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326 Acute & Chronic > Urinary Tract Infection > Flashcards

Urinary Tract Infection Flashcards

1
Q

How does a urinary tract infection occur?

A

Results from pathogens invading one or more urinary tract structures.

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2
Q

Describe urinary tract infection.

A
  • Urinary Tract Infections (UTIs) are usually bacterial and most often caused by E. Coli bacteria.
  • Can be caused by a fungus or parasite but that usually occurs in:
    – Immunosuppression
    – Diabetes
    – Multiple courses of antibiotic therapy
    – Kidney function problems
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3
Q

What are the different types of urinary infections?

A

Pyelonephritis
- Infection of the kidney or renal pelvis
Cystitis
- Infection of the bladder
Urethritis
- Infection of the urethra
Urosepsis
- a UTI that has spread systemically and can be life-threatening

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4
Q

What part of the urinary tract is considered sterile?

A

The area above the urethra

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5
Q

What mechanisms keep the area above the urethra sterile?

A
  • Normal voiding with complete emptying of the bladder
  • Uretovesical junction competence.
  • Ureteral peristaltic activity that propels urine toward the bladder.
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6
Q

How is the urinary tract kept sterile?

A
  • Antibacterial characteristics of urine
  • Acidic pH of urine (less than 6.0)
  • High urea concentration
  • Glycoproteins that interfere with bacterial growth
  • Please note: A change in any of these defenses will increase the risk of developing a UTI.
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7
Q

How does the urinary tract defend itself?

A
  • Washout phenomenon – bacteria are removed from the bladder and urethra when voiding.
  • Bladder lining – assists in providing a barrier against bacterial invasion.
  • Body’s immune responses
    – Peristaltic movement within the ureters.
    – Normal flora in peri-urethral area in women consists of Lactobacillus which is a defense mechanism.
    > Estrogen- protects the peri-urethral flora
    – Normal flora in the prostatic secretions
    – Acidic environment
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8
Q

Describe bacterial entry.

A
  • Ascending Infection
  • Hematogenous Spread
  • Lymphatogenous Spread
  • Direct Extension
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9
Q

What is the most common cause of a UTI?

A

Infection acquired through the urethra

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10
Q

What increases the risk of UTI in women?

A

Short urethra and rectal bacteria

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11
Q

Why is sexual intercourse a major precipitating factor of UTI?

A
  • Sexual intercourse allows “milking” of bacteria from the vagina and perineum and may cause minor urethral trauma that predisposes women to urinary tract infections.
  • Can occur as quickly as 12 hours after intercourse.
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12
Q

What can cause an ascending infection?

A
  • Urologic Instrumentation
  • Catheterization
  • Cystoscopic examination
  • Allows bacteria that are normally present at the opening of the urethra to enter into the urethra or bladder
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13
Q

How does a Hematogenous infection occur?

A
  • Blood-borne bacteria secondarily invade the kidneys, ureters, or bladder from elsewhere in the body.
  • There must be a prior injury to the urinary tract, such as obstruction of the ureter, damage caused by stones, or renal scars, for a kidney infection to occur via this route.
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14
Q

What can a hematogenous infection occur with?

A
  • Tuberculosis
  • Renal abscesses
  • Perinephric abscesses.
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15
Q

How common is a lymphatogenous infection?

A

rare

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16
Q

How does a lymphatogenous infection occur?

A

Bacteria travel through rectal & colonic lymphatics to:
- Prostate and bladder in males
- Thru periuterine lymphatics to the female genitourinary tract.

17
Q

How does a direct extension injection occur?

A

from another organ

18
Q

What does a direct extension injection occur with?

A
  • Intraperitoneal abscesses, especially those associated with inflammatory bowel disease,
  • Pelvic inflammatory disease
  • Paravesical abscesses
  • Genitourinary tract fistulas.
19
Q

What do most urinary tract infections occur from?

A
  • E. Coli
  • Candida Albicans- most often with indwelling catheters
  • Pseudomonas
  • Klebsiella
  • Proteus
  • Backflow of urine
  • Urinary stasis
  • Impaired bladder emptying
  • neurogenic disorders
20
Q

Who is at risk for a urinary tract infection?

A
  • People who have mobility challenges
  • Older adults
  • Immunosuppressed – disease or drugs
  • Diabetes
21
Q

List the clinical manifestations of a lower UTI.

A
  • Frequency (more than q 2 hours)
  • Urgency
  • Dysuria (burning on urination)
  • Cloudy or foul-smelling urine
  • Suprapubic discomfort or pressure
  • Hematuria (red blood cells in the urine)
  • Pyuria (white blood cells in the urine)
22
Q

List the clinical manifestations of an upper UTI.

A
  • Fever
  • Flank pain
  • Costovertebral angle tenderness
  • Nausea
  • Vomiting
23
Q

What are some minor symptoms of a UTI?

A
  • Asymptomatic
  • Fatigue
  • Anorexia
24
Q

List some clinical manifestations of a UTI in older adults.

A
  • non-localized abdominal discomfort
  • cognitive impairment
  • less likely to experience a fever
25
Q

What are some diagnostic tests for UTI?

A
  • Urine Culture
    – Clean-catch urine specimen
    – Specimen via catheterization
  • IVP (used to visualize the ureters or to detect strictures or stones)
  • CT (may detect areas of pyelonephritis or abscesses)
  • Ultrasound (extremely sensitive for detecting obstruction, abscesses, tumors, and cysts)
26
Q

When should urine cultures be obtained?

A

Prior to antibiotic therapy to:
- Confirm the organism’s sensitivity
- To decrease the development of resistant organisms.

27
Q

How long does it take to get results from urine culture?

A
  • 24-48 hours are usually required to determine the results.
  • A broad-spectrum antibiotic may be prescribed until results are obtained
28
Q

Describe bacteriuria.

A

Positive urine cultures
- Growth of a single pathogen over 100,000 colony-forming units (CFU)/ml of urine in a clean catch or catheterized specimen is considered clinically significant.
- Growth as low as 100 or 1000 CFU/ml with clinical manifestations of a UTI.

29
Q

When should men and young children get a more extensive workup for a urinary infection?

A

If they have recurrent UTIs because it is rare for recurrent UTIs to occur in these populations
- May indicate a urinary tract abnormality

30
Q

How to manage and treat a urinary infection?

A

Increase fluid intake. It is recommended that fluid intake is half a person’s weight.
- Dilutes urine
- Lessens irritation and burning
- Provides a continual flow of urine to minimize stasis and multiplication of bacteria in the urinary tract.

31
Q

What do sitz baths do?

A

may provide comfort for the individual with urethritis.

32
Q

How can cranberry juice help with urinary infections?

A
  • Cranberry juice also has been shown to have positive effects on UTIs.
  • Make sure the cranberry juice is 100% juice.
  • Quality cranberry juice produces hippuric acid in the urine which acidifies the urine and prevents bacteria from sticking to the walls of the bladder.
    – Drink 2-3 glasses daily
33
Q

What are some medications that can help with a urinary tract infection?

A
  • Empiric Therapy
  • Trimethoprim-sulfamethoxazole
  • Nitrofurantoin
  • Fluconazole
34
Q

Empiric Therapy

A

Usually broad-spectrum antibiotics

35
Q

Trimethoprim-sulfamethoxazole

A
  • Relatively inexpensive
  • Taken BID
  • E-Coli tends to be resistant to this drug.
36
Q

Nitrofurantoin

A
  • 3-4x/day
  • Avoid/limit sunlight/photosensitivity
  • Avoid if the patient’s creatinine clearance is less than 30ml/min
  • Take with meals
  • Do not take if the patient has liver disease- it is hepatotoxic
37
Q

Fluconazole

A

used for fungal infections

326 Acute & Chronic (3 decks)

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