Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 Jul 3;19(Suppl 16):18.
doi: 10.1186/s12919-025-00333-5.

Urinary tract infection in adults: gaps in current guidelines - opinions from an international multidisciplinary panel and relevance to clinical practice

Kalpana Gupta #  1   2   3 , Florian Wagenlehner #  4 , Mark Wilcox #  5 , Sonali D Advani  6 , Manu Bilsen  7 , Gernot Bonkat  8 , Rafael Cantón  9 , Suzanne Geerlings  10 , Beatrice Grabein  11 , Juan P Horcajada  12   13 , Pamela Kushner  14 , Navaneeth Narayanan  15 , Marc Scheetz  16
Affiliations

Urinary tract infection in adults: gaps in current guidelines - opinions from an international multidisciplinary panel and relevance to clinical practice

Kalpana Gupta et al. BMC Proc. .

Abstract

Purpose: Although urinary tract infections (UTIs) are one of the most common infections encountered in clinical practice, many challenges remain with respect to classification and management. The purpose of this report is to discuss key issues in the management of UTIs and identify gaps in current knowledge and guidelines, as well as future research needs.

Design: A multidisciplinary panel of 13 experts from 6 European countries and the United States met on April 27, 2024. They discussed predefined key clinical questions, including classification of UTIs, current management guidelines, management of UTIs in men, antimicrobial switching, and post-treatment asymptomatic bacteriuria.

Results: The panel agreed that differentiation between complicated and uncomplicated UTIs is crucial to antimicrobial selection and can impact outcomes. In particular, definitions of complicated UTIs (cUTIs) vary widely between guidelines and in the literature. Patients with cUTIs are not a homogeneous group and differences in risk factors and prognosis should be considered. However, a balance must be sought between appropriate antimicrobial treatment and complexity of guidelines, which can hinder their implementation, especially in primary care. Guidelines published by the European Urology Association and the Infectious Diseases Society of America differ in their antimicrobial treatment recommendations for cUTIs, which is important at a time of increasing antimicrobial resistance. In men with UTIs, it has been established that a longer duration of antimicrobial therapy is needed in cases where fever is present. De-escalation from broad- to narrow-spectrum antimicrobials is recommended wherever possible, and is associated with similar outcomes in many patients relative to remaining on broad-spectrum treatment. Post-treatment asymptomatic bacteriuria should not be assessed, and treatment is not recommended. Non-specialist physician education is crucial to achieving better outcomes for patients with UTIs.

Implications: Many challenges remain in the management of UTIs in adults, most notably making an accurate classification, which drives antimicrobial treatment selection. A balance between adequacy of management guidelines and their uptake in routine clinical practice is needed to improve outcomes.

Keywords: Antimicrobial de-escalation; Antimicrobial resistance; Complicated urinary tract infection; Guideline; Uncomplicated urinary tract infection.

PubMed Disclaimer

Conflict of interest statement

Declarations. Competing interests: SA is an employee of GSK/ViiV Healthcare, and has received grants or contracts from the Society for Healthcare Epidemiology of America (SHEA), Centers from Disease Control and Prevention, and the National Institutes of Health—National Institute of Diabetes and Digestive and Kidney Diseases. She has received consultancy fees from the Infectious Diseases Society of America (IDSA), Biomerieux, GSK, Locus Biosciences, Sysmex America, and honoraria for presentations from Brooks Army Medical Center, Virginia Commonwealth University, SOVAH Danville Medical Center, Belmont University, GSK, Northwestern University, and the University of Pittsburgh. Financial support for attending meetings has been provided by SHEA/IDSA, DICON hospitals, Belmont University, Washington University, and Virginia Commonwealth University. She has received payment for participation in advisory boards for Biomerieux and from SHEA, the LEAP Fellowship, IDSA, and the American Society for Healthcare Engineering for participation in other boards, societies, committees or advocacy groups. GB has received consultancy fees from GSK, Hoechst Marion Roussel, IBSA, Janssen-Cilag AG, OM Pharma, and Zambon SpA, and honoraria for presentations from IBSA, OM Pharma and Sun Pharma. He has received financial support for meeting attendance from GSK, Hoechst Marion Roussel, IBSA, Janssen-Cilag AG, OM Pharma, and Zambon SpA, and for participation in advisory boards from IBSA, Janssen-Cilag AG and OM Pharma. MB has no conflicts of interest. RC has received a research grant from Shionogi, and honoraria for presentations from GSK, Menarini, MSD and Shionogi. BG has received honoraria for presentations from Advanz, Gilead, Infectopharm, MSD, Pfizer and Shionogi and for participation in advisory boards from MSD and Pfizer. KG serves as a consultant for GSK, Iterum Therapeutics, Utility Therapeutics, VenatorX, PhenUTest, and Qiagen and receives royalties from UpToDate on UTI topics, and is an uncompensated member of the IDSA UTI Guideline Committee. SG has received consultancy fees from Immunotek and Biomerieux. JH has acted as a consultant to Advanz, Mundipharma, Alifax, Menarini, and TFT Pharmaceuticals. He has received honoraria for presentations from Alifax, GSK, MSD and Pfizer, and support for attending meetings from MSD, Pfizer and Shionogi. He has been paid for his attendance at advisory boards and involved in a clinical trial sponsored by DSMB and TFT Pharmaceuticals. PK has acted as an advisor to GSK and received honoraria from GSK and AstraZeneca for presentations, and financial support from GSK for attending meetings. NN has received research grants from Merck and Shionogi, and honoraria for presentations from Astellas and Beckman-Coulter. FW has acted as an consultant to GSK, VenatoRX and Advance Pharma and was a principal investigator in a GSK-sponsored study. He has received honoraria for presentations from Astellas, AstraZeneca, Bionorica, GSK, Janssen, Klosterfrau, MPI-Pharma, OM-Pharma, and Pfizer. He has received financial support from Bionorica, GSK and MIP-Pharma for attendance at meetings and has been involved in the development of the German S3 guideline for urinary tract infection and the European Association of Urology guidelines for urological infections. MW has received consulting fees from Astra Zeneca, BioInteractions, Debiopharm, Ferring, GSK, Nestlé, Paion, Pfizer, Phico Therapeutics, Qpex Biopharma, Seres, Summit, The European Tissue Symposium, Tillotts, and Vedanta; lecture fees from GSK, Pfizer, Seres & Tillotts; and grant support from Debiopharm, GSK, Pfizer, Seres, Summit, The European Tissue Symposium and Tillotts. MS has acted as a consultant for ASHP, Basilea/3D consulting, Cidara, DoseMe, Duke/ARLG, Entasis, F2G, GSK, Lykos Therapeutics, National Institutes of Health, Roche, Third Pole Therapeutics, University of Pennsylvania, and Xellia. He has received honoraria for presentations from ASHP, Duke/ARLG, and the National Institutes of Health, financial support for travel from DoseMe and GSK and participated in advisory boards for DoseMe and F2G.

Figures

Fig. 1
Fig. 1
The European Section of Infections in Urology (ESIU) classification of urinary tract infections [8] RF, risk factor; SIRS, systemic inflammatory response syndrome. This figure has been reproduced with permission from Wagenlehner FME, et al. Nature Reviews in Urology 2020;17:586–600
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. European Association of Urology. EAU guidelines on urological infections. April 2024. https://uroweb.org/guidelines/urological-infections. Accessed May 6, 2024.
    1. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011;52(5):e103–20. 10.1093/cid/ciq257. - PubMed
    1. Marantidis J, Sussman RD. Unmet needs in complicated urinary tract infections: Challenges, recommendations, and emerging treatment pathways. Infect Drug Resist. 2023;16:1391–405. 10.2147/idr.s382617. - PMC - PubMed
    1. Anger J, Lee U, Ackerman AL, et al. Recurrent uncomplicated urinary tract infections in women: AUA/CUA/SUFU guideline. J Urol. 2019;202(2):282–9. 10.1097/ju.0000000000000296. - PubMed
    1. Bilsen MP, Jongeneel RMH, Schneeberger C, et al. Definitions of urinary tract infection in current research: A systematic review. Open Forum Infect Dis. 2023;10(7):ofad332. 10.1093/ofid/ofad332 - PMC - PubMed

LinkOut - more resources