Day 5 - Urinary Tract Infections

Common UTI Organisms

  • E. Coli

  • Klebsiella

  • Enterococcus

  • Proteus

  • Staphylococcus

    • Staph. Aureus is NEVER a contaminant. S. aureus in urine should prompt blood cultures and source identification.

Urine cultures and sensitivities should be obtained to guide therapy.

Asymptomatic Bacteriuria - Does not need treatment with antibiotics, even if urine culture is positive

Symptoms include: dysuria, urinary frequency, urinary urgency, suprapubic tenderness
Foul smelling urine or cloudy urine is not a symptom of UTI

Simple Cystitis/Lower Urinary Tract Infection

  • First Line as per IDSA guidelines - Macrobid 100mg PO BID, Setra DS 1 tab BID, or Cephalexin 500mg PO BID

  • If patient is minimally symptomatic, can get urine culture and treat based on culture results and sensivity

  • Treatment duration: 3 days

Complicated UTI

  • Presents with fever, flank pain, CVA tenderness, other systemic signs (tachycardia, hypotension, general malaise)

  • Empiric Antibiotics: Ceftriaxone 1g IV q24h or Ciprofloxacin 500mg PO BID

  • If patient has prior known ESBL: Meropenem 1g IV q8h or Ertapenem 1g q24h

  • Imaging required only if concern for renal stones, renal abscess, associated unexplained renal dysfunction, or symptoms not improving after 48-72 h

  • Treatment length: 5 - 7 days

Pyelonephritis

  • Treated similarly to complicated UTI in terms of antibiotic therapy

  • Evidence of obstruction on imaging requires urgent urological intervention (ie: nephrostomy tube)

  • Treatment length: ~ 7 days

    • May change depending on presence of renal abscess, nephrostomy tube etc.

Frequently Asked Questions

  • My patient is delirious and has a positive urinalysis, should I treat for a UTI?

    • Ongoing evidence suggests that UTI’s are not sole causes of delirium. Other sources should be considered.

  • When should I consider ESBL organisms?

    • History of ESBL

    • Frequent UTIs treated with antibiotics

    • Frequent hospitalization, resides in long-term care facilities

    • Not improving after first line non-ESBL antibiotics in 48-72 hours

  • What if my patient has a foley?

    • Bacteriuria is common in patients with a foley, without necessarily representing a UTI. The foley should be changed or discontinued if possible, and patients can be monitored for further signs of UTI.

  • Is there evidence for suppressive antibiotics for patients with recurrent UTIs?

    • There is evidence for low-dose antibiotic therapy for patients with recurrent UTIs, however benefits and risks should be discussed with patient prior to starting therapy. Further, referral to urologist may be beneficial in this setting to assess for anatomical abnormalities that may predispose too UTIs.

The Intern at Work -