OICHP Policy Approved November 2006 by Dr J Turnbull
Urinary Tract Infection (UTI)
Definition: A UTI is an overgrowth of bacteria in the bladder, kidneys, or urethra. They
can be classified according to location: Lower UTI -bladder (cystitis), urethra (urethritis),
and Upper UTI- kidneys (pyelonephritis). Prostatis in men may mimic or complicate a
UTI.
Background
UTIs are very common and effects up to 20% of women in their lifetime. Rates of
infection are high in postmenopausal women because of bladder or uterine prolapse
causing incomplete bladder emptying and loss of estrogen. This leads to changes in
vaginal flora facilitating bacteria growth. In the elderly the incidence of men with UTIs
increases as the presence of urinary tract outflow obstructions such as Benign Prostatic
Hyperplasia (BPH) are more common. In both elderly men and women there is a higher
likelihood of concomitant medical illness, such as diabetes, and immunosuppression.
Another common source of infection is catheters, or tubes, placed in the urethra and
bladder.
 Uncomplicated UTI: any lower UTI in nonpregnant women w/o underlying
structural or neurological disease.
 Complicated UTI: any upper UTI in women or any UTI in men or pregnant
women or UTI with underlying structural or neurological disease.
Microbiology: E.coli (80%), Klebsiella, S. saprophyticus, other Grm –ve bacilli, or
uretheritis :STIs Clamydia trachomatis, Neisseria gonorrhea
Predisposing/Risk Factors
 Sexually active women
 Men with prostatitis or Benign Prostatic Hyperplasia (BPH)
 Urinary tract obstruction
 Neurogenic bladder dysfunction (brain, spinal cord, or nerve)
People who are at risk for complicated UTIs are:
 advanced age
 Chronic renal disease
 Diabetes Mellitus or Immunodeficiency (HIV, steroid therapy) Diabetes mellitus
and AIDS destroy the nerves to the bladder and may lead to silent, painless
distention of the bladder.
 Pregnancy
 Recent urinary tract instrumentation (catheter)
 Urologic abnormalities
Signs/Symptoms
 Dysuria (pain/burning with urination)
 Urgency and Increased frequency
 Change in urine colour/odor
OICHP Policy Approved November 2006 by Dr J Turnbull
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Suprapubic pain
Fever (generally absent unless infection has traveled up to the kidneys)
Urethritis: above symptoms plus urethral discharge
Prostatitis may include symptoms of obstruction – hesitancy, weak stream
Upper UTI (kidneys): fever, chills, shakes, flank or lower back pain, nausea,
vomiting plus above sx (burning, frequency, urgency, suprapubic pain)
In some clients there will be none of the above signs or symptoms and a UTI will
manifest as confusion or delirium
Investigations
Clients with suspected UTIs should be asked to give a urine sample.
The urine can then be dipped for a quick urinalysis and sent off for culture.
Urinalysis: pyuria (positive leukocytes dip), may also have positive nitrates and
hematuria (25% of cases)
Urine culture: best is clean catch mid-stream or straight catheter specimen
Imaging: Urologic workup (renal U/S, abdo CT, voiding cystography) ONLY if frequent
recurrent UTIs
Management
Prevention:
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Women should wipe themselves front to back.
Women should empty bladder before and after intercourse.
Client encouraged to rink a lot of fluids to increase urination.
Cranberry juice is thought to help acidify the urine and decrease bacterial
adherence to urinary tract.
Catheters: Bacteria on the catheter can infect the bladder, so it is important for
staff to take special care to keep the catheter clean and remove it as soon as
possible.
Treatment:
Comfort measures: Tylenol can be given for fever, encourage fluids, and a hot compress
may provide relief of lower back pain.
UTI: Best indicators that Antibiotics are warranted are the classic symptoms (burning,
frequency, urgency) plus pyuria (microscopically or on dip leukocyte esterase testing).
You do not have to wait for culture results to start treatment.
Septra 2 tabs bid or 1 double strength tab bid x3days
*Alternatives to Septra should be considered when antibiotic resistance suspected:
Nitrofurantoin (Macrobid) 100mg bid x7days
Amoxicillin 250-500mg tid x 7 days
Ciprofloxacin 250mg bid or 500mg OD x 7days
For intense dysuria, a bladder analgesic, such as phenazopyridine (Pyridium) 200mg po
tid x1-2 days
OICHP Policy Approved November 2006 by Dr J Turnbull
UTI Recurrent infection: Culture urine and reassess for upper tract infection.
Retreat for 10-14 days. Drug of choice for recurrent infection should be based on
cultures.
Complicated UTI or Kidney infection: pre-treatment urine culture required.
Treat with antibiotics (same as above for regular UTI) for 10-14 day therapy.
Severe Upper UTI (severe kidney infection): IV antibiotic therapy is indicated
Acute Prostatitis: can also be treated with Septra, Norfloxacin, Cipro dosing as above x
2-4 weeks
Complications
A simple UTI can have bacteria spread from bladder up to the kidneys leading to an
upper UTI (kidney infection). This can then lead to serious complications including renal
abscesses, renal failure, renal papillary necrosis, sepsis, and shock.
NOTE: In the elderly white blood cells in the urine may not necessarily indicate a UTI
that needs treatment. Also there is a critical level of bacteria (>10 * CFU) in the urine that
would suggest a clinically significant UTI.