{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,6]],"date-time":"2026-07-06T13:05:01Z","timestamp":1783343101427,"version":"3.54.6"},"reference-count":30,"publisher":"American Medical Association (AMA)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Netw Open"],"abstract":"\n Importance<\/jats:title>\n Urinary tract infection (UTI) is common in ambulatory care settings and the primary reason for antibiotic prescribing. Despite several guidelines focused on the type and duration of antibiotics prescribed for treating UTI, there is limited outpatient guidance on how to best triage patients with presumed UTI.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the appropriateness of different triage and management recommendations involving empiric antibiotics, urine testing strategies, and visit types and how these recommendations vary by patient sex, age, presenting symptoms, and clinical history.<\/jats:p>\n <\/jats:sec>\n \n Evidence Review<\/jats:title>\n Using the RAND\/UCLA Appropriateness Method, a 13-member multidisciplinary panel (physicians, advanced practice providers, and nurses) performed a scoping review of the literature publications from 2009 to June 2024 and rated the appropriateness of 136 clinical scenarios (48 for women, 49 for men, and 39 scenarios not specific to sex) with up to 9 management strategies per scenario for a total of 1094 scenarios. For each scenario, experts rated the appropriateness of empiric treatment, types of urine testing, and triage to visit type (in-person, virtual, or none) as appropriate (ie, benefits outweigh risks), inappropriate, or of uncertain appropriateness. Appropriateness ratings were summarized into 2 groups: nonpregnant adult women and adult men.<\/jats:p>\n <\/jats:sec>\n \n Findings<\/jats:title>\n Major recommendations based on symptoms included (1) same-day in-person evaluation if symptoms were concerning for pyelonephritis, complicated cystitis, or urinary obstruction; (2) a visit if additional nonurinary symptoms were present (ie, diarrhea, genital discharge, or cough); (3) neither urine testing nor empiric treatment solely due to a change in urine color or appearance without other bladder (cystitis) symptoms; (4) empiric treatment without testing or a visit, for women, if there were new classic cystitis symptoms of dysuria, urinary frequency, urgency, or suprapubic pain without risks for antibiotic resistance; (5) urinalysis with culture (ideally reflexed to culture) before taking first antibiotic dose for women at risk of antibiotic resistance (eg, recent antibiotic treatment for UTI or recurrent UTIs) and all men; and (6) empiric treatment considered for patients with barriers to obtaining timely urine testing or visits.<\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n The appropriateness of empiric antibiotics, urine testing, and different clinical evaluation options were defined for adults presenting with concerns for UTI in common ambulatory triage settings, including telehealth. These criteria for ambulatory triage of suspected UTI symptoms in adults are anticipated to help standardize and improve the appropriateness of empiric antibiotic prescribing, urine testing, and visit type triage.<\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamanetworkopen.2025.56135","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T16:30:24Z","timestamp":1769704224000},"page":"e2556135","source":"Crossref","is-referenced-by-count":1,"title":["Ann Arbor Guide to Triaging Adults With Suspected Urinary Tract Infection for In-Person and Telehealth Settings"],"prefix":"10.1001","volume":"9","author":[{"given":"Jennifer","family":"Meddings","sequence":"first","affiliation":[{"name":"Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan"},{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor"},{"name":"Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan"},{"name":"Department of Pediatrics, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Chrouser","sequence":"additional","affiliation":[{"name":"Urology Division, Surgery Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor"},{"name":"Department of Urology, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karen E.","family":"Fowler","sequence":"additional","affiliation":[{"name":"Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Ameling","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason M.","family":"Engle","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sanjay","family":"Saint","sequence":"additional","affiliation":[{"name":"Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan"},{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor"},{"name":"Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven J.","family":"Bernstein","sequence":"additional","affiliation":[{"name":"Medicine Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan"},{"name":"Department of Internal Medicine, University of Michigan Medical School, Ann Arbor"},{"name":"Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"issue":"2","key":"zcs250009r1","doi-asserted-by":"publisher","first-page":"277","DOI":"10.1016\/j.idc.2024.03.006","article-title":"Antibiotic stewardship interventions for urinary tract infections in outpatient settings.","volume":"38","author":"Grigoryan","year":"2024","journal-title":"Infect Dis Clin North Am"},{"issue":"4","key":"zcs250009r3","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00003-20","article-title":"The Five Ds of outpatient antibiotic stewardship for urinary tract infections.","volume":"34","author":"Goebel","year":"2021","journal-title":"Clin Microbiol Rev"},{"issue":"11","key":"zcs250009r4","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.44495","article-title":"Guidelines for the prevention, diagnosis, and management of urinary tract infections in pediatrics and adults: a WikiGuidelines group consensus statement.","volume":"7","author":"Nelson","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zcs250009r6","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1093\/cid\/ciz764","article-title":"Outpatient urinary tract infections in an era of virtual healthcare: trends from 2008 to 2017.","volume":"71","author":"Bruxvoort","year":"2020","journal-title":"Clin Infect Dis"},{"issue":"9","key":"zcs250009r8","doi-asserted-by":"publisher","first-page":"S1","DOI":"10.7326\/M14-1304","article-title":"The Ann Arbor Criteria for appropriate urinary catheter use in hospitalized medical patients: results obtained by using the RAND\/UCLA appropriateness method.","volume":"162","author":"Meddings","year":"2015","journal-title":"Ann Intern Med"},{"issue":"1","key":"zcs250009r9","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1136\/bmjqs-2018-008025","article-title":"Michigan Appropriate Perioperative (MAP) criteria for urinary catheter use in common general and orthopaedic surgeries: results obtained using the RAND\/UCLA Appropriateness Method.","volume":"28","author":"Meddings","year":"2019","journal-title":"BMJ Qual Saf"},{"issue":"12","key":"zcs250009r10","first-page":"e366","article-title":"Catheter management after benign transurethral prostate surgery: RAND\/UCLA Appropriateness Criteria.","volume":"25","author":"Skolarus","year":"2019","journal-title":"Am J Manag Care"},{"issue":"7","key":"zcs250009r11","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.22281","article-title":"Urinary retention evaluation and catheterization algorithm for adult inpatients.","volume":"7","author":"Chrouser","year":"2024","journal-title":"JAMA Netw Open"},{"issue":"1","key":"zcs250009r12","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1004326","article-title":"ACCORD (ACcurate COnsensus Reporting Document): a reporting guideline for consensus methods in biomedicine developed via a modified Delphi.","volume":"21","author":"Gattrell","year":"2024","journal-title":"PLoS Med"},{"issue":"9","key":"zcs250009r13","doi-asserted-by":"publisher","first-page":"979","DOI":"10.2105\/AJPH.74.9.979","article-title":"Consensus methods: characteristics and guidelines for use.","volume":"74","author":"Fink","year":"1984","journal-title":"Am J Public Health"},{"issue":"2","key":"zcs250009r17","doi-asserted-by":"publisher","DOI":"10.1136\/bmjoq-2022-002156","article-title":"Development of quality indicators for the diagnosis and treatment of urinary tract infections in general practice: a RAND appropriateness method.","volume":"12","author":"Saust","year":"2023","journal-title":"BMJ Open Qual"},{"issue":"1","key":"zcs250009r18","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1017\/S0266462300002774","article-title":"A method for the detailed assessment of the appropriateness of medical technologies.","volume":"2","author":"Brook","year":"1986","journal-title":"Int J Technol Assess Health Care"},{"issue":"7","key":"zcs250009r19","doi-asserted-by":"publisher","first-page":"766","DOI":"10.2105\/AJPH.76.7.766","article-title":"Physician ratings of appropriate indications for six medical and surgical procedures.","volume":"76","author":"Park","year":"1986","journal-title":"Am J Public Health"},{"issue":"5","key":"zcs250009r22","doi-asserted-by":"publisher","first-page":"e103","DOI":"10.1093\/cid\/ciq257","volume":"52","author":"Gupta","year":"2011","journal-title":"Clin Infect Dis"},{"issue":"2","key":"zcs250009r23","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1097\/JU.0000000000000296","article-title":"Recurrent uncomplicated urinary tract infections in women: AUA\/CUA\/SUFU guideline.","volume":"202","author":"Anger","year":"2019","journal-title":"J Urol"},{"issue":"11","key":"zcs250009r24","doi-asserted-by":"publisher","first-page":"1082","DOI":"10.1016\/S1701-2163(16)34717-X","article-title":"Recurrent urinary tract infection.","volume":"32","author":"Epp","year":"2010","journal-title":"J Obstet Gynaecol Can"},{"issue":"Suppl 3","key":"zcs250009r25","doi-asserted-by":"publisher","first-page":"11","DOI":"10.1111\/bju.15756","article-title":"Guideline of guidelines: management of recurrent urinary tract infections in women.","volume":"130","author":"Kwok","year":"2022","journal-title":"BJU Int"},{"issue":"3","key":"zcs250009r26","doi-asserted-by":"publisher","first-page":"501","DOI":"10.1016\/j.ogc.2021.05.005","article-title":"Recurrent urinary tract infections: Diagnosis, treatment, and prevention.","volume":"48","author":"Peck","year":"2021","journal-title":"Obstet Gynecol Clin North Am"},{"issue":"6","key":"zcs250009r27","doi-asserted-by":"publisher","first-page":"833","DOI":"10.1097\/MOU.0000000000000823","article-title":"New paradigms in the management of recurrent urinary tract infections.","volume":"30","author":"Taich","year":"2020","journal-title":"Curr Opin Urol"},{"issue":"3","key":"zcs250009r28","doi-asserted-by":"publisher","first-page":"e31","DOI":"10.1093\/cid\/ciae653","article-title":"State-of-the-art review: recurrent uncomplicated urinary tract infections in women.","volume":"80","author":"Advani","year":"2025","journal-title":"Clin Infect Dis"},{"key":"zcs250009r29","doi-asserted-by":"publisher","DOI":"10.1097\/JU.0000000000004589","author":"Kaufman","year":"2025","journal-title":"J Urol"},{"issue":"6","key":"zcs250009r30","doi-asserted-by":"publisher","first-page":"636","DOI":"10.1016\/S0002-9343(99)00122-9","article-title":"The effectiveness of a clinical practice guideline for the management of presumed uncomplicated urinary tract infection in women.","volume":"106","author":"Saint","year":"1999","journal-title":"Am J Med"},{"key":"zcs250009r7","volume-title":"The RAND\/UCLA Appropriateness Method User\u2019s Manual","author":"Fitch","year":"2001"},{"key":"zcs250009r2","unstructured":"US Department of Health and Human Services. CDC: 1 in 3 antibiotic prescriptions unnecessary. Accessed May 20, 2025. https:\/\/archive.cdc.gov\/www_cdc_gov\/media\/releases\/2016\/p0503-unnecessary-prescriptions.html"},{"key":"zcs250009r5","unstructured":"Trautner? BW, Cort\u00e9s-Penfield? NW, Gupta? K, . Complicated Urinary Tract Infections (cUTI): Clinical Guidelines for Treatment and Management. Accessed November 5, 2025. https:\/\/www.idsociety.org\/practice-guideline\/complicated-urinary-tract-infections\/"},{"key":"zcs250009r14","unstructured":"GitHub. Globbestael\/DedupEndNote. Accessed May 20, 2025. https:\/\/github.com\/globbestael\/DedupEndNote"},{"key":"zcs250009r15","unstructured":"Clarivate. Endnote reference management software. Accessed June 24, 2025. https:\/\/endnote.com\/"},{"key":"zcs250009r16","unstructured":"Covidence systematic review software. Veritas Health Innovation. Accessed May 20, 2025. https:\/\/www.covidence.org\/"},{"key":"zcs250009r20","unstructured":"Zoom Communications Inc. Zoom video conferencing software. Accessed June 24, 2025. https:\/\/www.zoom.com\/"},{"key":"zcs250009r21","unstructured":"Qualtrics. Qualtrics survey software. Accessed May 20, 2025. https:\/\/www.qualtrics.com"}],"container-title":["JAMA Network Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/articlepdf\/2844483\/meddings_2026_cs_250009_1769100844.889.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T16:30:26Z","timestamp":1769704226000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamanetworkopen\/fullarticle\/2844483"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":30,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2026,1,2]]}},"URL":"https:\/\/doi.org\/10.1001\/jamanetworkopen.2025.56135","relation":{},"ISSN":["2574-3805"],"issn-type":[{"value":"2574-3805","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]}}}