Urinary tract infection: Difference between revisions
Content deleted Content added
m →Prevention: bypass redirect |
←Replaced page with 'wat losers' |
||
| Line 1: | Line 1: | ||
wat losers |
|||
{{DiseaseDisorder infobox | |
|||
Name = Urinary tract infection | |
|||
ICD10 = {{ICD10|N|39|0|n|30}} | |
|||
ICD9 = {{ICD9|599.0}} | |
|||
ICDO = | |
|||
Image = Bacteriuria pyuria 4.jpg | |
|||
Caption = Multiple rod-shaped bacteria shown between [[white cell]]s at urinary microscopy from a patient with urinary tract infection.| |
|||
OMIM = | |
|||
OMIM_mult = | |
|||
MedlinePlus = 000521 | |
|||
eMedicineSubj = emerg | |
|||
eMedicineTopic = 625 | |
|||
eMedicine_mult = {{eMedicine2|emerg|626}}| |
|||
DiseasesDB = 13657 | |
|||
MeshID = D014552 | |
|||
}} |
|||
A '''urinary tract infection''' ('''UTI''') is a bacterial [[infection]] that affects any part of the [[urinary tract]]. Although [[urine]] contains a variety of fluids, salts, and waste products, it usually does not have bacteria in it.<ref>{{cite web |url=http://www.med.umich.edu/1libr/aha/aha_asybac_crs.htm |title=Adult Health Advisor 2005.4: Bacteria in Urine, No Symptoms (Asymptomatic Bacteriuria) |accessdate=2007-08-25 |format= |work=}}</ref> When bacteria get into the [[Urinary bladder|bladder]] or [[kidney]] and multiply in the urine, they cause a UTI. The most common type of UTI is a bladder infection which is also often called [[cystitis]]. Another kind of UTI is a kidney infection, known as [[pyelonephritis]], and is much more serious. Although they cause discomfort, urinary tract infections are usually quickly and easily treated by seeing a doctor promptly.<ref>{{cite web |url=http://www.braithwaite.yourmd.com/ypol/user/userMain.asp?siteid=1713982&content=userCustomPage&bcx=My%20Doctor^TAB~Web%20Site^MNU~Dr%20S.%20Braithwaite^PST^1713982~UTI^CAT^9&pageid=336989&rndm=0.2728092846502904 |title=Urinary Tract Infections |accessdate=2007-08-25 |format= |work=}}</ref> |
|||
==Symptoms & signs== |
|||
===For bladder infections=== |
|||
* [[Frequent urination]] along with the feeling of having to [[urinate]] even though there may be very little urine to pass. |
|||
* [[Nocturia]]: Need to urinate during the night. |
|||
* [[Urethritis]]: Discomfort or pain at the [[urinary meatus|urethral meatus]] or a burning sensation throughout the urethra with [[urination]] ([[dysuria]]). |
|||
* [[Pain]] in the midline suprapubic region. |
|||
* [[Pyuria]]: Pus in the urine or discharge from the urethra. |
|||
* [[Hematuria]]: Blood in urine. |
|||
* [[Pyrexia]]: Mild [[fever]] |
|||
* Cloudy and foul-smelling urine |
|||
* Increased confusion and associated falls are common presentations to Emergency Departments for elderly patients with UTI. |
|||
* Some urinary tract infections are [[asymptomatic]]. |
|||
===For kidney infections=== |
|||
* The above symptoms. |
|||
* [[Emesis]]: Vomiting is common[http://www.askdrsears.com/html/8/T080800.asp]. |
|||
* Back, side (flank) or groin pain. |
|||
* Abdominal pain or pressure. |
|||
* Shaking chills and high spiking fever. |
|||
* Night sweats. |
|||
* Extreme fatigue. |
|||
==Epidemiology== |
|||
UTIs are most common in sexually active women and increase in [[diabetes mellitus|people living with diabetes]] and people with [[sickle-cell disease]] or anatomical malformations of the urinary tract. |
|||
Since bacteria can enter the urinary tract through the [[urethra]] (an ascending infection), poor toilet habits can predispose to infection, but other factors ([[pregnancy]] in women, [[prostate]] enlargement in men) are also important and in many cases the initiating event is unclear. |
|||
While ascending infections are generally the rule for lower urinary tract infections and [[cystitis]], the same may not necessarily be true for upper urinary tract infections like [[pyelonephritis]] which may be hematogenous in origin. |
|||
Allergies can be a hidden factor in urinary tract infections. For example, allergies to foods can irritate the bladder wall and increase susceptibility to urinary tract infections. Keep track of your diet and have allergy testing done to help eliminate foods that may be a problem. Urinary tract infections after sexual intercourse can be also be due to an allergy to latex condoms, spermicides, or oral contraceptives. In this case review alternative methods of birth control with your doctor. |
|||
The use of [[urinary catheter]]s in both women and men who are elderly, people experiencing nervous system disorders and people who are convalescing or unconscious for long periods of time may result in an increased risk of urinary tract infection for a variety of reasons. Scrupulous aseptic technique may decrease this risk. |
|||
The bladder wall is coated with various mannosylated proteins, such as Tamm-Horsfall proteins (THP), which interfere with the binding of bacteria to the uroepithelium. As binding is an important factor in establishing pathogenicity for these organisms, its disruption results in reduced capacity for invasion of the tissues.{{Clarifyme|date=March 2008}} Moreover, the unbound bacteria are more easily removed when voiding. The use of urinary catheters (or other physical trauma) may physically disturb this protective lining, thereby allowing bacteria to invade the exposed epithelium. |
|||
Elderly individuals, both men and women, are more likely to harbor bacteria in their genitourinary system at any time. These bacteria may be associated with symptoms and thus require treatment with an antibiotic. The presence of bacteria in the urinary tract of older adults, without symptoms or associated consequences, is also a well recognized phenomenon which may not require antibiotics. This is usually referred to as asymptomatic bacteriuria. The overuse of antibiotics in the context of bacteriuria among the elderly is a concerning and controversial issue. |
|||
Women are more prone to UTIs than males because in females, the [[urethra]] is much shorter and closer to the [[anus]] than in males,<ref>Urethra length is approximately 25–50 mm / 1-2 inches long in females, versus about 20 cm / 8 inches in males.</ref> and they lack the bacteriostatic properties of prostatic secretions. Among the elderly, UTI frequency is in roughly equal proportions in women and men.{{Fact|date=December 2007}} |
|||
A common cause of UTI is an increase in sexual activity, such as vigorous sexual intercourse with a new partner. The term "honeymoon cystitis", although somewhat demeaning, has been applied to this phenomenon.<ref>{{cite web |url=http://healthlink.mcw.edu/article/998784819.html |title=Honeymoon Cystitis |accessdate=2007-11-02 |format= |work=}}</ref> |
|||
==Diagnosis== |
|||
[[Image:Bacteriuria pyuria 4.jpg|right|thumb|300px|Multiple [[bacilli]] (rod-shaped bacteria, here shown as black and bean-shaped) shown between [[white cell]]s at urinary microscopy. This is called [[bacteriuria]] and [[pyuria]], respectively. These changes are indicative of a urinary tract infection, so this sample should be sent for [[bacterial culture]] and [[antibiogram]].]] |
|||
A patient with [[dysuria]] (painful voiding) and urinary frequency generally has a spot mid-stream urine sample sent for [[urinalysis]], specifically the presence of [[nitrite]]s, [[leukocyte]]s or [[leukocyte esterase]]. If there is a high bacterial load without the presence of leukocytes, it is most likely due to contamination. The diagnosis of UTI is confirmed by a urine [[microbiological culture|culture]]. |
|||
If the urine culture is negative: |
|||
* symptoms of urethritis may point at ''[[Chlamydia trachomatis]]'' or ''[[Neisseria gonorrheae]]'' infection. |
|||
* symptoms of cystitis may point at [[interstitial cystitis]]. |
|||
* in men, [[prostatitis]] may present with dysuria. |
|||
In severe infection, characterized by [[fever]], [[rigor (medicine)|rigor]]s or flank pain, [[urea]] and [[creatinine]] measurements may be performed to assess whether [[renal function]] has been affected. |
|||
Most cases of lower urinary tract infections in females are benign and do not need exhaustive laboratory work-ups. However, UTI in young infants must receive some imaging study, typically a retrograde urethrogram, to ascertain the presence/absence of congenital urinary tract anomalies. Males too must be investigated further. Specific methods of investigation include [[x-ray]], [[Magnetic resonance imaging|MRI]] and [[Computed Axial Tomography|CAT]] scan technology. |
|||
==Treatment== |
|||
Most uncomplicated UTIs can be treated with oral [[antibiotic]]s such as [[trimethoprim]], [[cephalosporin]]s, [[nitrofurantoin]], or a [[fluoroquinolone]] (e.g. [[ciprofloxacin]], [[levofloxacin]]). These are usually taken for 3 days in young adults, and 5 days in elderly. Whilst [[co-trimoxazole]] was previously internationally used (and continues to be used in the U.S.), the additional of the [[sulfonamide]] gave little additional benefit compared to the trimethoprim component alone, but was responsible for its both high incidence of mild allergic reactions and rare but serious complications. |
|||
If the patient has symptoms consistent with [[pyelonephritis]], [[intravenous]] antibiotics may be indicated. Regimens vary, usually [[Aminoglycosides]] (such as Gentamicin) are used in combination with a beta-lactam, such as Ampicillin or Ceftriaxone. These are continued for 48 hours after fever subsides. The patient may then be discharged home on oral antibiotics for a further 5 days. |
|||
If the patient makes a poor response to IV antibiotics (marked by persistent fever, worsening renal function), then imaging is indicated to rule out formation of an [[abscess]] either within or around the kidney, or the presence of an obstructing lesion such as a stone or tumor. The gold-standard imaging modality is [[CT scan]]. |
|||
As an at-home treatment, increased water-intake, frequent voiding, the avoidance of sugars and sugary foods, drinking unsweetened cranberry juice, as well as taking vitamin C with the last meal of the day can shorten the time duration of the infection. Sugars and alcohol can feed the bacteria causing the infection, and worsen pain and other symptoms. Vitamin C at night raises the acidity of the urine, which retards the growth of bacteria in the urinary tract. However, if pain is in the back region (suggesting kidney infection) or if pain persists, if there is fever, or if blood is present in the urine, doctor care is recommended. |
|||
===Recurrent UTIs=== |
|||
:See also [[Urinary tract infection#Prevention|Prevention]] (below) |
|||
Patients with recurrent UTIs may need further investigation. This may include [[medical ultrasonography|ultrasound]] scans of the kidneys and bladder or [[intravenous urography]] (X-rays of the urological system following intravenous injection of iodinated contrast material). If there is no response to treatments, [[interstitial cystitis]] may be a possibility. |
|||
During cystitis, uropathogenic ''[[Escherichia coli]]'' (UPEC) subvert innate defenses by invading superficial umbrella cells and rapidly increasing in numbers to form intracellular bacterial communities (IBCs).<ref>{{cite journal |author=Justice S, Hunstad D, Seed P, Hultgren S |title=Filamentation by Escherichia coli subverts innate defenses during urinary tract infection |journal=Proc Natl Acad Sci U S A |volume=103 |issue=52 |pages=19884-9 |year=2006 |id=PMID 17172451}}</ref> |
|||
==Prevention== |
|||
The following are measures that studies suggest may reduce the [[incidence (epidemiology)|incidence]] of urinary tract infections. These may be appropriate for people, especially women, with recurrent infections: |
|||
* Cleaning the [[urinary meatus|urethral meatus]] (the opening of the [[urethra]]) after [[sexual intercourse|intercourse]] has been shown to be of some benefit; however, whether this is done with an [[antiseptic]] or a [[placebo]] ointment (an ointment containing no active ingredient) does not appear to matter.<ref name=meyhoff>{{cite journal | author = Meyhoff H, Nordling J, Gammelgaard P, Vejlsgaard R | title = Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis? | journal = Scand J Urol Nephrol | volume = 15 | issue = 2 | pages = 81-3 | year = 1981 | id = PMID 7036332}}</ref> |
|||
* It has been advocated that [[cranberry]] juice can decrease the incidence of UTI (some of these opinions are referenced in External Links section). A specific type of [[tannin]] found only in cranberries and [[blueberries]] prevents the [[adherence]] of certain [[pathogens]] (eg. E. coli) to the [[epithelium]] of the urinary bladder. A review by the [[Cochrane Collaboration]] of randomized controlled trials states 'some evidence from trials to show cranberries (juice and capsules) can prevent recurrent infections in women. Many people in the trials stopped drinking the juice, suggesting it may not be a popular intervention'.<ref name=jepson>{{cite journal | author = RG Jepson, JC Craig | title = [http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001321/frame.html Cranberries for preventing urinary tract infections]. | journal = Cochrane Database Syst Rev | volume = | issue = | pages = CD001321 | year = 2008 | id = PMID 14973968}}</ref> |
|||
* For post-menopausal women, a [[randomized controlled trial]] has shown that intravaginal application of topical estrogen cream can prevent recurrent cystitis.<ref name=Raz>{{cite journal | author = Raz R, Stamm W | title = A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. | journal = N Engl J Med | volume = 329 | issue = 11 | pages = 753-6 | year = 1993 | id = PMID 8350884}}</ref> In this study, patients in the experimental group applied 0.5 mg of estriol vaginal cream nightly for two weeks followed by twice-weekly applications for eight months. |
|||
*Often long courses of low dose antibiotics are taken at night to help prevent otherwise unexplained cases of recurring cystitis. |
|||
*[[Acupuncture]] has been shown to be effective in preventing new infections in recurrent cases.<ref name="TidsskrNorLaegeforen1998-Aune">{{cite journal | author=Aune A, Alraek T, Huo L, Baerheim A | title=[Can acupuncture prevent cystitis in women?] | journal=Tidsskr Nor Laegeforen | year=1998 | pages=1370-2 | volume=118 | issue=9 | id=PMID 9599500 }} ''(cf acupuncture group, x2 incidents in the sham group, x3 in the control group)''</ref><ref name="ComplementTherMed2001-Alraek">{{cite journal | author=Alraek T, Baerheim A | title='An empty and happy feeling in the bladder.. .': health changes experienced by women after acupuncture for recurrent cystitis | journal=Complement Ther Med | year=2001 | pages=219-23 | volume=9 | issue=4 | id=PMID 12184349}}</ref><ref name="JAlternComplementMed2003-Alraek">{{cite journal | author=Alraek T, Baerheim A | title=The effect of prophylactic acupuncture treatment in women with recurrent cystitis: kidney patients fare better | journal=J Altern Complement Med | year=2003 | pages=651-8 | volume=9 | issue=5 | id=PMID 14629843}} ''(highlights need for considering different TCM diagnostic categories in acupuncture research)''</ref> One study showed that urinary tract infection occurrence was reduced by 50% for 6 months.<ref name=Alraek2002>{{cite journal | author = Alraek T, Soedal L, Fagerheim S, Digranes A, Baerheim A | title = Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. | journal = Am J Public Health | volume = 92 | issue = 10 | pages = 1609-11 | year = 2002 | id = PMID 12356607}}</ref> However, this study has been criticized for several reasons.<ref name="AmJPublicHealth2003-Katz">{{cite journal | author=Katz AR | title=Urinary tract infections and acupuncture | journal=Am J Public Health | year=2003 | pages=702; author reply 702-3 | volume=93 | issue=5 | id=PMID 12721123 (no abstract)}}</ref> Acupuncture appears to reduce the total amount of residual urine in the bladder {{Fact|date=February 2007}}. All of the studies are done by one research team without independent reproduction of results. |
|||
The following measures seem sensible, but have not been studied: |
|||
* Cleaning genital areas prior to and after [[sexual intercourse]]. |
|||
* Men engaging in [[anal sex]] should wear [[condom]]s to protect themselves from bacteria found in the [[bowels]]. Similarly, women engaging in anal sex should ensure that their partner does not penetrate their [[vagina]] after removal from the anus without cleaning themselves first with soap. |
|||
* For sexually active women, and to a lesser extent men, urinating within 15 minutes of sexual intercourse to allow the flow of urine to expel the bacteria before specialized extensions anchor the bacteria to the walls of the urethra. |
|||
* Having adequate fluid intake, especially water. |
|||
* Not resisting the urge to urinate. |
|||
* Bathing in warm water without soap, bath foams, etc. |
|||
* Practicing good hygiene, including wiping from the front to the back to avoid contamination of the urinary tract by fecal pathogens. |
|||
==References== |
|||
{{Reflist|2}} |
|||
== See also == |
|||
* [[Nosocomial infection]] |
|||
* [[vulvovaginal health]] |
|||
==External links== |
|||
*[[NIH]] articles on Urinary Tract Infections in [http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/ Adults] and in [http://kidney.niddk.nih.gov/kudiseases/pubs/utichildren/ Children]. |
|||
* {{MedlinePlusOverview|urinarytractinfections}} |
|||
* {{GPnotebook|-375783424}} |
|||
* {{DMOZ|Health/Conditions_and_Diseases/Genitourinary_Disorders/Urinary_Tract_Infections/}} |
|||
{{Nephrology}} |
|||
[[Category:Infectious diseases]] |
|||
[[Category:Urology]] |
|||
[[Category:Nephrology]] |
|||
[[de:Harnwegsinfekt]] |
|||
[[es:Infección urinaria]] |
|||
[[fr:Infection urinaire]] |
|||
[[ja:尿路感染症]] |
|||
[[no:Urinveisinfeksjon]] |
|||
[[pl:Zakażenie układu moczowego]] |
|||
[[pt:Infecção do trato urinário]] |
|||
[[sv:Urinvägsinfektion]] |
|||
[[tr:İdrar yolu enfeksiyonları]] |
|||
[[vi:Nhiễm trùng đường tiểu]] |
|||
[[zh:泌尿道感染]] |
|||
Revision as of 00:28, 20 March 2008
wat losers