Respond  on two different days who selected at least one different  factor than you, in one or more of the following ways:Offer alternative  diagnoses and prescription of treatment options for urinary tract  infections.Share an insight from having read your colleague’s posting,  synthesizing the information to provide new perspectives                                                  Main Post Urinary tract infections (UTI)  are one of the most common infections in the world, and advanced  practitioners must be able to diagnose and treat the varying types of UTIs. Understanding the location of the UTI, upper or lower, the pathophysiology,  and specific signs and symptoms are crucial for treatment. An advanced  practitioner must also be aware of the roles that gender and age play in  the development of a UTI. UTIs are  common in the outpatient setting but can also happen in the hospital  and can also be caused by a Foley catheter, which is considered a  hospital-acquired event that the hospital will not receive  reimbursement.  Pathophysiology of Lower Urinary Tract Infection A  lower urinary tract infection involves the path of least resistance or  the most opportunistic point of entry for an organism, usually bacterial  and involves the urethra and the bladder. An infection in the urethra  or bladder (cystitis) are considered a lower urinary tract  infection. The microbial spectrum of UTIs consists mainly of Escherichia coli, with occasional other species of Enterobacteriaceae such as  Proteus mirabilis and Klebsiella pneumoniae and other bacteria such as Staphylococcus saprophyticus (Yamamichi, Shigemura, Kitagawa, and Fujisawa, 2018).   Pathophysiology of Upper Urinary Tract Infection The  upper urinary tract consists of the kidneys and ureters. Infection in  the upper urinary tract generally affects the kidneys (pyelonephritis),  which can cause fever, chills, nausea, vomiting, and other severe  symptoms. It can be caused by an infection that has made its way up the  urinary tract and can become a complicated infection from an  obstruction, such as benign prostatic hypertrophy, and calculi. Similarities and Differences Although  the location of the infection is different many of the signs and  symptoms can present the same; fever, dysuria, frequency, or urgency may  be present in both. Many lower tract UTIs may be asymptomatic, and in upper tract UTIs, the symptoms may be more severe, including nausea and vomiting, flank pain, or costovertebral angle  tenderness. Finding the underlying cause and treatment is the same;  antibiotics for bacterial infections and analgesics for pain control.  Intravenous antibiotics are preferred for upper tract UTIs in an attempt to preserve organ damage, but mat be converted to oral after initial treatment.  Gender and Age as Factors While common in both males and females, females are more prone to community-acquired UTIs than men, basically because of anatomical differences. Lema (2015)  ackno.

1. Respond on two different days who selected at least one
different factor than you, in one or more of the following
ways:Offer alternative diagnoses and prescription of treatment
options for urinary tract infections.Share an insight from
having read your colleague’s posting, synthesizing the
information to provide new perspectives
Main Post
Urinary tract infections (UTI) are one of the most common
infections in the world, and advanced practitioners must be
able to diagnose and treat the varying types of UTIs.
Understanding the location of the UTI, upper or lower,
the pathophysiology, and specific signs and symptoms are
crucial for treatment. An advanced practitioner must also be
aware of the roles that gender and age play in
the development of a UTI. UTIs are common in the outpatient
setting but can also happen in the hospital and can also be
caused by a Foley catheter, which is considered a hospital-
acquired event that the hospital will not receive
reimbursement.
Pathophysiology of Lower Urinary Tract Infection
A lower urinary tract infection involves the path of least
resistance or the most opportunistic point of entry for an
organism, usually bacterial and involves the urethra and the
bladder. An infection in the urethra or bladder (cystitis) are
considered a lower urinary tract infection. The microbial
spectrum of UTIs consists mainly of Escherichia coli, with
occasional other species of Enterobacteriaceae such as

2. Proteus mirabilis and Klebsiella pneumoniae and other bacteria
such as Staphylococcus saprophyticus
(Yamamichi, Shigemura, Kitagawa, and Fujisawa, 2018).
Pathophysiology of Upper Urinary Tract Infection
The upper urinary tract consists of the kidneys and ureters.
Infection in the upper urinary tract generally affects the
kidneys (pyelonephritis), which can
cause fever, chills, nausea, vomiting, and other severe
symptoms. It can be caused by an infection that has made its
way up the urinary tract and can become a complicated
infection from an obstruction, such as benign prostatic
hypertrophy, and calculi.
Similarities and Differences
Although the location of the infection is different many of the
signs and symptoms can present the same; fever, dysuria,
frequency, or urgency may be present in both. Many lower
tract UTIs may be asymptomatic, and in upper tract UTIs, the
symptoms may be more severe, including nausea and vomiting,
flank pain, or costovertebral angle tenderness. Finding the
underlying cause and treatment is the same; antibiotics for
bacterial infections and analgesics for pain control. Intravenous
antibiotics are preferred for upper tract UTIs in an attempt to
preserve organ damage, but mat be converted to oral after initial
treatment.
Gender and Age as Factors
While common in both males and females, females are more
prone to community-acquired UTIs than men, basically because
of anatomical differences. Lema (2015) acknowledges that the
close proximity of the vagina and urethral meatus to the anal
opening, the shorter length of the female urethra, and the

3. opportunity for trauma during intercourse allows for the
opportunity for a UTI to be acquired. Although this happens
across the lifespan of a woman, the peak times are from mid-
teens to the early forties or the sexually active years. Young
children, especially females, are a high-risk group due to not
being able to clean themselves properly after using the
bathroom or poor technique. Older patients are also high risk;
men with prostate issues cannot empty their bladder are also at
risk.
Diagnosis and Treatment
Diagnosis of a lower tract UTI can be done with the assessment
of signs and symptoms and urine culture, midstream is
preferred. Research by Lee (2018) acknowledges that patients
with non-febrile uncomplicated UTIs, active pain control and
minimal use of antibiotics should be prioritized, including
uncomplicated cystitis. Pain in acute cystitis is a natural
consequence of the inflammatory response, and pain-mediated
urinary frequency or urgency is the chief complaint of patients.
Painkillers, including nonsteroidal anti-inflammatory drugs
(NSAIDs), are a good choice for managing symptoms while
reducing the usage of antibiotics. Urinalysis and urine culture
confirms the diagnosis of acute pyelonephritis and according to
the Infectious Diseases Society of America (2019) a urine
culture showing at least 10,000 colony-forming units (CFU) per
mm3 and symptoms compatible with the diagnosis. Symptoms
management and oral antibiotic therapy are needed, and in
severe cases, hospitalization with intravenous antibiotic
therapy may be required.
Conclusion
As future practitioners, understanding the pathophysiologies of
an upper tract UTI and a lower tract UTI is paramount to
obtaining a diagnosis. Untreated and under treated UTIs can

4. lead to life-threatening complications. Management of the signs
and symptoms is important, but the treatment of the underlying
cause can stop a lower tract UTI from spreading into the upper
urinary tract. Age and gender play significant roles in UTIs,
women of childbearing years, and older men who have trouble
emptying their bladder are at high risk. Assessment and quality
interviews can assist the practitioner in prevention through
education.
References
Acute pyelonephritis. (2019). Retrieved July 18, 2019, from
https://www.idsociety.org/clinical-practice/patient-care/patient-
care/
Lee, S. (2018). Recent advances in managing lower urinary tract
infections.
F1000Research,
7
, 1964.
https://doi-
org.ezp.waldenulibrary.org/10.12688/f1000research.16245.1
Lema, V. M. (2015). Urinary Tract Infection In Young Healthy
Women Following Heterosexual Anal Intercourse: Case
Reports.
African Journal Of Reproductive Health
,
19
(2), 134–139. Retrieved from
https://search-ebscohost-
com.ezp.waldenulibrary.org/login.aspx?direct=true&db=mnh&A
N=26506666&site=eds-live&scope=site

5. Yamamichi, F., Shigemura, K., Kitagawa, K., & Fujisawa, M.
(2018). Comparison between non-septic and septic cases in
stone-related obstructive acute pyelonephritis and risk factors
for septic shock: A multi-center retrospective study.
Journal Of Infection And Chemotherapy: Official Journal Of
The Japan Society Of Chemotherapy
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