URINARY TRACT INFECTION
OVERVIEW
Urinary tract infections (UTIs) occur when bacteria invades the urethra, bladder, or kidneys and
multiply. The most common cause of urinary tract infections is Escherichia coli (E. coli) bacteria
which lives harmlessly in stool (or in the colon) but are potentially dangerous if they enter the
urinary tract. Due to the female anatomy (shorter urethra), women are at higher risk for
developing UTIs than men. These bladder infections (cystitis) can work their way up the urinary
tract, resulting in kidney infections (pyelonephritis) which are more serious.
Symptoms of a UTI include burning with urination, increased frequency of urination,
fever/chills, flank or back pain and mental changes or confusion in the elderly. Uncomplicated
urinary tract infections occur in healthy patients who do not have any underlying structural or
functional abnormalities of the urinary tract. Complicated urinary tract infections occur in
patients who have structural or functional abnormalities of the urinary tract.
Bacteriuria is the medical term for the presence of bacteria in the urine. Asymptomatic
bacteriuria describes a condition where bacteria are growing in the urine but not invading the
surrounding tissue; thus, symptoms are absent. Multiple clinical trials have demonstrated that,
in most populations, testing for asymptomatic bacteriuria is counterproductive. Pregnant
women, individuals who are to undergo urologic procedures such as transurethral resection of
the prostate and other urologic procedures in which mucosal bleeding is anticipated should be
screened and treated for asymptomatic bacteriuria. Pregnant women should be screened for
bacteriuria at least once in early pregnancy and treated if the results are positive. Treatment of
asymptomatic bacteriuria in pregnant women may prevent adverse outcomes such as
premature delivery, low birth weight, or life-threatening urinary infections.
The elderly are especially prone to urinary tract infections due to decreased immunity,
comorbid diseases, chronic indwelling catheters as well as physical changes. With age, the
bladder loses elasticity and some men develop an enlarged prostate which blocks the urethra,
which can lead to urinary retention or incontinence. Nonspecific symptoms such as mental
status changes are sometimes the only symptoms that are observed in the elderly. Mental
status changes can often be mistaken for early signs of other cognitive impairing diseases such
as alzheimer’s. Caregivers should notify a healthcare provider immediately if they suspect that
an elder has a UTI.
Risk factors for developing Urinary Tract Infections include:
 Recent sexual intercourse;
 Diabetes - people with diabetes may develop UTIs more frequently due to changes in
their body’s defense system;
 Menopause - the decrease in estrogen is associated with impaired voiding and thinning
of the vagina and urethral walls which increases the risk of infection;
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
Problems emptying the bladder completely due to spinal cord injuries or nerve damage incomplete voiding allows bacteria to grow in the urine that is left in the bladder;
 Indwelling urinary catheter - catheters can introduce bacteria into the urinary tract and
they also interfere with the body’s ability to clear microbes;
 History of UTI’s;
 Incontinence;
 Obesity;
 Enlarged prostate, narrowed urethra, kidney stones, or anything that blocks the flow of
urine; and
 Pregnancy.
Every 12-18 months the Infectious Diseases Society of America reviews and updates guidelines
on: Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults; Diagnosis, Prevention, and
Treatment of Catheter-Associated Urinary Tract Infection; and Guidelines for Antimicrobial
Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women. The guidelines can be
found online at http://www.idsociety.org/Organ_System/.
STATISTICS
UTIs account for about 8 million doctor visits yearly. According to the World Health
Organization, urinary tract infections are the most frequent health care-associated infections in
high-income countries.
In Texas, urinary tract infections resulted in 34,037 hospitalizations in 2012 and the average age
of adults hospitalized was 65 years. Females accounted for 74.9% of the hospitalizations. The
average hospital stay was 4 days and the average charge was $27,141. At discharge, 16.7% of
the patients were released to a skilled nursing facility while another 12.3% were released to the
care of home health services.
PREVENTION
Prevention of UTIs can be accomplished by:
 Drinking plenty of fluids and emptying your bladder as soon as you feel the urge - this
serves to “flush out” the urinary tract and may reduce the risk of infection;
 Drinking unsweetened cranberry juice or taking cranberry pills - cranberry may prevent
UTIs by interfering with the bacteria’s ability to attach to the urinary tract;
 Practicing good personal hygiene, particularly in females. Women should be advised to:
o Wipe from front to back (away from the urethra) after a bowel movement or
urination;
o Wash the skin around and between the anus and the vagina, particularly before
and after sexual intercourse; and
o Wear cotton underwear - wearing non-cotton undergarments made of less
breathable synthetic fabrics may create a potential breeding ground for bacteria
and increase UTI risk.
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 Using topical estrogens in postmenopausal women - estrogen reduces vaginal pH and
promotes the growth of lactobacillus which replaces the more pathogenic bacteria;
 Using sterile technique when inserting the catheter in order to avoid introducing
harmful bacteria into the urinary tract;
 Cleaning the area round the catheter and the catheter frequently and changing the
catheter at least once a month;
 Positioning the catheter bag below the level of the bladder in such a way that drainage
by gravity is possible and emptying it whenever it is full or every eight hours; and
 Permanently removing urinary catheters unless they are absolutely necessary to relieve
urinary tract obstruction or retention.
TREATMENT
In most cases, UTIs can be treated with proper antibiotics in an outpatient setting. Empiric
antibiotic therapy is recommended to treat urinary tract infections. Trimethoprimsulfamethoxazole (TMP/SMZ), nitrofurantoin, fluoroquinolones and beta lactams are some of
the commonly used antibiotics. Phenazopyridine is also used to relieve the burning and pain
during urination that is caused by the UTI but does not cure the infection.
REDUCING REHOSPITALIZATIONS
Some of the ways that urinary tract infection hospitalizations/rehospitalizations can be reduced
include:
 Eradicating the infecting organism through the selection of the appropriate antibiotic;
 Setting up appropriate follow up care;
 Following the proper guidelines of treating asymptomatic bacteriuria - Incorrect
antibiotic use can lead to the development of multi drug-resistant organisms, which
eventually require hospitalization for treatment with costly intravenous antibiotics;
 Following proper urinary catheter care;
 Considering antibiotic prophylaxis for patients who have recurrent urinary tract
infections which is defined as three or more episodes in a year. Continuous prophylaxis
involves taking low doses of antibiotics for six months or longer while post coital
prophylaxis involves taking a single antibiotic dose after sexual intercourse. The rate of
UTI’s usually returns to baseline after antibiotic prophylaxis is discontinued. Taking
antibiotics when symptoms of a UTI occur which is also known as patient-initiated
therapy can be beneficial in these patients.
RESOURCES
 Call 2-1-1 or visit www.211texas.org to find information about resources in your local
community.
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Cranberry. Natural Medicines Comprehensive Database. Stockton, CA: Therapeutic
Research Faculty. Available at:
http://naturaldatabase.therapeuticresearch.com/home.aspx?cs=&s=ND. Updated
February 18, 2014. Accessed February, 28 2014.
Kalpana G, Barbara W. T. Urinary Tract Infections, Pyelonephritis, and Prostatitis. In:
Fauci AS, Kasper DL, Jameson JL, Longo DL, Hauser SL. Harrison's Principles of Internal
Medicine. 18th ed. New York: McGraw-Hill; 2012. Harrison's Principles of Internal
Medicine, 18e. Accessed February 20, 2014.
Lindsay N, Suzanne B, Richard C, James C. R, Anthony S, Thomas M. H. Infectious
Diseases Society of America Guidelines for the Diagnosis and Treatment of
Asymptomatic Bacteriuria in Adults. Clinical Infectious Diseases; 2005; 40: 643 -654.
National Kidney Foundation. Urinary Tract Infections. Available at: http://www.
kidney.org/atoz/content/uti.cfm. Updated May 24, 2012. Accessed February 18, 2014.
Thomas M.H, Suzanne F.B, Diana D.C, et al. Diagnosis, Prevention, and Treatment of
Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical
Practice Guidelines from the Infectious Diseases Society of America. Clinical Infectious
Diseases; 2010; 50: 625 -663.
Urinary tract infection; adult; female. 5-Minute Clinical Suite. Clin-eguide. St. Louis, MO:
Wolters Kluwer Health. Available at: http://clineguide.ovid.com/clinicalresource .
Updated September, 2013. Accessed February 18, 2014
US Nation Library of Medicine, National Institutes of Health. Aging changes in the
kidneys and bladder. Available at:
http://www.nlm.nih.gov/medlineplus/ency/article/004010.htm. Published Feb 26,
2014. Accessed February 28, 2014.
US Nation Library of Medicine, National Institutes of Health. Urinary tract infection –
adults. Available at: http://www.nlm.nih.gov/medlineplus/ency/article/000521.htm.
Published Feb 26, 2014. Accessed February 28, 2014.
World Health Organization. Health care-associated infections fact sheet. Available at:
http://www.who.int/gpsc/country_work/gpsc_ccisc_fact_sheet_en.pdf. Accessed
February 18, 2014.
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