Urinary Tract Infection

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Complicated UTI :

A complicated UTI is one that occurs because of anatomic,

functional or pharmacologic factors that predispose the patient to persistent infection recurrent infection or treatment failure. These factors include enlargement of the prostate gland, blockages and other problems necessitating the placement of indwelling
urinary devices, and the presence of bacteria that are resistant to multiple antibiotics.

Although antibiotic-susceptible E. coli is responsible for more than 80 percent

of uncomplicated UTIs, it accounts for fewer than one third of complicated cases. Clinically, the spectrum of complicated UTIs may range from cystitis to urosepsis with septic shock. Accurate urine culture and susceptibility information are necessary to best target and eradicate the pathogens in complicated UTIs. These infections are usually associated with high-count bacteriuria (greater than 100,000 CFU per mL of urine). Occasionally, lower quantitative counts may be encountered in patients who are undergoing diuresis or who are in renal failure.

The initial empiric therapy for these patients should include an agent with a broad spectrum of activity against the expected uropathogens. Treatment most often includes a fluoroquinolone, administered orally if possible. In patients who are unable to tolerate oral medication or who require hospitalization for concomitant medical problems, appropriate initial therapy may be parenteral administration of one of the following: a thirdgeneration cephalosporin with antipseudomonal activity such as ceftazidime or the combination of an antipse- udomonal penicillin (ticarcillin) with an aminoglycoside.

Patients with complicated UTIs require at least a 10- to 14 day course of therapy. Follow-up urine cultures should be performed within 10 to 14 days after treatment to ensure that the uropathogen has been eradicated. Patients initially placed on parenteral therapy can be switched to oral therapy within 72 hours as long as they are clinically improving and able to tolerate the oral agent, and a regimen is available that covers the identified pathogen(s).


Anatomic, functional, pharmacologic factors

1/3 due to E.Coli

Urine C/S - absolutely necessary

Empiric therapy: Fluoquinelone (oral)

IV therapy: 3rd generation cephalosporine with antipseudomonal activity e.g. Ceftazidime (or)

Ticarcilin with aminoglycoside (combincation)

10 to 14 day course of therapy

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dada 

for urinary problem which doctor shall I contact Medicine or Urologist

kkgrg 

I have UTI generally recurring. Last time I had around a years back and got treated with Ofloxacin for about 15 days. Today I am suffering for very frequent urination with sensation and unable to control. Kindly suggest some medicine.

lovetoread 

First UTI in over 10 yrs. Unfortunately I've had over a month of UTI symptoms. The first two urine specimens were [ ] for blood, WBC, and bacteria but were NEVER cultured. I went through two different rounds of antibiotics. Symptoms still there. My doctors were saying obviously it isn't an UTI, that it must be stress or something else. We'll finally after suffering a month, the next urine sample WAS cultured and it came back I have coagulase negative staph. And get this, the bacteria is resistant to most antibiotics, including penicillin, Levaquin, Sulfa, and Cipro. I'm not so sure not culturing a positive urine sample is such a great idea. I know I have greatly suffered. I'm now on macrobid and hoping this will take care of it.

Anglkitty77 

I have a recalled bladder sling and I have been having recurring UTI synptoms. Nitrites and leukocytes are always present, but cultures grow nothing. I am at a loss and so is my Dr. I am seeing a specialist at Vanderbilt and he is removing the sling in a couple of weeks. Anyone else have this issue?

edouartawil 

i have found that UTIs with no symptoms should not be treated especially if they have ESBL or KPC.
A well known case ESBL to me I stoped treating her with antibiotics works now well for more than 8 months

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