Recurrent Urinary Tract Infection Definition and Management

Diagnostic Criteria

• The American Urological Association defines recurrent UTI as 2 or more symptomatic episodes within 6 months or 3 or more episodes within 12 months, with complete symptom resolution between episodes and documented symptomatic episodes 1
• The American College of Radiology specifies that an infection can be counted toward the definition of recurrence if there is at least one episode verified by urine culture showing a significant number of organisms 2

Mechanisms of Recurrence

• Reinfection, the most common mechanism, occurs when a new infection happens more than 2 weeks after symptomatic cure, often caused by a different pathogen 2
• Relapse or persistent infection occurs when the same organism recurs within 2 weeks of treatment completion, suggesting bacterial persistence without symptom resolution despite therapy 2

Management and Prevention

• The American College of Radiology recommends that patients with rapid recurrence or bacterial persistence should be reclassified as complicated UTI and require imaging to identify treatable structural causes 2
• Women meeting the definition of rUTI may benefit from prophylactic strategies after behavioral modifications have been attempted, according to the American College of Radiology 2, 3