URINARY

TRACT
INFECTION

BSN112
• UTI is a bacterial infection that affects any part of the urinary tract.

•The urinary tract is the system that makes urine and carries it out of
your body. It includes your bladder and kidneys and the tubes that
connect them. When germs get into this system, they can cause an
infection.

• It can affect not only the urethra and the bladder, but also ascend up
into the kidneys

•Urinary tract infections are common sexually transmited disease in

woman.

•Women are more prone to because the urethra is shorter in women

than in men, so bacteria have a shorter distance to travel.

BSN112
 Types of Urinary Tract Infection
 Bladder Infection (Cystitis or lower tract infections)

 Bladder infections are infections that are limited to the bladder. They are
much more common than kidney infections and usually are less serious.

 Symptoms:
 lower abdominal pain(over the bladder
 pain, burning, or stinging on urination (dysuria)
 frequent urination (frequency)
 urgent need to pee (urgency).

BSN112
Types of Urinary Tract Infection
 Urethritis

 Urethritis is the irritation of the urethra, and is considered

to be a kind of lower-tract infection. It usually is caused
by irritants such as stool, soap (especially those
containing perfumes), bubble bath, or shampoo in
prepubescent girls, and may be due to sexually
transmitted diseases such as Chlamydia and gonorrhea
in adolescent males and females.

 Like cystitis, it causes pain with urination (dysuria),

frequency, and urgency.

BSN112
Types of Urinary Tract Infection
 Kidney Infection ( Pyelonephritis or uppre tract infection)

 Kidney infections are infections of the ureters and the tissues of

the kidney itself. These infections are less common, but usually
more serious, than those of the lower tract.

 Symptoms:
 high fever and more severe disease (including bloodstream infection-
or sepsis-and even shock in some cases).
 They also are more likely to lead to permanent kidney scarring and
other complications such as high blood pressure (hypertension).

BSN112
Stages of Urinary Tract Infection
1st Stage
(Urethral Infection)

2nd Stage
(Bladder infection)

3rd Stage
(Kidney Infection)

BSN112
CAUSE
 The urine is normally sterile. An infection occurs when bacteria get
into the urine and begin to grow. The infection usually starts at the
opening of the urethra where the urine leaves the body and moves
upward into the urinary tract.

 Escherichia coli, ( E. coli) -these bacteria normally live in the

bowel (colon) and around the anus.

 -The two most common causes of this are poor hygiene and sexual
intercourse

Etiology
 Commensal colonic gram-negative aerobic bacteria cause most
bacterial UTIs. The remaining gram-negative urinary pathogens are
other enterobacteria, especially Klebsiella , Proteus mirabilis, and
Pseudomonas aeruginosa. Enterococci (group D streptococci) and
coagulase-negative staphylococci (eg, Staphylococcus saprophyticus)
are the most frequently implicated gram-positive organisms.

BSN112
UTI Risk Factors
 Gender (women are more likely to have urinary tract infections
than men are)
 Urinary tract problems (such as an enlarged prostate or
kidney stones)
 Sexual intercourse
 Certain habits (such as waiting too long to pass urine)
 Urinary catheter
 Age (elderly people are more likely to develop a UTI)
 Medical conditions (such as diabetes, sickle cell anemia, and
vesicoureteral reflux)
 Immunosuppressant medications
 Urinary tract abnormalities
 Diaphragms or spermicidal foam
 Menopause
 Skin allergies to soaps and cleansers used in the vaginal area.

BSN112
The following special groups may be
at increased risk of urinary tract
infection:

 Very young infants

 Young children

 Children of all ages

 Hospitalized patients or nursing home residents:

○ Many of these individuals are catheterized for long
periods and are thus vulnerable to infection of the urinary
tract.

BSN112
Pathophysiology
 The urinary tract, from the kidneys to the urethral meatus, is
normally sterile and resistant to bacterial colonization despite
frequent contamination of the distal urethra with colonic bacteria.

 Mechanisms that maintain the tract's sterility include:

○ urine acidity
○ emptying of the bladder at micturition
○ ureterovesical and urethral sphincters
○ and various immunologic and mucosal barriers.
 Complicated UTI
 is considered to be present when there are underlying factors that predispose to
ascending bacterial infection. Predisposing factors include urinary instrumentation
(eg, catheterization, cystoscopy), anatomic abnormalities, and obstruction of urine
flow or poor bladder emptying.

BSN112
Pathophysiology
 A common consequence of anatomic abnormality is
vesicoureteral reflux (VUR), which is present in 30 to 45% of
young children with symptomatic UTI. VUR is usually caused by a
congenital defect that results in incompetence of the ureterovesical
valve.
 Other anatomic abnormalities predisposing to UTI include
urethral valves (a congenital obstructive abnormality), delayed
bladder neck maturation, bladder diverticulum, and urethral
duplications. Urine flow can be compromised by calculi and
tumors.
 Bladder emptying can be impaired by neurogenic, pregnancy,
uterine prolapse, cystocele, and prostatic enlargement. UTI
caused by congenital factors presents most commonly in
childhood. Most other factors are more common in the elderly.


BSN112
Pathophysiology
 Uncomplicated UTI
 Occurs without underlying abnormality or impairment of urine flow.
 It is most common in young women but also somewhat common in younger men who
have unprotected anal intercourse, an uncircumcised penis, unprotected intercourse
with a woman whose vagina is colonized with urinary pathogens, or AIDS.
 Risk factors in women include:
○ sexual intercourse
○ Diaphragm
○ spermicide use
○ antibiotic use
○ history of recurrent UTIs
○ use of spermicide-coated condoms
 The increased risk of UTI in women using antibiotics or spermicides probably occurs because of
alterations in vaginal flora that allow overgrowth of Escherichia coli.

BSN112
Diagnostic Exam
 Diagnostic exams:
 Urinalysis
 Sometimes urine culture
 Urine collection: If a sexually transmitted disease (STD) is
suspected, a urethral swab for STD testing is obtained prior to
voiding. Urine collection is then by clean-catch or catheterization.
 To obtain a clean-catch, midstream-voided specimen -- the first
5 mL of urine is not captured; the NEXT 5 to 10 mL is collected
in a sterile container.
 Urine testing-microscopic examination of urine is useful but not
definitive.
 Dipstick tests also are commonly used. A positive nitrite test on a
freshly voided specimen (bacterial replication in the container
renders results unreliable if the specimen is not tested rapidly) is
highly specific for UTI, but the test is not very sensitive.

BSN112
Diagnostic Exam
 Cultures - are recommended when symptoms are suggestive but
urinalysis is nondiagnostic
 for complicated UTI (including UTI in patients with diabetes,
immunosuppression, recent hospitalization or urethral
instrumentation, or recurrent UTI; for patients > 65 yr; and perhaps
for patients with symptoms of pyelonephritis)
 All prepubertal children should have a urine culture when a UTI is
suspected
 Urine should be cultured as soon as possible or stored at 4° C if a
delay of > 10 min is expected.
 Infection localization-clinical differentiation between upper and lower
UTI is impossible in many patients, and testing is not usually
advisable.
 The best noninvasive technique for differentiating bladder from
kidney infection appears to be the response to a short course of
antibiotic therapy. If the urine has not cleared after 3 days of
treatment, pyelonephritis should be checked for.

BSN112
Diagnostic Exam
 Other testing: Seriously ill patients require evaluation for sepsis,
typically with CBC, electrolytes, BUN, creatinine, and blood
cultures. Patients with abdominal pain or tenderness are
evaluated for other causes of an acute abdomen. Pyuria without
bacteriuria can be present with appendicitis, inflammatory bowel
disease, and other extrarenal disorders.

BSN112
UTI: MEDICAL
MANAGEMENT
 Inhibit Bacterial Growth
To promote comfort and decrease complications,
broad-spectrum antibiotics typically begin before the culture
and sensitivity results are known.

 Modify Diet
Certain foods are known to irritate the bladder, such
as caffeine, alcohol, tomatoes, spicy food, chocolate, and
some berries. Client should be encouraged to avoid bladder
irritants during the acute phase of UTI.
Cranberry juice and ascorbic acid (vitamin C) have
been used to acidify the urine and help for prevention of
symptomatic UTIs.
UTI: MEDICAL MANAGEMENT
Increased fluid intake
To treat and prevent UTI, encourage
increased fluid intake, especially water, if the client
is not required to restrict fluids. The desired
amount is 3-4L/day. Increased fluids flush the
urinary system and are important in preventing
urolithiasis (urinary calculi, or stones).

Prevent Complications
Broad spectrum antibiotic therapy may
destroy normal flora in the body and allow an
overgrowth of opportunistic organisms. On
occasion, diarrhea, associated bowel problems, and
vaginal candidiasis may develop. Some antibiotics
may reduce the effectiveness of oral contraceptives
and estrogen, whereas sulfa drugs increase
sensitivity to the effects of the sun. Complications
can also occur if the infection is not completely
eradicated.
 UTI: Surgical Management
 The need for surgery is rare; operations are performed only to address
structural anomalies that cause repeated infections.

UTI: Nursing
Management
Administer prescribed medications, give adequate instructions to client
regarding antibiotic therapy

 Provide information about dietary changes needed to keep the urine

acidic and to reduce bladder irritation
Instruct client to eliminate fluids that increase urgency and frequency such
as caffeinated beverages and to increase the intake of other fluids to 3-
4L/day to flush the urinary system.

Instruct client on hygienic measures, including showering rather than

bathing, wiping from front to back after a bowel movement, and wearing
cotton underwear.

Encourage client to void every 2-3 hours during the day, making sure the
bladder is completely emptied.

Discuss the importance of follow up visits with the health care provider to
obtain urine culture and sensitivity after antibiotic therapy.