A Common Dilemma: Urinary Track Infection and Diabetes

What is a Urinarytrad infection (UTI)?un is an infection invoMng the urinary tract which consists of the kidneys, ureters (tubes that connect the kidneys and the urinary bladder), urinary bladder and urethra (the tube running from the bladder to the outside). Ufls can occur in any part of the urinary tract. Most infections involve the lower urinary tract, the bladder and the urethra. Most UTls are caused by bacteria. .They typically occur when bacteria enter the urinary tract through the urethra, multiply in the bladder and sometimes even ascend to the kidneys.There are different medical terms for UTI depending upon the part of the urinary system specifically involvedSymptomsSymptoms of UTI depend on the part of the urinary tract that is involved, but they could overlap in some people. If you experience any of the following symptoms mentioned below, it is advised that you consult the doctor.A burning sensation and persistent urge to urinate may not always be associated with an infection, especially in women. This is referred to as the "Urethral Syndrome" and does not need antibiotic treatment.UTI may not always cause typical signs and symptoms. In the elderly population, these symptoms may not be present. It can present as disorientation, confusion or even altered sensorium.Risk factorsAlthough anyone can suffer from un,there are some cases when people are at an increased risk of getting UTI.WomenWomen are more likely to get Ufls because the urethra is much shorter (approximately 3-4 cm) than in men hence bacteria has to travel a shorter distance to reach the bladder. The other reason is that the urethral opening is relatively close to the anus in women, so the bacteria from the stool can easily contaminate the female urethra leading to UTI. This is seen especially when the awareness about hygiene is limited. A urinary tract infection in young women may be associated with sexual activity, frequently referred to as 'honeymoon cystitis'.• Postmenopausal women - UTls may become more common after menopause because the lack of oestrogen hormone causes dryness of the urogenital tract making it more vulnerable to infections.• During pregnancy - Hormonal and mechanical changes in pregnancy increase the risk of urinary stasis. These changes, along with difficulty in maintaining hygiene due to a distended pregnant belly, increase the frequency of UTls in pregnant women. Additionally, pregnant women are immunocompromised and hence there is an increased risk of complications from urinary infections even in healthy pregnant women.Obstruction of urinepassageThis could occur due to the presence of a stone or tumour; prostate or anatomic abnormality in the urinary tract. Urinary obstruction makes a person more prone to UTls and in such cases, it occurs recurrently. Therefore, treating the infection only by antibiotics is not enough but removing the obstruction is important.People with DiabetesA person with Diabetes is at an increased risk of UTI. Diabetes results in several abnormalities of the immune system which leads to an immunocompromised state that might result in a higher risk of certain infections. Diabetic neuropathy causes impaired bladder emptying which increases the chances of UTI mainly cystitis. Also,high sugar concentration in urine may serve as a medium for the growth of pathogenic microorganisms . Newer anti-diabeticSGLT2 inhibitors act on the kidneys and flush extra sugar from the blood into the urine. They might also increase the risk of fungal genital infection and UTI, especially in post-menopausal women.Urinary tract interventionThe risk of UTI increases after catheterisation as the urethral catheters inoculate organisms into the bladder and provide a surface for bacterial adhesion. Catheters also lead to mucosal irritation increasing the chances of UTI. Tests to confirm UTl• Grine test for microscopy and biochemistry - After washing the genital area with water midstream urine is collected in a clean container provided by the laboratory. The urine sample is then analysed for the presence of white blood cells, red blood cells or bacteria. The reports are received 2-3 hours after sample collection.• Urine culture and sensitivity test - Lab analysis of the urine is sometimes followed by a urine culture test; a test that uses a urine sample to grow bacteria in a lab. This test confirms active infection and tells us which bacteria are causing the infection and which antibiotic will be effective for treatment. The reports are received after 48 -72 hours of sample collection.• Ultrasonography of abdomen - This helps detect obstruction if any in the urine passage. Infection in the kidneys can also be diagnosed by USG. This type of investigation can be safely done in pregnant women.• Blood tests - Serum creatinine and blood urea levels give an insight into kidney function while a blood test can show increased white cell count in severe infection.• Some people need an intravenous pyelogram (IVP), which uses X-rays with contrast dye to create images of the urinary system. Occasionally a CT scan of the urinary system or cystoscopy may be needed. Complications• Acute kidney failure - With severe UTI, there could be an acute shut down of kidneys with decreased urine output. Sometimes people may also need dialysis.• Septicaemia - Bacteria from the urinary tract spread to blood circulation. If not treated early this can be life-threatening.• High blood sugar levels - In people with Diabetes, infection in the body leads to unusually high blood sugar levels.• Recurrent UTI - Suboptimal treatment of UTI can lead to recurrent UTls. Recurrent UTI is defined as three or more episodes of UTI in 12 months. They need to be investigated for the cause and treated properly. Besides, preventive measures need to be followed meticulously.• Pregnancy - If UTI is not treated during pregnancy it might lead to low birth weight foetus or premature birth.When treated promptly and properly, lower urinary tract infections rarely lead to complications. TreatmentUTI is treated by antibiotic medications, which concentrate in the urine and kill the bacteria in the urinary system. For UTls of mild severity oral antibiotics are sufficient to treat the condition. Usually, the duration of the antibiotic course is 3-5 days, but for people with Diabetes or with recurrent UTI, the treatment may take 7-10 days.Depending on the urine culture report, the doctor may change or alter the treatment plan to target the specific bacteria. For people who suffer from recurrent UTls, the antibiotic course may extend from6 months to a year to prevent a relapse. If the bacteria are resistant to oral antibiotics then injectable antibiotics are prescribed.Syrup formulations of disodium hydrogen citrate (e.g. Cital Syrup) are also prescribed to provide symptomatic relief to people.These formulations work by making the urine alkaline and decreasing the symptoms like burning and pain while urinating. Also, adequate hydration is recommended in people with UTI. PreventionAdequate water intake is one of the best ways to prevent UTI and stone formation.