Source Citation: Trautner BW, Cortés-Penfield NW, Gupta K, et al. 2025 clinical practice guideline by Infectious Diseases Society of America (IDSA): management and treatment of complicated urinary tract infections. Clinical Infectious Diseases. Published online July 17, 2025.

Document Scope, Criteria, and Use Cases

Document Objectives: IDSA has released the first IDSA guidelines on management and treatment of complicated urinary tract infections (cUTIs). These guidelines provide practical advice for clinicians who manage patients with cUTIs in inpatient and outpatient settings. These guidelines expand the scope of prior UTI guidelines to address complicated UTI, provide a clinically-relevant classification of uncomplicated and complicated UTI, guide the empiric choice of antibiotics for complicated UTI through a step-wise process, offer a recommendation for the timing of IV to oral switch, and address duration of therapy. The panel’s recommendations are based upon evidence derived from systematic literature reviews and adhere to a standardized methodology for rating the certainty of evidence and strength of recommendation according to the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach.

Diseases/Conditions (MeSH)

D014552 - Urinary Tract Infections

Keywords: UTI, cUTI, complicated urinary tract infections, urinary tract infection (UTI), urinary tract infections

Target Patient Population: Patients with complicated urinary tract infections in inpatient and outpatient settings

Target Provider Population: Infectious diseases specialists, primary care, and other clinicians caring for patients with cUTIs in inpatient and outpatient settings

Recommendation Development Processes & Methodology

PICO Questions

In patients with cUTI, which classes of empiric antibiotic therapy should initially be prioritized?
In patients with suspected cUTI (including pyelonephritis), should selection of empiric antibiotic therapy be guided by severity of illness?
In patients with cUTI (including pyelonephritis), should selection of empiric antibiotic therapy be guided by patient-specific prior urine culture results and patient-specific risk factors for resistant uropathogens to optimize selection)?
In patients with cUTI (including pyelonephritis), should selection of empiric antibiotic therapy be further guided by patient-specific considerations?
In patients with cUTI (including pyelonephritis), should selection of empiric antibiotic therapy be further tailored by consulting an antibiogram?
In patients with microbiologically confirmed cUTI, should definitive effective antibiotic therapy be targeted based on the results of urine culture rather than continuing empiric broad-spectrum antibiotics?
In patients who are being treated parenterally for cUTI, are clinically improving, can take an oral medication and for whom an oral option is available, should parenteral therapy be transitioned to oral rather than continued for the complete duration of therapy?
In patients presenting with complicated UTI (cUTI) with a clinical response to therapy, should total duration of antibiotics be prolonged to >7 days rather than shorter (<=7 days)?