41. Urinary Tract Infections

I. Definition

Presence of microorganisms in the urine that have the potential to invade tissues of the urinary tract and adjacent structures, such as the bladder, urethra, prostate, renal parenchyma (kidneys), and collecting system.

Associated with a positive urine culture: more than 100,000 colonies in asymptomatic patients and between 100 and 10,000 colonies in symptomatic patients.

II. Etiology/incidence

A. Urinary tract infections (UTIs) account for 7 million office visits annually.

B. UTIs are more common in women than in men.

C. UTI is the most common bacterial infection in the elderly, and nursing home patients are more likely to have resistant pathogens compared with others of the same age.

E. Risk factors for both genders:

1. Diabetes mellitus

2. Urinary instrumentation and catheterization

3. Obstruction of normal flow of urine due to calculi, tumors, urethral strictures

4. Neurogenic bladder disease resulting from stroke, multiple sclerosis, spinal cord injury

5. Vesicoureteral reflux

F. Contributing factors in women:

1. Short urethra

2. Sexual intercourse

3. Use of a diaphragm and spermicide

4. Pregnancy

G. Contributing factors in men:

1. Prostatic enlargement, resulting in urine residual

2. Prostatitis

3. Homosexuality

4. Having a sexual partner with vaginal colonization by uropathogens

5. HIV infection with CD4+ T-lymphocyte counts lower than 200/mm3

III. Clinical manifestations

A. Lower urinary tract (cystitis/urethritis/prostatitis)

1. Dysuria

2. Frequency

3. Urgency

4. Nocturia

5. Suprapubic pain

6. Hematuria with bacteriuria

7. Malodorous urine

8. Incontinence

9. Fever and chills are uncommon but may be present.

10. No flank or costovertebral pain

B. Upper urinary tract (pyelonephritis, renal abscess)

1. Flank pain

2. Fever

3. Hematuria

4. Nausea and vomiting

5. Mental status changes (in elderly patients)

6. Malaise

7. Shaking chills (rigors)

8. Tachypnea

9. Tachycardia

10. If symptoms last for longer than 3 days, abscess formation should be considered.

IV. Laboratory findings/diagnostics
Mar 3, 2017 | Posted by in NURSING | Comments Off on 41. Urinary Tract Infections

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