcan be a major cause of UTI's. Also, people experiencing nervous system disorders, people who are convalescing or unconscious for long periods of time, will have an increased risk of urinary tract infection for a number of reasons. Scrupulous aseptic techniques may decrease these associated risks.
The bladder wall is coated with various mannosylated proteins, such as Tamm-Horsfall proteins (THP), which interfere with the binding of bacteria to the uroepithelium. As binding is an important factor in establishing pathogenicity for these organisms, its disruption results in reduced capacity for invasion of the tissues.Clarifyme|date=March 2008 Moreover, the unbound bacteria are more easily removed when voiding. The use of urinary catheters (or other physical trauma) may physically disturb this protective lining, thereby allowing bacteria to invade the exposed epithelium.
Elderly individuals, both men and women, are more likely to harbor bacteria in their
genitourinary systemat any time. These bacteria may be associated with symptoms and thus require treatment with an antibiotic. The presence of bacteria in the urinary tract of older adults, without symptoms or associated consequences, is also a well recognized phenomenon which may not require antibiotics. This is usually referred to as asymptomatic bacteriuria. The overuse of antibiotics in the context of bacteriuria among the elderly is a concerning and controversial issue.
Women are more prone to UTIs than males because in females, the
urethrais much shorter and closer to the anusthan in males, [Urethra length is approximately 25–50 mm / 1-2 inches long in females, versus about 20 cm / 8 inches in males.] and they lack the bacteriostatic properties of prostatic secretions. Among the elderly, UTI frequency is in roughly equal proportions in women and men.
A common cause of UTI is an increase in sexual activity, such as vigorous sexual intercourse with a new partner. The term "honeymoon cystitis" has been applied to this phenomenon. [cite web |url=http://healthlink.mcw.edu/article/998784819.html |title=Honeymoon Cystitis |accessdate=2007-11-02 |format= |work=]
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. 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
* in men,
prostatitismay present with dysuria.
In severe infection, characterized by
fever, rigors or flank pain, ureaand creatininemeasurements may be performed to assess whether renal functionhas been affected.
Most cases of lower urinary tract infections in females are benign and do not need exhaustive laboratory work-ups. However, UTI in young infants must receive some imaging study, typically a retrograde urethrogram, to ascertain the presence/absence of congenital urinary tract anomalies. Males too must be investigated further. Specific methods of investigation include
x-ray, Nuclear Medicine, MRI and CAT scan technology.
Most uncomplicated UTIs can be treated with oral
antibiotics such as trimethoprim, cephalosporins, nitrofurantoin, or a fluoroquinolone("e.g.", ciprofloxacinor levofloxacin). Trimethoprim is probably the most widely used antibiotic for UTIs and is usually taken for 7 days. It is often recommended that trimethoprim be taken at night to ensure maximal urinary concentrations and increase its effectiveness. Whilst co-trimoxazolewas previously internationally used (and continues to be used in the U.S.), the additional of the sulfonamidegave little additional benefit compared to the trimethoprim component alone, but was responsible for its high incidence of mild allergic reactions and rare but serious complications.
If the patient has symptoms consistent with
pyelonephritis, intravenousantibiotics may be indicated. Regimens vary, usually Aminoglycosides(such as Gentamicin) are used in combination with a beta-lactam, such as Ampicillin or Ceftriaxone. These are continued for 48 hours after fever subsides. The patient may then be discharged home on oral antibiotics for a further 5 days.
If the patient makes a poor response to IV antibiotics (marked by persistent fever, worsening renal function), then imaging is indicated to rule out formation of an
abscesseither within or around the kidney, or the presence of an obstructing lesion such as a stone or tumor.
As an at-home treatment, increased water-intake, frequent voiding, the avoidance of sugars and sugary foods, drinking unsweetened
cranberryjuice, taking cranberrysupplements, as well as taking vitamin C with the last meal of the day can shorten the time duration of the infectionFact|date=July 2008. Sugars and alcohol can feed the bacteria causing the infection, and worsen pain and other symptoms. Vitamin C at night raises the acidity of the urine Fact|date=September 2008}, which retards the growth of bacteria in the urinary tract. However, if pain is in the back region (suggesting kidney infection) or if pain persists, if there is fever, or if blood is present in the urine, doctor care is recommended.
complementary and alternative medicine, D-mannosepills are advocated as a herbal remedyfor urinary tract infections. [http://www.peacehealth.org/kbase/cam/hn-1283006.htm Urinary Tract Infection] - Alternative medicine. Accessed October 4, 2008.] Theoretically, if D-mannose would be present in sufficient concentration in the urine, it could interfere with the adherence of the bacterium E. colito the epithelial cells lining the urinary tract (similar to the mechanism underlying the effect of cranberry juice).cite journal |author=Sharon N, Eshdat Y, Silverblatt FJ, Ofek I |title=Bacterial adherence to cell surface sugars |journal=Ciba Foundation symposium |volume=80 |issue= |pages=119–41 |year=1981 |pmid=6114817 |doi= |url=] cite journal |author=Toyota S, Fukushi Y, Katoh S, Orikasa S, Suzuki Y |title= [Anti-bacterial defense mechanism of the urinary bladder. Role of mannose in urine] |language=Japanese |journal=Nippon Hinyōkika Gakkai zasshi. The japanese journal of urology |volume=80 |issue=12 |pages=1816–23 |year=1989 |month=December |pmid=2576290 |doi= |url=] One study showed that it could significantly influence bacteriuriain rats,cite journal |author=Michaels EK, Chmiel JS, Plotkin BJ, Schaeffer AJ |title=Effect of D-mannose and D-glucose on Escherichia coli bacteriuria in rats |journal=Urological research |volume=11 |issue=2 |pages=97–102 |year=1983 |pmid=6346629 |doi= |url=] but there are no studies showing any effect in humans.
:See also Prevention (below)
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). If there is no response to treatments, interstitial cystitismay be a possibility.
During cystitis, uropathogenic "
Escherichia coli" (UPEC) subvert innate defenses by invading superficial umbrella cells and rapidly increasing in numbers to form intracellular bacterial communities (IBCs). [cite journal |author=Justice S, Hunstad D, Seed P, Hultgren S |title=Filamentation by Escherichia coli subverts innate defenses during urinary tract infection |journal=Proc Natl Acad Sci U S A |volume=103 |issue=52 |pages=19884–9 |year=2006 |pmid=17172451 | doi = 10.1073/pnas.0606329104 ]
The following are measures that studies suggest may reduce the incidence of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:
* 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 antisepticor a placeboointment (an ointment containing no active ingredient) does not appear to matter.cite journal | author = Meyhoff H, Nordling J, Gammelgaard P, Vejlsgaard R | title = Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis? | journal = Scand J Urol Nephrol | volume = 15 | issue = 2 | pages = 81–3 | year = 1981 | pmid = 7036332]
* It has been advocated that
cranberryjuice can decrease the incidence of UTI (some of these opinions are referenced in External Links section). A specific type of tanninfound only in cranberries and blueberriesprevents the adherenceof certain pathogens(eg. E. coli) to the epitheliumof the urinary bladder. A review by the Cochrane Collaborationof randomized controlled trials states "some evidence from trials to show cranberries (juice and capsules) can prevent recurrent infections in women. Many people in the trials stopped drinking the juice, suggesting it may not be a popular intervention".cite journal | author = RG Jepson, JC Craig | title = [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001321/frame.html Cranberries for preventing urinary tract infections] . | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001321 | year = 2008 | pmid = 14973968]
* For post-menopausal women, a
randomized controlled trialhas shown that intravaginal application of topical estrogen cream can prevent recurrent cystitis.cite journal | author = Raz R, Stamm W | title = A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. | journal = N Engl J Med | volume = 329 | issue = 11 | pages = 753–6 | year = 1993 | pmid = 8350884 | doi = 10.1056/NEJM199309093291102 ] In this study, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months.
*Often long courses of low dose antibiotics are taken at night to help prevent otherwise unexplained cases of recurring cystitis.
Acupuncturehas been shown to be effective in preventing new infections in recurrent cases.cite journal | author=Aune A, Alraek T, Huo L, Baerheim A | title= [Can acupuncture prevent cystitis in women?] | journal=Tidsskr Nor Laegeforen | year=1998 | pages=1370–2 | volume=118 | issue=9 | pmid=9599500 "(cf acupuncture group, x2 incidents in the sham group, x3 in the control group)"] cite journal | author=Alraek T, Baerheim A | title='An empty and happy feeling in the bladder.. .': health changes experienced by women after acupuncture for recurrent cystitis | journal=Complement Ther Med | year=2001 | pages=219–23 | volume=9 | issue=4 | pmid=12184349 | doi = 10.1054/ctim.2001.0482 ] cite journal | author=Alraek T, Baerheim A | title=The effect of prophylactic acupuncture treatment in women with recurrent cystitis: kidney patients fare better | journal=J Altern Complement Med | year=2003 | pages=651–8 | volume=9 | issue=5 | pmid=14629843 | doi = 10.1089/107555303322524508 "(highlights need for considering different TCM diagnostic categories in acupuncture research)"] One study showed that urinary tract infection occurrence was reduced by 50% for 6 months.cite journal | author = Alraek T, Soedal L, Fagerheim S, Digranes A, Baerheim A | title = Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. | journal = Am J Public Health | volume = 92 | issue = 10 | pages = 1609–11 | year = 2002 | pmid = 12356607] However, this study has been criticized for several reasons.cite journal | author=Katz AR | title=Urinary tract infections and acupuncture | journal=Am J Public Health | year=2003 | pages=702; author reply 702–3 | volume=93 | issue=5 | pmid=12721123] Acupuncture appears to reduce the total amount of residual urine in the bladder Fact|date=February 2007. All of the studies are done by one research team without independent reproduction of results.
NIHarticles on Urinary Tract Infections in [http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/ Adults] and in [http://kidney.niddk.nih.gov/kudiseases/pubs/utichildren/ Children] .
Wikimedia Foundation. 2010.
Look at other dictionaries:
urinary tract infection — infection of any part of the urinary tract, esp. the urethra or bladder, usually caused by a bacterium, Escherichia coli, and often precipitated by increased sexual activity, vaginitis, enlargement of the prostate, or stress. Abbr.: UTI * * * … Universalium
urinary tract infection — noun any infection of any of the organs of the urinary tract • Hypernyms: ↑inflammatory disease • Hyponyms: ↑cystitis, ↑pyelonephritis, ↑urethritis * * * infection of any part of the urinary tract, esp. the urethra or bladder, usually caused by a … Useful english dictionary
urinary tract infection — inflammation which causes a burning sensation during urination, UTI … English contemporary dictionary
Urinary tract infection (UTI) — Infection of the kidney, ureter, bladder, or urethra. Not everyone with a UTI has symptoms. Common symptoms include a frequent urge to urinate and a painful, burning when urinating. More females than males have UTIs. Underlying conditions that… … Medical dictionary
Pregnancy danger from urinary tract infection (UTI) — A pregnant woman who develops a UTI should be treated promptly to avoid premature delivery of her baby and other risks such as high blood pressure. Some antibiotics are not safe to take during pregnancy. In selecting the best treatment, doctors… … Medical dictionary
Infection, urinary tract (UTI) — An infection in the urinary system that begins when microorganisms cling to the opening of the urethra (the canal from the bladder) and begin to multiply. Most UTIs are due to one type of bacteria, E. (Escherichia) coli, a normal denizen of the… … Medical dictionary
urinary tract obstruction — ▪ pathology blockage or constriction at any point in the urinary tract that impedes the normal flow of urine and causes urine to be retained in the bladder or kidneys. When an obstruction causes urine to become backed up into the kidneys,… … Universalium
urinary tract — noun Urinary tract is used before these nouns: ↑infection … Collocations dictionary
Lower urinary tract symptoms — (LUTS) are a common problem affecting approximately 40% of older men [RoehrbornCG and McConnell JD: Etiology, pathophusiology, epidemiology, and natural history of benign prostatic hyperplasia. Campell s Urology. WB Saunders Co 2002; chapt 38,… … Wikipedia
Feline lower urinary tract disease — (FLUTD) is a term that is used to cover many problems of the feline urinary tract, including stones and cystitis. The term feline urologic syndrome (FUS) is an older term which is still sometimes used for this condition. The condition can lead to … Wikipedia