Urinary Tract Infection: A Case Study

Urinary tract infection (UTI) is a bacterial infection or inflammation of the bladder (cystitis), kidneys (pyelonephritis), or urethra (urethritis), leading to bacterial colonization of the urine. Infection of the urinary tract is a common problem, causing more than eight million office visits annually in the United States. UTI is the second most common infection that affects women. UTIs typically affect young, sexually active women. A lower UTI is an infection or inflammation of the bladder or urethra. Upper UTIs involve infections of the ureters and kidneys. Simple or uncomplicated UTIs are infections experienced by women with no significant history of UTIs and are characterized by new onset of mild to moderate symptoms. A complicated UTI

commonly occurs due to structural or functional abnormality of the urinary tract. UTIs can be due to acute or chronic infections (Buttaro, Trybulski, Bailey, & Sandberg-Cook, 2011).
Risk factors for UTIs include stool contamination, history of past urinary tract infection, low fluid intake, irregular bladder emptying, vaginal pH lower than 4.5, sexual intercourse, failure to void within 10 to 15 minutes of sexual intercourse, diaphragm or spermicide use, symptomatic partner, pregnancy, menopause, hyperuricemia, neurogenic bladder, kidney disease, urologic abnormalities, and immunocompromised (Buttaro et al., 2011).

Symptoms of acute uncomplicated UTIs are due to bladder irritation exhibiting signs of increased frequency, urgency, dysuria, and occasional hematuria. An uncomplicated UTI is a rare occurrence in the affected individual who is otherwise healthy. Usually, there are a small number of responsible pathogens vulnerable to first-line narrow-spectrum antimicrobial agents, and there are no urologic or gynecologic abnormalities. A complicated presentation including high fever, chills, flank pain, costovertebral angle tenderness, nausea, and vomiting is indicative of pyelonephritis or urosepsis (Buttaro et al.,

2011).
A urinalysis is essential when the patient presents with urinary symptoms indicative of an UTI.

A clean-voided specimen reduces vaginal and labial contamination. It is advised that urine dipstick tests be used to guide treatment decisions in healthy women younger than 65 years whose UTI symptoms are mild, or presents with less than two symptoms (Shah & Goundrey-Smith, 2013). A urine dipstick provides rapid diagnostics by assessing the presence of leukocytes, nitrites, blood, protein, and/or bacteria. The presence of nitrites and leukocytes indicates bacteria in the urine, which causes urinary nitrates to breakdown into nitrites. A higher concentration of the leukocyte esterase enzyme will be present in the urine due to the increased presence of neutrophils with infection. In addition to the information obtained from the dipstick, microscopy can be used to detect hematuria, pyuria (white cells in the urine), or bacteriuria to confirm the type of bacteria and guide antibiotic selection in complicated UTI or pyelonephritis (kidney infection). A urine culture is needed for upper UTI, complicated UTI, unsuccessful treatment or reinfection of UTI (Buttaro et al.,

2011).
Nonpharmacologic measures have shown to prevent sporadic or frequent UTIs. Sexual intercourse and failure to void within 10 to 15 minutes after sexual intercourse are the two main influences most consistently associated with UTIs. In discussing the association between these two factors and UTIs with a patient, the provider must distinguish between UTIs and STIs. Explanations and suggestions must be presented in a way that is nonjudgmental without implying guilt. It should be suggested to void within 10 to 15 minutes after sexual intercourse, drink plenty of water (64 to 80 ounces/day), urinate frequently, wipe front to back, and avoid feminine products that include deodorants, avoid close-fitting or synthetic underwear, vaginal douching to decrease the occurrence of UTIs (Buttaro et al., 2011). Additionally, regular consumption of cranberries supplementation in the form of juice, concentrate, cocktail formulation, or capsule has shown to have a positive role in preventing UTIs. Studies have shown cranberry as having preventative capabilities for UTI symptoms. Cranberries consist of anthocyanins, which may inhibit bacterial adhesion to the urinary tract. A meta-analysis in 2012 determined that adults who consumed cranberry juice on a regular basis were 38% less likely to develop symptoms of UTI, and the juice was more effective than cranberry capsules or tablets (Bass-Ware, Weed, Johnson, & Spurlock, 2014).