Description
UTI, or urinary tract infection, is a common condition that affects many people, especially women. It is caused by the presence of bacteria in the urinary tract, which can lead to symptoms such as frequent urination, pain or burning during urination, and cloudy or strong-smelling urine. In some cases, untreated or recurrent UTIs can lead to more serious complications such as kidney infections, so it's important to seek medical attention if symptoms persist or worsen.
Summary Listen
- Dr. Ravi Andrews, a nephrologist, discusses urinary tract infections (UTIs), covering their causes, definitions, types, management, and prevention. He emphasizes the importance of understanding the urinary tract's anatomy to differentiate between types of UTIs.
- The lower urinary tract consists of the urethra and bladder, while the upper urinary tract includes the kidneys and ureters. Infections can manifest as urethritis (urethra), cystitis (bladder), or pyelonephritis (kidneys).
- The definition of UTI has evolved since Cass's initial concept in 1963, which focused on bacterial colony counts exceeding 10^5 per mL. The Infectious Disease Society of America later added the criteria of symptomatic bacteriuria, acknowledging that lower counts can still be significant in symptomatic patients.
- UTIs can be categorized anatomically (lower vs. upper), etiologically (bacterial vs. non-bacterial), and epidemiologically (community-acquired vs. hospital-acquired). Ascending infections are common, originating from skin bacteria and progressing upwards, while descending infections are less frequent, stemming from infections elsewhere in the body.
- Clinical presentations vary depending on the location of the infection, including dysuria, frequency, and urethral tenderness in urethritis, or fever, chills, and perineal discomfort in prostatitis. Cystitis typically involves suprapubic pain, frequency, and cloudy urine, while pyelonephritis presents with fever, shaking, nausea, and renal angle tenderness.
- Diagnosis involves urine analysis, examining WBCs, pH, nitrites, and leukocyte esterase. Urine culture remains the gold standard for confirming infection. Sterile pyuria, indicated by WBCs without bacterial growth, requires ruling out other conditions like renal tuberculosis, fungal infections, or drug-related causes.
- Imaging techniques like X-rays and ultrasounds are used to identify complications like calculi, abscesses, or hydronephrosis. MCUG helps assess reflux, while CT scans can reveal perinephric fat stranding, indicating pyelonephritis. DMSAs help decide whether there are scars in the kidney and if the likelihood of being chronic.
- Treatment strategies differ based on whether the UTI is uncomplicated or complicated, and whether it involves the lower or upper urinary tract. Uncomplicated lower UTIs in women are treated with short courses of antibiotics like nitrofurantoin or quinolones, while complicated UTIs require longer durations and potentially higher doses.
- Chemoprophylaxis, involving low-dose antibiotics taken at night, may be used for recurrent infections. Preventing catheter-associated UTIs requires diligent sterile techniques. Untreated UTIs can lead to severe complications like pyelonephritis, abscesses, chronic kidney disease, and papillary necrosis.
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About the Speakers
Dr. Ravi Andrews
MBBS, DNB(Internal Medicine), DNB(Nephrology) , Senior Consultant, Apollo Hospitals MBBS, DCH, MRCPCH Fellow in Neonatal Medicine PGPN Bostan Pediatrician Mumbai, India.
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