Urinary

Tract

Infections

What Causes Urinary Tract Infections?

The urinary tract is normally sterile UTIs occur when a micro-organism enters the urinary system via the urethra or rarely through the bloodstream

Most commonly infecting organisms are E. coli and Staphylococcus

Risk Factors for UTIs

Sexual intercourse

Contraceptives: especially the use of diaphragms or spermicides

Obstructions of the urinary tract: kidney stones

Pregnancy: 4 times greater risk of developing UTIs which can lead to low birth weight
Diseases that impair immunity: diabetes and HIV Previous urinary tract surgery Catheterisation: the longer the catheter is in the higher the risk

Who is affected?
Children: During first 6 months more common in boys from thereafter they become more common in girls Adults: 50 times more common in women!

Elderly (after 50): Almost as high in men as in women

How Are UTIs Classified?

UTIs are classified by four criteria
Duration: Acute, recurrent or chronic

Location: Urethra (Urethritis) Bladder (Cystitis) Kidneys (Pyelonephritis) Complicated / uncomplicated Occurring with or without an anatomical abnormality Community or hospital acquired Hospital acquisition is usually catheter associated

Symptoms of UTIs
Dysuria (painful, burning urination)
Urinary frequency and urgency often with voiding

Suprapubic or lower back pain

Cloudy, unpleasant smelling or bloody urine

Low fever

Complications of UTIs
Most UTIs are mild, treatable and have no long term consequences.
Untreated UTIs may ascend the urinary tract leading to pyelonephritis, renal failure and sepsis.

Recurrent UTIs may result in renal scarring which can lead to renal failure
In pregnant women complications can lead to low birth weight, birth defects and foetal death.

Treatment of UTIs
Antibiotics are the recommended treatment for both simple and complex UTIs Amoxycillin, trimethoprim (avoid if pregnant) and nitrofurantoin (not rec. for children) Fluoroquinolones should not be used as first line drugs, as they are the only orally active drugs available for multi resistant infections. Treatment can range from 5 14 days Paracetamol to reduce pain and fever Heat pad to reduce discomfort on abdomen or lower back Urinary alkalinisers may help to reduce symptoms of dysuria but should be used with caution in patients with cardiac failure, hypertension or renal impairment Drink cranberry juice

Prevention of UTIs
Women with recurrent (>3 infections per year) may take prophylactic antibiotics Urinate immediately after sexual intercourse and avoid the use of diaphragms and spermicides Do not delay urinating and empty the bladder fully when urinating Clean the genital area from front to back (very important in babies) Wear cotton underwear and avoid tight fitting jeans