When should I refer a patient with a complicated urinary tract infection to secondary care?

Refer a patient with a complicated urinary tract infection (UTI) to secondary care if any of the following apply:

• There are severe systemic symptoms or signs suggesting a serious or life-threatening complication such as pyelonephritis or sepsis, requiring urgent hospital admission.
• The patient is unable to tolerate or adhere to treatment in primary care.
• There is a risk factor for complicated UTI or treatment failure, including recurrent catheter-associated UTI or catheter-associated UTI.
• A urine culture shows an atypical or resistant organism.
• There is a suspected serious underlying cause such as renal disease, urinary tract obstruction, urogynaecological malignancy, or structural/functional urinary tract abnormalities.
• In men, ongoing symptoms despite appropriate antibiotic treatment, recurrent UTIs (two or more episodes in 6 months), or suspected urinary tract obstruction or history of pyelonephritis warrant referral.
• In children, immediate referral is indicated for babies under 3 months with suspected UTI or those at high risk of serious illness; consider referral for children over 3 months with upper UTI or recurrent UTI.
• Urgent referral is needed if there are signs of urosepsis (e.g., nausea, vomiting, confusion, tachypnoea, tachycardia, hypotension) or acute kidney injury complications related to urinary obstruction.

These criteria ensure timely specialist assessment and management to prevent complications and guide appropriate treatment.

References: ¹,²,⁴,⁵