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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" />.
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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>
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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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An estimation of 150 million UTIs occur every year world-wide, adding to $6 billion in health care costs<ref name="Pontari" />. 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, etc<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: uretha is shorter allowing bacteria quicker access to the bladder and the urethral opening is near bacteria sources, such as the anus and vagina<ref name="Urinary" />. UTI is frequent in young and sexually active women with reported incidence rates ranging from 50-70% 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" />.
An estimation of 150 million UTIs occur every year world-wide, adding to $6 billion in health care costs<ref name="Pontari" />. 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, etc<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: uretha is shorter allowing bacteria quicker access to the bladder and the urethral opening is near bacteria sources, such as the anus and vagina<ref name="Urinary" />. UTI is frequent in young and sexually active women with reported incidence rates ranging from 50-70% 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" />.
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UTI is one of the most commonly diagnosed infections in older adults and the most frequently diagnosed infection in long-term care residents, with over 10% of women over 65 years old reported having a UTI within the past 12 months<ref name="Rowe" />. Asymptomatic bacteriuria 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>
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UTI is one of the most commonly diagnosed infections in older adults and the most frequently diagnosed infection in long-term care residents, with over 10% of women over 65 years old reported having a UTI within the past 12 months<ref name="Rowe" />. Asymptomatic bacteriuria 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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*Increased sexual activity
*Increased sexual activity
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<br>Catheters placed in the uretha and bladder interferes with the body's ability to clear microbes from the urinary tract, therefore, increasing the risk for bacteria to travel through or around the catheter<ref name="Urinary" />. To reduce the risk of a UTI, the Infectious Diseases Society of America recommends using catheters for the shortest time possible<ref name="Urinary" />.<br><br>
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<br>Catheters placed in the uretha and bladder interferes with the body's ability to clear microbes from the urinary tract, therefore, increasing the risk for bacteria to travel through or around the catheter<ref name="Urinary" />. To reduce the risk of a UTI, the Infectious Diseases Society of America recommends using catheters for the shortest time possible<ref name="Urinary" />.<br><br>
== Medications ==
== Medications ==
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Antibiotics or antimicrobials are generally used to treat UTIs, as these infections are usually caused by bacteria<ref name="Urinary" />. The type of bacteria and patient's history play a role in the choice of medication and length of treatment determined by the health care provider<ref name="Urinary" />. Health care providers will often perform a sensitivity test and analyze the results to select the most effective antibiotic specific to the patient based on the the site of infection and severity of illness<ref name="Pontari" />.<br>
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Antibiotics or antimicrobials are generally used to treat UTIs, as these infections are usually caused by bacteria<ref name="Urinary" />. The type of bacteria and patient's history play a role in the choice of medication and length of treatment determined by the health care provider<ref name="Urinary" />. Health care providers will often perform a sensitivity test and analyze the results to select the most effective antibiotic specific to the patient based on the the site of infection and severity of illness<ref name="Pontari" />.<br>
== Diagnostic Tests/Lab Tests/Lab Values ==
== Diagnostic Tests/Lab Tests/Lab Values ==
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'''Common Causative Pathogens in Adult UTIs<ref name="Pontari" />:'''<br>- Escherichia coli (80% of outpatient UTIs)<br>- Klebsiella; Enterobacter<br>- Proteus<br>- Pseudomonas<br>- Staphylococcus saprophyticus (5 - 15%)<br>- Enterococcus<br>- Candida<br>- Adenovirus type 11 <br>
'''Common Causative Pathogens in Adult UTIs<ref name="Pontari" />:'''<br>- Escherichia coli (80% of outpatient UTIs)<br>- Klebsiella; Enterobacter<br>- Proteus<br>- Pseudomonas<br>- Staphylococcus saprophyticus (5 - 15%)<br>- Enterococcus<br>- Candida<br>- Adenovirus type 11 <br>
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The urinary tract encompasses several systems to prevent infection including preventing urine from backing up toward the kidneys and urination washing microbes out of the body<ref name="Urinary" />. Immune defenses also can prevent infection in both sexes, but infections can still occur due to some bacteria having a strong ability to attach to the urinary tract lining<ref name="Urinary" />.<br> <br>
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The urinary tract encompasses several systems to prevent infection including preventing urine from backing up toward the kidneys and urination washing microbes out of the body<ref name="Urinary" />. Immune defenses also can prevent infection in both sexes, but infections can still occur due to some bacteria having a strong ability to attach to the urinary tract lining<ref name="Urinary" />.<br> <br>
== Systemic Involvement ==
== Systemic Involvement ==
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Nursing home patients present with nonspecific symptoms, such as confusion and a decline in functional status <ref name="Rowe" />.
Nursing home patients present with nonspecific symptoms, such as confusion and a decline in functional status <ref name="Rowe" />.
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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.<ref name="Beck" /> Young children with incontinence and abdominal pain should be checked for UTI. <ref name="Beck" /><br>
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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.<ref name="Beck" /> Young children with incontinence and abdominal pain should be checked for UTI. <ref name="Beck" /><br>
== Case Reports/ Case Studies ==
== Case Reports/ Case Studies ==
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Choices in Health<br>http://choicespc.net/physical-therapy-for-urinary-problems-and-pelvic-floor-dysfunction/<br><br>
Choices in Health<br>http://choicespc.net/physical-therapy-for-urinary-problems-and-pelvic-floor-dysfunction/<br><br>
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])
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== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])
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Australian Institute of Sport and the Australian Paralympic Committee position statement: urinary tract infection in spinal cord injured athletes
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http://bjsm.bmj.com.libproxy.bellarmine.edu/content/49/19/1236.full
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== References ==
== References ==
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1. Rowe, TA, Juthani-Mehta, M. Urinary tract infection in older adults. Aging Health. 2013;9(5).
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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.
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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.
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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.
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5. Mody, L, Juhani-Mehtta, M. Urinary Tract Infections in Older Women: A Clinical Review. JAMA. 2014;311:844–854.
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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.
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7. M, P, D, S. Adult UTI. Advancing Urology. Available at: www.auanet.org/education/adult-uti.cfm.
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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
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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.
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10. Grabe, M. Guidelines on Urological Infections. Urological Infections. Available at: http://uroweb.org/wp-content/uploads/19-urological-infections_lr2.pdf.
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[[Category:Bellarmine_Student_Project]]
[[Category:Bellarmine_Student_Project]]