Patient selection: urinary tract infection and/or sepsis secondary to a urinary catheter
Catheter-related tasks:
(1) Remove the catheter.
(2) Inspect the catheter for signs of encrustations and luminal obstruction.
(3) Do not insert a new catheter right away.
(4) Once the infection is controlled reconsider the need for an indwelling catheter.
Culture-related tasks:
(1) Obtain urine and blood specimens for Gram stain and culture.
(2) Identify bacteria and/or yeast in the Gram stain.
(3) Identify the likely pathogens (exclude contaminants) in the various cultures.
(4) Suspect a urease producing bacteria if encrustations are present and/or the urine is alkaline.
(5) Determine the antibiotic susceptibility of the pathogen(s) involved.
Antibiotic-therapy related tasks:
(1) Identify antibiotics that the patient has recently received.
(2) Initially treat with an extended spectrum penicillin OR cephalosporin OR fluoroquinolone, with or without an aminoglycoside.
(3) Add antibiotics pending Gram stain results (to cover enterococci, yeast, etc).
(4) Once the susceptibility tests are known reduce the number of antibiotics, ideally to one agent.
(5) Antibiotic therapy often can be completed within 1 week.
Other:
(1) Perform an ultrasound of the kidney and bladder to identify stones, obstruction or abscesses.
(2) Rehydrate and make sure that electrolytes are in balance.
(3) Provide pressor drugs as needed during initial hypotensive periods.
