59 RECURRENT URINARY TRACT INFECTION General Discussion In the general population, urinary tract infection (UTI) is primarily an infection of sexually active women, with the prevalence of UTI in women outnumbering men by a ratio of 30:1. However, the prevalence of UTI increases in both sexes with advancing age, reducing the ratio to 2:1. Recurrent UTI is defined as three or more episodes of symptomatic bacteriuria within 1 year. A recurrent infection is one that occurs following documented, successful resolution of an antecedent infection. In younger adults, recurrent infection occurs most often as a bladder infection in women, and is usually related to sexual intercourse. In older persons, recurrence is primarily a lower tract disease as a result of different risk or contributing factors, which may include incomplete bladder emptying or age-related diseases such as diabetes mellitus. The decision to evaluate recurrent UTI radiologically, endoscopically, urodynamically, or otherwise should be based on the patient’s clinical presentation, history, findings, response to antimicrobial therapy, and pattern of recurrent UTIs. A patient with a severe UTI warrants further evaluation. Severe UTI is defined as sepsis, fever, history of UTI lasting more than 7 days, gross hematuria, signs or symptoms of obstruction, or history of stones. Risk factors such as diabetes mellitus, immunosuppression, debilitating disease, or pregnancy also may warrant further evaluation. If a patient has a history of recurrent UTI, urine culture should be used to document the infection, identify the pathogen, and determine the frequency of infection. Urine culture is also used to distinguish between unresolved and recurrent infection. If the same pathogen is documented repeatedly and at close intervals, an underlying abnormality should be suspected and an evaluation should be initiated. If the same pathogen is not found or UTIs do not occur in a close temporal relationship, the likelihood of the infections being associated with functional, metabolic, or anatomic abnormalities is low and the patient may be treated with low-dose antimicrobial prophylaxis. However, men with recurrent infections should be evaluated further because they usually are associated with an anatomic or functional urinary tract abnormality. Conditions Associated with Recurrent UTI Advancing age Bacterial resistance Chronic bacterial prostatitis Diabetes mellitus Genitourinary anatomic abnormalities (bladder polyp, urethral diverticula, fistula, medullary sponge kidney) Genitourinary calculi Immunosuppression Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on RECURRENT URINARY TRACT INFECTION Full access? Get Clinical Tree
59 RECURRENT URINARY TRACT INFECTION General Discussion In the general population, urinary tract infection (UTI) is primarily an infection of sexually active women, with the prevalence of UTI in women outnumbering men by a ratio of 30:1. However, the prevalence of UTI increases in both sexes with advancing age, reducing the ratio to 2:1. Recurrent UTI is defined as three or more episodes of symptomatic bacteriuria within 1 year. A recurrent infection is one that occurs following documented, successful resolution of an antecedent infection. In younger adults, recurrent infection occurs most often as a bladder infection in women, and is usually related to sexual intercourse. In older persons, recurrence is primarily a lower tract disease as a result of different risk or contributing factors, which may include incomplete bladder emptying or age-related diseases such as diabetes mellitus. The decision to evaluate recurrent UTI radiologically, endoscopically, urodynamically, or otherwise should be based on the patient’s clinical presentation, history, findings, response to antimicrobial therapy, and pattern of recurrent UTIs. A patient with a severe UTI warrants further evaluation. Severe UTI is defined as sepsis, fever, history of UTI lasting more than 7 days, gross hematuria, signs or symptoms of obstruction, or history of stones. Risk factors such as diabetes mellitus, immunosuppression, debilitating disease, or pregnancy also may warrant further evaluation. If a patient has a history of recurrent UTI, urine culture should be used to document the infection, identify the pathogen, and determine the frequency of infection. Urine culture is also used to distinguish between unresolved and recurrent infection. If the same pathogen is documented repeatedly and at close intervals, an underlying abnormality should be suspected and an evaluation should be initiated. If the same pathogen is not found or UTIs do not occur in a close temporal relationship, the likelihood of the infections being associated with functional, metabolic, or anatomic abnormalities is low and the patient may be treated with low-dose antimicrobial prophylaxis. However, men with recurrent infections should be evaluated further because they usually are associated with an anatomic or functional urinary tract abnormality. Conditions Associated with Recurrent UTI Advancing age Bacterial resistance Chronic bacterial prostatitis Diabetes mellitus Genitourinary anatomic abnormalities (bladder polyp, urethral diverticula, fistula, medullary sponge kidney) Genitourinary calculi Immunosuppression Only gold members can continue reading. Log In or Register to continue Share this:Click to share on Twitter (Opens in new window)Click to share on Facebook (Opens in new window) Related Related posts: ARTHRITIS AND ARTHRALGIA HAIR LOSS HYPOTHYROIDISM SYNCOPE Stay updated, free articles. Join our Telegram channel Join Tags: Instant Work-ups A Clinical Guide to Medicine Aug 17, 2016 | Posted by admin in PEDIATRICS | Comments Off on RECURRENT URINARY TRACT INFECTION Full access? Get Clinical Tree
