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Genotyping and phenotyping patterns of Escherichia coli from UTI specimens from patients referred to the urology ward of Baqiyatallah hospital. GENE REPORTS 2020. [DOI: 10.1016/j.genrep.2020.100594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Karami N, Lindblom A, Yazdanshenas S, Lindén V, Åhrén C. Recurrence of urinary tract infections with extended-spectrum β-lactamase-producing Escherichia coli caused by homologous strains among which clone ST131-O25b is dominant. J Glob Antimicrob Resist 2020; 22:126-132. [PMID: 32061816 DOI: 10.1016/j.jgar.2020.01.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 01/24/2020] [Accepted: 01/28/2020] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Bacterial features associated with recurrent urinary tract infections (RUTIs) due to extended-spectrum β-lactamase-producingEscherichia coli (ESBL-E. coli) are not well understood. In this study, phylogenetic groups and ST131 subclones were investigated to assess strain homology of ESBL-E. coli isolates in patients with RUTIs in inpatient and outpatient settings in western Sweden. METHODS Almost all isolates (319/356) from 123 patients with 2-7 episodes (median 2 episodes) of ESBL-E. coli UTI within 1 year were examined for seven E. coli phylogroups, the ST131-O25b clone and its subclone fimH30-Rx. Antimicrobial resistance and ESBL genes were determined for the index isolates. A subset of isolates was typed using pulsed-field gel electrophoresis (PFGE). RESULTS The same phylogroup and ST131 subclones were seen for all recurrences in 119/123 patients, and PFGE confirmed strain homology in recurrences for 43/44 patients tested. Phylogroup B2 dominated (56%), followed by D (19%) and F (10%). ST131-O25b andfimH30-Rx isolates were detected in 44% and 30%, respectively. CTX-M group 1 (71%) predominated. Elderly patients were in the majority. There were no associations between patient demographics or time to recurrence and bacterial characteristics. The fimH30-Rx subclone was associated with a higher number of recurrences (P = 0.015) compared with the remaining B2 isolates. CONCLUSION In ESBL-E. coli RUTI, most recurrences were caused by the initial infecting strain. The high frequency of the multidrug-resistant fimH30-Rx subclone and its association with multiple recurrences warrants further attention and early detection of this subclone in patients at risk of developing RUTI with ESBL-E. coli.
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Affiliation(s)
- Nahid Karami
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Anna Lindblom
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden; Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Shora Yazdanshenas
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Viktoria Lindén
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Christina Åhrén
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden; Swedish Strategic Program against Antimicrobial Resistance (Strama), Region Västra Götaland, Gothenburg, Sweden
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Nabi T. Clinical profile and risk factors of recurrent urinary tract infection in patients with type 2 diabetes. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2020. [DOI: 10.4103/ijam.ijam_83_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Zhang F, Bai J, Zheng Y, Liang S, Lei L, Deng X, Li W, Liu P, Yang G, Ren Y. Investigation of the Optimum Preparation of Peach Gum Polysaccharides and the In Vivo and In Vitro Therapeutic Effects on Acute Pyelonephritis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2019; 2019:2729343. [PMID: 31911807 PMCID: PMC6930766 DOI: 10.1155/2019/2729343] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/24/2019] [Accepted: 11/02/2019] [Indexed: 12/15/2022]
Abstract
BACKGROUND Acute pyelonephritis (APN), known as stranguria in traditional Chinese medicine, is commonly treated with antibiotics. However, the rise in antibiotic resistance and the high rates of recurrence of APN make its treatment complicated, thus the development of alternative therapies is critical. Peach gum has long been recognized by traditional Chinese medicine as a food with medicinal value of relieving stranguria, but whether and how its primary constituent peach gum polysaccharides (PGPs) contribute to the diuretic function is still not clear. PURPOSE The aim of this study was to investigate the optimum extraction process of PGPs and to evaluate its therapeutic effect on APN rats and to discover the underlying mechanism. METHODS In this study, surface design optimization was adopted to optimize the preparation of PGPs and HPLC and FT-IR spectra were used to evaluate the quality of PGPs; APN model rat was established by the Escherichia coli urinary tract infection method; the therapeutic effect and mechanism of PGPs on APN were determined by the visceral index, biochemical indicators, pathological section of the APN rat, and diuretic activity on mice and antibacterial activity in vitro. RESULTS Compared with an untreated APN group, the results showed that treatment with PGPs increased the APN-induced attenuation of secretory immunoglobulin A (sIgA) and creatinine clearance and decreased the APN-induced enhancement of the number of white blood cell (WBC), neutrophil counts (NC), bacteria load of the kidneys, kidney index, serum creatinine, urine volume, blood urea nitrogen (BUN), and interleukin-2 (IL-2) levels. The mechanism underlying these effects was further elucidated through in vitro experiments of the antibacterial and antiadhesion effects of PGPs. CONCLUSION Due to the good therapeutic effects and advantages of PGPs, it could be considered as an alternative medicine to treat APN.
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Affiliation(s)
- Feifei Zhang
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Jie Bai
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Yao Zheng
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Shuai Liang
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Lei Lei
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Xin Deng
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Weijun Li
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Peng Liu
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Guangzhong Yang
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
| | - Yongshen Ren
- School of Pharmaceutical Science, South-Central University for Nationalities, Wuhan 430074, China
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Tseng CS, Chang SJ, Meng E, Chang HC, Lee YJ. The efficacy of pentosan polysulfate monotherapy for preventing recurrent urinary tract infections in women: A multicenter open-label randomized controlled trial. J Formos Med Assoc 2019; 119:1314-1319. [PMID: 31813658 DOI: 10.1016/j.jfma.2019.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/23/2019] [Accepted: 11/12/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/PURPOSE Pentosan polysulfate sodium (PPS), a semi-synthetic polysaccharide that adheres to bladder mucosa, is effective in treating interstitial cystitis. We evaluated the clinical benefit of PPS for the prevention of recurrent urinary tract infection (UTI) in women. METHODS We conducted a multicenter, open-label, prospective, phase II, randomized controlled trial enrolling women with recurrent UTI ≥ 2 times in the past 6 months or ≥ 3 times in the past 12 months. Patients received oral PPS monotherapy for 16 weeks in treatment group. All patients were followed every 28 days until UTI recurrence or up to 112 days. The primary endpoint was the UTI recurrence-free survival. Adverse events were recorded as secondary endpoint. RESULTS A total of 26 women were eligible for analysis. In the PPS group, none (0%) of the 12 patients had UTI recurrence during the study period. However, 9 (64%) of 14 patients had UTI recurrence in the control group. The UTI recurrence-free survival was significantly higher in the PPS group than in the control group (log-rank test p = 0.0004). One adverse event which led to discontinuation of the trial regimen was regarded as irrelevance of PPS treatment. The limitation was the small number of cases. CONCLUSION Among women with recurrent UTI, 16-week PPS monotherapy significantly reduced UTI recurrence when compared with the control group.
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Affiliation(s)
- Chi-Shin Tseng
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Shang-Jen Chang
- Department of Urology, Taipei Tzu Chi Hospital, New Taipei, Taiwan
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hong-Chiang Chang
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Yuan-Ju Lee
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Scarneciu I, Bungau S, Lupu AM, Scarneciu CC, Bratu OG, Martha O, Tit DM, Aleya L, Lupu S. Efficacy of instillation treatment with hyaluronic acid in relieving symptoms in patients with BPS/IC and uncomplicated recurrent urinary tract infections - Long-term results of a multicenter study. Eur J Pharm Sci 2019; 139:105067. [DOI: 10.1016/j.ejps.2019.105067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 12/27/2022]
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Incidence and Antibiotics Resistance of Staphylococci and Escherichia coli Isolated from Diabetic Urinary Tract Infection Patients in Egypt. JOURNAL OF PURE AND APPLIED MICROBIOLOGY 2019. [DOI: 10.22207/jpam.13.3.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Abstract
Urinary tract infections (UTIs) are highly prevalent, lead to considerable patient morbidity, incur large financial costs to health-care systems and are one of the most common reasons for antibiotic use worldwide. The growing problem of antimicrobial resistance means that the search for nonantibiotic alternatives for the treatment and prevention of UTI is of critical importance. Potential nonantibiotic measures and treatments for UTIs include behavioural changes, dietary supplementation (such as Chinese herbal medicines and cranberry products), NSAIDs, probiotics, D-mannose, methenamine hippurate, estrogens, intravesical glycosaminoglycans, immunostimulants, vaccines and inoculation with less-pathogenic bacteria. Some of the results of trials of these approaches are promising; however, high-level evidence is required before firm recommendations for their use can be made. A combination of these agents might provide the optimal treatment to reduce recurrent UTI, and trials in specific population groups are required.
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Thänert R, Reske KA, Hink T, Wallace MA, Wang B, Schwartz DJ, Seiler S, Cass C, Burnham CA, Dubberke ER, Kwon JH, Dantas G. Comparative Genomics of Antibiotic-Resistant Uropathogens Implicates Three Routes for Recurrence of Urinary Tract Infections. mBio 2019; 10:e01977-19. [PMID: 31455657 PMCID: PMC6712402 DOI: 10.1128/mbio.01977-19] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 08/06/2019] [Indexed: 11/20/2022] Open
Abstract
The rise of antimicrobial resistance in uropathogens has complicated the management of urinary tract infections (UTIs), particularly in patients who are afflicted by recurrent episodes of UTIs. Antimicrobial-resistant (AR) uropathogens persistently colonizing individuals at asymptomatic time points have been implicated in the pathophysiology of UTIs. The dynamics of uropathogen persistence following the resolution of symptomatic disease are, however, mostly unclear. To further our understanding, we determined longitudinal AR uropathogen carriage and clonal persistence of uropathogenic Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae isolates in the intestinal and urinary tracts of patients affected by recurrent and nonrecurrent UTIs. Clonal tracking of isolates in consecutively collected urine and fecal specimens indicated repeated transmission of uropathogens between the urinary tract and their intestinal reservoir. Our results further implicate three independent routes of recurrence of UTIs: (i) following an intestinal bloom of uropathogenic bacteria and subsequent bladder colonization, (ii) reinfection of the urinary tract from an external source, and (iii) bacterial persistence within the urinary tract. Taken together, our observation of clonal persistence following UTIs and uropathogen transmission between the intestinal and urinary tracts warrants further investigations into the connection between the intestinal microbiome and recurrent UTIs.IMPORTANCE The increasing antimicrobial resistance of uropathogens is challenging the continued efficacy of empiric antibiotic therapy for UTIs, which are among the most frequent bacterial infections worldwide. It has been suggested that drug-resistant uropathogens could persist in the intestine after the resolution of UTI and cause recurrences following periurethral contamination. A better understanding of the transmission dynamics between the intestinal and urinary tracts, combined with phenotypic characterization of the uropathogen populations in both habitats, could inform prudent therapies designed to overcome the rising resistance of uropathogens. Here, we integrate genomic surveillance with clinical microbiology to show that drug-resistant clones persist within and are readily transmitted between the intestinal and urinary tracts of patients affected by recurrent and nonrecurrent UTIs. Thus, our results advocate for understanding persistent intestinal uropathogen colonization as part of the pathophysiology of UTIs, particularly in patients affected by recurrent episodes of symptomatic disease.
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Affiliation(s)
- Robert Thänert
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kimberly A Reske
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Tiffany Hink
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Meghan A Wallace
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Bin Wang
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Drew J Schwartz
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Sondra Seiler
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Candice Cass
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C A Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Erik R Dubberke
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennie H Kwon
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri, USA
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri, USA
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Yu L, O'Brien VP, Livny J, Dorsey D, Bandyopadhyay N, Colonna M, Caparon MG, Roberson EDO, Hultgren SJ, Hannan TJ. Mucosal infection rewires TNFɑ signaling dynamics to skew susceptibility to recurrence. eLife 2019; 8:46677. [PMID: 31429405 PMCID: PMC6701943 DOI: 10.7554/elife.46677] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/20/2019] [Indexed: 12/20/2022] Open
Abstract
A mucosal infectious disease episode can render the host either more or less susceptible to recurrent infection, but the specific mechanisms that tip the balance remain unclear. We investigated this question in a mouse model of recurrent urinary tract infection and found that a prior bladder infection resulted in an earlier onset of tumor necrosis factor-alpha (TNFɑ)-mediated bladder inflammation upon subsequent bacterial challenge, relative to age-matched naive mice. However, the duration of TNFɑ signaling activation differed according to whether the first infection was chronic (Sensitized) or self-limiting (Resolved). TNFɑ depletion studies revealed that transient early-phase TNFɑ signaling in Resolved mice promoted clearance of bladder-colonizing bacteria via rapid recruitment of neutrophils and subsequent exfoliation of infected bladder cells. In contrast, sustained TNFɑ signaling in Sensitized mice prolonged damaging inflammation, worsening infection. This work reveals how TNFɑ signaling dynamics can be rewired by a prior infection to shape diverse susceptibilities to future mucosal infections.
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Affiliation(s)
- Lu Yu
- Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, United States
| | - Valerie P O'Brien
- Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, United States
| | - Jonathan Livny
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, United States
| | - Denise Dorsey
- Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, United States
| | - Nirmalya Bandyopadhyay
- The Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, United States
| | - Marco Colonna
- Department of Pathology and Immunology, Washington University School of Medicine, St Louis, United States
| | - Michael G Caparon
- Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, United States
| | - Elisha DO Roberson
- Department of Medicine, Division of Rheumatology, Washington University School of Medicine, St Louis, United States.,Department of Genetics, Washington University School of Medicine, St Louis, United States
| | - Scott J Hultgren
- Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, United States
| | - Thomas J Hannan
- Department of Molecular Microbiology and Center for Women's Infectious Disease Research, Washington University School of Medicine, St Louis, United States.,Department of Pathology and Immunology, Washington University School of Medicine, St Louis, United States
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De Nisco NJ, Neugent M, Mull J, Chen L, Kuprasertkul A, de Souza Santos M, Palmer KL, Zimmern P, Orth K. Direct Detection of Tissue-Resident Bacteria and Chronic Inflammation in the Bladder Wall of Postmenopausal Women with Recurrent Urinary Tract Infection. J Mol Biol 2019; 431:4368-4379. [PMID: 31002774 DOI: 10.1016/j.jmb.2019.04.008] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 04/05/2019] [Accepted: 04/05/2019] [Indexed: 02/02/2023]
Abstract
Urinary tract infections (UTIs) are the most commonly reported infections in adult women and have high rates of recurrence, especially in postmenopausal women. Recurrent UTI (RUTI) greatly reduces quality of life, places a significant burden on the healthcare system, and contributes to antimicrobial resistance. Because treatment of RUTI by long-term antibiotic therapy is often ineffective or poorly tolerated in elderly women, new therapies must be developed. The molecular basis of RUTI, especially in postmenopausal women, has remained unclear because modeling RUTI in mice is difficult, and human data are limited. Invasion of the urothelium and induction of host inflammation are hypothesized to be key mechanisms by which bacterial pathogens cause RUTI. To further our understanding of RUTI in humans, we performed a systematic analysis of urine and bladder biopsy samples from postmenopausal women undergoing cystoscopy with fulguration of trigonitis in the advanced management of antibiotic-refractory RUTI. We provide direct evidence that bacteria reside in the bladder wall of postmenopausal RUTI patients and that diverse bacterial species can be isolated from the bladder tissue. Histopathological scoring revealed significant edema and alterations of urothelial architecture in RUTI patient biopsies. Lymphocytes, including plasma B-cells, were detected within the mesenchyme, urothelium, and follicular aggregates in the majority of patients, indicating that the local adaptive immune response is active during human RUTI. These data provide conclusive evidence that bacteria invade the human urothelium and suggest that diverse bacterial species and the adaptive immune response play important roles in RUTI in humans.
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Affiliation(s)
- Nicole J De Nisco
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
| | - Michael Neugent
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Jason Mull
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Luming Chen
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Amy Kuprasertkul
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Marcela de Souza Santos
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kelli L Palmer
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX 75080, USA
| | - Philippe Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA
| | - Kim Orth
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA; Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA.
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Definition of Recurrent Urinary Tract Infections in Women: Which One to Adopt? Female Pelvic Med Reconstr Surg 2019; 24:424-429. [PMID: 29135809 DOI: 10.1097/spv.0000000000000509] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to systematically review the various definitions of recurrent urinary tract infection (RUTI) recommended by experts and specialty societies cited in biomedical literature. METHODS A systematic review of RUTI in women was conducted using MEDLINE, EMBASE, and PubMed between 1966 and 2016 according to the Preferred Reporting Items for Systematic Review and Meta-Analyses Statement. Twenty-five publications were selected for inclusion in this analysis. RESULTS From review of included publications, 14 definitions of RUTI were obtained. Each source was searched for a textual definition of RUTI as well as presence or absence of specific key elements including urinary symptoms, colony forming unit count, bacterial species, number of UTIs per year, interval time between infections and a negative intervening culture. All data were reviewed by 2 separate investigators. The definition of RUTI was found highly variable in the literature. The tallying of key elements in included definitions suggests that a minimum RUTI definition should include urinary symptoms, urine culture colony forming unit/mL threshold, differentiation of bacterial persistence versus reinfection by bacterial species, and number of UTIs per year. CONCLUSIONS This review of major RUTI definition recommendations by expert individuals and specialty societies underlines the lack of uniformity and the need for a more robust and generally agreeable RUTI definition for use in clinical and academic practice.
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Associations between antibiotic prescriptions and recurrent urinary tract infections in female college students. Epidemiol Infect 2019; 147:e119. [PMID: 30869014 PMCID: PMC6518459 DOI: 10.1017/s0950268818003369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Urinary tract infections (UTIs) are common among college-aged women and often recur. Some antibiotics recommended to treat UTIs trigger dysbiosis of intestinal and vaginal microbiomes - where uropathogens originate, though few studies have investigated associations between these therapies with recurrent infections. We retrospectively analysed the electronic medical records of 6651 college-aged women diagnosed with a UTI at a US university student health centre between 2006 and 2014. Women were followed for 6 months for incidence of a recurrent infection. In a secondary analysis, associations in women whose experienced UTI recurrence within 2 weeks were also considered for potential infection relapse. Logistic regression was used to assess associations between infection recurrence or relapse and antibiotics prescribed, in addition to baseline patient characteristics including age, race/ethnicity, region of origin, year of encounter, presence of symptomology, pyelonephritis, vaginal coinfection and birth control consultation. There were 1051 instances of infection recurrence among the 6620 patients, indicating a prevalence of 16%. In the analysis of patient characteristics, Asian women were statistically more likely to experience infection recurrence whereas African American were less likely. No significant associations were identified between the antibiotic administered at the initial infection and the risk of infection recurrence after multivariable adjustment. Treatment with trimethoprim-sulphamethoxazole and being born outside of the USA were significantly associated with increased odds of infection relapse in the multivariate analysis. The results of the analyses suggest that treatment with trimethoprim-sulphamethoxazole may lead to an increased risk of UTI relapse, warranting further study.
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Ahn ST, Kim SW, Kim JW, Park HS, Moon DG, Oh MM. Does urinary tract infection caused by extended-spectrum β-lactamase-producing Escherichia coli show same antibiotic resistance when it recurs? J Infect Chemother 2019; 25:498-502. [PMID: 30852104 DOI: 10.1016/j.jiac.2019.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 01/22/2019] [Accepted: 02/12/2019] [Indexed: 11/25/2022]
Abstract
This study was performed to evaluate what percentage of urinary tract infections (UTIs) caused by extended spectrum β-lactamase (ESBL)-producing strains recurs with ESBL-producing strains during follow up and to assess the risk factors for recurrence with ESBL-producing Escherichia coli strains on subsequent first recurrence episode. We enrolled female patients with UTIs caused by ESBL-producing E. coli between May 2012 and December 2015, who were longitudinally followed up for at least 24 months. Among the 206 patients with ESBL positive UTI, 180 completed the study. 60 (60/180, 33.3%) of patient with first episode of UTI caused by ESBL-producing E. coli experienced recurrent UTIs during follow up. Of 60 patients, 43 (43/60, 71.7%) recurred with ESBL-producing E. coli on the first UTI recurrence episode. On multivariate analysis, the time to recurrence and history of cephalosporin usage in the last 6 months were identified as risk factors for recurrence with ESBL-producing E. coli per se (odds ratio [OR] = 0.9, 95% confidence interval [CI] 0.8-1.0, p = 0.030 and OR = 27.0, 95% CI 2.4-299.8, p = 0.007, respectively). These findings show that high proportion of patient with UTI caused by ESBL-producing E. coli recurs with ESBL-producing E. coli on subsequent recurrence episode. While result of antibiotic susceptibility cannot be identified on the visit day empirical treatment should be referred to the antecedent antibiotic resistance profile in patients whose previous UTIs were due to ESBL-producing strains.
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Affiliation(s)
- Sun Tae Ahn
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Sang Woo Kim
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Jong Wook Kim
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Hong Seok Park
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Du Geon Moon
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea
| | - Mi Mi Oh
- Department of Urology, Korea University Guro Hospital, #148 Gurodong-ro, Guro-gu, Seoul, 152-703, South Korea.
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[CORRESPONDENCE OF POLYMICROBIAL BACTERIURIA IN THE UNCOMPLICATED URINARY TRACT INFECTION OF THE PREMENOPAUSAL WOMAN]. Nihon Hinyokika Gakkai Zasshi 2019; 108:24-29. [PMID: 29367505 DOI: 10.5980/jpnjurol.108.24] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
(Objectives) We report the clinical features about polymicrobial bacteria detection cases in the uncomplicated urinary tract infection of the premenopausal woman from the voided midstream urine culture. (Methods) We retrospectively reviewed the premenopausal woman from 18-49 years patients visited Sendai City Hospital from April, 2006 to December, 2014, diagnosed uncomplicated cystitis or uncomplicated pyelonephritis. We analyzed for 375 specimens from the voided midstream urine culture. (Results) Among 375 specimens, the urine culture-positive for uropathogens were 211 specimens. The monomicrobial bacterial were detected in 184 specimens (87.2%) and polymicrobial bacterial specimens were 27 specimens (12.8%). The most combination group was the caused bacteria and periurethral microorganisms in 20 specimens (74.1%). Then 6 periurethral microorganisms specimens (22.2%), the caused bacteria were only 1 specimen was overlapped (3.7%). The case of urinary tract infections recurrence or revealed voiding dysfunction that need periodic treatment were more prevalent in the polymicrobial than the monomicrobial group (22.2% vs 9.8%, p=0.043). (Conclusions) When polymicrobial bacteria were detected in uncomplicated urinary tract infection in premenopausal woman, it was confirmed that there were the most combinations of caused bacteria and periurethral microorganisms. In these cases, treatment intended for only the caused bacteria. A risk of the infection recurrence and voiding dysfunction were statistically significant higher rate in the polymicrobial bacteria detection cases, and it might be necessary to consider that search to complicated urinary tract infection.
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Patient Distress in Women with Recurrent Urinary Tract Infections: How Can Physicians Better Meet Patients Needs? Curr Urol Rep 2018; 19:97. [PMID: 30338430 DOI: 10.1007/s11934-018-0849-1] [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] [Indexed: 10/28/2022]
Abstract
PURPOSE OF REVIEW Recurrent urinary tract infections are a common condition that can impact patients' quality of life. The purpose of this review is to summarize and analyze the literature regarding the distress that these infections can cause to patients and provide guidance to clinicians on how to improve care of these patients. RECENT FINDINGS The current literature on patient perspectives in urinary tract infections shows an emotional symptom experience that is not consistent with the typical symptoms expected by clinicians. The infections can impact all aspects of quality of life, including social, emotional, and financial domains. Women with recurrent urinary tract infections experience a significant amount of distress. They have a strong desire for validation of their experiences by their physicians. Clinicians can best serve these patients by understanding the true impact of their condition and creating treatment strategies that include shared decision making to meet patients' goals.
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Akgül T, Karakan T. The role of probiotics in women with recurrent urinary tract infections. Turk J Urol 2018; 44:377-383. [PMID: 30487041 DOI: 10.5152/tud.2018.48742] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 06/18/2018] [Indexed: 12/21/2022]
Abstract
Urinary tract infections (UTIs) still represent a significant bother for women and result in high costs to the health system. Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent UTIs. Evidence shows that the microorganisms inhabit many sites of the body, including the urinary tract which has long been assumed to be sterile in healthy individuals, might have a role in maintaining urinary health. Studies of the urinary microbiota (UM) have identified remarkable differences between healthy populations and those with urologic diseases. The depletion of these organisms in women susceptible to UTIs raised the question of whether artificial supplementation of these microorganisms as probiotics could lower infection rates. In the literature, probiotic interventions were shown to have some efficacy in the treatment and prevention of urogenital infections. Despite previous controversy regarding the use of probiotics, as treatment for UTIs, there are increasing signs that it may be possible to use them as a first step in regulating the UM so as to reduce the risk of or as a treatment for certain urinary diseases. However, further future clinical trials, involving large numbers of patients, will be mandatory to achieve definite evidence of the preventive and curative role of probiotics in UTIs. Details about correct formulations in terms of amount of bacteria, viability and associated growth factors, will be required in order to standardize the administration schedule and achieve homogeneous and comparable results on selected patients.
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Affiliation(s)
- Turgay Akgül
- Department of Urology, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
| | - Tolga Karakan
- Department of Urology, University of Health Sciences Ankara Training and Research Hospital, Ankara, Turkey
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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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Goddard JC, Janssen DAW. Intravesical hyaluronic acid and chondroitin sulfate for recurrent urinary tract infections: systematic review and meta-analysis. Int Urogynecol J 2018; 29:933-942. [PMID: 29181550 PMCID: PMC6004275 DOI: 10.1007/s00192-017-3508-z] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 11/01/2017] [Indexed: 12/02/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to assess the efficacy of intravesical hyaluronic acid (HA) and chondroitin sulfate (CS), alone or in combination, for recurrent urinary tract infections (RUTIs) in adult female patients using a systematic review and meta-analysis. METHODS English-language articles were obtained from the MEDLINE, Embase, and Cochrane databases through November 2016, by manual searching and cross-referencing. Randomized and nonrandomized trials of adult female patients with a documented history of RUTIs who received HA, CS or HA plus CS were included. The random effects model was applied to all pooled analyses. Risk of bias was assessed for individual studies and across studies. RESULTS Two randomized (n = 85) and six nonrandomized (n = 715) studies met the inclusion criteria. These studies assessed HA ± CS; studies of CS alone were not identified in the search. HA ± CS decreased the UTI rate per patient-year (pooled mean difference [MD] -2.56; 95% confidence interval [CI] -3.86, -1.26; p < 0.001) and increased the time to first UTI recurrence (pooled MD 130.05 days; 95% CI 5.84, 254.26; p = 0.04). There was heterogeneity in most outcomes considered, and publication bias in many studies. The standard of trial reporting was low. The patient population size, and the number of studies included, were small. CONCLUSIONS HA ± CS appears to reduce the rate of UTI and increase the time to recurrence in women with RUTI. As randomized controlled studies are available only for HA plus CS, the quality of evidence is higher for the combination than for HA alone.
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Affiliation(s)
| | - Dick A W Janssen
- Department of Urology, Radboud University Medical Center, Geert Grootteplein Zuid 10, 6525, Nijmegen, GA, Netherlands.
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Lindblom A, Karami N, Magnusson T, Åhrén C. Subsequent infection with extended-spectrum β-lactamase-producing Enterobacteriaceae in patients with prior infection or fecal colonization. Eur J Clin Microbiol Infect Dis 2018; 37:1491-1497. [PMID: 29796984 DOI: 10.1007/s10096-018-3275-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
Abstract
In clinical practice, there is a growing need to assess the impact of prior colonization or infection with extended-spectrum β-lactamase-producing Enterobacteriaceae (EPE) on new EPE infections. We have investigated the frequency of, and duration to, a subsequent EPE infection in patients with prior fecal carriage or infection with EPE. Culture data for 3272 EPE-positive patients in Western Sweden during 2004-2014 were evaluated. The median follow-up time was 3.7 years. The first recorded EPE-positive fecal screen, or clinical (urine, blood) culture, and subsequent EPE-positive clinical samples were analyzed, focusing on the first and last recurrence of EPE infection. ESBL Escherichia coli dominated (95%). Almost all (94%) patients initially positive in fecal screen (n = 1436) and 72 and 71% of those initially positive in urine (n = 1717) and blood (n = 119) had no further EPE clinical isolates. Subsequent EPE bacteremia was only detected in 0.7, 1.6, and 4.2% of the respective patient group. Recurrent EPE-positive urine cultures occurred in 27% (460/1717), most (75%) within 6 months, and rarely (13%) after 1 year. Repeated EPE-positive clinical samples were significantly (p < 0.01) more common in patients > 65 years and in men with ESBL Klebsiella pneumoniae. In our low-endemic setting, subsequent EPE infections in previously colonized patients were rare. On the other hand, in patients previously EPE-positive in urine or blood, subsequent EPE urinary tract infections were common, especially within 6 months and in patients > 65 years old.
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Affiliation(s)
- Anna Lindblom
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden. .,Department of Clinical Microbiology, Sahlgrenska University Hospital, Guldhedsgatan 10 A, 413 46, Gothenburg, Sweden.
| | - Nahid Karami
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Department of Clinical Microbiology, Sahlgrenska University Hospital, Guldhedsgatan 10 A, 413 46, Gothenburg, Sweden
| | - Tim Magnusson
- Department of Clinical Microbiology, Sahlgrenska University Hospital, Guldhedsgatan 10 A, 413 46, Gothenburg, Sweden
| | - Christina Åhrén
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy and Centre for Antibiotic Resistance Research (CARe), University of Gothenburg, Gothenburg, Sweden.,Swedish Strategic Program Against Antimicrobial Resistance (Strama), Region Västra Götaland, Gothenburg, Sweden
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71
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Ennis SS, Guo H, Raman L, Tambyah PA, Chen SL, Tiong HY. Premenopausal women with recurrent urinary tract infections have lower quality of life. Int J Urol 2018; 25:684-689. [PMID: 29788547 DOI: 10.1111/iju.13698] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Accepted: 03/30/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To examine the impact on quality of life of recurrent acute uncomplicated urinary tract infection among premenopausal Singaporean women, and to determine the risk factors for lower quality of life among these patients. METHODS A total of 85 patients with recurrent acute uncomplicated urinary tract infection who were referred to the Urology Department at the National University Hospital, Singapore, were prospectively recruited over a 3-year period to complete the validated Short Form 36 Health Survey version 1. In addition, demographic and clinical details including symptomology and medical history were analyzed for factors impacting quality of life. Short Form 36 Health Survey version 1 results were compared with published population norms. RESULTS After adjusting for age, gender and race, recurrent acute uncomplicated urinary tract infection patients had significantly lower quality of life on seven out of eight Short Form 36 Health Survey version 1 domains when compared with age-, gender- and race-adjusted population norms for Singapore. Among those with recurrent acute uncomplicated urinary tract infection, those who also reported caffeine consumption had significantly lower Short Form 36 Health Survey version 1 scores than those who did not. Those who reported chronic constipation also had consistently lower Short Form 36 Health Survey version 1 scores across all domains. CONCLUSIONS Recurrent acute uncomplicated urinary tract infection has a negative impact on the quality of life of premenopausal, otherwise healthy women. Recurrent acute uncomplicated urinary tract infection patients who also have chronic constipation or consume caffeine have lower quality of life than those who do not. More studies are required to understand the relationships between these common problems and risk factors.
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Affiliation(s)
- Siobhan S Ennis
- GERMS and Infectious Diseases Group, Genome Institute of Singapore, Singapore
| | - Huifang Guo
- Department of Urology, National University Health System, Singapore
| | - Lata Raman
- Department of Urology, National University Health System, Singapore
| | - Paul A Tambyah
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Swaine L Chen
- GERMS and Infectious Diseases Group, Genome Institute of Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Health System, Singapore
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Liu JM, Chang YL, Hsu RJ, Su HY, Teng SW, Chang FW. The climate impact on female acute pyelonephritis in Taiwan: A population-based study. Taiwan J Obstet Gynecol 2018; 56:437-441. [PMID: 28805597 DOI: 10.1016/j.tjog.2016.06.022] [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] [Accepted: 06/13/2016] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE Urinary tract infection (UTI) is the main reason of community-acquired infection which causes large losses in social economy. The individual as well as climate factors make changes on the incidence. Acute pyelonephritis (APN) is one of the most serious UTI in female. The object of our study is to analyze whether climate factors will have effect on the incidence of female APN in Taiwan. MATERIALS AND METHODS This study consisted of 14,568 female patients with APN from 2001 to 2013 in Taiwan and patients with repeated APN were excluded. The monthly climate data was collected from the Central Weather Bureau. The available monthly climate data included highest, lowest, and average level of temperatures, humidity, rainfall, total rain days, and sunshine hours. RESULTS The total incidence of female APN was 23.44 each 10,000 populations. The incidence of APN was positively correlated with temperature (r = 0.66), sunshine hours (r = 0.45), rainfall (r = 0.42), rain days (r = 0.29), and humidity (r = 0.23) per month. There is the strongest correlation between the average monthly temperature and the incidence of APN (β = 0.54). The correlation with the incidence of APN was also followed by rain days (β = 0.28) and humidity (β = 0.27). CONCLUSION There is a significant expression on the incidence of female APN affected by seasonality and climate parameters. The monthly average temperature has the strongest correlation with female APN. The results of this research may facilitate the potential preventive strategies on female APN.
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Affiliation(s)
- Jui-Ming Liu
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Department of Medicine, National Yang-Ming University, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Lung Chang
- Division of Urology, Department of Surgery, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan; Department of Biomedical Engineering, College of Engineering, Chung Yuan Christian University, Chung Li, Taiwan; Department of Urology, National Yang-Ming University, School of Medicine, Taipei, Taiwan
| | - Ren-Jun Hsu
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; Biobank Management Center of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Department of Pathology and Graduate Institute of Pathology and Parasitology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Her-Young Su
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Sen-Wen Teng
- Department of Obstetrics and Gynecology, Cardinal Tien Hospital, Fu Jen Catholic University, Taipei, Taiwan
| | - Fung-Wei Chang
- Department of Obstetrics & Gynecology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
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Abstract
OBJECTIVE To provide an update of the definition, epidemiology, clinical presentation, investigation, treatment, and prevention of recurrent urinary tract infections in women. OPTIONS Continuous antibiotic prophylaxis, post-coital antibiotic prophylaxis, and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection. Vaginal estrogen and cranberry juice can also be effective prophylaxis alternatives. EVIDENCE A search of PubMed and The Cochrane Library for articles published in English identified the most relevant literature. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date restrictions. VALUES This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). OPTIONS Recurrent urinary tract infections need careful investigation and can be efficiently treated and prevented. Different prophylaxis options can be selected according to each patient's characteristics. RECOMMENDATIONS
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Reevaluation of the Acute Cystitis Symptom Score, a Self-Reporting Questionnaire. Part I. Development, Diagnosis and Differential Diagnosis. Antibiotics (Basel) 2018; 7:antibiotics7010006. [PMID: 30720775 PMCID: PMC5872117 DOI: 10.3390/antibiotics7010006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/16/2022] Open
Abstract
This study aimed to reevaluate the Acute Cystitis Symptom Score (ACSS). The ACSS is a simple and standardized self-reporting questionnaire for the diagnosis of acute uncomplicated cystitis (AC) assessing typical and differential symptoms, quality of life, and possible changes after therapy in female patients with AC. This paper includes literature research, development and evaluation of the ACSS, an 18-item self-reporting questionnaire including (a) six questions about "typical" symptoms of AC, (b) four questions regarding differential diagnoses, (c) three questions on quality of life, and (d) five questions on additional conditions that may affect therapy. The ACSS was evaluated in 228 women (mean age 31.49 ± 11.71 years) in the Russian and Uzbek languages. Measurements of reliability, validity, predictive ability, and responsiveness were performed. Cronbach's alpha for ACSS was 0.89, split-half reliability was 0.76 and 0.79 for first and second halves, and the correlation between them was 0.87. Mann-Whitney U test revealed a significant difference in scores of the "typical" symptoms between patients and controls (10.50 vs. 2.07, p < 0.001). The optimal threshold score was 6 points, with a 94% sensitivity and 90% specificity to predict AC. The "typical" symptom score decreased significantly when comparing before and after therapy (10.4 and 2.5, p < 0.001). The reevaluated Russian and Uzbek ACSS are accurate enough and can be recommended for clinical studies and practice for initial diagnosis and monitoring the process of the treatment of AC in women. Evaluation in German, UK English, and Hungarian languages was also performed and in other languages evaluation of the ACSS is in progress.
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75
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Soria Segarra C, Soria Baquero E, Cartelle Gestal M. High Prevalence of CTX-M-1-Like Enzymes in Urinary Isolates of Escherichia coli in Guayaquil, Ecuador. Microb Drug Resist 2018; 24:393-402. [PMID: 29298110 DOI: 10.1089/mdr.2017.0325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Escherichia coli is one of the major causes of urinary tract infections in primary healthcare, and treatment is more complicated due to the increase in antibiotic resistance. Extended-spectrum β-lactamases are the most common mechanism of resistance against third-generation cephalosporin, and CTX-M-like are among the most prevalent. The aim of our work is to investigate the prevalence of blaCTX-M in isolates of E. coli obtained from samples of patients without previous known contact with the hospital. Ninety-four E. coli isolates with resistance to third-generation cephalosporin were collected between 2008 and 2013 in Guayaquil, Ecuador. Polymerase chain reaction, followed by sequencing, was performed to identify the type of blaCTX-M-Like. Enterobacterial repetitive intergenic consensus (ERIC)-PCR was carried out to determine the clonal relationship between isolates. These results show an increase in resistance to third-generation cephalosporin from 10.58% to 23.96%. CTX-M-15 was the most prevalent mechanism of resistance being that the isolates were not clonal. Overall, these results show an increase in antibiotic resistance in the community over time, suggesting that more precise antibiotic stewardship needs to be implemented to control the dissemination of antibiotic-resistant bacteria in this region.
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Affiliation(s)
- Claudia Soria Segarra
- 1 Section of Bacteriology, Sosegar Clinical Laboratory , Guayaquil, Ecuador .,2 Faculty of Medical Sciences, University of Guayaquil , Guayaquil, Ecuador
| | | | - Monica Cartelle Gestal
- 3 Department of Infectious Diseases, Center for Vaccine and Immunology, University of Georgia , Athens, Georgia
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Schreiber HL, Conover MS, Chou WC, Hibbing ME, Manson AL, Dodson KW, Hannan TJ, Roberts PL, Stapleton AE, Hooton TM, Livny J, Earl AM, Hultgren SJ. Bacterial virulence phenotypes of Escherichia coli and host susceptibility determine risk for urinary tract infections. Sci Transl Med 2017; 9:9/382/eaaf1283. [PMID: 28330863 DOI: 10.1126/scitranslmed.aaf1283] [Citation(s) in RCA: 93] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 05/12/2016] [Accepted: 12/12/2016] [Indexed: 01/01/2023]
Abstract
Urinary tract infections (UTIs) are caused by uropathogenic Escherichia coli (UPEC) strains. In contrast to many enteric E. coli pathogroups, no genetic signature has been identified for UPEC strains. We conducted a high-resolution comparative genomic study using E. coli isolates collected from the urine of women suffering from frequent recurrent UTIs. These isolates were genetically diverse and varied in their urovirulence, that is, their ability to infect the bladder in a mouse model of cystitis. We found no set of genes, including previously defined putative urovirulence factors (PUFs), that were predictive of urovirulence. In addition, in some patients, the E. coli strain causing a recurrent UTI had fewer PUFs than the supplanted strain. In competitive experimental infections in mice, the supplanting strain was more efficient at colonizing the mouse bladder than the supplanted strain. Despite the lack of a clear genomic signature for urovirulence, comparative transcriptomic and phenotypic analyses revealed that the expression of key conserved functions during culture, such as motility and metabolism, could be used to predict subsequent colonization of the mouse bladder. Together, our findings suggest that UTI risk and outcome may be determined by complex interactions between host susceptibility and the urovirulence potential of diverse bacterial strains.
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Affiliation(s)
- Henry L Schreiber
- Department of Molecular Microbiology, Washington University, St. Louis, MO 63110, USA.,Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Matt S Conover
- Department of Molecular Microbiology, Washington University, St. Louis, MO 63110, USA
| | - Wen-Chi Chou
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Michael E Hibbing
- Department of Molecular Microbiology, Washington University, St. Louis, MO 63110, USA
| | - Abigail L Manson
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA
| | - Karen W Dodson
- Department of Molecular Microbiology, Washington University, St. Louis, MO 63110, USA
| | - Thomas J Hannan
- Department of Pathology and Immunology, Washington University, St. Louis, MO 63110, USA
| | - Pacita L Roberts
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Ann E Stapleton
- Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA 98195, USA
| | - Thomas M Hooton
- Division of Infectious Diseases, Department of Medicine, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Jonathan Livny
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA.
| | - Ashlee M Earl
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA 02142, USA.
| | - Scott J Hultgren
- Department of Molecular Microbiology, Washington University, St. Louis, MO 63110, USA. .,Center for Women's Infectious Disease Research, Washington University, St. Louis, MO 63110, USA
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Ismail MD, Ali I, Hatt S, Salzman EA, Cronenwett AW, Marrs CF, Rickard AH, Foxman B. Association of Escherichia coli ST131 lineage with risk of urinary tract infection recurrence among young women. J Glob Antimicrob Resist 2017; 13:81-84. [PMID: 29258889 DOI: 10.1016/j.jgar.2017.12.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 10/30/2017] [Accepted: 12/10/2017] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES The aim of this study was to test the hypothesis that urinary tract infections (UTIs) caused by Escherichia coli of the sequence type 131 (ST131) lineage are more likely to recur than UTIs caused by other E. coli lineages. METHODS Isolates from 221 young women with UTI caused by E. coli participating in a randomised controlled trial were used. Participants were followed for 6 months or until UTI recurrence. RESULTS Sequence type was not associated with risk of recurrence. Isolates in the ST131 lineage were more resistant than other STs to quinolones (6.2% vs. 1.3%) but not trimethoprim/sulfamethoxazole (15.4% vs. 15.0%). CONCLUSIONS These results do not support an increased risk of recurrent UTI among otherwise healthy women with UTI caused by E. coli ST131.
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Affiliation(s)
- Miriam D Ismail
- The Center for Molecular and Clinical Epidemiology of Infectious Diseases (MAC-EPID), Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA
| | - Ihsan Ali
- The Center for Molecular and Clinical Epidemiology of Infectious Diseases (MAC-EPID), Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA
| | - Savannah Hatt
- The Center for Molecular and Clinical Epidemiology of Infectious Diseases (MAC-EPID), Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA
| | - Elizabeth A Salzman
- The Center for Molecular and Clinical Epidemiology of Infectious Diseases (MAC-EPID), Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA
| | - Anna W Cronenwett
- The Center for Molecular and Clinical Epidemiology of Infectious Diseases (MAC-EPID), Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA
| | - Carl F Marrs
- The Center for Molecular and Clinical Epidemiology of Infectious Diseases (MAC-EPID), Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA
| | - Alexander H Rickard
- The Center for Molecular and Clinical Epidemiology of Infectious Diseases (MAC-EPID), Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA
| | - Betsy Foxman
- The Center for Molecular and Clinical Epidemiology of Infectious Diseases (MAC-EPID), Department of Epidemiology, University of Michigan, School of Public Health, Ann Arbor, MI 48109, USA.
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Maki KC, Nieman KM, Schild AL, Kaspar KL, Khoo C. The Effect of Cranberry Juice Consumption on the Recurrence of Urinary Tract Infection: Relationship to Baseline Risk Factors. J Am Coll Nutr 2017; 37:121-126. [PMID: 29111902 DOI: 10.1080/07315724.2017.1370398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to assess relationships between clinical predictors of urinary tract infection (UTI) and effects of cranberry juice consumption on recurrence in a post hoc analysis of a 24-week, randomized, double-blind, placebo-controlled, multicenter clinical trial in women with a recent history of UTI. METHODS Participants consumed a cranberry (n = 185) or placebo (n = 188) beverage (240 mL) daily. Odds ratios (OR) from 20 candidate predictor variables were evaluated in univariate analyses to assess clinical UTI incidence relationships in the placebo group. A multivariate logistic regression model was developed. The effects of cranberry juice consumption were evaluated in subsets categorized by the likelihood of a UTI event based on the prediction model. RESULTS In the placebo group, the final multivariate regression model identified four variables associated with the odds for having ≥ 1 UTI: intercourse frequency ≥ 1 time during the prior 4 weeks (OR: 2.36; 95% confidence interval [CI]: 0.98, 5.71; p = 0.057), use of vasectomy or hormonal methods for contraception (OR: 2.58; 95% CI: 1.20, 5.58; p = 0.016), most recent UTI < 90 days prior to screening (OR: 2.28; 95% CI; 1.12, 4.67; p = 0.024), and living in France compared with the United States (OR: 0.17; 95% CI: 0.04, 0.79; p = 0.024). Three propensity categories were investigated (24-week probability < 10%, 10%-21%, and > 21%). Incidence rate ratios for the cranberry vs placebo groups were 0.76 (95% CI: 0.22, 2.60; p = 0.663) for those with < 10% probability, 0.73 (95% CI: 0.35, 1.53; p = 0.064) for those with 10% to 21% probability, and 0.58 (95% CI: 0.35, 0.97; p = 0.039) for those with > 21% probability. CONCLUSIONS Results suggest that clinical predictors identify women with low and high risk of clinical UTI recurrence, which may be useful for design of clinical studies evaluating preventive therapies.
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Affiliation(s)
- Kevin C Maki
- a Midwest Biomedical Research/Center for Metabolic and Cardiovascular Health , Glen Ellyn , Illinois , USA
| | - Kristin M Nieman
- a Midwest Biomedical Research/Center for Metabolic and Cardiovascular Health , Glen Ellyn , Illinois , USA
| | - Arianne L Schild
- a Midwest Biomedical Research/Center for Metabolic and Cardiovascular Health , Glen Ellyn , Illinois , USA
| | - Kerrie L Kaspar
- b Ocean Spray Cranberries , Lakeville-Middleboro , Massachusetts , USA
| | - Christina Khoo
- b Ocean Spray Cranberries , Lakeville-Middleboro , Massachusetts , USA
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Epp A, Larochelle A. N° 250-Infection Récurrente Des Voies Urinaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e464-e474. [PMID: 28935070 DOI: 10.1016/j.jogc.2017.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Urinary tract infection (UTI) is one of the most common bacterial infections, and the incidence in women is much higher than in men. The diagnosis of a UTI can be made based on a combination of symptoms and a positive urine analysis or culture. Most UTIs are uncomplicated UTIs, defined as cystitis in a woman who is not pregnant, is not immunocompromised, has no anatomical and functional abnormalities of the urogenital tract, and does not exhibit signs of tissue invasion and systemic infection. All UTIs that are not uncomplicated are considered to be complicated UTIs. Differentiation between uncomplicated and complicated UTIs has implications for therapy because the risks of complications or treatment failure are increased for patients with a complicated UTI. Asymptomatic bacteriuria (ASB) is defined as the presence of a positive urine culture collected from a patient without symptoms of a UTI. Concerning the complicated UTI, it is possible to make a differentiation between UTI with systemic symptoms (febrile UTI) and UTI in a host, which carries an increased risk to develop complications of this UTI. Febrile UTIs are urosepsis, pyelonephritis, and prostatitis. A complicated host is defined as one that has an increased risk for complications, to which the following groups belong: men, pregnant women, immunocompromised patients, or those who have an anatomical or functional abnormality of the urogenital tract (e.g., spinal cord-injury patients, renal stones, urinary catheter).
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Wagenlehner F, Wullt B, Ballarini S, Zingg D, Naber KG. Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT). Expert Rev Pharmacoecon Outcomes Res 2017; 18:107-117. [PMID: 28737469 DOI: 10.1080/14737167.2017.1359543] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Uncomplicated lower urinary tract infections (UTIs) occur in approximately 50% of women, and 20-30% experience recurrent UTI. Data on UTIs and quality of life (QoL) in Europe are limited. METHODS This was an anonymous, self-administered web-based survey conducted in 5 countries (Germany, Switzerland, Poland, Russia and Italy), on adult women who had experienced recurrent UTI and were affected by acute UTI currently or within 4 weeks of study entry. Questions covered disease course; management; social and economic burden; education, income, and health insurance status. QoL was evaluated using the SF-12v2. RESULTS Participants reported a mean of 5.15 UTI symptoms, ranging from 4.85 - 5.38 in Russia and Germany. There was a mean of 2.78 doctor visits per year (1.74 - 3.71 in Russia and Germany; p < 0.0001). 80.3% of participants had been treated with antibiotics, mean prescriptions ranged from 2.17 (Poland) to 3.36 (Germany) per person per year. A mean of 3.09 days sick leave due to UTIs, and 3.45 days of limited activities, were reported. Although 73.8% of participants had tried prophylaxis recurrence was common and associated with mental stress for a high proportion of women. CONCLUSIONS Our results indicate that recurrent UTIs have a significant impact on QoL of women in Europe.
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Affiliation(s)
- Florian Wagenlehner
- a Clinic for Urology, Pediatric Urology and Andrology , Justus-Liebig University , Giessen , Germany
| | - Björn Wullt
- b Section of MIG , Lund University , Lund , Sweden
| | | | | | - Kurt G Naber
- d Technical University of Munich , Munich , Germany
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Wagenlehner FME, Naber KG. A new way to prevent urinary tract infections? THE LANCET. INFECTIOUS DISEASES 2017; 17:467-468. [DOI: 10.1016/s1473-3099(17)30107-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 02/10/2017] [Indexed: 01/09/2023]
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Guglietta A. Recurrent urinary tract infections in women: risk factors, etiology, pathogenesis and prophylaxis. Future Microbiol 2017; 12:239-246. [PMID: 28262045 DOI: 10.2217/fmb-2016-0145] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
Urinary tract infections (UTIs) are one of the most common bacterial infections in women, often as a recurrent disease. Uropathogenic Escherichia coli (UPEC) is the most common pathotype of extraintestinal pathogenic E. coli (ExPEC) found among patients with UTI. The human intestinal can act as a reservoir of UPEC, with the female urethra being infected by fecal material containing UPEC. Adhesion of bacteria to the epithelial cells of urogenital mucosa is an important mechanism in the pathogenesis of UTI. Alternative nonantibiotic based approaches, such as mechanical barrier protection of the intestinal mucosa have been proposed to reduce bacterial adherence to intestinal epithelium, bacteria proliferation and decrease of the load of UPEC in the intestinal lumen and in the fecal material.
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85
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Schreiber HL, Spaulding CN, Dodson KW, Livny J, Hultgren SJ. One size doesn't fit all: unraveling the diversity of factors and interactions that drive E. coli urovirulence. ANNALS OF TRANSLATIONAL MEDICINE 2017; 5:28. [PMID: 28217693 PMCID: PMC5300855 DOI: 10.21037/atm.2016.12.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 12/23/2022]
Affiliation(s)
- Henry L. Schreiber
- Department of Molecular Microbiology, Washington University, St. Louis, MO, USA
- Center for Women’s Infectious Disease Research, Washington University, St. Louis, MO, USA
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Caitlin N. Spaulding
- Department of Molecular Microbiology, Washington University, St. Louis, MO, USA
- Center for Women’s Infectious Disease Research, Washington University, St. Louis, MO, USA
| | - Karen W. Dodson
- Department of Molecular Microbiology, Washington University, St. Louis, MO, USA
- Center for Women’s Infectious Disease Research, Washington University, St. Louis, MO, USA
| | - Jonathan Livny
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Scott J. Hultgren
- Department of Molecular Microbiology, Washington University, St. Louis, MO, USA
- Center for Women’s Infectious Disease Research, Washington University, St. Louis, MO, USA
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Efficacy of an orally administered combination of hyaluronic acid, chondroitin sulfate, curcumin and quercetin for the prevention of recurrent urinary tract infections in postmenopausal women. Eur J Obstet Gynecol Reprod Biol 2016; 207:125-128. [DOI: 10.1016/j.ejogrb.2016.10.018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 10/07/2016] [Accepted: 10/18/2016] [Indexed: 11/15/2022]
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Foust-Wright CE, Pulliam SJ, Batalden RP, Berk TK, Weinstein MM, Wakamatsu MM, Phillippe M. Hormone Modulation of Toll-Like Receptor 5 in Cultured Human Bladder Epithelial Cells. Reprod Sci 2016; 24:713-719. [PMID: 27651177 DOI: 10.1177/1933719116667489] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM The effect of hormone levels on the stimulation of Toll-like receptor 5 (TLR5) in the bladder is unknown. We aimed to study the effect of estradiol and progesterone on TLR5 expression and function in human bladder epithelial cells. METHODS After growing to near confluence, T24 human urinary bladder (HUB) cells were incubated in hormone-free (HF) media for 72 hours. Human urinary bladder cells were then incubated in (1) HF media, (2) estradiol media, (3) progesterone media, or (4) media containing estradiol and progesterone at physiologic concentrations. Following flagellin exposure, cells and media were collected. Toll-like receptor 5 expression and stimulated cytokine release were analyzed using enzyme-linked immunosorbent assays. Results were normalized with cellular protein assays. A TLR5 antagonist was used to confirm that stimulation from flagellin was mediated by TLR5 signaling. RESULTS Cultured HUB cells express TLR5 protein. Estradiol and progesterone environments suppress TLR5 expression compared to HF environment. The function of TLR5 was measured by interleukin 6 (IL-6) and monocyte chemoattractant protein 1 production after flagellin exposure. Interleukin 6 production was 75% higher in the estradiol than progesterone environment. The progesterone environment produced IL-6 levels twice that observed in HF and combined estrogen-progesterone environments. Interestingly, higher TLR5 expression was associated with lower IL-6 production. CONCLUSION Our study demonstrated that TLR5 expression and functional activity as measured by IL-6 are modulated by hormones. The increase in TLR5-associated IL-6 may play a role in increasing the rate of symptomatic urinary tract infection. Likewise, low TLR5 functional activity may dampen the response of the innate immune system, thereby lessening the likelihood of a symptomatic bladder infection.
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Affiliation(s)
- Caroline E Foust-Wright
- 1 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Samantha J Pulliam
- 2 Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
| | - Rebecca Posthuma Batalden
- 1 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Tucker K Berk
- 3 Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
| | - Milena M Weinstein
- 1 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - May M Wakamatsu
- 1 Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA
| | - Mark Phillippe
- 3 Department of Obstetrics and Gynecology, Vincent Center for Reproductive Biology, Massachusetts General Hospital, Boston, MA, USA
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Chang PC, Hsu YC, Hsieh ML, Huang ST, Huang HC, Chen Y. A pilot study on Trichomonas vaginalis in women with recurrent urinary tract infections. Biomed J 2016; 39:289-294. [PMID: 27793272 PMCID: PMC6139873 DOI: 10.1016/j.bj.2015.11.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 11/18/2015] [Indexed: 11/29/2022] Open
Abstract
Background Trichomoniasis and recurrent urinary tract infections (UTIs) shared similar risk factors, age distribution and overlapping symptoms. The aim of this study was to determine the prevalence of Trichomonas vaginalis (TV) in women with recurrent UTIs, attending a urology clinic in a medical center, in order to inform screening and treatment policies. Methods Women with recurrent UTIs, defined as the presence of lower urinary tract symptoms (dysuria, frequency and urgency) and three positive urine cultures on voided urine specimens in the previous year, were enrolled prospectively from January 2013 to April 2014. Urine samples were collected for culture and tested for TV using immunochromatographic strip. Outpatient follow-up was arranged to diagnose any symptomatic UTI recurrence. Results Sixty-five women were recruited. Mean age was 57.4 ± 14.3 year-old and follow-up duration was 9.5 ± 4.0 months. The prevalence of TV was 16.9% (11/65). Eight women had UTI recurrence in the follow-up period. Recurrence rate did not differ in patients with and without concomitant TV infection. Conclusions Given the high prevalence of TV, we suggest that testing for TV should be considered in women with recurrent UTIs. Further larger studies are needed to evaluate the potential benefit of treating TV in this group of patients.
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Affiliation(s)
- Po-Chih Chang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu-Chao Hsu
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Ming-Li Hsieh
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Shih-Tsung Huang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Hsin-Chieh Huang
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Yu Chen
- Department of Urology, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan, Taiwan.
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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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91
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Maki KC, Kaspar KL, Khoo C, Derrig LH, Schild AL, Gupta K. Consumption of a cranberry juice beverage lowered the number of clinical urinary tract infection episodes in women with a recent history of urinary tract infection. Am J Clin Nutr 2016; 103:1434-42. [PMID: 27251185 DOI: 10.3945/ajcn.116.130542] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 03/17/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are among the most common bacterial infections and are often treated with antibiotics. Concerns about multidrug-resistant uropathogens have pointed to the need for safe and effective UTI-prevention strategies such as cranberry consumption. OBJECTIVE We assessed the effects of the consumption of a cranberry beverage on episodes of clinical UTIs. DESIGN In this randomized, double-blind, placebo-controlled, multicenter clinical trial, women with a history of a recent UTI were assigned to consume one 240-mL serving of cranberry beverage/d (n = 185) or a placebo (n = 188) beverage for 24 wk. The primary outcome was the clinical UTI incidence density, which was defined as the total number of clinical UTI events (including multiple events per subject when applicable) per unit of observation time. RESULTS The dates of the random assignment of the first subject and the last subject's final visit were February 2013 and March 2015, respectively. The mean age was 40.9 y, and characteristics were similar in both groups. Compliance with study product consumption was 98%, and 86% of subjects completed the treatment period in both groups. There were 39 investigator-diagnosed episodes of clinical UTI in the cranberry group compared with 67 episodes in the placebo group (antibiotic use-adjusted incidence rate ratio: 0.61; 95% CI: 0.41, 0.91; P = 0.016). Clinical UTI with pyuria was also significantly reduced (incidence rate ratio: 0.63; 95% CI: 0.40, 0.97; P = 0.037). One clinical UTI event was prevented for every 3.2 woman-years (95% CI: 2.0, 13.1 woman-years) of the cranberry intervention. The time to UTI with culture positivity did not differ significantly between groups (HR: 0.97; 95% CI: 0.56, 1.67; P = 0.914). CONCLUSION The consumption of a cranberry juice beverage lowered the number of clinical UTI episodes in women with a recent history of UTI. This study was registered at clinicaltrials.gov as NCT01776021.
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Affiliation(s)
- Kevin C Maki
- Biofortis Clinical Research, Addison, IL; MB Clinical Research, Glen Ellyn, IL;
| | | | | | | | | | - Kalpana Gupta
- Department of Medicine, Boston University School of Medicine, Boston, MA; and VA Boston Healthcare System, Boston, MA
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The Yersiniabactin-Associated ATP Binding Cassette Proteins YbtP and YbtQ Enhance Escherichia coli Fitness during High-Titer Cystitis. Infect Immun 2016; 84:1312-1319. [PMID: 26883590 DOI: 10.1128/iai.01211-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/06/2016] [Indexed: 12/11/2022] Open
Abstract
The Yersinia high-pathogenicity island (HPI) is common to multiple virulence strategies used by Escherichia coli strains associated with urinary tract infection (UTI). Among the genes in this island are ybtP and ybtQ, encoding distinctive ATP binding cassette (ABC) proteins associated with iron(III)-yersiniabactin import in Yersinia pestis In this study, we compared the impact of ybtPQ on a model E. coli cystitis strain during in vitro culture and experimental murine infections. A ybtPQ-null mutant exhibited no growth defect under standard culture conditions, consistent with nonessentiality in this background. A growth defect phenotype was observed and genetically complemented in vitro during iron(III)-yersiniabactin-dependent growth. Following inoculation into the bladders of C3H/HEN and C3H/HeOuJ mice, this strain exhibited a profound, 10(6)-fold competitive infection defect in the subgroup of mice that progressed to high-titer bladder infections. These results identify a virulence role for YbtPQ in the highly inflammatory microenvironment characteristic of high-titer cystitis. The profound competitive defect may relate to the apparent selection of Yersinia HPI-positive E. coli in uncomplicated clinical UTIs.
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93
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Salvatorelli N, García-Larrosa A, Allegrini A, Pavone D. A New Approach to the Treatment of Uncomplicated Cystitis: Results of a Randomized Placebo-Controlled Clinical Trial. Urol Int 2016; 97:347-351. [PMID: 27055257 DOI: 10.1159/000445326] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 03/03/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To assess the efficacy and safety of a new medical device (MD; a capsule whose main component is a cross-linked protein) in the prevention of uncomplicated cystitis recurrences. METHODS Adult women with acute cystitis symptoms and a ciprofloxacin-susceptible isolate in urine culture were included in a randomized, double-blind clinical trial. Patients were treated with ciprofloxacin 500 mg/day and 1 capsule/day or matched placebo for 5 days, 1 capsule/day or placebo for 15 additional days, and 2 additional cycles of 1 capsule/day or placebo for 15 days on months 1 and 2 after initial treatment. RESULTS No recurrence was observed after the first month of follow-up in the MD-treated group. In addition, symptomatic recurrence was reduced by 19.4% compared with placebo after 6 months. CONCLUSIONS The new MD can help prevent the recurrence of uncomplicated cystitis as well as help to reduce antibiotic use in management of urinary tract infection in women.
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Ciani O, Arendsen E, Romancik M, Lunik R, Costantini E, Di Biase M, Morgia G, Fragalà E, Roman T, Bernat M, Guazzoni G, Tarricone R, Lazzeri M. Intravesical administration of combined hyaluronic acid (HA) and chondroitin sulfate (CS) for the treatment of female recurrent urinary tract infections: a European multicentre nested case-control study. BMJ Open 2016; 6:e009669. [PMID: 27033958 PMCID: PMC4823394 DOI: 10.1136/bmjopen-2015-009669] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare the clinical effectiveness of the intravesical administration of combined hyaluronic acid and chondroitin sulfate (HA+CS) versus current standard management in adult women with recurrent urinary tract infections (RUTIs). SETTING A European Union-based multicentre, retrospective nested case-control study. PARTICIPANTS 276 adult women treated for RUTIs starting from 2009 to 2013. INTERVENTIONS Patients treated with either intravesical administration of HA+CS or standard of care (antimicrobial/immunoactive prophylaxis/probiotics/cranberry). PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was occurrence of bacteriologically confirmed recurrence within 12 months. Secondary outcomes were time to recurrence, total number of recurrences, health-related quality of life and healthcare resource consumption. Crude and adjusted results for unbalanced characteristics are presented. RESULTS 181 patients treated with HA+CS and 95 patients treated with standard of care from 7 centres were included. The crude and adjusted ORs (95% CI) for the primary end point were 0.77 (0.46 to 1.28) and 0.51 (0.27 to 0.96), respectively. However, no evidence of improvement in terms of total number of recurrences (incidence rate ratio (95% CI), 0.99 (0.69 to 1.43)) or time to first recurrence was seen (HR (95% CI), 0.99 (0.61 to 1.61)). The benefit of intravesical HA+CS therapy improves when the number of instillations is ≥ 5. CONCLUSIONS Our results show that bladder instillations of combined HA+CS reduce the risk of bacteriologically confirmed recurrences compared with the current standard management of RUTIs. Total incidence rates and hazard rates were instead non-significantly different between the 2 groups after adjusting for unbalanced factors. In contrast to what happens with antibiotic prophylaxis, the effectiveness of the HA+CS reinstatement therapy improves over time. TRIAL REGISTRATION NUMBER NCT02016118.
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Affiliation(s)
- Oriana Ciani
- Centre for Research on Health and Social Care Management, Università Bocconi, Milan, Italy
- Evidence Synthesis & Modelling for Health Improvement, Institute of Health Research, University of Exeter Medical School, Exeter, UK
| | - Erik Arendsen
- Diaconessenhuis, Maatschap, Urologie, Leiden, The Netherlands
| | - Martin Romancik
- Department of Urology, St. Cyril and Method University Hospital, Bratislava, Slovakia
| | - Richard Lunik
- Department of Urology, Fakultná nemocnica s poliklinikou, Prešov, Slovakia
| | - Elisabetta Costantini
- Department of Surgical and Biomedical Science, University of Perugia, Urology and Andrology Clinic, Perugia, Italy
| | - Manuel Di Biase
- Department of Surgical and Biomedical Science, University of Perugia, Urology and Andrology Clinic, Perugia, Italy
| | - Giuseppe Morgia
- Department of Urology, University of Catania, Catania, Italy
| | - Eugenia Fragalà
- Department of Urology, University of Catania, Catania, Italy
| | - Tomaskin Roman
- Department of Urology, Jessenius School of Medicine, University Hospital, Martin, Slovakia
| | | | - Giorgio Guazzoni
- Department of Urology, Humanitas Clinical and Research Center, Milan, Italy
| | - Rosanna Tarricone
- Centre for Research on Health and Social Care Management, Università Bocconi, Milan, Italy
- Department of Policy Analysis and Public Management, Università Bocconi, Milano, Italy
| | - Massimo Lazzeri
- Department of Urology, Humanitas Clinical and Research Center, Milan, Italy
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Zacchè MM, Giarenis I. Therapies in early development for the treatment of urinary tract inflammation. Expert Opin Investig Drugs 2016; 25:531-40. [DOI: 10.1517/13543784.2016.1161024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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96
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Butler DSC, Silvestroni A, Stapleton AE. Cytoprotective Effect of Lactobacillus crispatus CTV-05 against Uropathogenic E. coli. Pathogens 2016. [PMCID: PMC4810148 DOI: 10.3390/pathogens5010027] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The vaginal flora consists of a subset of different lactic acid producing bacteria, typically creating a hostile environment for infecting pathogens. However, the flora can easily be disrupted, creating a favorable milieu for uropathogenic Escherichia coli (UPEC), making it possible to further infect the urinary system via the urethra. Probiotic use of different lactobacilli to restore the normal flora of the vagina has been proposed as a potential prophylactic treatment against urinary tract infections. This project evaluated the protective- and anti-inflammatory roles of the probiotic Lactobacillus crispatus strain CTV-05 in an in vitro system. The inflammatory response and the cytotoxic effect were studied by Enzyme-linked immunosorbent assays and by trypan blue exclusion of cells inoculated with L. crispatus CTV-05 and comparing it to non-infected controls and UPEC infected cells. L. crispatus CTV-05 showed no cytotoxicity to vaginal epithelial cells compared to non-infected controls and provided significant protection against UPEC infection (p < 0.05). Further more, L. crispatus CTV-05 did not create a pro-inflammatory response in vitro, with no significant increase of IL-1β or IL-6. These results demonstrate the protective effect of using L. crispatus CTV-05 as a probiotic treatment to reduce the risk of recurrent urinary tract infections.
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Affiliation(s)
- Daniel S. C. Butler
- Department of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, 221 00 Lund, Sweden;
| | - Aurelio Silvestroni
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195-5852, USA;
| | - Ann E. Stapleton
- Department of Medicine, Division of Allergy and Infectious Diseases, University of Washington, Seattle, WA 98195-5852, USA;
- Correspondence: ; Tel.: +1-206-616-4121
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Bleidorn J, Hummers-Pradier E, Schmiemann G, Wiese B, Gágyor I. Recurrent urinary tract infections and complications after symptomatic versus antibiotic treatment: follow-up of a randomised controlled trial. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2016; 14:Doc01. [PMID: 26909012 PMCID: PMC4749724 DOI: 10.3205/000228] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2005] [Revised: 01/19/2016] [Indexed: 11/30/2022]
Abstract
Background: Uncomplicated urinary tract infections (UTI) are common in general practice, and are usually treated with antibiotics. Recurrent UTI often pose a serious problem for affected women. Little is known about recurrent UTI and complications when uncomplicated UTI are treated without antibiotics. With ICUTI (Immediate vs. conditional antibiotic use in uncomplicated UTI, funded by BMBF No. 01KG1105) we assessed whether initial symptomatic treatment with ibuprofen could be a treatment alternative for uncomplicated UTI. The presented analysis aims to assess the influence of initial (non-)antibiotic treatment on recurrent UTI rates and pyelonephritis after day 28 up to 6 months after trial participation. Methods: This study is a retrospective long-term follow-up analysis of ICUTI patients, surveyed telephonically six months after inclusion in the trial. Recurrent UTI, pyelonephritis or hospitalizations were documented. Statistical evaluation was performed by descriptive and multivariate analyses with SPSS 21. Results: For the six months follow-up survey, 386 trial participants could be contacted (494 had been included in ICUTI initially, 446 had completed the trial). From day 28 until 6 months after inclusion in ICUTI, 84 recurrent UTI were reported by 80 patients. Univariate and multivariate analyses showed no effect of initial treatment group or antibiotic treatment on number of patients with recurrent UTI. Yet, both analyses showed that patients with a history of previous UTI had significantly more often recurrent UTI. Pyelonephritis occurred in two patients of the antibiotic group and in one patient in the non-antibiotic group. Conclusion: This follow-up analysis of a trial comparing antibiotic vs. symptomatic treatment for uncomplicated UTI showed that non-antibiotic treatment has no negative impact on recurrent UTI rates or pyelonephritis after day 28 and up to six months after initial treatment. Thus, a four week follow-up in UTI trials seems adequate.
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Affiliation(s)
- Jutta Bleidorn
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Eva Hummers-Pradier
- Department of General Practice and Family Medicine, University Medical Center, Goettingen, Germany
| | - Guido Schmiemann
- Institute for Public Health and Nursing Research, Department for Health Services Research, University of Bremen, Germany
| | - Birgitt Wiese
- Institute for General Practice, Hannover Medical School, Hannover, Germany
| | - Ildikó Gágyor
- Department of General Practice and Family Medicine, University Medical Center, Goettingen, Germany
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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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Cortes JA, Perdomo D, Morales RA, Alvarez CA, Cuervo SI, Leal AL, Gómez JC, Reyes P, Pinilla AE, Castellanos E, Donoso W. Guía de práctica clínica sobre diagnóstico y tratamiento de infección de vías urinarias no complicada en mujeres adquirida en la comunidad. REVISTA DE LA FACULTAD DE MEDICINA 2015. [DOI: 10.15446/revfacmed.v63.n4.44185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
<p class="p1"><span class="s1">Mediante un proceso de adaptación de guías de práctica clínica se seleccionaron y evaluaron guías de infección de vías urinarias en mujeres premenopáusicas no embarazadas; se identificaron 3 de alta calidad. Con base en las evidencias y las recomendaciones aportadas por estas guías, se realizó un consenso para realizar recomendaciones para personal de salud —médicos, personal de laboratorio y enfermeros— sobre el diagnóstico de las infecciones urinarias —cistitis y pielonefritis—, sus tratamientos y prevención de la recurrencia.</span></p>
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Nseir W, Farah R, Mahamid M, Sayed-Ahmad H, Mograbi J, Taha M, Artul S. Obesity and recurrent urinary tract infections in premenopausal women: a retrospective study. Int J Infect Dis 2015; 41:32-5. [PMID: 26518067 DOI: 10.1016/j.ijid.2015.10.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 10/21/2015] [Accepted: 10/21/2015] [Indexed: 01/01/2023] Open
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