urinary tract infection

infection

[in-fek´shun] invasion and multiplication of microorganisms in body tissues, as in an infectious disease. The infectious process is similar to a circular chain with each link representing one of the factors involved in the process. An infectious disease occurs only if each link is present and in proper sequence. These links are (1) the causative agent, which must be of sufficient number and virulence to destroy normal tissue; (2) reservoirs in which the organism can thrive and reproduce; for example, body tissues and the wastes of humans, animals, and insects, and contaminated food and water; (3) a portal through which the pathogen can leave the host, such as the respiratory tract or intestinal tract; (4) a mode of transfer, such as the hands, air currents, vectors, fomites, or other means by which the pathogens can be moved from one place or person to another; and (5) a portal of entry through which the pathogens can enter the body of (6) a susceptible host. Open wounds and the respiratory, intestinal, and reproductive tracts are examples of portals of entry. The host must be susceptible to the disease, not having any immunity to it, or lacking adequate resistance to overcome the invasion by the pathogens. The body responds to the invasion of causative organisms by the formation of antibodies and by a series of physiologic changes known as inflammation.
The spectrum of infectious agents changes with the passage of time and the introduction of drugs and chemicals designed to destroy them. The advent of antibiotics and the resultant development of resistant strains of bacteria have introduced new types of pathogens little known or not previously thought to be significantly dangerous to man. A few decades ago, gram-positive organisms were the most common infectious agents. Today the gram-negative microorganisms, and Proteus, Pseudomonas, and Serratia are particularly troublesome, especially in the development of hospital-acquired infections. It is predicted that in future decades other lesser known pathogens and new strains of bacteria and viruses will emerge as common causes of infections.
The development of resistant strains of pathogens can be limited by the judicious use of antibiotics. This requires culturing and sensitivity testing for a specific antibiotic to which the identified causative organism has been found to be sensitive. If the patient has been receiving a broad-spectrum antibiotic prior to culture and sensitivity testing, this should be discontinued as soon as the specific antibiotic for the organism has been found. It would be helpful, too, if the general public understood that antibiotics are not cure-alls and that there is danger in using them indiscriminately. In some instances an antibiotic can upset the normal flora of the body, thus compromising the body's natural resistance and making it more susceptible to a second infection (superinfection) by a microorganism resistant to the antibiotic.
Although antibacterials have greatly reduced mortality and morbidity rates for many infectious diseases, the ultimate outcome of an infectious process depends on the effectiveness of the host's immune responses. The antibacterial drugs provide a holding action, keeping the growth and reproduction of the infectious agent in check until the interaction between the organism and the immune bodies of the host can subdue the invaders.
Intracellular infectious agents include viruses, mycobacteria, Brucella, Salmonella, and many others. Infections of this type are overcome primarily by lymphocytes" >T lymphocytes and their products, which are the components of cell-mediated immunity. Extracellular infectious agents live outside the cell; these include species of Streptococcus and Haemophilus. These microorganisms have a carbohydrate capsule that acts as an antigen to stimulate the production of antibody, an essential component of humoral immunity.
Infection may be transmitted by direct contact, indirect contact, or vectors. Direct contact may be with body excreta such as urine, feces, or mucus, or with drainage from an open sore, ulcer, or wound. Indirect contact refers to transmission via inanimate objects such as bed linens, bedpans, drinking glasses, or eating utensils. Vectors are flies, mosquitoes, or other insects capable of harboring and spreading the infectious agent.Patient Care. Major goals in the care of patients with threatening, suspected, or diagnosed infectious disease include the following: (1) prevent the spread of infection, (2) provide physiologic support to enhance the patient's natural curative powers and resources for warding off or recovering from an infection, (3) provide psychologic support, and (4) prepare the patient for self-care if this is feasible.
Special precautions for prevention of the spread of infection can vary from strict isolation of the patient and such measures as wearing gloves, mask, or gown to simply using care when handling infective material. No matter what the diagnosis or status of the patient, handwashing before and after each contact is imperative.
Unrecognized or subclinical infections pose a threat because many infectious agents can be transmitted when symptoms are either mild or totally absent.
In the care of patients for whom special precautions have not been assigned, gloves are indicated whenever there is direct contact with blood, wound or lesion drainage, urine, stool, or oral secretions. Gowns are worn over the clothing whenever there is copious drainage and the possibility that one's clothes could become soiled with infective material.
When a definitive diagnosis of an infectious disease has been made and special precautions are ordered, it is imperative that everyone having contact with the patient adhere to the rules. Family members and visitors will need instruction in the proper techniques and the reason they are necessary.
Physiologic support entails bolstering the patient's external and internal defense mechanisms. Integrity of the skin is preserved. Daily bathing is avoided if it dries the skin and predisposes it to irritation and cracking. Gentle washing and thorough drying are necessary in areas where two skin surfaces touch, for example, in the groin and genital area, under heavy breasts, and in the axillae. Lotions and emollients are used not only to keep the skin soft but also to stimulate circulation. Measures are taken to prevent pressure ulcers from prolonged pressure and ischemia. Mouth care is given on a systematic basis to assure a healthy oral mucosa.
The total fluid intake should not be less than 2000 ml every 24 hours. Cellular dehydration can work against adequate transport of nutrients and elimination of wastes. Maintenance of an acid urine is important when urinary tract infections are likely as when the patient is immobilized or has an indwelling urinary catheter. This can be accomplished by administering vitamin C daily. Nutritional needs are met by whatever means necessary, and may require supplemental oral feedings or total parenteral nutrition. The patient will also need adequate rest and freedom from discomfort. This may necessitate teaching her or him relaxation techniques, planning for periods of uninterrupted rest, and proper use of noninvasive comfort measures, as well as judicious use of analgesic drugs.
Having an infectious disease can alter patients' self-image, making them feel self-conscious about the stigma of being infectious or “dirty,” or making them feel guilty about the danger they could pose to others. Social isolation and loneliness are also potential problems for the patient with an infectious disease.
Patients also can become discouraged because some infections tend to recur or to involve other parts of the body if they are not effectively eradicated. It is important that they know about the nature of their illness, the purposes and results of diagnostic tests, and the expected effect of medications and treatments.
Patient education should also include information about the ways in which a particular infection can be transmitted, proper handwashing techniques, approved disinfectants to use at home, methods for handling and disposing of contaminated articles, and any other special precautions that are indicated. If patients are to continue taking antibacterials at home, they are cautioned not to stop taking any prescribed medication even if symptoms abate and they feel better.

Chain of infection.

Stages of infection. Each period varies with different pathogens and different diseases.airborne infection infection by inhalation of organisms suspended in air on water droplets or dust particles.infection control 1. in the nursing interventions classification, a intervention" >nursing intervention defined as minimizing the acquisition and transmission of infectious agents.2. the use of surveillance, investigation, and compilation of statistical data in order to reduce the spread of infection, particularly nosocomial infections.
Practitioners in infection control are often nurses employed by hospitals. They have titles such as Infection Control Officer and Infection Control Nurse, and they function as liaisons between staff nurses, physicians, department heads, the infection control committee, and the local health department. Such practitioners also assume some responsibility for teaching patients and their families, as well as employees of the hospital.
The centers for disease control and prevention is an excellent source of information related to infection control; their web site is http://www.cdc.gov. Another source of help and support for infection control practitioners is the Association for Practitioners in Infection Control and Epidemiology, 1275 K St., NW, Suite 100, Washington, DC 20005-4006.cross infection infection transmitted between patients infected with different pathogenic microorganisms.droplet infection infection due to inhalation of respiratory pathogens suspended on liquid particles exhaled by someone already infected.dustborne infection infection by inhalation of pathogens that have become affixed to particles of dust.endogenous infection that due to reactivation of organisms present in a dormant focus, as occurs, for example, in tuberculosis.exogenous infection that caused by organisms not normally present in the body but which have gained entrance from the environment.mixed infection infection with more than one kind of organism at the same time.nosocomial infection see nosocomial infection.opportunistic infection infection by an organism that does not ordinarily cause disease but becomes pathogenic under certain circumstances, as when the patient is immunocompromised.pyogenic infection infection by pus-producing organisms, most commonly species of Staphylococcus or Streptococcus.risk for infection a nursing diagnosis accepted by the North American Nursing Diagnosis Association, defined as a state in which an individual is at increased risk for being invaded by pathogenic organisms.secondary infection infection by a pathogen following an infection by a pathogen of another kind.subclinical infection infection associated with no detectable symptoms but caused by microorganisms capable of producing easily recognizable diseases, such as poliomyelitis or mumps; this may occur in an early stage of the infection, with signs and symptoms appearing later during the course of the infection, or the symptoms and signs may never appear. It is detected by the production of antibody, or by delayed hypersensitivity exhibited in a skin test reaction to such antigens as tuberculoprotein.terminal infection an acute infection occurring near the end of a disease and often causing death.urinary tract infection see urinary tract infection.vector-borne infection infection caused by microorganisms transmitted from one host to another by a carrier, such as a mosquito, louse, fly, or tick.waterborne infection infection by microorganisms transmitted in water.

urinary

[u´rĭ-ner″e] 1. pertaining to urine.2. containing or secreting urine.urinary tract infection (UTI) infection in the tract" >urinary tract; types are named for the part of the tract involved, such as urethritis, cystitis, ureteritis, pyelonephritis, and glomerulonephritis. It is more common in women than in men because of the relative shortness of the female urethra" >urethra. Men over the age of 50 are more susceptible because of enlargement of the prostate and urinary stasis. Symptoms include dysuria, malaise, nausea, urinary frequency and urgency, and nocturia. There also may be a feeling of suprapubic fullness not relieved by urination. If the infection is higher in the urinary tract, in the ureters or kidney, there can be lower back pain or genital pain.

Factors that contribute to infection of the urinary tract include structural defects and systemic disorders that interfere with the free flow of urine. Examples include congenital disorders, neuromuscular disease or spinal cord injury, and renal stones. Infectious agents that cause sexually transmitted diseases can also invade the urinary tract. Moreover, urinary tract infection is a constant threat and a major cause of morbidity in patients with indwelling catheters.
Antimicrobial drugs are prescribed for treatment of urinary tract infection. Some drugs such as trimethoprim and sulfamethoxazole combinations (Bactrim or Septra), or kanamycin, can be given in a single dose, while others may be prescribed in one- to three-day doses or over a longer period of time.Patient Care. Prevention of recurrence is a major goal in the care of patients with UTI. Increased intake of fluids is encouraged to increase the force of the stream of urine and facilitate removal of microorganisms and debris. Patients are taught to urinate at first urge rather than postponing emptying the bladder. Women should know that it is important to keep the perineal area clean and that all wiping motions should be from front to back to avoid transporting fecal bacteria to the urinary meatus. Any vaginitis should be treated promptly and effectively to reduce the risk of spreading infection from the vagina to the urinary tract.

Other measures are related to control or management of underlying systemic or structural disorders, meticulous catheter care for patients with an indwelling catheter, and prevention and treatment of sexually transmitted diseases.

u·ri·nar·y tract in·fec·tion (UTI),

microbial infection, usually bacterial, of any part of the urinary tract; may involve the parenchyma of the kidney, the renal pelvis, the ureter, the bladder, the urethra or combinations of these organs. Often, the entire urinary tract is affected; the most common organism causing such infection is Escherichia coli.

urinary tract infection

Infection of the kidney, ureter, bladder, or urethra Epidemiology Affects ± 7 million/yr, often young ♀ with acute uncomplicated pyelonephritis or cystitis, or recurrent cystitis, and adults with asymptomatic bacteruria or with complicated UTI Epidemiology Common in young, sexually active ♀, often associated with sexual intercourse, use of a diaphragm with a spermicide, Hx of recurrent UTIs Clinical Dysuria, burning, ↑ frequency, urgency Lab Leukocyte esterase + by dipstick, 102–105 colony-forming U/mL Microbiology E coli–± 80%, Staphylococcus saprophyticus, Proteus mirabilis, K pneumoniae Treatment Oral T-S, norfloxacin, ciprofloxacin

u·ri·nar·y tract in·fec·tion

(UTI) (yūr'i-nar-ē trakt in-fek'shŭn) Microbial infection, usually bacterial, of any part of the urinary tract.

Urinary Tract Infection

DRG Category:	689
Mean LOS:	5.5 days
Description:	MEDICAL: Kidney and Urinary Tract Infections With Major CC

Urinary tract infections (UTIs) are common and usually occur because of the entry of bacteria into the urinary tract at the urethra. Approximately 20% to 25% of women have a UTI sometime during their lifetime, and acute UTIs account for approximately 7 million healthcare visits per year for young women. About 20% of women who develop a UTI experience recurrences. Women are more prone to UTIs than men because of natural anatomic variations. The female urethra is only about 1 to 2 inches in length, whereas the male urethra is 7 to 8 inches long. The female urethra is also closer to the anus than the male urethra, increasing women’s risk for fecal contamination. The motion during sexual intercourse also increases the female’s risk for infection.

Urinary reflux is one reason that bacteria spread in the urinary tract. Vesicourethral reflux occurs when pressure increases in the bladder from coughing or sneezing and pushes urine into the urethra. When pressure returns to normal, the urine moves back into the bladder, taking with it bacteria from the urethra. In vesicoureteral reflux, urine flows backward from the bladder into one or both of the ureters, carrying bacteria from the bladder to the ureters and widening the infection. If they are left untreated, UTIs can lead to chronic infections, pyelonephritis, and even systemic sepsis and septic shock. If infection reaches the kidneys, permanent renal damage can occur, which leads to acute and chronic renal failure.

Causes

The pathogen that accounts for about 90% of UTIs is Escherichia coli. Other organisms that are commonly found in the gastrointestinal tract and may contaminate the genitourinary tract include Enterobacter,Pseudomonas, group B beta-hemolytic streptococci, Proteus mirabilis,Klebsiella species, and Serratia. Two growing causes of UTIs in the United States are Staphylococcus saprophyticus and Candida albicans.

Predisposing factors are urethral damage from childbirth, catheterization, or surgery; decreased frequency of urination; other medical conditions such as diabetes mellitus; and, in women, frequent sexual activity and some forms of contraceptives (poorly fitting diaphragms, use of spermicides).

Genetic considerations

Increased susceptibility to UTIs has been observed in women and female children who have no anatomic predisposing factors, making genetic contributions suspect. Incidence of UTIs among first-degree female relatives has been reported to be 50% higher than in nonrelatives. In some families, the predisposition has suggested a dominantly inherited trait determined by a single gene, while in others, recessive or polygenic inheritance seems more likely.

Gender, ethnic/racial, and life span considerations

UTIs are uncommon in children. The largest group of individuals with UTI is adult women, and the incidence increases with age. Once young and adult women become sexually active, the incidence of UTI increases dramatically. UTIs are common during pregnancy and are caused by the hormonal changes and urinary stasis that result from ureteral dilation. Men secrete prostatic fluid that serves as an antibacterial defense, particularly during their teen and early adulthood years. As men age past 50, however, the prostate gland enlarges, which increases the risk for urinary retention and infection. As women age, vaginal flora and lubrication change; decreased lubrication increases the risk of urethral irritation in women during intercourse. By age 70, prevalence is similar for men and women. There are no known ethnic and racial considerations.

Global health considerations

In men living in developed nations, the incidence is comparable to that in the United States, but in developing nations with a shorter life expectancy, rates are lower than in the United States. Urinary tract infections in both developed and developing nations are extremely common in women.

Assessment

History

The patient with a UTI has a variety of symptoms that range from mild to severe. The typical complaint is of one or more of the following: frequency, burning, urgency, nocturia, blood or pus in the urine, and suprapubic fullness. If the infection has progressed to the kidney, there may be flank pain (referred to as costovertebral tenderness) and low-grade fever.

Question the patient about risk factors, including recent catheterization of the urinary tract, pregnancy or recent childbirth, neurological problems, volume depletion, frequent sexual activity, and presence of a sexually transmitted infection (STI). Ask the patient to describe current sexual and birth control practices because poorly fitting diaphragms, the use of spermicides, and certain sexual practices such as anal intercourse place the patient at risk for a UTI.

Physical examination

Physical examination is often unremarkable in the patient with a UTI, although some patients have costovertebral angle tenderness in cases of pyelonephritis. On occasion, the patient has fever, chills, and signs of a systemic infection. Inspect the urine to determine its color, clarity, odor, and character. Surveillance for STIs is recommended as part of the examination.

Psychosocial

UTIs rarely result in disruption of the patient’s normal activities. The infection is generally acute and responds rapidly to antibiotic therapy. The general guidelines to increase fluid intake and concomitant frequent urination may be problematic for some patients in restrictive work environments. The accompanying discomfort may result in temporary restriction of sexual activity, especially if an STI is diagnosed.

Diagnostic highlights

General Comments: UTIs are very easy to diagnose; follow-up testing demonstrates the effectiveness of treatment.

Test	Normal Result	Abnormality With Condition	Explanation
Leukocyte esterase dip test	Negative	Positive (purple shade)	Presence of leukocyte esterase indicates UTI; 90% accurate in detecting white blood cells (WBCs) in the urine
Urine culture and sensitivity	< 10,000 bacteria/mL	> 10,000 bacteria/mL or > 100 in acutely symptomatic patients	Identifies causative organism; determines appropriate antibiotic
Urinalysis	WBCs: 0–4; red blood cells (RBCs): ≤ 2; nitrites: none; pH: 4.6–8; no crystals; clear, aromatic	Increased WBCs, RBCs, pH, nitrites, crystals; cloudy, odor present	Presence of bacteria in the urine is indicated by several changes noted in a urinalysis

Other Tests: Voiding cystoureterography may detect congenital anomalies that predispose patients to recurrent UTI; dynamic computed tomography.

Primary nursing diagnosis

Diagnosis

Altered urinary elimination related to infection

Outcomes

Urinary elimination; Knowledge: Medication, Symptom control

Interventions

Medication prescribing; Urinary elimination management

Planning and implementation

Collaborative

An acid-ash diet may be encouraged. A diet of meats, eggs, cheese, prunes, cranberries, plums, and whole grains can increase the acidity of the urine. Foods not allowed on this diet include carbonated beverages, anything containing baking soda or powder, fruits other than those previously stated, all vegetables except corn and lentils, and milk and milk products. Because the action of some UTI medications is diminished by acidic urine (nitrofurantoin), review all prescriptions before instructing patients to follow this diet.

UTIs are treated with antibiotics specific to the invading organism. Usually, a 7- to 10-day course of antibiotics is prescribed, but shortened and large single-dose regimens are currently under investigation. Most elderly patients need a full 7- to 10-day treatment, although caution is used in their management because of the possibility of diminished renal capacity. Women being treated with antibiotics may contract a vaginal yeast infection during therapy; review the signs and symptoms (cheesy discharge and perineal itching and swelling) and encourage the woman to purchase an over-the-counter antifungal or to contact her primary healthcare provider if treatment is indicated.

Pharmacologic highlights

Medication or Drug Class	Dosage	Description	Rationale
Cephalosporins	Varies with drug	Ceftriaxone (Rocephin), cephalexin monohydrate (Keflex)	Bacteriocidal
Ciprofloxacin (Cipro)	250–500 mg PO bid	Quinolone	Bacteriocidal
Sulfisoxazole (Gantrisin)	Initially 2–4 g PO, then 1–2 g qid for 10–14 days	Anti-infective, sulfonamide	Bacteriocidal
Cotrimoxazole (Bactrim, Septra)	160 mg q 12 hr for 7–14 days	Anti-infective, sulfonamide	Bacteriocidal
Nitrofurantoin (Macrodantin)	50–100 mg PO qid for 10–14 days	Urinary antiseptic	Bacteriocidal; concentrates in the urine and kidneys to kill bacteria
Phenazopyridine (Pyridium)	100–200 mg PO tid until pain subsides	Urinary analgesic	Relieves pain

Other Drugs: Tobramycin (Nebcin), Ertapenem (Invanz), amoxicillin/clavulanate (Augmentin)

Independent

Encourage patients with infections to increase fluid intake to promote frequent urination, which minimizes stasis and mechanically flushes the lower urinary tract. Strategies to limit recurrence include increasing vitamin C intake, drinking cranberry juice, wiping from front to back after a bowel movement (women), regular emptying of the bladder, avoiding tub and bubble baths, wearing cotton underwear, and avoiding tight clothing such as jeans. These strategies have been beneficial for some patients, although there is no research that supports the efficacy of such practices.

Encourage the patient to take over-the-counter analgesics unless contraindicated for mild discomfort but to continue to take all antibiotics until the full course of treatment has been completed. If the patient experiences perineal discomfort, sitz baths or warm compresses to the perineum may increase comfort.

Evidence-Based Practice and Health Policy

Chant, C., Smith, O.M., Marshall, J.C., & Friedrich, J.O. (2011). Relationship of catheter-associated urinary tract infection to mortality and length of stay in critically ill patients: A systematic review and meta-analysis of observational studies. Critical Care Medicine, 39(5), 1167–1173.

Results of a meta-analysis of 11 studies comparing 2,745 critically ill patients with a catheter-associated urinary tract infection (CAUTI) to 60,719 patients critically ill patients without a CAUTI revealed an increased mortality risk by nearly double among patients with a CAUTI (95% CI, 1.72 to 2.31; p < 0.00001).
Patients with a CAUTI experienced an increased length of stay in an intensive care unit by a mean of 12 days (95% CI, 9 to 15; p < 0.00001) and an increased hospital length of stay by a mean of 21 days (95% CI, 11 to 32; p < 0.0001).

Documentation guidelines

Physical response: Pain, burning on urination, urinary frequency; vital signs; nocturia; color and odor of urine; patient history that may place the patient at risk
Location, duration, frequency, and severity of pain; response to medications
Absence of complications such as pyelonephritis

Discharge and home healthcare guidelines

Treatment of a UTI occurs in the outpatient setting. Teach the patient an understanding of the proposed therapy, including the medication name, dosage, route, and side effects. Explain the signs and symptoms of complications such as pyelonephritis and the need for follow-up before leaving the setting.

Explain the importance of completing the entire course of antibiotics even if symptoms decrease or disappear. If the patient experiences gastrointestinal discomfort, encourage the patient to continue taking the medications but to take them with a meal or milk unless contraindicated. Warn the patient that drugs with phenazopyridine turn the urine orange.

u·ri·nary tract in·fec·tion

(UTI) (yūr'i-nar-ē trakt in-fek'shŭn) Microbial infection, usually bacterial, of any part of the urinary tract.

Patient discussion about urinary tract infection

Q. How to prevent getting a bladder infection? I am worried about getting another bladder infection like I just had now. I am during my second trimester. How can I avoid getting it again?A. drink more cranberry juice,its 100% natural, and wont harm the baby in anyway.

More discussions about urinary tract infection

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urinary

u·ri·nar·y tract in·fec·tion (UTI),

urinary tract infection

u·ri·nar·y tract in·fec·tion

Urinary Tract Infection

Causes

Genetic considerations

Gender, ethnic/racial, and life span considerations

Global health considerations

Assessment

History

Physical examination

Psychosocial

Diagnostic highlights

Primary nursing diagnosis

Diagnosis

Outcomes

Interventions

Planning and implementation

Collaborative

Pharmacologic highlights

Independent

Evidence-Based Practice and Health Policy

Documentation guidelines

Discharge and home healthcare guidelines

u·ri·nary tract in·fec·tion

Patient discussion about urinary tract infection

urinary tract infection

Words related to urinary tract infection

noun any infection of any of the organs of the urinary tract

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