UTI encompasses a broad range of clinical entities that differ in terms of clinical presentation, degree of tissue invasion, epidemiologic setting, and requirements for antibiotic therapy. There are several types of UTIs: urethritis, ureteritis, asymptomatic bacteriuria, cystitis, the urethral syndrome, and pyelonephritis. Sometimes UTIs are classified as uncomplicated or complicated. Uncomplicated infections occur primarily in otherwise healthy females and occasionally in male infants and adolescent and adult males. Most uncomplicated infections respond readily to antibiotic agents to which the etiologic agent is susceptible. Complicated infections occur in both sexes. In general, individuals who develop complicated infections often have certain risk factors. Some of these risk factors are listed in Box1. In general, complicated infections are more difficult to treat and have greater morbidity (e.g., kidney damage, bacteremia) and mortality compared with uncomplicated infections.

Box1. Risk Factors Associated with Complicated Urinary  Tract Infections

The clinical presentation of UTIs may vary, ranging from asymptomatic infection to full-blown pyelonephritis (infection of the kidney and its pelvis). Some UTI symptoms may be nonspecific, and frequently symptoms overlap considerably in patients with lower UTIs and in those with upper UTIs.

Urethritis

Symptoms associated with urethritis (infection of the urethra), dysuria (painful or difficult urination), and frequency are similar to those associated with lower UTIs. Urethritis is a common infection. Because Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis are common causes of urethritis and considered to be sexually transmitted.

Ureteritis

Inflammation or infection within the ureters is considered in combination with kidney infections. UTI within the ureters indicates that organisms have begun or are in the process of ascending into the kidneys and should be treated similarly to prevent further infection.

Asymptomatic Bacteriuria

Asymptomatic bacteriuria or asymptomatic UTI is the isolation of a specified quantitative count of bacteria in an appropriately collected urine specimen obtained from a person without symptoms or signs of urinary infection. Asymptomatic bacteriuria is common, but its prevalence varies widely with age, gender, and the presence of genitourinary abnormalities or underlying diseases. For example, the prevalence of bacteriuria increases with age in healthy women from as low as about 1% among school-age females to greater than or equal to 20% among women 80 years of age or older living in the community, whereas bacteriuria is rare in healthy young men. Because its clinical significance was controversial (asymptomatic bacteriuria precedes UTI but does not always lead to asymptomatic infection), guidelines have been published for the diagnosis and treatment of asymptomatic bacteriuria in adults older than 18 years of age. The foundation of these guidelines rests on the premise that screening of asymptomatic sub jects for bacteriuria is appropriate if bacteriuria has adverse outcomes that can be prevented by antimicrobial therapy. Thus, screening and treatment for asymptomatic bacteriuria is recommended for pregnant women (because the risk of progression to severe symptomatic UTI and possible harm to the fetus), males undergoing transurethral resection of the prostate, and individuals undergoing urologic procedures for which mucosal bleeding is anticipated. In contrast, screening for or treatment of asymptomatic bacteriuria is not recommended for premenopausal, nonpregnant women, diabetic women, older persons living in the community, older institutionalized subjects, persons with spinal cord injury, or catheterized patients while the catheter is in place.

Cystitis

Typically, patients with cystitis (infection of the bladder) complain of dysuria, frequency, and urgency (compelling need to urinate). These symptoms are due not only to inflammation of the bladder but also to multiplication of bacteria in the urine and urethra. Often, there is tenderness and pain over the area of the bladder. In some individuals, the urine is grossly bloody. The patient may note urine cloudiness and a bad odor. Because cystitis is a localized infection, fever and other signs of a systemic (affecting the body as a whole) illness are usually not present.

Acute Urethral Syndrome

Another UTI is acute urethral syndrome. Patients with this syndrome are primarily young, sexually active women, who experience dysuria, frequency, and urgency but yield fewer organisms than 10⁵ colony-forming units of bacteria per milliliter (CFU/mL) urine on culture. (The criterion of greater than 105 CFU/mL of urine is highly indicative of infection in most patients with UTIs.) Almost 50% of all women who seek medical attention for complaints of symptoms of acute cystitis fall into this group. Although Chlamydia trachomatis and N. gonorrhoeae urethritis, anaerobic infection, genital herpes, and vaginitis account for some cases of acute urethral syndrome, most of these women are infected with organisms identical to those that cause cystitis but in numbers less than 10⁵ CFU/mL of urine. One must use a cutoff of 10² CFU/ mL, rather than 10⁵ CFU/mL, for this group of patients but must insist on concomitant pyuria (presence of eight or more leukocytes per cubic millimeter on microscopic examination of uncentrifuged urine). Approximately 90% of these women have pyuria, an important discriminatory feature of infection.

Pyelonephritis

Pyelonephritis refers to inflammation of the kidney parenchyma, calices (cup-shaped division of the renal pelvis), and pelvis (upper end of the ureter that is located inside the kidney) and is usually caused by bacterial infection. The typical clinical presentation of an upper urinary tract infection includes fever and flank (lower back) pain and, frequently, lower tract symptoms (frequency, urgency, and dysuria). Patients can also exhibit systemic signs of infection such as vomiting, diarrhea, chills, increased heart rate, and lower abdominal pain. Of significance, 40% of patients with acute pyelonephritis are bacteremic.

Urosepsis

Approximately 25% of sepsis cases (severe blood infection) are a result of urosepsis, a systemic infection that may develop from community- or hospital-acquired urinary tract infections. Early diagnosis and treatment of urinary tract infections are essential in preventing urosepsis.

اخر الاخبار

اخبار العتبة العباسية المقدسة

العتبة العباسية المقدسة تشهد تشييع جثمان المحقق الشيخ محمد رضا المامقاني

قسم الشؤون الفكرية يختتم برنامج (فتية سيد الماء) لرعاية الأيتام بنسخته الثانية

لتطوير المهارات الإدارية.. العتبة العباسية المقدسة تطلق الدورة التعليمية الأولى لمسؤولي وحداتها

قسم التطوير يقيم دورة تدريبية عن الظهور الإعلامي لملاكاته

المزيد

الآخبار الصحية

دراسة تكشف "السبب الخفي" وراء ترك التمارين الرياضية

كشف التوقيت "المثالي" لتغيير فرشاة الأسنان

بلاستيك في أنسجة بشرية.. دراسة تكشف مفاجأة طبية

دراسة تحذر من الإفراط في ممارسة الرياضة.. كيف يضر دماءك؟

المزيد

الآخبار التكنلوجية

"ديب سيك" تحجب أحدث نماذجها عن شركات الرقائق الأميركية

"سامسونغ" تطلق سلسلة هواتف "غالاكسي إس 26"

حملات سرية ورسائل تشويه.. كيف يتم استغلال "تشات جي بي تي"؟

أثر نفسي غير متوقع للرياضة.. مرتبط بالغضب

المزيد

مواضيع ذات صلة

Nosology of Hemoglobinopathies

Toxic Goitre

Infections of the Urinary Tract : Pathogenesis

Infections of the Urinary Tract : Etiologic Agents

Infections of the Sinuses

Pathology of Acromegaly

clinical Features of Hyperprolactinaemia and Prolactinomas

Infections of the Ears : Diseases, Epidemiology, and Etiology of Disease

Encephalitis/Meningoencephalitis

Secondary Forms of Pure Red Cell Aplasia

Pathophysiology of Paroxysmal Nocturnal Hemoglobinuria

Clinical Manifestations of Paroxysmal Nocturnal Hemoglobinuria