Urinary Tract Infections

Research Summary Table: Urinary Tract Infections

Author (year) Purpose Sample/Number of Participants Design Level of Evidence Findings Limitations
Blanck, Donahue, Brentlinger, Stinger, & Polito (2014) To investigate a bundled approach to catheter care practices and clarify its impact on patients with UTI. Two groups (18 years of age or more) with 317 participants in the pre-intervention group and 310 participants in the intervention group. A quasi-experimental study VI: evidence gathered from a quasi-experimental study 50% reduction in catheter-associated urinary tract infections is observed The inability to withhold catheter care from the participants, adult patients only
Carlsson, Haglin, Rosendahl, & Gustafson (2013) To identify and analyze the factors that could be associated with poor nutritional status among older people 188 participants (136 women and 52 men) with physical and cognitive impairments A cross-sectional study VI: evidence is gathered from the Frail Older People-Activity and Nutrition Study in Umea 50% of the participants as malnourished, and 66% at risk of malnutrition UTIs are chosen for the analysis. No other urine samples and clusters are considered.
Gágyor et al. (2015) To clarify if ibuprofen could be used to treat the symptoms of UTI 18-65-year-old women who have some UTI symptoms but are not at risk of having serious complications. One group (fosfomycin) (N 243), another group (ibuprofen) (N 241) A pragmatic trial in a general practice setting VI: Evidence is gathered from good clinical practice with the help of which patient safety and data quality could be considered. 25% of women with UTI are treated with antibiotics. 2/3 of the female participants recovered without antibiotics The inclusion criteria are biased to the patients with less severe symptoms, symptom score, and resulting measurements are not validated.
Nuñez-Forero et al. (2016) To analyze tests that are offered to women with lower UTI symptoms 14-49-year-old women who have lower UTI symptoms (N -1500). A cross-sectional study VI: evidence is gathered from the study of several healthcare organizations The sensitivity of UTI is not 100% Interobserver is not evaluated. An inappropriate number of cases of NG.

Summary

Research Question and Search Strategy

The research question that is addressed in this study is the course of urinary tract infections in patients with diverse diagnoses, the risk factors associated with UTIs, and the approaches to the identification of the disease. Less than a decade ago, the number of people with UTIs totaled more than 170 million, as estimated by the WHO (Nuñez-Forero et al., 2016). The prevalence of the disease is alarming, which necessitates the present research, the primary purpose of which is educatory: people want to know more about their opportunities, threats to their health, and the solutions to their problems.

The presence of this infection in the organism influences its work and a general condition of a human. Still, not many people understand how serious urinary tract infections could be (Nuñez-Forero et al., 2016). Credible information about urinary tract infections, their impact, their treatment methods, and their outcomes should be found to conform to the educatory purpose of this study. For that sake, the identification of databases should be made.

Medscape, Ebscohost, and Elsevier were chosen among the rest due to the possibility of finding original studies based on quantitative research. Second, it was necessary to identify clear keywords with the help of which the required material could be found. The keywords and word combinations that were used for the search included “urinary tract infections,” “treatment,” “quantitative research,” and “health problem.” Finally, it was also important to consider the year of publication. Therefore, articles written after 2011 were taken into consideration to ensure the information was not outdated.

Study Designs

Four articles with original quantitative studies were chosen for the analysis. Each article has its own design, clearly established goals, and methods developed by its authors. For example, Blanck, Donahue, Brentlinger, Stinger, and Polito (2014) choose a quasi-experimental study with the help of which the comparison of the rates in two groups could be organized in order to understand if a bundled approach to catheter care could reduce the level of urinary tract infections in the period of three months. With the help of this study, the authors explain the main characteristics of the infections and the possibility of reducing them using a particular approach.

The work of Carlsson, Haglin, Rosendahl, and Gustafson (2013) is a good example of a cross-sectional study with the help of which it became possible to analyze the baseline nutritional status and a number of factors that could be associated with the chosen topic. Urinary tract infections turn out to be the factor that helped to gather the participants and unite them in groups.

The pragmatic trial in a general practice setting with certain inclusion criteria (the level of abdominal pain, dysuria, and micturition) and exclusion criteria (upper UTI like fever or tenderness) is the type of design chosen by Gágyor et al. (2015). The peculiar feature of this project is the consideration of the Good Clinical Practice Guidelines within the frames of which safety data and serious events connected with urinary tract infections in women could be defined and monitored (Gágyor et al., 2015).

Finally, there was another cross-sectional study developed by Nuñez-Forero et al. (2016), with the help of which it was possible to gather the experiences of women aged 14-49 in 2010 and analyze their reactions on rapid tests that defined the number of possible urinary tract infections. All studies provide a VI level of evidence.

Study Findings

The findings of four studies indicate that urinary tract infection is a serious problem for a number of people. Today, people have access to different tests that help to check the level of sensitivity and specificity for certain infections like Chlamydia trachomatis (CT), Neisseria gonorrhea (NG), and syphilis, in addition to the UTIs in the body (Nuñez-Forero et al., 2016). However, UTIs are not the only problem that should be investigated.

There are many reasons why people could have them, and the possibility of reducing UTIs should not be neglected (Blanck et al., 2014). The findings of Gágyor et al. (2015) prove that antibiotics are not the only medications that could be offered to the patients, and Carlsson et al. (2013) explain that UTI misunderstanding or neglect could lead to a number of problems that are more serious.

Sample Selection

All samples in the four studies were selected randomly. Each researcher established their own exclusion and inclusion criteria with the help of which the correct choice of participants was made. The choices of samples had their reasons and helped to answer the main research questions in all studies. All authors clearly described their participants, identified their ages and explained why certain frames were made. Nuñez-Forero et al. (2016) used 1500 women in their study: assuming the 2% prevalence of Neisseria gonorrhoeae, this number of participants was calculated to predictably produce 30 cases of the said disease.

Blanck et al. (2014) worked with 627 people: the sample size was determined by the setting (a single acute care unit), the number of patients with catheter-related UTIs, and the number of catheter days. Carlsson et al. (2013) used a stratified sample of 487, of which 188 people met the inclusion criteria. Gágyor et al. (2015) conducted their study with the help of two groups (the first group contained 243 people, and the second group consisted of 241 participants): the sample size was determined by the non-inferiority part of the trial: a variation coefficient of 80% would require 420 participants, which, when the dropout of 15% was predicted, turned into 494.

Limitations of the Studies

Each study had its limitations and explanations of why the problems could be observed. Nuñez-Forero et al. (2016) were limited by order of sample acquisition. Gágyor et al. (2015) admitted that the severity of symptoms was questionable. Blanck et al. (2014) focused on the lack of randomization for the required group assignments. Carlsson et al. (2013) could not be confident in their results because of too definite measurements of UTIs.

Recommendations and a Rationale for the Study

The findings largely support the change in practice in terms of both medications and patient education, which lies within the responsibility of the nurses. The studies illustrate that UTIs have a large prevalence, that antibiotics are not the one and only option in treating UTIs, and that UTIs are associated with poor nutrition in vulnerable groups. Such statements justify the necessity to conduct more extensive and somewhat more focused research concerned with a specific problem to develop an educational framework for patients, which falls within the nurses’ responsibility.

References

Blanck, A. M., Donahue, M., Brentlinger, L., Stinger, K. D., & Polito, C. (2014). A quasi-experimental study to test a prevention bundle for catheter-associated urinary tract infections. Journal of Hospital Administration, 3(4), 101-108. Web.

Carlsson, M., Haglin, L., Rosendahl, E., & Gustafson, Y. (2013). Poor nutritional status is associated with urinary tract infection among older people living in residential care facilities. The Journal of Nutrition, Health & Aging, 17(2), 186-191. Web.

Gágyor, I., Bleidorn, J., Kochen, M. M., Schmiemann, G., Wegscheider, K., & Hummers-Pradier, E. (2015). Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: Randomized controlled trial. BMJ, 351(6544). Web.

Nuñez-Forero, L., Moyano-Ariza, L., Gaitán-Duarte, H., Ángel-Müller, E., Ruiz-Parra, A., González, P.,… & Tolosa, J. E. (2016). Diagnostic accuracy of rapid tests for sexually transmitted infections in symptomatic women. Sexually Transmitted Infections, 92(1), 24-28. Web.