Complicated UTI/Males

Complicated UTI associated with functional and anatomical abnormalities of the genitourinary (GU) tract including:

- Obstructive uropathies - strictures, tumors/cysts, stones, prostatic hypertrophy, congenital abnormalities.

- Recent GU instrumentation - cystoscopy/urologic procedures, catheterization, ureteric stent, nephrostomy tubes.

- Delayed/impaired voiding - neurogenic bladder, vesicoureteral reflux, ileal conduit, cystocele.

- Metabolic abnormalities - renal failure/dysfunction, nephrocalcinosis, poorly controlled diabetes.

- Immunocompromised states - renal transplant, neutropenia, HIV

Special Considerations:

- Males - UTIs are typically considered complicated as functional or anatomical abnormalities are often present.

Exception: males with first time UTI related to sexual activity.

Urologic work-up recommended in males with recurrent cystitis, pyelonephritis, and all young boys.

Investigations:

- Asymptomatic bacteriuria is common in the elderly and does NOT require antibiotic therapy.

- If febrile, do blood culture.

- Pre treatment urine cultures recommended. Post treatment cultures to ensure clearance not generally recommended unless upper urinary tract obstruction.

- Consultation with microbiologist or Infectious Diseases physician recommended for all culture negative recurrent UTIs.

- Modify empiric therapy to most narrow spectrum option based on C&S results.