Innate Defense Mechanisms

Urinary Tract Infections (UTI’s) are responsible for nearly 10 million health care office visits, 1.5 million hospitalizations and $1 billion in costs annually in the United States, according to the National Kidney Foundation. Millions of the people, who ever suffered from UTI, experience the recurrent bladder infection. Moreover, after the first infection, some people get a second, third and fourth or more UTIs, with each successive infection making them more susceptible to recurrent episodes. Scientists have found that the reason for this is the bacteria, which stays in the inner layers of the bladder and quietly hide from antibiotics used to treat the primary infection of the bladder. As antibiotics don’t get rid of bacteria populations

A sample of the patients bacteria causing the urinary tract infection can only be used if a urine sample is bacteriologically viable (1 Radar). Infected urine and sterile urine are common samples used for the diagnosis of patients (1 Radar). It is important to gain further knowledge of multiple organisms’ resistance to antibiotics that cause urinary tract infections (1Radar). Escherichia coli has distinct characteristics and structures that help identify their unique properties (2 Johnson). Escherichia coli is the most common and most prevalent bacteria present in the fecal flora of the human colon (2 Johnson). Because of Escherichia coli unique ability to overcome the obstacles of a new environment, it makes easy for bacteria to spread into the urinary tract and produce a discomforting infection (2 Johnson). All research conducted lead to the belief that Escherichia coli was the Enterobacteriaceae pathogen causing the UTI in the patient. In order to confirm this prediction a set of differential tests and biochemical test must be conducted.

The four specific databases that were used in this research are, Cinahl, Medline, Joanna Briggs and Cochrane Library. All of these databases were chosen because they provided up to date peer reviewed evidence that was relevant to the search terms. This ensures that the evidence that was found was relevant and reliable. The Cinahl website was useful to gather background information on the topic such as how a UTI is contracted and how it effects the body. The Cochrane Library and Medline website was useful to because it gave specific information on studies that had already been done by other researchers. This helped to ensure that the study that is being undertaken was searching for the right results.

Proteus vulgaris also produces urease which can increase the chances of pyelonephritis. It does this by hydrolyzing urea to ammonia, which in turn, makes urine more basic. The basic environment allows the bacteria to survive and flourish (NCBI, 2008). Another important virulence factor includes the microbe’s motility. It moves by a mechanism called swarming, which is defined as a rapid surface movement by use of rotating flagella. The swarming effect allows the bacteria to move about the host in great numbers (NCBI, 2010). The combination of fimbriae, urease production and swarming favors the production of urinary tract infections.

However, most of the problem with catheters arises when organisms enter the urinary tract via the urinary catheter causing the infection. Urinary catheters pose a threat to the patient’s safety, as bacteria can travel up the tube from the bag. Thirty percent of catheter associated urinary tract infections (CAUTI) are caused by this type lumen contamination. (Donelli & Vuotto, 2014). The longer the catheter remains; the surfaces of the catheter become colonized by bacteria and grow a bio-film that causes infection (Donelli & Vuotto, 2014). Instrumentation of the urethra by a catheter places the patient at risk for infection. Studies show that urinary catheters left in place more than 48 hours are directly associated with CAUTI (Meddings, et al., 2014; Carter, et al., 2014). According to CDC, (2015) CAUTI is a urinary tract infection that occurs 2 days after a catheter is inserted or day one after the catheter was discontinued (Center for Disease Control and Prevention (CDC),

Most urinary tract infections are primarily caused by bacteria that live in the bowel region of the body. The bacterium Escherichia coli, commonly referred to as “E. coli”, causes most UTIs. The urinary tract has several systems to prevent infection. The points where the ureters attach to the bladder act as only one way valves to prevent urine from moving back up toward the kidneys. Urination is intended to wash microbes and any infectious bacteria out of the body. In males, the prostate gland produces secretions that slow down bacterial growth in the urinary tract. In both woman and men, immune defenses try to prevent infections, but despite these safety procedures put in place by the body, infections still do occur in some individuals.

The cardiovascular system plays an immensely important role in the urinary system, without proper blood supply to the kidneys there would be no filtration and no urine to pass into the bladder. Proper blood supply is essential and renal failure would be catastrophic to the process of urination. Maintaining healthy renal arteries and veins is very important also to the respiratory system which keeps the tissues oxygenated, without this the tissue could not perform the duties required or even stay alive. The immune system could undesirably affect the kidneys as well, which would impede the flow of urine to the bladder. Acute or systemic inflammation on the urinary system would directly affect the bladder as well, this is why we need the immune system to keep this inflammation at bay. Kidney damage from this would directly affect all the systems mentioned here, so it is very important to keep the immune system healthy not just for the sake of the urinary system but almost every system of the human body. The urinary system although often overlooked is extremely valuable and required to stay alive and maintain homeostasis. So is the bladder and if you appreciate the ability to hold your urine in until you can find a nearby restroom you should be thankful for it as

Lehne (2013) continues by stating that in nosocomial caused cystitis E. coli makes up only 50 percent of UTI’s. In hospital settings more common gram negative causative agents of cystitis are Pseudomonas, Proteus or Klebsiella pneumoniae. There is also a gram positive agent named Staphylococcus saprophyticus that makes up 10 to 15 percent of nosocomial UTI’s.

For example; for leukocyte esterase levels, nitrite levels, microscopic evaluation, and culture of urine is an important component in most cases. Broad-spectrum antibiotics are typically used. There are two main categories of bacterial urethritis: gonorrheal and nongonococcal. Gonorrheal urethritis is caused by Neisseria gonorrhoeae and is associated with gonorrhea, a common STI. The term nongonococcal urethritis (NGU) refers to inflammation of the urethra that is unrelated to N. gonorrhoeae. In women, NGU is often asymptomatic. In men, NGU is typically a mild disease, but can lead to purulent discharge and dysuria. Because the symptoms are often mild or nonexistent, most infected individuals do not know that they are infected, yet they are carriers of the disease. Asymptomatic patients also have no reason to seek treatment, and although not common, untreated NGU can spread to the reproductive organs, causing pelvic inflammatory disease and salpingitis in women and epididymitis and prostatitis in men. Important bacterial pathogens that cause nongonococcal urethritis include Chlamydia trachomatis, Mycoplasma genitalium, Ureaplasma urealyticum, and Mycoplasma hominis. (Lumen Microbiology)

Feline cystitis is a very common disease in cats in which the urinary tract is blocked. It occurs in 50-70% of middle-aged cats (Caney et. al 2011). The blockage usually originates from either a bladder stone or a crystal accumulation. The “crystal build up” refers to a bacterial build up in the form of sand (Buffington et. al 2011). The crystals can lead to a blockade which causes their bodies to develop stationary urine, making it very difficult for the cat to urinate. If this urine is blocked for too long, the build up can get to a point where there is harm to the kidneys, which can ultimately result in kidney failure (Towell et. al 2015). The non-movement of urine is also the perfect environment for faster bacteria build up. Feline cystitis

The Quality Improvement nursing process that I have chosen to research is patient safety. I have chosen to focus specifically on the topic of catheter associated urinary tract infections (CAUTI’s) during hospitalization and their preventions. It is estimated that 15-25% of hospitalized patients receive a urinary catheter throughout their stay, whether or not they need it. A large 80% of all patients diagnosed with a urinary tract infection (UTI) can be attributed to a catheter (Bernard, Hunter, and Moore, 2012). The bacteria may gain entry into the bladder during insertion of the catheter, during manipulation of the catheter or drainage system, around the catheter, and after removal.

Bacterial urinary tract infections represent the most common type of nosocomial infections. Often, the ability of bacteria to both establish and maintain these infections are directly related to biofilm formation on indwelling devices or within the urinary tract itself (30). Enterococci (especially E. faecalis) are one of the main causative agents of urinary tract infection and Catheter-associated urinary tract infections (CAUTIs) besides gram-negative pathogens (31, 32). In these infections Biofilm provides a favorable milieu for microbial survival within the host as the organisms are shielded from the host immune response, as well as antibiotics and antimicrobial agents (33, 34). Several studies conducted to introduce main virulence genes of enterococci that are associated with biofilm formation in these bacteria (11, 13,-17), but virulence mechanism and related genes for biofilm formation are not well understood (35). In this study we investigated biofilm formation of clinical enterococci isolates isolated from Urinary tract infections. These strains were characterized for presence of adhesions and secretory virulence factors. Isolates had diverse presence of virulence from lack to highest amount of virulence genes. Several previous studies investigated relation of virulence genes and biofilm formation, especially presence of esp and gel. Enterococci esp has been implicated as a contributing factor in colonization and persistence of infection within the urinary tract

The urinary tract naturally flushes away bacteria that are present in the urethra. However, an abundance of bacteria present can overcome the flushing power of the urinary tract and begin to grow. There are species of non-pathogenic bacteria that inhabit the urinary tract and result in no symptoms for the individual. A problem arises when pathogenic bacteria enter the urinary tract and are not flushed away, this results in a urinary tract infection (UTI) (Foxman and Schaeffer, 2011).

Stenzelius, K., Laszlo, L., Madeja, M., Pessah-Rasmusson, H., & Grabe, M. (2016). Catheter-associated urinary tract infections and other

The epidemiological rationale for this teaching is that “nearly 1 in 3 women will have had at least 1 episode of UTI requiring antimicrobial therapy by the age of 24 years. Almost half of all women will experience 1 UTI during their lifetime” (Foxman, 2003). According to Robichaud and Blondeau (2008), in the community setting, the rate of Urinary tract infection accounts for 24% of all diagnosed infections, followed by respiratory tract infections. It is the most common infection reported in long term care facilities too. I also choose this topic because i take care of kids who have also been treated of UTI which also reoccurs.