n CME : Your SA Journal of CPD - Urinary tract infection in adults : main topic

Volume 22, Issue 4
  • ISSN : 0256-2170



UTI is a commonly encountered problem in clinical practice, particularly in women. <br>Symptomatic UTI includes lower or upper tract involvement (cystitis or pyelonephritis). <br>UTIs that occur in the setting of underlying medical conditions, pregnancy or long-term use of a catheter are considered to be complicated. <br>The incidence of asymptomatic bacteriuria increases with age. However, it poses no threat in healthy nonpregnant women, men and the well elderly. Screening should be limited to selected patient groups where treatment is mandatory (pregnancy, prior to urinary tract instrumentation, and renal transplantation). <br>UTI in the diabetic, elderly or debilitated patient may lack classic presentation. <br>Complications of upper tract infection are emphysematous pyelonephritis, abscess formation, papillary necrosis and bacteraemia. These are particularly prevalent in patients with diabetes mellitus. <br>Pregnant women with UTI are at risk of preterm labour, prematurity and low-birth-weight infants - they should undergo urine screening early in pregnancy and asymptomatic bacteriuria should be treated aggressively. <br>Investigation and treatment of UTI should be individualised according to the clinical setting in which it occurs. <br>Dipstick tests are cheap, fast and convenient screening tools in patients with uncomplicated cystitis. Urine cultures should be performed in patients with complicating factors and blood cultures may be positive in up to 20% of patients with upper tract involvement. <br>Factors that should be taken into consideration in selecting an antibiotic for treatment are: local microbial susceptibility patterns, duration of therapy with known efficacy for the clinical syndrome versus cost and adverse effects and patient factors (allergy and specific contraindications) as well as clinical severity. <br>Antibiotic prophylaxis is indicated for women who experience at least 2 symptomatic UTIs in less than 6 months. Alternative strategies are intermittent patient-initiated treatment, correction of biological or behavioural factors and use of probiotics and cranberry extracts.

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