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September 17, 1973

Urinary Tract InfectionPractical Aspects of Diagnosis and Treatment

JAMA. 1973;225(12):1509-1513. doi:10.1001/jama.1973.03220400035008

Urinary tract infections include a spectrum of clinical entities in which the presence of bacteriuria is the common denominator. Other types of microorganisms such as viruses and fungi may also infect the urinary tract but usually do so under special circumstances of systemic infection or decreased host resistance.

The purpose of this report is to review a large volume of data1-7 on bacteriuria, with emphasis on what is applicable to adopting a sound clinical approach to diagnosis and treatment.

Pathogenesis  While urinary tract infections occasionally result from the hematogenous spread of bacteria from distant foci of infection or via lymphatics that drain the lower gastrointestinal or genital tracts, they usually result from the intraluminal ascent of fecal bacteria which normally contaminate the distal urethra (Fig 1).The risk of bladder colonization is generally minimized by normal body defenses. With the voiding mechanism intact, most bacteria are washed out when the