From the Guidelines
Complicated Urinary Tract Infections (UTIs) are diagnosed based on the presence of specific factors, including obstruction, foreign bodies, incomplete voiding, vesicoureteral reflux, recent instrumentation, and underlying conditions such as diabetes, immunosuppression, and pregnancy, as outlined in the 2024 European Association of Urology guidelines 1. The diagnostic criteria for Complicated UTI include:
- Obstruction at any site in the urinary tract
- Urinary tract infection in males
- Presence of a foreign body
- Incomplete voiding
- Vesicoureteral reflux
- Recent history of instrumentation
- Underlying conditions such as:
- Diabetes mellitus
- Immunosuppression
- Pregnancy
- Health care–associated infections
- Multidrug-resistant organisms isolated These factors increase the likelihood of treatment failure or serious complications, and the presence of unusual or resistant pathogens, such as ESBL-producing organisms, also indicates a complicated UTI 1. The microbial spectrum of complicated UTIs is greater than that of uncomplicated UTIs, with common species including E. coli, Proteus spp., Klebsiella spp., Pseudomonas spp., Serratia spp., and Enterococcus spp. 1. Appropriate management of the underlying abnormality or complicating factor is mandatory, and optimal antimicrobial therapy depends on the severity of the illness, local resistance patterns, and specific host factors, such as allergies 1. A urine culture and susceptibility testing should be performed, and initial empiric therapy should be tailored and followed by administration of an appropriate antimicrobial agent for the uropathogen isolated 1.
From the Research
Diagnostic Criteria for Complicated Urinary Tract Infection (UTI)
The diagnostic criteria for Complicated UTI are not explicitly defined in the provided studies. However, the following points can be considered:
- A complicated UTI is associated with an underlying condition that increases the risk of failing therapy 2
- Complicated UTIs are a heterogeneous group associated with conditions that increase the risk of acquiring infection or treatment failure 3
- Diagnosis is especially challenging in the elderly and in patients with in-dwelling catheters 3
Key Considerations
Some key considerations for diagnosing Complicated UTI include:
- Clinical presentation helps differentiate between upper and lower urinary tract infections (UTIs) 2
- Primary laboratory tests for UTIs consist of urinalysis and urine culture 2
- The increasing prevalence of resistant uropathogens further compromises treatment of both complicated and uncomplicated UTIs 3
Challenges in Diagnosis
The diagnosis of Complicated UTI can be challenging due to: