INFECTIOUS DISEASE
UTI/PYELONEPHRITIS/UROSEPSIS
PromptDefinition of urinary tract infection
ResponseUrinary tract symptoms (at least 1 of: suprapubic tenderness, renal angle tenderness, urinary urgency, frequency or dysuria)
AND
Isolation of a urinary pathogen at >105 colony forming units/mL in freshly voided mid stream urine. (ie: isolation of bacteria in urine)
AND
Isolation of a urinary pathogen at >105 colony forming units/mL in freshly voided mid stream urine. (ie: isolation of bacteria in urine)
PromptMost common bacteria causing UTI/Pyelo/Urosepsis
ResponseE. Coli
Klebsiella
Proteus mirabilis
Pseudomonas
Enterococci
Klebsiella
Proteus mirabilis
Pseudomonas
Enterococci
PromptRisks for UTI
ResponsePMHx:
Prior antibiotics for treatment of UTI
Nephrolithiasis
Urinary incontinence
Renal tract pathology - Cystocoeles, Prostatic hypertrophy, Recent instrumentation of urinary tract/surgery
Cognitive impairment
Immunocompromised/diabetes
Symptoms
Dysuria
Urgency, frequency, new incontinence
Flank pain
Haematuria
Signs
Temperature
Prior antibiotics for treatment of UTI
Nephrolithiasis
Urinary incontinence
Renal tract pathology - Cystocoeles, Prostatic hypertrophy, Recent instrumentation of urinary tract/surgery
Cognitive impairment
Immunocompromised/diabetes
Symptoms
Dysuria
Urgency, frequency, new incontinence
Flank pain
Haematuria
Signs
Temperature
PromptCauses of chronic dysuria (non UTI)
ResponseChronic prostatisis
Bladder malignancy
Bladder malignancy
PromptDDx of sudden onset flank pain
ResponseLumbar back pain
Epidural abscess with septic shock
Ruptured AAA
Aortic dissection with rupture
Renal colic
Spontaneous retroperitoneal haemorrhage
Perforated DU
Epidural abscess with septic shock
Ruptured AAA
Aortic dissection with rupture
Renal colic
Spontaneous retroperitoneal haemorrhage
Perforated DU
PromptInvestigations for UTI/Pyelo
ResponseUrine micro - confirm UTI
Urine culture - Guide subsequent antibiotic therapy
Renal tract imaging USS renal tract) - especially if male ? structural abnormality
EUC - ? renal impairment, guide gentamycin dosing
Blood cultures - Confirm bacteraemia and guide management
?Lactate - guide and assess resuscitation
Urine culture - Guide subsequent antibiotic therapy
Renal tract imaging USS renal tract) - especially if male ? structural abnormality
EUC - ? renal impairment, guide gentamycin dosing
Blood cultures - Confirm bacteraemia and guide management
?Lactate - guide and assess resuscitation
PromptIndications for imaging in pyelonephritis
ResponseShock
New renal impairment
History of renal calculi
Failed outpatient management
Single kidney
Immunosuppression (although diabetes may still score points)
New renal impairment
History of renal calculi
Failed outpatient management
Single kidney
Immunosuppression (although diabetes may still score points)
PromptLeft flank pain and fever
ResponseEnlarged left kidney
Air in kidney
Surrounding fat stranding
= Emphysematous pyelonephritis
Air in kidney
Surrounding fat stranding
= Emphysematous pyelonephritis
PromptManagement of UTI/Pyelo
ResponseAntibiotics
Analgesia - morphine 2.5mg + repeat for comfort
Admission/urology referral/Central access/ICU
- Amp 2g + gentamycin 5-7 mg/kg
- Gent contraindicated = ceftriaxone
- ESBL = Meropenem
Analgesia - morphine 2.5mg + repeat for comfort
Admission/urology referral/Central access/ICU