Upper and lower urinary tract infections: amikacin's role in managing surgical complications.

Approximately one out of every 40 patients admitted to United States hospitals each year acquires a urinary tract infection while hospitalized. Urologic instrumentation is the precipitating cause in 75 to 80 percent of the cases. Such infections are responsible for a mortality rate among these patients that is three times the rate observed for all other hospitalized patients. When associated with gram-negative bacteremia, nosocomial urinary tract infections can progress rapidly to an irreversible state, resulting in death in 10 percent of those patients affected. Survivors are faced with escalating costs of hospital care and drug therapy. Presumptive administration of antibiotics is routinely recommended in selected types of genitourinary surgery, primarily because of the contaminated nature of the procedures, and especially advised when the surgery is likely to be followed by the placement of an indwelling urinary catheter. Quite often, the regimen for presumptive treatment of urinary tract infections includes aminoglycosides, such as amikacin, alone or in combination. The role of amikacin in empiric management of postoperative urinary tract infections is even more obvious. The fact that it has the broadest spectrum of activity compared with other aminoglycosides reduces the chance of therapeutic failure and results in a shorter hospital stay. In that respect, amikacin may effect an overall decrease in total costs of hospitalization.