URINARY TRACT INFECTION Flashcards
MANAGEMENT
CIRCULATION:
Adults:
Isotonic Crystalloid IV Bolus 20 cc / kg
Pediatrics:
10-20 ml/kg crystalloid bolus (will be dehydrated)
Levophed:
4 mg OR 8 mg in 250 ml saline = 16 ug / ml or 32 ug / ml
0.05 - 0.5 ug / kg / min ~ (0.1-0.3 most common), if BP in boots (SBP 70 start at 0.3)
titrate by 0.02 μg/kg/minute every 5 minutes
OR
5 - 20 ug / min
BROAD SPECTRUM ANTIBIOTICS:
Ceftriaxone 1 g IV q24 hours plus or minus aminoglycoside
OR
Ciprofloxacin 400 mg IV q12 hours
OR
Meropenem 2 g IV q8 hours
OR
Piperacillin-tazobactam 3.375 g IV q6 hours plus or minus aminoglycoside
OR
Gentamicin 5 milligrams per kilogram intravenous every 24 hours plus or minus ampicillin 2 g intravenous every 4 hours
EXPOSURE:
Look to indwelling catheters
Instrumentation
Consider CT or U/S imaging to evaluate for renal abscess, obstructing stone, or other surgical pathology.
Consult interventional radiology and/or surgery if needed.
CRITICAL DDX
Perirenal / Renal Abscess
Septic Nephrolithiasis
Pyelonephritis
Emphysematous Pyelonephritis
PID
torsion
Fournier’s gangrene
INVESTIGATIONS
Urine Dipstick for uncomplicated UTI
U/A & Culture for suspected pyelo or complicated UTI
Imaging if suspected obstruction
MANAGEMENT: 1ST LINE UNCOMPLICATED
Septra DS
1 tab Po bid x 3 days
Nitrofurantoin 100 mg
1 tab PO bid x 5 days
Fosfomycin (Less effective)
3 g single dose PO x 1
MANAGEMENT: 2ND LINE UNCOMPLICATED
Ciprofloxacin 250 mg
1 tab PO bid x 3 days
Ciprofloxacin XR 500 mg
1 tab PO daily x 3 days
Levofloxacin 250 mg
1 tab PO daily x 3 days
Cefixime x 5 days
MANAGEMENT: 3RD LINE UNCOMPLICATED
Amox / Clav 500/125
1 tab PO bid x 7 days
Cephalexin 500 mg
1 tab PO tid x 7 days
MANAGEMENT: COMPLICATED OR PYELONEPHRITIS
Fluoroquinolone if local resistance is < 10%. If > 10%, initial dose of Ceftriaxone IV or Gentamycin IV then outpatient fluorquinolone
Ciprofloxacin 500 mg
1 tab PO bid x 7 days
Ciprofloxacin XR 500 mg
2 tab PO daily x 7 days
TMP / SMX DS
1 tab PO bid x 14 days
PREGNANCY:
treat when asymptomatic bacturia
MANAGEMENT: INPATIENT
Ceftriaxone 1 g IV q 24 hrs
OR
Ciprofloxacin 400 mg IV q 24 hrs
OR
Gentamycin 4-7 mg / kg q 24 hrs
AND
Ampicillin 1-2 g IV q 4 hrs
DISPOSITION: ADMISSION
Impacted stone
Renal failure
Retention
Sepsis
Pyelo*
DOCUMENTATION
CLINICAL FEATURES
Frequency 60% sp
urgency 78%-88% sp
dysuria 52%-58% sp
hematuria 89%-92% sp
fever 69%-91% sp
flank pain
abdo pain
Nausea vomiting
RISK FACTORS
Female
Atrophic vaginitis
Sexually active
Using diaphragms
Vseicourethral reflux
History of UTI
Posterior urethral valves
RISK FACTORS: COMPLICATED UTI
Male
Preadolescent
Postmenopausal
Pregnancy
Recent catheter or instrumentation
PMHx: History of childhood UTI, Known Anatomical abnormailities (Neurogenic Bladder, PKD etc), Chronic Renal disease, Immunosuppressed, DM
DDx
CRITICAL
Perirenal / Renal Abscess
Septic Nephrolithiasis
Pyelonephritis
Emphysematous Pyelonephritis
PID
torsion
Fournier’s gangrene
GU DDx
vaginitis
urethritis
proctitis
sexually transmitted infection [STI]
