Urinary tract infection (UTI) is a general term that describes infection anywhere in the urinary system. UTI can be further subclassified by the exact location of the infection, presence or absence of symptoms, and complications. In everyday practice, these classifications are subject to significant overlap and cause clinical confusion.
Definitions
Bacteriuria – Presence of bacteria in the urine.
Asymptomatic bacteriuria – Presence of >105 colony-forming units (CFU)/mL urine in the absence of symptoms.
Cystitis – Syndrome involving constellation of dysuria, frequency, urgency, and occasionally suprapubic tenderness; can be present in the setting of lower urinary tract inflammation in the absence of infection or urethritis.
Acute pyelonephritis – Clinical syndrome characterized by flank pain, flank tenderness, and fever often associated with cystitis symptoms in the presence of significant bacteriuria. Triad of pyelonephritis (flank pain, fever, and nausea/vomiting) can have noninfectious etiologies like renal calculi and renal infarction.
Uncomplicated UTI – UTI in a structurally and neurologically normal urinary tract.
Complicated UTI – UTI in the presence of anatomical or functional abnormalities. In general, UTIs in men, pregnant individuals, children, and patients in a health care-associated setting may be considered complicated.
Urosepsis – Sepsis caused by a UTI.
Incidence and Prevalence
The prevalence of asymptomatic bacteruria increases in the female population once adulthood is reached, with a female-to-male ratio approaching 30:1.
After the age of 65 the female-to-male ratio steadily declines while the prevalence rises consistently in both sexes; asymptomatic bacteriuria is much more common than symptomatic UTI.
Prevalence of asymptomatic bacteriuria in pregnant individuals is estimated to be 1.9%-9.5%.
The most common infecting organisms are Escherichia coli (70%), Klebsiella pneumoniae (7%), and Enterococcus spp. (6%) in community-acquired infections. Staphylococcus saprophyticus accounts for 5%-15% of UTIs in young sexually active women in the United States.
Patients admitted to hospitals and long-term care facilities have a higher number of Proteus, Enterobacter, Pseudomonas, Staphylococcus, and Enterococcus isolates compared with outpatients. Anaerobic organisms are rarely the cause of UTIs.
Uncommon organisms include Mycobacterium tuberculosis.
Pathogenesis
Ascending route – In the majority of the UTIs, pathogens gain access to the urinary tract by ascending up the urethra to the bladder. Further ascent of pathogens is the cause of the majority of renal parenchymal infections. Urethral massage and sexual intercourse facilitate the first step of this process in females. Indwelling catheters facilitate ascent, and spermicides promote vaginal colonization with pathogens.
Hematogenous route – Associated with abscess formation in the kidneys. Usually results from bacteremia with virulent pathogens such as Staphylococcus aureus, Salmonella, or possibly Candida. Infection of the kidney with gram-negative bacilli through a hematogenous route is rare in humans, although ascending pyelonephritis can lead to bacteremia in 20%-30% of cases.
Signs and Symptoms Strong diagnostic indicators of UTI include self diagnosis, hematuria, urinary frequency, costovertebral angle tenderness on physical exam, back pain, and fever. Poor diagnostic indicators include vaginal discharge and vaginal irritation.
Codes
ICD10CM: N39.0 – Urinary tract infection, site not specified
Vaginitis (see also vulvovaginal candidiasis) – Presents with vaginal discharge and itching, both of which have negative likelihood ratios for UTI diagnosis.
Urethritis – May present with a cystitis triad (dysuria, frequency, and urgency), but urine culture will be negative. Look for a negative nitrite test and absence of pyuria; there is often a urethral discharge.
Pelvic inflammatory disease – Usually accompanied by deep-seated abdominal or pelvic pain, vaginal discharge, and fever.
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Drug Reaction Data
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Contributors: Medical staff writerAcute Pyelonephritis
Overview
A urinary tract infection (UTI) is the spread of bacteria anywhere in the urinary system. A UTI typically begins when bacteria enters the urethra and multiplies in the bladder, where urine collects. The UTI can be in the kidneys, bladder, ureter, or urethra, but they mostly occur in the lower urinary tract (urethra and bladder). Recurrent UTIs without complications are common in young, healthy women. However, anyone can get a UTI.
Who’s At Risk
Some risk factors for UTIs include:
History of previous UTI
Frequent sexual activity with difficulty urinating after intercourse
Use of spermicidal agents or diaphragms as birth control
After menopause, experiencing estrogen deficiency
Blockage to the urinary tract such as a kidney stone
Diseases that suppress your immune system or transplant surgery
Diabetes mellitus or bladder prolapse
Urinary procedures or urinary catheter use
A woman's shorter urethra is more susceptible to infection, but men get UTIs too.
Signs & Symptoms
UTIs do not always occur with symptoms, but when they do, a UTI can cause:
Burning or painful sensation when urinating
Persistent urge to urinate
Cloudy or pink urine
Strong-smelling urine
Pelvic pain for women
Fever
Self-Care Guidelines
These guidelines should be followed when you have a UTI or want to avoid getting a UTI:
Drink lots of water to help clear bacteria from your urine
Stay away from irritating beverages such as coffee, citrus juice, alcohol, and soft drinks
After a bowel movement, be careful to wipe front to back so bacteria is not spread to the urethra and bladder
Use a warm heating pad for short periods of time for bladder pain relief
Nonprescription pain relief may be helpful (Tylenol, Motrin, Advil)
Avoid cranberry juice if you are taking blood thinners like warfarin (Coumadin), aspirin, or any medications that may impact the liver.
When to Seek Medical Care
Contact your health care provider when you have signs or symptoms of UTI, especially flank pain, back pain, fever, blood in the urine, painful urination, nausea and vomiting, and urinary urgency and frequency.
Treatments
Your doctor may prescribe medication for your UTI:
A complete course of oral antibiotics for infection; in more severe cases, antibiotics may be administered by tube
Patient Information for Urinary tract infection in Adult