Urinary Tract Infection (cont.)

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When should people seek medical care for a UTI?

Any adult or child who develops any of the symptoms of a urinary tract infection needs to be evaluated by a medical professional, preferably within 24 hours. Most medical offices can test urine for infection by using a quick urine "dipstick" test.

  • Someone who has symptoms of a lower urinary tract infection should call a health-care professional for an appointment, preferably on the very day that symptoms are recognized.
  • Someone who has symptoms of an upper urinary tract infection involving the kidneys should call a health-care professional immediately. Depending on the situation, he or she will recommend either a visit to the office or to a hospital emergency department.

If someone has symptoms of a lower urinary tract infection and any of the following applies, he or she may have a urinary tract infection that can potentially be serious. Go to a hospital emergency department right away.

  • Vomiting and inability to keep down clear fluids or medication
  • Not better after taking antibiotics for two days
  • Pregnant
  • Having diabetes or another disease that affects the immune system
  • Taking medication that suppresses the immune system such as cancer chemotherapy

Infants, children, and elderly people with any of the signs and symptoms of UTI should see their health-care professional as soon as possible or go to an emergency department for evaluation.

  • Fever, lethargy, and poor appetite may indicate a urinary tract infection in these groups, but they may also be signs of something more serious.
  • Urinary tract infections have the potential to make these vulnerable people very ill when the bacteria spread into the bloodstream.

How do physicians diagnose a urinary tract infection?

Diagnosis of a urinary tract infection is based on information someone gives about his or her symptoms, medical and surgical history, medications, habits, and lifestyle. A physical examination and lab tests complete the evaluation.

A doctor may simply perform a urine dipstick test in the office. Only a few minutes are needed to obtain results. A doctor may also send a urine sample to the lab for culture testing (see below). These results take a few days to come back. This tells the doctor the exact bacteria causing the infection and to which antibiotics these bacteria have resistance or sensitivity. The culture is usually sent for special populations, including men, because they are less likely to get UTIs. It is not necessary to send a culture for everyone because the majority of UTIs are caused by the same bacteria.

  • The single most important lab test is urinalysis. A urine sample will be tested for signs of infection, such as the presence of white blood cells and bacteria.
  • In certain circumstances, urine also may be "cultured." This means that a small amount of the urine is brushed on a sterile nutrient substance in a plastic plate. The plate is allowed to sit for a few days and then examined to see what kind of bacteria are growing on it. These bacteria are treated with different antibiotics to see which works best against them. This helps determine the best treatment for the specific infection.
  • Blood tests usually are not required unless a complicated condition, such as pyelonephritis or kidney failure, is suspected.

For a culture specimen, the patient will be asked to give a clean-catch, midstream urine specimen. This avoids contamination of the urine with bacteria from the skin. Patients will be instructed in how to do this.

  • Midstream means urinating a little into the toilet before collecting a specimen. The idea is to avoid collecting the urine that comes out first, as this urine is often contaminated.
  • Clean-catch refers to a midstream sample that was collected after cleaning the area of the urethral opening.
  • Adult women and older girls: Cleanse the area around the urethral opening gently (but completely) using a sterile wipe or soap and water. Catch the urine midstream. For some women, catheterization (inserting a tube into the bladder) may be the only way to obtain a sterile, uncontaminated specimen.
  • Men and boys: A sterile specimen can usually be obtained with a midstream catch. Uncircumcised males should retract the foreskin and cleanse the area before urinating.
  • Newborns: Urine may be obtained with a catheter or a procedure in which a needle is introduced through the lower abdominal wall to draw (aspirate) urine from the bladder.
  • Infants and children: Either catheterization or the needle aspiration method is used.

If someone cannot produce a urine specimen or is unable to follow instructions for a clean-catch specimen, a health-care professional may obtain a urine specimen by catheterization.

  • This means placing a thin tube (catheter) in the urethra to drain urine from the bladder.
  • The catheter usually is removed after the bladder is emptied.
  • The catheter may remain in place if someone is very ill or if it is necessary to collect all urine or measure urine output.

Depending on their symptoms, sexually active women could require a pelvic examination because pelvic infections can have similar symptoms as a urinary tract infection. Males will require a genital examination, and depending on the symptoms, most likely a prostate examination. A prostate infection (prostatitis) requires a longer course of antibiotics than a urinary tract infection.

Men will most likely require a rectal examination so that the prostate can be checked. A prostate infection (prostatitis) requires a longer course of antibiotics than a urinary tract infection.

In some cases, an imaging test may be indicated to detect any underlying problem in the urinary tract that could cause an infection. This is usually only necessary in repeat infections or special circumstances (unusual bacteria, suspected anatomic abnormalities).

  • An ultrasound examination can evaluate kidney and bladder problems.
  • A fluoroscopic study can show any physical problems that predispose children to urinary tract infections.
  • Intravenous pyelogram (IVP) is a special series of X-rays that uses a contrast dye to highlight abnormalities in the urinary tract.
  • Cystoscopy involves insertion of a thin, flexible tube with a tiny camera on the end through the urethra into the bladder. This allows detection of abnormalities inside the bladder that might contribute to infections.
  • A CT scan gives a very detailed three-dimensional picture of the urinary tract.

Imaging tests are most often needed for the following groups:

  • Children with urinary tract infections, especially boys
  • Up to 50% of infants and 30% of older children with a urinary tract infection have an anatomic abnormality. The child's pediatrician should investigate this possibility.
  • Adults with frequent or recurrent urinary tract infections
  • People who have blood in the urine
Medically Reviewed by a Doctor on 6/12/2014

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