Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2022)

Question 1

Recurrent Uncomplicted Urinary Tract Infections in Women:
AUA/CUA/SUFU Diagnosis & Treatment Algorithm

Answer 1

Question 2

What percentage of women will experience symptomatic acute bacterial cystitis in their lifetime?
A) 10%
B) 20%
C) 40%
D) 60%

Answer 2

D) 60%
Explanation: According to the given introduction, approximately 60% of women will experience symptomatic acute bacterial cystitis in their lifetime.

Question 3

What is the estimated cost of evaluation and treatment of UTI globally per year?

Answer 3

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.

Question 4

What is recurrent uncomplicated urinary tract infection (rUTI), and what are the risk factors associated with it?

Answer 4

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.

Question 5

What are the common symptoms of recurrent uncomplicated urinary tract infection (rUTI), and how is it diagnosed and treated?

Answer 5

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.

Question 6

TABLE 1: Guideline Definitions

Answer 6

Question 7

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

Answer 7

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.

Question 8

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

Answer 8

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.

Question 9

What is the difference between uncomplicated and complicated cystitis? Give some examples of complicating factors.

Answer 9

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.

Question 10

What is the definition of rUTI and what are the two most commonly used definitions?

Answer 10

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.