URINARY TRACT INFECTIONS (UTIs)

Definition of UTIs

UTIs are infections involving the organs that produce urine and carry it out of the body: the 2 kidneys with the ureters, the bladder and the urethra. There are 3 types of infection, depending on the localisation :

Pyelonephritis: this is a most serious infection of the urinary tract. It is located in the kidneys, after the bacteria have migrated from the bladder through the ureters up to the kidneys.
Cystitis: this infection of the bladder is by far the most common UTI and concerns mostly women. The infection is generally caused by the proliferation of intestinal bacteria called Escherichia coli. These bacteria spread from the anus to the urethra and bladder where they multiply, invade the tissue and cause infection.
Urethritis: this infection is limited to the urethra (the canal that carries off the urine from the bladder). It is generally a sexually transmitted disease frequent in men, but can also concern women. Different pathogens can cause urethritis, the most frequent being Chlamydia and Gonococcus (the bacteria causing gonorrhea).

Frequency of UTIs

Women are much more likely to suffer from a UTI than men. Around 1 in 3 women will experience at least one UTI requiring antibacterial treatment by the age of 24 years and about half of all women will present at least one UTI during their lifetime. Nearly 20% of women who have a UTI will have another one, and 30% of those will have yet another. Of the latter, 80% will have recurrences. Recurrent UTI is usually defined as the occurrence of 3 urinary infections in the past 12 months or 2 in the past 6 months.
Regarding pregnant women, between 2 and 4% of them will develop a UTI.
In children, the risk for presenting a UTI during childhood is 3% for boys and 8% for girls.
In the elderly, genito-urinary infections represent about 25% of their diagnosed infections.
In patients with urinary catheter, UTIs are the most common infection acquired in hospitals and nursing homes, accounting for more than 1 million cases par year in the USA.
In patients with spinal cord injuries, mostly men, UTIs are very common, often accompanied by complications.

UTI symptoms

Common symptoms are :

pain, discomfort or a burning sensation during urination
intense urge to urinate
unusually frequent urination during the day
awakening from sleep to pass urine
cloudy, foul or unusually strong smelling urine with sometimes blood in the urine
pain, pressure or tenderness in the bladder area (midline, above or near the pubic area)

and in children:
complaints or crying during urination
bedwetting in a child who has usually been dry at night

and in case the infection has reached the kidneys :
pain in the side or mid-to-upper back
fever, with or without chills
nausea and vomiting.

Diagnosis of UTIs

It is diagnosed painlessly with a simple test on a urine sample. After washing the genital area, collect a midstream sample of urine in a sterile container which your doctor has previously given to you. This method prevents bacteria from the genital area to get into the sample and alter the test results. The sample is then either tested at your doctor’s office or sent to a laboratory for identification of the germ responsible for the infection, including its concentration in urine and occurrence in particular of white and red blood cells. It is now possible to test for a UTI at home with a home test kit but the same collection method of that described above must also be followed.

Subjects at risk for UTI

Women, especially those sexually active. The infection rate is 50% higher than in men. One factor explaining this difference may be that a woman’s urethra is short, allowing bacteria a quick access to the bladder. A woman’s urethral opening is also near sources of bacteria from the anus and the vagina, facilitating bacterial contamination.
Pregnant women because of the pressure applied by the baby on the urinary system, but also because of the hormonal changes linked to pregnancy.
In some women using a diaphragm for contraception, the urethra may be compressed, impairing the complete emptying of the bladder and thus favouring bladder infections.
Some women using spermicides as contraception may develop a urethritis.
Men with benign prostatic hyperplasia, as the enlarged prostate compresses the urethra, thus decreases the urine flow, preventing the complete emptying of the bladder and favouring germ proliferation.
Diabetics due to their high blood sugar level favouring bacterial growth and their increased susceptibility to infections following changes in the immune defence system.
Children and adults with a structural urinary tract abnormality or kidney stones that obstruct or impair the flow of urine.
Subjects with indwelling catheter or tube in the urethra and the bladder facilitating bacterial contamination.

Costs of UTIs

It is a costly burden with respect to

direct costs : doctors, antimicrobial medications and other treatments, as well as hospitalisations
indirect costs : expenses for absence from work.

About 11.3 million women in the USA had 1 or more presumed acute community-acquired UTI requiring antimicrobial therapy, with direct costs estimated at US$ 659 million and indirect costs at US$ 936 million (1995). Regarding UTIs acquired in hospitals, their cost is estimated to be about US$ 440 million per year.

Prevention and management of UTI

Several different approaches are available:

General preventive measures
- Drink several glasses of water each day. Fluids hinder the growth of bacteria by flushing out the urinary tract. Drinking cranberry juice or taking vitamin C supplements may also curb bacterial growth.
- Urinate when the need arises, don’t resist the urge to urinate.
- Take showers instead of tub baths.
- After having a bowel movement, wipe from front to back to prevent the spread of intestinal bacteria from the rectum to the urinary tract in women.
- If possible, for women, cleanse the area around the genitals before having sex. Urination after sexual intercourse helps to flush bacteria from the bladder.
- Avoid using feminine hygiene sprays and scented douches which may irritate the urethra.

Pharmacological preventive measures
- Immunostimulating bacterial extract that reinforces the body’s immune defences, thus contributing to decrease the frequency, duration and severity of urinary tract infections. Such medication is devoid of the risk of developing bacterial resistance as it is the case with several antibiotics, thus making them inefficient against bacterial infections.
- There is presently no vaccine on the market for preventing UTIs, but research is under way.
- In some patients with frequent UTIs (more than 2 infections per half-year), antibiotics may be prescribed as prevention. The antibiotic may be taken either daily at low dose for 6 months or longer, or at a single dose after sexual intercourse, or for 1 or 2 days when symptoms occurs.

Treatments
UTIs are generally quickly and easily treated with antibacterial drugs. The choice of the antibiotic and treatment duration depends on the patient’s medical history and the results of the urine analysis identifying the invading bacteria. Symptoms do usually disappear within the first 24 to 48 hours. It is very important to follow exactly the doctor’s prescription until the end of the treatment in order to limit the emergence of resistant bacterial strains. If the prescribed antibiotic is not efficient after 48 hours, the doctor must be informed and he/she may prescribe a different antibiotic. An immunostimulating bacterial extract can also be administered together with the antibiotic in order to boost the patient’s immune system. This immunotherapeutic drug leads to decreased duration, severity and frequency of urinary tract infections, but not to the emergence of resistant bacterial strains.

Any medical information on this website is not intended as a substitute for informed medical advice. No action should be taken before consulting with a healthcare professional.

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