Urinary Tract Infections Flashcards
What is the 2nd most common type of infection?
UTIs
What gender do UTIs occur more frequently in & why?
Women → b/c their urethra is shorter & closer to the anus where bacteria is present
What is the most common cause of UTIs?
E. coli
UTIs account for ~ ____% of all HAIs & list the most common cause
~ 50%
Most common cause → Catheter acquired UTI (CAUTI)
Which classification of UTI is more common?
Lower UTI → involves the bladder & structures below the bladder
List 3 examples of lower UTIs
1) Cystitis
2) Prostatitis
3) Urethritis
Which classification of UTI is much more serious & why?
Upper UTI → b/c it is deeper in the urinary tract & involves the kidneys & ureters
List one example of upper UTI
1) Pyelonephritis
What % of UTIs occur in women aged 20-50 yrs?
40-50%
Most uncomplicated lower UTIs are caused by _____
E. coli (75-90%)
How do lower UTIs caused by E. coli develop?
Bacteria surface has adhesins which allow attachment to the mucosal surface
List 4 bacterias that cause complicated UTIs
1) Staphylococcus Saprophyticus
2) Klebsiella Pneumoniae
3) Proteus Mirablis
4) Pseudomonas species
Where do UTIs usually enter & what occurs?
Usually enter through the urethra → distal urethra often has pathogens the urine formed in the kidney & in the bladder is usually sterile
Urinary tract usually sterile
What is the washout phenomenon?
Occurs when urine washes out the bacteria in the urethra during urination
List 2 main causes & sub causes of UTIs
1) Urinary obstruction
→ Anatomic
→ Functional
2) Reflux
→ Ureterovesical Reflux
→ Vesicoureteral Reflux
List 3 anatomic causes of UTI
1) Stones
2) BPH
3) Pregnancy
What is Benign Prostatic Hypertrophy/ Hyperplasia (BPH)?
A non-cancerous enlargement of the prostate gland, a common condition in older men that can cause urinary problems
List 5 functional causes of UTIs
1) Neurogenic bladder
2) Infrequent voiding
3) Detrusor (bladder) muscle instability
4) Constipation
How does ureterovesical reflux occur in women?
Urine moves from bladder into urethra & then flows back into the bladder
What activities can trigger Ureterovesical reflux?
Coughing or squatting
Where does vesicoureteral reflux occur?
At the level of the bladder & ureter → “back flow of urine”
brings bacteria back into bladder
Why do we not want to leave foleys in for long periods of time?
They can cause CAUTIs → bag MUST be lower than the bladder!!
List 11 populations at risk for UTIs
1) sexually active women
2) post menopausal women
3) pregnancy
4) bladder cancer
5) renal stones (calculi)
6) men w/ prostate abnormalities
7) older adults
8) catheterization
9) instrumentation
10) diabetics
11) pts using Abx
Why are diabetics at risk for UTIs?
Bacteria loves glucose
Pathophysiology:
The defense system is challenged by what?
The virulence of the pathogen
Pathophysiology:
What lines the bladder & protects against bacteria?
A protective mucin layer
Pathophysiology:
What are the local immune system reactions?
IgA & phagocytic cells remove the bacteria
Pathophysiology:
How does IgA play a role in prevention of UTIs?
An immunoglobulin that helps prevent the bacteria from adhering from the bladder wall
Pathophysiology:
What is part of a woman’s normal flora?
lactobacillus is part of normal flora of periurethral area
Pathophysiology:
What contains immunoglobulins in men?
Prostatic fluid (IgA, IgG)
What is considered a sterile environment?
The urinary tract
Explain the osmolarity of urine
Urine has a high osmolarity → urea helps decrease bacteria from getting into the bladder
What occurs when we urinate?
We are removing some contaminated bacteria; inhibiting it from being able to move & cause infection
Host–Agent interactions:
Mucin layer Hint: 3 things
1) Epithelial cells that line bladder produce protective substances
2) Believed that by binding water provides a barrier btwn the bacteria & the bladder epithelium
3) Role of estrogen as older women & post menopausal women do NOT have as much mucin
What can happen to lactobacillus (normal flora) from prolonged Abx use?
Can cause destruction of normal flora that will actually cause a UTI to develop
Explain the purpose of prostate secretions in men
These secretions have antibacterial properties which protect the urethra from colonization
List 2 reasons young men do not get UTIs as often
1) Urethral length (longer)
2) Drier periurethral environment
List 2 risk factors for men developing UTIs
1) Lack of circumcision
2) Anal intercourse
All UTIs in men are considered _____. Why?
Complicated
→ b/c of the longer urethra
List 5 clinical manifestations of uncomplicated UTIs
1) Dysuria
2) Frequency
3) Urgency
4) Hematuria
5) Suprapubic pain
List 6 clinical manifestations of complicated UTIs
1) Asymptomatic or present w/ septic shock!
2) Fever
3) Chills
4) Nausea
5) Vomiting
6) Back pain/ Flank pain
Define urosepsis
Spread of infection from urinary tract to blood stream
List 6 clinical manifestations seen in older adults
1) Incontinence
2) Foul smelling concentrated urine
3) Fatigue
4) Confusion
5) Dementia → could develop/ make Sx worse
6) Hallucinations
What does it mean if a patient with a UTI develops a fever?
Th eUTI has traveled deeper & further in the bladder to the kidneys causing pyelonephritis (very bad)
What can back pain / flank pain indicate?
Pyelonephritis
What can bladder pain indicate?
UTI
Describe the prevalence of UTIs in children
Occur more frequently in boys up to 3 mos & more frequently in girls after 3 mos of age
List 3 types of children at increased risk of UTI
1) Premature infants d/c from neonatal ICUs
2) Those with systemic / immunologic disease
3) Those with urinary tract abnormalities
List 2 examples of urinary tract abnormalities that can cause UTIs in children
1) Neurogenic bladder
2) Vesicoureteral Reflux
What classification of UTI do we usually see in children?
Upper UTI
What is interstitial cystitis?
Characterized by pain, urgency & feeling of bladder fullness; also pressure in pelvic area
Chronic condition
Sx are variable
Is interstitial cystitis more common in males or females?
Females
List 4 possible causes of interstitial cystitis
1) Believe > 1 mechanism is involved
2) Defects in part of mucus layer of bladder that protects the bladder
3) defects may allow toxins in urine to leak through & damage nerve & muscle tissue which trigger pain & hypersensitivity
4) Infection or autoimmune
List 5 clinical manifestations of interstitial cystitis
1) Chronic pelvic pain
2) Chronic perineal pain
3) Bladder fullness
4) Urgency & frequency
5) Remission & exacerbation
List 6 ways to Dx interstitial cystitis
1) Medical Hx
2) Physical exam
3) Cystoscopy
4) Urodynamic testing
5) R/o endometriosis
6) R/o infection (i.e. UTI)
Urinary testing:
What is specific gravity
Amount of solutes: pure water
More solutes higher specific gravity
Urinary testing:
Normal Specific gravity
No true normal as it depends on individual reference level 1.010
Urinary testing:
Considerations for specific gravity
Extremes of either side can indicate pathology
Urinary testing:
Normal pH
6.5-7 in the AM
7.5-8 in the PM
Urinary testing:
pH considerations
Can be affected by food etc
Urinary testing:
Normal Leukocytes (WBCs)
Negative
Urinary testing:
Leukocyte (WBC) considerations
Present in ALL patients with UTIs
Urinary testing:
Normal Nitrites
Negative
Enzyme released by enterobacteriaceae
Urinary testing:
Nitrite considerations
Can be negative and still have UTI
Urinary testing:
Normal blood
Negative
Micro or macrocytic
Urinary testing:
Blood considerations
Can be seen in trauma, hemolysis, UTI, malignancy
Urinary testing:
Normal protein
Negative
Albumin is the protein measured
Urinary testing:
Protein considerations
Renal disease; pregnancy; inflammation
What is microscopic and won’t be seen unless UA is sent out for culture?
Hematuria
Urinary testing:
What is glucose
Renal threshold to eliminate excess glucose
Urinary testing:
Normal glucose
negative
Urinary testing:
What are ketones
Measures metabolites of fat metabolism
Urinary testing:
Normal ketones
Negative
Urinary testing:
Ketone considerations
Insulin insufficiency, starvation, vomiting
Think DKA
Urinary testing:
Normal bilirubin
Negative
Urinary testing:
Bilirubin considerations
Liver disease obstruction
Urinary testing:
Normal urobilirubin
Negative
Urinary testing:
Urobilirubin considerations
Liver disease; hemolysis; mono; cirrhosis
Urinary testing:
What are casts
Coagulated protein by kidney cells
Urinary testing:
Normal casts
Negative
Hyaline (0-5) in healthy people
Cellular not normal
Urinary testing:
Casts considerations
Hyaline are clear
Can have cellular RBC or WBC
Urinary testing:
What are crystals
Waste solutes
Based on pH & urine temperature
Urinary testing:
Normal Crystals
None but some are ok
How do we manage acute UTIs?
3 or 7 day course of Abx if uncomplicated
How do we manage chronic or relapsed UTIs?
Up to 2 week course of Abx
How do we manage an upper UTI?
2 week course of Abx
(May require up to 6 weeks)
List 6 Abx commonly used to Tx UTIs
1) Cephalexin
2) Ciprofloxacin
3) Levofloxacin
4) Ampicillin
5) Amoxicillin
6) Bactrim
Explain the reasoning for using cranberry pills/ capsules to help Tx UTIs
Thought to create more acidic environment; research shows this is not the case
→ b/c they are acidic it does prevent bacteria from adhering to bladder wall
→ does help to void
→ for it to work we would need to drink a gallon a day
What 7 important patient education teaching points when managing/ Tx UTIs?
1) Hydration!!
2) Void before & after intercourse (reflux could occur)
3) Avoid douching
4) Take Abx as prescribed
5) Avoif tight/ restrictive clothing
6) Shower instead of baths
7) Good personal hygiene
What may be needed/ ordered in an older adult experiencing recurrent UTIs?
1) Could actually order PT
2) Worst case → may have surgery of some kind
