Urinary Tract Infection

Urinary tract infection health information

Expats.cz Staff

Written by Expats.cz Staff Published on 13.05.2004 10:57:00 (updated on 13.05.2004) Reading time: 3 minutes

Urinary tract infection (UTI) is common in women and uncommon in men,and of special importance in children.

Men over the age of 60 with prostatic hypertrophy often have repeated episodes of UTI.

UTI is associated with multiplication of organisms in the urinary tract and is defined by the presence of more than 100,000 organisms per ml in a midstream sample of urine.


UNCOMPLICATED : It is characterised by anatomically and physiologically normal urinary tract,normal renal function and no associated disorder which impairs local defence mechanism.It rarely results in permanent renal damage.

COMPLICATED: It is characterised by

  • Abnormal urinary tract e.g, obstruction, calculi,vesico-ureteric reflux,indwelling catheter,chronic prostatitis,cystic kidney.
  • Impaired renal function
  • Associated disorder which impairs defence mechanism .e.g diabetes mellitus


  • Escherichia coli 68%
  • Proteus 12%
  • Klebsiella 4%
  • Enterococcus Faecalis 6%
  • Staphylococcus Saprophyticus 10%

Klebsiella and enterococcus faecalis are common in hospital settings.


1. Periurethral Colonization:Normally the periurethral area is colonized by the uropathogenic bacteria,but the quantity is not significant enough to cause any pathology. However, the periurethral colonization by the bacteria can be enhanced by the following factors ,which can then cause the infection.

  • Use of a diaphragm , spermicidal jelly and deodorants.
  • Hormone deficient vaginal atrophy
  • Systemic antibiotic treatmaent for non- urinary tract infection
  • Inadequate perineal hygiene

2. Transurethral Passage: Bacteria are transferred along the urethra to the bladder.

This is facilitated by

  • Sexual intercourse
  • Cathterization
  • Spontaneous transfer along the short female urethra is easy,while the male urethra protects against transfer of bacteria to the bladder and also the prostatic fluid has defensive bactericidal properties.

3. Establishment and multiplication of bacteria within the bladder:Bladder urine is normally sterile due to the defence mechanism in the bladder .A low urine flow rate and poor emptying predispose to infection.


The common symptoms are

  • Frequency of micturation by day and night
  • Painful voiding (dysuria)
  • Suprapubic pain and tenderness
  • Haematuria
  • Smelly urine


  • Quantitative culture of midstream urine or urine obtained by suprapubic aspiration in complicated cases.
  • Microscopic examination of urine for red blood cells,white blood cells and casts.
  • Examination of urine for blood, protein,glucose(dipstick).

Dipstick tests positive for both nitrite and leucocyte esterase are highly predictive of acute infection.

In complicated cases SPECIAL INVESTIGATIONS are carried

  • Excretion urography
  • Plain abdominal X-rays and Ultrasonography
  • Micturating cystourethrography
  • Cystoscopy


Antibiotic treatment is given in almost all cases. Ideally results of urine culture should be available before starting specific therapy,but if the patient is in acute discomfort an MSU should be sent for culture and treatment should be started awaiting the result.Since infection is usually due to E.coli ,use of Trimethoprim or amoxycillin is rational .

  • Trimethoprim 300mg daily for three days or
  • Ampicillin or Amoxycillin 250 mg 8 hourly for three days or
  • Ciprofloxacin 250-500mg 12-hourly for three days.

A fluid intake of atleast 2 litres/ day should be advised to the patient as it ensures regular voiding.

Urine culture should be repeated on the seventh day after the end of the antibiotic course.


Recurrent infection is due to relapse or reinfection

In RELAPSE ,there is usally a cause e.g stones or scarred kidneys.

In this case the cause has to be eradicated.

In REINFECTION the patient has a predisposition to periurethral colonization or poor bladder defence mechanism ,e.g women using diaphragm and spermicidal jelly and postmenopausal women with atrophic vaginitis.


  • Fluid intake of at least 2 litres /day
  • Regular emptying of bladder(3 hr intervals by day and before retiring.
  • Ensure complete emptying of bladder.
  • Double micturation if reflux present.(the patient should be advised ,particularly before retiring for the night to empty the bladder and then attempt to empty the bladder a second time approximately 10-15 mins later)
  • Emptying bladder before and after intercourse.
  • Avoidance of constipation which may impair bladder emptying.
  • Avoidance of bubble baths and other chemicals in bathwater.

This Article was provided by Canadian Medical Care
For more information about their Prague clinic
Visit : http://www.cmcpraha.cz/

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