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 | |||||||||||||||||||||||||||||||||||||||||
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 | Complicated/Catheter-Associated Cystitis | Acute Cystitis in Pregnancy | |||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||
| Consider pyelonephritis | Consider alternative diagnosis such as; Prostatitis Urethritis Renal abscess | ||||||||||||||||||||||||||||||||||||||||||||
| Acute pyelonephritis (Outpatient) | Acute 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 | ||||||||||||||||||||||||||||||||||||||||||||