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.