Florian Wagenlehner1, Lindsay Nicolle2, Riccardo Bartoletti3, Ana C Gales4, Larissa Grigoryan5, Haihui Huang6, Thomas Hooton7, Gustavo Lopardo8, Kurt Naber9, Aruna Poojary10, Ann Stapleton11, David A Talan12, José Tirán Saucedo13, Mark H Wilcox14, Shingo Yamamoto15, Stephen S Yang16, Seung-Ju Lee17. 1. Department of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Rudolf Buchheim Strasse 7, 35385 Giessen, Germany. Electronic address: Florian.Wagenlehner@chiru.med.uni-giessen.de. 2. University of Manitoba, Winnipeg, Canada. 3. Department of Translational Research and New Technologies, University of Pisa, Pisa, Italy. 4. Division of Infectious Diseases, Federal University of São Paulo, São Paulo, Brazil. 5. Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA. 6. Institute of Antibiotics, Huashan Hospital, Fudan University, Shanghai, China. 7. Department of Medicine, School of Medicine, University of Miami, Miami, Florida, USA. 8. University of Buenos Aires, Buenos Aires, Argentina. 9. Department of Urology, Technical University of Munich, Munich, Germany. 10. Department of Pathology and Microbiology, Breach Candy Hospital Trust, Mumbai, India. 11. Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA. 12. Department of Emergency Medicine, Department of Medicine, Division of Infectious Diseases, Ronald Reagan UCLA Medical Center, David Geffen School of Medicine at UCLA, Los Angeles, California, USA. 13. Mexican Institute for Infectious Diseases in Obstetrics and Gynecology, Monterrey, Mexico. 14. Leeds Institute of Medical Research, School of Medicine, University of Leeds & Leeds Teaching Hospitals, Leeds, UK. 15. Hyogo College of Medicine, Nishinomiya, Japan. 16. Taipei Tzu Chi Hospital and School of Medicine, Buddhist Tzu Chi University, New Taipei, Taiwan. 17. Department of Urology, The Catholic University of Korea School of Medicine, Seoul, South Korea.
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.
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.