Urinary Tract Infections - Essay Example

URINARY TRACT INFECTIONS (UTIs) Abstract A urinary tract infection (UTI) affects the human urinary tract (UT) system, which consists of the kidneys, ureters, bladder and urethra. The main function of these organs is to filter and balance fluids and salts. Escherichia coli, a bacterium, is the main cause of UTIs, which are a rising health concern in hospitals and communities, costing about US$6 billion annually and accounting for more than 10 million visits to the doctor per year. Any part of the UT system can be infected. Women across their life spans are the most vulnerable to UTIs. Uraemia, nocturia, pain during urinating and urgency to urinate with little or no urine, among others, are some of the symptoms that can present in a person with a UTI. Care should be taken when collecting specimens to avoid secondary contamination. Urine culture, dipstick and microscopy methods are used to test for the presence of bacteriuria. These tests can be used solely or in combination depending on their specificity and sensitivity to the presence or absence of a UTI. Antibiotics are the first line in the management of a UTI. Introduction The human urinary system is comprised of the kidneys, ureters, bladder and urethra. The system plays a very important role in eradicating waste from the body and balancing salts and body fluids (Hickling & Nitti 2013, p. 42). The kidneys are a pair of bean-shaped organs found one on each side in the middle of the back and below the rib cage. One of main functions of the kidneys is to sieve waste from the blood. Tubes referred to as ureters transfer the waste or urine from the kidneys to the bladder. The bladder functions as urine storage, from which it leaves the body via the urethra (Hickling & Nitti 2013, p. 43). A urinary tract infection (UTI) affects the human urinary tract (UT) system. Any part of the UT system can be infected. Escherichia coli, a bacterium, is the main cause of UTIs, which are a rising health concern in hospitals and communities, costing about US$6 billion annually and accounting for more than 10 million visits to the doctor per year. Women across their life spans are the most vulnerable to UTIs. All of these body components can be infected, but most infections are common in the lower tract (the urethra and the bladder). This essay will look into the significance of UTIs to the community, symptoms, specimen collection and treatment. Significance of UTIs to the community A UTI is a fundamental health concern, both in hospitals and in community settings. About 150 million UTI cases occur globally annually. As a result, about US$6 billion is paid for hospital expenditures. In the US, the UTI incidence among premenopausal women is about 0.5–0.7 per person each year. Medicare beneficiaries or those aged 65 years and older alone represent about 1.8 million annual office visits of about 10 million visits made to the doctor annually for UTIs (Shoskes 2012, p. 737). Aetiology A UTI infection can occur anywhere along the urinary tract (UT). UTIs have different names with reference to the site of infection within the tract (Al-Badri & Al-Sheikh 2013, p. 362). Bacterial Escherichia coli that lives within the large intestine, particularly the rectum, causes most urinary tract infections. An infection of the kidneys leads to a serious condition called pyelonephritis (Bettcher et al. 2014, p. 2). Adult women commonly suffer from UTIs following the anatomical make up of their urethra that opens nearer to the anus and is shorter than that of their counterparts in men. About 40% of women in their lifetime suffer from cystitis at least once (Bettcher et al. 2014, p. 3). UTIs are common among pregnant women, sexually active women, and in women during menopause and after surgery. Urinary tract infection symptoms UTI symptoms occur in a great percentage, but a patient may not experience all of them. In addition, other symptoms appear as opportunistic symptoms. According to Hassan et al. (2014, p 415), the common symptoms include: • feeling pressure in the lower pelvis or a lower backache. • An urgent desire to urinate with little to no urine passage, frequent urination, pain during urination and a foul odour. • Nocturia, which involves a foul odour or cloudy urine being produced. • Uraemia is common, presenting with fever, chills, nausea and vomiting, indicating signs of severe infection. • Pain during urination Patient specimen collection It is not advisable to test for a UTI with urine from a bag specimen. Pediatric Babies and young children who cannot pass urine when prompted need to have a clean/safe catch urine sample collected (Bettcher et al. 2014, p. 7). To catch this urine sample, wash the external genitalia and perineum with clean water and soap; using a flannel or clean cloth, dry the area. The child should be positioned on a bed or in your lap. Let the foil dish be within reach or place it under the girl’s perineum or boy’s penis wherein the child can urinate. The urine sample from the foil dish is then poured into a sterile container. A sample of midstream urine (MSU) can be collected from grown children able to respond to their nature’s call when asked (Masungura & Nakamura 2013, p. 1512). The specimen is carefully labelled with the client’s name, date of birth, date and time of specimen collection and request form number to ensure consistency of the information. If the specimen is collected far from the hospital, the caregiver of the patient places it in a polythene bag, then in a fridge or a cool place if not taken to the hospital, pathology laboratory or to a health care provider within 30 minutes. Adult males and females Most urine specimens are obtained from adult male and female patients via the clean-catch midstream void technique. It is advantageous, as it is neither invasive nor uncomfortable, it is simple and inexpensive, it can be performed in almost any clinical setting, it produces no risk of introducing bacteria to the patient’s bladder by catheterisation and there is no risk of complications (Ninan, Walton & Barlow 2014, p. 63). Colony counts from urine specimens collected by this method correlate reasonably well with those of specimens collected via suprapubic aspiration or straight catheterisation done for surgical patients on catheters (Hasan et al. 2014, p. 418). The main disadvantage of the midstream void technique, however, is the sample of urine can become contaminated commensally by bacteria as it passes via the distal urethra. The mucous membrane and skin cleaning adjacent to the orifice of the urethra has proven to decrease the rate of contamination if done before maturation. In addition, passing the first urine into toilet, then collecting the second part of it is another form, which provides urine free from contamination, or collecting from the MSU for culture (Collier 2014, p. 140). Proper urine sample collection should be ensured for the elderly and physically disabled to avoid contamination at all costs. Surgical patients A urine sample is already available from the catheter in use; clamp the catheter for a minimum of 30 minutes to allow some urine to accumulate in the bladder. Do not take urine from the urine bag, as it is normally contaminated. Clamp the tube to a point below the point at which you will take the specimen. Using a large syringe with a needle, insert the needle at a 90-degree angle and draw the urine. Unclamp the tubing and place the urine sample into a sterile container, label and forward to the lab (Hasan et al. 2014, p. 418). Others Non-toilet-trained infants’ specimens can be collected through suprapubic aspiration. This involves using a needle with a syringe and piercing through the bladder at a point above the pubic bone and collecting the urine specimen (Bhat, Katy & Place 2011, p. 637). Laboratory diagnosis Various common tests can be used, including urinalysis by dipstick and urine microscopy under 40x power, both of which are readily available in the clinical setting. The other test is urine culture, which is more expensive and requires 24 to 48 hours for results to be achieved. Historically however, none of these tests has been shown or proven to be the ideal screening tool (Hassan, et al. 2014, p. 420). A dipstick analysis in a leukocyte esterase test for a UTI also tests indirectly for the presence of pyuria (elevated white blood cells [WBCs]) (Hasan et al. 2014, p. 420). It is believed to be the least expensive and time intensive. It has about 75–96% sensitivity and 94–98% specificity. It has a 50% positive pyuria predictive value in comparison to a microscopy test, though dipstick has so far been incomparable to urine culture regarding leukocyte esterase. However, the dipstick method has a low sensitivity to lower UTI thresholds in comparison to culture (i.e. 102–104 cfu/mL) and specificity is disparately higher for similar thresholds. Nitrite testing using a dipstick is considered less beneficial, probably in large part because it is only positive if bacteria that produce nitrate reductase are present and can therefore be baffled by ascorbic acid consumption. Microscopic examination using microscopy of 40x power of centrifuged, unstained urine performed by an expert produces an 82–97% sensitivity and 84–95% specificity. This, however, varies depending on preset verges for UTIs. A microscopic urinalysis showing pyuria has a widely variable predictive value for a UTI based on the pretest probability. Depending on the UTI threshold the sensitivity of urine culture varies from about 50–95% with about 85–99% specificity (Anathanarayan & Jayaram 2013, p. 672) Urine culture is not advisable for verifying or diagnosing uncomplicated UTIs. This is because urine culture sensitivity is limited. In addition, the results take a 2-3days to be availed for treatment and during this time the disease can progress (Government of Western Australia 2014, p. 2). Therefore, with short treatment courses, treatment may be completely administered before culture results are available in the literal sense. Several factors affect diagnostic testing validity. Apparent pyuria, though collected through a clean mechanism, may be contaminated by vaginal discharge. In this case, the bacteriuria may represent perineal or vaginal contamination. Leukocyte esterase, which indirectly tests for WBCs in urine, may appear negative during the early stages of UTI, yet may cause a detrimental infection. This may call for a diagnosis in reference to the symptoms, which may not always be correct. The health practitioner being able to realise the uncertainty of the test validity can determine whether the patient is likely to benefit from treatment (Collier et al. 2014, p. 140). Treatment According to Shoskes (2012, p. 745), treatment is done with reference to judicious antibiotics use, catheter removal, if feasible, urinary tract obstruction relief and hydration. Treatment using antibiotics depends on severity of illness, factors of the host and site of infection. According to research, many people with UTIs respond to recommended antibiotics that become highly concentrated in urine procedures, including those with cases of recurrent UTIs, to clean the UTI (Hickling & Nitti 2013, p. 43), such as from the lowest to highest mean urine concentration. Nitrofurantoin Read More