Urinary Tract Infections - Causes, symptoms, treatments

  • A urinary tract infection is an infection caused by the entry of microorganisms into the urinary tract which normally is free of germs. 
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  • Urethritis is a condition in which the microbe is in the urethra, prostatitis when the microorganisms are found in the prostate, acute pyelonephritis when there is bacterial invasion of the renal parenchyma and cystitis which is a bladder infection. Most urinary tract infections are caused by bacteria that normally live in the intestine. Escherichia coli (E. coli) bacteria causes the overwhelming majority of urinary tract infections.
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  • How often do they appear?
  • Urinary tract infection is not the same at all ages. They are more common among younger boys (infants, toddlers) than in girls, possibly due to anatomical anomalies. During reproductive age, they are more common in women, possibly due to the short urethra, while in young men they are rare and almost always associated with prostate infection or functional and anatomical abnormalities. In the elderly, both men and women have an equal chance of symptomatic or asymptomatic bacteriuria due to the atrophy of the vaginal epithelium in women and prostatic hypertrophy in men that prevents the smooth flow of urine.
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  • What are the risk factors for urinary tract infections?
  • Poor genital hygiene, poor urination habits (repeated postponement of urination), contraceptive methods (diaphragm or spermicide), residual urine (e.g. large prostate), diabetes mellitus, and urinary catheter use (which as a foreign body increases susceptibility to urinary tract infections).
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  • What are the symptoms?
  • The clinical picture is correlated to the level of the localization of the infection. Bladder infection (acute cystitis) is more common in women, with 95% showing signs of urinary tract infection. The symptomatology in this case usually includes frequent urination, dysuria, abdominal pain, and cloudy urine with unpleasant odor or even with hematuria. When the infection is detected in the prostate (prostatitis), it usually includes dysuria, frequent fever (with shiver) and intense pain when the doctor uses his finger to palpate the prostate gland. When the patient experiences high fever and shivering, a tendency to vomit, severe back pain near the kidneys, theinfection is then detected in the kidney (pyelonephritis) and hospitalization is mandatory. A cystitis may have preceded that spread to kidneys.
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  • How is diagnosis made?
  • Suspicion originates from the clinical picture and diagnosis is confirmed by a urine culture. Urine culture is used to examine the presence of microbes in the urine, the identity of the microbe and its sensitivity to various antibiotics. Usually results of a urine culture are typically ready in 48 hours.
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  • What is the procedure for urine culture?
  • The sample should be taken using the first urine in the morning or at least 3 hours must have passed from the previous urination. Wash the genitals carefully with plain soap and then rinse thoroughly. Urine should be collected in a sterile container, which are available at the pharmacy. Carefully remove the lid from the sterile container. Discard the first urine void, and begin the collection from the middle of the urine. Close the cap carefully, without touching the inside of the container and transfer it to the lab.
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  • What is the proper treatment?
  • Which antibiotics will be prescribed and for how long depend on the doctor to treat urinary tract infections, if needed. For example, some forms of urinary tract infection do not need treatment (asymptomatic microbial in a patient with a permanent urinary catheter). The decision concerning the type of the treatment and the antibiotics will be taken by the doctor who considers gender, medical history, previous antibiotics prescription, detection of urinary tract infection and previous relapses.It makes no sense to consume large amounts of water while taking the antibiotics (resulting in large drug dilution). It is better to consume more than 2-3 liters of water before starting medication and after 6 hours (since the microbial load has been reduced) to initiate antimicrobial therapy.
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  • What are recurrent urinary tract infections?
  • They are infections of the urinary tract that keep recurring 3-4 times per year. At less than 5% of these cases, we can find out the cause of the relapses.
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  • Are there precautions for relapses?
  • -Consumption of large quantities of liquids and especially water, to drain the bladder frequently and to dilute the microbial population.
  • -Women should avoid wiping from the rectum to the urethra (to prevent the microbes of the perianal area from being carried into the urethra).
  • -Both partners should follow specific hygiene rules during sexual intercourse.
  • -Empty the bladder as soon as you feel the need. The opposite, it favors multiplication of the microbes.
  • -The daily consumption of cramps juice has been indicated to reduce the risk of urinary tract infections in women by 15-20% (one of its components prevents microbes from sticking to the bladder walls).
  • -Never stay in a wet swimsuit for too long during thesummer months and avoid direct contact with the sand.
  • -It is recommended that postmenopausal women with relapsing urinary tract infections follow an intravaginal estrogen therapy, but consult your gynecologist first. The so-called chemoprophylaxis, e.g. the long-term low-dose antibiotic, is an option. It should be decided by the doctor about the type of antibiotics, dose, as well as duration.
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  • Pregnancy and urinary tract infection
  • The frequency of urinary tract infections in pregnant women is not very different from that of non-pregnant women. But their relapse is more common. However, if the asymptomatic microbe (meaning the presence of microbes in urine without symptomatology) remains untreated in pregnant women, then 30-40% will experience pyelonephritis. Thus, in pregnancy, asymptomatic microbial is treated with a five-day pattern and a new test by performing a new urine culture in the next 15 days. We advise that you consult your doctor and NEVER take antibiotics without his advice.
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  • Mesogeios Dialysis Centers Group Scientific Team
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  • Bibliography
  • 1.Community Infections and Their Treatment, Eleni Giamarellou, IFET Publishing
  • 2.Urinary tract infection in adults, in The Kidney, Brenner& Rector’s, 9th Edition , Elsevier
  • 3.Detweiler K, Mayers D, Fletcher SG. Bacteruria and Urinary Tract Infections in the Elderly. Urol Clin North Am. 2015 Nov;42(4):561-8.
  • 4.Glaser AP, Schaeffer AJ. Urinary Tract Infection and Bacteriuria in Pregnancy. Urol Clin North Am. 2015 Nov;42(4):547-60.doi: 10.1016/j.ucl.2015.05.004.
  • 5.Kumar S, Dave A, Wolf B, Lerma EV. Urinary tract infections. Dis Mon. 2015 Feb;61(2):45-59. doi: 10.1016/j.disamonth.2014.12.002. Review.
  • 6.Casey G. Understanding urinary tract infections. Nurs N Z. 2014 Jun;20(5):20-3. Review.
  • 7.Chenoweth CE, Gould CV, Saint S. Diagnosis, management, and prevention of catheter-associated urinary tract infections. Infect Dis Clin North Am. 2014 Mar;28(1):105-19
  • 8.Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA. 2014 Feb 26;311(8):844-54. doi: 10.1001/jama.2014.303. Review.
  • 9.Wang A, Nizran P, Malone MA, Riley T. Urinary tract infections. Prim Care. 2013 Sep;40(3):687-706.
  • 10.Nicolle LE. Urinary tract infection. Crit Care Clin. 2013 Jul;29(3):699-715.
  • 11.Matthews SJ, Lancaster JW. Urinary tract infections in the elderly population. Am J Geriatr Pharmacother. 2011 Oct;9(5):286-309.
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