Monitoring
Acute Uncomplicated Cystitis
Routine post-treatment urinalysis or urine culture is not indicated in asymptomatic patients. Urine culture and antimicrobial susceptibility testing are indicated in patients who remain symptomatic after completion of treatment or if the patient has a recurrence of symptoms within 2 weeks. Retreatment with another agent for 7 days should be considered. The antimicrobial agent must be changed empirically pending the result of post-treatment urine culture and sensitivity testing in patients showing poor response to therapy.
Acute Uncomplicated Pyelonephritis
After improvement, which is usually apparent within 48-72 hours, switch parenteral antibiotics to an oral regimen to complete a 1- to 2-week course of therapy. Post-treatment urinalysis or urine cultures are not needed in patients who respond and remain asymptomatic. Radiologic (eg renal ultrasound, CT, or renal scintigraphy) and urologic evaluation and repeat urine culture/susceptibility testing are indicated in patients who remain febrile after 72 hours of treatment or if the patient has a recurrence of symptoms within 2 weeks. Alternative tailored treatment should be considered in the absence of urological abnormalities. Rule out possible complications (eg nephrolithiasis, renal or perirenal abscess) in patients who relapse with the same pathogen.
Complications
Complicated urinary tract infection (UTI) is an infection in patients with functional or structural urinary tract abnormalities or with underlying disease that interferes with host defense mechanisms that increases the risk of acquiring infection or of failing therapy.
Complicated UTIs should be considered in patients with obstruction, such as ureteric or urethral strictures, tumors, urolithiasis, prostatic hypertrophy, diverticula, pelvicaliceal obstruction, and renal cysts. This should also be considered in patients with instrumentation, including indwelling catheters, intermittent catheterization, ureteric stents, nephrostomy tubes, and those who have undergone urological procedures. Other risk factors include impaired voiding, such as neurogenic bladder, vesicoureteral reflux, and ileal conduit; metabolic abnormalities, including nephrocalcinosis, medullary sponge kidney, and renal failure; and postvoid residual urine >100 mL. Peri- and postoperative UTI, male sex, immunodeficiency such as renal transplant or diabetes mellitus (DM), and pregnancy are also factors that warrant consideration of a complicated UTI.
Please see Urinary Tract Infection - Complicated and Urinary Tract Infection in Women - Complicated disease management charts for further information.