Approach to urinary tract infections
Open Access
- 1 January 2009
- journal article
- review article
- Published by Medknow in Indian Journal of Nephrology
- Vol. 19 (4), 129-139
- https://doi.org/10.4103/0971-4065.59333
Abstract
Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of both community-acquired and nosocomial infections for patients admitted to hospitals. For better management and prognosis, it is mandatory to know the possible site of infection, whether the infection is uncomplicated or complicated, re-infection or relapse, or treatment failure and its pathogenesis and risk factors. Asymptomatic bacteriuria is common in certain age groups and has different connotations. It needs to be treated and completely cured in pregnant women and preschool children. Reflux nephropathy in children could result in chronic kidney disease; otherwise, urinary tract infections do not play a major role in the pathogenesis of end-stage renal disease. Symptomatic urinary tract infections occur most commonly in women of child-bearing age. Cystitis predominates, but needs to be distinguished from acute urethral syndrome that affects both sexes and has a different management plan than UTIs. The prostatitis symptoms are much more common than bacterial prostatic infections. The treatment needs to be prolonged in bacterial prostatitis and as cure rates are not very high and relapses are common, the classification of prostatitis needs to be understood. The consensus conference convened by National Institute of Health added two more groups of patients, namely, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis, in addition to acute and chronic bacterial prostatitis. Although white blood cells in urine signify inflammation, they do not always signify UTI. Quantitative cultures of urine provide definitive evidence of UTI. Imaging studies should be done 3-6 weeks after cure of acute infection to identify abnormalities predisposing to infection or renal damage or which may affect management. Treatment of cystitis in women should be a three-day course and if symptoms are prolonged, then a seven day course of antibiotics should be given. Selected group of patients benefits from low-dose prophylactic therapy. Upper urinary tract infection may need in-patient treatment. Treatment of acute prostatitis is 30-day therapy of appropriate antibiotics and for chronic bacterial prostatitis a low dose therapy for 6-12 months may be required. It should be noted that no attempt should be made to eradicate infection unless foreign bodies such as stones and catheters are removed and correctable urological abnormalities are taken care of. Treatment under such circumstances can result only in the emergence of resistant organisms and complicate therapy further.Keywords
This publication has 28 references indexed in Scilit:
- Candida tropicalis-associated bilateral renal papillary necrosis and emphysematous pyelonephritisClinical Nephrology, 2004
- Acute Uncomplicated Urinary Tract Infection in WomenThe New England Journal of Medicine, 2003
- NIH Consensus Definition and Classification of ProstatitisJAMA, 1999
- Diagnosis of acute flank pain: value of unenhanced helical CT.American Journal of Roentgenology, 1996
- Clinical Aspects of Fungal Infection in Organ Transplant RecipientsClinical Infectious Diseases, 1994
- Bladder Irrigation with Amphotericin B for Treatment of Fungal Urinary Tract InfectionsClinical Infectious Diseases, 1994
- Urinary Tract Infections: From Pathogenesis to TreatmentThe Journal of Infectious Diseases, 1989
- Diagnosis of Coliform Infection in Acutely Dysuric WomenThe New England Journal of Medicine, 1982
- Acute Infections of the Urinary Tract and the Urethral Syndrome in General PracticeBMJ, 1965
- THE LOCALIZATION AND TREATMENT OF URINARY TRACT INFECTIONS: THE ROLE OF BACTERICIDAL URINE LEVELS AS OPPOSED TO SERUM LEVELSMedicine, 1965