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The term “urinary infection” is not synonymous with “positive urine culture”. In general, if there are no symptoms of infection, treatment is required only on rare occasions. Even if the urine test indicates that there is a germ. Antibiotic treatment should be done only when there are symptoms and signs of urinary infection. If not, increasingly resistant germs can develop in the urinary system, making it increasingly difficult to treat when there are symptoms.
Antibiotics cannot be prescribed “just in case”. Evaluation by a doctor is required and an antibiotic prescribed only when necessary. The treatment must be carried out under the dose and duration indicated. If this rule is not followed, antibiotic-resistant bacteria may develop.
It is impossible to keep a probe in a sterile environment. Whether the use of antibiotics is necessary in this situation has been carefully studied, and evidence has been found that their use is counterproductive. They should be used only when the doctor treating the catheterised person deems it necessary: in the presence of an active urinary tract infection, which is different from a positive urine culture.
Constipation; drinking small amounts of liquid (very concentrated urine is produced); or residual urine after urination (this can be detected by performing an ultrasound after urination). After menopause, women can also develop an atrophy of the vulvar and vaginal mucosa, which usually causes the alteration of germs at that level. In general, anything that alters the intestinal or vulvovaginal flora can promote infection of the urinary system.
Like all drugs, antibiotics also have side effects that should not be underestimated. Antibiotic treatment is the only strategy that has been shown to be highly effective against urinary tract infection, both in acute treatment and to prevent recurrence. However, the most common side effects are vaginal yeast infections, clostridioides difficile bacterial infection and the acquisition of antibiotic resistance.
Studies show that the germs that cause urinary tract infections are present in the intestinal flora. Currently, everything seems to indicate that the route of acquisition of these germs is usually related to ingestion. Some people have a more predisposing intestinal "environment", but the features of that environment and how it can be modified have not yet been established.
Since urinary tract infections are not caused by inadequate hygiene, there is no specific recommendation beyond the recommendations applicable to the general public. Patients with recurrent urinary tract infections should pay special attention to urinating with adequate frequency, avoiding persistent moisture in the vaginal area, and avoiding the use of feminine hygiene pads. If these are necessary, frequent replacement is recommended.
Urinary tract infection shares symptoms with other vaginal and urethral area conditions, such as vaginal dryness, lichen, vaginal or bladder prolapse and many more. Although urine infection can be recurrent, treatment of an acute episode is relatively simple, especially if a urine culture is available to identify which germ is causing it. This narrows down the choice of antibiotic. If the patient does not improve with antibiotic treatment, an alternative diagnosis should then be considered.
By definition, there are no "bad" or "good" bacteria, but microorganisms that coexist with the human body, with some even helping it to carry out some of its functions. Other microorganisms, on the other hand, cause diseases. Establishing whether a microorganism has pathogenic potential is not easy and is done only in the field of research. It is the role of health professionals to establish whether a microorganism in the urine is causing disease or not, with information about the symptoms provided by the patient.
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Substantiated information by:
Ascensión Gómez PorcelNurseUrology Department
Pilar LuqueUrologistUrology Department
Verónica Rico Caballero
Published: 30 March 2022
Updated: 30 March 2022
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