Treatment
14
Table 3. Factors That May Predispose Residents with a Urinary
Tract Infection to Treatment Failure or Complications
Complicating
Factors Clinical Examples Considerations
Obstruction • Ureteric or urethral
strictures
• Tumors of the
urinary tract
• Urolithiasis
• Prostatic hypertrophy
• Diverticulae
• Pelvicalyceal
obstruction
• Renal cysts
• Congenital
abnormalities
A history of obstruction, by itself, is
not a complicating factor unless the
obstruction is still ongoing.
Elderly males have been historically
considered to be at high risk as many
presenting with UTI may also have
underlying urologic abnormalities
like prostatic hypertrophy. More
recent evidence indicates that 7
days of antibiotic is sufficient to
treat cystitis in men (see manuscript
text). Prostatitis (which requires
longer length of therapy) should be
suspected in residents with recurrent
cystitis or if resident also has fever or
pelvic or perineal pain.
Management of obstruction is also a
key component of UTI treatment.
Instrumentation • Indwelling urethral
catheter
• Intermittent
catheterization
• Ureteric stent
• Nephrostomy tube
• Urological
procedures
Frequently reassess the need for an
indwelling catheter and, if deemed
unnecessary, remove the catheter.
Impaired Voiding • Neurogenic bladder
• Cystocele
• Vesicoureteral reflux
• Ileal conduit
Risks of complication may
depend on severity of the voiding
impairment.
Metabolic
abnormalities
• Nephrocalcinosis
• Medullary sponge
kidney
• Renal failure (eCrCl
<30 mL/min)
• Diabetes mellitus
Risks of complications in diabetic
patients with good glycemic control
and without long-term diabetes
complications will be lower than
those with poor glycemic control and
presence of diabetic complications
Immunocompromised • Renal transplant
Source: Ashraf MS et al. Diagnosis, Treatment, and Prevention of Urinary Tract Infections in Post-
Acute and Long-Term Care Settings: A Consensus Statement From AMDA's Infection Advisory
Subcommittee. J Am Med Dir Assoc. 2020 Jan;21(1):12-24
