From the Guidelines
A complicated Urinary Tract Infection (UTI) in women is defined by the presence of underlying structural or medical problems, such as anatomical abnormalities, functional abnormalities, or comorbidities like diabetes or immunosuppression 1.
Key Factors
- Anatomical abnormalities: include conditions like cystoceles, bladder or urethral diverticula, fistulae, indwelling catheters, urinary tract obstruction 1
- Functional abnormalities: include voiding dysfunction, neurogenic bladder 1
- Comorbidities: include diabetes, immunosuppression, pregnancy 1
- Systemic symptoms: such as fever, flank pain, or costovertebral angle tenderness 1
Clinical Definitions
The clinical definitions of complicated UTIs may vary, but they typically involve factors that increase the risk of infection or treatment failure, such as catheters, foreign bodies, or systemic symptoms 1.
Diagnosis and Management
The diagnosis and management of complicated UTIs may require imaging studies, such as CT or MRI, to detect underlying abnormalities or to monitor the progress of treatment 1.
Imaging Recommendations
Imaging is usually not appropriate for recurrent uncomplicated lower UTIs, but it may be considered for recurrent complicated UTIs or for patients who do not respond to conventional therapy 1.
From the Research
Definition of Complicated Urinary Tract Infection (UTI)
A complicated UTI is defined as an infection that occurs in a patient with a structural or functional abnormality impeding urine flow, or in a host with altered defences 2. This definition is supported by other studies, which state that a complicated UTI is associated with an underlying condition that increases the risk of failing therapy 3, and that it occurs in a patient with an anatomically abnormal urinary tract or significant medical or surgical comorbidities 4.
Characteristics of Complicated UTI
The following characteristics are commonly associated with complicated UTIs:
- Presence of structural or functional abnormalities in the urinary tract 2
- Altered defences in the host 2
- Underlying medical or surgical comorbidities 4
- Increased risk of failing therapy 3
- Higher likelihood of antimicrobial resistance 5
Distinction from Uncomplicated UTI
The distinction between complicated and uncomplicated UTIs is important, as complicating factors can lead to: