Home

Search

Pathway AI

Account ⋅ Sign Out

Table of contents

Acute cystitis

Definition
Acute uncomplicated cystitis is a lower UTI occurring in the absence of anatomic or functional abnormalities of the urinary tract or any other complicating factors.
1
Pathophysiology
Acute uncomplicated cystitis is mostly caused by bacteria, including E. coli (86%), S. saprophyticus (4%), Klebsiella species (3%), Proteus species (3%), Enterobacter species (1.4%), Citrobacter species (0.8%), and Enterococcus species (0.5%).
2
Disease course
Bacterial infection of the lower urinary tract results in acute uncomplicated cystitis, which causes classic symptoms of dysuria, frequent voiding of small volumes, and urinary urgency. Occasional hematuria and suprapubic discomfort may be present.
2
Prognosis and risk of recurrence
Acute uncomplicated cystitis is not associated with an increase in mortality.
2
Key sources
The following summarized guidelines for the evaluation and management of acute cystitis are prepared by our editorial team based on guidelines from the American Academy of Family Physicians (AAFP 2024), the European Association of Urology (EAU 2023), the American College of Obstetricians and Gynecologists (ACOG 2023), the Infectious Diseases Society of America (IDSA 2022; 2016), the American College of Physicians (ACP 2021), the German Society of Urology (GUS 2018), the Spanish Society of Clinical Microbiology and Infectious Diseases (SEIMC 2017), the American Urological Association (AUA 2017), and the Infectious Diseases Society of America (IDSA/ESCMID 2011).
1
2
3
4
5
6
7
8
9
11
12
13

Guidelines

1.Screening and diagnosis

Etiology
Recognize that the most common cause of uncomplicated UTIs is E. coli, followed by S. saprophyticus, K. pneumoniae, and P. mirabilis. Recognize that other pathogens are rare.
A
Recognize that Enterococci are most commonly found in mixed infections, therefore, their pathogenicity is uncertain in uncomplicated UTIs.
B
Create free account

More topics in this section

  • Diagnostic criteria

  • Differential diagnosis

2.Classification and risk stratification

Severity assessment: use the Acute Cystitis Symptom Score to assess the severity of symptoms, the course of the disease over time, and the effect of therapy.
B

3.Diagnostic investigations

History and physical examination: obtain a symptom-related medical examination with clinical examination in the first presentation of acute UTI or if the patient is unknown to the physician.
B

More topics in this section

  • Urine dipstick

  • Urine culture

  • Urethrocystoscopy

  • Diagnostic imaging

4.Medical management

Antibiotic therapy, general principles, AAFP: consider prescribing a backup antibiotic (to be filled if symptoms do not improve within 48-72 hours or worsen at any time) in female patients with no signs of pyelonephritis or complicated infection not wishing to take antibiotics.
C

More topics in this section

  • Antibiotic therapy (first-line therapy)

  • Antibiotic therapy (second-line therapy)

  • Symptomatic management

5.Nonpharmacologic interventions

Fluid intake: advise drinking at least 1.5 L of fluids daily in patients with a UTI.
B

6.Specific circumstances

Pregnant patients, evaluation, ACOG
Obtain urine culture in pregnant patients with symptoms of acute cystitis.
E
Consider obtaining urinalysis to support the diagnosis. Confirm the diagnosis based on urine culture showing ≥ 10⁵ CFU/mL.
E

More topics in this section

  • Pregnant patients (management)

  • Patients with antimicrobial-resistant UTI

  • Patients with Candida UTI

7.Preventative measures

Periprocedural antibiotic prophylaxis: do not use antibiotic prophylaxis to reduce the rate of symptomatic urinary infection following urodynamics, cystoscopy, or extracorporeal shockwave lithotripsy.
D
Show 4 more

8.Follow-up and surveillance

Post-treatment surveillance: do not obtain routine post-treatment cultures in asymptomatic female patients following treatment for cystitis.
D