Urinary Tract Infection (UTI)

An infection of one or more parts of the urinary tract. A UTI is sometimes referred to by the part of the tract affected:
Urethritis – urethra.
Cystitis – bladder.
Pyelonephritis – kidney.



Pathophysiology

Urine does not normally contain micro-organisms, but if it is obstructed from leaving the body, or retained in the bladder, it provides a good environment for bacteria to grow. Most UTIs are due to bacteria that are introduced into the opening of the urethra, especially bacteria from around the anus. They stick to the walls of the urethra, multiplying and moving up to the bladder. Most remain in the lower urinary tract, where they cause annoying symptoms, but are more easily treated. If untreated, infection may move up through the ureters and into the kidneys. A kidney infection is more serious, and may cause permanent damage. 80-90% of bacteria involved in a UTI are E-coli. Others include klebsiella, proteus, enterococcus, staphylococcus. Occasionally a UTI may be due to a yeast infection – candida albicans.

Risk factors:
Any age, especially very young infants and young children.
Women.
Anatomical problem – narrowing of urethra/ureters.
Urine retention (bladder doesn’t empty properly).
Vesicoureteral reflux (abnormal flow of urine from the bladder back to the ureters).
Kidney stones.
Bladder catheterisation.
Spinal cord injuries.
Diabetes.
Kidney disease.
Any condition suppressing the immune system, e.g. diabetes, HIV.
In men, an enlarged prostate.
Poor hygiene.
Frequent sexual intercourse, especially when entering the vagina from behind.
Women who use a diaphragm.

Diagnosis:
Suspicion of UTI is based on symptoms, history of medication, medical and surgical history, lifestyle, habits and Urinalysis (colour, clarity, concentration, smell, presence of nitrites and leucocytes, protein and blood).

Following suspicion of a UTI, a mid-stream urine sample is sent off for culture and specimen, to reveal which bacteria is causing the infection, and therefore the appropriate treatment. A pelvic examination may be required to rule out pelvic infection.

Differential diagnosis:
Vaginitis, urethritis, pylonephritis.

Signs and Symptoms:
Urinary urgency - Strong, persistent desire to urinate.
Dysuria – difficulty and pain in passing urine.
Frequency of urination.
Suprapubic pain.
Fever.
Cloudy, strong-smelling urine.
Lower back pain.
Burning sensation on micturition.
Confusion.
Nausea and vomiting.
Haematuria (blood in the urine).
Proteinuria.

Side-effects/complications
Pylonephritis (kidney infection)
Chronic/recurrent UTIs.
Kidney failure.
Sepsis.
Premature labour in pregnancy.
In men, prostate infection.
Permanent scarring of the urinary tract.
Rarely, death.

Management:
Medication – antibiotics (3-5 days) – trimethoprim, amoxicillin, nitrofurantonin.

checked as accurate - K (RM)

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