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A global perspective on improving patient care in uncomplicated urinary tract infection: expert consensus and practical guidance
Journal article   Open access   Peer reviewed

A global perspective on improving patient care in uncomplicated urinary tract infection: expert consensus and practical guidance

Florian Wagenlehner, Lindsay Nicolle, Riccardo Bartoletti, Ana C. Gales, Larissa Grigoryan, Haihui Huang, Thomas Hooton, Gustavo Lopardo, Kurt Naber, Aruna Poojary, …
Journal of global antimicrobial resistance, Vol.28, pp.18-29
03/2022
DOI: 10.1016/j.jgar.2021.11.008
PMID: 34896337
url
https://doi.org/10.1016/j.jgar.2021.11.008View
Published (Version of record) Open Access

Abstract

•Diagnosis of uncomplicated urinary tract infection (uUTI) is typically symptom-based.•uUTI is treated empirically with antibiotics.•Antimicrobial resistance (AMR) is a growing concern with antibiotics used to treat uUTIs.•Risk factors for AMR can be identified without urine culture. Uncomplicated urinary tract infections (uUTIs) are a common problem in female patients. Management is mainly based on empirical prescribing, but there are concerns about overtreatment and antimicrobial resistance (AMR), especially in patients with recurrent uUTIs. A multidisciplinary panel of experts met to discuss diagnosis, treatment, prevention, guidelines, AMR, clinical trial design and the impact of COVID-19 on clinical practice. Symptoms remain the cornerstone of uUTI diagnosis, and urine culture is necessary only when empirical treatment fails or rapid recurrence of symptoms or AMR is suspected. Specific antimicrobials are first-line therapy (typically nitrofurantoin, fosfomycin, trimethoprim/sulfamethoxazole and pivmecillinam, dependent on availability and local resistance data). Fluoroquinolones are not first-line options for uUTIs primarily due to safety concerns but also rising resistance rates. High-quality data to support most non-antimicrobial approaches are lacking. Local AMR data specific to community-acquired uUTIs are needed, but representative information is difficult to obtain; instead, identification of risk factors for AMR can provide a basis to guide empirical antimicrobial prescribing. The COVID-19 pandemic has impacted the management of uUTIs in some countries and may have long-lasting implications for future models of care. Management of uUTIs in female patients can be improved without increasing complexity, including simplified diagnosis and empirical antimicrobial prescribing based on patient characteristics, including a review of recent antimicrobial use and past pathogen resistance profiles, drug availability and guidelines. Current data for non-antimicrobial approaches are limited. The influence of COVID-19 on telehealth could provide an opportunity to enhance patient care in the long term.
 Acute cystitis Antimicrobial prescribing Antimicrobial resistance Recurrent urinary tract infection Uncomplicated urinary tract infection

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