Urinary tract infection (UTI) is the term used to describe acute urethritis and cystitis caused by a microorganism.
Prevalance: the prevalence of UTI in women is about 3% at the age of 20, increasing by about 1% each subsequent decade. In males, UTI is uncommon, except in the first year of life and in men over 60, when it may complicate bladder outflow.
Incomplete bladder emptying
Bladder outflow obstruction
Benign prostatic enlargement
Urethral catheter or ureteric stent
Loss of host defences
Atrophic urethritis and vaginitis in post-menopausal women
Urine is a excellent culture medium for bacteria; in addition, the urothelium of susceptible persons may have more receptors, to which virulent strains of E. coli become adherent. In women the ascent of organisms into the bladder is easier than in men; the urethra is shoter and the absence of bactericidal prostatic secretions may be relevant. Sexual intercourse may cause minor urethral trauma and transfer bacteria from the perineum into the bladde. Instrumentation of the bladder may also introduce organisms. Multiplication of organisms then depends on a number of factors, including the size of the inoculum and virulence of the bacteria.
Causative Organism For UTI:
In the United States, Escherichia coli accounts for 75–90% of cystitis isolates;
Staphylococcus saprophyticusfor 5–15%; and Klebsiellaspp., Proteus spp., Enterococcus spp., Citrobacterspp., and other organisms for 5–10%.
Typical feature of cystitis and urethritis include:
Abrupt onset of frequency of micturition and urgency
Scalding pain in the urethra during micturition(dysuria)
Suprapubic pain during and after voiding
Intense desire to pass more urine after micturition
Urine may appear cloudy and have an unpleasant odour
Microscopic or visible haematuria.
Systemic symptoms are usually slight or absent. However infection in the lower urinary tract can spread . Acute pyelionephritis is suggested by prominent systemic symptoms with fever, rigors, vomiting, hypotension and loin pain, guarding or tenderness and may be an indication of hospitalization.
The diagnosis can be made from the combination of typical and clinical feature and abnormalities on urine analysis.
Most urinary pathogens can reduce nitrate to nitrite, and neutrophils and nitrites can usually be detected in symptomatic infections by urine dipstick tests for leucocyte esterase and nitrite, respectively. the absence of both nitrites an leucocyte esterasein the urine makes uti unlikely.
Interpretaion of bacterial counts in the urine and what is a ‘significant’ culture result, is based on probabilities. Urine taken by suprapubic aspiration should be sterile, so the presence of any organismis significant. If the patient has symptoms and there are neutrophils in the urine, a small number of organisms is significant. In asymptomatic patients, more than 105 organisms/Ml is usually regarded as significant.
Investigations of patients with urinary tract infection:
For all patients-
Dipstick estimation of nitrite, leucocyte esterase and glucose
Microscopy/cytometry of urine for white blood cells, organisms
Urine culture: For infants, children and anyone with fever or complicated infections:
Full blood count; urea, electrolytes, creatinine
Blood culture: Pyelonephritis; males; children; women with recurrent infections
Renal tract ultrasound or CT
Pelvic examination in women, rectal examination in men: Continuing haematuria or other suspicious of bladder lesion
Antibiotics are recommended in all cases of proven UTI. For infection of lower urinary tract, treatment for 3 days is the norm and is less likely to induce significant alterations in bowel flora than more prolonged therapy. Trimethoprim is the usual choice for initial treatment; however between 10% and 40% of organisms causing UTI are resistant to it. Penicillins and cephosporins are safe to use in pregnancy but trimethoprim, sulphonamides, quinolones and tetracyclines should be avoided..
In more severe infection, antibiotics should be continued for 7-14 days. Seriously ill patients may require intravenous therapy with antibiotic therapy.
In the urinary tract, all of the stigmata may manifest themselves, but most frequently these manifestations are psoric and sycotic, here also the combined assault of all these stigmata are represented in the malignancies.
Psora: In children with these underlying conditions, we find retention of urine whenever the body gets chilled, and this condition arises in old people also. An opposite indication of psoric stigma is involuntary urination when sneezing, coughing or laughing. There is smarting and burning on urination, but not from pathological causes.
Sycosis: There is intense pain on urination, children scream from the pain. This is due to a spasmodic contraction affecting the urethra. Where we find fibrous changes we may sure there is a strong sycotic influence.
1. Cantharis vesicatoria
Constant urging to urinate, passing but a few drops at a time, which is mixed with blood
Intolerable urging, before, during and after urination; violent pains inbladder.
Burning, cutting pains in urethra during micturation; violent tenesmus and stranguary.
The burning pain and intolerable urging to urinate, is the red strand of cantharis in all inflammatory affection.
Severe dull pain in the bladder, as from distension, not> after urination.
Frequent and intolerable urging to urinate, with severe pain at close of urination
Constant desire to urinate; large quantity of clear, watery urine, without >
Sharp, burning, cutting pain in urethra while urinating.
Severe, almost unbearable pain at conclusion of urination
Painful distension and tenderness in bladder; urine dribbles while sitting, standing , passes freely
Sand in urine or on diaper; child screams before and while passing it.
Urging to urinate, has to sit at urinal for hours; in young married women; after coitus; after difficult labor (op); burning in urethra when not urinating; urging and pain after urinating in prostatic troubles of old men; prolapsed of bladder.
Urethra very sensitive to touch or pressure; cannot walk with legs close together, it hurts the urethra.
Tearing pains along urethra in zigzag direction.
Pain extending from orifice of urethra backward, burning-biting,posteriorly more stick, while urinating.