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Feature Article

Investigation and management of recurrent urinary tract infection

Holly Hutton, Liv Amos, Peter G Kerr

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Abstract

Recurrent urinary tract infections are common in women; after investigations to exclude common predisposing causes and complications, the focus is on strategies to prevent recurrence. In children and men, there is a higher index of suspicion for an underlying cause and further investigation is usually needed.

Key Points

  • Most patients with recurrent urinary tract infections (UTIs) are women who have no anatomical abnormalities of the urinary tract and will not have adverse renal outcomes; they do not require extensive or repeated investigation and their management focuses on preventing recurrences.
  • All men and children who present with a UTI require investigation for a predisposing cause.
  • All patients presenting with recurrent UTI should be screened for type 2 diabetes.
  • Urine culture and sensitivity testing should be performed for all patients who do not respond to empirical antibiotic therapy.
  • Pregnant women should be screened with a midstream urine test at the first antenatal visit.
  • Asymptomatic bacteriuria generally does not require investigation or treatment, except in pregnant women and patients undergoing urinary tract instrumentation.

    Picture credit: © Articulate Graphics.

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