Urinary tract infection

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In medicine, urinary tract infections are "inflammatory responses of the epithelium of the urinary tract to microbial invasions. They are often bacterial infections with associated bacteriuria and pyuria."[1]

Classification

More common types of urinary tract infections in include:

Cause

Males

In males, urinary tract infections are usually secondary to an underlying cause such as benign prostatic hyperplasia or genitourinary instrumentation.[2] However, a single episode is unlikely to be due to a serious underlying cause.[3]

Diagnosis

The best symptoms and physical examination findings for diagnosis have been identified in a systematic review by the Rational Clinical Examination in 2002.[4]

Regarding symptoms, a subsequent study and clinical prediction rule found the best findings are urine cloudiness, offensive smell, moderately severe dysuria, moderately severe nocturia.[5]

A subsequent study and clinical prediction rule showed the best predictors were urinary nitrite, leucocyte esterase and blood[5] ; however, these tests may not be very accurate[6].

Urinary tract infections may be overdiagnosed in geriatric patients.[7]

Various testing strategies have been compared.[8]

Treatment

Clinical practice guidelines are available"[9]

  • Nitrofurantion 100 mg twice daily for 5 days is recommended and may be cost effective when:[10]
    • TMP-SMX resistance is > 17%
    • Quinolone resistance is > 12%

Prevention

Cranberry juice probably does not help.[11]

Patients without urinary catheterization

Patients with urinary catheterization

Various interventions may reduce urinary tract infection.[12][13]

References

  1. Anonymous (2015), Urinary tract infection (English). Medical Subject Headings. U.S. National Library of Medicine.
  2. Lipsky BA (January 1989). "Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment". Ann. Intern. Med. 110 (2): 138–50. PMID 2462391[e]
  3. Abarbanel J, Engelstein D, Lask D, Livne PM (July 2003). "Urinary tract infection in men younger than 45 years of age: is there a need for urologic investigation?". Urology 62 (1): 27–9. PMID 12837416[e]
  4. Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S (2002). "Does this woman have an acute uncomplicated urinary tract infection?". JAMA 287 (20): 2701–10. PMID 12020306[e]
  5. 5.0 5.1 Little P, Turner S, Rumsby K, Warner G, Moore M, Lowes JA et al. (2009). "Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study.". Health Technol Assess 13 (19): iii-iv, ix-xi, 1-73. DOI:10.3310/hta13190. PMID 19364448. Research Blogging. Review in: Evid Based Med. 2009 Oct;14(5):155
  6. Little P, Turner S, Rumsby K, Jones R, Warner G, Moore M et al. (2010). "Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women.". Br J Gen Pract 60 (576): 495-500. DOI:10.3399/bjgp10X514747. PMID 20594439. PMC PMC2894378. Research Blogging.
  7. Woodford HJ, George J (November 2008). "Diagnosis and Management of Urinary Tract Infection in Hospitalized Older People". J Am Geriatr Soc. DOI:10.1111/j.1532-5415.2008.02073.x. PMID 19054190. Research Blogging.
  8. Little P, Moore MV, Turner S, Rumsby K, Warner G, Lowes JA et al. (2010). "Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial.". BMJ 340: c199. DOI:10.1136/bmj.c199. PMID 20139214. PMC PMC2817051. Research Blogging.
  9. Gupta, Kalpana; Thomas M. Hooton, Kurt G. Naber, Björn Wullt, Richard Colgan, Loren G. Miller, Gregory J. Moran, Lindsay E. Nicolle, Raul Raz, Anthony J. Schaeffer, David E. Soper (2011-03-01). "Executive Summary: International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clinical Infectious Diseases 52 (5): 561 -564. DOI:10.1093/cid/cir102. PMID 21292658. Retrieved on 2011-03-08. Research Blogging.
  10. McKinnell JA, Stollenwerk NS, Jung CW, Miller LG (2011). "Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis.". Mayo Clin Proc 86 (6): 480-8. DOI:10.4065/mcp.2010.0800. PMID 21576512. PMC PMC3104907. Research Blogging.
  11. Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B (2011). "Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial.". Clin Infect Dis 52 (1): 23-30. DOI:10.1093/cid/ciq073. PMID 21148516. Research Blogging.
  12. Parker D, Callan L, Harwood J, Thompson DL, Wilde M, Gray M (2009 Jan-Feb). "Nursing interventions to reduce the risk of catheter-associated urinary tract infection. Part 1: Catheter selection.". J Wound Ostomy Continence Nurs 36 (1): 23-34. DOI:10.1097/01.WON.0000345173.05376.3e. PMID 19155821. Research Blogging.
  13. Willson M, Wilde M, Webb ML, Thompson D, Parker D, Harwood J et al. (2009 Mar-Apr). "Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques.". J Wound Ostomy Continence Nurs 36 (2): 137-54. DOI:10.1097/01.WON.0000347655.56851.04. PMID 19287262. Research Blogging.