Our topic nomination is Treatment of Urinary Tract Infections in Nonpregnant Women. The following is a list of clinical questions practitioners consider when managing such casesoIn nonpregnant women with symptoms of a urinary tract infection is empiric treatment of urinary tract infection without performing urinalysis more effective than performing a urinalysis before treatmentoIn nonpregnant women with a urinary tract infection does the use of urine culture improve treatment outcomes compared with no urine cultureoIn nonpregnant women with uncomplicated acute bacterial cystitis what is the most effective antimicrobial treatment regimenoIn nonpregnant women with uncomplicated acute bacterial cystitis is singledose therapy as effective as therapy of longer durationoIn nonpregnant women with a urinary tract infection what is the most effective treatment for uncomplicated acute pyelonephritis compared with other treatmentsoIn nonpregnant women with recurrent cystitis is cranberry an effective intervention to prevent recurrence compared with other treatmentsoIn nonpregnant women with cystitis is estrogen an effective preventive intervention compared with other treatmentsoIn nonpregnant postoperative women with an indwelling bladder catheter are antibiotics an effective treatment for urinary tract infections compared with other treatmentsoIn nonpregnant women is screening and treatment for asymptomatic bacteriuria effective at lowering the rate of complicated urinary tract infectionsNonpregnant women with symptoms or diagnosis of urinary tract infection including acute uncomplicated cystitis acute uncomplicated pyelonephritis and recurrent cystitis.We are interested in improving the treatment and prevention of urinary tract infections in nonpregnant women by identifying the most effective treatment regimens while avoiding overtreatment.

Urinary tract infections are the second most common type of infection in adults particularly in women and account for 4 million ambulatorycare visits each year and 13 of hospital acquired infections12. The burden from urinary tract infections on both the clinical and financial aspects of health care in the United State is immense. Despite the frequency of urinary tract infections there is confusion about diagnostic strategies leading to overtreatment and changes in antimicrobial resistance among uropathogens require alterations in traditional treatment regimens.1.Centers for Disease Control and Prevention. Urinary tract infections. Atlanta GA CDC 2005. Available at httpwww.cdc.govncidoddbmddiseaseinfourinarytractinfectionst.htm. Retrieved March 27 2015.2.Magill SS Edwards JR Bamberg W Beldavs ZG Dumyati G Kainer MA et al. Multistate pointprevalence survey of health careassociated infections. Emerging Infections Program HealthcareAssociated Infections and Antimicrobial Use Prevalence Survey Team. N Engl J Med 20143701198208.

Clinicians will be more equipped to make appropriate treatment decisions for nonpregnant women with urinary tract infections based on the needs of the individual patient resources and limitations unique to the institution or type of practice. Recommendations based on the systematic review will be used by clinicians to optimize treatment and prevention strategies and improve outcomes for these patients.

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Professional society

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American College of Obstetricians and Gynecologists

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Christine Chang MD MPH Agency for Healthcare Research and Quality