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Urology834 papers

Chronic urinary tract infection

Last edited: 29 days ago

Overview

Chronic urinary tract infections (UTIs) represent persistent infections that recur over time, often challenging management due to evolving bacterial resistance and patient-specific factors. 1415

Diagnosis

  • Clinical symptoms including dysuria, frequency, and hematuria.
  • Urinalysis showing pyuria and bacteriuria.
  • Urine culture to identify causative organism and antibiotic sensitivities. 2929
  • Management

  • First-line treatments:
  • - Antibiotics: Trimethoprim-sulfamethoxazole, fosfomycin, or nitrofurantoin for uncomplicated UTIs. 7838 - Duration: Typically 3-7 days for uncomplicated UTIs; longer durations for complicated UTIs or pyelonephritis. 730
  • Adjunctive measures:
  • - Prophylactic antibiotics: Considered for high-risk patients with recurrent UTIs, though non-antibiotic options are increasingly explored. 101117 - Non-antibiotic prophylaxis: Methenamine hippurate, probiotics, and cranberry products may reduce recurrence rates. 1011222327323334 - Behavioral modifications: Hydration, wiping technique, and avoiding irritants. 13

    Special Populations

  • Pediatrics:
  • - Early diagnosis crucial; urine culture essential for infants and young children. 2122125
  • Elderly:
  • - Higher risk of complications; consider underlying comorbidities and frailty. 294447
  • Pregnancy:
  • - Prompt treatment to prevent complications; avoid certain antibiotics like fluoroquinolones. 6614
  • Comorbidities:
  • - Tailor management considering immune status and antibiotic resistance patterns. 151847

    Key Recommendations

  • Use culture-directed antibiotic therapy for UTIs to ensure efficacy and minimize resistance. (Evidence: Strong 738)
  • Consider non-antibiotic prophylactic strategies such as methenamine hippurate or probiotics for recurrent UTIs, especially in high-risk groups. (Evidence: Moderate 101122)
  • Optimize urine collection methods to improve diagnostic accuracy, particularly in pediatric patients. (Evidence: Moderate 929)
  • Avoid inappropriate use of fluoroquinolones due to resistance concerns and potential side effects. (Evidence: Strong 14)
  • Implement catheter management protocols to reduce catheter-associated UTIs, including timely catheter removal and bladder training techniques. (Evidence: Moderate 655)
  • References

    Showing 100 most recent of 454 indexed papers.

    1 Ackerman AL, Bradley M, D'Anci KE, Hickling D, Kim SK, Kirkby E. Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2025). The Journal of urology 2026. link 2 Gnech M, Bujons A, Radmayr C, 't Hoen L, Bogaert G, Burgu B et al.. Update and summary of the EAU/ESPU paediatric guidelines on urinary tract infection in children. Journal of pediatric urology 2026. link 3 Yarger J, Suskind AM, Park IU, Wong I, Hecht HK, Harper CC. Perceived Barriers to Care for Urinary Tract Infections in Emerging Adulthood. Journal of general internal medicine 2026. link 4 Fehér ÁM, Safikhani M, Bajory Z, Lázár A, Burián K, Rárosi F et al.. Urinary bacterial spectrum and antibiotic resistance trends at a Urology Clinic in Hungary between 2012 and 2023. International urology and nephrology 2026. link 5 Hussein AA, Mahmood AW, Ahmad A, Houenstein H, Harrington G, Khan M et al.. Do Prophylactic Antibiotics Decrease the Rate of Urinary Tract Infections After Robot-Assisted Radical Cystectomy? A Randomized Controlled Trial. The Journal of urology 2025. link 6 Su L. Effectiveness of Nurse-Driven Protocols in Reducing Catheter-Associated Urinary Tract Infections: A Systematic Review and Meta-Analysis. Journal of nursing care quality 2025. link 7 Zahavi I, Kunwar D, Olchowski J, Dallasheh H, Paul M. Short vs. long antibiotic treatment for pyelonephritis and complicated urinary tract infections: a living systematic review and meta-analysis of randomized controlled trials. Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2025. link 8 Puttagunta S, Aronin SI, Gupta J, Das AF, Gupta K, Dunne MW. Sulopenem versus Amoxicillin/Clavulanate for the Treatment of Uncomplicated Urinary Tract Infection. NEJM evidence 2025. link 9 Mayombo Ngoussou E, Mounioko F, Mundunge M, Mabika Mabika R, Zong Minko O, Ondjiangui LF et al.. Descriptive Epidemiology of . BioMed research international 2025. link 10 Han Z, Yi X, Li J, Liao D, Ai J. Nonantibiotic prophylaxis for urinary tract infections: a network meta-analysis of randomized controlled trials. Infection 2025. link 11 Heltveit-Olsen SR, Arnljots ES, Sundvall PD, Gunnarsson R, Kowalczyk A, Godycki-Cwirko M et al.. Methenamine hippurate as prophylaxis for recurrent urinary tract infections in older women-a triple-blind, randomised, placebo-controlled, phase IV trial (ImpresU). Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases 2025. link 12 Wilson LM, Klassen TP, Crombie T, Gangwani A, Wai Lai VK, Gripp K et al.. Practice Variation in Urine Collection Among Emergency Department Providers in Pre-toilet-trained Children With Suspected Urinary Tract Infection. Pediatric emergency care 2025. link 13 Lefranc R, Waeckel T, Doerfler A, Tillou X. Emergency nephrectomy in surgical pyelonephritis: outcomes and predictors of conservative management failure. World journal of urology 2025. link 14 Burgos JG, Jirsova E, Kranz J, Bonkat G. A Call To Prevent Inappropriate Prescribing of Fluoroquinolones from the European Medicines Agency and the European Association of Urology Guidelines Panel for Urological Infections. European urology 2025. link 15 Ceccato T, Botti S, Tascini C, Lanzafame M, Brugnolli A, Ruggera L et al.. Emerging strategies in tackling antimicrobial resistance in urology: Narrative review and expert opinion. Urologia 2025. link 16 Cicek M, Tufekci B, Fehruzlu E, Kose M, Caskurlu H, Tahra A et al.. Annual changes of antimicrobial resistance and antibiotic preference in urology inpatient group; a tertiary hospital experience. BMC urology 2025. link 17 Alebachew GB, Dagnew M, Ambachew A, Tessema B. Bacterial profile and antimicrobial susceptibility pattern of community and hospital-acquired urinary tract infections among UTI suspected geriatrics in Gondar town, Northwest Ethiopia. PloS one 2025. link 18 Bitew G, Dagnew M, Dereje M, Birhanu A, Gashaw Y, Ambachew A et al.. Burden of multi-drug resistant bacterial isolates and its associated risk factors among UTI-confirmed geriatrics in Gondar town. Scientific reports 2025. link 19 Paul I, Roy A, Sarkar T, Dutta S, Ray S. An in silico vaccinomics strategy to develop multiepitope vaccine using essential hypothetical protein as a target against Brevundimonas subvibrioides: A combined subtractive proteomics and immunoinformatics approach. Microbial pathogenesis 2025. link 20 Thomas A, Davis L, Dolan A, Prewett R. Utilization of Antibiotics for the Treatment of Urinary Tract Infections in End-of-Life Patients. The American journal of hospice & palliative care 2025. link 21 Hari P, Meena J, Kumar M, Sinha A, Thergaonkar RW, Iyengar A et al.. Evidence-based clinical practice guideline for management of urinary tract infection and primary vesicoureteric reflux. Pediatric nephrology (Berlin, Germany) 2024. link 22 Nelson Z, Aslan AT, Beahm NP, Blyth M, Cappiello M, Casaus D et al.. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA network open 2024. link 23 Kouri TT, Hofmann W, Falbo R, Oyaert M, Schubert S, Gertsen JB et al.. The EFLM European Urinalysis Guideline 2023. Clinical chemistry and laboratory medicine 2024. link 24 González Rodríguez JD, Fraga Rodríguez GM, García Vera CJ, Gómez Fraile A, Martín Sánchez JI, Mengual Gil JM et al.. Update of the Spanish clinical practice guideline for urinary tract infection in infants and children. Summary of recommendations for diagnosis, treatment and follow-up. Anales de pediatria 2024. link 25 Chandra T, Bajaj M, Iyer RS, Chan SS, Bardo DME, Chen J et al.. ACR Appropriateness Criteria® Urinary Tract Infection-Child: 2023 Update. Journal of the American College of Radiology : JACR 2024. link 26 Li JM, Cosler LE, Harausz EP, Myers CE, Kufel WD. Methenamine for urinary tract infection prophylaxis: A systematic review. Pharmacotherapy 2024. link 27 Gkiourtzis N, Stoimeni A, Glava A, Chantavaridou S, Michou P, Cheirakis K et al.. Prophylaxis Options in Children With a History of Recurrent Urinary Tract Infections: A Systematic Review. Pediatrics 2024. link 28 Davidson SM, Brown JN, Nance CB, Townsend ML. Use of Methenamine for Urinary Tract Infection Prophylaxis: Systematic Review of Recent Evidence. International urogynecology journal 2024. link 29 Bausch K, Stangl FP, Prieto J, Bonkat G, Kranz J. Urinary Infection Management in Frail or Comorbid Older Individuals. European urology focus 2024. link 30 Montini G, Tessitore A, Console K, Ronfani L, Barbi E, Pennesi M. Short Oral Antibiotic Therapy for Pediatric Febrile Urinary Tract Infections: A Randomized Trial. Pediatrics 2024. link 31 Wagenlehner FM, Gasink LB, McGovern PC, Moeck G, McLeroth P, Dorr M et al.. Cefepime-Taniborbactam in Complicated Urinary Tract Infection. The New England journal of medicine 2024. link 32 Gupta V, Mastromarino P, Garg R. Effectiveness of Prophylactic Oral and/or Vaginal Probiotic Supplementation in the Prevention of Recurrent Urinary Tract Infections: A Randomized, Double-Blind, Placebo-Controlled Trial. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2024. link 33 Moro C, Phelps C, Veer V, Jones M, Glasziou P, Clark J et al.. Cranberry Juice, Cranberry Tablets, or Liquid Therapies for Urinary Tract Infection: A Systematic Review and Network Meta-analysis. European urology focus 2024. link 34 Hayward G, Mort S, Hay AD, Moore M, Thomas NPB, Cook J et al.. d-Mannose for Prevention of Recurrent Urinary Tract Infection Among Women: A Randomized Clinical Trial. JAMA internal medicine 2024. link 35 Westgeest AC, van Uhm JIM, Pattacini L, Rozemeijer W, Schout BMA, Groenwold RHH et al.. "Catheter replacement in catheter-associated urinary tract infection: current state of evidence ". European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2024. link 36 Mak Q, Greig J, Dasgupta P, Malde S, Raison N. Bacterial Vaccines for the Management of Recurrent Urinary Tract Infections: A Systematic Review and Meta-analysis. European urology focus 2024. link 37 Tsiakoulias E, Gravas S, Hadjichristodoulou C, Oikonomou KG, Kyritsi M, Dadouli K et al.. Randomized, placebo-controlled, double-blinded study of prophylactic cranberries use in women with recurrent uncomplicated cystitis. World journal of urology 2024. link 38 Hadidi MF, Alhamami N, Alhakami M, Abdulhamid AS, Alsharif A, Alomari MS et al.. Antibiotics efficacy in clinical and microbiological cure of uncomplicated urinary tract infection: a systematic review and network meta-analysis. World journal of urology 2024. link 39 Gohil SK, Septimus E, Kleinman K, Varma N, Avery TR, Heim L et al.. Stewardship Prompts to Improve Antibiotic Selection for Urinary Tract Infection: The INSPIRE Randomized Clinical Trial. JAMA 2024. link 40 Sachdeva A, Rai BP, Veeratterapillay R, Harding C, Nambiar A. Non-steroidal anti-inflammatory drugs for treating symptomatic uncomplicated urinary tract infections in non-pregnant adult women. The Cochrane database of systematic reviews 2024. link 41 Farfour E, Vasse M, Vallée A. Oligella spp.: A systematic review on an uncommon urinary pathogen. European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology 2024. link 42 Iacovelli V, Ficarra V, Maestroni UV, Tutolo M, Finazzi Agrò E. Open questions on lower urinary tract infections: Results of a Delphi consensus study. Neurourology and urodynamics 2024. link 43 Rondanelli M, Mansueto F, Gasparri C, Solerte SB, Misiano P, Perna S. Supplementation with Highly Standardized Cranberry Extract Phytosome Achieved the Modulation of Urinary Tract Infection Episodes in Diabetic Postmenopausal Women Taking SGLT-2 Inhibitors: A RCT Study. Nutrients 2024. link 44 Houston CG, Azar WS, Huang SS, Rubin R, Dorris CS, Sussman RD. A Cost Savings Analysis of Topical Estrogen Therapy in Urinary Tract Infection Prevention Among Postmenopausal Women. Urology practice 2024. link 45 Liang D, Li X. Rare Urinary Tract Infections in Immunosuppressed Patients: Not Just Anti-Infectives. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2024. link 46 Meena J, Bagga A, Hari P. Management of Urinary Tract Infections and Vesicoureteric Reflux: Key Updates From Revised Indian Society of Pediatric Nephrology Guidelines 2023. Indian pediatrics 2024. link 47 Mantica G, Cai T, Medina J, Kranz J, Bonkat G. Antibiotic-sparing Strategies for Prevention of Recurrent Urinary Tract Infection. European urology focus 2024. link 48 Ye XQ, Bi WH, Wang T. Purple Urine Bag Syndrome Amelioration without Antibiotic Therapy. Journal of the College of Physicians and Surgeons--Pakistan : JCPSP 2024. link 49 Marchesi JR, Drake MJ. The Urinary Microbiome Is a Potential Driver of Urinary Tract Pathology Through Multiple Mechanisms Including Deglucuronidation and DNA Damage. European urology focus 2024. link 50 Haislip I, Rindorf D, Cool C, Tester B. Workflow efficiencies for flexible cystoscopy: comparing single-use vs reusable cystoscopes. BMC urology 2024. link 51 Kranz J, Bartoletti R, Bruyère F, Cai T, Geerlings S, Köves B et al.. European Association of Urology Guidelines on Urological Infections: Summary of the 2024 Guidelines. European urology 2024. link 52 Bonkat G, Wagenlehner F, Kranz J. Keep it Simple: A Proposal for a New Definition of Uncomplicated and Complicated Urinary Tract Infections from the EAU Urological Infections Guidelines Panel. European urology 2024. link 53 Rubilotta E, Chiarulli EF, Ammirati E, Bevacqua MC, Manodoro S, Chierchia S et al.. Antibiotic prophylaxis in invasive urodynamics, a Delphi consensus of the Italian Society of Urodynamics (SIUD). Neurourology and urodynamics 2024. link 54 Tsai IH, Wang YC. Cefepime-induced encephalopathy in an older patient with polypharmacy and renal insufficiency: a case report. The Journal of international medical research 2024. link 55 Ishaq Z, Zaheer T, Waseem M, Shahwar Awan H, Ullah N, AlAsmari AF et al.. Immunoinformatics aided designing of a next generation poly-epitope vaccine against uropathogenic . Journal of biomolecular structure & dynamics 2024. link 56 Yang H, Ding Z, An Z. Urinary tract infection following the use of BTK inhibitors: a real-world analysis of post-marketing surveillance data. Expert opinion on drug safety 2024. link 57 Morello W, Baskin E, Jankauskiene A, Yalcinkaya F, Zurowska A, Puccio G et al.. Antibiotic Prophylaxis in Infants with Grade III, IV, or V Vesicoureteral Reflux. The New England journal of medicine 2023. link 58 El-Agamy EI, Elhelaly MA, Abouelgreed TA, Abdrabuh AM, Elebiary MF, Elatreisy A et al.. Randomized comparison of effect of standard antibiotic prophylaxis versus enhanced prophylactic measures on rate of urinary tract infection after flexible ureteroscopy. Archivio italiano di urologia, andrologia : organo ufficiale [di] Societa italiana di ecografia urologica e nefrologica 2023. link 59 Williams G, Hahn D, Stephens JH, Craig JC, Hodson EM. Cranberries for preventing urinary tract infections. The Cochrane database of systematic reviews 2023. link 60 Mengistu DA, Alemu A, Abdukadir AA, Mohammed Husen A, Ahmed F, Mohammed B. Incidence of Urinary Tract Infection Among Patients: Systematic Review and Meta-Analysis. Inquiry : a journal of medical care organization, provision and financing 2023. link 61 Shoureshi PS, Niino C, Eilber KS. Can vaginal lactobacillus suppositories help reduce urinary tract infections?. International urogynecology journal 2023. link 62 Dunne MW, Aronin SI, Das AF, Akinapelli K, Zelasky MT, Puttagunta S et al.. Sulopenem or Ciprofloxacin for the Treatment of Uncomplicated Urinary Tract Infections in Women: A Phase 3, Randomized Trial. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2023. link 63 Williams G, Stothart CI, Hahn D, Stephens JH, Craig JC, Hodson EM. Cranberries for preventing urinary tract infections. The Cochrane database of systematic reviews 2023. link 64 Jepson RG, Mihaljevic L, Craig JC. Cranberries for treating urinary tract infections. The Cochrane database of systematic reviews 2023. link 65 Ma S, Gu J, Fan X. Need to clamp indwelling urinary catheters before removal after different durations: a systematic review and meta-analysis. BMJ open 2023. link 66 Salari N, Khoshbakht Y, Hemmati M, Khodayari Y, Khaleghi AA, Jafari F et al.. Global prevalence of urinary tract infection in pregnant mothers: a systematic review and meta-analysis. Public health 2023. link 67 Yang S, Gill PJ, Anwar MR, Nurse K, Mahood Q, Borkhoff CM et al.. Kidney Ultrasonography After First Febrile Urinary Tract Infection in Children: A Systematic Review and Meta-analysis. JAMA pediatrics 2023. link 68 Güven O, Sayılan S, Tataroğlu Ö, Hökenek NM, Keleş DV. Antibiotic versus cranberry in the treatment of uncomplicated urinary infection: a randomized controlled trial. Revista da Associacao Medica Brasileira (1992) 2023. link 69 Llor C, Moragas A, Aguilar-Sánchez M, García-Sangenís A, Monfà R, Morros R. Best methods for urine sample collection for diagnostic accuracy in women with urinary tract infection symptoms: a systematic review. Family practice 2023. link 70 Dunne MW, Aronin SI, Das AF, Akinapelli K, Breen J, Zelasky MT et al.. Sulopenem for the Treatment of Complicated Urinary Tract Infections Including Pyelonephritis: A Phase 3, Randomized Trial. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America 2023. link 71 Salvatore S, Ruffolo AF, Stabile G, Casiraghi A, Zito G, De Seta F. A Randomized Controlled Trial Comparing a New D-Mannose-based Dietary Supplement to Placebo for the Treatment of Uncomplicated Escherichia coli Urinary Tract Infections. European urology focus 2023. link 72 Nollen JM, Pijnappel L, Schoones JW, Peul WC, Van Furth WR, Brunsveld-Reinders AH. Impact of early postoperative indwelling urinary catheter removal: A systematic review. Journal of clinical nursing 2023. link 73 Davis M, Jethani L, Robbins E, Kaner M. Is It Really the Foley? A Systematic Review of Bladder Management and Infection Risk. Topics in spinal cord injury rehabilitation 2023. link 74 Baran C, Akan AT, Sezgin V, Boylu A, Arabaci Ç, Polat EC et al.. The effect of urinary tract infection on overall mortality in elderly male patients. Folia medica 2023. link 75 Churchill K. The management of recurrent urinary tract infections within a nurse-led urology team. British journal of nursing (Mark Allen Publishing) 2023. link 76 Place J. Advances in clean intermittent self-catheterisation: impact on trauma and urinary tract infections. British journal of nursing (Mark Allen Publishing) 2023. link 77 Korman A, Ramanathan S, Shen N, Gerndt ZA, Luke N, Wang D et al.. The Diagnosis of Urinary Tract Infections Using a Novel At-home Testing Protocol to Enhance Telemedicine: A Retrospective Analysis. Urology 2023. link 78 Elliott CS. Sustainability in Urology: Single-use Versus Reusable Catheters for Intermittent Catheterization. European urology focus 2023. link 79 Paola Pérez Riveros B, Mohseni MM. Emphysematous Cystitis: A Rare Urologic Emergency. The American journal of case reports 2023. link 80 Roger PM, Bastian S, Breurec S, Saliège M, Blanchet P, Brureau L. Simplified antibiotic guidelines in urology are associated with decreased multidrug-resistant Enterobacterales. Infectious diseases now 2023. link 81 Gan Y, You S, Ying J, Mu D. The Association between Serum Vitamin D Levels and Urinary Tract Infection Risk in Children: A Systematic Review and Meta-Analysis. Nutrients 2023. link 82 Gremke N, Kostev K, Kalder M. Association between antihypertensive medication and the risk of urinary tract infection (UTI) of outpatients: a retrospective cohort study. Infection 2023. link 83 Rast D, Evers KS, Egli A, Rudin C, Goischke A, Ritz N. Aerococcus urinae - significance of detection in the paediatric urinary tract: a case series. European journal of pediatrics 2023. link 84 Hill JB, Fixen C, Wright G, Saseen JJ. Medications Associated with Occurrence of Urinary Tract Infections in Patients with Diabetes, Heart Failure or Both. Current drug safety 2023. link 85 Ramírez F, Exeni A, Alconcher L, Coccia P, García Chervo L, Suarez Á et al.. [Clinical practice guideline for the diagnosis and management of urinary tract infections: 2022 update]. 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Effect of urinary catheter removal on different time after hysterectomy: a network meta-analysis. International urogynecology journal 2022. link 95 New FJ, Theivendrampillai S, Juliebø-Jones P, Somani B. Role of Probiotics for Recurrent UTIs in the Twenty-First Century: a Systematic Review of Literature. Current urology reports 2022. link 96 Renko M, Salo J, Ekstrand M, Pokka T, Pieviläinen O, Uhari M et al.. Meta-analysis of the Risk Factors for Urinary Tract Infection in Children. The Pediatric infectious disease journal 2022. link 97 Zhao M, Pi Y, Zhang L. Knowledge Discovery-Based Analysis of Health Factors of Urinary Infections in Elderly Cardiology Inpatients. Journal of healthcare engineering 2022. link 98 Tan KK, Chien TW, Kan WC, Wang CY, Chou W, Wang HY. Research features between Urology and Nephrology authors in articles regarding UTI related to CKD, HD, PD, and renal transplantation. Medicine 2022. link 99 Castañeda NR, Doodlesack A, Fyfe W, Edlow J, Grossman SA. The data and the reality: urine cultures and emergency medicine physicians. Internal and emergency medicine 2022. link 100 Tiago V, Sousa D, Luque J, Rei MJ, Borrega R, Cabedal M et al.. Circumstances of the ambulatory prescription of quinolones in Urology and opportunities for intervention. Journal of healthcare quality research 2022. link

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      Urinary bacterial spectrum and antibiotic resistance trends at a Urology Clinic in Hungary between 2012 and 2023.Fehér ÁM, Safikhani M, Bajory Z, Lázár A, Burián K, Rárosi F et al. International urology and nephrology (2026)
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