Urinary Tract Infections Summary
Grand Rounds Presentation 11/12/14
Uncomplicated UTI
1) Macrobid x5d (avoid if early pyelo, CrCl<60) OR Bactrim x3d (avoid if used in
previous 3 months) OR Fosfomycin single dose (avoid if early pyelo).
2) Cipro x3d OR Keflex/Augmentin/Cefpodoxime/Cefdinir x5d
Uncomplicated Pyelonephritis
1) Cipro x 7d +/- Ceftriaxone IV one-time prior to discharge
2) Bactrim x10-14d +/- Ceftriaxone IV one-time prior to discharge
Complicated UTI/Pyelonephritis (1-2 week treatment course)
Extremes of age, male, or pregnant; Anatomic or functional abnormalities of urinary
tract (obstruction); Concurrent kidney stone, foreign body (catheter, stents);
Immunosuppressed, comorbid conditions; Hospital acquired or history of MDR
organisms; Recent instrumentation; Pyelonephritis with complication
-1-2 week treatment course: Ceftriaxone, Cipro, Unasyn OR Cefepime, Zosyn,
Aminoglycoside, Carbapenem depending on susceptibilities or suspicion
+/-Amioglycoside: consider if severe sepsis/septic shock
+/-Vancomycin or Ampicillin: consider if suspect MRSA or enterococcus
(NH/hospital acquired, indwelling catheter, elderly men/BPH, recent
instrumentation or renal transplant)
Catheter-associated UTI
 Diagnosis includes SIRS, AMS or UTI symptoms in those who have catheter or
recently removed in previous 2d. Pyuria does not equal infection.
 Culture: >/=103 cfu/mL of a single bacterial species in a single catheter urine
specimen or urine specimen from a patient.
 Replace foley and culture urine from freshly placed catheter and not the old
catheter or the urine bag
Asymptomatic bacteriuria
 Asymptomatic bacteriuria + pyuria = no treatment
 Asymptomatic bacteriruia in diabetics, nonpregnant women, elderly,
neurogenic bladder, foley patients = no treatment
 Asymptomatic bacteriuria in pregnancy = treat
UTI in Pregnancy
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Treat asymptomatic bacteriuria: Macrobid x5d, Keflex or Augmentin x 5-7
days, Fosfomycin 3g single dose
Acute pyelonephritis: always admit; Ceftriaxone, Unasyn, Augmentin,
Cefpodoxime x 10-14 days