Complicated Urinary Tract Infection .pdf

Complicated UTI includes UTI syndromes that increases the risk for serious complications or treatment failure.

This presentation describes about the pathogenesis , clinical features and the management of complicated UTI.

1. COMPLICATED UTI

2. Categories of UTI in adults
●Acute uncomplicated cystitis in healthy women
●Recurrent acute uncomplicated cystitis in healthy
women
●Acute uncomplicated pyelonephritis in healthy
women
●Complicated UTI
●Asymptomatic bacteriuria

3. What is complicated UTI ?

UTI that increases the risk for serious complications or treatment failure.

4. Pathogenesis
Factors that predispose individuals to complicated UTI generally do
so by causing obstruction or stasis of urine flow , facilitating entry of
uropathogens into the urinary tract by bypassing normal host
defense mechanisms, providing a nidus for infection that is not
readily treatable with antimicrobials, or compromising the host
immune system.

UTIs are more likely to become complicated in the setting of
impaired host defense, as occurs with indwelling catheter use, VUR,
obstruction, neutropenia, and immune deficiencies.

5. Diabetes mellitus is associated with several syndromes of complicated
UTI, including renal and perirenal abscess, emphysematous pyelonephritis
and cystitis, papillary necrosis, and xanthogranulomatous pyelonephritis.

Uropathogen virulence determinants are less important in the
pathogenesis of complicated UTIs compared with uncomplicated UTIs.
However, infection with multidrug-resistant uropathogens is more likely
with complicated UTI.

6. Clinical Features
●Patients with complicated UTI may present with classic signs of
cystitis and pyelonephritis but also may have vague or nonspecific
symptoms, such as fatigue, irritability, nausea, headache, and
abdominal or back pain.
●Acute cystitis in healthy individuals other than young women is
more likely to involve occult renal or prostatic infection and may
respond poorly to short-course therapy.
● Some patients, such as those who are diabetic or pregnant, warrant
special attention because of the serious complications that can
occur if treatment is inadequate.

7. ● The IDSA consensus definition of complicated UTI is 10
5
cfu/ml or
more in the urine of women and 10
4
cfu/ml or more in men, but lower
counts in symptomatic persons, as demonstrated in patients with
uncomplicated UTI, may well represent significant bacteriuria.
●This is especially true when the specimen is collected from a urinary
catheter.
●Thus it is reasonable to use a colony count threshold of 10
3
cfu/ml of
uropathogens to diagnose complicated UTI.
Urine culture should always be performed in patients with
suspected complicated UTI.

12. ● Urethritis must be excluded in dysuric sexually active men by a
urethral Gram stain or a first-voided urine specimen wet-mount
evaluation for urethral leukocytosis.

●Correction of any underlying anatomic, functional, or metabolic
defect must be attempted, because antibiotics alone may not be
successful.

13. ●Routine post-treatment cultures are not indicated unless the
patient is symptomatic, except in pregnant women .

●In men, early recurrence of UTI with the same species suggests a
prostatic source of infection and warrants a 4- to 6-week regimen
of either a fluoroquinolone (preferable) or TMP-SMX, depending
on the antimicrobial susceptibility of the infecting strain.

14. REFERENCE -
Comprehensive
Clinical Nephrology
6th Edition