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1. Urinary tract infection - adults
Bladder infection - adults; UTI - adults; Cystitis - bacterial - adults; Pyelonephritis - adults; Kidney infection -
adults
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A urinary tract infection, or UTI, is an infection that can happen anywhere along the urinary tract. Urinary tract
infections have different names, depending on what part of the urinary tract is infected.
Bladder -- an infection in the bladder is also called cystitis or a bladder infection
Kidneys -- an infection of one or both kidneys is called pyelonephritis or a kidney infection
Ureters -- the tubes that take urine from each kidney to the bladder are only rarely the site of infection
Urethra -- an infection of the tube that empties urine from the bladder to the outside is called urethritis.
Causes, incidence, and risk factors
Urinary tract infections are caused by germs, usually bacteria that enter the urethra and then the bladder. This can
lead to infection, most commonly in the bladder itself, which can spread to the kidneys. Most of the time, your body
can get rid of these bacteria. However, certain conditions increase the risk of having UTIs.
Women tend to get them more often because their urethra is shorter and closer to the anus than in men. Because of
this, women are more likely to get an infection after sexual activity or when using a diaphragm for birth control.
Menopause also increases the risk of a UTI. The following also increase your chances of developing a UTI:
Diabetes
Advanced age (especially people in nursing homes)
Problems emptying your bladder completely (urinary retention)
A tube called a urinary catheter inserted into your urinary tract
Bowel incontinence
Enlarged prostate, narrowed urethra, or anything that blocks the flow of urine
Kidney stones
Staying still (immobile) for a long period of time (for example, while you are recovering from a hip fracture)
Pregnancy
Surgery or other procedure involving the urinary tract
Symptoms
The symptoms of a bladder infection include:
Cloudy or bloody urine, which may have a foul or strong odor
Low fever (not everyone will have a fever)
Pain or burning with urination
Pressure or cramping in the lower abdomen (usually middle) or back
Strong need to urinate often, even right after the bladder has been emptied.
If the infection spreads to your kidneys, symptoms may include:
Chills and shaking or night sweats
Fatigue and a general ill feeling
Fever above 101 degrees
Flank (side), back, or groin pain
Flushed, warm, or reddened skin
Mental changes or confusion (in the elderly, these symptoms often are the only signs of a UTI)
Nausea and vomiting
Severe abdominal pain (sometimes).
Signs and tests
A urine sample is usually collected to perform the following tests:
Urinalysis is done to look for white blood cells, red blood cells, bacteria, and to test for certain chemicals, such as
nitrites in the urine. Most of the time, your doctor or nurse can diagnose an infection using a urinalysis.
Urine culture - clean catch may be done to identify the bacteria in the urine to make sure the correct antibiotic is being
used for treatment. CBC and a blood culture may be done.
Treatment
Your doctor must first decide whether you have a mild or simple bladder or kidney infection, or whether your infection
is more serious.
MILD BLADDER AND KIDNEY INFECTIONS
Antibiotics taken by mouth are usually recommended because there is a risk that the infection can spread to the

2. kidneys.
For a simple bladder infection, you will take antibiotics for 3 days (women) or 7 - 14 days (men). For a bladder
infection with complications such as pregnancy or diabetes, OR a mild kidney infection, you will usually take
antibiotics for 7 - 14 days. It is important that you finish all the antibiotics, even if you feel better. If you do not finish all
your antibiotics, the infection could return and may be harder to treat.
Your doctor will also want to know whether you could be pregnant. Your doctor may also recommend drugs to relieve
the burning pain and urgent need to urinate. You will still need to take antibiotics. Everyone with a bladder or kidney
infection should drink plenty of fluids. Some women have repeat or recurrent bladder infections. Your doctor may
suggest several different ways of treating these.
MORE SEVERE KIDNEY INFECTIONS
If you are very sick and cannot take medicines by mouth or drink enough fluids, you may be admitted to the hospital.
You may also be admitted to the hospital if you:
Are elderly
Have kidney stones or changes in the anatomy of your urinary tract
Have recently had urinary tract surgery
Have cancer, diabetes, multiple sclerosis, spinal cord injury, or other medical problems Are pregnant and have a
fever or are otherwise ill.
At the hospital, you will receive fluids and antibiotics through a vein. Some people have urinary tract infections that
keep coming back or that do not go away with treatment. Such infections are called chronic UTIs. If you have a
chronic UTI, you may need antibiotics for many months, or stronger antibiotics may be prescribed. If a structural
(anatomical) problem is causing the infection, surgery may be recommended.
Expectations (prognosis)
A urinary tract infection is uncomfortable, but treatment is usually successful. Symptoms of a bladder infection usually
disappear within 24 - 48 hours after treatment begins. If you have a kidney infection, it may take 1 week or longer for
your symptoms to go away.
Contact your health care provider if you have symptoms of a UTI. Call right away if the following symptoms develop:
Back or side pain
Chills
Fever
Vomiting.
These may be signs of a possible kidney infection. Also call if you have already been diagnosed with a UTI and the
symptoms come back shortly after treatment with antibiotics.
Prevention
Lifestyle changes may help prevent some UTIs. After menopause, a woman may use estrogen cream in the vagina
area to reduce the chance of further infections.
BATHING AND HYGIENE
Choose sanitary pads instead of tampons, which some doctors believe make infections more likely. Change the pad
each time you use the bathroom.
Do not douche or use feminine hygiene sprays or powders. As a general rule, do not use any product containing
perfumes in the genital area.
Take showers instead of baths. Avoid bath oils.
Keep your genital area clean. Clean your genital and anal areas before and after sexual activity.
Urinate before and after sexual activity.
Wipe from front to back after using the bathroom.
CLOTHING
Avoid tight-fitting pants.
Wear cotton-cloth underwear and pantyhose, and change both at least once a day.
DIET
Drink plenty of fluids (2 to 4 quarts each day).
Drink cranberry juice or use cranberry tablets, but NOT if you have a personal or family history of kidney stones.
Do NOT drink fluids that irritate the bladder, such as alcohol and caffeine.

3. References
Lin K, Fajardo K; U.S. Preventive Services Task Force. Screening for asymptomatic bacteriuria in adults: evidence for
the U.S. Preventive Services Task Force reaffirmation recommendation statement. Ann Intern Med. 2008 Jul
1;149(1):W20-4.
Little P, Moore MV, Turner S, et al. Effectiveness of five different approaches in management of urinary tract
infection: randomized controlled trial. BMJ. 2010 Feb 5;340:c199. doi: 10.1136/bmj.c199.
Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute
uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America
and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar;52(5):e103-20.
Hooton TM, Bradley SF, Cardenas DD, et al. Diagnosis, prevention, and treatment of catheter-associated urinary
tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of
America. Clin Infect Dis. 2010 Mar 1;50(5):625-63.
Urinary tract infection - children
UTI - children; Cystitis - children; Bladder infection - children; Kidney infection - children; Pyelonephritis -
children
A urinary tract infection (UTI) is an infection of the urinary tract. The urinary tract includes the:
Bladder
Kidneys
Ureters -- the tubes that take urine from each kidney to the bladder
Urethra -- the tube that empties urine from the bladder to the outside
Causes, incidence, and risk factors
Urinary tract infections (UTIs) can occur when bacteria find their way into the bladder or the kidneys. These bacteria
are normally found on the skin around the anus or sometimes around the vagina.
Normally, there are no bacteria in the urinary tract itself. However, certain things can make it easier for bacteria to
enter or stay in the urinary tract. These include:
A problem in the urinary tract, called vesicoureteral reflux, which is usually present at birth. This condition allows urine
to flow back up into the ureters and kidneys
Brain or nervous system illnesses (such as myelomeningocele, spinal cord injury, hydrocephalus) that make it harder
to empty the bladder
Bubble baths or tight-fitting clothes (girls)
Changes or birth defects in the structure of the urinary tract
Not urinating (peeing) often enough during the day
Wiping from back (near the anus) to front after going to the bathroom. In girls, this can bring bacteria to the opening
where the urine comes out.
UTIs are more common in girls, especially around age 3 when they first begin toilet training. In boys who are not
circumcised, the risk for UTIs is slightly higher before the first birthday.
Symptoms
Young children with UTIs may only have a fever, poor appetite, vomiting, or no symptoms at all. Most urinary tract
infections in children only involve the bladder. If the infection spreads to the kidneys, it is called pyelonephritis and
may be more serious. Symptoms of a bladder infection in children include:
Blood in the urine
Cloudy urine
Foul or strong urine odor
Frequent or urgent need to urinate
General ill feeling (malaise)
Pain or burning with urination
Pressure or pain in the lower pelvis or lower back
Wetting problems after the child has been toilet trained

4. Symptoms that the infection may have spread to the kidneys include:
Chills with shaking
Fever
Flushed, warm, or reddened skin
Nausea
Pain in the side (flank) or back
Severe pain in the belly area
Vomiting
Signs and tests
A urine sample is needed to diagnose a UTI in children. The sample is examined under a microscope and sent to a
lab for a urine culture. In children who are not toilet trained, getting a urine sample can be difficult. The test cannot be
done using a wet diaper. Possible ways to collect a urine sample in very young children include:
Urine collection bag -- A special plastic bag is placed over the child's penis or vagina to catch the urine. This is not
the best method because the sample may become contaminated.
Catheterized specimen urine culture -- A plastic tube (catheter) placed into the tip of the penis in boys, or straight into
the urethra in girls, collects urine right from the bladder.
Suprapubic urine collection -- A needle is placed through the skin of the lower abdomen and muscles into the
bladder. It is used to collect urine.
If this is your child's first UTI, special imaging tests may be done to find out why the infection happened, or to see if
there is any kidney damage. Tests may include:
Kidney ultrasound
X-ray taken while the child is urinating (voiding cystourethrogram)
These studies may be done while the child has an infection. Most often they are done weeks to several months
afterward. Your doctor will consider many things when deciding if and when a special study is needed, including:
How old is the child? (Infants and younger children usually need follow-up tests.)
Has the child had infections in the past?
Is the infection severe?
Does the child have other illnesses?
Does the child have a problem with the spinal cord or defects of the urinary tract?
Has the child responded quickly to antibiotics?
Treatment
In children, UTIs should be treated quickly with antibiotics to protect the kidneys. Any child under 6 months old or who
has other complications should see a specialist right away.
Younger infants will usually stay in the hospital and be given antibiotics through a vein. Older infants and children are
treated with antibiotics by mouth. If this is not possible, they are admitted to the hospital where they are given
antibiotics through a vein.
It is important that your child drink plenty of fluids while they have a urinary tract infection.
Some children may be treated with antibiotics for long periods of time (as long as 6 months - 2 years). This treatment
is more likely when the child has had repeat infections or a condition called vesicoureteral reflux, which causes urine
to flow back up into the ureters and kidneys. Follow-up urine cultures may be needed to make sure that bacteria are
no longer in the bladder.
Expectations (prognosis)
Most children are cured with proper treatment. The treatment may continue over a long period of time. Long-term
problems from repeated UTIs in children can be serious. However, these infections can usually be prevented.
Call for an appointment with your health care provider if your child's UTI symptoms continue after treatment or come

5. back more than twice in 6 months. Call your health care provider if the child's symptoms get worse, or new symptoms
develop, especially: Back pain or flank pain
Bad-smelling, bloody, or discolored urine
Fever of 100.4 °F (38 °C) rectally in infants, or over 101 °F (38.3 °C) in children
Low back pain or abdominal pain (especially below the belly button)
Persistent fever
Unusually frequent urination or frequent urination during the night
Vomiting.
Prevention
Avoid giving your child bubble baths
Have your child wear loose-fitting underpants and clothing
Increase your child's intake of fluids
Keep your child's genital area clean to prevent bacteria from entering through the urethra
Teach your child to go the bathroom several times every day
Teach your child to wipe the genital area from front to back to reduce the chance of spreading bacteria from the anus
to the urethra.
References
White B. Diagnosis and treatment of urinary tract infection in children. Am Fam Physician. 2011;83:409-415.
Williams G, Craig JC. Long-term antibiotics for preventing recurrent urinary tract infection in children. Cochrane
Database Syst Rev. 2011;(3):CD001534.
Craig JC, Simpson JM, Williams GJ, et al. Antibiotic prophylaxis and recurrent urinary tract infection in children. N
Engl J Med. 2009;361:1748-1759.
Skoog SJ, Peters CA, Arant BS Jr, et al. Pediatric Vesicoureteral Reflux Guidelines Panel summary report: clinical
practice guidelines for screening siblings of children with vesicoureteral reflux and neonates/infants with prenatal
hydronephrosis. J Urol. 2010;184:1145-1151.
Shaikh N, Morone NE, Lopez J, Chianese J, Sangvai S, D'Amico F, Hoberman A, Wald ER. Does this child have a
urinary tract infection? JAMA. 2007;298:2895-2904.
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