An 40 year old woman presented with complaints of painful urination, urgency, lower back pain and burning urination. Urine culture showed 105 colony-forming units/ml of bacteria. She was treated with an antibiotic (Trimethoprim–sulfamethoxazole) twice daily for 3 days and pain medication, which reduced her symptoms. Urinary tract infections are common and occur when bacteria or other microbes infect the urethra, bladder, ureters, or kidneys. Symptoms include painful urination and back pain. Diagnosis involves a urine test and culture. Treatment is usually a short course of antibiotics along with pain medication and hydration.

1. Case scenario….
An 40 yrs old woman came to hospital with complaints of painful
urination,urgency,lower back pain and burning micturition.Urine culture
indicates 105colony- forming units/ml. She was treated with
Trimethoprim–sulfamethoxazole 1 tablet (160 mg trimethoprim–800 mg
sulfamethoxazole) twice daily for 3 days and some pain medication
were given..And after the treatment her symptoms reduced.

2. URINARY TRACT
INFECTIONS
Moderator: Ms.Manju
Lecturer,CON,AIIMS
Presenter,
Jiya Maria Thomas
MSc Nsg 1 st year

3. OBJECTIVES
At the end of the class students should be able to :
 Define UTI
 Enlist the etiology of UTI
 Understand the pathogenesis.
 Enlist the risk factors of UTI.
 Enlist the symptoms of UTI.
 Understand different diagnostic measures .
 Understand management of UTI.

4. INTRODUCTION
• UTI is the symptomatic presence of microorganisms within urinary
tract ie, kidney ,uretera,bladder and urethra.
• Associated with inflammation
of urinary tract.
• Associated with presence of more than 100 000
organism/ml in midstream sample of urine.

5. Normal mechanisms that maintain sterility of urine :
 Adequate urine volume
 Free-flow from kidneys through urinary meatus
 Complete bladder emptying
 Normal acidity of urine
 Peristaltic activity of ureters and competent ureterovesical junction
 In males, antibacterial effect of zinc in prostatic fluid

6. ETIOLOGY
BACTERIA VIRUSES FUNGI PROTOZOA
 E.Coli
 Klebsiella
 Proteus
 Streptococcus
 Enterococcus faecalis
 Pseudomonas
 Staphylococcus
(saprophyticus/epidermidis)
 Rubella
 Mumps
 HIV
 Herpes
 Candida
 Histoplasma
 T.Vaginalis
 S.Hematobium

7. RISK FACTORS…
• In females-
-short uretha,
-sexual intercourse
-poor hygiene
- Altered vaginal pH during pregnancy
& post menopause.
-Barrier Contraceptives
-Allergens & irritants

8. RISK FACTORS
 Inability or failure to empty the bladder completely
• Obstructed urinary flow because of….
• Congenital anomalies
• Strictures
• Bladder tumors
• Calculi
• Compression of the ureters

9. RISK FACTORS…
• Decreased host defences or immunosuppression.
• Instrumentation of urinary tract.
• Ageing
• Contributing conditions –DM, pregnancy,
neurologic disorders, & urinary stasis.

10. PATHOGENISIS
• Four well recognised routes are…
1.Ascending Infection
2.Hematogenous spread
3.Direct extension from another organ.
4. Lymphatogenous spread

11. • Ascending infection
• Most common route.
• Organism ascend through
urethra into bladder.
Organism
Colonize in perineal
and periurethral areas
Ascend into the
bladder
UTI

12. • Hematogenous spread
• Blood borne spread to kidney.
• Occurs in bacteraemia.
• Mostly S.aureus.

13. • Lymphatogenous spread
Men through rectal and colonic lymphatic vessels to prostate and
bladder.
Women through periuterine lymphatic to urinary tract.
• Direct extension from other organ
PID
Genito urinary tract fistula

14. CLASSIFICATION
UTI
Prostatitis pyelonephritis(acute/chronic)
Cystistis Ureteritis
Urethritis Renal and peri renal abscess
Lower Upper

15. LOWER UTI

16. LOWER UTI
• URETHRITIS: Inflammation of the urethra with bacteria (or with
protozoa, viruses, or fungi) .
• CYSTITIS:
It is an inflammation of bladder.
• PROSTATITIS:
Inflammation of prostate gland.

17. MANIFESTATIONS OF LOWER UTI
 Frequent urination
 Pain in the midline,
suprapubic region, back pain.
 Nocturia
 Urethritis
• Pyuria
• Hematuria
• Pyrexia
 Cloudy and foul-smelling urine

18. UPPER UTI

19. UPPER UTI
• 1.PYELONEPHRITIS: is an exudative purulent localized inflammation of
the renal pelvis (collecting system) and kidney.
• 2.RENAL ABSCESS: These condition are suppurative infections
localized either within the Parenchyma of the kidney ( intarenal
abscess) .
• 3.URETERITIS: Inflammation of ureter,commonly associated with
pyelonephritis.

20. MANIFESTATIONS OF UPPER UTI
• Back pain or flank pain
• Severe abdominal pain (occurs occasionally)
• Fatigue
• Fever with Chills
• General ill feeling
• Mental changes or confusion*

21. MANIFESTATIONS OF UPPER UTI
• Skin changes
• Flushed or reddened skin
• Moist skin (diaphoresis)
• Urination problems
• Cloudy or abnormal urine color
• Foul or strong urine odor
• Increased urinary frequency or urgency
• nocturia
• Painful urination

22. DIAGNOSIS
1) Urinalysis
• Nitrite positive
• Leukocyte esterase positive
• Urine microscopy reveals presence of pyuria.
2)Urine culture:
≥105colony- forming units/ml =indicates an infection .
3) Cellular studies:
• Microscopic hematuria: >4 RBC’S

23. DIAGNOSIS
4) Rapid Diagnostic Method:
Multistrip dipstick testing
WBC’s
Protein
glucose
5) Gram Stain
6) Tests for STD’s

24. IMAGING
• Intravenous pyelogram (IVP)
• Cystoscopy
• Renal ultrasound
• Doppler studies
• CT scan

26. MANAGEMENT
• A mild urinary tract infection may go away on its own without
treatment.
• ANTIBIOTICS are usually recommended because there is a risk
that the infection can spread to the kidneys.
• Can be………..
1) SHORT TERM THERAPY(3-7days)
2) LONG TERM THERAPY( upto 6mths or yrs)

27. MANAGEMENT
Empirical therapy must be broad spectrum with definitive therapy based on
culture and sensitivity.
For uncomplicated acute bacterial cystitis,
• Trimethoprim–sulfamethoxazole: 1 tablet (160 mg trimethoprim–800 mg
sulfamethoxazole) twice daily for 3 days.

28. MANAGEMENT
• Ciprofloxacin 250 mg twice daily for 3 days, levofloxacin 250 mg
once daily for 3 days, norfloxacin 400 mg twice daily for 3 days, or
gatifloxacin 200 mg, once daily for 3 days.
• Nitrofurantoin macrocrystals 50 to 100 mg 4 times daily for 7 days, or
nitrofurantoin monohydrate 100 mg twice daily for 7 days.

29. Therapies that may help manage
symptoms include …
• Alpha blockers:
Include:
• Alfuzosin (uroxatral) and doxazosin (cardura).
• Common side effects include headaches and a decrease in blood
pressure.

30. Therapies that may help manage
symptoms include …
•Pain relievers
• Such as aspirin or ibuprofen (advil, motrin, others)
• Overuse of pain medication can cause serious side effects
• Abdominal pain,
• Intestinal bleeding or
• Ulcers.

31. LONG TERM TREATMENT
• INDICATED FOR:
• Recurrent UTI’s
• Pyelonephritis
• Other complicated UTI’s.
• Chronic UTI

32. • A urinary tract infection is considered chronic if any of the following
occur:
• The infection does not respond to usual treatment
• It lasts longer than 2 weeks
• It occurs more than
twice in 6 months

33. SURGICAL MANAGEMENT
If there is……..
• Obstruction
• Kidney stones
• Abscess
• Congenital abnormalities

34. NUTRITIONAL MANAGEMENT
• Stay hydrated .
• Increase flavonol intake(cranberry,plum,apple,berries)
• Consume food that contain probiotic bacteria(eg.fermented diary products)
• Food rich in vit A and betacarotene (eg.carrot,sweet potato,pumkin spinach).
• Avoid irritating foods ( alcohol,citrus fruits,caffeine,chocolate,spicy foods,
artifical sweetners,aged cheese etc).

35. PROGNOSIS
• A urinary tract infection is uncomfortable, but treatment is usually
successful.
• Symptoms of a bladder infection usually disappear within 24 - 48
hours after treatment begins.
• A kidney infection, it may take 1 week or longer for your symptoms to
go away.

36. COMPLICATIONS
 Kidney damage or scarring
 Kidney infection
 Urosepsis
Risk is greater among ….
 Pts with indwelling catheters
 Complicated UTI’s
 Untreated UTI in
Immunocompromised (HIV)
Immunosuppression therapy
chemotherapy.

37. PREVENTION
• Practice good toilet and personal hygiene.
Wash hands after using toilet.
Practice proper wiping technique (front to back) to prevent rectal bacteria
from entering the utero genitial area.
Choose sanitary pads instead of tampons.
Do not douche or use feminine hygiene sprays or powders.
 As a general rule, do not use any product containing perfumes in the
genital area.
Keep your genital area clean.

38. PREVENTION
Avoid spermicidal jellies and bubble baths and other chemicals in
bathwater.
Clean the genital and anal areas before and after sexual activity.
Urinate before and after sexual activity.
• Always urinate as soon as you feel the need.
• Dress for prevention
Avoid tight-fitting pants.
Wear cotton-cloth underwear and change at least once a day.

39. • Dietary meaures to prevent UTI.
 Plenty of fluids.
• Watch your back.
Maintain proper posture.

40. NURSING
MANAGEMENT

41. NURSING ASSESSMENT
Assessment:
• Presence of pain
• Frequency, urgency
• Changes in urine (color changes,cloudiness)
• Sexual behaviour
• Contraceptive practices
• Personal hygiene
• Pt’s knowledge about preventive measures for UTI’s.

42. NURSING MANAGEMENT
 Acute pain related to inflammation & infection of
urinary tract
• Administer prescribed medications for pain
• Encourage increased fluid intake, antibiotic therapy.
• Sitz bath to decrease muscle spasms.

43. NURSING MANAGEMENT
Altered urinary elimination:
• To control the urgency & frequency pt may limit rather than increasing
fluid intake.
• Eliminate fluids that increase urgency & frequency (caffeinated
beverages).
• Avoid intake of irritating fluids.
• To increase the intake of other fluids to 3-4 L/day to flush the urinary
system.

44. NURSING MANAGEMENT
Risk for deficient fluid volume related to fever,
nausea,vomiting & possible diarrhea.
• Maintain proper intake/output chartings.
• I/V replacement may be required for severe nausea & vomoting.

45. NURSING MANAGEMENT
Anxiety related to diagnosis and
Disturbed self-esteem related to changes in sexual function:
 Educate the pt regarding sexual transmission of UTI.
 Advice to avoid coitus until the manifestations suside or treatment of
STD is completed.
 Advice use of a barrier contraception.
 Use of lubricants if there is pain.

46. SUMMARY
• Definition
• Risk factors
• Etiology
• Pathophysiology
• Clinical manifestations
• Diagnostic methods
• Management

47. References
• Harrison’s Principles of internal medicine ,18th edition page no2567-
2587
• Roger Gabriel.Practial Renal Medicine ,page no: 91-123.
• Schrier W.Robert, Diseases of kidney and urinary tract. 7th
ed.Lippincott Williams &Wilkins,2001.
• Brunner & Suddarth’s, Textbook of Medical Surgical Nursing.10th ed.
Lippincott Williams
• http://kidney.niddk.nih.gov/Kudiseases/pubs/utiadult