[Medical aspects of urinary tract infections]

The authors undertake a general review of recent advances in the field of urinary tract infections. Attention is drawn to the fact that bacteria can proliferate only if they adhere to the wall of the urinary tract before penetrating the epithelial cells. This adhesion is dependent upon adhesins which, in the urinary tract, can fix only upon specific receptors. It can therefore be understood that a mucosa bearing many receptors can easily by reinfected with organisms with the intestinal flora as their point of departure, via perineal and peri-urethral meatal infestation in the woman. A recent therapeutic advance is based upon the use of beta-lactamase inhibitors. A beta-lactamine neutralises the beta-lactamase produced by the organism and the other beta-lactamine acts as an antibiotic and kills the organism. This combination of two lactamines will probably be increasingly widely used in dealing with organisms. It is important to note that bacteriologists draw attention to the need to detect congenital abnormalities or foreign bodies or neighbouring infections, before incriminating only problems of bacterial virulence and the abnormally abundant presence of receptors on the urethrovesical mucosa. In the absence of urological disease, the treatment of lower urinary tract infections in the woman is not based upon any particular rules since short-term treatment seems just as effective as long-term treatment. The problem is completely different in the treatment of acute pyelonephritis which requires a minimum of three weeks using an antibiotic with powerful tissue diffusion.