Respond  on two different days who selected at least one different  factor than you, in one or more of the following ways:Offer alternative  diagnoses and prescription of treatment options for urinary tract  infections.Share an insight from having read your colleague’s posting,  synthesizing the information to provide new perspectives

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Urinary tract infections (UTI)  are one of the most common infections in the world, and advanced  practitioners must be able to diagnose and treat the varying types of UTIs. Understanding the location of the UTI, upper or lower, the pathophysiology,  and specific signs and symptoms are crucial for treatment. An advanced  practitioner must also be aware of the roles that gender and age play in  the development of a UTI. UTIs are  common in the outpatient setting but can also happen in the hospital  and can also be caused by a Foley catheter, which is considered a  hospital-acquired event that the hospital will not receive  reimbursement.

Pathophysiology of Lower Urinary Tract Infection

A  lower urinary tract infection involves the path of least resistance or  the most opportunistic point of entry for an organism, usually bacterial  and involves the urethra and the bladder. An infection in the urethra  or bladder (cystitis) are considered a lower urinary tract  infection. The microbial spectrum of UTIs consists mainly of Escherichia coli, with occasional other species of Enterobacteriaceae such as  Proteus mirabilis and Klebsiella pneumoniae and other bacteria such as Staphylococcus saprophyticus (Yamamichi, Shigemura, Kitagawa, and Fujisawa, 2018).

Pathophysiology of Upper Urinary Tract Infection

The  upper urinary tract consists of the kidneys and ureters. Infection in  the upper urinary tract generally affects the kidneys (pyelonephritis),  which can cause fever, chills, nausea, vomiting, and other severe  symptoms. It can be caused by an infection that has made its way up the  urinary tract and can become a complicated infection from an  obstruction, such as benign prostatic hypertrophy, and calculi.

Similarities and Differences

Although  the location of the infection is different many of the signs and  symptoms can present the same; fever, dysuria, frequency, or urgency may  be present in both. Many lower tract UTIs may be asymptomatic, and in upper tract UTIs, the symptoms may be more severe, including nausea and vomiting, flank pain, or costovertebral angle  tenderness. Finding the underlying cause and treatment is the same;  antibiotics for bacterial infections and analgesics for pain control.  Intravenous antibiotics are preferred for upper tract UTIs in an attempt to preserve organ damage, but mat be converted to oral after initial treatment.

Gender and Age as Factors

While common in both males and females, females are more prone to community-acquired UTIs than men, basically because of anatomical differences. Lema (2015)  acknowledges that the close proximity of the vagina and urethral meatus  to the anal opening, the shorter length of the female urethra, and the  opportunity for trauma during intercourse allows for the opportunity for  a UTI to  be acquired. Although this happens across the lifespan of a woman, the  peak times are from mid-teens to the early forties or the sexually  active years. Young children, especially females, are a high-risk group  due to not being able to clean themselves properly after using the  bathroom or poor technique. Older patients are also high risk; men with  prostate issues cannot empty their bladder are also at risk.

Diagnosis and Treatment

Diagnosis of a lower tract UTI can  be done with the assessment of signs and symptoms and urine culture,  midstream is preferred. Research by Lee (2018) acknowledges  that patients with non-febrile uncomplicated UTIs,  active pain control and minimal use of antibiotics should be  prioritized, including uncomplicated cystitis. Pain in acute cystitis is  a natural consequence of the inflammatory response, and pain-mediated  urinary frequency or urgency is the chief complaint of patients.  Painkillers, including nonsteroidal anti-inflammatory drugs (NSAIDs),  are a good choice for managing symptoms while reducing the usage of  antibiotics. Urinalysis and urine culture confirms the diagnosis of  acute pyelonephritis and according to the Infectious Diseases Society of  America (2019) a urine culture showing at least 10,000 colony-forming  units (CFU) per mm3 and  symptoms compatible with the diagnosis. Symptoms management and oral  antibiotic therapy are needed, and in severe cases, hospitalization with  intravenous antibiotic therapy may be required.

Conclusion

As future practitioners, understanding the pathophysiologies of an upper tract UTI and a lower tract UTI is paramount to obtaining a diagnosis. Untreated and under treated UTIs can  lead to life-threatening complications. Management of the signs and  symptoms is important, but the treatment of the underlying cause can  stop a lower tract UTI from spreading into the upper urinary tract. Age and gender play significant roles in UTIs,  women of childbearing years, and older men who have trouble emptying  their bladder are at high risk. Assessment and quality interviews can  assist the practitioner in prevention through education.

References

Acute pyelonephritis. (2019). Retrieved July 18, 2019, from https://www.idsociety.org/clinical-practice/patient-care/patient-care/

Lee, S. (2018). Recent advances in managing lower urinary tract infections. F1000Research, 7, 1964. https://doi-org.ezp.waldenulibrary.org/10.12688/f1000research.16245.1

Lema, V. M. (2015). Urinary Tract Infection In Young Healthy Women Following Heterosexual Anal Intercourse: Case Reports. African Journal Of Reproductive Health19(2), 134–139. Retrieved from https://search-ebscohost-com.ezp.waldenulibrary.org/login.aspx?direct=true&db=mnh&AN=26506666&site=eds-live&scope=site

Yamamichi, F., Shigemura, K., Kitagawa, K., & Fujisawa,  M. (2018). Comparison between non-septic and septic cases in  stone-related obstructive acute pyelonephritis and risk factors for  septic shock: A multi-center retrospective study. Journal Of Infection And Chemotherapy: Official Journal Of The Japan Society Of Chemotherapy24(11), 902–906. https://doi-org.ezp.waldenulibrary.org/10.1016/j.jiac.2018.08.002

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