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 over-diagnosis and therefore over-treatment 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. Pro-calcitonin 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.
Stalenhoef JE, van Dissel JT, van Nieuwkoop C. Are you the author?
Department of Infectious Diseases, Leiden University Medical Center, Leiden; Department of Internal Medicine, Haga Hospital, The Hague, The Netherlands.
Reference: Curr Opin Infect Dis. 2015 Feb;28(1):106-11.