Urinary tract infection: Difference between revisions
Jump to navigation
Jump to search
imported>Robert Badgett No edit summary |
imported>Robert Badgett |
||
| (12 intermediate revisions by 2 users not shown) | |||
| Line 10: | Line 10: | ||
==Cause== | ==Cause== | ||
===Males=== | ===Males=== | ||
In males, urinary tract infections are usually secondary to an underlying cause such as | In males, urinary tract infections are usually secondary to an underlying cause such as [[benign prostatic hyperplasia]] or genitourinary instrumentation.<ref name="pmid2462391">{{cite journal |author=Lipsky BA |title=Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment |journal=Ann. Intern. Med. |volume=110 |issue=2 |pages=138–50 |year=1989 |month=January |pmid=2462391 |doi= |url= |issn=}}</ref> However, a single episode is unlikely to be due to a serious underlying cause.<ref name="pmid12837416">{{cite journal |author=Abarbanel J, Engelstein D, Lask D, Livne PM |title=Urinary tract infection in men younger than 45 years of age: is there a need for urologic investigation? |journal=Urology |volume=62 |issue=1 |pages=27–9 |year=2003 |month=July |pmid=12837416 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0090429503001468 |issn=}}</ref> | ||
==Diagnosis== | |||
The best [[symptom]]s and [[physical examination]] findings for diagnosis have been identified in a [[systematic review]] by the [http://sgim.org/index.cfm?pageId=666 Rational Clinical Examination] in 2002.<ref name="pmid12020306">{{cite journal |author=Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S |title=Does this woman have an acute uncomplicated urinary tract infection? |journal=JAMA |volume=287 |issue=20 |pages=2701–10 |year=2002 |pmid=12020306 |doi= |url=http://jama.ama-assn.org/cgi/pmidlookup?view=long&pmid=12020306 |issn=}}</ref> | |||
Regarding symptoms, a subsequent study and [[clinical prediction rule]] found the best findings are urine cloudiness, offensive smell, moderately severe dysuria, moderately severe nocturia.<ref name="pmid19364448">{{cite journal| author=Little P, Turner S, Rumsby K, Warner G, Moore M, Lowes JA et al.| title=Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study. | journal=Health Technol Assess | year= 2009 | volume= 13 | issue= 19 | pages= iii-iv, ix-xi, 1-73 | pmid=19364448 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19364448 | doi=10.3310/hta13190 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19794030 Review in: Evid Based Med. 2009 Oct;14(5):155]</ref> | |||
A subsequent study and [[clinical prediction rule]] showed the best predictors were urinary nitrite, leucocyte esterase and blood<ref name="pmid19364448">{{cite journal| author=Little P, Turner S, Rumsby K, Warner G, Moore M, Lowes JA et al.| title=Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study. | journal=Health Technol Assess | year= 2009 | volume= 13 | issue= 19 | pages= iii-iv, ix-xi, 1-73 | pmid=19364448 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19364448 | doi=10.3310/hta13190 }} [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=19794030 Review in: Evid Based Med. 2009 Oct;14(5):155]</ref> ; however, these tests may not be very accurate<ref name="pmid20594439">{{cite journal| author=Little P, Turner S, Rumsby K, Jones R, Warner G, Moore M et al.| title=Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women. | journal=Br J Gen Pract | year= 2010 | volume= 60 | issue= 576 | pages= 495-500 | pmid=20594439 | doi=10.3399/bjgp10X514747 | pmc=PMC2894378 }} </ref>. | |||
Urinary tract infections may be overdiagnosed in [[geriatrics|geriatric]] patients.<ref name="pmid19054190">{{cite journal |author=Woodford HJ, George J |title=Diagnosis and Management of Urinary Tract Infection in Hospitalized Older People |journal=J Am Geriatr Soc |volume= |issue= |pages= |year=2008 |month=November |pmid=19054190 |doi=10.1111/j.1532-5415.2008.02073.x |url=http://dx.doi.org/10.1111/j.1532-5415.2008.02073.x |issn=}}</ref> | |||
Various testing strategies have been compared.<ref name="pmid20139214">{{cite journal| author=Little P, Moore MV, Turner S, Rumsby K, Warner G, Lowes JA et al.| title=Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. | journal=BMJ | year= 2010 | volume= 340 | issue= | pages= c199 | pmid=20139214 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=20139214 | pmc=PMC2817051 | doi=10.1136/bmj.c199 }}</ref> | |||
==Treatment== | |||
[[Clinical practice guideline]]s are available"<ref name="pmid21292658">{{Cite journal | |||
| doi = 10.1093/cid/cir102 | volume = 52 | issue = 5 | pages = 561 -564 | last = Gupta | first = Kalpana | |||
| coauthors = Thomas M. Hooton, Kurt G. Naber, Björn Wullt, Richard Colgan, Loren G. Miller, Gregory J. Moran, Lindsay E. Nicolle, Raul Raz, Anthony J. Schaeffer, David E. Soper | title = Executive Summary: International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases | journal = Clinical Infectious Diseases | accessdate = 2011-03-08 | date = 2011-03-01 |pmid=21292658 | url = http://cid.oxfordjournals.org/content/52/5/561.full }}</ref> | |||
* [[Nitrofurantion]] 100 mg twice daily for 5 days is recommended and may be cost effective when:<ref name="pmid21576512">{{cite journal| author=McKinnell JA, Stollenwerk NS, Jung CW, Miller LG| title=Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis. | journal=Mayo Clin Proc | year= 2011 | volume= 86 | issue= 6 | pages= 480-8 | pmid=21576512 | doi=10.4065/mcp.2010.0800 | pmc=PMC3104907 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21576512 }} </ref> | |||
**TMP-SMX resistance is > 17% | |||
** Quinolone resistance is > 12% | |||
==Prevention== | |||
Cranberry juice probably does not help.<ref name="pmid21148516">{{cite journal| author=Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B| title=Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. | journal=Clin Infect Dis | year= 2011 | volume= 52 | issue= 1 | pages= 23-30 | pmid=21148516 | doi=10.1093/cid/ciq073 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=21148516 }} </ref> | |||
===Patients without urinary catheterization=== | |||
===Patients with urinary catheterization=== | |||
Various interventions may reduce urinary tract infection.<ref name="pmid19155821">{{cite journal| author=Parker D, Callan L, Harwood J, Thompson DL, Wilde M, Gray M| title=Nursing interventions to reduce the risk of catheter-associated urinary tract infection. Part 1: Catheter selection. | journal=J Wound Ostomy Continence Nurs | year= 2009 Jan-Feb | volume= 36 | issue= 1 | pages= 23-34 | pmid=19155821 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19155821 | doi=10.1097/01.WON.0000345173.05376.3e }}</ref><ref name="pmid19287262">{{cite journal| author=Willson M, Wilde M, Webb ML, Thompson D, Parker D, Harwood J et al.| title=Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques. | journal=J Wound Ostomy Continence Nurs | year= 2009 Mar-Apr | volume= 36 | issue= 2 | pages= 137-54 | pmid=19287262 | |||
| url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=clinical.uthscsa.edu/cite&email=badgett@uthscdsa.edu&retmode=ref&cmd=prlinks&id=19287262 | doi=10.1097/01.WON.0000347655.56851.04 }}</ref> | |||
==References== | ==References== | ||
<references/> | <references/> | ||
Revision as of 11:40, 7 July 2011
In medicine, urinary tract infections are "inflammatory responses of the epithelium of the urinary tract to microbial invasions. They are often bacterial infections with associated bacteriuria and pyuria."[1]
Classification
More common types of urinary tract infections in include:
Cause
Males
In males, urinary tract infections are usually secondary to an underlying cause such as benign prostatic hyperplasia or genitourinary instrumentation.[2] However, a single episode is unlikely to be due to a serious underlying cause.[3]
Diagnosis
The best symptoms and physical examination findings for diagnosis have been identified in a systematic review by the Rational Clinical Examination in 2002.[4]
Regarding symptoms, a subsequent study and clinical prediction rule found the best findings are urine cloudiness, offensive smell, moderately severe dysuria, moderately severe nocturia.[5]
A subsequent study and clinical prediction rule showed the best predictors were urinary nitrite, leucocyte esterase and blood[5] ; however, these tests may not be very accurate[6].
Urinary tract infections may be overdiagnosed in geriatric patients.[7]
Various testing strategies have been compared.[8]
Treatment
Clinical practice guidelines are available"[9]
- Nitrofurantion 100 mg twice daily for 5 days is recommended and may be cost effective when:[10]
- TMP-SMX resistance is > 17%
- Quinolone resistance is > 12%
Prevention
Cranberry juice probably does not help.[11]
Patients without urinary catheterization
Patients with urinary catheterization
Various interventions may reduce urinary tract infection.[12][13]
References
- ↑ Anonymous (2024), Urinary tract infection (English). Medical Subject Headings. U.S. National Library of Medicine.
- ↑ Lipsky BA (January 1989). "Urinary tract infections in men. Epidemiology, pathophysiology, diagnosis, and treatment". Ann. Intern. Med. 110 (2): 138–50. PMID 2462391. [e]
- ↑ Abarbanel J, Engelstein D, Lask D, Livne PM (July 2003). "Urinary tract infection in men younger than 45 years of age: is there a need for urologic investigation?". Urology 62 (1): 27–9. PMID 12837416. [e]
- ↑ Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S (2002). "Does this woman have an acute uncomplicated urinary tract infection?". JAMA 287 (20): 2701–10. PMID 12020306. [e]
- ↑ 5.0 5.1 Little P, Turner S, Rumsby K, Warner G, Moore M, Lowes JA et al. (2009). "Dipsticks and diagnostic algorithms in urinary tract infection: development and validation, randomised trial, economic analysis, observational cohort and qualitative study.". Health Technol Assess 13 (19): iii-iv, ix-xi, 1-73. DOI:10.3310/hta13190. PMID 19364448. Research Blogging.
Review in: Evid Based Med. 2009 Oct;14(5):155 Cite error: Invalid
<ref>tag; name "pmid19364448" defined multiple times with different content - ↑ Little P, Turner S, Rumsby K, Jones R, Warner G, Moore M et al. (2010). "Validating the prediction of lower urinary tract infection in primary care: sensitivity and specificity of urinary dipsticks and clinical scores in women.". Br J Gen Pract 60 (576): 495-500. DOI:10.3399/bjgp10X514747. PMID 20594439. PMC PMC2894378. Research Blogging.
- ↑ Woodford HJ, George J (November 2008). "Diagnosis and Management of Urinary Tract Infection in Hospitalized Older People". J Am Geriatr Soc. DOI:10.1111/j.1532-5415.2008.02073.x. PMID 19054190. Research Blogging.
- ↑ Little P, Moore MV, Turner S, Rumsby K, Warner G, Lowes JA et al. (2010). "Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial.". BMJ 340: c199. DOI:10.1136/bmj.c199. PMID 20139214. PMC PMC2817051. Research Blogging.
- ↑ Gupta, Kalpana; Thomas M. Hooton, Kurt G. Naber, Björn Wullt, Richard Colgan, Loren G. Miller, Gregory J. Moran, Lindsay E. Nicolle, Raul Raz, Anthony J. Schaeffer, David E. Soper (2011-03-01). "Executive Summary: International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clinical Infectious Diseases 52 (5): 561 -564. DOI:10.1093/cid/cir102. PMID 21292658. Retrieved on 2011-03-08. Research Blogging.
- ↑ McKinnell JA, Stollenwerk NS, Jung CW, Miller LG (2011). "Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis.". Mayo Clin Proc 86 (6): 480-8. DOI:10.4065/mcp.2010.0800. PMID 21576512. PMC PMC3104907. Research Blogging.
- ↑ Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B (2011). "Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial.". Clin Infect Dis 52 (1): 23-30. DOI:10.1093/cid/ciq073. PMID 21148516. Research Blogging.
- ↑ Parker D, Callan L, Harwood J, Thompson DL, Wilde M, Gray M (2009 Jan-Feb). "Nursing interventions to reduce the risk of catheter-associated urinary tract infection. Part 1: Catheter selection.". J Wound Ostomy Continence Nurs 36 (1): 23-34. DOI:10.1097/01.WON.0000345173.05376.3e. PMID 19155821. Research Blogging.
- ↑ Willson M, Wilde M, Webb ML, Thompson D, Parker D, Harwood J et al. (2009 Mar-Apr). "Nursing interventions to reduce the risk of catheter-associated urinary tract infection: part 2: staff education, monitoring, and care techniques.". J Wound Ostomy Continence Nurs 36 (2): 137-54. DOI:10.1097/01.WON.0000347655.56851.04. PMID 19287262. Research Blogging.