Health Dictionary
Reliable, easy-to-read patient information on common medical conditions — written in plain language, free of jargon, and grounded in current evidence. Browse the most frequent diagnoses, understand what they mean for everyday life, and learn which steps and questions help you have a focused conversation with your doctor.
Urinary tract infection resident survival guide
Introduction
Overview
Overview
A urinary tract infection (UTI) is a bacterial infection that affects any part of the urinary tract.
Causes
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
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 urine 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 spermicides | |||||||||||||||||||||||||||||||||||||||||
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 with urine culture (≥ 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] TMP-SMX 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 Preferred regimen For those who can tolerate ORALLY Ciprofloxacin 500mg PO bid x 5-14 days OR Ciprofloxacin Extended Release 1000mg daily x 5-14 days OR PARENTERALLY IV Levofloxacin 500mg OR IV Ceftriaxone 1g OR IV Ertapenem 1g Catheter-Associated UTI Remove catheter or intermittent catheterization Use same antibiotic therapy as above for CA-Cystitis Alternative regimen: Template:See main | Acute Cystitis in Pregnancy Preferred regimen Nitrofurantoin 100mg PO q12h x 5 days OR Amoxicillin-clavulanate 500mg PO q12h 3-7 days OR Fosfomycin 3g PO single dose Alternative regimen: TMP-SMX DS PO bid x 3 days only in 2nd trimester Template:See main | |||||||||||||||||||||||||||||||||||||||||||
| 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 TMP-SMX 160/800mg bid x 14 days Alternative regimen: Template:See main | Complicated pyelonephritis (Inpatient) Preferred regimen IV Ceftriaxone 1g q24h OR IV Ciprofloxacin 400mg q12h OR IV Levofloxacin 750mg q24h OR IV Cefepime q12h Alternative regimen: Template:See main | Acute pyelonephritis in Pregnancy Preferred regimen IV Ceftriaxone 1g q24h OR IV Ampicillin 1-2g q6h OR IV Cefepime 1g q12h Alternative regimen: Template:See main | Is there urethral discharge? | ||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||
| Consider Urethritis For treatment of urethritis: Template:See main | Weak urine stream or hesitancy? | ||||||||||||||||||||||||||||||||||||||||||||
| Yes | No | ||||||||||||||||||||||||||||||||||||||||||||
| Consider Prostatitis | Renal USS to rule out renal abscess (drainage + antibiotics for renal abscess) Other investigations (Abdominal CT, VSUG, for anatomic abnormality or obstructions | ||||||||||||||||||||||||||||||||||||||||||||
Dont’s
Dont’s
- Don’t use fluoroquinolones empirically for treatment of acute uncomplicated cystitis.[1]
- Do not give fluoroquinolones in pregnancy.
- Don’t give TMP-SMX in first trimester or near term of pregnancy.
References
References
- ↑ 1.0 1.1 1.2 “Drugs for urinary tract infections”. JAMA. 311 (8): 855–6. 2014. doi:10.1001/jama.2014.972. PMID 24570249.
- ↑ 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.
Editor-In-Chief:
C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ogheneochuko Ajari, MB.BS, MS [2] Iqra Qamar M.D.[3]