The urinary system is normally composed of two kidneys, two ureters, a single urinary bladder and a single urethra. Urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. UTI is the second most common type of infection in the body.
The symptoms of urinary tract infections may vary with severity of infection, age and location of infection in the tract.
This is the most serious symptom of urinary tract infection as it implies systemic involvement. Inadequate and delayed treatment can be life threatening.
Important causes of frequent or recurrent urinary tract infections are:
Recurrent lower urinary tract infection usually does not cause damage to kidneys in adults.
UTI in adults can cause damage to the kidneys if predisposing factors such as stone, blockage or narrowing of flow of urine and tuberculosis of the genito-urinary tract are not corrected.
However, in young children, delayed or improper treatment of recurrent urinary tract infection can cause irreversible damage to the growing kidney especially in those with vesico-ureteral reflux. This damage may lead to reduction of kidney function and high blood pressure later in life. So the problem of urinary tract infection is more serious in children compared to adults.
Investigations are performed to establish diagnosis and severity of urinary tract infection. In a person with complicated or recurrent urinary tract infection different tests are performed to establish the presence of predisposing or risk factors.
Most important screening test for UTI is routine urinalysis. Early morning urine sample is preferable for this test. In microscopic examination of urine, presence of significant white blood cells is suggestive of UTI.
Presence of white blood cells in urine suggests inflammation of the urinary tract but its absence does not exclude UTI.
Special urine dipstick (leukocyte esterase and nitrite) tests are useful screening tests for UTI that can be done at the office or home. A positive urine dipstick test suggests UTI and such patients need further evaluation. The intensity of colour change is proportional to the number of bacteria in the urine.
The gold standard for the diagnosis of UTI is a urine culture test and it should be done before starting antibiotic therapy. A urine culture is recommended in complicated or resistant UTI and, in a few cases, for the confirmation of the clinical diagnosis of urinary tract infection. Urine culture test results are available after 48-72 hours. The significant time delay between collection of sample and availability of the report is a major drawback of this test. Urine culture identifies the specific bacteria causing infection based on the nature of growth of the organism and the number of colony forming units that grow in the Petri dish in the laboratory. The urine culture result also includes the type of antibiotics that the organism grown may be sensitive or resistant to. This guides the doctor in the appropriate choice of antibiotic.
To avoid potential contamination of the urine sample, the patient is asked first to clean the genital area and to collect midstream urine in a sterile container. Other methods used for sample collection for urine culture are supra-pubic aspiration, catheter-specimen urine and bag specimen urine.
Blood tests usually performed in a patient with UTI include a complete blood count (CBC), blood urea, serum creatinine, blood sugar and C reactive protein.
If the infection does not respond to treatment or if there is repetition of infections, further investigations, as mentioned below, are required to detect underlying predisposing or risk factors:
Drink plenty of water. A person who is very ill, dehydrated or unable to take adequate oral fluids due to vomiting, will need hospitalization and administration of IV fluids.
Take medications to reduce fever and pain. Use of heating pad reduces pain. Avoid coffee, alcohol, smoking and spicy foods, all of which irritate the bladder. Follow all preventive measures of urinary tract infection.
urinary tract infection.
In a healthy young female, short term antibiotics for three days is usually enough. Some drugs need to be given for seven days to complete a course.
Patients with moderate-to-severe acute kidney infection, those with severe symptoms or sick patients need hospitalization. Urine and blood cultures are obtained before initiating therapy to identify causative bacteria and proper selection of antibiotics. Patients are treated with intravenous fluids and antibiotics for several days, followed by 10-14 days of oral antibiotics. If response to IV antibiotics is poor (marked by persistent symptoms and fever, worsening kidney function) imaging is indicated. Follow up urine tests are necessary to assess response to therapy.
In patients with recurrent UTI, proper identification of the underlying cause is essential. According to the underlying cause, specific medical or surgical treatment is planned. These patients need follow-up, strict adherence to preventive measures and long term preventive antibiotic therapy.
All children with UTI should be evaluated by a doctor. Adult patients with UTI should immediately consult a doctor when there is: