Recurrent urinary tract infection

Published on 10/03/2015 by admin

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Chapter 35 RECURRENT URINARY TRACT INFECTION

Theodore O’Connell

In the general population, urinary tract infection (UTI) is primarily an infection of sexually active women; the prevalence of UTI in women outnumbers that in men by a ratio of 30:1. However, the prevalence of UTI increases in both sexes with advancing age, reducing the ratio to 2:1. Recurrent UTI is defined as three or more episodes of symptomatic bacteriuria within 1 year. A recurrent infection is one that occurs after documented, successful resolution of an antecedent infection.

In younger adults, recurrent infection occurs most often as a bladder infection in women and is usually related to sexual intercourse. In older persons, recurrence is primarily a lower tract disease as a result of different risk or contributing factors, which may include incomplete bladder emptying or diseases such as diabetes mellitus.

The decision to evaluate recurrent UTI radiologically, endoscopically, urodynamically, or otherwise should be based on the patient’s clinical presentation, history, findings, response to antimicrobial therapy, and pattern of recurrent UTIs. Severe UTI—defined as sepsis, fever, history of UTI lasting more than 7 days, gross hematuria, signs or symptoms of obstruction, or history of stones—warrants further evaluation. Risk factors such as diabetes mellitus, immunosuppression, debilitating disease, or pregnancy also may warrant further evaluation.

If a patient has a history of recurrent UTI, urine culture should be used to document the infection, identify the pathogen, and determine the frequency of infection. Urine culture is also used to distinguish between unresolved and recurrent infection. If the same pathogen is documented repeatedly and at close intervals, an underlying abnormality should be suspected, and an evaluation should be initiated. If the same pathogen is not found or if UTIs do not occur in a close temporal relationship, the likelihood that the infections are associated with functional, metabolic, or anatomic abnormalities is low, and the patient may be treated with low-dose antimicrobial prophylaxis.

Conditions Associated with Recurrent Urinary Tract Infection

Bacterial resistance

Diabetes mellitus

Genitourinary anatomic abnormalities (bladder polyp, urethral diverticula, fistula, medullary sponge kidney)

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