Overview of Urinary Tract Infections


Kim Leuthner, PharmD, FIDSA, provides insight on distinguishing between complicated and uncomplicated UTIs, and patients who are at high risk for developing complicated UTIs.

Kim Leuthner, PharmD, FIDSA: What’s the difference between a complicated and an uncomplicated urinary tract infection [UTIs]? Unfortunately, complicated gets complicated, pardon the pun. You’ve got devices, surgical involvement, things that are abnormal from the human anatomy that result in a higher risk of complications and bacterial infection, which are more difficult to treat vs antibiotics. It can make it a bigger host, a bigger pathogen breeding ground—for lack of better terms—resulting in more difficult therapies needed for these patients.

Which patients are at high risk for developing complicated UTIs? There are a wide variety. On 1 side are male patients, who have complications because their anatomy is unique compared with female patients. They often have their own problems involving the prostate. On the opposite extreme, some transplant patients don’t have a typical kidney function and have bladder abnormalities due to the surgery. Patients who’ve had stents put in, who have drains because of hydronephrosis, bladder stones, or kidney stones, can make the source of bacteria difficult to eradicate.

How do you distinguish asymptomatic bacteria vs a complicated UTI and the importance of distinguishing the 2? It’s important because you don’t need to treat most patients with asymptomatic bacteria. Unfortunately, some forget that the urine and bladder aren’t sterile site and can be a home for a lot of bacteria that live there and enjoy the warm environment. Unfortunately, patients who have complicated devices have an opportunity for normal pathogens to move in and have a place to hide from the immune system and cause actual infections. The biggest difference is the presence or absence of symptoms. Most patients who have a complicated UTI have systemic symptoms, such as white blood cell count, fever, aches, chills, and back pain. They may have hesitancy or burning because of other issues that override those, but for asymptomatic patients, the only real presence you have is the bacteria in the urine.

Transcript Edited for Clarity

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