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Guideline Resources

  • Title: Complicated Urinary Tract Infection (cUTI) Guideline on Treatment and Management
  • Society: Infectious Disease Society of America (ISDA)
  • Publish Date: June 17, 2025
  • Guideline Summary
  • Full-text

Video Transcription

Today we’ll be going over The Infectious Disease Society of America’s newest guideline on Complicated Urinary Tract Infection (cUTI) Treatment and Management

The objective of this guideline is to provide practical advice for clinicians who manage patients with complicated UTIs 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.

There are 8 recommendations, so let’s get started

  • For patients with sepsis due to complicated UTI, the guidelines suggest initially selecting among the following antibiotics: third- or fourth-generation cephalosporins, carbapenems, piperacillin-tazobactam, or fluoroquinolones, rather than newer agents or older aminoglycosides
    • For patients with suspected complicated UTI without sepsis, the guidelines suggest initially selecting among the following antibiotics, using the four-step assessment: third- or fourth-generation cephalosporins, piperacillin-tazobactam, or fluoroquinolones, rather than carbapenems and newer agents or older aminoglycosides 
  • For patients with suspected complicated UTI, the guidelines suggest that the selection of empiric antibiotic therapy be initially guided by the severity of illness, specifically by whether the patient is in sepsis or not 
  • In patients with complicated UTI, the guidelines suggest avoiding antibiotics to which the patient has had a resistant pathogen isolated from the urine previously
    • In patients with complicated UTI, the guidelines suggest avoiding fluoroquinolones if the patient has been exposed to that class of antibiotic in the past 12 months 
  • In patients suspected of cUTI, empiric antibiotic therapy selection should account for patient-specific considerations to avoid preventable adverse events 
  • In patients with sepsis assumed to be caused by complicated UTI the guidelines suggest using an antibiogram to further tailor empiric antibiotic choice only if the antibiogram is local, recent, and relevant to the patient
    • For patients with suspected complicated UTI without sepsis , the guidelines make no specific recommendation about using an antibiogram to further tailor empiric antibiotic choice 
  • In patients with confirmed complicated UTI, the guidelines suggest selecting a definitive effective antibiotic with a targeted spectrum based on the results of urine culture as soon as these are available, rather than continuing empiric broad-spectrum antibiotics for the complete duration of treatment 
  • In patients with complicated UTI treated initially with parenteral therapy who are clinically improving, able to take oral medication, and for whom an effective oral option is available, the guidelines suggest transitioning to oral antibiotics rather than continuing parenteral therapy for the remaining treatment duration
    • In patients presenting with complicated UTI and associated Gram-negative bacteremia treated initially with parenteral therapy who are clinically improving, able to take oral medication, and for whom an effective oral option is available, the guidelines suggest transitioning to oral antibiotics rather than continuing parenteral therapy for the remaining treatment duration 
  • In patients presenting with complicated UTI and who are improving clinically on effective therapy, the guidelines suggest treating with a shorter course of antimicrobials, using either 5-7 days of a fluoroquinolone or 7 days of a non-fluoroquinolone antibiotic, rather than a longer course.

And there you have it. Make sure to check out the full guideline from The Infectious Disease Society of America and other related clinical decision support tools at guidelinecentral.com.

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