Clinical Evaluation, Identification, and Treatment of Urinary Tract Infections Urgent message: Urinary tract infections are a common cause of abdominal pain and a common presenting complaint in urgent care. Proper diagnosis, treatment, and patient education on preventive measures are key to optimal outcomes. William Gluckman, DO, MBA, FACEP, Karen Keaney Gluckman, MSN, APN, C, CWCN, CCCN percent to 50% of women will have at least one UTI in their lifetimes, and approx- imately 20% of those who get a UTI will have a recur- rent episode. Urinary tract infections can affect male and female infants, children, and adults. Each of these groups has dif- ferences in causes, treat- ments, and work-ups. This article will focus on adult fe- male infections. Introduction he global term urinary tract infection (UTI) incor- porates cystitis and infec- tion involving the blad- der (a lower tract source), as well as pyelonephritis, an infection involving the kid- neys (an upper tract source). Acute cystitis occurs when bacteria attach to and/or in- vade the bladder wall. Pyelonephritis is a more serious disorder that can lead to bacteremia, sepsis, or renal abscess formation. Interstitial cystitis (also known as painful bladder syndrome) is a disorder that causes chronic abdominal pain and urinary symptoms, particularly frequency and dysuria, but by definition does not involve an infection. Acute cystitis is very common, affecting 8 million to 10 million people per year and prompting 9.6 mil- lion doctor visits at a cost of over $4.5 billion. Forty T w w w. j u c m . c o m © Getty.com/3D Clinic Pathophysiology Urine is a good culture medium for bacteria, as it is typically sterile but can become infected either by retrograde transmission of pathogens up the urethra or hematogenously. Women are at great risk for UTI primarily because of the significantly shorter urethra and closer proxim- ity to the rectum. The female genitalia may become colonized with pathogenic bacteria that can more JUCM T h e J o u r n a l o f U r g e n t C a r e M e d i c i n e | O c t o b e r 2 0 0 7 13