Recurrent Uncomplicated Urinary Tract Infections in Women
Publication Date: October 1, 2022
Last Updated: March 14, 2022
Guideline Statements
Evaluation
1. Clinicians should obtain a complete patient history and perform a pelvic examination in women presenting with rUTIs. (Clinical Principle, )
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2. To make a diagnosis of rUTI, clinicians must document positive urine cultures associated with prior symptomatic episodes. (Clinical Principle, )
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3. Clinicians should obtain repeat urine studies when an initial urine specimen is suspect for contamination, with consideration for obtaining a catheterized specimen. (Clinical Principle, )
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4. Cystoscopy and upper tract imaging should not be routinely obtained in the index patient presenting with a rUTI. (Expert Opinion , )
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5. Clinicians should obtain urinalysis, urine culture and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment in patients with rUTIs. (Moderate, C)
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6. Clinicians may offer patient-initiated treatment (self-start treatment) to select rUTI patients with acute episodes while awaiting urine cultures. (Moderate, C)
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Asymptomatic Bacteriuria
7. Clinicians should omit surveillance urine testing, including urine culture, in asymptomatic patients with rUTIs. (Moderate, C)
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8. Clinicians should not treat ASB in patients. (Strong, B)
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Antibiotic Treatment
9. Clinicians should use first-line therapy (i.e., nitrofurantoin, TMP-SMX, fosfomycin) dependent on the local antibiogram for the treatment of symptomatic UTIs in women. (Strong, B)
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10. Clinicians should treat rUTI patients experiencing acute cystitis episodes with as short a duration of antibiotics as reasonable, generally no longer than seven days. (Moderate, B)
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11. In patients with rUTIs experiencing acute cystitis episodes associated with urine cultures resistant to oral antibiotics, clinicians may treat with culture-directed parenteral antibiotics for as short a course as reasonable, generally no longer than seven days. (Expert Opinion , )
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Antibiotic Prophylaxis
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12. Following discussion of the risks, benefits, and alternatives, clinicians may prescribe antibiotic prophylaxis to decrease the risk of future UTIs in women of all ages previously diagnosed with UTIs. (Moderate, B)
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Non–Antibiotic Prophylaxis
13. Clinicians may offer cranberry prophylaxis for women with rUTIs. (Conditional, C)
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Follow–up Evaluation
14. Clinicians should not perform a post-treatment test of cure urinalysis or urine culture in asymptomatic patients (Expert Opinion , )
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15. Clinicians should repeat urine cultures to guide further management when UTI symptoms persist following antimicrobial therapy. (Expert Opinion , )
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Estrogen
16. In peri– and post–menopausal women with rUTIs, clinicians should recommend vaginal estrogen therapy to reduce the risk of future UTIs if there is no contraindication to estrogen therapy. (Moderate, B)
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Title
Recurrent Uncomplicated Urinary Tract Infections in Women
Authoring Organizations
American Urological Association
Society of Urodynamics Female Pelvic Medicine & Urogenital Reconstruction
Publication Month/Year
October 1, 2022
Last Updated Month/Year
August 20, 2024
External Publication Status
Published
Country of Publication
US
Document Objectives
Guidance for the evaluation and management of patients with rUTIs to prevent inappropriate use of antibiotics, decrease the risk of antibiotic resistance, reduce adverse effects of antibiotic use, provide guidance on antibiotic and non-antibiotic strategies for prevention, and improve clinical outcomes and quality of life for women with rUTIs by reducing recurrence of UTI events.
Inclusion Criteria
Female, Adult
Health Care Settings
Ambulatory, Hospital, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Prevention, Treatment
Diseases/Conditions (MeSH)
D014552 - Urinary Tract Infections
Keywords
bacteriuria, urinary tract infection (UTI), urinary tract infection, Acute bacterial cystitis
Source Citation
Bixler BR, Anger JT. Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline. Journal of Urology [Internet]. 2022 Oct 1 [cited 2024 Aug 20];208(4):754–6. Available from: https://doi.org/10.1097/JU.0000000000002888