urinary%20tract%20infection%20in%20women%20-%20complicated
URINARY TRACT INFECTION IN WOMEN - 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.

Definition

  • A urinary tract infection (UTI) that is associated w/ a condition [eg structural or functional abnormalities of the genitourinary tract (GUT)] or the presence of an underlying disease that interferes w/ host defense mechanisms, which increases the risks of acquiring infection, failing therapy or having recurrent infections
  • Also associated w/ altered microbiology that favors more antimicrobial-resistant strains that are sometimes less virulent than those found in uncomplicated UTI

Etiology

  • The spectrum of bacteria causing complicated urinary tract infection (UTI) is much larger than that of uncomplicated UTI & more likely to be antibiotic-resistant
    • Escherichia coli, Proteus, Klebsiella, Pseudomonas, Serratia spp & enterococci are the usual strains found in urine culture
  • Catheter-associated UTI
    • Short-term (<1 week): E coli, Pseudomonas aeruginosa
    • Long-term (>1 week): Proteus mirabilis, E coli, P aeruginosa, Providencia stuartii, Morganella morganii, Citrobacter sp, Enterobacter sp, Enterococcus sp, Candida spp 
  • Diabetes mellitus (DM) patients: E coli, Klebsiella pneumoniae, P mirabilis, P aeruginosa, Enterobacter spEnterococcus sp, Candida spp
  • Renal transplant patients: E coli, P mirabilis, K pneumoniae, P aeruginosa, Gram-positive cocci, Enterobacter sp, Enterococci sp, Serratia sp, Acinetobacter sp, Citrobacter spp, Corynebacterium urealyticum
  • Neutropenic patients: Gram-negative bacilli especially P aeruginosa, Staphylococcus aureus, Candida sp 
  • Patients w/ anatomic abnormalities: E coli, K pneumoniae, P aeruginosa, P mirabilis

Signs and Symptoms

  • A complicated urinary tract infection (UTI) does not necessarily present w/ clinical symptoms
  • Dysuria, urgency, frequency, flank pain, costovertebral angle tenderness, suprapubic pain & fever may or may not be present
  • May present w/ signs of sepsis: Hypotension, temp >40°C, tender subcostal or intractable nausea & vomiting
  • Symptoms may vary from severe obstructive acute pyelonephritis w/ imminent urosepsis to a catheter-associated post-operative UTI
  • Concomitant medical conditions [eg diabetes mellitus (DM), renal failure] are often present

Risk Factors

Factors that suggest a potential complicated urinary tract infection (UTI):

  • >7 days of symptoms prior to presentation
  • Azotemia due to intrinsic renal disease
  • Chemical or radiation injuries of the uroepithelium
  • Comorbidities that predispose to papillary necrosis [eg sickle cell disease, severe diabetes mellitus (DM), analgesic abuse, Pseudomonas sp infection]
  • Elderly
  • Pregnancy
  • Healthcare-associated or hospital-acquired infection
  • Immunosuppression
  • Incomplete bladder emptying w/ >100 mL of residual urine
  • Obstructive uropathy (eg bladder outlet obstruction, calculi, stones, stricture, tumor)
  • Peri- & postoperative urinary tract infection (UTI)
  • Presence of an indwelling urinary catheter or use of intermittent bladder catheterization
  • Recent antimicrobial use
  • Recent urinary tract intervention or instrumentation
  • Renal insufficiency & transplantation
  • Unresolved UTI due to failed response to antibiotic therapy
  • Urinary tract modifications (eg ileal loop or pouch)
  • Vesicoureteral reflux or other functional abnormalities
  • Residence in an institution providing extended care
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS JPOG - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
07 Jun 2018
Age, weight, oral corticosteroid use and strenuous exercise at age 18 years appear to be useful in predicting the 5-year risk of height loss of at least 1 inch in postmenopausal women, according to a study.
06 Jun 2018
Among postmenopausal women, anxiety levels are associated with the bone mineral density n the lumbar spine and femoral neck, a study reports.
20 Jul 2018
Laparoscopic sacropexy (LS) better preserves sexual function than transvaginal mesh repair (TVM) with lower rates of complications and reoperations, a recent trial has found.
Rachel Soon, 07 Jun 2018

For the first time, healthcare professionals may now refer to the Malaysian Clinical Practice Guidelines on the Management of Diabetes in Pregnancy for treatment options.