Urinary Tract Infections (UTI) Risk Factors

Urinary Tract Infections (UTIs)

• Risk factors: neurologic disorders, gout, altered states caused by incomplete emptying of the bladder and urinary stasis, decreased natural host defenses or immunosuppression, inability or failure to empty the bladder completely, inflammation or abrasion of the urethral mucosa, instrumentation of the urinary tract (e.g., catheterization, cystoscopic procedures)
• Obstructed urinary flow caused by: congenital abnormalities, urethral strictures, contracture of the bladder neck, bladder tumors, calculi (stones) in the ureters or kidneys, and compression of the ureters
• Urethrovesical reflux: reflux of urine from the urethra into the bladder
• Ureterovesical or vesicoureteral reflux: backward flow of urine from the bladder into one or both ureters
• Bacteria enter the urinary tract in three ways: ascending infection, hematogenous spread, and direct extension
• Most common route of infection is transurethral

Signs and Symptoms of UTIs

• Burning on urination
• Urinary frequency (voiding more than every 3 hours)
• Urgency
• Nocturia (awakening at night to urinate)
• Incontinence
• Suprapubic or pelvic pain
• Hematuria and back pain may also be present

Sepsis and Shock

• Pathophysiology of shock: cellular changes, vascular responses, and changes in blood pressure
• Sepsis: response to infection becomes generalized and involves normal tissues remote from the site of injury or infection
• Stages of shock: compensatory (stage 1), progressive (stage 2), and irreversible (stage 3)
• Risk factors for septic shock: immunosuppression, extremes of age, chronic conditions, malnourishment, chronic illness, invasive procedures, emergent and/or multiple surgeries, increased use of invasive procedures and indwelling medical devices, and the aging population

Sepsis Signs and Symptoms

• Evolving process that may result in septic shock and life-threatening organ dysfunction if not recognized and treated early
• Early stage: BP may remain within normal limits, or patient may be hypotensive but responsive to fluids
• Heart rate increases, progressing to tachycardia
• Hyperthermia and fever, chills, feeling cold, with warm, pale, flushed skin and bounding pulses
• Respiratory rate is elevated, with SOB

Treatments and Interventions for Sepsis

• Rapid identification and elimination of the cause of infection
• Fluid replacement: initial fluid challenge, which includes an IV infusion of at least 30 mL/kg of crystalloids over 30 minutes
• Broad-spectrum antibiotic agents started until culture and sensitivity reports are received
• Vasopressors, inotropic agents, packed red blood cells, neuromuscular blockade agents, and sedation agents
• DVT prophylaxis with low-dose unfractionated heparin or low-molecular-weight heparin
• Ulcer prophylaxis
• Aggressive nutritional supplementation should be initiated within 24 to 48 hours of ICU admission

1-Hour Sepsis Bundle

• Recognize signs and symptoms of sepsis or septic shock
• Measure lactate levels (remeasure if greater than 2 mmol)
• Blood cultures before giving antibiotics
• Broad-spectrum antibiotics
• 30 mL/kg rapid IV crystalloid fluids
• Vasopressors if hypotensive during or after fluid resuscitation

Q-SOFA Screening Tool

• Q-SOFA: non-ICU patient
• SOFA: ICU patient
• Greater than or equal to 2 greater risk for a poor outcome, altered mental status, tachypnea greater than 22, systolic less than 100
• Glasgow Scale: lower the score, lower level of consciousness

COVID-19

• Risk factors: unknown
• Signs and symptoms: fever, chills, SOB, fatigue, loss of smell or taste, sore throat, congestion, runny nose, headache, muscle aches, N/V/D
• Complications: unknown
• Management: oxygen, cardiorespiratory monitoring, endotracheal intubation, oral or nasal intubation, mechanical ventilation, ECMO, suctioning
• Diagnostics: PCR test, nasopharynx, blood, bronchoscopy
• Treatment: medications (Remdesivir, Corticosteroids, Bamlanivimab), clinical trials