Urinary Tract Infections, What Both Men and Women Should Know

Urinary tract infections (UTIs) are the most common bacterial infections in the United States and the most common ill­ness in men and women ages 65 and older. In fact, UTIs are the leading cause of emergency department (ED) visits among older adults: Yet, a recent study reports that ED doctors often over diagnose UTIs in older women who actually don't have them, resulting in needless treatment-with antibiotics. Men, on the other hand, can be seriously affected: A separate study says that significantly more older men than women are likely to be hospitalized with a UTI.

About UTI’s

More than 8 million adults are treated for UT1s each year, according to the Ameri­can Urological Association. About 40 per­cent of women and 12 percent of men can expect to suffer at least one UTI in their lifetime. Most UTIs occur in the bladder (a bladder infection, or cystitis). Less frequently, UTIs affect the kidneys (a kidney infection, or pyelonephritis); urethra, which is the tube that passes urine from the body (urethritis); or ureters, the tubes that carry urine from the kidney to the bladder. Bac­teria can enter the urethra and travel up the urinary tract to cause infection.

The most common symptoms associ­ated with UTIs are:

• A burning or painful sensation when you urinate (dysuria)

• Cloudy urine that may have an unpleas­ant odor

• Blood in the urine (hematuria)

• A frequent and sometimes urgent need to urinate, though often just a few drops are produced

• Pain, tenderness or cramps in the lower abdomen or back

Kidney infections can produce more severe symptoms like fever; chills; fatigue; side, back or groin pain; mental confusion; and nausea and vomiting. See your doctor immediately if you have one or more symp­toms of a kidney infection to avoid serious complications. Bloody urine also merits prompt medical attention.

People who have difficulty emptying their bladders are more prone to UTIs because bacteria can linger in the urinary tract. Inability to fully void maybe a result of conditions such as Alzheimer's disease, Parkinson's disease, diabetes or urinary-tract obstruction. Kidney stones, an enlarged prostate or a dropped bladder in women (cystocele) may be responsible for obstructive symptoms. Women become more vulnerable to infection after meno­pause: Lower estrogen levels have been linked to recurrent UTIs.

UTIs are also common in hospital or nursing home patients who require fre­quent or prolonged use of a urinary cath­eter (a tube placed through the urethra to drain the bladder).

Overdiagnosed and overtreated

A short course of antibiotics usually clears up uncomplicated UTIs within a few days. But UTIs can be difficult to diagnose in older adults, who tend to have nonspe­cific symptoms more often than younger patients and may also have cognitive or communication problems that prevent them from describing their symptoms. UTIs may trigger episodes of severe confu­sion in elderly people, especially those with dementia; this delirium may be the only UTI symptom they have. Other studies have shown that older women with UTIs are more likely than younger females to have symptoms not specifically related to the urinary tract, such as back pain.

Difficulty diagnosing UTIs is espe­cially encountered in emergency depart­ment settings. Typically, when a doctor suspects a UTI, a urinalysis is obtained. A lab technician examines the urine sam­ple for the presence of white blood cells and other markers of infection. Results of the urinalysis are usually considered together with the results of a urine cul­ture, which determines the type and amount of bacteria in the specimen. Since urine cultures take a day or two before the results can be obtained, ED clinicians usually rely solely on the patient's symptoms and urinalysis results for diagnosis.

As a result, doctors diagnose UTIs and prescribe antibiotics even though they have not yet received the results of the urine culture. Some studies suggest that up to 40 percent of hospitalized older people are incorrectly diagnosed. This is cause for concern because overprescribing antibiotics has led to the growing public health problem of antibiotic resistance, which has diminished the effectiveness of many important drugs. Moreover, taking antibiotics puts older patients at height­ened risk for Clostridium difficile infec­tions. These cause severe diarrhea and are responsible for 14,000 deaths annually in the United States.

A case in point

To determine how often the infection is overdiagnosed, a study in the May 2013 Journal of the American Geriatric Society reviewed the cases of 153 women older than 70 who had been diagnosed with UTIs at one Rhode Island hospital's emer­gency department over 15 months.

In the study, 43 percent of the women diagnosed with UTIs had negative urine cultures—signifying they did not have UTIs after all. Yet, 95 percent of them were treated with antibiotics even though fewer than one in five arrived at the ED with urinary symptoms — the hallmark of a UTI—as their primary complaint. They mainly came to the ED because of a fall or a change in mental status, such as becom­ing acutely confused. These cognitive and non-urinary tract symptoms have other potential causes, which doctors should rule out before prescribing antibiotics, the researchers suggest.

They recommend alternate methods to procure a urine sample for analysis to yield a more accurate diagnosis. In the study, most samples were obtained via a "clean-catch" method by having the patient uri­nate into a container. But many people who don't have UTIs nonetheless carry harm­less bacteria in the urethra or surrounding area, which can taint a dean-catch sample and produce a false-positive result. They found that a better method was insertion of a temporary catheter into the urethra to remove urine directly from the bladder. This method is invasive but less likely to produce a contaminated result.

What the experts say

Current guidelines from the Infectious Disease Society of America say that most patients shouldn't take antibiotics if they don't have any UTI symptoms, even if white blood cells are found in the urine. If you have symptoms and a UTI is con­firmed by appropriate test results, your doctor should prescribe a narrow-spectrum antibiotic, which targets a specific type of bacteria and is less likely to promote antibiotic resistance. (Broad-spectrum antibiotics treat a wider range of diseases) You'll typi­cally be instructed to take the antibiotics as a single dose or up to a seven-day course. The most commonly used first-line drugs are trimethoprim-sulfamethoxazole and nitrofurantoin. Complicated UTIs that occur in the kidneys require a longer course of antibiotic treatment—usually seven to 14 days—that may be best done in the hos­pital. More potent antibiotics are usually used and delivered intravenously.

If you have three or more UTIs a year, your doctor may prescribe a preventive antibiotic to take regularly, after intercourse or at the first sign of infection. Some women are candidates for topical estrogen for the vagina. If UTIs continue, however, your doctor will perform further testing such as a computed tomography scan or ultrasound to look for abnormalities.

Guarding against UTI’s

You can lower your risk for urinary tract infections (UTIs) by managing conditions that might trigger them. Drinking plenty of fluids (aim for 6 to 8 ounces of water a day) can help prevent kidney stones and thwart UTIs since you'll urinate more often and flush bacteria out of your system. Urinate when you feel the need and try not to "hold it." Also, make sure to empty your bladder completely each time you void. Women can further lower their risk for UTIs by taking these steps:

• Wipe from front to back after a bowel movement to prevent bacteria from enter­ing your urinary tract. Clean your anus and the outer lips of your vagina every day. Don't use douches or feminine hygiene sprays.

• Bacteria flourish in a moist climate, so wear underpants with a cotton crotch and avoid tight-fitting pants.

• Skip baths and take showers instead.

• Urinate after sexual activity.

Cranberry juice's track record for preventing UTIs is mixed, and you should avoid the juice if you've had kidney stones or are taking warfarin. Still, many women insist that drinking cranberry juice, or taking dietary supplements containing cranberry, keeps urinary tract infections at bay. A 2012 review of nine clinical studies found that women who used cranberry products lowered their risk for UTIs by 38 percent. However, some studies were flawed, raising questions about their findings.

UTI’s in males

While women suffer from the bulk of urinary tract infections (UTls), older men tend to develop UTIs that are more severe. Men are hospitalized more often for serious kidney infections; too. Their infections are more likely triggered by urinary-tract obstructions with kidney stones, an enlarged prostate or other blockage of urinary flow. That's why management of UTls in men is consid­ered complex. A study published online by World Journal of Urology last Septem­ber found that older men who develop UTIs are 58 percent more likely than women to require hospitalization.  The researchers also found that advanced age in men was an independent risk fac­tor for emergency department visits and subsequent hospitalization for a UTI. The average age of admission was 74 years. However, admission could have been a result of coexisting conditions such as heart failure, kidney failure and pneumonia, conditions more commonly encountered in the elderly.