Background: We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Results are published in 2 parts. Part 1 covers methods, the definition of patient groups, and diagnostics. This second publication focuses on treatment of acute episodes of cystitis and pyelonephritis as well as on prophylaxis of recurrent UTIs. Materials and Methods: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010–2015. Results: For the treatment of acute uncomplicated cystitis (AUC), fosfomycin-trometamol, nitrofurantoin, nitroxoline, pivmecillinam, and trimethoprim (depending on the local rate of resistance) are all equally recommended. Cotrimoxazole, fluoroquinolones, and cephalosporins are not recommended as antibiotics of first choice, for concern of an unfavorable impact on the microbiome. Mild to moderate uncomplicated pyelonephritis should be treated with oral cefpodoxime, ceftibuten, ciprofloxacin, or levofloxacin. For AUC with mild to moderate symptoms, instead of antibiotics symptomatic treatment alone may be considered depending on patient preference after discussing adverse events and outcomes. Primarily non-antibiotic options are recommended for prophylaxis of recurrent urinary tract infection. Conclusion: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.

Objectives: We aimed to update the 2010 evidence-and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. Materials and Methods: An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, EMBASE, and the Cochrane Library to identify literature published in 2010-2015. Results: We provide 75 recommendations and 68 statements in the updated evidence-and consensus-based national clinical guideline. The diagnostics part covers practical recommendations on cystitis and pyelonephritis for each defined patient group. Clinical examinations, as well as laboratory testing and microbiological pathogen assessment, are addressed. Conclusion: In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.

rinary tract infections account for 21.6% of all nosocomial infections in Germany and are thus among the more frequent types of nosocomial infection, along with lower respiratory infections (24%), postoperative wound infections (22.4%), Clostridium difficile infections (10%), and primary sepsis (5.1%) (1, 2). In more than 60% of cases (407 of 670 patients), nosocomial urinary tract infections are associated with catheters (2, 3). 15-25% of all hospitalized patients are catheterized at some time during their hospital stay (4); among patients in intensive care units, the corresponding percentage has been reported as 18% to 81.7% (5-7). The incidence of bacteriuria in medical facilities rises by 3-8% per day for each day after catheter insertion; nearly all patients have bacteriuria after 30 days of catheterization (8, 9). Most episodes of catheter-associated bacteriuria are asymptomatic (catheter-associated asymptomatic bacteriuria, CA-ABU), and fewer than 5% of cases lead to bacteremia requiring treatment (10). Overall, catheter-associated bacteremia accounts for 15% of nosocomial bloodstream infections (11) and is associated with 10% mortality (12, 13). With antibiotic resistance on the rise and presenting major challenges, including increased costs, to health-care systems worldwide (14), it has become essential to distinguish CA-ABU, which needs no treatment, from CA-UTI, which must be treated (15). The goal of this article is to provide an overview of urinary catheter management and UTI prevention. Method A rapid evidence analysis (16) was performed with a literature search in Medline for the period January 2000 to March 2019. Symptomatic CA-UTI in adults was a primary or secondary endpoint of all of the included studies. Only randomized trials and systematic reviews were included in the present analysis. Further information on the methods of this analysis can be found in the supplementary material available over the Internet (eBox). Results Findings of the literature search The literature search yielded 508 hits (eFigure), of which 69 studies were included in the analysis Summary Background: Urinary tract infections are among the more common types of nosocomial infection in Germany and are associated with catheters in more than 60% of cases. With increasing rates of antibiotic resistance worldwide, it is essential to distinguish catheter-associated asymptomatic bacteriuria from catheter-associated urinary tract infection (CA-UTI). Methods: This review is based on publications from January 2000 to March 2019 that were retrieved by a selective search in Medline. Randomized clinical trials and systematic reviews in which the occurrence of CA-UTI in adult patients was a primary or secondary endpoint were included in the analysis. Two authors of this review, working independently, selected the publications and extracted the data. Results: 508 studies were identified and 69 publications were selected for analysis by the prospectively defined criteria. The studies that were included dealt with the following topics: n...