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The cause of 80-90% of urinary tract infections is Escherichia coli. Klebsiella, Enterococcus, Proteus mirabilis, and Staphylococcus saprophyticus are some of the other causes. Most of the causes are naturally occurring in your GI tract (Lees, 2012). The classifications of UTIs are: lower UTI where there the symptoms are bladder tenderness and urinary frequency, and upper UTI where the symptoms of the lower UTI are expanded to include chills, fever, flank pain, malaise, costovertebral angle tenderness and leukocytosis (Ribeiro, 2015).
Some risk factors include indwelling catheters that allow a direct pathway for bacteria to enter the bladder, recent antibiotic use that disrupts the natural flora of the bladder, a voiding disfunction with post void volumes allowing more time for bacteria to proliferate, being female with a short urethra, pregnancy that naturally can cause a post void residual due to compression of the uterus on the ureters and UTI’s tend to cluster in families (Lees, 2012).
Urinary culture is a test that checks for germs like bacteria that may cause an infection in the urine. A sample of urine is added to culture material to see if it promotes the growth of these germs. If it does not the culture is negative. If it does the culture is positive. Typically after the culture is positive, the growth is sent for sensitivity testing against possible antibiotics for treatment to see which is the most susceptible to this organism (UM, 2018). Urinary reflux testing is done by ultra sound to detect structural abnormalities, a cystourethrogam to test the bladder while it is full and when it is emptying for abnormalities or a nuclear scan by injecting a dye to test the bladder while it is full and emptying for abnormalites (Mayo, 2018)
Treatment of UTI’s is aimed at the bacteria that is causing the infection and eradicating it. The chosen antibiotics are depending on the extent of the infection, the common local pathogens and their resistance patterns (Lees, 2012). They can range from doxycycline, cephalosporins, Bactrim, to nitrofurantoin, it just depends on the causative agent.
I would tell my patients to prevent UTI’s void when you have the urge to, attempting to empty the bladder completely, to drink lots of water, drink cranberry juice to help keep bacteria from adhering to the bladder wall, and as a female remember to wipe front to back to avoid introducing fecal material into the urethra.
Hospitals are concerned about CAUTI’s as they are reportable and the incidence of these directly impacts their government funding. In turn this saves the hospital money and undue suffering of its patients when they have a good process in place to prevent CAUTI infections.
My hospital nurse driven catheter protocol for removals almost follows the ANA’s to the T. Nurses are only allowed to insert a foley catheter if the patient meets the ANA’s guidelines. The daily care also follows the ANA guidelines. For removal there are a set of guidelines that have to do with the alertness of the patient, their ability for the patient to identify their need to urinate related to their typical normal is this matter, and the ability to offer other ways for patient to urinate. We do not have a nurse driven ability to remove though, we must still notify the physician to take the foley out. However, I can say that our hospitalist group is very adamant about not having a foley in place when it is not necessary.
The cause of 80-90% of urinary tract infections is Escherichia coli. Klebsiella, Enterococcus, Proteus mirabilis, and Staphylococcus saprophyticus are some of the other causes. Most of the causes are naturally occurring in your GI tract (Lees, 2012).