Journal of Community Nursing - page 88

88 JCN
2013,Vol 27, No 4
CONTINENCE
U
rinary tract infections (UTIs)
are commonly seen in
general practice, accounting
for 1–3% of all GP consultations
each year (National Prescribing
Centre [NPC], 2009) and are the
second most common clinical
indication for antibiotic treatment
in primary and secondary care
(Scottish Intercollegiate Guidelines
Network [SIGN, 2012]).
UTIs affect women more
commonly than men — around
50% of women will suffer from
a symptomatic UTI during their
lifetime, with the incidence
increasing with advancing age
(NPC, 2009) from approximately
7–8% for those aged 60 to 80
years of age to around 20% for
those aged 80 years and above
(Mahaffey, 2006).
Apart from being female and
increasing in age, other risk factors
for developing UTIs include
institutionalisation, being sexually
active, co-morbid diabetes and the
presence of a catheter (SIGN, 2012).
Managing the symptoms of urinary
tract infection in women
This article will focus on the
signs, symptoms, diagnosis and
management of uncomplicated
UTIs in women.
SIGNS AND SYMPTOMS
Common signs and symptoms of
UTIs include (Health Protection
Agency (now known as Public
Health England) [HPA], 2010):
Dysuria
Urinary frequency
Urinary urgency
Suprapubic pain or tenderness
Haematuria
Polyuria.
Other symptoms that may also
present are malodorous and cloudy
urine, rigors, pyrexia (fever), nausea
and an acute confusional state
(Mahaffey, 2006). The presence of
bacteria in the urine, also referred
to as bacteriuria, can often lead to
inappropriate antibiotic treatment
— bacteriuria alone is rarely an
indication for antibiotic treatment
(SIGN, 2012). The diagnosis of UTI
should be primarily based on the
signs and symptoms described above
(SIGN, 2012).
DIAGNOSIS AND TESTING
A full history should be taken,
which encompasses information
regarding any previous UTIs and
their treatment. Aids to diagnosis
include (Mahaffey, 2006):
Near-patient testing
Microbiology.
Near-patient testing
Near-patient testing may include
observing the urine sample to see
if it is ‘cloudy’, or the use of urine
dipsticks. In the absence ofinfection,
a urine sample should be odour-
free and clear. Any sample that is
malodorous and cloudy is likely
to be indicative of an UTI (SIGN,
2012). However, visual inspection
of a urine sample is prone to
observer error and, therefore, may
not be a useful discriminator when
attempting to diagnose a UTI
(SIGN, 2012).
Urine dipsticks, or testing strips,
are placed into a sample of urine
for a short period of time — the
urine will react with the stick,
changing colour to indicate the
presence of biochemicals and
blood cells.
Although the quality of evidence
for urine dipsticks strips is weak
(SIGN, 2012), they may have a useful
role to play in allowing treatment
to commence while awaiting
confirmation of the infection (it
may take the laboratory a while to
confirm a diagnosis, so treatment
might need to be commenced in
the meantime). The SIGN (2012)
guidance advises the use of dipstick
tests to guide treatment decisions
in otherwise healthy women aged
under 65 years whose UTI symptoms
are mild, or those who present with
less than two symptoms.
Urine dipsticks test for four
factors:
Nitrites
Leucocytes
Chetan Shah, Senior Lecturer in Pharmacy
Practice/Public Health, University of Hertfordshire;
Stephen Goundrey-Smith, Consultant Pharmacist,
PDC Healthcare Ltd, Leicestershire
Urinary tract infections are often seen in community settings
and can be debilitating for patients, involving dysuria (painful
urination), increased urinary frequency and urgency, suprapubic
pain, haematuria (blood in the urine), and polyuria (excessive urine
production). This article takes an in-depth look at these symptoms,
as well as the diagnosis and management of this common problem,
which mostly affects female patients.
KEYWORDS:
Continence
Urinary tract infection
Antibiotic therapy
Chetan Shah, Stephen Goundrey-Smith
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