PURPOSE OF REVIEW: To review the recent advances in the diagnostic and therapeutic approach to adults presenting with febrile urinary tract infection (UTI) in the emergency department (ED). RECENT FINDINGS: Recent research suggests overdiagnosis and therefore overtreatment of UTI in the ED, especially in the elderly. Antimicrobial pretreatment, an indwelling catheter, and malignancy are independent risk factors for bacteremia with uropathogens that cannot be cultured from urine. A simple clinical prediction rule can predict clinically relevant radiologic findings in patients with invasive UTI. Procalcitonin is a marker for bacteremia; pro-adrenomedullin predicts a complicated course and 30-day mortality in complicated UTI. Several reports have identified the risk factors for resistant uropathogens in community-acquired febrile UTI. Adherence to the guidelines and early culture-guided intravenous-to-oral switch reduces the length of hospitalization. SUMMARY: An effective strategy is needed to improve the diagnosis of UTIs in acute care. Further research regarding biomarker-guided triage might improve the management of patients with febrile UTI. Future efforts should be directed toward the improvement of adherence to UTI treatment guidelines.
PURPOSE OF REVIEW: To review the recent advances in the diagnostic and therapeutic approach to adults presenting with febrile urinary tract infection (UTI) in the emergency department (ED). RECENT FINDINGS: Recent research suggests overdiagnosis and therefore overtreatment of UTI in the ED, especially in the elderly. Antimicrobial pretreatment, an indwelling catheter, and malignancy are independent risk factors for bacteremia with uropathogens that cannot be cultured from urine. A simple clinical prediction rule can predict clinically relevant radiologic findings in patients with invasive UTI. Procalcitonin is a marker for bacteremia; pro-adrenomedullin predicts a complicated course and 30-day mortality in complicated UTI. Several reports have identified the risk factors for resistant uropathogens in community-acquired febrile UTI. Adherence to the guidelines and early culture-guided intravenous-to-oral switch reduces the length of hospitalization. SUMMARY: An effective strategy is needed to improve the diagnosis of UTIs in acute care. Further research regarding biomarker-guided triage might improve the management of patients with febrile UTI. Future efforts should be directed toward the improvement of adherence to UTI treatment guidelines.
Authors: Daniel Drozdov; Stefanie Schwarz; Alexander Kutz; Eva Grolimund; Anna Christina Rast; Deborah Steiner; Katharina Regez; Ursula Schild; Merih Guglielmetti; Antoinette Conca; Barbara Reutlinger; Cornelia Ottiger; Florian Buchkremer; Sebastian Haubitz; Claudine Blum; Andreas Huber; Ulrich Buergi; Philipp Schuetz; Andreas Bock; Christoph Andreas Fux; Beat Mueller; Werner Christian Albrich Journal: BMC Med Date: 2015-05-01 Impact factor: 8.775
Authors: Kathrin Rothe; Christoph D Spinner; Birgit Waschulzik; Christian Janke; Jochen Schneider; Heike Schneider; Krischan Braitsch; Christopher Smith; Roland M Schmid; Dirk H Busch; Juri Katchanov Journal: PLoS One Date: 2020-10-22 Impact factor: 3.240