Editing Urinary Tract Infections (section)

=== Recurrent UTI ===
* '''See [[AUA & CUA Recurrent UTI (2019)|AUA/CUA Guideline Notes]]'''
* '''Recurrent UTIs are caused by either re-emergence of bacteria from a site within the urinary tract (bacterial persistence) or new infections from bacteria outside the urinary tract (re-infection).'''
** Clinical identification of these two types of recurrence is based on the pattern of recurrent infections. Bacterial persistence must be caused by the same organism in each instance, and infections that occur at close intervals are characteristic. Conversely, reinfections usually occur at varying and sometimes long intervals and often are caused by different species.
** The distinction between bacterial persistence and reinfection is important in management because '''patients with bacterial persistence can usually be cured of the recurrent infections by identification and surgical removal or correction of the focus of infection. Conversely, women with reinfection usually do not have an alterable urologic abnormality and require long-term medical management.'''
** '''The probability of recurrent UTIs'''
*** '''Increases with the number of previous infections'''
*** '''Decreases in inverse proportion to the elapsed time between the first and the second infections'''
* '''Bacterial persistence'''
** Once the bacteriuria has resolved (i.e., the urine shows no growth for several days after the antimicrobial agent has been stopped), recurrence with the same organism can arise from a site within the urinary tract that was excluded from the high urine concentrations of the antimicrobial agent.
** '''Correctable urologic abnormalities that cause bacteria to persist within the urinary tract between episodes of recurrent bacteriuria:'''
**# '''Infection stones'''
**# '''Chronic bacterial prostatitis'''
**# '''Foreign bodies'''
**# '''Urethral diverticula and infected periurethral glands'''
**# '''Unilateral infected atrophic kidney'''
**# '''Ureteral duplication and ectopic ureters'''
**# '''Unilateral medullary sponge kidney'''
**# '''Non-refluxing, normal-appearing, infected ureteral stumps after nephrectomy'''
**# '''Infected urachal cysts'''
**# '''Infected communicating cysts of the renal calyces'''
**# '''Papillary necrosis'''
**# '''Perivesical abscess with fistula to bladder'''
* '''Re-infections'''
** Patients with recurrent infections caused by different species or occurring at long intervals almost invariably have reinfections. These reinfections most often occur in females and are associated with ascending colonization from the bowel flora. Reinfections in men are often associated with a urinary tract abnormality.
** '''The possibility of a vesicoenteric or vesicovaginal fistula should be considered when the patient has any history of pneumaturia, fecaluria, diverticulitis, obstipation, previous pelvic surgery, or radiation therapy.'''
** Evaluation for presumed reinfections must be individualized.