Urinary tract infection is the infection of urinary tract where there is a present of bacteria in the urine. Infection is most often due to bacteria from the patient’s own bowel flora and been transfer to urinary tract may be via the bloodstream.
Risk factors
- Pregnancy
- Genital and urinary tract malformations
- Urinary tract obstruction
- Instrumentation to genital and urinary tract
- Urethral reverberations at sexual intercourse
- Calculus
- Prostatic obstruction
- Bladder diverticulum
- Spinal injury
- Trauma
- Urinary tract tumor
- Diabetes mellitus
- Immunosuppression
- Decrease estrogen level (during menopause)
Types of UTI
- Pyelonephritis : infection of the kidney
- Cystitis : infection of the bladder
- It can be simple and complicated UTI
Symptoms:
General symptoms:
- Frequency / dysuria / haematuria
- Urinary incontinence
- Urinary retention
- Fever associate with nausea and vomiting
- Urgency and stangury
- Abdominal pain (loin pain, suprapubic pain, right and left iliac fossa pain)
Acute pyelonephritis:
- Loin and flank pain
- Dysuria (painful urination)
- Frequency
- Fever
- Rigors
- Cloudy or blood stained urine
Cystitis:
- Frequency
- Urgency
- Dysuria
- Haematuria (blood stained urine)
- Usually no fever, but you might experience of mild fever
- Loin tenderness
- Enlarged bladder
- Large prostate
- Renal mass
- Meatal ulcer
- Vaginal discharge
- Hypertension
- Signs of chronic renal failure
- Urinalysis (Urine FEME) Colony count of greater than 100 000 organisms/ml is significant ( In fresh mid stream specimen of urine).
- Urine microscopy – in UTI, there is presentation of pus cells and organisms (usually Gram negative rods)
- Urine culture and sensitivity – to look for the organism and the sensitivity of the antibiotic. Usually done if there is recurrent infection.
- Full blood count – to look for haemoglobin and white cell count.
- Urea and electrolytes.
- Serum creatinine level – to look for renal function.
Common organisms that cause UTI
- Escherichia Coli – it cause >70% of all simple UTI
- Proteus
- Klebsiella
- Pseudomonas
- Faecal streptococci
- Drink plenty of clear fluid.
- Urinate often.
- Antibiotics will be prescribed by your doctor – Some antibiotics of choice are bacampicillin, amoxicillin and trimethoprim (antibiotics should be change according to urine culture and sensitivity result)
- Analgesic or pain killer should be prescribed if loin pain is present
- Mist potassium citrate or other type of urinary alkalinizer can be given to relief the symptom of dysuria. However, it shouldn’t be given to patient that suffers for renal failure and hypernatremia.
- Try to avoid sexual intercourse during infection.
- Double voiding (going again after 5 minutes).
- Voiding after sexual intercourse may prevent reinfection.
- Keep the hygiene.
- Wrong antibiotics.
- Failure to complete the course of the antibiotics.
- Resistant organisms.
- There is underlying obstruction of the urinary tract.
- Renal or bladder calculus (or stones).
- Urinary tract tumor.
- Urinary retention.
- Specific infection (e.g.: tuberculosis).
- Further investigations is needed includes IVU (intravenous urography), KUB (kidney ureter bladder) x-ray or ultrasound and cystoscopy.
- Recurrent infection causes considerable morbidity.
- It can cause severe renal disease including end stage renal failure.
- Common source of life threatening Gram Negative septicemia.
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