Urinary tract infections (UTIs) occur when bacteria—most commonly E. coli from the intestine—enter the urethra and travel up into the urinary tract.

In lower UTIs, the bacteria reach the bladder, stick to its lining, and multiply, causing inflammation known as cystitis. This leads to symptoms like burning during urination, urgency, and frequency.

If untreated, the infection can spread up the ureters to the kidneys, resulting in a more serious infection called pyelonephritis, which may cause fever, flank pain, and systemic illness.

Risk factors for UTIs include: 

• Females
  • About 50-60% of women will have at least one UTI in their lifetime. This is because women have a shorter urethra, which means bacteria have a shorter distance to travel to reach the bladder.
• Sexual activity
• Spermicides and diaphragms
• Pregnancy
• Post menopausal women 
• Urinary catheters
• Benign prostatic hyperplasia and neurogenic bladder
  • Due to incomplete bladder emptying
•  Diabetes mellitus
• Anatomical abnormalities e.g. vesicoureteric reflux

Symptoms: 

• Dysuria (or painful urination)

• Urinary urgency

• Urinary frequency

• Haematuria or blood in the urine

• Cloudy or foul-smelling urine

• Suprapubic pain

• Occasionally a low-grade fever

Signs:

• Mild suprapubic tenderness 

The presence of flank pain, vomiting and high-grade fever suggest upper tract involvement, such as pyelonephritis, and require urgent attention.

• BEDSIDE
  • Urine dipstick
    • Leucocytes +ve
    • Nitrites +ve
    • May also be erythrocytes +ve
• PATHOLOGY
  • Urine Microscopy, Culture and Sensitivities (MCS)
  • Consider STI screening
• IMAGING
  • USS or CT KUB (if recurrent UTIs)

• Disposition:
  • Outpatient
• Conservative:
  • Oral antibiotics e.g. trimethoprim, nitrofurantoin, cephalexin 
  • Analgesia
  • Hydration
  • Safety-netting

• COMPLICATIONS
  • Pyelonephritis
  • Urosepsis
  • Recurrent UTIs