Further Inpatient Care
Repeat blood cultures, if positive, to document clearance.
Remove catheters as soon as possible. Replace only if required and only after patient has completely responded to therapy.
Switch from intravenous to oral therapy as soon as possible once directed based on identification and sensitivities.
Monitor renal function and provide adequate fluid support either via the intravenous or oral route.
Deterrence/Prevention
Avoid procedures that introduce bacteria through the urethra and devices that come into contact with the urethra. Postprocedure antimicrobials are appropriate for high-risk individuals.
Complications
Other presentations of hematogenous spread must also be considered.
The presence of calculi results in obstruction of urinary flow. This increases the risk of perinephric abscesses and is associated with them 20-60% of the time. While a single species may be recovered through culture, multiple species may also be found. If multiple organisms are cultured, consider a perinephric or renal abscess.
Intraspinal bacterial infections most often occur within the posterior epidural space. Bacteria may gain access to the epidural space through hematogenous spread from distant infections, usually in the skin or pelvic structures, or by contiguous spread from adjacent vertebral osteomyelitis. Penetrating injuries may implant bacteria in the epidural space. Staphylococcus aureus is the most common causative organism, being isolated in 60-90% of cases. Proteus species, along with E coli,P aeruginosa,S pneumoniae, and Klebsiella species have been reported.
Meningitis is a more common predisposing condition in neonates and infants. Gram-negative organisms and Proteus and Citrobacter species are the most frequent causative organisms.
Acute infection of the stomach may produce diffuse phlegmonous or suppurative gastritis. This rare condition probably arises from preexisting disease of the stomach, such as damage by ethanol or noxious agents, chronic gastritis, trauma, or upper gastrointestinal surgery. Alpha-hemolytic streptococci are the most common organisms involved, although P vulgaris and other bacteria (eg, E coli, Clostridium perfringens, Bacillus subtilis, staphylococci, pneumococci) have been implicated. Suppurative gastritis is a medical emergency with a high mortality rate and may necessitate surgical resection after appropriate treatment with fluids, electrolytes, and antibiotics.
A spinal epidural abscess may extend over many spinal levels. The epidural mass may consist of pus and granulation tissue in acute cases or of fibrous granulation tissue in chronic cases.
The thoracic spine is the site of the abscess in 50-80% of patients, followed in frequency by the cervical and lumbar spine. Isolated epidural abscesses resulting from hematogenous spread generally occur dorsal to the thecal sac, whereas contiguous spread of infection from an underlying osteomyelitis collects anterior to the thecal sac.
Prognosis
Treatment of uncomplicated UTIs has a low mortality/morbidity index and can be treated with a short course of empiric antibiotic therapy.
Recurrence rates are directly influenced by eradicating the underlying cause (ie, catheter, anatomical obstruction, renal calculi).
Once the infectious agent spreads beyond the bladder, morbidity and mortality increase significantly. If hematogenous spread occurs, the chance of death can be as high as 30-45% despite the use of antibiotic therapy and intensive care. Patients with preexisting medical problems, neonates, and elderly individuals are at the greatest risk for complications.
Patient Education
Education concerning catheter care may reduce the frequency of infections.
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After 24 hours, this inoculated MacConkey agar culture plate cultivated colonial growth of gram-negative, rod-shaped, and facultatively anaerobic Proteus vulgaris bacteria. Courtesy of the CDC.
