All urines undergo dipstick testing, which can be done at the bedside. Crystal clear urine can be grossly infected. Cloudy urine can be aseptic the cloudiness can come from protein or calcium phosphate debris in the sample, not necessarily from an infection. ĭo not base the diagnosis of a UTI solely upon visual inspection of the urine. Urine should be sent to the lab immediately or refrigerated because bacteria grow rapidly when the sample is left at room temperature, causing an overestimate of the infection's severity. Men should start the urine stream to clean the urethra and then obtain a midstream sample. In-and-out catheterization of the bladder will cause UTI in uninfected women about 1% of the time. This might require a quick catheterization. Get a clean sample with very few epithelial cells. Most obese women cannot give a clean specimen, and epithelial cells in the UA mean the urine sample was exposed to the genital surface and did not come directly out of the urethra. A clean catch specimen in non-obese women is preferred. However, the use of antibiotics can erase this protective effect.Ī good, clean urinalysis (UA) specimen is vital to the workup. Premenopausal women have large concentrations of lactobacilli in the vagina and an acidic pH, preventing colonization with uropathogens. In addition, a short urethra also makes it easier for the uropathogen to invade the urinary tract. Frequent urination and high urinary volumes are also known to decrease the risk of UTIs.īacteria that cause UTIs tend to have adhesins on their surface, which allow the organism to attach to the urothelial mucosal surface. Factors that make it less favorable for bacterial growth include a pH of less than 5, the presence of organic acids, and high urea levels. Urine is an ideal medium for bacterial growth. People who frequently void and empty the bladder tend to have a lower risk of a UTI. Sexual intercourse is a common cause of a UTI as it promotes the migration of bacteria into the bladder. These organisms ascend the urethra into the bladder and cause UTIs. The majority of organisms causing a UTI are enteric coliforms that typically inhabit the periurethral vaginal introitus. When bacteria invade the bladder mucosal wall, an inflammatory reaction called cystitis is produced. The diagnosis of a UTI is made from the clinical history (symptoms) and urinalysis with confirmation by a urine culture, but the proper collection of the urine sample is important.Īn uncomplicated UTI usually only involves the bladder. Į.coli causes the vast majority of UTIs, followed by Klebsiella, but other organisms of importance include Proteus, Enterobacter, and Enterococcus. Treatment is aimed at preventing the spread to the kidneys or developing into upper tract disease/pyelonephritis, which can cause the destruction of the delicate structures in the nephrons and eventually lead to hypertension. Many cases of uncomplicated UTIs will resolve spontaneously, without treatment, but many patients seek therapy for symptom relief. UTIs are uncommon in circumcised males by definition, any male UTI is usually considered complicated. Forty percent of women in the United States will develop a UTI during their lifetime, making it one of the most common infections in women. Typical symptoms include urinary frequency, urgency, suprapubic discomfort, and dysuria. Bacteriuria alone does not constitute a UTI without symptoms. Uncomplicated UTI is also known as cystitis or lower UTI. These patients have no structural abnormality and comorbidities, such as diabetes, immunocompromised state, or pregnancy. An uncomplicated urinary tract infection (UTI) is a bacterial infection of the bladder and associated structures.
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