Urinary Tract Infection (UTI)
What causes urinary tract infections?
There are many different causes of urinary tract infection but in general, they are more common in women and the most common bacteria are E. coli and Proteus species. Most infections result from the bacteria around the urethra ascending into the bladder. Infections can also be the result of stones, foreign bodies, hormonal changes, and poor bladder emptying.
What are the symptoms of a UTI?
Typically, UTI’s will cause pain or burning with urination (dysuria) and can also cause urinary frequency and urgency. They can also lead to blood in the urine (hematuria) and in some cases, UTI’s can cause the bladder to not function properly and patients may not be able to urinate at all (urinary retention).
More severe infections can cause lower abdominal or suprapubic pain and tenderness and if the infection ascends to the kidneys, a condition known as pyelonephritis, severe back/flank pain and fevers and chills can occur.
How are urinary tract infections evaluated?
The mainstay in diagnosing and properly treating a UTI is a urinalysis and urine culture. The urinalysis in a patient with a UTI often shows white blood cells or leukocytes, red blood cells, and on dipstick examination, can be nitrite positive which is a sign of infection. The urine culture will identify the specific organism and the lab will then test several antibiotics to determine which ones will work to treat the infection.
In patient s with recurrent or severe infections, abdominal imaging of the kidneys, ureters, and bladder is often also performed to look for stones or other sources of infection in the urinary tract.
How are urinary tract infections treated?
Urinary tract infections are treated with antibiotics. Initially, a broad spectrum antibiotic that treats the most common organisms responsible for the infection, is usually employed until the culture results are available. Common medications include the penicillins, quinolones like ciprofloxacin (Cipro) and levofloxacin (Levaquin), and sulfa drugs like Bactrim. Nitrofurantoin (Macrodantin, Marcrobid) is another medication that commonly treats the majority of UTI’s.
If the infections are found to be due to a stone, obstruction, or other anatomic problem, correction of the problem with surgery is often required to help prevent future infections.
In post-menopausal women, decreased estrogen levels can lead to dryness around the urethra and an increase in bacteria sticking to the tissue. Topical estrogen can help to prevent bacteria from adhering to the urethra.
In some patients, recurrent infections occur without a clearly identifiable cause and then patients may be put on prophylactic antibiotics which are a low, daily dose, to help prevent infection.