Dr. Dmochowski discusses diagnosis and treatment of urinary tract infection

In this video, Roger R. Dmochowski, MD, MMHC, FACS, shares the take-home messages from the Neurology and Urodynamics study “Recurrent and complicated urinary tract infections in women: Utility of advanced testing to enhance care.” Dmochowski is professor of urology, surgery and gynecology and vice chair for faculty affairs and professionalism, and associate surgeon in chief at Vanderbilt University Medical Center in Nashville Tennessee.

Transcription:

What is the take-home message for the practicing urologist?

I think the take-home messages are a couple. One is we as a specialty have to do a better job of educating our colleagues and referring docs. Our internal medicine and family practice colleagues are overwhelmed with patients, and obviously they see the same patients we’re seeing and obviously, we have to educate about asymptomatic bacteriuria and the importance of not treating those patients, especially in the menopausal and peri menopausal female group. We also need to do a better job of appropriately focusing our therapy, utilizing very directed and limited-spectrum antibiotics for those patients with uncomplicated infections rather than immediately going to sort of, if you will, “the big guns”—the broad-spectrum, very powerful antibiotics; for instance, the fluoroquinolones. Those medications should really be reserved for the more complicated presentations to avoid…the emergence of very specifically worrisome resistant organisms, such as DSBL, which are problematic and also put the patients in contact precautions, and also put the patients at great risk for other major complications related to treatment.

Is there anything you would like to add?

I think it’s just really a good idea to understand the demographics of this condition, which is very common, the emergence of resistant organisms that are problematic from a treatment standpoint, and also judicious use of antibiotics. And again, if we can focus ourselves with appropriately used either standard urinary culture or, when indicated, advanced testing modalities, such as PCR, I think we’re going to do a much better job of giving specific and targeted therapy and also preventing our patients from some of the risks that are associated with misdiagnosis or overtreatment of urinary tract infection, including such things as antibiotic-related diarrhea.

This transcription was edited for clarity.