Bladder
Infection (Cystitis)Introduction: Normally there
is no pathogen in urine, in other words urine is sterile. In children there is
usually a structural congenital abnormality, if there is an infection. Women in
their middle age outnumber men by a factor of 50-fold in frequency of bladder
infections. In the age group of older than 50 years, when prostate hypertrophy
becomes an important factor in males, more males get bladder infections. Although
we talk about "bladder infection", the truth is that the infecting agents
are opportunists and do not know where the limit of the bladder is. Although there
might be a start in the bladder, the bacteria very quickly ascend via the ureter
and lymphatic connections and cause a kidney infection. This leads to pyelonephritis
(see "pyelonephritis" under "abdominal pain"). We call
the infection of the urinary tract system simply URI (=urinary tract infection)
and this includes cystitis (bladder infection), urethritis (infection of the urethra)
and pyelonephritis. Here is a breakdown of the common bugs found in patients
with UTI's found in either the office setting or the hospital setting:
| Comparison of bacteria
found in urine samples of patients with UTI's in the
office or hospital setting | | Type
of bacterium: | Office
setting: | Hospital
setting: | | Escherichia
coli( the main bacterium of the colon and rectum) | 80% | 50% |
| Staphylococcus saprophyticus | 10% | 2% |
| Klebsiella, Enterobacter, Proteus
and Serratia | 0% | 40% |
| Enterococcus faecalis, Staph. saprophyticus
and aureus | 0% | 5% |
| Other bacteria | 10% | 3% |
It is clear from this table that the patient population in
the hospital is quite different from the population seen in the typical office
setting. Klebsiella and related species are typically found in patients who are
having chronic problems with their kidneys, ureters and bladders. They are older
people and people who suffer from other illnesses and recurrent kidney stones.
Urinary Tract Infection Symptoms: While an infection
of the urethra is mild and comes on gradually, the onset of a bladder infection
is abrupt with frequent and painful urination. There is a stinging, burning feeling
when urinating, but the amounts of urine each time are very small. Even when the
bladder is empty, it feels as if there would be more urine in the bladder. About
1/3 of patients with a cystitis have blood in the urine, which originates from
the inflamed bladder wall. There is a burning pain just above the pelvic bone
deep inside the lower mid abdomen. Urinary Tract Infection Treatment :
The doctor will likely order a mid stream urine sample to be sent to the lab for
a culture and sensitivity test. This tells the doctor what bacteria grew and to
which antibiotic they are sensitive or resistant to. In the meantime, when the
sample has been taken, an antibiotic is prescribed. As about 30% to 50%
of patients with bladder infections also have silent kidney infection (pyelonephritis),
the doctor will likely choose an antibiotic, which at the same time would eradicate
a kidney infection. Two common antibiotics used as an initial therapy while awaiting
cultures are trimethoprim-sulfamethoxazole (brand names: Bactrim, Sulfatrim, Septra)
or ciprofloxacin (Ciloxan, Cipro). Often the culture and sensitivity report will
confirm that the antibiotic chosen was correct. But if the patient did not get
better in a few days and the results suggest that another antibiotic would likely
have a better response, the doctor can prescribe the antibiotic that fits based
on the sensitivity test. Occasionally a urethritis or bladder infection can be
part of venereal disease and another antibiotic has to be prescribed for that.
Follow-up exams may be necessary to ensure that there is no venereal disease elsewhere
in the body. The doctor needs to remember that recurrent UTI's have an underlying
reason and may need a referral to a urologist. One common congenital reason for
UTI's in children of the 1 to 5 year-old group is a vesico-ureteral reflux (=urine
flows backwards from the bladder into the urethra) because of a weak valve in
that area. X-ray studies need to be organized and the urologist needs to do a
reimplantation surgery of the ureter. This surgery has helped many children to
never develop chronic pyelonephritis, which used to be and still is a main reason
for the need of dialysis or the need for kidney transplants in the end stage.
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