Urinary infection

Urinary tract infections (UTI) are a group of diseases caused by microorganisms that can affect any region of the urinary tract, being designated by several names: cystitis (infection in the bladder), urethritis (in the urethra), epididymitis (in the epididymis), orchitis (testicular inflammation) and prostatitis (in the prostate); and of the high pathways, when it reaches the kidney, called pyelonephritis or ureteritis (the ureters being the tubes or channels that transport urine from the kidneys to the bladder). They can be divided into uncomplicated and complicated.
Urinary infections are more frequent in women. The most common causes are bacterial infections, mostly caused by E. coli. In fungal infections, the most common causative agent is Candida albicans. Several factors may be related to the increased proliferation of microorganisms in urinary infections, such as urine retention, presence of stones in the urinary tract, use of diaphragms, poor intimate hygiene, among others. Some risk groups include diabetics and menopausal women.

Symptoms usually include urgency, discomfort and burning when urinating, fever (in cases of pyelonephritis), change in urine color, etc. Diagnosis is usually made by analyzing the urine and culturing the bacteria, but the doctor may also use imaging methods to check for abnormalities in the urinary tract. In complicated cases, the urinary tract infection can spread to the human body, causing sepsis.

Treatment is with antibiotics , such as quinolones (ciprofloxacin, norfloxacin), amoxicillin, cephalosporins, and fosfomycin. Some medicinal plants with disinfectant and diuretic properties can help in the treatment, such as horsetail and cranberry. To avoid urinary infections, drink plenty of water during the day, have intimate hygiene habits, regularly change your underwear and have healthy living habits.

Definition

Urinary tract infection (UTI) is an infection that can reach any part of the patient’s urinary system: kidneys, bladder and urethra, and can also reach the prostate in men. Urinary infections can be classified according to their anatomical location: those of the lower pathways as cystitis (infection in the bladder), urethritis (in the urethra), epididymitis (in the epididymis), orchitis (testicular inflammation) and prostatitis (in the prostate); and in the upper airways, when it reaches the kidney, called pyelonephritis.

Urinary tract infections can also be classified as uncomplicated, when there are no structural or functional abnormalities, no relevant kidney diseases (such as nephropathy) and no other comorbidities; or complicated, characterized by being more severe and having a heterogeneous range of clinical characteristics and being associated with other diseases, such as tumors, metabolic causes, renal failure, etc.

Urinary infections are usually caused by microorganisms such as bacteria and fungi.

In most cases, urinary tract infections affect the bladder (cystitis) and urethra (urethritis). Other infections are rarer.

Epidemiology

Urinary tract infections are frequent in the population, being one of the most common infections caused by microorganisms. The incidence of urinary infections varies according to age group. In the first year of life, it is more common in males due to a greater number of congenital malformations in this sex, especially the posterior urethral valve. After this period, it becomes more common in women (about 10 to 20 times greater than in men) because the female urethra is shorter, favoring colonization by fecal flora. Another relevant aspect in women would be the probability of bacterial contamination of the female urethra during sexual intercourse.

In men, the greater urethral length, greater urinary flow and the prostatic antibacterial factor due to the elimination of zinc by the prostate are some of the factors that contribute to the decrease in the incidence of UTI. Men over the age of 50 become more susceptible to UTI due to prostatism, which is the compression and obstruction of the urethra by the prostate caused by benign prostatic hyperplasia or prostate cancer.

Most urinary infections are of the uncomplicated type, such as acute cystitis or acute uncomplicated pyelonephritis. Many urinary infections occur in hospital beds, and this disease corresponds to approximately 40% of hospital infections.

It is estimated that 40% to 60% of women suffer from cystitis or urinary tract infection at least once in their lives.

Causes

The most common agents causing urinary tract infections are bacteria from the Enterobacteriaceae family, with Escherichia coli being the most prevalent (70-85% of cases acquired outside the hospital and 50% of cases of nosocomial infection). Other common species acquired outside the hospital environment include Staphylococcus saprophyticus , Proteus spp., Klebsiella spp., Enterococcus faecalis and Staphylococcus aureus , and of the mentioned bacteria, only S. saprophyticus , S. aureus and E. faecalis are Gram-positive .

In fungal urinary infections, the microorganism Candida albicans is the most frequently found in urine cultures.

These pathological agents go up the urinary tract and can cause infections in various parts of the urinary tract. Some factors favor this development:

– Retention of urine, which can favor bacterial proliferation;

– Vesico-urethral reflux, which is a condition in which there is reflux of urine during urination, favoring the proliferation of bacteria;

– Pregnancy can mean a cause of increased incidence of urinary infections, due to the mechanical and physiological changes imposed on the female body. In this case, pelvic dilation and hydroureter (dilated ureter), increase in kidney size (1 cm), change in position of the bladder that becomes an abdominal and not a pelvic organ, increased bladder capacity due to reduced hormone-mediated bladder tone and relaxation of the smooth muscle of the bladder and progesterone-dependent ureter contribute to the emergence of infections;

– Diabetes (type I and type II) makes the patient more susceptible to urinary infections;

– Sexual intercourse and use of the diaphragm;

– Bad hygiene of intimate parts;

– Use of urethral probes;

– Menopause and increasing age (in both sexes);

– Constipation (constipation);

– Herpes genital;

– Presence of kidney stones, which can trigger urinary retention;

– Prostatism (occurrence of benign prostatic hypertrophy or prostate carcinoma), which is a situation of obstruction to urinary flow with consequent incomplete bladder emptying;

– Kidney transplant. In this case, the infectious agent can be obtained from the donor’s kidney, in addition to the use of immunosuppressants that can reactivate endogenous agents.

– Urethritis
In the case of urethritis, in addition to bacteria of gastrointestinal origin, bacteria that cause sexually transmitted diseases (STDs), such as those that cause genital herpes, gonorrhea or chlamydia, may also be responsible for this inflammation of the urethra.

Although sex life is a factor that favors the onset of urinary tract infections, the disease is not transmitted through sex or any other means.

Groups of risk

Some groups are likely to have a higher incidence of urinary tract infection and include:

– Women, due to anatomical issues, such as a shorter urethra, which facilitates the access of pathogenic agents to the bladder;

– Have an active sex life: women with an active sex life tend to have more urinary tract infections than those without sex life;

– Users of certain birth control methods, such as the diaphragm or spermicidal agents;

– Women in menopause;

– People with urinary tract abnormalities;

– People with kidney stones;

– People with a deficient immune system, such as patients with diabetes;

– Patients using a urinary catheter.

Symptoms

Urinary tract infections may or may not have symptoms. Common symptoms include:

– Urgency to urinate;

– Frequent need to urinate (polakiuria);

– Burning sensation and pain when urinating;

– Reduced urinary stream;

– Urinal safety;

– Signs of blood in the urine, giving it a dark or pink color;

– Strong smell in urine;

– Pelvic pain, in women;

– Rectal pain, in men.
In the case of pyelonephritis, symptoms almost always include fever, back and flank pain, nausea, and vomiting.

Diagnosis

The diagnosis of urinary infections can be made by the clinical symptoms presented by the patient. In the laboratory, the diagnosis can be made by analyzing a urine sample, in which the doctor will observe the presence of pus, red blood cells, number of bacteria, presence of leukocytes and urinary sediments.

Critics of diagnostic tests based on a urine culture, almost all women with symptoms actually suffer from a bacterial infection
Most women with typical symptoms of a urinary tract infection (UTI) (such as cystitis), in other words, who suffer painful urination, frequent or urgent need to urinate; have a general bacterial infection caused by E. Coli., even when no infection is detected using a urine culture analysis test. The latter is most often performed in a laboratory and not in a doctor’s office.
These conclusions come from a study carried out by the University of Ghent in Belgium and published in the journal Clinical Microbiology and Infectionin April 2017. Belgian researchers used a more sensitive method called quantitative polymerase chain reaction (qPCR) and found that 98.2% of women with typical UTI symptoms actually had a bacterial infection. Using normal tests or urine culture standards, this value was only 80.9%. More than 300 Belgian women participated in this study.

The Dutch guidelines on urinary tract infections state that a woman can easily recognize the symptoms of a urinary tract infection (UTI) such as cystitis if she has had a UTI in the past. This means that looking for clinical signs (symptoms) is increasingly preferred over chemical or biological tests looking for bacteria.

Other tests include imaging the urinary tract to identify abnormalities such as kidney stones and malformations. These techniques include ultrasonography, excretory urography (UGE), voiding cystourethography, scintigraphy, computed tomography, and cystoscopy to analyze the bladder and urethra.

Complications

Urinary infections, when not properly treated, can reach the upper regions of the urinary tract, causing acute or chronic pyelonephritis, causing kidney damage and possibly kidney failure. A specific type of is emphysematous and xanthogranulomatous pyelonephritis. Other diseases include perinephric abscess and papillary necrosis (both in the kidneys).

The longer the treatment, the more bacteria and causative agents become resistant and difficult to treat. This can put the patient’s life at risk, since these microorganisms can gain the bloodstream, spreading. This spread can generate thrombi and the patient can go into sepsis with organ failure, usually lung and kidneys.

Treatments

The treatment of urinary tract infections is mainly aimed at eliminating the causative agents from the urinary tract. Antibiotics are normally prescribed in the treatment of the disease For simple infections, commonly used antibiotics are trimethoprim-sulfamethoxazole, amoxicillin , ampicillin, and quinolone antibiotics (ciprofloxacin, norfloxacin, and levofloxacin). Some alternatives are 1st and 3rd generation cephalosporins (cephalexin, cefadroxil, cefixime etc), pipemidic acid and nitrofurantoin.

Symptoms usually disappear within the first few days of treatment, but it is necessary to continue with the entire treatment until the end. The doctor may also prescribe an analgesic in case the patient feels pain, antipyretic in case of fever, antispasmodic or even anti-inflammatory.

Fosfomycin is a particularly useful drug in the treatment of cystitis , since a single pill can cure the disease, in addition to having high specificity and a lower bacterial resistance profile when compared to quinolones. In the case of frequent urinary infections, treatment time is usually longer.

Review of fluoroquinolones
Fluoroquinolones, used in the past against cystitis and urinary infections, have been increasingly discouraged since the 2010s due to potential side effects, sometimes serious, especially on muscles and joints, tendons and neurological. Since 2016, the FDA (United States drug regulatory agency) advises against the use of fluoroquinolones against simple urinary tract infections (e.g. simple cystitis)1

The antimicrobials of choice for the treatment of complicated urinary tract infections are fluoroquinolones, 2nd and 3rd generation cephalosporins, synthetic penicillins with beta-lactamase inhibitors (such as the association amoxicillin + clavulanic acid) and aminoglycosides (streptomycin, apramycin, etc.). In clinically severe cases or initial failure after one to three days of treatment, anti-Pseudomonas drugs, except fluoroquinolones, should be used with hospitalization and intravenous treatment.

When the causative agent is a fungus, the drugs normally used are fluconazole. Amphotericin B is used when there is no response to fluconazole. Ketoconazole is not indicated for fungal urinary infections.

It is important that antibiotic and antifungal treatment be carefully selected as bacteria can become resistant. Treatment control should be done by urinalysis. The use of antibiotics as a prophylactic use is of limited use.

Menopause and urinary tract infections
After menopause , some doctors prescribe estrogens (eg vaginally) to prevent the risk of urinary tract infections in women.

Herbal medicine

Phytotherapy can help in the treatment of urinary infections and must be prescribed by a doctor. Below are some examples of medicinal plants:

– Red cranberry  ( blueberry ), used in juices.

– Cranberry , used in juices or in capsules.

– Birch , used in teas or capsules.

– Heather ( Erica cinera ), used in capsules

– Nettle , used in teas or capsules.

– Horsetail , used in teas or capsules.

– Uva-ursi , used in teas or capsules.

– Soursop, used in the form of leaves

– Leather hat, used in teas

– Carqueja, used in teas

Many of these herbal drugs have diuretic and urinary tract disinfectant properties that help in the treatment of urinary infections. It is important to point out that the leather hat is contraindicated in patients with low blood pressure and carqueja is not indicated for pregnant and lactating women.

Tips

Some tips are useful for patients with urinary tract infection:

– Drink plenty of water during the day, about 2 liters;

– Avoid drinking sodas or other fizzy drinks. Give preference to leaf teas, water and cranberry juice;

– During treatment with antibiotics, strictly follow the medical prescription and use the medicine until the end of the indicated treatment period;

– Avoid ingesting drinks that irritate the bladder, such as coffee, alcoholic beverages;

– In case of abdominal pain, use warm heating pads to relieve discomfort.

Prevention

– Drink plenty of water during the day, about 2 liters;

– Maintain healthy intimate hygiene habits;

– Regularly change your underwear to prevent the proliferation of bacteria and infectious agents;

– Do not hold the urine for too long to avoid bacterial proliferation. When urinating, wait for the bladder to empty completely;

– Avoid jacuzzi, as they may be full of infectious agents;

– Maintain healthy living habits, such as a balanced diet. Avoid stress, fatigue and nervousness, as they can reduce the immune system and lead to infections;

– Properly treat constipation problems;

– Avoid showers and intimate hygiene sprays. There is no reduction in infection levels using these methods;

– For women: after urinating, wipe from front to back to prevent fecal bacteria from coming into contact with the urinary tract;

– For women: after intercourse, completely empty your bladder. Drink a full glass of water to aid urination. Clean the genital areas after intercourse;

– Wear warm clothes in winter, avoid very tight, short or synthetic underwear (give preference to cotton garments). Young women should be careful with the fashion for showing their bellies in winter, as cold weather weakens the immune system, thus increasing the risk of getting cystitis.

Jeanne Kenney
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I’m a stylist trainer, a content creator, and an entrepreneur passion. Virgo sign and Pisces ascendant, I move easily between my dreams, the crazy world I want, and my feet on the ground to carry out my projects.

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