urinary%20tract%20infection%20-%20complicated
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.

Urinary%20tract%20infection%20-%20complicated Management

Indications For Hospital Admission

  • The decision to hospitalize the patient will depend on the severity of the illness
Consider hospitalization if any of the following exist:
  • Patient w/ complicated urinary tract infection & unable to maintain oral hydration or take oral medications
  • Concerns regarding patient adherence to treatment
  • Uncertainty of diagnosis
  • Severe illness w/ high fever & severe pain
  • Marked debility & signs of sepsis
Outpatient
  • Patients who do not meet the above categories may be considered for treatment on an outpatient basis

Follow Up

  • Perform urine analysis to ensure that causative agent has been eradicated
  • A urine culture obtained 1-2 weeks after completing therapy & thereafter as clinically indicated may also be done
  • Further genitourinary investigation should be made in cases of:
    • Delayed or incomplete response to appropriate antimicrobial therapy
    • Early recurrence of infection after therapy
  • Further follow-up to identify & correct anatomical, functional or metabolic abnormalities is indicated
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Elvira Manzano, 28 Aug 2020

Post-infection mortality is higher in older patients with dementia than those without in an analysis of Danish national registry data presented at AAIC 2020.