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Urinary tract infection 

Urinary tract infection
Urinary tract infection

Charles Tomson

, and Neil Sheerin

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date: 25 February 2021

Urinary tract infection (UTI) is a common condition, accounting for 1 to 3% of all primary care consultations in the United Kingdom. It affects patients of both sexes and all ages. The commonest organism causing uncomplicated community-acquired bacterial UTI is Escherichia coli. The occurrence and course of a UTI is influenced by the integrity of the host defence and by bacterial virulence factors. Disruption of the highly specialized transitional cell epithelium which lines the urinary tract, incomplete bladder emptying, anatomical abnormalities, and the presence of a foreign body, such as a urinary catheter, can all contribute to disruption of the host defence and increase the likelihood of infection. Sexual intercourse and use of spermicides increase the risk, and genetic factors influence the susceptibility of some people. Diagnosis—acute uncomplicated UTI can often be diagnosed on symptoms alone, with urinalysis increasing diagnostic accuracy. Submission of a sample for microbiological testing is unnecessary in most cases. Differential diagnoses (‘culture-negative syndromes’) include chlamydial infection, urethral syndrome, and painful bladder syndrome (interstitial cystitis). Investigation—beyond microbiological testing, further investigation of women with uncomplicated UTI is seldom justified. In men, and those women with features indicating complicated infection, investigation for an underlying cause should be considered. Management: antibiotics—trimethoprim and nitrofurantoin remain the first choice for community-acquired UTI in the United Kingdom. Complicated UTI is caused by a wider spectrum of organisms, and recommendations for treatment differ. This chapter discusses the prevention of recurrent uncomplicated UTI and management of complicated UTIs due to urethral catheterization, urinary tract stones, anatomically abnormal kidneys, and pregnancy, and other causes such as fungal infections, tuberculosis, and schistosomiasis.

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