From the Guidelines
Complicated urinary tract infections (UTIs) are characterized by symptoms such as fever, flank pain, nausea, vomiting, and altered mental status, in addition to typical UTI symptoms like frequent urination, burning sensation, and cloudy urine, and require prompt medical attention with empiric broad-spectrum antibiotics and management of underlying conditions. The symptoms of a complicated UTI can vary depending on the underlying condition, but common symptoms include:
- Fever
- Flank pain
- Nausea
- Vomiting
- Altered mental status
- Frequent urination
- Burning sensation while urinating
- Cloudy urine According to the most recent study 1, complicated UTIs can be effectively treated with short-course antibiotics, with a duration of 7-14 days, depending on the severity of the infection. The European Association of Urology guidelines 1 recommend using a combination of antibiotics, such as amoxicillin plus an aminoglycoside, or a second-generation cephalosporin plus an aminoglycoside, for the treatment of complicated UTIs. It is essential to address underlying conditions, such as removing obstructions, managing diabetes, or replacing indwelling catheters, to prevent recurrence and reduce the risk of serious complications like sepsis. Adequate hydration and follow-up urine cultures after treatment completion are also crucial to confirm resolution of the infection. The ACR Appropriateness Criteria 1 highlight the importance of considering the patient's underlying medical conditions and risk factors when diagnosing and treating complicated UTIs.
From the FDA Drug Label
CLINICAL STUDIES Complicated Urinary Tract Infection and Pyelonephritis – Efficacy in Pediatric Patients The FDA drug label does not answer the question.
From the Research
Characteristics of Complicated UTI
- A complicated UTI may involve the lower or upper urinary tract and can be more complex to diagnose compared to uncomplicated UTI 2
- The presence of pyuria is usually a sign of UTI, regardless of location, and its absence may suggest another condition is causing the symptoms 2
- Symptoms of cystitis include dysuria, frequency, and/or urgency without fever, while pyelonephritis is usually manifested by fever and back pain/costovertebral angle tenderness 2, 3
Treatment Options for Complicated UTI
- Treatment of complicated UTI is often more complex due to antimicrobial resistance, which can limit treatment choices 2
- Third-generation cephalosporins are preferred for management of pyelonephritis 3
- Hospitalization and intravenous antibiotics are indicated for pregnant patients with pyelonephritis 3
- Early diagnosis and appropriate therapy with antibiotics are crucial for preventing complicated UTI conditions such as urosepsis 4
Risk Factors and Complications
- Recurrent UTIs are common, occurring in 20% to 30% of women, and can increase the risk of complicated UTI 3
- Significant complications of pyelonephritis include sepsis or septic shock, obstructive pyelonephritis, emphysematous pyelonephritis, perinephric abscess, and kidney transplant rejection 3
- Diagnostic failures and delay in treatment can contribute to improper use of antibiotics and low survival rate in septic conditions 4