Importance听
Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence.
Objective听
To create a clinical guideline for the diagnosis and management of urinary tract infections that addresses the gap between the evidence and recommendation strength.
Evidence Review听
This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In May 2023, new and existing members were solicited for questions on urinary tract infection prevention, diagnosis, and management. For each topic, literature searches were conducted up until early 2024 in any language. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were developed discussing the available literature and associated risks and benefits of various approaches.
Findings听
A total of 54 members representing 12 countries reviewed 914 articles and submitted information relevant to 5 sections: prophylaxis and prevention (7 questions), diagnosis and diagnostic stewardship (7 questions), empirical treatment (3 questions), definitive treatment and antimicrobial stewardship (10 questions), and special populations and genitourinary syndromes (10 questions). Of 37 unique questions, a clear recommendation could be provided for 6 questions. In 3 of the remaining questions, a clear recommendation could only be provided for certain aspects of the question. Clinical reviews were generated for the remaining questions and aspects of questions not meeting criteria for a clear recommendation.
Conclusions and Relevance听
In this consensus statement that applied the WikiGuidelines method for clinical guideline development, the majority of topics relating to prevention, diagnosis, and treatment of urinary tract infections lack high-quality prospective data and clear recommendations could not be made. Randomized clinical trials are underway to address some of these gaps; however further research is of utmost importance to inform true evidence-based, rather than eminence-based practice.
Urinary tract infections (UTIs) are among the most common infections globally, notably impacting patient quality of life and posing substantial clinical and economic challenges. UTIs exhibit diverse etiologies and clinical severities, from simple cystitis to pyelonephritis and life-threatening sepsis. Diagnosis can be a challenge, due to the lack of validated, highly accurate testing. Management is further complicated by evolving multidrug resistance. Despite advancements in diagnosis and treatment, UTIs can cause high morbidity and mortality, with profound implications in both community and health care settings.
In this third WikiGuidelines consensus statement, we provide an evidence-based approach to UTI management developed by a global network of experts for practical use across diverse clinical settings. This guideline fills a critical gap by providing pragmatic, broadly applicable recommendations tailored for generalist care and systems-based practice. Our guidance is rooted in the best available evidence and is designed for clinicians from various backgrounds and health care environments. It emphasizes a patient-centered approach to the diagnosis, prevention and treatment of UTIs and related genitourinary infections.
Our multinational team includes 54 experts from 12 countries, including 31 physicians and 23 pharmacists or PhDs with expertise in internal medicine, pediatrics, infectious diseases, and/or microbiology (eTable 1 and 2 in the Supplement). This study followed the Standards for Quality Improvement Reporting Excellence () reporting guideline and followed the WikiGuidelines charter, which requires issuing clear recommendations only when supported by sufficient hypothesis鈥揷onfirming evidence, including 2 well-conducted concordant randomized clinical trials (RCTs) or 1 well-conducted RCT and a well-conducted concordant prospective observational study. When evidence does not meet these criteria, a review of the literature and discussion is presented in lieu of a recommendation with the goal of proposing reasonable management strategies that maximize benefits, minimize harms, and avoid definitive recommendations for unsubstantiated practices.
On March 15, 2023, crowdsourcing efforts began via social media to identify experts interested in contributing to the guideline development. Authors were selected based on their active professional licenses and relevant clinical expertise, with additional participants chosen for their technical expertise, such as medical librarianship, epidemiology, and biostatistics. The steering committee, elected by the board of directors, selected the chair and cochair to oversee the development of the guideline. On May 1, 2023, we solicited questions from authors about UTI prevention, diagnosis, and management, and organized by theme. Specialized groups were formed, and section leads were appointed by the cochairs to address the 5 distinct themes. Volunteer authors and section leads produced each section through performing extensive literature reviews in PubMed, Medline, and other databases without date or language restrictions. Initial drafts created by the groups were reviewed and refined by the primary and senior authors, followed by collaborative review and feedback from the entire group. Consensus was achieved through a structured process involving a series of meetings, literature reviews, and iterative revisions, with the final approval requiring either a consensus or, if necessary, a majority vote among the committee members. After multiple rounds of revisions and feedback, a finalized version for each section was realized and compiled into a cohesive manuscript by the primary and senior authors.
Section 1: Prophylaxis and Prevention
An overview of findings relating to empirical treatment can be found in Table 1. Additional information can be found in eAppendix 1 in the Supplement.
Question 1: What Is the Role of Pharmacotherapy for the Prevention of UTIs?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Pharmacotherapy can be considered for the prevention of UTIs in women with recurrent UTIs (Table 1). Postcoital administration of trimethoprim/sulfamethoxazole (TMP/SMX) or ciprofloxacin appears to reduce the incidence of UTIs in women compared with placebo.1 No significant difference in effectiveness between intermittent, defined as the use of antibiotics after a trigger such as coitus, and continuous strategies has been demonstrated in high quality studies.2 Benefits of antibiotic prophylaxis appear confined to their usage period and the optimal duration that balances individual and ecological risks with effectiveness are unclear. Observational data indicate that nitrofurantoin, norfloxacin, and TMP/SMX are comparatively effective; however, conclusions are limited based on the study design.3 There is limited and conflicting data on antibiotic prophylaxis for children.4-6
Question 2: Is There a Role for Cranberry Juice or Supplements in the Prevention of UTIs?
A sufficient quality and quantity of evidence was found to provide a clear recommendation for the role of cranberry juice or supplements in the prevention of UTIs. Most prospective studies have indicated that cranberry products can reduce the risk of symptomatic, culture-verified UTIs in women with recurrent UTIs, children, and individuals susceptible to UTIs after interventions (Table 1).7-23 Evidence for their use in older adults, those with bladder emptying problems, or pregnant women is insufficient to make a clear recommendation for or against use.
Question 3: Can Water Intake Play a Role in the Prevention of UTIs?
The clinical review found insufficient quality of evidence to enable a clear recommendation. One RCT24 that explored the effect of hydration on UTIs found that increased water intake significantly reduced cystitis frequency in healthy women. This RCT included 140 healthy women with recurrent cystitis, defined as 3 or more episodes in the past year, who drank less than 1.5 L of fluid per day. Participants were randomly assigned to either drink an additional 1.5 L of water daily or no additional fluids for 12 months. An observational nursing home study25 was unable to demonstrate a benefit; however, it was underpowered. Beyond this single RCT,24 studies are limited and further research is needed to confirm these findings and explore this intervention in broader populations (Table 1).
Question 4: Is There a Role for Topical Estrogen in the Prevention of UTIs?
A sufficient quality and quantity of evidence was found to provide a clear recommendation for the use of topical estrogen to prevent UTIs. Based on available evidence from 30 RCTs and 1 large retrospective observational study, topical estrogen is effective at reducing recurrent UTIs in postmenopausal women (Table 1).26 The loss of estrogen during perimenopause causes changes within the vaginal microbiome, which can lead to a loss of Lactobacillus species, an increase in vaginal pH, and an increased risk of UTIs.27 The use of topical estrogen may help to reduce vaginal atrophy, restore the vaginal microbiome, and reduce the frequency of UTIs.28 Recent evidence supports using vaginal estrogen therapy for breast cancer patients with genitourinary symptoms when nonhormonal treatments fail.29 Topical estrogen is thought to have minimal systemic absorption and no concerning safety signals with regard to the risk of stroke, venous thromboembolism, invasive breast cancer, colorectal cancer, or endometrial cancer were identified in a large prospective cohort study of more than 45鈥�000 women.30 It remains reasonable for biological females with a history of estrogen-related malignant neoplasms to discuss the risk and benefit of this treatment with their health care team prior to initiation.
Question 5: Is There a Role for Methenamine Hippurate in the Prevention of UTIs?
A sufficient quality and quantity of evidence was found to provide a clear recommendation for the use of methenamine hippurate to prevent UTIs. Methenamine, which was approved in 1967 for recurrent UTI prophylaxis in those aged 12 years and older, works by releasing formaldehyde in acidic urine, thus resulting in bacteriostasis. A systematic review,31 which included a multicenter, open-label, randomized noninferiority trial conducted in the UK from June 2016 to June 2018, compared the efficacy of methenamine with daily low-dose antibiotics in preventing recurrent UTIs in women aged 18 years and older and found that methenamine was noninferior to antibiotics for the prevention of UTIs. Similarly, a nonblinded RCT compared methenamine with trimethoprim for preventing recurrent UTIs over 12 months in women aged 18 years and older found noninferiority for methenamine, with no significant difference in UTI recurrence rates between the 2 groups and similar adverse effects.32 Therefore, we recommend the use of methenamine as an alternative to prophylactic antibiotics in patients with intact bladder anatomy (Table 1).
Question 6: Are Probiotics Effective in the Prevention of UTIs?
The clinical review found insufficient quality of evidence to enable a clear recommendation. There is inconclusive evidence to recommend for or against the use of oral or vaginal probiotics to prevent UTIs (Table 1). Studies were heterogeneous as it pertains to the patient populations (children, premenopausal women, postmenopausal women, complicated UTI in patients with comorbidities), specific probiotics, route of administration, and study design.33-36
Question 7: Is There a Role for D-Mannose in the Prevention of UTIs?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Despite biological plausibility for effectiveness,37 there is currently insufficient evidence to support or refute the use of D-mannose for the prevention of UTIs. Only 3 RCTs,38-40 1 small open-label prospective cohort study,41 and a subgroup of another prospective cohort study42 evaluated D-mannose alone for only prevention (not treatment) of UTIs. Discordant or uncertain results among the prospective studies along with small sample sizes and heterogeneity of specific D-mannose regimens, study populations, comparators, UTI definitions, potential for reporting bias, and follow-up periods preclude a clear recommendation for or against its use. Although poorly reported, adverse effects were seemingly infrequent, and most included gastrointestinal symptoms and vaginal burning.40,43,44
Section 2: Diagnosis and Diagnostic Stewardship
An overview of findings relating to diagnosis and diagnostic stewardship can be found in Table 2. Additional information can be found in eAppendix 2 in the Supplement.
Question 8: What Are the Clinical Definitions of Cystitis, Complicated UTIs, and Pyelonephritis?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Cystitis and pyelonephritis are typically diagnosed clinically through signs and symptoms with evidence of inflammation (pyuria) and the presence of pathogenic bacteria in the urine (Table 2). Typical nomenclature includes the use of terms, such as cystitis, uncomplicated UTI, complicated UTI, and pyelonephritis. Cystitis, an inflammation of the bladder often indicated by dysuria, urgency, and suprapubic pain, is typically described not to show systemic infection signs like fever. Unfortunately, complicated UTI lacks a standard clinical definition due to diverse criteria in literature and guidelines. Complicated UTIs may involve catheters or other foreign bodies, complicating factors like structural anomalies or immunosuppression, or systemic symptoms. Pyelonephritis, kidney inflammation due to infection, includes cystitis symptoms plus systemic signs like fever and flank pain. More precise clinical definitions, based on clinical studies linked to outcomes, are needed. Most WikiGuidelines authors strongly encourage the use of more precise descriptions of UTI in clinical practice rather than continuing to use vague terms, such as complicated or uncomplicated.
Question 9: What Is the Role and the Sensitivity and Specificity of a Urinalysis (UA) for the Diagnosis of UTIs and When Should Clinicians Order Urine Cultures?
The clinical review found insufficient quality of evidence to enable a clear recommendation. A UA encompasses physical, chemical, and microscopic evaluations designed to aid in diagnosing kidney, metabolic, oncologic, and infectious disorders. Unfortunately, the diagnostic value of UA for UTI is limited.45,46 While the absence of pyuria can help rule out infection in most patient populations, the positive predictive value of pyuria for diagnosing infection is exceedingly low as it often indicates the presence of genitourinary inflammation due to many other possible noninfectious reasons (Table 3). For these reasons, WikiGuidelines authors believe that evidence-based diagnosis of UTI should be primarily based on clinical symptoms. Clinical symptoms may be integrated with UA findings, but authors caution clinicians to not rely solely on the UA alone. Urine cultures are reasonable for complicated cases and/or recurrent UTIs, particularly in suspected pyelonephritis, to guide targeted therapy. In simple uncomplicated cystitis in healthy nonpregnant patients, routine cultures are not necessary.47,48
Question 10: What Is the Role of UA and Urine Culture Testing for the Workup of Fever?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Routine use of UA and urine cultures for the workup of fever in hospitalized patients leads to unnecessary testing and antimicrobial use.46,49,50 Studies show that UTIs, including catheter-associated UTIs (CAUTI), are infrequently the source of fever, particularly in the absence of urinary tract obstruction, recent urological procedures, or immunocompromise.51 Consequently, urine testing should not be automatic in febrile patients, especially geriatric patients, or those with known nonurinary sources of fever and should be reserved for cases with specific urinary or related symptoms. Further research is needed to establish clear criteria for urine testing in febrile patients.
Question 11: How Can Diagnostic Stewardship Strategies Be Effectively Implemented in the Management of UTIs to Prevent Unnecessary Treatment of Asymptomatic Bacteriuria?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Effective management of UTI hinges on appropriate diagnostic testing and antimicrobial stewardship, aiming to prevent the misuse of antibiotics for ASB. Symptom-based testing is key to ensure appropriate urine culture testing and proper diagnosis of UTI.52,53 A 2017 systematic review54 showed 45% of included patients experienced inappropriate initiation of antimicrobial treatment for ASB; various interventions, such as education on diagnostic protocols, provided a significant absolute risk reduction of 33%. Avoiding overtesting and resulting overtreatment of ASB is essential to preserving antimicrobial effectiveness.
Question 12: What Is the Role of Novel Molecular Tests in the Diagnosis of UTI?
The clinical review found insufficient quality of evidence to enable a clear recommendation. The role of molecular techniques for UTI diagnosis is currently limited. Molecular diagnostics cannot distinguish true infection from ASB. Urine culture is the current reference standard for confirming the etiologic pathogen in patients with suspected infection. Although 100鈥�000 colony forming unit (CFU)/mL has been considered the historical standard threshold for bacteriuria and diagnosing UTIs, lower CFU counts can still indicate significant infections in symptomatic patients.55-58 In contrast, molecular techniques are generally unable to determine bacterial viability or quantitation in urine specimens.59 These factors are crucial to differentiate colonization vs infection and to delineate pathogenic organisms vs commensal flora. The increased sensitivity of these molecular tests may lead to overtreatment by detecting clinically insignificant bacteria, especially now that metagenomics has identified endogenous genitourinary microflora,60-64 underscoring the need for clear guidelines to avoid unnecessary therapy. More research is required to determine the ideal role of molecular testing in UTI diagnosis.
Question 13: What Is the Role of Different Imaging Modalities, Such as Ultrasonography and Computed Tomography, for the Diagnosis of UTIs, and What Is the Sensitivity and Specificity These Imaging Modalities?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Computed tomography (CT) scans do not appear to be useful in the routine initial diagnostic workup of cystitis or pyelonephritis and may not routinely alter treatment65,66 CT imaging may be useful if symptoms persist or worsen beyond 72 hours or if there are concerns for kidney calculi, kidney abscess, or an alternative focus of infection.67-69 Contrast CT imaging is best discussed with the radiologist but may have advantages in terms of detecting kidney abscesses. Ultrasonography, while safer and more accessible, has limited accuracy but may be a preferrable first imaging modality in younger patients, pregnancy, and/or kidney transplant recipients because there is no associated ionizing radiation, and may be able to more directly visualize the transplanted organ(s) (Table 4). Magnetic resonance with or without contrast and/or diffusion-weighted imaging is less effective for early disease detection and stone visualization but may also have an advantage in identifying graft infection (Table 4).70,71 We caution clinicians to only obtain radiographic studies if they are likely to alter management for a patient with known or suspected UTI.
Question 14: What Are the Limitations of Usual Diagnostics in Patients With Indwelling Urinary Catheters or Ileal Conduits?
The clinical review found insufficient quality of evidence to enable a clear recommendation. UA has a very low specificity in diagnosing UTIs in patients with indwelling urinary catheters or ileal conduits but has excellent negative predictive value.72 This suggests that a negative UA can rule out CAUTI for patients with functioning bone marrow, but given the low specificity of UA in patients with urinary catheters or ileal conduits, a positive UA does not mean the patient has a CAUTI. In addition, urine cultures are not reliable tests for patients with chronic urinary catheters or ileal conduits.73-75 In these cases, bacteriuria is almost always present regardless of symptoms and are a likely source of appropriate initiation of antimicrobial treatment.
Section 3: Empirical Treatment
An overview of findings relating to empirical treatment can be found in Table 3. Additional information can be found in eAppendix 3 in the Supplement.
Question 15: What Are Reasonable Empirical Treatment Regimen(s) for Pediatric or Adult Patients Diagnosed With a UTI?
A sufficient quality and quantity of evidence was found to provide a clear recommendation for empirical treatment regimens for pediatric and adult patients diagnosed with UTIs. Empirical treatment regimens for pediatric and adult patients should contain antimicrobials that have historically demonstrated efficacy and safety in the treatment of UTIs, achieve adequate urinary concentrations, and provide reliable activity against the most common pathogens based on local resistance rates. A proposed framework for selecting empirical treatment regimens is presented in eFigure 1 and eFigure 2 in the Supplement. Presence of risk factors for antimicrobial resistance along with clinical severity also play an important role in the selection of empirical choices.76,77,182 For patients with uncomplicated cystitis, nitrofurantoin is a reasonable drug of choice, based on robust evidence of efficacy and its ability to spare use of more systemically active agents for treating other infections.78 For patients with pyelonephritis, TMP/SMX or a first-generation cephalosporin represent reasonable first-line agents but should be dependent upon local resistance rates. Due to low resistance rates and clinical effectiveness, ceftriaxone is the recommended empirical choice for patients who require intravenous therapy, barring any risk factors for multidrug resistance.79,80 In general, agents with antipseudomonal activity should only be used in patients with risk factors for nosocomial pathogens. However, it may be reasonable to use carbapenem therapy empirically in hemodynamically unstable patients for whom there is a specific concern regarding extended-spectrum 尾-lactamase-producing bacteria. Overall, selection should be guided by local susceptibilities and patient-specific risk factors.
Question 16: What Are Reasonable Empirical Treatment Regimens for Treatment of a CAUTI?
The clinical review found insufficient quality of evidence to enable a clear recommendation. There is an absence of high-quality data to inform empirical treatment in patients with CAUTI. Observational data suggest that, where possible, it may be preferable to replace or discontinue existing catheters prior to the collection of cultures and initiation of antimicrobial treatment.81 UTIs diagnosed after catheter exchange are likely to respond similarly to noncatheterized patients. Empirical treatment decisions can be made based on review of the individual patient鈥檚 urinary tract anatomy or dysfunction, allergies medication list for interactions, microbiological and prior treatment history, the type of UTI (eg, cystitis vs pyelonephritis), and the clinical severity of presentation.
Question 17: What Are the Established Risk Factors for UTI Due to Multidrug Resistant Organisms and When Should Empirical Treatment Account for These Pathogens?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Although no validated models exist, prior health care exposure, previous antibiotic use, and a history of UTI or known colonization seem to be the most consistent and important estimators of development of a UTI due to a multidrug resistant organism (MDRO).82-84 Due to heterogeneity in the populations and methods of available studies, the timing and/or combination of the exposure(s) and the subsequent effects on the outcome are unclear. There is insufficient data available to clearly guide decisions on when empirical treatment should include the possibility of an MDRO. In the absence of such data, it may be reasonable to suggest that the severity of an infection may be an important driver of empirical antibiotic choice when combined with local resistance patterns, proposed epidemiologic risk factors, and an individualized microbiologic history.
Section 4: Definitive Treatment and Antimicrobial Stewardship
An overview of findings relating to definitive treatment can be found in Table 4. Additional information can be found in eAppendix 4 in the Supplement.
Question 18: What Is Considered Treatment Failure of a UTI and Are There Host-Related Risk Factors That May Influence the Risk of Treatment Failure?
The clinical review found insufficient quality of evidence to enable a clear recommendation. There is no agreed upon universal definition of treatment failure. In general, treatment failure may result from clinical failure, microbiological failure, or a combination thereof. Current US Food and Drug Administration guidance suggests a composite endpoint that includes both clinical and microbiological responses. The true implications of the combination of clinical cure with microbiologic failure at follow-up remains uncertain. An analysis of individual participant data from several phase 3 studies found an increased risk of late clinical failure in patients with clinical cure but microbiological persistence,85 but this phenomenon is often difficult to distinguish from a new infection. Notably, in 2 recent large RCTs, positive urine cultures at follow-up in patients who had resolved clinical signs and symptoms of infection did not appear to predict a higher risk of relapse of infection within the follow-up period.86,87 Commonly identified epidemiologic risk factors for treatment failure identified in observational studies include older age, diagnosis of diabetes, presentation with septic shock, pregnancy, and immunosuppression.88-99 No compelling data exist to support adjusting UTI treatment based on the potential risk factors for treatment failure that have been identified in these retrospective studies.
Question 19: What Is the Appropriate Duration of Treatment of Acute Cystitis in Pediatric Patients Older Than 2 Months of Age?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Based on several randomized trials, shorter courses (3 to 5 days, depending on the antimicrobial used) result in comparable outcomes to longer courses (7 to 14 days) and are reasonable for the treatment of cystitis in children older than 2 months of age when the likelihood of pyelonephritis is deemed to be low.100-102 Small study size, heterogeneity in trial design (various durations, various antibiotics), end point definitions (with frequent use of positive culture at follow-up defining treatment failure), and outcomes, preclude a clear recommendation for duration of treatment. Several observational studies suggest that a single parenteral dose of an aminoglycoside may be a reasonable alternative treatment option.103 No data exists to suggest that initial (or any) parenteral treatment for cystitis is necessary in patients who can tolerate oral treatment.
Question 20: What Is the Appropriate Duration of Treatment of Acute Pyelonephritis in Pediatric Patients Older Than 2 Months of Age?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Available randomized trial data are inadequate to provide a clear recommendation on the optimal duration of treatment for acute pyelonephritis in children older than 2 months of age.86,104,105 Most existing data suggest similarly high rates of clinical success when patients receive 5 to 9 days (depending on the antimicrobial used) when compared with 10 to 14 days total.106,107
Question 21: What Is the Appropriate Duration of Treatment for Acute Cystitis in Adults?
Based on the totality of the evidence available, we can provide clear recommendations on the optimal durations of treatment for cystitis (regardless of biological sex) for the antimicrobial classes listed below:
Data are insufficient to enable clear recommendations for duration of treatment for other potential treatment options, including 尾-lactams and parenteral aminoglycosides. Some pediatric data support a 5-day treatment duration when oral 尾-lactams are used to treat cystitis.105
Question 22: What Is the Appropriate Duration of Treatment for Acute Pyelonephritis and/or Febrile UTI in Adults?
Based on several randomized clinical trials, we can provide a clear recommendation on the duration of therapy for the following antimicrobial classes (regardless of biological sex) for the treatment of acute pyelonephritis:
The clinical review found insufficient quality of evidence to enable a clear recommendation for fosfomycin, TMP/SMX, and aminoglycoside monotherapy. We cannot provide clear recommendations for pyelonephritis treatment duration with TMP/SMX, fosfomycin, or aminoglycoside monotherapy due to the lack of reproducible high-quality data or heterogeneity across small studies. We are unable to provide a clear recommendation for the treatment duration for febrile UTI. When considering the available data for pyelonephritis and gram-negative bacteremia from a urinary source, it may be reasonable for febrile UTI to be treated in a similar fashion to pyelonephritis.
Question 23: What Is the Appropriate Duration of Treatment for CAUTIs?
The clinical review found insufficient quality of evidence to enable a clear recommendation. The optimal duration of antimicrobial therapy for CAUTIs has not been rigorously evaluated in large RCTs.81 Data are limited to observational studies or small subgroups of RCTs evaluating complicated UTIs, so a clear recommendation cannot be made. Based on available observational data, 5 to 7 days appears as effective as longer treatment courses and represents a reasonable duration of treatment for most cases of CAUTI in conjunction with catheter exchange and/or removal, if possible.144 No existing data demonstrate an association between longer courses and improved patient outcomes.
Question 24: What Are Optimal Oral Agents and an Appropriate Duration of Treatment for Gram-Negative Bacteremia From a Urinary Source?
A sufficient quality and quantity of evidence was found to provide a clear recommendation. Multiple RCTs comprised patients with gram negative bacteremia from predominantly urinary sources demonstrate noninferiority of 7 days compared with 14 total days of treatment for a variety of patient-oriented outcomes, such as clinical cure, clinical failure, relapse, and all-cause mortality.145-148 Thus, we can provide a clear recommendation for 7 days of treatment for gram negative bacteremia from a urinary source when source control has been addressed (if applicable). Whether shorter durations might also be effective is unknown as they have not been studied. These trials tested duration as a strategy and not specific drugs; thus, while no specific class of medications can be recommended, it is also reasonable to ensure that the choice of drug and the doses used are optimized for the patient and a urinary focus of infection.
Question 25: What Are Potential Treatment Option(s) and Appropriate Durations of Treatment for Asymptomatic Bacteriuria in Populations in Which Treatment Is Indicated?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Unnecessary treatment of asymptomatic bacteriuria (ASB) risks side effects without benefit represents low value care and poses a threat to antimicrobial sustainability.53,149-152 There is no conclusive evidence that there is any population in which treatment of ASB is required and randomized clinical trials are welcomed. There are theoretical reasons and limited evidence which support treatment of ASB in pregnant patients153,154 and in those undergoing invasive urologic procedures associated with expected mucosal bleeding.155-158 When treating ASB, the ideal duration of treatment is unknown. In pregnancy, it may be reasonable not to exceed the duration used for symptomatic cystitis (eg, 3 to 5 days, depending on the antimicrobial used). For patients undergoing invasive urologic procedures, most authors believe that many patients could receive a single dose of preoperative prophylaxis prior to the scheduled procedure.
Question 26: What Are Potential Treatment Option(s) and Duration of Treatment for UTIs Caused by Multidrug Resistant Organisms?
The clinical review found insufficient quality of evidence to enable a clear recommendation. The potential treatment option(s) depend on the organism identified and specific resistance mechanisms. To our knowledge, no data exist to suggest that the duration of treatment for UTIs caused by multidrug resistant organisms (MDROs) needs to be modified compared with those caused by nonresistant organisms. We feel it is reasonable to determine a treatment duration based on the anatomical location and clinical severity (eg, cystitis or pyelonephritis) as well as the clinical response to treatment provided that (1) the antimicrobial being used has demonstrated activity against the organism, (2) the antimicrobial has proven or a high likelihood of efficacy for treatment of UTIs, and (3) any applicable source control has been obtained.
Question 27: What Are Effective Antimicrobial Stewardship Strategies That Can Optimize the Rational and Sustainable Use of Antimicrobials in the Setting of Treatment of UTIs?
A sufficient quality and quantity of evidence was found to provide a clear recommendation for deescalation and mostly or all oral treatment. Randomized clinical trials have demonstrated the individual and ecological benefits to antibiotic deescalation and all authors encourage its use when able during the treatment of UTIs.159,160 Additionally, multiple RCTs demonstrate treatment of a variety of UTIs with all or mostly oral regimens result in comparable outcomes with intravenous-only treatment and may reduce hospital length of stay and adverse events associated with antibiotics and/or central venous catheters.161-174
The clinical review found insufficient quality of evidence to enable a clear recommendation for allergy assessment and cascade reporting. Our review did not yield any RCTs evaluating antibiotic allergy assessment specifically for the management of UTIs; however all authors of this consensus statement agree that thorough allergy assessment (and challenge, if indicated) can likely prevent a variety of harms based on existing data and recommendations from specialists in allergy or immunology.175-177 Although we cannot provide a clear recommendation due to the observational nature of the data, we agree that optimizing the reporting of antimicrobial susceptibility results through selective or cascade reporting is a reasonable strategy to optimize treatment selection.178-180
Section 5: Special Populations and Genitourinary Syndromes
An overview of findings relating to special populations can be found in Table 5. Additional information can be found in eAppendix 5 in the Supplement.
Question 28: What Are Special Considerations for the Diagnosis and Treatment of UTI in Older Adults?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Asymptomatic bacteriuria is prevalent in the older adults, particularly in institutionalized individuals, with treatment showing no benefit over placebo.181,182Overtesting and overtreatment with antibiotics for these nonsymptomatic cases remains high.183,184 UTIs are more frequent in the institutionalized older adult populations and clinical tools for assessing symptoms exist to help discourage tests for nondelirium behavioral changes or falls.183 Using clinical scores alongside microbiological tests is crucial due to the high rates of bacteriuria with pyuria, and the potential misinterpretation of UA results, which often leads to unnecessary antibiotic use.185,186 Further research comparing clinical prediction scores for UTIs is needed.
Question 29: What Is the Role and Utility of UA and Urine Culture Testing in Pediatric Populations?
The clinical review found insufficient quality of evidence to enable a clear recommendation. In pediatric care, the workup for febrile illness often includes UA and urine culture, particularly in younger populations where symptoms cannot be elicited.187 These practices can lead to the overtreatment and overdiagnosis of UTI. Major societies recommend using proper microbiological methods for diagnosis, yet clinical practices deviate, depending on less reliable methods like bagged urine samples.188-190 The interpretation of UA and colony forming unit counts in urine cultures in the pediatric population are not clearly defined, leading to variability in the diagnosis and treatment of pediatric UTI.
Question 30: For Pediatric Patients, How Do We Delineate Cystitis vs Pyelonephritis When the Child Is Unable to Verbalize Symptoms Characteristic of UTI?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Pediatric cystitis and pyelonephritis are common yet complex conditions in children, impacting quality of life and requiring comprehensive management.191,192 In pediatric patients, distinguishing cystitis from pyelonephritis can be challenging, particularly in young children who are unable to verbalize symptoms. Clinical evaluation, including assessment for systemic signs such as fever and poor feeding, along with UA and imaging studies, are essential in making this differentiation.47,193 While infections are mainly caused by gram-negative bacteria, noninfectious causes also contribute to the diagnostic challenge. Prevention of long-term kidney damage from pyelonephritis necessitates prompt recognition and treatment, considering genetic, urinary, and environmental factors.
Question 31: What Is the Optimal Follow-Up Timeframe for Pediatric Patients With UTI?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Observational data suggests that clinical improvement, including fever resolution, typically occurs after 48 to 72 hours of treatment in children.194,195 Authors believe it to be reasonable to conduct additional work-up (eg, kidney and bladder ultrasonography) and/or reassess the current treatment plan if patients do not experience clinical improvement within that timeframe.194,196-200 Assuming the patient improves as expected, previously described treatment durations of 3 to 5 days for cystitis and 7 to 10 days for pyelonephritis are reasonable (more detail in questions 19 and 20). Routine follow-up is not necessary unless the patient is younger than age 2 years and experiences a febrile UTI or a child of any age experiences a recurrence of febrile UTI. It is reasonable to deescalate and/or target treatment as soon as culture and susceptibility results are available based on the discussion in question 27 and other studies of children who are hospitalized.201,202
Question 32: For Kidney Transplant Recipients, What Is the Significance of a Positive Urine Culture?
The clinical review found insufficient quality of evidence to enable a clear recommendation. UTIs are an important postkidney transplant complication.203,204 The spectrum of causative microorganisms is broad and includes typical uropathogens, atypical pathogens, and MDROs.205 This complexity demands a nuanced understanding of microbial behavior in the context of immunosuppressed individuals. Cultures need to be interpreted within their clinical context, including specific timing posttransplantation and symptoms. Routine treatment of ASB in kidney transplant recipients increases colonization with resistant organisms without providing clear benefit and should be avoided after the first 2 months from transplantation.206
Question 33: What Is the Empirical and Definitive Treatment of Emphysematous Cystitis and Pyelonephritis?
The clinical review found insufficient quality of evidence to enable a clear recommendation. The treatment of emphysematous cystitis and pyelonephritis (caused by gas producing pathogens) lacks robust data, with recommendations mostly relying on clinical judgment and case studies.207 Early appropriate antibiotics targeting common pathogens like Escherichia coli and Klebsiella species is reasonable, with a general treatment approach mirroring that for nonemphysematous UTIs.208 While most cases respond to medical therapy, severe instances may need surgical intervention. Percutaneous catheter drainage, along with antibiotics, shows lower mortality for emphysematous pyelonephritis and is advisable in severe cases to include broader coverage until culture results are available.209 Most authors believe a treatment duration of 7 to 14 days (adjusted per clinical response) is reasonable.210
Question 34: What Is the Clinical Presentation and Diagnostic Approach for Kidney or Perinephric Abscess? What Is the Empirical and Definitive Treatment of Kidney Abscess and Perinephric Abscess?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Perinephric abscesses are serious conditions with varied presentations.211 Typical symptoms include lumbar pain and fever, with many patients presenting with costovertebral angle tenderness. CT imaging is crucial for diagnosis and management, which may include medical therapy, percutaneous drainage, or surgery for refractory cases.211 These abscesses are commonly caused by gram-negative bacteria or hematogenous seeding from organisms like Staphylococcus aureus. Decision to opt for drainage of the abscess is often influenced by the size,212,213 however, some form of drainage is often necessary for definitive treatment. Further research is needed on optimal source control intervention strategies and when medical management alone may be used.214-216
Question 35: What Is the Clinical Presentation, Diagnostic Approach, and Treatment for Acute and Chronic Prostatitis?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Acute bacterial prostatitis (ABP) and chronic bacterial prostatitis (CBP) are inflammatory prostate syndromes with ABP often presenting abruptly with febrile UTI symptoms and CBP involving more persistent symptoms or recurrent UTIs.217,218 Diagnosis for ABP relies on clinical presentation and laboratory tests. CBP diagnosis involves comparing bacteria levels in prostatic fluid and urinary cultures, yet definitive testing is debated. Testing for prostate specific antigen (PSA) appears of limited utility.219 Maneuvers to express prostatic fluid, such as prostate massage, are of limited clinical utility and urology consultation may be needed.219,220 The optimal durations of treatment for ABP or CBP are unknown and have not been established by high-quality studies. Additional prospective studies are needed to determine the appropriate duration of treatment for ABP and CBP.
Question 37: What Are Nonbacterial Causes of UTI to Consider in Certain Special Populations?
The clinical review found insufficient quality of evidence to enable a clear recommendation. Most nonbacterial UTIs are due to Candida species230 While 25% of intensive care unit UTIs in the US are attributed to Candida species, most cases of candiduria are asymptomatic and benign. If symptomatic, fluconazole and amphotericin B are preferred due to favorable urinary pharmacokinetics and pharmacodynamics, but no RCTs are available to determine the best treatment choice or duration.230,231 Viral UTIs (especially BK polyomavirus and adenovirus) are less common but a noteworthy risk in immunocompromised patients.232-234 A reduction in the intensity of existing immunosuppression is the primary treatment. Small case reports detail individual experiences with antivirals with in vitro activity against these viruses exist, but their retrospective nature and small size limit generalizability.235-237
Question 36: What Is the Optimal Clinical Approach for Patients With Nephrolithiasis, Foreign Objects, Nephrostomy Tubes, and/or Ureteral Stents?
A sufficient quality and quantity of evidence was found to provide a clear recommendation for the optimal clinical approach for patients with nephrolithiasis, foreign objects, nephrostomy tubes, and/or ureteral stents. Routine cystoscopy and urodynamic studies do not require antimicrobial prophylaxis in asymptomatic patients. Preoperative antibiotics do not appear to reduce infectious complications from routine cystoscopic stent removal nor nephrostomy tube placement.221,222 The majority of patients with uncomplicated urologic cases undergoing percutaneous nephrolithotomy, a single dose of antimicrobial prophylaxis appears to reduce the risk of infection.158,223-225 However, in a recent meta-analysis,226 single dose was found to be associated with higher rates of systemic inflammatory response syndrome (SIRS) postnephrolithotomy compared with extended perioperative dosing in patients considered high risk; however, the use of a nonspecific measure, such as SIRS, to detect complications may overidentify complications.227 If there are particularly vulnerable patients, such as in pregnancy or kidney transplant, extended preoperative dosing schedules are reasonable to consider. Published RCTs use a 7-day duration preoperatively, however, it is unclear if that long of a course is routinely necessary.228,229
Despite decades of research and nearly 1000 studies reviewed, we remain unable to provide a clear recommendation on many, even some essential, aspects of the prevention, diagnosis, and treatment of urinary tract infections. This consensus statement highlights the dramatic impact of historical practice patterns on certain aspects of UTI treatment, such as duration of therapy, while also highlighting critical gaps in knowledge that impact our understanding of how effective our treatments are, such as the impact of clinical improvement without resolution of bacteriuria. Additionally, there is an obvious need to use more precise terminology to describe site(s) and extent of infections rather than the vague terms that have become commonplace in clinical practice. This will ensure that there are more clearly defined study populations, reduced heterogeneity in generalizability of those studies, and ensure that individual patients receive the highest value, most appropriate care for their specific infection.
This consensus statement has limitations. The main limitation of this guideline is the overall dearth of hypothesis-confirming evidence. Using the WikiGuidelines method of guideline development, only 6 clear recommendations were able to be established out of 37 questions, highlighting the need for additional high-quality prospective studies in all aspects of the management of urinary tract infections. Additionally, certain sections of the article may be less generalizable than others, such as in the empiric treatment section, which is heavily influenced by local epidemiology. Despite these limitations, we attempted to equip readers with the foundational principles that they may apply to their individual practice settings. We made an effort within this guideline to include experts internationally; however, most of the guideline authors are from high-income countries and in the future, we hope to incorporate the essential perspective of and thus provide guidance for clinicians practicing in low and middle-income countries and other resource-constrained settings.
This consensus statement presents evidence-based strategies for managing UTIs and clinical reviews in areas where strong evidence is lacking. The guidance is based on information available up to early 2024. Pressing research gaps remain, including the need for high-quality studies to validate novel diagnostic methods, optimize treatment durations, establish standard definitions, and refine antimicrobial stewardship strategies for asymptomatic bacteriuria and MDROs. Suggestions for alternative evidence or recommendations are welcome for consideration by the authors, with updates to the guideline made as needed. No single guideline can encompass all clinical scenarios; therefore, this document is not intended to set legal medical standards or replace professional judgment for individual patient cases.
Accepted for Publication: September 17, 2024.
Published: November 4, 2024. doi:10.1001/jamanetworkopen.2024.44495
Open Access: This is an open access article distributed under the terms of the CC-BY License. 漏 2024 Nelson Z et al. 糖心vlog Open.
Corresponding Author: Zachary Nelson, PharmD, MPH, Park Nicollet Health Services, 6500 Excelsior Blvd, St Louis Park, MN 55426 (Zachary.nelson2@parknicollet.com).
Author Contributions: Dr Nelson had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Concept and design: Nelson, Tar谋k Aslan, Beahm, Casaus, Anderson, Chahine, Christensen, Fitzpatrick, Fleece, Ghanem, Hamilton, Joseph, Kludjian, R. Lee, McDonald, Ravindra, Spellberg, Veve, Mena Lora.
Acquisition, analysis, or interpretation of data: Nelson, Tar谋k Aslan, Beahm, Blyth, Cappiello, Casaus, Dominguez, Egbert, Hanretty, Khadem, Olney, Abdul Azim, Aggrey, Anderson, Barosa, Bosco, Chahine, Chowdhury, Christensen, de Lima Corvino, Fitzpatrick, Footer, Fox, Hayes, Jegorovic, Jent, Jimenez-Juarez, Kang, Kludjian, Kurz, T. Lee, Li, Maraolo, Maximos, Mehta, Moore, Nguyen, Papan, Taylor, Thumann, Tong, Veve, Wilson, Yassin, Zafonte, Mena Lora.
Drafting of the manuscript: Nelson, Tar谋k Aslan, Beahm, Cappiello, Casaus, Dominguez, Egbert, Hanretty, Khadem, Olney, Abdul Azim, Aggrey, Anderson, Barosa, Bosco, Chahine, Chowdhury, Christensen, de Lima Corvino, Fitzpatrick, Fleece, Fox, Jimenez-Juarez, Joseph, Kang, Kludjian, Kurz, R. Lee, T. Lee, Li, Maraolo, Maximos, Mehta, Moore, Nguyen, Papan, Ravindra, Spellberg, Taylor, Thumann, Veve, Wilson, Yassin, Zafonte, Mena Lora.
Critical review of the manuscript for important intellectual content: Nelson, Tar谋k Aslan, Beahm, Blyth, Cappiello, Hanretty, Khadem, Olney, Aggrey, Anderson, Chahine, Christensen, Fitzpatrick, Footer, Ghanem, Hamilton, Hayes, Jegorovic, Jent, Jimenez-Juarez, Kang, Kurz, R. Lee, T. Lee, Maximos, McDonald, Moore, Nguyen, Papan, Spellberg, Taylor, Tong, Veve, Mena Lora.
Statistical analysis: T. Lee, Papan, Taylor.
Obtained funding: Christensen, Mehta, Spellberg, Taylor.
Administrative, technical, or material support: Tar谋k Aslan, Beahm, Cappiello, Dominguez, Hanretty, Olney, Christensen, Fleece, Footer, Kang, Kurz, McDonald, Moore, Nelson, Ravindra, Spellberg, Tong, Mena Lora.
Supervision: Nelson, Blyth, Cappiello, Dominguez, Egbert, Khadem, Olney, Fitzpatrick, Ghanem, Moore, Papan, Spellberg, Veve, Mena Lora.
Conflict of Interest Disclosures: Dr Hanretty reported receiving personal fees from Abbvie outside the submitted work. Dr Olney reported receiving grants from the Society of Infectious Diseases Pharmacists outside the submitted work. Dr Chahine reported receiving personal fees from Seqirus, Gilead, and Shionogi outside the submitted work. Dr Joseph reported receiving grants from Pfizer, nonfinancial support from Eumedica, and personal fees from Glaxo-Smith-Kline, Advanz Pharma, Pfizer, Biomerieux, and Global Access Diagnostics outside the submitted work. Dr T. Lee reported receiving salary support from Fonds de Recherche du Quebec鈥擲ante Research and grants from Canadian Institutes of Health Research Operating Funds for clinical trials outside the submitted work. Dr McDonald reported being a member of the WikiGuidelines board and receiving governmental research salary support from Fonds de Recherche du Quebec鈥擲ante outside the submitted work. No other disclosures were reported.
Group Information: The WikiGuidelines Group that established this guideline is entirely voluntary and unpaid; the group intends to establish a nonprofit organization to support development of other guidelines using this novel methodology, and eventually intends to trademark the name WikiGuidelines. All authors are members of the WikiGuidelines Group.
Additional Contributions: We thank Gurmeet Sehgal MS, MLS (University Libraries, Loma Linda University, Loma Linda, CA), for literature compilation for Section 5.
1.Stapleton
听A锘�, Latham
听RH锘�, Johnson
听C锘�, Stamm
听WE锘�. 听Postcoital antimicrobial prophylaxis for recurrent urinary tract infection: a randomized, double-blind, placebo-controlled trial.听锘� 听闯础惭础. 1990;264(6):703-706. doi:
2.Melekos
听MD锘�, Asbach
听HW锘�, Gerharz
听E锘�, Zarakovitis
听IE锘�, Weingaertner
听K锘�, Naber
听KG锘�. 听Post-intercourse versus daily ciprofloxacin prophylaxis for recurrent urinary tract infections in premenopausal women.听锘� 听J Urol. 1997;157(3):935-939. doi:
3.Jent
听P锘�, Berger
听J锘�, Kuhn
听A锘�, Trautner
听BW锘�, Atkinson
听A锘�, Marschall
听J锘�. 听Antibiotics for preventing recurrent urinary tract infection: systematic review and meta-analysis.听锘� 听Open Forum Infect Dis. 2022;9(7):ofac327. doi:
4.Buettcher
听M锘�, Trueck
听J锘�, Niederer-Loher
听A锘�,
听et al. 听Swiss consensus recommendations on urinary tract infections in children.听锘� 听Eur J Pediatr. 2021;180(3):663-674. doi:
5.Autore
听G锘�, Bernardi
听L锘�, Ghidini
听F锘�,
听et al; The Uti-Ped-Er Study Group. 听Antibiotic prophylaxis for the prevention of urinary tract infections in children: guideline and recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) study group.听锘� 听Antibiotics (Basel). 2023;12(6):1040. doi:
6.Mattoo
听TK锘�, Shaikh
听N锘�, Nelson
听CP锘�. 听Contemporary management of urinary tract infection in children.听锘� 听笔别诲颈补迟谤颈肠蝉. 2021;147(2):e2020012138. doi:
7.McGuinness
听SD锘�, Krone
听R锘�, Metz
听LMA锘�. 听Double-blind, randomized, placebo-controlled trial of cranberry supplements in multiple sclerosis.听锘� 听J Neurosci Nurs. 2002;34(1):4. doi:
8.Cowan
听CC锘�, Hutchison
听C锘�, Cole
听T锘�,
听et al. 听A randomised double-blind placebo-controlled trial to determine the effect of cranberry juice on decreasing the incidence of urinary symptoms and urinary tract infections in patients undergoing radiotherapy for cancer of the bladder or cervix.听锘� 听Clin Oncol (R Coll Radiol). 2012;24(2):e31-e38. doi:
9.Stothers
听L锘�. 听A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women.听锘� 听Can J Urol. 2002;9(3):1558-1562.
10.Maki
听KC锘�, Kaspar
听KL锘�, Khoo
听C锘�, Derrig
听LH锘�, Schild
听AL锘�, Gupta
听K锘�. 听Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection.听锘� 听Am J Clin Nutr. 2016;103(6):1434-1442. doi:
11.Jepson
听RG锘�, Williams
听G锘�, Craig
听JC锘�. 听Cranberries for preventing urinary tract infections.听锘� 听Cochrane Database Syst Rev. 2012;10(10):CD001321. doi:
12.Mantzorou
听M锘�, Giaginis
听C锘�. 听Cranberry consumption against urinary tract infections: clinical stateof- the-art and future perspectives.听锘� 听Curr Pharm Biotechnol. 2018;19(13):1049-1063. doi:
13.Foxman
听B锘�, Cronenwett
听AEW锘�, Spino
听C锘�, Berger
听MB锘�, Morgan
听DM锘�. 听Cranberry juice capsules and urinary tract infection after surgery: results of a randomized trial.听锘� 听Am J Obstet Gynecol. 2015;213(2):194.e1-194.e8. doi:
14.Barbosa-Cesnik
听C锘�, Brown
听MB锘�, Buxton
听M锘�, Zhang
听L锘�, DeBusscher
听J锘�, Foxman
听B锘�. 听Cranberry juice fails to prevent recurrent urinary tract infection: results from a randomized placebo-controlled trial.听锘� 听Clin Infect Dis. 2011;52(1):23-30. doi:
15.McMurdo
听MET锘�, Argo
听I锘�, Phillips
听G锘�, Daly
听F锘�, Davey
听P锘�. 听Cranberry or trimethoprim for the prevention of recurrent urinary tract infections: a randomized controlled trial in older women.听锘� 听J Antimicrob Chemother. 2009;63(2):389-395. doi:
16.Wing
听DA锘�, Rumney
听PJ锘�, Preslicka
听CW锘�, Chung
听JH锘�. 听Daily cranberry juice for the prevention of asymptomatic bacteriuria in pregnancy: a randomized, controlled pilot study.听锘� 听J Urol. 2008;180(4):1367-1372. doi:
17.McMurdo
听MET锘�, Bissett
听LY锘�, Price
听RJG锘�, Phillips
听G锘�, Crombie
听IK锘�. 听Does ingestion of cranberry juice reduce symptomatic urinary tract infections in older people in hospital: a double-blind, placebo-controlled trial.听锘� 听Age Ageing. 2005;34(3):256-261. doi:
18.Linsenmeyer
听TA锘�, Harrison
听B锘�, Oakley
听A锘�, Kirshblum
听S锘�, Stock
听JA锘�, Millis
听SR锘�. 听Evaluation of cranberry supplement for reduction of urinary tract infections in individuals with neurogenic bladders secondary to spinal cord injury: a prospective, double-blinded, placebo-controlled, crossover study.听锘� 听J Spinal Cord Med. 2004;27(1):29-34. doi:
19.Babar
听A锘�, Moore
听L锘�, Leblanc
听V锘�,
听et al. 听High dose versus low dose standardized cranberry proanthocyanidin extract for the prevention of recurrent urinary tract infection in healthy women: a double-blind randomized controlled trial.听锘� 听BMC Urol. 2021;21(1):44. doi:
20.Kontiokari
听T锘�, Sundqvist
听K锘�, Nuutinen
听M锘�, Pokka
听T锘�, Koskela
听M锘�, Uhari
听M锘�. 听Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women.听锘� 听叠惭闯. 2001;322(7302):1571. doi:
21.Stapleton
听AE锘�, Dziura
听J锘�, Hooton
听TM锘�,
听et al. 听Recurrent urinary tract infection and urinary Escherichia coli in women ingesting cranberry juice daily: a randomized controlled trial.听锘� 听Mayo Clin Proc. 2012;87(2):143-150. doi:
22.Di Martino
听P锘�, Agniel
听R锘�, David
听K锘�,
听et al. 听Reduction of Escherichia coli adherence to uroepithelial bladder cells after consumption of cranberry juice: a double-blind randomized placebo-controlled cross-over trial.听锘� 听World J Urol. 2006;24(1):21-27. doi:
23.Lee
听BB锘�, Haran
听MJ锘�, Hunt
听LM锘�,
听et al. 听Spinal-injured neuropathic bladder antisepsis (SINBA) trial.听锘� 听Spinal Cord. 2007;45(8):542-550. doi:
24.Hooton
听TM锘�, Vecchio
听M锘�, Iroz
听A锘�,
听et al. 听Effect of increased daily water intake in premenopausal women with recurrent urinary tract infections: a randomized clinical trial.听锘� 听闯础惭础 Intern Med. 2018;178(11):1509-1515. doi:
25.Mentes
听JC锘�, Culp
听K锘�. 听Reducing hydration-linked events in nursing home residents.听锘� 听Clin Nurs Res. 2003;12(3):210-225. doi:
26.Tan-Kim
听J锘�, Shah
听NM锘�, Do
听D锘�, Menefee
听SA锘�. 听Efficacy of vaginal estrogen for recurrent urinary tract infection prevention in hypoestrogenic women.听锘� 听Am J Obstet Gynecol. 2023;229(2):143.e1-143.e9. doi:
27.Stamm
听WE锘�. 听Estrogens and urinary-tract infection.听锘� 听J Infect Dis. 2007;195(5):623-624. doi:
28.Simuni膰
听V锘�, Banovi膰
听I锘�, Ciglar
听S锘�, Jeren
听L锘�, Pavici膰 Baldani
听D锘�, Sprem
听M锘�. 听Local estrogen treatment in patients with urogenital symptoms.听锘� 听Int J Gynaecol Obstet. 2003;82(2):187-197. doi:
29.McVicker
听L锘�, Labeit
听AM锘�, Coupland
听CAC锘�,
听et al. 听Vaginal estrogen therapy use and survival in females with breast cancer.听锘� 听闯础惭础 Oncol. 2024;10(1):103-108. doi:
30.Crandall
听CJ锘�, Hovey
听KM锘�, Andrews
听CA锘�,
听et al. 听Breast cancer, endometrial cancer, and cardiovascular events in participants who used vaginal estrogen in the Women鈥檚 Health Initiative Observational Study.听锘� 听惭别苍辞辫补耻蝉别. 2018;25(1):11-20. doi:
31.Harding
听C锘�, Chadwick
听T锘�, Homer
听T锘�,
听et al. 听Methenamine hippurate compared with antibiotic prophylaxis to prevent recurrent urinary tract infections in women: the ALTAR non-inferiority RCT.听锘� 听Health Technol Assess. 2022;26(23):1-172. doi:
32.Botros
听C锘�, Lozo
听S锘�, Iyer
听S锘�,
听et al. 听Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a randomized clinical trial.听锘� 听Int Urogynecol J. 2022;33(3):571-580. doi:
33.Wolff
听BJ锘�, Price
听TK锘�, Joyce
听CJ锘�, Wolfe
听AJ锘�, Mueller
听ER锘�. 听Oral probiotics and the female urinary microbiome: a double-blinded randomized placebo-controlled trial.听锘� 听Int Urol Nephrol. 2019;51(12):2149-2159. doi:
34.Toh
听SL锘�, Boswell-Ruys
听CL锘�, Lee
听BSB锘�, Simpson
听JM锘�, Clezy
听KR锘�. 听Probiotics for preventing urinary tract infection in people with neuropathic bladder.听锘� 听Cochrane Database Syst Rev. 2017;9(9):CD010723. doi:
35.Toh
听SL锘�, Lee
听BB锘�, Ryan
听S锘�,
听et al. 听Probiotics [LGG-BB12 or RC14-GR1] versus placebo as prophylaxis for urinary tract infection in persons with spinal cord injury [ProSCIUTTU]: a randomised controlled trial.听锘� 听Spinal Cord. 2019;57(7):550-561. doi:
36.Abdullatif
听VA锘�, Sur
听RL锘�, Eshaghian
听E锘�,
听et al. 听Efficacy of probiotics as prophylaxis for urinary tract infections in premenopausal women: a systematic review and meta-analysis.听锘� 听颁耻谤别耻蝉. 2021;13(10):e18843. doi:
37.Ala-Jaakkola
听R锘�, Laitila
听A锘�, Ouwehand
听AC锘�, Lehtoranta
听L锘�. 听Role of D-mannose in urinary tract infections鈥攁 narrative review.听锘� 听Nutr J. 2022;21(1):18. doi:
38.Porru
听D锘�, Parmigiani
听A锘�, Tinelli
听C锘�,
听et al. 听Oral D-mannose in recurrent urinary tract infections in women: a pilot study.听锘� 听J Clin Urol. 2014;7(3):208-213. doi:
39.Kranj膷ec
听B锘�, Pape拧
听D锘�, Altarac
听S锘�. 听D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial.听锘� 听World J Urol. 2014;32(1):79-84. doi:
40.Hayward
听G锘�, Mort
听S锘�, Hay
听AD锘�,
听et al. 听D-mannose for prevention of recurrent urinary tract infection among women: a randomized clinical trial.听锘� 听闯础惭础 Intern Med. 2024;184(6):619-628. doi:
41.Ph茅
听V锘�, Pakzad
听M锘�, Haslam
听C锘�,
听et al. 听Open label feasibility study evaluating D-mannose combined with home-based monitoring of suspected urinary tract infections in patients with multiple sclerosis.听锘� 听Neurourol Urodyn. 2017;36(7):1770-1775. doi:
42.Domenici
听L锘�, Monti
听M锘�, Bracchi
听C锘�,
听et al. 听D-mannose: a promising support for acute urinary tract infections in women: a pilot study.听锘� 听Eur Rev Med Pharmacol Sci. 2016;20(13):2920-2925.
43.Cooper
听TE锘�, Teng
听C锘�, Howell
听M锘�, Teixeira-Pinto
听A锘�, Jaure
听A锘�, Wong
听G锘�. 听D-mannose for preventing and treating urinary tract infections.听锘� 听Cochrane Database Syst Rev. 2022;8(8):CD013608. doi:
44.Lenger
听SM锘�, Bradley
听MS锘�, Thomas
听DA锘�, Bertolet
听MH锘�, Lowder
听JL锘�, Sutcliffe
听S锘�. 听D-mannose vs other agents for recurrent urinary tract infection prevention in adult women: a systematic review and meta-analysis.听锘� 听Am J Obstet Gynecol. 2020;223(2):265.e1-265.e13. doi:
45.Simerville
听JA锘�, Maxted
听WC锘�, Pahira
听JJ锘�. 听Urinalysis: a comprehensive review.听锘� 听Am Fam Physician. 2005;71(6):1153-1162.
46.Advani
听SD锘�, Polage
听CR锘�, Fakih
听MG锘�. 听Deconstructing the urinalysis: a novel approach to diagnostic and antimicrobial stewardship.听锘� 听Antimicrob Steward Healthc Epidemiol. 2021;1(1):e6. doi:
47.Roberts
听KB锘�; Subcommittee on Urinary Tract Infection, Steering Committee on Quality Improvement and Management. 听Urinary tract infection: clinical practice guideline for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months.听锘� 听笔别诲颈补迟谤颈肠蝉. 2011;128(3):595-610. doi:
48.Bhat
听RG锘�, Katy
听TA锘�, Place
听FC锘�. 听Pediatric urinary tract infections.听锘� 听Emerg Med Clin North Am. 2011;29(3):637-653. doi:
49.Mena Lora
听AJ锘�, Hua
听J锘�, Ali
听M锘�, Krill
听C锘�, Takhsh
听E锘�, Bleasdale
听SC锘�. 听Changing the culture: impact of a diagnostic stewardship intervention for urine culture testing and CAUTI prevention in an urban safety-net community hospital.听锘� 听Antimicrob Steward Healthc Epidemiol. 2024;4(1):e14. doi:
50.Werneburg
听GT锘�, Rhoads
听DD锘�. 听Diagnostic stewardship for urinary tract infection: a snapshot of the expert guidance.听锘� 听Cleve Clin J Med. 2022;89(10):581-587. doi:
51.O鈥橤rady
听NP锘�, Alexander
听E锘�, Alhazzani
听W锘�,
听et al. 听Society of Critical Care Medicine and the Infectious Diseases Society of America Guidelines for evaluating new fever in adult patients in the ICU.听锘� 听Crit Care Med. 2023;51(11):1570-1586. doi:
52.Nicolle
听LE锘�, Bradley
听S锘�, Colgan
听R锘�, Rice
听JC锘�, Schaeffer
听A锘�, Hooton
听TM锘�; Infectious Diseases Society of America; American Society of Nephrology; American Geriatric Society. 听Infectious Diseases Society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults.听锘� 听Clin Infect Dis. 2005;40(5):643-654. doi:
53.Nicolle
听LE锘�, Gupta
听K锘�, Bradley
听SF锘�,
听et al. 听Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of America.听锘� 听Clin Infect Dis. 2019;68(10):1611-1615. doi:
54.Flokas
听ME锘�, Andreatos
听N锘�, Alevizakos
听M锘�, Kalbasi
听A锘�, Onur
听P锘�, Mylonakis
听E锘�. 听Inappropriate management of asymptomatic patients with positive urine cultures: a systematic review and meta-analysis.听锘� 听Open Forum Infect Dis. 2017;4(4):ofx207. doi:
55.Stamm
听WE锘�, Counts
听GW锘�, Running
听KR锘�, Fihn
听S锘�, Turck
听M锘�, Holmes
听KK锘�. 听Diagnosis of coliform infection in acutely dysuric women.听锘� 听N Engl J Med. 1982;307(8):463-468. doi:
56.Hooton
听TM锘�, Roberts
听PL锘�, Cox
听ME锘�, Stapleton
听AE锘�. 听Voided midstream urine culture and acute cystitis in premenopausal women.听锘� 听N Engl J Med. 2013;369(20):1883-1891. doi:
57.Tullus
听K锘�. 听Defining urinary tract infection by bacterial colony counts: a case for less than 100,000 colonies/mL as the threshold.听锘� 听Pediatr Nephrol. 2019;34(10):1651-1653. doi:
58.Kass
听EH锘�. 听Asymptomatic infections of the urinary tract.听锘� 听Trans Assoc Am Physicians. 1956;69:56-64.
59.Szlachta-McGinn
听A锘�, Douglass
听KM锘�, Chung
听UYR锘�, Jackson
听NJ锘�, Nickel
听JC锘�, Ackerman
听AL锘�. 听Molecular diagnostic methods versus conventional urine culture for diagnosis and treatment of urinary tract infection: a systematic review and meta-analysis.听锘� 听Eur Urol Open Sci. 2022;44:113-124. doi:
60.Hilt
听EE锘�, McKinley
听K锘�, Pearce
听MM锘�,
听et al. 听Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder.听锘� 听J Clin Microbiol. 2014;52(3):871-876. doi:
61.Lewis
听DA锘�, Gumede
听LYE锘�, van der Hoven
听LA锘�,
听et al. 听Antimicrobial susceptibility of organisms causing community-acquired urinary tract infections in Gauteng Province, South Africa.听锘� 听S Afr Med J. 2013;103(6):377-381. doi:
62.Wolfe
听AJ锘�, Toh
听E锘�, Shibata
听N锘�,
听et al. 听Evidence of uncultivated bacteria in the adult female bladder.听锘� 听J Clin Microbiol. 2012;50(4):1376-1383. doi:
63.Hugon
听P锘�, Dufour
听JC锘�, Colson
听P锘�, Fournier
听PE锘�, Sallah
听K锘�, Raoult
听D锘�. 听A comprehensive repertoire of prokaryotic species identified in human beings.听锘� 听尝补苍肠别迟 Infect Dis. 2015;15(10):1211-1219. doi:
64.Neugent
听ML锘�, Hulyalkar
听NV锘�, Nguyen
听VH锘�, Zimmern
听PE锘�, De Nisco
听NJ锘�. 听Advances in understanding the human urinary microbiome and its potential role in urinary tract infection.听锘� 听尘叠颈辞. 2020;11(2):e00218-e00220. doi:
65.Kim
听Y锘�, Seo
听MR锘�, Kim
听SJ锘�,
听et al. 听Usefulness of blood cultures and radiologic imaging studies in the management of patients with community-acquired acute pyelonephritis.听锘� 听Infect Chemother. 2017;49(1):22-30. doi:
66.Soulen
听MC锘�, Fishman
听EK锘�, Goldman
听SM锘�, Gatewood
听OM锘�. 听Bacterial renal infection: role of CT.听锘� 听搁补诲颈辞濒辞驳测. 1989;171(3):703-707. doi:
67.Pierce
听C锘�, Keniston
听A锘�, Albert
听RK锘�. 听Imaging in acute pyelonephritis: utilization, findings, and effect on management.听锘� 听South Med J. 2019;112(2):118-124. doi:
68.Enikeev
听DV锘�, Glybochko
听P锘�, Alyaev
听Y锘�, Enikeev
听M锘�, Rapoport
听L锘�. 听Imaging technologies in the diagnosis and treatment of acute pyelonephritis.听锘� 听鲍谤辞濒辞驳颈补. 2017;84(3):179-184. doi:
69.Johnson
听JR锘�, Russo
听TA锘�. 听Acute pyelonephritis in adults.听锘� 听N Engl J Med. 2018;378(1):48-59. doi:
70.Faletti
听R锘�, Cassinis
听MC锘�, Fonio
听P锘�,
听et al. 听Diffusion-weighted imaging and apparent diffusion coefficient values versus contrast-enhanced MR imaging in the identification and characterisation of acute pyelonephritis.听锘� 听Eur Radiol. 2013;23(12):3501-3508. doi:
71.Leyendecker
听JR锘�, Clingan
听MJ锘�. 听Magnetic resonance urography update鈥攁re we there yet?听锘� 听Semin Ultrasound CT MR. 2009;30(4):246-257. doi:
72.Tambyah
听PA锘�, Maki
听DG锘�. 听The relationship between pyuria and infection in patients with indwelling urinary catheters: a prospective study of 761 patients.听锘� 听Arch Intern Med. 2000;160(5):673-677. doi:
73.Warren
听JW锘�, Tenney
听JH锘�, Hoopes
听JM锘�, Muncie
听HL锘�, Anthony
听WC锘�. 听A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters.听锘� 听J Infect Dis. 1982;146(6):719-723. doi:
74.Abdel-Latif
听M锘�, Mosbah
听A锘�, El Bahnasawy
听MS锘�, Elsawy
听E锘�, Shaaban
听AA锘�. 听Asymptomatic bacteriuria in men with orthotopic ileal neobladders: possible relationship to nocturnal enuresis.听锘� 听BJU Int. 2005;96(3):391-396. doi:
75.Morris
听EJ锘�, Bracken
听RB锘�, Hopfer
听RL锘�, Mills
听K锘�, Rodriguez
听DB锘�. 听Urinary findings in 20 asymptomatic patients with an ileal conduit.听锘� 听J Enterostomal Ther. 1982;9(2):24-27. doi:
76.Gupta
听K锘�, Hooton
听TM锘�, Naber
听KG锘�,
听et al; Infectious Diseases Society of America; European Society for Microbiology and Infectious Diseases. 听International clinical practice guidelines for the 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.听锘� 听Clin Infect Dis. 2011;52(5):e103-e120. doi:
77.Hooton
听TM锘�, Bradley
听SF锘�, Cardenas
听DD锘�,
听et al; Infectious Diseases Society of America. 听Diagnosis, prevention, and treatment of catheter-associated urinary tract infection in adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America.听锘� 听Clin Infect Dis. 2010;50(5):625-663. doi:
78.Huttner
听A锘�, Kowalczyk
听A锘�, Turjeman
听A锘�,
听et al. 听Effect of 5-day nitrofurantoin vs single-dose fosfomycin on clinical resolution of uncomplicated lower urinary tract infection in women: a randomized clinical trial.听锘� 听闯础惭础. 2018;319(17):1781-1789. doi:
79.Park
听DW锘�, Peck
听KR锘�, Chung
听MH锘�,
听et al. 听Comparison of ertapenem and ceftriaxone therapy for acute pyelonephritis and other complicated urinary tract infections in Korean adults: a randomized, double-blind, multicenter trial.听锘� 听J Korean Med Sci. 2012;27(5):476-483. doi:
80.Kaye
听KS锘�, Gupta
听V锘�, Mulgirigama
听A锘�,
听et al. 听Antimicrobial resistance trends in urine escherichia coli isolates from adult and adolescent females in the United States from 2011 to 2019: rising ESBL strains and impact on patient management.听锘� 听Clin Infect Dis. 2021;73(11):1992-1999. doi:
81.Raz
听R锘�, Schiller
听D锘�, Nicolle
听LE锘�. 听Chronic indwelling catheter replacement before antimicrobial therapy for symptomatic urinary tract infection.听锘� 听J Urol. 2000;164(4):1254-1258. doi:
82.Tenney
听J锘�, Hudson
听N锘�, Alnifaidy
听H锘�, Li
听JTC锘�, Fung
听KH锘�. 听Risk factors for aquiring multidrug-resistant organisms in urinary tract infections: a systematic literature review.听锘� 听Saudi Pharm J. 2018;26(5):678-684. doi:
83.Larramendy
听S锘�, Deglaire
听V锘�, Dusollier
听P锘�,
听et al. 听Risk factors of extended-spectrum beta-lactamases-producing Escherichia coli community acquired urinary tract infections: a systematic review.听锘� 听Infect Drug Resist. 2020;13:3945-3955. doi:
84.Brown
听DG锘�, Worby
听CJ锘�, Pender
听MA锘�,
听et al. 听Development of a prediction model for the acquisition of extended spectrum beta-lactam-resistant organisms in US international travellers.听锘� 听J Travel Med. 2023;30(6):taad028. doi:
85.Kadry
听N锘�, Natarajan
听M锘�, Bein
听E锘�, Kim
听P锘�, Farley
听J锘�. 听discordant clinical and microbiological outcomes are associated with late clinical relapse in clinical trials for complicated urinary tract infections.听锘� 听Clin Infect Dis. 2023;76(10):1768-1775. doi:
86.Zaoutis
听T锘�, Shaikh
听N锘�, Fisher
听BT锘�,
听et al. 听Short-course therapy for urinary tract infections in children: the SCOUT randomized clinical trial.听锘� 听闯础惭础 Pediatr. 2023;177(8):782-789. doi:
87.Lafaurie
听M锘�, Chevret
听S锘�, Fontaine
听JP锘�,
听et al; PROSTASHORT Study Group. 听Antimicrobial for 7 or 14 days for febrile urinary tract infection in men: a multicenter noninferiority double-blind, placebo-controlled, randomized clinical trial.听锘� 听Clin Infect Dis. 2023;76(12):2154-2162. doi:
88.Lawrenson
听RA锘�, Logie
听JW锘�. 听Antibiotic failure in the treatment of urinary tract infections in young women.听锘� 听J Antimicrob Chemother. 2001;48(6):895-901. doi:
89.Efstathiou
听SP锘�, Pefanis
听AV锘�, Tsioulos
听DI锘�,
听et al. 听Acute pyelonephritis in adults: prediction of mortality and failure of treatment.听锘� 听Arch Intern Med. 2003;163(10):1206-1212. doi:
90.Pertel
听PE锘�, Haverstock
听D锘�. 听Risk factors for a poor outcome after therapy for acute pyelonephritis.听锘� 听BJU Int. 2006;98(1):141-147. doi:
91.Karve
听S锘�, Ryan
听K锘�, Peeters
听P锘�,
听et al. 听The impact of initial antibiotic treatment failure: real-world insights in patients with complicated urinary tract infection.听锘� 听J Infect. 2018;76(2):121-131. doi:
92.Rosa
听R锘�, Abbo
听LM锘�, Raney
听K锘�, Tookes
听HE
听III锘�, Supino
听M锘�. 听Antimicrobial resistance in urinary tract infections at a large urban ED: factors contributing to empiric treatment failure.听锘� 听Am J Emerg Med. 2017;35(3):397-401. doi:
93.Jorgensen
听S锘�, Zurayk
听M锘�, Yeung
听S锘�,
听et al. 听Risk factors for early return visits to the emergency department in patients with urinary tract infection.听锘� 听Am J Emerg Med. 2018;36(1):12-17. doi:
94.Pujades-Rodriguez
听M锘�, West
听RM锘�, Wilcox
听MH锘�, Sandoe
听J锘�. 听Lower urinary tract infections: management, outcomes and risk factors for antibiotic re-prescription in primary care.听锘� 听贰颁濒颈苍颈肠补濒惭别诲颈肠颈苍别. 2019;14:23-31. doi:
95.Eliakim-Raz
听N锘�, Babitch
听T锘�, Shaw
听E锘�,
听et al; RESCUING Study Group. 听Risk factors for treatment failure and mortality among hospitalized patients with complicated urinary tract infection: a multicenter retrospective cohort study (RESCUING study group).听锘� 听Clin Infect Dis. 2019;68(1):29-36. doi:
96.Martischang
听R锘�, Godycki-膯wirko
听M锘�, Kowalczyk
听A锘�,
听et al. 听Risk factors for treatment failure in women with uncomplicated lower urinary tract infection.听锘� 听PLoS One. 2021;16(8):e0256464. doi:
97.Trautner
听BW锘�, Kaye
听KS锘�, Gupta
听V锘�,
听et al. 听Risk factors associated with antimicrobial resistance and adverse short-term health outcomes among adult and adolescent female outpatients with uncomplicated urinary tract infection.听锘� 听Open Forum Infect Dis. 2022;9(12):ofac623. doi:
98.Dunne
听MW锘�, Puttagunta
听S锘�, Aronin
听SI锘�, Brossette
听S锘�, Murray
听J锘�, Gupta
听V锘�. 听Impact of empirical antibiotic therapy on outcomes of outpatient urinary tract infection due to nonsusceptible Enterobacterales.听锘� 听Microbiol Spectr. 2022;10(1):e0235921. doi:
99.Lamas Ferreiro
听JL锘�, 脕lvarez Otero
听J锘�, Gonz谩lez Gonz谩lez
听L锘�,
听et al. 听Pseudomonas aeruginosa urinary tract infections in hospitalized patients: mortality and prognostic factors.听锘� 听PLoS One. 2017;12(5):e0178178. doi:
100.Michael
听M锘�, Hodson
听EM锘�, Craig
听JC锘�, Martin
听S锘�, Moyer
听VA锘�. 听Short versus standard duration oral antibiotic therapy for acute urinary tract infection in children.听锘� 听Cochrane Database Syst Rev. 2003;(1):CD003966. doi:
101.Fitzgerald
听A锘�, Mori
听R锘�, Lakhanpaul
听M锘�, Tullus
听K锘�. 听Antibiotics for treating lower urinary tract infection in children.听锘� 听Cochrane Database Syst Rev. 2012;2012(8):CD006857. doi:
102.Moreira
听MVB锘�, de Freitas
听LR锘�, Fonseca
听LM锘�,
听et al. 听Shorter versus longer-course of antibiotic therapy for urinary tract infections in pediatric population: an updated meta-analysis.听锘� 听Eur J Pediatr. 2024;183(5):2037-2047. doi:
103.Goodlet
听KJ锘�, Benhalima
听FZ锘�, Nailor
听MD锘�. 听A systematic review of single-dose aminoglycoside therapy for urinary tract infection: is it time to resurrect an old strategy?听锘� 听Antimicrob Agents Chemother. 2018;63(1):e02165-e18. doi:
104.Strohmeier
听Y锘�, Hodson
听EM锘�, Willis
听NS锘�, Webster
听AC锘�, Craig
听JC锘�. 听Antibiotics for acute pyelonephritis in children.听锘� 听Cochrane Database Syst Rev. 2014;7. doi:
105.Montini
听G锘�, Tessitore
听A锘�, Console
听K锘�, Ronfani
听L锘�, Barbi
听E锘�, Pennesi
听M锘�; STOP Trial Group. 听Short oral antibiotic therapy for pediatric febrile urinary tract infections: a randomized trial.听锘� 听笔别诲颈补迟谤颈肠蝉. 2024;153(1):e2023062598. doi:
106.Fox
听MT锘�, Amoah
听J锘�, Hsu
听AJ锘�, Herzke
听CA锘�, Gerber
听JS锘�, Tamma
听PD锘�. 听Comparative effectiveness of antibiotic treatment duration in children with pyelonephritis.听锘� 听闯础惭础 Netw Open. 2020;3(5):e203951. doi:
107.Afolabi
听TM锘�, Goodlet
听KJ锘�, Fairman
听KA锘�. 听Association of antibiotic treatment duration with recurrence of uncomplicated urinary tract infection in pediatric patients.听锘� 听Ann Pharmacother. 2020;54(8):757-766. doi:
108.Huttner
听A锘�, Verhaegh
听EM锘�, Harbarth
听S锘�, Muller
听AE锘�, Theuretzbacher
听U锘�, Mouton
听JW锘�. 听Nitrofurantoin revisited: a systematic review and meta-analysis of controlled trials.听锘� 听J Antimicrob Chemother. 2015;70(9):2456-2464. doi:
109.Kim
听DK锘�, Kim
听JH锘�, Lee
听JY锘�,
听et al. 听Reappraisal of the treatment duration of antibiotic regimens for acute uncomplicated cystitis in adult women: a systematic review and network meta-analysis of 61 randomised clinical trials.听锘� 听尝补苍肠别迟 Infect Dis. 2020;20(9):1080-1088. doi:
110.Christiaens
听TCM锘�, De Meyere
听M锘�, Verschraegen
听G锘�, Peersman
听W锘�, Heytens
听S锘�, De Maeseneer
听JM锘�. 听Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women.听锘� 听Br J Gen Pract. 2002;52(482):729-734.
111.Trienekens
听TA锘�, Stobberingh
听EE锘�, Winkens
听RA锘�, Houben
听AW锘�. 听Different lengths of treatment with co-trimoxazole for acute uncomplicated urinary tract infections in women.听锘� 听叠惭闯. 1989;299(6711):1319-1322. doi:
112.Gossius
听G锘�, Vorland
听L锘�. 听A randomised comparison of single-dose vs three-day and ten-day therapy with trimethoprim-sulfamethoxazole for acute cystitis in women.听锘� 听Scand J Infect Dis. 1984;16(4):373-379. doi:
113.Hooton
听TM锘�, Latham
听RH锘�, Wong
听ES锘�, Johnson
听C锘�, Roberts
听PL锘�, Stamm
听WE锘�. 听Ofloxacin versus trimethoprim-sulfamethoxazole for treatment of acute cystitis.听锘� 听Antimicrob Agents Chemother. 1989;33(8):1308-1312. doi:
114.Neringer
听R锘�, Forsgren
听A锘�, Hansson
听C锘�, Ode
听B锘�; The South Swedish Lolex Study Group. 听Lomefloxacin versus norfloxacin in the treatment of uncomplicated urinary tract infections: three-day versus seven-day treatment.听锘� 听Scand J Infect Dis. 1992;24(6):773-780. doi:
115.Trienekens
听TA锘�, London
听NH锘�, Houben
听AW锘�, De Jong
听RA锘�, Stobberingh
听EE锘�. 听Treating acute urinary tract infections: an RCT of 3-day versus 7-day norfloxacin.听锘� 听Can Fam Physician. 1993;39:514-518.
116.Arredondo-Garc铆a
听JL锘�, Figueroa-Dami谩n
听R锘�, Rosas
听A锘�,
听et al; uUTI Latin American Study Group. 听Comparison of short-term treatment regimen of ciprofloxacin versus long-term treatment regimens of trimethoprim/sulfamethoxazole or norfloxacin for uncomplicated lower urinary tract infections: a randomized, multicentre, open-label, prospective study.听锘� 听J Antimicrob Chemother. 2004;54(4):840-843. doi:
117.Vogel
听T锘�, Verreault
听R锘�, Gourdeau
听M锘�, Morin
听M锘�, Grenier-Gosselin
听L锘�, Rochette
听L锘�. 听Optimal duration of antibiotic therapy for uncomplicated urinary tract infection in older women: a double-blind randomized controlled trial.听锘� 听颁惭础闯. 2004;170(4):469-473.
118.Bahman
听H锘�, Hyaide
听O锘�, Omid
听N锘�,
听et al. 听Comparison of 3-day and 7-day ciprofloxacin regimen for the treatment of uncomplicated urinary tract infection in women: a randomized double-blind clinical trial.听锘� 听Iranian J Clin Infect Dis. 2010;55(2):70-74.
119.Boerema
听JB锘�, Willems
听FT锘�. 听Fosfomycin trometamol in a single dose versus norfloxacin for seven days in the treatment of uncomplicated urinary infections in general practice.听锘� 听滨苍蹿别肠迟颈辞苍. 1990;18(suppl 2):S80-S88. doi:
120.Crocchiolo
听P锘�; Multicenter Group of General Practitioners. 听Single-dose fosfomycin trometamol versus multiple-dose cotrimoxazole in the treatment of lower urinary tract infections in general practice.听锘� 听颁丑别尘辞迟丑别谤补辫测. 1990;36(suppl 1):37-40. doi:
121.Selvaggi
听FP锘�, Ditonno
听P锘�, Traficante
听A锘�, Battaglia
听M锘�, Di Lorenzo
听V锘�. 听Fosfomycin trometamol (Monuril) versus norfloxacin in single dose for adult female uncomplicated UTIs: multicenter randomized, double-blind study.听锘� 听颁丑别尘辞迟丑别谤补辫测. 1990;36(suppl 1):31-33. doi:
122.Naber
听KG锘�, Thyroff-Friesinger
听U锘�. 听Fosfomycin trometamol versus ofloxacin/co-trimoxazole as single dose therapy of acute uncomplicated urinary tract infection in females: a multicentre study.听锘� 听滨苍蹿别肠迟颈辞苍. 1990;18(suppl 2):S70-S76. doi:
123.de Jong
听Z锘�, Pontonnier
听F锘�, Plante
听P锘�. 听Single-dose fosfomycin trometamol (Monuril) versus multiple-dose norfloxacin: results of a multicenter study in females with uncomplicated lower urinary tract infections.听锘� 听Urol Int. 1991;46(4):344-348. doi:
124.Van Pienbroek
听E锘�, Hermans
听J锘�, Kaptein
听AA锘�, Mulder
听JD锘�. 听Fosfomycin trometamol in a single dose versus seven days nitrofurantoin in the treatment of acute uncomplicated urinary tract infections in women.听锘� 听Pharm World Sci. 1993;15(6):257-262. doi:
125.Elhanan
听G锘�, Tabenkin
听H锘�, Yahalom
听R锘�, Raz
听R锘�. 听Single-dose fosfomycin trometamol versus 5-day cephalexin regimen for treatment of uncomplicated lower urinary tract infections in women.听锘� 听Antimicrob Agents Chemother. 1994;38(11):2612-2614. doi:
126.Minassian
听MA锘�, Lewis
听DA锘�, Chattopadhyay
听D锘�, Bovill
听B锘�, Duckworth
听GJ锘�, Williams
听JD锘�. 听A comparison between single-dose fosfomycin trometamol (Monuril) and a 5-day course of trimethoprim in the treatment of uncomplicated lower urinary tract infection in women.听锘� 听Int J Antimicrob Agents. 1998;10(1):39-47. doi:
127.Ceran
听N锘�, Mert
听D锘�, Kocdogan
听FY锘�,
听et al. 听A randomized comparative study of single-dose fosfomycin and 5-day ciprofloxacin in female patients with uncomplicated lower urinary tract infections.听锘� 听J Infect Chemother. 2010;16(6):424-430. doi:
128.PIVYA. Highlights of prescribing information. US Food and Drug Administration; 2024. Accessed May 25, 2024.
129.Richards
听HH锘�. 听Comparative efficacy of 3-day and 7-day chemotherapy with twice-daily pivmecillinam in urinary tract infections seen in general practice.听锘� 听Curr Med Res Opin. 1984;9(3):197-203. doi:
130.Pitk盲j盲rvi
听T锘�, Pyyk枚nen
听ML锘�, Kannisto
听K锘�, Piippo
听T锘�, Viita
听P锘�. 听Pivmecillinam treatment in acute cystitis: three versus seven days study.听锘� 听础谤锄苍别颈尘颈迟迟别濒蹿辞谤蝉肠丑耻苍驳. 1990;40(10):1156-1158.
131.Ferry
听SA锘�, Holm
听SE锘�, Stenlund
听H锘�, Lundholm
听R锘�, Monsen
听TJ锘�. 听Clinical and bacteriological outcome of different doses and duration of pivmecillinam compared with placebo therapy of uncomplicated lower urinary tract infection in women: the LUTIW project.听锘� 听Scand J Prim Health Care. 2007;25(1):49-57. doi:
132.Jans氓ker
听F锘�, Th酶nnings
听S锘�, Hertz
听FB锘�,
听et al. 听Three versus five days of pivmecillinam for community-acquired uncomplicated lower urinary tract infection: a randomised, double-blind, placebo-controlled superiority trial.听锘� 听贰颁濒颈苍颈肠补濒惭别诲颈肠颈苍别. 2019;12:62-69. doi:
133.Wagenlehner
听F锘�, Perry
听CR锘�, Hooton
听TM锘�,
听et al. 听Oral gepotidacin versus nitrofurantoin in patients with uncomplicated urinary tract infection (EAGLE-2 and EAGLE-3): two randomised, controlled, double-blind, double-dummy, phase 3, non-inferiority trials.听锘� 听尝补苍肠别迟. 2024;403(10428):741-755. doi:
134.Dinh
听A锘�, Davido
听B锘�, Etienne
听M锘�,
听et al. 听Is 5 days of oral fluoroquinolone enough for acute uncomplicated pyelonephritis? The DTP randomized trial.听锘� 听Eur J Clin Microbiol Infect Dis. 2017;36(8):1443-1448. doi:
135.Peterson
听J锘�, Kaul
听S锘�, Khashab
听M锘�, Fisher
听AC锘�, Kahn
听JB锘�. 听A double-blind, randomized comparison of levofloxacin 750 mg once-daily for five days with ciprofloxacin 400/500 mg twice-daily for 10 days for the treatment of complicated urinary tract infections and acute pyelonephritis.听锘� 听鲍谤辞濒辞驳测. 2008;71(1):17-22. doi:
136.Klausner
听HA锘�, Brown
听P锘�, Peterson
听J锘�,
听et al. 听A trial of levofloxacin 750 mg once daily for 5 days versus ciprofloxacin 400 mg and/or 500 mg twice daily for 10 days in the treatment of acute pyelonephritis.听锘� 听Curr Med Res Opin. 2007;23(11):2637-2645. doi:
137.Eliakim-Raz
听N锘�, Yahav
听D锘�, Paul
听M锘�, Leibovici
听L锘�. 听Duration of antibiotic treatment for acute pyelonephritis and septic urinary tract infection鈥�7 days or less versus longer treatment: systematic review and meta-analysis of randomized controlled trials.听锘� 听J Antimicrob Chemother. 2013;68(10):2183-2191. doi:
138.Talan
听DA锘�, Stamm
听WE锘�, Hooton
听TM锘�,
听et al. 听Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial.听锘� 听闯础惭础. 2000;283(12):1583-1590. doi:
139.Sandberg
听T锘�, Skoog
听G锘�, Hermansson
听AB锘�,
听et al. 听Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial.听锘� 听尝补苍肠别迟. 2012;380(9840):484-490. doi:
140.Ode
听B锘�, Br枚ms
听M锘�, Walder
听M锘�, Cronberg
听S锘�. 听Failure of excessive doses of ampicillin to prevent bacterial relapse in the treatment of acute pyelonephritis.听锘� 听Acta Med Scand. 1980;207(4):305-307. doi:
141.Jernelius
听H锘�, Zbornik
听J锘�, Bauer
听CA锘�. 听One or three weeks鈥� treatment of acute pyelonephritis: a double-blind comparison, using a fixed combination of pivampicillin plus pivmecillinam.听锘� 听Acta Med Scand. 1988;223(5):469-477. doi:
142.Mensa
听J锘�, Moreno-Martinez
听A锘�, Martinez
听J锘�. Treatment of acute uncomplicated pyelonephritis (AUP): a randomized trial comparing 7- vs. 14-day therapy. Presented at: American Society for Microbiology Abstracts of the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy. September 1999; San Francisco, CA.
143.Wagenlehner
听FM锘�, Umeh
听O锘�, Steenbergen
听J锘�, Yuan
听G锘�, Darouiche
听RO锘�. 听Ceftolozane-tazobactam compared with levofloxacin in the treatment of complicated urinary-tract infections, including pyelonephritis: a randomised, double-blind, phase 3 trial (ASPECT-cUTI).听锘� 听尝补苍肠别迟. 2015;385(9981):1949-1956. doi:
144.Langford
听BJ锘�, Daneman
听N锘�, Diong
听C锘�,
听et al. 听Antibiotic Selection and duration for catheter-associated urinary tract infection in non-hospitalized older adults: a population-based cohort study.听锘� 听Antimicrob Steward Healthc Epidemiol. 2023;3(1):e132. doi:
145.Yahav
听D锘�, Franceschini
听E锘�, Koppel
听F锘�,
听et al; Bacteremia Duration Study Group. 听Seven versus 14 days of antibiotic therapy for uncomplicated gram-negative bacteremia: a noninferiority randomized controlled trial.听锘� 听Clin Infect Dis. 2019;69(7):1091-1098. doi:
146.von Dach
听E锘�, Albrich
听WC锘�, Brunel
听AS锘�,
听et al. 听Effect of C-reactive protein-guided antibiotic treatment duration, 7-day treatment, or 14-day treatment on 30-day clinical failure rate in patients with uncomplicated gram-negative bacteremia: a randomized clinical trial.听锘� 听闯础惭础. 2020;323(21):2160-2169. doi:
147.Molina
听J锘�, Montero-Mateos
听E锘�, Praena-Segovia
听J锘�,
听et al; SHORTEN trial team. 听Seven-versus 14-day course of antibiotics for the treatment of bloodstream infections by Enterobacterales: a randomized, controlled trial.听锘� 听Clin Microbiol Infect. 2022;28(4):550-557. doi:
148.Turjeman
听A锘�, von Dach
听E锘�, Molina
听J锘�,
听et al. 听Duration of antibiotic treatment for gram-negative bacteremia鈥攕ystematic review and individual participant data (IPD) meta-analysis.听锘� 听贰颁濒颈苍颈肠补濒惭别诲颈肠颈苍别. 2022;55:101750. doi:
149.Al Lawati
听H锘�, Blair
听BM锘�, Larnard
听J锘�. 听Urinary tract infections: core curriculum 2024.听锘� 听Am J Kidney Dis. 2024;83(1):90-100. doi:
150.Liu
听F锘�, MacDonald
听B锘�, Jain
听R锘�,
听et al. 听Prevalence and treatment of asymptomatic bacteriuria at academic and critical-access hospitals鈥攐pportunities for stewardship efforts.听锘� 听Infect Control Hosp Epidemiol. 2023;44(6):979-981. doi:
151.Petty
听LA锘�, Vaughn
听VM锘�, Flanders
听SA锘�,
听et al. 听Risk factors and outcomes associated with treatment of asymptomatic bacteriuria in hospitalized patients.听锘� 听闯础惭础 Intern Med. 2019;179(11):1519-1527. doi:
152.Petty
听LA锘�, Vaughn
听VM锘�, Flanders
听SA锘�,
听et al. 听Assessment of testing and treatment of asymptomatic bacteriuria initiated in the emergency department.听锘� 听Open Forum Infect Dis. 2020;7(12):ofaa537. doi:
153.Smaill
听FM锘�, Vazquez
听JC锘�. 听Antibiotics for asymptomatic bacteriuria in pregnancy.听锘� 听Cochrane Database Syst Rev. 2019;2019(11):CD000490. doi:
154.Henderson
听JT锘�, Webber
听EM锘�, Bean
听SI锘�. 听Screening for asymptomatic bacteriuria in adults: updated evidence report and systematic review for the US Preventive Services Task Force.听锘� 听闯础惭础. 2019;322(12):1195-1205. doi:
155.Grabe
听M锘�, Forsgren
听A锘�, Hellsten
听S锘�. 听The effect of a short antibiotic course in transurethral prostatic resection.听锘� 听Scand J Urol Nephrol. 1984;18(1):37-42. doi:
156.Grabe
听M锘�, Forsgren
听A锘�, Bj枚rk
听T锘�, Hellsten
听S锘�. 听Controlled trial of a short and a prolonged course with ciprofloxacin in patients undergoing transurethral prostatic surgery.听锘� 听Eur J Clin Microbiol. 1987;6(1):11-17. doi:
157.Sayin Kutlu
听S锘�, Aybek
听Z锘�, Tekin
听K锘�,
听et al. 听Is short course of antimicrobial therapy for asymptomatic bacteriuria before urologic surgical procedures sufficient?听锘� 听J Infect Dev Ctries. 2012;6(2):143-147. doi:
158.Lightner
听DJ锘�, Wymer
听K锘�, Sanchez
听J锘�, Kavoussi
听L锘�. 听Best practice statement on urologic procedures and antimicrobial prophylaxis.听锘� 听J Urol. 2020;203(2):351-356. doi:
159.Moehring
听RW锘�, Yarrington
听ME锘�, Warren
听BG锘�,
听et al; Centers for Disease Control and Prevention鈥檚 Prevention Epicenters Program. 听Evaluation of an opt-out protocol for antibiotic de-escalation in patients with suspected sepsis: a multicenter, randomized, controlled trial.听锘� 听Clin Infect Dis. 2023;76(3):433-442. doi:
160.Leone
听M锘�, Bechis
听C锘�, Baumstarck
听K锘�,
听et al; AZUREA Network Investigators. 听De-escalation versus continuation of empirical antimicrobial treatment in severe sepsis: a multicenter non-blinded randomized noninferiority trial.听锘� 听Intensive Care Med. 2014;40(10):1399-1408. doi:
161.Chopra
听V锘�, O鈥橦oro
听JC锘�, Rogers
听MAM锘�, Maki
听DG锘�, Safdar
听N锘�. 听The risk of bloodstream infection associated with peripherally inserted central catheters compared with central venous catheters in adults: a systematic review and meta-analysis.听锘� 听Infect Control Hosp Epidemiol. 2013;34(9):908-918. doi:
162.Chopra
听V锘�, Anand
听S锘�, Krein
听SL锘�, Chenoweth
听C锘�, Saint
听S锘�. 听Bloodstream infection, venous thrombosis, and peripherally inserted central catheters: reappraising the evidence.听锘� 听Am J Med. 2012;125(8):733-741. doi:
163.Chopra
听V锘�, Flanders
听SA锘�, Saint
听S锘�. 听The problem with peripherally inserted central catheters.听锘� 听闯础惭础. 2012;308(15):1527-1528. doi:
164.Chopra
听V锘�, Anand
听S锘�, Hickner
听A锘�,
听et al. 听Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis.听锘� 听尝补苍肠别迟. 2013;382(9889):311-325. doi:
165.Tamma
听PD锘�, Avdic
听E锘�, Li
听DX锘�, Dzintars
听K锘�, Cosgrove
听SE锘�. 听Association of adverse events with antibiotic use in hospitalized patients.听锘� 听闯础惭础 Intern Med. 2017;177(9):1308-1315. doi:
166.Rybak
听MJ锘�, Le
听J锘�, Lodise
听TP锘�,
听et al. 听Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists.听锘� 听Am J Health Syst Pharm. 2020;77(11):835-864. doi:
167.Keller
听SC锘�, Williams
听D锘�, Gavgani
听M锘�,
听et al. 听Rates of and risk factors for adverse drug events in outpatient parenteral antimicrobial therapy.听锘� 听Clin Infect Dis. 2018;66(1):11-19. doi:
168.Rieger
听KL锘�, Bosso
听JA锘�, MacVane
听SH锘�, Temple
听Z锘�, Wahlquist
听A锘�, Bohm
听N锘�. 听Intravenous-only or intravenous transitioned to oral antimicrobials for enterobacteriaceae-associated bacteremic urinary tract infection.听锘� 听笔丑补谤尘补肠辞迟丑别谤补辫测. 2017;37(11):1479-1483. doi:
169.Gamble
听KC锘�, Rose
听DT锘�, Sapozhnikov
听J锘�. 听Intravenous to oral antibiotics versus intravenous antibiotics: a step-up or a step-down for extended spectrum 尾-lactamase (ESBL)-producing urinary tract infections without concomitant bacteraemia?听锘� 听Int J Antimicrob Agents. 2022;59(3):106541. doi:
170.Mouwen
听AMA锘�, Dijkstra
听JA锘�, Jong
听E锘�, Buijtels
听PCAM锘�, Pasker-de Jong
听PCM锘�, Nagtegaal
听JE锘�. 听Early switching of antibiotic therapy from intravenous to oral using a combination of education, pocket-sized cards and switch advice: a practical intervention resulting in reduced length of hospital stay.听锘� 听Int J Antimicrob Agents. 2020;55(1):105769. doi:
171.Gandhi
听K锘�, Wrzesinski
听M锘�, Bunnell
听K锘�, Gibble
听A锘�. 听Oral antibiotic step-down therapy for nonstaphylococcal gram-positive bloodstream infections.听锘� 听Diagn Microbiol Infect Dis. 2023;107(4):116068. doi:
172.Olson
听J锘�, Franz-O鈥橬eal
听E锘�, Cipriano
听FA锘�, Ou
听Z锘�, Presson
听AP锘�, Thorell
听EA锘�. 听Impact of early oral antibiotic therapy in infants with bacteremic urinary tract infections.听锘� 听Hosp Pediatr. 2022;12(7):632-638. doi:
173.McAlister
听MJ锘�, Rose
听DT锘�, Hudson
听FP锘�, Padilla-Tolentino
听E锘�, Jaso
听TC锘�. 听Oral 尾-lactams vs fluoroquinolones and trimethoprim/sulfamethoxazole for step-down therapy for Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae bacteremia.听锘� 听Am J Health Syst Pharm. 2023;80(suppl 1):S33-S41. doi:
174.Eron
听LJ锘�, Passos
听S锘�. 听Early discharge of infected patients through appropriate antibiotic use.听锘� 听Arch Intern Med. 2001;161(1):61-65. doi:
175.Khan
听DA锘�, Banerji
听A锘�, Blumenthal
听KG锘�,
听et al; Chief Editor(s); Workgroup Contributors; Joint Task Force on Practice Parameters Reviewers. 听Drug allergy: a 2022 practice parameter update.听锘� 听J Allergy Clin Immunol. 2022;150(6):1333-1393. doi:
176.Blumenthal
听KG锘�, Peter
听JG锘�, Trubiano
听JA锘�, Phillips
听EJ锘�. 听Antibiotic allergy.听锘� 听尝补苍肠别迟. 2019;393(10167):183-198. doi:
177.Blumenthal
听KG锘�, Li
听Y锘�, Banerji
听A锘�, Yun
听BJ锘�, Long
听AA锘�, Walensky
听RP锘�. 听The cost of penicillin allergy evaluation.听锘� 听J Allergy Clin Immunol Pract. 2018;6(3):1019-1027.e2. doi:
178.Hayden
听DA锘�, White
听BP锘�, Neely
听S锘�, Bennett
听KK锘�. 听Impact of fluoroquinolone susceptibility suppression on discharge prescribing for acute uncomplicated cystitis.听锘� 听Open Forum Infect Dis. 2023;10(10):ofad459. doi:
179.Langford
听BJ锘�, Seah
听J锘�, Chan
听A锘�, Downing
听M锘�, Johnstone
听J锘�, Matukas
听LM锘�. 听Antimicrobial stewardship in the microbiology laboratory: impact of selective susceptibility reporting on ciprofloxacin utilization and susceptibility of gram-negative isolates to ciprofloxacin in a hospital setting.听锘� 听J Clin Microbiol. 2016;54(9):2343-2347. doi:
180.Langford
听BJ锘�, Daneman
听N锘�, Diong
听C锘�,
听et al. 听Antibiotic susceptibility reporting and association with antibiotic prescribing: a cohort study.听锘� 听Clin Microbiol Infect. 2021;27(4):568-575. doi:
181.Nicolle
听LE锘�. 听Asymptomatic bacteriuria in the elderly.听锘� 听Infect Dis Clin North Am. 1997;11(3):647-662. doi:
182.Ariathianto
听Y锘�. 听Asymptomatic bacteriuria鈥攑revalence in the elderly population.听锘� 听Aust Fam Physician. 2011;40(10):805-809.
183.Lin
听YT锘�, Chen
听LK锘�, Lin
听MH锘�, Hwang
听SJ锘�. 听Asymptomatic bacteriuria among the institutionalized elderly.听锘� 听J Chin Med Assoc. 2006;69(5):213-217. doi:
184.Childs
听SJ锘�, Egan
听RJ锘�. 听Bacteriuria and urinary infections in the elderly.听锘� 听Urol Clin North Am. 1996;23(1):43-54. doi:
185.Boscia
听JA锘�, Kobasa
听WD锘�, Knight
听RA锘�, Abrutyn
听E锘�, Levison
听ME锘�, Kaye
听D锘�. 听Epidemiology of bacteriuria in an elderly ambulatory population.听锘� 听Am J Med. 1986;80(2):208-214. doi:
186.Boscia
听JA锘�, Kobasa
听WD锘�, Abrutyn
听E锘�, Levison
听ME锘�, Kaplan
听AM锘�, Kaye
听D锘�. 听Lack of association between bacteriuria and symptoms in the elderly.听锘� 听Am J Med. 1986;81(6):979-982. doi:
187.Ostrow
听O锘�, Prodanuk
听M锘�, Foong
听Y锘�,
听et al. 听Decreasing misdiagnoses of urinary tract infections in a pediatric emergency department.听锘� 听笔别诲颈补迟谤颈肠蝉. 2022;150(1):e2021055866. doi:
188.Choi
听DM锘�, Heo
听TH锘�, Yim
听HE锘�, Yoo
听KH锘�. 听Evaluation of new American Academy of Pediatrics guideline for febrile urinary tract infection.听锘� 听Korean J Pediatr. 2015;58(9):341-346. doi:
189.Brandstr枚m
听P锘�, Lind茅n
听M锘�. 听How Swedish guidelines on urinary tract infections in children compare to Canadian, American and European guidelines.听锘� 听Acta Paediatr. 2021;110(6):1759-1771. doi:
190.鈥檛 Hoen
听LA锘�, Bogaert
听G锘�, Radmayr
听C锘�,
听et al. 听Update of the EAU/ESPU guidelines on urinary tract infections in children.听锘� 听J Pediatr Urol. 2021;17(2):200-207. doi:
191.Azzarone
听G锘�, Liewehr
听S锘�, O鈥機onnor
听K锘�. 听Cystitis.听锘� 听Pediatr Rev. 2007;28(12):474-476. doi:
192.Raszka
听WV
听Jr锘�, Khan
听O锘�. 听Pyelonephritis.听锘� 听Pediatr Rev. 2005;26(10):364-370. doi:
193.SUBCOMMITTEE ON URINARY TRACT INFECTION. 听Reaffirmation of AAP Clinical Practice Guideline: the diagnosis and management of the initial urinary tract infection in febrile infants and young children 2-24 months of age.听锘� 听笔别诲颈补迟谤颈肠蝉. 2016;138(6):e20163026. doi:
194.Tullus
听K锘�, Shaikh
听N锘�. 听Urinary tract infections in children.听锘� 听尝补苍肠别迟. 2020;395(10237):1659-1668. doi:
195.Karavanaki
听K锘�, Koufadaki
听AM锘�, Soldatou
听A锘�,
听et al. 听Fever duration during treated urinary tract infections and development of permanent renal lesions.听锘� 听Arch Dis Child. 2019;104(5):466-470. doi:
196.Massanyi
听EZ锘�, Preece
听J锘�, Gupta
听A锘�, Lin
听SM锘�, Wang
听MH锘�. 听Utility of screening ultrasound after first febrile UTI among patients with clinically significant vesicoureteral reflux.听锘� 听鲍谤辞濒辞驳测. 2013;82(4):905-909. doi:
197.Nelson
听CP锘�, Johnson
听EK锘�, Logvinenko
听T锘�, Chow
听JS锘�. 听Ultrasound as a screening test for genitourinary anomalies in children with UTI.听锘� 听笔别诲颈补迟谤颈肠蝉. 2014;133(3):e394-e403. doi:
198.Alon
听US锘�, Ganapathy
听S锘�. 听Should renal ultrasonography be done routinely in children with first urinary tract infection?听锘� 听Clin Pediatr (Phila). 1999;38(1):21-25. doi:
199.Shaikh
听N锘�, Spingarn
听RB锘�, Hum
听SW锘�. 听Dimercaptosuccinic acid scan or ultrasound in screening for vesicoureteral reflux among children with urinary tract infections.听锘� 听Cochrane Database Syst Rev. 2016;7(7):CD010657. doi:
200.Jahnukainen
听T锘�, Honkinen
听O锘�, Ruuskanen
听O锘�, Mertsola
听J锘�. 听Ultrasonography after the first febrile urinary tract infection in children.听锘� 听Eur J Pediatr. 2006;165(8):556-559. doi:
201.Battula
听V锘�, Krupanandan
听RK锘�, Nambi
听PS锘�, Ramachandran
听B锘�. 听Safety and feasibility of antibiotic de-escalation in critically ill children with sepsis鈥攁 prospective analytical study from a pediatric ICU.听锘� 听Front Pediatr. 2021;9:640857. doi:
202.Ibrahim
听NA锘�, Bakry
听MM锘�, Ching
听SE锘�, Tahir
听NM锘�, Shah
听NN锘�. 听Early empiric antibiotic de-escalation in suspected early onset neonatal sepsis.听锘� 听Indian J Pharm Sci. 2019;81(5):913-921. doi:
203.Antonio
听MEE锘�, Cassandra
听BGC锘�, Emiliano
听RJD锘�,
听et al. 听Treatment of asymptomatic bacteriuria in the first 2 months after kidney transplant: a controlled clinical trial.听锘� 听Transpl Infect Dis. 2022;24(6):e13934. doi:
204.Alexopoulos
听E锘�, Memmos
听D锘�, Sakellariou
听G锘�, Paschalidou
听E锘�, Kyrou
听A锘�, Papadimitriou
听M锘�. 听Urinary tract infections after renal transplantation.听锘� 听Drugs Exp Clin Res. 1985;11(2):101-105.
205.Khosravi
听AD锘�, Abasi Montazeri
听E锘�, Ghorbani
听A锘�, Parhizgari
听N锘�. 听Bacterial urinary tract infection in renal transplant recipients and their antibiotic resistance pattern: a four-year study.听锘� 听Iran J Microbiol. 2014;6(2):74-78.
206.Goldman
听JD锘�, Julian
听K锘�. 听Urinary tract infections in solid organ transplant recipients: guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.听锘� 听Clin Transplant. 2019;33(9):e13507. doi:
207.Amano
听M锘�, Shimizu
听T锘�. 听Emphysematous cystitis: a review of the literature.听锘� 听Intern Med. 2014;53(2):79-82. doi:
208.Wu
听SY锘�, Yang
听SSD锘�, Chang
听SJ锘�, Hsu
听CK锘�. 听Emphysematous pyelonephritis: classification, management, and prognosis.听锘� 听Tzu Chi Med J. 2022;34(3):297-302. doi:
209.Somani
听BK锘�, Nabi
听G锘�, Thorpe
听P锘�, Hussey
听J锘�, Cook
听J锘�, N鈥橠ow
听J锘�; ABACUS Research Group. 听Is percutaneous drainage the new gold standard in the management of emphysematous pyelonephritis: evidence from a systematic review.听锘� 听J Urol. 2008;179(5):1844-1849. doi:
210.Thomas
听AA锘�, Lane
听BR锘�, Thomas
听AZ锘�, Remer
听EM锘�, Campbell
听SC锘�, Shoskes
听DA锘�. 听Emphysematous cystitis: a review of 135 cases.听锘� 听BJU Int. 2007;100(1):17-20. doi:
211.Rubilotta
听E锘�, Balzarro
听M锘�, Lacola
听V锘�, Sarti
听A锘�, Porcaro
听AB锘�, Artibani
听W锘�. 听Current clinical management of renal and perinephric abscesses: a literature review.听锘� 听鲍谤辞濒辞驳颈补. 2014;81(3):144-147. doi:
212.Lee
听SH锘�, Jung
听HJ锘�, Mah
听SY锘�, Chung
听BH锘�. 听Renal abscesses measuring 5 cm or less: outcome of medical treatment without therapeutic drainage.听锘� 听Yonsei Med J. 2010;51(4):569-573. doi:
213.Siegel
听JF锘�, Smith
听A锘�, Moldwin
听R锘�. 听Minimally invasive treatment of renal abscess.听锘� 听J Urol. 1996;155(1):52-55. doi:
214.Coelho
听RF锘�, Schneider-Monteiro
听ED锘�, Mesquita
听JLB锘�, Mazzucchi
听E锘�, Marmo Lucon
听A锘�, Srougi
听M锘�. 听Renal and perinephric abscesses: analysis of 65 consecutive cases.听锘� 听World J Surg. 2007;31(2):431-436. doi:
215.Shu
听T锘�, Green
听JM锘�, Orihuela
听E锘�. 听Renal and perirenal abscesses in patients with otherwise anatomically normal urinary tracts.听锘� 听J Urol. 2004;172(1):148-150. doi:
216.Meng
听MV锘�, Mario
听LA锘�, McAninch
听JW锘�. 听Current treatment and outcomes of perinephric abscesses.听锘� 听J Urol. 2002;168(4 Pt 1):1337-1340. doi:
217.Etienne
听M锘�, Chavanet
听P锘�, Sibert
听L锘�,
听et al. 听Acute bacterial prostatitis: heterogeneity in diagnostic criteria and management: retrospective multicentric analysis of 371 patients diagnosed with acute prostatitis.听锘� 听BMC Infect Dis. 2008;8:12. doi:
218.McNaughton Collins
听M锘�, Fowler
听FJ
听Jr锘�, Elliott
听DB锘�, Albertsen
听PC锘�, Barry
听MJ锘�. 听Diagnosing and treating chronic prostatitis: do urologists use the four-glass test?听锘� 听鲍谤辞濒辞驳测. 2000;55(3):403-407. doi:
219.Gam茅
听X锘�, Vincendeau
听S锘�, Palascak
听R锘�, Milcent
听S锘�, Fournier
听R锘�, Houlgatte
听A锘�. 听Total and free serum prostate specific antigen levels during the first month of acute prostatitis.听锘� 听Eur Urol. 2003;43(6):702-705. doi:
220.Gill
听BC锘�, Shoskes
听DA锘�. 听Bacterial prostatitis.听锘� 听Curr Opin Infect Dis. 2016;29(1):86-91. doi:
221.Bradshaw
听AW锘�, Pe
听M锘�, Bechis
听SK锘�,
听et al. 听Antibiotics are not necessary during routine cystoscopic stent removal: a randomized controlled trial at UC San Diego.听锘� 听Urol Ann. 2020;12(4):373-378. doi:
222.Westhoff
听N锘�, Anokhin
听A锘�, Patroi
听P锘�, Neuberger
听M锘�, Siegel
听F锘�, Pfalzgraf
听D锘�. 听Prospective evaluation of antibiotic management in ureteral stent and nephrostomy interventions.听锘� 听Urol Int. 2022;106(4):411-418. doi:
223.Bonkat
听G锘�, Bartoletti
听R锘�, Bruyere
听F锘�. EAU Guidelines on Urological Infections 2022. Published online 2022. Accessed September 20, 2023.
224.Yang
听C锘�, Wei
听H锘�, Zhan
听H锘�,
听et al. 听Effect of preoperative prophylactic antibiotic use on postoperative infection after percutaneous nephrolithotomy in patients with negative urine culture: a single-center randomized controlled trial.听锘� 听World J Urol. 2023;41(12):3687-3693. doi:
225.Darenkov
听AF锘�, Derevianko
听II锘�, Martov
听AG锘�, Kotliarova
听GA锘�, Kondrat鈥檈va
听EM锘�, Siniukhin
听VN锘�. 听[The prevention of infectious-inflammatory complications in the postoperative period in percutaneous surgical interventions in patients with urolithiasis].听锘� 听Urol Nefrol (Mosk). 1994;(2):24-26.
226.Jung
听HD锘�, Cho
听KS锘�, Moon
听YJ锘�, Chung
听DY锘�, Kang
听DH锘�, Lee
听JY锘�. 听Antibiotic prophylaxis for percutaneous nephrolithotomy: an updated systematic review and meta-analysis.听锘� 听PLoS One. 2022;17(4):e0267233. doi:
227.Levy
听MM锘�, Fink
听MP锘�, Marshall
听JC锘�,
听et al; SCCM/ESICM/ACCP/ATS/SIS. 听2001 SCCM/ESICM/ACCP/ATS/SIS International Sepsis Definitions Conference.听锘� 听Crit Care Med. 2003;31(4):1250-1256. doi:
228.Bag
听S锘�, Kumar
听S锘�, Taneja
听N锘�, Sharma
听V锘�, Mandal
听AK锘�, Singh
听SK锘�. 听One week of nitrofurantoin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study.听锘� 听鲍谤辞濒辞驳测. 2011;77(1):45-49. doi:
229.Mariappan
听P锘�, Smith
听G锘�, Moussa
听SA锘�, Tolley
听DA锘�. 听One week of ciprofloxacin before percutaneous nephrolithotomy significantly reduces upper tract infection and urosepsis: a prospective controlled study.听锘� 听BJU Int. 2006;98(5):1075-1079. doi:
230.Fisher
听JF锘�, Sobel
听JD锘�, Kauffman
听CA锘�, Newman
听CA锘�. 听Candida urinary tract infections鈥搕reatment.听锘� 听Clin Infect Dis. 2011;52(suppl 6):S457-S466. doi:
231.Mathers
听MJ锘�, Lazica
听DA锘�, Roth
听S锘�. 听[Non-bacterial cystitis: principles, diagnostics and etiogenic therapy options].听锘� 听Aktuelle Urol. 2010;41(6):361-368. doi:
232.Luciani
听LG锘�, Mattevi
听D锘�. 听Urinary tract infections: virus.听锘� 听Encyclopedia Infection Immunity. 2022;3:32-43. doi:
233.Hirsch
听HH锘�. 听BK virus: opportunity makes a pathogen.听锘� 听Clin Infect Dis. 2005;41(3):354-360. doi:
234.Allen
听CW锘�, Alexander
听SI锘�. 听Adenovirus associated haematuria.听锘� 听Arch Dis Child. 2005;90(3):305-306. doi:
235.Sawinski
听D锘�, Goral
听S锘�. 听BK virus infection: an update on diagnosis and treatment.听锘� 听Nephrol Dial Transplant. 2015;30(2):209-217. doi:
236.Ambalathingal
听GR锘�, Francis
听RS锘�, Smyth
听MJ锘�, Smith
听C锘�, Khanna
听R锘�. 听BK polyomavirus: clinical aspects, immune regulation, and emerging therapies.听锘� 听Clin Microbiol Rev. 2017;30(2):503-528. doi:
237.Krajewski
听W锘�, Kami艅ska
听D锘�, Poterek
听A锘�,
听et al. 听Pathogenicity of BK virus on the urinary system.听锘� 听Cent European J Urol. 2020;73(1):94-103. doi: