Urinary Tract Infection (UTI)
Urinary tract infections (UTIs) are one of the most common infections in modern medicine, ranking second after respiratory tract infections, causing more than seven million physicians’ visits and 100,000 hospitalizations per year in the USA [1, 2]. UTIs a
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Mohammand Kabbani and Mario Kramer
32.1
General Facts
Urinary tract infections (UTIs) are one of the most common infections in modern medicine, ranking second after respiratory tract infections, causing more than seven million physicians’ visits and 100,000 hospitalizations per year in the USA [1, 2]. UTIs are responsible for nearly 15 % of all community prescription antibiotics and are causes for more than one billion dollar costs per year to manage them [1, 3]. Women are in general more likely to be affected with UTIs. Almost half of all women will experience at least one UTI during their lifetime [3]. High prevalence of UTIs in conjunction with inappropriate and excessive antimicrobial treatment are risk factors of increasing antibiotic resistance. Since many clinical studies regarding treatment of UTIs have investigated women in large healthcare facilities in the USA, physicians should evaluate whether reviews and guidelines for UTI treatment are suitable to their local patients population. On the other side, inconsequent therapy of UTIs may result in potentially lethal urosepsis, renal abscess formation, and chronic pyelonephritis.
32.2
Symptoms, Classification
Typical symptoms of urinary tract infections are the onset of frequency, dysuria, and urgency. Without evidence of significant bacteriuria, these symptoms are defined as acute urethral syndrome. Urinary dipstick revealing positive nitrite
M. Kabbani, MD (*) • M. Kramer MD Department of Urology and Uro-Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, Hannover 30625, Germany e-mail: [email protected]; [email protected] A.S. Merseburger et al. (eds.), Urology at a Glance, DOI 10.1007/978-3-642-54859-8_32, © Springer-Verlag Berlin Heidelberg 2014
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and/or leukocytes may indicate for UTI. UTI is defined by significant bacteriuria with more than 105 cfu/ml from midstream urine, more than 102 cfu/ml from urine of urinary catheters, every evidence of bacteria from suprapubic catheter urine and pyuria (>10 white blood cells per high-power field [×400]). Asymptomatic bacteriuria is often seen in elderly and/or catheterized patients. The acute onset of fever, chills, nausea and vomiting, abnormal fatigue, flank pain, and renal angle tenderness refer to acute pyelonephritis. Urinary tract infections are defined by both clinical course and localization. Upper urinary tract infections are pyelonephritis and ureteritis, whereas lower urinary tract infections are cystitis, urethritis, and prostatitis. The most common appearance of UTIs is uncomplicated cystitis among sexually active women. Complicating factors of UTIs are age (70 years), pregnancy, urinary obstruction, anatomical abnormalities, vesicoureteral reflux, foreign bodies (e.g., ureteral stents), urinary catheterization, diabetes mellitus, immunosuppression, recurrent urinary tract infections, and recently undergone urologic surgery. Chronic cystitis is defined by persistent cystitis or more than 3 cystitides per year. Recurrent urinary tract
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