October 5, 2022

Urinary Tract Infections (UTIs) are any infection of the urinary system such as the kidneys, ureters, bladder, and urethra. When any of these organs are infected, we say you have UTIs.

Urinary tract infections are common in humans; occur more in women due to the shortness of their urethra than in men, and are caused mostly by bacteria as well as certain fungi.

Urinary Tract Infections start as a result of bad toilet habits, inconveniences, and sexual habits.

Urinary Tract Infections, as the inflammatory disorders of the urinary tract caused by pathogenic microorganisms, affect 150 million people each year worldwide.

Urinary Tract Infections in the body range from asymptomatic (without noticeable symptoms) infections to serious systematic kidney diseases which can lead to shock and death, or cause short-term morbidity in terms of fever, dysuria, and lower abdominal pain.

This type of infection is usually classified as complicated or uncomplicated.

UTIs can be acquired in the community setting, hospital-acquired (nosocomial) after 48 hours of admission, from a sexual partner/ spouse, and/or unhygienic.

Some pathogens involved in Urinary tract infections

Urinary Tract Infection is caused by any of these pathogenic microorganisms:

1. Escherichia coli

2. Klebsiella pneumonia

3. Proteus mirabilis

4. Enterococcus (Streptococcus faecalis)

5. Pseudomonas aeruginosa

6. Enterobacter aerogenes

7. Staphylococcus saprophyticus

8. Staphylococcus aureus

9. Salmonella species

10. Neisseria gonorrhoeae

11. Mycobacteria tuberculosis

12. Candida albicans

Your doctor will request you to do a urine culture test to look out for any of the above-listed pathogenic microorganisms when diagnosing UTIs.

Some commensal flora like Staphylococcus epidermis, Diphtheroids, Acinetobacter, Mycobacterium segments, contaminants from the skin, or fecal flora is not always considered pathogenic when diagnosed.

Complicated UTIs are those UTIs caused by activities that compromise the urinary tract or host defense leading to infection while Uncomplicated UTIs are those UTIs that affect healthy individuals without any neurological urinary tract abnormalities.

Both complicated and uncomplicated UTIs can be summarized as lower, and upper UTIs, and urinary tract abnormalities.

Urinary Tract Infections

Types of Urinary Tract Infections (UTIs)

1. Cystitis (lower UTIs): This is the infection of the bladder, which occurs when your bladder is infected with pathogenic microorganisms such as Escherichia coli. Some of the risk factors of cystitis are female gender, recurrent UTIs, sexual activity, vaginal infection, diabetes, obesity, and genetic susceptibility. Back pain or side pain, high fever, shaky and chills, nausea, and vomiting are some of the symptoms associated with cystitis.

2. Pyelonephritis (upper UTIs): This is the infection of the kidneys, which occurs when your kidney is infected as a result of obstruction of the urinary tract. The chances increase when there is urine retention due to the bladder not emptying, obstruction of urine flow due to renal stones, or the presence of urinary schistosomiasis, enlarged prostate in men, or tumors. It’s far less common than cystitis having 250,000 cases per year in the United States. Pelvic pressure, painful urination (dysuria), frequent urination, blood in the urine (hematuria), and abdominal discomfort are the symptoms associated with Pyelonephritis caused by Escherichia coli, Proteus species, and Klebsiella species.

3. Urethritis (urinary tract abnormalities): This is the infection of the urethra, which occurs when the urethra is infected with pathogenic microorganisms like Neisseria gonorrhea and Chlamydia. The symptoms include burning with urination and discharge.

Common pathogens involved in UTIs

The most common pathogens involved in UTIs are:

• Escherichia coli: This causes about 75-95% of UTIs followed by Klebsiella pneumonia, Staphylococcus saprophyticus, Enterococcus faecalis, Proteus mirabilis, etc

• Neisseria gonorrhea and Chlamydia trachomatis: These are the common causes of Urethritis. Both of them are transmitted through sexual intercourse.

• Mycobacterium tuberculosis: This is carried from any site of infection to the kidney through the blood. It’s commonly seen in persons with chronic fever when there is pyuria but the culture is sterile.

Causes of UTIs

The urinary tract is made up of the kidneys, bladder, urethra, and ureters.

Normally, the bladder, urine, and urinary tract system are sterile. They are usually free from bacteria, parasites, fungi, and viruses. Any infection occurs whenever pathogens say bacteria from the digestive tract enter the opening of the urethra and begin to multiply. In females, the urine may become contaminated with microorganisms from the vagina. Vaginal contamination is often indicated by the presence of epithelial cells and mixed bacterial flora.

However, whenever bacteria enter from your rectal area into the urinary tract through the urethra to the bladder, multiple causes an infection.

If the infection is only within the urethra is called Urethritis, but if it moves to the bladder and multiplies, it becomes a bladder infection called Cystitis.

If you leave it untreated, the bacteria are capable of traveling further up the Ureters and infecting the kidneys called Pyelonephritis. This implies that UTIs are infections that occur in any part of the urinary tract. E.coli is a common organism causing about 75-95% of UTIs due to its position in the colon. Patients with catheters also have the chance of being infected with UTIs.

Catheter-associated UTIs are Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus, Streptococcus faecalis, and Klebsiella species.

What are the things that can increase the chances of developing UTIs

Diabetes

• Age (in elderly people )

• Urinary retention

• Urinary catheter

• Enlarged prostate

• Bowel incontinence

• Kidney stone

• Pregnancy

• Being in one place (immobile)

What are the Risk Factors for UTIs

1. Holding your urine for too long: The bacteria spend a greater time in the bladder before it replicates and multiplies, therefore it multiplies the bacteria.

2. Personal hygiene: Contamination with feces increase the risk of coliform bacteria in the vagina and urethra.

3. Sexual activity: The bacteria may be mechanically pushed into the urethra during sexual activities.

4. Spermicidal contraception: The use of superficial contraception changes the normal flora in the vagina and allows coliform bacteria to multiply and colonize the area.

5. Genetics: Some cells on the vaginal mucosa and urethra sometimes allow bacteria to attach and pull themselves into the bladder causing UTIs.

6. Hormonal status: The vagina and urethra become vulnerable to UTIs when estrogen is lacking thereby increasing the chances of UTIs.

7. Diabetes: Constant rise in the blood sugar levels leads to immunosuppression which also increases the chances of UTIs.

8. Immunosuppression: This decreases the ability to resist pathogens that cause UTIs.

9. Sexual intercourse: Having sex with an infected person.

10. Not being circumcised: The foreskin of the penis can easily contract infections.

11. Weak immune system: You can’t fight against infection and diseases if your immune system is weak.

12. Urinary tract problem: Uncontrollable urination as a result of urinary tract problems can cause UTIs.

Problems of Urinary Tract Infections among Pregnant women

Urinary tract infections are more common among pregnant women than in other healthy women. As such it poses adverse effects to the mother, the fetus, and the newborn.

This is because as you become pregnant, the chances of change in your urinary tract and immune system increase which can lead to bacteriuria, causing serious risk for you and your baby.

Infection in the first trimester of pregnancy is proven to be difficult to treat as strong antibiotics are required for the treatment, but due to the early pregnancy, they may not be used. Strong antibiotics to treat UTIs are not good for pregnant women else they cause serious complications such as low birth weight, preterm labor, hypertension, pre-eclampsia, anemia, pyelonephritis, stillbirth, amnionitis, neonatal death, bacteremia, toxic septicemia, waist and back pain, and abdominal pain.

However, if UTIs occur in early pregnancy, moderate antibiotics like Amoxicillin, Penicillin, Celtaxidime, Norfloxacin, and Cefoxitin are recommended to treat the majority of the urinary tract pathogens at this stage.

A concluded study has revealed that UTIs can be a danger for pregnant women with whom it has been revealed that up to 50% of those with asymptomatic bacteriuria go on to get Pyelonephritis.

Not only that, the acidity of urine during pregnancy reaches the percentage that helps Escherichia coli to grow. This means that undetected, untreated, asymptomatic bacteriuria can lead to Pyelonephritis later in the pregnancy or during Puerperium.

Diagnosis of Urinary Tract Infections

There are steps to take when diagnosing urinary tract infections.

• Urine Collection

In diagnosing UTI, your doctor or healthcare provider will request that you collect the first urine passed at the beginning of the day for the examination because the urine at this time is most concentrated and most suitable for culture, microscopy, and other tests.

For accurate and precise examination, mid-stream urine (MSU) should be used.

Your doctor or healthcare provider will direct you on how to get the mid-stream urine.

You’ll be given a sterile, dry, wide-mouthed, leakproof screw-capped container to get about 20mls of urine immediately after you wash your hands and the urethral opening with clean water (for females) and screw on the cap of the container.

Urine Microscopy

• Urine Culture

Only urine which is not bio-chemically and microscopically normal is cultured.

From the urine microscopy, the laboratory professional will know if the urine is normal or not unless in asymptomatic bacteriuria mostly in pregnancy. Some laboratory professionals would rather culture all urine specimens whether biochemical or microscopic results are normal or not. The laboratory professional will run the test and ask you to back in a few days. Your doctor will interpret the result for you.

Treatment of Urinary Tract Infection

This is always treated effectively with strong antibiotics, especially with injections.

According to the online journal, the most commonly used Antibiotics for UTIs and their possible side effects:

1. Macrodantin (Macrobid or nitrofurantoin) –Side effects of long-term use may include fibrosis or scarring of the lungs and peripheralneuropathy.Generally, the medication is considered safe duringpregnancy, except with rare genetic metabolic deficiencies.

2. Bactrim (Septra or sulfa/TMP) –This drug should not be taken early during pregnancy and may affect the effectiveness of oral contraceptives.

3. Trimethoprim –It should not be taken during pregnancy.

4. Quinolones (Levaquin, Levofloxacin, or Cipro) – This drug should not be taken during pregnancy.

5. Cephalosporin (Keflex) – This may affect the effectiveness of oral contraceptives.

6. Doxycycline –It is not safe during pregnancy or breastfeeding.

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