Urinary Tract Infection

Case Study: Urinary Tract Infection CHIEF COMPLAINT: Urination with a burning sensation, pelvic genital pain, frequent and urgent urination, urine which is colored for the past three days and dribbling urination. HISTORY OF PRESENT ILLNESS: A patient visits complaining about urination with a burning sensation, pelvic genital pain, frequent and urgent urination, urine which is colored for three days and dribbling urination. He is an African American who is 58 years old. However, he denies having fever.

Assessment This 58-year-old man describes his symptoms as having urination with a burning sensation, pelvic genital pain, frequent and urgent urination, urine which is colored for three days and dribbling urination. These symptoms show that he has a urinary tract infection commonly known as UTI. This infection has been often diagnosed in older adults. Most of the times, it has been diagnosed in residents with long-term care. This accounts for over a third of all infections associated with nursing home (Tsan et al., 2010).

For men younger than 60 years of age, UTI is uncommon especially those who don’t have indwelling catheters. However, for men with 60 years or older, the infection is highly defined (Schaeffer & Nicolle, 2016). The typical symptoms for UTI are pelvic pain, fever, burning sensation during urination, urgency and frequency in urination and urine with a bad odor (Murrell, 2018). The patient in question reported similar symptoms but rejected having experienced fever.

If the infection escalates to the kidneys, the symptoms become severe and might include back pain, nausea, flushed skin, vomiting and fever (Murrell, 2018). This patient did not report such symptoms and this brings out the fact that the infection had not affected the other parts of the body. Urinary Tract Infections are classified in two categories: uncomplicated and complicated UTI. Complicated UTI means that the urinary tract has an abnormality in its function and structure but this term also entails all UTI in men (Beveridge, Davey, Phillips & McMurdo, 2011).

The organism known for causing UTI in both healthcare and community setting is Escherichia coli The other one is Enterobacteraciae, such as Proteus mirabilis, Klebsiella and Providentia species. Organisms which are gram-positive are not common but are mostly found in a healthcare setting and in adults with serious indwelling catheters. These organisms include methicillin-resistant Staphylococcus aureus and Enterococcus (Routh et al., 2009). Plan One of the most common antibiotic infections in older adults is UTI. In the healthcare setting, studies have shown that 40-75% of use of antimicrobials is not appropriate.

Overusing antibiotics causes negative consequences like increased healthcare costs, growth of organisms which are multidrug resistant, and side effects which are unwanted (like Clostridium difficile infection). For residents in long-term care facilities, TMP/SMX and nitrofurantoin are the acceptable empiric antimicrobial choices. In older adults, nitrofurantoin is mostly underutilized because it has a contraindication for patients with renal insufficiency. However, recent analysis show that nitrofurantoin is very effective for treating UTI with a creatinine clearance of over 40 ml/min in older adults.

It has a lower frequency of general resistance when compared to fluoroquinolones and TMP/SMX making it very effective for use as an empiric antibiotic choice for older adults. Even though most E. coliisolates are prone to nitrofurantoin, other Enterobacteriaceae such as Proteus mirabilis have an inbred resistance to nitrofurantoin. In cases where patients have a history of gram-negative infections which resist nitrofurantoin, TMP/SMX would be used as an alternative.

For long-term care facilities residents, when treatment for UTI with antimicrobials is initiated, they should have a routine checkup for antibiotic susceptibilities. If they are available, they should be used based on antimicrobial susceptibility patterns (Rowe & Juthani-Mehta, 2013). The patient is also advised to take adequate fluids. Even though this may increase their rate of urination and, make them uncomfortable, it goes a long way in helping.