Urinary Tract Infections - Medical Microbiology and Immunology - Case Study Example

Urinary Tract Infections Name Medical Microbiology and Immunology 2 Instructor Date Abstract The aim of this paper is to discuss the urinary tract infections. A desk research was conducted by including PubMed articles that are relevant to the topics. The inclusion criteria for articles entailed significance of UTI to the community and burden, symptoms, methods of specimen collection, laboratory diagnosis and treatment options. Urinary tract infections are common among the population, especially among women. UTIs present a significant burden to the community through healthcare expenditure. A lot of time that could have been used for work is used for healthcare visits, and having to rest while undergoing treatment. UTIs also present symptoms that may be uncomfortable to the affected person. UTIs are named according to the location of the infection. Pyelonephritis in the kidney is riskier than bladder’s cystitis. Laboratory diagnosis is achieved by urinalysis involving culture and non-culture methods. Treatment options with antibiotics regimen are preferred in most cases. 1. Introduction Urinary tract infections (UTIs) are usually bacterial infections that affect the urinary tract system. Cystitis occurs in the bladder, urethritis occurs in the urethra, and pyelonephritis occurs in the kidney (Vasudevan 2014). Discussed in this paper is the significance of UTIs in relevance to the burden they cause to the community, UTI symptoms, methods of specimen collection, laboratory diagnosis and treatment options. 2. General content a. Significance Urinary tract infections (UTIs) caused by bacteria pose a significant health problem on the community. UTIs occur more in women than men (Salvatore et al. 2011). Premenopausal women between ages 16 and 35 years have the highest occurrence frequency with ten percent of this population having a UTI every year, and sixty percent having a UTI at a certain point in their life (Emiru et al. 2013) Recurrences are also common as some people can get more than one infection within a year. Cystitis is the most common form of UTI while pyelonephritis occurs less frequently (Vasudevan 2014). UTIs present higher risks in pregnancy (Vasudevan 2014). UTI’s are also common among the elderly in the community. UTIs account for over 2 million clinical visits per year from people aged 65 years and older (Matthews & Lancaster 2011). The rate of asymptomatic infection in the urine increases with age by 2 to 7 percent in premenopausal women to over 50 percent in elderly women. In men above 75 years, the rate of asymptomatic infection is between 7 to 10 percent (Beveridge et al. 2011). At least 10% of the population has had a UTI during childhood. Among children, UTIs have been shown to be more common among uncircumcised boys and girls under one year (White 2011). UTI’s account for the largest cause of hospital acquired infections especially among surgical patients. According to Meddings et al., (2013) majority of healthcare associated UTIs occur due to forgetting to remove urinary catheters. At least one million catheter-related UTIs occur per year with an associated cost of USD 676 per admission and up to USD 2386 if complicated by bacteraemia (Meddings et al. 2013). It is estimated that at least 150 million cases of UTIs occur annually and account for at least USD 6 billion used in health care expenditures (Oladeinde et al. 2011). UTI’s account for over 7 million consultations, over a million visits to the emergency departments, and at least a hundred thousand hospitalisations. b. Patient symptoms Symptoms are helpful in UTI diagnosis, although some cases are asymptomatic. Symptoms accompanying cystitis, urethritis, and prostatitis include urgency to pass urine, frequent urination, foul –smelling urine, dysuria, hematuria, and pain in the suprapubic region (Vasudevan 2014). It can be difficult to accurately localise the symptoms with most UTI cases, except epididymis in men which is easily localizable. Upper UTIs such as pyelonephritis may include symptoms typical of cystitis, in addition to fever, chills or rigors, abdominal pain, nausea and vomiting. Chills and fever is usually a sign that the UTI has spread to the kidneys (Vasudevan 2014). c. Patient specimen collection The method of urine collection from the patient is significant in making a distinction between a contamination and an infection. Common methods for specimen collection include, catheterisation, clean-catch midstream voiding, and suprapubical aspiration. Clean-catch midstream specimen is obtained by washing the urethral opening with a mild non-foaming cleanser and air drying (Emiru et al. 2013). The aim is to minimise contact between the urinary stream and the mucosa layer. The first 5ml of urine is discarded while the next 5ml to 10 ml is captured in a clean container. It is the most commonly used method because it is non-invasive, cheap and comfortable for the patient (Vasudevan 2014). Catheterisation involves the collection of sample by inserting a catheter in the urethra. It lessens chances of specimen contamination (Hooton et al. 2010). However, it is invasive, costly, and increasing evidence suggests that it further introduced bacteria into the bladder. Suprapubic aspiration is the least used method because it is invasive, uncomfortable, labour-intensive, and involves a lot of resources (Hooton et al. 2010). However, it is the best to eliminate specimen contamination with bacteria in the distal urethra region and recommended in special cases. a. Paediatric In older children that have urinary or bladder control, the specimen is collected by the clean-catch midstream voiding method (Sahay 2012). In infants and children that are unable to control the bladder for whichever reason, the suprapubic or urethral catheterisation methods are used (Sahay 2012). b. Adult male The adult male sample can be collected using the clean-catch midstream voiding or the urethral catheterisation method for sterile sample (Sarpong et al. 2012). In uncircumcised males, the foreskin is pulled back to get sterile specimen using clean-catch midstream voiding method (Hooton et al. 2010). c. Adult female Clean catch midstream voiding is commonly used to collect the specimen from the adult female (Emiru et al. 2013). The collection method is suitable because of the female anatomy where contamination of urine by vaginal and perineal microorganisms is possible (Vasudevan 2014). Specimen is obtained by parting the labia to avoid possible contamination with vaginal microorganisms. For elderly women and those experiencing vaginal bleeding or discharge, catheterisation is preferred because of difficulty in obtaining a clean-catch specimen (Minardi et al. 2011). d. Surgical patients Catheterisation and suprapubic aspiration are more suitable for surgical patients. The method is ideal for those that require pelvic examination as it is difficult to obtain specimen through the clean-catch method in these patients (Hooton et al. 2010). e. Other Where sexually transmitted diseases (STDs) are suspected, a urethral swab is obtained for testing the STD, followed by collecting the sample by either clean-catch midstream voiding or catheterisation (Sarpong et al. 2012). d. Laboratory diagnosis UTI can be diagnosed in the laboratory culture and non-culture methods (Minardi et al. 2011). Non-culture methods include urinalysis through urine microscopy which detects bacteriuria after Gram staining of urine sample that has not been centrifuged. The bacteria can also be observed directly in the urine specimen. This is a simple method but limited in its sensitivity to detect a wide array of UTIs such as pyelonephritis (Minardi et al. 2011). Other non-culture diagnostic methods include nitrite test for bacteriuria detection, and urine microscopy and leukocyte esterase tests for pyuria detection (Minardi et al. 2011). Culture methods entail quantification of bacteria culture in the urine sample collected from the patient (Delanghe & Speeckaert 2014). The culture is a significant test to identify the infecting microorganism and testing its susceptibility to antimicrobials (Minardi et al. 2011). Several culture methods can be used to quantify bacteria in urine. Simple and commonly used methods include sterile filter paper, calibrated loop technique and multipoint technology (Delanghe & Speeckaert 2014). e. Treatment options Antibiotics are commonly used to treat UTIS. These include nitrofurantoin, fosfomycin and trimethoprim/sulfamethoxazole (Colgan & Williams 2011). Other antibiotics that can be used include cephalosporins, clavulanic acid and floroquionolone. The type, dosage and duration depend with the nature of the UTI and level of complication, the background of the patient, and the response to the initial dosage (Colgan & Williams 2011). Antibiotics administration is avoided in asymptomatic cases and also the elderly and those with spinal cord injuries and urinary catheters. Pregnant women can be prescribed seven-day course antibiotics (Minardi et al. 2011). Pyelomephritis is treated more aggressively compared to cystitis. For those with fevers, the physician can prescribe acetaminophen. Pharmacotherapy administration can be oral or intravenous (Colgan & Williams 2011). Conclusion This has been an explanation of urinary tract infections. UTIs can affect anyone in the community from infants to the elderly. The female gender population experiences the highest occurrence due to anatomy and reproductive physiology reasons. Patients can be asymptomatic, but symptoms can also present as abdominal pain, urinary urgency, and higher urine frequency. Cases such as pyelonephritis present fevers and chills. Specimen collection methods include clean-catch midstream voiding, catheterisation and suprapubic aspiration. Clean-catch would be preferred in most cases for its non-invasive, easy and comfortable procedure but it may not be suitable for some cases such as surgical patients, elderly and infants. UTI’s can be diagnosed in the laboratory using culture and non-culture methods. Culture methods entail counting colonies of bacteria with the aid of a microscope. Non-culture methods include an array of tests to identify the infection-causing bacteria. Antibiotic regimens provide pharmacotherapy options for UTI treatment. References Beveridge, L, Davey, P, Phillips, G, & McMurdo, M 2011, ‘Optimal management of urinary tract infections in older people’, Clinical Interventions in Aging, vol. 6, pp. 173-180. Colgan, R, & Williams, M 2011, ‘Diagnosis and treatment of acute uncomplicated cystitis’, American Family Physician, vol. 84, no. 7, pp. 771-776. Delanghe, J & Speeckaert, M 2014, ‘Preanalytical requirements of urinalysis’, Biochemia Medica, vol. 24, no. 1, pp. 89-104 Emiru, T, Beyene, G, Tsegaye, W, & Melaku, S 2013, ‘Associated risk factors of urinary tract infection among pregnant women at Felege Hiwot Referral Hospotal, Bahir Dar, North West Ethiopia’, BMC Research Notes, vol. 6, no. 292, pp. 1-6. Hooton, T, Bradley, S, Cardenas, D, Colgan, R, Geerlings, S, Rice, J...2010, ‘Diagnosis, prevention and treatment of catheter associated urinary tract infection in adults’, Clinical Infectious Diseases, vol. 50, pp. 625-663. Matthews, S, & Lancaster J 2011, ‘Urinary tract infections in the elderly population’, American Journal of Geriatrics Pharmacotherapy, vol. 9, pp.286–309 Meddings, J, Rogers, M, Krein, S, Fakih, M, Olmsted, R, & Saint, S 2013, ‘Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: An integrated review.’ BMJ Quality & Safety. Doi:10.1136/bmjqs-2012-001774 Minardi, D, Anzeo, G, Cantoro, D, Conti, A, & Muzzonigro, G 2011, ‘Urinary tract infections in women: Etiology and treatment options’, International Journal of General Medicine, vol. 4, pp. 333-343. 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White, B 2011, ‘Diagnosis and treatment of urinary tract infections in children’, American Family Physician, vol. 83, no. 4, pp. 409-415. Read More