Urinary Tract Infection (UTI) in Females

Urinary Tract Infection (UTI) in Females is a topic covered in the 5-Minute Clinical Consult.

To view the entire topic, please or .

5-Minute Clinical Consult (5MCC) app and website powered by Unbound Medicine helps you diagnose and manage 900+ medical conditions. Exclusive bonus features include Diagnosaurus DDx, 200 pediatrics topics, and medical news feeds. Explore these free sample topics:

-- The first section of this topic is shown below --

Basics

Description

  • Urinary tract infection (UTI) is the presence of pathogenic microorganisms within the urinary tract and associated symptoms (dysuria, urinary urgency/frequency, hematuria, new or worsening incontinence).
  • This topic refers primarily to acute infectious cystitis; other complicated UTIs, such as pyelonephritis, are discussed elsewhere.
  • Uncomplicated UTI: occurs in patients who have a normal, unobstructed urinary tract, who have no history of recent urologic procedure, and whose symptoms are confined to the lower urinary tract. Uncomplicated UTIs are most common in young, sexually active women.
  • Complicated UTI: an infection of the lower or upper urinary tract in the presence of an anatomic abnormality, a functional abnormality, immunocompromised host, or presence of a multi-drug resistant organism (see “Risk Factors”)
  • Recurrent UTI: symptomatic UTIs that follow resolution of an earlier episode after appropriate treatment
    • Three UTIs within 12 months or two within 6 months
    • Most recurrences are thought to represent reinfection rather than relapse.
    • No evidence indicates that recurrent UTIs lead to health problems such as hypertension or renal disease in the absence of anatomic or functional abnormalities of the urinary tract.
  • System(s) affected: renal, urologic
  • Synonym(s): cystitis

Epidemiology

Incidence
  • Accounts for 8 million doctor visits and 1 million emergency room visits and contributes to >100,000 hospital admissions each year with a cost of over $2.6 billion annually
  • Primarily affects young adults and older adults.
  • Predominant sex: female > male

Prevalence
  • >50% of females have at least one UTI in their lifetime.
  • One in four women experience recurrent UTIs.
  • 1/4 of women with uncomplicated UTI experience a second UTI within 6 months and 1/2 at some time during their lifetime.

Etiology and Pathophysiology

  • Bacteria and subsequent infection in the urinary tract arise chiefly via ascending bacterial movement and propagation.
  • Pathogenic organisms (Escherichia coli) possess adherence factors and toxins that allow initiation and propagation of genitourinary infections:
  • Most UTIs are caused by bacteria originating from bowel flora:
    • E. coli is the causative organism in 80% of cases of uncomplicated cystitis.
    • Staphylococcus saprophyticus accounts for 15% of infections.
  • Candida is associated with nosocomial UTI.

Genetics
Women with human leukocyte antigen 3 (HLA-3) and nonsecretor Lewis antigen have an increased bacterial adherence, which may lead to an increased risk in UTI.

Risk Factors

Previous UTI; diabetes mellitus (DM); pregnancy; sexual activity; use of spermicides or diaphragm; underlying abnormalities of the urinary tract such as tumors, calculi, strictures, bladder diverticula, incomplete bladder emptying, urinary incontinence, neurogenic bladder; catheterization; recent antibiotic use; poor hygiene; estrogen deficiency; inadequate fluid intake

General Prevention

  • Maintain good hydration.
  • Women with frequent or intercourse-related UTI should empty bladder immediately before and following intercourse; consider postcoital antibiotic.
  • Avoid feminine hygiene sprays and douches.
  • Wipe urethra from front to back.
  • Cranberry tabs may prevent recurrent infections.
  • Vaginal estrogen in postmenopausal women may prevent infection.

Commonly Associated Conditions

See “Risk Factors.”

Geriatric Considerations

  • Elderly patients are more likely to have underlying urinary tract abnormality or voiding dysfunction.
  • Acute UTI may be associated with incontinence or mental status changes in the elderly.
  • Asymptomatic bacteriuria is very common in the elderly and should not be confused for infection. Treatment does not improve outcomes and may cause morbidity and therefore should be avoided.

Pediatric Considerations
Pediatric patients are more likely to have bowel bladder dysfunction or congenital urinary tract abnormalities such as vesicoureteral reflux or a duplicated collecting system.

-- To view the remaining sections of this topic, please or --

Basics

Description

  • Urinary tract infection (UTI) is the presence of pathogenic microorganisms within the urinary tract and associated symptoms (dysuria, urinary urgency/frequency, hematuria, new or worsening incontinence).
  • This topic refers primarily to acute infectious cystitis; other complicated UTIs, such as pyelonephritis, are discussed elsewhere.
  • Uncomplicated UTI: occurs in patients who have a normal, unobstructed urinary tract, who have no history of recent urologic procedure, and whose symptoms are confined to the lower urinary tract. Uncomplicated UTIs are most common in young, sexually active women.
  • Complicated UTI: an infection of the lower or upper urinary tract in the presence of an anatomic abnormality, a functional abnormality, immunocompromised host, or presence of a multi-drug resistant organism (see “Risk Factors”)
  • Recurrent UTI: symptomatic UTIs that follow resolution of an earlier episode after appropriate treatment
    • Three UTIs within 12 months or two within 6 months
    • Most recurrences are thought to represent reinfection rather than relapse.
    • No evidence indicates that recurrent UTIs lead to health problems such as hypertension or renal disease in the absence of anatomic or functional abnormalities of the urinary tract.
  • System(s) affected: renal, urologic
  • Synonym(s): cystitis

Epidemiology

Incidence
  • Accounts for 8 million doctor visits and 1 million emergency room visits and contributes to >100,000 hospital admissions each year with a cost of over $2.6 billion annually
  • Primarily affects young adults and older adults.
  • Predominant sex: female > male

Prevalence
  • >50% of females have at least one UTI in their lifetime.
  • One in four women experience recurrent UTIs.
  • 1/4 of women with uncomplicated UTI experience a second UTI within 6 months and 1/2 at some time during their lifetime.

Etiology and Pathophysiology

  • Bacteria and subsequent infection in the urinary tract arise chiefly via ascending bacterial movement and propagation.
  • Pathogenic organisms (Escherichia coli) possess adherence factors and toxins that allow initiation and propagation of genitourinary infections:
  • Most UTIs are caused by bacteria originating from bowel flora:
    • E. coli is the causative organism in 80% of cases of uncomplicated cystitis.
    • Staphylococcus saprophyticus accounts for 15% of infections.
  • Candida is associated with nosocomial UTI.

Genetics
Women with human leukocyte antigen 3 (HLA-3) and nonsecretor Lewis antigen have an increased bacterial adherence, which may lead to an increased risk in UTI.

Risk Factors

Previous UTI; diabetes mellitus (DM); pregnancy; sexual activity; use of spermicides or diaphragm; underlying abnormalities of the urinary tract such as tumors, calculi, strictures, bladder diverticula, incomplete bladder emptying, urinary incontinence, neurogenic bladder; catheterization; recent antibiotic use; poor hygiene; estrogen deficiency; inadequate fluid intake

General Prevention

  • Maintain good hydration.
  • Women with frequent or intercourse-related UTI should empty bladder immediately before and following intercourse; consider postcoital antibiotic.
  • Avoid feminine hygiene sprays and douches.
  • Wipe urethra from front to back.
  • Cranberry tabs may prevent recurrent infections.
  • Vaginal estrogen in postmenopausal women may prevent infection.

Commonly Associated Conditions

See “Risk Factors.”

Geriatric Considerations

  • Elderly patients are more likely to have underlying urinary tract abnormality or voiding dysfunction.
  • Acute UTI may be associated with incontinence or mental status changes in the elderly.
  • Asymptomatic bacteriuria is very common in the elderly and should not be confused for infection. Treatment does not improve outcomes and may cause morbidity and therefore should be avoided.

Pediatric Considerations
Pediatric patients are more likely to have bowel bladder dysfunction or congenital urinary tract abnormalities such as vesicoureteral reflux or a duplicated collecting system.

There's more to see -- the rest of this entry is available only to subscribers.