1/8 Preview of revised @IDSAInfo Complicated UTI Guidelines, including simpler definition ("infection beyond the bladder"). Men CAN have an uncomplicated UTI.
2/8 STEP ONE - Assess the severity of illness: SOFA 2+ indicates sepsis, need for vasopressors + serum lactate persistently >2 indicates septic shock.
3/8 STEP TWO - Review urine and blood cultures in prior 12 months and exposure to fluoroquinolones in prior 12 months. Exposure to other antibiotics has not shown consistent correlation with predicting resistance.
4/8 STEP THREE - Assess allergies, drug-drug interactions, contraindications, risk of C difficile infection, and preferred route of delivery.
5/8 STEP FOUR - Look at antibiogram, typically focused on E coli (but potentially also Klebsiella pneumoniae and Proteus mirabilis). For patients with septic shock, select an empiric antibiotic with 90%+ susceptibility. Otherwise, including for sepsis without shock, aim for 80%+.
6/8 STEP FIVE - Select an empiric antibiotic to treat the complicated UTI.
7/8 STEP SIX - Assess clinical improvement. Is the patient afebrile and hemodynamically stable with relief of any obstruction, drainage of any abscess, and no further procedures planned to control the infection? If so, ready for oral switch!
8/8 STEP SEVEN - Treat for 7 days, even if pyelonephritis or GNR bacteremia that has promptly resolved. Longer therapy may be needed if there is prostatitis.
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