COMPLICATED URINARY TRACT INFECTIONS

Course overview

URINARY TRACT INFECTIONS (UTIS) ARE AMONG THE MOST COMMON PRESENTING CAUSES OF SEPSIS IN HOSPITALS, AND URINARY TRACT INFECTIONS HAVE A WIDE VARIETY OF PRESENTATIONS. SOME ARE SIMPLE UTIS THAT CAN BE MANAGED WITH OUTPATIENT ANTIBIOTICS AND LEAD TO ALMOST UNIVERSALLY GOOD OUTCOMES. ON THE OTHER END OF THE SPECTRUM, FLORID UROSEPSIS IN A PATIENT WITH COMORBIDITIES CAN BE FATAL. THERE ARE SEVERAL RISK FACTORS THAT CAN COMPLICATE URINARY TRACT INFECTIONS AND LEAD TO TREATMENT FAILURE, REPEAT INFECTIONS, OR SIGNIFICANT MORBIDITY AND MORTALITY. IT IS VITALLY IMPORTANT TO DETERMINE IF THE PATIENT'S INFECTION MAY HAVE RESULTED FROM ONE OF THESE RISK FACTORS AND WHETHER THE EPISODE IS LIKELY TO RESOLVE WITH FIRST-LINE ANTIBIOTICS. COMPLICATED URINARY TRACT INFECTIONS ARE THOSE THAT CARRY A HIGHER RISK OF TREATMENT FAILURE, AND TYPICALLY REQUIRE LONGER ANTIBIOTIC COURSES AND OFTEN ADDITIONAL WORKUP. COMPLICATED URINARY TRACT INFECTIONS INCLUDE THOSE THAT OCCUR: IN MALES, IN PREGNANT FEMALES (INCLUDING ASYMPTOMATIC BACTERIURIA), AS A RESULT OF OBSTRUCTION, HYDRONEPHROSIS, RENAL TRACT CALCULI, OR COLOVESICAL FISTULA, IN IMMUNOCOMPROMISED PATIENTS OR THE ELDERLY, DUE TO ATYPICAL ORGANISMS, AFTER INSTRUMENTATION OR IN CONJUNCTION WITH MEDICAL EQUIPMENT SUCH AS URINARY CATHETERS, IN RENAL TRANSPLANT PATIENTS, IN PATIENTS WITH IMPAIRED RENAL FUNCTION, OR AFTER PROSTATECTOMIES OR RADIOTHERAPY. ADDITIONALLY, URINARY TRACT INFECTIONS THAT RECUR DESPITE ADEQUATE TREATMENT ARE COMPLICATED. THIS ACTIVITY REVIEWS THE EVALUATION AND MANAGEMENT OF COMPLICATED URINARY TRACT INFECTIONS AND HIGHLIGHTS THE ROLE OF INTERPROFESSIONAL TEAM MEMBERS IN COLLABORATING TO PROVIDE WELL-COORDINATED CARE AND ENHANCE OUTCOMES FOR AFFECTED PATIENTS.