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URINARY TRACT INFECTION
DHANYA K CHANDRAN
MSc NURSING
DEFINITION
Lower Urinary tract infection also known
as cystitis, inflammation of the bladder
wall, usually caused by ascending bacteria
or obstructive voiding patterns that lead to
decreased flow or stasis of urine.
URINARY TRACT INFECTION
 5 types
Women with acute uncomplicated cystitis
Women with recurrent cystitis
Women with acute uncomplicated
pyelonephritis
Complicated UTI
Asymptomatic bacteriuria
COMPLICATED UTI
UTI that increases the risk for serious
complications or treatment failure.
They diagnosed only after a patient has
a poor response to treatment.
ASYMPTOMATIC BACTERIURIA
The presence of two separate
consecutive clean voided urine
specimens, both with 105 or more
colony forming units per
milliliter(cfu/ml) of the same uro
pathogen in the absence of symptoms
referable to the urinary tract.
EPIDEMIOLOGY
 Acute uncomplicated UTIs are extremely
common, with several million episodes of acute
cystitis and atleast 250,000 episodes of acute
pyelonephritis in US.
 The incidence of cystitis in sexually active young
women is about 0.5 per 1 person year.
 Acute uncomplicated cystitis may recur in 27-
44% of healthy women.
Contd…
 Pyelonephritis in young women is about 3
per 1000 person-years.
 Symptomatic UTI in post menopausal
women is about 10% per year.
 Symptomatic UTI in adult men younger
than 50 years is much lower than in
women, ranging from 5-8 per 10,000 men
annually.
ETIOLOGY
 Acute complicated cystitis
 Recurrent acute uncomplicated cystitis in healthy women
 Acute uncomplicated pyelonephritis in healthy women
 Complicated urinary tract infection
Male sex
Pregnancy
Poorly controlled diabetes mellitus
Obstruction or other structural factor, Urolithiasis, Malignancies,
ureteral and urethral strictures. bladder diverticula, renal cysts, fistulas,
ileal conduits, other urinaly diversions
 Functional abnormahty: Neurogenic bladder ,vesicoureteral reflux
Contd…
 Foreign bodies: Indwelling catheter, ureteral
stent. Nephrostomy tube
 Other conditions- Renafailure , renal
transplantation, immosuppression, multi drug
resistant uropathogens health care
associated(includes hospital acquired infection),
prostatitis related infection. upper tract
infection in an adult other than a healthy
women other functional or anatomic
abnormality of urinary tract
 Asmptomatic bacteriuria
ETIOLOGICAL AGENTS
Organisms Uncomplicate
d
Complicate
d
GRAM NEGATIVE ORGANISMS
%
Escherichia coli 70-95 21-54
Proteus mirabilis 1-2 1-10
Klebsiella saprophyticus 1-2 2-17
Citrobacter spp <1 5
Enterobacter spp <1 2-10
Psuedomonas aeruginosa <1 2-19
Other <1 6-20
GRAM POSITIVE ORGANISMS
Coagulase negative
staphylococci
5-20 or more 1-4
Enterococci 1-2 1-23
Group B streptococci <1 1-4
Staphylococcus aureus <1 1-2
PATHOPHYSIOLOGY
CLINICAL MANIFESTATIONS
 Dysuria
 Frequency, urgency
 Dribbling of urine or innability to void
 Incomplete emptying of bladder
 Cloudy urine
 Haematuria
 Suprapubic tenderness
 Chills and sweats, Fever
 Flank pain (may radiate to groin, often dull
and constant)
DIAGNOSTIC EVALUATION
DIAGNOSTIC EVALUATION
 Urine dipstick test
 Nitrite: positive due to bacterial reduction of
endogenous nitrates to nitrites; classically
positive in Gram
negative Enterobacteriaceae family of enteric
uropathogens. However, nitrite dipstick may
also be clinically useful in
detecting Enterococcus and
Staphylococcus bacteria.
 Leukocyte esterase: positive as neutrophil
granules contain enzymes with esterase
activity; presence of neutrophils in urine due
to inflammation and leukocyte migration into
the urinary tract.
MANAGEMENT
 Trimethoprim-sulfamethoxazole
◦Inhibition of microbial DNA synthesis by
inhibiting the folic acid synthesis and
consequently the purines required for DNA
Eg: Bactrim, Septra
 Fluoroquinolones
◦Inhibition of microbial DNA synthesis by
blocking DNA gyrase and topoisomerase IV
needed for successful DNA replication and
transcription.
Eg:Ciprofloxacin, Levofloxacin, Ofloxacin
Contd….
 Nitrofurantoin
◦ The mechanism is not fully understood, but it directly causes
selective damage to microbial DNA, which metabolises the toxic
intermediates of nitrofurantoin more rapidly than human cells.
Eg: Macrobid
 Cefpodoxime proxetil
Cefpodoxime is a bactericidal agent that acts by inhibition of
bacterial cell wall synthesis. Cefpodoxime has activity in the
presence of some beta-lactamases, both penicillinases and
cephalosporinases, of Gram-negative and Gram-positive
Eg: Cefoprox, Cefcep
Contd…
 Amoxicillin- clavulanate
 Cefixime
 Cefaclor
NURSING MANAGEMENT
1. Impaired urinary elimination related to
irritation and inflammation of the
bladder mucosa
2. Acute pain related to irritation and
inflammation of bladder and urethral
mucosa
3. Knowledge deficit related to unfamiliarity
with nature and treatment of UTI as
evidenced by multiple questions and
verbalizing inaccurate information
4. Disturbed sleep Pattern related to
nocturia, pain as evidenced by
restlessness, irritability
Contd…
5. Hyperthermia related to inflammation as
evidenced by increased body temperature
and flushed skin,warm to touch
COMPLICATIONS
a) Recurrent UTIs occurring at least twice in six
months or four times in a year, most commonly
in women.
b) Urethral narrowing (stricture) in men with
recurrent infections15
c) Increased risk of preterm birth and low birth
weight in pregnancy.
d) Permanent kidney damage.
e) Sepsis (a potentially life-threatening, whole-
body inflammatory response caused by a
severe infection)
Urinary tract infection

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Urinary tract infection

  • 1. URINARY TRACT INFECTION DHANYA K CHANDRAN MSc NURSING
  • 2.
  • 3. DEFINITION Lower Urinary tract infection also known as cystitis, inflammation of the bladder wall, usually caused by ascending bacteria or obstructive voiding patterns that lead to decreased flow or stasis of urine.
  • 4. URINARY TRACT INFECTION  5 types Women with acute uncomplicated cystitis Women with recurrent cystitis Women with acute uncomplicated pyelonephritis Complicated UTI Asymptomatic bacteriuria
  • 5. COMPLICATED UTI UTI that increases the risk for serious complications or treatment failure. They diagnosed only after a patient has a poor response to treatment.
  • 6. ASYMPTOMATIC BACTERIURIA The presence of two separate consecutive clean voided urine specimens, both with 105 or more colony forming units per milliliter(cfu/ml) of the same uro pathogen in the absence of symptoms referable to the urinary tract.
  • 7. EPIDEMIOLOGY  Acute uncomplicated UTIs are extremely common, with several million episodes of acute cystitis and atleast 250,000 episodes of acute pyelonephritis in US.  The incidence of cystitis in sexually active young women is about 0.5 per 1 person year.  Acute uncomplicated cystitis may recur in 27- 44% of healthy women.
  • 8. Contd…  Pyelonephritis in young women is about 3 per 1000 person-years.  Symptomatic UTI in post menopausal women is about 10% per year.  Symptomatic UTI in adult men younger than 50 years is much lower than in women, ranging from 5-8 per 10,000 men annually.
  • 9.
  • 10.
  • 11. ETIOLOGY  Acute complicated cystitis  Recurrent acute uncomplicated cystitis in healthy women  Acute uncomplicated pyelonephritis in healthy women  Complicated urinary tract infection Male sex Pregnancy Poorly controlled diabetes mellitus Obstruction or other structural factor, Urolithiasis, Malignancies, ureteral and urethral strictures. bladder diverticula, renal cysts, fistulas, ileal conduits, other urinaly diversions  Functional abnormahty: Neurogenic bladder ,vesicoureteral reflux
  • 12. Contd…  Foreign bodies: Indwelling catheter, ureteral stent. Nephrostomy tube  Other conditions- Renafailure , renal transplantation, immosuppression, multi drug resistant uropathogens health care associated(includes hospital acquired infection), prostatitis related infection. upper tract infection in an adult other than a healthy women other functional or anatomic abnormality of urinary tract  Asmptomatic bacteriuria
  • 13. ETIOLOGICAL AGENTS Organisms Uncomplicate d Complicate d GRAM NEGATIVE ORGANISMS % Escherichia coli 70-95 21-54 Proteus mirabilis 1-2 1-10 Klebsiella saprophyticus 1-2 2-17 Citrobacter spp <1 5 Enterobacter spp <1 2-10 Psuedomonas aeruginosa <1 2-19 Other <1 6-20 GRAM POSITIVE ORGANISMS Coagulase negative staphylococci 5-20 or more 1-4 Enterococci 1-2 1-23 Group B streptococci <1 1-4 Staphylococcus aureus <1 1-2
  • 15. CLINICAL MANIFESTATIONS  Dysuria  Frequency, urgency  Dribbling of urine or innability to void  Incomplete emptying of bladder  Cloudy urine  Haematuria  Suprapubic tenderness  Chills and sweats, Fever  Flank pain (may radiate to groin, often dull and constant)
  • 17. DIAGNOSTIC EVALUATION  Urine dipstick test  Nitrite: positive due to bacterial reduction of endogenous nitrates to nitrites; classically positive in Gram negative Enterobacteriaceae family of enteric uropathogens. However, nitrite dipstick may also be clinically useful in detecting Enterococcus and Staphylococcus bacteria.  Leukocyte esterase: positive as neutrophil granules contain enzymes with esterase activity; presence of neutrophils in urine due to inflammation and leukocyte migration into the urinary tract.
  • 18. MANAGEMENT  Trimethoprim-sulfamethoxazole ◦Inhibition of microbial DNA synthesis by inhibiting the folic acid synthesis and consequently the purines required for DNA Eg: Bactrim, Septra  Fluoroquinolones ◦Inhibition of microbial DNA synthesis by blocking DNA gyrase and topoisomerase IV needed for successful DNA replication and transcription. Eg:Ciprofloxacin, Levofloxacin, Ofloxacin
  • 19. Contd….  Nitrofurantoin ◦ The mechanism is not fully understood, but it directly causes selective damage to microbial DNA, which metabolises the toxic intermediates of nitrofurantoin more rapidly than human cells. Eg: Macrobid  Cefpodoxime proxetil Cefpodoxime is a bactericidal agent that acts by inhibition of bacterial cell wall synthesis. Cefpodoxime has activity in the presence of some beta-lactamases, both penicillinases and cephalosporinases, of Gram-negative and Gram-positive Eg: Cefoprox, Cefcep
  • 21. NURSING MANAGEMENT 1. Impaired urinary elimination related to irritation and inflammation of the bladder mucosa 2. Acute pain related to irritation and inflammation of bladder and urethral mucosa 3. Knowledge deficit related to unfamiliarity with nature and treatment of UTI as evidenced by multiple questions and verbalizing inaccurate information 4. Disturbed sleep Pattern related to nocturia, pain as evidenced by restlessness, irritability
  • 22. Contd… 5. Hyperthermia related to inflammation as evidenced by increased body temperature and flushed skin,warm to touch
  • 23. COMPLICATIONS a) Recurrent UTIs occurring at least twice in six months or four times in a year, most commonly in women. b) Urethral narrowing (stricture) in men with recurrent infections15 c) Increased risk of preterm birth and low birth weight in pregnancy. d) Permanent kidney damage. e) Sepsis (a potentially life-threatening, whole- body inflammatory response caused by a severe infection)