Updated international guidelines for the diagnosis and management of patients with urinary tract infection: an analytical review

Perepanova T.S., Kozlov R.S., Pushkar D.Yu., Apolikhin O.I., Kaprin A.D.

1) Lopatkin Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Radiological Centre, Ministry of Health of Russia, Moscow, Russia; 2) Smolensk State Medical University, Ministry of Health of Russia, Smolensk, Russia; 3) Russian University of Medicine, Department of Urology, Moscow, Russia; 4) Botkin Moscow Multidisciplinary Scientific and Clinical Center, Moscow, Russia; 5) National Medical Research Radiological Centre, Ministry of Health of Russia, Moscow, Russia; 6) P.A. Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre, Ministry of Health of Russia, Moscow, Russia; 7) Peoples’ Friendship University of Russia (RUDN University), Moscow, Russia

The latest 2025 guidelines of the European Association of Urology (EAU), the American Urological Association, the Canadian Urological Association, and the Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction (AUA/CUA/SUFU) introduce a new classification system for urinary tract infections (UTIs) and update sections on cystitis and asymptomatic bacteriuria (ABU). Current approaches to the management of patients with UTIs, ABU, and even symptomatic bacteriuria are being reconsidered. In the era of increasing antimicrobial resistance among uropathogens, advances in researching of human microbiome and urobiome have changed the long-standing assumption that any bacteriuria necessarily requires antimicrobial treatment. At present, even in patients with a confirmed diagnosis of acute bacterial cystitis, international recommendations consider symptomatic treatment and a watchful waiting strategy as acceptable options for selected patient groups.
The new UTI classification, diagnostic features and symptoms of UTIs and ABU, non-antibiotic treatment options for cystitis, and age-related characteristics of UTI presentation are discussed in this review. Key aspects of the pathogenesis of recurrent UTIs are briefly addressed. Various urine sampling approaches are discussed, along with a differentiated strategy for prescribing antimicrobial therapy to women with acute and recurrent cystitis and non-antibiotic measures for recurrence prevention.
The diagnostic value of urinalysis has also expanded to include new indicators of microbial load and assessment of urine contamination. The role of modern molecular diagnostic methods, beyond standard urine culture, in the diagnosis and treatment of UTIs is analyzed. The need to adhere to principles of rational antibiotic use to avoid collateral damage associated with antimicrobial therapy for UTIs is emphasized.

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About the Authors

Corresponding author: T.S. Perepanova – Ph.D., MD, Professor, Head of the Group for Infectious and Inflammatory Diseases and Clinical Pharmacology, Department of General and Reconstructive Urology, Lopatkin Research Institute of Urology and Interventional Radiology – Branch of the National Medical Research Radiological Centre, Ministry of Health of Russia, Moscow, Russia; e-mail: Perepanova2003@mail.ru

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