Urology and Urinary Tract Infections in Adults
|
|
- Dwight Shepherd
- 6 years ago
- Views:
Transcription
1 Urology and Urinary Tract Infections in Adults Full Title of Guideline: Author (include and role): Division & Speciality: Scope (Target audience, state if Trust wide): Review date (when this version goes out of date): Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis): Guideline for the treatment of urinary tract infections in adults Dr A Joseph, SpR Microbiology Mr R Parkinson, Consultant Urologist Annette Clarkson Specialist Pharmacist antimicrobials and Infection Control All adult specialties except Obstetrics Doctors, Pharmacists, Nurses August 2019 Inclusion: Adult patients including Urology Exclusion: Pregnant patients, refer to guideline for antibiotics in obstetrics Changes from previous version (not applicable if this is a new guideline, enter below if extensive): Addition of fosfomycin for first line treatment of lower UTI Changes to UTI diagnostic algorithm Changes to format of antimicrobial treatment regimens. Updated wording and clarification of advice around oral follow on therapy in upper UTI. Updated information on epididymitis/orchitis algorithm 15/12/17 updated frequency of fosfomycin dosing as per PHE Summary of evidence base this IDSA guideline for treatment of uncomplicated cystitis and guideline has been created from: pyelonephritis in women 2010 Local microbiological sensitivity surveillance and local audit of E. coli bacteraemias. Recommended best practice based on clinical experience of guideline developers. Public Health England. Management of infection guidance for primary care for consultation and local adaptation -updated 2016 BASHH Prostatitis 2008 European Association of Urology Guidelines on Urological Infections 2015 BASHH 2010 guidelines epididymitis orchitis GRASP 2013 report: The gonococcal resistance to antimicrobials surveillance program (England & Wales) Cochrane Database of Systematic Reviews: Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women Renal Drug Database access 10/07/2017 Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America (2010) This guideline has been registered with the trust. However, clinical guidelines are guidelines only. The interpretation and application of clinical guidelines will remain the responsibility of the individual clinician. If in doubt contact a senior colleague or expert. Caution is advised when using guidelines after the review date or outside of the Trust. Nottingham Antibiotic Guidelines Committee Page 1 of 15
2 Contents Urinary tract infection diagnosis algorithms: - Non-catheterised patient 65 years - Non-catheterised patient <65 years - Catheterised patient Lower urinary tract infection (cystitis) Catheter-associated urinary tract infection Prophylaxis for change of long-term catheters Recurrent urinary tract infections Upper urinary tract infections (pyelonephritis and systemic infection of urinary tract origin) Acute prostatitis Epididymitis and Orchitis Appendix 1: Example fosfomycin prescriptions Page 3 Page 4 Page 5 Page 6 Page 8 Page 9 Page 9 Page 10 Page 13 Page 14 Page 15 Glossary of abbreviations: NPV MSU CSU MC&S WCC CRP ESBL Negative predictive value Mid-stream urine Catheter specimen urine Microscopy, culture and sensitivity test White Cell Count C-reactive protein Extended beta-lactamase Nottingham Antibiotic Guidelines Committee Page 2 of 15
3 * Urine samples sent in red top containers must have a minimum volume of 20ml to provide sufficient sample for testing. If <20ml urine, please send in a white top container. All samples should be sent to the lab immediately. Nottingham Antibiotic Guidelines Committee Page 3 of 15
4 * Urine samples sent in red top containers must have a minimum volume of 20ml to provide sufficient sample for testing. If <20ml urine, please send in a white top container. All samples should be sent to the lab immediately. Nottingham Antibiotic Guidelines Committee Page 4 of 15
5 * Urine samples sent in red top containers must have a minimum volume of 20ml to provide sufficient sample for testing. If <20ml urine, please send in a white top container. All samples should be sent to the lab immediately. Nottingham Antibiotic Guidelines Committee Page 5 of 15
6 Lower Urinary Tract Infection (Cystitis) An infection of the bladder or lower urinary tract; without features of pyelonephritis or high risk of death red sepsis. Clinical practice points: 1. Use algorithm on pages 3-5 to determine if treatment is needed. 2. Review previous cultures prior to prescribing. If a multi-resistant isolate is present or the following choices are unsuitable, discuss with Microbiology regarding other treatment options. 3. For patients with a urinary catheter please see the section on page Antibiotics are not indicated for asymptomatic bacteriuria, unless pregnant or awaiting urology surgery where bleeding is expected. 5. Review antibiotic with culture results at hours. 6. Simple lower UTI in women - 3 days oral treatment is usually sufficient (excluding when prescribing fosfomycin single dose) 7. For male patients, diabetics, those with structural or functional abnormality of the urinary tract, or recent urinary surgery/ instrumentation (excluding urinary tract catheterisation) - treat for 5-7 days (or two fosfomycin doses 48 hours apart on day 1 and day 3). Nottingham Antibiotic Guidelines Committee Page 6 of 15
7 Lower UTI Treatment first-line oral choices These agents are concentrated in the urine so are good options for lower UTI. They all currently have low resistance rates and minimal effect on normal flora (low C. difficile risk). However they are NOT suitable for patients who are systemically unwell or have High risk of death Red Sepsis (see guidelines). These are agents specifically targeting urinary tract infections. They will not offer broad cover for foci of infection outside of the urinary tract. Most multi-resistant isolates including ESBL-producing strains remain sensitive to nitrofurantoin, pivmecillinam and fosfomycin; these options should be used when possible. If these are not suitable, then discuss with Microbiology. Fosfomycin Nitrofurantoin Pivmecillinam Lower UTI in women: 3g as a single dose orally Lower UTI in men, diabetes, those with structural or functional abnormality of the urinary tract, or recent surgery/instrumentation: 3g on day 1 and a second dose of 3g on day 3 (The second dose is off label, though it is recommended practice within the literature and in PHE guidelines) Ensure prescribe on the antibiotic section of the prescription chart, even for single doses- See appendix 1 (page 15) for examples Not recommended when CrCl <10mL/min A 3g dose provides effective therapy for approximately 48 hours Most effective when taken an hour before or two hours after food 100mg MR BD orally Duration: Lower UTI in women: 3 days Lower UTI in men, diabetes, those with structural or functional abnormality of the urinary tract, or recent surgery/instrumentation: 7 days If to be used via an enteral feeding tube prescribe Nitrofurantoin normal release tablets 50mg QDS and see memo on antibiotic website: Not recommended when CrCl <45mL/min Considerations: This is a urinary antiseptic with no activity outside of the bladder Should not be used in systemically unwell patients, or where pyelonephritis is a possibility. Pulmonary reactions are rare (0.001%) but more common in the elderly and those with impaired renal function 400mg immediately, followed by 200mg TDS orally Duration: Lower UTI in women: 3 days Lower UTI in men, diabetes, those with structural or functional abnormality of the urinary tract, or recent surgery/instrumentation: 7 days Not recommended when CrCl <10mL/min Contra-indicated in penicillin allergy Contra-indicated in patients with oesophageal strictures Avoid in patients taking sodium valproate or valproic acid Tablets are film coated and must be swallowed whole with at least half a glass of water whilst upright Nottingham Antibiotic Guidelines Committee Page 7 of 15
8 Catheter-associated Urinary Tract Infections (CA-UTI): In patients with urinary catheters in situ, bacteriuria is commonly present and treatment is not indicated in the absence of symptoms. Urine dipstick is not clinically useful. Do not send catheter-specimen urine (CSU) for culture as a routine "screen" in the absence of symptoms. Only send a CSU for culture if the patient is symptomatic, or has signs of pyelonephritis or systemic infection The results of CSU samples should always be interpreted in conjunction with clinical parameters. Clinical assessment should be made regarding whether infection is likely to involve only the lower urinary tract, or upper urinary tract (pyelonephritis and systemic infection of urinary tract origin), see the empirical treatment of Sepsis Guideline for further information. a.aspx The ongoing need for the urinary catheter should be assessed, alternatives considered, and the catheter should be removed if possible. If an indwelling catheter has been in place for longer than 2 weeks at the onset of CA-UTI (and there is ongoing need for a urinary catheter) the catheter should be changed during the treatment course. Treatment Review previous Microbiology results prior to prescribing, send a pretreatment CSU sample. Follow the first-line treatment choices outlined in either the lower or upper urinary tract sections of this guideline (page 7, and page 11) according to the clinical assessment. Duration 7 days. In women who have had the catheter removed, this can be shortened to 3 days if rapid clinical response to antibiotics. Nottingham Antibiotic Guidelines Committee Page 8 of 15
9 Prophylaxis for change of long-term catheters Routine antibiotic prophylaxis is not recommended and will select for resistant bacteria. Urine dipstick is not clinically useful, only send CSU if the patient has symptoms. Do not send a catheter-specimen urine (CSU) for culture as a routine "screen". Consider prophylaxis for those who have history of recurrent post catheter change infections. The antibiotic choice is as follows: 1st Line: Gentamicin 2mg/kg IV as a single dose. Check for history of Gentamicinresistant organisms before prescribing. 2nd Line: Treat according to previous sensitivities, where possible use PO Nitrofurantoin M/R 100mg BD give two doses only (one dose approx. 4 hours before catheter change and second dose 12 hours after the first dose) Not suitable for patients with CrCl < 45mL/min. MRSA Positive patients: Patients with a catheter and a diagnosis of MRSA in their urine who are at risk of developing a bacteraemia at catheter change because they have traumatic catheter changes or who have had infections following catheter change previously. Gentamicin 2mg/kg IV single dose prior to catheter change. A minority of MRSA strains locally are resistant to Gentamicin so please review the susceptibility results and seek advice if required. Recurrent Urinary Tract Infections Patients with recurrent UTIs may be more likely to have resistant organisms due to repeated exposure to antibiotics. In patients known to have recurrent UTIs, a pretreatment MSU should be sent and previous microbiology results reviewed prior to prescribing. Assessment for possible underlying urinary tract abnormalities should be considered and Urology referral made if appropriate. Prophylaxis for recurrent urinary tract infections should not be routinely started. If considering prophylaxis then discussion with Microbiology and/or Urology is required, with regards to choice of agent, monitoring and follow-up. If a patient is admitted on prophylactic antibiotics for recurrent UTIs, review urine culture results and stop the prophylaxis if resistance is demonstrated on culture. Consider whether ongoing antibiotic prophylaxis is appropriate and discuss with microbiology regarding choice of agent. All changes must be communicated to the GP on discharge. Nottingham Antibiotic Guidelines Committee Page 9 of 15
10 Upper Urinary Tract Infections: Pyelonephritis and Systemic Infection of Urinary Tract origin Defined as: Patients with pyelonephritis: usually have loin pain, kidney tenderness and signs of systemic infection. Patients with lower urinary tract symptoms and signs of systemic infection. Patients with known or possible structural or functional abnormalities of the urinary tract and signs of systemic infection. Assess patient according to the NUH Sepsis guidelines a.aspx. Ensure two sets of blood cultures and a urine sample are sent (clearly labelled with the type of specimen e.g. MSU, CSU, nephrostomy urine) Review previous culture results and assess risk of Multi-resistant Gram-negative Organisms (MRGNO) prior to prescribing antibiotic: Risk factors for Multiresistant Gram-negative Organisms (MRGNO) Previous history of isolation of ESBL positive E. coli or multi-resistant gram negative organisms OR Recurrent urinary or biliary tract infections ( 3 in last 12 months) Systemic infection despite current or recent (within last week) treatment with broad-spectrum antibiotics e.g. co-amoxiclav, cefuroxime or quinolones (ciprofloxacin, levofloxacin) Recurrent admissions with neutropenic sepsis requiring treatment with piperacillin-tazobactam. Nottingham Antibiotic Guidelines Committee Page 10 of 15
11 Treatment If no risk factors for Multiresistant Gram Negative Organism (MRGNO) 1 st line Non-severe penicillin allergy E.g. No anaphylaxis, angioedema or urticarial rash in first 72 hours Severe penicillin allergy Temocillin IV 2 gram BD Note, THIS IS A PENICILLIN Cefuroxime IV 1.5gram TDS If patient is previous C. difficile positive (PCR or toxin), cefuroxime required microbiology approval before use. Ciprofloxacin IV 400mg BD if High risk red sepsis or unable to take orally, converting as soon as possible to: PO Ciprofloxacin 500mg BD If patient is previous C. difficile positive (PCR or toxin), or MRSA colonisation, ciprofloxacin requires microbiology approval before use. If the patient has High risk red sepsis or the blood pressure fails to respond to initial bolus fluids: Consider adding single dose Gentamicin IV 5mg/kg (max 500mg) if normal renal function. For advice on dosing in renal impairment, refer to Trust antibiotic website. If at risk of Multiresistant Gram Negative Organism (MRGNO) Meropenem IV 500mg QDS Review antibiotics with microbiology within 48 hours Not to be used in severe penicillin allergy (i.e. anaphylaxis, angioedema, urticarial rash within 72 hours of starting). Please discuss with microbiology. Further therapy Review need for IV antibiotics at 48 hours with microbiology results using IV-PO switch guideline on antibiotic website. If culture results available to guide therapy, a narrow spectrum agent should be used according to sensitivities. See table below for recommended course lengths Nottingham Antibiotic Guidelines Committee Page 11 of 15
12 MSU sensitivity No MSU result available Switch to Ciprofloxacin PO 500mg BD Total Course length IV+PO Comments 7 days Micro approval required if previous C. difficile (PCR or toxin) or MRSA colonisation MSU result available and agent chosen based on sensitivities Trimethoprim PO 200mg BD Ciprofloxacin PO 500mg BD Cefalexin PO 500mg TDS 10 days Targeted therapy to be used whenever sensitive Severe drug interaction with methotrexate, avoid concomitant use. 7 days Micro approval required if previous C. difficile (PCR or toxin) or MRSA colonisation 10 days Not in severe penicillin allergy Micro approval required if previous C. difficile (PCR or toxin) If above options not appropriate due to resistance, allergies etc: Discuss with microbiology Pivmecillinam and Fosfomycin little evidence in upper-uti. Discuss with microbiology before prescribing DO NOT USE Nitrofurantoin as an oral stepdown after IV therapy for upper UTI (pyelonephritis or systemic infection of urinary tract origin) as it has insufficient systemic concentrations to be used for this indication. Nottingham Antibiotic Guidelines Committee Page 12 of 15
13 Acute Prostatitis Acute prostatitis is caused by urinary tract pathogens. Infection may spread from the distal urethra but can also spread from the bladder, blood and lymphatic system. Acute prostatitis is an uncommon complication of UTI, urological instrumentation or catheterisation. Acute prostatitis is an acute severe systemic illness. Symptoms include: symptoms of a urinary tract infection: dysuria, frequency and urgency symptoms of prostatitis: low back pain, perineal, penile and sometimes rectal pain symptoms of bacteraemia: fever and rigors; arthralgia and myalgia; recurrent Gram negative bacteraemia of unknown focus. Signs include: an extremely tender, swollen and tense, smooth textured prostate gland which is warm to the touch Cases of suspected prostatitis should be discussed with Urology, so that appropriate imaging +/- intervention can be arranged. Ensure a urine sample is sent for MC&S (clearly-labelled with the specimen type e.g. MSU), and two sets of blood cultures are taken. First line: PO Ciprofloxacin 500mg bd for 28 days If patient is previous C.difficile positive (PCR or toxin) ciprofloxacin requires Microbiology approval before use If vomiting, concerns about absorption or if High risk red sepsis, give IV ciprofloxacin 400mg BD, converting to oral as soon as oral route available Second line (If ciprofloxacin unsuitable e.g. resistant organism or contra-indicated): PO Trimethoprim 200mg bd for 28 days (off label use) Antibiotic choice should be reviewed at 48 hours with urine MC&S, blood cultures, and imaging results. Nottingham Antibiotic Guidelines Committee Page 13 of 15
14 MANAGEMENT OF EPIDIDYMITIS AND ORCHITIS Clinical presentation: Pain and swelling of the epididymis +/- testes (Orchitis), pyrexia, with or without urethral discharge (ENSURE TESTICULAR TORSION EXCLUDED). Sexual history: It is important to take a sexual history in ALL cases. Sexually transmitted infections (STIs) may be the underlying cause of epididymitis and orchitis, especially in younger patients (under 35 years). However, patients over 35 years of age without suggestion of sexual contact are more likely to have infections of urological origin. Gram negative enteric organisms are more commonly the cause if recent instrumentation or catheterisation has occurred. Causative agents: Organisms of the urinary tract e.g. Escherichia coli. Sexually transmitted infection (STI) e.g. Chlamydia trachomatis, Neisseria gonorrhoea In non-immunised males born between mumps orchitis must be considered. Send an inside cheek/throat viral swab for mumps PCR testing. Nottingham Antibiotic Guidelines Committee Page 14 of 15
15 Appendix 1: Example Prescriptions for Fosfomycin dosing in lower UTI: Nottingham Antibiotic Guidelines Committee Page 15 of 15
Diagnosis and Management of UTI s in Care Home Settings. To Dip or Not to Dip?
Diagnosis and Management of UTI s in Care Home Settings To Dip or Not to Dip? 1 Key Summary Points: Treat the patient NOT the urine In people 65 years, asymptomatic bacteriuria is common. Treating does
More informationLower Urinary Tract Infection (UTI) in Males
Lower Urinary Tract Infection (UTI) in Males Clinical presentation For patients in care homes see UTI in adults where IV Antibiotics in the community may be appropriate (under development) History and
More informationAntibiotic Guidelines for URINARY TRACT/ UROLOGY infections
Antibiotic Guidelines f URINARY TRACT/ UROLOGY infections CLINICAL CONDITION USEFUL INFORMATION RECOMMENDATIONS ALTERNATIVE (suitable in serious penicillin allergy) Asymptomatic Bacteriuria (in the absence
More informationUrinary Tract Infections Antibiotic Guidelines (Adult) Contents. Section
Urinary Tract Infections Antibiotic Guidelines (Adult) Classification: Clinical Guideline Lead Author: Antibiotic Steering Committee Additional author(s): Authors Division: Pharmacy/Microbiology Unique
More informationChildren s Services Medical Guideline
See also: NICE Guidelines These local guidelines are in conjunction with NICE UTI Algorithms Renal scarring and subsequent nephropathy are important causes of later hypertension and renal failure. Early
More informationMICHIGAN MEDICINE GUIDELINES FOR TREATMENT OF URINARY TRACT INFECTIONS IN ADULTS
When to Order a Urine Culture: Asymptomatic bacteriuria is often treated unnecessarily, and accounts for a substantial burden of unnecessary antimicrobial use. National guidelines recommend against testing
More informationGuidelines for the management of urinary tract infections in children 0-17 years
Guidelines for the management of urinary tract infections in children 0-17 years Guideline to be used where appropriate in conjunction with the Ashford and St Peter s sepsis guideline (Dr Ruth Mew 2016)
More informationManagement of suspected bacterial urinary tract infections in older people. based on SIGN 88. Jane Lawson Infection Prevention and Control Nurse
Management of suspected bacterial urinary tract infections in older people based on SIGN 88 Jane Lawson Infection Prevention and Control Nurse Bacterial urinary tract infection (UTI s) UTI s are common
More informationLecture 1: Genito-urinary system. ISK
Urinary Tract Infections Lecture 1: Genito-urinary system. ISK 07 08 2009. Getting Clear on the Terminology UTI Cystitis Urosepsis Asymptomatic Bacteriuria Asymptomatic UTI Pyuria Symptomatic UTI Pylonephritis
More informationEMPIRICAL TREATMENT OF SELECT INFECTIONS ADULT GUIDELINES. Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection
URINARY TRACT Refer to VIHA Algorithm for the empiric treatment of Urinary Tract Infection and Asymptomatic Bacteriuria on the VIHA Intranet: https://intranet.viha.ca/departments/pharmacy/clinical_pharmacy/pages/infec
More informationpatient group direction
NITROFURANTOIN v01 1/12 NITROFURANTOIN PGD Details Version 1.0 Legal category Staff grades Approved by POM Paramedic (Non-ECP) Nurse (Non-ECP) Emergency Care Practitioner (Paramedic) Emergency Care Practitioner
More information11/15/2010. Asymptomatic Bacteriuria UTI. Symptomatic UTI. Asymptomatic UTI. Cystitis. Pylonephritis. Pyuria. Urosepsis
Urinary Tract Infections Renal vein Inferior vena cava Urinary bladder Urethra Renal artery Kidney Aorta Ureter Lecture 1: Genito-urinary system. 06 08 2010. (a) Sherwood Fig. 12-6a, p.530 An introduction
More informationUrinary Tract Infections: From Simple to Complex. Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014
Urinary Tract Infections: From Simple to Complex Adriane N Irwin, MS, PharmD, BCACP Clinical Assistant Professor Ambulatory Care October 25, 2014 Learning Objectives Develop empiric antimicrobial treatment
More informationLaboratory Investigation of UTI. Quiz Feedback
Laboratory Investigation of UTI Quiz Feedback bpac nz better medicin e Laboratory Investigation of UTI Quiz Feedback bpac nz GP Review Panel: Dr Janine Bailey, Motueka Dr Stephen Kuzmich, Wellington Dr
More informationGUIDELINE FOR THE MANAGEMENT OF ANTIBIOTIC- ASSOCIATED DIARRHOEA IN ADULTS
GUIDELINE FOR THE MANAGEMENT OF ANTIBIOTIC- ASSOCIATED DIARRHOEA IN ADULTS Version 3.0 Date ratified May 2008 Review date May 2010 Ratified by NUH Antibiotic Guidelines Committee NUH Drugs and Therapeutics
More informationFREEDOM OF INFORMATION ACT 2000 Dudley CCG: Prescribing of Antibiotics Ref: RFI0861
Freedom of Information Team Dudley CCG 17 November 2017 2nd Floor, Brierley Hill Health and Social Care Centre Venture Way Brierley Hill DY5 1RU FREEDOM OF INFORMATION ACT 2000 Dudley CCG: Prescribing
More informationNew Medicines Committee Briefing. July Fosfomycin trometamol for the treatment of multidrug resistant urinary tract infection
New Medicines Committee Briefing July 2014 Fosfomycin trometamol for the treatment of multidrug resistant urinary tract infection (unlicensed indication) Fosfomycin trometamol to be reviewed for use within:
More informationUrinary Tract Infection
67 Urinary Tract Infection Dr Kawa Ahmad PhD Pharmaceutics 1 Introduction The term urinary tract infection (UTI) usually refers to the presence of organisms in the urinary tract together with symptoms,
More informationTrust Guideline for the Management of: Condition or Procedure in Adults and / or Children
Trust Guideline for the Management of: Condition or Procedure in Adults and / or Children A clinical guideline recommended For use in: By: For: Division responsible for document: Key words: Name of document
More informationGASTRO-INTESTINAL TRACT INFECTIONS - ANTIMICROBIAL MANAGEMENT
GASTRO-INTESTINAL TRACT INFECTIONS - ANTIMICROBIAL MANAGEMENT Name & Title Of Author: Dr Linda Jewes, Consultant Microbiologist Date Amended: December 2016 Approved by Committee/Group: Drugs & Therapeutics
More informationInvestigators Meeting
Outcomes of Urinary Tract Infection Management by Pharmacists (R x OUTMAP) Investigators Meeting June 11, 2017 Overview 1. Introductions and Opening Remarks 2. Epidemiology and Definitions 3. UTI Assessment
More informationNorth Derbyshire OPAT (Outpatient Parenteral Antimicrobial Therapy) Pathway for Primary Care (Step-Up Pathway/Admission Avoidance)
North Derbyshire OPAT (Outpatient Parenteral Antimicrobial Therapy) Pathway for Primary Care (Step-Up Pathway/Admission Avoidance) Introduction OPAT services provide intravenous (IV) antibiotics to patients
More informationPatient Group Direction for the Supply of Nitrofurantoin MR 100mg capsules
October 2016 Patient Group Direction for the Supply of Nitrofurantoin MR 100mg capsules This Patient Group Direction (PGD) is a specific written instruction for the supply and/or administration of nitrofurantoin
More informationEAU GUIDELINES ON UROLOGICAL INFECTIONS
EAU GUIDELINES ON UROLOGICAL INFECTIONS (Limited text update March 2018) G. Bonkat (Co-chair), R. Pickard (Co-chair), R. Bartoletti, T. Cai, F. Bruyere, S.E. Geerlings, B. Köves, F. Wagenlehner Guidelines
More informationCASE SCENARIO EXERCISE
påçííáëü=pìêîéáää~ååé=çñ=eé~äíüå~êé ^ëëçåá~íéç=fåñéåíáçå=mêçöê~ããé CASE SCENARIO EXERCISE CATHETER-ASSOCIATED URINARY TRACT INFECTION SURVEILLANCE SCOTTISH SURVEILLANCE OF HEALTHCARE ASSOCIATED INFECTION
More informationGuidelines for Recurrent Urinary Tract Infections in Adults: Antibiotic Prophylaxis
Guidelines for Recurrent Urinary Tract Infections in Adults: Antibiotic Prophylaxis Definition of recurrent lower urinary tract infection: The symptoms of a lower urinary tract infection include: frequency,
More informationTitle Protocol for the Management of Urinary Tract Infections for Adult Females and Children in MIUs and WICs
Document Control Title Protocol for the Management of Urinary Tract Infections for Adult Females and Children in MIUs and WICs Author Author s job title Professional Lead, Minor Injuries Unit Directorate,
More informationCustomary urine test is the dip stick and the mid-stream culture of voided urine. Up to 77% of cystitis cases are cultured
9 million visits/year! Customary urine test is the dip stick and the mid-stream culture of voided urine. Up to 77% of cystitis cases are cultured Interpretation of the culture result has been controversial-
More informationAsyntomatic bacteriuria, Urinary Tract Infection
Asyntomatic bacteriuria, Urinary Tract Infection C. Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asyntomatic Bacteriuria in Adults (2005) Pyuria accompanying asymptomatic
More informationUrinary tract infection. Mohamed Ahmed Fouad Lecturer of pediatrics Jazan faculty of medicine
Urinary tract infection Mohamed Ahmed Fouad Lecturer of pediatrics Jazan faculty of medicine Objectives To differentiate between types of urinary tract infections To recognize the epidemiology of UTI in
More informationANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS
ANTIBIOTIC GUIDELINES FOR THE MANAGEMENT OF COMMUNITY-ACQUIRED MENINGITIS AND ENCEPHALITIS IN ADULTS Version 4.0 Date ratified February 2009 Review date February 2011 Ratified by Authors Consultation Evidence
More informationPatient Group Direction for the Supply of Trimethoprim 200mg tablets
October 2016 Patient Group Direction for the Supply of Trimethoprim 200mg tablets This Patient Group Direction (PGD) is a specific written instruction for the supply of trimethoprim 200mg tablets to groups
More informationTreatment Regimens for Bacterial Urinary Tract Infections. Characteristic Pathogen. E. coli, S.saprophyticus P.mirabilis, K.
HEALTHSPAN URINARY TRACT INFECTIONS (ADULT FEMALE) Methodology: Evidence-Based Issue Date: 1-98 Champion: Internal Medicine Most Recent Review: 4-10, 4-12, 4-14 Key Stakeholders: IM, Urology, Next Review:
More informationTo Dip or Not To Dip. March Zoe Mason Care Home Pharmacist HCCG
To Dip or Not To Dip March 2017 Zoe Mason Care Home Pharmacist HCCG TDONTD A patient centred approach to improve the management of UTIs in Care Homes Overarching Priorities: Patient Safety, Improved Quality
More informationFull title of guideline INTRAVENOUS VANCOMYCIN PRESCRIBING AND MONITORING GUIDELINE FOR ADULT PATIENTS. control
Full title of guideline Author: Contact Name and Job Title Division and specialty Scope Explicit definition of patient group to which it applies (e.g. inclusion and exclusion criteria, diagnosis) Changes
More informationPediatric urinary tract infection. Dr. Nariman Fahmi Pediatrics/2013
Pediatric urinary tract infection Dr. Nariman Fahmi Pediatrics/2013 objectives EPIDEMIOLOGY CAUSATIVE PATHOGENS PATHOGENESIS CATEGORIES OF URINARY TRACT INFECTIONS AND CLINICAL MANIFESTATIONS IN pediatrics
More informationUTI IN ELDERLY. Zeinab Naderpour
UTI IN ELDERLY Zeinab Naderpour Urinary tract infection (UTI) is the most frequent bacterial infection in elderly populations. While urinary infection in the elderly person is usually asymptomatic, symptomatic
More informationIndex. urologic.theclinics.com. Note: Page numbers of article titles are in boldface type.
Index Note: Page numbers of article titles are in boldface type. A Acinetobacter baumannii, carbapenem-resistant, 497 498 Adolescents, urinary tract infections in, 520 521 Aminoglycosides, for UTIs and
More informationKAISER PERMANENTE OHIO URINARY TRACT INFECTIONS (ADULT FEMALE)
KAISER PERMANENTE OHIO URINARY TRACT INFECTIONS (ADULT FEMALE) Methodology: Evidence-Based Issue Date: 1-98 Champion: Internal Medicine Most Recent Review: 4-10, 4-12 Key Stakeholders: IM, Urology, Next
More informationURINARY TRACT INFECTIONS
URINARY TRACT INFECTIONS Learning Objectives Identify signs and symptoms that may indicate presence of UTI (both complicated and uncomplicated) List common causative organisms and risk factors for UTIs
More informationWhen should UTIs be treated in the Elderly? Shelby L. Wentworth, MS4 University of Florida College of Medicine 29 AUG 2018
When should UTIs be treated in the Elderly? Shelby L. Wentworth, MS4 University of Florida College of Medicine 29 AUG 2018 UTIs in Patients >/ 65 yo - Most common infectious illness [1]. - Urinary tract
More informationDiagnostic approach and microorganism resistance pattern in UTI Yeva Rosana, Anis Karuniawati, Yulia Rosa, Budiman Bela
Diagnostic approach and microorganism resistance pattern in UTI Yeva Rosana, Anis Karuniawati, Yulia Rosa, Budiman Bela Microbiology Department Medical Faculty, University of Indonesia Urinary Tract Infection
More informationInfective Endocarditis Empirical therapy Antibiotic Guidelines. Contents
Infective Endocarditis Empirical therapy Antibiotic Guidelines Classification: Clinical Guideline Lead Author: Antibiotic Steering Group Additional author(s): as above Authors Division: Division of Clinical
More informationRECURRENT URINARY TRACT INFECTIONS: WHAT AN INTERNIST
RECURRENT URINARY TRACT INFECTIONS: WHAT AN INTERNIST MUST KNOW PROF. MD. ENAMUL KARIM Professor of Medicine Green Life Medical College INTRODUCTION Urinary tract infection (UTI) is one of the commonest
More informationNeutropenic Sepsis Guideline
Neutropenic Sepsis Guideline Neutropenic Sepsis Guideline - definitions Suspected or proven infection in a neutropenic patient is a MEDICAL EMERGENCY and is an indication for immediate assessment and prompt
More informationASPIRES Urinary Tract Infection Algorithm
ASPIRES Urinary Tract Infection Algorithm Dr. Jennifer Grant Dr. Tim Lau Donna Leung February 2013 VCH Antimicrobial Stewardship 1 Programme: Innovation, Research, Education & Safety KEY PRINCIPLES 1.
More informationIDEAL FOR NEW STAFF TRAINING AND REFRESHER TRAINING!
1 IDEAL FOR NEW STAFF TRAINING AND REFRESHER TRAINING! 2 Contents Page 1. Background 4-5 2. Urinary tract Infections in older people 6-7 3. What is the problem with urine dipsticks?? 8 4. Antibiotics more
More informationStRs and CT doctors in haematology. September Folinic acid dose modified.
High dose Methotrexate and folinic acid rescue Full Title of Guideline: Author (include email and role): Division & Speciality: Clinical Guideline Review Date September 2018 GUIDELINE FOR THE USE OF HIGH
More informationPatient Group Direction (PGD)
Patient Group Direction (PGD) Supply of Nitrofurantoin for uncomplicated Urinary Tract Infections in females aged 16 years and over (Telford and Wrekin and Shropshire Pharmacies Only) For the supply of
More informationNATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE SCOPE
NATIONAL INSTITUTE FOR HEALTH AND CLINICAL EXCELLENCE 1 Guideline title SCOPE Urinary tract infection: diagnosis, treatment and long-term management of urinary tract infection in children 1.1 Short title
More informationINTRAVENOUS VANCOMYCIN PRESCRIBING AND MONITORING GUIDELINE FOR ADULT PATIENTS
Title of guideline (must include the word Guideline (not protocol, policy, procedure etc) INTRAVENOUS VANCOMYCIN PRESCRIBING AND MONITORING GUIDELINE FOR ADULT PATIENTS Author: Contact Name and Job Title
More informationAntimicrobial Management of Febrile Neutropenic Sepsis
Antimicrobial Management of Febrile Neutropenic Sepsis Written by: Dr J Joseph, Consultant Haematologist Dr K Gajee, Consultant Microbiologist Amended by: Larissa Claybourn, Antimicrobial Pharmacist Date:
More informationAntimicrobial Guidelines for the Empirical Management of Diabetic Foot Infections
Antimicrobial Guidelines for the Empirical Management of Diabetic Foot Infections Version 7.2 PAGL Inclusion Approved at January 2017 PGC APPROVED BY: TRUST REFERENCE: B3/2017 AWP REF: UHL Policies and
More informationUTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys.
UTI are the most common genitourinary disease of childhood. The prevalence of UTI at all ages is girls and 1% of boys. 1-3% of Below 1 yr. male: female ratio is 4:1 especially among uncircumcised males,
More informationAntibiotic Protocols for Paediatrics Steve Biko Academic Hospital
Antibiotic Protocols for Paediatrics Steve Biko Academic Hospital Respiratory tract infections in children Uncomplicated URTI A child with a cold should not receive an antibiotic Paracetamol (15 mg/kg/dose
More informationURINARY TRACT INFECTIONS 3 rd Y Med Students. Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan
URINARY TRACT INFECTIONS 3 rd Y Med Students Prof. Dr. Asem Shehabi Faculty of Medicine, University of Jordan Urinary Tract Infections-1 Normal urine is sterile.. It contains fluids, salts, and waste products,
More informationCLASSIFICATION OF URINARY TRACT INFECTIONS AND SURGICAL FIELD CONTAMINATION CATEGORIES AS A BASIS FOR TREATMENT AND PROPHLAXIS
CLASSIFICATION OF URINARY TRACT INFECTIONS AND SURGICAL FIELD CONTAMINATION CATEGORIES AS A BASIS FOR TREATMENT AND PROPHLAXIS Magnus Grabe, M.D., Ph.D. Associate Professor of Urology University of Lund
More informationUnwell returned traveller
Unwell returned traveller Full Title of Guideline: Author (include email and role): Division & Speciality: Scope (Target audience, state if Trust wide): Review date (when this version goes out of date):
More informationSummary of the risk management plan (RMP) for Zerbaxa (ceftolozane / tazobactam)
EMA/513109/2015 Summary of the risk management plan (RMP) for Zerbaxa (ceftolozane / tazobactam) This is a summary of the risk management plan (RMP) for Zerbaxa, which details the measures to be taken
More informationManagement of NGU (Non-gonococcal urethritis)
Management of NGU (Non-gonococcal urethritis) First line Doxycycline 100mg po bd for 7 days (contra-indicated in pregnancy) Alternative regimens Azithromycin 1G po stat Azithromycin 500mg po stat, then
More informationClinical Pearls Infectious Diseases. Pritish K. Tosh, MD MN ACP Nov 7, [Answers and discussion slides will be posted after the meeting]
Clinical Pearls Infectious Diseases Pritish K. Tosh, MD MN ACP Nov 7, 2014 [Answers and discussion slides will be posted after the meeting] Case 1 A 33-year-old male with diffuse large B-cell lymphoma
More informationPlazomicin for complicated urinary tract infection
October 2016 Horizon Scanning Research & Intelligence Centre Plazomicin for complicated urinary tract infection NIHR HSRIC ID: 9787 Lay summary Serious infections caused by Gram-negative bacteria are becoming
More informationBacterial Infections of the Urinary System *
OpenStax-CNX module: m64804 1 Bacterial Infections of the Urinary System * Douglas Risser This work is produced by OpenStax-CNX and licensed under the Creative Commons Attribution License 4.0 1 Learning
More informationPAINFUL URINATION CAUSES & NATURAL REMEDY. Dr. Bestman Anyatonwu
LIBRACIN NATURAL MEDICINE IND. LTD PAINFUL URINATION CAUSES & NATURAL REMEDY Dr. Bestman Anyatonwu MEANING Painful urination is a broad term that describes discomfort during urination. This pain may originate
More informationCARE PATHWAY FOR CHILDREN AND YOUNG PERSONS WITH FEBRILE NEUTROPENIA, NEUTROPENIC SEPSIS OR SUSPECTED CENTRAL VENOUS LINE INFECTIONS
CARE PATHWAY FOR CHILDREN AND YOUNG PERSONS WITH FEBRILE NEUTROPENIA, NEUTROPENIC SEPSIS OR SUSPECTED CENTRAL VENOUS LINE INFECTIONS This Care Pathway has been developed by a multidisciplinary team. It
More informationManagement of Catheter Related Bloodstream Infection (CRBSI), including Antibiotic Lock Therapy.
Management of Catheter Related Bloodstream Infection (CRBSI), including Antibiotic Lock Therapy. Written by: Dr K Gajee, Consultant Microbiologist Date: June 2017 Approved by: Drugs & Therapeutics Committee
More informationClinical guideline Published: 22 August 2007 nice.org.uk/guidance/cg54
Urinary tract infection in under 16s: diagnosis and management Clinical guideline Published: 22 August 2007 nice.org.uk/guidance/cg54 NICE 2017. All rights reserved. Subject to Notice of rights (https://www.nice.org.uk/terms-and-conditions#notice-ofrights).
More informationURINARY TRACT INFECTION
A LITTLE YELLOW INFECTION CONTROL BOOK URINARY TRACT INFECTION YES, IT IS A BACTERIURIA - BUT IS IT A SYMPTOMATIC UTI? Grampians Region Infection Control Group ABOUT THIS BOOK Urinary tract infections
More informationOCTOBER 2017 DRUG ANTIBIOTICS. Presence of bacteria in the urine with no symptoms or clinical signs.
OCTOBER 2017 DRUG ANTIBIOTICS This optimal usage guide is mainly intended for primary care health professionnals. It is provided for information purposes only and should not replace the clinician s judgement.
More informationUrinary Tract Infections in Hospitalized Patients
Urinary Tract Infections in Hospitalized Patients Puerto Rico Chapter Annual Meeting Daniel C. DeSimone, MD March 9, 2019 2017 MFMER slide-1 Disclosures for speaker: Date of presentation: 3/9/2019 No relevant
More informationCatheter-Associated Urinary Tract Infection (CAUTI) Event
Catheter-Associated Urinary Tract Infection () Event Introduction: The urinary tract is the most common site of healthcare-associated infection, accounting for more than 30% of infections reported by acute
More informationTMP/SMZ DS Ciprofloxacin Norfloxacin Ofloxacin Cefadroxil * 30 Amoxicilin 86* 19 25
Evidence-Based Evaluation and Treatment of UTI UTI Prevalence Leslee L. Subak, MD Associate Professor Obstetrics, Gynecology & RS Epidemiology & Biostatistics University of California, San Francisco 50%
More informationManagement of UTI. Disclosures. Uncomplicated UTI UTI CLASSIFICATION. Where do UTI bugs come from? Food Sex
Management of UTI Thomas M. Hooton, M.D. University of Miami Miami, Florida Disclosures Fimbrion a biotech company with mission to develop novel approaches to treat and prevent UTI Co-founder and shareholder
More information(Facility Name and Address) (1D) Surveillance of Urinary Tract Infections in the Long-Term Care Setting
Policy Number: 1D Date: 4/16/14 Version: 1 (1D) Surveillance of Urinary Tract Infections in the Long-Term Care Setting Introduction: One-quarter of the older adult population in the United States will
More informationThe objectives of this presentation are; to increase awareness of the issue of antimicrobial resistant gonorrhea, and to inform primary care and
1 Antimicrobial resistant gonorrhea is an emerging public health threat that needs to be addressed. Neisseria gonorrhoeae is able to develop resistance to antimicrobials quickly. Effective antibiotic stewardship
More informationHaemodialysis central venous catheter-related sepsis management guideline Version 3. NAME M. Letheren Chair Clinical Effectiveness Advisory Group
Lancashire Teaching Hospitals NHS Foundation Trust Haemodialysis central venous catheter-related sepsis management guideline Version 3 AUTHOR APPROVED BY DATE AUTH REF. NO NAME REBG/00018/July12 Michael
More informationUrinary Tract Infections
Urinary Tract Infections Michelle Eslami, M.D., FACP Professor of Medicine Division of Geriatrics David Geffen SOM at UCLA Urinary Tract Infection (UTI) One of most common infections in outpatient and
More informationURINARY TRACT INFECTIONS
URINARY TRACT INFECTIONS Dr Caroline CHARLIER-WOERTHER Université Paris Descartes Paris, France Definitions Clinical presentation by type Complications Spectrum of pathogens Pathophysiology Management
More informationLifting the lid on a difficile problem part 2 (Clinical) Evidence Based Practice. Problem in evolution (1) Problem in evolution (1) Interventions (2)
Lifting the lid on a difficile problem part (Clinical) Dr Philip T Mannion Consultant Microbiologist, Rhyl Evidence Based Practice Antibiotic prescribing guidance Isolation policy Hand hygiene (soap and
More informationWest Yorkshire Major Trauma Network Clinical Guidelines 2015
WYMTN: Pelvic fracture with urogenital trauma KEY RECOMMENDATIONS 1. During the initial exploratory survey / secondary survey, a. The external urethral meatus and the transurethral bladder catheter (if
More informationBacterial urinary tract infections
Vet Times The website for the veterinary profession https://www.vettimes.co.uk Bacterial urinary tract infections Author : CATHERINE F LE BARS Categories : Vets Date : February 11, 2008 CATHERINE F LE
More informationGUIDELINES ON THE MANAGEMENT OF URINARY AND MALE GENITAL TRACT INFECTIONS
GUIDELINES ON THE MANAGEMENT OF URINARY AND MALE GENITAL TRACT INFECTIONS M. Grabe (chairman), M.C. Bishop, T.E. Bjerklund-Johansen, H. Botto, M. Çek, B. Lobel, K.G. Naber, J. Palou, P. Tenke Introduction
More informationThe Impact of a Pharmacist Managed Culture Review for Discharged ED Patients
The Impact of a Pharmacist Managed Culture Review for Discharged ED Patients May 2, 2017 Tracey A. King, Pharm.D., MSP, BCPS Lead Clinical Pharmacist Emergency Medicine Riverside Methodist Hospital Amy
More informationProtocol for the Management of Neutropenic Sepsis in Adult Patients P
Protocol for the Management of Neutropenic Sepsis in Adult Patients P Version 2 Date April 2015 Review Date April 2016 Author Rachel Onions Change Approver Acute Oncology Team UHMBT. Version 2. CHANGE
More informationGUIDELINES ON UROLOGICAL INFECTIONS
GUIDELINES ON UROLOGICAL INFECTIONS (Text update April 2010) M. Grabe (chairman), T.E. Bjerklund-Johansen, H. Botto, M. Çek, K.G. Naber, R.S. Pickard, P. Tenke, F. Wagenlehner, B. Wullt Introduction Infections
More informationAmy-Jo Hooley Specialist Clinical Pharmacist
Gut Decontamination Title of Guideline (must include the word Guideline (not protocol, policy, procedure etc) Contact Name and Job Title (author) Directorate & Speciality Guideline for the Safe Administration
More informationBugs in Urology Infections of the lower urinary tract. Mr Chandran Tanabalan, MRCS MSc Urology SpR Homerton University Hospital
Bugs in Urology Infections of the lower urinary tract Mr Chandran Tanabalan, MRCS MSc Urology SpR Homerton University Hospital Outline UTIs Recurrent cystitis/ UTIs Catheter Associated UTIs (CAUTIs) Epididymitis/
More informationLaser vaporisation of prostate (Green light laser prostate surgery): procedure-specific information
PATIENT INFORMATION Laser vaporisation of prostate (Green light laser prostate surgery): procedure-specific information What is the evidence base for this information? This leaflet includes advice from
More informationPatient Group Direction (PGD) Supply of Nitrofurantoin for uncomplicated Urinary Tract Infections in females aged 16 years and over
Patient Group Direction (PGD) Supply of Nitrofurantoin for uncomplicated Urinary Tract Infections in females aged 16 years and over Version Control This document is only valid on the day it was printed
More informationGuidance on the use of molecular testing for Neisseria gonorrhoeae in Diagnostic Laboratories 2011
Guidance on the use of molecular testing for Neisseria gonorrhoeae in Diagnostic Laboratories 2011 Molecular testing for gonorrhoea working group (see Appendix) Prepared by Kirstine Eastick March 2012-1
More informationTrans urethral resection of prostate (TURP)
Trans urethral resection of prostate (TURP) Information for patients Urology PROUD TO MAKE A DIFFERENCE SHEFFIELD TEACHING HOSPITALS NHS FOUNDATION TRUST What is the prostate? Only men have a prostate
More informationWhat s new in Infectious Diseases. Petronella Adomako, MD Infectious Disease Specialist Mckay-Dee Hospital
What s new in Infectious Diseases Petronella Adomako, MD Infectious Disease Specialist Mckay-Dee Hospital None Disclosures Objectives New information in infectious diseases. New diseases and outbreaks.
More informationTransperineal ultrasound-guided biopsy of the prostate gland
PLEASE PRINT WHOLE FORM DOUBLE SIDED ON YELLOW PAPER Patient Information to be retained by patient biopsy of the prostate gland affix patient label What is a transperineal (TP) ultrasound-guided prostate
More informationTreatment of febrile neutropenia in patients with neoplasia
Treatment of febrile neutropenia in patients with neoplasia George Samonis MD, PhD Medical Oncologist Infectious Diseases Specialist Professor of Medicine The University of Crete, Heraklion,, Crete, Greece
More informationURINARY TRACT INFECTION
A LITTLE YELLOW INFECTION CONTROL BOOK Cartoons in this booklet by URINARY TRACT INFECTION http://www.davegibb.com.au/index.htm YES, IT IS A BACTERIURIA BUT IS IT A SYMPTOMATIC UTI? Resources For other
More informationH(a)ematuria. FX Keeley Consultant Urologist Bristol Urological Institute
H(a)ematuria FX Keeley Consultant Urologist Bristol Urological Institute From Philadelphia to Bristol, England Southmead Hospital, 1916 Southmead Hospital, 2013 Southmead Hospital, 2014 H(a)ematuria Blood
More informationPAEDIATRIC FEBRILE NEUTROPENIA CARE PATHWAY
PAEDIATRIC FEBRILE NEUTROPENIA CARE PATHWAY Purpose: This document is intended as a guide to the investigation and management of children presenting in Salisbury District Hospital with suspected neutropenic
More informationUrological infections in men
Infections Urological infections in men Luke A McGuinness, Urology Clinical Fellow; Robert C Calvert, Consultant Urologist, Royal Liverpool and Broadgreen University Hospitals; Frederick Banks, Consultant
More informationInfection Prevention & Control Core Skills Level 2
Infection Prevention & Control Core Skills Level 2 Learning outcomes Risk assessment of patients Critical examination of the situation MRSA, CDT & CPE Ongoing challenges future-proofing infection control
More informationCatheter-Associated Urinary Tract Infection (CAUTI) Event
Device-associated Events Catheter-Associated Urinary Tract Infection () Event Introduction: The urinary tract is the most common site of healthcare-associated infection, accounting for more than 30% of
More information