[Therapy of complicated urinary tract infections]

Abstract

The term "complicated urinary tract infections" includes all microbial infections of the urinary tract in the presence of abnormalities within the urinary tract which may be different in kind but all are disturbing the urodynamics to a relevant extent independently from the severity of the infection. The clinical aspects, however, are of important influence on the bacterial spectrum and thus on the choice of antibiotics. It has to be distinguished whether the treatment is performed according to the sensitivity testing or whether it has to be started empirically. In complicated urinary tract infections, especially when hospital acquired, multiresistant pathogens are frequent. Therefore, the classical oral antibiotics should only be chosen if sensitivity testing is available. Empiric therapy usually requests the newer broad-spectrum quinolones. Regarding the clinical status of the patient sometimes therapy has to be started parenterally with acylureidopenicillins or cephalosporins of the 2nd and 3rd generation. As soon as possible, however, the therapy should be switched to an oral one. With antimicrobial therapy long-term success in complicated urinary tract infections can only be obtained, if the underlying abnormalities can be corrected and the urodynamics become normal. In patients this condition cannot be reached by any reason relapses and reinfections are common. But in these patients usually treated several times and with various antibiotics by selection multiresistant pathogens are frequently found. Therefore, a repeated antibiotic therapy is only indicated, if necessary according to the infectious symptoms and if diagnostic and therapeutic interventions within the urinary tract are considered.