Urinary Tract Infection
Authors: Kalpana Gupta, Barbara Trautner
Journal: Annals of Internal Medicine (2012)

In the Clinic6 March 2012Urinary Tract InfectionKalpana Gupta, MD, MPH, Barbara Trautner, MD, PhD, Deborah Cotton, MD, MPH, Darren Taichman, MD, PhD, and Sankey Williams, MDKalpana Gupta, MD, MPH, Barbara Trautner, MD, PhD, Deborah Cotton, MD, MPH, Darren Taichman, MD, PhD, and Sankey Williams, MDAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-156-5-201203060-01003 SectionsSupplemental MaterialAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail BackgroundWhat patient populations are at greatest risk for UTI?In the absence of known abnormalities of the urinary tract, women are at higher risk for UTIs than are men. Premenopausal adult women are at especially high risk for acute cystitis; incidence is 0.5 to 0.7 per person-year among sexually active women (1). Other populations at risk for UTI include patients with voiding abnormalities related to diabetes, neurogenic bladder, spinal cord injury, pregnancy, prostatic hypertrophy, or urinary tract instrumentation. Bacteriuria, with or without accompanying symptoms, is generally considered unavoidable in patients requiring long-term indwelling catheters.What lifestyle factors or comorbid conditions ...References1. Hooton TM, Scholes D, Hughes JP, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med. 1996;335:468-74. [PMID:8672152] Google Scholar2. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182:1177-82. [PMID:10979915] Google Scholar3. Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001;17:259-68. [PMID:11295405] Google Scholar4. Hooton TM. Pathogenesis of urinary tract infections: an update. J Antimicrob Chemother. 2000;46 Suppl 1:1-7. [PMID:11051617] Google Scholar5. Scholes D, Hawn TR, Roberts PL, et al. Family history and risk of recurrent cystitis and pyelonephritis in women. J Urol. 2010;184:564-9. [PMID:20639019] Google Scholar6. Nicolle LE, Bradley S, Colgan R, Rice JC, Schaeffer A, Hooton TM; Infectious Diseases Society of America. Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin Infect Dis. 2005;40:643-54. [PMID:15714408] Google Scholar7. Abrutyn E, Mossey J, Berlin JA, et al. Does asymptomatic bacteriuria predict mortality and does antimicrobial treatment reduce mortality in elderly ambulatory women? Ann Intern Med. 1994;120:827-33. [PMID:7818631] Google Scholar8. Hooton TM, Scholes D, Stapleton AE, et al. A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med. 2000;343:992-7. [PMID:11018165] Google Scholar9. Patterson TF, Andriole VT. Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era. Infect Dis Clin North Am. 1997;11:593-608. [PMID:9378925] Google Scholar10. Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2007:CD000490. [PMID:17443502] Google Scholar11. Fiorante S, Fernández-Ruiz M, López-Medrano F, et al. Acute graft pyelonephritis in renal transplant recipients: incidence, risk factors and long-term outcome. Nephrol Dial Transplant. 2011;26:1065-73. [PMID:20805254] Google Scholar12. Fiorante S, López-Medrano F, Lizasoain M, et al. Systematic screening and treatment of asymptomatic bacteriuria in renal transplant recipients. Kidney Int. 2010;78:774-81. [PMID:20720526] Google Scholar13. Stapleton A, Latham RH, Johnson C, Stamm WE. Postcoital antimicrobial prophylaxis for recurrent urinary tract infection. A randomized, double-blind, placebo-controlled trial. JAMA. 1990;264:703-6. [PMID:2197450] Google Scholar14. Albert X, Huertas I, Pereiró II, Sanfélix J, Gosalbes V, Perrota C. Antibiotics for preventing recurrent urinary tract infection in non-pregnant women. Cochrane Database Syst Rev. 2004:CD001209. [PMID:15266443] Google Scholar15. Perrotta C, Aznar M, Mejia R, Albert X, Ng CW. Oestrogens for preventing recurrent urinary tract infection in postmenopausal women. Cochrane Database Syst Rev. 2008:CD005131. [PMID:18425910] Google Scholar16. Bent S, Nallamothu BK, Simel DL, Fihn SD, Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002;287:2701-10. [PMID:12020306] Google Scholar17. Gupta K, Hooton TM, Roberts PL, Stamm WE. Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women. Ann Intern Med. 2001;135:9-16. [PMID:11434727] Google Scholar18. Hooton TM, Bradley SF, Cardenas DD, et al; Infectious Diseases Society of America. Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America. Clin Infect Dis. 2010;50:625-63. [PMID:20175247] Google Scholar19. Huppert JS, Biro F, Lan D, Mortensen JE, Reed J, Slap GB. Urinary symptoms in adolescent females: STI or UTI? J Adolesc Health. 2007;40:418-24. [PMID:17448399] Google Scholar20. Saint S, Scholes D, Fihn SD, Farrell RG, Stamm WE. The effectiveness of a clinical practice guideline for the management of presumed uncomplicated urinary tract infection in women. Am J Med. 1999;106:636-41. [PMID:10378621] Google Scholar21. Lachs MS, Nachamkin I, Edelstein PH, Goldman J, Feinstein AR, Schwartz JS. Spectrum bias in the evaluation of diagnostic tests: lessons from the rapid dipstick test for urinary tract infection. Ann Intern Med. 1992;117:135-40. [PMID:1605428] Google Scholar22. Geerlings SE. Urinary tract infections in patients with diabetes mellitus: epidemiology, pathogenesis and treatment. Int J Antimicrob Agents. 2008;31 Suppl 1:S54-7. [PMID:18054467] Google Scholar23. Merçon M, Regua-Mangia AH, Teixeira LM, et al. Urinary tract infections in renal transplant recipients: virulence traits of uropathogenic Escherichia coli. Transplant Proc. 2010;42:483-5. [PMID:20304171] Google Scholar24. Nicolle LE. Catheter-related urinary tract infection. Drugs Aging. 2005;22:627-39. [PMID:16060714] Google Scholar25. Ulleryd P, Zackrisson B, Aus G, Bergdahl S, Hugosson J, Sandberg T. Selective urological evaluation in men with febrile urinary tract infection. BJU Int. 2001;88:15-20. [PMID:11446838] Google Scholar26. Abarbanel J, Engelstein D, Lask D, Livne PM. Urinary tract infection in men younger than 45 years of age: is there a need for urologic investigation? Urology. 2003;62:27-9. [PMID:12837416] Google Scholar27. Gupta K, Hooton TM, Naber KG, et al; Infectious Diseases Society of America. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52:e103-20. [PMID:21292654] Google Scholar28. Gupta K, Hooton TM, Roberts PL, Stamm WE. Short-course nitrofurantoin for the treatment of acute uncomplicated cystitis in women. Arch Intern Med. 2007;167:2207-12. [PMID:17998493] Google Scholar29. Falagas ME, Kastoris AC, Kapaskelis AM, Karageorgopoulos DE. Fosfomycin for the treatment of multidrug-resistant, including extended-spectrum beta-lactamase producing, Enterobacteriaceae infections: a systematic review. Lancet Infect Dis. 2010;10:43-50. [PMID:20129148] Google Scholar30. Falagas ME, Kotsantis IK, Vouloumanou EK, Rafailidis PI. Antibiotics versus placebo in the treatment of women with uncomplicated cystitis: a meta-analysis of randomized controlled trials. J Infect. 2009;58:91-102. [PMID:19195714] Google Scholar31. Little P, Moore MV, Turner S, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ. 2010;340:c199. [PMID:20139214] Google Scholar32. Stapleton AE, Dziura J, Hooton TM, Cox ME, Yarova-Yarovaya Y, Chen S, et al. Recurrent Urinary Tract Infection and Urinary Escherichia coli in Women Injesting Cranberry Juice Daily: A Randomized Controlled Trial. Mayo Clin Proc. 2012;87:143-50. [PMID:22305026] Google Scholar33. Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, DeBusscher J, Foxman B. Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial. Clin Infect Dis. 2011;52:23-30. [PMID:21148516] Google Scholar34. Beerepoot MA, ter Riet G, Nys S, et al. Cranberries vs antibiotics to prevent urinary tract infections: a randomized double-blind noninferiority trial in premenopausal women. Arch Intern Med. 2011;171:1270-8. [PMID:21788542 Google Scholar35. Talan DA, Stamm WE, Hooton TM, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA. 2000;283:1583-90. [PMID:10735395] Google Scholar36. Saint S, Meddings JA, Calfee D, Kowalski CP, Krein SL. Catheter-associated urinary tract infection and the Medicare rule changes. Ann Intern Med. 2009;150:877-84. [PMID:1952856784] Google Scholar37. Warye KL, Murphy DM. Targeting zero health care-associated infections [Editorial]. Am J Infect Control. 2008;36:683-4. [PMID:19084162] Google Scholar Author, Article, and Disclosure InformationAffiliations: PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byTcpC inhibits toll-like receptor signaling pathway by serving as an E3 ubiquitin ligase that promotes degradation of myeloid differentiation factor 88Lack of uniformity among United States recommendations for diagnosis and management of acute, uncomplicated cystitisIntroductory Chapter: An Overview on Urinary Tract Infections, Pathogens, and Risk FactorsConsideration of sexually transmitted infections in the differential diagnosis: Case studiesAcute cystitis in the practice of an obstetrician-gynecologistUrinary Tract Infection Antibiotic Resistance in the United StatesDiagnosis and treatment of urinary tract infections across age groupsPharmacokinetics and Pharmacodynamics of Fosfomycin and Its Activity against Extended-Spectrum-β-Lactamase-, Plasmid-Mediated AmpC-, and Carbapenemase-Producing Escherichia coli in a Murine Urinary Tract Infection ModelDiagnosis, Treatment, and Prevention of Urinary Tract InfectionDiagnosis, Treatment, and Prevention of Urinary Tract InfectionActivity of Fosfomycin against Extended-Spectrum-β-Lactamase-Producing Uropathogens in Patients in the Community and Hospitalized PatientsThe antimicrobial activity of mecillinam, nitrofurantoin, temocillin and fosfomycin and comparative analysis of resistance patterns in a nationwide collection of ESBL-producing Escherichia coli in Norway 2010–2011Evaluation of Urinalyses Ordered for Diagnosis of Urinary Tract Infections at an Inpatient Psychiatric HospitalUrinary Tract Infections 6 March 2012Volume 156, Issue 5Page: ITC3-1KeywordsAntibioticsAntimicrobialsBladderCystitisPregnancyPyelonephritisUrinary tract infectionsUrine ePublished: 6 March 2012 Issue Published: 6 March 2012 Copyright & PermissionsCopyright © 2012 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...