Kalpana Gupta, MD, MPH; Barbara Trautner, MD, PhD
Gupta K, Trautner B. Urinary Tract Infection. Ann Intern Med. 2012;156:ITC3-1. doi: 10.7326/0003-4819-156-5-201203060-01003
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Published: Ann Intern Med. 2012;156(5):ITC3-1.
In the absence of known abnormalities of the urinary tract, women are at higher risk for UTIs than are men. Premenopausal adult women are at especially high risk for acute cystitis; incidence is 0.5 to 0.7 per person-year among sexually active women (1). Other populations at risk for UTI include patients with voiding abnormalities related to diabetes, neurogenic bladder, spinal cord injury, pregnancy, prostatic hypertrophy, or urinary tract instrumentation. Bacteriuria, with or without accompanying symptoms, is generally considered unavoidable in patients requiring long-term indwelling catheters.
The strongest risk factors for acute uncomplicated cystitis in premenopausal women include sexual intercourse, use of spermicides, pregnancy, and previous UTI. A history of maternal UTI and age at first UTI are also important risk factors in this group, suggesting a genetic component to susceptibility (2). Changes in vaginal microbial flora in perimenopausal women may increase risk for UTI. In contrast to the predominant role of behavioral risk factors in premenopausal women, mechanical and physiologic factors that affect bladder emptying become important in postmenopausal women (3). Diabetes may increase the risk for certain urinary tract disorders, including asymptomatic bacteriuria, perirenal abscess, and emphysematous pyelonephritis (4). In men, risk for UTI is primarily related to the prostatic hypertrophy that occurs with advancing age. Temporary instrumentation of the urinary tract is the major medical intervention that increases the risk for UTI in hospitalized patients. Other comorbid conditions that increase risk in both sexes include stones or foreign bodies, such as ureteral stents, in the urinary system, and diseases associated with a neurogenic bladder.
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Infectious Disease, Nephrology, Urological Disorders, Urinary Tract Infection.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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