37 - Lower Urinary Tract Infection in Adults

Summary

INTRODUCTION

Symptomatic acute lower urinary tract infection (LUTI), also known as acute bacterial cystitis, can be described as complicated or uncomplicated. In uncomplicated LUTI, there are no signs and symptoms of upper urinary tract infection (UTI) such as fever, chills, or flank pain. Uncomplicated LUTI is a common diagnosis in healthy, young, nonpregnant females with normal renal function, no underlying structural defect in urinary anatomy, and no condition causing immunocompromise, such as diabetes or human immunodeficiency virus (HIV) infection.

LUTI is considered complicated in the setting of a functional or anatomic abnormality of the urinary tract, nephrolithiasis, neurogenic bladder, diabetes mellitus, other immunosuppression, pregnancy, indwelling urinary catheter use, or recent urinary tract instrumentation. UTI in a patient with a history of pyelonephritis or symptoms lasting more than 14 days also qualifies as complicated. All UTIs in men are considered complicated, as these are almost associated with other conditions requiring specific therapy.

The majority of uncomplicated infections do not require extensive diagnostic tests and are effectively treated with short-term antimicrobial regimens. Complicated infections often require additional diagnostic tests, are treated with longer duration antimicrobial therapy, and may have a higher risk of treatment failure and complications.

EPIDEMIOLOGY

UTI affects half of all women at least once during their lifetime, and during any given year, 11% of women report having had a UTI. The incidence increases with age and sexual activity.