Urinary tract infection [Neurosurgery Wiki]

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====== Urinary tract infection ======

Urinary tract [[infection]]s (UTIs) account for about 35% of all [[nosocomial infection]]s and 75% are associated with the use of [[urethral catheter]]s.

[[Escherichia coli]] & [[Proteus]] spp. are common



Side effects of [[Botulinum toxin]] include [[urinary tract infection]] and [[urinary retention]].
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===== 🧫 Classification =====

Urinary tract infections (UTIs) are classified based on anatomical location, clinical severity, and complicating factors.

===== 🏷️ By Anatomical Location =====

  * **Lower UTI**
    * ''Cystitis'' – bladder infection
    * ''Urethritis'' – inflammation/infection of the urethra
    * ''Prostatitis'' – prostate involvement (usually acute bacterial)

  * **Upper UTI**
    * ''Pyelonephritis'' – infection of the renal pelvis and kidney parenchyma
    * ''Renal abscess'' – localized suppuration
    * ''Perinephric abscess''

===== 🚻 By Patient Category =====

  * **Uncomplicated UTI**
    * Occurs in healthy, non-pregnant women
    * No structural or functional urinary abnormalities

  * **Complicated UTI**
    * Occurs in:
      * Men
      * Pregnant women
      * Patients with urinary tract abnormalities (e.g., stones, obstruction)
      * Immunosuppressed patients
      * [[Catheter-Associated Urinary Tract Infection]]
      * Diabetes mellitus
    * Includes **catheter-associated UTI (CAUTI)**

===== ⏱️ By Duration =====

  * **Acute UTI** – sudden onset, usually short course
  * **Chronic UTI** – persistent infection despite treatment or recurrent symptoms over time

===== 🔁 By Recurrence Pattern =====

  * **Recurrent UTI**
    * ≥2 infections in 6 months or ≥3 in 12 months
    * Subtypes:
      * **Relapse** – same organism, usually due to inadequate treatment
      * **Reinfection** – different organism or same organism after eradication

===== 🦠 By Microbiological Pattern =====

  * **Monomicrobial** (most common, typically ''E. coli'')
  * **Polymicrobial** (usually in complicated or nosocomial infections)
  * **Sterile pyuria** (suggests TB, interstitial nephritis, or partially treated UTI)

===== 🧬 Special Types =====

  * **Asymptomatic bacteriuria**
    * Presence of ≥10⁵ CFU/mL in urine without symptoms
    * Only treat in:
      * Pregnancy
      * Prior to urologic procedures

  * **Nosocomial UTI**
    * Acquired in hospital settings, often multidrug-resistant organisms
    * Includes CAUTI

===== 📚 References =====
  * IDSA Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria (2019)
  * European Association of Urology (EAU) Guidelines on Urological Infections
  * CDC Healthcare-Associated Infections Guidelines (2023)

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Adult meningioma patients treated with craniotomy in US hospitals between 2002 and 2007 were queried from the Nationwide Inpatient Sample (NIS) database. Univariate and multivariate analyses that correct for sample survey design data were used to study the association of perioperative UTIs and outcomes.

In all, 46,344 patients were included. Women comprised the majority (70.0%), had lower mortality (1.2% vs 2.0%), shorter in-hospital stay (6.7 vs 7.5 days), lower hospital charges (US$76,682 vs 87,220) and higher UTI rates (6.3% vs 3.9%) than men. In multivariate analysis, female gender (odds ratio: 2.2; P < 0.0001), older age (1.4; P < 0.001), emergency room admissions (1.8; P < 0.0001), total length of stay (1.08; P < 0.0001), comorbidity score (1.04; P = 0.0147), postoperative fluid abnormalities (1.96; P < 0.0001) and pulmonary complications (1.3; P < 0.0011) were associated with UTI. UTI was associated with an additional 2.3 days of hospital stay and an incremental US$18,920 in hospital charges.

Perioperative UTIs are associated with specific comorbidities and postoperative complications. They significantly increase in-hospital length of stay and costs. Our data emphasize the need to support national efforts that are underway to reduce hospital-acquired UTIs within the neurosurgical population
((Nosova K, Nuño M, Mukherjee D, Lad SP, Boakye M, Black KL, Patil CG. Urinary
tract infections in meningioma patients: analysis of risk factors and outcomes. J
Hosp Infect. 2013 Feb;83(2):132-9. doi: 10.1016/j.jhin.2012.10.011. Epub 2012 Dec
27. PubMed PMID: 23273964.
)).

===== Prevention =====

[[Urinary Tract Infection Prevention]].


===== Risk factors =====
Children with [[myelomeningocele]] (MMC) qualifying for [[fetal surgery]] who underwent [[cerebrospinal fluid shunt]] [[placement]] were more likely to have recurrent UTIs, develop [[kidney failure]], and be hospitalized. Since approximately half of the shunt procedures could be avoided by fetal surgery, there is a clinical benefit and a possible financial benefit to the implementation of this technology 
((Peixoto-Filho FM, Cervante TP, Bellas AR, Gomes Junior SC, Lapa DA, Acácio GL, Carvalho PRN, Sá RAM. Historical Clinical Outcomes of [[Child]]ren with [[Myelomeningocele]] Meeting the Criteria for [[Fetal Surgery]]: A [[Retrospective]] Cohort [[Survey]] of Brazilian Patients. Rev Bras Ginecol Obstet. 2022 Feb 9. English. doi: 10.1055/s-0042-1742404. Epub ahead of print. PMID: 35139573.)).
===== Treatment =====
The first-choice agents for treatment of uncomplicated acute cystitis in women include nitrofurantoin monohydrate/macrocrystals, trimethoprim-sulfamethoxazole (TMP-SMX), or fosfomycin. Beta-lactam antibiotics may be used when other recommended agents cannot be used
((Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. Mar 2011;52(5):e103-20.))
((Wagenlehner FM, Schmiemann G, Hoyme U, Fünfstück R, Hummers-Pradier E, Kaase M, et al. [National S3 guideline on uncomplicated urinary tract infection: recommendations for treatment and management of uncomplicated community-acquired bacterial urinary tract infections in adult patients]. Urologe A. Feb 2011;50(2):153-69)).

Increasing resistance rates among uropathogens have complicated treatment of acute cystitis. Individualized assessment of risk factors for resistance and regimen tolerability is needed to choose the optimum empirical regimen
((Grigoryan L, Trautner BW, Gupta K. Diagnosis and management of urinary tract
infections in the outpatient setting: a review. JAMA. 2014 Oct
22-29;312(16):1677-84. doi: 10.1001/jama.2014.12842. Review. PubMed PMID:
25335150.
)).