Urinary tract infection in adults: gaps in current guidelines – opinions from an international multidisciplinary panel and relevance to clinical practice
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 c...
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2025-07-01
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| Online Access: | https://doi.org/10.1186/s12919-025-00333-5 |
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| author | Kalpana Gupta Florian Wagenlehner Mark Wilcox Sonali D. Advani Manu Bilsen Gernot Bonkat Rafael Cantón Suzanne Geerlings Beatrice Grabein Juan P. Horcajada Pamela Kushner Navaneeth Narayanan Marc Scheetz |
| author_facet | Kalpana Gupta Florian Wagenlehner Mark Wilcox Sonali D. Advani Manu Bilsen Gernot Bonkat Rafael Cantón Suzanne Geerlings Beatrice Grabein Juan P. Horcajada Pamela Kushner Navaneeth Narayanan Marc Scheetz |
| author_sort | Kalpana Gupta |
| collection | DOAJ |
| description | 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. |
| format | Article |
| id | doaj-art-72be44dbe3ea4caba984bb27eee95b51 |
| institution | Kabale University |
| issn | 1753-6561 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Proceedings |
| spelling | doaj-art-72be44dbe3ea4caba984bb27eee95b512025-08-20T03:37:19ZengBMCBMC Proceedings1753-65612025-07-0119S1611310.1186/s12919-025-00333-5Urinary tract infection in adults: gaps in current guidelines – opinions from an international multidisciplinary panel and relevance to clinical practiceKalpana Gupta0Florian Wagenlehner1Mark Wilcox2Sonali D. Advani3Manu Bilsen4Gernot Bonkat5Rafael Cantón6Suzanne Geerlings7Beatrice Grabein8Juan P. Horcajada9Pamela Kushner10Navaneeth Narayanan11Marc Scheetz12Boston University School of MedicineClinic for Urology, Paediatric Urology and Andrology, Justus Liebig UniversitySchool of Medicine, Leeds Institute of Medical Research, University of Leeds & Leeds Teaching HospitalsViiV HealthcareDepartment of Infectious Diseases, Leiden University Medical CenterAlta Uro AG, Merian Iselin Klinik, Center of Biomechanics & Calorimetry, University of BaselServicio de Microbiología, Hospital Universitario Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain and CIBER de Investigación en Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos IIIDepartment of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research InstituteStabsstelle Klinische Mikrobiologie und Krankenhaushygiene, LMU KlinikumInfectious Diseases Service, Hospital del Mar; Hospital del Mar Research Institute (IMIM), Universitat Pompeu Fabra (UPF)Department of Family Medicine, University of California Irvine Medical CenterDepartment of Pharmacy Practice and Administration, Rutgers University Ernest Mario School of PharmacyDepartments of Pharmacy Practice and Pharmacology, Colleges of Pharmacy and Graduate Studies, Midwestern UniversityAbstract 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.https://doi.org/10.1186/s12919-025-00333-5Antimicrobial de-escalationAntimicrobial resistanceComplicated urinary tract infectionGuidelineUncomplicated urinary tract infection |
| spellingShingle | Kalpana Gupta Florian Wagenlehner Mark Wilcox Sonali D. Advani Manu Bilsen Gernot Bonkat Rafael Cantón Suzanne Geerlings Beatrice Grabein Juan P. Horcajada Pamela Kushner Navaneeth Narayanan Marc Scheetz Urinary tract infection in adults: gaps in current guidelines – opinions from an international multidisciplinary panel and relevance to clinical practice BMC Proceedings Antimicrobial de-escalation Antimicrobial resistance Complicated urinary tract infection Guideline Uncomplicated urinary tract infection |
| title | Urinary tract infection in adults: gaps in current guidelines – opinions from an international multidisciplinary panel and relevance to clinical practice |
| title_full | Urinary tract infection in adults: gaps in current guidelines – opinions from an international multidisciplinary panel and relevance to clinical practice |
| title_fullStr | Urinary tract infection in adults: gaps in current guidelines – opinions from an international multidisciplinary panel and relevance to clinical practice |
| title_full_unstemmed | Urinary tract infection in adults: gaps in current guidelines – opinions from an international multidisciplinary panel and relevance to clinical practice |
| title_short | Urinary tract infection in adults: gaps in current guidelines – opinions from an international multidisciplinary panel and relevance to clinical practice |
| title_sort | urinary tract infection in adults gaps in current guidelines opinions from an international multidisciplinary panel and relevance to clinical practice |
| topic | Antimicrobial de-escalation Antimicrobial resistance Complicated urinary tract infection Guideline Uncomplicated urinary tract infection |
| url | https://doi.org/10.1186/s12919-025-00333-5 |
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