Journal of Global Antimicrobial Resistance (Mar 2022)

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,
  • Ann Stapleton,
  • David A. Talan,
  • José Tirán Saucedo,
  • Mark H. Wilcox,
  • Shingo Yamamoto,
  • Stephen S. Yang,
  • Seung-Ju Lee

Journal volume & issue
Vol. 28
pp. 18 – 29

Abstract

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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.

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