Editing Urinary tract infection (section)

==Cause==
[[File:UPEC adhered to BEC.jpg|thumb|[[UPEC|Uropathogenic ''Escherichia coli'' (UPEC)]] cells adhered to bladder epithelial cell]]
[[UPEC|Uropathogenic ''E. coli'']] from the gut is the cause of 80–85% of community-acquired urinary tract infections,<ref>{{cite journal | vauthors = Abraham SN, Miao Y | title = The nature of immune responses to urinary tract infections | journal = Nature Reviews. Immunology | volume = 15 | issue = 10 | pages = 655–663 | date = October 2015 | pmid = 26388331 | pmc = 4926313 | doi = 10.1038/nri3887 }}</ref> with ''[[Staphylococcus saprophyticus]]'' being the cause in 5–10%.<ref name=Review08/> Rarely they may be due to [[Virus|viral]] or [[fungal]] infections.<ref>{{cite journal | vauthors = Amdekar S, Singh V, Singh DD | title = Probiotic therapy: immunomodulating approach toward urinary tract infection | journal = Current Microbiology | volume = 63 | issue = 5 | pages = 484–490 | date = November 2011 | pmid = 21901556 | doi = 10.1007/s00284-011-0006-2 | s2cid = 24123416 }}</ref> Healthcare-associated urinary tract infections (mostly related to [[urinary catheterization]]) involve a much broader range of pathogens including: ''E. coli'' (27%), ''[[Klebsiella]]'' (11%), ''[[Pseudomonas]]'' (11%), the fungal pathogen ''[[Candida albicans]]'' (9%), and ''[[Enterococcus]]'' (7%) among others.<ref name=Sal2011/><ref>{{cite journal | vauthors = Sievert DM, Ricks P, Edwards JR, Schneider A, Patel J, Srinivasan A, Kallen A, Limbago B, Fridkin S | title = Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2009-2010 | journal = Infection Control and Hospital Epidemiology | volume = 34 | issue = 1 | pages = 1–14 | date = January 2013 | pmid = 23221186 | doi = 10.1086/668770 | s2cid = 7663664 | url = https://zenodo.org/record/1235706 | access-date = 2 July 2019 | archive-date = 16 March 2020 | archive-url = https://web.archive.org/web/20200316215808/https://zenodo.org/record/1235706 | url-status = live }}</ref><ref>{{cite journal | vauthors = Bagshaw SM, Laupland KB | title = Epidemiology of intensive care unit-acquired urinary tract infections | journal = Current Opinion in Infectious Diseases | volume = 19 | issue = 1 | pages = 67–71 | date = February 2006 | pmid = 16374221 | doi = 10.1097/01.qco.0000200292.37909.e0 | s2cid = 23726078 }}</ref> During recent years of intensive care, ''[[Enterococcus]]'' spp. have several times been found as the primary cause of urinary tract infection, suggested related to broad treatment with [[cephalosporin]] antibiotics against which they are tolerant.<ref name=":3">{{Cite journal |last1=Karlsson |first1=Philip A. |last2=Pärssinen |first2=Julia |last3=Danielsson |first3=Erik A. |last4=Fatsis-Kavalopoulos |first4=Nikos |last5=Frithiof |first5=Robert |last6=Hultström |first6=Michael |last7=Lipcsey |first7=Miklos |last8=Järhult |first8=Josef D. |last9=Wang |first9=Helen |date=7 February 2023 |title=Antibiotic use during coronavirus disease 2019 intensive care unit shape multidrug resistance bacteriuria: A Swedish longitudinal prospective study |journal=Frontiers in Medicine |volume=10 |doi=10.3389/fmed.2023.1087446 |doi-access=free |issn=2296-858X |pmc=9941185 |pmid=36824610}}</ref><ref>{{Cite journal |last1=Toc |first1=Dan Alexandru |last2=Mihaila |first2=Razvan Marian |last3=Botan |first3=Alexandru |last4=Bobohalma |first4=Carina Nicoleta |last5=Risteiu |first5=Giulia Andreea |last6=Simut-Cacuci |first6=Bogdan Nicolae |last7=Steorobelea |first7=Bianca |last8=Troanca |first8=Stefan |last9=Junie |first9=Lia Monica |date=7 June 2022 |title=Enterococcus and COVID-19: The Emergence of a Perfect Storm? |journal=International Journal of Translational Medicine |volume=2 |issue=2 |pages=220–229 |doi=10.3390/ijtm2020020 |doi-access=free |issn=2673-8937}}</ref><ref>{{Cite journal |last1=Trześniewska-Ofiara |first1=Zuzanna |last2=Mendrycka |first2=Mariola |last3=Cudo |first3=Andrzej |last4=Szmulik |first4=Magdalena |last5=Woźniak-Kosek |first5=Agnieszka |date=11 July 2022 |title=Hospital Urinary Tract Infections in Healthcare Units on the Example of Mazovian Specialist Hospital Ltd |journal=Frontiers in Cellular and Infection Microbiology |volume=12 |doi=10.3389/fcimb.2022.891796 |doi-access=free |issn=2235-2988 |pmc=9309389 |pmid=35899043}}</ref> Urinary tract infections due to ''[[Staphylococcus aureus]]'' typically occur secondary to blood-borne infections.<ref name=EM2011/> ''[[Chlamydia trachomatis]]'' and ''[[Mycoplasma genitalium]]'' can infect the urethra but not the bladder.<ref>{{cite web |url=http://kidney.niddk.nih.gov/kudiseases/pubs/utiadult/ |title=Urinary Tract Infections in Adults |access-date=1 January 2015 |url-status=live |archive-url=https://web.archive.org/web/20150109084836/http://kidney.niddk.nih.gov/KUDiseases/pubs/utiadult/ |archive-date=9 January 2015 }}</ref> These infections are usually classified as a [[urethritis]] rather than urinary tract infection.<ref>{{cite journal | vauthors = Brill JR | title = Diagnosis and treatment of urethritis in men | journal = American Family Physician | volume = 81 | issue = 7 | pages = 873–878 | date = April 2010 | pmid = 20353145 }}</ref>

==={{anchor|Honeymoon cystitis}}Intercourse===
In young sexually active women, sexual activity is the cause of 75–90% of bladder infections, with the risk of infection related to the frequency of sex.<ref name=Review08/> The term "honeymoon cystitis" has been applied to this phenomenon of frequent UTIs during early marriage. In [[Menopause|post-menopausal]] women, sexual activity does not affect the risk of developing a UTI.<ref name=Review08/> [[Spermicide]] use, independent of sexual frequency, increases the risk of UTIs.<ref name=Review08 /> [[Diaphragm (birth control)|Diaphragm]] use is also associated.<ref name="recurrent uti">{{cite journal | vauthors = Franco AV | title = Recurrent urinary tract infections | journal = Best Practice & Research. Clinical Obstetrics & Gynaecology | volume = 19 | issue = 6 | pages = 861–873 | date = December 2005 | pmid = 16298166 | doi = 10.1016/j.bpobgyn.2005.08.003 }}</ref> Condom use without spermicide or use of [[birth control pills]] does not increase the risk of uncomplicated urinary tract infection.<ref name=Review08/><ref>{{cite book | vauthors = Engleberg NC, DiRita V, Dermody TS |title=Schaechter's Mechanism of Microbial Disease |year=2007 |publisher=Lippincott Williams & Wilkins |location= Baltimore|isbn=978-0-7817-5342-5}}</ref>

=== Sex ===
Women are more prone to UTIs than men because, in females, the [[urethra]] is much shorter and closer to the [[anus]].<ref name=NA2011>{{cite journal | vauthors = Dielubanza EJ, Schaeffer AJ | title = Urinary tract infections in women | journal = The Medical Clinics of North America | volume = 95 | issue = 1 | pages = 27–41 | date = January 2011 | pmid = 21095409 | doi = 10.1016/j.mcna.2010.08.023 | doi-access = free }}</ref> As a woman's estrogen levels decrease with [[menopause]], her risk of urinary tract infections increases due to the loss of protective [[vaginal flora]].<ref name=NA2011/> Additionally, [[vaginal atrophy]] that can sometimes occur after menopause is associated with recurrent urinary tract infections.<ref name="vaginal atrophy">{{cite journal | vauthors = Goldstein I, Dicks B, Kim NN, Hartzell R | title = Multidisciplinary overview of vaginal atrophy and associated genitourinary symptoms in postmenopausal women | journal = Sexual Medicine | volume = 1 | issue = 2 | pages = 44–53 | date = December 2013 | pmid = 25356287 | pmc = 4184497 | doi = 10.1002/sm2.17 }}</ref>

Chronic prostatitis in the forms of [[chronic prostatitis/chronic pelvic pain syndrome]] and [[chronic bacterial prostatitis]] (not acute bacterial prostatitis or [[asymptomatic inflammatory prostatitis]]) may cause recurrent urinary tract infections in males.<!-- <ref name=AFP2016ChronProst/> --> Risk of infections increases as males age.<!-- <ref name=AFP2016ChronProst/> --> While bacteria is commonly present in the urine of older males this does not appear to affect the risk of urinary tract infections.<ref name=AFP2016ChronProst>{{cite journal | vauthors = Holt JD, Garrett WA, McCurry TK, Teichman JM | title = Common Questions About Chronic Prostatitis | journal = American Family Physician | volume = 93 | issue = 4 | pages = 290–296 | date = February 2016 | pmid = 26926816 }}</ref>

===Urinary catheters===
[[Urinary catheterization]] increases the risk for urinary tract infections.<!-- <ref name=NA2011/> --> The risk of [[bacteriuria]] (bacteria in the urine) is between three and six percent per day and prophylactic antibiotics are not effective in decreasing symptomatic infections.<ref name=NA2011/> The risk of an associated infection occurs linearly for enteric bacteria,<ref>{{Cite journal |last1=Karlsson |first1=Philip A. |last2=Bolin |first2=Christian |last3=Spång |first3=Labolina |last4=Frithiof |first4=Robert |last5=Hultström |first5=Michael |last6=Lipcsey |first6=Miklos |last7=Wang |first7=Helen |last8=Järhult |first8=Josef D. |date=7 November 2024 |title=Bacteriuria and antibiotic use during the third wave of COVID-19 intensive care in Sweden |journal=Infectious Diseases |pages=1–10 |doi=10.1080/23744235.2024.2423884 |pmid=39509144 |issn=2374-4235|doi-access=free }}</ref><ref name=":3" /> and can be decreased by catheterizing only when necessary, using [[aseptic technique]] for insertion, and maintaining unobstructed closed drainage of the catheter.<ref name="Nic2001"/><ref>{{cite journal | vauthors = Phipps S, Lim YN, McClinton S, Barry C, Rane A, N'Dow J | title = Short term urinary catheter policies following urogenital surgery in adults | journal = The Cochrane Database of Systematic Reviews | issue = 2 | pages = CD004374 | date = April 2006 | pmid = 16625600 | doi = 10.1002/14651858.CD004374.pub2 | veditors = Phipps S }}</ref><ref name="Gould2009"/>

Male [[scuba divers]] using [[External urine collection devices#Texas catheter|condom catheters]] and female divers using external catching devices for their [[dry suit]]s are also susceptible to urinary tract infections.<ref name="pmid22752741">{{cite journal | vauthors = Harris R | title = Genitourinary infection and barotrauma as complications of 'P-valve' use in drysuit divers | journal = Diving and Hyperbaric Medicine | volume = 39 | issue = 4 | pages = 210–212 | date = December 2009 | pmid = 22752741 | url = http://archive.rubicon-foundation.org/9482 | access-date = 4 April 2013 | url-status = usurped | archive-url = https://web.archive.org/web/20130526025635/http://archive.rubicon-foundation.org/xmlui/handle/123456789/9482 | archive-date = 26 May 2013 }}</ref>

===Others===
A predisposition for bladder infections may run in families.<ref name=Review08/> This is believed to be related to genetics.<ref name=Review08/> Other risk factors include [[diabetes mellitus|diabetes]],<ref name=Review08/> being [[circumcise|uncircumcised]],<ref name="pmid23152269">{{cite journal | vauthors = Jagannath VA, Fedorowicz Z, Sud V, Verma AK, Hajebrahimi S | title = Routine neonatal circumcision for the prevention of urinary tract infections in infancy | journal = The Cochrane Database of Systematic Reviews | volume = 11 | pages = CD009129 | date = November 2012 | pmid = 23152269 | doi = 10.1002/14651858.CD009129.pub2 | quote = The incidence of urinary tract infection (UTI) is greater in uncircumcised babies }}</ref><ref>{{cite journal | vauthors = Morris BJ, Wiswell TE | title = Circumcision and lifetime risk of urinary tract infection: a systematic review and meta-analysis | journal = The Journal of Urology | volume = 189 | issue = 6 | pages = 2118–2124 | date = June 2013 | pmid = 23201382 | doi = 10.1016/j.juro.2012.11.114 }}</ref> and having a [[benign prostatic hypertrophy|large prostate]].<ref name=EM2011/> In children UTIs are associated with [[vesicoureteral reflux]] (an abnormal movement of [[urine]] from the [[urinary bladder|bladder]] into [[ureter]]s or [[kidney]]s) and [[constipation]].<ref name=PeadsNA2011/>

Persons with [[spinal cord injury]] are at increased risk for urinary tract infection in part because of chronic use of catheter, and in part because of [[urination|voiding]] dysfunction.<ref name=Spine2010>{{cite journal | vauthors = Eves FJ, Rivera N | title = Prevention of urinary tract infections in persons with spinal cord injury in home health care | journal = Home Healthcare Nurse | volume = 28 | issue = 4 | pages = 230–241 | date = April 2010 | pmid = 20520263 | doi = 10.1097/NHH.0b013e3181dc1bcb | s2cid = 35850310 | doi-access = free }}</ref> It is the most common cause of infection in this population, as well as the most common cause of hospitalization.<ref name=Spine2010/>