Urinary Tract Infection (UTI)

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UTI

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UTI
-DDx includes: urethritis, prostatitis, cystitis, abscess, nephrolithiasis, urinary tract obstruction, ectopic pregnancy, pelvic inflammatory disease.
-Pyelonephritis due to dysuria, fever, chills, flank pain, nausea & vomiting.
-Complicated pyelonephritis if male, pregnant, uncontrolled diabetes, kidney transplants, urinary anatomical abnormalities, acute or chronic kidney failure, hospital-acquired bacterial infections, as well as immunocompromised patients otherwise uncomplicated pyelonephritis.
-If recurrent UTI, admission will need to r/o vesicoureteral reflux.
-Remove or exchange indwelling Foley urethral catheter.
-Obtain urinalysis and culture, CBC, CMP, and blood cultures.
-Abdominal/pelvic CT with contrast indicated for patients with a renal transplant, patients in septic shock, those patients with poorly controlled diabetes, complicated UTIs, immunocompromised patients, or those with toxicity persisting for longer than 72hrs. 
-Bedside ultrasound, if available.
-Antibiotics, analgesics, and antipyretics. 
-Empiric antibiotics with Ceftriaxone. If hypotensive, Vancomycin and Zosyn. Will look at antibiogram and past urine cultures sensitivity to guide antibiotics. 
-Will deescalate following cx sensitivities or when clinically improved and afebrile after 48hrs.
-If complicated UTI, needs set-up post discharge for follow-up imaging to identify any abnormalities that predispose the patient to further infections.
-Monitor for sepsis and shock, renal or perinephric abscess formation, renal vein thrombosis, papillary necrosis, or acute renal failure and emphysematous pyelonephritis.
-Will consult urology for emphysematous pyelonephritis or other complication.
-Will consult ID if immunocompromised, has persistent bacteremia >48hrs or resistant organism.