Urinary Infection

A urinary infection is defined by the colonization of the urinary tracts by Bactérie S, which generally results in urinary infectious signs. They are very frequent, in particular at the Nourrisson S and the young children, the pregnant women . There exist two principal tables of urinary infection: the Cystitis (infection of the bladder) and the Pyelonephritis (infection of the kidney). They treat very well by Antibiotique S. the insufficiency or the absence of treatment of pyelonephritis can lead to severe complications (cf will infra). The urinary infections are the bacterial infections most frequent some is the age.

Between 20 and 50 years, the infections are 50 times more frequent at the woman, but after 50 years the incidence at the man increases clearly because of increase in the diseases prostate sufferers, and the ratio is thus only of 3/1 at the old subjects.

The urinary infection at the man practically always has an anatomical cause. Schematically: congenital malformations in childhood and adolescence, prostatic problems at the old man, calculations and tumors between these two old. Renal tuberculosis seems to also be able to be a " cause; anatomique" supporting.

Most of the time, the bacteria come from the Intestin S. For this reason, the Femme S are more prone to the urinary infections (cystitis) because of the proximity of the urinary Méat and the Anus and the brevity of the urethra.

Physiopathology

The germs most frequently in question are Escherichia coli (75% of the cases), Proteus mirabilis , Klebsiella , all three of the Entérobactérie S (bacilli Gram-negative). It is necessary to add Staphylococcus saprophyticus , cocci with gram-positive, whose frequency oscillates between 5 and 25% of the cases according to the countries and some other germs much rarer. The particular case of the urinary infections with Lactobacillus enters, with some other cases, in the category of what one called the " cystitides with urines claires" who leaves this framework.

A perhaps simple or complicated urinary infection. It is known as simple (criteria ANDEM) when all the following elements are joined together: evolution since less than three days at a woman 15 years old to 65 years, without ground at the particular risk (diabetes, pregnancy, impaired renal function, immunodépression, hospital context…), without particular urologic anomaly, urinary episode of infection in the three previous months. It is known as complicated in the case contraire.
A urinary infection is known as sporadic if there is less than two episodes in the six previous months, or less than three episodes in the previous year. If not it is with repetition.

In the child

The immaturity of the urinary tracts is frequently responsible for a vesical backward flow (by abnormal permeability of the Uretère S: the Urine contained in the Vessie cannot normally go up towards the Rein S). There exists sometimes in addition to the urinary Malformation S.

In the expectant mother

The urinary infections are particularly frequent because of anatomical modifications and physiological inherent in the pregnancy which benefits the bacteria:

the growth of the Utérus involves a compression of the bladder (from where a residue post- Miction nel, i.e. a damning up of the urines with incomplete micturitions) and uretères,
the Progestérone involves a hypotonia of the urinary tracts,
the estrogen S tend to return the epithelium urinary more favourable with the development of the bacteria,
It exists a physiological glycosurie (by lowering of the threshold of resorption of the Glucose),
the bacterial contamination vulvo-périnéale is more frequent,
urinary pH is high (alkaline urines).

In the adult

The urinary leading cause of infection is the length of the urethra, which explains their much higher prevalence among women: a short Urètre more easily makes it possible the bacteria to reach the bladder, then sometimes the kidney. The prevention rests on a regular personal hygiene, drinking 1,5 L of water per day and especially the micturition pre and post- Coït ale.

Diagnosis

Asymptomatic Bactériurie

Prevalence: 1% among young girls of less than 10 years, 10 to 20% among old women in primary education care, 20 to 50% in hospital medium. It is strongly correlated with the sexual activity

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