KEEP: UTI organisms & antibiotic treatment mnemonic (I KEEP getting UTIs)

The “KEEP” mnemonic is a tool to remember the most common organisms causing urinary tract infections (UTIs). Here’s how the mnemonic breaks down, followed by key information relevant for emergency medicine boards:K - Klebsiella species • Relevance: Klebsiella is the second most common organism causing UTIs, especially hospital-acquired infections. • Key Points: • Gram-negative rod. • Often seen in patients with underlying conditions like diabetes, or those with urinary catheters. • Resistant to many antibiotics, so susceptibility testing is important. • Treatment Options: Cephalosporins (like ceftriaxone), carbapenems in resistant cases.E - Escherichia coli (E. coli) • Relevance: The most common organism causing both community-acquired and some hospital-acquired UTIs. • Key Points: • Gram-negative rod. • Responsible for approximately 70-90% of uncomplicated UTIs. • Often originates from the gut. • Can exhibit antibiotic resistance, particularly to trimethoprim-sulfamethoxazole. • Treatment Options: Trimethoprim-sulfamethoxazole (Bactrim), nitrofurantoin, fosfomycin, or ciprofloxacin based on resistance patterns.E - Enterococcus species • Relevance: More common in complicated UTIs, particularly in hospital settings. • Key Points: • Gram-positive cocci. • Often found in patients with catheters, immunocompromised status, or structural abnormalities in the urinary tract. • Can be resistant to many antibiotics, including vancomycin-resistant Enterococcus (VRE). • Treatment Options: Ampicillin or amoxicillin when susceptible; for resistant cases, vancomycin or linezolid.P - Proteus species • Relevance: Known for causing complicated UTIs and is associated with kidney stones. • Key Points: • Gram-negative rod. • Produces urease, which increases urine pH and can lead to the formation of struvite stones. • Can cause upper UTIs and is known to colonize catheters. • Treatment Options: Ciprofloxacin, trimethoprim-sulfamethoxazole, cephalosporins; nitrofurantoin is usually not effective.Summary of the Mnemonic ‘KEEP’ • Klebsiella: Second most common UTI organism; hospital-acquired; antibiotic resistance common. • E. coli: Most frequent cause of UTIs; community-acquired; potential resistance to some antibiotics. • Enterococcus: Complicated and hospital-acquired UTIs; often found in patients with urinary abnormalities. • Proteus: Associated with kidney stones; catheter-related UTIs; produces urease.By remembering “KEEP,” you can recall the key organisms responsible for UTIs and their relevance to diagnosis and treatment in emergency settings.