The epidemiology of urinary tract infection

Abstract

Urinary tract infections (UTIs) are among the most common bacterial infections acquired in the community and in hospitals. In individuals without anatomical or functional abnormalities, UTIs are generally self limiting, but have a propensity to recur. Uropathogens have specialized characteristics, such as the production of adhesins, siderophores and toxins that enable them to colonize and invade the urinary tract, and are transmitted between individuals both through person-to-person contact and possibly via food or water. Although generally self limiting, treatment of UTIs with antibiotics leads to a more rapid resolution of symptoms and is more likely to clear bacteriuria, but also selects for resistant uropathogens and commensal bacteria and adversely affects the gut and vaginal microbiota. As uropathogens are increasingly becoming resistant to currently available antibiotics, it may be time to explore alternative strategies for managing UTI.

Key Points

  • Urinary tract infection (UTI) is diagnosed using a combination of urinary symptoms and urine culture; 20% of women presenting with symptoms indicative of UTI will have a negative urine culture

  • Escherichia coli are the bacteria most frequently implicated in uncomplicated UTI and catheter-associated UTI, and are becoming increasingly resistant to antibiotics

  • Positive urine culture in the absence of symptoms should not be treated, except in pregnant women or those undergoing invasive genitourinary procedures

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Figure 1: The variation in bacteriology of urinary tract infection (UTI) according to population.
Figure 2: Geographical variation in the prevalence of uropathogenic E. coli resistant to selected antibiotics.
Figure 3: Symptomatic and bacteriologic cure rates at 7 days in two placebo-controlled trials (pivmecillinam versus placebo3 and nitrofurantoin versus placebo37) and an equivalency trial (ciprofloxacin versus ibruprofen [placebo]63), all performed in women with uncomplicated lower UTI.

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Foxman, B. The epidemiology of urinary tract infection. Nat Rev Urol 7, 653–660 (2010). https://doi.org/10.1038/nrurol.2010.190

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