Urinary Tract Infection

 

Urinary tract infection (UTI) is the presence of micro-organisms in the urine or tissues of the normally sterile genitourinary tract. Infection may be localized to the bladder alone or the kidneys or, in men the prostate.

Acute uncomplicatted UTI occures in women with a normal genitourinary tract and usually manifests as acute cystitis (bladder infection or lower  tract infection). Complicated UTI occures in individuals with structural or functional abnormalities of the genitourinary tract,including those with indwelling devices such as urethral catheters.

Congenital abnormalities of the genito-urinary tract predispose children to UTI. Proven UTI in a child or recurrent UTI requires further urogenital evaluation

Definitive treatment of UTI depends on culture and sensitivity reports. However, empirical treatment may be initiated while awaiting the report. 

 

CAUSES

• Bacteraemia or septicaemia
• Urinary tract obstruction e.g. enlarged prostate in adult males, posterior urethral valves in infants/children

SYMPTOMS

• Frequent painful urination
• Vomiting
• Haematuria
• Suprapubic pain
• Cloudy/foul smelling urine
• Fever-may be persistent and unexplained (in children)
• There may be feeding problems, diarrhoea, and failure to thrive as well (in children)

 UTI symptoms can be non-specific in young children.

SIGNS

• Fever
• Loin tenderness
• Foul smelling urine
• Suprapubic tenderness

INVESTIGATIONS

• FBC
• Abdominal ultrasound scan in children if indicated
• Mid-stream specimen of urine for microscopy, culture and sensitivity (re-culture urine after treatment)

 
TREATMENT
Treatment objectives

• To relieve symptoms such as fever and pain
• To prevent complications
• To eradicate causative agent
• To identify patients with abnormalities of the genito-urinary tract

Non-pharmacological treatment

• Liberal oral fluids to encourage good urinary output
• Personal hygiene and proper cleaning after defaecation

 

 Pharmacological treatment

 Treatment of Uncomplicated UTI

• Ciprofloxacin, oral
  

       Or

• Cefuroxime, oral 

Treatment of Complicated UTI

• Ciprofloxacin, IV

       Or

• Gentamicin, IV, (if kidney function is normal)

       Or

• Ceftriaxone, IV

      Or

• Amoxicillin + Clavulanic Acid, IV