RT Book, Section
A1 Sheehan, Gerard J.
A1 Mooka, Busi
A2 Hall, Jesse B.
A2 Schmidt, Gregory A.
A2 Wood, Lawrence D.H.
SR Print(0)
ID 2291815
T1 Chapter 56. Urinary Tract Infections
T2 Principles of Critical Care, 3e
YR 2005
FD 2005
PB The McGraw-Hill Companies
PP New York, NY
SN 9780071416405
LK accessanesthesiology.mhmedical.com/content.aspx?aid=2291815
RD 2023/09/22
AB All  patients  with  severe  urosepsis  requiring  admission  to  the  intensive  care  unit  should  have  immediate  imaging  of  the  urinary  tract  preferably  by  computed  tomography  with  contrast  because  suppurative  complications  are  common  and  require  drainage  as  a  priority.Percutaneous  drainage  can  be  used  to  drain  definitively  or  stabilize  temporarily  a  patient  with  suppurative  complications.Empiric  antimicrobial  therapy  for  acute  complicated  urosepsis  should  include  two  agents  with  activity  against  gram-negative  bacilli,  such  as  a  combination  of  ciprofloxacin  or  piperacillin/tazobactam  with  an  aminoglycoside,  until  the  pathogen  is  isolated  and  antimicrobial  sensitivities  are  known.Urinary  catheters  are  associated  with  a  high  incidence,  1%  to  5%  per  day,  of  bacteriuria.  Patients  are  also  predisposed  to  candiduria,  especially  those  receiving  broad-spectrum  antibacterial  therapy.Asymptomatic  bacteriuria  should  be  treated  in  all  patients  before  instrumentation  of  the  urinary  tract  to  avoid  the  development  of  gram-negative  bacteremia.The  continued  usefulness  of  a  urinary  catheter  needs  to  be  reassessed  on  a  regular  basis,  and  removal  in  selected  awake  stable  patients  needs  to  be  considered.Treatment  of  bacteriuria  without  local  signs  of  infection  should  be  considered  only  in  patients  with  fever  or  sepsis  after  exclusion  of  other  potential  causes  of  infection.