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Urinary tract infection

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}} A urinary tract infection (UTI) is an infectionof the urinary tract. An infection anywhere from the kidneysto the uretersto the bladderto the urethraqualifies as a urinary tract infection.

Inhaltsverzeichnis

  • 1 Symptoms & Signs
  • 2 Diagnosis
  • 3 Causative agents
  • 4 Prevention
  • 5 Epidemiology
  • 6 Treatment
  • 7 External links

Symptoms & Signs

  • Urethritis: discomfort or pain at the urethral meatusor 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

Diagnosis

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, leukocytesor leukocyte esterase. If there is a high bacterial load without the presence of leukocytes, it is most likely due to contamination. Pyelonephritisis 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, prostatitismay present with dysuria.

In severe infection, characterised by fever, rigorsor flank pain, ureaand creatininemeasurements may be performed to assess whether renal functionhas 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 mnemonicthat can be used to remember the bacteria that cause UTIs is SEEK PP (Staph saprophyticus, E. coli, Enterococcus, Klebsiella, Proteus, Pseudomonas).

Prevention

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.
  • Practicing good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by faecal pathogens.
  • 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 by some, that cranberry-juice would decrease the incidenceof UTI, by generating some metaboliteinhibiting the adherenceof certain pathogens(eg. E. coli) to the epitheliumof the urinary bladder.

Epidemiology

UTIs are most common in sexually active women, and increased in diabeticsand people with sickle-cell diseaseor anatomical malformations of the urinary tract.

The use of urinary cathetersin both men and women who are elderly, people experiencing nervous system disorders and people who are convalescing or unconscious for long periods of time may result in an increased risk of urinary tract infection for a variety of reasons. Scrupulous aseptic technique may decrease this risk.

Women are more prone to UTIs than males because in females, the urethrais much shorter and closer to the anusthan in males. The article on vulvovaginal healthhas some health tips for preventing UTIs.

A common cause of UTI is an increase in sexual activity, such as vigorous sexual intercourse with a new partner. The term "honeymoon cystitis", although somewhat demeaning, has been applied to this phenomenon[1].

Treatment

Most uncomplicated UTIs can be treated with oral antibioticssuch as trimethoprim, cephalosporins, Macrodantin, or a fluoroquinolone(e.g. ciprofloxacin, levofloxacin). (Whilst co-trimoxazolewas previously used (and continues to be used in the U.S.), the additional benefits of the sulphonamidegave 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, intravenousantibiotics may be indicated.

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

External links

  • NIHarticles on Urinary Tract Infections in Adultsand in Children.
  • eMedicineemerg/625
  • eMedicineemerg/626
  • MedlinePlus Overviewurinarytractinfections
  • GPnotebook-375783424de:Harnwegsinfekt

fr:Infection urinaire no:Urinveisinfeksjon sv:Urinvägsinfektion




This article is licensed under the GNU Free Documentation License.
It uses material from the http://en.wikipedia.org/wiki/Urinary+tract+infection Wikipedia article Urinary tract infection.

 
  All text is available under the terms of the GNU Free Documentation License