Febrile urinary tract infection in the emergency room.
OBJECTIVE
To review the recent advances in the diagnostic and therapeutic approach to adults presenting with febrile urinary tract infection (UTI) in the emergency department (ED).


RESULTS
Recent research suggests overdiagnosis and therefore overtreatment of UTI in the ED, especially in the elderly. Antimicrobial pretreatment, an indwelling catheter, and malignancy are independent risk factors for bacteremia with uropathogens that cannot be cultured from urine. A simple clinical prediction rule can predict clinically relevant radiologic findings in patients with invasive UTI. Procalcitonin is a marker for bacteremia; pro-adrenomedullin predicts a complicated course and 30-day mortality in complicated UTI. Several reports have identified the risk factors for resistant uropathogens in community-acquired febrile UTI. Adherence to the guidelines and early culture-guided intravenous-to-oral switch reduces the length of hospitalization.


CONCLUSIONS
An effective strategy is needed to improve the diagnosis of UTIs in acute care. Further research regarding biomarker-guided triage might improve the management of patients with febrile UTI. Future efforts should be directed toward the improvement of adherence to UTI treatment guidelines.
aDepartment of Infectious Diseases, Leiden University Medical Center, Leiden bDepartment of Internal Medicine, Haga Hospital, The Hague, the Netherlands.
Janneke E
JE
Stalenhoef
Jaap T
JT
van Dissel
Cees
C
van Nieuwkoop
D053607:Adrenomedullin / Q000097:blood*; D000900:Anti-Bacterial Agents; D015415:Biomarkers / Q000097:blood; D002116:Calcitonin / Q000097:blood*; D015740:Calcitonin Gene-Related Peptide; D002408:Catheters, Indwelling; D002985:Clinical Protocols; D004636:Emergency Service, Hospital; D005334:Fever / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology; D019983:Guideline Adherence; D006760:Hospitalization; D006801:Humans; D007902:Length of Stay; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011498:Protein Precursors / Q000097:blood*; D012307:Risk Factors; D014218:Triage / Q000379:methods*; D014552:Urinary Tract Infections / Q000097:blood* / Q000188:drug therapy / Q000503:physiopathology
D000900:Anti-Bacterial Agents; D015415:Biomarkers; C000606589:CALCA protein, human; D011498:Protein Precursors; C088633:proadrenomedullin; D053607:Adrenomedullin; D002116:Calcitonin; D015740:Calcitonin Gene-Related Peptide