Urinary Tract Infection A urinary tract infection or UTI is a bacterial infection that occurs when bacteria invade the

urinary tract system; the bacteria multiply throughout the urinary track system. While the majority of urinary tract infections or UTIs are not serious, they often cause severe symptoms such as pain and/or burning upon urination.

Urinary tract infections (UTIs) may be referred to as cystitis or pyelonephritis, terms that refer to the lower and upper urinary tract, respectively. The terms bacteriuria and candiduria describe bacteria or yeast in the urine. Very ill patients may be referred to as having urosepsis. UTI is defined as significant bacteriuria in the setting of symptoms of cystitis or pyelonephritis. These infections account for a significant number of emergency department (ED) visits, and 20% of women develop at least one UTI during their lifetimes.

FUNCTION: Regulation of ion levels in their blood (Na, K, Ca, Cl, HPO) Regulation of blood volume and blood pressure Regulation of blood pH Production of hormones (Calcitriol, Erythropoietin) Excretion of wastes

The URINARY TRACT SYSTEM is the body's filtering system for removal of liquid waste. The urinary tract consists of the kidneys, bladder, ureters, and urethra. URINE, fluid produced by the kidneys that contains wastes and excess materials excreted from the body through the urethra. 1-2 litres / 24 hours per normal adult. However, the amount per day varies considerably.

Urinary System

Components of Urine: Water accounts for about 95% of the total volume of urine. In addition to urea, creatinine, potassium, and ammonia, typical solutes normally present in urine include uric acid as well as sodium, chloride, magnesium, sulfate, phosphate, and calcium ions.

Physical Characteristics of Normal Urine:

Volume - one to two liters (about 1 to 2 quarts) in 24 hours but varies considerably. Color yellow or amber but varies with urine concentration and diet. Color is due to urochrome and urobilin. Concentrated urine is darker in color. Diet, medications, and certain disease affect color. Kidney stones may produce blood in urine.

Turbidity transparent when freshly voided, but becomes turbid after a while. Odor mildly aromatic but becomes ammonialike after a time. pH ranges between pH 4.6 and 8.0; averages 6.0; varies considerably with diet. High-protein diets increase acidity; vegetarian diets increase alkalinity.

Specific Gravity ranges from 1.001 to 1.035. the higher the concentration of solutes, the higher the specific gravity.

Summary of Abnormal Constituents in Urine

Albumin the presence of excessive albumin in th urine, albuminuria, indicates an increase in the permeability of filtering membranes due to injury or disease, increased blood pressure, or damage to kidney cells. Glucose glucosuria, the presence of glucose in the urine, usually indicates diabetes mellitus.

Red blood cells hematuria, the presence of hemoglobin from ruptured red blood cells in the urine, can occur with acute inflammation of the urinary organs as a result of disease or irritation from kidney stones, tumors, trauma, and kidney disease. White blood cells the presence of white blood cells and other components of pus in the urine, reffered to as pyuria, indicates infection in the kidneys or other urinary organs.

Bilirubin an above-normal level of bilirubin in urine is called bilirubinuria. Uribilinogen the presence of uribilinogen in urine called urobilinogenuria. Casts are tiny masses of material that have hardened and assumed the shape of the lumen of a tubule in which they formed. Microbes the number and type of bacteria vary with specific infection in the urinary tract. (E. coli, Candida albicans, Trichonomas vaginalis)

Escherichia (E.) coli is responsible for most uncomplicated cystitis cases in women, especially in younger women. E. coli is generally a harmless microorganism originating in the intestines. If it spreads to the vaginal opening, it may invade and colonize the bladder, causing an infection. The spread of E. coli to the vaginal opening most commonly occurs when women or girls wipe themselves from back to front after urinating, or after sexual activity.

Staphylococcus saprophyticus accounts for 5 15% of UTIs, mostly in younger women. Klebsiella, Enterococci bacteria, and Proteus mirabilis account for most of remaining bacterial organisms that cause UTIs. They are generally found in UTIs in older women. Rare bacterial causes of UTIs include ureaplasma urealyticum and Mycoplasma hominis, which are generally harmless organisms.

Klebsiella

Enterococci

Staphylococcus saprophyticus

E. coli

Abdominal pain or tenderness over the bladder area Chills Cramps or bladder spasm Dysuria Feeling of warmth during urination Fever Flank pain Hematuria

Itching Low back pain Malaise Nausea, vomiting Nocturia Urethra discharge in male (possibly) Urinary frequency Urinary Urgency

Benign prostatic hyperplasia Bowel incontinence Catheterization Cystoscopy Diabetes History of analgesic or reflux nephropathy Immobility or decreased mobility Incomplete emptying of the bladder (in elderly patients)

Indwelling urinary catheter Lack of adequate fluids Pregnancy Prostatitis Urethral strictures Unhygienic sexual intercourse

Characteristics signs and symptoms and microscopic urinalysis showing red blood cell and white blood cell and white blood cell counts greater than 10 per high-power field suggest lower UTI. Voiding cystoureterography or excretory urography may disclose congenital anomalies that predispose the patient to recurrent UTIs.

Sensitivity testing determines the appropriate therapeutic antimicrobial agent A clean-catch, midstream urine specimen revealing a bacterial count of more than 100,000/ml confirms that diagnosis. Lower counts don'ts necessarily rule out infection; especially if the patient is voiding frequently, because bacteria require 30 t0 45 min. to reproduce in urine. Careful midstream, clean-catch collection is preferred to catheterization, which can reinfect the bladder with urethral bacteria.

Appropriate antimicrobials are the treatment of choice for most initial lower UTIs. A 7-to-10 course of antibiotic therapy is standard, but recent studies suggest that a single dose of an antibiotic or a 3-to-5 day antibiotic regimen may be sufficient to render the urine sterile. After 3 days of antibiotic therapy, urine culture should show no organism.

If the urine isnt sterile after 3 days of antibiotic therapy, bacterial resistance has probably occurred, making the use of a different antimicrobial necessary. Single-dose antibiotic therapy with amoxicillin or co-trimoxazole may be effective in females with an acute, uncomplicated UTI. A urine culture taken 1 to 2 weeks later indicates whether the infection has been eradicated.

Recurrent infections due to infected renal calculi, chronic prostatitis, or a structural abnormality may necessitate surgery; prostatitis also requires long-term antibiotic therapy. In patients without these predisposing conditions, long-term, low dosage antibiotic therapy is the treatment of choice.

Teach the female client patient how to clean the perineum properly and keep the labia separated during voiding to collect and clean-catch, midstream urine specimen. Explain that an uncontaminated midstream specimen is essential for accurate diagnosis. Watch for GI disturbance from antimicrobial therapy.

Teach the patient how to prevent and treat UTIs Collect all urine samples for culture and sensitivity testing carefully and promptly

Nursing: The Series for Clinical Excellence; Understanding Disease, Wolters Kluwer/Lippincott Williams and Wilkins (pages 661-663) Disease: A Nursing Process Approach to Excellence (Care, Lippincott Williams and Wilkins (pages 913-915) Essentials of Anatomy and Physiology, Gerard J. Tortora & Bryan Derrickson (pages 538-552)