Recurrent Urinary Tract Infection

Recurrent Urinary Tract Infection
Urinary tract infection (UTIs)s often occur in women than men and is the most frequent clinical bacterial infection in women. Research demonstrates that about 50% to 60% of women will develop a UTI in their lifetime and investigations will definitely demonstrate Escherichia coli as the causes organism in most cases (Aydin et al., 2015). Recurrence of UTIs is observed to be a problem among many women and is related to resistance to antibiotics alongside other preventable causes. This discussion focuses on a 26-year-old woman with recurrent UTIs to analyze the causes, differential diagnoses, tests, and special care for the patient.

Differential Diagnoses

The woman has had five episodes of acute cystitis in the past year and currently presents with dysuria, increased frequency, and urgency to urinate. Physical examination reveals mild tenderness in the suprapubic area and the vital signs are normal. The following differential diagnoses can be made.

Pyelonephritis: This is an infection of the kidney caused by the ascent of bacteria from the bladder to the kidney. In most cases, patients will present with urinary symptoms such as dysuria, urgency, and frequency of urination. However, fever is always present in this condition and much pain is experienced in the flanks rather than the suprapubic area (Douglas-Moore & Goddard, 2017). Gross hematuria is also expected and none of these classical symptoms are available in the patient to lead to the diagnosis of pyelonephritis.

Pelvic inflammatory disease: This disease affects female reproductive organs in the pelvis including the fallopian tubes, ovaries, cervix, and uterus. The disease presents with signs such as painful urination, pain in the lower abdomen, irregular bleeding, and fever. PID is not a probable diagnosis here because fever, irregular bleeding, and vaginal discharge are absent.

Cystitis: It is the most common type of UTI in women that involves the urinary tract and the bladder. It occurs when bacteria travel up the urethra into the bladder causing inflammation in the bladder ring (Douglas-Moore & Goddard, 2017). Symptoms include frequent urge to urinate only to pass a few drops, burning pain on urination, pain in the lower abdomen, and bloody urine.

Preliminary Diagnosis

My preliminary diagnosis for this patient is cystitis. The patient has had five episodes of the same condition confirmed through laboratory investigations. Secondly, the symptoms observed are associated with cystitis including mild pain in the lower abdomen, dysuria, increased urgency, and frequency of urination. With no evidence of vaginal discharge and fever, it is right to rule out vaginitis, PID, pyelonephritis, and other conditions presenting with dysuria.

Tests

Urine microscopy and culture: The first test I will request is the analysis of urine to detect the presence of bacteria or blood alongside other findings like leukocytes which will indicate inflammation. A urine bacterial culture will be necessary to detect the causal bacteria and resistance to drugs.

Ultrasound: Because the patient has had recurrent episodes of the same infection, I will request an ultrasound to examine the bladder and the kidneys to observe structural abnormalities. This test will be important especially if the laboratory findings will suggest no signs of infection.

Cystoscopy: It is a procedure performed by a doctor that involves the insertion of a cystoscope to visualize the internal structure of the bladder. The test will be effective in observing signs of infection and identification of structural abnormalities inside the bladder alongside things like stones, obstruction, or lesions (Douglas-Moore & Goddard, 2017).

Causes of Recurrence

Recurrence of UTIs represents the ability of the infection to occur again within two weeks of therapy from the same microorganism, or when a different organism grows during any period following treatment. Recurrence is caused by the persistence of the infecting bacteria in the fecal flora and subsequently recolonizing the introitus and the bladder (Aydin et al., 2015). Secondly, local PH changes in the vagina secondary to practices such as douching can cause regrowth of bacteria. Practices such as delayed voiding and changing sexual partners can predispose the patient to recurrent infections. High recurrence rates are observed in women with increased frequency of sexual intercourse and those with a maternal history of UTIs.

Most Likely Cause

I think the cause of recurrence in the patient is the persistence of the causal microorganism especially the E. coli which reactivates after completion of treatment. There is supportive evidence that the bacteria is eradicated within days of treatment but small clusters remain intracellularly only to be active again later (Wales et al., 2019).

Collaboration with Professionals

I will collaborate with professionals after receiving the laboratory investigation results alongside other tests ordered. If microscopy reveals the presence of bacteria that caused the infection before, I will definitely involve the physician team because it might be due to antibiotic resistance. The collaborative practice will help in identifying the most appropriate course of treatment including changing medication and health education for better hygiene practices. Additionally, specialist care will be necessary since the infection keeps on recurring, and advanced tests like cystoscopy will be best interpreted by a specialist.

References

Aydin, A., Ahmed, K., Zaman, I., Khan, M. S., & Dasgupta, P. (2015). Recurrent urinary tract infections in women. International Urogynecology Journal, 26(6), 795-804. https://doi.org/10.1007/s00192-014-2569-5

Douglas-Moore, J. L., & Goddard, J. (2017). Current best practice in the management of cystitis and pelvic pain. Therapeutic Advances in Urology, 10(1), 17–22. https://doi.org/10.1177/1756287217734167

Wales, K. E., Mecia, L., & Gray, T. (2019). Recurrent urinary tract infection in women. InnovAiT, 12(12), 697-702. https://doi.org/10.1177/1755738019876667

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