Urinary Tract Infection

Aug 26 , 2022 | 3 min read

UTI is the presence of microorganisms in the urinary tract, and 150 million people per year get infected with UTI. 20% of women (20-65 yrs.) get at least one attack/year, and approx. 50% of women develop UTIs during their lives. 5% of general practitioner visits are for UTIs.

Bactriology

Bactriology Urinary tract is normally sterile as bacteria moving upwards are regularly washed out by urination. Normal flora found in the urethra consists of Lactobacillus and Staphylococcus, to name a few. UTIs occur mainly due to gram-negative aerobic organisms originating from the gut flora. UTI-causing E. coli adheres to the urinary tract epithelium to prevent being washed out with the help of the fimbriae or pili. Other bacteria which cause UTIs are Klebsiella, Pseudomonas, and Proteus.

UTI

UTI can be in the lower tract, e.g., Vaginitis /Urethritis /Cystitis /Prostatitis or upper tract, i.e., Pyelonephritis – Acute and Chronic or Intrarenal and perinephric abscess (pus collection)

Urethritis

Urethritis symptoms could be increased Frequency of urination, painful urination, and burning, cloudiness in urine, or Blood in urine

Cystitis

Cystitis bladder inflammation is caused by bacterial infection mainly E. coli. Frequency, dysuria, urgency, lower abdominal pain, and Cloudy, malodorous urine can be the symptoms. Females are prone to getting an infection because of the shorter urethra and proximity to the anus & vagina where E. coli is found.

Prostatitis

Prostatitis is an acute bacterial infection of prostate glands in males and causes severe pain in the seating area with poor urinary flow, burning, Frequency and fever with chills and sometimes can cause retention of urine. If inadequately treated or repeated attacks of prostatitis can lead to chronic prostatitis.

Acute Pyelonephritis

Acute pyelonephritis is an Acute infection of the kidneys caused by progressively untreated cystitis or infection spread through the bloodstream. High-grade fever with Chills, nausea, vomiting, high pulse rate, low BP etc., can be presenting symptoms. Deep abdominal tenderness and sick feelings are frequent. This can complicate sepsis, papillary necrosis, ureteral obstruction, abscess, and decreased renal function.

Chronic Pyelonephritis

Chronic pyelonephritis is caused by chronic inflammation of kidney tissue with scarring and shrinkage secondary to fibrosis or scarring.

Predisposing Conditions to UTI

Females

Short and wide urethra, proximity to vagina and anus, termination beneath labial folds, sexual activity, Pregnancy (2-3% have UTI), Postmenopausal women with lack of oestrogen, uterine or bladder prolapse (incomplete emptying), decreased normal flora, Diabetes.

Children

UTIs often signal an underlying genitourinary tract abnormality and can lead to renal scarring with resultant hypertension and end-stage renal failure. Incidence in girls is higher than in boys 7% of children <2 years who present with fever without a source can have UTI. Various risk factors are age < 1 year, Female gender, uncircumcised male, constipation, Voiding dysfunction, Improper wiping, birth defects, and colonization with bacteria.

Males

Males usually have fewer UTIs, but prostatic enlargement, narrowing in the urethra, stones, catheterization, unprotected sex, bladder defects etc., are common causes of UTIs.

Symptoms in UTI

Burning while passing urine
High Frequency and urgency to pass urine
Males can have discharge from the urethra penis
Lower abdominal pain or back pain
Fever with or without shivering
Sometimes red colour urine

Diagnosis of Urinary Tract Infection (UTI)

Uncomplicated UTI where there is no structural or functional defect in the urinary system is diagnosed with Urine R/M and Culture and Ultrasound, while complicated UTI may require further imaging, i.e. IVP/CT scan / DTPA scan / RGU MCU

How is Urinary Tract Infection Treated?

UTI is treated with antibiotics.
Usually, with treatment, symptoms of UTI settle in a day or so, but patient needs to complete the course of antibiotic
Treatment of predisposing factors requires prolonged antibiotic therapy or surgical treatment depending upon the cause