Korean J Urol.  2006 Jun;47(6):559-567. 10.4111/kju.2006.47.6.559.

Introduction to Urinary Tract Infections

Affiliations
  • 1Department of Urology, College of Medicine, The Catholic University of Korea, Seoul, Korea. cyh0831@catholic.ac.kr

Abstract

Urinary tract infections (UTIs) are common infectious diseases, which can be associated with substantial morbidity and significant expenditures. This review highlights the current concepts and recent advances in our understanding and management of these conditions, specifically the pathogenesis, host factors, antimicrobial resistance, diagnosis and clinical approach to treatment. UTIs can be viewed as an interaction between specific bacterial virulence factors and the susceptibility of the host. For effective patient management, the critical step in the clinical management is to define the complicating urological factors. Current treatment trends for the reduction of UTI include empirical antimicrobial and short-course therapies. The management of complicated urinary tract infections is determined by the treatment of anatomical and functional abnormalities and antimicrobial therapy, as well as supportive care when needed. For the further proper management of UTIs, a profound understanding of their pathogenesis and a strict rationale for antimicrobial therapy, under constant surveillance, are required.


MeSH Terms

Communicable Diseases
Diagnosis
Health Expenditures
Humans
Urinary Tract Infections*
Urinary Tract*
Virulence Factors
Virulence Factors

Reference

1. Foxman B. Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Am J Med. 2002. 113:Suppl 1A. S5–S13.
2. Yamamoto S, Tsukamoto T, Terai A, Kurazono H, Takeda Y, Yoshida O. Genetic evidence supporting the fecal-perinealurethral hypothesis in cystitis caused by Escherichia coli. J Urol. 1997. 157:1127–1129.
3. Schaeffer AJ, Jones JM, Dunn JK. Association of vitro Escherichia coli adherence to vaginal and buccal epithelial cells with susceptibility of women to recurrent urinary-tract infections. N Engl J Med. 1981. 304:1062–1066.
4. Langermann S, Palaszynski S, Barnhart M, Auguste G, Pinkner JS, Burlein J, et al. Prevention of mucosal Escherichia coli infection by FimH-adhesin-based systemic vaccination. Science. 1997. 276:607–611.
5. Guyer DM, Gunther NW 4th, Mobley HL. Secreted proteins and other features specific to uropathogenic Escherichia coli. J Infect Dis. 2001. 183:Suppl 1. S32–S35.
6. Johnson JR, Stell AL. Extended virulence genotypes of Escherichia coli strains from patients with urosepsis in relation to phylogeny and host compromise. J Infect Dis. 2000. 181:261–272.
7. Schilling JD, Mulvey MA, Hultgren SJ. Structure and function of Escherichia coli type 1 pili: new insight into the pathogenesis of urinary tract infections. J Infect Dis. 2001. 183:Suppl 1. S36–S40.
8. Domingue GJ, Roberts JA, Laucirica R, Ratner MH, Bell DP, Suarez GM, et al. Pathogenic significance of P-fimbriated Escherichia coli in urinary tract infections. J Urol. 1985. 133:983–989.
9. Hicks RM. The mammalian urinary bladder: an accommodating organ. Biol Rev Camb Philos Soc. 1975. 50:215–246.
10. Schilling JD, Mulvey MA, Vincent CD, Lorenz RG, Hultgren SJ. Bacterial invasion augments epithelial cytokine responses to Escherichia coli through a lipopolysaccharide-dependent mechanism. J Immunol. 2001. 166:1148–1155.
11. Mulvey MA, Schilling JD, Hultgren SJ. Establishment of a persistent Escherichia coli reservoir during the acute phase of a bladder infection. Infect Immun. 2001. 69:4572–4579.
12. Schilling JD, Lorenz RG, Hultgren SJ. Effect of trimethoprim-sulfamethoxazole on recurrent bacteriuria and bacterial persistence in mice infected with uropathogenic Escherichia coli. Infect Immun. 2002. 70:7042–7049.
13. Anderson GG, Palermo JJ, Schilling JD, Roth R, Heuser J, Hultgren SJ. Intracellular bacterial biofilm-like pods in urinary tract infections. Science. 2003. 301:105–107.
14. Donlan RM, Costerton JW. Biofilms: survival mechanisms of clinically relevant microorganisms. Clin Microbiol Rev. 2002. 15:167–193.
15. Fowler JE Jr, Latta R, Stamey TA. Studies of introital colonization in women with recurrent urinary infections. VIII. The role of bacterial interference. J Urol . 1977. 118:296–298.
16. Stapleton A, Nudelman E, Clausen H, Hakomori S, Stamm WE. Binding of uropathogenic Escherichia coli R45 to glycolipids extracted from vaginal epithelial cells is dependent on histo-blood group secretor status. J Clin Invest. 1992. 90:965–972.
17. Lomberg H, Cedergren B, Leffler H, Nilsson B, Carlstrom AS, Svanborg-Eden C. Influence of blood group on the availability of receptors for attachment of uropathogenic Escherichia coli. Infect Immun. 1986. 51:919–926.
18. Raz R. Hormone replacement therapy or prophylaxis in postmenopausal women with recurrent urinary tract infection. J Infect Dis. 2001. 183:Suppl 1. S74–S76.
19. Hooton TM, Stapleton AE, Roberts PL, Winter C, Scholes D, Bavendam T, et al. Perineal anatomy and urine-voiding characteristics of young women with and without recurrent urinary tract infections. Clin Infect Dis. 1999. 29:1600–1601.
20. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000. 182:1177–1182.
21. Gupta K, Hillier SL, Hooton TM, Roberts PL, Stamm WE. Effects of contraceptive method on the vaginal microbial flora: a prospective evaluation. J Infect Dis. 2000. 181:595–601.
22. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis. 1999. 29:745–758.
23. Cockerill FR, Edson RS. Trimethoprim-sulfamethoxazole. Mayo Clin Proc. 1991. 66:1260–1269.
24. Karlowsky JA, Kelly LJ, Thornsberry C, Jones ME, Sahm DF. Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli from femal outpatients in the United States. Antimicrob Agents Chemother. 2002. 46:2540–2545.
25. Kim SW, Lee JY, Park WJ, Cho YH, Yoon MS. Antibiotic sensitivity to the causative organism of acute simple urinary tract infection. Korean J Urol. 2000. 41:1117–1124.
26. Lee SJ, Cho YH, Kim BW, Lee JG, Jung SI, Lee SD, et al. A multicenter study of antimicrobial susceptibility of uropathogens causing acute uncomplicated cystitis in woman. Korean J Urol. 2003. 44:697–701.
27. Talan DA, Stamm WE, Hooton TM, Moran GJ, Burke T, Iravani A, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA. 2000. 283:1583–1590.
28. Tice AD. Short-course therapy of acute cystitis: a brief review of therapeutic strategies. J Antimicrob Chemother. 1999. 43:Suppl A. S85–S93.
29. Song HJ, KIM SJ. A study of antimicrobial sensitivity to the causative organism of urinary tract infection. Korean J Urol. 2004. 46:68–73.
30. Kass EH. Asymptomatic infections of the urinary tract. Trans Assoc Am Physicians. 1956. 69:56–64.
31. Stamm WE, Counts GW, Running KR, Fihn S, Turck M, Holmes KK. Diagnosis of coliform infection in acutely dysuric women. N Engl J Med. 1982. 307:463–468.
32. Rubin RH, Shapiro ED, Andriole VT, Davis RJ, Stamm WE. Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Infectious Diseases Society of America and the Food and Drug Administration. Clin Infect Dis. 1992. 15:Suppl 1. S216–S227.
33. Kunin CM. Urinary tract infections in females. Clin Infect Dis. 1994. 18:1–10.
34. Naber KG. Experience with the new guidelines on evaluation of new anti-infective drugs for the treatment of urinary tract infections. Int J Antimicrob Agents. 1999. 11:189–196.
35. Naber KG, Bishop MC, Bjerklund-Johansen TE, Botto H, Cek M, Grabe M, et al. European Association of Urology. The management of urinary and male genital tract infections. European Association of Urology Guidelines. 2006. Arnhem: Drukkerij Gelderland;1–126.
36. Andriole VT. When to do culture in urinary tract infections. Int J Antimicrob Agents. 1999. 11:253–255.
37. Fenwick EA, Briggs AH, Hawke CI. Management of urinary tract infection in general practice: a cost-effectiveness analysis. Br J Gen Pract. 2000. 50:635–639.
38. Preston SL, Abdel-Rahman SM, Nahata MC. Empiric treatment of uncomplicated urinary tract infections. Ann Pharmacother. 1998. 32:1231–1233.
39. Norrby SR. Short-term treatment of uncomplicated lower urinary tract infections in women. Rev Infect Dis. 1990. 12:458–467.
40. Iravani A, Klimberg I, Briefer C, Munera C, Kowalsky SF, Echols RM. A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection. J Antimicrob Chemother. 1999. 43:Suppl A. S67–S75.
41. McCarty JM, Richard G, Huck W, Tucker RM, Tosiello RL, Shan M, et al. A randomized trial of short-course ciprofloxacin, ofloxacin, or trimethoprim/sulfamethoxazole for the treatment of acute urinary tract infection in women. Ciprofloxacin Urinary Tract Infection Group. Am J Med. 1999. 106:292–299.
42. Brumfitt W, Hamilton-Miller JM. Efficacy and safety profile of long-term nitrofurantoin in urinary infections: 18 years' experience. J Antimicrob Chemother. 1998. 42:363–371.
43. Schaeffer AJ, Stuppy BA. Efficacy and safety of self-start therapy in women with recurrent urinary tract infections. J Urol. 1999. 161:207–211.
44. Melekos MD, Asbach HW, Gerharz E, Zarakovitis IE, Weingaertner K, Naber KG. Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal women. J Urol. 1997. 157:935–939.
45. Zimakoff JD, Pontoppidan B, Larsen SO, Poulsen KB, Stickler DJ. The management of urinary catheters: compliance of practice in Danish hospitals, nursing homes and home care to national guidelines. Scand J Urol Nephrol. 1995. 29:299–309.
46. Peloquin CA, Cumbo TJ, Schentag JJ. Kinetics and dynamics of tobramycin action in patients with bacteriuria given single doses. Antimicrob Agents Chemother. 1991. 35:1191–1195.
47. Ooi BS, Chen BT, Yu M. Prevalence and site of bacteriuria in diabetes mellitus. Postgrad Med J. 1974. 50:497–499.
48. Neal DE Jr. Host defense mechanisms in urinary tract infections. Urol Clin North Am. 1999. 26:677–686.
49. Kessler M, Hoen B, Mayeux D, Hestin D, Fontenaille C. Bacteremia in patients on chronic hemodialysis. A multicenter prospective survey. Nephron. 1993. 64:95–100.
50. Saitoh H, Nakamura K, Hida M, Satoh T. Urinary tract infection in oliguric patients with chronic renal failure. J Urol. 1985. 133:990–993.
51. Tolkoff-Rubin NE, Rubin RH. Urinary tract infection in the immunocompromised host. Lessons from kidney transplantation and the AIDS epidemic. Infect Dis Clin North Am. 1997. 11:707–717.
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