Urinary tract infections, or UTIs, are some of the most common complaints seen in the community. Not only are they common in the general population, they are also seen frequently in hospitals and long term care facilities. In fact, preventing UTIs is a large part of infection control in facilities, and they are tracked and monitored like any other infection. Being able to identify the symptoms of urinary tract infections is essential, as is the need to have a thorough understand of the anatomy behind the urinary tract. Finally, treatments are important, as a UTI could become a serious systemic infection.
Describing the Urinary Tract
When medical professionals think of the urinary tract, they may think only of the urethra. In fact, this is only part of the urinary tract that can become infected. This structure comprises the kidneys, the ureters, the bladder, and the urethra. Each part of the anatomy can cause different symptoms in the person, so it helps to understand how the urine passes through these structures and where they can become infected. The kidneys can sometimes be the first point of infection, as they filter blood of toxins and regulate electrolytes, or can also be the last structure infected.
Sometimes the infection moves up the urinary tract from the urethra, which has access to the outside world. It is far more likely that the urethra becomes infected due to poor hygiene, sex, or the insertion of urinary catheters. Once infected, the bug can move up into the bladder and then onto the kidneys. Once the kidneys are infected, the situation becomes more severe, and it results in symptoms that simple UTIs do not display. It is important to determine where the infection is occurring to decide how best to treat the UTI and support the patient’s symptoms.
Common Symptoms of UTIs
Most UTIs have some symptoms in common. For instance, the urgent need to urinate and the inability to hold urine are common signs of an infection. A burning sensation with urinating is also commonly seen, as is passing small amounts of urine frequently. A person may also exhibit cloudy urine, especially on a urinalysis, and sometimes blood may appear in the urine. A clean catch urine culture and screen (c/s) or mid-stream urinalysis will indicate the presence of a bacterial infection.
UTIs that occur in different places along the tract have several symptoms that are specific to that region. For instance, an infection that is primarily in the urethra will cause the patient pain on urinating. When the infection is into the bladder, you may see pelvic pain, blood in the urine, frequent urination, and lower abdominal discomfort. Another term for this type of UTI is cystitis. When the infection makes it to the kidneys, the pain tends to focus on the flank—the upper back or the side. Fever, nausea, rigors (shaking), and chills are also more likely to be seen with kidney infections than with other types of UTIs.
Treatments for UTIs
The standard treatment for a UTI starts with diagnostic tests. A urinalysis will determine if there is any blood or cloudiness in the urine. The urine c/s, though, is the most important. A culture and screen will attempt to determine what bacteria may be present in the urinary tract and what antibiotics they are susceptible to. It is very easy to get a contaminated sample with this test, so false positives are common. You need to thoroughly instruct your patient on how to perform a clean catch or use impeccable technique when getting a sample through a catheter.
The treatment for UTIs is generally antibiotics. When the culture grows a bacteria set the screen will then determine which antibiotics are lethal to the colony. However, many doctors simply give a broad-spectrum antibiotic to help the patient recover. This is a medication that is capable of killing most bugs. When the c/s comes back the doctor can refine the antibiotic to a more specific type. If the UTI is severe enough, then the patient may need IV antibiotics to overcome the infection. This is especially true of kidney infections. For more chronic cases of UTIs, cystoscopy may be used to examine the urinary tract and find the reason for the chronic infections. Further reading on this topic is available on the Mayo Clinic website.