Urinary tract infections: what's new?

OBJECTIVE

This review provides practicing urologists with important basic information about urinary tract infections (UTIs) that can be applied to everyday clinical problems.

METHODS

A review is presented of provocative and controversial concepts in the current literature.

RESULTS

Bacterial virulence mechanisms are critical for overcoming the normal host defenses. Increasing antimicrobial resistance of uropathogens has led to reconsideration of traditional treatment recommendations in many areas. For effective patient management the first issue is to define complicating urological factors. Managing complicated urinary tract infections, particularly in urology, is determined by clinical experience to define the pertinent anatomy and to determine the optimal interventions. New clinical data are summarized on UTIs in long-term care patients, behavioral risks for UTI in healthy women and anatomical differences associated with an increased risk for UTI. The rationale is presented for UTI prophylaxis using cranberry juice, immunization and bacterial interference. Current treatment trends for UTI include empiric therapy (without urine culture and sensitivity testing), short-course therapy, patient-administered (self-start) therapy and outpatient therapy for uncomplicated pyelonephritis.

CONCLUSIONS

Recommendations for treating patients with UTIs have changed based on basic science and clinical experience.