Urinary tract infections (UTIs) are more common in women than men, with one third of women having at least one infection at some point in their life (2). The infection can occur at different sites in the urinary tract, including the bladder, kidneys, ureters, and the urethra.
Most UTIs are caused by bacteria that enter the urethra and then the bladder. These include E. coli, P. mirabilis, S. saprophyticus, P. aeruginosa, E. faecalis and Klebsiella (3-5).
The bladder epithelium has natural defences such as surface mucopolysaccharides which prevent small numbers of bacteria adhering to the bladder wall and increase the likelihood of the bacteria being flushed out during urination. Urine osmolality and pH, as well as urea also inhibit bacterial growth (6).
Urinary pathogens have several means of invading the host, including adherence to host cells with adhesins, toxin production and immune evasion (5). Once adhered, the growing bacterial population triggers an inflammatory response and neutrophil invasion. It is these bacterial toxins, enzymes and metabolites that are released from dead neutrophils that can irritate the epithelial lining of the bladder and urethra, which causes the typical symptoms of pain during urination, frequent urination or the urge to urinate, fever and flank pain (7).
Women tend to get UTIs more often than men because their urethra is shorter and closer to the anus. Because of this, women are more likely to get an infection during sexual activity or when using a contraceptive diaphragm. Menopause and pregnancy also increase the risk of getting a UTI (7).
Anatomical, or functional abnormalities in the urinary tract, illness, immunodeficiency and catheterisation are also risk factors (6). Urinary retention is a common problem among the elderly, and UTIs are the most common infection in care home residents, with the standard treatment being catheterisation, which can also cause a UTI (8). The pathogens associated with catheter-related UTIs are E. coli, P. aeruginosa, Klebsiella, Enterobacter and Candida spp. (9).
UTIs affect all ages and genders and can cause a dramatic decrease in the quality of life. They have several local and systemic associations, including:
- Sepsis and endotoxemia
- Vaginal and genital infections
- Gastrointestinal co-morbidities
- Pregnancy complications, including pre-term delivery