urinary%20tract%20infection%20-%20uncomplicated
URINARY TRACT INFECTION - UNCOMPLICATED
Acute uncomplicated urinary tract infection (UTI) is one of the most common bacterial infections in adults that may involve the lower or upper urinary tract or both.
Acute cystitis is an infection limited to the lower urinary tract while acute pyelonephritis is an infection that involves the upper urinary tract (renal parenchyma and pelvicaliceal system) that usually has significant bacteriuria.
Recurrent UTI is characterized by 2 episodes of uncomplicated UTI in the last 6 months or ≥3 episodes with positive cultures in the last 12 months in patients with no structural or functional abnormalities.

Indications For Hospital Admission

  • Severely ill or evidence of sepsis
  • Presence of complications
  • Concern about compliance
  • Failure to respond to outpatient treatment
  • Inability to maintain oral hydration or take medications, vomiting, dehydration
  • Uncertainty about the diagnosis

Follow Up

Acute Uncomplicated Cystitis
  • Routine post-treatment urinalysis or culture is not indicated in asymptomatic patients
  • Urine culture and antimicrobial susceptibility testing are indicated in patients who remain symptomatic after completion of treatment or if patient has recurrence of symptoms within 2 weeks
    • Retreatment with another agent for 7 days should be considered
  • Antimicrobial agent must be changed empirically pending the result of post-treatment urine culture and sensitivity testing in patients showing poor response to therapy
Acute Uncomplicated Pyelonephritis
  • After improvement, which is usually apparent within 48-72 hours, switch parenteral antibiotic to oral regimen to complete 1- to 2-week course of therapy
  • Post-treatment urinalysis and urine culture are not needed in patients who respond and remain asymptomatic
  • Radiologic (eg renal ultrasound, CT or renal scintigraphy) and urologic evaluation, and repeat urine culture/susceptibility testing are indicated in patients who remain febrile within ≥72 hours of treatment or if patient has recurrence of symptoms within 2 weeks
    • Alternative tailored treatment should be considered in the absence of urological abnormality
    • Rule out possible complications (eg nephrolithiasis, renal or perirenal abscess) in patients who relapse with the same pathogen
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