Recurrent Urinary Tract Infections Including Covert Bacteriuria

During the past thirty years there have been many important changes in the diagnosis and management of urinary tract infection (UTI), and research undertaken during this period has led to a better understanding of the significance of bacteriuria. The great upsurge of interest in the subject in the sixties and seventies, in response to the work of Kass, has been followed by the workload and financial pressures of the eighties. Decisions must constantly be made, by clinicians and by laboratories, about the appropriate use of resources in the diagnosis and management of UTI. It is useful, therefore, to survey the current state of knowledge in the field and to endeavour to lay down some guidelines for laboratory and clinical work. Aspects which will be considered in this review will include a concept of UTI which takes account of infection anywhere in the urinary tract or us adjacent structures rather than, as has been customary, confining attention to the kidneys and bladder only; the changes in laboratory methods and diagnosis which have resulted from this concept; the clinical significance of UTI, the management ot symptoms. and ways in which the small minority of bacteriuric patients who are at risk from serious consequences may be identified; antibacterial agents and management protocols and, finally, the problem of covert bacteriuria.