Urinary Tract Infection - Complicated Disease Summary

Overview

As stated in the Introduction section, complicated urinary tract infection (UTI) is a form of UTI with an increased chance of a complicated course, possibly extending beyond the bladder, occurring in men, pregnant women, patients with anatomical or functional abnormalities of the genitourinary tract.

Approximately 2.88 million cases of complicated UTI are reported annually. A detailed discussion about the prevalence of UTI is in the Epidemiology section.

The spectrum of bacteria causing complicated UTI is much larger than that of uncomplicated UTI and is more likely to include antibiotic-resistant organisms. The discussion on the different pathogens involved in complicated UTI is in the Etiology section.

The Pathophysiology section states that the most common route of urinary tract infection is the ascending spread of bacteria from the urethra to the bladder. An additional consideration in complicated UTI is bladder compromise.

Factors associated with complicated UTI are listed in the Risk Factors section.

Urinary Tract Infection - Complicated_Disease Summary

History and Physical Examination

The Clinical Presentation section describes the different signs and symptoms of patients with complicated UTI.

In the History section, the importance of specific questioning to determine the presence or absence of prior urinary infections and therapy, genitourinary surgeries, nephrolithiasis, gross hematuria, sickle cell disease and other associated diseases is emphasized.  

Different physical examination findings seen in complicated UTI like abdominal and suprapubic tenderness are discussed in the Physical Examination section. Women are also assessed for cervical motion or uterine tenderness to assess for pelvic inflammatory disease.

Diagnosis

As mentioned in the Laboratory Tests and Ancillaries, urine culture is the recommended method to identify clinically significant bacteriuria in patients suspected of having complicated UTI. Other laboratory examinations are discussed in this section.

The Imaging section mentions that most patients with complicated UTI do not warrant imaging unless they are severely ill, unresponsive to therapy or with suspected underlying conditions.

Other conditions that should be ruled out in the diagnosis of complicated UTI are listed in the Differential Diagnosis section.

Management

Indications for outpatient management and hospital admission are discussed in the Evaluation section.

General therapy principles in the management of complicated UTI are in the Principles of Therapy section.

The Pharmacological Therapy section discusses the different therapeutic options for empiric therapy and specific therapy for complicated UTI.

The Monitoring section lists recommendations regarding follow-up. Details regarding further investigations and repeat testing are also found in this section.