Clinical presentation, risk factors and use of antibiotics in urinary tract infections

The European Section for Infections in Urology (EAU) has introduced a new concept of severity assessment of urinary tract infections (UTI). The assessment is based on clinical presentation, patient risk factors and availability of effective antibiotics. Instead of the old classification of uncomplicated and complicated UTI, ESIU suggests to describe risk factors by means of phenotyping. In this paper we present the new classification and give practical recommendations on antibiotic treatment of the most common community acquired and hospital acquired urinary tract infections.Antibiotics have been prescribed so extensively that resistant bacteria have made prophylaxis and treatment of urinary tract infections a more difficult task.Prophylaxis during surgical procedures should be prescribed according to the risk of infective complications. The most important criterion is the contamination category of the procedure. Basically there are four categories: clean, clean-contaminated, contaminated and dirty, but in urology the clean-contaminated category is subdivided depending on whether the urinary tract or the gastrointestinal tract is opened.International guidelines consider pharmacokinetic and pharmacodynamics features of antibiotics and global resistance data. These recommendations may therefore need local adaptations. Urologists, microbiologists and infectious disease specialists should meet in every hospital to adapt their own guidelines according to local resistance data.