Enfeksiyonlar ve Karın Ağrısı: Piyelonefrit ve İdrar Yolu Enfeksiyonları
Özet
Akut komplike idrar yolu enfeksiyonu (İYE), üst üriner sistem yapılarının tutulumunu düşündüren semptomlarla seyreden bir klinik tablodur. Bunlar arasında ateş (>37,7°C), sistemik hastalık semptomları (üşüme-titreme, bilinç bozukluğu, oral alım azlığı, halsizlik gibi), yan ağrısı ve kostovertebral açı hassasiyeti (KVAH) sayılabilir. Ek olarak sistit belirtileri de eşlik edebilir. Ayrıca septik şok, çoklu organ yetmezliği veya akut böbrek yetmezliği gibi ciddi tablolar da izlenebilir. En sık Escherichia coli etkendir. İYE tanısı, idrar mikroskopisi veya dipstick testle, tutarlı klinik bulgulara ek olarak piyüri ve bakteriüri gözlenerek konulur. Yatış gerektiren durumlar arasında sepsis, sürekli yüksek ateş veya ağrı, belirgin genel durum bozukluğu, üriner obstrüksiyon varlığı, ilaç uyumsuzluğu ve oral alım bozukluğu yer alır. Altta yatan idrar yolu patolojileri olan hastalar, daha sık kateterizasyon, kateterin değiştirilmesi veya çıkarılması, üroloji konsültasyonu gerektirebilir.
Acute complicated urinary tract infection (UTI) is a clinical condition characterized by symptoms suggestive of involvement of the upper urinary tract structures. These include fever (>37.7°C), systemic symptoms (chills, altered consciousness, decreased oral intake, weakness, etc.), flank pain, and cardiovascular disease. Additionally, cystitis symptoms may be present. Furthermore, serious conditions such as septic shock, multiple organ failure, or acute renal failure may occur. The most common causative agent is Escherichia coli. Diagnosis of UTI is made by urine microscopy or dipstick test, based on consistent clinical findings plus pyuria and bacteriuria. Conditions requiring hospitalization include sepsis, persistently high fever or pain, significant general malaise, urinary obstruction, medication non-compliance, and impaired oral intake. Patients with underlying urinary tract pathologies may require more frequent catheterization, catheter replacement or removal, and urology consultation.
Referanslar
Trautner BW, Cortes-Penfield NW, Gupta K, et al. IDSA practice guidelines: Complicated Urinary Tract Infections (cUTI): Clinical Guidelines for Treatment and Management. July 17, 2025. [Online] https://www.idsociety.org/practice-guideline/complicated-urinary-tract-infections/ [Accessed 01.02.2026].
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. Clinical Infectious Diseases. 2011; 52:e103.
Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clinical Infectious Diseases. 2007;45:273.
Nicolle LE. A practical guide to antimicrobial management of complicated urinary tract infection. Drugs & Aging. 2001; 18:243.
Khawcharoenporn T, Vasoo S, Singh K. Urinary Tract Infections due to Multidrug-Resistant Enterobacteriaceae: Prevalence and Risk Factors in a Chicago Emergency Department. Emergency Medicine International. 2013; 2013:258517.
Killgore KM, March KL, Guglielmo BJ. Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Annals of Pharmacotherapy. 2004; 38:1148.
Walker E, Lyman A, Gupta K, et al. Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens. Clinical Infectious Diseases. 2016; 63:960.
Smithson A, Chico C, Ramos J, et al. Prevalence and risk factors for quinolone resistance among Escherichia coli strains isolated from males with community febrile urinary tract infection. European Journal of Clinical Microbiology & Infectious Diseases. 2012; 31:423.
Linsenmeyer K, Strymish J, Gupta K. Two Simple Rules for Improving the Accuracy of Empiric Treatment of Multidrug-Resistant Urinary Tract Infections. Antimicrobial Agents and Chemotherapy. 2015; 59:7593.
Zilberberg MD, Shorr AF. Secular trends in gram-negative resistance among urinary tract infection hospitalizations in the United States, 2000-2009. Infection Control & Hospital Epidemiology. 2013; 34:940.
Talan DA, Takhar SS, Krishnadasan A, et al. Fluoroquinolone-Resistant and Extended-Spectrum β-Lactamase-Producing Escherichia coli Infections in Patients with Pyelonephritis, United States(1). Emerging Infectious Diseases. 2016; 22.
Lautenbach E. Editorial commentary: flying under the radar: the stealth pandemic of Escherichia coli sequence type 131. Clinical Infectious Diseases. 2013; 57:1266.
Colpan A, Johnston B, Porter S, et al. Escherichia coli sequence type 131 (ST131) subclone H30 as an emergent multidrug-resistant pathogen among US veterans. Clinical Infectious Diseases.2013; 57:1256.
Fairley KF, Carson NE, Gutch RC, et al. Site of infection in acute urinary-tract infection in general practice. Lancet. 1971; 2:615.
Griebling TL. Urologic diseases in america project: trends in resource use for urinary tract infections in men. Journal of Urology. 2005; 173:1288.
Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infectious Disease Clinics of North America. 1997; 11:551.
Stamm WE. Measurement of pyuria and its relation to bacteriuria. The American Journal of Medicine. 1983; 75:53.
Wilson ML, Gaido L. Laboratory diagnosis of urinary tract infections in adult patients. Clinical Infectious Diseases. 2004; 38:1150.
Lipsky BA, Ireton RC, Fihn SD, et al. Diagnosis of bacteriuria in men: specimen collection and culture interpretation. The Journal of Infectious Diseases.1987; 155:847.
Echols RM, Tosiello RL, Haverstock DC, Tice AD. Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis. Clinical Infectious Diseases. 1999; 29:113.
Boel JB, Jansåker F, Hertz FB, et al. Treatment duration of pivmecillinam in men, non-pregnant and pregnant women for community-acquired urinary tract infections caused by Escherichia coli: a retrospective Danish cohort study. Journal of Antimicrobial Chemotherapy. 2019;74:2767.
Montelin H, Forsman KJ, Tängdén T. Retrospective evaluation of nitrofurantoin and pivmecillinam for the treatment of lower urinary tract infections in men. Public Library of Science One. 2019;14:e0211098.
Gupta K. Emerging antibiotic resistance in urinary tract pathogens. Infectious Disease Clinics of North America. 2003; 17:243.
Raz R, Chazan B, Kennes Y, et al. Empiric use of trimethoprim-sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens. Clinical Infectious Diseases. 2002; 34:1165.
Krieger JN, Ross SO, Simonsen JM. Urinary tract infections in healthy university men. Journal of Urology. 1993; 149:1046.
Drekonja DM, Trautner B, Amundson C, et al. Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection: A Randomized Clinical Trial. Journal of the American Medical Association. 2021; 326:324.
Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious Disease Clinics of North America. 2014; 28:1.
Scholes D, Hooton TM, Roberts PL, et al. Risk factors associated with acute pyelonephritis in healthy women. Annals of Internal Medicine. 2005; 142:20.
Kahlmeter G, ECO.SENS. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. Journal of Antimicrobial Chemotherapy. 2003; 51:69.
Naber KG, Schito G, Botto H, et al. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. European Urology. 2008; 54:1164.
Zhanel GG, Hisanaga TL, Laing NM, et al. Antibiotic resistance in Escherichia coli outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA). International Journal of Antimicrobial Agents. 2006; 27:468.
Larkin C, Valappil SP, Palanisamy N. Global prevalence of nitrofurantoin-resistant uropathogenic Escherichia coli (UPEC) in humans: a systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy. 2025; 80:2609.
Dunne MW, Aronin SI, Yu KC, et al. A multicenter analysis of trends in resistance in urinary Enterobacterales isolates from ambulatory patients in the United States: 2011-2020. BMC Infectious Diseases. 2022; 22:194.
Bent S, Nallamothu BK, Simel DL, et al. Does this woman have an acute uncomplicated urinary tract infection? Journal of the American Medical Association. 2002; 287:2701.
Dasgupta M, Brymer C, Elsayed S. Treatment of asymptomatic UTI in older delirious medical in-patients: A prospective cohort study. Archives of Gerontology and Geriatrics. 2017; 72:127.
Nace DA, Drinka PJ, Crnich CJ. Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. Journal of the American Medical Directors Association. 2014; 15:133.
Hooton TM, Roberts PL, Cox ME, Stapleton AE. Voided midstream urine culture and acute cystitis in premenopausal women. New England Journal of Medicine. 2013; 369:1883.
Gupta K, Trautner B. In the clinic. Urinary tract infection. Annals of Internal Medicine. 2012; 156:ITC3.
Brosh-Nissimov T, Navon-Venezia S, Keller N, Amit S. Risk analysis of antimicrobial resistance in outpatient urinary tract infections of young healthy adults. Journal of Antimicrobial Chemotherapy. 2019; 74:499.
Singh N, Gandhi S, McArthur E, et al. Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women. Canadian Medical Association Journal. 2015; 187:648.
Oplinger M, Andrews CO. Nitrofurantoin contraindication in patients with a creatinine clearance below 60 mL/min: looking for the evidence. Annals of Pharmacotherapy. 2013; 47:106.
By the American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society. 2015; 63:2227.
Arredondo-García JL, Figueroa-Damián R, Rosas A, et al. Comparison of short-term treatment regimen of ciprofloxacin versus long-term treatment regimens of trimethoprim/sulfamethoxazole or norfloxacin for uncomplicated lower urinary tract infections: a randomized, multicentre, open-label, prospective study. Journal of Antimicrobial Chemotherapy. 2004; 54:840.
Iravani A, Klimberg I, Briefer C, et al. A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection. Journal of Antimicrobial Chemotherapy. 1999; 43 Suppl A:67.
Kavatha D, Giamarellou H, Alexiou Z, et al. Cefpodoxime-proxetil versus trimethoprim-sulfamethoxazole for short-term therapy of uncomplicated acute cystitis in women. Antimicrobial Agents and Chemotherapy. 2003; 47:897.
Lee RA, Centor RM, Humphrey LL, et al. Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians. Annals of Internal Medicine. 2021; 174:822.
Lutters M, Vogt-Ferrier NB. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database of Systematic Reviews. 2008; :CD001535.
Auquer F, Cordón F, Gorina E, et al. Single-dose ciprofloxacin versus 3 days of norfloxacin in uncomplicated urinary tract infections in women. Clinical Microbiology and Infection. 2002; 8:50.
Hooton TM, Scholes D, Gupta K, et al. Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial. Journal of the American Medical Association. 2005; 293:949.
Nicolle LE, Madsen KS, Debeeck GO, et al. Three days of pivmecillinam or norfloxacin for treatment of acute uncomplicated urinary infection in women. Scandinavian Journal of Infectious Diseases. 2002; 34:487.
Little P, Moore MV, Turner S, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. British Medical Journal. 2010; 340:c199.
Fromer DL, Luck ME, Cheng WY, et al. Risk Factors for Empiric Treatment Failure in US Female Outpatients with Uncomplicated Urinary Tract Infection: an Observational Study. Journal of General Internal Medicine. 2025; 40:862.
Woo S, Seo D, Cho YS, et al. Clinical factors distinguishing renal infarction from acute pyelonephritis: A randomly matched retrospective case-control study. American Journal of Emergency Medicine. 2023; 72:88.
Expert Panel on Urological Imaging, Smith AD, Nikolaidis P, et al. ACR Appropriateness Criteria® Acute Pyelonephritis: 2022 Update. Journal of the American College of Radiology. 2022; 19:S224.
Meyrier A, Condamin MC, Fernet M, et al. Frequency of development of early cortical scarring in acute primary pyelonephritis. Kidney International. 1989; 35:696.
Kawashima A, LeRoy AJ. Radiologic evaluation of patients with renal infections. Infectious Disease Clinics of North America. 2003; 17:433.
Demertzis J, Menias CO. State of the art: imaging of renal infections. Emergency Radiology. 2007; 14:13.
Ward G, Jorden RC, Severance HW. Treatment of pyelonephritis in an observation unit. Annals of Emergency Medicine. 1991; 20:258.
Nelson Z, Aslan AT, Beahm NP, et al. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Open Access Medical Research and Commentary. 2024; 7:e2444495.
Kaye KS, Rice LB, Dane AL, et al. Fosfomycin for Injection (ZTI-01) Versus Piperacillin-tazobactam for the Treatment of Complicated Urinary Tract Infection Including Acute Pyelonephritis: ZEUS, A Phase 2/3 Randomized Trial. Clinical Infectious Diseases. 2019; 69:2045.
Singh KP, Li G, Mitrani-Gold FS, et al. Systematic review and meta-analysis of antimicrobial treatment effect estimation in complicated urinary tract infection. Antimicrobial Agents and Chemotherapy. 2013; 57:5284.
Hooper DC, Wolfson JS. Fluoroquinolone antimicrobial agents. New England Journal of Medicine. 1991; 324:384.
Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrobial Agents and Chemotherapy. 2012; 56:2181.
Peterson J, Kaul S, Khashab M, et al. A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology. 2008; 71:17.
Sandberg T, Skoog G, Hermansson AB, et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012; 380:484.
Vellinga A, Tansey S, Hanahoe B, et al. Trimethoprim and ciprofloxacin resistance and prescribing in urinary tract infection associated with Escherichia coli: a multilevel model. Journal of Antimicrobial Chemotherapy. 2012; 67:2523.
Tamma PD, Conley AT, Cosgrove SE, et al. Association of 30-Day Mortality With Oral Step-Down vs Continued Intravenous Therapy in Patients Hospitalized With Enterobacteriaceae Bacteremia. Journal of the American Medical Association Internal Medicine. 2019; 179:316.
Koehl J, Spolsdoff D, Negaard B, et al. Cephalosporins for Outpatient Pyelonephritis in the Emergency Department: COPY-ED Study. Annals of Emergency Medicine. 2025; 85:240.
Talan DA, Klimberg IW, Nicolle LE, et al. Once daily, extended release ciprofloxacin for complicated urinary tract infections and acute uncomplicated pyelonephritis. Journal of Urology. 2004; 171:734.
Sandberg T, Skoog G, Hermansson AB, et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012; 380:484.
Vellinga A, Tansey S, Hanahoe B, et al. Trimethoprim and ciprofloxacin resistance and prescribing in urinary tract infection associated with Escherichia coli: a multilevel model. Journal of Antimicrobial Chemotherapy. 2012; 67:2523.
Referanslar
Trautner BW, Cortes-Penfield NW, Gupta K, et al. IDSA practice guidelines: Complicated Urinary Tract Infections (cUTI): Clinical Guidelines for Treatment and Management. July 17, 2025. [Online] https://www.idsociety.org/practice-guideline/complicated-urinary-tract-infections/ [Accessed 01.02.2026].
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. Clinical Infectious Diseases. 2011; 52:e103.
Czaja CA, Scholes D, Hooton TM, Stamm WE. Population-based epidemiologic analysis of acute pyelonephritis. Clinical Infectious Diseases. 2007;45:273.
Nicolle LE. A practical guide to antimicrobial management of complicated urinary tract infection. Drugs & Aging. 2001; 18:243.
Khawcharoenporn T, Vasoo S, Singh K. Urinary Tract Infections due to Multidrug-Resistant Enterobacteriaceae: Prevalence and Risk Factors in a Chicago Emergency Department. Emergency Medicine International. 2013; 2013:258517.
Killgore KM, March KL, Guglielmo BJ. Risk factors for community-acquired ciprofloxacin-resistant Escherichia coli urinary tract infection. Annals of Pharmacotherapy. 2004; 38:1148.
Walker E, Lyman A, Gupta K, et al. Clinical Management of an Increasing Threat: Outpatient Urinary Tract Infections Due to Multidrug-Resistant Uropathogens. Clinical Infectious Diseases. 2016; 63:960.
Smithson A, Chico C, Ramos J, et al. Prevalence and risk factors for quinolone resistance among Escherichia coli strains isolated from males with community febrile urinary tract infection. European Journal of Clinical Microbiology & Infectious Diseases. 2012; 31:423.
Linsenmeyer K, Strymish J, Gupta K. Two Simple Rules for Improving the Accuracy of Empiric Treatment of Multidrug-Resistant Urinary Tract Infections. Antimicrobial Agents and Chemotherapy. 2015; 59:7593.
Zilberberg MD, Shorr AF. Secular trends in gram-negative resistance among urinary tract infection hospitalizations in the United States, 2000-2009. Infection Control & Hospital Epidemiology. 2013; 34:940.
Talan DA, Takhar SS, Krishnadasan A, et al. Fluoroquinolone-Resistant and Extended-Spectrum β-Lactamase-Producing Escherichia coli Infections in Patients with Pyelonephritis, United States(1). Emerging Infectious Diseases. 2016; 22.
Lautenbach E. Editorial commentary: flying under the radar: the stealth pandemic of Escherichia coli sequence type 131. Clinical Infectious Diseases. 2013; 57:1266.
Colpan A, Johnston B, Porter S, et al. Escherichia coli sequence type 131 (ST131) subclone H30 as an emergent multidrug-resistant pathogen among US veterans. Clinical Infectious Diseases.2013; 57:1256.
Fairley KF, Carson NE, Gutch RC, et al. Site of infection in acute urinary-tract infection in general practice. Lancet. 1971; 2:615.
Griebling TL. Urologic diseases in america project: trends in resource use for urinary tract infections in men. Journal of Urology. 2005; 173:1288.
Hooton TM, Stamm WE. Diagnosis and treatment of uncomplicated urinary tract infection. Infectious Disease Clinics of North America. 1997; 11:551.
Stamm WE. Measurement of pyuria and its relation to bacteriuria. The American Journal of Medicine. 1983; 75:53.
Wilson ML, Gaido L. Laboratory diagnosis of urinary tract infections in adult patients. Clinical Infectious Diseases. 2004; 38:1150.
Lipsky BA, Ireton RC, Fihn SD, et al. Diagnosis of bacteriuria in men: specimen collection and culture interpretation. The Journal of Infectious Diseases.1987; 155:847.
Echols RM, Tosiello RL, Haverstock DC, Tice AD. Demographic, clinical, and treatment parameters influencing the outcome of acute cystitis. Clinical Infectious Diseases. 1999; 29:113.
Boel JB, Jansåker F, Hertz FB, et al. Treatment duration of pivmecillinam in men, non-pregnant and pregnant women for community-acquired urinary tract infections caused by Escherichia coli: a retrospective Danish cohort study. Journal of Antimicrobial Chemotherapy. 2019;74:2767.
Montelin H, Forsman KJ, Tängdén T. Retrospective evaluation of nitrofurantoin and pivmecillinam for the treatment of lower urinary tract infections in men. Public Library of Science One. 2019;14:e0211098.
Gupta K. Emerging antibiotic resistance in urinary tract pathogens. Infectious Disease Clinics of North America. 2003; 17:243.
Raz R, Chazan B, Kennes Y, et al. Empiric use of trimethoprim-sulfamethoxazole (TMP-SMX) in the treatment of women with uncomplicated urinary tract infections, in a geographical area with a high prevalence of TMP-SMX-resistant uropathogens. Clinical Infectious Diseases. 2002; 34:1165.
Krieger JN, Ross SO, Simonsen JM. Urinary tract infections in healthy university men. Journal of Urology. 1993; 149:1046.
Drekonja DM, Trautner B, Amundson C, et al. Effect of 7 vs 14 Days of Antibiotic Therapy on Resolution of Symptoms Among Afebrile Men With Urinary Tract Infection: A Randomized Clinical Trial. Journal of the American Medical Association. 2021; 326:324.
Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infectious Disease Clinics of North America. 2014; 28:1.
Scholes D, Hooton TM, Roberts PL, et al. Risk factors associated with acute pyelonephritis in healthy women. Annals of Internal Medicine. 2005; 142:20.
Kahlmeter G, ECO.SENS. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECO.SENS Project. Journal of Antimicrobial Chemotherapy. 2003; 51:69.
Naber KG, Schito G, Botto H, et al. Surveillance study in Europe and Brazil on clinical aspects and Antimicrobial Resistance Epidemiology in Females with Cystitis (ARESC): implications for empiric therapy. European Urology. 2008; 54:1164.
Zhanel GG, Hisanaga TL, Laing NM, et al. Antibiotic resistance in Escherichia coli outpatient urinary isolates: final results from the North American Urinary Tract Infection Collaborative Alliance (NAUTICA). International Journal of Antimicrobial Agents. 2006; 27:468.
Larkin C, Valappil SP, Palanisamy N. Global prevalence of nitrofurantoin-resistant uropathogenic Escherichia coli (UPEC) in humans: a systematic review and meta-analysis. Journal of Antimicrobial Chemotherapy. 2025; 80:2609.
Dunne MW, Aronin SI, Yu KC, et al. A multicenter analysis of trends in resistance in urinary Enterobacterales isolates from ambulatory patients in the United States: 2011-2020. BMC Infectious Diseases. 2022; 22:194.
Bent S, Nallamothu BK, Simel DL, et al. Does this woman have an acute uncomplicated urinary tract infection? Journal of the American Medical Association. 2002; 287:2701.
Dasgupta M, Brymer C, Elsayed S. Treatment of asymptomatic UTI in older delirious medical in-patients: A prospective cohort study. Archives of Gerontology and Geriatrics. 2017; 72:127.
Nace DA, Drinka PJ, Crnich CJ. Clinical uncertainties in the approach to long term care residents with possible urinary tract infection. Journal of the American Medical Directors Association. 2014; 15:133.
Hooton TM, Roberts PL, Cox ME, Stapleton AE. Voided midstream urine culture and acute cystitis in premenopausal women. New England Journal of Medicine. 2013; 369:1883.
Gupta K, Trautner B. In the clinic. Urinary tract infection. Annals of Internal Medicine. 2012; 156:ITC3.
Brosh-Nissimov T, Navon-Venezia S, Keller N, Amit S. Risk analysis of antimicrobial resistance in outpatient urinary tract infections of young healthy adults. Journal of Antimicrobial Chemotherapy. 2019; 74:499.
Singh N, Gandhi S, McArthur E, et al. Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women. Canadian Medical Association Journal. 2015; 187:648.
Oplinger M, Andrews CO. Nitrofurantoin contraindication in patients with a creatinine clearance below 60 mL/min: looking for the evidence. Annals of Pharmacotherapy. 2013; 47:106.
By the American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society. 2015; 63:2227.
Arredondo-García JL, Figueroa-Damián R, Rosas A, et al. Comparison of short-term treatment regimen of ciprofloxacin versus long-term treatment regimens of trimethoprim/sulfamethoxazole or norfloxacin for uncomplicated lower urinary tract infections: a randomized, multicentre, open-label, prospective study. Journal of Antimicrobial Chemotherapy. 2004; 54:840.
Iravani A, Klimberg I, Briefer C, et al. A trial comparing low-dose, short-course ciprofloxacin and standard 7 day therapy with co-trimoxazole or nitrofurantoin in the treatment of uncomplicated urinary tract infection. Journal of Antimicrobial Chemotherapy. 1999; 43 Suppl A:67.
Kavatha D, Giamarellou H, Alexiou Z, et al. Cefpodoxime-proxetil versus trimethoprim-sulfamethoxazole for short-term therapy of uncomplicated acute cystitis in women. Antimicrobial Agents and Chemotherapy. 2003; 47:897.
Lee RA, Centor RM, Humphrey LL, et al. Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians. Annals of Internal Medicine. 2021; 174:822.
Lutters M, Vogt-Ferrier NB. Antibiotic duration for treating uncomplicated, symptomatic lower urinary tract infections in elderly women. Cochrane Database of Systematic Reviews. 2008; :CD001535.
Auquer F, Cordón F, Gorina E, et al. Single-dose ciprofloxacin versus 3 days of norfloxacin in uncomplicated urinary tract infections in women. Clinical Microbiology and Infection. 2002; 8:50.
Hooton TM, Scholes D, Gupta K, et al. Amoxicillin-clavulanate vs ciprofloxacin for the treatment of uncomplicated cystitis in women: a randomized trial. Journal of the American Medical Association. 2005; 293:949.
Nicolle LE, Madsen KS, Debeeck GO, et al. Three days of pivmecillinam or norfloxacin for treatment of acute uncomplicated urinary infection in women. Scandinavian Journal of Infectious Diseases. 2002; 34:487.
Little P, Moore MV, Turner S, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. British Medical Journal. 2010; 340:c199.
Fromer DL, Luck ME, Cheng WY, et al. Risk Factors for Empiric Treatment Failure in US Female Outpatients with Uncomplicated Urinary Tract Infection: an Observational Study. Journal of General Internal Medicine. 2025; 40:862.
Woo S, Seo D, Cho YS, et al. Clinical factors distinguishing renal infarction from acute pyelonephritis: A randomly matched retrospective case-control study. American Journal of Emergency Medicine. 2023; 72:88.
Expert Panel on Urological Imaging, Smith AD, Nikolaidis P, et al. ACR Appropriateness Criteria® Acute Pyelonephritis: 2022 Update. Journal of the American College of Radiology. 2022; 19:S224.
Meyrier A, Condamin MC, Fernet M, et al. Frequency of development of early cortical scarring in acute primary pyelonephritis. Kidney International. 1989; 35:696.
Kawashima A, LeRoy AJ. Radiologic evaluation of patients with renal infections. Infectious Disease Clinics of North America. 2003; 17:433.
Demertzis J, Menias CO. State of the art: imaging of renal infections. Emergency Radiology. 2007; 14:13.
Ward G, Jorden RC, Severance HW. Treatment of pyelonephritis in an observation unit. Annals of Emergency Medicine. 1991; 20:258.
Nelson Z, Aslan AT, Beahm NP, et al. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Open Access Medical Research and Commentary. 2024; 7:e2444495.
Kaye KS, Rice LB, Dane AL, et al. Fosfomycin for Injection (ZTI-01) Versus Piperacillin-tazobactam for the Treatment of Complicated Urinary Tract Infection Including Acute Pyelonephritis: ZEUS, A Phase 2/3 Randomized Trial. Clinical Infectious Diseases. 2019; 69:2045.
Singh KP, Li G, Mitrani-Gold FS, et al. Systematic review and meta-analysis of antimicrobial treatment effect estimation in complicated urinary tract infection. Antimicrobial Agents and Chemotherapy. 2013; 57:5284.
Hooper DC, Wolfson JS. Fluoroquinolone antimicrobial agents. New England Journal of Medicine. 1991; 324:384.
Sanchez GV, Master RN, Karlowsky JA, Bordon JM. In vitro antimicrobial resistance of urinary Escherichia coli isolates among U.S. outpatients from 2000 to 2010. Antimicrobial Agents and Chemotherapy. 2012; 56:2181.
Peterson J, Kaul S, Khashab M, et al. A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis. Urology. 2008; 71:17.
Sandberg T, Skoog G, Hermansson AB, et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012; 380:484.
Vellinga A, Tansey S, Hanahoe B, et al. Trimethoprim and ciprofloxacin resistance and prescribing in urinary tract infection associated with Escherichia coli: a multilevel model. Journal of Antimicrobial Chemotherapy. 2012; 67:2523.
Tamma PD, Conley AT, Cosgrove SE, et al. Association of 30-Day Mortality With Oral Step-Down vs Continued Intravenous Therapy in Patients Hospitalized With Enterobacteriaceae Bacteremia. Journal of the American Medical Association Internal Medicine. 2019; 179:316.
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