Urinary tract infection

all content is available

1. Urinary tract infection J yoti Dwivedi

2. INTRODUCTION   urinary tract infection (UTI) is an infection in any part of your urinary.. Women are at greater risk of developing a UTI than are men. Among adults aged 20 to 50 years, UTIs are about 50- fold more common in women . The incidence of UTI increases in patients > 50 years, but the female: male ratio decreases because of the increasing frequency of prostate enlargement and instrumentation in men. 

3. DEFINITION A   urinary tract infection , or UTI, is an infection in any part of your urinary system, which includes your  kidneys ,  bladder , ureters, and urethra.

4. TYPES UTIs are caused by micro-organisms or germs, usually bacteria. The different types of UTI can include : urethritis   – infection of the urethra cystitis  – infection of the bladder pyelonephritis  – infection of the kidneys vaginitis – infection of the vagina .

5. ETIOLOGY The bacteria that most often cause cystitis and pyelonephritis are the following: Enteric , usually gram-negative aerobic bacteria (most often) Escherichia coli : 75 to 95% of cases. Klebsiella Proteus mirabilis Pseudomonas aeruginosa. Gram-positive bacteria (less often ) Staphylococcus saprophyticus is isolated in 5 to 10% of bacterial UTIs. In hospitalized patients, E . coli accounts for about 50% of cases. The gram-negative species Klebsiella, and the gram-positive bacterial cocci , and Staphylococcus aureus account for the remainder.

6. RISK FACTOR Some people are at greater risk than others of developing UTIs. These include: women – sexually active women are vulnerable, in part because the urethra is only four centimeters long and bacteria have only this short distance to travel from the outside to the inside of the bladder people with urinary catheters – such as people who are critically ill, who can’t empty their own bladder people with diabetes – changes to the immune system make a person with diabetes more vulnerable to infection men with prostate problems – such as an enlarged prostate gland that can cause the bladder to only partially empty babies – especially those born with physical problems (congenital abnormalities) of the urinary system.

7. Additional UTI risk factors for women Spermicides- Spermicides may increase UTI risk. They can cause skin irritation in some women. This increases the risk of bacteria entering the bladder. Condom use during sex Non-lubricated latex condoms may increase friction and irritate the skin of women during sexual intercourse. This may increase the risk of a UTI. .To help prevent friction and skin irritation from condoms, be sure to use enough water-based lubricant, and use it often during intercourse.

8. CONT… Diaphragms Diaphragms may put pressure on a woman’s urethra. This can decrease bladder emptying. Decrease in estrogen levels After  menopause , a decrease in your estrogen level changes the normal bacteria in your vagina. This can increase the risk of a UTI.

9. PATHOPHYSIOLOGY

10. CLINICAL MANIFESTATION

11. CONT… A burning feeling when you pee A frequent or intense urge to pee, even though little comes out when you do Cloudy, dark, bloody, or strange-smelling pee Feeling  tired  or shaky Fever  or  chills  (a sign that the infection may have reached your kidneys) Pain  or pressure in your back or lower  abdomen

12. DIAGNOSTIC EVALUATION Analyzing a urine sample.  Your doctor may ask for a urine sample for lab analysis to look for white blood cells, red blood cells or bacteria. To avoid potential contamination of the sample, you may be instructed to first wipe your genital area with an antiseptic pad and to collect the urine midstream. Creating images of your urinary tract.  If you are having frequent infections that your doctor thinks may be caused by an abnormality in your urinary tract, you may have an ultrasound, a computerized tomography (CT) scan or magnetic resonance imaging ( MRI Using a scope to see inside your bladder.  If you have recurrent UTIs, your doctor may perform a cystoscopy , using a long, thin tube with a lens ( cystoscope ) to see inside your urethra and bladder. The cystoscope is inserted in your urethra and passed through to your bladder.

13. PREVENTION Drink plenty of water and other fluids to flush the urinary system. Treat vaginal infections such as thrush or trichomonas quickly. Avoid using spermicide -containing products, particularly with a diaphragm contraceptive device. Go to the toilet as soon as you feel the urge to urinate, rather than holding on. Wipe yourself from front to back (urethra to anus) after going to the toilet. Empty your bladder after sex. Avoid constipation.

14. CONT… Cranberry  juice is often promoted to prevent or treat UTIs. The red berry contains a tannin that might prevent  E. coli  bacteria -- the most common cause of urinary tract infections -- from sticking to the walls of your bladder, where they can cause an infection.

15. TREATMENTS Amoxicillin / augmentin Ceftriaxone  ( Rocephin ) Cephalexin  ( Keflex ) Ciprofloxacin  ( Cipro ) Fosfomycin  ( Monurol ) Levofloxacin  ( Levaquin ) Nitrofurantoin  ( Macrodantin ,  Macrobid ) Trimethoprim / sulfamethoxazole  ( Bactrim ,  Septra .

16. CONT… Antibiotics that can be used to treat UTI in children Therapeutic dose Trimethoprim (TMP) ‘ Alprim ’ •4 mg/kg BD Max : 150 mg BD Trimethoprim–sulfamethoxazole (TMP–SMX) ‘ Bactrim ’ • 4 + 20 mg/kg BD Max: 16 0+ 180mg BD Cephalexin ‘ Keflex ’ • 12.5mg/kg QID Max: 500 mg QID Amoxycillin and Clavulanic acid ‘ Augmentin ’ •22.5 + 3.2 mg/kg BD Max: 875 + 125 mg BD

17. COMPLICATIONS Recurrent UTIs occurring at least twice in six months or four times in a year, most commonly in women Urethral narrowing ( stricture ) in  men  with recurrent infections 15  Increased risk of preterm birth and low birth weight in pregnancy Permanent kidney damage Sepsis  (a potentially life-threatening, whole-body inflammatory response caused by a severe infection)

18. NURSING MANAGEMENT