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 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,…
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