Pathophysiology:

The urinary tract, from the kidneys to the urethral meatus,

is normally sterile and resistant to bacterial colonization
despite frequent contamination of the distal urethra with colonic
bacteria. Mechanisms that maintain the tract's sterility include
urine acidity, emptying of the bladder at micturition,
ureterovesical and urethral sphincters, and various immunologic
and mucosal barriers.

About 95% of UTIs occur when bacteria ascend the urethra to the
bladder and, in the case of acute uncomplicated pyelonephritis,
ascend the ureter to the kidney. The remainder of UTIs are
hematogenous. Systemic infection can result from UTI,
particularly in the elderly. About 6.5% of cases of hospital-
acquired bacteremia are attributable to UTI.

A urinary tract infection is an infection of any of the organs in

the urinary tract, which consist of the bladder, the ureter, the
urethra, and the kidneys.

A urinary tract infection (UTI) may occur in the: Bladder -

Cystitis is an infection of the bladder. This is the most common
form of UTI; it can be aggravated if the bladder does not empty
completely when you urinate. Urethra - Urethritis is
infection/inflammation of the urethra. This can be due to other
things besides the organisms usually involved in UTI’s; in
particular, many sexually transmitted diseases (STD’s) appear
initially as urethritis. Ureter – Ureteritis is infection of a
ureter. This can occur if the bacteria entered the urinary tract
from above, or if the ureter-to-bladder valves don’t work
properly and allow urine to “reflux” from the bladder into the
ureters. Kidney – Pyelonephritis is an infection of the kidney
itself. This can happen with infection from above, or if reflux
into the ureters is so bad that infected urine refluxes all the
way to the kidney.

Commensal colonic gram-negative aerobic bacteria cause most

bacterial UTIs. In relatively normal tracts, strains of E. coli
with specific attachment factors for transitional epithelium of
the bladder and ureters are the most frequent causes. The
remaining gram-negative urinary pathogens are other
enterobacteria, especially Klebsiella , Proteus mirabilis, and
Pseudomonas aeruginosa. Enterococci (group D streptococci) and
coagulase-negative staphylococci (eg, Staphylococcus
saprophyticus) are the most frequently implicated gram-positive
organisms.

E. coli causes > 75% of community-acquired UTIs in all age

groups; S. saprophyticus accounts for about 10%. In hospitalized
patients, E. coli accounts for about 50% of cases. The gram-
negative species Klebsiella , Proteus, Enterobacter, and Serratia
account for about 40%, and the gram-positive bacterial cocci
Enterococcus faecalis and S. saprophyticus and Staphylococcus
aureus account for the remainder.

People more susceptible to UTI’s:

 Diabetics because of changes in the immune system

 Infants who are born with abnormalities of the urinary tract
 A woman has shorter length of the urethra.
 Women whose partners use a condom with spermicidal foam
 A person who has already had a UTI
 Pregnant women
 Post-menopausal women
  Women with lowered immunity
 Women with obstructions in the urinary tract

Signs and Symptoms of UTI

 Burning sensation at the start of urination

 Burning sensation in the middle of urination
 Fever
 Lower abdominal pain
 Funny smell, color, or appearance (cloudy, dark, blood
tinged) of urine
 Pain in back, flanks, or abdomen
 Nausea
 Vomiting

Other Signs and Symptoms of UTI

 Uncomfortable pressure above pubic bone

 Fullness in rectum (in men only)
 Small amount of urine, despite urge to urinate
 Irritability (in children only