© The Canadian Journal of Urology™; 19(Supplement 1); October 2012
Address correspondence to Dr. Tony Mazzulli, Department
of Microbiology, Mount Sinai Hospital, 600 University
Avenue, Toronto, Ontario M5G 1X5 Canada
Diagnosis and management of simple and
complicated urinary tract infections (UTIs)
Tony Mazzulli, MD
1,2
1
Department of Microbiology, Mount Sinai Hospital and University Health Network, Toronto, Ontario, Canada
2
Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
MAZZULLI T. Diagnosis and management of
simpleandcomplicatedurinarytract infections (UTIs).
Can J Urol
2012;19(
Suppl 1):42-48.
Urinary tract infections (UTIs) remain a common
clinical problem in both the community and healthcare-
associated settings. Each patient should be carefully
assessed to ensure that a correct diagnosis is made and that
antimicrobial therapy is appropriately prescribed—defined
as using a clinically indicated agent in the correct dose
and route of administration, for the correct duration—for
symptomatic patients, and avoided for most asymptomatic
patients. This should help stem the growing tide of
antimicrobial resistance and allow for the continued use
of simpler, less expensive agents. Continued surveillance
and monitoring of antimicrobial resistance rates will be
critical to help formulate and update future treatment
recommendations for all categories of patients with UTIs.
Key Words:
UTI, antimicrobial resistance, ESBL
reflects the widespread, often inappropriate use of
urinary catheterization.
4
Thus the impact of UTIs in
terms of cost and healthcare resources is considerable,
and it is important to have a rational approach to
managing, treating, and preventing them.
3
Diagnosis
The initial approach to manage UTIs requires a careful
assessment of the patient in order to stratify them
into one of three categories of UTIs: asymptomatic
bacteriuria; uncomplicated (simple) UTI; or complicated
UTI. Further classification may be made to determine
if patients have recurrent UTIs due to reinfection or
relapse. The initial separation of patients into having
one of these three categories of UTIs will impact the
extent of the work up that is performed, the location
of treatment (i.e., outpatient versus inpatient), and the
selection and duration of antimicrobial therapy.
42
Introduction
Urinary tract infections (UTIs)—bacteriuria and true
symptomatic infections—remain one of the most
common reasons patients in the community seek
medical attention and are prescribed an antibiotic.
Most patients in outpatient settings who have UTIs
are premenopausal women, and in some studies, as
many as 50% of women have reported having at least
one UTI by age 30.
1,2
The recurrence rate is high, and a
study reported that about 25% of women experienced
a second episode within 6 months of their first UTI.
3
In the hospital setting, UTIs remain the most common
healthcare-associated infections worldwide, and this
