urinary tract health

Escherichia Coli in the Urina

Generality

Escherichia coli, a negative GRAM bacterium normally present in the colon, is the main cause of urinary infections, supporting up to 90% of cases in the absence of concurrent risk factors or complications. Furthermore, it is estimated that the percentage of recurrences after recovery from a first urinary infection supported by Escherichia Coli is around 44% over the following 12 months.

Role in Urinary Infections

It is not surprising, therefore, that Escherichia coli is often found in urine following laboratory tests conducted to investigate the origin of one or more symptoms attributable to a urinary tract infection: pain or burning during urination, frequent urge to urinate, cloudy urine and pungent odor, pains in the lower part of the abdomen or kidneys, chills, fever, sweat, and pain during sexual intercourse.

Urinary infections sustained by Escherichia coli are more common in women, due to the aforementioned unfavorable anatomical characteristics (shorter urethra, urinary meatus closer to the anal region) and due to the absence of bactericidal activity of prostatic secretions. The risk also increases during pregnancy and in the presence of diabetes.

Escherichia coli uropathogenic

Not all Escherichia coli strains are capable of causing urinary infections; the microorganisms with this capacity are therefore defined as "uropathogenic". This characteristic is due to the presence of adhesion factors, which allow Escherichia coli to anchor itself to the membrane of uroepithelial cells by means of protein structures called adhesins, located at the distal end of thin filaments (pilio fimbrie) that are projected from the wall of bacterium. Among these, the P (mannose-resistant) fimbriae bind to a galactose disaccharide present on the surface of uroepithelial cells, and to the erythrocyte P antigen.

Consequently, patients who harbor uropathogenic strains in their intestines are at greater risk of developing urinary tract infections with Escherichia coli (for more information: mannose and cystitis); these infections can involve the urethra (urethritis), the bladder (cystitis), the kidney (pyelonephritis) or the prostate (prostatitis).

Complications

Complicated urinary infections and pyelonephritis are mostly observed in elderly patients with structural urinary tract abnormalities or obstructive problems, caused for example by an enlarged prostate or a tumor. In the most serious cases, before a compromised immune system and a general physical debilitation, Escherichia coli can enter the bloodstream, causing a systemic reaction to its antigens, which can lead to disseminated intravascular coagulation with poor prognosis.

The presence of localized pains in the side or in the lower back, accompanied by high fever (> 39 ° C), chills, sweating, headache, nausea and high frequency and urgency in urination, should lead to suspicion of a renal infection (pyelonephritis) or a complicated urinary infection.

Treatment

Escherichia coli is normally susceptible to various antibiotics, such as trimethoprim, sulfamethoxazole, ciprofloxacin and nitrofurantoin; in most uncomplicated urinary tract infections, single administration of one of these antibiotics is sufficient. The choice of drug and duration of treatment depend on the patient's medical history and the results of the tests conducted on the urine; the antibiogram, for example, allows to test the susceptibility of the bacterium to various antibiotics, limiting the spread of resistance to these drugs.

In cases of recurrent cystitis from Escherichia coli, the condition can be treated with a prolonged daily therapy (six months) or with postcoital prophylaxis with antibiotics (trimethoprim / sulfamethoxazole, fluoroquinolone or nitrofurantoin).

Prevention

In addition to antibiotic treatment, in order to eradicate and, above all, prevent urinary tract infections from Escherichia coli, it is important to drink generous amounts of water every day, urinate at the time of need without holding back urine, prefer the shower to the bath in the tub, clean the genital area and urinating after sexual intercourse, and avoiding the use of scented sprays and showers for feminine intimate hygiene, as they can irritate the urethra. Finally, in washing and cleaning operations, it is advisable to start from the vulva and descend towards the anus, not vice versa; this, to prevent intestinal bacteria such as Escherichia coli from coming into contact with the vagina or urinary tract.

Natural remedies include the juice of the American cranberry, which inhibits the adhesion of the bacterium to the walls of the urinary tract, while an antimicrobial activity directed towards Escherichia coli is often ascribed to bearberry, despite its bactericidal effect turn out to be still uncertain.