Antibiotics are used mainly for treatment of infections caused by bacteria. The inappropriate use of antibiotics leads to the problem of antimicrobial resistance. As a result some antibiotics may become ineffective when used for certain bacterial infections. According to studies, resistance rates to antimicrobials like amoxicillin and co-trimoxazole are high worldwide. Overuse or misuse of antibiotics and growing genetic diversity of the organisms are the possible causes of various issues such as increase in antibiotic resistance among these urinary pathogens. This poses a challenge.
The Urinary Tract Infection (UTI) is more frequent in girls than boys since the female urethra is shorter and the chances of vaginal vestibular contamination with fecal flora are more. This condition can also occur primarily in older adult men with urologic structural abnormalities. In younger women, the incidence of the urinary tract infection are higher and have some correlation with sexual activity. According to the research studies, about 3% of women over the world get medicine at least once each year for UTI while at least 50% of women have experience at least one UTI in a lifetime. UTI is an infection caused by the presence and growth of microorganism in genitourinary system while it is a common problem and can affect all women, particularly the aged, children and pregnant women. It causes significant injury and death, especially if complicated, can cause severe renal (kidney) damage.
Pathophysiology of UTI
Clinically, UTIs are categorised into two groups namely uncomplicated UTI and complicated UTI.
Uncomplicated UTIs typically affect individuals who are healthy and have no structural or neurological urinary tract abnormalities. There are two different types of uncomplicated UTI infections such as lower UTIs and upper UTIs .
Lower UTIs: Is also known as cystitis which is significantly more predominant in women than in men due to anatomic differences, including shorter urethral length and moist periurethral environment in women. Typically, UTI triggers with periurethral contamination by an uropathogen residing in the gut, followed by colonization of the urethra and, subsequently they migrate to the bladder or kidney by using their ﬂagella and pili which used by pathogen for their movements. Bacterial adherence to the uroepithelium is key in the pathogenesis of UTI while infections occur when bacterial virulence mechanisms overcome efficient the host defense mechanisms.
Upper UTIs: Is also known as pyelonephritis and develops when
uropathogens reach the kidneys through the ureters. Infections can occur when bacteria bind to an urinary catheter, a kidney, or a bladder stone or when they are retained in the urinary tract by a physical obstruction. In severe cases of pyelonephritis, the affected kidney may be enlarged, with raised inflammations on the surface.
Complicated UTI is associated with factors that compromise the urinary tract or host defense such as urinary obstruction, urinary retention caused by neurological disease, immunosuppression, renal failure, renal transplantation, pregnancy and the presence of foreign bodies such as calculi, indwelling catheters or other drainage devices.
Possible Risk Factors of UTI
- Sexual intercourse
- Use of spermicide
- A new sexual partner
- A mother or female relatives with a history of UTI
- History of UTI during childhood
- History of UTI before menopause (time that marks the end of your menstrual cycles)
- Urinary incontinence (the loss of bladder control)
- Dryness of the vagina due to oestrogen deficiency
- Cystocoele (Condition in which woman’s bladder swells into her vagina)
- Increased post‑void urine volume (the amount of urine retained in the bladder after a voluntary void)
- Blood group antigen urine secretory status
- Use of urine catheter
- History of UTI or UTI during childhood
- Functional or mental impairment
- Abnormalities of the urinary tract, such as kidney or renal stones, which act as a focus for infection
Uropathogens caused for UTIs
UTIs are caused by both Gram-negative and Gram-positive bacteria, as well as by certain fungi. The most common infected agent for both uncomplicated and complicated UTIs is Uropathogenic Escherichia Coli (UPEC).
Uncomplicated UTI - E. coli, S. saprophyticus, Enterococcusspp, K. pneumonia and P. mirabilis
Complicated UTI - Antibiotic-resistant E. coli, P. aeruginosa, Acinetobacter
baumannii, Enterococcus spp and Staphylococcus spp
Catheter associated UTI -P.mirabilis, Morganellamorganii, Providenciastuartii, C. urealyticum and Candida spp (Yeast)
UTI in pregnancy
Urinary tract infection is a common phenomenon that occurs during pregnancy with an estimated incidence of approximately 20% as mentioned in research findings and it is a serious cause of preterm birth, low birth weight, maternal and perinatal morbidity and mortality. E. coli is the most common pathogen reasons for UTI in pregnant women.
Pregnant women easily develop urinary UTI due to functional, hormonal and anatomical changes and also because of expansion of urethra and the location of the urethralmeatus, which allows uropathogenic bacteria which is found in rectal flora and is accessed from the vagina to the lower urinary tract. And also the larger urinary tract, along with increased bladder volume and decreased bladder tone allows bacteria to grow.
Diabetic and UTI
According to the research studies, the incidence of urinary tract infection is 20% for diabetes mellitus, 14% for hypertension, 80% for hydronephrosis and
nephrolithiasis and greater than 50% for long term indwelling catheters. In diabetic patients, greater frequency of infections is occurred due to hyperglycemic environment that favours immune dysfunction (damage to neutrophil function, depression of the antioxidant system, and humoral immunity), micro-and macro-angiopathies, neuropathy, and a decrease in the antibacterial activity of urine.
The main reason for UTI in diabetic patients are inadequate sugar control, duration of diabetic, diabetic microangiopathy (abnormal small vessels found in many organs and tissue), impaired leukocyte function, recurrent vaginitis (inflammation of the vagina), and anatomical and functional abnormalities of the urinary tract.
Symptoms of UTI
Pains during urination
A frequent or intense urge to urinate
Pain or pressure in back or lower abdomen
Cloudy, dark, bloody, or strange-smelling urine
Feeling tired or shaky
Fever or chills
How to manage UTI
Better management of UTI is very important to avoid serious health problems which arise as a part of severer infection.
Therefore, pregnant mothers and other patient who infect with UTI have to pay more attention, do proper diagnosis and take medicines at early stages are essential to prevent mortality and morbidity. Moreover, personal hygiene plays critical role in UTI.
The writer is a medical laboratory technologist at a private hospital and holds an MSc. Degree in Industrial and Environmental Chemistry from the University of Kelaniya and BSc. Food Production and Technology Management degree from the Wayamba University of Sri Lanka.