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Urinary tract infection - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of urinary tract infections.

Alternative Names

Cystitis; UTI

Highlights:

Urinary Tract Infections (UTIs)

Urinary tract infections (UTIs) are a common type of infection caused by bacteria (most often E. coli) that travel up the urethra to the bladder. A bladder infection is called cystitis. If bacterial infection spreads to the kidneys and ureters, the condition is called pyelonephritis. Cystitis is considered a lower urinary tract infection. Pyelonephritis is an upper urinary tract infection and is much more serious.

Risk Factors

Women are more prone to urinary tract infections than men, and these infections tend to recur. One reason is that the urethra (the tube that carries urine away from the bladder) is shorter in women than in men. Frequent sexual intercourse also increases a woman� ' s risk of developing UTIs. Contraceptive spermicides and diaphragm use are other risk factors. When women reach menopause, the loss of estrogen thins the lining of the urinary tract, which increases susceptibility to bacterial infections.

Pregnancy does not increase the risk of getting a urinary tract infection but it can increase the risk of developing a serious infection that could potentially endanger the mother and fetus. Pregnant women should report any symptoms of UTIs to their doctors, and should get screened for asymptomatic bacteriuria (presence of significant numbers of bacteria but no symptoms).

Symptoms

Symptoms of urinary tract infections may include:

Strong urge to urinate frequently, even immediately after the bladder is emptied
Painful burning sensation when urinating
Discomfort, pressure, or bloating in the lower abdomen
Pain in the pelvic area or back
Cloudy or bloody urine, which may have a strong smell

A urine test can determine if these symptoms are caused by a bacterial infection. Antibiotics are used to treat UTIs. Older people may have a urinary tract infection but have few or no symptoms.

Treatment

Antibiotics are used to treat UTIs. Most cases of UTIs clear up after a few days of drug treatment, but more severe cases may require several weeks of treatment.

Resources

http://kidney.niddk.nih.gov -- National Kidney and Urologic Diseases Clearinghouse
www.urologyhealth.org -- American Urological Association
www.acog.org -- American College of Obstetricians and Gynecologists

References

Azzarone G, Liewehr S, O'Connor K. Cystitis. Pediatr Rev. 2007 Dec;28(12):474-6.

Colgan R, Nicolle LE, McGlone A, Hooton TM. Asymptomatic bacteriuria in adults. Am Fam Physician. 2006 Sep 15;74(6):985-90.

Conway PH, Cnaan A, Zaoutis T, Henry BV, Grundmeier RW, Keren R. Recurrent urinary tract infections in children: risk factors and association with prophylactic antimicrobials. JAMA. 2007 Jul 11;298(2):179-86

Faust WC, Pohl HG. Role of prophylaxis in vesicoureteral reflux. Curr Opin Urol. 2007 Jul;17(4):252-6.

Foster RT Sr. Uncomplicated urinary tract infections in women. Obstet Gynecol Clin North Am. 2008 Jun;35(2):235-48, viii.

Hodson EM, Wheeler DM, Vimalchandra D, Smith GH, Craig JC. Interventions for primary vesicoureteric reflux. Cochrane Database Syst Rev. 2007 Jul 18;(3):CD001532.

Jepson RG, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001321.

Lin K, Fajardo K; U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: evidence for the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2008 Jul 1;149(1):W20-4.

Litwin MS, Saigal CS, editors. Urologic Diseases in America. US Department of Health and Human Services, Public Health Service, National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Washington, DC: US Government Printing Office, 2007; NIH Publication No. 07-5512.

Modgil G, Baverstock A. Should bubble baths be avoided in children with urinary tract infections? Arch Dis Child. 2006 Oct;91(10):863-5.

Moore KN, Fader M, Getliffe K. Long-term bladder management by intermittent catheterisation in adults and children. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD006008.

Mori R, Lakhanpaul M, Verrier-Jones K. Diagnosis and management of urinary tract infection in children: summary of NICE guidance. BMJ. 2007 Aug 25;335(7616):395-7.

Norrby SR. Approach to the patient with urinary tract infection. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap.306.

Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008 Apr 16;(2):CD005131.

Peterson J, Kaul S, Khashab M, Fisher AC, Kahn JB. A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology. 2008 Jan;71(1):17-22.

Pohl A. Modes of administration of antibiotics for symptomatic severe urinary tract infections. Cochrane Database Syst Rev. 2007 Oct 17;(4):CD003237.

Roussey-Kesler G, Gadjos V, Idres N, Horen B, Ichay L, Leclair MD, et al. Antibiotic prophylaxis for the prevention of recurrent urinary tract infection in children with low grade vesicoureteral reflux: results from a prospective randomized study. J Urol. 2008 Feb;179(2):674-9; discussion 679. Epub 2007 Dec 20.

Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald ER. Does this child have a urinary tract infection? JAMA. 2007 Dec 26;298(24):2895-904.

U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2008 Jul 1;149(1):43-7. Ann Intern Med. 2008 Jul 1;149(1):W20-4.

Williams GJ, Wei L, Lee A, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane Database Syst Rev. 2006 Jul 19;3:CD001534.

Reviewed last on: 8/4/2009
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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