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Urinary tract infections in immunocompromised patients
Cesar J Figueroa-Ortiz1,2, Peter A Mead1,2
1Division of Infectious Diseases, Department of Medicine, Memorial Sloan Kettering Cancer Center.
Current Opinion in Infectious Diseases
|June 11, 2025
Summary
Urinary tract infections (UTIs) are a significant concern for immunocompromised patients, often caused by resistant bacteria. Accurate diagnosis and antibiotic stewardship are crucial for managing these complex cases effectively.
Area of Science:
- Infectious Diseases
- Immunology
- Urology
Background:
- Urinary tract infections (UTIs) pose a substantial morbidity risk for immunocompromised individuals, including transplant recipients, those with hematologic malignancies, HIV-positive individuals, and those on immunosuppressive therapies.
- These infections present unique challenges due to atypical presentations and the increasing prevalence of antimicrobial resistance.
Purpose of the Study:
- To synthesize recent evidence on the diagnosis, management, and antimicrobial resistance of UTIs in high-risk immunocompromised populations.
- To highlight the complexities and challenges associated with UTI care in these vulnerable patient groups.
Main Methods:
- Review of recent scientific literature focusing on UTIs in immunocompromised patients.
- Synthesis of evidence regarding diagnostic challenges, management strategies, and antimicrobial resistance patterns.
Main Results:
- UTIs are highly prevalent in immunocompromised patients and frequently involve multidrug-resistant pathogens.
- Common risk factors include immunosuppression, diabetes, urologic instrumentation, and catheterization.
- Diagnostic uncertainty often leads to overtreatment; emerging stewardship tools show promise in reducing inappropriate antibiotic use.
Conclusions:
- UTIs in immunocompromised patients are complex, necessitating accurate diagnosis and judicious antibiotic use.
- Implementation of antimicrobial stewardship interventions is essential.
- Further research is required to validate diagnostic tools and enhance outpatient stewardship infrastructure.
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