Test 2 - UTIs

Four ways to categorize UTIs

Upper
Lower
Uncomplicated
Complicated

S/S of Upper UTIs

More systemic
Costovertebral tenderness (back) and flank pain
Fever and chills
Edema (peripherally)

costovertebral angle

Where ribs come together with spine

S/S of lower UTI

Localized symptoms
Urgency, frequency, nocturia, dysuria, burning, dribbling, suprapubic pain, hematuria

Causes of complicated UTIs

Have coexisting conditions
Obstruction
Antibiotic resistance
Recurring infections

Problem with antibiotic resistance

challenging to treat the infection

Types of coexisting conditions that can cause complicated UTIs

abnormality or urinary tract
Diabetes, pregnancy, neurologic condition

Uncomplicated UTIs

Only involve bladder
No comorbidities
Normal urinary tract

Most common bacterial infection in women

bacterial uti

Asymptomatic bacteriuria

Normal bacteria in the urine

When does asymptomatic bacteriuria need treatment

in pregnant women

Most common pathogen of UTI

E. coli

Fungal and parasitic infections

Not common
Found in people who have diabetes, kidney problems, lots of courses of antibiotics
Travel to developing countries

Upper UTIs

Involve renal parenchyma, pelvis, and ureters
Fever, chills, and flank pain

Pyelonephritis

Inflammation of renal parenchyma and collecting system

Cystitis

inflammation of the bladder

Urosepsis

UTI has spread systemically and if life threatening

Classifications of UTIs

Upper, lower, pyelonephritis, cystitis, urethritis, urosepsis, uncomplicated UTI, and complicated UTI

what is patient at risk for with complicated UTI

pyelonephritis, urosepsis, and renal damage

urinary tract above urethra is normally

sterile

Defense mechanisms that assist in sterility

Complete emptying of bladder with voiding
Ureterovesical junction competence
Ureteral peristaltic activity that propels urine toward bladder

How are antibacterial characteristics of urine maintained

acidic pH of less than 6, high urea concentration, and abundant glycoprotein that interfere with growth of bacteria

Organisms that cause UTI

Introduced from ascending route from the urethra and originate in the perineum
Most infections caused by gram-negative bacilli normally found in GI tract
Some gram-positive organisms cause infections as well

What can introduce bacteria into urinary tract

sex and catheters

Hematogenous route of UTIs

Rare
Must be an injury to the kidneys or ureter from obstruction, renal scars, or kidney infection

Catheter associated urinary tract infections (CAUTIs)

Common HAI
Usually caused by e. coli

Older people UTI s/s

Confusion, abdominal discomfort, no increased temperature

Factors contributing to lower UTIs

bladder tumors
intravesical chemotherapy
pelvic radiation

Diagnostic studies

Dipstick urinalysis
Urine culture
Ultrasound or CT scan

Dipstick urinalysis

Identify presence of nitrates, WBCs, and leukocyte esterase

Urine Culture

Clean catch urine sample is preferred to get sample
Refrigerate upon collection
Should be cultured within 24 hours

For more accurate urine culture results get urine from where

foley

when is a urine culture indicated

complicated or HAI UTIs
persistent bacteriuria
frequently recurring UTIs (more than 2-3 a year)

Why is sensitivity testing done in urine cultures

determines bacteria's susceptibility to a variety of antibiotic drugs
Results allow doctor to select antibiotic

How long is uncomplicated cystitis treated with antibiotics

3 days

how long is complicated UTIs treated with antibiotics

7-14 days

First choice medications for UTIs

Trimethoprim/sulfamethoxazole (bactrim)
Nitrofurantoin (macrodantin)
Fosfomycin (Monurol)

Trimethoprim/Sulfamethoxazole (Bactrim)

Taken twice daily
Inexpensive
E. Coli is becoming resistant to it

Nitrofurantoin (Macrodantin)

Take 3-4 times a day

Medications for complicated UTIs

fluoroquinolones

Other antibiotics that are used to treat UTIs

amoxicillin, cephalosporins, and ampicillin

How to relieve pain from urination

use urinary analgesic like phenazopyridine
Urine can turn orange/red

What to do with recurrent UTIs

prophylactic or suppressive antibiotics
low dose/prophylactic dose after sex
strategy is limited because of antibiotic resistance