Urinary tract infection (UTI) is a collective term that describes any infection involving any part of the urinary tract, namely the kidneys, ureters, bladder and urethra. The urinary tract can be divided into the upper (kidneys and ureters) and lower tract (bladder and urethra).
HOW RELEVANT IS THIS TO MY PRACTICE?Uncomplicated lower UTI remains one of the most commonly treated infections in primary care. The urinary tract is a common source of infection in children and infants and is the most common bacterial infection in children < 2 years of age, both in the community and hospital setting.(1) During the first six months of life, UTIs are more common in boys.(2) The outcome is usually benign, but UTIs can progress to renal scarring in early infancy, especially when associated with congenital anomalies of the urinary tract. Renal scarring may lead to complications in adulthood including hypertension, proteinuria, renal damage and even chronic renal failure, which requires dialysis treatment. In general, 40% of women develop a UTI at some point in their life. In Singapore, 4% of young adult women are affected and the incidence increases to 7% at 50 years of age.(2) Adult women are 30 times more likely than men to develop a UTI, with almost half of them experiencing at least one episode of UTI during their lifetime.(4) It is reported that one in three women have their first episode of UTI by the age of 24 years.(4) UTIs are most commonly seen in sexually active young women. Other susceptible adults include the elderly and patients requiring urethral catheterisation.According to statistics from Singapore's Ministry of Health, a total of 4,144 patients were admitted to private and government hospitals in Singapore from 1 January 2015 to 31 December 2015 for UTIs, with an average hospital stay of 2-4.8 days.(5) Our article aimed to focus on UTI management in adults.
Uncomplicated versus complicated UTIA complicated UTI is an infection associated with a condition, such as a structural or functional abnormality of the genitourinary tract, or the presence of an underlying disease; this increases the risk of the outcome of a UTI being more serious than expected, as compared to its occurrence in individuals without any identified risk factors (i.e. uncomplicated UTI).(4) The European Association of Urology's classification system for UTIs, known as ORENUC, is based on the clinical presentation of the UTI and its associated host risk factors (Table I). In adults, uncomplicated UTIs fall under categories O, R and partially E, while complicated UTIs are mainly in categories N, U and C.
Recurrent UTIRecurrent UTIs are symptomatic UTIs that follow the resolution of an earlier episode, usually after appropriate treatment. They are common among young, healthy women even though these women generally have anatomically and physiologically normal urinary tracts. Common risk factors are given in Box 1.Recurrent UTIs can be diagnosed clinically without performing a urine culture, although urine cultures are essential in management. ...
