|Urinary Tract Infection
Urinary tract infection is a common problem. There is a 50% chance of a woman getting it in her
life-time. It can be very disturbing and occasionally life-threatening. Urinary tract infection is more
common in females because of the short urinary passage (Urethra) and injuries that can
happen during sexual acts. There are several misconceptions regarding urinary tract infections
both among lay people and many doctors. Colonisation of the urinary tract by organisms is called
urinary tract infection. The urinary tract consists of a collecting system in the kidney, the ureter (tube
from the kidney to the bladder), the bladder and lastly the urethra. The kidneys and the ureter
constitute the upper urinary tract. The bladder and urethra constitute the lower urinary tract. The
urinary tract is devoid of organisms till the terminal portion where it is exposed to the
atmosphere. Infections occur once organisms ascend to the bladder and the kidneys. Males
get urinary tract infections either in the first year of life due to abnormalities in the urinary tract
from birth or after the age of sixty when the prostate gland blocks the urinary tract. Otherwise
during the sexually active period, it is predominantly a disease of females.
Causes of Urinary Tract Infection
Urinary infections can be community-acquired or acquired in the hospital due to instrumentation of the urinary tract (bladder catheterisation). Community-acquired infections are bacterial in origin and the commonest organism is called E.Coli. Hospital- acquired infections can be caused by resistant bacteria and fungi.
Symptoms of Urinary Tract Infections
Classical symptoms of urinary infections are painful urination (dysuria) and increased frequency of urination. This results from an irritation of the bladder and urethra. Urinary infections normally should not be diagnosed in the absence of these symptoms. Discolouration and passing of blood in urine in isolation (i.e) without dysuria do not indicate urinary infections. Fever and loin pain occur in upper urinary tract infection. Lower abdominal pain and frequency of urination alone are features of lower urinary tract infection. In the absence of symptoms if an organism grows in the urine in the laboratory, it is called asymptomatic bacteriuria. This is a laboratory test and does not require treatment except in rare situations. Dysuria or painful micturition can happen in the absence of urinary infection due to inflammation or injury to urethra (urethral syndrome). Thus differentiation between upper and lower urinary tract infection and urethral syndrome is important to decide the line of treatment.
It is essentially by symptoms, sudden onset of dysuria with increased frequency is almost
diagnostic of urinary infection. Laboratory test only confirms the diagnosis and helps decide the choice of
Interpretation of urine reports
Presence of pus cells in the urine indicates an inflammation of the urinary tract. The
commonest cause of this is infection. However, stones, tumours and nephritis can all produce pus
cells in the urine. Presence of albumin is not a feature of uncomplicated urinary tract infection. It
indicates a disease of the kidneys. Presence of the epithelial cells indicates
contamination during collection of urine sample. The ideal way to collect is to first clean the private
part with water, discard the initial few ml in urine and subsequently
collect in a clean/sterilized container. This is called a mid stream sample or clean catch specimen and
should be transported to the laboratory immediately.
This test is fraught with errors due to poor collection. It is absolutely essential to mention
the colony count while giving the result of culture. Colony counts more than 1 lakh are only considered
significant. Beware of urine culture reports without colony counts. Apart from the type of bacteria,
culture reports should contain the list of drugs with antibacterial sensitivity. This will help to decide
the drug to be given for treatment. The drug with least toxicity, narrow spectrum of action and
good tissue penetration should be chosen.
Detailed investigations like ultrasound, x-rays and cystoscopies are required in certain situations such as those
Treatment of urinary tract infection
- All males with urinary tract infection.
- Females in childhood or above the age of sixty.
- Sexually active females if there are recurrent of repeated urinary tract infections.
This depends upon whether it is community-acquired or hospital-acquired, and if it is an upper or lower urinary
tract infection. Lower urinary tract infections acquired in the community can be treated with
simple drugs including single-dose antibiotics. Other infections require longer period of
Prevention of urinary infection in sexually active females
Role of water in Urinary Tract Infection
- Good personal hygiene and passing of urine after sexual act.
- Low dose antibiotic after sexual act.
- Prolonged night time low-dose antibiotic
Consumption of large quantities of water can reduce urinary tract irritation. However it can also
dilute the antibiotic administered.
Role of alkaline mixture
Alkaline mixtures can also symptomatically relieve urinary irritation. However it cannot
High animal protein in diet leads to highly acidic urine. This can increase urinary
irritation. Vegetables reduce the acidity of urine and make it alkaline.
- Urinary infections are diagnosed using patient history and examination (CLINICAL DIAGNOSIS).
The laboratory is used only for confirmation. In the absence of symptoms
urinary infections are not treated except in special situations.
- Laboratory examinations are fraught with errors.
- Need to differentiate between upper and lower urinary tract infections.
- Investigate persons who are not vulnerable (other than sexually active females).
- Prevent urinary infections by simple measures.