Definition of UTI in Women
- Criteria for the presumptive diagnosis of urinary tract infection
- Symptoms of bladder irritation (dysuria, urgency or frequency of urination) or of infection of the kidney (flank pain, fever, costovertebral angle tenderness).
- Urine sediment containing 8 to 10 or more white blood cells per high-powered field
- Quantitative urine culture revealing at least 100,000 microorganisms per milliliter of urine in a clean-voided specimen
- It is possible to have a bacterial urinary tract infection with a negative urinalysis and/or bacterial counts in the urine of less than 105
- The presence of 100,000 microorganisms per milliliter of urine in a patient without symptoms is termed "asymptomatic bacteriuria."
- Consistent sterile cultures can be used to rule out bacterial infection of the urinary tract as a cause of symptoms, and make one look to other diagnoses
Classification of UTI in Women
- Site of origin
- Cystitis
- Refers to the nonspecific clinical syndrome of dysuria, urinary frequency, urgency, and suprapubic fullness
- Pyelonephritis
- Fever, chills, and flank pain caused by bacterial infection of the renal parenchyma
- Based on symptoms, it is remarkably difficult to differentiate infection involving the upper tracts from bacteriuria confined to the bladder.
- Localizing the site of infection in clinically uncomplicated infections is unnecessary.
- Fever, chills, and flank pain caused by bacterial infection of the renal parenchyma
- Cystitis
- Complexity
- Uncomplicated: occurring in a normal urinary tract
- Complicated: structural or anatomic impairments that decrease antibiotic efficacy
- Stamey Classification
- First infections: isolated or remotely occurring bacterial cystitis
- Unresolved bacteriuria occurs when the urine cannot be sterilized despite antibiotic treatment
- Common causes include preexisting or acquired bacterial resistance, inadequate coverage of a second organism, rapid reinfection with a new organism during therapy, azotemia preventing access of the antibiotic to the urinary tract, and noncompliance with treatment
- Recurrent infection is an infection diagnosed after successful treatment of an antecedent infection (95% of UTI in women)
- Bacterial persistence: sterilization of the urine is short-lived, and within weeks, a relapse with the identical organism occurs
- Indicates a site of persistent infection within the urinary tract that could represent a stone, enterovesical fistula, or infected anatomic anomaly
Etiology of UTI in Men
- Neurogenic bladder
- Can be secondary to prolonged outlet obstruction, neurologic disorder, diabetes
- Diabetes can cause a sensory neuropathy and resultant bladder decompensation with chronic residual urine. Glyocsuria can impair bacterial phagocytosis.
- Urethral stricture disease
- Infected bladder calculi
- Urethral catheterization
- Incidence of bacteriuria 5 percent per single catheterization and 5 percent increase per day of catheterization
- External collecting devices
- Unprotected anal intercourse
- Poor preputial care in uncircumcized males
- Enterovesical fistula secondary to tumor or diverticulitis
Signs & Symptoms of Bacterial Cystitis
- Signs and symptoms
- Dysuria, urgency, frequency, nocturia
- Suprapubic or low back pain may be present
- Hematuria
- Fever and chills may indicate systemic infection, pyelonephritis, acute bacterial prostatitis
- Asymptomatic bladder colonization is not infrequent in elderly populations