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Our approach to categorizing UTI in adults and adolescents

Acute simple cystitis*	Acute UTI that is presumed to be confined to the bladder There are no signs or symptoms that suggest an upper tract or systemic infection (refer to below)
Acute complicated UTI	Acute UTI accompanied by signs or symptoms that suggest extension of infection beyond the bladder: Fever (>99.9°F/37.7°C)^¶ Chills, rigors, significant fatigue or malaise beyond baseline, or other features of systemic illness Flank pain Costovertebral angle tenderness Pelvic or perineal pain in men
Special populations with unique management considerations	Pregnant women Renal transplant recipients

We categorize UTI as either acute simple cystitis or acute complicated UTI based on the extent and severity of infection. This categorization informs management and differs somewhat from other conventions. Specifically, cystitis or pyelonephritis in a nonpregnant premenopausal woman without underlying urologic abnormalities has traditionally been termed acute uncomplicated UTI, and complicated UTI has been defined, for the purposes of treatment trials, as cystitis or pyelonephritis in a patient with underlying urologic abnormalities or other significant comorbidities. Individuals who do not fit into either category have often been treated as having a complicated UTI by default. Rather than use this convention, we favor an approach to treatment based on the presumed extent of infection and severity of illness. Patients categorized as having acute uncomplicated cystitis according to traditional definitions would fall under the category of acute simple cystitis that we use here.

UTI: urinary tract infection.
* We do not automatically consider patients with underlying urologic abnormalities (such as nephrolithiasis, strictures, stents, or urinary diversions), immunocompromising conditions (such as neutropenia or advanced HIV infection), or poorly controlled diabetes mellitus to have a complicated UTI if they have no concerning symptoms for upper tract or systemic infection. However, such patients can be at higher risk for more serious infection and have not traditionally been included in studies evaluating the antibiotic regimens we typically use for acute simple cystitis. Thus, we follow such patients more closely and/or have a low threshold to manage them as complicated UTI (eg, if they have subtle symptoms other than those listed above that could be suggestive of more extensive infection).
¶ This temperature threshold is not well defined and should be individualized, taking into account baseline temperature, other potential contributors to an elevated temperature, and the risk of poor outcomes should empiric antimicrobial therapy be inappropriate.

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