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

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.

Zachary Nelson,1 Abdullah Tarik Aslan,2 Nathan P Beahm,3 Michelle Blyth,4 Matthew Cappiello,5 Danielle Casaus,6 Fernando Dominguez,7 Susan Egbert,8 Alexandra Hanretty,9 Tina Khadem,10 Katie Olney,6 Ahmed Abdul-Azim,11 Gloria Aggrey,12 Daniel T Anderson,13 Mariana Barosa,14 Michael Bosco,15 Elias B Chahine,16 Souradeep Chowdhury,17 Alyssa Christensen,1 Daniela de Lima Corvino,18 Margaret Fitzpatrick,19 Molly Fleece,18 Brent Footer,20 Emily Fox,21 Bassam Ghanem,22 Fergus Hamilton,23 Justin Hayes,24 Boris Jegorovic,25 Philipp Jent,26 Rodolfo Norberto Jimenez-Juarez,27 Annie Joseph,28 Minji Kang,29 Geena Kludjian,9 Sarah Kurz 30, Rachael A Lee,18 Todd C Lee,31 Timothy Li,32 Alberto Enrico Maraolo,33 Mira Maximos,34 Emily G McDonald,31 Dhara Mehta,35 William Justin Moore,36 Cynthia T Nguyen,37 Cihan Papan,38 Akshatha Ravindra,39 Brad Spellberg,40 Robert Taylor,41,42 Alexis Thumann,43 Steven Y C Tong,44,45 Michael Veve,46 James Wilson,47 Arsheena Yassin,48 Veronica Zafonte,49 Alfredo J Mena Lora50

  1. HealthPartners and Park Nicollet Health Services, St Louis Park, Minnesota.
  2. The University of Queensland, Faculty of Medicine, UQ Centre for Clinical Research, Brisbane, Queensland, Australia.
  3. Faculty of Pharmacy and Pharmaceutical Sciences, University of Alberta, Edmonton, Alberta, Canada.
  4. Louisiana State University, New Orleans.
  5. Loma Linda University Medical Center, Loma Linda, California.
  6. University of Kentucky Healthcare, Lexington.
  7. Family Health Centers of San Diego, San Diego, California.
  8. University of Manitoba, Winnipeg, Manitoba, Canada.
  9. Cooper University Health Care, Camden, New Jersey.
  10. University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
  11. Rutgers Health Robert Wood Johnson Medical School, New Brunswick, New Jersey.
  12. Montgomery Medical Associates, Rockville, Maryland.
  13. Wellstar MCG Health, Augusta, Georgia.
  14. NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal.
  15. NYU Langone Hospital-Long Island, Mineola, New York.
  16. Palm Beach Atlantic University, West Palm Beach, Florida.
  17. All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India.
  18. University of Alabama at Birmingham.
  19. University of Colorado School of Medicine and Anschutz Medical Center, Aurora.
  20. UNC Health, Chapel Hill, North Carolina.
  21. UT Southwestern MD Anderson Cancer Center, Houston, Texas.
  22. King Abdulaziz Medical City, Jeddah, Saudi Arabia.
  23. University of Bristol, Bristol, United Kingdom.
  24. University of Arizona, Tucson.
  25. Clinic for Infectious and Tropical Diseases "Prof. Dr. Kosta Todorovic", Belgrade, Serbia.
  26. Bern University Hospital and University of Bern, Bern, Switzerland.
  27. Hospital Infantil de Mexico Federico Gomez, Mexico City, Mexico.
  28. Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
  29. UT Southwestern Medical Center, Dallas, Texas.
  30. University of Michigan Medical School, Ann Arbor.
  31. McGill University, Montreal, Quebec, Canada.
  32. The Chinese University of Hong Kong, Hong Kong, China.
  33. Department of Clinical Medicine and Surgery, Section of Infectious Diseases, University of Naples Federico II, Italy.
  34. University of Toronto and Women's College Hospital, Toronto, Ontario, Canada.
  35. Bellevue Hospital Center, Manhattan, New York, New York.
  36. Northwestern Medicine, Chicago, Illinois.
  37. University of Chicago Medicine, Chicago, Illinois.
  38. Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.
  39. All India Institute of Medical Sciences, Jodhpur, Rajasthan, India.
  40. Los Angeles General Medical Center, Los Angeles, California.
  41. Newfoundland and Labrador Health Services, St John's, Newfoundland & Labrador, Canada.
  42. Memorial University, St. John's, Newfoundland & Labrador, Canada.
  43. Mercy Medical Center, Cedar Rapids, Iowa.
  44. Department of Infectious Diseases, The University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
  45. Victorian Infectious Diseases Service, The Royal Melbourne Hospital at the Peter Doherty Institute for Infection and Immunity, Melbourne, Australia.
  46. Henry Ford Hospital and Wayne State University, Detroit, Michigan.
  47. Rush University Medical Center, Chicago, Illinois.
  48. Rutgers Health Robert Wood Johnson University Hospital, New Brunswick, New Jersey.
  49. Jamaica Hospital Medical Center, Queens, New York, New York.
  50. University of Illinois, Chicago.
Source: Nelson Z, Tarık Aslan A, Beahm NP, et al. Guidelines for the Prevention, Diagnosis, and Management of Urinary Tract Infections in Pediatrics and Adults: A WikiGuidelines Group Consensus Statement. JAMA Netw Open. 2024;7(11):e2444495. doi:10.1001/jamanetworkopen.2024.44495