Urinary+Tract+Infections

=Urinary Tract Infections=

What it is
Urinary tract infection is the term given to any infection of part of the urinary system.

Causes
For uncomplicated UTI: //Escherichia coli// (70% to 95%) and //Staphylococcus saprophyticus// (5% to 10%) Complicated UTI: //E. coli// are isolated in 20% to 50% of cases, but other Gramnegative bacteria (eg //Proteus, Klebsiella//), //enterococci//, and //group B streptococci// (//Streptococcus agalactiae//) are more common in this group

- Being female. UTIs are more common in women than in men because a women’s urethra is located closer to their rectum than a man’s. Also, the female urethra is shorter, so it is easier for bacteria to reach the bladder. - Being pregnant. - Having tumours or stones in the urinary tract. - Having diabetes. - Using a diaphragm as contraception.
 * Risk factors:**

Symptoms
When you have a UTI, the bladder and the lining of the urethra become red and inflamed. Common symptoms related to UTIs may include: - a burning sensation or lower abdominal discomfort when you pass urine - needing to urinate urgently - passing urine much more frequently than usual - 'leaking’ urine - feeling an urge to urinate, but being unable to or only passing a few drops - foul smelling urine - urine that is cloudy, bloody or dark - having a temperature.

Elderly people may present with features such as secondary incontinence, confusion, anorexia, high temperature or shock //need to eliminate pneumonia and dehydration (and others) as causes of these//

//When symptoms may indicate pyelonephritis (upper urinary tract infection)// - Symptoms lasting longer than 5-7 days - A temperature of > 38.5°C is more - Pain experienced in loin area //Also if cystitis occurs in:// - children (may be sign of structural urinary tract abnormality) - elderly female patients (they have a higher rate of complications associated with cystitis) - men - pregnancy - diabetics
 * When to refer:**

How to Treat
//consult page 4 of// [|NPS - Antibiotic use in UTI] //for full list (includes alternatives)// Non-pregnant women: Trimethoprim for 3 days Pregnant women: Cephalexin for 10 days Men: Trimethoprim for 14 days Children: Cephalexin for 5 days Recurrent Prophylaxis: Trimethoprim for 3-6 months (women with frequent occurrences - at least 3 symptomatic episodes per year) //recurrent or relapsing UTI may indicate an abnormality of the urinary tract (elderly men: prostatic enlargement causing urinary obstruction)//
 * Antibiotic treatment**

- Paracetamol or ibuprofen can be used to relieve pain and high temperatures. - Urine alkalinising agents - High fluid intake (effectiveness is unproven) - Complete bladder emptying - Cranberry juice has not been shown to be of benefit in the treatment of acute urinary tract infection.There is some evidence to suggest that cranberry juice may be effective in prevention by reducing the number of symptomatic UTIs in women. Its effectiveness in children, elderly women and elderly men remains unclear
 * Symptomatic treatment**

Other advice
- Drink lots of water. - Urinate as soon as you feel the need. - Wipe your bottom from front to back to prevent bacteria from around the anus entering the urethra. - Make sure you have adequate lubrication during sex, and urinate after having sex. //offer a self-care card to reduce embarrassment// - Avoid using feminine hygiene products such as sprays or douches.

When cystitis is confirmed by a positive urine culture, males of all ages, females under 5 years of age and premenarcheal females with recurrent UTI should be investigated further to exclude any underlying abnormality (e.g. vesico-ureteric reflux, reflux nephropathy, prostate enlargement, urinary obstruction)

Additional Resources
[|NPS - Antibiotic use in UTI]: an indepth view into types of antibiotics used in UTI [|NPS - Case Study: UTI in chidren:] has statistics on what GPs would prescribe and has practice points for each section [|Facts behind the Fact Card - UTI]: contains a lot of information on the treatment of UTI [|mydr.com.au - UTIs] [|Self-Care Card - UTI] [|UTI, STDs, CNS and Gastro Infections]
 * Lecture Notes**