URINARY TRACT INFECTION

I. INTRODUCTION

 It is the most common of all bacterial infections and affects humans

throughout their life span.
 UTI occurs in all populations, from the neonate to the geriatric patient.

II. DEFINITION OF TERMS

URINARY TRACT INFECTION (UTI)
 is an infection in any part of your urinary system your kidneys, ureters,
bladder and urethra.
 The vast majority of urinary tract infections (UTIs) are caused by the
bacterium Escherichia coli (E. coli), usually found in the digestive system. 

Cystitis
 Bladder inflammation
Urethritis
 urethra inflammation
Pyelonephritis
 kidney inflammation

III. ANATOMY
 FEMALE URINARY SYSTEM MALE URINARY
SYSTEM

Urethra is responsible for removing waste from your body through urine.
Kidneys are located toward the back in the upper abdomen, produce urine by
filtering waste and fluid from the blood. That urine then travels through the
uterus to the bladder, where urine is stored until it will be eliminated in an
appropriate time.
Urinary system
- Group of organs in the body concerned with filtering out excess fluid and other
substances from the bloodstream
- The substances are filtered out from the body in the form of urine
- Urine is a liquid produced by the kidneys, collected in the bladder and excreted
through the urethra
- One of the major functions of the urinary system is the process of excretion.
- The male and female urinary tracts are similar except for the length of the
urethra

 Kidneys – A pair of bean-shaped, brown organs that filter the blood of the waste,
unused minerals and water that makes up urine.
 Ureters – A pair of tubes that carry urine from kidneys to the bladder
 Bladder – An organ where urine is collected for excretion
 Urethra – A tube that carries urine from the bladder out of the body.

IV. RISK FACTORS

 Catheter
 Pregnancy
 Female
 Menopause
 Sexual Intercourse
 Urinary Tract Malformation
 Vesicoureteral reflux
 Urinary Stones
V. PATHOPHYSIOLOGY
VI. CLINICAL FINDINGS

The symptoms of an infection in your upper urinary tract (kidney and ureters) are
different from symptoms of infection in your lower urinary tract (bladder and
urethra).

A. Upper UTI
- Infection in the upper urinary tract generally affects the kidneys

Symptoms of an upper UTI can include: 

 a high temperature (fever) of 38ºC (100.4ºF) or above
 uncontrollable shivering
 nausea (feeling sick)
 vomiting
 diarrhea
 With an upper UTI you may also notice pain in your side, back or groin.
The pain can range from moderate to severe, and it is often worse when
you're urinating
 Signs of shock if the infection is more severe. (Septicemia)

TRIAD of Upper UTI or Pyelonephritis: VOMITING, BACK PAIN, FEVER

 B. Lower UTI
- Infection in the lower urinary tract can affect the urethra (urethritis) or the
bladder (cystitis).

Symptoms of a lower UTI can include:

 urethral syndrome – this includes needing to urinate more often, a
constant, dull pain in the pubic region, and pain when urinating (dysuria)
 cloudy urine or blood in your urine (hematuria)
 urine that smells unusually unpleasant
 burning sensation with urination

CLASSIFICATION OF URINARY TRACT INFECTION

- Any part of this system can become infected. As a rule, the farther up in
the urinary tract the infection is located, the more serious it is.
- UTIs are generally classified as:

 Uncomplicated or complicated, depending on the factors that

trigger the infections
 Recurrent, depending on whether the infection is occurring for
the first time or is a repeat event

 UNCOMPLICATED UTI
- Also known as “Simple UTI”
- Refers to the invasion of a structurally and functionally normal urinary
tract by a
nonresident infectious organism.
- Simple UTI is due to a bacterial infection, most often E. coli.
- They affect women much more often than men

 COMPLICATED UTI
- refers to the occurrence of infection in patients with an abnormal
structural or
functional urinary tract, or both
- Complicated infections, which occur in men and women of any age, are
also
caused by bacteria but they tend to be more severe, more difficult to
treat, and
recurrent.
 - Men are much less likely than women to get UTIs. When it does happen,
it’s
often related to other underlying conditions such as kidney stone or
enlarged
prostate.

They are often the result of:

 Catheter use in the hospital setting or chronic indwelling catheter in the
outpatient setting
 Bladder and kidney dysfunction.

Recurrences can occur in patients with complicated UTI if the underlying

structural or anatomical abnormalities are not corrected.

RECURRENT UTI
• Most women who have had an uncomplicated UTI have occasional recurrences.
• About 25 - 50% of these women can expect another infection within a year of the
previous one.

Recurrence is often categorized as either reinfection or relapse:

 Reinfection
Most cases of recurring UTIs are reinfections.
The infecting organism is usually introduced through fecal bacteria and moves up
through the urinary tract.

 Relapse
• Relapse is the less common form of recurrent urinary tract infection.
• It is diagnosed when a UTI recurs within 2 weeks of treatment of the first episode and is
due to treatment failure.
• Relapse usually occurs in kidney infection (pyelonephritis) or is associated with
obstructions such as kidney stones, structural abnormalities or, in men, chronic
prostatitis.

VII. DIAGNOSIS

Tests and procedures used to diagnose urinary tract infections include:

  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.

 Growing urinary tract bacteria in a lab/ Urine Culture Sensitivity. Lab analysis

of the urine is sometimes followed by a urine culture. This test tells your doctor
what bacteria are causing your infection and which medications will be most
effective.

 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). Your doctor may also use a contrast dye to highlight
structures in your urinary tract.

 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

 Genital Examination with swab. If discharge or itch with signs of UTI consider
having genital examination with swab for STI.
NON-PHARMACOLOGIC MANAGEMENT & PATIENT COUNSELING:

A urinary tract infection (UTI) can cause increased activity in the muscle of your bladder
wall. This causes your bladder to become overly active, triggering the urge to urinate more.

 Avoid Caffeinated products

Caffeine is known to irritate the bladder and worsen bladder infection symptoms.
Caffeine can increase bladder activity and act as a diuretic.

To relieve some pain, you could try removing the following from your diet until you heal:

 Coffee
 Teas
 Caffeinated sodas
 Chocolate (With a UTI, chocolate is best avoided. However, if you must have it,
dark chocolate has less caffeine than milk chocolate.)
 Avoid Alcohol
Though you want to get plenty of fluids when you've got a UTI, it's important to
avoid
alcohol. Alcohol is a diuretic, so it can increase the frequency of urination. Plus, the
dehydrating effect of alcohol may cause some bladder irritation, like pain and
burning while urinating.

 Stop smoking
Smokers are more likely to have bladder control problems and to have more-severe
symptoms. Heavy smokers also tend to develop a chronic cough, which can place
added pressure on the bladder and aggravate urinary incontinence.

 Cranberry juice (unsweetened, & not from concentrate)

Cranberry is high in phytochemicals, called proanthocyanidins, which help reduce
the ability of e.coli bacteria to adhere to the urinary tract walls, making it easier to
pee them away and that may help to prevent infection-causing bacteria from
adhering to the urinary tract walls.

 Avoid Acidic Fruits

According to a June 2015 study published in the Journal of Biological Chemistry,
researchers found that acidic urine and the presence of small molecules related to
your diet can influence how bacteria grows in the urinary tract.
This cause urine to become more acidic and lead to bladder irritation and increased
urgency.
For this reason, you should avoid fruits like tomatoes, pineapple and citrus fruits
such as lemons, limes and grapefruits.

 Avoid Spicy Foods

You should also avoid spicy foods, such as Indian and Mexican (known for their
heavy spice content) during a UTI, according to the Consumer's Handbook of
Urological Health published by the Canadian Urological Association. The spice can
make your urination feel more painful.
Super spicy foods have a tendency to irritate the bladder lining and can contribute to
chronic bladder pain.

 Avoid sugar and sweeteners

It is thought that sugar acts as a stimulant on the bladder leading to increased
urgency and frequency.

 Empty your bladder regularly.

 If you feel like you’ve got to go, GO! Don’t hold it, as this simply delays getting rid of
more bacteria. Holding your urine also provides the perfect environment inside your
bladder for bacteria to grow.

 Drink lots of water

Water is critical to dilute the contents of the bladder, leading to less irritation and to
encourage urination so you can flush more bacteria from your system.
 Urinate shortly after sex
Peeing after sex is thought to help flush out bacteria before it can travel to the
bladder

 Wipe from front to back after urinating and bowel movement

The thought is that when you wipe from back to front, you are moving fecal
material towards the vagina and thus the urethra. Bacteria gets in the urethra,
travels up to the bladder, and soon enough you got a UTI.
 Keep the genital area clean
 Avoid using any perfumed products in the genital area
These can affect the healthy balance of bacteria and pH levels in the vagina and
cause irritation.
 Do not wear tight-fitting undergarments made of non-breathing materials.
With such fabrics, accumulating moisture builds up. This leads to maceration of the
skin and bacterial over growth adjacent to the opening of the bladder Cotton
underwear for general use is suggested.