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Urinary tract infection

"UTI" redirects here. For other uses, see UTI (disambiguation).

Urinary tract infection
Other namesAcute cystitis, simple cystitis, bladder infection, symptomatic bacteriuria
Multiple white cells seen in the urine of a person with a urinary tract infection using microscopy
SpecialtyInfectious disease, Urology
SymptomsPain with urination, frequent urination, feeling the need to urinate despite having an empty bladder[1]
CausesMost often Escherichia coli[2]
Risk factorsCatheterisation (foley catheter), female anatomy, sexual intercourse, diabetes, obesity, family history[2]
Diagnostic methodBased on symptoms, urine culture[3][4]
Differential diagnosisVulvovaginitis, urethritis, pelvic inflammatory disease, interstitial cystitis,[5] kidney stone disease[6]
TreatmentAntibiotics (nitrofurantoin or trimethoprim/sulfamethoxazole)[7]
Frequency152 million (2015)[8]
Deaths196,500 (2015)[9]

A urinary tract infection (UTI) is an infection that affects a part of the urinary tract.[1] Lower urinary tract infections may involve the bladder (cystitis) or urethra (urethritis) while upper urinary tract infections affect the kidney (pyelonephritis).[10] Symptoms from a lower urinary tract infection include suprapubic pain, painful urination (dysuria), frequency and urgency of urination despite having an empty bladder.[1] Symptoms of a kidney infection, on the other hand, are more systemic and include fever or flank pain usually in addition to the symptoms of a lower UTI.[10] Rarely, the urine may appear bloody.[7] Symptoms may be vague or non-specific at the extremities of age (i.e. in patients who are very young or old).[1][11]

The most common cause of infection is Escherichia coli, though other bacteria or fungi may sometimes be the cause.[2] Risk factors include female anatomy, sexual intercourse, diabetes, obesity, catheterisation, and family history.[2] Although sexual intercourse is a risk factor, UTIs are not classified as sexually transmitted infections (STIs).[12] Pyelonephritis usually occurs due to an ascending bladder infection but may also result from a blood-borne bacterial infection.[13] Diagnosis in young healthy women can be based on symptoms alone.[4] In those with vague symptoms, diagnosis can be difficult because bacteria may be present without there being an infection.[14] In complicated cases or if treatment fails, a urine culture may be useful.[3]

In uncomplicated cases, UTIs are treated with a short course of antibiotics such as nitrofurantoin or trimethoprim/sulfamethoxazole.[7] Resistance to many of the antibiotics used to treat this condition is increasing.[1] In complicated cases, a longer course or intravenous antibiotics may be needed.[7] If symptoms do not improve in two or three days, further diagnostic testing may be needed.[3] Phenazopyridine may help with symptoms.[1] In those who have bacteria or white blood cells in their urine but have no symptoms, antibiotics are generally not needed,[15] although during pregnancy is an exception.[16] In those with frequent infections, a short course of antibiotics may be taken as soon as symptoms begin or long-term antibiotics may be used as a preventive measure.[17]

About 150 million people develop a urinary tract infection in a given year.[2] They are more common in women than men, but similar between anatomies while carrying indwelling catheters.[7][18] In women, they are the most common form of bacterial infection.[19] Up to 10% of women have a urinary tract infection in a given year, and half of women have at least one infection at some point in their lifetime.[4][7] They occur most frequently between the ages of 16 and 35 years.[7] Recurrences are common.[7] Urinary tract infections have been described since ancient times with the first documented description in the Ebers Papyrus dated to c. 1550 BC.[20]

Video summary (script)
  1. ^ a b c d e f "Urinary Tract Infection". Centers for Disease Control and Prevention (CDC). 17 April 2015. Archived from the original on 22 February 2016. Retrieved 9 February 2016.
  2. ^ a b c d e Flores-Mireles AL, Walker JN, Caparon M, Hultgren SJ (May 2015). "Urinary tract infections: epidemiology, mechanisms of infection and treatment options". Nature Reviews. Microbiology. 13 (5): 269–284. doi:10.1038/nrmicro3432. PMC 4457377. PMID 25853778.
  3. ^ a b c Colgan R, Williams M, Johnson JR (September 2011). "Diagnosis and treatment of acute pyelonephritis in women". American Family Physician. 84 (5): 519–526. PMID 21888302.
  4. ^ a b c Nicolle LE (February 2008). "Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis". The Urologic Clinics of North America. 35 (1): 1–12, v. doi:10.1016/j.ucl.2007.09.004. PMID 18061019.
  5. ^ Caterino JM, Kahan S (2003). In a Page: Emergency medicine. Lippincott Williams & Wilkins. p. 95. ISBN 9781405103572. Archived from the original on 24 April 2017.
  6. ^ Cite error: The named reference statspe was invoked but never defined (see the help page).
  7. ^ a b c d e f g h Salvatore S, Salvatore S, Cattoni E, Siesto G, Serati M, Sorice P, Torella M (June 2011). "Urinary tract infections in women". European Journal of Obstetrics, Gynecology, and Reproductive Biology. 156 (2): 131–136. doi:10.1016/j.ejogrb.2011.01.028. PMID 21349630.
  8. ^ Vos T, Allen C, Arora M, Barber RM, Bhutta ZA, Brown A, et al. (October 2016). "Global, regional, and national incidence, prevalence, and years lived with disability for 310 diseases and injuries, 1990-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1545–1602. doi:10.1016/S0140-6736(16)31678-6. PMC 5055577. PMID 27733282.
  9. ^ Wang H, Naghavi M, Allen C, Barber RM, Bhutta ZA, Carter A, et al. (October 2016). "Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980-2015: a systematic analysis for the Global Burden of Disease Study 2015". Lancet. 388 (10053): 1459–1544. doi:10.1016/S0140-6736(16)31012-1. PMC 5388903. PMID 27733281.
  10. ^ a b Lane DR, Takhar SS (August 2011). "Diagnosis and management of urinary tract infection and pyelonephritis". Emergency Medicine Clinics of North America. 29 (3): 539–552. doi:10.1016/j.emc.2011.04.001. PMID 21782073.
  11. ^ Woodford HJ, George J (February 2011). "Diagnosis and management of urinary infections in older people". Clinical Medicine. 11 (1): 80–83. doi:10.7861/clinmedicine.11-1-80. PMC 5873814. PMID 21404794.
  12. ^ Study Guide for Pathophysiology (5 ed.). Elsevier Health Sciences. 2013. p. 272. ISBN 9780323293181. Archived from the original on 16 February 2016.
  13. ^ Introduction to Medical-Surgical Nursing. Elsevier Health Sciences. 2015. p. 909. ISBN 9781455776412. Archived from the original on 11 January 2023. Retrieved 17 September 2017.
  14. ^ Jarvis WR (2007). Bennett & Brachman's hospital infections (5th ed.). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins. p. 474. ISBN 9780781763837. Archived from the original on 16 February 2016.
  15. ^ Ferroni M, Taylor AK (November 2015). "Asymptomatic Bacteriuria in Noncatheterized Adults". The Urologic Clinics of North America. 42 (4): 537–545. doi:10.1016/j.ucl.2015.07.003. PMID 26475950.
  16. ^ Glaser AP, Schaeffer AJ (November 2015). "Urinary Tract Infection and Bacteriuria in Pregnancy". The Urologic Clinics of North America. 42 (4): 547–560. doi:10.1016/j.ucl.2015.05.004. PMID 26475951.
  17. ^ "Recurrent uncomplicated cystitis in women: allowing patients to self-initiate antibiotic therapy". Prescrire International. 23 (146): 47–49. February 2014. PMID 24669389.
  18. ^ Lee JH, Kim SW, Yoon BI, Ha US, Sohn DW, Cho YH (January 2013). "Factors that affect nosocomial catheter-associated urinary tract infection in intensive care units: 2-year experience at a single center". Korean Journal of Urology. 54 (1): 59–65. doi:10.4111/kju.2013.54.1.59. PMC 3556556. PMID 23362450.
  19. ^ Colgan R, Williams M (October 2011). "Diagnosis and treatment of acute uncomplicated cystitis". American Family Physician. 84 (7): 771–776. PMID 22010614.
  20. ^ Al-Achi A (2008). An introduction to botanical medicines : history, science, uses, and dangers. Westport, Conn.: Praeger Publishers. p. 126. ISBN 978-0-313-35009-2. Archived from the original on 28 May 2016.

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