URINARY TRACT INFECTION (UTI)

What is Urinary Tract Infection(UTI)?

A urinary tract infection (UTI) is an infection involving the kidneys, ureters, bladder, or urethra. These are the structures that urine passes through before being eliminated from the body.

• The kidneys are a pair of small organs that lie on either side of the spine at about waist level. They have several important functions in the body, including removing waste and excess water from the blood and eliminating them as urine. These functions make them important in the regulation of blood pressure. Kidneys are also very sensitive to changes in blood sugar levels and blood pressure and electrolyte balance. Both diabetes and hypertension can cause damage to these organs.
• Two ureters, narrow tubes about 10 inches long, drain urine from each kidney into the bladder.
• The bladder is a small saclike organ that collects and stores urine. When the urine reaches a certain level in the bladder, we experience the sensation that we have to void, then the muscle lining the bladder can be voluntarily contracted to expel the urine.
• The urethra is a small tube connecting the bladder with the outside of the body. A muscle called the urinary sphincter, located at the junction of the bladder and the urethra, must relax at the same time the bladder contracts to expel urine.

Reasons for Urinary tract Infection:

The urine is normally sterile. An infection occurs when bacteria get into the urine and begin to grow. The infection usually starts at the opening of the urethra where the urine leaves the body and moves upward into the urinary tract.

• The culprit in at least 90% of uncomplicated infections is a type of bacteria called Escherichia coli, better know as E. coli. These bacteria normally live in the bowel (colon) and around the anus.
• These bacteria can move from the area around the anus to the opening of the urethra. The two most common causes of this are improper wiping and sexual intercourse.
• Usually, the act of emptying the bladder (urinating) flushes the bacteria out of the urethra. If there are too many bacteria, urinating may not stop their spread.
• The bacteria can travel up the urethra to the bladder, where they can grow and cause an infection.
• The infection can spread further as the bacteria move up from the bladder via the ureters.
• If they reach the kidney, they can cause a kidney infection (pyelonephritis), which can become a very serious condition if not treated promptly.
• The following people are at increased risk of urinary tract infection:
• People with conditions that block (obstruct) the urinary tract, such as kidney stones
• People with medical conditions that cause incomplete bladder emptying (for example, spinal cord injury or bladder decompensation after menopause)
• People with suppressed immune systems: Examples of situations in which the immune system is suppressed are HIV/AIDS and diabetes. People who take immunosuppressant medications such as chemotherapy for cancer also are at increased risk.
• Women who are sexually active: Sexual intercourse can introduce larger numbers of bacteria into the bladder. Urinating after intercourse seems to decrease the likelihood of developing a urinary tract infection.
• Women who use a diaphragm for birth control
• Men with an enlarged prostate: Prostatitis or obstruction of the urethra by an enlarged prostate can lead to incomplete bladder emptying, thus increasing the risk of infection. This is most common in older men.
• Males are also less likely to develop UTIs because their urethra (tube from the bladder) is longer. There is a drier environment where a man's urethra meets the outside world, and fluid produced in the prostate can fight bacteria.
• Breastfeeding has been found to decrease the risk for urinary tract infections in children.

The following special groups may be at increased risk of urinary tract infection:

• Very young infants: Bacteria gain entry to the urinary tract via the bloodstream from other sites in the body.
• Young children: Young children have trouble wiping themselves and washing their hands well after a bowel movement. Poor hygiene has been linked to an increased frequency of urinary tract infections.
• Children of all ages: Urinary tract infection in children can be (but is not always) a sign of an abnormality in the urinary tract, usually a partial blockage. An example is a condition in which urine moves backward from the bladder up the ureters (vesicoureteral reflux).
• Hospitalized patients or nursing-home residents: Many of these individuals are catheterized for long periods and are thus vulnerable to infection of the urinary tract. Catheterization means that a thin tube (catheter) is placed in the urethra to drain urine from the bladder. This is done for people who have problems urinating or cannot reach a toilet to urinate on their own.

What are urinary tract infection symptoms and signs?

Lower urinary tract infection

• Bladder (cystitis): The lining of the urethra and bladder becomes inflamed and irritated.
• Dysuria: pain or burning during urination
• Frequency: more frequent urination (or waking up at night to urinate, sometimes referred to as nocturia); often with only a small amount of urine
• Urinary urgency: the sensation of having to urinate urgently
• Cloudy, bad-smelling, or bloody urine
• Lower abdominal pain or pelvic pressure
• Mild fever (less than 101 F), chills, and "just not feeling well" (malaise)
• Urethra (urethritis): Burning with urination

Upper urinary tract infection (pyelonephritis)

Symptoms develop rapidly and may or may not include the symptoms for a lower urinary tract infection.

• Fairly high fever (higher than 101 F)
• Shaking chills
• Nausea
• Vomiting
• Flank pain: pain in the back or side, usually on only one side at about waist level

In newborns, infants, children, and elderly people, the classic symptoms of a urinary tract infection may not be present. Other symptoms may indicate a urinary tract infection.

• Newborns: fever or hypothermia (low temperature), poor feeding, jaundice
• Infants: vomiting, diarrhea, fever, poor feeding, not thriving
• Children: irritability, eating poorly, unexplained fever that doesn't go away, loss of bowel control, loose bowels, change in urination pattern
• Elderly people: fever or hypothermia, poor appetite, lethargy, change in mental status

Pregnant women are at increased risk for an UTI. Typically, pregnant women do not have unusual or unique symptoms. If a woman is pregnant, her urine should be checked during prenatal visits because an unrecognized infection can cause pregnancy complications.
Although most people have symptoms with a urinary tract infection, some do not.

When should people seek medical care for a UTI?

Any adult or child who develops any of the symptoms of a urinary tract infection needs to be evaluated by a medical professional, preferably within 24 hours. Most medical offices can test urine for infection by using a quick urine "dipstick" test.

• Someone who has symptoms of a lower urinary tract infection should call a health-care professional for an appointment, preferably on the same day that symptoms are recognized.
• Someone who has symptoms of an upper urinary tract infection involving the kidneys should call a health-care professional immediately. Depending on the situation, he or she will recommend either a visit to the office or to a hospital emergency department.

If someone has symptoms of a lower urinary tract infection and any of the following applies, he or she may have a urinary tract infection that can potentially be serious. Go to a hospital emergency department right away.

• Vomiting and inability to keep down clear fluids or medication
• Not better after taking antibiotics for two days
• Pregnant
• Having diabetes or another disease that affects the immune system
• Taking medication that suppresses the immune system such as cancer chemotherapy

Infants, children, and elderly people with any of the signs and symptoms of UTI should see their health-care professional as soon as possible or go to an emergency department for evaluation.

• Fever, lethargy, and poor appetite may indicate a urinary tract infection in these groups, but they may also be signs of something more serious.

• Urinary tract infections have the potential to make these vulnerable people very ill when the bacteria spread into the bloodstream

Medicines useful in UTI:

• amikacin
• ampicillin
• cefepime
• cefixime
• cefoxitin
• doxycycline
• flavoxate
• gatifloxacin
• nalidixic acid
• norfloxacin
• sultamicillin
• ticrcillin

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