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A Practical Guide to the Management of Complicated Urinary Tract Infection

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Summary

Complicated urinary tract infections are infections in the setting of structural or functional abnormalities of the genitourinary tract. They encompass a wide variety of clinical syndromes and anticipated outcomes. The infecting microorganisms isolated are more varied and demonstrate a higher prevalence of antimicrobial resistance in complicated compared to uncomplicated urinary tract infections. The usual duration of therapy is 7 to 14 days, although comparative trials to define optimal treatment duration are lacking. Long term success of antimicrobial treatment is dependent upon whether or not the underlying genitourinary abnormality can be corrected. Treatment of complicated urinary tract infections will usually be successful and may be permanent if the underlying abnormality can be corrected. If the underlying abnormality cannot be corrected, failure rates of 50% at 4 to 6 weeks following therapy are expected. Antimicrobial agents are similar to those used to treat uncomplicated urinary tract infection. Certain agents, such as nitrofurantoin, should be avoided for individuals with renal failure. No specific agent or class of agents has consistently demonstrated greater therapeutic efficacy where the infecting organism is susceptible to the given agent.

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References

  1. Rubin RH, Shapiro ED, Andriole VT, et al. Evaluation of new anti-infective drugs for the treatment of urinary tract infection. Clin Infect Dis 1992; 15Suppl. 1: S216–27

    Article  PubMed  Google Scholar 

  2. Harding GKM, Nicolle LE, Ronald AR, et al. How long should catheter-acquired urinary tract infection in women be treated? Ann Intern Med 1991; 114: 713–9

    PubMed  CAS  Google Scholar 

  3. Nicolle LE, Louie TJ, Dubois J, et al. Treatment of complicated urinary tract infections with lomefloxacin compared with trimethoprim-sulfamethoxazole. Antimicrob Agents Chemother 1994; 38: 1368–73

    Article  PubMed  CAS  Google Scholar 

  4. Biering-Sorensen F, Hoiby N, Nordenbo A, et al. Ciprofloxacin as prophylaxis for urinary tract infection: prospective, randomized, cross-over, placebo controlled study in patients with spinal cord lesion. J Urol 1994; 151: 105–8

    PubMed  CAS  Google Scholar 

  5. Cox CE, Holloway WJ, Geckler RW. A multicenter comparative study of meropenem and imipenem/cilastatin in the treatment of complicated urinary tract infections in hospitalized patients. Clin Infect Dis 1995; 21: 86–92

    Article  PubMed  CAS  Google Scholar 

  6. Johnson JR. Virulence factors in Escherichia coli urinary tract infection. Clin Microbiol Rev 1991; 4: 80–128

    PubMed  CAS  Google Scholar 

  7. Smith JW, Jones SR, Reed WP, et al. Recurrent urinary tract infections in men. Characteristics and response to therapy. Ann Intern Med 1979; 91: 544–8

    PubMed  CAS  Google Scholar 

  8. Cardenas DD, Hooton TM. Urinary tract infection in persons with spinal cord injury. Arch Phys Med Rehabil 1995; 76: 272–80

    Article  PubMed  CAS  Google Scholar 

  9. Mohler JL, Cowen DL, Flanigan RC. Suppression and treatment of urinary tract infection in patients with an intermittent catheterized neurogenic bladder. J Urol 1987; 138: 336–40

    PubMed  CAS  Google Scholar 

  10. Waites KB, Kanupp KC, DeVivo MJ. Efficacy and tolerance of norfloxacin in treatment of complicated urinary tract infections in outpatients with neurogenic bladder secondary to spinal cord injury. Urology 1991; 38: 589–96

    Article  PubMed  CAS  Google Scholar 

  11. Waites KB, Canupp KC, DeVivo MJ. Eradication of urinary tract infection following spinal cord injury. Paraplegia 1993; 31: 645–52

    Article  PubMed  CAS  Google Scholar 

  12. Gleckman R, Crowley M, Natsios GA. Recurrent urinary tract infections in men: an assessment of contemporary treatment. Am J Med Sci 1980; 279: 31–6

    Article  PubMed  CAS  Google Scholar 

  13. Gleckman R, Crowley M, Natsios GA. Therapy of recurrent invasive urinary tract infections of men. N Engl J Med 1979; 301: 878–80

    Article  PubMed  CAS  Google Scholar 

  14. Hoepelman IM, Havinga WH, Benne RA, et al. Safety and efficacy of lomefloxacin versus norfloxacin in the treatment of complicated urinary tract infections. Eur J Clin Microbiol Infect Dis 1993; 12: 343–7

    Article  PubMed  CAS  Google Scholar 

  15. Sandock DS, Gothe BG, Bodner DR. Trimethoprim-sulfamethoxazole prophylaxis against urinary tract infection in the chronic spinal cord injury patient. Paraplegia 1995; 33: 156–60

    Article  PubMed  CAS  Google Scholar 

  16. Gribble MJ, Puterman ML. Prophylaxis of urinary tract infection in persons with spinal cord injury. A prospective, randomized, double-blind, placebo-controlled study of trimethoprim-sulfamethoxazole. Am J Med 1993; 95: 141–52

    Article  PubMed  CAS  Google Scholar 

  17. Sheehan GJ, Harding GKM, Haase DA, et al. Double-blind, randomized comparison of 24 weeks of norfloxacin followed by 12 weeks of placebo in the therapy of complicated urinary tract infection. Antimicrob Agents Chemother 1988; 32: 1292–3

    Article  PubMed  CAS  Google Scholar 

  18. Jr Fowler JE. Antimicrobial therapy in the management of infected renal calculi. In: Mulholland SG, editor. Antibiotic therapy in urology. Philadelphia (PA): Lippencott-Raven, 1996: 165–86

    Google Scholar 

  19. Naber KG. Use of quinolones in urinary tract infections and prostatitis. Rev Infect Dis 1989; 11: S1321–37

    Article  PubMed  Google Scholar 

  20. Lerner SA, Price S, Kulkarni S. Microbiological studies of fosfomycin trometamol against urinary isolates in vitro. In: Williams N, editor. New Trends in Urinary Tract Infections International Symposium, Room 1987. Karger, Basel 1988: 121–9

    Google Scholar 

  21. Pinson AG, Philbrick JT, Lindbeck GH, et al. Oral antibiotic therapy for acute pyelonephritis: a methodologic review of the literature. J Gen Intern Med 1992; 7: 544–53

    Article  PubMed  CAS  Google Scholar 

  22. Bennett WM, Craven R. Urinary tract infections in patients with severe renal disease. Treatment with ampicillin and trimethoprim-sulfamethoxazole. JAMA 1976; 236: 946–8

    Article  PubMed  CAS  Google Scholar 

  23. Kunin CM, Craig WA, Uching DT. Trimethoprim therapy for urinary tract infection. Long-term prophylaxis in a uremic patient. JAMA 1978; 239: 2588–90

    Article  PubMed  CAS  Google Scholar 

  24. Craven R, Bennett W, Hartnett M, et al. Serum, urine and tissue antibiotic concentrations in patients with renal disease. Proc Am Soc Nephrol 76;8: 12

  25. Sullivan JW, Bucschen AJ, Schlegal JU. Nitrofurantoin, sulfamethoxazole and cephalexin urinary concentration in unequally functioning pyelonephritis kidneys. J Urol 1975; 114: 344–7

    Google Scholar 

  26. Sachs J, Geer T, Noell D, et al. Effect of renal function on urinary recovery of orally administered nitrofurantoin. N Engl J Med 1968; 278: 1032–5

    Article  PubMed  CAS  Google Scholar 

  27. Garibaldi RA, Burke JP, Dickman ML, et al. Factors predisposing to bacteriuria during indwelling urethral catheterization. N Engl J Med 1974; 291: 215–9

    Article  PubMed  CAS  Google Scholar 

  28. Hustinx WNM, Mintjes-de Groot AJ, Verkooyen RP, et al. Impact of concurrent antimicrobial therapy on catheter-associated urinary tract infection. J Hosp Infect 1991; 18: 45–56

    Article  PubMed  CAS  Google Scholar 

  29. Warren JW. Catheter-associated urinary tract infections. Infect Dis Clinics North Am 1987; 1: 823–54

    CAS  Google Scholar 

  30. Warren JW, Jr Muncie HL, Hall-Craggs M. Acute pyelonephritis associated with bacteriuria during long-term catheterization: a prospective clinicopathological study. J Infect Dis 1988; 158: 1341–6

    Article  PubMed  CAS  Google Scholar 

  31. Alling B, Brandberg A, Seeberg S, et al. Effect of consecutive antibacterial therapy on bacteriuria in hospitalized geriatric patients. Scand J Infect Dis 1975; 7: 201–7

    PubMed  CAS  Google Scholar 

  32. Warren JW, Anthony WC, Hoopes JM, et al. Cephalexin for susceptible bacteriuria in afebrile, long term catheterized patients. JAMA 1982; 248: 454–8

    Article  PubMed  CAS  Google Scholar 

  33. Stamm WE. Catheter-associated urinary tract infections: epidemiology, pathogenesis, and prevention. Am J Med 1991; 91Suppl. 3B: 65S–71S

    Article  PubMed  CAS  Google Scholar 

  34. Grahn D, Norman DC, White ML, et al. Validity of urinary catheter specimen for diagnosis of urinary tract infection in the elderly. Arch Intern Med 1985; 145: 1858–60

    Article  PubMed  CAS  Google Scholar 

  35. Bakke A, Digranes A. Bacteriuria in patients treated with clean intermittent catheterization. Scand J Infect Dis 1991; 23: 577–82

    Article  PubMed  CAS  Google Scholar 

  36. National Institute on Disability and Rehabilitation Research. The prevention and management of urinary tract infections among people with spinal cord injuries. Consensus Statement: January 27–29, 1992. J Am Paraplegia Soc 1992; 15: 194–204

    Google Scholar 

  37. Krieger JN, Rudd TG, Mayo ME. Current treatment of infection stones in high risk patients. J Urol 1984; 132: 874–7

    PubMed  CAS  Google Scholar 

  38. Michaels EK, Jr Fowler JE, Mariano M. Bacteriuria following extracorporeal shock wave lithotripsy of infection stones. J Urol 1988; 140: 254–6

    PubMed  CAS  Google Scholar 

  39. Chinn RH, Maskell R, Mead JA, et al. Renal stones and urinary infection: a study of antibiotic treatment. BMJ 1976; 2: 1411–3

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Internal Medicine, University of Manitoba, Health Sciences Centre, and St Boniface Hospital, Winnipeg, Manitoba, Canada

    Lindsay E. Nicolle

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  1. Lindsay E. Nicolle
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Correspondence to Lindsay E. Nicolle.

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Nicolle, L.E. A Practical Guide to the Management of Complicated Urinary Tract Infection. Drugs 53, 583–592 (1997). https://doi.org/10.2165/00003495-199753040-00004

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