Class 6: UTI

Bacteremia

Culture of the blood reveals bacteria.

Septicemia

When bacteremia results in a systemic infection.

Emerging Infection Example

COVID-19

Antibiotic-Resistant Bacteria

Develops when bacteria mutate or resist antibiotic therapy and the resulting reproduction of a colony of resistant bacteria can be spread through other organisms.

Reasons for a Rise in Antibiotic Resistant Bacteria

• Over prescription of antibiotics (Ex. Prescribing them for a viral infection.)

• Not completing an antibiotic course.

• Beta-lactamase

Healthcare-Associated Infections (HAI’s)

• Infections that are acquired because of exposure to microorganisms in a healthcare setting.

• The most at risk are surgical and immunocompromised clients.

• Ex. C-diff, CLABSI, MRSA.

Anti-Infectives

Medications that are used to treat pathogenic infections (bacterial, fungal, viral, and parasitic.) Only effective in the treatment of bacteria.

Bactericidal Antibiotics

Antibiotics that kill bacteria. Ex. Penicillin

Bacteriostatic Antibiotics

Do not kill bacteria, but inhibit their growth. Ex. Sulfonamides

Empiric Therapy

The administration of antibiotics based on the practitioner’s judgement of the pathogen that is most likely causing the apparent infection; it involves the presumptive treatment of an infection to avoid treatment delay before a specific culture and sensitivity has been obtained.

Antiseptic

• Topical antimicrobial agent.

• Chemical that inhibits the growth/reproduction of microorganisms without necessarily killing them.

• Also called -static agents.

Disinfectant

• Topical antimicrobial agent.

• Chemical applied to nonliving object to kill microorganisms.

• Also called -cidal agents.

Urinary Tract Infection

• Develop by either ascending or descending bacterial invasion into the urinary tract.

• The more common mode of infection is the ascending pathway, where fecal flora gain access to the urinary tract via colonization of the urethra.

Acute Kidney Injury

Continuous inflammatory response results in interstitial edema, interstitial nephritis, and ultimately this.

Pyelonephritis

Bacterial ascension or hematogenous spread infects the renal parenchyma

Uroepithelium Penetration

Bacterial fimbriae allows for attachment and penetration of bladder epithelial cells

UTI Pathogenesis

1. Colonization in the urethra

2. Uroepithelium penetration

3. Ascension to the ureters

4. Pyelonephritis

5. Acute kidney injury

UTI Risk Factors

• Anatomic risk factors

  • Obesity

• Aging

• Disease

  • Diabetes

  • HIV

• Factors increasing urinary stasis

  • Urinary stones

  • Enlarged prostate

• Foreign bodies

  • Catheters

  • Urinary stones

• Functional disorders

• Habitual delay of urination (“nurse’s bladder”)

• Poor personal hygiene

• Pregnancy

• Menopause

• Sexual activity (women)

  • Spermicidal agents

  • Contraceptive diaphragm

  • Douching

• Feminine Sprays

• Bubble baths

Upper UTI Assessment

• Flank pain/CVA tenderness

• Fatigue

• Fever and chills

• All other UTI symptoms

Lower UTI Symptoms

• Dysuria

• Frequency

• Urgency

• Suprapubic discomfort or pressure

• Hematuria

• Cloudy urine

• Impaired cognition

• Abdominal pain

UTI Risk Factors for the Elderly

• Malnutrition

• Poorly controlled diabetes mellitus

• Poor bladder control leads to urinary retention

• Incontinence

• Constipation

• Long-term hospitalizations

• Vaginal atrophy

• Catheterization

True

True or False: Constipation can block urine traveling from the ureters to the bladder, thus increasing the risk of a UTI.

Common UTI Symptoms in Seniors

• Irritation

• Behavioral change

• Confusions

• Dizziness

• Hallucination

• Lack of balance

• Falling dangerously

Worst UTI Symptoms in Seniors

• High fever

• Back pain

• Feeling nauseous

• Vomiting regularly

• Flushed skin

UTI Diagnosis

• History and physical assessment

• Urinalysis (midstream, “clean-catch” voided specimen)

• Urine for culture and sensitivity (if indicated)

• Imaging studies of the urinary tract

  • CT scan

  • Ultrasound

  • Cystoscopy

Complete Urinalysis

• Performed in lab

• Looks at urine composition

Rapid Urinalysis

• Performed at doctor’s office using test strips

• Checks for common renal abnormalities

24-Hours Urine Collection

• Performed at home over 24 hours

• Gives clearer picture of renal function

Culture and Sensitivity

• Determines bacteria that is colonizing the urinary tract.

• Specimens by catheterization are the most accurate.

• Aids in antibiotic selection

Nursing Interventions for CT with Contrast

• Check allergies for shellfish

• Check informed consent

• Check kidney function

• Check IV Access- Large bore IV

CT with Contrast Steps

1. Contrast agent given PO or IV

2. Lie on the table outside the scanner

3. Table slides into the scanner

4. Scanner spins around taking X-rays

UTI Patient Teaching

• Take all antibiotics as prescribed, regardless of improvement

• Practice appropriate hygiene:

  • Carefully clean the perineal region

  • Wipe from front to back after urinating

  • Cleanse with warm, soapy water after each bowel movement

• Empty the bladder before and after sexual intercourse

• Void regularly (every 3-4 hours)

• Avoid:

  • Vaginal douches

  • Harsh soaps

  • Bubble baths

  • Powders and sprays in the perineal area

• Report to HCP symptoms or signs of recurrent UTI

Antibiotics

• Fluconazole

• Fosfomycin

• Nitrofurantoin

• TMP/SMX (Bactrim)

• Trimethoprim alone (sulfa allergy patients

• Cephalexin

• Macrolides: Clindamycin, erythromycin, azithromycin

Nitrofurantoin

• Avoid use if the creatinine clearance is <30 mL/min

• Notify HCP at once if these develop:

  • Fever

  • Chills

  • Cough

  • Chest pain

  • Dyspnea

  • Rash

  • Numbness or tingling of the fingers or toes

Phenazopyridine

• For relief of burning pain from urgency and frequency caused by instruments, infection, trauma, etc. (Treats dysuria)

  • Releases analgesic flakes

• Coats the walls with an orange/red medication, turning the urine reddish-orange.

• Report headache and rash.

Complications of Pyelonephritis

• Hospitalization

• Adequate fluid intake (IV initially; switch to oral fluids and nausea, vomiting, and dehydration subside)

• NSAIDs or antipyretic drugs reverse fever and relieve discomfort

• IV antibiotics (Empirically selected broad-spectrum antibiotics)

  • Carbapenem

  • Vancomycin

  • Daptomycin

  • Linezolid

• Switch to sensitivity-guided antibiotic therapy when results of urine and blood culture are available

Vesicoureteral Reflux (VUR) Pyelonephritis

• Allows urine to go back up into the ureters and kidneys causing repeated urinary tract infections

• Cause of this is a form of reflex is most often from failure of the bladder to empty properly either due to blockage or failure of the bladder muscle or damage to the nerves that control normal bladder emptying

• Can lead to renal scarring and ultimately chronic kidney disease

Sepsis

• Untreated UTIs may spread to the kidney and then cause this.

Recurrent UTI

• Repeat urinalysis

• More urine culture and sensitivity testing

• Adequate fluid intake (8-9 8 oz. glasses/day)

• Repeat patient teaching

• Imaging studies of urinary tract

CAUTI Prevention Interventions

• Appropriate catheter use:

  • Only insert for approved indications

  • Consider alternatives to an indwelling foley

  • Assess for symptomatic infection prior to insertion

• Proper Insertion and Maintenance:

  • Aseptic insertion by trained providers

  • Perform daily meatal/perineal care and prn for soiling from diarrhea or incontinence

  • Place bag below bladder, but keep bag off of the floor

  • Maintain sterility/do not break close system

  • Do not touch drainage spout

  • Ensure unobstructed urine flow and no dependent loops or kinking in tubing

  • Verify continued daily need

  • Electronic or other visual reminders to alert caregivers of foley usage.

True

True or False: Urinalysis is the first study used to show abnormalities and the specimen should be collected in the morning then evaluated with one hour of collection.