Urinary tract infections: Clinical

Urinary tract infections or UTIs are infections that affect part of the urinary tract.

They’re usually caused by bacteria found in fecal flora, which normally colonizes the urethral meatus.

However, when those bacteria make their way up the urethra and into the bladder, they can cause lower UTIs, like cystitis, which is the inflammation of the bladder, or upper UTIs, like acute pyelonephritis, which is the inflammation of the renal pelvis and kidneys.

Both cystitis and acute pyelonephritis can be uncomplicated or complicated.

By complicated, we mean that the individual has an associated structural or functional condition of the genitourinary tract or an underlying disease which increases the risk of a severe infection.

So a complicated UTI is one that happens in a male, a pregnant female, and individuals with indwelling urinary catheters.

Additionally, it’s considered a complicated UTI when it happens in individuals with poorly controlled diabetes mellitus, immunocompromised individuals, those with urologic conditions- like urethral strictures, and those that have had urologic procedures.

So let’s start with uncomplicated cystitis.

The most common pathogens are Enterobacteriaceae which include Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis.

Another pathogen is Staphylococcus saprophyticus.

Uncomplicated cystitis usually appears in women, because they have a shorter urethra than men, making the urethral meatus closer to the anal orifice.

Risk factors for cystitis are recent sexual intercourse, as well as the use of spermicide-coated condoms, or general spermicides- because spermicides facilitate the growth of E.coli.

Shortly after a sexual intercourse, symptoms include dysuria, urinary frequency, urinary urgency, and suprapubic pain. In females over 65 years, symptoms can include chronic dysuria or urinary incontinence.