Editing Urinary Tract Infections (section)

== Definitions ==

* Cystitis: a clinical syndrome of dysuria, frequency, urgency, and occasionally suprapubic pain.
** These symptoms, although generally indicative of bacterial cystitis, may also be associated with infection of the urethra or vagina or non-infectious conditions such as interstitial cystitis, bladder carcinoma, or calculi.
** Conversely, patients may be asymptomatic and have infection of the bladder and possibly the upper urinary tract.
* '''Acute pyelonephritis: a clinical syndrome of chills, fever, and flank pain that is accompanied by bacteriuria and pyuria'''.
** '''The term should not be used if flank pain is absent.'''
** It may have no morphologic or functional components detectable by routine clinical modalities.
** There may be serious difficulties in diagnosing spinal cord–injured and elderly patients who may be unable to localize the site of their discomfort.
* '''Chronic pyelonephritis:''' a shrunken, scarred kidney, diagnosed by morphologic, radiologic, or functional evidence of renal disease that may be post-infectious but is frequently not associated with UTI.
* '''<span style="color:#ff0000">Uncomplicated vs. complicated infection'''
** '''<span style="color:#ff0000">Uncomplicated: infection in a healthy patient with a structurally and functionally normal urinary tract. The majority of these patients are women'''
** '''<span style="color:#ff0000">Complicated UTIs requires either (5):[https://www.auanet.org/meetings-and-education/for-medical-students/medical-students-curriculum/adult-uti §]'''
**# '''<span style="color:#ff0000">Anatomic or functional abnormality of urinary tract (outlet obstruction, stone disease, diverticulum, neurogenic bladder, VUR etc.)'''
**# '''<span style="color:#ff0000">Urinary instrumentation or foreign bodies in the urinary tract (i.e. catheters, stents, nephrostomy tubes)'''
**# '''<span style="color:#ff0000">Systemic disease (renal insufficiency, diabetes, immunodeficiency, organ transplantation)'''
**# '''<span style="color:#ff0000">Pregnancy'''
**# '''<span style="color:#ff0000">Multi–drug resistant bacteria'''
* Chronic is a poor term that should be avoided in the context of UTIs, except for chronic pyelonephritis or bacterial prostatitis, because the duration of the infection is not defined.
* UTIs may also be defined by their relationship to other UTIs:
** First or isolated: infection that occurs in an individual who has never had a UTI or has one remote infection from a previous UTI.
** '''Unresolved: infection that has not responded to antimicrobial therapy and is documented to be the same organism with a similar resistance profile.'''
** '''Recurrent: infection that occurs after documented, successful resolution of an antecedent infection.'''
*** '''Subtypes (2):'''
***# '''Bacterial re-infection: caused by re-introduction of bacteria into the urinary tract from outside'''
***# '''Bacterial persistence''': '''caused by the same bacteria re-emerging from a focus within the urinary tract''', such as an infectious stone, source with prostate, or infrected atrophic kidney.
***** Relapse is frequently used interchangeably.
**** These definitions require careful clinical and bacteriologic assessment and are important because they influence the type and extent of the patient’s evaluation and treatment.
* '''Antimicrobial prophylaxis: prevention of re-infections''' of the urinary tract by the administration of antimicrobial drugs.
* '''Antimicrobial suppression: prevention of growth of a focus of bacterial persistence''' that cannot be eradicated.