Week 13: Chp 63: Urinary Tract Infections Flashcards
Risk Factors for developing a UTI
sexual activity, diabetes, poor hygiene, estrogen deficiency, recent catheterizations, foreign objects such as kidney or bladder stones
-conditions causing incomplete bladder emptying, such as pelvic organ prolapse, because of retained urine acting as a reservoir for bacteria
Cystitis
if the infection is isolated to the lower urinary tract or bladder
Pyelonephritis
if the infection involves the upper urinary tract or kidneys
-fever, nausea, vomiting, and flank pain are associated if these symptoms are present
How does a UTI occur?
occurs when bacteria enters the sterile bladder, causing inflammation
-most common way is for bacteria to gain entrance to the bladder through the urethra
Why are females more at risk for developing a UTI?
because of their short urethra and its close proximity of the vagina and rectum
-this proximity allows vaginal and fecal flora to migrate to the urethra causing a UTI
Clinical Manifestations of a UTI
-bladder irritability or dysuria (painful urination)
-urinary frequency
-urinary urgency
-urinating in small volumes
-gross hematuria (blood in urine) or microhematuria (small amounts of blood in urine)
-suprapubic pain (lower abdomen pain)
>if fever, nausea, vomiting, and flank pain are present; infection has potentially migrated to the kidneys (pyelonephritis)
Diagnosis of a UTI is based on what?
clinical manifestations and aided by urinalysis
-urine culture may be done when necessary or in the case of a complicated UTI
A visual inspection of the urine specimen may reveal what?
bloody and/or cloudy urine
A urinalysis demonstrates what in the urine?
leukocytes, nitrates, hemoglobin, and bacteria
-
Why would leukocytes (WBCs) and red blood cells (RBCs) be present in the urine?
because of the inflammatory and infectious process associated with an infection
Why are nitrates present in the urine?
becomes some bacteria convert nitrate to nitrite
What would the urine culture reveal?
greater than 100,000 bacteria
- Escherichia coli, Enterobacter, Pseudomonas aeruginosa, and Klebsiella pneumoniae are common
- E. coli is 80% responsible for uncomplicated UTIs
Treatment of a UTI
-primarily medications
-first-line: antimicrobial therapy
>Complicated UTI: 7-10 day antibiotics
>Uncomplicated UTI: 3-day course
-Trimethoprim/ sulfamethoxazole (Bactrim DS)
-ciprofloxacin (Cipro)
-In addition, bladder analgesics: phenazopyridine (Pyridium)
The choice of antibiotics is dependent on what?
urine culture sensitivities
- an uncomplicated UTI can be treated on a 3-day course of antibiotics
- complicated UTI treated with 7 to 10 days of antibiotics
Uncomplicated UTI consists of?
women who are not pregnant, do not have diabetes, and are afebrile
-3 day course of antibiotics
Complicated UTI consists of?
diabetic, febrile, male gender
-7-10 day course of antibiotics
Common prescribed antibiotics for a UTI
-Trimethoprim/ sulfamethoxazole
-ciprofloxacin (Cipro)
>used because of their efficacy in treating urogenital pathogens
In addition to antibiotics, Bladder analgesics can be used for what?
decrease dysuria, frequency, and urgency
-phenazopyridine (Pyridium)
>can turn the urine an orange/red color
What needs to be obtained after completing antibiotics to verify the infection has been treated appropriately?
urinalysis and urine culture
Complications of a UTI
- drug resistance
- pyelonephritis
- renal abscess
How is drug resistance possible?
when a patient does not complete antibiotics as prescribed
What happens when the complication of drug resistance occurs?
the resistance makes it difficult to find an appropriate antibiotic when/if the infection returns
-untreated or incomplete treatment of a UTI allows for bacteria to migrate to the kidneys, causing pyelonephritis or renal abscess
Surgical Management of a UTI is reserved for when?
for patients with known risk factors for infection (bladder or kidney stones) or anatomical defects allowing for incomplete bladder emptying (pelvic organ prolapse in women or an enlarged prostate in men)
Example of a pelvic organ prolapse
cystocele
-occurs when the walls between the bladder and vagina are weakened, allowing the bladder to descend into the vagina
-this change in anatomy prevents the bladder from emptying completely, leading to UTIs
>surgical interventions: colporrhaphy; correct the defect in the vaginal wall, allowing the bladder to empty effectively, decreasing risk of UTI
