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Guidelines
Pathogens
Antimicrobials
Most likely pathogens and suggested antimicrobial therapy
Definition of uncomplicated UTI
Cystitis or pyelonephritis in a generally healthy, nonpregnant female with normal urinary tract anatomy
Definition of complicated UTI
Anatomical abnormality of the urinary tract including obstruction (i.e. stone), ileal conduit/urinary diversion, and instrumentation/foreign body (i.e. stent, nephrostomy tube).
Immunosuppressed patients (including poorly controlled diabetes).
The absence of pyuria strongly argues against UTI
Although uncomplicated UTI can be treated empirically in females, resistance among E. coli, especially to fluoroquinolones, is increasing in Newfoundland and Labrador, so culture guided therapy is recommended, especially if recurrent.
Always send blood culture for patients with febrile UTI and features of upper tract infection.
Additional Investigations:
Pregnancy test.
Pelvic exam and STI testing when appropriate.
In general radiology not required - the diagnosis of pyelonephritis is clinical.
Imaging is appropriate if suspicion of complication or obstruction.
