Urinary Tract Infection (UTI) in Females

Urinary Tract Infection (UTI) in Females is a topic covered in the 5-Minute Clinical Consult.

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Basics

Description

  • Urinary tract infection (UTI) is the presence of pathogenic microorganisms within the urinary tract with concomitant symptoms.
  • This topic refers primarily to infectious cystitis; other complicated UTIs, such as pyelonephritis, are discussed elsewhere.
  • Uncomplicated UTI: occurs in patients who have a normal, unobstructed urinary tract, who have no history of recent urologic procedure, and whose symptoms are confined to the lower urinary tract. Uncomplicated UTIs are most common in young, sexually active women.
  • Complicated UTI: an infection of the lower or upper urinary tract in the presence of an anatomic abnormality, a functional abnormality, or compromised host (see “Risk Factors”) (1)
  • Recurrent UTI: symptomatic UTIs that follow resolution of an earlier episode after appropriate treatment
    • Three UTIs within 12 months or two within 6 months
    • Most recurrences are thought to represent reinfection rather than relapse.
    • No evidence indicates that recurrent UTIs lead to health problems such as hypertension or renal disease in the absence of anatomic or functional abnormalities of the urinary tract.
  • System(s) affected: renal, urologic
  • Synonym(s): cystitis

Epidemiology

Incidence
  • Accounts for 8 million doctor visits and 1 million emergency room visits and contributes to >100,000 hospital admissions each year (1)
  • 11% of women have UTIs in any given year.
  • Predominant age: young adults and older
  • Predominant sex: female > male

Prevalence
  • >50% of females have at least one UTI in their lifetime.
  • One in four women has recurrent UTIs.

Etiology and Pathophysiology

  • Bacteria and subsequent infection in the urinary tract arise chiefly via ascending bacterial movement and propagation (2).
  • Pathogenic organisms (Escherichia coli) possess adherence factors and toxins that allow initiation and propagation of genitourinary infections:
    • Type 1 and P. pili (pyelonephritis-associated pili)
    • Lipopolysaccharide
  • Most UTIs are caused by bacteria originating from bowel flora:
    • E. coli is the causative organism in 80% of cases of uncomplicated cystitis.
    • Staphylococcus saprophyticus accounts for 15% of infections.
    • Enterobacteriaceae (i.e., Klebsiella, Proteus, Enterobacter, and Pseudomonas) also contribute.
  • Candida is associated with nosocomial UTI (2).

Genetics
Women with human leukocyte antigen 3 (HLA-3) and nonsecretor Lewis antigen have an increased bacterial adherence, which may lead to an increased risk in UTI.

Risk Factors

  • Previous UTI
  • Diabetes mellitus (DM)
  • Pregnancy
  • Sexual activity
  • Use of spermicides or diaphragm
  • Underlying abnormalities of the urinary tract such as tumors, calculi, strictures, incomplete bladder emptying, urinary incontinence, neurogenic bladder
  • Catheterization
  • Recent antibiotic use
  • Poor hygiene
  • Estrogen deficiency
  • Inadequate fluid intake

General Prevention

  • Maintain good hydration.
  • Women with frequent or intercourse-related UTI should empty bladder immediately before and following intercourse; consider postcoital antibiotic.
  • Avoid feminine hygiene sprays and douches.
  • Wipe urethra from front to back.
  • Cranberry may prevent recurrent infections.
  • Vaginal estrogen in postmenopausal women may prevent infection.

Commonly Associated Conditions

See “Risk Factors.”

Geriatric Considerations
  • Elderly patients are more likely to have underlying urinary tract abnormality.
  • Acute UTI may be associated with incontinence or mental status changes in the elderly (1).

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