Urinary tract infections in immunocompromised patients Review


Authors: Figueroa-Ortiz, C. J.; Mead, P. A.
Review Title: Urinary tract infections in immunocompromised patients
Abstract: Purpose of reviewUrinary tract infections (UTIs) are a major source of morbidity in immunocompromised patients, including transplant recipients, individuals with hematologic malignancies, people living with HIV, and those receiving immunosuppressive therapies. This review provides a synthesis of recent evidence, highlighting challenges in diagnosis, management, and antimicrobial resistance in these high-risk populations.Recent findingsRecent literature highlights the high burden of UTIs among immunocompromised patients. These infections are often caused by multidrug-resistant pathogens. Across these groups, common risk factors include immunosuppression, diabetes, urologic instrumentation, and catheterization. Diagnostic uncertainty - particularly distinguishing true infection from asymptomatic bacteriuria - frequently leads to overtreatment. Emerging stewardship tools, such as reflex urinalysis protocols and electronic phenotyping of antimicrobials (e.g. the use of the 'Acute Urinary Antibiotics' labelling), show promise for reducing inappropriate antibiotic use in outpatient settings.SummaryUTIs in immunocompromised patients are increasingly complex due to atypical presentations and resistant pathogens. Clinical care must prioritize accurate diagnosis, judicious use of antibiotics, and implementation of stewardship interventions. Further research is needed to validate risk-based diagnostic tools and expand outpatient stewardship infrastructure in transplant and oncology settings.
Keywords: urinary tract infection; immunocompromised host; asymptomatic bacteriuria; antimicrobial stewardship; renal transplant
Journal Title: Current Opinion in Infectious Diseases
Volume: 38
Issue: 4
ISSN: 0951-7375
Publisher: Lippincott Williams & Wilkins  
Date Published: 2025-08-01
Start Page: 322
End Page: 328
Language: English
ACCESSION: WOS:001517444100001
DOI: 10.1097/qco.0000000000001121
PROVIDER: wos
PMCID: PMC12282672
PUBMED: 40497539
Notes: Review -- MSK Cancer Center Support Grant (P30 CA008748) acknowledged in PubMed and PDF -- MSK corresponding author is Cesar Figueroa-Ortiz -- Source: WOS
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  1. Peter A Mead
    12 Mead