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Urinary tract infection (UTI)
Written by Dr Geoff Hackett, consultant in sexual dysfunction, Sutton Coldfield Hospital
Underlying disease:
UTIs are classified as either community acquired or hospital acquired. 70 per cent of infections are community acquired, usually caused by the bacteria
Hospital acquired infections are usually
What are the symptoms of UTI?
Symptoms differ, depending on whether the infection affects the lower (bladder and urethra) or upper (kidneys and ureters) parts of the urinary tract.
The symptoms of lower urinary tract infection are dysuria (burning on passing urine), frequency (frequent need to pass urine) and urgency (compelling need to urinate). The urine can be cloudy with an offensive odour. In older men, generalised symptoms such as confusion and incontinence can be present. Urine infections are much commoner in the elderly, due to poor bladder emptying, an enlarged prostate, or incontinence associated with stroke or dementia.
The symptoms of upper urinary tract infection are the same as lower tract symptoms plus loin (flank) pain, fever and chills. The patient is likely to be ill and might require hospital admission.
How is the diagnosis made?
Test strips dipped into a urine sample can detect indirect signs of infection such as blood, protein, white blood cells and nitrites (most common bacteria convert nitrate, which is a chemical normally present in urine into nitrites, which are not usually present).
A clean midstream urine sample should be sent to the laboratory for a microscopy examination. A level of 100,000 bacteria per millilitre of urine is regarded as a significant infection, especially if found together with pus or white blood cells (leucocytes) on microscopy. Any infecting bacteria are cultured in the laboratory to assess their sensitivity to common antibiotics.
How is UTI treated?
Antibiotic therapy
Antibiotics such as amoxicillin now have resistance levels of 50 per cent in the community, because of widespread use over many years. Based on such experiences, many specialists are concerned about the possible overuse of the more powerful antibiotics as first line therapy in the general community.
Recurrent UTI
Drinking 250 to 500ml of cranberry juice daily and avoidance of bubble baths may also help. If these measures fail, six months of continuous therapy with low dose antibiotics is usually required.
Antibiotics are the mainstay of treatment. Trimethoprim
is currently the first choice for lower UTI in the UK, because it is cost-effective, well tolerated and works in 80 per cent of infections. Cephalosporins, nitrofurantoin, and norfloxacin are reserved as second line drugs in patients with lower UTI, but are first choices in patients with signs of upper UTI or kidney infection.
If UTIs keep occurring, identification and treatment of the underlying cause is essential. Patients who have the same infection coming back can be managed successfully by attending to 'bladder toilet' (drinking 2 to 3 litres of fluid daily and always passing urine at bedtime and after sex).
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