Dr. med. Dirk Manski

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Urinary Tract Infections

Principles of urinary tract infection (1/4)

Review literature: (Krieger, 2002) (Nickel, 2005a) (Nickel, 2005b) (Sussman und Gally, 1999) (Wagenlehner und Naber, 2006) (S3-Leitline Harnwegsinfektionen der DGU), Leitlinie der EAU: (Bonkat u.a., 2017).

Definitions of Urinary Tract Infections


Bacteriuria is the presence of bacteria in the urine. Depending on the urine collection, different bacteria concentrations exist to distinguish significant bacteriuria from contamination or insignificant bacteriuria.

Acute Urethral Syndrome:

The acute urethral syndrome is defined by dysuria and urinary frequency without significant bacteriuria. There are many causes possible for acute urethral syndrome, see differential diagnosis of LUTS.


Acute urethritis is the bacterial infection of the urethra causing dysuria and urethral secretions, usually without signs of bladder infection [see section Gonorrhea and Non-gonococcal urethritis].

Acute Cystitis:

Acute cystitis is a common infection of the bladder, most often with coliform bacteria [see section bacterial cystitis and urinary tract infections in pregnancy].

Chronic Cystitis:

Chronic cystitis is defined by either a persistent bladder infection or cystitis more than 3 times in a year.

Acute Pyelonephritis:

Acute pyelonephritis is an acute bacterial infection of the renal pelvis and renal parenchyma causing fever, chills and flank pain [see section acute pyelonephritis].

Chronic Pyelonephritis:

Chronic pyelonephritis is a primarily radiological diagnosis with typical renal scars and deformity of the pyelocaliceal system. Bacteriuria and signs of infection are not mandatory.

Bacterial Prostatitis:

Acute prostatitis is the bacterial infection of the prostate with fever, painful swelling of prostate and voiding symptoms [see section bacterial prostatitis].

Chronic Prostatitis:

Chronic prostatitis is an inaccurate term for diseases such as chronic bacterial prostatitis, chronic non-bacterial prostatitis or chronic pelvic pain syndrome [see definition of prostatitis by NIH].


Epididymitis is a bacterial infection of the epididymis causing scrotal swelling, pain and fever.


Malacoplakia is a chronic infection/inflammation of the urinary tract with the formation of whitish-gray deposits.

Complicated urinary tract infection:

Complicated urinary tract infections are infections of the urinary tract in the presence of anatomical abnormalities, bladder catheter, ureteral stents or after operations of the urinary tract.

Recurrent urinary tract infections:

Recurrent urinary tract infections exist if the recurrence rate is ≥ 2 symptomatic episodes per half-year or ≥ 3 symptomatic episodes per year.


Urosepsis is a life-threatening systemic reaction to a bacterial urogenital infection with the risk of shock and high mortality [see section urosepsis].

Epidemiology of Urinary Tract Infections

Prevalence of Urinary Tract Infections:

Prevalence of urinary tract infections according to age and gender.
Age Prevalence Ratio (male:female)
Neonatal 1% 1.5:1
Preschool 2–3% 1:10
Pupils 1–2% 1:30
Adults 2.5% 1:50
Old age, at home 20–30% 1:10 to 1:2
Old age, nursing home 30% 1:1

Prevalence and incidence of UTI in premenopausal women:

The prevalence of asymptomatic bacteriuria in sexually active women is 5%, of which 8% develop a symptomatic urinary tract infection. The incidence of urinary tract infection in women before menopause is 0.5 to 0.7 per woman and per year.

Incidence of UTI in postmenopausal women:

7 urinary tract infections per 100 women per year.

Incidence of UTI im men (21–50 years):

6–8 urinary tract infections per 10,000 men per year.

Nosocomial infections:

Urinary tract infections cause 20–40% of nosocomial infections.

Causes of Urinary Tract Infections

See section causes of urinary tract infection.

Diagnostic Work-Up in Urinary Tract Infections

See section diagnostic work-up.

Antibiotic Therapy and Prevention of Urinary Tract Infections

See section antibiotic treatment and prevention.

Index: 1–9 A B C D E F G H I J K L M N O P Q R S T U V W X Y Z


Deutsche Gesellschaft für Urologie, S3-guideline for urinary tract infection
Epidemiologie, Diagnostik, Therapie und Management unkomplizierter bakterieller ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten
AWMF, 2010, Register-Nr. 043/044

Bauer u.a. 2002 BAUER, H. W. ; RAHLFS, V. W. ; LAUENER, P. A. ; BLESSMANN, G. S.:
Prevention of recurrent urinary tract infections with immuno-active E. coli fractions: a meta-analysis of five placebo-controlled double-blind studies.
In: Int J Antimicrob Agents
19 (2002), Nr. 6, S. 451–6

Kass 2002 KASS, E. H.:
Asymptomatic infections of the urinary tract. 1956.
In: J Urol
167 (2002), Nr. 2 Pt 2, S. 1016–9; discussion 1019–21

Krieger 2002 KRIEGER, J. N.:
Urinary tract infections: what’s new?
In: J Urol
168 (2002), Nr. 6, S. 2351–8

Nickel 2005a NICKEL, J. C.:
Management of urinary tract infections: historical perspective and current strategies: Part 1–Before antibiotics.
In: J Urol
173 (2005), Nr. 1, S. 21–6

Nickel 2005b NICKEL, J. C.:
Management of urinary tract infections: historical perspective and current strategies: Part 2-Modern management.
In: J Urol
173 (2005), Nr. 1, S. 27–32

Sobel und Vazquez 1999 SOBEL, J. D. ; VAZQUEZ, J. A.:
Fungal infections of the urinary tract.
In: World J Urol
17 (1999), Nr. 6, S. 410–4

Sussman und Gally 1999 SUSSMAN, M. ; GALLY, D. L.:
The biology of cystitis: host and bacterial factors.
In: Annu Rev Med
50 (1999), S. 149–58

Tauchnitz 1991 TAUCHNITZ, C:
In: HAHN, H (Hrsg.) ; FALKE, D (Hrsg.) ; KLEIN, P (Hrsg.): Medizinische Mikrobiologie.
Berlin, Heidelberg : Springer, 1991, S. 501–507

Wagenlehner und Naber 2006 WAGENLEHNER, F. M. ; NABER, K. G.:
Treatment of bacterial urinary tract infections: presence and future.
In: Eur Urol
49 (2006), Nr. 2, S. 235–44

  Deutsche Version: Harnwegsinfektion