Introduction
Urinary tract infections (UTIs) are the most common cause of sepsis. Some are simple UTIs that can be treated with antibiotics and carry a hopeful clinical course with good progress. A urinary tract infection (UTI) is an infection present in the urinary system. The urinary system comprises a pair of kidneys, ureters, a bladder, and the urethra. Most infections affect the lower urinary tract system which includes the bladder and the urethra. Women are at a remarkable risk of developing a UTI more than men. Serious health hazards can result if a UTI spreads to the kidneys.
What Are the Symtpoms of Urinary Tract Infections?
The symptoms of UTI include the following:
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A strong urge to urinate that does not subside.
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A burning sensation when urinating.
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Urinating often, and passing a little amount of urine from time to time.
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Cloudy urine.
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Urine that looks red indicates signs of blood in the urine.
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Foul-smelling urine.
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Pelvic pain in women especially in the center of the pelvis and around the area of the pelvic bone.
What Are Complicated Urinary Tract Infections?
Simple UTIs can be managed with antibiotics and lead to good results. However, complicated urinary tract infections can cause florid urosepsis, which can be lethal. Several risk factors that can complicate urinary tract infections can lead to recurrent infections, treatment failure, or significant morbidity and mortality. It is very important to differentiate if the patient's infection may be due to one of these risk factors or if the episode is likely to resolve with first-line antibiotics.
Complicated urinary tract infections are infections that present with greater morbidity, carry a higher risk of treatment failure, and typically require a longer antibiotic course. These include urinary tract infections occurring in males, in pregnant females (including asymptomatic bacteriuria), as a result of hydronephrosis, obstruction, renal tract calculi, or colovesical fistula, in immunocompromised patients or the elderly, due to atypical organisms, after instrumentation, involve urinary catheters, in renal transplant patients, in patients with impaired renal function, after prostatectomy or radiotherapy. Additionally, urinary tract infections that recur despite taking treatment are considered complicated UTIs.
A simple UTI is an infection of the urinary tract due to susceptible bacteria. Generally, this is an infection in an afebrile non-pregnant immune-competent female patient. Pyuria with or without bacteriuria without any symptoms is not a UTI and may not need treatment. A complicated UTI is a type of infection different from a simple UTI. Therefore, all urinary tract infections in males, immunocompromised patients, and those associated with stones, fever, sepsis, urinary obstruction, catheters, or affecting the kidneys are considered complicated infections.
The female urinary tract has a comparatively short urethra and, thus, carries an innate predilection to the proximal seeding of bacteria. This anatomy raises the commonness of infections. Even recurrent urinary tract infections are considered simple UTIs, provided there is an immediate response to first-line antibiotics without any long-term sequela.
Any urinary tract infection that does not fit in the above explanation is supposed to be a complicated UTI. The reason for the difference is that complicated UTIs have a broader spectrum of bacteria as an etiology and have a significantly higher risk of clinical complications. The presence of urinary tract calculi and catheters is likely to increase the chance of recurrences compared to patients without bacterial colonization
What Are Examples of Complicated Urinary Tract Infections?
Examples of a complicated UTI include:
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Infections that arise due to anatomical abnormalities, for example, hydronephrosis, obstruction, renal tract calculi, or colovesical fistula.
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Infections that arise despite the presence of anatomical protective measures (UTIs in males are by considered complicated UTIs).
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Infections that arise due to an immune-compromised state, for example, post-chemotherapy, steroid use, diabetes, elderly population, and HIV).
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Atypical microorganisms resulting in UTI.
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Urinary tract infections in renal transplant and spinal cord injury patients.
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Infections in patients with impaired kidney function, dialysis, or anuria.
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Infections following surgical prostatectomies or radiotherapy.
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Recurrent infections despite sufficient treatment (multidrug-resistant organisms).
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Infections happening in pregnancy (including asymptomatic bacteriuria).
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Infections arise after instrumentation, such as placing or replacement of nephrostomy tubes, ureteric stents, suprapubic tubes, or Foley catheters.
How to Treat Complicated Urinary Tract Infections?
Patients with septic shock may not respond to fluid resuscitation alone, and there should be a low threshold to evaluate vasopressor support in poor initial response to fluids. However, nonseptic stable patients may be treated with outpatient antibiotics.
Broad-spectrum antibiotics should always be changed to a targeted narrow-spectrum antibiotic, if feasible, once culture results are available. Initial broad-spectrum choices can be beta-lactams, penicillins, cephalosporins, fluoroquinolones, and carbapenems (especially if dealing with an extended-spectrum beta-lactamases (ESBL) organism). The specific option will depend on the individual microbiological spectrum and antibiogram.
Patients who present with recurrent infections may also be initially treated as per their earlier urine culture results until new cultures are available. Imaging to examine for a source of infection such as an abscess or stone should be done with relapsing infections that involve the same organisms. Patients who illustrated initially with hematuria should be checked for urinary blood again after the infection has been successfully treated.
Treatment response should be apparent in 24 to 48 hours in most cases. A poor response may indicate an improper antibiotic selection, polymicrobial infections, atypical infections, hydronephrosis, obstructing stone causing pyonephrosis, complications such as a perinephric abscess or emphysematous UTI, fluid collections such as urinary retention or anatomical lesions leading to poor response (nephrocalcinosis acting like an infective nidus, obstructive urinary tract lesions, urinary calculi, or fistulas). A temporary Foley catheter, to guarantee bladder drainage, is usually suggested for these patients if they are septic and especially if they have increased post-void residual volumes.
The period of antibiotic therapy in complicated UTIs is typically 10 to 14 days. While any UTI in a male is considered a "complicated UTI," they are treated as unambiguous lower urinary tract infection in an otherwise healthy human with no known bladder dysfunction.
Conclusion
Complicated urinary tract infections (UTIs) happen in the environment of pre-existing functional, metabolic, or structural abnormalities of the urinary tract. They may affect both lower and upper urinary tracts. Complicated UTIs may enormously increase the rate of therapy failures and cause damage that leads to recurrence. Structural abnormalities, such as infected cysts, renal or bladder abscesses, renal calculus, certain forms of pyelonephritis, spinal cord injury (SCI), and catheters are responsible for complicated urinary tract infections.
