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Importance: Traditional approaches to practice guidelines frequently result in dissociation between strength of recommendation and quality of evidence.
Objective: To create a clinical guideline for the diagnosis and management of urinary tract infections that addresses the gap between the evidence and recommendation strength.
Evidence Review: This consensus statement and systematic review applied an approach previously established by the WikiGuidelines Group to construct collaborative clinical guidelines. In May 2023, new and existing members were solicited for questions on urinary tract infection prevention, diagnosis, and management. For each topic, literature searches were conducted up until early 2024 in any language. Evidence was reported according to the WikiGuidelines charter: clear recommendations were established only when reproducible, prospective, controlled studies provided hypothesis-confirming evidence. In the absence of such data, clinical reviews were developed discussing the available literature and associated risks and benefits of various approaches.
Findings: A total of 54 members representing 12 countries reviewed 914 articles and submitted information relevant to 5 sections: prophylaxis and prevention (7 questions), diagnosis and diagnostic stewardship (7 questions), empirical treatment (3 questions), definitive treatment and antimicrobial stewardship (10 questions), and special populations and genitourinary syndromes (10 questions). Of 37 unique questions, a clear recommendation could be provided for 6 questions. In 3 of the remaining questions, a clear recommendation could only be provided for certain aspects of the question. Clinical reviews were generated for the remaining questions and aspects of questions not meeting criteria for a clear recommendation.
Conclusions And Relevance: In this consensus statement that applied the WikiGuidelines method for clinical guideline development, the majority of topics relating to prevention, diagnosis, and treatment of urinary tract infections lack high-quality prospective data and clear recommendations could not be made. Randomized clinical trials are underway to address some of these gaps; however further research is of utmost importance to inform true evidence-based, rather than eminence-based practice.
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http://dx.doi.org/10.1001/jamanetworkopen.2024.44495 | DOI Listing |
J Int Med Res
December 2024
Department of Nephrology, the First Affiliated Hospital of Shenzhen University, Shenzhen, China.
Objective: To explore the relationship between leukocyte count and renal function in patients with lupus nephritis (LN).
Methods: We performed a retrospective cross-sectional study of 100 patients with LN admitted to the Department of Nephrology between 1 January 2015 and 30 December 2023. Based on tertile of leukocyte count, they were allocated to Low, Medium, or High groups.
J Minim Access Surg
December 2024
Gem Hospital and Research Institute, Coimbatore, Tamil Nadu, India.
Acute appendicitis is one of the most common emergency surgical conditions, typically treated by laparoscopic appendectomy in most centres. Post-operative ascites is a rare complication after laparoscopic surgery, especially in the absence of a bowel, urinary tract or lymphatic injury. This condition creates a diagnostic challenge for surgeons, even after thorough investigation.
View Article and Find Full Text PDFClin Rheumatol
December 2024
Department of Rheumatology, Faculty of Medicine, Dokuz Eylul University, İnciraltı Mahallesi Mithatpaşa Cad. no:1606, Balçova, İzmir, Türkiye.
Objectives: To evaluate the incidence and characteristics of severe infections in rheumatic patients receiving biologic disease-modifying anti-rheumatic drugs (bDMARDs) after kidney transplantation.
Methods: This multicenter, retrospective study included 38 patients who had undergone kidney transplantation and received bDMARDs for rheumatic diseases. Demographic, clinical, and treatment data were collected.
Urolithiasis
December 2024
Department of Urology, University of Health Sciences School of Medicine, Ankara State Hospital, Ankara, Turkey.
The current study aimed to determine the risk factors and define a new scoring system for predicting febrile urinary tract infection (F-UTI) following retrograde intrarenal surgery (RIRS) by using machine learning methods. We retrospectively analyzed the medical records of patients who underwent RIRS and 511 patients were included in the study. The patients were divided into two groups: Group 1 consisted of 34 patients who developed postoperative F-UTI, and Group 2 consisted of 477 patients who did not.
View Article and Find Full Text PDFRadiology
December 2024
From the Departments of Radiology (G. Brembilla, M.C., A.D.P., T.R., R.P., S.L., F.D.C.), Urology (G. Basile, M.B., M.M., A.B., F.M.), and Medical Oncology (D.R., C.M., V.T., A.C., D.P., E.C., A.N.), IRCCS Ospedale San Raffaele, Milan, Italy; Vita-Salute San Raffaele University, Via Olgettina 58, 20132 Milan, Italy (G. Brembilla, G. Basile, M.C., T.R., R.P., D.P., E.C., M.B., M.M., A.B., F.M., A.N., F.D.C.); Division of Surgery and Interventional Science, University College London, London, United Kingdom (F.G.); Department of Radiology, University College London Hospital NHS Foundation Trust, London, United Kingdom (F.G.); Genitourinary Department, Programma Prostata (P.G.) and Department of Radiology (A. Messina, G. Calareso), Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Department of Urology, University of Texas MD Anderson Cancer Center, Houston, Tex (A. Martini); and Department of Radiology, IRCCS Ospedale San Raffaele-Turro, Milan, Italy (G. Cardone).
Background An accurate method of assessing the response of muscle-invasive bladder cancer (MIBC) to neoadjuvant treatment is needed for selecting candidates for bladder-sparing strategies. Purpose To evaluate the diagnostic accuracy and reproducibility of neoadjuvant chemotherapy Vesical Imaging Reporting and Data System (nacVI-RADS) scores and posttreatment Vesical Imaging Reporting and Data System (VI-RADS) scores when assessing MIBC response to neoadjuvant immunotherapy with multiparametric MRI (mpMRI). Materials and Methods A retrospective analysis of MRI scans was conducted in patients enrolled in the PURE-01 study (NCT02736266) from February 2017 to December 2019 who underwent pre- and postimmunotherapy mpMRI before radical cystectomy.
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