Urinary tract infection resident survival guide

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

• Escherichia coli
• Klebsiella pneumonia
• Neisseria gonorrhea
• Proteus mirabilis
• Pseudomonas aeruginosa
• Staphylococcus saprophyticus
• Urinary catheterization

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