Dr. Sudeep Singh Sachdev Consultant Nephrology and Renal Transplant, Narayana Superspeciality Hospital, Gurugram
A urinary tract infection denotes infection and microbial colonization of any part of the urinary tract including kidney, ureter, bladder and urethra. Most infections commonly involve the lower urinary tract i.e. the bladder and the urethra. Depending on the site involved there are different terminologies commonly used including:
Cystitis: infection limited to urinary bladder. It usually presents with burning micturition, urinary urgency, frequency, and/or suprapubic pain.
Pyelonephritis: infection involving the kidneys. It is the most dangerous type of UTI and presents with fever with chills or rigors, flank pain, nausea with or without vomiting.
Urethritis: infection involving the urethra. It usually presents with a burning pain during urination and a foul smelling urethral discharge.
Another important terminology in reference to Urinary tract infection is :
Complicated UTI : UTI with an increased chance of a complicated course, that is, all men, pregnant women, patients with structural or functional abnormalities of the urinary tract, indwelling urinary catheters, renal diseases, and/or other immune compromised state.
Etiology :
- Bacteria commonly E. Coli, Klebsiella, Proteus, Pseudomonas, Enterococcus, Staphylococcus
- Fungal : Candida species
- Tubercular
Signs and symptoms:
- Urgency – persistent urge to urinate
- Dysuria – burning sensation when urinating
- Frequency – passing frequent, small amounts of urine
- Cloudy, turbid urine
- Red, bright pink or cola-colored urine – sign of blood in urine
- Foul smelling urine
- Abdominal pain – suprapubic, bilateral flanks, pelvic pain (females), perineal pain
Risk Factors :
- Women – sexually active, post menopausal
- Pregnancy
- Immunocompromised state – Diabetes Mellitus, Post transplant, Age > 60 years, patient on steroids or any other immunosuppressive drugs
- Pregnancy
- Structural or Functional abnormalities of the Urinary tract – Vesicoureteric reflux, Neurogenic bladder, posterior urethral valve, calculus in the urinary tract, urethral stricture etc.
- Urinary tract instrumentation
Complications — Patients with acute complicated UTI can also present with bacteremia, sepsis, multiple organ system dysfunction, shock, and/or acute renal failure, renal corticomedullary abscess, perinephric abscess, emphysematous pyelonephritis, or papillary necrosis which can also be fatal.
Diagnosis : is made by history, physical examination, urine routine and culture sensitivity, Imaging studies including Ultrasound and CT scan
Treatment :
- Use of appropriate antibiotics, antifungals (according to culture reports)
- Use of iv antibiotics in case of severe complicated UTI (associated with septicemia, shock, Acute kidney injury)
- Definitive treatment of structural or functional abnormality of the urinary tract like stone removal, correction of urethral stenosis
- Prophylaxis with oral antibiotic for upto 3 months in case of recurrent UTI
Prevention :
- Drink plenty of liquids, especially water
- Drink cranberry juice
- Mantain personal hygiene and cleanliness
- Do not hold urine for long periods of time
- Avoid use of diaphragms, unlubricated spermicidal condoms for birth control, dirty public toilets and swimming pools
