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SKILLS - URINARY TRACT INFECTIONS IN WOMEN

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WHAT IS IT?

Abstract

 

VOL: 99, ISSUE: 21, PAGE NO: 29

 

 

WHAT IS IT?

 


 

- Urinary tract infection (UTI) is the occurrence of pathogenic micro-organisms in the urine, urethra, bladder, or kidney. Lower UTI refers to urethritis and/or cystitis.

 


 

- Most often caused by a single bacterial pathogen ascending through the urethra to the bladder. From here bacteria may reach the kidney to cause pyelonephritis, although in a minority of cases bacteria may reach the kidney via the bloodstream.

 


 

INCIDENCE

 


 

- About five per cent of women each year present to their GP with frequency and dysuria.

 


 

- Up to 50 per cent of women will have a symptomatic UTI during their lifetime (Drug and Therapeutics Bulletin, 1998).

 


 

- Urethral syndrome: about 50 per cent of women who present with urinary symptoms do not have bacteriuria (Brumfitt et al, 1998).

 


 

PREDISPOSING FACTORS

 


 

- Sexual intercourse.

 


 

- Atrophic urethritis and vaginitis (in postmenopausal women).

 


 

- Abnormalities of urinary tract function (indwelling catheter, neuropathic bladder, vesico-ureteric reflux, outflow obstruction, anatomical abnormalities).

 


 

- Incomplete bladder emptying (dysfunctional urination, chronic indwelling catheter).

 


 

- Female diaphragm, spermicide-coated condoms.

 


 

- Previous urinary tract surgery.

 


 

- Immunocompromise.

 


 

- Diabetes.

 


 

- Renal stones.

 


 

- Insufficient fluid intake.

 


 

SYMPTOMS

 


 

- Urgency - the overwhelming need to pass urine.

 


 

- Frequency - the need to pass urine very often.

 


 

- Dysuria - pain or a burning sensation on passing urine, or difficulty in passing urine.

 


 

- Pyuria - the presence of pus in the urine. The urine may be cloudy.

 


 

- Haematuria - presence of blood.

 


 

- UTIs can ascend above the bladder to cause pyelonephritis. Symptoms are similar to those of lower UTIs, but also include pyrexia and loin pain.

 


 

- Suprapubic discomfort.

 


 

- Atypical presentations of cystitis may occur in older people and include secondary incontinence, confusion, anorexia, high temperature, or shock.

 


 

- Foul-smelling urine.

 


 

INVESTIGATIONS

 


 

- Urine dipstick.

 


 

- Urine microscopy.

 


 

- Urine culture.

 


 

- Imaging and functional tests (not routinely indicated).

 


 

TREATMENT

 


 

- Symptomatic treatment - paracetamol or ibuprofen to relieve pain and high temperature (for approximately one to two days.) A temperature of more than 38.5°C is more characteristic of pyelonephritis.

 


 

- Urine-alkalinising agents, such as potassium citrate, sodium citrate, and sodium bicarbonate are popular remedies, however, their efficacy is doubted (Brumfitt et al, 1990).

 


 

- Antimicrobial treatment - adhere to local policies and be guided by local patterns of bacterial resistance.

 


 

- Frequently used - trimethoprim, nitrofurantoin, cefalexin

 


 

- Other antimicrobials: amoxicillin, co-amoxiclav, quinolones, and pivmecillinam. For healthy women with a UTI and who are not pregnant: three days of antimicrobial treatment is as effective as five or seven days. Longer treatment results in greater bacterial resistance.

 


 

WEBSITE

 


 

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