Urinary Tract Infection

Urinary tract infection (UTI) is common in women and uncommon in men,and of special importance in children.

Men over the age of 60 with prostatic hypertrophy often have repeated episodes of UTI.

UTI is associated with multiplication of organisms in the urinary tract and is defined by the presence of more than 100,000 organisms per ml in a midstream sample of urine.

UTI may be COMPLICATED OR UNCOMPLICATED

UNCOMPLICATED : It is characterised by anatomically and physiologically normal urinary tract,normal renal function and no associated disorder which impairs local defence mechanism.It rarely results in permanent renal damage.

COMPLICATED: It is characterised by

ORGANISMS CAUSING UTI

Klebsiella and enterococcus faecalis are common in hospital settings.

ASCENDING INFECTION OF THE URINARY TRACT:

1. Periurethral Colonization:Normally the periurethral area is colonized by the uropathogenic bacteria,but the quantity is not significant enough to cause any pathology. However, the periurethral colonization by the bacteria can be enhanced by the following factors ,which can then cause the infection.

2. Transurethral Passage: Bacteria are transferred along the urethra to the bladder.

This is facilitated by

3. Establishment and multiplication of bacteria within the bladder:Bladder urine is normally sterile due to the defence mechanism in the bladder .A low urine flow rate and poor emptying predispose to infection.

SYMPTOMS AND SIGNS

The common symptoms are

DIAGNOSIS:

Dipstick tests positive for both nitrite and leucocyte esterase are highly predictive of acute infection.

In complicated cases SPECIAL INVESTIGATIONS are carried

TREATMENT

Antibiotic treatment is given in almost all cases. Ideally results of urine culture should be available before starting specific therapy,but if the patient is in acute discomfort an MSU should be sent for culture and treatment should be started awaiting the result.Since infection is usually due to E.coli ,use of Trimethoprim or amoxycillin is rational .

A fluid intake of atleast 2 litres/ day should be advised to the patient as it ensures regular voiding.

Urine culture should be repeated on the seventh day after the end of the antibiotic course.

RECURRENT INFECTION:

Recurrent infection is due to relapse or reinfection

In RELAPSE ,there is usally a cause e.g stones or scarred kidneys.

In this case the cause has to be eradicated.

In REINFECTION the patient has a predisposition to periurethral colonization or poor bladder defence mechanism ,e.g women using diaphragm and spermicidal jelly and postmenopausal women with atrophic vaginitis.

PROPHYLACTIC MEASURES TO BE ADOPTED BY WOMEN WITH RECURRENT URINARY INFECTIONS: