Guideline of the Swiss Society of Gynaecology and Obstetrics (SSGO) on acute and recurrent urinary tract infections in women, including pregnancy

Abstract

Acute and recurrent urinary tract infections (UTIs) are common auto-infectious diseases transmitted from the intestinal tract. They affect the urinary tract either through recurrence or through persistence. The incidence of UTIs increases with age and comorbidities. In this guideline from the Swiss Society of Gynaecology and Obstetrics (SSGO), diagnosis and treatment of UTIs are grouped into uncomplicated and complicated cases. This is to our knowledge the first guideline that specifically considers UTIs in pregnancy and breastfeeding, and the prevention of UTIs in the context of urogynaecological diagnosis and surgery. Recommendations are based on observational, retrospective or randomised controlled studies. The level of evidence was rated according to recommendations made by the Oxford Centre of Evidence-based Medicine.In non-pregnant women and women <65 years with dysuria, pollakiuria and suprapubic pain, no urine diagnostic testing is needed. If the clinical presentation is unclear, urinary tests such as midstream urine stix or urine analysis should be used, and in cases of unclear or recurrent infections, a urine culture.Routine screening for asymptomatic bacteriuria (ASB) should not be carried out, and antibiotic treatment should be avoided in cases of incidentally detected ASB. As an exception, screening for bacteriuria should be carried out in patients prior to urogynaecological surgery where urinary drainage by catheter is necessary or probable. In pregnancy, systematic screening for ASB is not recommended, because most women with ASB do not develop complications during follow-up, and contamination of urine samples collected in pregnancy is common.Patients should be advised that most UTIs are self-limiting, that the symptoms can be relieved with non-steroidal anti-inflammatory drugs (NSAIDs) and that the same time is required to eradicate the bacteria using antibiotics or NSAIDs. For non-pregnant women with uncomplicated UTIs, a 48-hour-delayed antibiotic prescription is recommended, supplemented by NSAIDs for pain relief. If antibiotics are needed after 48 hours, or in case of direct antibiotic administration in pregnant women, the shortest possible course of treatment should be carried out.There is increasing interest in alternatives or complementary treatments to antibiotic therapy, especially for recurrent UTIs. Different recommendations and alternative medications are summarised. This short and comprehensive guideline provides quick answers for every day clinical questions concerning UTIs, especially for obstetricians and gynaecologists.

Guideline of guidelines: management of recurrent urinary tract infections in women

“…14 Ó 2022 The Authors. BJU International published by John Wiley & Sons Ltd on behalf of BJU International.rUTI in women, including in the context of pregnancy, and urogynaecological diagnoses and surgery[19]. rUTI management in men was not included.The Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) published in 2017 their consensus statement paper 'Executive summary of the diagnosis and treatment of urinary tract infection: Guidelines of the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC)'[20].The Association of Scientific Medical Societies in Germany (AWMF [Arbeitsgemeinschaft der WissenschaftlichenMedizinischen Fachgesellschaften]) S3 Guideline is written in German.…”

Which Antibiotic for Urinary Tract Infections in Pregnancy? A Literature Review of International Guidelines

“…Of the 13 guidelines coming from 4 different continents ( Table 1 ), 8 came from Europe, produced on behalf of the European Association of Urology (EAU) [ 7 ], German Society of Urology (German acronym: DGU) [ 11 ], Swiss Society of Gynaecology and Obstetrics (SSGO) [ 12 ], Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC) [ 13 ], joint report of French Infectious Diseases Society/Urological French Association (French acronym: SPILF/AFU) [ 14 ], joint report of the Institute of Obstetricians and Gynaecologists, Royal College of Physicians of Ireland/Clinical Strategy and Programs Division, Health Service Executive (IOGRCPI/ CSPDHSE) [ 15 ] and 2 guidelines coming from the National Institute for Health and Care Excellence (NICE) [ 16 , 17 ]; 1 from North America, produced on behalf of the Infectious Diseases Society of America (IDSA) [ 18 ]; 3 from South America, produced on behalf of the joint report of the Brazilian Society of Infectious Diseases/Brazilian Federation of Gynecology and Obstetrics Associations/Brazilian Society of Urology/Brazilian Society of Clinical Pathology/Laboratory Medicine (SBI/FEBRASGO/SBU/SBPC/ML) [ 19 ], joint report of the Argentinean Society of Infectious Disease (SADI) [ 20 ] and Colombian Association of Infectious Disease (Spanish acronym: ACIN) [ 21 ]; and 1 from Oceania, produced on behalf of South Australian Health (SAH) [ 22 ].…”

Xyloglucan, Hibiscus and Propolis in the Management of Uncomplicated Lower Urinary Tract Infections: A Systematic Review and Meta-Analysis

“…Only one study reported the drop-out rate (24%), while only one series required either an active UTI or history of UTI at study entry, although varying criteria and validated tools to define rUTIs were used. Despite the concept of ‘culture-negative’ UTI having emerged, which recognizes the demonstrated effect of antibiotics to resolve UTI symptoms in women who did not demonstrate a culture growth of uropathogens or who had low colony-count infections, it is common in clinical practice to initiate treatment without or before culture results are available, creating a significant bias [ 18 ]. In all clinical series, the medical device was adequately tolerated, resulting in excellent compliance, as negligible side effects were registered [ 19 ].…”