Urinary tract infection (UTI) is a term that is applied to a variety of clinical conditions ranging from localized infection of the bladder with lower urinary tract symptoms to pyelonephritis with severe infection of the kidney and the potential for resultant urosepsis. UTI is one of the more common medical problems. It is estimated that UTIs lead to 8.2 million office visits and 1.7 million emergency room departments visits, resulting in at least $6 billion in healthcare expenditures (Stamm and Norrby, 2001; Litwin et al, 2005). UTIs are at times difficult to diagnose; some cases respond to a short course of a specific antibiotic, while others require a longer course of a broad-spectrum antibiotic. Accurate diagnosis and treatment of a UTI is essential to limit its associated morbidity and mortality and avoid prolonged or unnecessary use of antibiotics. Advances in our understanding of the pathogenesis of UTI and the development of new diagnostic tests have allowed physicians to appropriately tailor specific treatment for each patient. Unfortunately, because of the increasing rates of bacterial resistance to various antibiotics, medical therapies are becoming less efficacious (Kodner and Gupton, 2010).
The epidemiology of UTI grouped by age and sex is shown in Table 14–1. In the neonatal period males are twice as likely as females to experience a UTI. From ages 1 to 6 months the rate of UTI is equal between genders, but from 6 to 12 months of age the rate of UTI in male and female children is 1 to 4. Overall, UTIs are more common in females (Shaikh et al, 2008; Hsiao et al, 2006). The incidence of UTI in uncircumcised males is 85% higher than circumcised males (Singh-Grewal et al, 2005). Risk factors for pediatric UTI include circumcision status, history of prior UTI, and sexual activity among older populations. In addition, anatomical abnormalities like vesicoureteral reflux, ureterocele, ureteropelvic junction obstruction, posterior urethral valves, neurogenic bladder, and bladder and bowel dysfunction portend a higher rate of UTI (Koff et al, 1998). At least 12–30% of patients with a history of symptomatic UTI will experience a recurrence (Conway et al, 2007). Upward of 60% of adult women will report having a UTI during their lifetime, and 11% will report having at least one infection per year (Fihn, 2003).
Table 14–1.Epidemiology of UTI by age, group, and sex. |Favorite Table|Download (.pdf) Table 14–1. Epidemiology of UTI by age, group, and sex.
|Incidence (%) |
|Age (y) ||Female ||Male ||Main risk factors |
|<1 ||0.7 ||2.7 ||Foreskin, anatomic GU abnormalities |
|1–5 ||4.5 ||0.5 ||Anatomic GU abnormalities, functional GU abnormalities |
|6–15 ||4.5 ||0.5 ||Functional GU abnormalities |
|16–35 ||20 ||0.5 ||Sexual intercourse, diaphragm use |
|36–65 ||35 ||20 ||Surgery, prostate obstruction, catheterization |
|>65 ||40 ||35 ||Incontinence, catheterization, prostate obstruction |
Approximately 7 million cases of acute cystitis are ...