Bacterial Urinary Tract Infection

The urinary tract consists of several structures, namely the urethra, ureters, bladder and kidneys. When any of these structures becomes infected by microscopic organisms called bacteria, the result is a bacterial urinary tract infection (UTI). [1]

Types

Bacterial UTI can be divided into three major categories depending on which structure is involved. Infection of the urethra causes urethritis. When bacteria ascend to the bladder, UTI is known as cystitis. When the kidney is affected, it is termed pyelonephritis. [2]

Epidemiology

UTI is a common medical concern, accounting for approximately 8.1 million clinic visits annually. [3] Around 80% of these cases are caused by the bacterial strain Escherichia coli. Bacterial UTI is also 50-fold more common in females than males among adults 20 to 50 years of age. [4] Beyond this age, the incidence increases with the female-to-male ratio decreasing, since bacterial UTI can also involve the prostate in elderly males. [5]

Causes

Females may get UTI when wiping from back to front during urination. [4] Bacteria can more easily get into the urinary tract because the female urethra is shorter and straighter compared with males. Being sexually active may also increase the chance of getting UTI; for instance, vaginal bacteria can be pushed up into the urethra and may go all the way up to the bladder. [2] Men may also acquire UTI through sexual intercourse, especially those with unprotected anal intercourse and an uncircumcised penis. Risk factors include use of contraceptives, urinary instrumentation such as catheterisation, advanced age, diabetes, anatomic abnormalities and poor bladder emptying. [5]

Signs and Symptoms

People affected may present with mild symptoms or no symptoms at all. The infection can also be spontaneously cleared in 2–5 days. Symptoms depend on age, gender and location of infection. Urethritis usually presents with pain or discomfort during urination, with STD infections commonly causing a pus-like discharge. [1] Symptoms of cystitis include cloudy or bloody urine, which may have a foul odour, low fever (not always), pain on urination, lower mid-abdominal cramps and urinary urgency. Pyelonephritis usually causes chills, night sweats, fever above 101 degrees Fahrenheit, nausea and vomiting, flushed skin, and pain in the flanks, back or groin. [6]

Diagnosis

After taking a medical history and performing a physical examination, urinalysis is usually done. Other tests may also be requested, such as urine cultures, kidney and bladder ultrasound, complete blood count (CBC) and other specialised laboratory tests. [5]

Treatment

Bacterial UTI usually needs antibiotics for treatment. Surgery may be done when necessary. [5]

Efficacy of Alternative and Other Treatments According to GRADE* Ranking

* www.gradeworkinggroup.org

Condition References

1. MedicineNet: Urine Infection
2. KidsHealth: UTI
3. NIDDK: Urinary Tract Infection in Adults
4. University of Maryland Medical Center: UTI infectious agents
5. Merck Manual: Bacterial Urinary Tract Infections
6. New York Times Health Guide: Urinary Tract Infection

Summary References

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