International Journal of Antimicrobial Agents 17 (2001) 343 – 348 Urinary tract infection in adults: research priorities and strategies A.R. Ronald a, *, L.E. Nicolle b , E. Stamm c , J. Krieger d , J. Warren e , A. Schaeffer f , K.G. Naber g , T.M. Hooton h , J. Johnson i , S. Chambers j , V. Andriole k a St. Boniface General Hospital Uniersity of Manitoba, Section of Infectious Diseases, Winnipeg, Man, Canada R2H 2A6 b Department of Medicine, C4 Health Sciences Center, 820 Sherbrook Street, Winnipeg, Man, Canada R3A IR9 c Harboriew Medical Center, Department of Medicine, 325 Ninth Aenue, Seattle, WA 98104, USA d Section of Urology (I 12 LJR), V.A. Puget Sound Health Care System, 1660 South Columbian Way, Seattle, WA 98108, USA e Uniersity of Maryland School of Medicine, Diision of Infectious Diseases, 10 South Pine Street, Room 9 -00, MSTF, Baltimore, NM 21201, USA f Herman Kretschmer Professor, Department of Urology, Northwestern Medical School, Chicago, IL, USA g Urologische Klinik, Klinikum St. Elisabeth, St. Elisabeth -Straße 23, 94315 Straubing, Germany h Department of Medicine, Harboriew Medical Center, 325 Ninth Aenue, Seattle, WA 98104, USA i 2224 Dayton Aenue, St. Paul, MN 55104, USA j Christchurch Hospital, Department of Infectious Diseases, Priate Bag, Christchurch, New Zealand k Yale Uniersity School of Medicine, Department of Internal Medicine, 333 Cedar Street, 201 LCI, New Haen, CT 06520 -8022, USA Abstract Waning interest in urinary tract infection (UTI) research has limited clinical advances during the past two decades. Although care has improved for some specific UTI syndromes, there is limited evidence for most of the decisions made each day in the management of these infections. Additional clinical research is necessary to improve UTI prevention and care strategies. © 2001 Published by Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved. Keywords: Urinary tract infection; Prevention and care; Adults; Research priorities www.ischemo.org 1. Introduction Urinary tract infections (UTI) are common with an estimated annual global incidence of at least 250 mil- lion, being costly to patients and health care funding agencies, and controversial with regard to management strategies. From 1960 to 1980, substantive advances occurred in our understanding of the epidemiology, pathogenesis, and management of UTI due to sustained and important research. During these decades, over 100 investigators made significant scientific contributions to the field. UTI research was a priority; significant inves- tigative groups were located in at least 30 sites around the world, and presentations at most major infectious disease meetings enabled discussion and debate, facili- tating excitement in the field. Beginning in about 1980, UTI research interest waned, the number of competitively funded ‘UTI’ sci- entists declined, and fewer important original observa- tions were made [1,2]. Reviews and updates became repetitive with few new ideas or significant additions to the knowledge base. In the year 2000, probably fewer than 15 research sites around the world receive compet- itive, non-pharmaceutical grants to support UTI research. We have expressed alarm about the decline of UTI research [1 – 3]. This current overview expands on this topic. Colleagues currently active in UTI research have been invited to criticise and contribute to this ‘opinion piece’. 2. Why the reduced UTI research emphasis? First, numerous clinical trials of women with acute urinary symptoms, particularly acute bacterial cystitis * Corresponding author. Tel.: +1-204-2372927; fax: +1-204- 2337125. E-mail address: aronald@ms.umanitoba.ca (A.R. Ronald). 0924-8579/01/$ - $20 © 2001 Published by Elsevier Science B.V. and International Society of Chemotherapy. All rights reserved. PII:S0924-8579(01)00303-X