title: Management of complicated urinary tract infections in a referral center in Mexico.
abstract: BACKGROUND
  Urinary tract infections are a common problem encountered by primary care, emergency physicians and urologists. A complicated urinary tract infection (CUTI) responds less effectively to the standard treatment. E. coli is the most common pathogen (40-70 %). In Mexico, there are ciprofloxacin resistance rates of 8-73 %, to trimethoprim/sulfamethoxazole 53-71 % and cephalosporins 5-18 %, with an ESBL E. coli prevalence of 10 %. For infections producing gas or purulent material, the percutaneous or endoscopic drainage is the standard.
  
  
  OBJECTIVE
  To describe the management of patients with CUTIs, their specifically clinical course and eventual culture results determining the most common isolated microorganisms and their resistance.
  
  
  METHODS
  The clinical records of patients hospitalized with CUTIs from January 2012 to July 2013 were reviewed.
  
  
  RESULTS
  One hundred and seventy-three patients were included. Acute pyelonephritis was the most common presentation (53.2 %). The most common microorganism was E. coli (83 %), with ESBL prevalence of 71.4 % and a resistance to quinolone, cephalosporin and trimethoprim of 89.7, 64.7 and 60.3 %, respectively. The most common factors associated with development of CUTIs were recent use of antibiotics (95.3 %) and obstructive uropathy (73.4 %). A total of 41 % received carbapenems and 40.5 % received minimally invasive treatments. Overall mortality was 2.9 %.
  
  
  CONCLUSIONS
  There were a greater ESBL-producing pathogen prevalence and an over 50 % resistance to classically first-choice antibiotics. The minimally invasive treatments for complicated infections are fundamental; however, nephrectomy still has a role.
  
  
  CONCLUSIONS
  Wide-spectrum antimicrobial therapy and minimally invasive approaches are the most common treatments for CUTIs in our center, and a reevaluation regarding antibiotic use in Mexico needs to be done.
authors.affiliation: Division of Urology, Hospital General "Dr. Manuel Gea González", Calzada de Tlalpan 4800, Colonia Sección XVI Delegación Tlalpan, CP 14080, México City, Mexico, cornejomd@gmail.com.
authors.forename: Victor
authors.initials: V
authors.lastname: Cornejo-Dávila
authors.forename: Mario A
authors.initials: MA
authors.lastname: Palmeros-Rodríguez
authors.forename: Israel
authors.initials: I
authors.lastname: Uberetagoyena-Tello de Meneses
authors.forename: Edgar
authors.initials: E
authors.lastname: Mayorga-Gómez
authors.forename: Gerardo
authors.initials: G
authors.lastname: Garza-Sáinz
authors.forename: Victor
authors.initials: V
authors.lastname: Osornio-Sánchez
authors.forename: Luis
authors.initials: L
authors.lastname: Trujillo-Ortiz
authors.forename: Jorge E
authors.initials: JE
authors.lastname: Sedano-Basilio
authors.forename: Mauricio
authors.initials: M
authors.lastname: Cantellano-Orozco
authors.forename: Carlos
authors.initials: C
authors.lastname: Martínez-Arroyo
authors.forename: Jorge G
authors.initials: JG
authors.lastname: Morales-Montor
authors.forename: Carlos
authors.initials: C
authors.lastname: Pacheco-Gahbler
mesh_terms: D000038:Abscess / Q000382:microbiology / Q000628:therapy; D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial; D004823:Epididymitis / Q000382:microbiology / Q000628:therapy; D004926:Escherichia coli / Q000378:metabolism; D004927:Escherichia coli Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008800:Mexico; D008875:Middle Aged; D009920:Orchitis / Q000382:microbiology / Q000628:therapy; D011472:Prostatitis / Q000382:microbiology / Q000628:therapy; D011704:Pyelonephritis / Q000382:microbiology / Q000628:therapy; D053018:Pyonephrosis / Q000382:microbiology / Q000628:therapy; D012307:Risk Factors; D015607:Stents; D014552:Urinary Tract Infections / Q000150:complications / Q000188:drug therapy* / Q000382:microbiology; D055815:Young Adult; D001618:beta-Lactamases / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases