Clinical Profile and Outcome in Patients of Complicated Urinary Tract Infections

Abstract

Background Complicated urinary tract infection (cUTI) is the one which is associated with structural and functional abnormalities of the urinary tract, thus increasing the risk of infection and failure of therapy. Aim: This study aims to determine the risk factors, changing trends in etiology, current treatment options, and outcomes in cUTI. Materials and Methods: This prospective observational study was done on patients presenting with cUTI. Hematological, biochemical workup, urine routine, urine culture, blood culture, ultrasonography, and wherever necessary computerized tomography of the genitourinary tract was done. The medical/surgical interventions and outcomes in these patients were recorded. Results: A total of 100 patients were enrolled in the study. Diabetes mellitus was the most common risk factor present in 53%. The most common organism isolated in urine culture was Escherichia coli (48%) followed by Klebsiella pneumoniae (19%) and similar trend but lesser positive yield was there in blood culture ( Escherichia coli - 26% followed by Klebsiella pneumoniae - 3%). The organisms were most susceptible to colistin/polymyxin (100%) followed by carbapenems (88%), and later were the most commonly used empirical antibiotics in our study, yielding 95% survival rate. Surgical interventions (percutaneous/endourological) were required in 28%, renal replacement therapy in 14%, intensive care in 40% and mechanical ventilation in 10%, with 4% overall mortality at the end of 1-month follow-up. The mean duration of hospital stay was 9.1 ± 2.7 days. Conclusion Escherichia coli was the most common organism causing cUTI, with diabetes being the most common risk factor. Most of the patients were treated with carbapenems with excellent survival outcomes.

The Essential Role of PCR and PCR Panel Size in Comparison with Urine Culture in Identification of Polymicrobial and Fastidious Organisms in Patients with Complicated Urinary Tract Infections

“…This showed that overall, PCR was 274.2% more effective than UC, detecting 90.2% of potential pathogens detected by UC whereas UC identified 31.9% of potential pathogens discovered by PCR. Concordance analysis found that E. coli and E. faecalis were the top two most frequently detected organisms by both UC and PCR, which is consistent with prior reports [ 29 , 30 , 31 ], accounting for 57.9% and 34.6% of organisms detected, respectively. For E. coli and E. faecalis , PCR was 134.0% and 242.9% more sensitive than UC.…”

Clinical characteristics and nomogram model for predicting the risk of recurrence of complicated urinary tract infection in pediatric patients

“…Anatomical structural abnormalities of the urinary tract can easily lead to urinary tract infections in both males and females. This study showed that cUTI in children was more common in boys, with a male to female ratio of 1.54:1, which might be related to the prevalence of obstructive urinary tract diseases in males [7]. Although it was shown that boys without circumcision had a high incidence rate in the rst year after birth, girls with the increase of age were more likely to suffer from urinary tract infection due to the anatomical structure of the urinary tract [14].…”

“…About 30% the pediatric patients with UTI experienced recurrent infections 6 to 12 months after their initial UTI [4][5][6]. Complicated urinary tract infections (cUTI) often occur in patients with structural or functional abnormalities of the genitourinary tract [7,8]. More than half of UTI patients have urinary tract abnormalities detected by ultrasound [9].…”

Plazomicin—a New Aminoglycoside—for Treating Complicated Urinary Tract Infections

“…Escherichia coli is the most common bacteria that causes cUTIs. However, Citrobacter, Enterobacter, Pseudomonas, Staphylococcus aureus, and others are isolated more often (6-20%) in cUTIs than in uncomplicated UTIs (10). AGs are broad spectrum bactericidal antibiotics used to treat nosocomial respiratory tract infections and cUTIs (3).…”