A Comprehensive Guide To Urinary Tract Infection (UTI)

Urinary Tract Infection (UTI) is the inflammatory response of the lining of the urinary tract most commonly due to bacterial or fungal invasion. This may affect any part of the urinary passage, including the bladder (cystitis), urethra (urethritis) or kidneys (kidney infection/pyelonephritis).

Urinary Tract Infections (UTIs) are common cause of morbidity and they may affect people of all ages and both sexes. It constitutes at least 10% of the patients referred to a specialist or seen in general out-patients. Careful diagnosis and early treatment result in the resolution of infection in most cases.

Understanding The Pathogenesis Of Urinary Tract Infection (UTI)

It is important to understand the pathogenesis of UTIs as the causes of infection are different in males and females and at different ages. Similarly, it is important to identify those patients who need conservative treatment versus those who need antibiotics or hospitalisation. Patients with complicated infections are sometimes at significant risk and may remain a challenge to treatment. The understanding of the host (patient), as well as bacterial factors, has helped in better identification of patients at risk.

Uncomplicated Urinary Tract Infection (UTI)

Uncomplicated urinary tract infection usually occurs in a healthy patient with no significant co-morbidity and with a structurally and functionally normal urinary tract. The majority of these patients are adult women in childbearing years.

Complicated Urinary Tract Infection (UTI)

Complicated Urinary Tract Infections usually affect patients who are either compromised and/or have a structural or functional abnormality in the urinary tract that would increase the chance of acquiring infection and/or reduce the efficacy of therapy.

The prevalence of UTIs in the overall population is around 11%. It increases to nearly 20% in women above the age of 65. The most common route of infection is ascending route. The bacteria from the faecal reservoir/ perineum ascend through the urethra into the bladder.
The incidence increases manyfold in women suffering from vaginal discharges, constipation or diabetes. The most common organism is E.Coli.

Classification Of Urinary Tract Infection (UTI)

Isolated Infections

The first infection or UTI isolated from the previous infection by six months is called an isolated infection. It usually effect adult women during their reproductive years.

Relapsing Infection (Unresolved Bacteria)

The most common is that the infecting organisms are resistant to antibiotics selected for the treatment. The other causes are the development of resistance in previously susceptible organisms or the presence of second unsuspected bacteria. There may be rapid re-infection with a new resistant organism or the presence of underlying diseases like stones.

Recurrent Infection

It is the UTI which occurs after two weeks of successful and complete treatment of the first infection. It may be due to the same bacteria or the new bacterial species. More than 95% of all recurrent infections in females are reinfections of the urinary tract.

Clinical Features of Urinary Tract Infection (UTI)

Symptoms of a urinary tract infection (UTI) may include:

Pain or a burning sensation while passing urine (dysuria)
Needing to pass urine more often than usual during the night (nocturia)
Urine that looks cloudy, dark or has a strong smell
Needing to pass urine suddenly or more urgently than usual
Blood in the urine
Lower tummy pain or pain in the back, just under the ribs
A high temperature, or feeling hot and shivery.

In children UTIs may also have the following features:

Older, frail people or people with a urinary catheter:

In older, frail people who have problems with memory, learning and concentration (such as dementia), and people with a urinary catheter, symptoms of a UTI may also include:

Things You Can Do Yourself To Help Ease Symptoms of UTI

Once the diagnosis of UTI is suspected particularly in individuals who suffer from recurrent infections, they may do the following measures to help ease symptoms of a urinary tract infection (UTI) before the diagnosis is established and proper treatment started:

You may also take cranberry drinks and products every day to prevent UTIs from happening, which may help. However, there’s no evidence they help ease symptoms or treat a UTI if the infection has already started.

Diagnosis of Urinary Tract Infection (UTI)

Diagnosis of UTI is established usually based on:

Routine Urinalysis

It may show increased pus cells, red blood cells or bacteria in the urine.

Urine Culture

The specimen taken for urine culture should be midstream urine and it should be brought to the laboratory early. It establishes the type of organism causing UTI and hence determines the appropriate antibiotics required.

Ultrasound or CT Scan

In cases of complicated urinary tract infections, imaging in the form of ultrasound or ct scan is usually required to diagnose the underlying condition.

Prevention of Urinary Tract Infection (UTI)

An isolated episode of UTI is not usually problematic and it settles down fairly well with a single course of oral antibiotics. However, the recurrent infections where the usual sufferers are women can sometimes be a source of significant morbidity. Efforts must be made in such cases to prevent the infection.

Prevention in Children

In children, unless there is an underlying anatomical problem in the urinary tract, constipation is the leading source of UTIs. Drinking enough water, avoiding constipation by eating a healthy diet and reducing junk food usually helps.

In Adult women

Adult women who suffer from recurrent UTIs should:

⇒ Drink plenty of fluids. It flushes out the bacteria from the urinary tract before they can set in to cause infection.

⇒ After passing urine and particularly after bowel movement they should wipe from front to back. In this way, bacteria around the anus are less likely to cause ascending infection through the urethra.

⇒ They must also avoid constipation which helps in decreasing the bacteria in the perineal area.

⇒ They should wash carefully before sexual intercourse and pass urine afterwards. Passing urine may push out any bacteria that entered the bladder.

⇒ They must avoid bubble baths, deodorant sprays or any chemicals around the perineum/genital area.

⇒ Some of the methods adopted for birth control may contribute to recurrent UTIs so they must be re-considered.

In Elderly Patients

Elderly patients usually have an underlying disease that must be investigated by imaging and if required by cystoscopy and treated to avoid recurrent infections.

Treatment of Urinary Tract Infection (UTI)

Antibiotics usually are the first-line treatment for urinary tract infections. The type and duration of the drug treatment depend on the patient’s health condition and the type of bacteria found in the urine.

Simple Infection

Usually, a short course of oral antibiotics is prescribed for these infections. Duration depends upon the medical history and how quickly the symptoms resolve.

Sometimes, analgesics and other supportive treatments are given along with antibiotics to relieve the discomfort and pain.

Frequent Infections

If you have frequent UTIs, your doctor may make certain treatment recommendations, such as:

Low-dose antibiotics, initially for six weeks but sometimes longer
Self-diagnosis and treatment, if you stay in touch with your doctor
A single dose of antibiotic after sexual intercourse if your infections are related to sexual activity
Vaginal estrogen therapy if you're postmenopausal

Severe Infection

For a severe UTI, you may need treatment with intravenous antibiotics in a hospital.

Author:

Dr Irfan Ahmed

Consultant Urologist & Cancer Surgeon

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