Management of Infections of the Urinary Tract
Urinary tract infections are among the most frequent infections encountered in both the community and the hospital environment. They range from harmless asymptomatic bacteriuria and self-curing cystitis to severe pyelonephritis with life-threatening sepsis. Escherichia coli is the most common gram-negative urinary tract pathogen followed by Proteus sp., Klebsiella sp., and other Enterobacteriaceae. Gram-positive species such as Enterococci and Staphylococcus spp. are often found in urine culture. Early diagnoses and determination of the severity of the infection are necessary for an effective medical treatment. Urological patients are particularly prone to urinary tract infections, and the identification of a possible risk factor requiring a surgical intervention or drainage can be vital to the patient. Bacillus tuberculosis is causing progressive destruction and scares of the urinary tract with retained calcifications. Tuberculosis is still a worldwide infectious disease of major importance and hits the urinary tract in at least some 5–10 % of the cases. Also the blood fl uke Schistosoma haematobium (bilharzias, snail fever) is endemic in defined geographic areas, producing fibrotic lesions, strictures, and scares of the ureter and bladder as well as being a possible underlying cause of bladder cancer.
The bowel constitutes the reservoir of the microorganisms colonizing the urogenital tracts. E.coli infections have been extensively studied and are caused by a disturbance in the host-parasite balance. Cystitis is the most common UTI, involving only the lower urinary tract, and is seen in both pre- and postmenopausal women. There is no fundamental difference in the principle of treatment. However, with increased age, the recurrence rate may increase and, thus, the regimens length. Acute bacterial prostatitis is a serious, usually febrile infection creating an inflammation of the glandular tissue. The condition is accompanied by dysuria, perineal pain, bladder outlet voiding symptoms, and fever. Inflammatory parameters such as CRP and white blood count are increased. In adult men, the causative microorganisms are the usually uropathogens, although sexually transmitted infections also have to be considered. In younger men, Chlamydia infection must be taken into account.
There is a growing worldwide threat in the development of multi resistant bacteria. This threat is to be taken seriously as at the end, even simple uncomplicated infection might become difficult to treat. There is a correlation between the use of antimicrobial agents and the development of resistant bacterial strains. The systematic use of some antibiotics produces also a collateral damage, selecting resistant strains in the community and the hospital environment. It is therefore recommended to reduce the prescription to the recommended regimens and to follow local and international guidelines in the management of UTI, as for other infections.
Journal of Nephrology and Urology