Subscribe for unlimited access to DynaMed content, CME/CE & MOC credit, and email alerts on content you follow.

Already subscribed? Sign in now


Uncomplicated Urinary Tract Infection (UTI) (Pyelonephritis and Cystitis)

General Information


  • An uncomplicated urinary tract infection (UTI) is an acute infection of urinary bladder or kidney in premenopausal, nonpregnant women who are not at risk for complications 1


  • classification of urinary tract infections (UTIs)
    • asymptomatic bacteriuria
      • ≥ 105 colony forming units (CFU)/mL of single bacterial strain isolated from 2 urine specimen in asymptomatic women
      • ≥ 105 CFU/mL of single bacterial strain isolated from single urine specimen in asymptomatic men
      • for catheterized women or men, bacteriuria ≥ 105 CFU/mL of a single bacterial strain from a single catheterized specimen likely represents true bacteriuria, but counts as low as ≥ 102 CFU/mL may also be used
    • acute cystitis - acute infection of urinary bladder
    • acute pyelonephritis - acute infection of kidney
    • References - 4, 22417256N Engl J Med 2012 Mar 15;366(11):1028, commentary can be found in 22784136N Engl J Med 2012 Jul 12;367(2):185, Clin Infect Dis 2019 Mar 21 early onlinefull-text
  • syndromic classification
    • uncomplicated UTI - acute cystitis or pyelonephritis occurring in healthy premenopausal, nonpregnant women with no history of abnormal urinary tract anatomy or function
      • acute uncomplicated cystitis defined as
        • no fever, flank pain, or other suspicion for pyelonephritis
        • premenopausal, nonpregnant woman
        • no known urogenital abnormalities or relevant comorbidities
    • complicated UTI
      • all UTI in children and men
      • all UTI in women with functional, metabolic, or anatomical abnormalities, such as urinary obstruction, urinary stone, pregnancy, diabetes, neurogenic bladder, renal insufficiency, or immunosuppression, as well as any UTI in a postmenopausal women
      • systemic symptoms of toxicity
    • References - 22417256N Engl J Med 2012 Mar 15;366(11):1028, commentary can be found in 22784136N Engl J Med 2012 Jul 12;367(2):185, 21292654Clin Infect Dis 2011 Mar 1;52(5):e103, editorial can be found in 21292654Clin Infect Dis 2011 Mar 1;52(5):e103

      Some physicians extend the definition of uncomplicated UTI to postmenopausal women and those in whom adverse outcomes are deemed unlikely in clinical practice.

  • recurrent urinary tract infection
    • refers to symptomatic UTI following clinical resolution of earlier UTI, typically after treatment which may be due to either
      • relapse - repeat infection occurring < 2 weeks after treatment that is caused by the same bacteria as the initial infection
      • reinfection - new infection occurring > 2 weeks after treatment of initial infection
    • Reference - 11295405Int J Antimicrob Agents 2001 Apr;17(4):259


General References Used

  1. Hooton TM. Clinical practice. Uncomplicated urinary tract infection. N Engl J Med. 2012 Mar 15;366(11):1028-37, editorial can be found in N Engl J Med 2012 Mar 15;366(11):1028
  2. Gupta K, Grigoryan L, Trautner B. Urinary Tract Infection. Ann Intern Med. 2017 Oct 3;167(7):ITC49-ITC64
  3. Gupta K, Hooton TM, Naber KG, et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin Infect Dis. 2011 Mar 1;52(5):e103-20full-text, editorial can be found in Clin Infect Dis 2011 Mar 1;52(5):e103
  4. Bonkat G, Bartoletti R, Bruyère F, et al. European Association of Urology (EAU). Guidelines on urological infections.EAU 2019

Recommendation Grading Systems Used

  • Infectious Diseases Society of America/European Society for Microbiology and Infectious Diseases (IDSA/ESCMID) grading system for recommendations
    • strength of recommendation grades
      • Grade A - good evidence to support recommendation for or against use
      • Grade B - moderate evidence to support recommendation for or against use
      • Grade C - poor evidence to support recommendation
    • quality of evidence ratings
      • I - evidence from ≥ 1 properly randomized, controlled trial
      • II - evidence from ≥ 1 well-designed nonrandomized clinical trial; from cohort or case-controlled analytic studies (preferably from > 1 center); from multiple time series; or from dramatic results from uncontrolled studies
      • III - evidence from opinions of respected authorities, based on clinical experience, descriptive studies, or reports of expert committees
    • Reference - IDSA/ESCMID clinical guideline on treatment of acute uncomplicated cystitis and pyelonephritis in women (21292654Clin Infect Dis 2011 Mar 1;52(5):e103), commentary can be found in 21765092Clin Infect Dis 2011 Aug 1;53(3):316
  • European Association of Urology (EAU) uses Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system
    • strength of recommendation
      • Strong or Weak based on:
        • overall quality of existing evidence
        • magnitude of effect (individual or combined effects)
        • certainty of results (including precision, consistency, heterogeneity, and other statistical or study-related factors)
        • balance between desirable and undesirable outcomes
        • patient values and preferences
        • certainty of patient values and preferences
    • levels of evidence
      • Level 1a - meta-analysis of randomized trials
      • Level 1b - ≥ 1 randomized trial
      • Level 2a - ≥ 1 well-designed controlled study without randomization
      • Level 2b - ≥ 1 other type of well-designed quasi-experimental study
      • Level 3 - well-designed nonexperimental studies; such as comparative studies, correlation studies, and case reports
      • Level 4 - expert committee reports or opinions or clinical experience of respected authorities
    • EAU guideline on urological infections (EAU 2018)

Synthesized Recommendation Grading System for DynaMed Content

  • The DynaMed Team systematically monitors clinical evidence to continuously provide a synthesis of the most valid relevant evidence to support clinical decision-making (see 7-Step Evidence-Based Methodology).
  • Guideline recommendations summarized in the body of a DynaMed topic are provided with the recommendation grading system used in the original guideline(s), and allow users to quickly see where guidelines agree and where guidelines differ from each other and from the current evidence.
  • In DynaMed content, we synthesize the current evidence, current guidelines from leading authorities, and clinical expertise to provide recommendations to support clinical decision-making in the Overview & Recommendations section.
  • We use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) to classify synthesized recommendations as Strong or Weak.
    • Strong recommendations are used when, based on the available evidence, clinicians (without conflicts of interest) consistently have a high degree of confidence that the desirable consequences (health benefits, decreased costs and burdens) outweigh the undesirable consequences (harms, costs, burdens).
    • Weak recommendations are used when, based on the available evidence, clinicians believe that desirable and undesirable consequences are finely balanced, or appreciable uncertainty exists about the magnitude of expected consequences (benefits and harms). Weak recommendations are used when clinicians disagree in judgments of relative benefit and harm, or have limited confidence in their judgments. Weak recommendations are also used when the range of patient values and preferences suggests that informed patients are likely to make different choices.
  • DynaMed synthesized recommendations (in the Overview & Recommendations section) are determined with a systematic methodology:
    • Recommendations are initially drafted by clinical editors (including ≥ 1 with methodological expertise and ≥ 1 with content domain expertise) aware of the best current evidence for benefits and harms, and the recommendations from guidelines.
    • Recommendations are phrased to match the strength of recommendation. Strong recommendations use "should do" phrasing, or phrasing implying an expectation to perform the recommended action for most patients. Weak recommendations use "consider" or "suggested" phrasing.
    • Recommendations are explicitly labeled as Strong recommendations or Weak recommendations when a qualified group has explicitly deliberated on making such a recommendation. Group deliberation may occur during guideline development. When group deliberation occurs through DynaMed Team-initiated groups:
      • Clinical questions will be formulated using the PICO (Population, Intervention, Comparison, Outcome) framework for all outcomes of interest specific to the recommendation to be developed.
      • Systematic searches will be conducted for any clinical questions where systematic searches were not already completed through DynaMed content development.
      • Evidence will be summarized for recommendation panel review including for each outcome, the relative importance of the outcome, the estimated effects comparing intervention and comparison, the sample size, and the overall quality rating for the body of evidence.
      • Recommendation panel members will be selected to include at least 3 members that together have sufficient clinical expertise for the subject(s) pertinent to the recommendation, methodological expertise for the evidence being considered, and experience with guideline development.
      • All recommendation panel members must disclose any potential conflicts of interest (professional, intellectual, and financial), and will not be included for the specific panel if a significant conflict exists for the recommendation in question.
      • Panel members will make Strong recommendations if and only if there is consistent agreement in a high confidence in the likelihood that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. Panel members will make Weak recommendations if there is limited confidence (or inconsistent assessment or dissenting opinions) that desirable consequences outweigh undesirable consequences across the majority of expected patient values and preferences. No recommendation will be made if there is insufficient confidence to make a recommendation.
      • All steps in this process (including evidence summaries which were shared with the panel, and identification of panel members) will be transparent and accessible in support of the recommendation.
    • Recommendations are verified by ≥ 1 editor with methodological expertise, not involved in recommendation drafting or development, with explicit confirmation that Strong recommendations are adequately supported.
    • Recommendations are published only after consensus is established with agreement in phrasing and strength of recommendation by all editors.
    • If consensus cannot be reached then the recommendation can be published with a notation of "dissenting commentary" and the dissenting commentary is included in the topic details.
    • If recommendations are questioned during peer review or post publication by a qualified individual, or reevaluation is warranted based on new information detected through systematic literature surveillance, the recommendation is subject to additional internal review.

DynaMed Editorial Process

  • DynaMed topics are created and maintained by the DynaMed Editorial Team and Process.
  • All editorial team members and reviewers have declared that they have no financial or other competing interests related to this topic, unless otherwise indicated.
  • DynaMed content includes Practice-Changing Updates, with support from our partners, McMaster University and F1000.

Special Acknowledgements

  • The American College of Physicians (Marjorie Lazoff, MD, FACP; ACP Deputy Editor, Clinical Decision Resource) provided review in a collaborative effort to ensure DynaMed provides the most valid and clinically relevant information in internal medicine.
  • DynaMed topics are written and edited through the collaborative efforts of the above individuals. Deputy Editors, Section Editors, and Topic Editors are active in clinical or academic medical practice. Recommendations Editors are actively involved in development and/or evaluation of guidelines.
  • Editorial Team role definitions
    Topic Editors define the scope and focus of each topic by formulating a set of clinical questions and suggesting important guidelines, clinical trials, and other data to be addressed within each topic. Topic Editors also serve as consultants for the internal DynaMed Editorial Team during the writing and editing process, and review the final topic drafts prior to publication.
    Section Editors have similar responsibilities to Topic Editors but have a broader role that includes the review of multiple topics, oversight of Topic Editors, and systematic surveillance of the medical literature.
    Recommendations Editors provide explicit review of Overview and Recommendations sections to ensure that all recommendations are sound, supported, and evidence-based. This process is described in "Synthesized Recommendation Grading."
    Deputy Editors oversee DynaMed internal publishing groups. Each is responsible for all content published within that group, including supervising topic development at all stages of the writing and editing process, final review of all topics prior to publication, and direction of an internal team.

How to cite

National Library of Medicine, or "Vancouver style" (International Committee of Medical Journal Editors):

  • DynaMed [Internet]. Ipswich (MA): EBSCO Information Services. 1995 - . Record No. T116894, Uncomplicated Urinary Tract Infection (UTI) (Pyelonephritis and Cystitis); [updated 2019 Jun 25, cited place cited date here]. Available from Registration and login required.

Published by EBSCO Information Services. Copyright © 2020, EBSCO Information Services. All rights reserved. No part of this may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission.

EBSCO Information Services accepts no liability for advice or information given herein or errors/omissions in the text. It is merely intended as a general informational overview of the subject for the healthcare professional.


Subscribe for unlimited access to DynaMed content.
Already subscribed? Sign in