Clinical Microbiology: Open

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Puca, Clin Microbiol 2014, 3:6

http://dx.doi.org/10.4172/2327-5073.1000e120

Editorial

Open Access

Urinary Tract Infection in Adults

Edmond Puca*
Infectolog, UHC Mother Teresa, Tirana, Albania
*Corresponding author: Edmond Puca, Service of Infectious Diseases, University Hospital Center Mother Teresa, Tirana, Albania, Tel: 0672058624; E-mail:

[email protected]
Rec date: Nov 26, 2014; Acc date: Nov 30, 2014; Pub date: Dec 11, 2014
Copyright: 2014 Puca E, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted
use, distribution, and reproduction in any medium, provided the original author and source are credited.

Editorial

Urinary tract infections (UTIs) are a frequent problem worldwide

which are caused by microbial invasion to different tissues of the
urinary tract. Urine is normally sterile, that is, free of bacteria, viruses,
and fungi. A urinary tract infection is a condition in which one or
more parts of the urinary system (the kidneys, ureters, bladder, and
urethra) become infected. UTIs are one of the most common bacterial
infections in the general population, with an estimated overall
incidence rate of 18 per 1000 person per year. It is the most frequent
bacterial infection recorded in older people [1]. In addition, UTIs are a
major cause of hospital admissions and are associated with significant
morbidity and mortality as well as a high economic burden [2]. In a
study performed by Sammon et al. 10.8 million patients in the United
States visited an Emergency Department (ED) for the treatment of a
UTI between 2006 and 2009. The economic burden of utilizing the ED
for the treatment of UTIs is estimated to be $2 billion US dollars
annually [3]. UTIs can manifest in a wide clinical range from
bacteriuria with limited clinical symptoms to sepsis [4].
1.
2.
3.
4.
5.
6.

Depending on the factors that trigger the infections UTIs are

classified as:
Uncomplicated or complicated,
Depending on whether the infection is occurring they are
classified as:
Primary or recurrent,
Depending on sing and symptoms they are classified as:
Symptomatic or asymptomatic

A complicated urinary tract infection (cUTI) is an infection

associated with a condition, such as a structural or functional
abnormality of the genitourinary tract, or the presence of an
underlying disease that interferes with host defense mechanisms,
which increase the risks of acquiring infection or of failing therapy
[1-8]. The primary risk factors for the development of UTI include:
age, presence of catheter, chronic comorbidities, neurogenic bladder,
diminished mental status, urinary incontinence, diabetes, being
female, gynecological disorders, male prostatic hypertrophy ect.
Secondary risk factors include dehydration, immobility, other
infection, colonization with resistant organisms, and poor personal
hygiene. Older adults, especially women, are at increased risk of a
secondary infection after the development of a urinary tract infection
[2]. The prevalence of UTIs increases in the female population.
Pregnancy is one of the factors which increase the risk of UTI partly
due to the pressure of gravid uterus on the ureters causing stasis of
urine flow and is also attributed to the humoral and immunological
changes during normal pregnancy [4]. Estrogen deficiency has been
recognized as a risk factor for recurrent UTIs in postmenopausal
women because of ensuing vaginal flora changes: protective lactobacilli
are replaced by E.coli and other uropathogens [2]. People with

Clin Microbiol
ISSN:2327-5073 CMO, an open access journal

indwelling catheters can also be more prone to infections of the

bloodstream and they are more generally at risk of urinary infections.
[3-5]. The patients are affected by microorganisms capable of inducing
inflammation within the urinary and male genital tract. Nearly 95% of
cases of UTIs are caused by bacteria that typically multiply at the
opening of the urethra and travel up to the bladder. Organisms
causing UTI are derived primarily from the aerobic members of the
fecal flora. An overwhelming majority of uncomplicated urinary tract
infections [95%] are caused by a single organism. In contrast,
infections among hospitalized patients, patients with urinary catheters,
or individuals with structural abnormalities of the urinary tract may be
polymicrobial. In uncomplicated UTIs Escherichia coli is the leading
organism, whereas in complicated UTIs the bacterial spectrum is
much broader including Gram-negative and Gram-positive and often
multiresistant organisms. The primary goal of managing UTIs is
optimal administration of appropriate antimicrobial agent and
correction of any underlying genitourinary abnormalities. A rapid
diagnosis is critical to meet the requirements of early goal directed
therapy [4]. The diagnosis of UTI is particularly difficult in elderly
patients, who are more likely to have asymptomatic bacteriuria as they
get older. Urinalysis usually provides enough information to start or
not treatment. A urine culture can help identify the specific bacteria
causing the infection, and determine which type of antibiotics to use.
Treatment of urinary-tract infection is based on its location and on
patient characteristics. A variety of antibiotics are available, and
choices depend on many factors, including whether the infection is
complicated or uncomplicated, primary or recurrent, symptomatic or
asymptomatic. Although antibiotics are the first treatment choice for
urinary tract infections, antibiotic-resistant strains of E. coli, the most
common cause of UTIs, are increasing worldwide.
Depending on difficulties of treatment: recurrent, complicated and
upper UTIs are more problematic compare with other types of UTI.
Complicated UTI is a very heterogeneous entity, with a common
pattern of the following complicating factors:
1.
2.
3.

Anatomical, structural or functional alterations of the urinary

tract.
Impaired renal function, by parenchymal diseases, or pre,-intra,or post renal nephropathies
Accompanying diseases, that impair the patients immune status

The therapy of uncomplicated UTIs is almost exclusively

antibacterial, whereas in complicated UTIs the complicating factors
have to be treated as well [4]. Whereas community acquired UTIs are
often uncomplicated, almost all nosocomial UTIs are complicated
infections [1]. Until recently antimicrobial resistance and healthcare
associated infections are increasing.
Many studies have indicated that cranberry juice may help decrease
the number of symptomatic UTIs, especially for women with recurrent

Volume 3 Issue 6 1000e120

Citation:

Puca E (2014) Urinary Tract Infection in Adults. Clin Microbiol 3: e120. doi:10.4172/2327-5073.1000e120

Page 2 of 2
urinary tract infections. Cranberries, blueberries, and lignonberry, are
three fruits that appear to have protective properties against urinary
tract infections. Probiotics are beneficial microorganisms that may
protect against infections in the genital and urinary tracts. The bestknown probiotics are the lactobacilli strains, such as acidophilus,
which is found in yogurt and other fermented milk products [kefir], as
well as in dietary supplement capsules [9,10]. Because of the
uncertainty regarding the importance of the adaptive immune
response in preventing UTI the role of vaccination has been unclear.
However some studies evidenced the undoubted efficacy of vaccines
and estrogen, especially in patients with recurrent infection and elderly
respectively [2,11,12].
As there are many different causes of underlying abnormality, a
simple recommendation cannot be made for the therapy duration.
Most clinical trials have evaluated 5-10 days of treatment. Successful
antimicrobial therapy will usually ameliorate symptoms promptly,
with substantial clinical improvement in 48 to 72 hours. Patients who
fail to respond in this time frame should be reassessed to exclude
urinary obstruction or abscess [which may require drainage], to
exclude resistance of the infecting organism to the antimicrobial
agents, or to consider an alternate diagnosis other than urinary
infection. Follow-up cultures should be done 2-4 weeks after cessation
of therapy to confirm cure [7]. Suppressive antimicrobial therapy may
be considered for selected patients with frequent, recurrent,
symptomatic infection in whom the underlying genitourinary
abnormality cannot be corrected [9]. Guidelines suggest that antibiotic
prophylaxis should not be used to prevent catheter associated UTI in
catheterized patients. Although prophylaxis may decrease the
incidence of asymptomatic bacteriuria in catheterized patients, it
increases the risk of antimicrobial resistance.

2.
3.
4.

5.
6.
7.

8.
9.
10.
11.

12.

Smith AC, Almond M (2007) Management of urinary tract infections in

the elderlyTrends in Urology Gynaecology & Sexual Health 12: 31-34.
Sammon JD, Sharma P, Rahbar H, Roghmann F, Ghani KR, et al. (2013)
Predictors of admission in patients presenting to the emergency
department with urinary tract infection. World J. Urol 32: 813-819.
Tazebew E, Getenet B, Wondewosen T, Silabat M (2013) Associated risk
factors of urinary tract infection among pregnant women at Felege Hiwot
Referral Hospital, Bahir Dar, North West Ethiopia BMC Research Notes
6: 292.
Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, et al (2001) Early
goal-directed therapy in the treatment of severe sepsis and septic shock.
N Engl J Med 345: 13681377.
Wagenlehner FME, Naber KG (2006) Treatment of Bacterial Urinary
Tract Infections: Presence and Future. European urology 49: 235-244
Kumar A, Roberts D, Wood KE, Light B, Parrillo JE, et al (2006)
Duration of hypotension before initiation of effective antimicrobial
therapy is the critical determinant of survival in human septic shock. Crit
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Kalra OP, Raizada A (2009) Approach to a Patient with Urosepsis. J Glob
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Pallett A, Hand K (2010) Complicated urinary tract infections: practical
solutions for the treatment of multiresistant Gram-negative bacteria. J
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Gmez MFL, Fernndez BP, Garca-Criado FJ, Canelo JAM, Vicente AG,
et al. (2013) Evaluation of a therapeutic vaccine for the prevention of
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References
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Laupland KB, Ross T, Pitout JD, Church DL, Gregson DB (2007)

Community-onset urinary tract infections: a population-based
assessment. Infection 35:150153.

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ISSN:2327-5073 CMO, an open access journal

Volume 3 Issue 6 1000e120