Urinary Tract Infection (UTI) in Females
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- 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
- 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
- >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)
- 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).
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.
- Previous UTI
- Diabetes mellitus (DM)
- 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
- Recent antibiotic use
- Poor hygiene
- Estrogen deficiency
- Inadequate fluid intake
- 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.”
- 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.