Urinary Tract Infection: what you should know

Urinary tract infections

By Dr Ajughoro Oghenetega (M.D)

What urinary tract infection (UTI)?

This is when there is an infection of the urinary tract most commonly by a bacterium or less commonly fungus.

Depending on the part of the urinary tract it can either be Upper (kidney) or lower urinary tract
infection (bladder, urethra).

Although Upper UTI is less common, they tend to cause more severe complications than lower UTI.

Urinary tract infections(UTI) may be either uncomplicated (when an otherwise healthy person develops a UTI) or complicated (a
person with a comorbidity like poorly controlled Diabetes develops a UTI).

How does a person get UTI?

Several factors are responsible for the development of a UTI, from the virulence of the causative agent
to the host immunity.

The most common causative agent is the E. coli bacteria which is usually found in the digestive tract (accounts form more than 80% of cases).

Other causative organisms include Staphylococcus Saprophyticus, Klebsiella species, Enterococcus
Faecalis, yeast infection, etc

Mechanism of Urinary tract infection (UTI)

Although there are 3 main mechanisms by which a person can develop a UTI, these include;

– Colonization with ascending spread: infection gets to the urethra, colonizes and spreads upward to the bladder and then to the kidneys.

Hematogenous spread: infection from the blood circulation

Peri urogenital spread: infection from surrounding tissues

Depending on the part of the Urinary System affected it is thus classified as:
-Pyelonephritis (Affecting the kidney)
-Cystitis (Affecting the bladder)
-Urethritis (Affecting the urethra)

Who is at Risk UTI?

  • – Female anatomy (shorter urethra) put women at higher risk of developing a UTI
  • – Catheter use (may introduce infection into the bladder)
  • – Multiple sexual partner
  • – Abnormal urinary tract (vesicoureteral reflux)
  • – Blockages in the urinary tract (enlarged prostate, stone, tumor)
  • – Comorbidities (Diabetes)
  • -Immunocompromised state (AIDS)
    -Pregnancy
    -Previous UTI

What are the Signs and Symptoms?

Although a bit similar, the symptoms can be divided into the Upper urinary tract and lower urinary tract
symptoms

For Lower UTI:

  • -Fever
    -Nausea and vomiting
    -Increased frequency of urination
    -Pain/Burning sensation while urinating
    -Bloody/Cloudy urine
    -Pelvic pain

For Upper UTI:

  • -Pain and tenderness in the lower back/flank (where the kidneys are located)
    -Fever
    -Nausea and vomiting
    -Bloody/Cloudy urine

How is UTI diagnosed?

  • -Elaborate history taking (onset, duration, contact), physical examination
    -complete blood count
    -Urine Microscopy Culture and Sensitivity (Gold standard for diagnosis)
    -Imagining: ultrasonography, excretory urography, cystoscopy.

Treatment of Urinary tract infection

The treatment modality depends on the extent and severity of the infection with mild cases treated on an outpatient basis and severe
cases needing admission

Treatment generally involves;

  • -Eliminating the causative factor (e.g removing the catheter)
    -Supportive care (fluids, control fever, vomiting, pain)
    -Antibiotic therapy
  • For recurrent UTIs, long term antibiotic therapy is required
  • Home remedies (cranberry extracts help prevent UTIs)

Possible Complications

  • -Urosepsis (infection spreads to the blood)
    -Permanent kidney damage
    -Urethral stricture (narrowing of urethra)
    -Low birth weight / premature babies

Prevention of Urinary tract infection

  • -Good hygiene: wipe from front to back (for females),
  • – Don’t use dirty underwear
    -Hydrate adequately to dilute urine (helps flush out bacteria)
    -Cranberry extracts
    -Don’t hold urine for too long
    -Change birth control method.

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