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| {{SK}} UTI | | {{SK}} UTI |
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| ==Overview== | | ==[[Urinary tract infection overview|Overview]]== |
| A urinary tract infection is a bacterial [[infection]] that affects any part of the [[urinary tract]].
| | ==[[Urinary tract infection pathophysiology |Pathophysiology]]== |
| | | ==[[Urinary tract infection causes|Causes]]== |
| ==Pathophysiology==
| | ==[[Urinary tract infection differential diagnosis|Differentiating Urinary tract infection from other Diseases]]== |
| Although urine contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it.<ref>{{cite web |url=http://www.med.umich.edu/1libr/aha/aha_asybac_crs.htm |title=Adult Health Advisor 2005.4: Bacteria in Urine, No Symptoms (Asymptomatic Bacteriuria) |accessdate=2007-08-25 |format= |work=}}</ref> When bacteria get into the bladder or kidney and multiply in the urine, they cause a UTI.
| | ==[[Urinary tract infection epidemiology and demographics|Epidemiology and Demographics]]== |
| ===Cystitis=== | | ==[[Urinary tract infection risk factors|Risk Factors]]== |
| The most common type of UTI is a bladder infection which is also often called [[cystitis]].
| | ==[[Urinary tract infection natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
| ===Pyelonephritis=== | |
| Another kind of UTI is a kidney infection, known as [[pyelonephritis]], and is much more serious.
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| ==Causes== | |
| Common organisms that cause UTIs include: ''[[Escherichia coli]]'' and ''[[Staphylococcus saprophyticus]]''. Less common organisms include ''[[Proteus mirabilis]]'', ''[[Klebsiella pneumoniae]]'', ''[[Enterobacter]] spp.'', ''[[Pseudomonas]]'' and ''[[Enterococcus]]'' spp.
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| A [[mnemonic]] that can be used to remember the bacteria that cause UTIs is '''SEEK PP''' (''Staph saprophyticus'', ''E. coli'', ''Enterococcus'', ''Klebsiella'', ''Proteus'', ''[[Pseudomonas]]'').
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| ==Epidemiology and Demographics== | |
| UTIs are most common in sexually active women, and increase in [[diabetes mellitus|diabetics]] and people with [[sickle-cell disease]] or anatomical malformations of the urinary tract.
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| Allergies can be a hidden factor in urinary tract infections. For example, allergies to foods can irritate the bladder wall and increase susceptibility to urinary tract infections. Keep track of your diet and have allergy testing done to help eliminate foods that may be a problem. Urinary tract infections after sexual intercourse can be also be due to an allergy to latex condoms, spermicides, or oral contraceptives. In this case review alternative methods of birth control with your doctor.
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| The use of urinary catheters in 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.
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| The bladder wall is coated with various mannosylated proteins, such as Tamm-Horsfall proteins (THP), which interfere with the binding of bacteria to the uroepithelium. As binding is an important factor in establishing pathogenicity for these organisms, its disruption results in reduced capacity for invasion of the tissues. Moreover, the unbound bacteria are more easily removed when voiding. The use of urinary catheters (or other physical trauma) may physically disturb this protective lining, thereby allowing bacteria to invade the exposed epithelium.
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| Elderly individuals, both men and women, are more likely to harbor bacteria in their genitourinary system at any time. These bacteria may be associated with symptoms and thus require treatment with an antibiotic. The presence of bacteria in the urinary tract of older adults, without symptoms or associated consequences, is also a well recognized phenomenon which may not require antibiotics. This is usually referred to as asymptomatic bacteriuria. The overuse of antibiotics in the context of bacteriuria among the elderly is a concerning and controversial issue.
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| Women are more prone to UTIs than males because in females, the [[urethra]] is much shorter and closer to the [[anus]] than in males, and they lack the bacteriostatic properties of prostatic secretions. The article on [[vulvovaginal health]] has some health tips for preventing UTIs.
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| 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[http://healthlink.mcw.edu/article/998784819.html].
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| ==Natural History, Complications, Prognosis==
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| Although they cause discomfort, urinary tract infections are usually quickly and easily treated by seeing a doctor promptly.<ref>{{cite web |url=http://www.braithwaite.yourmd.com/ypol/user/userMain.asp?siteid=1713982&content=userCustomPage&bcx=My%20Doctor^TAB~Web%20Site^MNU~Dr%20S.%20Braithwaite^PST^1713982~UTI^CAT^9&pageid=336989&rndm=0.2728092846502904 |title=Urinary Tract Infections |accessdate=2007-08-25 |format= |work=}}</ref>
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| ==Diagnosis== | | ==Diagnosis== |
| ===Symptoms===
| | [[Urinary tract infection history and symptoms|History and Symptoms]] | [[Urinary tract infection physical examination|Physical Examination]] | [[Urinary tract infection laboratory findings|Laboratory Findings]] | [[Urinary tract infection CT|CT]] | [[Urinary tract infection echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Urinary tract infection other imaging findings|Other Imaging Findings]] | [[Urinary tract infection other diagnostic studies|Other Diagnostic Studies]] |
| ====For Bladder Infections====
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| * [[Frequent urination]] along with the [[feeling of having to urinate badly]] even though little or no urine actually comes out
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| * [[Nocturia]]: [[Need to urinate during the night]]
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| * [[Urethritis]]: Discomfort or pain at the [[urethra]]l [[meatus]] or a [[burning sensation throughout the urethra]] with urination ([[dysuria]])
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| * [[Cystitis]]: Pain in the midline suprapubic region]]
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| * [[Pyuria]]: [[Pus in the urine]] or [[discharge from the urethra]]
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| * [[Hematuria]]: [[Blood in urine]]
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| * [[Pyrexia]]: Mild [[fever]]
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| * Cloudy and foul-smelling urine
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| * Increased [[confusion]] and associated [[falls]] are common presentations to Emergency Departments for elderly patients with UTI.
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| * Some urinary tract infections are [[asymptomatic]]
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| ===For Kidney Infections===
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| * The above symptoms
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| * [[Emesis]]: [[Vomiting]] is common
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| * [[Back pain]], [[side pain]] ([[flank pain]]) or [[groin pain]]
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| * [[Abdominal pain]] or pressure
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| * [[Shaking chills]] and high spiking [[fever]]
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| * [[Night sweats]]
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| * Extreme [[fatigue]]
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| ==Urinalysis and Culture==
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| A patient with [[dysuria]] ([[painful voiding]]) and [[urinary frequency]] generally has a spot mid-stream urine sample sent for [[urinalysis]], specifically the presence of [[nitrite]]s, [[leukocyte]]s or [[leukocyte esterase]]. If there is a high bacterial load without the presence of leukocytes, it is most likely due to contamination. The diagnosis of UTI is confirmed by a urine [[microbiological culture|culture]].
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| If the urine culture is negative:
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| * Symptoms of urethritis may point at ''[[Chlamydia trachomatis]]'' or ''[[Neisseria gonorrheae]]'' infection.
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| * Symptoms of cystitis, may point at [[interstitial cystitis]].
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| * In men, [[prostatitis]] may present with dysuria.
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| In severe infection, characterised by [[fever]], [[rigor (medicine)|rigor]]s or flank pain, [[urea]] and [[creatinine]] measurements may be performed to assess whether [[renal function]] has been affected.
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| ==Treatment== | | ==Treatment== |
| Most uncomplicated UTIs can be treated with oral [[antibiotic]]s such as [[trimethoprim]], [[cephalosporin]]s, [[nitrofurantoin]], or a [[fluoroquinolone]] (e.g. [[ciprofloxacin]], [[levofloxacin]]). These are usually taken for 3 days in young adults, and 5 days in elderly. Whilst [[co-trimoxazole]] was previously internationally used (and continues to be used in the U.S.), the additional of the [[sulphonamide]] gave 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.
| | [[Urinary tract infection medical therapy|Medical Therapy]] | [[Urinary tract infection primary prevention|Primary Prevention]] | [[Urinary tract infection cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Urinary tract infection future or investigational therapies|Future or Investigational Therapies]] |
| | | ==Case Studies== |
| If the patient has symptoms consistent with [[pyelonephritis]], [[intravenous]] antibiotics may be indicated. Regimens vary, usually Aminoglycosides (such as Gentamicin) are used in combination with a beta-lactam, such as Ampicillin or Ceftriaxone. These are continued for 48 hours after fever subsides. The patient may then be discharged home on oral antibiotics for a further 5 days.
| | :[[Urinary tract infection case study one|Case #1]] |
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| If the patient makes a poor response to IV antibiotics (marked by persistent fever, worsening renal function), then imaging is indicated to rule out formation of an [[abscess]] either within or around the kidney, or the presence of an obstructing lesion such as a stone or tumor. The gold-standard imaging modality is [[CT scan]].
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| ===Recurrent UTIs===
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| :See also [[Urinary tract infection#Prevention| Prevention]] (above)
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| Patients with recurrent UTIs may need further investigation. This may include [[medical ultrasonography|ultrasound]] scans of the kidneys and bladder or [[intravenous urography]] (X-rays of the urological system following intravenous injection of iodinated contrast material). If there is no response to treatments, [[interstitial cystitis]] may be a possibility.
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| During cystitis, uropathogenic ''[[Escherichia coli]]'' (UPEC) subvert innate defenses by invading superficial umbrella cells and rapidly increasing in numbers to form intracellular bacterial communities (IBCs).<ref>{{cite journal |author=Justice S, Hunstad D, Seed P, Hultgren S |title=Filamentation by Escherichia coli subverts innate defenses during urinary tract infection |journal=Proc Natl Acad Sci U S A |volume=103 |issue=52 |pages=19884-9 |year=2006 |id=PMID 17172451}}</ref>
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| Researchers at Center for Genomic Sciences, Allegheny Singer Research Institute, and the Department of Microbiology and Immunology, Drexel University College of Medicine have shown that biofilms are responsible for chronic infections and, from a clinical perspective, traditional antibiotic therapy will never be a successful treatment against biofilm bacteria.<ref>{{cite journal |author=Ehrlich G, Hu F, Shen K, Stoodley P, Post J |title=Bacterial plurality as a general mechanism driving persistence in chronic infections |journal=Clin Orthop Relat Res |volume= |issue= |pages=20-4 |year=2005 |month=Aug |id=PMID 16056021 |url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=16056021}}</ref>
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| ===Prevention===
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| ==Prevention==
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| The following are measures that studies suggest may reduce the [[incidence]] of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections:
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| * Cleaning the urethral [[meatus]] (the opening of the [[urethra]]) after [[sexual intercourse|intercourse]] has been shown to be of some benefit; however, whether this is done with an [[antiseptic]] or a [[placebo]] ointment (an ointment containing no active ingredient) does not appear to matter.<ref name=meyhoff>{{cite journal | author = Meyhoff H, Nordling J, Gammelgaard P, Vejlsgaard R | title = Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis? | journal = Scand J Urol Nephrol | volume = 15 | issue = 2 | pages = 81-3 | year = 1981 | id = PMID 7036332}}</ref>
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| * It has been advocated that cranberry juice can decrease the [[incidence]] of UTI (some of these opinions are referenced in External Links section). A specific type of [[tannin]] found only in cranberries and blueberries prevents the adherence of certain [[pathogens]] (eg. E. coli) to the [[epithelium]] of the urinary bladder. A review by the [[Cochrane Collaboration]] of randomized controlled trials states 'some evidence from trials to show cranberries (juice and capsules) can prevent recurrent infections in women. Many people in the trials stopped drinking the juice, suggesting it may not be a popular intervention'.<ref name=jepson>{{cite journal | author = Jepson R, Mihaljevic L, Craig J | title = Cranberries for preventing urinary tract infections. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001321 | year = | id = PMID 14973968}}</ref>
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| * For post-menopausal women, a [[randomized controlled trial]] has shown that intravaginal application of topical estrogen cream can prevent recurrent cystitis.<ref name=Raz>{{cite journal | author = Raz R, Stamm W | title = A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. | journal = N Engl J Med | volume = 329 | issue = 11 | pages = 753-6 | year = 1993 | id = PMID 8350884}}</ref> In this study, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months.
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| *Often long courses of low dose antibiotics are taken at night to help prevent otherwise unexplained cases of recurring cystitis.
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| *[[Acupuncture]] has been shown to be effective in preventing new infections in recurrent cases.<ref name="TidsskrNorLaegeforen1998-Aune">{{cite journal | author=Aune A, Alraek T, Huo L, Baerheim A | title=[Can acupuncture prevent cystitis in women?] | journal=Tidsskr Nor Laegeforen | year=1998 | pages=1370-2 | volume=118 | issue=9 | id=PMID 9599500 }} ''(cf acupuncture group, x2 incidents in the sham group, x3 in the control group)''</ref><ref name="ComplementTherMed2001-Alraek">{{cite journal | author=Alraek T, Baerheim A | title='An empty and happy feeling in the bladder.. .': health changes experienced by women after acupuncture for recurrent cystitis | journal=Complement Ther Med | year=2001 | pages=219-23 | volume=9 | issue=4 | id=PMID 12184349}}</ref><ref name="JAlternComplementMed2003-Alraek">{{cite journal | author=Alraek T, Baerheim A | title=The effect of prophylactic acupuncture treatment in women with recurrent cystitis: kidney patients fare better | journal=J Altern Complement Med | year=2003 | pages=651-8 | volume=9 | issue=5 | id=PMID 14629843}} ''(highlights need for considering different TCM diagnostic categories in acupuncture research)''</ref> One study showed that urinary tract infection occurrence was reduced by 50% for 6 months.<ref name=Alraek2002>{{cite journal | author = Alraek T, Soedal L, Fagerheim S, Digranes A, Baerheim A | title = Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. | journal = Am J Public Health | volume = 92 | issue = 10 | pages = 1609-11 | year = 2002 | id = PMID 12356607}}</ref> However, this study has been criticized for several reasons.<ref name="AmJPublicHealth2003-Katz">{{cite journal | author=Katz AR | title=Urinary tract infections and acupuncture | journal=Am J Public Health | year=2003 | pages=702; author reply 702-3 | volume=93 | issue=5 | id=PMID 12721123 (no abstract)}}</ref> Acupuncture appears to reduce the total amount of residual urine in the bladder. All of the studies are done by one research team without independent reproduction of results.
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| The following measures seem sensible, but have not been studied:
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| * Cleaning genital areas prior to and after [[sexual intercourse]].
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| * 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.
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| * Having adequate fluid intake, especially water.
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| * Not resisting the urge to urinate.
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| * Taking showers, not baths, or urinating soon after taking a bath.
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| * Practicing good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by fecal pathogens.
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| ==References==
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| {{Reflist|2}}
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| == See also == | | == See also == |
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| ==External links== | | ==External links== |
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| *[http://stdhelp.org/about/uti-urinary-tract-infection.php UTI Symptoms and Information]
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| *[[NIH]] articles on Urinary Tract Infections in [http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/ Adults] and in [http://kidney.niddk.nih.gov/kudiseases/pubs/utichildren/ Children]. | | *[[NIH]] articles on Urinary Tract Infections in [http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/ Adults] and in [http://kidney.niddk.nih.gov/kudiseases/pubs/utichildren/ Children]. |
| *[http://www.the-ic-community.com The IC Community (ICC)]
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| *[http://www.icadvice.com/ Interstitial Cystitis Advice (A Patient Based Community for People with IC)]
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| *[http://www.jr2.ox.ac.uk/bandolier/band6/b6-3.html Drug Watch: Cranberry juice reduces bacteriuria and pyuria]
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| * {{MedlinePlusOverview|urinarytractinfections}}
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| * {{GPnotebook|-375783424}}
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| *CNN article on [http://www.cnn.com/HEALTH/library/DS/00593.html kidney infections]
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| *[http://www.aboutinfections.com aboutinfections.com] information on [http://www.aboutinfections.com/bladder-infections/bladder-infections.html bladder infections]
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| *[http://www.scientistlive.com/food/20061201/ingredients/2.3.276.278/16794/cranberry-juice-tannins-can-defeat-e-coli-bacteria.thtml Cranberry juice tannins can defeat E. coli bacteria] Scientist Live
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| *[http://www.healthninjas.com/remedies/bladder_infections.shtml Natural Remedies for Bladder Infections]
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| {{Nephrology}} | | {{Nephrology}} |