Urinary Tract Infection in Females Disease

DESCRIPTION

Inflammation of the bladder mucosa. This topic refers primarily to infectious cystitis. Other urinary tract infections are discussed elsewhere.

System(s) affected: Renal/Urologic
Genetics: N/A
Incidence/Prevalence in USA: 3-8% of women have bacteriuria at any given time. 30% of females have at least one UTI; 7 million doctor visits a year
Predominant age: Young adults and older
Predominant sex: Female

SIGNS AND SYMPTOMS

Note: Any or all may be present

Burning during urination
Pain during urination
Urgency (sensation of need to urinate frequently)
Frequency
Sensation of incomplete bladder emptying
Blood in urine
Lower abdominal pain or cramping
Offensive odor of urine
Nocturia

CAUSES

Acute infection, usually with gram negative bacteria (E. coli in >90% of uncomplicated cystitis).

RISK FACTORS

Previous urinary tract infection
Diabetes mellitus
Pregnancy
More frequent or vigorous sexual activity than usual
Use of spermicides or diaphragm
Underlying abnormalities of the urinary tract such as tumors, calculi, strictures, incomplete bladder emptying, etc.

LABORATORY

Urinalysis demonstrating pyuria (more than 10 neutrophils per high power field on microscopic exam). Leukocyte esterase dipsticks are also useful for detecting pyuria but may fail to detect pyuria in up to 20% of patients, and false positives may occur from vaginal leukocytes.
Urinalysis demonstrating bacteriuria (any amount on unspun urine, or 10 rod-shaped bacteria per high power field on centrifuged urine). Nitrite dipsticks are also useful (94% specific) but may fail to detect bacteriuria in 30–50% of patients. Nitrite dipsticks may be negative in patients who do not eat meat.
Urine culture demonstrating growth of a single species of bacteria. A contaminated specimen should be suspected when culture shows multiple types of bacteria.

Drugs that may alter lab results: N/A
Disorders that may alter lab results: N/A

PATHOLOGICAL FINDINGS

N/A

SPECIAL TESTS

N/A

IMAGING

For all infants and may be indicated for older patients with recurrent infections:
- Radiographic, ultrasound, and/or endoscopic imaging of upper and lower urinary tract
- For infants and children, obtain ultrasound and if ureteral dilation is detected, obtain either voiding cystourethrogram or isotope cystogram to detect reflux

DIAGNOSTIC PROCEDURES

Suprapubic bladder aspiration or urethral catheterization to obtain urine specimen from infants
Urethral catheterization to obtain urine specimen from children and adults if voided urine is suspected of being contaminated
Classic symptoms in non-pregnant young adult females with first episode of UTI require no urine culture for diagnosis. Obtain urinalysis and culture in other age groups, if repeat episode, if pregnant, or if symptoms are not classic
Some recent research suggests the most cost-effective approach is empiric treatment without lab tests in non-pregnant premenopausal women with symptoms of UTI and no risk factors for complicated infection

APPROPRIATE HEALTH CARE

Outpatient, except for complicated or upper tract infections

GENERAL MEASURES

Maintain good hydration
One-fourth of women with simple UTI experience a second UTI within six months, and half at some time during their lifetime. Patients with multiple recurrent UTIs and no underlying urinary tract abnormality may receive long-term prophylactic antibiotic treatment. Trimethoprim-sulfamethoxazole and nitrofurantoin are commonly used.
Patients with chronic indwelling urinary catheters always have infections that should not be treated unless symptomatic with fever, sepsis, or other systemic symptoms.
Preliminary studies indicate that Vaccinium macrocarpon (Cranberry Juice) may help prevent and treat UTIs by inhibiting bacterial adherence to bladder epithelium.

SURGICAL MEASURES

N/A

ACTIVITY

Avoid sexual intercourse when symptoms present

DIET

No special diet

PATIENT EDUCATION

Take antibiotic as directed
Return if symptoms are not resolved or markedly improved within 48 hours
Return if fever, chills, or flank pain develop
If taking prophylactic antibiotics, take at bedtime

PREVENTION/AVOIDANCE

Maintain good hydration
Women with frequent or intercourse-related UTI should empty bladder immediately before and after intercourse and consider postcoital antibiotic treatment
Avoid feminine hygiene sprays and scented douches
Wipe urethra from front to back

POSSIBLE COMPLICATIONS

Pyelonephritis
Renal abscess

EXPECTED COURSE AND PROGNOSIS

Symptoms resolve within 2-3 days after starting treatment in almost all patients

ASSOCIATED CONDITIONS

Described under Risk Factors

AGE-RELATED FACTORS

Pediatric: Infants and young children at higher risk of pyelonephritis
Geriatric:

Elderly may have bacteriuria without symptoms; generally does not require treatment if urinary tract otherwise normal
Elderly more apt to have underlying urinary tract abnormality
Acute UTI often associated with incontinence in the elderly

Others: N/A

PREGNANCY

UTI during pregnancy always requires culture/sensitivity and usually requires 10-14 day treatment. Limited data suggest that single dose or three-day treatment may be effective in some women. Following treatment of acute infection, pregnant women often receive prophylactic antibiotics for the remainder of pregnancy.

OTHER NOTES

N/A

ABBREVIATIONS

TMP/SMX = trimethoprim-sulfamethoxazole

Clinical Investigations

ROLE OF HOMOEOPATHY

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