Urinary tract infection resident survival guide

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2]

Introduction

A urinary tract infection is a bacterial infection that affects any part of the urinary tract.

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.

Urinary tract infection does not have life threatening causes.

Common Causes

Management

Shown below is an algorithm depicting the initial approach to UTI.

 
 
 
Characterize the symptoms:
Fever
Dysuria
Frequent urination
❑ Suprapubic pain
Hematuria
Vomiting
Diarrhea
Nausea
Flank pain or back pain
❑ Weak stream
❑ Hesistancy
Nocturia
❑ Chills
Urethral discharge
Obtain a detailed history:
Use of urinary catheters
Pregnancy
Diabetes
❑ Female and sexually active
❑ Renal problems
❑ Menopausal
Sickle cell disease
Elderly
❑ Antibiotic use
❑ Urogynecologic surgery
Urinary retention
Urinary incontinence
❑ Anatomic malformations of the urinary tract
❑ Increased susceptibility to UTIs
❑ Allergies to latex condoms or spermicices
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Examine the patient:
❑ Suprapubic tenderness
❑ Flank pain or costovertebral angle tenderness
❑ Tender prostate
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider alternative diagnosis:
Urethritis
Prostatitis
❑ Renal abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Order tests:
Urine culture
Urinalysis
Blood culture
❑ Abdominal CT
❑ Renal ultrasound scan
Voiding cystourethrogram
Intravenous pyelogram
 
 
 
 
 
 
 
 
 
 
 



Diagnosis and Treatment

An algorithm using symptoms/physical finding in diagnosis and treatment of UTIs.


 
 
 
 
 
 
 
 
UTI confirmed
(≥ 105 CFU/mL) + Pyuria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Is there suprapubic pain?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider Cystitis
 
 
 
Is there flank or back pain?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute uncomplicated cystitis
Preferred regimen[1][2]
Trimethoprim/Sulfamethoxazole 160/800mg bid x 3 days
OR
Nitrofurantoin monohydrate/macrocrystals 100mg bid x 5-7 days
OR
Fosfomycin trometamol 3g once (single dose)
OR
Pivmecillinam 400mg bid x 5 days
Alternative regimen: Template:See main
 
Complicated/Catheter-Associated Cystitis
 
Acute Cystitis in Pregnancy
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider pyelonephritis
 
 
Consider alternative diagnosis such as;
Prostatitis
Urethritis
Renal abscess
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Acute uncomplicated pyelonephritis (Outpatient)
Preferred regimen[1][2]
Ciprofloxacin (immediate release) 500mg bid x 7 days
Ciprofloxacin (extended release) 1000mg once daily x 7 days
OR
Levofloxacin 750mg once daily x 5 days OR
Trimethoprim/Sulfamethoxazole 160/800mg bid x 14 days
Alternative regimen: Template:See main
 
Complicated pyelonephritis (Inpatient)
 
Acute pyelonephritis in Pregnancy
 
Is there urethral discharge?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider Urethritis
 
Weak stream or hesitancy?
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Yes
 
No
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Consider Prostatitis
 
Renal USS to rule out renal abscess
Other investigations (Abdominal CT, VSUG, for anatomic abnormality or obstructions
 



Do's

Dont's

References

  1. 1.0 1.1 "Drugs for urinary tract infections". JAMA. 311 (8): 855–6. 2014. doi:10.1001/jama.2014.972. PMID 24570249.
  2. 2.0 2.1 Gupta K, Hooton TM, Naber KG, Wullt B, Colgan R, Miller LG; et al. (2011). "International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases". Clin Infect Dis. 52 (5): e103–20. doi:10.1093/cid/ciq257. PMID 21292654.