URINARY TRACT INFECTION

PREDISPOSING FACTORS:
Female sex (no prostate, pregnancy, short urethra), old age,

Obstruction, P antigen on cells, no P antigen in secretions,

any anatomic lesions

Of papilla or lower tract.

The natural defense mechanisms against infection works

extremely well – 105 E. coli injected into the bladder are cleared,
and 105 injected IV do not cause pyelonephritis. Essentially the
only way to produce pyelonephritis experimentally is direct
medullary injection of bacteria (100 bacteria will do – WBC
function is paralyzed in the medulla due to osms, high H+ and
NH4+ content), or in the presence of obstruction.

UTI due to staph aureus, TB, & virus is thought to be via the
bloodstream – not ascending infection. Most infections, however,
are caused by gram negative rods which are thought to initiate
infection by the “ascending” route:
------diagnosis
Urinary Tract Infection. Fever, leukocytosis with left shift, or CVA
tenderness strongly suggest infection. A presumptive diagnosis of
infection should be made if urinalysis shows: >5 WBCs/HPF or >10
Bacteria/HPF; (+) nitrite; or (+) leukocyte esterase. Clean catch
culture of >105 or a catheter or aspiration with >104 is generally
diagnostic of infection. Cystitis causes frequency, dysuria,
hematuria, and positive urinalysis. Fever, leukocytosis, or CVA
tenderness suggests upper tract infection with or without bactiuria.
Prevention
Education about proper hygiene may prevent some infections in
females. Recurrent infections require evaluation of urologic
abnormalities. Children should be instructed about sexually
transmitted diseases and barrier methods as they approach
adolescence.
Patient and Parent Education
vaginal flora; loss of lactobacilli, which allows periurethral
colonization with gram-negative aerobes, such as E coli;
and higher likelihood of concomitant medical illness, such
as diabetes.
• UTI is unusual in males younger than 50 years, and
symptoms of dysuria and frequency are usually due to
urethral or prostatic infection. In older men, however, the
incidence of UTI rises because of prostatic obstruction or
subsequent instrumentation.

It is very important to discuss the renal concentrating defect with

patients, parents, and teachers to assure that there is sufficient intake
of water and so the child can be allowed to urinate as frequently as
may be required without stigmatization. The same understanding
approach and positive reward systems must be stressed in the child
with enuresis.

Patients must be instructed about the importance of completing full

courses of antibiotics as prescribed and in the importance of
obtaining full-up cultures to assure bacteriological cure.

Precipitating factors:

Race: No racial predilection exists.

Sex: The natural history of UTI varies with sex and age.

• Of neonates, boys are slightly more likely than girls to

present with UTI as part of a gram-negative sepsis
syndrome. The incidence in preschool children is
approximately 2% and is 10 times more common in girls.
Five percent of school-aged girls experience UTI. It is rare
in school-aged boys.

• The largest group of patients with UTI is adult women. The

incidence increases with age and sexual activity. Rates of
infection are high in postmenopausal women because of
bladder or uterine prolapse causing incomplete bladder
emptying; loss of estrogen with attendant changes in