Urinary tract infection: Treatment, symptoms, advice and help

About Urinary tract infection (UTI)

A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract. The most common type of UTI is acute cystitis often referred to as a bladder infection. An infection of the upper urinary tract or kidney is known as pyelonephritis and is potentially more serious.

Urinary tract infection: Incidence, age and sex

Bladder infections are most common in young women with about 10% of women getting an infection yearly and 60% having an infection at some point in their life. Nearly 1 in 3 women will have had at least 1 episode of urinary tract infections requiring antimicrobial therapy by the age of 24 years. The risk of urinary tract infection increases with increasing duration of catheterization. In non-institutionalized elderly populations, urinary tract infections are the second most common form of infection, accounting for nearly 25% of all infections.

Signs and symptoms of urinary tract infection: Diagnosis

The most common symptoms of a bladder infection are burning with urination (dysuria), frequency of urination and an urge to urinate. The symptoms of urinary tract infections may vary with age and the part of the urinary system that was affected. In young children, urinary tract infection symptoms may include diarrhea, loss of appetite, nausea and vomiting, fever and excessive crying. Older may experience abdominal pain or incontinence. Lower urinary tract infections in adults may manifest with symptoms including haematuria (blood in the urine), inability to urinate despite the urge and malaise. Other signs of urinary tract infections include foul smelling urine and urine that appears cloudy.

Infection of the kidneys (acute pyelonephritis) typically causes more serious symptoms such as chills, nausea, vomiting and high fever. In newborns the condition may cause jaundice and hypothermia, in the elderly, symptoms of urinary tract infections may even include lethargy and a change in the mental status.

Confirmation via urine microscopy looking for the presence of red blood cells, white blood cells and bacteria is useful. Urine culture is useful to guide the choice of antibiotics.

Causes and prevention of urinary tract infection

When bacteria gets into the bladder or kidney and multiply in the urine, they may cause an UTI. The main etiologic agent is Escherichia coli.

Urinary tract infection: Complications

UTIs may develop into very serious, life-threatening kidney infections (pyelonephritis) that may permanently scar or damage the kidneys leading to renal hypertension and eventual kidney failure. The infection may also spread into the bloodstream and then elsewhere in the body (septicemia).

In pregnant women, UTI may lead to the baby being born premature and also developing sepsis.

Urinary tract infection: Treatment

Uncomplicated UTIs can be treated with oral antibiotics such as trimethoprim, cephalosporins, nitrofurantoin, or a fluoroquinolone such as ciprofloxacin. About 50% of people will recover without treatment within a few days or weeks.

Pyelonephritis is treated more aggressively than a simple bladder infection using either a longer course of oral antibiotics or intravenous antibiotics. Regimens vary, and include SMX/TMP , fluorquinolones and aminoglycosides (such as gentamicin) used in combination with a beta-lactam, such as ampicillin or ceftriaxone. These are continued for 48 hours after fever subsides.

If there is 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 a tumour.