Burn UTI Evaluation

Original Date: 01/2022
Purpose: To standardize the work up of urinary tract infections in burn patients.

If a patient has signs or symptoms of a urinary tract infection (UTI), the work up starts with ordering a urinalysis without reflex culture (order in Care4: Urinalysis w/ Microscopic). Asymptomatic bacteriuria should only be treated in pregnant women.

Signs and symptoms of a UTI:

  • New onset or worsening fevers, rigors, altered mental status, malaise, or lethargy with no other identified cause
  • Flank pain
  • Costovertebral angle tenderness
  • Acute hematuria
  • Pelvic discomfort
  • In patients whose catheters have been removed, dysuria, urgency, frequency, and/or suprapubic pain.

Interpret the UA:

  • First, is it an adequate sample. An adequate urinalysis sample should have no or occasional epithelial cells. Any UA with more than this should be repeated.
  • Second, look at U bacteria/HPF and U Nitrite
    • Any bacteria or nitrites is suggestive of a UTI.
  • Third, look at U Leukocyte Esterase and U WBC/HPF
    • Negative leukocyte esterase and zero WBCs suggests no UTI

If you diagnose a UTI by UA:

  • Antimicrobial therapy:
    • Woman, no urinary catheter: ciprofloxacin 500 mg PO q12 hours x 5 days
    • Man, no urinary catheter: ciprofloxacin 500 mg PO q12 hours x 7 days
    • Woman or man with a urinary catheter: ciprofloxacin 500 mg PO q12 hours x 7 days
    • Concern for multidrug resistant bacteria causing UTI: order Culture: Urine and treat empirically with cefepime 1g IV q6 hours until culture results return.
  • Antifungal therapy:
    • If yeast identified on UA, fluconazole 400 mg PO daily x 14 days
  • Catheter maintenance:
    • If no longer needed, remove urinary catheter.
    • For patients who require extended catheterization, consider intermittent catheterization.
    • For patients in whom intermittent catheterization is infeasible, replace urinary catheter after first dose of antimicrobial therapy has been given.

Notes:

CA-UTI (catheter-associated urinary tract infection):

  • Definition: the diagnosis of a UTI in a patient whose urinary tract is currently or has been catheterized within the previous 48 hours.
  • The most effective strategy to reduce CA-UTIs is to remove unnecessary catheters.