Urinary Tract Infections http://www.emc.maricopa.edu/faculty/farabee/BIOBK/BioBookDiversity_2.html

Presented By: Candis Cook

Lauren Beller

and Randy Dumaplin

Incidence and Prevalence http://herpes-coldsores.com/std/urinary_tract_infections_pictures.htm Approximately 8 to 10 million people in the United States develop a UTI each year. Women develop the condition much more often than men. The condition is rare in boys and young men. The distance between the bladder and the urethral opening is relatively short in women, and this opening is in close proximity to the vagina and rectum. This makes it easy for bacteria to move from one place to another. In men, the urethral tube is longer and its opening is further removed from the rectum, thus resulting in a lower frequency of UTIs. UTI is uncommon in men below 60 years of age, but the frequency is similar in men and women in older age groups. Twenty percent of women in the United States (1 out of 5) develop a UTI and 20% of those have a recurrence. Urinary tract infections in children are more common in those under the age of 2. UTIs are classified as either community acquired or hospital acquired. 70 percent of infections are community acquired.

What are the causes? http://www.nlm.nih.gov/medlineplus/ency/imagepages/1122.htm Urinary tract infection (UTI) is an infection that usually occurs when bacteria enter the opening of the urethra and multiply in the urinary tract. The urinary tract includes the kidneys, the tubes that carry urine from the kidneys to the bladder (ureters), bladder, and the tube that carries urine from the bladder (urethra). The special connection of the ureters at the bladder help prevent urine from backing up into the kidneys, and the flow of urine through the urethra helps to eliminate bacteria. Men, women, and children develop UTIs.

http://health. allrefer. com/health/e-coli-enteritis-digestive-system http://health.allrefer.com/health/e-coli-enteritis-digestive-system.html The most common cause of UTI is bacteria from the bowel that lives on the skin near the rectum or in the vagina which can spread and enter the urinary tract through the urethra. Once bacteria enters the urethra it travels upward causing infection in the bladder and sometimes other parts of the urinary tract.

Rod-Shaped Bacterium, E. coli, dividing by binary fission http://www.emc.maricopa.edu/faculty/farabee/BIOBK/BioBookDiversity_2.html Escherichia coli (E. coli) causes about 80% of UTIs in adults. These bacteria are normally present in the colon and may enter the urethral opening from the skin around the anus and genitals. Other bacteria that cause urinary tract infections include Staphylococcus saprophyticus (5 to 15% of cases), Chlamydia trachomatis, and Mycoplasma hominis. Men and women infected with chlamydia trachomatis or mycoplasma hominis can transmit the bacteria to their partner during sexual intercourse, causing UTI.

Brief Background on E. coli E. coli strains undergoing conjugation http://www.emc.maricopa.edu/faculty/farabee/BIOBK/BioBookDiversity_2.html Escherichia coli (usually abbreviated to E. coli) is one of the main species of bacteria that live in the lower intestines of warm-blooded animals (including birds and mammals) and are necessary for the proper digestion of food. Its presence in groundwater is a common indicator of fecal contamination. ("Enteric" is the adjective that describes organisms that live in the intestines. "Fecal" is the adjective for organisms that live in feces, so it is often a synonym for "enteric.") The name comes from its discoverer, Theodor Escherich. It belongs among the Enterobacteriaceae, and is commonly used as a model organism for bacteria in general. The number of individual E. coli bacteria in the feces that one human passes in one day averages between 100 billion and 10 trillion. All the different kinds of fecal coli bacteria and all the very similar bacteria that live in the ground (in soil or decaying plants, of which the most common is Enterobacter aerogenes) are grouped together under the name "coliform" (meaning "like coli") bacteria. Technically, the "coliform group" is defined to be all the aerobic and facultative anaerobic, non-spore-forming, Gram-negative, rod-shaped bacteria that ferment lactose with the production of gas within 48 hours at 35°C (in the body, this gas is released as flatulence).

Types of UTI, Signs and Symptoms The short distance between the anus and vagina, and the short length of the urethra, make women more prone to urinary tract infections than men are. Inset: If muscles supporting your bladder weaken, your bladder may descend into your vagina, a condition called cystocele. Your bladder may not empty completely. Stagnation of urine can cause growth of bacteria, which may lead to an infection. Urinary tract infections usually develop first in the lower urinary tract (urethra, bladder) and, if not treated, progress to the upper urinary tract (ureters, kidneys). Each type of UTI may result in more specific signs and symptoms, depending on which part of your urinary tract is infected: Urethritis. Inflammation or infection of the urethra leads to burning with urination and sometimes pus in your urine. In men, urethritis may cause penile discharge. Cystitis. Inflammation or infection of your bladder may result in pressure in the pelvis and lower abdomen and strong-smelling urine. Acute pyelonephritis. Infection of your kidneys may occur after spreading from an infection in your bladder. Kidney infection can cause flank pain, high fever, shaking chills, and nausea or vomiting. This requires urgent treatment and can lead to reduced kidney function and possibly even death in untreated, severe cases.

Note: This is not a sign of UTI!!!

Risk Factors Women who are sexually active tend to have more UTIs. Sexual intercourse can irritate the urethra, allowing germs to more easily travel through the urethra into the bladder. Women who use diaphragms for birth control also may be at higher risk. After menopause UTIs may become more common because tissues of the vagina, urethra and the base of the bladder become thinner and more fragile due to loss of estrogen.. Women who use a diaphragm develop infections more often, and condoms with spermicidal foam may cause the growth of E. coli in the vagina, which may enter the urethra. Urinary catheterization (i.e., insertion of a small tube into the bladder through the urethra to drain urine) can also cause UTI by introducing bacteria into the urinary tract. The risk for developing a UTI increases when long-term catheterization is required. In infants, bacteria from soiled diapers can enter the urethra and cause UTI. E. coli may also enter the urethral opening when young girls do not wipe from front to back after a bowel movement. Other risk factors include the following: Bladder outlet obstructions (e.g., kidney stones) Conditions that cause incomplete bladder emptying (e.g., spinal cord injury) Congenital (present at birth) abnormalities of the urinary tract (e.g., vasicoureteral reflux) Diabetes and other chronic illnesses that may impair the immune system Being uncircumcised Certain blood types enable bacteria to attach more easily to cells that line the urinary tract, causing recurrent UTIs.

Screening and Diagnosis If symptoms of a urinary infection are present, a doctor should be contacted promptly. A urinalysis, sometimes followed by a urine culture, can reveal whether there is an infection. Although no simple test can differentiate between an upper and lower urinary tract infection, the presence of fever and flank pain would likely indicate kidney infection. Test strips dipped into a urine sample can detect indirect signs of infection such as blood, protein, white blood cells and nitrites (most common bacteria convert nitrate, which is a chemical normally present in urine into nitrites, which are not usually present). A clean midstream urine sample should be sent to the laboratory for a microscopy examination. A level of 100,000 bacteria per millilitre of urine is regarded as a significant infection, especially if found together with pus or white blood cells (leucocytes) on microscopy. Any infecting bacteria are cultured in the laboratory to assess their sensitivity to common antibiotics

Treatment Bladder infections and other urinary tract infections are often treated with antibacterial drugs. The type of drug used and the duration of treatment depend on the type of bacteria. Most UTIs are treated with trimethoprim-sulfamethoxazole (e.g., Bactrim®, Cotrim®, Septra®), amoxicillin (e.g., Amoxil®, Trimox®), or fluoroquinolones (e.g., Levaquin®, Cipro®). The infection may improve within a couple of days, but 1 to 2 weeks of medication is may be prescribed to prevent a kidney infection. UTIs that are caused by bacteria such as chlamydia trachomatis and mycoplasma hominis require a longer course of treatment with tetracycline (e.g., Achromycin®), trimethoprim-sulfamethoxazole, or doxycycline (e.g., Periostat®). Infections complicated by bladder outlet obstructions (e.g., kidney stone, BPH) and other risk factors (e.g., spinal cord injury) may require surgery to correct the cause of UTI. Kidney infections may require hospitalization and as many as 6 weeks of antibiotic treatment to prevent serious kidney damage. Over-the-counter pain relievers (e.g., Tylenol®, Advil®) and a heating pad may be used to relieve discomfort caused by UTI. Drinking plenty of water helps to cleanse bacteria out of the urinary tract. Coffee, alcohol, and smoking should be avoided. Frequent UTI (3 or more per year) may be treated with low-dose antibiotics for 6 months or longer or with a 1 to 2 day course when symptoms appear. Follow up urinalysis is performed after treatment to make sure that the urinary tract is bacteria free.

Prevention The following measures can reduce the risk for bladder infections and other UTIs: Drink plenty of water to remove bacteria from the urinary tract. Avoid products that may irritate the urethra (e.g., bubble bath, scented feminine products). Cleanse the genital area before sexual intercourse. Avoid using a diaphragm or condoms coated with spermicide. Change sanitary napkins often. Change soiled diapers in infants and toddlers promptly. Do not routinely resist the urge to urinate. Avoid constipation. Take showers instead of baths. Urinate after sexual intercourse. Women and girls should wipe from front to back after voiding to prevent contaminating the urethra with bacteria from the anal area.

Sources: “All About Urinary Tract Infections”. TeensHealth.(2005). 18 Nov. 2005 <http://kidshealth.org/teen/sexual_health/stds/uti.html> “Urinary Tract Infections”. Urology Channel.(2005).17 Nov. 2005 <http://www.urologychannel.com/uti/index.shtml> “Urinary Tract Infections in Adults”. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC). (2005).19 Nov. 2005 <http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/> “Urinary Tract Infection (UTI)”. Netdoctor.co.uk. (2005). 15 Nov. 2005 <http://www.netdoctor.co.uk/menshealth/facts/urinaryinfection.htm> “Urinary Tract Infections (UTI)”. Sexually Transmitted Disease Resource. (2005). 20 Nov. 2005 <http://herpes-coldsores.com/std/urinary_tract_infections.htm> “Women’s Health – Urinary Tract Infections”. About – Health and Fitness.(2005). 19 Nov. 2005 <http://womenshealth.about.com/cs/bladderhealth/a/UTI.htm> “Women’s Health – Urinary Tract Infection”. MayoClinic.com. (2005). 20 Nov. 2005 <http://www.mayoclinic.com/health/urinary-tract-infection/DS00286>