Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults
Authors: Nelson Zachary , Aslan Abdullah Tarık , Beahm Nathan P. , Blyth Michelle , Cappiello Matthew , Casaus Danielle , Dominguez Fernando , Egbert Susan , Hanretty Alexandra , Khadem Tina , Olney Katie , Abdul-Azim Ahmed , Aggrey Gloria , Anderson Daniel T. , Barosa Mariana , Bosco Michael , Chahine Elias B. , Chowdhury Souradeep , Christensen Alyssa , de Lima Corvino Daniela , Fitzpatrick Margaret , Fleece Molly , Footer Brent , Fox Emily , Ghanem Bassam , Hamilton Fergus , Hayes Justin , Jegorovic Boris , Jent Philipp , Jimenez-Juarez Rodolfo Norberto , Joseph Annie , Kang Minji , Kludjian Geena , Kurz Sarah , Lee Rachael A. , Lee Todd C. , Li Timothy , Maraolo Alberto Enrico , Maximos Mira , McDonald Emily G. , Mehta Dhara , Moore William Justin , Nguyen Cynthia T. , Papan Cihan , Ravindra Akshatha , Spellberg Brad , Taylor Robert , Thumann Alexis , Tong Steven Y. C. , Veve Michael , Wilson James , Yassin Arsheena , Zafonte Veronica , Mena Lora Alfredo J. 
Published: November 2024

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.