UTI/Urinary Tract Infection, Most common in Females

Urinary tract infection (UTI)  is a common medical problems in children and Adults, affecting 3-10% female and 1-3% male. (UTI) is an infection in any part of your urinary system — your kidneys, ureters, bladder and urethra. Most infections involve the lower urinary tract — the bladder and the urethra. Women are at greater risk of developing a UTI than are men. 

Bacteria of Urinary Tract Infection(UTI)

UTI are chiefly caused by E. coli the predominant periurethral flora, others include Klebsiella, Enterobacter and Staphylococcus saprophyticus.

Urinary tract Infection (UTI)

Causes of Urinary tract Infection (UTI)

Urinary tract infections typically occur when bacteria enter the urinary tract through the urethra. Although the urinary system is designed to keep out such microscopic invaders, these defenses sometimes fail. When that happens, bacteria may take hold and grow into a full-blown infection in the urinary tract.

The most common UTI occur mainly in women and affect the bladder and urethra.

UTI is usually caused by Escherichia coli (E. coli), a type of bacteria commonly found in the gastrointestinal (GI) tract. However, sometimes other bacteria are responsible.

Sexual intercourse may lead to cystitis, but you don’t have to be sexually active to develop it. All women are at risk of cystitis specifically, the short distance from the urethra to the anus and the urethral opening to the bladder.

UTI can occur when GI bacteria spread from the anus to the urethra. Also, because the female urethra is close to the vagina, sexually transmitted infections, such as herpes, gonorrhea, chlamydia and mycoplasma, can cause urethritis.

Babies born with urinary tract abnormalities that don’t allow urine to leave the body normally or cause urine to back up in the urethra have an increased risk of UTI.

Kidney stones or an enlarged prostate can trap urine in the bladder and increase the risk of UTI.

Diabetes and other diseases that impair the immune system  the body’s defense against germs can increase the risk of UTI.

People who can’t able to pass urine their own and use a tube (catheter) to urinate have an high risk of UTI. This may include people who are hospitalized, people with neurological problems that make it difficult to control their ability to urinate and people who are paralyzed.

Urinary surgery or an exam of your urinary tract that involves medical instruments can both increase your risk of developing a urinary tract infection.

It also seen in lot of infants, babies sometimes leave with heavy diaper with fill of potty and urine for several hours, so bacteria can also effect that infants because if you are not cleaning your child after passing a potty and urine for several hours the bacteria of her/his potty will present, it can be reached into ureteral it causes a E Coli infection this is the most common infection.

Female Urethra

Female urethras are around 4 cm, which is significantly shorter than male urethras, which are around 18-20 cm, making it easier for germs to reach the bladder. Women’s urethras are also located much closer to the anus compared to men’s, making it easy for bacteria from the anus to migrate to the urethra.

Male Urethra

In the human male, the urethra is on average 18 to 20 centimetres long and opens at the end of the external urethral meatus. It is not close to Anus so very unlikely seen UTI in male. 

UTI

Symptoms of UTI

High Fever

Problem in Urination

Pain In Lower Abdomen

Itching and pain during urination

A strong, persistent urge to urinate

A burning sensation when urinating

Passing frequent, small amounts of urine

Urine that appears cloudy

Urine that appears red, bright pink or cola-colored — a sign of blood in the urine

Strong-smelling urine

Pelvic pain, in women — especially in the center of the pelvis and around the area of the pubic bone.

It is difficult to distinguish between infection localized to the bladder (cystitis) and upper tracts (pyelonephritis). The distinction is not necessary since most UTI in children below 5 years of age involve the upper tracts.

Patients with high fever, systemic toxicity, persistent vomiting, dehydration, renal angle tenderness or raised creatinine are considered as complicated.

Patients with low grade fever, dysuria, frequency and urgency and absence of symptoms of complicated UTI are considered to have simple UTI.

Neonates show features of sepsis with fever, vomiting, diarrhea, jaundice, poor weight gain and lethargy. The older infant has unexplained fever, frequent micturition and occasionally convulsions. Gross hematuria(Blood in Urine) is uncommon. The presence of crying or straining during voiding, dribbling, weak or abnormal urine stream and palpable bladder suggest urinary obstruction.

Types of urinary tract infection

 
Part of urinary tract affected Signs and symptoms
Kidneys

(acute pyelonephritis)

Back pain or side (flank) pain

High fever

Shaking and chills

Nausea

Vomiting

Bladder (cystitis)

Most Common in Women

Pelvic pressure

Lower abdomen discomfort

Frequent, painful urination

Blood in urine

Urethra (urethritis)

Most Common in Women

Burning with urination

Discharge

Diagnosis and Test For UTI

Tests and procedures used to diagnose urinary tract infections include:

The diagnosis of UTI is based on growth of significant number of organisms of a single species in the urine. Significant bacteriuria is a colony count of >105/mL of a single species in a clean catch sample. Urine may be obtained by suprapubic bladder aspiration or urethral catheterization in children below 2 years.

Any colonies on suprapubic aspiration and >50,000/mL on urethral catheterization are considered significant. 

If you are having frequent infections that your doctor thinks may be caused by an abnormality in your urinary tract, you may have an ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging (MRI). Your doctor may also use a contrast dye to highlight structures in your urinary tract.

If you have recurrent UTI, your doctor may perform a cystoscopy, using a long, thin tube with a lens (cystoscope) to see inside your urethra and bladder. The cystoscope is inserted in your urethra and passed through to your bladder.

How to Collect Urine Sample?

Patients with orders for a urine culture and sensitivity are given the proper mid-stream urine collection kit and the appropriate instruction sheet

Give the patient a sterile urine collection kit or urine container. The kits or container are available in the  lab.

There are different instructions for males and females. Verify that then patient understands the instructions.

Male urine culture collection instructions:  

1. Wash hands thoroughly with soap and water, rinse and dry.

2. Open the container. Retract foreskin if present. Cleanse the urinary opening of the penis starting at the center and work outward.

3. Remove lid carefully from the collection container, DO NOT TOUCH the inside of the container or rim. Gently grasp the container.

4. Begin to void urine, letting the first 20-25 ml pass into the toilet. Position the cup in the stream of urine until the container is about half to two-thirds full. Finish voiding into the toilet.

5. After obtaining the urine specimen, screw the lid on tightly again being careful to avoid touching inside the container or lid.

6. Bring the specimen to the lab within 1 hour or collection or store refrigerated for up to 24 hours.

Female urine culture collection instructions: 

1. Wash hands thoroughly with soap and water, rinse and dry.

2. While seated on the toilet spread labia major (outer folds). Wipe one side of the labia minora (inner fold) using a single downward stroke.

3. Remove lid carefully from the collection container, DO NOT TOUCH the inside of the container or rim. Gently grasp the container.

4. Begin to void urine, letting the first 20-25 ml pass into the toilet. Position the cup in the stream of urine until the container is about one-half to two-thirds full. Finish voiding into the toilet.

5. After obtaining the urine specimen, screw the lid on tightly again being careful to avoid touching inside the container or lid.

6. Bring the specimen to the lab within 1 hour of collection  or store refrigerated for up to 24 hours.

Treatment of UTI

Once UTI is suspected, a urine specimen is sent for culture and treatment started.

Infants below 3 months of age and children with complicated UTI should initially receive parenteral antibiotics.

The initial choice of antibiotics is empiric and is modified once culture result is available. While a third generation cephalosporin is preferred, therapy with a single daily dose of aminoglycoside is also safe and effective.

Once oral intake improves and symptoms abate, usually after 48-72 hours, therapy is switched to an oral antibiotic.

The duration of treatment for complicated UTI is 10-14 days. Older infants and patients with simple UTI should receive treatment with an oral antibiotic for 7-10 days. Adolescents with cystitis may receive shorter duration of antibiotics, lasting 72 hours. Patients with asymptomatic bacteriuria do not require treatment.

All children with UTI are encouraged to take enough fluids and empty the bladder frequently. Routine alkalization of the urine is not necessary. With appropriate therapy, fever and systemic toxicity reduce and urine culture is sterile within 24-36 hours. Failure to obtain such results suggests either lack of bacterial sensitivity to the medication or presence of an underlying anomaly of the urinary tract. 

Some common Antibiotic Use in UTI

Nitrofurantoin

Levofloxacin

Amoxicillin/Clavulanate (Augmentin)

Ceftriaxone

Amikacin

Ciprofloxacin

Fluoroquinolones

Fosfomycin

Sulfamethoxazole-trimethoprim

Your doctor will choose your antibiotic based on your history, type of UTI, local resistance patterns, and cost considerations. First-line options are usually selected from nitrofurantoin, fosfomycin and sulfamethoxazole-trimethoprim. Amoxicillin/clavulanate (Augmentin) and certain cephalosporins, for example cefpodoxime, cefdinir, or cefaclor may be appropriate options when first-line options cannot be used.

Length of treatment for cystitis can range from a single, one-time dose, to a course of medication over 5 to 7 days. Kidney infections may require injectable treatment, hospitalization, as well as a longer course of antibiotic, depending upon severity of the infection.

Sometimes a UTI can be self-limiting in women, meaning that the body can fight the infection without antibiotics, however, most uncomplicated UTI cases can be treated quickly with a short course of oral antibiotics.

You must check your Routine Microscopic and culture sensitivity test, Culture sensitivity test is the most importance for know about bacterial growth and which bacteria cause UTI. If your doctor start a medicine on the based of routine microscopic urine test. They don’t have idea what bacteria grow in urethra and which antibiotic will effect they start antibiotic blindly . If you check culture sensitivity this test show the clear report which antibiotic effective in your body.

Never use an antibiotic that has been prescribed for someone else. Kindly advice your doctor this article only for educational purpose

Some other way to reduce UTI Infection

Urinary tract infections can be painful, but you can take steps to ease your discomfort until antibiotics treat the infection. Follow these tips:

Drink plenty of water. Water helps to dilute your urine and flush out bacteria.

Avoid drinks that may irritate your bladder. Avoid coffee, alcohol, and soft drinks containing citrus juices or caffeine until your infection has cleared. They can irritate your bladder and tend to aggravate your frequent or urgent need to urinate.

Use a heating pad. Apply a warm, but not hot, heating pad to your abdomen to minimize bladder pressure or discomfort.

Women can avoid bacteria called E-Coli taking care of few thing.

Maintain your personal hygiene 

Some women avoid bathing in menstruation time but in menstruation time hygiene is most important.

Most important thing to avoid E-Coli bacteria is to know whether the way of cleaning your potty is right. Does everyone know how we should clean the potty? So let’s we know.

I am taking about women pattern of potty cleaning when they are an adult or child. Most of women of child mother clean their potty from back to front as i mentioned above the anatomy of female urethra.

The urethra is very close to Anus. When women clean the potty from back to front, the bacteria that are in our intestine can enter our urethra through the vaginal route. It happen just because of women anus and vaginal distance is very short. so always wipe you potty from front to back it help to prevent E-Coli bacteria. It is the most common bacteria in females.

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