Pharm D
Urinary tract infections occur when microbes enter the urinary tract through the urethra. Left untreated, they can also enter the urinary bladder, causing cystitis. Most commonly, urinary tract infections occur because of bacteria.
In women, urinary tract infections are common because of their anatomy; having a shorter urethra close to the anus leads to fecal contamination, and the motion during sexual intercourse also puts them at risk of developing urinary tract infections.
According to the Centers for Disease Control and Prevention (CDC), urinary tract infections (UTIs) are the fifth most common type of healthcare-associated infection, accounting for more than 9.5% of infections reported by acute care hospitals. Experts say around 10% of women will get UTIs yearly.
Urinary tract infections are uncommon in children. They are most common in women and even more in sexually active women, and the incidence increases with age because the vaginal flora and lubrication change; decreased lubrication increases the risk of urethral irritation in women during intercourse. In pregnancy, UTIs are common because of hormonal changes and because the woman cannot empty the bladder fully because of the child’s weight. The urine remaining in the bladder becomes a hub for the bacteria to thrive. Men have the most minor incidence of a urinary tract infection because of their anatomy and the prostatic fluid that serves as an antibacterial defense, particularly during their teen and early adulthood years. As men age past 50, however, the prostate gland enlarges, which increases the risk of urinary retention and infection. By age 70, the prevalence is similar for men and women as they lose defensive mechanisms.
If left untreated, UTIs can lead to chronic diseases, pyelonephritis, and even systemic sepsis and septic shock. If the infection reaches the kidneys, permanent renal damage can occur, leading to acute and chronic renal failure.
The most common causative agent that accounts for 90% of UTIs is Escherichia coli, which is present in fecal matter and aids in digestion in the digestive tract. Therefore, if feces enter the urethra by contamination, the E. coli can cause a UTI.
Other organisms commonly found in the gastrointestinal tract and that may contaminate the genitourinary tract include Enterobacter, Pseudomonas, group B beta-hemolytic streptococci, Proteus mirabilis, Klebsiella species, and Serratia. The other two growing causes of UTIs in the United States are Staphylococcus saprophyticus and Candida albicans.
Factors predisposing a person to a UTI include surgery, catheterization, decreased urinary frequency, excessive urine, and drinking very little water. Patients with diabetes mellitus are at risk of developing recurrent urinary tract infections because of poor glycemic control. In men, UTIs are often severe and can occur because of urinary retention, usually benign prostatic hyperplasia. In women, frequent sexual activity, some forms of contraceptives such as poorly fitting diaphragms, use of spermicides, and poor sexual hygiene can put them at risk of developing UTIs.
Nurses should take the patient’s complete disease and medication history if they suspect a UTI.
The symptoms of a urinary tract infection can range from mild to severe. Patients often complain about frequency, burning, urgency, nocturia, blood or pus in the urine, and suprapubic fullness. If the infection has reached the kidney, they may also complain about flank pain, referred to as costovertebral tenderness, accompanied by low-grade fever.
While taking a patient’s history, ask about risk factors such as recent catheterization of the urinary tract, pregnancy or childbirth, neurological problems, volume depletion, frequent sexual activity, and the presence of a sexually transmitted infection (STI). Ask the patient to describe current sexual and birth control practices because poorly fitting diaphragms, the use of spermicides, and specific sexual practices, such as anal intercourse, can lead to an increased risk for a UTI.
During examination, a patient with a UTI might exhibit signs of systemic disease, such as chills, fever, and tachycardia. Inspect the urine to determine its color, clarity, odor, and character, and send it to the laboratory for detailed evaluation with culture and sensitivity, if required. Surveillance for STIs is recommended as part of the examination.
UTIs can be uncomfortable until treatment begins. Once antibiotics are given, the patient starts feeling better and can continue with their usual activities. They should rest if possible and drink plenty of fluids to flush out the toxins; however, in some patients, that might not be possible because of recurrent urination. Encourage the patient to stop sexual activities for some time with a UTI, especially if a sexually transmitted disease is diagnosed.
UTIs are treated with antibiotics specific to the invading microbe. Antibiotics are prescribed for seven to 10 days. However, shortened and extensive single-dose regimens, such as Fosfomycin, given in a single dose of 3g/packet, are under investigation. Most elderly patients need a full seven – to 10-day treatment, with caution in their management because of the possibility of diminished renal capacity.
Women taking antibiotics for a UTI may contract a vaginal yeast infection because their bacterial flora protects them from vaginal infections. Ask if they have any signs of vaginal yeast infection, such as cheesy discharge and perineal itching and swelling. Encourage the woman to get an over-the-counter antifungal or to contact her primary healthcare provider if treatment is needed.
To prevent the recurrence of a UTI, patients should drink plenty of fluids, drink cranberry juice to help flush out bacteria from the bladder, take vitamin C daily, wipe from front to back after a bowel movement (for women), do not hold urine for too long, empty bladder often, avoid spending a long time in tubs and bubble bath, avoid wearing tight clothing such as underwear and jeans. In some patients, these strategies help prevent UTIs.
Teach patients about the medication they take for the UTI, including dose, route of intake, frequency, and other details. Tell the patient not to stop antibiotic intake, even if they feel well, before seven to 14 days, as directed by the physician, as it can lead to antibiotic resistance.
Explain the signs and symptoms related to complications of a UTI, such as pyelonephritis, and the need for follow-up. If the patient experiences gastrointestinal discomfort, encourage the patient to continue taking the medication and not stop. Instruct the patient to take the medication with a meal or milk unless contraindicated. Warn the patient that drugs with phenazopyridine turn urine orange. Lastly, the essential part is to drink plenty of water so the bacteria can flush out of the urinary tract.
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