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Related Experiment Videos

Complicated urinary tract infections in patients with voiding dysfunction.

R D MacMillan1

  • 1University of Toronto, Toronto East General Hospital, Toronto Rehab Institute, Toronto, Ontario, Canada.

The Canadian Journal of Urology
|July 10, 2001
PubMed
Summary

Complicated urinary tract infections (UTIs) are difficult to treat due to abnormal anatomy and resistant bacteria. Long-term, broad-spectrum antibiotic treatment guided by urine cultures is essential for managing these challenging infections.

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Area of Science:

  • Urology
  • Infectious Diseases
  • Microbiology

Background:

  • Complicated urinary tract infections (UTIs) affect patients with abnormal urinary tracts, contrasting with simple cystitis.
  • Anatomical abnormalities make complicated UTIs challenging to treat, often leading to recurrent infections.
  • Resistant bacteria, including resistant coliforms (e.g., Citrobacter, Pseudomonas) and Gram-positive bacteria (e.g., Staphylococcus, Enterococcus), are common pathogens.

Purpose of the Study:

  • To review the challenges in treating complicated UTIs.
  • To highlight risk factors contributing to complicated UTIs.
  • To provide guidance on effective treatment strategies for complicated UTIs.

Main Methods:

  • Review of existing literature on complicated UTIs.

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  • Analysis of risk factors such as anatomical abnormalities, high residual bacteria, poor hygiene, and catheter use.
  • Evaluation of current and recommended treatment approaches, including antibiotic selection and duration.

    • Main Results:

    • Risk factors include structural/functional abnormalities, high residual bacteria (e.g., in spinal cord injury, BPH, geriatric patients), poor fluid intake, hygiene, nutrition, and catheterization.
    • Treatment requires urine culture-guided, broad-spectrum antibiotics with anti-pseudomonal activity.
    • Long-term oral antibiotics (e.g., fluoroquinolones) for at least 10 days, or longer, are recommended; short-course therapy is ineffective.

    Conclusions:

    • Effective management of complicated UTIs necessitates addressing underlying issues and employing prolonged, culture-guided antibiotic therapy.
    • Fluoroquinolones are often suitable due to their broad spectrum and anti-pseudomonal activity.
    • Reculturing and retreatment are frequently necessary due to the persistent nature of these infections.