Frank Hematuria in Klebsiella aerogenes UTI
Klebsiella aerogenes UTI does not typically cause frank (macroscopic) hematuria as a usual or characteristic presentation. While hematuria can occur with UTIs, it is listed as a general symptom rather than a defining feature of Klebsiella species infections specifically.
Clinical Presentation of Klebsiella aerogenes UTI
Typical symptoms of UTI caused by Klebsiella species mirror those of other bacterial UTIs and include:
- Dysuria (painful urination) 1
- Increased urinary frequency 1
- Urinary urgency 1
- Suprapubic discomfort 1
- Cloudy urine or changes in urine characteristics 1
Hematuria, when present, is more commonly microscopic rather than frank (visible) blood in the urine 1. The American College of Radiology guidelines note that hematuria is particularly associated with upper UTI/pyelonephritis rather than simple cystitis 1.
Klebsiella aerogenes as a Uropathogen
Klebsiella aerogenes (formerly Enterobacter aerogenes) is recognized as:
- A common pathogen in complicated UTIs, particularly in healthcare-associated infections 2
- An opportunistic nosocomial pathogen that commonly causes urinary tract infections 3
- Most frequently associated with catheter-related infections and long-stay hospital patients 4, 5
- A cause of UTI in patients with underlying conditions such as diabetes, immunosuppression, or chronic kidney disease 2, 6
When to Suspect Complicated Infection
Frank hematuria after infection resolution is actually listed as a risk factor suggesting a complicated UTI that warrants further investigation 2. If gross hematuria persists or appears, consider:
- Underlying structural abnormalities (stones, diverticula, obstruction) 2
- Upper tract involvement (pyelonephritis) 1
- Catheter-associated trauma or infection 2
- Concurrent conditions requiring imaging evaluation 2
Clinical Implications
The presence of frank hematuria with a Klebsiella aerogenes UTI should prompt evaluation for:
- Complicated infection requiring extended treatment (7-14 days rather than standard short-course therapy) 2
- Structural urinary tract abnormalities that may require imaging 2
- Multidrug resistance, as K. aerogenes frequently exhibits extensive antibiotic resistance requiring carbapenem or polymyxin therapy 7
In summary: Frank hematuria is not a usual or expected finding with Klebsiella aerogenes UTI and should raise suspicion for complicated infection, upper tract involvement, or underlying structural pathology requiring further evaluation.