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Flower A, Harman K, Willcox M, Stuart B, Moore M. The RUTI trial: A feasibility study exploring Chinese herbal medicine for the treatment of recurrent urinary tract infections. JOURNAL OF ETHNOPHARMACOLOGY 2019; 243:111935. [PMID: 31082512 DOI: 10.1016/j.jep.2019.111935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Chinese herbal medicine (CHM) is a widely used traditional intervention that may have a role to play in addressing the global problem of antimicrobial resistance in conditions such as recurrent urinary tract infections (RUTIs). AIM OF THE STUDY To evaluate the feasibility of administering standardised and individualised formulations of CHM for RUTIs as a Clinical Trial of an Investigational Medicinal Product (CTIMP) within primary care of the UKs National Health Service (NHS). MATERIALS AND METHODS Regulatory approval was applied for a placebo controlled, double blinded randomised controlled feasibility trial comparing a) standardised CHM vs placebo administered via General practitioners, and b) individualised CHM vs placebo administered by an experienced CHM practitioner. Primary feasibility outcomes included: gaining regulatory approval, recruitment, randomisation, retention, safety and the relevance of outcomes measures. RESULTS Regulatory approval for testing CHM as a CTIMP was successfully obtained. Recruitment to the trial was slow and non-NHS self help networks were required to find participants for the individualised arm (n = 31). Retention and data collection in the standardised arm (n-30) were problematic, but these were acceptable in the individualised arm. The use of a daily symptom diary was not a suitable outcome measure for women with continuous infection. Other measures showed promising preliminary data for the individualised arm on improvement in symptoms, and reduction in antibiotic use during and after the trial. CONCLUSION CHM can fulfil the demanding requirements of a CTIMP study but it may not be feasible at this point in time to recruit and treat via NHS primary care. However acceptable rates of recruitment and retention via self-help groups and promising preliminary results in the individualised arm suggest it would be worth testing this approach in a full trial.
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Affiliation(s)
- Andrew Flower
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
| | - Kim Harman
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
| | - Merlin Willcox
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
| | - Beth Stuart
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
| | - Michael Moore
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
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Tambunan MP, Rahardjo HE. Cranberries for women with recurrent urinary tract infection: a meta-analysis. MEDICAL JOURNAL OF INDONESIA 2019. [DOI: 10.13181/mji.v28i3.3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cranberries are the most widely used nonantibiotic prophylaxis for recurrent urinary tract infection (rUTI) in women; however, their efficacy still remains uncertain. Hence, this meta-analysis was aimed to assess the effectiveness, safety, and adherence of cranberry as a prophylactic drug for treating rUTI.
METHODS Literature search was conducted using PubMed, EBSCO, Science Direct, Scopus, Cochrane, and Google Scholar. Studies were screened for duplication, inclusion and exclusion criteria, and then reviewed by two authors independently. This included all randomized controlled trials of cranberry derivatives versus placebo and antibiotic prophylaxis. Cochrane risk-of-bias assessment tools were used to evaluate the quality of the study. Quantitative analysis was performed using the Review Manager 5.0 software.
RESULTS Nine studies were included. Among 1,542 participants, cranberry consumption reduced incidence of rUTI in women compared with placebo (p = 0.02). The subgroup analysis revealed that only cranberry capsules were superior to placebo (relative risk [RR] = 0.67, 95% confidence interval [CI] = 0.45–0.98), but not for cranberry juice (RR = 0.85, 95% CI: 0.7–1.04). Antibiotics had better outcome than cranberry for rUTI (RR = 0.83, 95% CI = 0.70–0.98). Most of the participants experienced minor adverse events such as rash and gastrointestinal symptoms. There was also a good adherence rate, ranging from 90.3–99% monthly dose.
CONCLUSIONS Cranberry, especially cranberry capsule consumption, had a significant effect in reducing the incidence of rUTI compared with placebo, with good adherence rates, and minor adverse events. In contrast, although antibiotic use had a greater efficacy, it was associated with a higher risk of severe adverse events.
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Koradia P, Kapadia S, Trivedi Y, Chanchu G, Harper A. Probiotic and cranberry supplementation for preventing recurrent uncomplicated urinary tract infections in premenopausal women: a controlled pilot study. Expert Rev Anti Infect Ther 2019; 17:733-740. [PMID: 31516055 DOI: 10.1080/14787210.2019.1664287] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: To assess efficacy and safety of Bio-Kult Pro-Cyan (BKPro-Cyan), a product containing two strains of Lactobacilli plus cranberry extract, for preventing recurrent UTIs in pre-menopausal adult women.Methods: This was a randomized, double-blind, placebo-controlled pilot study. Subjects received BKPro-Cyan or placebo twice-daily for 26 weeks. The primary endpoint was the proportion of subjects with recurrent UTI at the end of the study.Results: 115 subjects were screened; 90 were enrolled; 81 completed the study. After 26 weeks, a significantly lower number of women experienced recurrent UTIs with BKPro-Cyan compared to placebo (9.1 vs 33.3%; P = 0.0053). BKPro-Cyan produced statistically significant improvements compared to placebo for multiple secondary endpoints, including: greater number of subjects who experienced no UTIs (90 vs 67%; P < 0.05); longer time to first UTI (174 vs 90 days; P = 0.001); shorter duration of active UTI (5 vs 12 days; P = 0.009); Fewer subjects requiring antibiotics (3 vs 11; P < 0.05); and shorter median duration of antibiotic treatment (4 vs 7 days; P = 0.09).Conclusions: BKPro-Cyan was safe and effective for preventing recurrent UTI in pre-menopausal adult women. These findings support the need for further well-designed trials to clarify the benefits that may be achieved.
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Affiliation(s)
- Parshottam Koradia
- Dept of Clinical Research, BAPS Pramukh Swami Hospital , Ahmedabad , India
| | - Shital Kapadia
- Dept of Obstetrics and Gynecology, B.J. Medical College and Civil Hospital , Ahmedabad , India
| | - Yamini Trivedi
- Department of Obstetrics & Gynaecology, AMCMET L.G. General Hospital , Ahmedabad , India
| | - Gajendrasinh Chanchu
- Department of Data operations, QED Clinical Services Ind Pvt Limited , Ahmedabad , Gujarat , India
| | - Ashton Harper
- Medical Affairs Department, ADM Protexin Ltd , Somerset , UK
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Financial Burden of Recurrent Urinary Tract Infections in Women: A Time-driven Activity-based Cost Analysis. Urology 2019; 128:47-54. [PMID: 30796990 DOI: 10.1016/j.urology.2019.01.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To utilize Time-Driven Activity-Based Costing to quantify costs of managing recurrent urinary tract infections (RUTI) in women. METHODS RUTI was defined as ≥2 UTIs in 6 months or ≥3 UTIs in 12 months. A care-delivery value chain outlined RUTI management (visits, urine studies, and imaging) for acute UTI followed by a form of long-term prevention. Prevention strategies included conservative therapy (Cranberry tablets, d-mannose, or lactobacillus); Estrogen therapy if postmenopausal; Antibiotic use (self-start, postcoital, or continuous regimens); or intravenous antibiotics in case of drug-resistance or intolerance. Costs of each resource were largely obtained from the Medicare Physician Fee Schedule, GoodRx and local pharmacy pricing, and institutional expenses. The capacity cost rate was defined as cost of resources per minute of care. Individual costs were summed to estimate overall expense of initial RUTI workup and annual cost for each long-term prevention strategy. RESULTS Cost of acute RUTI workup ranged from $390 to $730. Acute antibiotics cost ranged from $10 for oral trimethoprim-sulfamethoxazole to $3970 for intravenous Ertapenem. Annually, mean cost of conservative therapy ranged from $50 for d-mannose to $1290 for vaginal estradiol ring, and antibiotic use for self-start $40, postcoital $60, and continuous $190. Capacity cost rate ranged from $0.003/min for urine culture to $80/min for estrogen ring. CONCLUSION Using Time-Driven Activity-Based Costing, costs of RUTI management were efficiently determined. This offers new perspectives for patient counseling and long-term decision making.
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Waller TA, Pantin SAL, Yenior AL, Pujalte GGA. Urinary Tract Infection Antibiotic Resistance in the United States. Prim Care 2018; 45:455-466. [PMID: 30115334 DOI: 10.1016/j.pop.2018.05.005] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Urinary tract infection (UTI) is one of the most common entities in medicine and affected patients present daily in a typical family medicine practice. The patients often present with the "classic symptoms" of dysuria and increased frequency, but sometimes they are asymptomatic or have a mixed picture. In most cases, an antibiotic is prescribed, and this practice is likely contributing to increasing worldwide antibiotic resistance. To help combat this problem, it is important that clinicians seek out their local bacterial resistance patterns and antibiograms, properly diagnose and treat UTI if indicated, and recognize their role in antibiotic stewardship.
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Affiliation(s)
- Thomas A Waller
- Department of Family Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA.
| | - Sally Ann L Pantin
- Department of Family Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - Ashley L Yenior
- Department of Family Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
| | - George G A Pujalte
- Department of Family Medicine, Mayo Clinic Florida, 4500 San Pablo Road, Jacksonville, FL 32224, USA
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Clinical implications of the anatomical position of the urethra meatus in women with recurrent post-coital cystitis: a case-control study. Int Urogynecol J 2018; 30:1351-1357. [PMID: 29968091 DOI: 10.1007/s00192-018-3710-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 06/20/2018] [Indexed: 01/12/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Recurrent post-coital urinary infection (rUTI)-usually cystitis-is a common entity among otherwise healthy young women. However, little is known about the possible influence of genital anatomical variations. Only a shorter urethral meatus-anus distance has been described as a risk factor. The aim of this study was to evaluate our hypothesis that a shorter urethra-vagina distance is involved in the etiology of post-coital urinary infection. METHODS In this prospective case-control study, 61 young women aged between 18 and 40 years with an acute post-coital UTI and a history of intercourse-related rUTI were consecutively recruited between January 2013 and February 2018. Fifty-six age-matched, sexually active women with no history of UTI served as controls. Perineal measurements included the distances between the clitoris-urethra (C-U), urethra-vagina (U-V), urethra-anus (U-A) and perineum. Demographic and sexual behavior characteristics and the morphology of the urethral meatus were also noted. Univariate analysis compared variables between groups. ROC analysis was used to define the efficiency of perineal measurements in predicting outcome. Odds ratios and 95% confidence intervals for UTI-predisposing variables were estimated using logistic regression analysis. RESULTS The U-V and U-A distance was shorter in patients compared with controls [median (interquatile range): 16 mm (14-18) vs. 21 mm (19-23) and 51 mm (47-53) vs. 59 mm (55-62), respectively, p < 0.001]. The U-V performed better in ROC analysis than the U-A distance (AUC 0.952 vs. 0.875, p = 0.023). The only statistically significant parameters in multivariate analysis influencing UTI were BMI (OR: 0.702; 0.510-0.967, p = 0.030) and U-V (OR: 0.297; 0.161-0.549, p < 0.001). CONCLUSIONS Our results indicate an association between shorter urethra-vagina distance and post-coital rUTIs.
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Cystoscopy Findings in Females with Recurrent Urinary Tract Infection. Nephrourol Mon 2018. [DOI: 10.5812/numonthly.61829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Rosen JM, Yaggie RE, Woida PJ, Miller RJ, Schaeffer AJ, Klumpp DJ. TRPV1 and the MCP-1/CCR2 Axis Modulate Post-UTI Chronic Pain. Sci Rep 2018; 8:7188. [PMID: 29739958 PMCID: PMC5940763 DOI: 10.1038/s41598-018-24056-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 03/23/2018] [Indexed: 02/06/2023] Open
Abstract
The etiology of chronic pelvic pain syndromes remains unknown. In a murine urinary tract infection (UTI) model, lipopolysaccharide of uropathogenic E. coli and its receptor TLR4 are required for post-UTI chronic pain development. However, downstream mechanisms of post-UTI chronic pelvic pain remain unclear. Because the TRPV1 and MCP-1/CCR2 pathways are implicated in chronic neuropathic pain, we explored their role in post-UTI chronic pain. Mice were infected with the E. coli strain SΦ874, known to produce chronic allodynia, and treated with the TRPV1 antagonist capsazepine. Mice treated with capsazepine at the time of SΦ874 infection failed to develop chronic allodynia, whereas capsazepine treatment of mice at two weeks following SΦ874 infection did not reduce chronic allodynia. TRPV1-deficient mice did not develop chronic allodynia either. Similar results were found using novelty-suppressed feeding (NSF) to assess depressive behavior associated with neuropathic pain. Imaging of reporter mice also revealed induction of MCP-1 and CCR2 expression in sacral dorsal root ganglia following SΦ874 infection. Treatment with a CCR2 receptor antagonist at two weeks post-infection reduced chronic allodynia. Taken together, these results suggest that TRPV1 has a role in the establishment of post-UTI chronic pain, and CCR2 has a role in maintenance of post-UTI chronic pain.
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Affiliation(s)
- John M Rosen
- Departments of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, 60611, USA
- Division of Pediatric Gastroenterology, Children's Mercy Hospital, Kansas City, MO, USA
| | - Ryan E Yaggie
- Departments of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, 60611, USA
| | - Patrick J Woida
- Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, 60611, USA
| | - Richard J Miller
- Department of Pharmacology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, 60611, USA
| | - Anthony J Schaeffer
- Departments of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, 60611, USA
| | - David J Klumpp
- Departments of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, 60611, USA.
- Microbiology-Immunology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, 60611, USA.
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Dutta S, Lane F. Intravesical instillations for the treatment of refractory recurrent urinary tract infections. Ther Adv Urol 2018; 10:157-163. [PMID: 29623107 DOI: 10.1177/1756287218757655] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 12/23/2017] [Indexed: 11/17/2022] Open
Abstract
Background Treatment options for refractory recurrent urinary tract infections (UTI) are limited; therefore, we sought to determine if intravesical instillations with heparin effectively treat recurrent UTIs. Methods Patients at an academic medical center who received intravesical instillations with heparin for recurrent UTIs/chronic cystitis between January 2011 and December 2015 were identified via International Classification of Diseases, Ninth Revision (ICD-9) and Current Procedural Terminology (CPT) procedure codes. All cases were analyzed for frequency of UTIs during the treatment phase as well as for the subsequent 6 months after completion of therapy. Demographic, clinical and treatment related factors were then collected from the medical records to draw associations with success or failure of treatment. Results Thirty-nine women were treated with heparin intravesical instillations for recurrent UTIs. The average age of the cohort was 68.38 years [range 25-88, standard deviation (SD) 12.92], with mean parity 2.38 (range 0-7, SD 1.55) and mean body mass index 27.85 (range 19.5-37.9, SD 4.84). A total of 84.6% completed the recommended 6-week treatment course while 69.2% went on to an additional maintenance phase. Twelve patients (30.8%) had a culture-proven UTI during the treatment phase. In the 6-month follow-up period, 46.2% of patients had at least one UTI with only seven patients (17.9%) meeting criteria for recurrent UTIs (two or more UTIs in 6 months). On univariable assessment, development of recurrent UTIs after completion of instillation therapy was associated with increasing age and vaginal estrogen use during the instillation treatment course. Conclusions Intravesical instillation with heparin is an effective option to consider for the treatment of refractory recurrent UTIs.
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Affiliation(s)
- Sonia Dutta
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, University of California, Irvine Medical Center, 333 City Blvd, West, Suite 1400, Orange, CA 92868, USA
| | - Felicia Lane
- University of California, Irvine Medical Center, Orange, CA, USA
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Infección urinaria recurrente en la mujer. REVISTA MÉDICA CLÍNICA LAS CONDES 2018. [DOI: 10.1016/j.rmclc.2018.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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van Dooren I, Foubert K, Theunis M, Naessens T, Pieters L, Apers S. Advantages of a validated UPLC–MS/MS standard addition method for the quantification of A-type dimeric and trimeric proanthocyanidins in cranberry extracts in comparison with well-known quantification methods. J Pharm Biomed Anal 2018; 148:32-41. [DOI: 10.1016/j.jpba.2017.09.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 09/01/2017] [Accepted: 09/03/2017] [Indexed: 11/15/2022]
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Fu Z, Liska D, Talan D, Chung M. Cranberry Reduces the Risk of Urinary Tract Infection Recurrence in Otherwise Healthy Women: A Systematic Review and Meta-Analysis. J Nutr 2017; 147:2282-2288. [PMID: 29046404 DOI: 10.3945/jn.117.254961] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 07/03/2017] [Accepted: 09/25/2017] [Indexed: 11/14/2022] Open
Abstract
Background: Cranberry (Vaccinium spp.) has been advocated for treatment of urinary tract infection (UTI); however, its efficacy is controversial. Women have a 50% risk of UTI over their lifetime, and ∼20-30% experience a subsequent UTI recurrence.Objective: We conducted this meta-analysis to assess the effect of cranberry on the risk of UTI recurrence in otherwise healthy women.Methods: Literature published before January 2011 was obtained from 2 published systematic reviews, and we conducted updated searches in EMBASE and MEDLINE (through July 2017). We included randomized controlled trials that were conducted in generally healthy nonpregnant women aged ≥18 y with a history of UTI, compared cranberry intervention to a placebo or control, and reported the outcome as the number of participants experiencing a UTI. Two researchers conducted abstract and full-text screenings, data extractions, and risk of bias assessments independently, and discrepancies were resolved by group consensus. Meta-analyses were performed by using Stata SE software (version 13). We employed a fixed-effect model using the Mantel-Haenszel method to estimate the summary risk if the heterogeneity was low to moderate (I2 < 50%). Otherwise, we applied a random-effects model using the DerSimonian-Laird method.Results: We identified 7 randomized controlled trials conducted in healthy women at risk of UTI (n = 1498 participants). Results of the meta-analysis showed that cranberry reduced the risk of UTI by 26% (pooled risk ratio: 0.74; 95% CI: 0.55, 0.98; I2 = 54%). Risk of bias indicated that 2 studies had high loss to follow-up or selective outcome reporting. Overall, the studies were relatively small, with only 2 having >300 participants.Conclusion: These results suggest that cranberry may be effective in preventing UTI recurrence in generally healthy women; however, larger high-quality studies are needed to confirm these findings. This trial was registered at crd.york.ac.uk/prospero as CRD42015024439.
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Affiliation(s)
- Zhuxuan Fu
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA
| | - DeAnn Liska
- Nutrition Science and Biostatistics, Biofortis Research, Addison, IL; and
| | - David Talan
- University of California, Los Angeles School of Medicine, UCLA-Olive View Medical Center, Sylmar, CA
| | - Mei Chung
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, MA;
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Impact of Allergy and Resistance on Antibiotic Selection for Recurrent Urinary Tract Infections in Older Women. Urology 2017; 113:26-33. [PMID: 29196069 DOI: 10.1016/j.urology.2017.08.070] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 08/24/2017] [Accepted: 08/30/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To review the impact of antibiotic allergy and resistance in older women with recurrent urinary tract infections (RUTIs) as determinants for a suitable oral antibiotic treatment choice. METHODS A prospectively maintained database of women 65 years old and older with documented RUTIs (≥3 UTI/y) and trigonitis on cystoscopy was reviewed. Demographic data, known drug allergies, renal function, antibiotic susceptibility of most recent urine culture, allergy, or resistance to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolones, and nitrofurantoin were obtained. RESULTS From 2006 to 2014, 86 women with RUTIs met study criteria. Mean age was 77.9 ± 7.8, with 94% being Caucasian. An estimated glomerular filtration rate >30 mL/min was noted in 94%. The percentage of women allergic, resistant, or both allergic and resistant to TMP-SMX was 33%, 29%, and 15%, to fluoroquinolones was 14%, 34%, and 8.1%, or nitrofurantoin was 16%, 14%, and 5%, respectively. Twenty-eight percent (24 of 86) of women who were allergic and/or resistant to TMP-SMX and fluoroquinolones were sensitive to nitrofurantoin. Twenty percent (17 of 86) were allergic and/or resistant to all 3 antibiotics. Women who were allergic or resistant to TMP-SMX had a significantly higher number of other antibiotic resistances compared with women sensitive to TMP-SMX (4.9 ± 3.6 vs 2.1 ± 2.3; P < .0001). Similarly, women with fluoroquinolone allergy or resistance had significantly more antibiotic resistances than those who were fluoroquinolone sensitive (5.8 ± 3.5 vs 2.3 ± 2.5; P < .0001). CONCLUSION Because of allergy and/or antibiotic resistance, several first-line antibiotics are not available for many older women with RUTIs. In nearly a third of women, nitrofurantoin was the only viable alternative.
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Armelle J. [Recurrent cystisis: No medicine preventive means]. Prog Urol 2017; 27:823-830. [PMID: 29033364 DOI: 10.1016/j.purol.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/04/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate from the literature review, the interest of hygienic and behavioural measures and the use of food supplements (herbal) to prevent female urinary tract infection. METHODS Pubmed research was focused on the efficiency of prophylactic measures in recurrent cystisis management. RESULTS Due to many predisposing factors such as anatomical charasteristics, hydration and lifestyle, cystisis is more common in female subjects than in male. The infection is mostly caused by uropathgenic Escherichia coli which is mostly found in the intestine. Recomendations propose a better use of antibiotics that causes undesirable side effects (such as nausea, candidiasis) and favours the development of resistant bacterial strains. Hygienic measures, good hydration, and respecting a good urinary rythm help to protect from new infectious episodes. Food supplements such as cranberry or D-mannose can also interfere with the recurrence of cystisis, by preventing the bacteria sticking to urinary tract epithelia. Their efficency is relative and seems to be dose-dependent. Better tolerated than prophylactic antibiotic treatments, they can increase times of respite. CONCLUSION Using prophylactic treatment still have an interest, even if they are questionable. Moreover, the combination of these methods (diet and lifestyle advice) can be an alternative to long-term prophylactic medical treatment.
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Affiliation(s)
- J Armelle
- Service hospitalisation de jour, clinique de rééducation fonctionnelle Korian Les grands chênes, 40, rue Stéhétin, 33021 Bordeaux, France.
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65
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Affiliation(s)
- Cathy Davis
- Clinical Nurse Specialist in Urogynaecology, King's College Hospital, London
| | - Angie Rantell
- Lead Nurse for Urogynaecology/Nurse Cystoscopist, King's College Hospital, London
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Boeri L, Capogrosso P, Ventimiglia E, Scano R, Graziottin A, Dehò F, Montanari E, Montorsi F, Salonia A. Six Out of Ten Women with Recurrent Urinary Tract Infections Complain of Distressful Sexual Dysfunction - A Case-Control Study. Sci Rep 2017; 7:44380. [PMID: 28295051 PMCID: PMC5353672 DOI: 10.1038/srep44380] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
Uncomplicated recurrent urinary tract infections (rUTIs) are common among reproductive-aged women. We aimed to assess the prevalence and predictors of sexual dysfunction (FSD) in a cohort of women with rUTIs and compare their psychometric scores to those of matched controls. Data from 147 rUTIs women and 150 healthy controls were analysed. Participants completed the International Prostatic Symptoms Score (IPSS), the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale (SDS). Descriptive statistics and logistic regression models tested prevalence and predictors of distressful FSD. Women with rUTIs had lower FSFI scores (p < 0.001) and a greater proportion of pathological FSFI (78.9% vs. 21.4%; p < 0.001) and SDS scores (77.8% vs. 21.4%; p < 0.001) than controls. Of rUTIs patients, 88 (60%), 77 (52.2%), and 75 (51.1%) reported pathological scores for FSFI-pain, lubrication and arousal, respectively; moreover, 64% had concomitant pathological FSFI and SDS scores. Age, IPSS severity, rUTIs, a history of ≥6 UTIs/year and a history of constipation were independent predictors of pathologic FSFI and SDS (all p ≤ 0.05). In conclusion, up to 80% of women with rUTIs showed pathologic FSFI and SDS scores, with 60% reporting scores suggestive of distressful FSD. Having ≥6 UTIs/year and a history of constipation independently predicted distressful FSD.
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Affiliation(s)
- Luca Boeri
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, 20132, Italy.,Department of Urology, IRCCS Fondazione Ca' Granda - Ospedale Maggiore Policlinico; Milan, 20122, Italy
| | - Paolo Capogrosso
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, 20132, Italy.,University Vita-Salute San Raffaele, Milan, 20132, Italy
| | - Eugenio Ventimiglia
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, 20132, Italy.,University Vita-Salute San Raffaele, Milan, 20132, Italy
| | - Roberta Scano
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, 20132, Italy
| | | | - Federico Dehò
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, 20132, Italy
| | - Emanuele Montanari
- Department of Urology, IRCCS Fondazione Ca' Granda - Ospedale Maggiore Policlinico; Milan, 20122, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, 20132, Italy.,University Vita-Salute San Raffaele, Milan, 20132, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, 20132, Italy.,University Vita-Salute San Raffaele, Milan, 20132, Italy
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Jhang JF, Kuo HC. Recent advances in recurrent urinary tract infection from pathogenesis and biomarkers to prevention. Tzu Chi Med J 2017; 29:131-137. [PMID: 28974905 PMCID: PMC5615991 DOI: 10.4103/tcmj.tcmj_53_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recurrent urinary tract infection (UTI) might be one of the most common problems in urological clinics. Recent research has revealed novel evidence about recurrent UTI and it should be considered a different disease from the first infection. The pathogenesis of recurrent UTI might include two mechanisms, bacterial factors and deficiencies in host defense. Bacterial survival in the urinary bladder after antibiotic treatment and progression to form intracellular bacterial communities might be the most important bacterial factors. In host defense deficiency, a defect in pathogen recognition and urothelial barrier function impairment play the most important roles. Immunodeficiency and urogenital tract anatomical abnormalities have been considered the essential risk factors for recurrent UTI. In healthy women, voiding dysfunction and behavioral factors also increase the risk of recurrent UTI. Sexual intercourse and estrogen deficiency in postmenopausal women might have the strongest association with recurrent UTI. Traditional lifestyle factors such as fluid intake and diet are not considered independent risk factors now. Serum and urine biomarkers to predict recurrent UTI from the first infection have also attracted a wide attention recently. Current clinical evidence suggests that serum macrophage colony-stimulating factor and urinary nerve growth factor have potential predictive value for recurrent UTI. Clinical trials have proven the efficacy of the oral immunoactive agent OM-89 for the prevention of UTI. Vaccines for recurrent UTI are recommended by the latest guidelines and are available on the market.
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Affiliation(s)
- Jia-Fong Jhang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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68
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Montorsi F, Gandaglia G, Salonia A, Briganti A, Mirone V. Effectiveness of a Combination of Cranberries, Lactobacillus rhamnosus , and Vitamin C for the Management of Recurrent Urinary Tract Infections in Women: Results of a Pilot Study. Eur Urol 2016; 70:912-915. [DOI: 10.1016/j.eururo.2016.05.042] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 05/29/2016] [Indexed: 10/21/2022]
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Wu Y(R, Rego LL, Christie AL, Lavelle RS, Alhalabi F, Zimmern PE. Recurrent Urinary Tract Infections Due to Bacterial Persistence or Reinfection in Women—Does This Factor Impact Upper Tract Imaging Findings? J Urol 2016; 196:422-8. [DOI: 10.1016/j.juro.2016.01.111] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 10/22/2022]
Affiliation(s)
| | - Lauren L. Rego
- University of Texas Southwestern Medical Center, Dallas, Texas
| | - Alana L. Christie
- Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Rebecca S. Lavelle
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Feras Alhalabi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Philippe E. Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
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70
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Liska DJ, Kern HJ, Maki KC. Cranberries and Urinary Tract Infections: How Can the Same Evidence Lead to Conflicting Advice? Adv Nutr 2016; 7:498-506. [PMID: 27184277 PMCID: PMC4863270 DOI: 10.3945/an.115.011197] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cranberry has been used traditionally to prevent urinary tract infections (UTIs), primarily among generally healthy women prone to recurrent UTIs. Results from a number of published clinical studies have supported this benefit; however, meta-analyses on cranberry and UTI prevention have reported conflicting conclusions. This article explores the methodological differences that contributed to these disparate findings. Despite similar research questions, the meta-analyses varied in the studies that were included, as well as the data that were extracted. In the 2 most comprehensive systematic reviews, heterogeneity was handled differently, leading to an I(2) of 65% in one and 43% in the other. Most notably, the populations influencing the conclusions varied. In one analysis, populations with pathological/physiological conditions contributed 75.6% of the total weight to the summary risk estimate (RR: 0.86; 95% CI: 0.71, 1.04); another weighted the evidence relatively equally across UTI populations (RR: 0.62; 95% CI: 0.49, 0.80); and a third included only women with recurrent UTIs (RR: 0.53; 95% CI: 0.33, 0.83). Because women with recurrent UTIs are the group to whom most recommendations regarding cranberry consumption is directed, inclusion of other groups in the efficacy assessment could influence clinical practice quality. Therefore, conclusions on cranberry and UTIs should consider differences in results across various populations studied when interpreting results from meta-analyses.
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Affiliation(s)
| | - Hua J Kern
- Biofortis Innovation Services, Addison, IL; and
| | - Kevin C Maki
- Midwest Center for Metabolic & Cardiovascular Research, Chicago, IL
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71
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Kumar M, Yadav AK, Verma V, Singh B, Mal G, Nagpal R, Hemalatha R. Bioengineered probiotics as a new hope for health and diseases: an overview of potential and prospects. Future Microbiol 2016; 11:585-600. [PMID: 27070955 DOI: 10.2217/fmb.16.4] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Despite the use of microorganisms as therapeutics for over a century, the scientific and clinical admiration of their potential is a recent phenomenon. Genome sequencing and genetic engineering has enabled researchers to develop novel strategies, such as bioengineered probiotics or pharmabiotics, which may become a therapeutic strategy. Bioengineered probiotics with multiple immunogenic or antagonistic properties could be a viable option to improve human health. The bacteria are tailored to deliver drugs, therapeutic proteins or gene therapy vectors with precision and a higher degree of site specificity than conventional drug administration regimes. This article provides an overview of methodological concepts, thereby encouraging research and interest in this topic, with the ultimate goal of using designer probiotics as therapeutics in clinical practice.
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Affiliation(s)
- Manoj Kumar
- Department of Clinical Microbiology & Immunology, National Institute of Nutrition, ICMR Hyderabad, India
| | - Ashok Kumar Yadav
- Department of Clinical Microbiology & Immunology, National Institute of Nutrition, ICMR Hyderabad, India
| | - Vinod Verma
- Centre of Biotechnology, Nehru Science Complex, University of Allahabad, Allahabad, India
| | - Birbal Singh
- ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, India
| | - Gorakh Mal
- ICAR-Indian Veterinary Research Institute, Regional Station, Palampur, India
| | - Ravinder Nagpal
- Probiotics Research Laboratory, Graduate School of Medicine, Juntendo University, Tokyo
| | - Rajkumar Hemalatha
- Department of Clinical Microbiology & Immunology, National Institute of Nutrition, ICMR Hyderabad, India
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72
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Potential host-related risk factors for recurrent urinary tract infection in Saudi women of childbearing age. Int Urogynecol J 2016; 27:1245-53. [PMID: 26872648 DOI: 10.1007/s00192-016-2965-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 01/20/2016] [Indexed: 10/22/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Risk factors for recurrent urinary tract infection (rUTI) in women may differ between individuals, age, and the community. This study aimed to evaluate host related risk factors for rUTI in sexually active Saudi women during the childbearing period. METHODS A case-control study was conducted in five healthcare centers and included married, nonpregnant women aged 18-40 years. A total of 217 women had rUTI (cases) and 252 did not (controls). A validated questionnaire, with a face-to-face interview, was applied to assess various demographic, behavioral, medical, and sexual data. Additionally, a thorough physical examination, saliva and blood analyses, uroflowmetry, and genitourinary ultrasonography were performed. Multivariate logistic regression analysis was used to identify the significant host related risk factors associated with rUTI. RESULTS In multivariate analysis, attributable risks for rUTI were a history of childhood UTI [odds ratio (OR) = 6.8)] back-to-front douching/wiping after bowel movement (OR = 2.6), younger age at first intercourse (OR = 6.3), increased frequency of sexual intercourse (OR = 4.8), obstructed urinary flow (OR = 1.9), and genital prolapse (OR = 3.4). A total of 9.68 % of cases and none of the controls had high postvoid residual urine (positive predictive value for rUTI = 100 %). CONCLUSIONS This is the first reported study to evaluate host related risk factors for rUTI in childbearing-age women in Saudi Arabia. Study findings indicate the association between rUTI and various factors that have been already established, with addition of improper rectal hygiene as a potential risk for recurrence.
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73
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Urinary Tract Infections in Women: Pathogenesis, Diagnosis, and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0351-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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74
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Rocha RM, Zanni PCMD, de Souza Bonfim-Mendonça P, Gimenes F, Alczuk SSD, Svidzinski TIE, Consolaro MEL. Effect of norfloxacin therapy for acute, uncomplicated lower urinary tract infection on vaginal Candida prevalence. Int Urogynecol J 2015; 27:773-80. [PMID: 26564224 DOI: 10.1007/s00192-015-2884-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Accepted: 10/26/2015] [Indexed: 11/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Acute uncomplicated lower urinary tract infections (UTI) and vulvovaginal candidiasis (VVC) both occur frequently in women. Although VVC is believed to commonly occur after antibiotic therapy, few studies have demonstrated this association. Thus, the aim of the study was to estimate the prevalence of colonization by Candida spp. and VVC after norfloxacin (NOR) use for UTI and the effects on the vaginal microbiota and inflammatory process. METHODS This was a prospective cohort study of women with culture-proven UTI who were treated with NOR (antibiotic group). The control group consisted of women with noninfectious diseases or in preventive care. Candida vaginal infections were monitored both clinically and mycologically at baseline and at the follow-up evaluation. RESULTS All women showed UTI remission after NOR treatment, and no woman in either group, antibiotic and control, showed symptoms of VVC. Both groups showed similar ratios of a positive Candida culture at baseline (6.7 % and 12.8 %, respectively) and at follow-up (3.3 % and 8.5 %, respectively) (p = 0.2768 and p = 0.5035, respectively). The antibiotic group showed no increased risk of Candida colonization or VVC after NOR treatment compared with the control group [odds ratio (OR) 0.556, 95 % confidence interval (CI) 0.2407-10.05]. CONCLUSIONS NOR was effective for UTI treatment, did not increase the risk of vaginal colonization by Candida or VVC, and did not lead to major disturbances of the vaginal microbiota.
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Affiliation(s)
- Rodrigo M Rocha
- Clinical Cytology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Pâmela C M Delvas Zanni
- Clinical Cytology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil.,Medical Mycology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Patrícia de Souza Bonfim-Mendonça
- Clinical Cytology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil.,Medical Mycology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Fabrícia Gimenes
- Clinical Cytology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | - Silvia S Dantas Alczuk
- Clinical Cytology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil.,Medical Mycology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil
| | | | - Márcia E Lopes Consolaro
- Clinical Cytology Laboratory, Department of Clinical Analysis and Biomedicine, State University of Maringá, Paraná, Brazil. .,Departamento de Análises Clínicas e Biomedicina, Universidade Estadual de Maringá, Av. Colombro, 5790, Maringá, Paraná, 87020-900, Brazil.
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