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On December 9-11, 2022, the 29th National Urology Conference (CUA 2022), hosted by the Chinese Medical Association and the Urology Branch of the Chinese Medical Association, was held
online.
Adhering to the concept of inheritance and development, this CUA conference focuses on the development frontier and latest progress in the field of urology, and fully demonstrates the new trends, new concepts and new technologies
of urology science research and clinical diagnosis and treatment.
The 2022 edition of CUA "Guidelines for the Diagnosis and Treatment of Urinary Tract Infections" has been officially published, on the occasion of this annual academic event, Professor Qiao Ludong of Beijing Tongren Hospital affiliated to Capital Medical University introduced the new developments and guidelines update highlights of urinary tract infections at home and abroad.
Professor Qiao Ludong
Ph.
D.
, Chief Physician, Department of Urology, Beijing Tongren Hospital, Capital Medical University
Member of the Infection Working Group of the Antibacterial Drug Special Committee of the National Health Commission
Deputy leader of the Infection and Inflammation Group of the Urology Branch of the Chinese Medical Association
Deputy leader of the Infectious Diseases Group of the Urology Branch of Beijing Medical Association
Member of North China Stone Disease Prevention and Control Base
Participated in the compilation of many domestic guidelines and consensus on urinary tract infection
The European Society of Urology (EAU) guidelines, as a bellwether, have always been the object
of reference when formulating domestic guidelines.
The highlights of the 2022 EAU Urinary Tract Infection Guidelines update are as follows:
Professor Qiao pointed out that the update of the 2022 EAU guidelines is mainly reflected in the "weak recommendation", and there is no major update
to the traditional and standard treatment regimen.
The 2022 CUA "Guidelines for the Diagnosis and Treatment of Urinary Tract Infections" has been updated on the basis of the 2019 version of the guidelines combined with relevant domestic research data, making the guidelines more in line with the current status of urinary tract infections, bacterial resistance and antibacterial drug applications in China, as well as
urology-related surgeries.
Compared with the EAU guidelines, the 2022 CUA guidelines highlight the highlights and present Chinese characteristics:
The elaboration is more comprehensive
The epidemiology of urinary tract infection (UTI) is characterized by "three highs and one chaos", that is, high incidence, high recurrence rate, high cost of antimicrobial drugs and confusion in antimicrobial drug treatment, Professor Qiao mentioned that this status quo is particularly emphasized in the 2022 CUA guidelines, aiming to attract the attention and attention
of the majority of urologists to UTI.
Different from the common isolated bacteria in foreign countries, according to the results of CHINET's annual bacterial resistance monitoring in 2021, the most common isolated strain in China's urinary tract specimens is Escherichia coli, followed by Enterococcus faecalis, Klebsiella pneumoniae and Enterococcus faecal, so for the treatment of complicated UTI, the recommendations of foreign guidelines cannot be copied, and antibacterial drugs need to be combined with the actual application of antibacterial drugs
in patients with urinary tract infections in China 。 At the same time, Professor Qiao mentioned that most of the CHINE reports are nosocomial infections rather than community-acquired UTIs, so he hopes that urologists will conduct further research
on isolated strains of community-acquired UTIs and antimicrobial resistance.
The 2022 CUA guidelines refer to the clinical classification recommended by the EAU guidelines and update the concept of non-complicated and complex UTI: noncomplicated UTI refers to acute, sporadic or recurrent lower (uncomplicated cystitis) and/or upper (uncomplicated pyelonephritis) UTIs in non-pregnant women with no known associated anatomical and functional abnormalities or comorbidities in the urinary tract; Complicated UTIs refer to all UTIs
that are not defined as uncomplicated and narrowly refer to patients with an increased chance of a complex course (all males, pregnant women, and patients with associated urinary tract anatomy or function, indwelling urinary catheters, renal disease, and/or other comorbid immunocompromised conditions such as diabetes).
。 The new CUA guidelines also outline emerging UTI laboratory diagnostic methods (such as automated chemical and microscopic urinalysis, microfluidic biosensors, etc.
) and UTI-related biomarkers (such as interleukin-8 and its receptors, prostaglandin E2 and vitamin D) that have emerged in recent years, aiming to promote the development of clinical precision treatment of
UTI.
Handling of new clinical problems
In recent years, the detection rate of carbapenem-resistant (CRE) Enterobacteriaceae has shown an overall upward trend, significantly increasing the risk of
inappropriate empiric antimicrobial therapy.
The results of a study in China showed that the CRE detection rate of hospitalized patients showed an upward trend from 2015 to 2019, reaching up to 20.
6%.
Meanwhile, a retrospective study in the United States of 40,137 hospitalized patients with urinary tract infection, pneumonia, and sepsis showed a significant increase in the likelihood of inappropriate empiric antimicrobial therapy in patients with CRE, and urinary tract infection-related mortality of up to 12.
4%
in patients with CRE.
CRE infection has become one of the
clinical challenges faced by urologists.
In view of this situation, the 2022 CUA guidelines have added introduction and treatment points
for CRE infection.
CRE has a resistance rate of 8>0% to most commonly used antimicrobials, but relatively low resistance to tigecycline, polymyxin B, and amikacin (4.
1%, 5.
9%, and 51.
7%, respectively
).
In addition to the principles of medical care, the new guidelines highlight the key points of management in urological operating departments:
Evaluation of new antibacterial drugs
The new version of the guidelines has made the following changes to the medication guidance for patients with complicated UTI, and the specific drug evaluation and medication regimen are detailed in the guidelines
.
Professor Qiao highlighted citafloxacin, a new generation of fluoroquinolone antibacterial drugs, which deserves our attention
for the clinical efficacy of complex/uncomplicated urinary tract infections comparable to levofloxacin.
In a randomized, double-blind active-controlled multicenter phase III clinical study in China, citafloxacin achieved an overall clinical cure rate of 89.
2%, bacterial clearance of 97.
1%, and a clinical cure rate of 81.
8% and a bacterial clearance of 93.
3%
for patients with complicated UTI.
New basic principles for the use of antibacterial drugs for male reproductive system infections
The 2022 CUA guidelines introduce for the first time the basic principles of the use of antimicrobials for urinary and male reproductive system infections, requiring clinicians to strictly grasp the application indications of antimicrobial drugs, select sensitive antibacterial drugs according to the results of drug susceptibility tests and the pharmacokinetic/pharmacodynamic (PK/PD) characteristics of antimicrobial drugs, and the therapeutic dose should be strictly in accordance with the latest guidelines recommended to select the appropriate dose
.
Please refer to the guide
for details.
In addition, empiric antimicrobial therapy requires prompt adjustment
based on patient response and susceptibility results.
The duration of treatment is 3-5 days after normal temperature or clearance of comorbidities, to minimize and minimize the development
of multidrug-resistant and pan-resistant strains.
UTI is the second most common infectious disease in China, and there are certain differences
in the epidemiology and distribution of pathogenic bacteria/pathogens of different types of UTI 。 The 2022 edition of CUA "Guidelines for the Diagnosis and Treatment of Urinary Tract Infections" combines the latest research at home and abroad, and updates and elaborates
on the clinical classification of urinary tract infections, the treatment of carbapene-resistant Enterobacteriaceae, emerging antibacterial drugs for the treatment of urinary tract infections, and the use of antibacterial drugs for urinary and male reproductive system infections.
I look forward to and firmly believe that the 2022 version of the guidelines will be of great benefit to the clinical management of UTIs and will greatly promote the development of the diagnosis and treatment of urinary tract infections in China!
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