URINARY TRACT

INFECTION
Archana . V
2nd Year Bsc Nursing
Almas College Of Nursing
DEFINITION
Urinary tract infection (UTI) is defined as a
disease caused by microbial invasion of the
genitourinary tract that extends from the renal
cortex of kidney to urethral meatus

 The presence of detectable bacteria in urine is

called : Bacteriuria

 pus cells in urine : Pyuria

TYPES
1. Lower UTI

Lower UTI is due to ascending Infection caused by

fecal coliforms
 Urethritis
 Cystitis
 Prostatitis

2. Upper UTI

 Acute pyelitis : infection of pelvis of kidney

 COMMON MICROORGANISMS
CAUSING UTI
• Escherichia coli : cause about 80% of UTI
• Enterococcus
• Klebsiella
• Proteus
• Pseudomonas
• Staphylococcus
• Candida albicans
ETIOLOGY
Mainly caused by colonic bacteria
 Acute uncomplicated UTI
 Escherichiacoli causes about 80% of UTI
 20% of UTI caused by
o gram negative enteric bacteria (klebsiella, Proteus)
o gram positive (streptococcus faecalis)
o Staphylococcus saprophytic : restricted to
infections in young sexually active women.
 Complicated UTI
• Pseudomonas aeruginosa, Enterobacter & serratia
• Isolated in hospital acquired infections and catheter and
catheter associated UTI
RISK FACTORS
 Poor personal hygiene
 Diabetes
 problems emptying the bladder completely
 sexual intercourse, especially if more frequent,
intense and With multiple or new partners
 Having urinary catheter
 Bowel incontinence
 kidney stones
 some forms of contraception eg: diaphragm
 Blocked flow of urine (holding urine)
 Pregnancy
 Inadequate water intake
 menopause
 Females : shorter urethra, Sexual intercourse,
contraceptives incomplete bladder emptying
with age
 Males : Prostatic hypertropy,Bacterial prostatis,
Age
PATHOGENESIS
 4 routes of bacterial entry to urinary tract

1. ASCENDING INFECTION
2. BLOOD BORNE SPREAD
3. LYMPHATOGENOUS SPREAD
4. DIRECT EXTENSION FROM OTHER
ORGANS
1. Ascending infection
• Most common route
• Organisms ascend through urethra into bladder

Microorganisms
Colonize in perineal and
periurethral areas
Ascend to bladder,
kidneys

UTI
2. Hematogenous spread
• Blood borne spread to kidney
• Occurs in bacteraemia mostly S.aureus
3. Lymphatogenous spread
• Men through rectal and colonic lymphatic
vessels to prostate and bladder
• Women through periuterine lymphocytes to
urinary tract
4. Direct extension from other organs
• pelvic inflammatory
• Genitourinary tract fistulas
CLINICAL MANIFESTATION
 Clinical manifestations depending on site of infection
 Urethritis
• Discomfort in voiding
• Dysuria
• Urgency
• frequency
 Cystitis
• Dysuria,
• Urgency and frequency urination
• Pelvic discomfort
• Abdominal pain
• Pyuria
 Pyleoneophritis :
• Invasive nature
• Suprapubic tenderness
• fever and chills
• WBC casts in urine
• Back pain
• Nausea and vomiting
 Hemorrhagic cystitis
• Visible blood in urine
• Irritating voiding symptoms
 Complications include sepsis, septic shock and
depth
 Clinical manifestations depending on age.
 Babies & infant
• Failure to thrive
• Fever
• Apathy
• diarrhoea
 Children
• Dysuria, Urgency, Frequency
• Hematuria
• acute abdominal pain
• Vomiting
 Adults:
• Lower UTI : Frequency, Urgency,
Dysuria, Haematuria
• Upper UTI - fever, rigor and pain and
symptoms of lower UTI
 Elderly patients
• Mostly asymptomatic
• Not diagnostic as the symptoms are
common with age
DIAGNOSTIC EVALUATIONS
• History collection & physical examination
• Urinanalysis :
o presence of pus, WBC, RBC
o Bacterial count>10^5 - significant bacteriuria
o Leukocyte esterase dipstick test - WBC in urine
o Nitrite dipstick - pink colour
• Urine culture : For pyelonephritis
: Not a rapid diagnostics tool
• Microscopic examination of urine
• Imaging techniques - CT scan and MRI
• Intravenous pyelography (IVP)- Adults
• Voiding cystourethrography (VCUG)
• cystoscopy - manual pelvic and prostate examination
• Ultrasound of kidney and urinary bladder
LABORATORY FINDINGS
NORMAL FINDINGS ABNORMAL FINDINGS
pH : 4.6-8.0 pH : Alkaline
Appearance : Clear Appearance : Cloudy
Color : Pale to Amber Yellow Color : Deep Amber
Odour : Aromatic Odour : Foul smell
Blood : Absent Blood : May be present
Leukocyte Esterase : Non Leukocyte Esterase : Present
WBC : Absent WBC : Present
Bacteria : Absent Bacteria : Present
MANAGEMENT
• MEDICAL MANAGEMENT
 prevention of over distention of the
bladder
 Emptying the bladder frequently and
completely
 Maintaining urine sterility with no stone
formation
 Maintain adequate bladder capacity
without reflex
PHARMACOLOGICAL MANAGEMENT
Pharmacological therapy:
• Parasympathetic mediation (Urecholine)
• Trimethoprim sultamethnoxazole
• Nitrofurantoin
• Ampicillin
• Aminoglycosides
• Cephalosporins
Conservative ;
• increased oral-fluid intake.
• Regular & complete bladder Emptying
increased dietary fiber intake
NURSING MANAGEMENT
In health promotion:
 Recognize individuals at risk;
• debelitated persons, older adults underlying
disease (HIV, diabetes)
• Taking immunosuppressive drug or
corticosteroids
 Emptying bladder regularly and completely
 Evacuating bowel regularly.
 wiping perineal area front to back
 Drinking adequate fluids (persons
weight in pounds / 2). 20% of fluid
comes from food.
 NURSING DIAGNOSIS
1. Impaired urinary elimination related to frequent
urgency as evidenced by dysuria, urge, urinary
hesitancy
2. Hyperthermia related to inflammation as
evidenced by increased body temperature 100°F
3. Acute pain related to infection and inflammation
of urethra bladder and other urinary tract
structures as evidenced by burning on urination.
4. Deficit knowledge related to lack of
information regarding predisposing factors
and prevention of disease.
5. Infection related to urinary retention as
evidenced by fever and chills, foul smelling
urine, heamturia.
6. Disturbed sleeping pattern related to
nocturia /pain as e/b Sleep maintenance
insomnia, irritability restlessness.
7. Risk for infection related prolonged
catheterization.
 PREVENTION
 Drink 8 ounce glass per day to flush bacteria out of
the urinary system
 Practice frequent voiding( every 2-4hours) to flush
bacteria out of urethra
 Avoid use of harsh soap, bubble bath, powder or
spray in the perineal area these substances can be
irritating to the urethra and encourage
inflammation and bacterial infection
 Girls and women should always wipe the
perineal area from front to back following
urination and defecation
 Were cotton rather than nylon under
clothes. Accumulation of the perineal
moisture facilities bacterial growth. Cotton
enhances ventilation of the perineal area