Correspondence (letter to the editor): Urine Culture is the Crucial Basis

The authors of the interdisciplinary S3 guidelines for the prevention and management of uncomplicated bacterial community-acquired urinary tract infections in adult patients urge “careful use of antibiotics” in view of the observed resistance trends. They point out that in their recommendations they especially considered aspects of rational antibiotic use (“antibiotic stewardship”) (1). The basis for targeted and forward-looking antibiotic use lies in rigorous microbiological diagnostics (i. e. the identification of the causative pathogen and determination of an antibiotic resistance profile). In this context, it is surprising that the guideline authors do not think urinary culture is required in women with clear-cut clinical signs and symptoms of an uncomplicated, non-recurrent or therapy-refractory cystitis. They base their recommendation on economic reasons and considerations of practicability in routine clinical practice. However, for example, in a seven-day therapy with nitrofurantoin, the results of a culture can be of clinical relevance. Furthermore, in Table S1 of the guideline, trimethoprim is recommended only when (according to the local resistance situation), = 20% of the E. coli isolates are categorized as resistant to trimethoprim. The responsible clinician, however, will only have recourse to reliable data on the local resistance situation if urine culture is done routinely. Since urine culture continues to be the basis of a sound antibiotic treatment of urinary tract infections, I advocate that urine should also be cultured in the case of community-acquired urinary tract infections. Joint interdisciplinary efforts are needed to overcome financial and organizational obstacles.