The Absence Of Recurrent Uti Guidelines
Because there are no guidelines on managing complex or recurrent UTI, primary care doctors are generally not in a position to help.
| Most UTI guidelines are aimed at management of simple uncomplicated UTI. It can be very difficult to successfully manage complex or recurrent UTI in primary care. If symptoms persist, or where there is diagnostic uncertainty GPs will need to make a referral for specialist assessment.” |
For females that progress from a single UTI, to recurrent UTI or chronic urinary tract infection, or to a diagnosis of Interstitial Cystitis, there has historically been very little hope of effective treatment. We hope to help change this.
How Is A Uti Diagnosed
In older adults who have symptoms of a UTI, a simple urine test called a urinalysis can confirm infection. In some cases, the doctor requests a urine culture to identify the type of bacteria causing the infection and help determine the best antibiotic to treat it.
However, its important to know that older adults often have bacteria in the urine that dont cause any symptoms. This condition is called asymptomatic bacteriuria, and it often resolves on its own without treatment.
Doctors now recommend against doing a urine test to check for a UTI, unless patients have typical, bothersome UTI symptoms. This is to avoid the excessive use of antibiotics to treat infection, which can lead to antibiotic resistance.
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Complicated Vs Uncomplicated Urinary Tract Infection
Persistent or recurrent UTI in adults with anatomically and functionally normal urinary tracts leads rarely, if ever, to renal damage. Therefore, it is important to distinguish between complicated and uncomplicated UTI. Complicated UTI implies infections of urinary tracts which are anatomically or functionally altered . Associated conditions complicating UTI are summarized in . Uncomplicated infections occur mainly in otherwise healthy females with structurally normal urinary tract and intact voiding mechanisms. In contrast, complicating factors put individuals of both genders at a higher risk of developing progressive renal damage, bacteraemia, and urosepsis.
Table 1.
Complicated UTI is a clear contraindication against short-term treatment . In such patients antibiotic therapy is recommended for 26 weeks. Furthermore, for accurate treatment of UTI it is important whether the complicating factor could be eliminated during therapy or whether it persists .
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What Is A Uti
A urinary tract infection is an infection of the bladder which is part of the urinary tract . Cystitis is another name given to a UTI or inflammation of the urinary tract. Its origins are in the Greek terms cyst, meaning bladder and itis, meaning inflammation. It is one of the most common bacterial infections in the world and an estimated 1 in 3 women suffer a UTI in their lifetime.
Pain But Nothing On Tests
Chronic UTI is not a universally accepted diagnosis, but James Malone-Lee, Emeritus Professor of Medicine at University College London, believes most people diagnosed with interstitial cystitis, also known as bladder pain syndrome, actually have chronic UTIs.
The National Institute of Diabetes and Digestive and Kidney Diseases reports that IC is common. The condition may affect between 3 million and 8 million women and between 1 million and 4 million men in the United States.
Though there is no standard treatment for such cases, David Kaufman, a New York urologist specializing in treating bladder and pelvic pain, says he believes new tests could help many people get diagnosed and treated.
I think the failure … to diagnose these patients definitively with chronic, low-grade infections is a result of the inability of two-to-three day commercial cultures to identify the infection. This will hopefully soon change as labs begin using molecular systems to identify microbial DNA and RNA in urine, Kaufman says. I do think the DNA sequencing testing is going to be a game-changer.
Dipsticks and cultures are being advocated in protocols and guidelines all over the world, so those guidelines are hopelessly deficient, Malone-Lee says. It is women who pay the price being denied treatment and told that they do not have a UTI when they do have a UTI.
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Older Adults Dont Need Powerful Antibiotics For Utis
Treatment for UTIs should begin with narrow-spectrum antibiotics, say Dr. Lathia and Dr. Goldman.
These drugs are less likely to lead to antibiotic resistance and problematic side effects than broad-spectrum antibiotics.
Today, amoxicillin is commonly prescribed as first-line treatment for UTIs in older adults.
Other common narrow-spectrum must be used with caution when patients have chronic kidney disease or take blood pressure medication, as many older adults do or because their side effects can be serious in older adults.
Accuracy Of Standard Uti Tests
In reality, antibiotics are very often prescribed without any form of UTI test. Patients and doctors are very competent at recognizing the symptoms of a UTI, but there are issues with this approach.
Statistics show that 26-44% of females will experience a recurrence of their first UTI. In this 26-44%, it is likely the initial treatment failed.
Evidence suggests that with each recurrence of UTI, another recurrence becomes more likely.
The more UTIs you have, the more likely you are to get another.
If your UTI treatment failed the first time, it is crucial to find out why as soon as possible, in order to break the cycle of recurrence before it escalates.
So why dont the standard UTI test methods provide the answers you need?
First, lets take a quick look at those urine test strips you can use at home or at the doctors office. Then well explain some of the problems with urine culturing done at a lab.
Knowing the issues with both of these tests will arm you with the right questions to ask if you feel like your negative results are wrong.
Weve also created a free download that provides a breakdown of the different types of testing. Provide the email address at which youd like to receive the download, at the end of this article. .
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How To Get Rid Of A Bladder Infection Fast
If youre reading this post, youre likely in the midst of a bladder infection or urinary tract infection and are in some serious need of relief now! We get it UTIs are no fun they can be really painful, leave you rushing to the bathroom nonstop, and can even lead to leaks. So its no wonder youre researching quick cures for bladder infections.
The best thing you can do for fast relief from a bladder infection is to is see your doctor, and get an antibiotic.
Antibiotics kill the bacteria that causes bladder infections and are the best way to stop a UTI in its tracks. They typically work pretty quickly, although be sure to take your medication for the full course, even if youre feeling better sooner than that. So, if youve been experiencing a UTI for more than a couple of days, make an appointment with your doctor now to get treatment.
How To Culture Urine
Bacteria will continue to multiply in the warm medium of freshly voided urine. It is therefore mandatory that urinalysis and culture tests should be performed without delay. The average time of replication of E. coli is n minutes, so that the number of bacteria increases exponentially with time . If bacterial examination is delayed by more than 2 h, specimens must be stored at 4°C, but for no more than 48 h. Dip-slide culture or a similar semiquantitative method of culture is generally preferable. These methods offer the advantage of reflecting the true approximate concentration of bacteria at the time the sample is taken so that storage at low temperature is unnecessary.
Occasionally, unusual or fastidious bacteria may induce UTI. These bacteria are difficult to detect without examination of the urine using Gram stain . For example, Haemophilus influenzae and Haemophilus parainfluenza do not grow well in culture media commonly used for enteric bacteria and as a result may go undetected. Other unusual organisms include Pneumococcus, Campylobacter, Legionella pneumophila, Salmonella, Shigella, Corynebacterium group D2, acid-fast bacilli , and fungi . Gram and acid-fast stains should be performed for patients with urinary symptoms and pyuria when routine cultures are reported to be negative.
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Expanded Quantitative Urine Culture
Expanded Quantitative Urine Culture is a UTI testing method that is relatively new, and has been used in many recent studies around the female urinary microbiome and recurrent UTI.
EQUC uses a modified urine culture protocol, that builds on the standard concept of urine culture with some very important changes. These include using larger volumes of urine, varied atmospheric conditions for incubation and longer incubation times.
The result is that the conditions of EQUC are far superior to those of the standard urine culture.
In fact, one study that compared the two techniques found that EQUC grew bacterial species in 80% of the samples tested. In comparison, 92% of these same samples were reported as no growth using standard urine culture.
EQUC has been adopted as a UTI test method by a selection of practitioners in the USA. Were looking into where patients can access EQUC and will publish further information as we find it.
Utis Can Be Caused By Multiple Pathogens
Another issue with the standard mid-stream urine culture, or Kass test, is that it looks for a single pathogen, and does not take into account the possibility of multiple infection-causing pathogens.
Instead, if multiple pathogens are found, it is generally assumed that the urine sample was contaminated.
This is a problem because some chronic infections have been found to be caused by multiple pathogens co-existing in the bladder. And each pathogen may require a different treatment approach.
| Our biological studies reveal mixed microbial infections hiding inside the cells of the bladder. Located there, the microbes seem quiescent but cause low-grade inflammation that may cause various bladder symptoms…Cloistered, inside cells bacteria escape antibiotic and immune attack. |
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Can You Have A Bladder Infection Without Pain
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Practical Tips On Urine Bacteria And Possible Utis In Older Adults
Given all this, what should you do if you are worried about bacteria in the urine, or a possible UTI?
Here are my tips for older adults and families:
- Realize that asymptomatic bacteriuria is common in older adults.
- If you keep having positive urine cultures despite feeling fine, you may have asymptomatic bacteriuria.
- Know that treatment of asymptomatic bacteriuria is not going to help, and might lead to harm.
- Unless you are having symptoms, its pointless to try to eradicate bacteria from the bladder. Studies show that this increases your risk of getting a real UTI later on, and that youll be more likely to be infected with bacteria that are resistant to antibiotics.
- Antibiotic treatment also affects the good bacteria in your gut and elsewhere in the body. Research to help us understand the role of the bodys usual bacteria is ongoing, but suggests there can be real downsides to disrupting the bodys bacteria. So you dont want to use antibiotics unless theres a good reason to do so.
If youre caring for an older adult who has dementia or is otherwise prone to delirium:
- Realize that it can be tricky to determine whether the person is experiencing UTI symptoms.
- The doctors should still attempt to do so before checking a urine culture or treating any bacteria found in the urine.
You can even share these peer-reviewed articles:
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How Do Utis Begin
Many types of bacteria live in the intestines and genital area, but this is not true of the urinary system. In fact, urine is sterile. So when errant bacteria, such as the E. coli shown here, is accidentally introduced into the urinary system, it can start a UTI. Typically, bacteria travel up the urethra to the bladder, where an infection can take hold. Women are more susceptible than men, probably because they have shorter urethras.
What Causes Bladder Cancer
Bladder cancer occurs when cells making up the bladder begin to grow and spread in an uncontrolled way, leading to the formation of a malignant tumor. This abnormal cell growth is caused by mutations in the genes that control cell replication, repair, and programmed death: genes that help cells to grow and divide may be switched on, whereas genes that regulate cell division, repair, and programmed death may be switched off.
Most of the gene mutations associated with bladder cancer are acquired, meaning that they develop during a persons life rather than being present at birth . Some of the acquired gene mutations are caused by exposure to toxins or chemicals that are recognized risk factors for developing bladder cancer, such as tobacco smoke.
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Interstitial Cystitis Vs Uti: How To Tell The Difference
Interstitial cystitis and urinary tract infections are frequently confused with one another. This article will illuminate the differences between IC and UTI.
Cystitis is the medical term for inflammation of the bladder.
Most cases of cystitis are caused by a bacterial infection, called a urinary tract infection . By definition, UTI occurs in the urinary tract, which includes the bladder, kidneys, urethra, etc.
UTI-caused cystitis may be called bacterial cystitis or bladder infection.
Interstitial cystitis is non-infectious cystitis caused by chronic inflammation in the bladder.
Both interstitial cystitis and UTI are more common in women than men. They both share similar symptoms. But treatment is very different for these interconnected conditions.
Interstitial cystitis affects up to 4 million men and up to 8 million women in the United States, according to the Urology Care Foundation. Many IC patients claim their IC symptoms began as kids, making it important to look for these symptoms in young children.
Well give you the basics on how to tell them apart, but youll need to see a doctor to be 100% sure whether or not you have interstitial cystitis or a UTI. This is because the high-quality diagnostics are mostly unavailable outside of a hospital lab.
How Is Ic Diagnosed
Interstitial cystitis is often mistaken for a urinary tract infection. Patients often go as long as four years between the time they first experience symptoms and the time they receive their diagnosis. It most commonly affects women, although men can get it too.
IC is diagnosed by ruling out other conditions, such as bladder infections or bladder cancer. Also, when it is advanced, it can be diagnosed by cystoscopy, as there will be visible ulcers on the lining of the bladder. For a cystoscopy, you will have to see a urologist. Not all doctors believe a cystoscopy is a necessary or effective way to diagnose the condition since the exam can be normal but you still may have IC.
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Ive Gained My Life Back: New Tests May Help Those With Persistent Urinary Tract Infections
In 2015, Jessica Price, a 29-year-old Air Force veteran in Illinois, started experiencing urinary tract infection symptoms, including an unrelenting urge to urinate and bladder pain. But standard dipstick testing, where a doctor dips a plastic stick into a urine sample to check it for signs of bacteria, kept coming back negative. Based on her symptoms and the negative tests, doctors told Price she had interstitial cystitis , an incurable syndrome of unknown cause and suggested several invasive procedures that only worsened her pain.
I was on more medications than I can remember, none of which helped and some which made the symptoms worse, she remembers. The urologists told me things such as, This is just like having blue or brown eyes you were destined to have it.
But when a nurse practitioner turned to a new type of test that used DNA analysis of her urine, she found bacteria she said was abnormal, and Price began two years of antibiotic treatments that after some time finally brought her relief.
What Causes Chronic Urinary Tract Infection
This is where the science gets a little more complicated.
Weve talked elsewhere about what causes UTIs. And above, we explained that recurrent UTIs can be attributed to a persistent bladder infection that is not properly eradicated by treatment.
A persistent bladder infection can last for years in the form of a chronic urinary tract infection. For many females, the cycle of acute and symptom-free periods is never broken, and some move on to be diagnosed with the conditions mentioned above, such as Interstitial Cystitis , or Painful Bladder Syndrome . More on that later.
Why has it been so difficult to detect and treat these infections?
There is a culprit here, so lets take a closer look. Behind the misdiagnosis of hundreds of thousands of people, are embedded chronic urinary tract infections that involve biofilms.
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The Problem Of Misdiagnosis In Women With Bladder Cancer
While bladder cancer is more common in men than in women, women often present with more advanced tumors and their overall survival rate is lower.17
A major reason for women presenting with more advanced tumors is the delay that can occur before receiving a bladder cancer diagnosis. Reasons for this delay may include:
- Blood in the urine, the most common symptom of bladder cancer, may be discounted by women as being related to menstruation or post-menopausal bleeding.
- When blood in the urine and urinary irritation are reported to a doctor they may be initially misdiagnosed as a UTI. Additionally, if a woman subsequently presents after treatment failure for a misdiagnosed UTI, further antibiotics may be prescribed rather than carrying out a complete urological evaluation.
- UTIs and bladder cancer can occur at the same time, in which case the UTI will be the logical first diagnosis.
Because of this diagnostic confusion, a definitive diagnosis of bladder cancer may be delayed in some women. Of particular concern in this case is the risk that bladder cancer has reached a more advanced stage that may be more difficult to treat.