What are the guideline sources, guidelines and references for Acute cystitis ?
Guideline sources The following summarized guidelines for the evaluation and management of acute cystitis are prepared by our editorial team based on guidelines from the European Association of Urology (EAU 2022), the Infectious Diseases Society of America (IDSA 2022; 2016), the American College of Physicians (ACP 2021), the German Society of Urology (GUS 2018), the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC 2017), the American Urological Association (AUA 2017), the Infectious Diseases Society of America (IDSA/ESCMID 2011), and the American Association of Family Physicians (AAFP 2011). 1 2 3 4 5 6 7 7 7 7 8 9 10 Definition Acute uncomplicated cystitis is a lower UTI occurring in the absence of anatomic or functional abnormalities of the urinary tract or any other complicating factors. 10 Epidemiology Acute uncomplicated cystitis is mostly caused by bacteria, including E. coli (86%), S. saprophyticus (4%), Klebsiella species (3%), Proteus species (3%), Enterobacter species (1.4%), Citrobacter species (0.8%), and Enterococcus species (0.5%). 7 Disease course https://web.pathway.md/diseases/recrCqxg7Xppqpnel 1/6 6/23/23, 1:38 AM Acute cystitis Pathway Disease course Bacterial infection of the lower urinary tract results in acute uncomplicated cystitis, which causes classic symptoms of dysuria, frequent voiding of small volumes, and urinary urgency. Occasional hematuria and suprapubic discomfort may be present. 7 Prognosis and risk of recurrence Acute uncomplicated cystitis is not associated with an increase in mortality. 7 Calculator Pediatric Emergency Care Appli Guidelines 1. Screening and diagnosis Etiology: Recognize that the most common cause of uncomplicated UTIs is E. coli, followed by S. saprophyticus, K. pneumoniae, and P. mirabilis. Recognize that other pathogens are rare. A Recognize that Enterococci are most commonly found in mixed infections, therefore, their pathogenicity is uncertain in uncomplicated UTIs. B Diagnostic criteria: As per EAU 2022 guidelines, diagnose uncomplicated cystitis in females with no other risk factors for complicated UTIs based on a focused history of LUTS (dysuria, frequency, and urgency) and the absence of vaginal discharge. A As per GUS 2018 guidelines: Suspect uncomplicated cystitis with high probability in female patients with typical symptoms (pain on micturition, pollakiuria, urgency), no vaginal symptoms (itching, altered discharge), no fever and flank pain, and in the absence of risk factors for complicated UTIs. B View colony counts of 10 CFU/mL of a typical uropathogen as clinically significant for acute uncomplicated cystitis in female patients with typical symptoms. B As per SEIMC 2017 guidelines, define a culture of 10 CFU/mL of a uropathogen as significant for cystitis in symptomatic female patients, A and a culture of 10 CFU/mL in male patients. B Differential diagnosis: Evaluate for other diagnoses, such as gynecological infections (chlamydia or trichomonas infection) at an early stage in patients with nonspecific symptoms, or inconsistent urine examination, including negative urine culture. B https://web.pathway.md/diseases/recrCqxg7Xppqpnel 2/6 6/23/23, 1:38 AM Acute cystitis Pathway Consider evaluating for other diagnoses in patients presenting with vaginal complaints, B such as vaginal itching or vaginal discharge. B 2. Classification and risk stratification Severity assessment: use the Acute Cystitis Symptom Score to assess the severity of symptoms, the course of the disease over time, and the effect of therapy. B 3. Diagnostic investigations History and physical examination: obtain a symptom-related medical examination with clinical examination in the first presentation of acute UTI or if the patient is unknown to the physician. B Urine dipstick: As per EAU 2022 guidelines, obtain urine dipstick testing for the diagnosis of acute uncomplicated cystitis. B As per GUS 2018 guidelines: Consider obtaining a urine dipstick for nitrite/WBCs to rule out UTI with sufficient certainty in patients with a low pretest probability. C Recognize that the presence of RBCs, WBCs, and nitrites independently increases the likelihood of the presence of a UTI, and the combination of the positive findings further increases the likelihood of the diagnosis. B Urine culture: As per EAU 2022 guidelines, obtain urine culture in the following situations: suspected acute pyelonephritis symptoms not resolving or recurring within 4 weeks after completion of treatment females presenting with atypical symptoms pregnant patients. A As per GUS 2018 guidelines, do not obtain urine culture in female patients with uncomplicated, non-recurrent or -refractory cystitis with clear clinical symptoms. D Show 2 more As per SEIMC 2017 guidelines, obtain a pre-treatment urine culture if the diagnosis is not clear from the history and physical examination, the episode represents an early symptomatic recurrence, there is reason to suspect antimicrobial resistance, or the patient's therapeutic options are limited due to medication intolerance. B Show 2 more Urethrocystoscopy: Perform urethrocystoscopy in patients with persistent hematuria or persistent detection of pathogens other than E. coli. B https://web.pathway.md/diseases/recrCqxg7Xppqpnel 3/6 6/23/23, 1:38 AM Acute cystitis Pathway Do not perform routine cystoscopy in female patients without recurrent UTIs and without relevant comorbidities. D Diagnostic imaging: obtain further imaging in patients with persistent hematuria or persistent detection of pathogens other than E. coli. B 4. Medical management Antibiotic therapy, first-line therapy: As per EAU 2022 guidelines, initiate fosfomycin trometamol, pivmecillinam, or nitrofurantoin as first-line therapy in female patients with uncomplicated cystitis. A As per ACP 2021 guidelines, initiate a short course of antibiotics with either nitrofurantoin for 5 days, TMP-sulfamethoxazole for 3 days, or fosfomycin as a single dose in female patients with uncomplicated bacterial cystitis. B As per SEIMC 2017 guidelines: Initiate fosfomycin trometamol (3 g in a single dose) or nitrofurantoin (for 5-7 days) as first-line therapy in female patients with uncomplicated cystitis, due to minimal resistance and propensity for collateral damage. A Complete a longer course of antibiotic therapy (at least 7 days) in male patients and in female patients with symptoms > 7 days, recent UTI, diabetes, renal insufficiency, immunosuppression, or with a vaginal diaphragm. B As per AAFP 2011 guidelines, initiate nitrofurantoin macrocrystals (100 mg BID for 5 days), TMP-sulfamethoxazole (160/800 mg BID for 3 days in regions where the uropathogen resistance is < 20%), or fosfomycin (a single 3-g dose) as first-line therapy in patients with acute uncomplicated cystitis. B As per ESCMID/IDSA 2011 guidelines, initiate any of the following regimens as first-line therapy in female patients with uncomplicated cystitis: nitrofurantoin monohydrate/macrocrystals 100 mg BID for 5 days, due to minimal resistance and propensity for collateral damage and efficacy compared to 3 days of TMP- sulfamethoxazole TMP-sulfamethoxazole 160/800 mg BID for 3 days, if local resistance rates of uropathogens causing acute uncomplicated cystitis are < 20% or if the infecting strain is known to be susceptible fosfomycin trometamol 3 g in a single dose, due to minimal resistance and propensity for collateral damage, recognizing that it appears to have inferior efficacy compared with standard short-course regimens pivmecillinam (in regions where it is available) 400 mg BID for 3-7 days, due to minimal resistance and propensity for collateral damage, recognizing that it may have inferior efficacy compared with other available therapies. A Antibiotic therapy, second-line therapy: https://web.pathway.md/diseases/recrCqxg7Xppqpnel 4/6 6/23/23, 1:38 AM Acute cystitis Pathway As per EAU 2022 guidelines, do not use aminopenicillins or fluoroquinolones for the treatment of uncomplicated cystitis. D As per AUA 2017 guidelines, do not use fluoroquinolones for the treatment of female patients with uncomplicated cystitis if other oral antibiotic treatment options exist. D As per SEIMC 2017 guidelines, consider reserving fluoroquinolones as alternative antimicrobials because of their high propensity for collateral damage C despite their high efficacy in 3-day regimens. B Show 2 more As per ESCMID/IDSA 2011 guidelines, reserve fluoroquinolones, ofloxacin, ciprofloxacin, and levofloxacin as alternative options for acute cystitis because of the propensity for collateral damage. B Show 2 more 5. Specific circumstances Patients with antimicrobial-resistant UTI: consider initiating ceftriaxone as a treatment option in patients with uncomplicated cystitis caused by organisms at moderate-to-high risk of clinically significant AmpC production (E. cloacae, K. aerogenes, and C. freundii) when susceptibility is demonstrated. E Show 8 more Landmark trials: ALLIUM In adult patients with a clinical diagnosis of complicated UTI or acute pyelonephritis caused by Gram-negative urinary pathogens, cefepime/enmetazobactam was superior to piperacillin/tazobactam with respect to overall treatment success at day 14. Keith S Kaye et al. JAMA. 2022 Oct 4. Patients with Candida UTI: initiate oral fluconazole 200 mg (3 mg/kg) daily for 2 in patients with symptomatic Candida cystitis caused by fluconazole-susceptible organisms. B Show 5 more 6. Preventative measures Periprocedural antibiotic prophylaxis: do not use antibiotic prophylaxis to reduce the rate of symptomatic urinary infection following urodynamics, cystoscopy, or extracorporeal shockwave lithotripsy. D Show 4 more https://web.pathway.md/diseases/recrCqxg7Xppqpnel 5/6 6/23/23, 1:38 AM Acute cystitis Pathway 7. Follow-up and surveillance Post-treatment surveillance: do not obtain routine post-treatment cultures in asymptomatic female patients following treatment for cystitis. D References 1. G. Bonkat, R. Bartoletti, F. Bruy re et al. EAU Guidelines on Urological Infections. EAU. 2022. Open 2. Kranz J, Schmidt S, Lebert C et al. The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients: Part 1. Urol Int. 2018;100 3 263 270. Open 3. Gupta K, Hooton TM, Naber KG et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: A 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52 5):e103 20. Open 4. de Cueto M, Aliaga L, Al s JI et al. Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases SEIMC . Enferm Infecc Microbiol Clin. 2017 May;35 5 314 320. Open 5. Pappas PG, Kauffman CA, Andes DR et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62 4):e1 50. Open 6. Rachael A Lee, Robert M Centor, Linda L Humphrey et al. Appropriate Use of Short-Course Antibiotics in Common Infections: Best Practice Advice From the American College of Physicians. Ann Intern Med. 2021 Apr 6. Open 7. Richard Colgan, Mozella Williams. Diagnosis and treatment of acute uncomplicated cystitis. Am Fam Physician. 2011 Oct 1;84 7 771 6. Open 8. Pranita D. Tamma, Samuel L. Aitken, Robert A. Bonomo et al. Infectious Diseases Society of America Guidance on the Treatment of Extended-Spectrum -lactamase Producing Enterobacterales ESBL E , Carbapenem-Resistant Enterobacterales CRE , and Pseudomonas aeruginosa with Difficult-to-Treat Resistance DTR P. aeruginosa). IDSA. 2022 Mar 7. Open 9. American Urological Association. Choosing Wisely AUA recommendations. Choosing Wisely. 2017. Open 10. No authors listed. Recurrent uncomplicated cystitis in women: allowing patients to self-initiate antibiotic therapy. 2014 Feb;23 146 47 9.2014 Feb;23 146 47 9. Open https://web.pathway.md/diseases/recrCqxg7Xppqpnel 6/6