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Whatisaurinarytractinfection(UTI)?
Aurinarytractinfection(UTI)isaninfectioninvolvingthekidneys,ureters,
bladder,orurethra.Thesearethestructuresthaturinepassesthroughbefore
beingeliminatedfromthebody.
Thekidneysareapairofsmallorgansthatlieoneithersideofthespineat
aboutwaistlevel.Theyhaveseveralimportantfunctionsinthebody,
includingremovingwasteandexcesswaterfromthebloodandeliminating
themasurine.Thesefunctionsmakethemimportantintheregulationof
bloodpressure.Kidneysarealsoverysensitivetochangesinbloodsugar
levelsandbloodpressureandelectrolytebalance.Bothdiabetesand
hypertensioncancausedamagetotheseorgans.
Twoureters,narrowtubesabout10incheslong,drainurinefromeach
kidneyintothebladder.
Thebladderisasmallsaclikeorganthatcollectsandstoresurine.When
theurinereachesacertainlevelinthebladder,weexperiencethesensation
thatwehavetovoid,thenthemuscleliningthebladdercanbevoluntarily
contractedtoexpeltheurine.
Theurethraisasmalltubeconnectingthebladderwiththeoutsideofthe
body.Amusclecalledtheurinarysphincter,locatedatthejunctionofthe
bladderandtheurethra,mustrelaxatthesametimethebladdercontracts
toexpelurine.
Anypartofthissystemcanbecomeinfected.Asarule,thefartherupinthe
urinarytracttheinfectionislocated,themoreseriousitis.
Theupperurinarytractiscomposedofthekidneysandureters.Infectionin
theupperurinarytractgenerallyaffectsthekidneys(pyelonephritis),which
cancausefever,chills,nausea,vomiting,andotherseveresymptoms.
Thelowerurinarytractconsistsofthebladderandtheurethra.Infectionin
thelowerurinarytractcanaffecttheurethra(urethritis)orthebladder
(cystitis).
IntheUnitedStates,urinarytractinfectionsaccountformorethan7millionvisits
tomedicalofficesandhospitalseachyear.
Urinarytractinfectionsaremuchmorecommoninadultsthaninchildren,
butabout1%2%ofchildrendogeturinarytractinfections.Urinarytract
infectionsinchildrenaremorelikelytobeseriousthanthoseinadults
(especiallyinyoungerchildren).
Urinarytractinfectionisthemostcommonurinarytractprobleminchildren
besidesbedwetting.
Urinarytractinfectionissecondonlytorespiratoryinfectionasthemost
commontypeofinfection.
Theseinfectionsaremuchmorecommoningirlsandwomenthaninboys
andmenyoungerthan50yearsofage.Thereasonforthisisnotwell
understood,butanatomicdifferencesbetweenthegenders(ashorter
urethrainwomen)mightbepartiallyresponsible.

About40%ofwomenand12%ofmenhaveaurinarytractinfectionatsome
timeintheirlife.

Whatcausesaurinarytractinfection?
Theurineisnormallysterile.Aninfectionoccurswhenbacteriagetintotheurine
andbegintogrow.Theinfectionusuallystartsattheopeningoftheurethrawhere
theurineleavesthebodyandmovesupwardintotheurinarytract.
Theculpritinatleast90%ofuncomplicatedinfectionsisatypeofbacteria
calledEscherichiacoli,betterknownasE.coli.Thesebacterianormallylive
inthebowel(colon)andaroundtheanus.
Thesebacteriacanmovefromtheareaaroundtheanustotheopeningof
theurethra.Thetwomostcommoncausesofthisareimproperwipingand
sexualintercourse.
Usually,theactofemptyingthebladder(urinating)flushesthebacteriaout
oftheurethra.Iftherearetoomanybacteria,urinatingmaynotstoptheir
spread.
Thebacteriacantraveluptheurethratothebladder,wheretheycangrow
andcauseaninfection.
Theinfectioncanspreadfurtherasthebacteriamoveupfromthebladder
viatheureters.
Iftheyreachthekidney,theycancauseakidneyinfection(pyelonephritis),
whichcanbecomeaveryseriousconditionifnottreatedpromptly.
Thefollowingpeopleareatincreasedriskofurinarytractinfection:
Peoplewithconditionsthatblock(obstruct)theurinarytract,suchaskidney
stones
Peoplewithmedicalconditionsthatcauseincompletebladderemptying(for
example,spinalcordinjury)
Postmenopausalwomen:Decreasedcirculatingestrogenmakestheurinary
tractmorevulnerabletoaUTI.
Peoplewithsuppressedimmunesystems:Examplesofsituationsinwhich
theimmunesystemissuppressedareHIV/AIDSanddiabetes.Peoplewho
takeimmunosuppressantmedicationssuchaschemotherapyforcancer
alsoareatincreasedrisk.
Womenwhoaresexuallyactive:Sexualintercoursecanintroducelarger
numbersofbacteriaintothebladder.Urinatingafterintercourseseemsto
decreasethelikelihoodofdevelopingaurinarytractinfection.
Womenwhouseadiaphragmforbirthcontrol
Menwithanenlargedprostate:Prostatitisorobstructionoftheurethrabyan
enlargedprostatecanleadtoincompletebladderemptying,thusincreasing
theriskofinfection.Thisismostcommoninoldermen.
MalesarealsolesslikelytodevelopUTIsbecausetheirurethra(tubefrom
thebladder)islonger.
Breastfeedinghasbeenfoundtodecreasetheriskforurinarytract
infectionsinchildren.
Thefollowingspecialgroupsmaybeatincreasedriskofurinarytractinfection:
Veryyounginfants:Bacteriagainentrytotheurinarytractviathe
bloodstreamfromothersitesinthebody.
Youngchildren:Youngchildrenhavetroublewipingthemselvesand
washingtheirhandswellafterabowelmovement.Poorhygienehasbeen
linkedtoanincreasedfrequencyofurinarytractinfections.
Childrenofallages:Urinarytractinfectioninchildrencanbe(butisnot
always)asignofanabnormalityintheurinarytract,usuallyapartial

blockage.Anexampleisaconditioninwhichurinemovesbackwardfrom
thebladderuptheureters(vesicoureteralreflux).
Hospitalizedpatientsornursinghomeresidents:Manyoftheseindividuals
arecatheterizedforlongperiodsandarethusvulnerabletoinfectionofthe
urinarytract.Catheterizationmeansthatathintube(catheter)isplacedin
theurethratodrainurinefromthebladder.Thisisdoneforpeoplewhohave
problemsurinatingorcannotreachatoilettourinateontheirown.
Patientsusingcatheters:Ifapatientisrequiredtoemptytheirbladderusing
acatheter,theyareatincreasedriskforinfection.

Areurinarytractinfectionscontagious?
No.Urinarytractinfections(UTIs)arenotcontagious.

Whatareurinarytractinfectionsymptomsandsigns?
Lowerurinarytractinfection
Bladder(cystitis):Theliningoftheurethraandbladderbecomesinflamed
andirritated.
Dysuria:painorburningduringurination
Frequency:morefrequenturination(orwakingupatnighttourinate,
sometimesreferredtoasnocturia)oftenwithonlyasmallamountofurine
Urinaryurgency:thesensationofhavingtourinateurgently
Cloudy,badsmelling,orbloodyurine
Lowerabdominalpainorpelvicpressureorpain
Mildfever(lessthan101F),chills,and"justnotfeelingwell"(malaise)
Urethra(urethritis):Burningwithurination

Upperurinarytractinfection(pyelonephritis)
Symptomsdeveloprapidlyandmayormaynotincludethesymptomsforalower
urinarytractinfection.
Fairlyhighfever(higherthan101F)
Shakingchills
Nausea
Vomiting
Flankpain:paininthebackorside,usuallyononlyonesideataboutwaist
level
Innewborns,infants,children,andelderlypeople,theclassicsymptomsofa
urinarytractinfectionmaynotbepresent.Othersymptomsmayindicateaurinary
tractinfection.
Newborns:feverorhypothermia(lowtemperature),poorfeeding,jaundice
Infants:vomiting,diarrhea,fever,poorfeeding,notthriving
Children:irritability,eatingpoorly,unexplainedfeverthatdoesn'tgoaway,
lossofbowelcontrol,loosebowels,changeinurinationpattern
Elderlypeople:feverorhypothermia,poorappetite,lethargy,changein
mentalstatus
PregnantwomenareatincreasedriskforanUTI.Typically,pregnantwomendo
nothaveunusualoruniquesymptoms.Ifawomanispregnant,herurineshould
becheckedduringprenatalvisitsbecauseanunrecognizedinfectioncancause
pregnancycomplications.

Althoughmostpeoplehavesymptomswithaurinarytractinfection,somedonot.
Thesymptomsofurinarytractinfectioncanresemblethoseofsexually
transmitteddiseases.

WhenshouldpeopleseekmedicalcareforaUTI?
Anyadultorchildwhodevelopsanyofthesymptomsofaurinarytractinfection
needstobeevaluatedbyamedicalprofessional,preferablywithin24hours.Most
medicalofficescantesturineforinfectionbyusingaquickurine"dipstick"test.
Someonewhohassymptomsofalowerurinarytractinfectionshouldcalla
healthcareprofessionalforanappointment,preferablyonthesameday
thatsymptomsarerecognized.
Someonewhohassymptomsofanupperurinarytractinfectioninvolving
thekidneysshouldcallahealthcareprofessionalimmediately.Depending
onthesituation,heorshewillrecommendeitheravisittotheofficeortoa
hospitalemergencydepartment.
Ifsomeonehassymptomsofalowerurinarytractinfectionandanyofthe
followingapplies,heorshemaybeatriskforcomplicationsoftheurinarytract
infection.
Vomitingandinabilitytokeepdownclearfluidsormedication
Notbetteraftertakingantibioticsfortwodays
Pregnant
Havingdiabetesoranotherdiseasethataffectstheimmunesystem
Takingmedicationthatsuppressestheimmunesystemsuchascancer
chemotherapy
Infants,children,andelderlypeoplewithanyofthesignsandsymptomsofUTI
shouldseetheirhealthcareprofessionalassoonaspossibleorgotoan
emergencydepartmentforevaluation.
Fever,lethargy,andpoorappetitemayindicateaurinarytractinfectionin
thesegroups,buttheymayalsobesignsofsomethingmoreserious.
Urinarytractinfectionshavethepotentialtomakethesevulnerablepeople
veryillwhenthebacteriaspreadintothebloodstream.

Howdophysiciansdiagnoseaurinarytractinfection?
Diagnosisofaurinarytractinfectionisbasedoninformationsomeonegives
abouthisorhersymptoms,medicalandsurgicalhistory,medications,habits,and
lifestyle.Aphysicalexaminationandlabtestscompletetheevaluation.
Adoctormaysimplyperformaurinedipsticktestintheoffice.Onlyafewminutes
areneededtoobtainresults.Yourhealthcareprovidermayalsosendaurine
sampletothelabforculturetesting(seebelow).Theseresultstakeafewdaysto
comeback.Thistellsthedoctortheexactbacteriacausingtheinfectionandto
whichantibioticsthesebacteriahaveresistanceorsensitivity.Thecultureis
usuallysentforspecialpopulations,includingmen,becausetheyarelesslikelyto
getUTIs.Itisnotnecessarytosendacultureforeveryonebecausethemajority
ofUTIsarecausedbythesamebacteria.
Thesinglemostimportantlabtestisurinalysis.Aurinesamplewillbetested
forsignsofinfection,suchasthepresenceofwhitebloodcellsandbacteria.
Incertaincircumstances,urinealsomaybe"cultured."Thismeansthata
smallamountoftheurineisbrushedonasterilenutrientsubstanceina

plasticplate.Theplateisallowedtositforafewdaysandthenexaminedto
seewhatkindofbacteriaaregrowingonit.Thesebacteriaaretreatedwith
differentantibioticstoseewhichworksbestagainstthem.Thishelps
determinethebesttreatmentforthespecificinfection.
Bloodtestsusuallyarenotrequiredunlessacomplicatedcondition,suchas
pyelonephritisorkidneyfailure,issuspected.
Foraculturespecimen,thepatientwillbeaskedtogiveacleancatch,midstream
urinespecimen.Thisavoidscontaminationoftheurinewithbacteriafromthe
skin.Patientswillbeinstructedinhowtodothis.
Midstreammeansurinatingalittleintothetoiletbeforecollectinga
specimen.Theideaistoavoidcollectingtheurinethatcomesoutfirst,as
thisurineisoftencontaminated.
Cleancatchreferstoamidstreamsamplethatwascollectedaftercleaning
theareaoftheurethralopening.
Adultwomenandoldergirls:Cleansetheareaaroundtheurethralopening
gently(butcompletely)usingasterilewipeorsoapandwater.Catchthe
urinemidstream.Forsomewomen,catheterization(insertingatubeintothe
bladder)maybetheonlywaytoobtainasterile,uncontaminatedspecimen.
Menandboys:Asterilespecimencanusuallybeobtainedwithamidstream
catch.Uncircumcisedmalesshouldretracttheforeskinandcleansethe
areabeforeurinating.
Newborns:Urinemaybeobtainedwithacatheteroraprocedureinwhicha
needleisintroducedthroughthelowerabdominalwalltodraw(aspirate)
urinefromthebladder.
Infantsandchildren:Eithercatheterizationortheneedleaspirationmethod
isused.
Ifsomeonecannotproduceaurinespecimenorisunabletofollowinstructionsfor
acleancatchspecimen,ahealthcareprofessionalmayobtainaurinespecimen
bycatheterization.
Thismeansplacingathintube(catheter)intheurethratodrainurinefrom
thebladder.
Thecatheterusuallyisremovedafterthebladderisemptied.
Thecathetermayremaininplaceifsomeoneisveryillorifitisnecessary
tocollectallurineormeasureurineoutput.
Dependingontheirsymptoms,sexuallyactivewomencouldrequireapelvic
examinationbecausepelvicinfectionscanhavesimilarsymptomsasaurinary
tractinfection.Maleswillrequireagenitalexamination,anddependingonthe
symptoms,mostlikelyaprostateexamination.Aprostateinfection(prostatitis)
requiresalongercourseofantibioticsthanaurinarytractinfection.
Menwillmostlikelyrequirearectalexaminationsothattheprostatecanbe
checked.Aprostateinfection(prostatitis)requiresalongercourseofantibiotics
thanaurinarytractinfection.
Insomecases,animagingtestmaybeindicatedtodetectanyunderlying
problemintheurinarytractthatcouldcauseaninfection.Thisisusuallyonly
necessaryinrepeatinfectionsorspecialcircumstances(unusualbacteria,
suspectedanatomicabnormalities).
Anultrasoundexaminationcanevaluatekidneyandbladderproblems.
Afluoroscopicstudycanshowanyphysicalproblemsthatpredispose
childrentourinarytractinfections.
Intravenouspyelogram(IVP)isaspecialseriesofXraysthatusesa
contrastdyetohighlightabnormalitiesintheurinarytract.

Cystoscopyinvolvesinsertionofathin,flexibletubewithatinycameraon
theendthroughtheurethraintothebladder.Thisallowsdetectionof
abnormalitiesinsidethebladderthatmightcontributetoinfections.
ACTscangivesaverydetailedthreedimensionalpictureoftheurinary
tract.
Imagingtestsaremostoftenneededforthefollowinggroups:
Childrenwithrepeaturinarytractinfections,especiallyboys
Upto50%ofinfantsand30%ofolderchildrenwithaurinarytractinfection
haveananatomicabnormality.Thechild'spediatricianshouldinvestigate
thispossibility.
Adultswithfrequentorrecurrenturinarytractinfections
Peoplewhohavebloodintheurine

Whatkindsofdoctorstreaturinarytractinfections?
Mosturinarytractinfectionscanbetreatedbyyourprimarycaredoctor(including
familymedicineandinternalmedicinespecialists,aswellasgynecologists)or
yourchild'spediatrician.Theyareusuallythebestprovidertotreatyouasthey
aremostfamiliarwithyourmedicalhistory,medicationsyouaretaking,andother
factorsthatmightaffectyourtreatment.Ifyouseektreatmentinanurgentcare
facility,aspecialistinemergencymedicinemaybeinvolvedinyourcare.
IftherearefrequentreoccurrencesofUTIsorifcomplicatingcircumstancesare
present,yourprimarycaredoctormightreferyoutoaurologist,aphysicianwho
specializesindiagnosisandtreatmentofconditionsrelatedtotheurinarysystem.

Aretherehomeremediesforaurinarytractinfection?
Thereareavarietyofselfcaremeasures(homeremedies)andothertreatments
availableforurinarytractinfections.
Useahotwaterbottletoeasepain.
Drinkplentyofwater.
Avoidcoffee,alcohol,andspicyfoods,allofwhichirritatethebladder.
Therearesomeindicationsthatcranberryjuicecanhelpfightaurinarytract
infection.
Becausethesymptomsofaurinarytractinfectionmimicthoseofotherconditions,
someoneshouldseeahealthcareprofessionalifaurinarytractinfectionis
suspected.Aurinetestisneededtoconfirmaninfection.Selfcareisnot
recommended.
It'spossibletoreducethediscomfortbytakingthefollowingsteps:
Followthehealthcareprofessional'streatmentrecommendations.
Finishallantibioticmedicationeveniffeelingbetterbeforethemedicationis
gone.
Takeapainrelievingmedication.
Quitsmoking.Smokingirritatesthebladderandisknowntocausebladder
cancer.

Whatisthetreatmentforaurinarytractinfection?
Theusualtreatmentforbothsimpleandcomplicatedurinarytractinfectionsis
antibiotics.Thetypeofantibioticanddurationoftreatmentdependonthe

circumstances.Examplesofcommonantibioticsusedintreatmentinclude,but
arenotlimitedto,amoxicillin,sulfamethoxazole/trimethoprim(Bactrim),
ciprofloxacin,nitrofurantoin(Macrobid),andmanyothers.Yourhealthcare
providerwillchosetheappropriatemedicationforyourconditionandthespecific
causativeorganisms.

Lowerurinarytractinfection(cystitis)
Inanotherwisehealthyperson,athreedaycourseofantibioticsisusually
enough.Someproviderspreferasevendaycourseofantibiotics.
Occasionally,asingledoseofanantibioticisused.Ahealthcare
professionalwilldeterminewhichoftheseoptionsisbest.
Inadultmales,iftheprostateisalsoinfected(prostatitis),fourweeksor
moreofantibiotictreatmentmayberequired.
Adultfemaleswithpotentialfororearlyinvolvementofthekidneys,urinary
tractabnormalities,ordiabetesareusuallygivenafivetosevendaycourse
ofantibiotics.
Childrenwithuncomplicatedcystitisareusuallygivena10daycourseof
antibiotics.
Toalleviateburningpainduringurination,phenazopyridine(Pyridium)ora
similardrug,canbeusedinadditiontoantibioticsforonetotwodays.

Upperurinarytractinfection(pyelonephritis)
Young,otherwisehealthypatientswithsymptomsofpyelonephritiscanbe
treatedasoutpatients.TheymayreceiveIVfluidsandantibioticsoran
injectionofantibioticsintheemergencydepartment,followedby1014days
oforalantibiotics.Theyshouldfollowupwiththeirhealthcareprofessional
inonetotwodaystomonitorimprovement.
Ifsomeoneisveryill,dehydrated,orunabletokeepanythinginhisorher
stomachbecauseofvomiting,anIVwillbeinsertedintothearm.Heorshe
willbeadmittedtothehospitalandgivenfluidsandantibioticsthroughthe
IVuntilhe/sheiswellenoughtoswitchtoanoralantibiotic.
Acomplicatedinfectionmayrequiretreatmentforseveralweeks.
Apersonmaybehospitalizedifheorshehassymptomsofpyelonephritisand
anyofthefollowing:
Appearveryill
Arepregnant
Havenotgottenbetterwithoutpatientantibiotictreatment
Haveunderlyingdiseasesthatcompromisetheimmunesystem(diabetesis
oneexample)oraretakingimmunosuppressivemedication
Areunabletokeepanythinginthestomachbecauseofnauseaorvomiting
Hadpreviouskidneydisease,especiallypyelonephritis,withinthelast30
days
Haveadevicesuchasaurinarycatheterinplace
Havekidneystones
Urethritisinmenandwomencanbecausedbythesamebacteriaassexually
transmitteddiseases(STDs).Therefore,peoplewithsymptomsofSTDs(vaginal
orpeniledischarge,forexample)shouldbetreatedwithappropriateantibiotics.

Whatfollowupisneededforaurinarytractinfection?
Followahealthcareprofessional'streatmentrecommendations.Finishall
medicationseveniffeelingbetterbeforethemedicationisgone.Ahealthcare

professionalwillwantthepatienttohaveafollowupappointmenttorepeatthe
urinalysisandmakesureheorsheisgettingbetter.
Childrenandadultswithkidneyinvolvementshouldbeseenagaininoneto
twodays.
Peoplerecoveringfromuncomplicatedlowerurinarytractinfectionsshould
beseenwithinoneweek.
Occasionally,theinfectiondoesnotgoawaywiththefirsttreatment.Ifsomeone
isbeingtreatedforaninfectionandhasanyofthefollowing,callahealthcare
professionalpromptly:
Feverorpainwithurinationisnotgoneaftertwodaysofantibiotic
treatment.
Someonecannotkeepthemedicationdownorithasseveresideeffects.
Someoneisunabletokeepfoods,fluids,ormedicationdownbecauseof
nauseaorvomiting.
Someonedevelopssignsofkidneyinvolvement(suchasflankpain,shaking
chills,highfever).
Someone'ssymptomsareworseratherthanbetteraftertwodaysof
antibiotics.

Isitpossibletopreventaurinarytractinfection?
Womenandgirlsshouldwipefromfronttoback(notbacktofront)afterbowel
movements.Thishelpspreventbacteriafromtheanusenteringtheurethra.
Emptythebladderregularlyandcompletely,especiallyaftersexualintercourse.
Drinkplentyoffluids,especiallywater.
Cranberryjuice,especially,hasbeenshowntohelppreventurinarytract
infections.
Womenshouldemptythebladdersoonaftersexualintercourse.

Whatistheprognosisofaurinarytractinfection?
Forpeoplewithuncomplicatedcystitisorpyelonephritis,antibiotictreatment
usuallybringscompleteresolutionoftheinfection.
Ifnottreatedpromptly,urinarytractinfectionscancausepermanentscarringof
theurinarytract.
Pyelonephritis,ifnottreatedpromptly,canspreadtothebloodstreamandcausea
verysevereinfection.
Shorttermandlongtermkidneydamagecanbearesultofpyelonephritis.
Deathfrompyelonephritisisrareinotherwisehealthypeople.
Factorsassociatedwithpooroutcomeareoldageorgeneraldebility,kidney
stones,recenthospitalization,diabetes,sicklecelldisease,cancer,or
chronickidneydisease.
REFERENCES:
Shaikh,N.,N.E.Morone,J.Lopez,J.Chianese,S.Sangvai,F.D'Amico,A.
HobermanA,andE.R.Wald."DoesThisChildHaveaUrinaryTractInfection?"
JAMA298.24Dec.26,2007:28952904.

St.John,A.,J.C.Boyd,A.J.Lowes,andC.P.Price."TheUseofUrinaryDipstick
TeststoExcludeUrinaryTractInfection:ASystematicReviewoftheLiterature."
AmJClinPathol126.3Sept.2006:428436.

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