Urinary infections: symptoms, diagnosis and treatment

By Cristiano Antonino On Nov 9, 2022

Urinary tract infections (UTI) are an inflammatory process of an infectious nature of the urinary tract

We usually speak of a urinary infection when the bacterial load presents a number of 100,000 colonies per ml/urine, but major urinary symptoms can usually also occur when the bacterial load presents only 1,000 colonies per ml/urine.

On the other hand, we can speak of asymptomatic bacteriuria (BA), when we have the presence of a significant bacterial load in the absence of symptoms.

Causes of urinary tract infection

The most common is ascending, i.e. bacteria ascend through the urethra into the bladder, but we also recognise other causes:

Haematogenic: characteristic in kidney abscesses;
Lymphatic: due to the spread of the infection to adjacent organs, such as the colon and the female genital apparatus;
By trans-parietal contiguity: typical in bacterial prostatitis.

Epidemiology of urinary tract infections

Urinary tract infections in the first years of life are more frequent in the male sex, while later with advancing age they occur to a greater extent in the female sex, this due to the anatomical difference between men and women.

The shortness of the urethra, only about 2 / 3 cm. in the female sex, allows bacteria to reach the bladder by the acenditic route, both because of the presence of alterations in local defence factors, such as the vaginal ph, which in the fertile woman is very acid, and because of the vaginal secretions that contain enzymes with bacteriostatic activity and secretory immunoglobulin A.

In the elderly, the prevalence of UTI increases in women due to the effects of climacteric, but is higher again in men due to the impact of prostatic diseases.

Classification and symptoms of Urinary Infections

Urinary infections can be distinguished into high infections when the cavities and kidney tissue are involved while low infections are those related to the bladder, such as cystitis.

According to the Disease Society of America, urinary infections can be classified into:

Uncomplicated lower urinary tract infection or Cystitis;
Acute uncomplicated pyelonephritis (woman);
Complicated infection (male or urinary stasis);
Asymptomatic bacteriuria.

Cystitis: epidemiology, causes and treatment

The uncomplicated infection of the lower urinary tract, represented by cystitis, is a frequent cause of morbidity and affects almost predominantly the female sex about 10/15% each year.

Symptomatology is mainly characterised by pollakiuria, dysuria, imperative urination, hypogastric pain or feeling of weight, and urinary burning. In some cases, episodes of macrohaematuria such as haemorrhagic cystitis may also occur.

The most commonly isolated bacterium that causes bacterial cystitis is Escherichia coli followed by Staphylococcus saprophyticus.

The therapy of cystitis or (uncomplicated UTI) is based on the use of antibiotic drugs that are effective on the most common uropathogens.

The standard treatment mainly consists of a 3-day course of antibiotic therapy; sometimes, however, a 3-day course of antibiotic therapy alone is not sufficient and a 7-day course is administered.

Acute uncomplicated pyelonephritis (female): symptoms and remedies

It represents an upper urinary tract infection involving both the renal cavities (pyelitis) and an involvement of the renal parenchyma (nephritis).

Symptomatology is characterised by unilateral or bilateral low back pain, pain in the lumbar region, the classic Giordano ++ sign, hyperpyrexia with chills and sometimes nausea and vomiting.

The diagnosis is made by analysing the urinary sediment, where we find microhaematuria, pyuria, and sometimes cylindruria.

Here too, the bacterium most responsible for the infection is E.Coli, although to a lesser extent than in cystitis.

In the mild forms, therapy is based on the administration of targeted antibiotic therapy for 7 days, while in the more severe forms, the patient should be hospitalised in order to administer intravenous antibiotic therapy with the latest generation of drugs.

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Complicated infections and urinary stasis

They are usually associated with conditions that increase the risk of infection such as anatomo-functional abnormalities or the presence of foreign bodies within the urinary tract, such as urinary catheters, jj stents, mono j or even the presence of renal, ureteral or bladder lithiasic formations.

The most frequent aetiological agents are Enterobacteriaceae, Pseudomonas aeruginosa, Staphylococcus spp. and Streptococcus spp.

Symptomatology in these complicated infections varies mainly depending on the region of infection, which may be either in the lower or upper urinary tract.

In these circumstances, diagnostics play a key role, starting with ultrasound and ending with CT scans, urinal cystography, urethrocystography and more.

Asymptomatic bacteriuria

This is defined as the isolation in two successive urine cultures of the same pathogen with a significant bacterial load > 100,000 colonies/ml in the absence of symptoms indicative of urinary tract infection.

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