Inpatient UTI Treatment

Initial Risk Stratification

The European Urology guidelines recommend determining if the UTI is complicated or uncomplicated, with complicated UTI factors including urinary tract obstruction, foreign body or catheter present, male sex, incomplete voiding or vesicoureteral reflux, recent instrumentation, pregnancy, diabetes, or immunosuppression, healthcare-associated infection, and history of ESBL-producing or multidrug-resistant organisms 1
Complicated UTI factors also include catheterization duration, which is the most important risk factor for catheter-associated UTI 3

The European Urology guidelines recommend empirical therapy with either amoxicillin plus an aminoglycoside, a second-generation cephalosporin plus an aminoglycoside, or an intravenous third-generation cephalosporin for hospitalized patients with complicated UTI and systemic symptoms 1
For patients with prior Pseudomonas infection, the preferred empiric choice is cefepime 2g IV every 8 hours, with alternative options including piperacillin-tazobactam 4.5g IV every 8 hours 2

The standard duration of treatment is 7 days for most complicated UTIs, with longer durations recommended for men with possible prostatitis (14 days) 1
Shorter durations (7 days) may be considered for patients who are hemodynamically stable and afebrile for at least 48 hours 3

The European Urology guidelines recommend obtaining urine culture and susceptibility testing before starting antibiotics, as well as blood cultures if fever is greater than 38°C or sepsis is suspected 1
Therapy should be tailored based on culture results, and underlying urological abnormalities or complicating factors should be addressed 1