Urine Infection (cont.)
Charles Patrick Davis, MD, PhD
Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.
Jerry R. Balentine, DO, FACEP
Dr. Balentine received his undergraduate degree from McDaniel College in Westminster, Maryland. He attended medical school at the Philadelphia College of Osteopathic Medicine graduating in1983. He completed his internship at St. Joseph's Hospital in Philadelphia and his Emergency Medicine residency at Lincoln Medical and Mental Health Center in the Bronx, where he served as chief resident.
In this Article
- Urinary tract infection (UTI) facts
- What is a urinary tract infection (UTI)?
- What causes a urinary tract infection (UTI)?
- What are urinary tract infection (UTI) risk factors?
- Common urinary tract infection (UTI) symptoms in women, men, and children
- What are urinary tract infection (UTI) symptoms and signs in women, men, and children?
- Is there a link between urinary tract infection (UTI) and pregnancy?
- How is a urinary tract infection (UTI) diagnosed?
- What is the treatment for a urinary tract infection (UTI)?
- What are common antibiotics used to treat a urinary tract infection (UTI)?
- Are there any home remedies for a urinary tract infection (UTI)?
- What are possible complications of a urinary tract infection (UTI)?
- What is the prognosis for a urinary tract infection (UTI)?
- Is it possible to prevent recurrent urinary tract infections (UTIs) with a vaccine?
- Can a urinary tract infection (UTI) be prevented?
- Is it possible to prevent urinary tract infections (UTIs) with diet and supplements?
Is there a link between urinary tract infection (UTI) and pregnancy?
Most clinicians think there are several reasons (links) that make a pregnant female more susceptible to UTIs than nonpregnant women. Investigators suggest that hormones cause the bladder and ureters to dilate; this slows urine flow and may decrease bladder emptying which, in turn, increases the likelihood that bacteria can survive and multiply. Also during pregnancy, the acidity of urine decreases and this favors bacterial growth. The enlarging uterus puts pressure on the bladder, so the urge to urinate is more frequent in pregnancy. But many times, pregnant women wait to urinate for various reasons and this further slows flow. In some women, the pressure from the uterus prevents complete bladder emptying, again favoring bacterial growth. In general, pregnancy predisposes women to more kidney infections than bladder infections.
How is a urinary tract infection (UTI) diagnosed?
The caregiver should obtain a detailed history from the patient, and if a UTI is suspected, a urine sample is usually obtained. The best sample is a midstream sample of urine placed in a sterile cup because it usually contains only the pathogenic organisms instead of the transient organisms that may be washed from adjacent surfaces when the urine stream begins. Male patients with foreskin should retract the foreskin before providing a midstream urine sample. In some patients who cannot provide a midstream sample, a sample can be obtained by a catheter. The urine sample is then sent for urinalysis. Patients with a "discharge," or possibility of having an STD, usually will have the discharge tested for STD organisms (for example, Neisseria and Chlamydia). A positive urinalysis is usually detection of about two to five leukocytes (white blood cells), about 15 bacteria per high-power microscopic field, and a positive nitrite test and/or positive leukocyte esterase test. Some clinicians and labs consider a positive test at least two of the above findings; still others report a positive for bacteria as >1,000 bacteria cultured per milliliter of urine. At best, the initial urinalysis, depending on the various criteria used by clinicians and labs, provides a presumptive positive test for a UTI. Most clinicians believe this presumptive test is adequate enough to begin treatment. A definitive test is usually considered to be isolation and identification of the infecting pathogen at a level of about 100,000 bacteria per cc of urine with the genus of the pathogen (usually bacterial) identified and antibiotic sensitivity determined by lab studies. This test takes 24 to 48 hours to obtain the results and your health care professional will usually start treatment before this result is available. Sometimes blood in the urine is a sign of a UTI but it may also indicate other problems, such as a urinary calculus or “stone.”
In young children, infants, and some elderly patients, the best urine specimen is obtained by catheterization, as they are unable to deliver a “clean catch" urine sample as described above. Urine can also be collected from "bags" placed over the urethral outlet (genital area), but these bagged specimens are only used for presumptive urinalysis as they are unreliable for culture. Some investigators consider any bagged urine samples as unreliable. Urine samples not processed within an hour of collection should either be discarded or be refrigerated before an hour passes because bacterial growth in urine at room temperature can yield false-positive tests. Special culture media and other tests are done for the infrequent or rare pathogens (for example, fungi and parasites).
Other tests may be ordered to further define the extent of a UTI. They may include blood cultures, a complete blood count (CBC), intravenous pyelogram, abdominal ultrasound, a CT scan, or other specialized tests.
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