A review of recent advances in the treatment of adults with complicated urinary tract infection

ABSTRACT

Introduction

Complicated urinary tract infections (cUTIs) entail diverse clinical conditions that could be managed differently and not necessarily with premature empiric therapy. Since multidrug-resistant organisms (MDROs) are widely spreading worldwide, the possibility of encountering these resistant bacteria is inevitably part of the daily life of physicians who manage cUTIs.

Areas covered

The advances in the management of cUTIs are explored, illustrating: 1) a proposed therapeutical approach to cUTIs within the antimicrobial stewardship context; 2) evidence regarding novel antibiotics targeting MDROs. Evidence research has been performed through MEDLINE/PubMed using appropriate keywords and terms regarding cUTIs published before June 2022.

Expert opinion

Novel antimicrobial drugs are available in the clinicians’ armamentarium. Selecting the optimal therapy for suitable patients may be challenging given the multifaceted group of cUTIs. Carbapenems use is widely increasing, the role of old β-lactam/β-lactamase inhibitors is constantly revised, and novel drugs lack real-life studies. Understanding the different ranges of the complexity of patients affected by cUTIs may help select the most suitable antibiotic for every single case. More multicentric observational studies targeting cUTIs are needed to elucidate the appropriate drug based on patient characteristics and presentations, providing stronger recommendations for cases encountered in everyday clinical practice.

KEYWORDS:

• Complicated urinary tract infections
• UTI treatment
• antimicrobial resistance
• MDRO
• ESBLs
• CRE
• Pseudomonas
• VRE
• A. baumannii

Article highlights

• The best management of cUTIs varied in the last years due to the increasing complexity of patients and the emergence of multidrug-resistant organisms.

• A careful assessment of the patient’s comorbidity and urologic history, along with a risk evaluation for MDROs is crucial in the current clinical practice.

• A watchful waiting approach can be considered based on patients’ characteristics, disease presentation, and the clinical setting.

• BL/BLI, aminoglycosides, or fosfomycin can be appropriate for stable patients at low risk of deterioration, without risk factors for MDROs.

• The choice between carbapenem and novel antimicrobials should be made considering the patient’s frailty and presentations and MDROs risk.

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.