Urinary Tract Infection Medical Malpractice

Urinary tract infection is a catch-all term for infections affecting any part of the urinary system. Women are at a greater risk for developing UTIs than men, as they have shorter urinary tracts, presenting a shorter distance for invasive bacteria to travel. Some have placed the lifetime odds of developing a UTI for women at 1 in every 2. While infections limited to the bladder may be painful nuisances, they are generally not serious. Only if it spreads to the kidneys can a UTI carry serious consequences. Urinary tract infections are typically treated with the correct course of antibiotics.

The urinary system is comprised of the kidneys, bladder, ureters, and urethra. The kidneys lie on either side of the spine at waist level. They are responsible for removing waste from the blood and eliminating excess water in the form of urine. The bladder is a sac-like organ. It collects and stores urine until it is ready for release, at which point we experience a sensation in which we need to void the bladder. Bladder infections are common but if not treated promptly can become serious. There are two ureters about 10 inches in length which are responsible for draining urine from each kidney to the bladder. The urethra is a simple tubular structure that transports urine from the bladder to an external opening.

Any organ in this system may become compromised by bacteria. The farther up in the system it reaches, the more serious the infection. There are generally two types of recognized UTIs, lower and upper tract infections. More severe infections are upper tract infections.

Hospital-acquired UTI infections account for approximately 40% of all hospital-acquired infections. Catheters and urological manipulations place patients at a greater risk of developing UTIs. Although pathogens causing UTIs tend to originate in the patients' intestinal flora, nosocomial (hospital-acquired) infections have proved more resistant to antibiotics than community acquired infection.

UTIs account for approximately 10 million US hospital visits annually. They are far more common in adults than children; just 1-2% of children are diagnosed each year.

Causes of UTIs

A UTI is typically caused when bacteria enter the urinary tract via the urethra, where they proceed to multiply in the bladder. The urinary system weaponizes certain defenses against invaders, but these defenses are not foolproof and evidently, can fail. In hospital-acquired infections, use of catheters is the single greatest risk to patients in developing a UTI. Health research organizations recognize catheter-associated infections as a unique category, with information specifically available on the causes and prevention techniques for so called "CAUTIs," catheter-associated UTIs. Especially if a catheter is used for a very long period of time, germs may gather at the site of the catheter and go on to infect the urinary tract.

E.coli is a common culprit in bladder infections, resulting in an infection known as cystitis. It is possible for E.coli in the GI tract to present in the anus where it may spread to the urethra and consequently to the bladder.

Another condition known as urethritis may occur when bacteria in the GI tract travels from the anus to the urethra. Microorganisms infecting the vagina such as herpes, gonorrhea, mycoplasma, and chlamydia can also be spread to the urethra and cause urethritis.

Constipation is another potential cause of UTIs. Because constipation discourages the complete voiding of one's bladder, any trapped bacteria are given ample time to flourish and cause infection. Diarrhea and fecal incontinence can also raise your risk of developing a UTI.

Constipation can be very common in both hospital and nursing home settings, due to factors such as age and use of opioid pain medications.

Holding in one's urine for 6 or more hours can increase the incidence of UTIs, for the same reason that constipation can cause UTIs - giving the bacteria a greater of a window of time to grow and spread.

Feminine products that are not changed in a timely manner can also lead to a UTI. In addition, kidney stones which block the urinary tract, backing up urine, give bacteria ample time to grow.

Symptoms of UTI

Symptoms for UTIs vary, as upper urinary tract infections present different symptoms from lower urinary tract infections.

In the case of lower urinary tract infections, symptoms include:

  • pain or burning sensation while urinating
  • frequent urination, often with very little urine
  • the sensation of needing to urinate when you don't have to
  • cloudy, foul-smelling or bloody urine
  • lower abdominal pain
  • pelvic pressure
  • mild fever
  • chills
  • malaise

In the case of upper urinary tract infections, symptoms include:

  • high fever (above 101)
  • shaking chills
  • nausea
  • back or side pain
  • vomiting

Treatment/Prognosis

To cure a lower urinary tract infection such as cystitis or bladder infection in an otherwise healthy person, a three to seven-day course of antibiotics is usually serviceable. The length is usually up to the discretion of the health care provider and determined by the specificities of the individual such as age, sex, and severity of the infection. In some cases, a single dose antibiotic may be used. For adult men who have acquired prostatitis (infection of the prostate), a four-week course of antibiotics may be required. To alleviate the burning sensation experienced when urinating, Pyridium or similar drugs may be prescribed in addition to the correct antibiotic.

To treat an upper urinary tract infection, those already in good health can normally be treated as outpatients. Antibiotics may be injected in the ER, preceding a 10 to 14 course of oral antibiotics. Followups with their health care provider are recommended so they may monitor improvement.

For those who are pregnant, already ill or have compromised immune systems, an IV will usually be inserted in the arm to administer fluids and antibiotics until the person is well enough for oral antibiotics.

Because UTIs can be caused by the same bacteria responsible for sexually transmitted diseases, healthcare providers should evaluate the patient for STDs and prescribe the appropriate antibiotic correspondent to their condition.

Risk Factors of UTIs

Because UTIs are exceptionally common in women, there are many risk factors unique to the female anatomy.

Female-specific risk factors:

  • shorter urethras, which shorten the distance bacteria must travel to reach and infect the bladder
  • certain forms of birth control such as spermicide and diaphragms
  • menopause, at which point estrogen declines in the body which can cause changes in the urinary tract, making the woman more vulnerable to infection
  • sexual activity, or taking on a new sexual partner. The motion of intercourse can present new bacteria to the urethra by transferring it from the vaginal or bowel cavity. A new sexual partner may introduce entirely new bacteria to the area, creating an opportunity for infection

General risk factors:

  • an immune system suppressed by diabetes, HIV or other immune-impairing illnesses
  • use of catheters for those who cannot urinate on their own
  • recovery from a recent urinary procedure

Groups at increased risk:

  • young children who may not wipe themselves properly
  • those with poor hygiene
  • hospitalized or nursing home residents

Prevention of UTIs in Hospitals

There are a number of infection control policies in place to limit the number nosocomial UTIs. Sterile equipment and aseptic techniques should be used during all catheterizations. Hospitals should employ the use of closed drainage systems. In the future, catheters may even be impregnated with antibiotics to reduce or wipe out the incidence of CAUTIs.

The CDC offers a set of guidelines for appropriate catheter use, outlining correct insertion, use, and maintenance of urinary catheters in order to prevent CAUTIs. In general, catheter use and duration should be minimized in all patients, especially high-risk groups of patients (the elderly, women, those with impaired immunity.) Catheter use should be avoided as a means of managing incontinence.

In addition to exceptional hand hygiene and the use of sanitary equipment, only trained persons should be given the responsibility of inserting catheters. Indwelling catheters should be properly secured after insertion to prevent movement and urethral traction.

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