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Introduction
The expanded form of UTI is Urinary tract infection. They are one of the commonest forms of infections caused by bacteria. A Urinary tract infection or UTI can be referred to as an infection that could manifest in different parts of the urinary tract. The different components include kidneys, ureters, bladder and urethra.
The urinary tract is classified into
- Upper urinary tract: it involves kidneys and ureter
- Lower urinary tract: it involves bladder and urethra
Based on clinical manifestation, UTIs are classified into
- Complicated UTIs: different factors that compromise the functioning of the urinary tract, display features associated with complicated UTIs
- Uncomplicated UTIs: it is displayed in an otherwise healthy individual, who shows the absence of any neurological or structural abnormalities of the urinary tract
Table of content
Causative Microorganisms of UTI's
Various microorganisms could lead to UTIs, including both the gram-negative and gram-positive classes of bacteria. The most common is Escherichia coli (causal agent in almost 80-90%). E.coli is capable of causing both complicated and uncomplicated urinary tract infections (UTI). Other contributing pathogens based on higher-order of prevalence to a lower rate of prevalence are as follows:
Uncomplicated UTI’s | Complicated UTI’s |
Escherichia coli | Escherichia coli |
Klebsiella pneumoniae | Enterococcus |
Staphylococcus saprophyticus | Klebsiella pneumoniae |
Enterococcus faecalis | Candida |
Streptococcus (group B) | S aureus |
Pseudomonas aeruginosa | Proteus mirabilis |
Staphylococcus aureus | P. aeruginosa |
Why UTI's are more prevalent in Females when compared to Male Population?
- The length of the urethra in females is shorter (4cm) than in males.
- Catheterisation: this could result in contracting CAUTIs. It refers to catheter-associated urinary tract infections. However meticulous the aseptic technique of catheterisation is, it is the easiest way to contract a urinary tract infection.
- Sexual intercourse is another contributing reason. It increases the pace of organisms to ascend from the lower part of the urethra into the bladder.
- The external urethral meatus lies near heavily contaminated bacterial areas like the vulva and lower third part of the vagina.
- Pregnancy increases the risk of getting a UTI by manifolds. There is laxity of urethral sphincters that cause a back influx of urine from the bladder to the ureters.
Portal of Entry of Infection
- Haematogenous route: septic foci or intestine takes the infection to the kidneys of the individual
- Lymphatic route: the spread might take place from ascending part of the colon/ genital organs
- Periureteral lymphatics may affect the kidneys
- Ascending route of infection: the commoner among all the portals, the bacteria invade from the anorectal region, lower parts of the vagina and vulvar region leading towards the urethra and finally entering the bladder and kidneys
Clinical Manifestations of Urinary Tract Infections (UTI's)
The following are the UTIs arising in the lower urinary tract that involves the bladder and urethra.
1.Cystitis: the commonest presentation of UTI. The individual shows the following symptoms-
- Dysuria
- Micturition urgency
- At the end of micturition, the individual complains of pain
- Urethritis: symptoms shown by the patient include-
- Palpation of the urethra is painful. It is tender to touch
- Squeezing out of pus may be present
- Urgency of micturition
- Dysuria (passing of urine is difficult)
- Urethral syndrome: when persistent urethritis converts into its chronic form it is called a urethral syndrome. Symptoms reveal-
- Difficulty in passing urine (dysuria)
- Inflammation of the mucosal lining of the urethra
- Frequency and micturition urgency
- The neck of the urinary bladder may go into spasm
Guidelines to prevent UTI's
Following are the guidelines that must be executed to prevent the risk of getting a UTI:
- Perineal hygiene: make it a necessity to clean the perineal region. It includes cleaning of vulva daily and wiping direction of the rectum should always be kept away from the urethra. It avoids colonisation and spread of the pathogens.
- Prophylactic measures after coitus: voiding of urine immediately after sexual intercourse ensures hygiene and protection.
- In the case of catheter: catheterisation always favours contracting a UTI despite numerous aseptic techniques kept in mind. To avoid CAUCIs, one must:
- The doctor should avoid unnecessary catheterisation unless required.
- Intake of fluid should be kept high.
- HRT is to be given to women who are sexually active post-menopause.
Treatment Methods for UTI's
The principles based on which treatment is planned are as follows:
- To prevent chances of reinfection
- To administer a drug with considerate efficacy that can be continued for an appropriate period
- Isolation of pathogen and its sensitivity to the drug is to be kept in mind
Methods of treatment:
1.Conservative general measures, it includes the following:
- Bed rest for an adequate length
- Easily digestible light meals are recommended
- Proper care of hydration.
- Appropriate water intake (at least 3-5 litres a day)
- Antibiotic therapy: it is the first line of therapy in case of UTIs. The most recommended range of drugs is ampicillin, ciprofloxacin (quinolones), trimethoprim and amikacin (aminoglycosides) which are used to manage persistent infection.
Conclusion
Urinary tract infections require special attention and care because of their capability of producing several serious consequences. Around 20% of women contract UTIs once in their lifetime. It has 3 portals of invasion into the human body. The various factors like the immunocompromised condition of an individual, colonisation of the lower urethra by bacteria contribute to increasing the risk of getting a UTI. Treatment methods are to be included based on concerning principles that consist of drug sensitivity and prevent drug resistance. A person should take all the preventive methods as stated above to avoid contracting a urinary tract infection (UTI).
