Acute complicated urinary tract infection (including pyelonephritis) in adults - UpToDate

INTRODUCTION Urinary tract infections (UTIs) include cystitis (infection of the bladder/lower urinary tract) and pyelonephritis (infection of the kidney/upper urinary tract). The pathogenesis of UTI begins with colonization of the vaginal introitus or urethral meatus by uropathogens from the fecal flora, followed by ascension via the urethra into the bladder. Pyelonephritis develops when pathogens ascend to the kidneys via the ureters. Pyelonephritis can also be caused by seeding of the kidneys from bacteremia. It is possible that some cases of pyelonephritis are associated with seeding of the kidneys from bacteria in the lymphatics. This topic will review the approach to adults with acute complicated UTI, which we define as a UTI that has possibly extended beyond the bladder (ie, UTI with fever or other systemic symptoms, suspected or documented pyelonephritis, and UTI with sepsis or bacteremia). In contrast, when there are symptoms of cystitis in the absence of fever, flank pain, cos

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