الأحد، 3 نوفمبر 2013
9:34 ص
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Any adult or child who develops any of the symptoms of a
urinary tract infection needs to be evaluated by a medical professional,
preferably within 24 hours. Most medical offices can test urine for infection
by using a quick urine "dipstick" test.
If
you have symptoms of a lower urinary tract infection, call your health-care
provider for an appointment, preferably on the very day that symptoms are
recognized.
If
you have symptoms of an upper urinary tract infection involving the kidneys,
call your health-care provider immediately. Depending on the situation, he or
she will recommend either a visit to the office or to a hospital emergency
department.
If
you have symptoms of a lower urinary tract infection and any of the following
applies to you, you may have a urinary tract infection that can potentially be
serious. Go to a hospital emergency department right away.
Vomiting
and inability to keep down clear fluids or medication
Not
better after taking antibiotics for two days
Pregnant
Having
diabetes or another disease that affects the immune system (for example, AIDS)
Taking
medication that suppresses the immune system such as cancer chemotherapy
Infants,
children, and elderly people with any of the signs and symptoms of UTI should
go to an emergency department for evaluation.
Fever,
lethargy, and poor appetite may indicate a simple lower urinary tract infection
in these groups, but they may also be signs of something more serious.
Urinary
tract infections have the potential to make these vulnerable people very ill.
Urinary
Tract Infection Diagnosis
Diagnosis
of a urinary tract infection is based on information you give about your
symptoms, medical and surgical history, medications, habits, and lifestyle. A
physical examination and lab tests complete the evaluation.
Your
doctor may simply perform a urine dipstick test in the office. Only a few
minutes are needed to obtain results. Your doctor may also send your urine to
the lab for testing. These results take a few days to come back. This tells
your doctor the exact bacteria causing your infection and to which antibiotics
these bacteria have resistance or sensitivity. The culture is usually sent for
special populations, including men, because they are less likely to get UTIs.
It is not necessary to send a culture for everyone because the majority of UTIs
are caused by the same bacteria.
The
single most important lab test is urinalysis. A sample of your urine will be
tested for signs of infection, such as the presence of white blood cells and
bacteria.
In
certain circumstances, your urine also may be "cultured." This means
that a small amount of the urine is brushed on a sterile nutrient substance in
a plastic plate. The plate is allowed to
sit for a few days and then examined to see what kind of bacteria are growing
on it. These bacteria are treated with different antibiotics to see which works
best against them. This helps determine the best treatment for your specific
infection.
Blood
tests usually are not required unless a complicated condition, such as
pyelonephritis or kidney failure, is suspected.
You
may be asked to give a clean-catch, midstream urine specimen. This avoids
contamination of the urine with bacteria from your skin. You should be
instructed in how to do this.
Midstream
means you urinate a little into the toilet before collecting a specimen. The
idea is that you don't collect the urine that comes out first, as this urine is
often contaminated.
Clean-catch
refers to a midstream sample that was collected after cleaning the area of the
urethral opening.
Adult
women and older girls: Cleanse the area around your urethral opening gently
(but completely) using a sterile wipe or soap and water. Catch the urine
midstream. For some women, catheterization (inserting a tube into the bladder)
may be the only way to obtain a sterile, uncontaminated specimen.
Men
and boys: A sterile specimen can usually be obtained with a midstream catch.
Uncircumcised males should retract the foreskin and cleanse the area before
urinating.
Newborns:
Urine may be obtained with a procedure in which a needle is introduced through
the lower abdominal wall to draw (aspirate) urine from the bladder.
Infants
and children: Either catheterization or the needle aspiration method is used.
If
you cannot produce a urine specimen or are unable to follow instructions for a
clean-catch specimen, your health-care provider may obtain a urine specimen by
catheterizing you.
This
means placing a thin tube (catheter) in your urethra to drain urine from your
bladder.
The
catheter usually is removed after the bladder is emptied.
The
catheter may remain in place if you are very ill or if it is necessary to
collect all urine or measure urine output.
Depending
on their symptoms, young sexually active women could require a pelvic
examination because pelvic infections can have similar symptoms as a urinary
tract infection.
Men
will most likely require a rectal examination so that the prostate can be
checked. A prostate infection (prostatitis) requires a longer course of
antibiotics than a urinary tract infection.
In
some cases, an imaging test may be indicated to detect any underlying problem
in the urinary tract that could cause an infection. This is usually only
necessary in repeat infections or special circumstances (unusual bacteria,
suspected anatomic abnormalities).
An ultrasound examination can evaluate
kidney and bladder problems.
A
fluoroscopic study can show any physical problems that predispose children to
urinary tract infections.
Intravenous
pyelogram (IVP) is a special series of X-rays that uses a contrast dye to
highlight abnormalities in the urinary tract.
Cystoscopy
involves insertion of a thin, flexible tube with a tiny camera on the end
through the urethra into the bladder. This allows detection of abnormalities
inside the bladder that might contribute to infections.
Imaging
tests are most often needed for the following groups:
Children
with urinary tract infections, especially boys
Up
to 50% of infants and 30% of older children with a urinary tract infection have
an anatomic abnormality. The child's pediatrician should investigate this
possibility.
Adults
with frequent or recurrent urinary tract infections
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