Can appendicitis cause urinary tract infections (UTIs)?

From the Guidelines

Appendicitis does not directly cause urinary tract infections (UTIs), but there can be connections between these two conditions. Appendicitis is inflammation of the appendix, while UTIs are bacterial infections affecting the urinary system. In some cases, appendicitis symptoms may mimic UTI symptoms, particularly when the inflamed appendix is located near the bladder or ureter, causing urinary symptoms like frequency or pain with urination. Additionally, the bacteria from a severely inflamed or ruptured appendix could potentially spread to nearby organs, including the urinary tract, though this is uncommon, as noted in studies such as 1. The proximity of the appendix to urinary structures, especially in women whose appendix may be closer to the right ureter or bladder, can sometimes lead to diagnostic confusion.

Some key points to consider include:

• The diagnosis of intra-abdominal infections, including appendicitis, is primarily based on clinical assessment, supported by laboratory tests and imaging studies when available, as discussed in 1.
• The management of appendicitis may involve surgical removal of the appendix or, in some cases, antibiotic therapy alone for uncomplicated appendicitis, as recommended in 1 and 1.
• UTIs, on the other hand, are typically treated with antibiotics, with the choice of antibiotic and duration of treatment depending on the severity and recurrence of the infection, as outlined in 1.
• It's essential to seek medical attention promptly for proper diagnosis and treatment, as appendicitis requires immediate medical intervention, while UTIs can often be managed with antibiotics.

In terms of the relationship between appendicitis and UTIs, while appendicitis itself does not directly cause UTIs, the proximity of the appendix to the urinary tract and the potential for bacterial spread from a ruptured appendix mean that there can be indirect connections between the two conditions. However, as noted in the guidelines for the management of intra-abdominal infections, including appendicitis 1, the primary focus is on the diagnosis and treatment of the intra-abdominal infection, with consideration of potential complications, including the rare possibility of spread to nearby organs. For recurrent UTIs, guidelines such as those outlined in 1 recommend a stepwise approach, including self-care measures, antibiotic prophylaxis, and imaging studies in selected cases to identify underlying anatomical abnormalities or other complicating factors.

From the Research

Association between Appendicitis and UTI

• Appendicitis can cause urinary tract infections (UTIs) due to the spread of bacteria from the appendix to the urinary tract 2.
• A study found that 48% of patients with acute appendicitis had abnormal urinalysis before appendectomy, and 32% had aerobes isolated from urine 2.
• Another study found that 54.3% of patients with non-ruptured acute appendicitis had uropathogens isolated from their urine samples 3.

Bacterial Profile of UTIs in Appendicitis

• The most common pathogens isolated from urine samples of patients with acute appendicitis were E. coli, Enterobacter species, and Enterococcus faecalis 3.
• The study also found that 80% of UTI cases had mixed culture, with at least one of Enterobacterial species 3.

Treatment and Management

• Antibiotics can be used as first-line therapy for acute appendicitis, with a success rate of 77% 4.
• However, the use of antibiotics should be individualized based on patient factors, such as allergies and community resistance rates 5.
• Surgery may be necessary in cases where antibiotic treatment fails or in patients with high-risk CT findings 6.