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For the 2020 Urological Infections Guidelines, new and relevant evidence was identified, collated and appraised through a structured assessment of the literature. Broad and comprehensive literature searches, covering these sections were performed. Databases searched included Medline, EMBASE, and the Cochrane Libraries. The number of unique records identified, retrieved and screened for relevance for each section were:
- 3.4 Uncomplicated cystitis: 694 abstracts; 78 full texts; all excluded.
- 3.6 Uncomplicated pyelonephritis: 1,006 abstracts; 48 full texts; 13 included.
- 3.7 Complicated urinary tract infections: 1,331 abstracts; 13 included
- 3.10 Urethritis: 488 abstracts; 71 full texts; 30 included.
Specific changes include:
- 3.4.4 Disease management of uncomplicated cystitis
On March 11, 2019 the European Commission implemented stringent regulatory conditions regarding the use of fluoroquinolones due to their disabling and potentially long-lasting side effects. This legally binding decision is applicable in all EU countries. National authorities have been urged to enforce this ruling and to take all appropriate measures to promote the correct use of this class of antibiotics. In uncomplicated cystitis a fluoroquinolone should only be used when it is considered inappropriate to use other antibacterial agents that are commonly recommended for the treatment of these infections.
- Table 4: Suggested regimens for empirical parenteral antimicrobial therapy in uncomplicated pyelonephritis has been updated to include last-line alternatives.
- 3.10.6 Summary of evidence and recommendations for the diagnostic evaluation and antimicrobial treatment of urethritis have been updated to reflect the evidence.
- Table 8: Suggested regimens for antimicrobial therapy for urethritis has been updated to reflect the evidence.
The 2019 Urological Infections Guidelines were subject to peer review prior to publication. All updates within the text reflect the comments of the independent review team. Specific changes include:
- The incorporation of the ‘Prostate biopsy’ chapter into section 3.15 Peri-procedural antibiotic prophylaxis.
- The inclusion of Table 12: Suggested regimens for antimicrobial prophylaxis prior to urological procedures also in section 3.15. As stated in section 220.127.116.11 of the Guidelines the panel have decided not to make recommendations for specific agents for particular procedures, those listed in table 12 represent possible choices only. Urologists should choose a specific antimicrobial based on their knowledge of local pathogen prevalence for each type of procedure, their antibiotic susceptibility profiles and virulence.
For the 2018 edition of the EAU Urological Infections Guidelines the Guidelines Office have transitioned to a modified GRADE methodology. For each recommendation within the guidelines there is an accompanying online strength rating form which addresses a number of key elements namely:
- the overall quality of the evidence which exists for the recommendation;
- the magnitude of the effect (individual or combined effects);
- the certainty of the results (precision, consistency, heterogeneity and other statistical or study related factors);
- the balance between desirable and undesirable outcomes;
- the impact of patient values and preferences on the intervention;
- the certainty of those patient values and preferences.
These key elements are the basis which panels use to define the strength rating of each recommendation. The strength of each recommendation is determined by the balance between desirable and undesirable consequences of alternative management strategies, the quality of the evidence, and nature and variability of patient values and preferences. The strength of each recommendation is represented by the words ‘strong’ or ‘weak’.
In addition, new and relevant evidence has been identified, collated and appraised through a structured assessment of the literature for sections:
- 3.8.5 Removal of indwelling bladder catheter
- 3.11 Bacterial Prostatitis
- 3.12 Acute Infective Epididymitis
- 3.13 Fournier’s Gangrene (Necrotizing fasciitis of the perineum and external genitalia)
- 3.15 Peri-Procedural Antibiotic Prophylaxis
A broad and comprehensive literature search, covering the above sections was performed. Thirty two additional references and text updates have been incorporated throughout the text as a result of this search. Furthermore, all recommendations have been rephrased throughout the current document to aid in their implementation.
For the 2017 Urological Infections Guidelines, specific chapters were updated based on systematic reviews of topics or questions prioritised by the Guideline Panel. These reviews were performed using standard Cochrane systematic review methodology. Systematic review results for the following evidence questions are included in the 2017 Urological Infections Guidelines:
- What is the most effective management for adults with asymptomatic bacteriuria?
- What is the best antimicrobial prophylaxis strategy to reduce risk of infectious complication of prostate biopsy?
The 2016 Urological Infections Guidelines consists of the first completed sections of an entirely new Urological Infections Guideline formulated following new EAU guideline production methodology. Subsequent sections will be added over the next three years to cover the key clinical questions. In the interim, the previous 2015 guidelines will be available through the EAU website Uroweb for sections not yet contained in the new guideline, http://uroweb.org/guideline/urological-infections/
For the 2015 Guidelines, the text has been significantly reduced so that only key information is included and re-formatted according to the EAU non-oncology template so that all Guidelines follow a similar format.
The new asymptomatic bacteriuria guideline (Chapter 3B) is based on a structured search for scientific articles using the term “asymptomatic bacteriuria”. The panel selected reviews, meta-analyses and randomised controlled trials, assigned according to the different patients groups covered.
Chapter 3 uncomplicated UTIs in adults:
3.3 Acute uncomplicated sporadic cystitis in premenopausal, non-pregnant women
3.3.2 Therapy and Recurrent uncomplicated UTIs in premenopausal women
3.5 Recurrent uncomplicated UTIs in premenopausal women
3.5.2 Antimicrobial treatment and prevention/18.104.22.168 Antimicrobial prophylaxis
- Chapter 2 (Classification of UTIs + tables)
- Chapter 13 (Fournier’s gangrene)
- Chapter 4 (Complicated UTIs due to urological disorders)
- Chapter 5 (Urosepsis)
- Chapter 11 (Epididymitis and orchitis, in particular section 11.1)
Smaller changes have been made throughout the document.