AJM online
Commentary
‘Urinary Tract Infection’ and the Microbiome

https://doi.org/10.1016/j.amjmed.2016.08.018Get rights and content

Section snippets

Diagnosis and Management of “UTI”

The ambiguous definition of “UTI” seems to promote antibiotic overuse. In one common usage, “urinary tract infection is defined as microbial infiltration of the normally sterile urinary tract.”3 With this definition, asymptomatic bacteriuria is a “UTI” and is often treated, even in patient groups where strong evidence shows lack of benefit.4 A second common definition, “significant bacteriuria in a patient with symptoms or signs attributable to the urinary tract and no alternate source”1 seems

Paradigm Shift?

With its various meanings, convenient diagnosis, long tradition, suggestive link to treatment, and uncritical acceptance by clinicians, patients, families, and insurers, “UTI” remains heavily embedded in practice; “one of the most common bacterial infections worldwide.”3 The paradigm provides tidy management for a patient with “UTI” who expects antibiotics. Further, the current paradigm does account for several findings. Standard bacteriuria is associated with pyuria, fever, and dysuria, for

Body-as-Battleground vs Human-as-Habitat

Costello et al10 outline a broader paradigm shift in the general approach to infection; “transitioning clinical practice from the Body-as-Battleground to the Human-as-Habitat perspective will require rethinking how one manages the human body.” To help in this transition, mindful language will be important. We suggest that authors use “UTI” only within quotation marks and that clinicians use the bimanual “air quotes” gesture in discussions. This small, repetitive annotation is intended to

References (10)

  • T.M. Hooton et al.

    Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America

    Clin Infect Dis

    (2010)
  • E.E. Hilt et al.

    Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder

    J Clin Microbiol

    (2014)
  • A.E. Barber et al.

    Urinary tract infections: current and emerging management strategies

    Clin Infect Dis

    (2013)
  • L.E. Nicolle et al.

    Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults

    Clin Infect Dis

    (2005)
  • J.D. Sobel

    Urinary tract infections

There are more references available in the full text version of this article.

Cited by (0)

Funding: None.

Conflict of Interest: None.

Authorship: The author is solely responsible for writing the manuscript.

View full text