Letter to the Editor: Urinary infection in European guidelines 2025 vs microbiology culture results in the management of urinary infection

Abstract

We read with great interest the study by Yadav et al published in the World Journal of Experimental Medicine, which postulated a nomogram including patient’s critical factors, other than urine sample. European Association of Urology (EAU) published the guidelines on urological infection 2025. The EAU guidelines 2025 of urinary infections (UIs) has classified in two distanced categories: Localized UTs and systemic UTs according to specific patient’s symptoms and clinical signs, this new practical classification replaced previous concept of non-complicated urinary tract infection (UTI) against complicated UTI. The new EAU classification categorizes UIs as either localized or systemic, according to the presence of specific clinical signs and symptoms, this new practical classification replaced previous concept of non-complicated UTI against complicated UTI, irrespective of the results of bacteriological findings. In the new classification of UIs, the classification is based on clinical set-up on which the practitioner or urologist will manage the patient. Management of UIs is crucial to consider the urinary and gut microbiota. It was established recently that antibiotic use affects microbiota homeostasis in the gut and urinary tract that will initiate dysbiosis.

Keywords: Microbial communities; Urinary infection; Urine culture; Microbiome; Probiotics; Metagenomics; Antibiotic

Core Tip: The European Association of Urology guidelines 2025 for urinary infections (UIs) published new classification describing localized and systemic UIs. Patient’s Symptoms, clinical examinations, laboratory, and imaging investigation are required to set up the diagnosis. Localized UIs could be treated on an ambulatory basis, while systemic infection indicates hospitalization and monitoring. Urine culture would not reveal all bacterial community in urine. Second generation sequencing reveals bacterial community including dysbiosis and helper microbiota. Implementing the new guidelines would lead to personalized medicine, minimizing antibiotics use, avoid antibiotic resistance, and considering probiotics in treatment of localized infections.