Urinary tract infection in intensive care units: diagnosis and treatment

In intensive care, urinary tract infections are usually the first to the third cause of nosocomial infection. There are almost exclusively related to a urinary catheter often present during most of the stay. They are usually asymptomatic and without severe complications. In some cases, they can give sepsis syndrome, often due to an extension of infection to the renal parenchyma. Clinical signs are often difficult to interpret because of the patient's severe state. The biologic diagnostic is made on criteria defined for the interpretation of urinalysis and quantitative culture. Micro-organisms are often very resistant. Today, Candida spp. are very frequently identified but their pathogenic role is difficult to determine. Asymptomatic Utis are usually not treated. Nevertheless the treatment must be administrated quickly in case of severe sepsis. Initially, it may be either empiric with a large spectrum antibiotic or determined by data from a previously reported colonization. It is later reviewed according to microbiological data. Most antibiotics reach high concentrations in urine. There is no argument in favour of a specific antimicrobial class. Antibiotic combinations are not required unless bacteria are little susceptible, or in case of abscess. Furthermore there are useful only in the first days of treatment. It is necessary to rule out a urologic cause. There are no specific recommandations concerning the interest of changing the indwelling catheter. Indications for vesical lavage with antibiotics or antiseptics are rare. (C) 2003 Editions scientifiques et medicales Elsevier SAS. Tous droits reserves.