URINARY TRACT INFECTION - Disease Management

Urinary tract infections (UTIs) are bacterial infections of the urinary tract, most often caused by the bacterium E Coli. A UTI occurs when micro-organisms, usual bacteria from the digestive tract, Chng to the opening of the urethra and begin to multiply. In most cases, bacteria first begin growing in the urethra and often move on to the bladder, causing cystitis. If the infection is not treated promptly, bacteria may then go up the ureters to infect the kidneys causing pyelonephritis. UTIs are one of the most common bacterial infections, and it is estimated that 40-50% of women will have at least one UTI in their lifetime.

Causes

• Escherichia coli bacteria (80% of infections) and other organisms like - klebsiella, Enterobacter, Proteus, Pseudomonas, Serratia, Streptococcus faecalis and Staphylococcus
• Normal bowel flora
• Menopause
• Sexual activity with an infected person
• Retention of urine
• Prostatic enlargement
• Pregnancy
• Urinary catheterization
• Spina bifida
• Multiple sclerosis
• Multiple sclerosis

Risk Factors

• Cognitive impairment
• Faecal incontinence
• Recent urologic surgery, catheterization
• Infection of the prostate or kidney
• Immunocompromised host
• Diabetics
• Immune system suppression
• Women
• Use of spermicides or diaphragm
• Pregnancy
• Sexual activity
• Underlying problems in the urinary tract such as tumours, calculi, strictures, incomplete bladder emptying, urinary incontinence, etc.

Signs and Symptoms

• Urinary frequency
• Urinary urgency
• Dysuria
• Slow urinary stream
• Dribbling of urine
• Nocturia
• Haematuria
• Systemic symptoms (chills, fever) present with concomitant pyelonephritis or prostatitis Cloudy urine, foul-smelling urine
• Low back pain
• Suprapubic discomfort
• Pain and burning sensation during urination
• The sensation of incomplete bladder emptying
• .A change in the colour or smell of urine
• Systemic symptoms (chills fever) present with concomitant pyelonephritis or prostatitis.

DIAGNOSIS

UTIs are diagnosed by looking at the patient's medical history followed by an examination of a mid-stream specimen of urine (MSU).

Differential Diagnosis

• Urethritis
• Vaginitis
• Epididymis

Investigations

• Microscopic examination of urine
• A semi-quantitative culture of urine
• Antibiotic sensitivity test
• Intravenous pyelography
• Cystoscopy
• Radiographic, ultrasound and/or endoscopic imaging of upper and lower urinary tract.

TREATMENT

Goal

• Culminate infection and prevent further complications
• Drugs used in different UTI conditions:- Acute uncomplicated urinary tract infections in women
• Cystitis:-Quinolones, cephalosporins, penicillins, nitrofurantoin
• Acute pyelonephritis, uncomplicated:-Quinolones, penicillins, cephalosporins, cotrimoxazole
• Complicated UTI:-Penicillins, carbapenems, quinolones, cefoperazone

PATIENT EDUCATION

• Urinate after intercourse.
• Stop usage of the diaphragm with spermicide.
• Urinate regularly and often during the day.
• Maintain good hydration.
• Don't resist the urge to urinate.

Complications

• Pyelonephritis
• Ascending infection
• Recurrent infection
• Renal abscess

Prognosis

Symptoms resolve within 2-3 days after starting treatment in almost all patients. Three-day therapy may be slightly more effective (higher cure rate) than single-dose therapy.