Introduction

A urinary tract infection (UTI) is a condition where one or more parts of the urinary system (the
kidneys, ureters, bladder, and urethra) become infected after bacteria overcome the system's
strong natural defenses. In spite of these defenses, UTIs are the most common of all infections
and can occur at any time in the life of an individual. Almost 95% of cases of UTIs are caused by
bacteria that typically multiply at the opening of the urethra and travel up to the bladder. Much
less often, bacteria spread to the kidney from the bloodstream.

The male and female urinary tracts are relatively the same except for the length of the urethra.
The Urinary System. The urinary system helps maintain proper water and salt balance throughout
the body and also expels urine from the body. It is made up of the following organs and
structures:
• The two kidneys, located on each side below the ribs and toward the middle of the back,
play the major role in this process. They filter waste products, water, and salts from the
blood to form urine.
• Urine passes from each kidney to the bladder through thin tubes called ureters.
• Ureters empty into the bladder, which rests on top of the pelvic floor. This is a muscular
structure similar to a sling running between the pubic bone in front to the base of the
spine.
• The bladder stores the urine, which is then eliminated from the body via another tube
called the urethra, the lowest part of the urinary tract. (In men it is enclosed in the penis.
In women it leads directly out.)
Defense Systems Against Bacteria. Infection does not always occur when bacteria are introduced
into the bladder. A number of defense systems protect the urinary tract against infection-causing
bacteria:
 • Urine itself functions as an antiseptic, washing potentially harmful bacteria out of the
body during normal urination. (Urine is normally sterile, that is, free of bacteria, viruses,
and fungi.)
• The ureters are structurally designed to prevent urine from backing up into the kidney.
• The prostate gland in men secretes infection-fighting substances.
• The immune system in both sexes continuously fights bacteria and other harmful micro-
invaders. In addition, immune system defenses and antibacterial substances in the
mucous lining of the bladder eliminate many organisms.
• In normal fertile women, the vagina is colonized by lactobacilli, beneficial
microorganisms that maintain a highly acidic environment (low pH). Acid is hostile to
other bacteria. Lactobacilli also produce hydrogen peroxide, which helps eliminate
bacteria and reduces the ability of Escherichia coli ( E. coli) to adhere to vaginal cells.
(E. coli is the major bacterial culprit in urinary tract infections.)

Significance

Who gets Urinary Tract Infection?

Urinary tract infections commonly occur in women but occur infrequently in the male
population. The increased rate of urinary infection in the female population is explained by the
difference in length ofthe male and female urethra. Most urinary tract infections occur when
bacteria ascend from the genital region through the urethra and into the urinary bladder above.
The average female urethra is approximately 4cm long, permitting easy entry of bacteria into the
bladder and cause infection. The average male urethra is 15-20cm long, providing better
protection against infection by way of its increased length. Besides the increased physical
distance bacteria must travel to cause infection, the male urethra has a greater surface area to
secrete antibodies to combat infection of the urinary tract.
Urinary tract infection also has special significance in children for a number of reasons. Firstly,
urinary tract infection is less easily diagnosed and thus more likely to progress to a serious extent
if the problem infection is not treated. Also, urinary tract infections during childhood may be the
first sign of "vesico-ureteric reflux" in which urine is allowed to flow back from the bladder to
the kidneys. If left untreated, these patients may develop long-term kidney problems. When
managed appropriately however, these long term problems are most often avoided.

Health teaching

Home Remedy For Urinary Tract Infection

 • Baking soda is effective in curing urinary tract infection. In an eight ounce glass of water,
add ½ tsp of baking soda. Mix this well and drink it.
• Have plenty of water in a day, as this would help in diluting and flushing out the
unwanted substances from the body.
• Drinking cranberry juice is another effective way to treat urinary tract infection. For
people who cannot have pure cranberry juice, mixing it with some apple juice is an
option.
• Mix equal proportions of sandalwood, bergamot, tea tree, frankincense and juniper oil.
Rub this combination of oil in the abdominal area once a day, for three to four days.
• Mix equal parts of pipsissewa, buchu, echinacea and urva ursi tinctures. Have 20 drops of
this mixture, every two hours, for the first two days and 1 tsp of this mixture, four times a
day, later on.
• Another useful remedy for UTI would be to boil the leaves of blue brinjal plant in water.
Cool the decoction, strain it and have an ounce of it two times in a day.
• Boil some coriander seeds in water. Cool the decoction, strain it and have an ounce of it
two times in a day. It will increase the urine flow.
• The seeds of carrot are useful in treating urinary tract infection. They can either be taken
as an infusion or as a decoction.
• In a bowl of water, put some petals of lotus and pink rose and bring it to boil. Strain the
liquid after it cools. Have an ounce of this, three times a day.
• Chameli plant decoction is helpful in curing urinary tract infection. In a bowl of water,
put chameli plant and bring it to boil. Allow it to cool. Strain the liquid and drink it once
daily.

How is UTI treated?

UTIs are treated with antibacterial drugs. The choice of drug and length of treatment depend on
the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is
especially useful in helping the doctor select the most effective drug. The drugs most often used
to treat routine, uncomplicated UTIs are trimethoprim (Trimpex),
trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox,
Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin (Omnipen, Polycillin,
Principen, Totacillin). A class of drugs called quinolones includes four drugs approved in recent
years for treating UTI. These drugs include ofloxacin (Floxin), norfloxacin (Noroxin),
ciprofloxacin (Cipro), and trovafloxin (Trovan).
Often, a UTI can be cured with 1 or 2 days of treatment if the infection is not complicated by an
obstruction or other disorder. Still, many doctors ask their patients to take antibiotics for a week
or two to ensure that the infection has been cured. Single-dose treatment is not recommended for
some groups of patients, for example, those who have delayed treatment or have signs of a
kidney infection, patients with diabetes or structural abnormalities, or men who have prostate
infections. Longer treatment is also needed by patients with infections caused by Mycoplasma or
Chlamydia, which are usually treated with tetracycline, trimethoprim/sulfamethoxazole
(TMP/SMZ), or doxycycline. A followup urinalysis helps to confirm that the urinary tract is
infection-free. It is important to take the full course of treatment because symptoms may
disappear before the infection is fully cleared.
Severely ill patients with kidney infections may be hospitalized until they can take fluids and
needed drugs on their own. Kidney infections generally require several weeks of antibiotic
treatment. Researchers at the University of Washington found that 2-week therapy with
TMP/SMZ was as effective as 6 weeks of treatment with the same drug in women with kidney
infections that did not involve an obstruction or nervous system disorder. In such cases, kidney
infections rarely lead to kidney damage or kidney failure unless they go untreated.
Various drugs are available to relieve the pain of a UTI. A heating pad may also help. Most
doctors suggest that drinking plenty of water helps cleanse the urinary tract of bacteria. During
treatment, it is best to avoid coffee, alcohol, and spicy foods. And one of the best things a smoker
can do for his or her bladder is to quit smoking. Smoking is the major known cause of bladder
cancer.

Prevalence of UTI
There were 80 positive results, 79% (63) in girls. All cultures were obtained by urethral
catheterization. The predominant urinary tract pathogen was Escherichia coli (93%), with 2%
Enterococcus, and one culture each of Enterobacter cloacae, Group A -hemolytic streptococci
Staphylococcus aureus, and Pseudomonas. The majority (79%) had growth of 100 000
CFU/mL, whereas 12% had 50 000 to 99 000 CFU/mL, and 9% had between 10 000 and 50 000
CFU/mL. The majority (86%) had evidence of pyuria ( 5 white blood cells [WBCs] per high
powered field in spun urine by microscopy, positive leukocyte esterase on dipstick, or 10
WBC/mm3 in unspun urine by cytometer) or bacteriuria (positive nitrite on dipstick or bacteria
seen on Gram stain or microscopy). The majority of these infants with positive results were
admitted to the hospital (75%), and all were treated with antibiotics, either initially or when
results of the culture were known. In accordance with current practice by nephrologists at our
institution, only 4 children underwent nuclear scans. Two infants, both 2-month-old girls, were
bacteremic with E coli.
Table 2 lists the prevalence of UTI by sex, race, age, and clinical parameters. Overall prevalence
of UTI was 3.3% (95% CI: 2.6,4.0), with higher prevalence in girls and whites. Strikingly, white
girls had a 16.1% (95% CI: 10.6,21.6) prevalence rate of UTI and white boys had prevalence
rates similar to nonwhite girls of 2.5%, whereas nonwhite boys had the lowest rates of UTI. This
association between race and UTI in girls did not change when adjusted for ZIP code of
residence or insurance type, or presence of another potential source of fever, which may be
markers for socioeconomic status or referral bias. The adjusted odds ratio for white race was
9.7 (95% CI: 5.1,18.5; P < .001). Although the number of UTIs in boys was small and the
prevalence rates show wide confidence intervals, it is clear that boys beyond the neonatal period
still are at risk for UTI, with a prevalence from 6 to 11 months of age of 1.7% (95% CI: 0.5,2.6).
The prevalence rate of UTI in girls is highest in the first year of life (P < .001).