1. NCUTI & Urosepsis guidelines
Dr. mahmood Almahjoob
MICU-TMC. TRIPOLI . LIBYIA

2. INTRODUCTION
• NCUTI among the most prevalent NCI
• Nosocomial bacteriuria develops in up to 25% of
patients requiring a urinary catheter for > 7 days
• The prevalence of hospital-acquired UTIs in the PEP
study was 10% and urosepsis accounted for 12% of all
episodes.

3. Nosocomial infections

4. MICROBIOLOGICAL DATA
• Gram-negative bacilli E.COLI account for majority of the cases
while Gram-positive organisms are involved less frequently
,
• with E. coli being the commonest bacterium isolated in both
catheterized and non-catheterized patients
• Organisms isolated from patients with complicated urinary
infection and urosepsis tend to be more resistant

5. Etiologic agents

6. RISK FACTORS Of NCUTI
 elderly patients
 diabetics
 immuno-suppressed patients.
 Structural and functional abnormalities of the genitourinary tract
 Indwelling urinary catheters

7. Classification of UTI
UncomplicatedUTI >>>healthy
individual
Complicated UTI >>> functional or
strucutional u t abnormality
Urosepsis
Special male genitourinary tract
infection eg epidedymitis

8. EVALUATION
• History is crucial in the evaluation of any UTI It
should include
any previous history of infections,
antibiotic use,
timeline of symptoms. If possible,
any laboratory results associated with previous
infections, including culture results should be
obtained.

9. • The physician should promptly look for evidence
of sepsis in sever form of UTI
• A thorough physical examination (including a
pelvic examination and digital rectal
examination to exclude acute prostatitis) should
also be performed.

10. INVISTIGATION
URINE FOR dipstick , R/E&CULTURE IS
CRUCIAL
ROUTINE BLOOD TEST +CRP
BLOOD CUTURE
LOCALIZING UNDERLYING URINARY TRACT
ABNORMALITY ULTRA SOUND CT&MRI
 Urine sample should be taken from sample port not from drainage bag
urine should be transported to lab &processed within 10minute
presence or high acount of pyuria not indicate diagnosis if culture shows less than
10 3 cfu/ml
gram stain of centrifuged urine is reliable in detection of infected
organism

11. Diagnosis
• CA-UTI in patients with indwelling urethral,
indwelling suprapubic, or intermittent
catheterization is defined by
– the presence of symptoms or signs compatible with UTI
– no other identified source of infection
– >103
colony forming units (cfu)/mL of 1 bacterial species
in a single catheter urine specimen or in a midstream
voided urine specimen from a patient whose urethral,
suprapubic, or condom catheter has been removed
within the previous 48 h

12. Diagnosis
• CA-ASB in patients with indwelling urethral,
indwelling suprapubic, or intermittent
catheterization is defined
– >105
cfu/mL of 1 bacterial species in a single catheter urine
specimen
– patient without symptoms compatible with UTI
• CA-ASB in a man with a condom catheter is
defined
– >105
cfu/mL of 1 bacterial species in a single urine
specimen from a freshly applied condom catheter
– patient without symptoms compatible with UTI

13. Diagnosis
• In the catheterized patient, pyuria is not
diagnostic of CA-bacteriuria or CA-UTI
– The presence, absence, or degree of pyuria should
not be used to differentiate CA-ASB from CA-UTI
– Pyuria accompanying CA-ASB should not be
interpreted as an indication for antimicrobial
treatment

14. TREATMENT
 GENERALSUPPORTIVE MANAGEMENT
• ANTIMICROBIAL THERAPY Antimicrobial Selection should
be depend on:
.Local(hospital /ward) pattern of microorganism isolation and
antibiotic resistance
Wherever possible, antimicrobial therapy should be delayed
pending results of urine culture and organism susceptibility,
unless sever form or impeding sepsis indicated empirical
regimes.
Where empirical therapy is initiated, the antimicrobial choice
should be reassessed once culture results become available,
usually within 48 h to 72hr

16. Antibiotic regime for NCUTI
Urinary tract infections Possible antibiotic
uncomplicated cystitis- Nitrofurntion 100mg orally for 3days
Bactrim DS orally twice daily for 3 day
Ciprofloxacin 250mg orally twice daily for 3 days
or Levofloxacin 250mg orally once daily for 3 days
or augamantine
uncomplicatepyelonephritisI
complicated cystitis or
pyelonephritisl
,Ciprofloxacin 200-400mg IV every 12 hour orLevofloxacin
250 to 500mg IV once
or aminoglycosideas 2line amikacinor gentamicin,
intravenous regimen such as a fluoroquinolone, amino
glycoside (with or without an extended-spectrum
cephalosporin, an extended-spectrum penicillin, or a
carbapenem for7-14d

17. hospital-acquired urosepsis
regime Dose
antipseudomonal third-generation
cephalosporin
cefepime,
ceftazidime
1–2g every 8–12 h
2g every 8 h
Or piperacillin/beta- lactamase inhibitor
imipenem or meropenem(tazocine(
or carbamide merepnem
.4 5g every 6 h
500mg every 6 h
plus
aminoglycoside (amikacin,
(gentamicin
‫ا‬
7mg/kg per d†
Amikacin 20 mg/kg per dt

18. community-acquired primary urosepsis
regime dose
Or
3rd
generation cephalosporin eg:Ceftriaxone 1to2g daily
+pipracillin
)beta-l actamase inhibitor (tazocin
.4 5g every 6 h
or
afluoroquinolone
levofloxcine,ciproflaxcine
750mg every d
400mg every 8 h
A combination therapy with an aminoglycoside or a carbapenem may
be essential in areas with high rate of fluoroquinolone resistance.

19. IMPORTANT NOTES
Most patients require treatment for about 14-21 days
Successful antimicrobial therapy will usually ameliorate
symptoms promptly,
Patients who fail to respond in this time frame should be
reassessed to exclude
urinary obstruction or abscess (which may require
drainage),
to exclude resistance of the infecting organism
consider an alternate diagnosis
Catheters should be replaced before initiating
antimicrobial therapy for the treatment of a symptomatic

20. REFRENCES
•Nottingham Antimicrobial Guidelines Committee April 2011 Review April 2012
•European Prevalence of Infection in Intensive care Study. EPIC International Advisory Committee
•European Society of Infections in Urology. Hospital acquired urinary tract infections in and use of
antibiotics. Data from the PEP and PEAP-studies.
•SENTRY Antimicrobial Surveillance Program (2000 Diagn Microbiol Infect((.
•The European and Asian guidelines on management and prevention of catheter- urinary tract
infections associated
•Surviving Sepsis Guidelines
•TMC infectious control

21. TMC GUIDELINE FOR NCUTI

22. always consider local pattren
of microrganisms resistence
,avilblity of antibiotic ,host factor
always consider delyed anti biotic
as much as patient clinical satuation
tolarate to direct antibiotic according
to result of culture& sensitvity