Recurrent Urinary Tract Infection

Case report:

A 42 year old female patient reported fourth UTI within the last six months, with two days now since a significant dysuria, urinary frequency and unpleasant odor of urine existed again. The patient is the mother of three children and has endeavored to take ample drinking daily amounts to be and also to avoid hypothermia of the abdomen as possible. Elevated temperatures or even a flank pain she had not noticed at present and also in the previous urinary tract infections; a urological examination with ultrasonography and cystoscopy was unremarkable two months ago.
The physical examination gives a normal finding, body temperature and blood pressure are normal. Both kidneys bearings are neither pressure nor sensitive to percussion.

Diagnosis:

The history with frequent relapses and the typical symptoms associated with an unremarkable urological examination findings indicate a urinary tract infection. The urine sediment examination showed a leucocyturia and bacteriuria, however, no proteinuria. From the bacteriological examination of urine results in a significant number of microbes more than 105 germs / ml, as pathogens Proteus mirabilis is detected. Further investigations with determination of blood count, ESR, and serum creatinine show no abnormalities.

Pathogenesis:

In women with state after multiple births, it may well come in the increased scope to Aszensionen of bacteria through the urethra. In addition, genetic factors play that promote an increased adhesion of bacteria on Urogenitalepithel, an important role.

Therapy:

On the basis of resistance testing is a minimum two weeks of treatment with cotrimoxazole forte (EUSAPRIM FORTE etc.) performed. Furthermore, the patient receives behavioral clues in the form of two liters of fluid intake daily, immediate bladder emptying with minimal urinary urgency and also the Council, to empty the bladder after sexual intercourse. Moreover, with fairly good prospects of success - after appropriate education of the patient and their consent - several months relapse prevention with low dose co-trimoxazole (for example, a tablet in the evening) or trimethoprim (TMP-ratiopharm, among other things, 0.2 g daily) may be tried.