urinary tract infection (UTI)
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Introduction
An infection in the urinary tract caused by the invasion of pathogenic micro-organisms, which proceed to establish themselves, multiply, & produce various symptoms in their host.
Classification
- uncomplicated:
- cystitis or pyelonephritis in non-pregnant women without structural or neurologic disorder or comorbidities[15]
- age alone does not define complicated vs uncomplicated UTI
- complicated:
- all orther cases
- includes men, urinary calculi, urinary catheter, recent antibiotics, urinary obstruction or cause of urinary retention, immunosuppression, kidney disease[15]
- all orther cases
Etiology
- colonic bacteria ascend through the urethra
- short length & positioning of urethra makes females more susceptible to UTIs & pyelonephritis than men
- urinary obstruction, especially prostatic hypertrophy predisposes men to UTIs
- etiologic agents
- risk factors
- female sex (especially if sexually active)
- diabetes
- pregnancy
- spermicide use in women
- urinary tract instrumentation
- neurogenic bladder[15]
- risk factors for infection with multidrug-resistant organism
- current or recent hospitalization
- immunodeficiency
- underlying urinary tract structural anomaly
- previous urinary tract infection
- renal transplantation
- recent antimicrobial therapy[15]
- 9 pathogens account for 90% of all urinary tract infections in nursing homes[62]
- Escherichia coli (41%)
- fluoroquinolone (50%) & extended-spectrum cephalosporin resistance [20%)
- Proteus (14%),Klebsiella pneumoniae/oxytoca (13%)
- Pseudomonas aeruginosa (11%) multidrug resistance most common
- Staphylococcus aureus (67% MRSA)
- Enterococcus faecium (60% vancomycin-resistant)[62]
- Escherichia coli (41%)
* inadequate data linking multidrug-resistant uropathogenic E coli to beef or other animal sources of food[9]
Epidemiology
- in neonates the female/male ratio is < 1
- in children, the female/male ratio is > 1
- 30% of women will have a UTI by age 24 years[15]
- in adults, UTIs are largely a disease of sexually-active women
- the female/male ratio is 2:1 after age 60
- UTIs are the most common bacterial infection in elderly
- UTIs are a common source of sepsis
Pathology
- toll like receptor 11 involved with clearance of uropathogenic bacteria in mice[8]
Clinical manifestations
- lower urinary tract infection (also see cystitis & urethritis)
- dysuria
- urinary frequency
- nocturia
- suprapubic pain/tenderness
- hematuria
- malodorous & cloudy urine*[21]
- urinary urgency
- urinary incontinence
- dyspareunia (premenopausal women)[67]
- upper urinary tract infection (also see pyelonephritis)
- fever/chills
- nausea/vomiting
- back or flank pain (costovertebral angle tenderness)
- symptoms of cystitis
- tachypnea
- tachycardia
- altered mental status (elderly)
- in the elderly, atypical presentations are common
- in institutionalized elderly, dysuria alone or fever plus
- urinary frequency, urinary urgency, flank pain, suprapubic pain, gross hematuria, rigors, or new onset urinary incontinence[25]
- in patients with Parkinson's disease, multiple sclerosis or previous stroke, deterioration of preexisting neurological deficits may occur[30]
* children
Diagnostic criteria
- any 2 of: fever, urinary frequency, urinary urgency, acute dysuria, suprapubic pain/tenderness, costovertebral angle tenderness
- a positive urine culture >= 100,000 CFU/mL confirms diagnosis[35]
Laboratory
- biochemical screening tests (urine dipstick)*
- glucose oxidase
- catalase
- nitrite reductase
- leukocyte esterase
- presence of both nitrite & leukocyte esterase is highly predictive of urinary tract infection[15]
- urinalysis
- clean-catch or in & out catheterization prior to antibiotic therapy
- for patient < 2 years of age, either urethral catheterization or suprapubic aspiration[18]
- reserve urethral catheterization for children with a positive dipstick screen from bagged urine[44]
- > 10 WBC/mL in fresh unspun urine (pyuria)
- spun urine specimen with >5 WBC/high-power field
- gram stain: >1 bacteria/hpf (oil) in unspun urine, or >10 bacteria/hpf (oil) in centrifuged urine correlates with: >10E5 colony forming units per mL on culture
- RBC (non-specific)
- WBC casts suggest pyelonephritis
- urine culture
- not needed for uncomplicated urinary tract infection because results rarely affect management[15]
- pyuria with asymptomatic bacteriuria is not an indication for urine culture[15]
- indications
- elderly, men
- an unusual or antimicrobial-resistant organism is suspected (in a patient recently infected with a non E coli organism or who recently received antimicrobial therapy)
- pregnancy (obtain after empiric treatment)
- relapse or treatment failure[15]
- children[45]; 13% without pyruria or leukocyte esterase +
- > 10E6 colonies/mL indicates significant infection
- pyuria with negative culture suggests infection by:
- Chlamydia
- Neisseria gonorrhoeae
- tuberculosis
- send urine for acid-fast bacilli stain & culture[13]
- presence of multiple organisms suggests contamination
- blood cultures in toxic or elderly patients with signs of pyelonephritis
- neither urine dipstick testing for leukocyte esterase nor urine culture enhances diagnostic sensitivity[34]
- complete blood count
- basic chemistry panel
* consideration of clinical hydration status, withholding diuretics &/or psychotropics, & a period of observation is recommended prior to urine dipstick testing in institutionalized elderly women with altered perception, disorganized speech, & lethargy[35]
Diagnostic procedures
- voiding cystourethrogram (VCUG)
- not routinely indicated after 1st febrile UTI
- indicated if renal & bladder ultrasonography reveals hydronephrosis, scarring, or other findings that would suggest either high-grade vesicoureteral reflux or obstructive uropathy[22]
- indicated for recurrent UTI in children[18]
Radiology
- routine imaging not indicated[15]
- renal & bladder ultrasound*
- abdominal radiograph* (KUB)
- intravenous pyelogram
* initial tests in men[6]
Differential diagnosis
- lower urinary tract infection (cystitis)
- urethritis
- vaginitis
- genital Herpes
- chemical irritation from:
- feminine hygiene products
- contraceptive agents
- prostatitis - most likely cause of urosepsis in men[15]
- epididymitis
- torsion of testes
- see pyelonephritis
- asymptomatic bacteriuria & asymptomatic candiduria (generally do not need treatment)
- antibiotic stewardship considerations in nursing home residents[61]
Management
- pyuria with asymptomatic bacteriuria is not considered an infection & is not an indication for antibiotic treatment[15]
acute uncomplicated bacterial lower UTI
- acute uncomplicated bacterial lower UTI in women*
- does not always require culture (see above)
- 3-5 days of oral antibiotics as outpatient*
- 3 days adequate treatment for women > 65 years*[7]
- 3 days for Bactrim, 5 days for nitrofurantoin[13][34]
- fluoroquinolone & fosfomycin are alternatives[15][34]
- ciprofloxacin clearly superior to cefpodoxime[20]
- gepotidacin 1500 mg PO BID for 5 days
- fosfomycin (single dose) if compliance an issue
- if pregnant
- empiric treatment for 3-7 days with amoxicillin clavulanate or cephalosporin
- nitrofurantoin associated with birth defects[15]
- fluoroquinolones are toxic to developing cartilage
- single dose of fosfomycin is acceptable[15]
- obtain follow-up urine cultures after completion of treatment[15]
- empiric treatment for 3-7 days with amoxicillin clavulanate or cephalosporin
- may be diagnosed & treated without office visit[34]
- no known anatomic urinary tract abnormalities
- no recent urinary tract instrumentation
- no recent systemic illness
- absence of vaginal discharge
- 2 of 3 symptoms: dysuria, urgency, or frequency
- NSAIDs inferior to antibiotics for treatment of UTI
- diclofenac significantly lowers antibiotic use but is inferior to norfloxacin for symptom resolution in women with uncomplicated UTI[51]
- ibuprofen is inferior to pivmecillinam for treating uncomplicated UTIs in women[53]
- acute uncomplicated bacterial lower UTI in men
- 7-14 days of oral antibiotics[24][34]
- no clinical benefit for treatment > 7 days[60]
- children:
- early antibiotic treatment may prevent renal scars[31][48]
- 3 days of IV antibiotics appears adequate in infants < 60 days of age[50]
complicated bacterial UTI
- 14 days of antibiotic therapy
- factors designating UTI as complicated
- age > 65 years* (may NOT indicate complicated UTI)[7]
- indwelling catheter
- replacing indwelling catheter does not improve outcomes[55]
- recent genitourinary instrumentation
- diabetes mellitus
- renal transplantation
- neutropenia
- recent antibiotic therapy
- recurrent UTI
- pregnancy
- glucocorticoid therapy
- immunocompromised host
- structural or functional urinary tract impairment
empiric oral antibiotics
- trimethoprim-sulfamethoxazole 160/800 mg (Bactrim DS, Septra DS) every 12 hours for 3 days (1st line)[11][19]
- trimethoprim 200 mg every 12 hours
- nitrofurantoin; first line all women[11]
- contraindicated in 3rd trimester of pregnancy near term (38-42 weeks gestation)[15]
- does not achieve tissue levels sufficent for treatment of pyelonephritis[15]
- may be less effective in patients with renal insufficiency
- less effective than ciprofloxacin for treatment of cystitis in elderly women regardless of renal function[42]
- despite this, MKSAP17 recommends nitrofurantoin to treat cystitis in elderly women[15][42]
- may not be a good choice for the elderly
- Macrodantin (Pediatrics): 5-7 mg/kg/day every 6 hours (1st line)[11]
- sustained-release nitrofurantoin (MacroBid)
- 3-7 days of therapy
- 5 days of nitrofurantoin results in greater likelihood of clinical & microbiological cure of uncomplicated UTI in women > 18 years of age than single dose fosfomycin[52]
- doxycycline 100 mg every 12 hours day 1, then 100-200 mg QD
- fluoroquinolone
- agent of choice in complicated UTIs
- norfloxacin (Noroxin) 400 mg every 12 hours
- ciprofloxacin* (Cipro) 500-750 mg every 12 hours
- levofloxacin
- risk factors for fluoroquinolone resistance
- fluoroquinolone use during the preceding 6 months
- use of a urinary catheter
- recent hospitalization[16]
- sulfisoxazole 120-150 mg/kg/day every 6 hours
- amoxicillin clavulanate (Augmentin) 250-500 mg PO every 6 hours
- cephalexin (Keflex) 250-500 mg PO every 6 hours
- ampicillin 250-500 mg PO every 6 hours
- fosfomycin: single dose for uncomplicated UTI due to multidrug-resistant gram negative bacteria[40]
* superior to Bactrim for empiric treatment of urinary tract infection in elderly women[5] & superior to Augmentin in younger women[10]
* serious side effects generally outweigh the benefits[43]
empiric intravenous antibiotics
- cefepime for urosepsis in men[15]
- ticarcillin clavulanate (Timentin) 3.1 g every 4-6 hours
- piperacillin tazobactam vs meropenem vaborbactam for complicated urinary tract infection
- carbapenem for extended-spectrum beta-lactamase producing organism (even if antibiotic susceptibility shows sensitivity to Zosyn)
- amoxicillin clavulanate 1.5-3.0 g every 6 hours
- cefazolin (Ancef, Kefzol) 0.25-1.5 g every 6 hours
- cephalothin (Keflin) 0.5 g every 6 hours - 2.0 g every 4 hours
- ceftazidime (Fortaz) 1-2 g every 6-12 hours
- ceftriaxone (Rocephin) 1-2 g every 12-24 hours
- gentamicin 3-5 mg/kg/day divided every 8 hours
UTI during pregnancy
- quinolones cannot be used during pregnancy
- sulfonamides & nitrofurantion cannot be used close to delivery[15]
- amoxicillin in 3rd trimester[15]
- cephalosporin such as cephalexin (Keflex) 250-500 mg every 6 hours
- 3-7 days of therapy
UTI during lactation
- cephalosporin such as cephalexin (Keflex) 250-500 mg every 6 hours
- if infant is > 1 month, nitrofurantoin may be used
- continue breast feeding
UTI in elderly
- 3-5 days of therapy for women (cystitis)
- 7-14 days of therapy for men (cystitis)
- no clinical benefit for treatment > 7 days, unless immunocompromised, prostatitis, pyelonephritis, nephrolithiasis, or benign prostatic hyperplasia[60]
- treatment for 7 days noninferior to 14 days of treatment[63]
- a delay in antibiotic therapy for elderly with UTI may put them at increased risk for urosepsis & death[58]
- men > 85 years of age particularly at risk[58]
recurrent UTI
- also see recurrent UTI
- presents > 2 weeks after completion of therapy for index UTI
- caused by a different organism than the index UTI[15]
- a different antibiotic may be prudent[15]
- indications for prophylactic antibiotics
- >= UTI in past 12 months or >=2 UTI in past 6 months
- vesicoureteral reflux (maybe not)[18]
- >= UTI in past 12 months or >=2 UTI in past 6 months
- Bactrim QD
- single dose of antibiotic after intercourse[15]
patient education
- patients should improve after 2-3 days of therapy
- patients should complete full course of antibiotics
- voiding after sexual intercourse can decrease frequency of UTIs in some women
- consider alternate form of contraception if UTI is associated with use of diaphragm
- adequate hydration is important
follow-up, prevention
- no indication for routine urinalysis or culture for non-pregnant women with acute uncomplicated cystitis after treatment
- UTI in men
- follow-up culture after completion of therapy
- genitourinary exam: especially prostate exam
- see radiology (above)
- recurrent UTI in women:
- IVP of little value
- low dose antibiotics for 4-6 months
- Septra DS 1 tab QD
- macrodantin 50-100 mg QD
- genitourinary exam
- cranberry juice:
- conflicting reports suggest little or no benefit[3]
- perhaps some benefit but less so than Bactrim[17]
- 30% risk reduction[23]
- cranberry may limit ability of bacteria to attach to uroepithelial cells[23]
- not effective for preventing bacteriuria plus pyuria in elderly women residing in nursing home[49]
- switch from spermicide-based contraception to non-spermicide based contraception
- post-coital antibiotic prophylaxis, particularly ifUTIs are temporally associated with coitus
- continuous antibiotic prophylaxis, particularly if UTIs are not associated with coitus or use of spermicide-based contraception
- self-initiated therapy for frequent recurrent episodes not associated with coitus
- urinary antiseptic methenamine hippurate may be useful alternative to low-dose antibiotics[64]
- hydrolyzed to formaldehyde (bactericidal) in the distal renal tubule[64]
- UTI in children
- follow-up culture 3-7 days after completion of therapy
- children under 5
surgical indications
More general terms
More specific terms
- catheter-associated urinary tract infection (CAUTI)
- kidney infection
- recurrent urinary tract infection
- urosepsis
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 544-49
- ↑ The Sanford Guide to Antimicrobial Therapy, 29th ed., Gilbert, DN et al (editors), Antimicrobial Therapy, Inc., Hyde Park VT, 1999
- ↑ 3.0 3.1 Journal Watch 21(17):138, 2001 Kontiokari T et al Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 322:1571 2001 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11431298
Barbosa-Cesnik C et al. Cranberry juice fails to prevent recurrent urinary tract infection: Results from a randomized placebo-controlled trial. Clin Infect Dis 2011 Jan 1; 52:23. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21148516 - ↑ Norman D, UCLA Intensive Course in Geriatric Medicine & Board Review, Marina Del Ray, CA, Sept 12-15, 2001
- ↑ 5.0 5.1 Journal Watch 22(3):25, 2002 Gomolin IH, Siami PF, Reuning-Scherer J, Haverstock DC, Heyd A; Oral Suspension Study Group. Efficacy and safety of ciprofloxacin oral suspension versus trimethoprim-sulfamethoxazole oral suspension for treatment of older women with acute urinary tract infection. J Am Geriatr Soc. 2001 Dec;49(12):1606-13. PMID: https://www.ncbi.nlm.nih.gov/pubmed/11843992
- ↑ 6.0 6.1 Journal Watch 22(8):65-66, 2002 Andrews SJ et al Ultrasonography and abdominal radiography versus intravenous urography in investigation of urinary tract infection in men: prospective incident cohort study. BMJ 324:454, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11859046
- ↑ 7.0 7.1 7.2 Journal Watch 24(6):47, 2004 Vogel T et al Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial. CMAJ 170:469, 2004 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14970093
- ↑ 8.0 8.1 Journal Watch 24(9):72, 2004 Zhang D, Zhang G, Hayden MS, Greenblatt MB, Bussey C, Flavell RA, Ghosh S. A toll-like receptor that prevents infection by uropathogenic bacteria. Science. 2004 Mar 5;303(5663):1522-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15001781
- ↑ 9.0 9.1 Journal Watch 25(4):32-33, 2005 Ramchandani M, Manges AR, DebRoy C, Smith SP, Johnson JR, Riley LW. Possible animal origin of human-associated, multidrug-resistant, uropathogenic Escherichia coli. Clin Infect Dis. 2005 Jan 15;40(2):251-7. Epub 2004 Dec 22. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15655743
- ↑ 10.0 10.1 Journal Watch 25(8):64, 2005 Hooton TM, Scholes D, Gupta K, Stapleton AE, Roberts PL, Stamm WE. Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial. JAMA. 2005 Feb 23;293(8):949-55. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15728165
- ↑ 11.0 11.1 11.2 11.3 Kallen AJ, Welch HG, Sirovich BE. Current antibiotic therapy for isolated urinary tract infections in women. Arch Intern Med. 2006 Mar 27;166(6):635-9. PMID: https://www.ncbi.nlm.nih.gov/pubmed/16567602
- ↑ Prescriber's Letter 13(5): 2006 Treatment of Uncomplicated Urinary Tract Infections Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=220610&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 13.0 13.1 13.2 Prescriber's Letter 15(1): 2008 Nitrofurantoin (Macrobid) Shortened Treatment Duration for Acute Uncomplicated Cystitis Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=240107&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 14.0 14.1 Woodford HJ and George J Diagnosis and management of urinary tract infection in hospitalized older people. J Am Ger Soc 2009, 57:107 PMID: https://www.ncbi.nlm.nih.gov/pubmed/19054190
- ↑ 15.00 15.01 15.02 15.03 15.04 15.05 15.06 15.07 15.08 15.09 15.10 15.11 15.12 15.13 15.14 15.15 15.16 15.17 15.18 15.19 15.20 15.21 15.22 15.23 15.24 15.25 15.26 Medical Knowledge Self Assessment Program (MKSAP) 14, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 2006, 2009, 2012, 2015, 2018, 2021.
Medical Knowledge Self Assessment Program (MKSAP) 19 Board Basics. An Enhancement to MKSAP19. American College of Physicians, Philadelphia 2022 - ↑ 16.0 16.1 van der Starre WE et al. Risk factors for fluoroquinolone-resistant Escherichia coli in adults with community-onset febrile urinary tract infection. J Antimicrob Chemother 2011 Mar; 66:650. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21123286
- ↑ 17.0 17.1 Beerepoot MAJ et al. Cranberries vs antibiotics to prevent urinary tract infections: A randomized double-blind noninferiority trial in premenopausal women. Arch Intern Med 2011 Jul 25; 171:1270 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21788542
Gurley BJ. Cranberries as antibiotics? Arch Intern Med 2011 Jul 25; 171:1279 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21788543 - ↑ 18.0 18.1 18.2 18.3 Subcommittee on Urinary Tract Infection. Urinary tract infection: Clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months. Pediatrics 2011 Sep; 128:595. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21873693 (corresponding NGC guideline withdrawn Nov 2016)
Subcommittee on Urinary Tract Infection. Reaffirmation of AAP Clinical Practice Guideline: The Diagnosis and Management of the Initial Urinary Tract Infection in Febrile Infants and Young Children 2-24 Months of Age. Pediatrics. 2016 Dec;138(6). PMID: https://www.ncbi.nlm.nih.gov/pubmed/27940735 - ↑ 19.0 19.1 Prescriber's Letter 18(12): 2011 Choosing a UTI Antibiotic for Elderly Patients Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=271210&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 20.0 20.1 Hooton TM et al. Cefpodoxime vs ciprofloxacin for short-course treatment of acute uncomplicated cystitis: A randomized trial. JAMA 2012 Feb 8; 307:583. PMID: https://www.ncbi.nlm.nih.gov/pubmed/22318279
- ↑ 21.0 21.1 Gauthier M et al. Association of malodorous urine with urinary tract infection in children aged 1 to 36 months. Pediatrics 2012 May; 129:885 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22473364
- ↑ 22.0 22.1 Coker TR Imaging after Initial Urinary Tract Infection (UTI) in Febrile Infants and Young Children: A Paradigm Shift deprecated reference - National Guideline Clearinghouse: Expert Commentary
- ↑ 23.0 23.1 23.2 Wang CH et al Cranberry-Containing Products for Prevention of Urinary Tract Infections in Susceptible Populations: A Systematic Review and Meta-analysis of Randomized Controlled Trials Arch Intern Med. 2012;172(13):988-996 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22777630 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1213845
- ↑ 24.0 24.1 Drekonja DM et al Urinary Tract Infection in Male Veterans: Treatment Patterns and Outcomes Arch Intern Med. 2012;():1-7 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23212273 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1470563
Drekonja DM et al. Urinary tract infection in male veterans: Treatment patterns and outcomes. JAMA Intern Med 2013 Jan 14; 173:62. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23212273 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1470563
Trautner BW. New perspectives on urinary tract infection in men. JAMA Intern Med 2013 Jan 14; 173:68. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23212451 <Internet> http://archinte.jamanetwork.com/article.aspx?articleid=1470570 - ↑ 25.0 25.1 Loeb M, Brazil K, Lohfeld L, McGeer A, Simor A, Stevenson K, Zoutman D, Smith S, Liu X, Walter SD. Effect of a multifaceted intervention on number of antimicrobial prescriptions for suspected urinary tract infections in residents of nursing homes: cluster randomised controlled trial. BMJ. 2005 Sep 24;331(7518):669. Epub 2005 Sep 8. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/16150741 <Internet> http://bmj.bmjjournals.com/cgi/content/full/331/7518/669
- ↑ Chenoweth CE, Saint S. Urinary tract infections. Infect Dis Clin North Am. 2011 Mar;25(1):103-15 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21315996
- ↑ Matthews SJ, Lancaster JW. Urinary tract infections in the elderly population. Am J Geriatr Pharmacother. 2011 Oct;9(5):286-309 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21840265
- ↑ Foxman B. The epidemiology of urinary tract infection. Nat Rev Urol. 2010 Dec;7(12):653-60 PMID: https://www.ncbi.nlm.nih.gov/pubmed/21139641
- ↑ 29.0 29.1 Gordon LB et al. Overtreatment of presumed urinary tract infection in older women presenting to the emergency department. J Am Geriatr Soc 2013 May; 61:788. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23590846
- ↑ 30.0 30.1 Hufschmidt A, Shabarin V, Rauer S, Zimmer T. Neurological symptoms accompanying urinary tract infections. Eur Neurol. 2010;63(3):180-3 PMID: https://www.ncbi.nlm.nih.gov/pubmed/20197663
- ↑ 31.0 31.1 Coulthard MG et al. Does prompt treatment of urinary tract infection in preschool children prevent renal scarring: Mixed retrospective and prospective audits. Arch Dis Child 2013 Dec 18 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/24351607 <Internet> http://adc.bmj.com/content/early/2014/01/21/archdischild-2013-304428
Coulthard MG, Lambert HJ, Vernon SJ Guidelines to identify abnormalities after childhood urinary tract infections: a prospective audit. Arch Dis Child. 2014 Jan 16 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24436366 - ↑ Beveridge LA, Davey PG, Phillips G, McMurdo ME. Optimal management of urinary tract infections in older people. Clin Interv Aging. 2011;6:173-80. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21753872
- ↑ Nicolle LE. Urinary tract infections in the elderly. Clin Geriatr Med. 2009 Aug;25(3):423-36. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19765490
- ↑ 34.0 34.1 34.2 34.3 34.4 34.5 Grigoryan L et al. Diagnosis and management of urinary tract infections in the outpatient settings: A review. JAMA 2014 Oct 22/29; 312:1677 PMID: https://www.ncbi.nlm.nih.gov/pubmed/25335150
- ↑ 35.0 35.1 35.2 Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA. 2014;311(8):844-854 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24570248
- ↑ Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med 2012 Mar 16; 366:1028 PMID: https://www.ncbi.nlm.nih.gov/pubmed/22417256
- ↑ Percival KM et al. Impact of an antimicrobial stewardship intervention on urinary tract infection treatment in the ED. Am J Emerg Med 2015 Sep; 33:1129. PMID: https://www.ncbi.nlm.nih.gov/pubmed/26027885
- ↑ Ninan S, Walton C, Barlow G. Investigation of suspected urinary tract infection in older people. BMJ. 2014;349:g4070. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24994808
- ↑ Nace DA, Drinka PJ, Crnich CJ. Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. J Am Med Dir Assoc. 2014;15:133-139. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24461240
- ↑ 40.0 40.1 Gagyor I et al. Ibuprofen versus fosfomycin for uncomplicated urinary tract infection in women: Randomised controlled trial. BMJ 2015 Dec 23; 351:h6544 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26698878
- ↑ Dielubanza EJ, Mazur DJ, Schaeffer AJ. Management of non-catheter-associated complicated urinary tract infection. Infect Dis Clin North Am. 2014 Mar;28(1):121-34. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24484579
Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect Dis Clin North Am. 2014 Mar;28(1):1-13. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24484571
Geerlings SE, Beerepoot MA, Prins JM. Prevention of recurrent urinary tract infections in women: antimicrobial and nonantimicrobial strategies. Infect Dis Clin North Am. 2014 Mar;28(1):135-47. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24484580
Trautner BW, Grigoryan L. Approach to a positive urine culture in a patient without urinary symptoms. Infect Dis Clin North Am. 2014 Mar;28(1):15-31. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24484572 Free PMC Article - ↑ 42.0 42.1 42.2 Singh N et al. Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women. CMAJ 2015 Jun 16; 187:648. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25918178 Free PMC Article <Internet> http://www.cmaj.ca/content/187/9/648
- ↑ 43.0 43.1 FDA Safety Watch. May 12, 2016 Fluoroquinolone Antibacterial Drugs: Drug Safety Communication
FDA Advises Restricting Use for Certain Uncomplicated Infections. http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm500665.htm - ↑ 44.0 44.1 Lavelle JM et al. Two-step process for ED UTI screening in febrile young children: Reducing catheterization rates. Pediatrics 2016 Jul; 138:e20153023 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27255151
- ↑ 45.0 45.1 Shaikh N, Shope TR, Hoberman A et al. Association between uropathogen and pyuria. Pediatrics. 2016 Jun 21. pii: e20160087 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/2732892 <Internet> http://pediatrics.aappublications.org/content/early/2016/06/19/peds.2016-0087
Friedman A. Management of UTI in children: Murky waters. Pediatrics 2016 Jul; 138:e20161247. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27328923 <Internet> http://pediatrics.aappublications.org/content/early/2016/06/19/peds.2016-1247 - ↑ D'Agata E, Loeb MB, Mitchell SL. Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. J Am Geriatr Soc. 2013 Jan;61(1):62-6. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23311553 Free PMC Article
- ↑ Nicolle LE. Symptomatic urinary tract infection in nursing home residents. J Am Geriatr Soc. 2009 Jun;57(6):1113-4. PMID: https://www.ncbi.nlm.nih.gov/pubmed/19490245
- ↑ 48.0 48.1 Shaikh N et al. Early antibiotic treatment for pediatric febrile urinary tract infection and renal scarring. JAMA Pediatr 2016 Jul 25; PMID: https://www.ncbi.nlm.nih.gov/pubmed/27455161
Marquez L, Palazzi DL. Antibiotic treatment for febrile urinary tract infection: The clock is ticking. JAMA Pediatr 2016 Jul 25 PMID: https://www.ncbi.nlm.nih.gov/pubmed/27454258 - ↑ 49.0 49.1 Juthani-Mehta M, Van Ness PH, Bianco L et al Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing Homes: A Randomized Clinical Trial. JAMA. Published online October 27, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27787564 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2576822
Nicolle LE Cranberry for Prevention of Urinary Tract Infection? Time to Move On. JAMA. Published online October 27, 2016 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27787544 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2576821 - ↑ 50.0 50.1 Lewis-de Los Angeles WW et al. Trends in intravenous antibiotic duration for urinary tract infections in young infants. Pediatrics 2017 Nov 2; e20171021 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29097611 <Internet> http://pediatrics.aappublications.org/content/early/2017/10/31/peds.2017-1021
- ↑ 51.0 51.1 Kronenberg A, Butikofer L, Odutayo A et al. Symptomatic treatment of uncomplicated lower urinary tract infections in the ambulatory setting: Randomised, double blind trial. BMJ 2017 Nov 8; 359:j4784. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29113968 Free PMC Article
Little P. Antibiotics or NSAIDs for uncomplicated urinary tract infection? BMJ 2017 Nov 8; 359:j5037 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29117972 - ↑ 52.0 52.1 Huttner A, Kowalczyk A, Turjeman A et al Effect of 5-Day Nitrofurantoin vs Single-Dose Fosfomycin on Clinical Resolution of Uncomplicated Lower Urinary Tract Infection in Women. A Randomized Clinical Trial. JAMA. Published online April 22, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29710295 https://jamanetwork.com/journals/jama/fullarticle/2679131
Datta R, Juthani-Mehta M. Nitrofurantoin vs Fosfomycin. Rendering a Verdict in a Trial of Acute Uncomplicated Cystitis. JAMA. Published online April 22, 2018 PMID: https://www.ncbi.nlm.nih.gov/pubmed/29710273 https://jamanetwork.com/journals/jama/fullarticle/2679130 - ↑ 53.0 53.1 Vik I, Bollestad M, Grude N et al Ibuprofen versus pivmecillinam for uncomplicated urinary tract infection in women - A double-blind, randomized non-inferiority trial. PLOS Medicine. May 15, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29763434 <Internet> http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1002569
- ↑ Tanya B et al. Replacement of urinary catheter for urinary tract infections: A prospective observational study. J Am Geriatr Soc 2018 Sep; 66:1779 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30094820
- ↑ 55.0 55.1 Kumar S, Dave A, Wolf B, Lerma EV. Urinary tract infections. Dis Mon. 2015 Feb;61(2):45-59. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/25732782
- ↑ Chenoweth CE, Saint S. Urinary Tract Infections. Infect Dis Clin North Am. 2016 Dec;30(4):869-885. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27816141
- ↑ Nicolle LE. Urinary Tract Infections in the Older Adult. Clin Geriatr Med. 2016 Aug;32(3):523-38. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/27394021
- ↑ 58.0 58.1 58.2 Gharbi M, Drysdale JH, Lishman H et al Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study. BMJ 2019;364:l525 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30814048 Free full text https://www.bmj.com/content/364/bmj.l525
Hay AD Antibiotic prescribing in primary care BMJ 2019;364:l780 PMID: https://www.ncbi.nlm.nih.gov/pubmed/30814116 https://www.bmj.com/content/364/bmj.l780 - ↑ Tanaka K, Arakawa S, Fujisawa M. [Urinary tract infection in elderly patients]. Nihon Ronen Igakkai Zasshi. 2010;47(6):565-8. Japanese. PMID: https://www.ncbi.nlm.nih.gov/pubmed/21301153 Free Article
- ↑ 60.0 60.1 60.2 Germanos GJ, Trautner BW, Zoorob RJ et al No Clinical Benefit to Treating Male Urinary Tract Infection Longer Than Seven Days: An Outpatient Database Study. Open Forum Infect Dis. 2019 May 6;6(6):ofz216. PMID: https://www.ncbi.nlm.nih.gov/pubmed/31249844 Free PMC Article
- ↑ 61.0 61.1 Nace DA, Hanlon JT, Crnich CJ et al. A multifaceted antimicrobial stewardship program for the treatment of uncomplicated cystitis in nursing home residents. JAMA Intern Med 2020 May 11; PMID: https://www.ncbi.nlm.nih.gov/pubmed/32391862 https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2764860
- ↑ 62.0 62.1 62.2 Tumolo J More Than a Third of Nursing Home UTIs Involve Antibiotic-Resistant Pathogen. Annals of Long-Term Care. June 2020 https://www.managedhealthcareconnect.com/content/more-third-nursing-home-utis-involve-antibiotic-resistant-pathogen
Eure TR, Stone ND, Mungai EA, Bell JM, Thompson ND. Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013-2017 Infect Control Hosp Epidemiol. 2020;1-6 [published online 2020 Aug 12] - ↑ 63.0 63.1 Drekonja DM, Trautner B, Amundson C et al Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection. A Randomized Clinical Trial. JAMA. 2021;326(4):324-331. July 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34313686 https://jamanetwork.com/journals/jama/fullarticle/2782300
Morgan DJ, Coffey KC Shorter Courses of Antibiotics for Urinary Tract Infection in Men. JAMA. 2021;326(4):309-310. July 27 PMID: https://www.ncbi.nlm.nih.gov/pubmed/34313705 https://jamanetwork.com/journals/jama/fullarticle/2782322 - ↑ 64.0 64.1 64.2 Harding C, Forbes R, Currer S et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: Multicentre, open label, randomised, non-inferiority trial. BMJ 2022 Mar 9; 376:e068229. PMID: https://www.ncbi.nlm.nih.gov/pubmed/35264408 Free article
- ↑ Muneer A, Macrae B, Krishnamoorthy S, Zumla A. Urogenital tuberculosis - epidemiology, pathogenesis and clinical features. Nat Rev Urol. 2019 Oct;16(10):573-598 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31548730 Review.
- ↑ Gupta K, Grigoryan L, Trautner B. Urinary tract infection. Ann Intern Med. 2017;167:ITC49-ITC64. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28973215
- ↑ 67.0 67.1 Vargas B This Symptom Signals UTI in 83% of Cases. Medscape. September 29, 2023 https://www.medscape.com/viewarticle/996951