Urinary tract infection
Urinary tract infections (UTIs) are among the most common infectious diseases, second only to respiratory infections. Urinary tract infection is a collective term that characterizes the inflammatory process in the urinary system without specifying its localization. There are infections of the lower and upper urinary tract. By the nature of the course, UTI can be divided into uncomplicated and complicated urinary tract infection. Uncomplicated UTI usually develops in people without obstructive uropathy and structural changes in the kidneys and urinary tract in the absence of underlying diseases. Women suffer from UTIs much more often than men: 60% of women experience episodes of UTIs throughout their lives, and every fourth woman in this category has a recurrent UTI. Uncomplicated cystitis is characterized as acute, sporadic, or recurrent cystitis in non-pregnant premenopausal women with no anatomical or functional changes in the urinary tract or associated diseases.
The main complaint is frequent, painful urination, pain at the end of the urination act, blood in the urine, urge to urinate. First of all, it is necessary to conduct an examination, exclude the presence of vaginal discharge, perform a general urinalysis and ultrasound examination of the bladder. The diagnosis can be established from the clinical picture of the disease, the presence of leukocyuria and the absence of masses in the bladder during ultrasound examination.
Given the variety of clinical manifestations of cystitis, it is necessary to carry out differential diagnosis with diseases such as neurogenic bladder, stress urinary incontinence, and neoplasms of the urinary tract. Since the dominant route of infection of the lower urinary tract in women is the ascending route, timely diagnosis and therapy of cervicitis, vaginitis and vulvovaginitis of mixed etiology, as well as the normalization of vaginal microcinosis, are of particular importance in the treatment of patients with uncomplicated cystitis.
Bacteriological examination is recommended if acute pyelonephritis is suspected, symptoms persist or reappear 2–4 weeks after the end of treatment, and if atypical symptoms are present in women beyond and during pregnancy.
The presence of asymptomatic bacteriuria is not an indication or manifestation of cystitis.
Asymptomatic bacteriuria is the presence of two consecutive, with an interval of 24 hours, positive bacteriological analyzes of urine obtained from the middle portion in women. During these studies, the same strain of the pathogen should be isolated in a clinically significant titer of microorganisms - more than 105 CFU/ml. The presence of bacteria in the urine of people without any clinical and laboratory signs of infectious and inflammatory urological diseases is common and refers to commensal colonization. Asymptomatic bacteriuria may protect against superinfection with virulent uropathogens, therefore, treatment of asymptomatic bacteriuria is recommended only if there is a proven benefit to the patient, in order to avoid the risk of selection of resistant strains and eradication of potentially protective strains of microorganisms.
Asymptomatic bacteriuria in pregnant women occurs in 2-10% and is an indication for a standard short course of antibiotic therapy. Treatment of asymptomatic bacteriuria in pregnant women decreases the likelihood of premature birth or low birth weight babies, and significantly reduces the number of clinical episodes of UTI compared with placebo or no treatment.
In half of patients who have had uncomplicated UTI, a relapse develops within a year after the first episode, in every third patient, a repeated exacerbation develops within six months. The diagnosis of "recurrent cystitis" implies 2 exacerbations of cystitis during the last 6 months or 3 during the year. In case of exacerbation of chronic cystitis, patients shall be prescribed with an antibiotic therapy depending on sensitivity of the pathogens.
The purpose of antibiotic therapy for uncomplicated urinary tract infection is to relieve symptoms, eradicate the pathogen, and prevent recurrence and reinfection.
Source: Pronkin E.A. Treatment strategy for acute uncomplicated urinary tract infections in women. Obstetrics and gynecology. 2018; 9: 165-9.https: //dx.doi.org/10/18565/aig.2018.9.165-169