← Diagnosis and Management Guides
Urinary Tract Infection
Key considerations: Pyelonephritis, Urosepsis, Urinary obstruction
Cannot miss
- Pyelonephritis
- Urosepsis
- Urinary obstruction
Likely diagnoses
- Uncomplicated cystitis
- Urethritis
- Vaginitis
Red flags
- Fever >38.5°C
- Flank pain
- Rigors
- Immunocompromised
Workup
- history: Dysuria, frequency, urgency, hematuria, fever, flank pain; exam: Suprapubic tenderness, CVA tenderness, fever; labs: Urinalysis, urine culture; CBC/BMP if systemic symptoms; imaging: CT abdomen/pelvis if obstruction or abscess suspected; bedside: Bladder scan for retention
Management
- immediate: IV fluids and antibiotics if septic; general: Uncomplicated cystitis: nitrofurantoin 5 days or TMP-SMX 3 days; Pyelonephritis: fluoroquinolone or ceftriaxone
Disposition
- admit: Urosepsis, inability to tolerate PO, obstructing stone; discharge: Uncomplicated cystitis with PO antibiotics; consults: Urology if obstruction
Clinical pearls
- Pyuria without bacteriuria: consider urethritis, interstitial cystitis, or contamination
Source and review
- IDSA UTI Guidelines 2022. Last reviewed: 2024-11-01