UTIs
What is it?
Urinary tract infections (UTIs) happen when bacteria enter the urethra, multiply, and infect the urinary tract. Several parts of the urinary system can be infected, like the bladder (cystitis) and kidneys (pyelonephritis).
What are the signs and symptoms?
Symptoms may be similar in males, females, and those with a catheter.
Burning, stinging, and or pain on passing urine
The need to pass urine urgently and often
New or worsening urinary incontinence
Visible blood in the urine
A temperature less than 36C or above 38C
New or increased confusion or agitation
Lower abdominal or back pain
Shivering or chills
Diagnosis
The Doctor will diagnose residents with UTIs based on their signs and symptoms. A urine sample should be collected to identify the microorganism infecting the urinary tract and determine which antibiotic may be effective.
Urine samples could be either clean catch, mid-stream urine (MSU), or catheter specimen urine (CSU).
Need a urine sample?
As part of antimicrobial stewardship in residential aged care facilities, urine cultures are very important for diagnosing older people with UTIs. If an antibiotic is required to treat the infection, the lab results will inform the Doctor which antibiotic is safest and best to use.
A urine sample is to be collected in the most sterile way possible
The container must have the relevant resident identifiers and indicate whether the urine is a clean catch, MSU, or a catheter sample
It should be immediately sent to the pathology lab for microbiological testing. If a delay in transport is expected, the sample must be refrigerated as bacteria grows rapidly when a urine sample is left at room temperature, and this may change the lab results
Contact the Doctor to review the lab results as soon as possible
To dip or not to dip?
Urine dipsticks are NOT very helpful in diagnosing older people with a UTI
A urine dipstick can detect the presence of nitrites and leukocytes, which can indicate a possible UTI. However, best practice indicates a urine sample should be collected for accurate results, as dipstick tests will usually be positive for bacteria in the urine, whether it is causing infection or not.
An antibiotic prescription from a dipstick result can harm the resident, as there may be another cause for the resident symptoms or an inappropriate antibiotic may be prescribed.
See Handling Laboratory Specimens for more information.
Can UTIs be prevented?
There are some ways that the incidence of UTIs can be reduced or prevented
- Encourage adequate fluid intake
- Avoid irritants for the urinary tract, such as tea, coffee, soft drinks, and alcohol
- Educate residents and caregivers on proper wiping (from front to back)
- There is some evidence that shows that taking a large dose cranberry capsule daily can reduce the incidence of UTIs in those who are prone to them