UTI is an infection that affects part of the urinary tract.

• Lower UTI's:
  • Painful urination
  • Burning sensation in the urethra, may hbe present even when not urinating, in some cases
  • Frequent urination
  • Urinary urge
• Higher UTI's, cause lower UTI Sx in addition to:
  • Systemic Sx, including fever
  • Flank pain
• Vague or non-specific Sx at the extremities of age

• E. coli, mainly, although other bacteria, virus or fungi may rarely be the cause
• Female anatomy, because the urethra is much shorter and closer to the anus
• Sexual intercourse, particularly anal intercourse
• Family Hx
• Previous UTI (recurrence is common)
• Although sexual intercourse is a risk factor, UTI’s are not classified as STI’s

• Cystitis, which is infection of the bladder, thereby confined to the lower urinary tract
• Pyelonephritis, which is infection of the kidney, thereby affecting the upper urinary tract. It usually follows cystitis, but can also result from bacteremia (i.e. blood-borne infection)

Patient information

What are the different types of UTI's?
UTI's are classified based on what part of the urinary tract is infected. The higher, the more concerned we are . So the next question is the route of the urinary tract . And that's the urethra, the bladder, the looooong ureter, and then kidneys. Any part can be infected.

What are their names?
Pyelonephritis, which is infection of the kidney. Now you may wonder how does the word "pyelo" relate to the kidneys, and the answer is that "pyelo" means "pelvis", which is where the kidneys are... generally located lol. And "nephr" deriving from the word "nephron", which is the functional unit of the kidney. So that's at the very top, at the kidneys. There's also cystitis, which is infection of the bladder. We prefer that, because it hasn't travelled up the ureter and affected the kidneys.

• Dx in young healthy women is based on Sx alone
• In those with vague Sx, because bacteria can be present w/o there being an infection
• Nitrituria, which is nitrites in urine, as gram negatives (most commonly E coli) make an enzyme, that changes urinary nitrates to nitrites
• Leukocyte esterase, which tests for WBC in urine, indicating UTI
• Urine culture, in complicated cases, or if Tx has failed (i.e. Sx not improving in 2-3 days after Tx)

• Prevention, w/:
  • Low dose abx, in those w/ frequent infections
  • Cranberry juice, which may assist with recurrent UTI's
• Short course of abx, if uncomplicated, although resistance is increasing. Complicated cases may require a longer course or IV abx. Note that women who have bacterial or WBC in the urine, but have NO symptoms, abx are generally not required, except in pregnant women
  • Nitrofuran is a class of antibiotics with a furan ring with a nitro group. It includes Nitrofurantoin (NIT, Macrodantin) and Nifurtoinol which are both used in the Tx of UTI's
  • Trimethoprim, abx used mainly in the Tx of bladder infections. Bactrim is trimethoprim + sulfamethoxazole
• Urinary alkalinsers, e.g. Citralite, Citravescent or Ural sachets, help neutralize the acid in the urinary tract, while assit with eliminating organisms that cause infection
• Antiseptics, e.g. hiprex

Patient information

How do you treat a bacterial infection of the urinary tract?
Antibiotics . Of course. You do a short course if there's no biggie, or a long course or IV in complicated cases. We generally use the Nitrofuran class of antibiotics.

What about if we find a patient with NO symptoms, but have bacteria or even WBC's in urine?
We only use it in patients who have symptoms. If they've got no symptoms, we don't use it .

• Pyelonephritis, if it occurs, usually follows a bladder infection but may also result from a blood-borne infection

• Occur more commonly in women than men, affecting 50% of women at least once in their lives
• In women, UTI's are the most common form of bacterial infectino, w/ 10% developing UTI's annually