Urinary Tract Infections (UTIs) occur when bacteria is present within the urinary tract in significant numbers. UTIs are common in women, with 1 in 5 adult women aged 20-65 experiencing a UTI at least once a year. Approximately 50% of women will experience UTIs at least once in their life.
Cystitis (bladder infection) makes up the majority of these infections. Involvement of the upper urinary tract (pyelonephritis) is less common compared to that of cystitis but can be associated with more serious complications.
The onset of Urinary Tract Infections (UTIs) can be associated with one or more of the following symptoms:
About 25 percent of women with acute cystitis develop recurrent Urinary Tract Infections (UTIs). Most recurrent infections are from bacteria present in the faecal or periurethral reservoirs. Some strategies can be undertaken to reduce the risk of recurrent infections.
In most cases of uncomplicated cystitis the Escherichia coli is involved. This bacteria is present in 70-95 percent of both upper and lower UTIs. Other common pathogens are
Enterococcus faecalis, Klebsiella species, Proteus species and yeast.
The largest group of patients with Urinary Tract Infections (UTIs) is that of adult women. Women are more prone to UTIs than men because in females, the urethra is much shorter and closer to the anus.
Other predisposing factors include:
The diagnosis of a Urinary Tract Infection (UTI) can be suspected from a well-taken history and physical examination.
Specific tests to confirm a Urinary Tract Infection (UTI) include a urine dipstick, urine analysis and urine culture. The main emphasis lies with the detection of pyuria (white blood cells or pus cells in the urine) on dipstick and urine analysis. Associated findings can include microscopic haematuria (blood in the urine which cannot be detected by the naked eye). A urine culture will help in the identification of the organism causing the infection.
No imaging studies are indicated in the routine evaluation of an uncomplicated cystitis.
Empirical antibiotics are usually prescribed for Urinary Tract Infections (UTIs). The patient may be prescribed alternative antibiotics after the urine culture results are available. The duration of treatment of the UTI depends on the antibiotic in use. Some common first-choice agents for the treatment of uncomplicated cystitis in women include nitrofuratoin, bactrim or beta-lactams such as cephalexins.
Most patients can be treated on an outpatient basis. However, hospital admission for management of complicated Urinary Tract Infections (UTIs) may be indicated in some patients. Complicating factors include the presence of structural abnormalities (e.g. stones, indwelling catheters), metabolic disease (e.g. diabetes, pre-existing kidney disease) or patients who are immunosuppressed and therefore more prone to serious infections (e.g. HIV, patients on chemotherapy).
Recurrent Urinary Tract Infection (UTI) is defined as having UTI three or more times in a year. This can be due to the same or different bacteria. In these cases, further investigations may need to be done, e.g. renal ultrasound, intravenous pyelogram, cystoscopy, urine for tuberculosis and cytology, to look for any underlying causes and complications of recurrent Urinary Tract Infections (UTIs).
Patients with recurrent Urinary Tract Infections (UTIs) may be given prophylactic antibiotics for a period of six months. They will also be advised on the various preventive measures and the importance of keeping good personal hygiene.