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Review
. 2022 Mar:28:18-29.
doi: 10.1016/j.jgar.2021.11.008. Epub 2021 Dec 8.

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

Florian Wagenlehner  1 , Lindsay Nicolle  2 , Riccardo Bartoletti  3 , Ana C Gales  4 , Larissa Grigoryan  5 , Haihui Huang  6 , Thomas Hooton  7 , Gustavo Lopardo  8 , Kurt Naber  9 , Aruna Poojary  10 , Ann Stapleton  11 , David A Talan  12 , José Tirán Saucedo  13 , Mark H Wilcox  14 , Shingo Yamamoto  15 , Stephen S Yang  16 , Seung-Ju Lee  17
Affiliations
Free article
Review

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

Florian Wagenlehner et al. J Glob Antimicrob Resist. 2022 Mar.
Free article

Abstract

Objectives: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

Keywords: Acute cystitis; Antimicrobial prescribing; Antimicrobial resistance; Recurrent urinary tract infection; Uncomplicated urinary tract infection.

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