Urinary Tract Infection: Difference between revisions
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<div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox"> | <div class="noeditbox">Welcome to [[Pathophysiology of Complex Patient Problems|PT 635 Pathophysiology of Complex Patient Problems]] This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. Please do not edit unless you are involved in this project, but please come back in the near future to check out new information!!</div><div class="editorbox"> | ||
'''Original Editors '''- [[Pathophysiology of Complex Patient Problems|Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | '''Original Editors '''- [[Pathophysiology of Complex Patient Problems|Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.]] | ||
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Urinary Tract Infection (UTI) is defined generally as an infection of the urinary system caused by microbes including mainly bacteria, but also fungi and viruses<ref name="Urinary" />. Typically, bacteria that enters the urinary tract is rapidly removed by the body before symptoms are presented, but sometimes this bacteria overcomes the natural defenses of the body and results in infection<ref name="Urinary" />. This infection may involve the lower urinary tract only or both the lower and upper urinary tracts<ref name="Rowe" />. | Urinary Tract Infection (UTI) is defined generally as an infection of the urinary system caused by microbes including mainly bacteria, but also fungi and viruses<ref name="Urinary" />. Typically, bacteria that enters the urinary tract is rapidly removed by the body before symptoms are presented, but sometimes this bacteria overcomes the natural defenses of the body and results in infection<ref name="Urinary" />. This infection may involve the lower urinary tract only or both the lower and upper urinary tracts<ref name="Rowe" />. | ||
A UTI involving the lower urinary tract can be subdivided into two classifications: infection in the urethra, urethritis, and infection in the bladder, cystitis<ref name="Urinary" />. In addition, bacteria can travel up the ureters to multiply and infect the upper urinary tract<ref name="Urinary" />. This can lead to a kidney infection, pyelonephritis or infection of the glomeruli, glomerulonephritis<ref name="Urinary" />. <br> | A UTI involving the lower urinary tract can be subdivided into two classifications: infection in the urethra, urethritis, and infection in the bladder, cystitis<ref name="Urinary" />. In addition, bacteria can travel up the ureters to multiply and infect the upper urinary tract<ref name="Urinary" />. This can lead to a kidney infection, pyelonephritis or infection of the glomeruli, glomerulonephritis<ref name="Urinary" />. <br> | ||
== Prevalence == | == Prevalence == | ||
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Across all age groups, the incidence of UTI is higher in women than men<ref name="Rowe" />. UTIs in men are often a result of an obstruction- urinary stone, enlarged prostrate, urinary catheter<ref name="Urinary" />. The lifetime risk of having a UTI is greater than 50% for women<ref name="Rowe" />. Women are especially prone due to anatomical reasons including a woman's urethria is shorter allowing bacteria quicker access to the bladder and the urethral opening is near bacteria sources-anus and vagina<ref name="Urinary" />. UTI is also frequent in women that are young and sexually active with reported incidence rates ranging from 0.5 to 0.7 per person-year<ref name="Rowe" />. Pregnancy does not show an increased risk compared to typical women, but a UTI is more likely to travel to the kidneys in pregnant women-due to hormonal and positional changes<ref name="Urinary" />. | Across all age groups, the incidence of UTI is higher in women than men<ref name="Rowe" />. UTIs in men are often a result of an obstruction- urinary stone, enlarged prostrate, urinary catheter<ref name="Urinary" />. The lifetime risk of having a UTI is greater than 50% for women<ref name="Rowe" />. Women are especially prone due to anatomical reasons including a woman's urethria is shorter allowing bacteria quicker access to the bladder and the urethral opening is near bacteria sources-anus and vagina<ref name="Urinary" />. UTI is also frequent in women that are young and sexually active with reported incidence rates ranging from 0.5 to 0.7 per person-year<ref name="Rowe" />. Pregnancy does not show an increased risk compared to typical women, but a UTI is more likely to travel to the kidneys in pregnant women-due to hormonal and positional changes<ref name="Urinary" />. | ||
UTI is one the most commonly diagnosed infections in older adults and the most frequently diagnosed infection in long-term care residents, with over 10% of women older than 65 years old reported having a UTI within the past 12 months<ref name="Rowe" />. ASB is more common in older adults compared to younger adults as the prevalence increases with age in both men and women<ref name="Rowe" />. <br><br> | UTI is one the most commonly diagnosed infections in older adults and the most frequently diagnosed infection in long-term care residents, with over 10% of women older than 65 years old reported having a UTI within the past 12 months<ref name="Rowe" />. ASB is more common in older adults compared to younger adults as the prevalence increases with age in both men and women<ref name="Rowe" />. <br><br> | ||
== Characteristics/Clinical Presentation == | == Characteristics/Clinical Presentation == | ||
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When a patient presents with both clinical features and laboratory evidence of a urinary infection, a symptomatic UTI diagnosis can be made<ref name="Mody" />. Patients presenting with '''two''' of the following meet the diagnostic criteria for a symptomatic UTI<ref name="Mody" />:<br>• worsened urinary urgency or frequency<br>• acute dysuria<br>• suprapubic tenderness<br>• costovertebral angle pain or tenderness<br>• fever<br><br> | When a patient presents with both clinical features and laboratory evidence of a urinary infection, a symptomatic UTI diagnosis can be made<ref name="Mody" />. Patients presenting with '''two''' of the following meet the diagnostic criteria for a symptomatic UTI<ref name="Mody" />:<br>• worsened urinary urgency or frequency<br>• acute dysuria<br>• suprapubic tenderness<br>• costovertebral angle pain or tenderness<br>• fever<br><br> | ||
Additional signs and symptoms include the following<ref name="Urinary" />: <br>• nausea and vomiting<br>• a frequent and intense urge to urinate<br>• a painful, burning feeling in the bladder or urethra during urination<br>• feeling tired, shaky, and weak<br>• muscle aches<br>• abdominal pain<br>• only small amounts of urine passed, despite a strong urge to urinate<br>• cloudy, dark, or bloody urine<br>• urine that has a foul smell<br>• pain in the back or side below the ribs<br><br> | Additional signs and symptoms include the following<ref name="Urinary" />: <br>• nausea and vomiting<br>• a frequent and intense urge to urinate<br>• a painful, burning feeling in the bladder or urethra during urination<br>• feeling tired, shaky, and weak<br>• muscle aches<br>• abdominal pain<br>• only small amounts of urine passed, despite a strong urge to urinate<br>• cloudy, dark, or bloody urine<br>• urine that has a foul smell<br>• pain in the back or side below the ribs<br><br> | ||
== Associated Co-morbidities == | == Associated Co-morbidities == | ||
Revision as of 03:52, 24 March 2016
Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Kaylee Whitehead, Melanie Anderson, Cate Hurst, Kim Jackson, Lucinda hampton, Vidya Acharya, Temitope Olowoyeye, Elaine Lonnemann, Krista Polanin, WikiSysop and Nicole Hills
Definition/Description[edit | edit source]
Urinary Tract Infection (UTI) is defined generally as an infection of the urinary system caused by microbes including mainly bacteria, but also fungi and viruses[1]. Typically, bacteria that enters the urinary tract is rapidly removed by the body before symptoms are presented, but sometimes this bacteria overcomes the natural defenses of the body and results in infection[1]. This infection may involve the lower urinary tract only or both the lower and upper urinary tracts[2].
A UTI involving the lower urinary tract can be subdivided into two classifications: infection in the urethra, urethritis, and infection in the bladder, cystitis[1]. In addition, bacteria can travel up the ureters to multiply and infect the upper urinary tract[1]. This can lead to a kidney infection, pyelonephritis or infection of the glomeruli, glomerulonephritis[1].
Prevalence[edit | edit source]
Across all age groups, the incidence of UTI is higher in women than men[2]. UTIs in men are often a result of an obstruction- urinary stone, enlarged prostrate, urinary catheter[1]. The lifetime risk of having a UTI is greater than 50% for women[2]. Women are especially prone due to anatomical reasons including a woman's urethria is shorter allowing bacteria quicker access to the bladder and the urethral opening is near bacteria sources-anus and vagina[1]. UTI is also frequent in women that are young and sexually active with reported incidence rates ranging from 0.5 to 0.7 per person-year[2]. Pregnancy does not show an increased risk compared to typical women, but a UTI is more likely to travel to the kidneys in pregnant women-due to hormonal and positional changes[1].
UTI is one the most commonly diagnosed infections in older adults and the most frequently diagnosed infection in long-term care residents, with over 10% of women older than 65 years old reported having a UTI within the past 12 months[2]. ASB is more common in older adults compared to younger adults as the prevalence increases with age in both men and women[2].
Characteristics/Clinical Presentation[edit | edit source]
When a patient presents with both clinical features and laboratory evidence of a urinary infection, a symptomatic UTI diagnosis can be made[3]. Patients presenting with two of the following meet the diagnostic criteria for a symptomatic UTI[3]:
• worsened urinary urgency or frequency
• acute dysuria
• suprapubic tenderness
• costovertebral angle pain or tenderness
• fever
Additional signs and symptoms include the following[1]:
• nausea and vomiting
• a frequent and intense urge to urinate
• a painful, burning feeling in the bladder or urethra during urination
• feeling tired, shaky, and weak
• muscle aches
• abdominal pain
• only small amounts of urine passed, despite a strong urge to urinate
• cloudy, dark, or bloody urine
• urine that has a foul smell
• pain in the back or side below the ribs
Associated Co-morbidities[edit | edit source]
add text here
Medications[edit | edit source]
add text here
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
add text here
Etiology/Causes[edit | edit source]
add text here
Systemic Involvement[edit | edit source]
Urinary Tract infections that are left untreated may lead to many complications, including urosepsis, systemic inflammatory response syndrome (SIRS), and chronic kidney infections. Sepsis associated with UTIs often requires hospitalization[3]. Urosepsis spreads into the bloodstream from its origin in the urinary tract. Kidney infections also progress to the blood stream, referred to as septicemia[1]. This complication can be life threatening. Systemic inflammatory response syndrome can also become life threatening if treatment fails. SIRS is usually the first incidence of multi-organ failure[4].
Medical Management (current best evidence)[edit | edit source]
Urinary tract infections are most commonly treated by antibiotic prescription. Frequently prescribed antibiotics include[5]:
- Nitrofurantoin
- Amoxicillin
- Trimethoprim
- Fluoroquinolones
Antibiotics are usually taken anywhere from 3 days to 10 days, depending on severity of symptoms, comorbidities, complications of infection, and dosage [2] [5]. Overutilization of antibiotics is a common issue, particularly in hospitals and long term facilities, which may cause patients to develop resistance to the medication over time[2].
Alternative treatment includes the use of probiotics, ensuring proper hydration, drinking cranberry juice, and urinating frequently [6] [3] [1]. Using a heating pad on the patient’s lower back or abdomen may also help the symptoms of the UTI[1]. Surgery may be required in the presence of an anatomical abnormality [5].
Physical Therapy Management (current best evidence)[edit | edit source]
Physical therapists that are trained in pelvic floor dysfunction can greatly improve a UTI patient’s quality of life. A typical approach includes manipulative techniques, local heat, breathing and relaxation techniques, postural education, muscle coordination reeducation, and behavioral therapy[7]. Therapists are also encouraged to educate the patient on drinking and voiding schedules to ensure consistency[8]. Treatments and patient education have been found to improve efficiency of emptying the bladder, create better bowel habits, and promote full relaxation of the pelvic-floor when voiding[7]. All of these factors may lead to a decreased incidence and reoccurrence of UTIs.
For those patients in the hospital, recent studies have shown that mobilization of patients with a catheter is safe and is not associated with urinary-related adverse effects, including urinary tract infections[9].
Differential Diagnosis[edit | edit source]
Other conditions that can cause symptoms similar to UTI include[10]:
- Herpes genitalis (HSV)
- Urethritis
- N. Gonorrhoeae
- Chlamydia
- Trichomonas
- Vaginitis
- Prostatitis
- Nephrolithiasis
- Trauma
- GU tuberculosis
- GU neoplasm
- Intra-abdominal abscess
- Sepsis
Variation in symptom presentation:
Post-menopausal women present with constitutional symptoms, such as abdominal pain, back pain, chills, and constipation[2].
Nursing home patients present with nonspecific symptoms, such as confusion and a decline in functional status [2].
Children are usually the hardest to diagnose due to the their vagueness of symptoms. The typical adult symptoms of frequency, urgency, and dysuria are usually absent in children. Young children sometimes present with irritability, poor feeding, vomiting, or jaundice. UTI should be considered in any child between two months and two years of age with fever that doesn't have an identifiable source of infection.[6] Young children with incontinence and abdominal pain should be checked for UTI. [6]
Case Reports/ Case Studies[edit | edit source]
1. Physiotherapy For Women With Recurrent Urinary Tract Infection: A Promising Approach
2. Pelvic floor therapy in girls with recurrent UTIs
Resources
[edit | edit source]
American Urological Association
http://www.auanet.org/education/adult-uti.cfm
NYU School of Medicine Department of Urology
http://www.med.nyu.edu/urology/patient-care-information/conditions-we-treat/recurrent-urinary-tract-infections#diagnosis
European Association of Neurology
http://uroweb.org/wp-content/uploads/19-Urological-infections_LR2.pdf
Choices in Health
http://choicespc.net/physical-therapy-for-urinary-problems-and-pelvic-floor-dysfunction/
Recent Related Research (from Pubmed)[edit | edit source]
see tutorial on Adding PubMed Feed
Extension:RSS -- Error: Not a valid URL: addfeedhere|charset=UTF-8|short|max=10
Australian Institute of Sport and the Australian Paralympic Committee position statement: urinary tract infection in spinal cord injured athletes
http://bjsm.bmj.com.libproxy.bellarmine.edu/content/49/19/1236.full
References[edit | edit source]
see adding references tutorial
- ↑ 1.00 1.01 1.02 1.03 1.04 1.05 1.06 1.07 1.08 1.09 1.10 1.11 Urinary Tract Infections in Adults. Urologic Diseases. 2013. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/pages/ez.aspx.
- ↑ 2.0 2.1 2.2 2.3 2.4 2.5 2.6 2.7 2.8 2.9 Rowe, TA, Juthani-Mehta, M. Urinary tract infection in older adults. Aging Health. 2013;9(5).
- ↑ 3.0 3.1 3.2 3.3 Mody, L, Juhani-Mehtta, M. Urinary Tract Infections in Older Women: A Clinical Review. JAMA. 2014;311:844–854.
- ↑ Grabe, M. Guidelines on Urological Infections. Urological Infections. Available at: http://uroweb.org/wp-content/uploads/19-urological-infections_lr2.pdf.
- ↑ 5.0 5.1 5.2 Rosenblum, N. Recurrent Urinary Tract Infections. Urology. Available at: http://www.med.nyu.edu/urology/patient-care-information/conditions-we-treat/recurrent-urinary-tract-infections
- ↑ 6.0 6.1 6.2 Becknell, B, Schober, M, Korbel, L, Spencer, JD. The Diagnosis, Evaluation and Treatment of Acute and Recurrent Pediatric Urinary Tract Infections. Expert Review of Anti-infective Therapy. 2015;13(1):81–90.
- ↑ 7.0 7.1 Souza, EL, Figueiredo, EM, Velloso, FB, Geo, MS. Physiotherapy For Women with Recurrent Urinary Tract Infection: A Promising Approach. International Continence Society. 2013:223.
- ↑ De Paepe, H, Hoebeke, P, Renson, C, et al. Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. British Journal of Urology. 1998;3:10–9113.
- ↑ Lima, NP, Cardim da Silva, GM, Park, M, Pires-Neto, RC. Mobility therapy and central or peripheral catheter-related adverse events on an ICU in Brazil. J bras pneumol. 2015;41(3):225–230.
- ↑ M, Pontari, D, Shoskes. Adult UTI. Advancing Urology. Available at: www.auanet.org/education/adult-uti.cfm.
1. Rowe, TA, Juthani-Mehta, M. Urinary tract infection in older adults. Aging Health. 2013;9(5).
2. Becknell, B, Schober, M, Korbel, L, Spencer, JD. The Diagnosis, Evaluation and Treatment of Acute and Recurrent Pediatric Urinary Tract Infections. Expert Review of Anti-infective Therapy. 2015;13(1):81–90.
3. Souza, EL, Figueiredo, EM, Velloso, FB, Geo, MS. Physiotherapy For Women with Recurrent Urinary Tract Infection: A Promising Approach. International Continence Society. 2013:223.
4. Lima, NP, Cardim da Silva, GM, Park, M, Pires-Neto, RC. Mobility therapy and central or peripheral catheter-related adverse events on an ICU in Brazil. J bras pneumol. 2015;41(3):225–230.
5. Mody, L, Juhani-Mehtta, M. Urinary Tract Infections in Older Women: A Clinical Review. JAMA. 2014;311:844–854.
6. De Paepe, H, Hoebeke, P, Renson, C, et al. Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. British Journal of Urology. 1998;3:10–9113.
7. M, P, D, S. Adult UTI. Advancing Urology. Available at: www.auanet.org/education/adult-uti.cfm.
8. Rosenblum, N. Recurrent Urinary Tract Infections. Urology. Available at: http://www.med.nyu.edu/urology/patient-care-information/conditions-we-treat/recurrent-urinary-tract-infections
9. Urinary Tract Infections in Adults. Urologic Diseases. 2013. Available at: http://www.niddk.nih.gov/health-information/health-topics/urologic-disease/urinary-tract-infections-in-adults/pages/ez.aspx.
10. Grabe, M. Guidelines on Urological Infections. Urological Infections. Available at: http://uroweb.org/wp-content/uploads/19-urological-infections_lr2.pdf.
