Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2022) Flashcards
Recurrent Uncomplicted Urinary Tract Infections in Women:
AUA/CUA/SUFU Diagnosis & Treatment Algorithm
What percentage of women will experience symptomatic acute bacterial cystitis in their lifetime?
A) 10%
B) 20%
C) 40%
D) 60%
D) 60%
Explanation: According to the given introduction, approximately 60% of women will experience symptomatic acute bacterial cystitis in their lifetime.
What is the estimated cost of evaluation and treatment of UTI globally per year?
D) $2 billion
Explanation: According to the given introduction, the evaluation and treatment of UTI costs several billion dollars globally per year, reaching approximately $2 billion per year in the United States alone.
What is recurrent uncomplicated urinary tract infection (rUTI), and what are the risk factors associated with it?
Recurrent uncomplicated urinary tract infection (rUTI) is a condition where a woman experiences multiple episodes of urinary tract infection. The term “uncomplicated” means that there are no anatomical or functional abnormalities in the urinary tract. The risk factors associated with rUTI include sexual activity, use of spermicide, diaphragm or other contraceptives, a history of urinary tract infections in childhood, a family history of UTIs, and menopause. Other medical conditions, such as diabetes, kidney stones, and bladder cancer, can also increase the risk of rUTI.
What are the common symptoms of recurrent uncomplicated urinary tract infection (rUTI), and how is it diagnosed and treated?
The common symptoms of recurrent uncomplicated urinary tract infection (rUTI) include frequent urination, urgency, burning or pain during urination, and cloudy or foul-smelling urine. Diagnosis of rUTI is based on symptoms, a physical exam, and a urine culture. A urine culture is necessary to confirm the diagnosis and to identify the bacteria causing the infection. Treatment of rUTI involves antibiotics to eliminate the bacteria causing the infection. The choice of antibiotics is based on the results of the urine culture and the sensitivity of the bacteria to different antibiotics. In some cases, long-term antibiotic prophylaxis may be recommended to prevent future infections. Non-pharmacologic strategies, such as drinking plenty of water, urinating frequently, and practicing good hygiene, can also be helpful in preventing rUTI.
TABLE 1: Guideline Definitions
What is the definition of “uncomplicated” in regards to recurrent cystitis in women?
a. The patient has a known factor that would make her more susceptible to develop a UTI
b. The patient has no known factors that would make her more susceptible to develop a UTI
c. The patient has an anatomic or functional abnormality of the urinary tract
d. The patient is immunocompromised
b. The patient has no known factors that would make her more susceptible to develop a UTI.
Explanation: “Uncomplicated” means that the patient has no known factors that would make her more susceptible to develop a UTI, while “complicated” indicates that other complicating factors may put one at higher risk for UTI and decreased treatment efficacy.
What is the definition of rUTI?
a. Three episodes of acute bacterial cystitis within six months
b. Two episodes of acute bacterial cystitis within six months
c. Two episodes of acute bacterial cystitis within one year
d. Three episodes of acute bacterial cystitis within one month
c. Two episodes of acute bacterial cystitis within one year.
Explanation: While there are multiple definitions for rUTI, this guideline endorses the two most commonly used definitions of two episodes of acute bacterial cystitis within six months or three episodes within one year.
What is the difference between uncomplicated and complicated cystitis? Give some examples of complicating factors.
Uncomplicated cystitis refers to recurrent episodes of cystitis in women without any known factors that would make her more susceptible to develop a UTI. On the other hand, complicated cystitis indicates that other complicating factors may put one at higher risk for UTI and decreased treatment efficacy. Such complicating factors may include an anatomic or functional abnormality of the urinary tract (e.g., stone disease, diverticulum, neurogenic bladder), an immunocompromised host, or infection with multi-drug resistant (MDR) bacteria.
What is the definition of rUTI and what are the two most commonly used definitions?
While there are multiple definitions for rUTI, this guideline endorses the two most commonly used definitions of two episodes of acute bacterial cystitis within six months or three episodes within one year. These definitions typically consider these episodes to be separate infections with the resolution of symptoms between episodes, and do not include those who require more than one treatment or multiple antibiotic courses for symptomatic resolution, as can occur with inappropriate initial or empiric treatment. Any patient experiencing episodes of symptomatic acute cystitis after previous resolution of similar symptoms meets the criteria for rUTI. However, it should be noted that those patients initially treated for uncomplicated bacterial cystitis who recur rapidly (i.e. within two weeks of initial treatment) after symptom resolution or display bacterial persistence without symptom resolution may be reclassified as complicated and require imaging, cystoscopy, or other further investigation for bacterial reservoirs.
What should a clinician do when evaluating a patient with recurrent urinary tract infections?
–Clinicians should obtain a complete patient history and perform a pelvic examination in women presenting with rUTIs.
–To make a diagnosis of rUTI, clinicians must document positive urine cultures associated with prior symptomatic episodes.
–Clinicians should obtain repeat urine studies when an initial urine specimen is suspect for contamination, with consideration for obtaining a catheterized specimen.
What should a clinician NOT do when evaluating a woman for recurrent UTIs?
Cystoscopy and upper tract imaging should not be routinely obtained in the index patient presenting with rUTI.
If a patient with rUTIs has a symptomatic acute cystitis episode, what should be done?
Clinicians should obtain urinalysis, urine culture and sensitivity with *each* symptomatic acute cystitis episode prior to initiating treatment in patients with rUTIs.
Clinicians may offer patient-initiated treatment (self-start treatment) to select rUTI patients with acute episodes while awaiting urine cultures.
If a healthy, (female) index patient has asymptomatic bacteriuria, what should be done?
Clinicians should omit surveillance urine testing, including urine culture, in asymptomatic patients with rUTIs.
Clinicians should not treat ASB in patients.
What should be first line antibiotic treatment for a UTI in a woman? How long should it be given for?
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.
Clinicians should treatr UTI patients experiencing acute cystitis episodes with as short a duration of antibiotics as reasonable, generally no longer than seven days.
In patients with rUTIs experiencing acute cystitis episodes associated with urine cultures resistant to oral antibiotics, what should be given and for how long?
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.
Antibiotic Prophylaxis in rUTIs
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.
Non-Antibiotic Prophylaxis
Clinicians may offer cranberry prophylaxis for women with rUTIs.
Follow up for recurrent UTIs
Clinicians should not perform a post-treatment test of cure urinalysis or urineculture in asymptomatic patients.
Clinicians should repeat urine cultures to guide further management when UTI symptoms persist following antimicrobial therapy.
Estrogen in rUTIs
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.
What is the definition of a complicated UTI?
An infection in a patient in which one or more complicating factors may put her at higher risk for development of a UTI and potentially decrease efficacy of therapy. Such factors include the following:
Anatomic or functional abnormality of the urinary tract (e.g., stone disease, diverticulum, neurogenic bladder)
Immunocompromised host
Multi-drug resistant bacteria
