Simple urinary tract infections (UTIs) such as cystitis are extremely common.\u00a0 Infants, girls and young women, and elderly men and women are most commonly affected.\u00a0 There is often a sudden onset of dysuria and increased frequency. Suprapubic pain, haematuria and odorous or cloudy urine may also occur. Youngest and oldest patients, and the immunosuppressed, may not complain of all these symptoms.\u00a0 Malaise, pyrexia, loin pain and nausea and vomiting, suggest upper tract infection and pyelonephritis.<\/p>\n
Urine contains white blood cells and organisms (dipstick tests may show temporary blood and protein).\u00a0 E.coli and other bowel organisms are the most common pathogens.<\/p>\n
All patients should have urine examined for blood cells and culture, and a dipstick examination for blood, protein and glucose.\u00a0 Severe upper tract infections require blood cultures, blood count, renal function tests.<\/p>\n
Antibiotics should be based on likely pathogens and local resistance patterns.\u00a0 Treatment for 3 days gives higher success rate for cystitis than shorter courses.\u00a0 Oral antibiotics should be combined with advice to take plenty of fluid.\u00a0 Injected antibiotics may be required for pyelonephritis, and treatment is longer.\u00a0 Asymptomatic bacteriuria should not usually be treated, except in pregnancy or if there are other risk factors for complicated infection.<\/p>\n
Further investigations are indicated in infants, children, men with a single UTI, and women with pyelonephritis or frequent recurrences.\u00a0 Ultrasound is usually adequate and can assess completeness of bladder emptying. CT urography or IVU gives better delineation of collecting system if required.\u00a0 Isotope renogram may show scars of reflux nephropathy and can identify continuing reflux.<\/p>\n
Simple urinary tract infections (UTIs) such as cystitis are extremely common.\u00a0 Infants, girls and young women, and elderly men and women are most commonly affected.\u00a0 There is often a sudden onset of dysuria and increased frequency. Suprapubic pain, haematuria and odorous or cloudy urine may also occur. Youngest and oldest\u2026<\/p>\n