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 instrumentation, 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 a urinary catheter
  • Recurrent UTI: symptomatic UTIs that follow resolution of an earlier episode, usually 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 (1)[A].
  • System(s) affected: renal/urologic
  • Synonym(s): cystitis; infectious cystitis

Epidemiology

Incidence
  • Accounts for 8 million doctor visits and 1 million emergency room visits and contributes to >100,000 hospital admissions each year (2)
  • 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 (1).
  • 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 (3).

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 juice (not cranberry juice cocktail) consumption may prevent recurrent infections.

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.

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Citation

* When formatting your citation, note that all book, journal, and database titles should be italicized* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Urinary Tract Infection (UTI) in Females ID - 1688022 ED - Baldor,Robert A, ED - Domino,Frank J, ED - Golding,Jeremy, ED - Stephens,Mark B, BT - 5-Minute Clinical Consult, Updating UR - https://im.unboundmedicine.com/medicine/view/5-Minute-Clinical-Consult/1688022/all/Urinary_Tract_Infection__UTI__in_Females PB - Wolters Kluwer ET - 27 DB - Medicine Central DP - Unbound Medicine ER -