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Urinary Tract Infection (UTI) in Adults Mind Map: An Overview
What is Urinary Tract Infection (UTI)?
It is an infection that occurs in
the urinary tract; often caused by bacteria such as Escherichia coli.
UTI Epidemiology
About 60% of women suffer a UTI in
their life. Symptomatic infection is more common in young women after the onset
of sexual activity (20 to 50 years old).
And it is uncommon in males < 50 years old. The incidence of urinary
tract infection increases in both sexes over 50 years, but the female: male
ratio decreases due to the increased frequency of prostate disease in males.
Why do women have a
greater incidence of urinary tract infections than men?
- Women's urethras are shorter, which makes it easier for bacteria to make it's way into the body and cause infections. Women's urethras are also located closer to their rectums which makes it easier for bacteria to travel to the urethra and gain entry into the body. In addition, urine is stagnant in women; forming a good medium for growth of microorganisms. This is more significant with pregnant women due to the weak peristaltic movement of urethra in pregnancy, which means more urine stagnation.
What causes Urinary Tract Infection?
Causative Organisms include:
Common organisms causing Uncomplicated
UTI: Escherichia coli is responsible for 85% of UTI. Staph.
saprophyticus 5-15%. klebsiella, proteus, pseudomonas 5-10%.
Pathophysiology of Urinary Tract Infection
Bacterial entry into the urinary
tract can occur through one or more of the following routes:
Ascending from urethra (mainly
from the GIT; the easiest in treatment)
Through blood stream
Through lymphatic system
During bladder catheterization
UTI Risk Factors include:
- Obstruction of the urinary tract
(e.g. presence of kidney stones)
- Female gender
- Pregnancy
- Sexual intercourse
- Bladder catheterization (the
longer it's used, the more infection
- Diabetes mellitus
- Genitourinary malformation
- Prostatic hypertrophy in males
What are the Types of Urinary Tract Infection (UTI)?
UTI can be classified according to
the section of urinary tract affected into:
Lower UTI: Cystitis (bladder) - Urethritis (urethra) -
Epididymitis (epididymis)
Upper UTI: Pyelonephritis (kidney & renal pelvis), more
serious
UTI is also classified into:
Uncomplicated UTI: affects mainly healthy females of age 15-45 yr
Complicated UTI:
Defined as: UTIs that are
associated with metabolic disorders and anatomic or functional abnormalities
that impair urinary tract drainage.
Complicating Factors include:
Immunosuppression - Urologic
Structural - Functional Abnormality - Nephrolithiasis present - Recent
Hospitalization - Nursing home – Catheter - Symptoms for > 7 days.
Examples: Prostatitis - Renal abscesses
– Pyonephrosis – Pyelonephritis – Urethritis
Diagnosis of UTI
Urinary tract infection diagnosis
depends on:
A- Signs and Symptoms
Lower
UTI: Dysuria, urgency,
frequency, nocturia, suprapubic heaviness, gross hematuria
Upper
UTI: Flank pain, fever,
nausea, vomiting, malaise
B- Lab Tests for UTI, including:
1-
Urinalysis, which is done through dipstick tests or microscopic
examination of urine. Tests' results and indications are stated in the map.
2-
Urine Culture & Sensitivity, which is a quantitative test that is not
recommended to diagnose or verify uncomplicated UTI.
Special Conditions
Asymptomatic Bacteruria (ASB)
A condition in which 2 consecutive
urine cultures growing more than 100,000 colony-forming units (CFU) of bacteria
/ ml urine in a patient lacking symptoms of a UTI. It is common in elderly,
pregnant women, diabetic patients, and cathetarized patients. To know how to
manage Asymptomatic Bacteruria, see the map above. Just click the image to
enlarge it .
Symptomatic cystitis in pregnancy
Should be treated and followed-up
similarly to ASB.
UTI & Sexual Intercourse
How to prevent urinary tract
infection caused by sexual intercourse? !
Nondrug Therapy includes:
-
Voiding immediately after sexual intercourse and before taking the
prophylactic antibiotic.
-
Drinking cranberry juice reduces pyuria and bacteriuria.
-
Increasing total fluid intake.
Drug therapy is revealed in the
map above.
How to Treat Urinary Tract Infection?
Treatment Goals of UTI:
1-
Eradication of the invading microorganism
2-
Prevent recurrence of infection
3-
Resolve symptoms
4-
Avoid permanent kidney damage
5-
Avoid side effects from treatment
Antibiotics for urinary tract infection:
Uncomplicated UTI
First line therapy for
uncomplicated UTI is Trimethoprim/sulfamethoxazole 1 double strength
(DS) tablet (160/800 mg) twice daily for 3 days.
Second line therapy includes:
-
Quinolones as
Ciprofloxacin 250mg twice daily for 3 days, or
-
Nitrofurantoin, amoxicillin, first-generation cephalosporin for 7 days
Treatment duration (according
to the severity of urinary tract infection), is shown in this table:
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| Duration of therapy for different types of urinary tract infections |
Treatment regimen for different
types of urinary tract infections
are represented in a table in the map.
Go to Urinary tract infection mind map to see the whole map.
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| Urinary Tract Infections - Antibiotic Regimens |
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UTI Mind Map by Maha Atef, B Pharm
Last update: 3 July 2014
References
"Bacterial Urinary Tract Infections." The Merck Manual for Healthcare Professional. Sep. 2007. Merck Sharp & Dohme Corp., Web. 2 Feb 2010. <http://www.merck.com/mmpe/sec17/ch231/ch231b.html>.
Cunha, Burke A. "Urinary Tract Infection, Males." eMedicine. 19 Oct 2009. Medscape, Web. 3 Fab 2010. <http://emedicine.medscape.com>.
Cunha, Burke A. "Urinary Tract Infection, Females." eMedicine. 19 Oct 2009. Medscape, Web. 3 Fab 2010. <http://emedicine.medscape.com>.
DiPiro, Joseph T. Pharmacotherapy: A Pathophysiologic Approach. 6th. The McGraw-Hill Companies , 2005.
Fauci, Anthony S., et al. Harrison's Online. 17th Edition ed. The McGraw-Hill Companies, 2008. Merck Medicus. 2008. 17 Feb. 2009 <http://www.merckmedicus.com/pp/us/hcp/frame_textbooks.jsp?pg=http://www.accessmedicine.com>
Gradwhol, Steven E., et al. "UMHS Urinary Tract Infection Guideline." National Guidline Clearinghouse. May 2005. University of Michigan Health System, Web. 8 Feb 2010. <http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7407>.
"Investigation of Urine." Health Protection Agency. Oct. 2009. Web. 9 Feb 2010. <http://www.evaluations-standard.org.uk>.
"Management of Suspected Bacterial Urinary Tract Infection in Adults. A National Clinical Guidelines." National Guidline Clearinghouse. July 2006. Scottish Intercollegiate Guidelines Network , Web. 10 Feb 2010. <http://www.guidelines.gov>
Cunha, Burke A. "Urinary Tract Infection, Males." eMedicine. 19 Oct 2009. Medscape, Web. 3 Fab 2010. <http://emedicine.medscape.com>.
Cunha, Burke A. "Urinary Tract Infection, Females." eMedicine. 19 Oct 2009. Medscape, Web. 3 Fab 2010. <http://emedicine.medscape.com>.
DiPiro, Joseph T. Pharmacotherapy: A Pathophysiologic Approach. 6th. The McGraw-Hill Companies , 2005.
Fauci, Anthony S., et al. Harrison's Online. 17th Edition ed. The McGraw-Hill Companies, 2008. Merck Medicus. 2008. 17 Feb. 2009 <http://www.merckmedicus.com/pp/us/hcp/frame_textbooks.jsp?pg=http://www.accessmedicine.com>
Gradwhol, Steven E., et al. "UMHS Urinary Tract Infection Guideline." National Guidline Clearinghouse. May 2005. University of Michigan Health System, Web. 8 Feb 2010. <http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=7407>.
"Investigation of Urine." Health Protection Agency. Oct. 2009. Web. 9 Feb 2010. <http://www.evaluations-standard.org.uk>.
"Management of Suspected Bacterial Urinary Tract Infection in Adults. A National Clinical Guidelines." National Guidline Clearinghouse. July 2006. Scottish Intercollegiate Guidelines Network , Web. 10 Feb 2010. <http://www.guidelines.gov>
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