Ask the Expert: Questions and Answers about Complicated UTIs (cUTIs)

We think of UTIs as recurrent when a patient has two UTIs within six months or three UTIs within a year. A cUTI means the infection has spread outside the bladder, and that puts the patient at risk for sepsis, which is a life-threatening response to an infection.

With recurrent UTIs, we’re talking about their frequency or how often they happen. With cUTIs, we’re talking about the spread of the infection. Fortunately, cUTIs are less common.

We can tell a UTI is complicated when we see symptoms like fever, chills, kidney pain or a bladder that won’t clear. The fever is a whole-body response to infection and is a big indicator. In the late stages, or in patients around 70 or older, we’ll sometimes see altered mental status as well.

Like simple or uncomplicated UTIs, complicated UTIs are caused by bacteria, and the most common culprit is E. coli. Bacteria can get in through a catheter or by a kidney stone that’s causing a blockage in the urinary tract. In women, bacteria can be spread from wiping back to front when using the toilet.

Patients who have catheters are at risk for cUTIs. So are patients who have undergone recent urological surgery. Having kidney stones or anything that blocks urine, including an anatomical blockage, can put you at risk as well.

Clinicians will look at your symptoms and your lab work. When we see elevated white blood cells in the lab work, that’s the evidence that the infection has spread outside the bladder. We’ll look at those results, and when we’re asking about symptoms, we’ll ask about kidney pain. It’s not routine to do imaging of the kidney, but sometimes that’s done as well.

You should see a specialist if you’re experiencing symptoms of a cUTI or if you’re getting recurring UTIs. Your first line of defense is a urologist or urogynecologist. If your UTI is resisting treatment or if cUTIs are recurring, an infectious disease specialist would be your next step.

Patients with cUTIs are at risk for sepsis and need to get treated urgently. They will get a longer course of antibiotic therapy, generally between 10–14 days. Until the bacteria that’s causing it has been identified, your medical team will usually prescribe an antibiotic that fights a broad range of bacteria. Uncomplicated UTIs will take a shorter course of antibiotics to resolve the infection, usually between three and seven days.