Urinary Tract Infections

Urinary tract infection are amongst the most common complaints that a physician will see in the outpatient, as well as inpatient services (1). Predisposing factors include age (impaired bladder emptying, obstructive uropathy from prostatic disease and consequent surgical instrumentation), diabetes mellitus, urinary tract calculi and obstruction (2,3,5).

The incidence of bacteruria in diabetes is 2-4 times higher in Diabetics. They are also more likely to have severe complications, such as papillary necrosis, emphysematous pyelonephritis and perinephric abscess (2).

The prevalence of bacteruria among women over age 60 is 6-10%, whereas among men over age 60, it is 1-3% (5,6). The prevalence increases to about 20-35% in women over age 80 and to about 0-20% in men of that age (5,6). For women, don't forget that restoring estrogen locally can restore the normal vaginal epithelium and enable lactobacillus to return and restore the low vaginal pH defense mechaism (7).

References:

  1. Mesley RE Jr, Levison ME. Host defense mechanisms in the pathogenesis of urinary tract infection. Med Clin North Am 1991; 7(2):275-86.
  2. Vejlsgaard R. Studies on urinary tract infection in diabetics. 1. Bacteriuria in patients with diabetes mellitus and in control subjects. Acta Med Scand 1966; 179(2): 173-82.
  3. Stamm WE, Hooton TM. Management of urinary tract infections in adults. N Engl J Med 1993; 329(18): 1328-34.
  4. Hooton TM. A simplified approach to urinary tract infection. Hosp Pract 1995; 30(2):27,29.
  5. Nicolle LE. Urinary tract infecion in the elderly. J Antimicrob Chemother, 1994; 34:1165-67.
  6. Gray RP, Malone-Lee J. Review: urinary tract infection in elderly people - time to review management? Age Ageing. 1995; 24:341-45.
  7. Raz R, Stmm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1992; 329:753-56.

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