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Guidelines on

Urological Infections
M. Grabe (chairman), T.E. Bjerklund-Johansen, H. Botto, M. Çek, K.G. Naber, R.S. Pickard, P. Tenke, F. Wagenlehner, B. Wullt

© European Association of Urology 2013

TABLE OF CONTENTS
1. INTRODUCTION 1.1 Background 1.2 Bacterial resistance development 1.3 The aim of the guidelines 1.4 Pathogenesis of UTIs 1.5 Microbiological and other laboratory findings 1.6Methodology 1.6.1 Level of evidence and grade of guideline recommendations 1.6.2 Publication history 1.7 References CLASSIFICATION OF UTIs 2.1 Introduction 2.2 Anatomical level of infection 2.3 Grade of severity 2.4 Pathogens 2.5 Classification of UTI 2.6 Reference UNCOMPLICATED UTIS IN ADULTS 3.1 Summary and recommendations 3.2 Definition 3.2.1 Aetiological spectrum 3.3 Acute uncomplicatedcystitis in premenopausal, non-pregnant women 3.3.1 Diagnosis 3.3.1.1 Clinical diagnosis 3.3.1.2 Laboratory diagnosis 3.3.2 Therapy 3.3.3 Follow-up 3.4 Acute uncomplicated pyelonephritis in premenopausal, non-pregnant women 3.4.1 Diagnosis 3.4.1.1 Clinical diagnosis 3.4.1.2 Laboratory diagnosis 3.4.1.3 Imaging diagnosis 3.4.2 Therapy 3.4.2.1 Mild and moderate cases of acute uncomplicatedpyelonephritis (Table 3.2) 3.4.2.2 Severe cases of acute uncomplicated pyelonephritis (Table 3.2) 3.4.3 Follow-up 3.5 Recurrent (uncomplicated) UTIs in women 3.5.1 Diagnosis 3.5.2 Prevention 3.5.2.1 Antimicrobial prophylaxis 3.5.2.2 Immunoactive prophylaxis 3.5.2.3 Prophylaxis with probiotics 3.5.2.4 Prophylaxis with cranberry 3.6 UTIs in pregnancy 3.6.1 Diagnosis of UTI in pregnant women 3.6.2 Definition ofbacteriuria 3.6.3 Screening 3.6.4 Treatment of asymptomatic bacteriuria and acute cystitis 3.6.5 Duration of therapy 3.6.6 Follow-up 3.6.7 Prophylaxis 3.6.8 Treatment of pyelonephritis 3.6.9 Complicated UTI 3.7 UTIs in postmenopausal women 3.7.1 Risk factors

pAgE
8 8 8 8 8 9 10 10 10 11 12 12 12 13 14 14 15 15 15 15 15 15 15 15 15 15 16 16 16 16 16 17 17 17 17 20 20 20 20 20 21 21 21 21 21 2122 22 22 22 22 22 22 23 23

2.

3.

2

UROLOGICAL INFECTIONS - LIMITED UPDATE MARCH 2013

3.8

3.9

3.10 4.

3.7.2 Diagnosis 3.7.3 Treatment Acute uncomplicated UTIs in young men 3.8.1 Men with acute uncomplicated UTI 3.8.2 Men with UTI and concomitant prostate infection Asymptomatic bacteriuria 3.9.1 Diagnosis 3.9.2 Screening References

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COMPLICATED UTIs DUE TO UROLOGICAL DISORDERS 4.1 Summary and recommendations 4.2 Definitions and classification 4.2.1 Clinical presentation 4.2.2 Urine cultures 4.3 Microbiology 4.3.1 Spectrum and antibiotic resistance 4.3.2 Complicated UTIs associated with urinary stones 4.3.3Complicated UTIs associated with urinary catheters 4.4 Treatment 4.4.1 General principles 4.4.2 Choice of antibiotics 4.4.3 Duration of antibiotic therapy 4.4.4 Complicated UTIs associated with urinary stones 4.4.5 Complicated UTIs associated with indwelling catheters 4.4.6 Complicated UTIs in patients with spinal cord injury 4.4.7 Follow-up after treatment 4.5 References SEPSIS SYNDROME IN UROLOGY(UROSEPSIS) 5.1 Summary and recommendations 5.2 Background 5.3 Definition and clinical manifestation of sepsis in urology 5.4 Physiology and biochemical markers 5.4.1 Cytokines as markers of the septic response 5.4.2 Procalcitonin is a potential marker of sepsis 5.5 Prevention 5.5.1 Preventive measures of proven or probable efficacy (9,10) 5.5.2 Appropriate perioperative antimicrobial prophylaxis 5.5.3Preventive measures of debatable efficacy 5.5.4 Ineffective or counterproductive measures 5.6 Algorithm for the management of urosepsis 5.7 Treatment 5.7.1 Clinical algorithm for management of urosepsis 5.7.2 Relief of obstruction 5.7.3 Antimicrobial therapy 5.7.4 Adjunctive measures (12,13) 5.8 Conclusion 5.9 Acknowledgement 5.10 References CATHETER-ASSOCIATED UTIs 6.1 Abstract 6.2 Summary of...
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