Guidelines
Hospitalized UTI - Febrile

Hospitalized UTI - Febrile

Clinical/Diagnostic Considerations

Diagnosis requires clinical, and laboratory and culture criteria:

Clinical criteria:  fever, irritability, decreased feeding, crying with micturition and if verbal, dysuria, urinary frequency, new incontinence, back or flank pain, malaise.  

Laboratory criteria: positive nitrites and/or leukocyte esterase (LE) on urinalysis and/or pyuria (>5-10) on microscopy. If both LE and nitrites are negative, do not send a urine culture as low probability of a UTI. Blood culture should be done.

Culture criteria: ≥50 X 10 CFU/L of a single uropathogen such as E. coli, Klebsiella. Amounts less that this or mixed growth are most likely due to contamination. 

If above criteria are not met, consider other diagnoses/explanations (e.g., sterile pyuria in other inflammatory conditions).

Infection Prevention and Control

Routine Practices

Most Likely Pathogens

Empiric Antimicrobials

If renal dysfunction, use alternative agent such cefotaxime or ceftriaxone

OR

Usual Duration

Usually 7 days including oral antibiotics if rapid response to therapy. 

Can step down to oral when afebrile for 24-48 hours and susceptibilities available.   

Duration should be longer than 7 days (e.g.,10 days) if patient is slow to respond OR has structural abnormality of the urinary tract OR has a relatively resistant pathogen. 

Complicated infections such as abscess will require individualized durations.