Urinary tract infection Urinary tract infection (UTI), also known as urinary infection or urogenital infection, is an infectious disease caused by the growth and proliferation of pathogens in the urinary tract. Pathogens can include bacteria, mycoplasma, chlamydia, viruses, etc. Typically, when people refer to UTI, they are mostly referring to bacterial urinary tract infections.

Urinary tract infection (UTI), also known as urinary tract infection, is an infectious disease caused by the growth and reproduction of pathogens in the urinary tract. Pathogens can include bacteria, mycoplasma, chlamydia, viruses, and others. Typically, when people refer to UTI, they are mainly referring to bacterial urinary tract infections.

Classification based on the site of infection:

UTIs can be classified into upper urinary tract infection and lower urinary tract infection. The former mainly includes pyelonephritis and ureteritis, while the latter mainly includes cystitis and urethritis.

Classification based on clinical symptoms:

UTIs are classified into symptomatic UTIs and asymptomatic UTIs.

Classification based on the presence of urinary tract abnormalities:

Simple/non-complicated UTIs: These occur without associated urinary tract abnormalities and include simple lower urinary tract infections and simple upper urinary tract infections.

Complicated UTIs: Patients with functional or structural abnormalities in the urinary tract or immunodeficiency, such as nosocomial UTIs and catheter-related UTIs, fall into this category.

Classification based on the relationship between two infections:

UTIs can be either isolated (sporadic) infections or recurrent infections.

Recurrent UTIs can further be classified as reinfection and persistent bacteriuria.

Reinfection refers to a new infection caused by the invasion of external bacteria into the urinary system.

Persistent bacteriuria refers to recurrent infections caused by the same bacteria present in the urinary system (e.g., urinary tract stones or prostate diseases), also known as relapse.

Bacterial infection:

More than 95% of UTIs are caused by a single bacterium.

The most common pathogen is gram-negative bacilli, with Escherichia coli being the most common, accounting for about 85% of all UTIs, followed by Klebsiella pneumoniae, Proteus mirabilis, and Citrobacter species. E. coli is most commonly found in asymptomatic bacteriuria, non-complicated UTIs, or first-time UTIs.

5-15% of UTIs are caused by gram-positive bacteria, mainly Enterococcus and coagulase-negative staphylococci.

UTIs occurring after hospitalization, complicated or recurrent UTIs, and UTIs following urinary tract instrumentation are mostly caused by Enterococcus, Proteus mirabilis, Klebsiella pneumoniae, and Pseudomonas aeruginosa. Proteus mirabilis is common in patients with urinary tract stones, Pseudomonas aeruginosa is common after urinary tract instrumentation, and Staphylococcus aureus is common in bloodstream UTIs.

Other pathogen infections:

Adenovirus can cause acute hemorrhagic cystitis in children and some young adults, and can even cause outbreaks. In addition, Mycobacterium tuberculosis, Chlamydia, fungi, and others can also cause UTIs. In recent years, due to the widespread use of antibiotics and immunosuppressants, there has been an increase in UTIs caused by gram-positive bacteria and fungi, and there is an increasing trend of drug resistance and even multidrug resistance.

Due to the various classification methods of UTIs, different types have different symptomatic characteristics. Common types include:

Cystitis

Clinical manifestations mainly include frequent urination, urgency, dysuria, discomfort in the suprapubic area or perineum, and a burning sensation in the urethra.

Cystitis can be further divided into acute uncomplicated cystitis and recurrent cystitis.

Patients with acute uncomplicated cystitis often have urinary urgency and incontinence, cloudy urine, leukocytes in the urine, and often terminal hematuria, sometimes gross hematuria, and even passing blood clots. Generally, there are no systemic symptoms, and the body temperature is normal or only slightly elevated.

Acute pyelonephritis

The main symptoms include frequent urination, urgency, dysuria, hematuria, difficulty urinating, dull pain in the flank on the affected side or both sides, obvious tenderness or percussion tenderness in the costovertebral angle. Concurrent symptoms may include chills, headache, nausea, and high fever, with the patient's temperature rising to over 39°C.

Chronic pyelonephritis

The systemic and local manifestations of the urinary system may be atypical, sometimes only manifesting as asymptomatic bacteriuria. More than half of the patients may have a history of acute pyelonephritis, followed by varying degrees of low-grade fever, intermittent urinary frequency, discomfort during urination, and lumbar pain, and may also experience increased nocturia. In the later stages, it can progress to chronic renal failure.

Asymptomatic bacteriuria

Patients have no clinical symptoms, only a microbiological diagnosis, with no significant abnormalities in routine urine tests or increased white blood cells, but bacteria are present in urine cultures.

Complicated UTIs

Due to the concomitant urinary tract abnormalities or immunodeficiency in these patients, the clinical manifestations vary greatly. They may have mild urinary system symptoms, cystitis, and pyelonephritis symptoms, and even more severe cases may present with septicemia and sepsis.

During the acute phase, patients should rest, drink plenty of water, and urinate frequently. For those with fever, a diet that is easy to digest, high in calories, and rich in vitamins is recommended.

Aggressive antimicrobial therapy should be initiated, with the following principles for antibiotic selection:

- Use antibiotics to which the causative bacteria are sensitive.

- Ensure high concentrations of antibiotics in the urine and kidneys.

- Choose antibiotics with low renal toxicity and minimal side effects.

- In cases of treatment failure with a single drug, severe infection, mixed infection, or emergence of resistant strains, combination therapy should be considered.

The duration of treatment varies for different types of urinary tract infections.

Urinary tract infections in TCM fall under the categories of "Lin Zheng" (dysuria) and "waist pain." The main pathogenesis involves kidney deficiency, damp-heat obstruction, and poor qi transformation in the kidneys and bladder. Kidney deficiency is the root cause, while damp-heat obstruction is the manifestation. Treatment in TCM primarily involves the use of Chinese herbal medicine, acupuncture, and proprietary Chinese medicines.

Chinese herbal medicine prescription:

It is divided into three types of patterns, and the selection and use of medications are guided by the overall view and the differentiation of symptoms for treatment.

- For the pattern of bladder damp-heat, the treatment involves clearing heat, promoting diuresis, and relieving dysuria, using a combination of Bazhen San and Simiao San with modifications.

- For the pattern of kidney deficiency and liver depression with damp-heat retention, the treatment involves draining the liver and nourishing yin, promoting diuresis, using a combination of Longdan Xiegan Tang and Liuwei Dihuang Tang with modifications.

- For the pattern of deficiency of both qi and yin, with damp-heat and blood stasis obstruction, the treatment involves nourishing qi and yin, clearing heat, promoting diuresis, activating blood, and relieving dysuria, using a combination of Zhibai Dihuang Tang and Erzhi Wan with modifications.

Acupuncture treatment:

Acupuncture treatment includes simple needling, moxibustion, combined acupuncture and moxibustion, combined acupuncture and medication, acupuncture and herbal sitz baths, moxibustion combined with antibiotics, and moxibustion combined with Chinese medicine.

Proprietary Chinese medicine treatment:

Currently, many proprietary Chinese medicines can be used to treat urinary tract infections. For example, Sanjin Pian has the effects of clearing heat, detoxification, promoting diuresis, and nourishing the kidneys. It is used to treat heat lin syndrome, short, red urine, dysuria, frequent urination, and other symptoms caused by lower damp-heat. Qinglin Granules have the effects of clearing heat, draining fire, promoting diuresis, and treating urinary tract infections caused by bladder damp-heat, urinary retention, frequent painful urination, and dry mouth and throat.

Traditional Chinese medicine treatment for urinary tract infections has a long history and remarkable efficacy. It has unique advantages in reducing the adverse reactions caused by Western medicine treatment, improving the quality of life of patients, controlling disease progression, and reducing recurrence rates. However, there are also limitations that need to be objectively addressed, and efforts should be made to actively integrate with modern medicine to seek more effective treatment methods.

- Drink plenty of water and urinate every 2-3 hours to flush the bladder and urethra, preventing bacterial overgrowth in the urinary tract. This is the most practical and effective method of prevention.

- Maintain genital hygiene to reduce the bacterial population in the urethral opening. Female patients should pay special attention during menstruation, pregnancy, and the postpartum period. For males with phimosis, proper hygiene should be observed, and surgical treatment may be necessary.

- Avoid the use of urinary tract infection-prone instruments. If their use is necessary, strict aseptic techniques should be followed. Urine culture should be performed 48 hours after using urinary instruments to monitor for urinary tract infections. For individuals with a history of recurrent urinary tract infections or urinary tract abnormalities, antibiotic prophylaxis should be considered 48 hours before and after urinary instrumentation.

- If indwelling catheterization is necessary, administering antibiotics for the first 3 days can delay the onset of urinary tract infections.

- For recurrent urinary tract infections related to sexual activity, immediate urination and rinsing after intercourse, along with a single dose of prophylactic antibiotic, should be considered.

- For individuals with vesicoureteral reflux, a "double voiding" technique is recommended, where after each urination, a second voiding should be done after a few minutes.