Under a urinary tract infection refers to a by pathogens causing infectious disease of the urinary tract. The infection can be up to the kidneys and blood stream spread and consequently threatening diseases cause. UTIs can be very successfully with antibiotics are discussed. Here, depending on the risk potential of patients different drugs used. In uncomplicated cases there is often no medication to cure the disease. Non-drug measures may encourage them.

Propagation

The number of new cases in one year (incidence) lies in women of younger age at about 5%. It rises at the age around 20% to. While UTIs are rare in younger women, their risk is similar to the increasing age of women at. There are three peaks of incidence of urinary tract infections in the population. An initial clustering of cases occurs in infants and young children, as they more often have untreated malformations of the urinary tract. Similarly, in this age group, smear infections more often. The second frequency peak affects adult women. He is on the increased rate of infections associated with sexual activity and increased vulnerability in pregnancies reduced. Older people of both sexes are the third group with increased incidence of the disease. This is due to narrowing of the urinary tract by age-related degeneration, such as a prostate or a prolapsed of the uterus.

Among the hospital-acquired ( nosocomial ) infections, urinary tract infections are the most common. A German study from the 1990s estimated the proportion of urinary tract infections in the nosocomial infections to more than 40%.

Rod-shaped bacteria and white blood cells on microscopic examination of urine

A urinary tract infection occurs in 95-98% of cases on the rise of the pathogen on the urethra about. In the other cases is the infectious urogenital tract via the circulation. The excitation (usually bacteria ) derived in most cases, the body’s intestinal flora reach, to the external urethral opening and moves the urethra up into the bladder , where a bladder infection ( cystitis ) leads. On further rise may lead to renal pelvic inflammation, including the involvement of the kidney tissue itself ( pyelonephritis ), and finally to blood poisoning ( septicemia ) may occur.

The pathogens have this body’s own defense mechanisms to overcome. These consist of the liquid stream while urinating, the urothelium , and the attachment of bacteria to counteract one, as well as IgA antibodies, which occur on the surface of the urothelium. This bubble will be held at the healthy germ-free. The urine itself has only a few species against bacterial and can even promote the growth of many types of pathogens. Factors, the germs in the rise to help, are the formation of a bacterial capsule , the production of hemolysins for dissolution of red blood cells , and the formation of filamentous cell organelles, the attachment of bacteria to the surface tissue tract serve, called pili, the receptor density these pili are in receipt of the vagina , bladder, ureter and renal pelvis cup system is particularly high.

In addition to these properties of the pathogen even encourage many other possible factors of the host the training of a urine infection. Instrumental interventions such as a bladder or a bladder catheter constitute a possible portal of entry. Abnormalities of the urinary tract, bladder dysfunction or a reduction of urine flow affect the flushing of pathogens and facilitate their advancement. Similarly, sexual activity is a risk factor, as they spread germs favors. Diabetes mellitus also contributes a urinary tract infection at, as he the functioning of the immune system decreases and any urine excreted glucose as a nutrient for the bacteria used. Other risk factors for women are the use of spermicides or pessaries for prevention. Similarly, a previous antibiotic therapy by the killing of the physiological vaginal flora establishment of pathogenic bacteria promote the. A urinary tract infection in prehistory is – regardless of gender – represents a significant risk factor, since recurrences are common. Even the relatively short urethra in women is supporting factor for the rise of agents appointed. In recent publications, however, is individual susceptibility to infections by abnormalities of the immune system more weight than this anatomical fact. So today is a low excretion of protein Uromodulin in children and women, and certain isotypes of the T-cell receptor with increased incidence of urinary tract infections connection brought in .

Lower urinary tract

The subdivision is subject to the institutions involved in a lower or upper urinary tract infection or according to the potential severity of the course in a complicated or uncomplicated infection.

The lower urinary tract infection affects only the urethra and bladder and from the upper urinary tract infection, in which the kidneys or ureters are defined accomplice. The top one comes from a lower urinary tract infection.

In addition, will be divided between complicated and uncomplicated infections. As complicated urinary tract infections are in patients in whom.

• The development is favored, for example by limited defenses in immunosuppressant or diabetes mellitus,
• usually there are no urinary tract infections (men or children),
• Damages are likely or very dangerous (pregnant women, older patients),
• an instrumental surgery of the urinary tract was made ( bladder catheter , cystoscopy , surgery, regardless of how long the operation lags),
• an anatomical or neurological disorders of bladder function or
• an abnormality (such as polycystic kidney disease ) or renal insufficiency is present.[6]

Of a recurrent urinary tract infection (relapse) occurs within six months if the disease twice, or three times during a year occurs.

A particularly serious, potentially life-course, go where the bacteria into the bloodstream is known as urosepsis.

 

Excitation spectrum

A distinction is made between the hospital or nursing homes acquired so-called nosocomial urinary tract infections acquired in the normal and the so-called community- acquired infections.

Outside of health facilities is 70% Escherichia coli , a gram-negative bacillus of the intestinal flora, leading. Furthermore, contact other enterobacteria such as Klebsiella, or Proteus species on. Also staphylococci or enterococci are not uncommon. Rarely, hard detected germs such as Ureaplasma urealyticum or Mycoplasma hominis occur. In addition, Chlamydia trachomatis , which is transmitted sexually in front of all, cause a urinary tract infection. Another sexually transmitted organism is Neisseria gonorrhoeae , the causative agent of gonorrhea (clap). Overall, gram-negative pathogens predominate in approximately 86% of uncomplicated infections strong against gram-positive pathogens.

For infections that are acquired in healthcare facilities, is Escherichia coli also common. Occur here but increasingly Klebsiella, Proteus species and Pseudomonas on. The germs in healthcare facilities are often resistant to multiple antibiotics. A resistance testing is therefore essential for these infections is necessary.

A rare cause of urinary tract infections in the literature viruses and protozoa such as Trichomonas vaginalis described.

Clinical manifestations

Depending on how far the infection has risen in the system of the urinary tract, which can be made symptoms varied. An infection of the urethra itself triggers pain during urination ( Algurie itching or off). In a bladder infection (cystitis) are these symptoms also occurring. In addition, urine flow is often reduced. Any one can purulent ( pyuria ) or bloody ( hematuria blending show in urine). Characteristic (also urinary frequency in which the patients but only small amounts of urine, stop urinary frequency ). Typically occurs at a rather cystitis no fever. In acute pyelonephritis are flank pain and fever in the foreground, nausea and vomiting may also occur. In the clinical examination often reveals pain on percussion of the kidney bearing . The renal involvement but can also run completely without symptoms. It appears for around 30% of the bladder an asymptomatic renal pelvic inflammation.

If men in the prostate affected by, patients often show a severe clinical picture of abdominal pain in the perineal area and a fever. For children, the elderly or patients a kidney transplant received, the symptoms can occur quite uncharacteristic. Thus, there is a severe disease with renal involvement only in fever or abdominal pain express themselves. Confusion in the elderly can occur as a single symptom. The distinction between the upper and lower urinary tract infection is not on the basis of clinical symptoms certainly possible.

In children, the symptoms make depending on the age group of different. This may include the diagnosis and adequate treatment in some cases substantially more difficult. When newborns can weight loss, poor feeding, jaundice , pale-gray discoloration of the skin, disorders of the central nervous system sensitivity to touch on an already ascended into the kidney infection and point. In older infants often shows a high fever. It is not uncommon even diarrhea, vomiting and meningitis sign on. In 4-7% of all infants with fever of unknown origin is a urinary tract infection as a basis. Infants with lower urinary tract infections often show typical signs, with a pyelonephritis these missing sometimes. Often, this case is the only comprehensible abdominal symptoms displayed in. Typical flank pain, renal involvement indicates, can children fourth or fifth year of life often do not speak on the up.

Diagnostic Tests

Urine Rapid Test Strip

After collecting the medical history ( history ) is a simple urine infection symptom in women to a secondary diagnosis to be dispensed at typical. Complicated or hospital-acquired infections but require further investigations. The emphasis is on the detection of the virus. An examination of the urine by means of a test strip is white blood cells ( leukocytes ) and nitrite show. The absence of nitrite does an infection is not enough. The white blood cells as part of an inflammatory reaction of the immune response to infection constitutes at the sediment are also detectable leukocytes, are a minimum of ten white blood cells per μl of proof shall be clinically significant. Similarly, in this study, the microscopic bacteria may directly visible.

Another method of investigation is the urine culture, in the wet with urine agar plates growing bacteria serve. To accomplish this, the urine sample as midstream be obtained by catheterization, or to contamination outside the urinary tract to avoid possible one. The urine specimen should be refrigerated or processed it quickly in order to avoid false high values.

Significant number of bacteria

Midstream          105/ Ml

Urinary 102/ Ml

Catheterized      102-10 3/ ml

In the presence of fever is a blood test carried out. Elevated levels of CRP , and a proliferation of white blood cells are a sign of an inflammatory process. The taking of a blood culture is used to prove them to transfer the virus in the bloodstream, also may the type of pathogen culture established by the. The removal of the culture is beginning antibiotic treatment to be carried out before. An elevated creatinine value function shows damage to the kidneys to one who had risen due to infection may be a by far. If this is the case, one is as ultrasound necessary to exclude as a cause of urinary outflow obstructions.

Treatment

UTIs can be treated successfully with antibiotics. The goal is to eliminate the causative pathogen. This is a dose of the antibiotic before sleep best short to the active ingredient in the bladder to increase the concentration. It is also possible in principle, the non-drug therapy on measures (→ prevention limit). Spontaneous healing of half of the cases expected in round. The disadvantage of this method is that the patients of the disease, the symptoms must endure for more than an antibiotic therapy.

Should drug therapy be initiated, is trimethoprim the drug of first choice. This substance inhibits the bacterial folate metabolism and thus the growth of pathogens. Consequently Trimethoprim is effective against gram-positive and gram-negative bacteria equivalent. Another means is nitrofurantoin there, however, in the urine and only in the tissue of the kidney does not reach. Both drugs are relatively inexpensive and well tolerated by the body’s bacterial flora. Severe side effects, including pneumonia, hepatitis and polyneuropathy occur only extremely rarely. The treatment will be based on short-term therapy for only three days. Resistance to nitrofurantoin are rare. Studies from other European countries are the increased incidence of resistance to trimethoprim over.

 The combination drug Cotrimoxazole , in addition to trimethoprim nor the sulfonamide sulfamethoxazole , shall be distributed by the German Society for General no longer recommended in the guidelines. By Sulfonamidanteil patients appear at around 4% of allergic reactions to skin. In addition, hypoglycemia , and drug-induced skin damage ( Lyell’s syndrome ) is possible. These side effects would be in uncomplicated infections no increased effect of the combination product compared with trimethoprim alone against. Other recent publications and the Guideline of the German Society of Gynecology and Obstetrics recommend the combination but still. Another reserve may fluoroquinolones are used. There are also publications such Watch as the first-choice.

General measures as supportive fluid intake is at least one and a half liters per day is recommended by. These areas are the seeds from the populated flushed out. According to the guidelines of the German Society of General higher than the widely used herbal supplements, teas and cranberry no reliable studies which prove the effectiveness.

The usefulness of a study to monitor the success of therapy for symptomatic improvement is between guidelines and textbooks controversial. Within 48 hours no clinical improvement one step, then the failure of the drug assumed. In this case, other means should be switched to one.

Recurrence of uncomplicated urinary tract infection

Approximately 50% of patients relapse within one year of the infection occurs on one. If the infection within 14 days, is one of the pathogen survival in spite of clinical improvement assumed. In this case, the first therapy with another drug of first choice treated as to counteract development of resistance. Therapy should be extended to the case for ten days in this. One urinary tract infection more than 14 days after the first infection on clinical healing occurs, is a new infection assumed to exist. A change of the drug and an extension of the short-term treatment is not necessary.

Is there a connection between one patient the recurrent infections and sexual intercourse, a prophylaxis with trimethoprim after each sexual intercourse help. Is also working to urinate after intercourse against the rise of pathogens directly. Moreover, in the literature mentioned in the urine with L- methionine acidify. The acidic environment of urine while offering poorer growing conditions for bacteria. This method has been but in a small study a success only confirms. Large studies are pending, the effect of Methionintherapie inconclusive secured that.

Complicated urinary tract infection

In the case of a complicated infection prior to the start of antibiotic therapy, a urine culture to create. The therapy should be an agent and the drugs of choice for at least seven days be started without proof. Once the pathogen detection is available through the culture, if necessary, another antibiotic should be chosen, against the established agent acts optimally. If the complicated infection is a treatable underlying disease cause, it should be treated.

In the case of urine infection in pregnant women is recommended by the German Society of Gynecology and Obstetrics, the administration of ampicillin , amoxicillin , or nitrofurantoin as a drug of first choice.

Asymptomatic bacteriuria

Found in the urine in significant number of bacteria, but no symptoms of a urine infection, so Bacteria of asymptomatic bacteriuria spoken of. This is in pregnant women require treatment only. After successful treatment until delivery was a monthly monitoring of urine for bacteria done to prevent damage to the child.

Pyelonephritis

Is a urinary tract infection progressed so that it pyelonephritis has led to one, the combined preparation cotrimoxazole drug of first choice. It should be at least 14 days used. Pregnant women, children and complicated infection should be hospitalized in a hospital to be treated other patients with clinical picture ever after. As second choice are quinolones described. Moreover, in the literature, the use of combinations of several antibiotics recommended. Possible combinations consist of an amino glycoside and broad-spectrum penicillin or a broad-spectrum cephalosporin with an Acylaminopenicillin .

Urethritis

If an isolated inflammation of the urethra is on, often an infection with chlamydia based, the swab can be detected by. The treatment of a chlamydial infection is preferably in a seven-day administration of doxycycline . Pregnant women should not be treated with this drug. You can use a single dose of azithromycin or a cephalosporin treated. Since Chlamydia is sexually transmitted primarily, is a co-treatment of the sexual partner, even if this has no symptoms, as well as with gonorrhea mandatory. A possible therapy is the single dose of ampicillin or amoxicillin. It can also be a seven-day treatment with tetracycline or doxycycline done. Also gyrase inhibitors have been described as effective.

 Prevention

For prevention and to improvement of the symptoms will continue the medical literature, numerous measures recommended. An adequate fluid intake of about 2 liters per day is recommended that, unless there are no pre-existing conditions, but the talk. In addition, the urge to urinate can not be suppressed. The bladder should be emptied as completely as possible during urination. For the reduction of infections after intercourse after urination is recommended directly. Blockages are suspected to promote urinary tract infections and should therefore be treated. Moreover, the hygiene in the genital area should not be exaggerated, as this the normal bacterial flora can be destroyed. In cases of repeated infections in women is a change of method of birth control suggested. In addition to people at risk and avoid hypothermia wet. The effectiveness of these strategies of non-pharmacological prophylaxis has been demonstrated by studies not been valid, however.