Urinary Sepsis / Pyelonephritis

Antimicrobial prescribing: NHS Fife
NHS Fife

Clinical features

Causes include upper or lower urinary tract infection. Often seen in association with a catheter

Signs and symptoms of upper UTI are as for lower UTI, plus:

  • Loin pain
  • Fever > 38
  • Rigors
  • New / worse mental state change

Be aware of the potential for Necrotising Fasciitis / Fournier's Gangrene

Investigations

  • Blood culture
  • Urine culture

Infection Control

Basic universal precautions

Treatment

Always consider changing any catheter if present. Do so after commencing antibiotic therapy. For a septic patient where the catheter is the most likely source, aim to do this promptly – removing the source of sepsis will improve the chances of a good clinical outcome

Review culture findings as soon as possible

Consider IV to Oral switch when the patient has been afebrile for 24 hours, is clinically improving and the oral route is available

Avoid Cotrimoxazole in pregnancy

IV

AMOXICILLIN IV 1g 8 hourly 

PLUS

GENTAMICIN IV Dose as per calculator

 If true penicillin allergy:

GENTAMICIN IV Dose as per calculator 

Do NOT continue Gentamicin beyond 3-4 days

If IV antibiotics are still required after this period, stop Gentamicin and start

TEMOCILLIN IV 2g 8 hourly

For penicillin allergy, switch Gentamicin to:

COTRIMOXAZOLE IV 960mg 12 hourly (eGFR >35)

Or if eGFR<35:

CIPROFLOXACIN IV 400mg 12 hourly (review MHRA Safety Advice before prescribing)

Oral step-down

COTRIMOXAZOLE PO 960mg 12 hourly

If eGFR <35:

CO-AMOXICLAV PO 625mg 8 hourly

If eGFR <35 and penicillin allergy 

CIPROFLOXACIN PO 500mg 12 hourly (review MHRA Safety Advice before prescribing)

Duration: 7 days