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Urinary Tract Infections (UTI)

UTI is the result of response of the urinary tract to the bacterial infection, usually associated with bacteria and pus cells in urine. Normally, URINE IS FREE OF BACTERIA. UTIs are common, affect men and women of all age groups and vary in their symptoms and sequelae. Bowels are the most common source of bacteria, which ascend through urethra into urinary bladder and upwards into

Uncomplicated UTI: infection in a healthy patient with structurally and functionally normal urinary tract

Complicated UTI: urinary tract is structurally or functionally abnormal, patient has other concurrent illnesses or is a child/elderly and/or bacteria are more dangerous or resistant to multiple antibiotics.

Re-infection: re-introduction of bacteria from outside after successful treatment.

Bacterial persistence: recurrent UTI caused by the same bacteria, which has reemerged from some focus within the urinary tract, e.g. prostate, stone Once a patient develops UTI, he/she is likely to develop more subsequent infections. Possibility of recurrent UTI increases with number of previous infections.

Presence of bacteria in urine is known as bacteriuria. It is more common in women as compared to men in all age groups. Almost half of women suffer from UTI in their lifetime and would require treatment.

Around 10% of women and 5% of men in older age group carry asymptomatic bacteria in their urine. Until and unless it causes some symptoms, it is best left untreated with no immediate or delayed long term effects to the carrier.

The incidence of UTI increases during pregnancy, diabetes, hospitalization, catheterization, spinal cord injury, etc.

Risk factors of UTI

  1. Obstruction to outflow of urine like prostatic enlargement, urethral stricture, etc.
  2. Dehydration
  3. Constipation
  4. Sexual activity
  5. Use of spermicidal agents
  6. Menopause
  7. Antibiotic use – disturbs normal bacteria
  8. Catheterization (indwelling tube to drain urine)
  9. Urinary or fecal incontinence
  10. Biological pre-disposition in certain females

What are the symptoms of UTI?

  • Frequent urge to go to washroom
  • Small amount of urine comes out, and associated with pain
  • Supra-pubic discomfort
  • Burning sensation
  • lood in urine

Treatment of un-complicated UTI

An uncomplicated UTI is usually not associated with fever and in young females, usually does not require extensive investigations. This is most commonly caused by E. coli or Streptococcus spp. and is usually treated with a short course of antibiotics.

What are the symptoms of complicated UTI?

Presence of fever, + chills/shivers – signifies invasion of bacteria into

blood stream

  • Pain in flank/loin region
  • Vomiting
  • Severe malaise

Treatment of complicated UTI

Neglected and not properly treated in timely fashion, it can cause serious damage to the kidneys and may even be life threatening. Management requires more detailed evaluation like urine culture, Ultrasound, etc. to begin with. Admission and injectable/long term antibiotic course may be required for optimal treatment. Depending upon clinical presentation, your urologist may go for specialized tests to find out any correctable problem.

Unresolved UTI

Symptoms of UTI do not resolve by the end of therapy or recur shortly after therapy. Can be due to inadequate therapy (inadequate duration or dose) or presence of resistant organisms. Urinalysis and culture are mandatory. Renal function tests and radiological evaluation may be required to identify the cause of bacterial persistence.

Recurrent UTIs

a. Bacterial persistence: reemergence of bacteria from within urinary tract Caused by same bacteria

Occurs at close interval

Usually due to presence of some focus of infection like infection stones, wherein antibiotics can not reach and kill bacteria

b. Reinfection: new infection from outside
Bacteria may be different
Occurs at varying, sometimes long intervals

Reinfections mostly occur in girls and women; in men, it is usually due to some structural abnormality.

How to avoid re-infections?

  1. Ensure adequate fluid intake, as dehydration can increase possibility if infection
  2. Regular bowel habits
  3. Avoid un-necessary antibiotics
  4. Women should ensure undergarments are dry.
  5. Diaphragms and spermicides as contraceptive agents increase infection rates – use alternative contraceptives
  6. Sexual activity can increase infection rate – go to pass urine (pee) post act to flush out any bacteria which may have reached urinary bladder
  7. Post menopausal women should consult their gynecologist for hormone replacement therapy/local estrogen crèmes if required
  8. Cranberry juice/tablets have been shown to be effective in some studies to decrease incidence of recurrent UTI

Role of low dose prophylactic antibiotics

Low dose of bedtime antibiotic for around 6 months have shown to decrease recurrence rates. This does not cause increase in resistant bugs, or any significant side effect. Patient needs to be monitored every 1 – 3 months. Any breakthrough infection can be treated with regular full dose antibiotic course.

Post-intercourse antibiotic therapy

In women suffering from recurrent UTI especially after sexual activity are benefitted with a single dose of antibiotic after intercourse.

Kidney infections

Though uncommon as compared to bladder infection, these causes more problems both to the patient and the physician. Can be severe, damage kidneys transiently or permanently and may even be life threatening. Are usually associated with fever of more than 100.3 F, may be associated with flank pain, burning sensation in urine and sometimes, nausea and vomiting. These are even more dangerous if associated with diabetes or kidney stone diseases. These infections require prompt medical attention, thorough evaluation and antibiotic course, which may range up to 3 – 6 weeks for optimal results.

Repeat urine cultures are advisable on 5 th – 7 th day of therapy and 10 – 14 days after completion of antibiotic course to ensure complete eradication of bacteria from the system.

Failure to respond to antibiotics requires more intensive work up to find out other conditions and may require surgical intervention for proper cure.

Hospital

Address: Room No: 3, Department of Urology, Uro-oncology, Robotics And Renal Transplantation, Ground Floor, Max Super Specialty Hospital – East Block, 2, Press Enclave Road, Saket, New Delhi – 110085

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