urinary tract infections

Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults A WikiGuidelines Group Consensus Statement

Nathan Hinkle — Wed, 17 Jun 2026 01:19:59 +0000

Date Added:

June 16, 2026

Journal/Publication:

JAMA Network Open

Publisher:

The American Medical Association

Publication Date:

November 4, 2024

Pages:

1-29

URL:

Guidelines for the Prevention, Diagnosis and Management of Urinary Tract Infections in Pediatrics and Adults A Wiki Guidelines Group Consensus Statement

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

doi:10.1001/jamanetworkopen.2024.44495

Keywords

urinary tract infections

pediatrics

Treatment guidelines

MeSH

urinary tract infections

risk assessment

RPR Commentary: Suggested guidelines from the WikiGuidelines Group for diagnosis and management of children and adults with urinary tract infections. James W. Molds, MD, MPH

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Importance Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence.

Objective 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 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 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 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.

Author/s:

Zachary Nelson, Abdullah Tarik Aslan, Nathan P. Beahm

Ann Arbor Guide to Triaging Adults With Suspected Urinary Tract Infection for In-Person and Telehealth Settings

Megan George — Mon, 02 Feb 2026 15:48:55 +0000

Date Added:

February 2, 2026

Journal/Publication:

Consensus Statement Infectious Diseases

Publication Date:

January 29, 2026

URL:

Ann Arbor Guide to Triaging Adults With Suspected Urinary Tract Infection for In-Person and Telehealth Settings

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamanetworkopen.2025.56135

Keywords

urinary tract infections

Triage

Urinalysis

telemedicine

PMID (1):

41609831

MeSH

Anti-Bacterial Agents* / therapeutic use

practice guidelines as topic

Urinary Tract Infections* / diagnosis

Urinary Tract Infections* / drug therapy

Guidance regarding how to triage adults with symptoms of urinary tract infection. I'm not sure it applies well to older women who may have UTI-like symptoms related to atrophic changes in the urethra. James W. Mold, MD, MPH

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Importance: Urinary tract infection (UTI) is common in ambulatory care settings and the primary reason for antibiotic prescribing. Despite several guidelines focused on the type and duration of antibiotics prescribed for treating UTI, there is limited outpatient guidance on how to best triage patients with presumed UTI.

Objective: To assess the appropriateness of different triage and management recommendations involving empiric antibiotics, urine testing strategies, and visit types and how these recommendations vary by patient sex, age, presenting symptoms, and clinical history.

Evidence review: Using the RAND/UCLA Appropriateness Method, a 13-member multidisciplinary panel (physicians, advanced practice providers, and nurses) performed a scoping review of the literature publications from 2009 to June 2024 and rated the appropriateness of 136 clinical scenarios (48 for women, 49 for men, and 39 scenarios not specific to sex) with up to 9 management strategies per scenario for a total of 1094 scenarios. For each scenario, experts rated the appropriateness of empiric treatment, types of urine testing, and triage to visit type (in-person, virtual, or none) as appropriate (ie, benefits outweigh risks), inappropriate, or of uncertain appropriateness. Appropriateness ratings were summarized into 2 groups: nonpregnant adult women and adult men.

Findings: Major recommendations based on symptoms included (1) same-day in-person evaluation if symptoms were concerning for pyelonephritis, complicated cystitis, or urinary obstruction; (2) a visit if additional nonurinary symptoms were present (ie, diarrhea, genital discharge, or cough); (3) neither urine testing nor empiric treatment solely due to a change in urine color or appearance without other bladder (cystitis) symptoms; (4) empiric treatment without testing or a visit, for women, if there were new classic cystitis symptoms of dysuria, urinary frequency, urgency, or suprapubic pain without risks for antibiotic resistance; (5) urinalysis with culture (ideally reflexed to culture) before taking first antibiotic dose for women at risk of antibiotic resistance (eg, recent antibiotic treatment for UTI or recurrent UTIs) and all men; and (6) empiric treatment considered for patients with barriers to obtaining timely urine testing or visits.

Conclusions and relevance: The appropriateness of empiric antibiotics, urine testing, and different clinical evaluation options were defined for adults presenting with concerns for UTI in common ambulatory triage settings, including telehealth. These criteria for ambulatory triage of suspected UTI symptoms in adults are anticipated to help standardize and improve the appropriateness of empiric antibiotic prescribing, urine testing, and visit type triage.

Author/s:

Jennifer Meddings, Kristin Chrouser, Karen E. Fowler

Urinary tract infections after menopause

Alex Haga — Tue, 11 Feb 2025 23:25:58 +0000

Date Added:

February 11, 2025

Journal/Publication:

Canadian Medical Association Journal

Publication Date:

February 2, 2025

Issue:

Volume:

197

Pages:

E96

URL:

Urinary tract infections after menopause

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1503/cmaj.241258

Keywords

urinary tract infections

UTIs

postmenopause

PMID (1):

39900362

MeSH

postmenopause

urinary tract infections

menopause

A concise review of the diagnosis and management of UTIs in post menopausal women. James W. Mold, MD, MPH

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No abstract is included with this article.

Author/s:

Erin A Brennand, Jayna Holroyd-Leduc

Genital Herpes

Alex Haga — Tue, 20 Aug 2024 20:03:33 +0000

Date Added:

August 20, 2024

Journal/Publication:

JAMA

Publication Date:

August 14, 2024

URL:

Genital Herpes

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2024.12743

Keywords

sexually transmitted diseases

urinary tract infections

herpes

genital herpes

PMID (1):

39141407

MeSH

sexually transmitted diseases

urinary tract infections

Genitalia

A review of what we currently understand about genital herpes simplex infections. James W Mold, MD, MPH

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This JAMA Insights examines the history, diagnosis, prevention, and stigma of genital herpes infection in the US and explores treatments such as suppressive therapy.

Author/s:

Christine Johnston, Anna Wald

What Should I Know About Recurrent UTIs in Older Women?

Alex Haga — Thu, 13 Jun 2024 21:47:57 +0000

Date Added:

June 13, 2024

Journal/Publication:

JAMA Internal Medicine

Publication Date:

June 10, 2024

URL:

What Should I Know About Recurrent UTIs in Older Women?

Type:

Patient Education Materials

Format:

Article

DOI (1):

10.1001/jamainternmed.2024.1854

Keywords

urinary tract infections

female

PMID (1):

38857042

MeSH

female

Urinary Bladder

Urination

urinary tract infections

Vagina

menopause

Information for older women and their caregivers about diagnosis and treatment of suspected urinary tract infections. James W. Mold, MD, MPH

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This JAMA Internal Medicine Patient Page describes urinary tract infections, their causes, and how to treat them and prevent future episodes.

Author/s:

Sonali D Advani, Kimberly C Claeys, Nazema Y Siddiqui

Recurrent Urinary Tract Infection in Older Outpatient Women

Alex Haga — Thu, 13 Jun 2024 21:35:58 +0000

Date Added:

June 13, 2024

Journal/Publication:

JAMA Internal Medicine

Publisher:

JAMA

Publication Date:

June 10, 2024

URL:

Recurrent Urinary Tract Infection in Older Outpatient Women

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jamainternmed.2024.1069

Keywords

urinary tract infections

PMID (1):

38856992

MeSH

urinary tract infections

A review of some of the challenges involved in the diagnosis and management of urinary tract infections in older women. James W. Mold, MD, MPH

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This Clinical Insights discusses special considerations in recurrent urinary tract infection diagnosis and management in older women.

Author/s:

Alison J Huang, Deborah Grady, Lona Mody

Optimal Urine Culture Diagnostic Stewardship Practice-Results from an Expert Modified-Delphi Procedure

Aubrey Delammermore — Thu, 08 Sep 2022 05:00:00 +0000

Date Added:

September 8, 2022

Journal/Publication:

Clinical Infectious Diseases

Publisher:

Infectious Diseases Society of America

Publication Date:

August 1, 2022

Issue:

Volume:

Pages:

382-389

URL:

Optimal Urine Culture Diagnostic Stewardship Practice-Results from an Expert Modified-Delphi Procedure

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1093/cid/ciab987

Keywords

Diagnostic Stewardship

Expert consensus

modified Delphi

urinary tract infections

urine cultures

PMID (1):

34849637

MeSH

Anti-bacterial Agents / therapeutic use

Delphi Technique

anti-bacterial agents

urinalysis

Urinary Tract Infections* / diagnosis

A useful summary of practical recommendations for the appropriate ordering and interpretation of urine cultures. James W. Mold, MD, MPH

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Background: Urine cultures are nonspecific and often lead to misdiagnosis of urinary tract infection and unnecessary antibiotics. Diagnostic stewardship is a set of procedures that modifies test ordering, processing, and reporting in order to optimize diagnosis and downstream treatment. In this study, we aimed to develop expert guidance on best practices for urine culture diagnostic stewardship.

Methods: A RAND-modified Delphi approach with a multidisciplinary expert panel was used to ascertain diagnostic stewardship best practices. Clinical questions to guide recommendations were grouped into three thematic areas (ordering, processing, reporting) in practice settings of emergency department, inpatient, ambulatory, and long-term care. Fifteen experts ranked recommendations on a 9-point Likert scale. Recommendations on which the panel did not reach agreement were discussed during a virtual meeting, then a second round of ranking by email was completed. After secondary review of results and panel discussion, a series of guidance statements was developed.

Results: One hundred and sixty-five questions were reviewed. The panel reaching agreement on 104, leading to 18 overarching guidance statements. The following strategies were recommended to optimize ordering urine cultures: requiring documentation of symptoms, sending alerts to discourage ordering in the absence of symptoms, and cancelling repeat cultures. For urine culture processing, conditional urine cultures and urine white blood cell count as criteria were supported. For urine culture reporting, appropriate practices included nudges to discourage treatment under specific conditions and selective reporting of antibiotics to guide therapy decisions.

Conclusions: These 18 guidance statements can optimize use of urine cultures for better patient outcomes.

Keywords: diagnostic stewardship; expert consensus; modified Delphi; urinary tract infection; urine cultures.

Author/s:

Claeys, K. C., Trautner, B. W., Leekha, S., Coffey, K. C., Crnich, C. J., Diekema, D. J., Fakih, M. G., Goetz, M. B., Gupta, K., Jones, M. M., Leykum, L., Liang, S. Y., Pineles, L., Pleiss, A., Spivak, E. S., Suda, K. J., Taylor, J. M., Rhee, C., Morgan, D. J.

Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

Jeffrey Wilson — Mon, 22 Oct 2018 16:08:25 +0000

Date Added:

October 22, 2018

Journal/Publication:

Comparative Effectiveness Review

Publisher:

Agency for Healthcare Research and Quality

Publication Date:

August 8, 2018

Issue:

212

URL:

Nonsurgical Treatments for Urinary Incontinence in Women: A Systematic Review Update

Type:

Meta-analyses, Reviews, and Guidelines

DOI (1):

10.23970/AHRQEPCCER212

Keywords

urinary tract infections

MeSH

botulinum toxins, type A

urinary tract infections

This is a concise summary of the evidence regarding management of stress and urge-type urinary incontinence in women.

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Introduction. About 17 percent of adult women have had urinary incontinence (UI), classified as stress, urgency, or mixed. Stress UI is associated with an inability to retain urine with activities that increase intraabdominal pressure. Urgency UI is associated with the sudden, compelling urge to void. Mixed UI occurs when both are present.

Methods. We updated the Agency for Healthcare Research and Quality's 2012 systematic review with new literature searches in MEDLINE®, the Cochrane Central Trials Registry, the Cochrane Database of Systematic Reviews, and Embase® from 2011 through December 4, 2017. We included UI outcomes (cure, improvement, satisfaction), quality of life, and adverse events. For UI outcomes, we conducted network meta-analyses, combining direct and indirect comparisons across studies. Quality of life and adverse event outcomes are narratively described.

Results. We identified 233 eligible studies, of which 140 reported on UI outcomes, 96 on quality of life, and 127 on adverse events. Studies evaluated 16 categories of interventions with 53 specific interventions. Fourteen intervention categories have been evaluated for UI outcomes; all except hormones and periurethral bulking agents were more effective to achieve at least one favorable UI outcome than no treatment (variable strength of evidence [SoE]). Among 1st or 2nd line interventions for stress UI, behavioral therapy (BT, alone and in combination with hormones) was more effective than either alpha agonists or hormones to achieve cure or improvement (moderate SoE); alpha agonists were more effective than hormones to achieve improvement (moderate SoE). Among treatments used as 1st or 2nd line interventions for urgency UI, BT was significantly more effective than anticholinergics to achieve cure or improvement (high SoE). Among 3rd line interventions for stress UI, intravesical pressure release, but not periurethral bulking agents, was more effective than no treatment (variable SoE). Neuromodulation, which is commonly used for treatment of urgency UI, is more effective than no treatment of stress UI for cure, improvement, and satisfaction (high SoE). Among studies of women with only stress UI, indirect evidence suggests that intravesical pressure release is more effective to achieve improvement than combination BT and neuromodulation, and triple combination neuromodulation, hormones, and BT may be more effective than either periurethral bulking or combination neuromodulation and BT (all low SoE). Among treatments used as 3rd line interventions for urgency UI, both neuromodulation and onabotulinum toxin A (BTX) are more effective than no treatment (high SoE), and BTX may be more effective than neuromodulation to achieve cure (low SoE). BT, neuromodulation, and anticholinergics resulted in better quality of life than no treatment (low SoE). Urinary tract infections (UTIs) were reported in 11 percent of women receiving transcutaneous electrical nerve stimulation and erosion in 1.6 percent of women with the periurethral bulking agent macroplastique (low SoE). Dry mouth was the most commonly reported adverse event for the anticholinergic oxybutynin (36%) and the alpha agonist duloxetine (13%) (high SoE). BTX was associated with UTIs (36%) and urinary retention (10% to 20%) (moderate SoE). Constitutional adverse events (e.g., nausea, insomnia, fatigue) were common with duloxetine (moderate SoE).

Conclusions. Network meta-analyses demonstrated that most nonpharmacological and pharmacological interventions are more likely than no treatment to improve UI outcomes and quality of life. BT, alone or in combination with other interventions, is generally more effective than 2nd line (pharmacological) therapies alone for both stress and urgency UI. Common adverse events with pharmacological treatments include dry mouth, nausea, and fatigue. BTX is associated with urinary infections and retention. Periurethral bulking agents are associated with erosion and need for surgical removal. Large gaps remain in the literature regarding head-to-head comparisons of individual interventions.

Author/s:

Balk, Ethan, Adam, Gaelen P., Kimmel, Hannah, Rofeberg, Valerie, Saeed, Iman, Jeppson, Peter, Trikalinos, Thomas