Urinary tract infections (UTIs) are symptomatic inflammatory conditions of the lower urinary tract including the bladder (cystitis) or upper tract including the kidneys (acute pyelonephritis), caused by infectious organisms. These are one of the most commonly occurring bacterial infections in both the community and health care settings. Uncomplicated, infrequent lower tract UTIs carry little risk of long-term harm but are associated with considerable discomfort including dysuria, frequency and urgency. Complicated infections may devolve into a bacteraemia with septic shock. A significant proportion of the population experience recurrent UTIs, but why this occurs is poorly understood. The presence of an indwelling catheter (IDC) for longer than 4 days is associated with high risk of UTI. Complicating this picture is the high incidence of asymptomatic bacteriuria in persons with long term IDCs and in older adults.

Effective and appropriate strategies for the prevention and management of UTI are becoming increasingly important as more and more of the causative organisms develop antibiotic resistance. Nurses play key roles in acute and long term care and in the community when identifying UTI, implementing treatment, and preventing recurrence. Careful management of catheters during insertion and use can help to reduce the risk of this most common of hospital-acquired infections.

After reading this article and completing the accompanying online learning activities you should be able to:

• Describe normal bladder defences against infection and the mechanisms used by invading pathogens to overcome these.
• Outline risk factors associated with the development of urinary tract infections.
• Discuss management strategies for prevention and treatment of urinary tract infection.
• Differentiate between urinary tract infection and asymptomatic bacteriuria and appropriate management of these.