Bacterial cystitis in women

Sydney Urodynamic - Friday, March 02, 2018

Bacterial cystitis is a highly prevalent and distressing condition in women but is usually uncomplicated in those who are healthy and not pregnant. Based on symptom assessment and urinalysis, treatment of this condition can generally be managed in primary care.

Bacterial cystitis refers to infection of the bladder (lower urinary tract) and is the most common infection in women. It is estimated that 50% of women will develop
cystitis in their life,1 and it is a frequent cause of presentation to GPs. The incidence of bacterial cystitis increases with age and is related to sexual activity. It is also common in postmenopausal women.

Bacterial cystitis is usually uncomplicated in otherwise healthy, nonpregnant women. An uncomplicated urinary tract infection is defined as one in which there is no concern that the infection has extended beyond the bladder. Complicated urinary tract infection is defined as an infection associated with fever, suspected or documented pyelonephritis (upper urinary tract infection), sepsis or bacteraemia. Bacterial cystitis can occur alone or in association with pyelonephritis. This article will deal only with lower urinary tract infections in women.

Among sexually active women, the incidence of cystitis is 0.5 to 0.7 episodes/person/year. Cystitis in postmenopausal women occurs with an incidence of 0.07 episodes/person/year.4 This incidence is higher in women in residential aged care.

Recurrent cystitis occurs in 12 to 27% of women after their first episode and in 48% of women who have had more than one episode.5 Recurrence is more common in postmenopausal women.6 Recurrent cystitis may be caused by relapse of the original infection or reinfection with the same or a different strain of pathogen.

In bacterial cystitis, the vaginal introitus is first colonised by uropathogens, usually from the lower gastrointestinal tract, after which the pathogens move up the urethra into the bladder. Cystitis in healthy women is rarely explained by underlying functional or anatomical abnormalities of the urinary tract. It is not known why vaginal colonisation progresses to cystitis in some women, whereas in others it never does.

Most women (75 to 95%) develop cystitis as a result of Escherichia coli infection, with infections occasionally caused by other species of gut organisms, such as Proteus mirabilis and Klebsiella pneumoniae, or other bacteria such as Staphylococcus

The bacteriological finding of lactobacilli, enterococci, group B streptococci and coagulase-negative staphylococci is usually caused by a poorly collected, contaminated specimen.9 However, it may be reasonable to consider such organisms as a cause of
cystitis if they are found in urine with high counts and with pure growth.

Antibiotic resistance is common in patients with complicated cystitis who have obstructive renal disease, functional abnormalities, foreign bodies, diabetes, pregnancy, renal failure or immunosuppression, or who are in hospital.
Click here to view the full article by Dr Andrew Korda as published in Medicine Today.
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