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Urinary Tract Infection (UTI)
Urinary tract infection (UTI) is associated with the presence of organisms in the urinary tract together with symptoms, and sometimes signs, of inflammation.
However, it is more precise to use one of the following terms.
Significant bacteriuria:
It is estimated by the presence of at least 100,000 bacteria/mL of urine.
Asymptomatic bacteriuria:
significant bacteriuria in the absence of symptoms in the patient.
Cystitis:
In condition there is a frequency of dysuria, and urgency, which usually suggests infection restricted to the lower urinary tract.
Urethral syndrome:
a syndrome of frequency and dysuria in the absence of significant bacteriuria which has pathogen.
Acute pyelonephritis:
an acute infection of one or both kidneys.
Chronic pyelonephritis:
It can refer to continuous excretion of bacteria from the kidney, to frequent recurring infection of the renal tissue or to a particular type of pathology of the kidney seen microscopically or by radiographic imaging, which may or may not is due to infection.
Relapse and reinfection:
In this condition there is recurrence of urinary infection which may be due to either relapse or reinfection.
Signs And Symptoms Of UTIs
Most UTIs are asymptomatic. Symptoms, when they do occur, are principally the result of irritation of the bladder and urethral mucosa. However, the clinical features of UTI are extremely variable and to some extent depend on the age of the patient.
Babies and infants Infections in newborn babies and infants are often overlooked or misdiagnosed because the signs may not be referable to the urinary tract. Common but non-specific presenting symptoms include failure to thrive, vomiting, fever, diarrhea, and apathy.
Children Above the age of 2, children with UTI are more likely to present with some of the classic symptoms such as frequency, dysuria, and haematuria. However, some children present with acute abdominal pain and vomiting, and this may be so marked as to raise suspicions of appendicitis or other intra-abdominal pathology.
Adults In adults, the typical symptoms of lower UTI include frequency, dysuria, urgency, and haematuria. Acute pyelonephritis (upper UTI) usually causes fever, rigors and loin pain in addition to lower tract symptoms.
Elderly Although UTI is frequent in the elderly, the great majority of cases are asymptomatic, and even when present, symptoms are not diagnostic because of frequency, dysuria, hesitancy, and incontinence are fairly common in elderly people without infection.
Incidence
UTIs are among the most common infectious diseases occurring in either the community or health care setting. Uncomplicated UTIs typically occur in healthy adult nonpregnant women, whereas complicated UTIs are found in either sex and at any age.
Babies and infants
UTI is a problem in all age groups, although its prevalence varies markedly. In infants up to the age of 6 months, symptomatic UTI has a prevalence of about two cases per 1000 and is much more common in boys than in girls.
Children
In preschool children, UTIs become more common and the sex ratio reverses, such that the prevalence of bacteriuria is 4.5% in girls and 0.5% in boys. In older children, the prevalence of bacteriuria falls to 1.2% among girls and 0.03% among boys. Overall, about 3–5% of girls and 1–2% of boys will experience a symptomatic UTI during childhood. However, in girls, about two-thirds of UTIs are asymptomatic.
Adults
When women reach adulthood, the prevalence of bacteriuria rises to between 3% and 5%. Each year, about a quarter of these bacteriuria women clear their infections spontaneously and are replaced by an equal number of newly infected women, who are often those with a history of previous infections.
Elderly
In the elderly of both sexes, the prevalence of bacteriuria rises dramatically, reaching 20% among women and 10% among men.
Causes And Risk Factors Of UTIs
In acute uncomplicated UTI acquired in the community, Escherichia coli is by far the most common causative bacterium, being responsible for about 80% of infections. Other 20% are caused by other Gram-negative enteric bacteria such as Klebsiella and Proteus species, and by Gram positive cocci, particularly enterococci and Staphylococcus saprophytic us.
Diagnosis
The key to the successful laboratory diagnosis of UTI lies in obtaining an uncontaminated urine sample for microscopy and culture.
Contaminating bacteria can arise from the skin, vaginal flora in women and penile flora in men.
Patients therefore 36 Therapeutics 564 need to be instructed in how to produce a midstream urine sample (MSU).
Treatment Of UTI
Although many, and perhaps most, cases clear spontaneously given time, symptomatic UTI usually merits antibiotic treatment to eradicate both symptoms and pathogen. Asymptomatic bacteriuria may or may not need treatment depending on the circumstances of the individual case.
Bacteriuria in children and in pregnant women requires treatment, as does bacteriuria present when surgical manipulation of the urinary tract is to be undertaken, because of the potential complications. On the other hand, in non-pregnant, asymptomatic bacteriuric adults without any obstructive lesion, screening and treatment are probably unwarranted in most circumstances.
Unnecessary treatment will lead to a selection of resistant organisms and puts patients at risk of adverse drug effects including bowel infection with Clostridium difficult, which has been particularly associated with the use of cephalosporins and quinolones.
Non-specific treatments
Advising patients with UTI to drink a lot of fluids is common practice on the theoretical basis that more infected urine is removed by frequent bladder emptying. This is plausible, although not evidence based.
Some clinicians recommend urinary analgesics such as potassium or sodium citrate, which alkalinise the urine, but these should be used as an adjunct to antibiotics. They should not be used in conjunction with nitrofurantoin, which is active only at acidic pH.
Prevention and prophylaxis
There are a number of folklore and naturopathic recommendations for the prevention of UTI. Most of these have not been put to statistical study, but at least are unlikely to cause harm.
Cranberry juice:
Cranberry juice (Vaccinium macrocarpon) has long been thought to be beneficial in preventing UTI, and this has been studied in a number of clinical trials. Cranberry is thought to inhibit adhesion of bacteria to urinary tract cells on the surface of the bladder.
Antibiotic prophylaxis:
In some patients, mainly women, reinfections are so frequent that long-term antimicrobial prophylaxis with specific antibiotics is indicated.
Children:
In children, recurrence of UTI is common and the complications potentially hazardous, so many clinicians recommend antimicrobial prophylaxis following documented infection
