Urinary tract infections - Summary of diagnostic and treatment options

Urinary tract infection (UTI) can take one of several forms, including asym ptomatic bacteriuria, cystitis and pyelonephritis. It can lead to local com plications including abscess formation and through bacteraemia to metastati c infection and sepsis syndrome. This is defined as the presence of local s ymptoms with systemic inflammation and is more common in the elderly and th e diabetic and immunosuppressed patient. It is an important aspect of the w ider problem of nosocomial infection. Complicated UTI is defined as acute o r chronic infection usually involving the renal parenchyma and associated w ith functional or structural urinary tract abnormality. The predominant mic ro-organism in UTI is Escherichia coli but in hospital acquired and complic ated infection the spectrum will include Pseudomonas aeruginosa, Enterococc us spp. and Staphylococcus spp. including Staphylococcus saprophyticus. Unc omplicated UTI includes cystitis and pyelonephritis. Both can recur or rela pse through failure of primary therapy. This is more likely in the setting of complicated UTI. The predominant organism is again E. coli. Treatment of UTI includes trimethoprim/sulphamethoxazole (TMP/SMX), cephalosporins, ami nopenicillins, nitrofurantoin and fluoroquinolones. TMP/SMX and fluoroquino lones should not be administered to pregnant women or nursing mothers. The choice of antibiotic should reflect local resistance patterns in the hospit al or community. Urosepsis should be avoidable by limiting risk factors, e. g. hospitalisation, use of catheters and stents in susceptible individuals.