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URINARY TRACT INFECTION - COMPLICATED
Urinary tract infection (UTI) is complicated if the UTI is associated with factors that increases colonization and decreases therapy efficacy. Factors may include one or all of the following: Structural or functional abnormalities of the genitourinary tract; presence of an underlying disease that interferes with host defense mechanisms or the patient being immunocompromised; and being infected by a multi-drug resistant bacteria.
Principles of therapy includes effective antimicrobial antimicrobial therapy, optimal management of the underlying abnormalities or other diseases & adequate life-supporting measures.

Diagnosis

  • Urine specimen for culture should be obtained prior to the administration of antibiotics
    • Selection of antibiotic should be re-evaluated once culture results become available
  • If possible, to avoid the emergence of resistant strains, therapy should be guided by urine culture

History

  • Specific questioning for the presence or absence of prior urinary infections & therapy, genitourinary surgeries, nephrolithiasis, gross hematuria, sickle cell disease & other associated disease predispositions

Laboratory Tests

  • Urine analysis w/ microscopic exam, urine culture & sensitivity testing should be performed before, during & after therapy
Significant Bacteriuria
  • Women: ≥105 colony forming units (cfu)/mL in midstream urine (MSU) sample or >104 cfu/mL in straight catheter urine sample
  • Men: ≥104 cfu/mL in MSU or straight catheter urine sample
  • Asymptomatic patients: 2 consecutive urine samples showing ≥105 cfu/mL taken at least 24 hours apart w/ the same bacterial species
Pyuria
  • ≥10 WBC/mm3
Dipstick Method
  • For routine assessment including leukocyte esterase test, hemoglobin & nitrite reaction

Imaging

  • Radiologic studies are indicated to find the cause of complicated urinary tract infection (UTI)
  • Imaging of the urinary tract should be undertaken to evaluate for hydronephrosis, stone disease & urinary tract abnormalities
    • Plain abdominal radiographs may be useful to evaluate for abnormal calcifications, renal contour & gas patterns
    • Intravenous (IV) pyelogram for radiographic images of the bladder, kidneys & ureters to determine extent of urinary obstruction
    • Voiding cystourethrogram for evaluation of the neurogenic bladder & urethral diverticulum, & to determine the presence of vesicoureteral reflux
    • Renal ultrasonography is an extremely valuable tool to evaluate for hydronephrosis, pyonephrosis & perirenal abscesses
    • Computed tomography (CT) scan is more sensitive for nephrolithiasis, defining renal & suprarenal pathology
    • Cystoscopy for a convenient inspection of the urethra & the bladder
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02 Nov 2017
In this issue of MIMS Anti-Infective Supplement, we bring you clinical updates related to combating infectious diseases, and also a symposium highlight in conjunction with the launch of ceftolozane/tazobactam (Zerbaxa; Merck Sharp & Dohme Sdn Bhd) in Malaysia. 
Stephen Padilla, 20 Nov 2017
Diclofenac reduces the use of antibiotics in women with uncomplicated lower urinary tract infection (UTI) but remains less effective than norfloxacin for symptom relief of UTI, according to a recent study. In addition, diclofenac appears to be associated with an elevated risk of pyelonephritis.