Uti Case Study

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Objectives:
¥ Discuss the most common microorganisms that can cause urinary tract infections and understand the pathogenesis of urinary tract infections.
¥ Review the most common laboratory tests in diagnosing as well as the clinical signs and symptoms.
¥ Review treatment options, both non-pharmacologic and pharmacologic.

Overview: Urinary Tract Infections (UTIs) are one of the most common illnesses seen in adult patients over the age of 65. [1] Therefore, managing and treating an elderly patient with diagnosed UTI is not without its challenges. Because of the elderly population’s unique characteristics, each patient requires a tailored approach to diagnosis and treatment.

Epidemiology/Etiology: Escherichia coli is the common pathogen
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A urinary analysis looks at the appearance of the urine to determine if there are any abnormalities.[6] These abnormalities include cloudiness, presence of bacteriuria, white blood cells, hematuria, nitrates, leukocyte esterases, white blood cells, and protein. [6] Urinary cultures are used to identify the specific organism present in the infection. Results are generated in a preliminary report and then the final results are later confirmed. [6] These, along with susceptibility reports, are used to determine the appropriate antimicrobial therapy.[6]

Non-Pharmacologic Interventions: [6]
• Encourage patients to drink plenty of water and daily
• Cranberry juice may help prevent recurrent infection
• Patients should empty the bladder as they feel the urge
• Patients must wipe from front to back after using the toilet
• Patients should void before and after intercourse

Pharmacologic Treatment for Acute Uncomplicated Cystitis : [7]
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The program was implemented in more than 10% of U.S. acute care hospitals, both catheter use and catheter-associated UTI rates were significantly decreased in the non-ICU setting.

References:
1. Ronald, A., The etiology of urinary tract infection: traditional and emerging pathogens. Dis Mon, 2003. 49(2): p. 71-82.
2. Foxman, B., Epidemiology of urinary tract infections: incidence, morbidity, and economic costs. Dis Mon, 2003. 49(2): p. 53-70.
3. Pathophysiology of Complicated Urinary Tract Infections: Overview, Host Factors, Diabetes Mellitus. 2016.
4. Mehnert-Kay, S.A., Diagnosis and Management of Uncomplicated Urinary Tract Infections - American Family Physician. 2016.
5. Balogun, S.A. and J.T. Philbrick, Delirium, a Symptom of UTI in the Elderly: Fact or Fable? A Systematic Review. Can Geriatr J, 2014. 17(1): p. 22-6.
6. Bermingham, S.L. and J.F. Ashe, Systematic review of the impact of urinary tract infections on health-related quality of life. BJU Int, 2012. 110(11 Pt C): p. E830-6.
7. IDSA : Infections by Organ System. 2016; Available from:

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