Urinary Disorders Q 99

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Which patient is at greatest risk for developing a urinary tract infection (UTI)?

  

    A. A 35 y.o. woman with a fractured wrist

    B. A 20 y.o. woman with asthma

    C. A 50 y.o. postmenopausal woman

    D. A 28 y.o. with angina

    

    

Correct Answer: C. A 50 y.o. postmenopausal woman

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Women are more prone to UTIs after menopause due to reduced estrogen levels. Reduced estrogen levels lead to reduced levels of vaginal Lactobacilli bacteria, which protect against infection. Premenopausal women have large concentrations of lactobacilli in the vagina and prevent the colonization of uropathogens. However, the use of antibiotics can erase this protective effect.

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Option A: An uncomplicated UTI usually only involves the bladder. When the bacteria invade the bladder mucosal wall, cystitis is produced. The majority of organisms causing a UTI are enteric coliforms that usually inhabit the periurethral vaginal introitus. These organisms ascend into the bladder and cause a UTI.

Option B: Sexual intercourse is a common cause of a UTI as it promotes the migration of bacteria into the bladder. People who frequently void and empty the bladder have a much lower risk of a UTI. Pathogenic bacteria ascend from the perineum, causing UTI. Women have shorter urethras than men and therefore are more susceptible to UTI. Very few uncomplicated UTIs are caused by blood-borne bacteria. Escherichia coli is the most common organism in uncomplicated UTI by a large margin.

Option D: A major risk factor for UTI is the use of a catheter. In addition, manipulation of the urethra is also a risk factor. Sexual intercourse and the use of spermicide and diaphragm are also risk factors for UTI. Frequent pelvic exams and the presence of anatomical abnormalities of the urinary tract can also predispose one to UTI.

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