Skenario 5
Author
: Nova
Urinary Tract Infection
Urinary tract infection may occur more often due to sugar in urine
A urinary tract infection is a bacterial
infection that grows within the urinary tract - anywhere from the kidneys, the
ureters, the bladder and through to the urethra. Urinary tract infections can
be a particular problem for people with diabetes as sugar in the urine makes
for a fertile breeding ground for bacteria.
Increased Urine Glucose
Excess
glucose is filtered in the kidneys and results in significantly higher urine
glucose concentrations when compared to the urine of non-diabetics. Filtered
glucose attracts water into the renal tubules, which can increase the urge and
frequency of urination. High glucose concentrations in the urine provide an
abundant source of nutrients for bacteria, which can proliferate and cause an
infection.
Urinary
tract infection (UTI) are very uncomfortable, and if left untreated they can
lead to serious illness. Once you have had one UTI, it seems that you will be
prone for more. There are many possible causes for urinary tract infections;
the most common cause for UTI is from E. coli bacteria and yeast which is
spread from the rectal and vaginal to the urinary meatus. UTIs are most common
among females, because women have a short meatus that is in close proximity to
vagina and rectum. Other triggers for UTI are diet, dehydration, having
diabetes, overuse of antibiotics, sexual activity, contraceptives and
allergies.
Diabetic
women are at a higher risk of developing to urinary tract infection (UTI) after
menopause as compared to non-diabetic women. In fact, a study by University of
Washington, Seattle revealed that the risk of UTI in diabetic women was 80%
higher than others. UTI in diabetic patients is not only more severe but also
is more recurrent as compared to non-diabetic patients.
The
bacterial strains that cause UTI include :
Escherichia (E.) coli is responsible for most
uncomplicated cystitis cases in women, especially in younger women. E. coli is
generally a harmless microorganism originating in the intestines. If it spreads
to the vaginal opening, it may invade and colonize the bladder, causing an
infection. The spread of E. coli to the vaginal opening most commonly occurs
when women or girls wipe themselves from back to front after urinating, or
after sexual activity.
Staphylococcus saprophyticus accounts for 5 -
15% of UTIs, mostly in younger women.
Klebsiella, Enterococci bacteria, and Proteus
mirabilis account for most of remaining bacterial organisms that cause UTIs.
They are generally found in UTIs in older women.
Rare bacterial causes of UTIs include
ureaplasma urealyticum and Mycoplasma hominis, which are generally harmless
organisms
Cause of urinary
tract infections - Diabetic
Diabetic puts stress on the entire body. A
common characteristic of diabetes is that the blood contains elevated levels of
glucose. People, especially women, who have elevated glucose levels, are prone
to yeast infections. Yeast infections can trigger a urinary tract infection. A
good way for diabetics to prevent UTIs is to try to keep their blood glucose
levels under control. It is important to avoid foods and beverages which will
increase the blood sugar level. It is also important to stay well hydrated to
flush out bacteria.
UTI in
diabetic patients can be a traumatic experience leading to complications if not
treated in time. Urinary tract infection cure for diabetic patients requires a
longer period, lasting from anything between seven to fourteen days, of antibiotic
treatment even for uncomplicated infections. In many cases it may have to be
accompanied by bladder infection treatment.
Tests and
diagnosis
Tests and procedures used to diagnose urinary
tract infections include :
-
Analyzing a urine sample. Your doctor may ask for a urine sample
for lab analysis to look for white blood cells, red blood cells or bacteria. To
avoid potential contamination of the sample, you may be instructed to first
wipe your genital area with an antiseptic pad and to collect the urine
midstream.
-
Growing urinary tract bacteria in a lab. Lab analysis of the urine
is sometimes followed by a urine culture — a test that uses your urine sample
to grow bacteria in a lab. This test tells your doctor what bacteria are
causing your infection and which medications will be most effective.
-
Creating images of your urinary tract. If your doctor suspects
that an abnormality in your urinary tract causes frequent infections, you may
have an ultrasound or a computerized tomography (CT) scan to create images of
your urinary tract. In certain situations, your doctor may also use a contrast
dye to highlight structures in your urinary tract. Another test, called an
intravenous pyelogram (IVP), uses X-rays with contrast dye to create images.
Historically, doctors used this test for urinary tract imaging, but it's being
replaced more often by ultrasound or CT scan.
-
Using a scope to see inside your bladder. If you have recurrent
UTIs, your doctor may perform a cystoscopy, using a long, thin tube with a lens
(cystoscope) to see inside your urethra and bladder. The cystoscope is inserted
in your urethra and passed through to your and bladder. The cystoscope is
inserted in your urethra and passed through to your
Treatments
and drugs
Doctors typically use antibiotics to treat
urinary tract infections. Which drugs are prescribed and for how long depend on
your health condition and the type of bacterium found in your urine.
Simple infection
Drugs commonly recommended for simple UTIs
include:
-
Sulfamethoxazole-trimethoprim (Bactrim, Septra, others)
-
Amoxicillin (Amoxil, Augmentin, others)
-
Nitrofurantoin (Furadantin, Macrodantin, others)
-
Ampicillin
-
Ciprofloxacin (Cipro)
-
Levofloxacin (Levaquin)
Usually, symptoms clear up within a few days
of treatment. But you may need to continue antibiotics for a week or more. Take
the entire course of antibiotics prescribed by your doctor to ensure that the
infection is completely gone.
For an uncomplicated UTI that occurs when
you're otherwise healthy, your doctor may recommend a shorter course of
treatment, such as taking an antibiotic for one to three days. But whether this
short course of treatment is adequate to treat your infection depends on your
particular symptoms and medical history.
Your doctor may also prescribe a pain
medication (analgesic) that numbs your bladder and urethra to relieve burning
while urinating. One common side effect of urinary tract analgesics is
discolored urine — orange or red.
Complication
of diabetic uti
The sugar content of urine in a diabetic
patient provides a breeding ground for bacteria once they enter the bladder.
The most serious but rare types of UTI like :
1)
widespread infections
2)
abscesses
3)
inflammation of the bladder
wall
4)
pyelonephritis
Infection of
the kidney
o
Overview : More common in women than in men, Infection of the
kidney can occur due to organisms spreading to the kidney from the bladder
(ascending infection) or from the bloodstream, Ascending infection is more
common, E. Coli is the most common organism, Abnormalities of the heart valves
can be the source of organisms being spread by the bloodstream.
o
Types : Bacterial. Fungal
o
Symptoms : Typically the patient experiences flank pain (pain in
the back just below the ribcage), fevers and often nausea and vomiting, The
pain can be located in the upper right abdomen as well, Kidney infection may or
may not be accompanied by symptoms of bladder infection (see acute cystitis)
and on occasion the urine will have blood that is visible.
o
Complications :
§ If not
treated completely and in a timely manner an abscess can form in the kidney or
in rare cases the infection can get into the bloodstream and make one very ill
requiring hospitalization.
§ If
pyelonephritis develops as a patient is passing a kidney stone, immediate
intervention may be necessary to decompress the kidney and allow proper
drainage of the kidney for infection to clear.
o
Clinical Findings/signs : include flank or upper abdominal
tenderness, fever and usually a positive urine analysis and culture for
bacteria. Nausea and vomiting are often present. If the bladder is infected
there may be tenderness of the lower abdomen overlying the bladder as well.
Imaging with ultrasound, CT or other modality can be used when there is
suspicion of a stone or other complicating factor. Patients can have a wide
range of symptoms including septic physiology (critically low blood pressure
and unstable vital signs) if the infection has spread to the bloodstream.
o
Treatment :
§ Lifestyle –
there are no lifestyle modifications to decrease the chances of pyelonephritis
unless one is prone to recurrent bladder infections.
§ Medication –
Antibiotics are generally used to treat the infection. The length of time the
patient is on antibiotics depends upon the specific antibiotic and the clinical
situation. Though most pyelonephritis episodes can be treated on an outpatient
basis, admission to the hospital may be warranted for IV antibiotics.
§ Surgery:
Surgical intervention may be necessary if the pyelonephritis is complicated by
renal abscess or a urinary stone. The type of surgery or intervention depends
upon the clinical situation. Occasionally the intervention can be performed by
the radiologist without going under an anesthetic.
o
Prognosis : The prognosis for acute bacterial pyelonephritis is
good assuming that there is no complicating factor such as abcess, sepsis or
stone. In children, whose kidneys are still developing, bacterial
pyelonephritis can cause scarring of the kidney tissue and, if recurrent, can
lead to overall decreased kidney function later in life.
Reference
