Urogenit Tract Infect.  2016 Dec;11(3):93-96. 10.14777/uti.2016.11.3.93.

How Do You Diagnose Recurrent Urinary Tract Infections and Confirm the Diagnosis?

• Choi H
• Bae JH

• KMID: 2366144
• DOI: http://doi.org/10.14777/uti.2016.11.3.93

Abstract

Recurrent urinary tract infections (UTIs) are the most prevalent conditions affected mainly by reinfection by the same bacteria in young women with no functional or anatomic problem. Recurrent UTIs present both storage (dysuria, irritative etc.) and voiding symptoms. For example, frequency subsequently followed by sexual intercourse is a powerful predictor of recurrent UTI. In patients with morbid situations or other factors, recurrent complicated infections or sepsis may be aggravated. Escherichia coli is the most common organism responsible for UTIs, but Pseudomonas, Proteus, Klebsiella, and other organisms are also frequent, particularly, in patients higher risk of complicated infections. Urine culture is not often needed to diagnose typical uncomplicated infection. Generally, urine culture with more than 10² colony-forming units/ml is used to diagnose UTIs in symptomatic patients. Recurrent UTIs could be managed with several techniques with the help of urine culture and by imaging studies when suspicious of anatomical abnormalities.

Keyword

Urinary tract infection; Culture; Anti-bacterial agents

MeSH Terms

Anti-Bacterial Agents
Bacteria
Coitus
Diagnosis*
Escherichia coli
Female
Humans
Klebsiella
Proteus
Pseudomonas
Sepsis
Urinary Tract Infections*
Urinary Tract*
Anti-Bacterial Agents

Reference

1.Dason S., Dason JT., Kapoor A. Guidelines for the diagnosis and management of recurrent urinary tract infection in women. Can Urol Assoc J. 2011. 5:316–22.

2.Foxman B., Barlow R., D'Arcy H., Gillespie B., Sobel JD. Urinary tract infection: self-reported incidence and associated costs. Ann Epidemiol. 2000. 10:509–15.

3.Foxman B. Recurring urinary tract infection: incidence and risk factors. Am J Public Health. 1990. 80:331–3.

4.Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001. 17:259–68.

5.Echols RM., Tosiello RL., Haverstock DC., Tice AD. Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis. Clin Infect Dis. 1999. 29:113–9.

6.Epp A., Larochelle A., Lovatsis D., Walter JE., Easton W., Farrell SA, et al. Recurrent urinary tract infection. J Obstet Gynaecol Can. 2010. 32:1082–101.

7.Hooton TM. Recurrent urinary tract infection in women [Internet]. Wolters Kluwer Health;2011. [cited 2011 Sep 21]. Available from:. http://www.uptodate.com/contents/recurrent-urinary-tract-infection-in-women.

8.Bent S., Nallamothu BK., Simel DL., Fihn SD., Saint S. Does this woman have an acute uncomplicated urinary tract infection? JAMA. 2002. 287:2701–10.

9.Giesen LG., Cousins G., Dimitrov BD., van de Laar FA., Fahey T. Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs. BMC Fam Pract. 2010. 11:78.

10.Dielubanza EJ., Schaeffer AJ. Urinary tract infections in women. Med Clin North Am. 2011. 95:27–41.

11.Hooton TM., Scholes D., Hughes JP., Winter C., Roberts PL., Stapleton AE, et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med. 1996. 335:468–74.

12.Neal DE Jr. Complicated urinary tract infections. Urol Clin North Am. 2008. 35:13–22.

13.Raz R., Gennesin Y., Wasser J., Stoler Z., Rosenfeld S., Rottensterich E, et al. Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis. 2000. 30:152–6.

14.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. 29:1600–1.

15.Nicolle LE. Uncomplicated urinary tract infection in adults including uncomplicated pyelonephritis. Urol Clin North Am. 2008. 35:1–12.

16.Lawrentschuk N., Ooi J., Pang A., Naidu KS., Bolton DM. Cystoscopy in women with recurrent urinary tract infection. Int J Urol. 2006. 13:350–3.

17.van Haarst EP., van Andel G., Heldeweg EA., Schlatmann TJ., van der Horst HJ. Evaluation of the diagnostic workup in young women referred for recurrent lower urinary tract infections. Urology. 2001. 57:1068–72.

18.Nickel JC., Wilson J., Morales A., Heaton J. Value of urologic investigation in a targeted group of women with recurrent urinary tract infections. Can J Surg. 1991. 34:591–4.

19.Engel G., Schaeffer AJ., Grayhack JT., Wendel EF. The role of excretory urography and cystoscopy in the evaluation and management of women with recurrent urinary tract infection. J Urol. 1980. 123:190–1.

20.Fowler JE Jr., Pulaski ET. Excretory urography, cystography, and cystoscopy in the evaluation of women with urinary-tract infection: a prospective study. N Engl J Med. 1981. 304:462–5.

21.Wollin T., Laroche B., Psooy K. Canadian guidelines for the management of asymptomatic microscopic hematuria in adults. Can Urol Assoc J. 2009. 3:77–80.

22.Spencer J., Lindsell D., Mastorakou I. Ultrasonography compared with intravenous urography in investigation of urinary tract infection in adults. BMJ. 1990. 301:221–4.

23.Andrews SJ., Brooks PT., Hanbury DC., King CM., Prendergast CM., Boustead GB, et al. Ultrasonography and abdominal radiography versus intravenous urography in investigation of urinary tract infection in men: prospective incident cohort study. BMJ. 2002. 324:454–6.

24.McNicholas MM., Griffin JF., Cantwell DF. Ultrasound of the pelvis and renal tract combined with a plain film of abdomen in young women with urinary tract infection: can it replace intravenous urography? A prospective study. Br J Radiol. 1991. 64:221–4.

25.Kodner CM., Thomas Gupton EK. Recurrent urinary tract infections in women: diagnosis and management. Am Fam Physician. 2010. 82:638–43.