1
|
Hamilton ADK, Sparsoe LV, Skov M, Johnsen N, Chreistensen MH, Corydon TJ, Praetorius H. Increased water intake dilutes protective uromodulin levels in urine and results in increased rates of pyelonephritis in a murine model. Acta Physiol (Oxf) 2024:e14204. [PMID: 39007512 DOI: 10.1111/apha.14204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 07/01/2024] [Accepted: 07/04/2024] [Indexed: 07/16/2024]
Abstract
AIM Urinary tract infections (UTIs) rank among the most prevalent infections in humans, carrying substantial implications for public health. Women experiencing recurrent UTIs are often advised to boost their fluid intake to help eliminate bacteria. In this study, we explored the impact of elevated fluid consumption during UTIs using a mouse model of pyelonephritis. METHODS UTI was induced in 8-10 w female BALB/cJ-mice by surgically injecting Escherichia coli (O6:K13:H1) into the bladder whereafter mice were randomized to gel food (GF) or regular chow. Immune response and infection severity were determined 24-h post-infection. In vitro bacterial growth (OD600) was determined in urine from mice or from human volunteers. RESULTS Gel feeding increased urine output (1.40 ± 0.77 μL min-1, p < 0.01) and diluted the urine (668.7 ± 177 mOsmol kg-1, p < 0.0001) compared to controls on regular chow (urine output: 0.34 ± 0.27 μL min-1, osmolality: 1439 ± 473.5 mOsmol kg-1). Mice on GF had a higher risk of pyelonephritis (87.5%) and more severe infections (26.22 ± 9.88 CFU mg-1 tissue) compared to controls (43.75%; 3.87 ± 3.56 CFU mg-1, p < 0.01). Correspondingly, the growth of E. coli was markedly reduced at osmolalities above 1200 mOsmol kg-1 compared to 600 mOsmol kg-1 and GF mice had lower urine levels of uromodulin (13.70 ± 1.89 μg mL-1, p < 0.01) compared to controls (24.65 ± 2.70 μg mL-1). CONCLUSION Increased water intake and urine flow in mice will markedly increase the risk of pyelonephritis. The increased risk may reflect reduced urine uromodulin combined with optimized growth conditions for E. coli. The study does not immediately support the notion that established UTIs can be eliminated by increased water intake.
Collapse
Affiliation(s)
| | - Laura V Sparsoe
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | - Mathias Skov
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | - Nanna Johnsen
- Department of Biomedicine, Aarhus University, Aarhus C, Denmark
| | | | | | | |
Collapse
|
2
|
Yan P, Yao J, Ke B, Fang X. Mendelian randomization analysis reveals higher whole body water mass may increase risk of bacterial infections. BMC Med Genomics 2024; 17:183. [PMID: 38982318 PMCID: PMC11232203 DOI: 10.1186/s12920-024-01950-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 06/25/2024] [Indexed: 07/11/2024] Open
Abstract
BACKGROUND AND PURPOSE The association of water loading with several infections remains unclear. Observational studies are hard to investigate definitively due to potential confounders. In this study, we employed Mendelian randomization (MR) analysis to assess the association between genetically predicted whole body water mass (BWM) and several infections. METHODS BWM levels were predicted among 331,315 Europeans in UK Biobank using 418 SNPs associated with BWM. For outcomes, we used genome-wide association data from the UK Biobank and FinnGen consortium, including sepsis, pneumonia, intestinal infections, urinary tract infections (UTIs) and skin and soft tissue infections (SSTIs). Inverse-variance weighted MR analyses as well as a series of sensitivity analyses were conducted. RESULTS Genetic prediction of BWM is associated with an increased risk of sepsis (OR 1.34; 95% CI 1.19 to 1.51; P = 1.57 × 10- 6), pneumonia (OR: 1.17; 95% CI 1.08 to 1.29; P = 3.53 × 10- 4), UTIs (OR: 1.26; 95% CI 1.16 to 1.37; P = 6.29 × 10- 8), and SSTIs (OR: 1.57; 95% CI 1.25 to 1.96; P = 7.35 × 10- 5). In the sepsis and pneumonia subgroup analyses, the relationship between BWM and infection was observed in bacterial but not in viral infections. Suggestive evidence suggests that BWM has an effect on viral intestinal infections (OR: 0.86; 95% CI 0.75 to 0.99; P = 0.03). There is limited evidence of an association between BWM levels and bacteria intestinal infections, and genitourinary tract infection (GUI) in pregnancy. In addition, MR analyses supported the risk of BWM for several edematous diseases. However, multivariable MR analysis shows that the associations of BWM with sepsis, pneumonia, UTIs and SSTIs remains unaffected when accounting for these traits. CONCLUSIONS In this study, the causal relationship between BWM and infectious diseases was systematically investigated. Further prospective studies are necessary to validate these findings.
Collapse
Affiliation(s)
- Peng Yan
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330000, China.
| | - Jiahuizi Yao
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330000, China
| | - Ben Ke
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330000, China
| | - Xiangdong Fang
- Department of Nephrology, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330000, China.
| |
Collapse
|
3
|
Sunardi D, Chandra DN, Medise BE, Manikam NRM, Friska D, Lestari W, Insani PNC. Health effects of alkaline, oxygenated, and demineralized water compared to mineral water among healthy population: a systematic review. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:339-349. [PMID: 36571558 DOI: 10.1515/reveh-2022-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 12/11/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVES There are many water types available on the market. They are widely known in public with health claims. The questions are, are those claims are scientifically proven or those are just testimonies from the consumers or overclaimed by the producers. This study aims to systematically review evidences on the health effects of alkaline, oxygenated, and demineralized water in comparison with mineral water among healthy population. CONTENTS Data were obtained from databases PubMed, Cochrane, Scopus, EBSCO, dan Science Direct since January 2000 until July 2022. There were 10 eligible articles, consisted of two articles on alkaline, four articles on oxygenated, and four articles on demineralized water, that furtherly being analyzed. SUMMARY Compared to consumption of mineral water, consumption of alkaline and oxygenated water did not show any significant difference on gut microbiota, urine pH, blood parameter, or fitness parameter. While, consumption of demineralized water in the long term resulted in lower quality of certain nutrient intake. OUTLOOK Recent evidences do not prove any additional health effects of alkaline, oxygenated, or demineralized water compared to mineral water. In contrast, demineralized water consumption in the long run was proven to lead to adverse effect.
Collapse
Affiliation(s)
- Diana Sunardi
- Indonesian Hydration Working Group, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Nutrition, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dian Novita Chandra
- Indonesian Hydration Working Group, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Nutrition, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Bernie Endyarni Medise
- Indonesian Hydration Working Group, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Child Health Department, Faculty of Medicine Universitas Indonesia - Dr.Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Nurul Ratna Mutu Manikam
- Indonesian Hydration Working Group, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Nutrition, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Dewi Friska
- Indonesian Hydration Working Group, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Occupational Medicine, Department of Community Medicine, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
| | - Wiji Lestari
- Indonesian Hydration Working Group, Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
- Department of Nutrition, Faculty of Medicine Universitas Indonesia - Dr. Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | | |
Collapse
|
4
|
Lazarus JE, Gupta K. Recurrent UTI in Women-Risk Factors and Management. Infect Dis Clin North Am 2024; 38:325-341. [PMID: 38599896 DOI: 10.1016/j.idc.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2024]
Abstract
Urinary tract infections (UTIs) are common in women; more than 50% of women will be diagnosed with a UTI in her lifetime. Many of these women will go on to develop recurrent UTI. Nevertheless, evidence-based prevention of recurrent UTI is under-utilized. Here, the authors provide detailed practical advice on UTI prevention with a thorough review of the evidence. Non-antibiotic prevention measures discussed include increased fluid intake, vaginal estrogen therapy, methenamine, and cranberry. Antibiotic prophyalxis for carefully selected patients is also discussed.
Collapse
Affiliation(s)
- Jacob E Lazarus
- Department of Medicine, Division of Infectious Diseases, Massachusetts General Hospital, 55 Fruit Street, GRJ 512C, Boston, MA 02114, USA; Harvard Medical School, Boston, MA, USA
| | - Kalpana Gupta
- Harvard Medical School, Boston, MA, USA; Veterans Affairs Boston Healthcare System, 1400 VFW Parkway, Executive Suite, West Roxbury, MA 02132, USA; Boston University School of Medicine, Boston, MA, USA.
| |
Collapse
|
5
|
Fitzpatrick MA, Nwafo N. Urinary Tract Infection Diagnostic and Management Considerations in People with Spinal Cord Injury and Neurogenic Bladder. Infect Dis Clin North Am 2024; 38:381-393. [PMID: 38580574 DOI: 10.1016/j.idc.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024]
Abstract
Urinary tract infections (UTIs) are common complications in people with neurogenic bladder. Prevention, diagnosis, and treatment are challenging for several reasons, including a high prevalence of asymptomatic bacteriuria and catheter use, frequent ambiguous nonlocalizing signs and symptoms, increased risk for complications and difficult-to-treat pathogens, and a lack of effective preventative methods. Current research aims to improve elicitation and evaluation of signs and symptoms, implement algorithms to avoid urine cultures in asymptomatic patients and use appropriate antibiotics for UTI, and identify novel effective prevention methods.
Collapse
Affiliation(s)
- Margaret A Fitzpatrick
- Department of Medicine, Section of Infectious Diseases, VA Eastern Colorado Healthcare System, Aurora, CO, USA; Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Center, Aurora, CO, USA.
| | - Nnamdi Nwafo
- Department of Medicine, Division of Infectious Diseases, University of Colorado Anschutz Medical Center, CU Research Complex II, 12700 East 19th Avenue. Mail Stop B168, Aurora, CO 80045, USA
| |
Collapse
|
6
|
Schmiemann G, Kranz J, Mandraka F, Schubert S, Wagenlehner F, Gágyor I. The Diagnosis, Treatment, and Prevention of Recurrent Urinary Tract Infection. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:373-382. [PMID: 38686602 DOI: 10.3238/arztebl.m2024.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 04/03/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Urinary tract infection has a one-year prevalence of 11% in women and ranges among the most common reasons for consulting a primary care physician and for receiving a prescription for antibiotics. In the case of recurrent urinary tract infection (rUTI), there are questions about the further work-up, treatment, and preventive measures. METHODS The systematic literature search performed for the update of the German clinical practice guideline on uncomplicated urinary tract infection (043-044) (up to February 2022) was supplemented with a selective search for clinical trials (up to August 2023). RESULTS Urine culture and ultrasonography are reasonable steps in the diagnostic evaluation of rUTI. Further invasive testing is suggested for men but is not routinely indicated for women. Antibiotics are among the most effective preventive measures (risk ratio [RR] 0.15, 95% confidence interval [0.1; 0.3]) but carry a high risk of side effects. Non-antibiotic preparations such as cranberry juice (RR 0.74 [0.5; 0.99]), mannose (RR 0.23 [0.14; 0.37]), and vaginal estrogen (RR, 0.42 [0.30; 0.59]) can also reduce the infection rate, with a low risk of side effects. Increased daily fluid intake has been shown to lower infection rates in the short term (odds ratio [OR] 0.13 [0.07; 0.25]); the use of hygienically advisable wiping techniques after passing stool or urine has been little studied but can be implemented with no risk. CONCLUSION rUTI poses a challenge for the treating physician. The measures to be taken must be considered on an individual basis. Vulnerable groups, such as older patients, need special attention.
Collapse
Affiliation(s)
- Guido Schmiemann
- Institute of Public Health and Nursing Research, Department for Health Services Research, University of Bremen; Clinic of Urology and Pediatric Urology, University Hospital Aachen; University Hospital and Department of Urology, University Hospital of Halle (Saale); Laboratory Dr. Wisplinghoff, Specialist in Internal Medicine and Infectiology, ABS-Expert (DGI), Köln; Max von Pettenkofer-Institute, Chair of Medical Microbiology and Hospital Hygiene, Ludwig-Maximilians-University (LMU) Munich; Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen; Departement of General Practice, Julius-Maximilians-Universität of Würzburg
| | | | | | | | | | | |
Collapse
|
7
|
Peden DL, Derbyshire S, Funnell MP, McLeod CJ, Rumbold P, Hansell E, Clifford T, Mears SA, James LJ. Fluid and electrolyte balance following consumption of skimmed milk and a plant-based soya beverage at rest in euhydrated males. Eur J Appl Physiol 2024:10.1007/s00421-024-05516-0. [PMID: 38809478 DOI: 10.1007/s00421-024-05516-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
PURPOSE Cow's milk is one of the most hydrating beverages, but many individuals choose not to consume dairy in their diet due to intolerance, allergy, or dietary preference. Milk is commonly replaced with plant-based beverages, including soya which has the most comparable protein content, but little is known about their hydration potential. This study compared fluid and electrolyte balance responses between a soya beverage and skimmed cow's milk. METHODS Ten healthy males [age 27 (6) y; body mass index 24.6 (2.3) kg/m2] completed two randomised counterbalanced trials, involving consuming 1000 mL water from approximately isocaloric amounts of skimmed cow's milk (MILK) or a sweetened soya beverage (SOYA), in four aliquots over 30 min in a euhydrated fasted state. Volume, specific gravity, and electrolyte (sodium, potassium, chloride) concentrations were determined in total-void urine samples collected pre-/post-beverage ingestion, and hourly for 180 min thereafter. Hunger, thirst, nausea and stomach fullness were rated proximal to urine samples. RESULTS Total urine mass (MILK, 986 ± 254 g; SOYA, 950 ± 248 g; P = 0.435) and urine specific gravity (P = 0.156) did not differ between trials. Potassium balance was greater in SOYA 0-180 min post-beverage (P ≤ 0.013), whilst chloride balance was greater in MILK 0-120 min post-beverage (P ≤ 0.036). Sodium balance (P = 0.258), total electrolyte balance (P = 0.258), and subjective measures (P ≥ 0.139) were not different between trials. CONCLUSION Replacing cow's milk with a soya beverage did not negatively impact fluid balance in healthy young males, making it a viable option for those who choose not to consume dairy in their diet.
Collapse
Affiliation(s)
- Donald L Peden
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Seamus Derbyshire
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Mark P Funnell
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
- NIHR Applied Research Collaboration East Midlands, Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Chris J McLeod
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Penny Rumbold
- Department of Sport, Exercise and Rehabilitation, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Emily Hansell
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Tom Clifford
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Stephen A Mears
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Lewis J James
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK.
| |
Collapse
|
8
|
Sridharan K, Sivaramakrishnan G. Genito-urinary infectious adverse events related to sodium glucose cotransporter-2 inhibitors: a network meta-analysis and meta-regression. Expert Rev Clin Pharmacol 2024; 17:515-524. [PMID: 38733378 DOI: 10.1080/17512433.2024.2355287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Accepted: 05/10/2024] [Indexed: 05/13/2024]
Abstract
INTRODUCTION Sodium glucose cotransporter-2 inhibitors (SGLT2is) are an emerging class of drugs with wide indications. Controversial evidence exists regarding the risk of urinary tract infection (UTI) and genital infections (GI) with SGLT2is paving way for undertaking this network meta-analysis and meta-regression study. METHODS Data from randomized trials evaluating SGLT2is reporting the number of patients with UTI and GI were included. Odds ratios (OR) with 95% confidence intervals (95% CI) were the effect estimates. Meta-regression analysis identified risk factors. Number needed to harm (NNH) was estimated. RESULTS Two hundred and sixty-four articles were included [UTI (213 studies; 150,140 participants) and GI (188 studies; 121,275 participants)]. An increased risk of UTI (OR: 1.11; 95% CI: 1.06, 1.16) and GI (OR: 3.5, 95% CI: 3.1, 3.9) was observed. Men showed a lower risk of UTI (OR: 0.2; 95% CI: 0.2, 0.3) and GI (OR: 0.4; 95% CI: 0.4, 0.5). Meta-regression analyses revealed BMI ≥ 30 kg/m2 and duration of SGLT2i treatment for ≥6 months as risk factors. NNH was 16 for UTI and 25 for GI. CONCLUSION SGLT2is increase the risk of UTI and GI that needs to be incorporated in the treatment guidelines with precautions in high-risk patients. PROSPECTIVE PROTOCOL REGISTRATION https://osf.io/5fwyk.
Collapse
Affiliation(s)
- Kannan Sridharan
- Department of Pharmacology & Therapeutics, College of Medicine & Medical Sciences, Arabian Gulf University, Manama, Kingdom of Bahrain
| | | |
Collapse
|
9
|
Naber KG, Alidjanov JF, Fünfstück R, Strohmaier WL, Kranz J, Cai T, Pilatz A, Wagenlehner FM. Therapeutic strategies for uncomplicated cystitis in women. GMS INFECTIOUS DISEASES 2024; 12:Doc01. [PMID: 38764941 PMCID: PMC11099625 DOI: 10.3205/id000086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/21/2024]
Abstract
Uncomplicated cystitis is affecting many women of all ages and has a great impact on the quality of life, especially in women suffering from recurrent, uncomplicated cystitis. By far the most frequent uropathogen, E. coli, may have acquired increasing resistance against a variety of oral antibiotics, which may differ between countries and regions. Therefore, local resistance data are important to be considered. On the other hand, non-antibiotic therapy has also become an option which should be discussed and offered to the patient. In patients suffering from recurrent uncomplicated cystitis, individual risk factors and possible behavioral changes should first be taken into account. Non-antimicrobial prophylactic strategies shown to be successful in well-designed clinical studies are the next options. Long term antibiotic prophylaxis, however, should only be considered as a last option. For some of those patients self-diagnosis and self-treatment may be suitable, e.g. by using a recognized questionnaire.
Collapse
Affiliation(s)
- Kurt G. Naber
- Department of Urology, Technical University of Munich, Germany
| | | | | | - Walter L. Strohmaier
- Medical School Regiomed, Coburg, Germany
- Julius Maximilian University, Wuerzburg, Germany
- University of Split, Croatia
| | - Jennifer Kranz
- Department of Urology and Pediatric Urology, University Medical Center RWTH Aachen, Germany
- Department of Urology and Kidney Transplantation, Martin Luther University, Halle (Saale), Germany
| | - Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Germany
| | - Florian M. Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Germany
| |
Collapse
|
10
|
Chavez JW, Christie AL, Zimmern PE. In-Depth Analysis of Diet Diary and Urine pH Measurements Improved Food Diet Reporting in Postmenopausal Women with RUTI. WOMEN'S HEALTH REPORTS (NEW ROCHELLE, N.Y.) 2024; 5:367-375. [PMID: 39035142 PMCID: PMC11257122 DOI: 10.1089/whr.2024.0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 07/23/2024]
Abstract
Introduction We proceeded with an in-depth review of diet diaries for nutrient analysis from a cohort of women suffering from uncomplicated recurrent urinary tract infection (RUTI) to validate the accuracy of our current food diet record (FDR) form and evaluate possible domains of improvement. Materials and Methods As part of an IRB-approved study, this previously published cohort of NHANES-comparable women was analyzed for consistency of the nutrient intake over 3 days, the influence of the time between meals and urine pH, the effect of nutrient intake over interval time between meals, and seasonal and before/during the COVID-19 pandemic changes. Intrarater reliability for nutrient analysis and intrapatient variability for urine pH were computed to test for consistency. Results Intrarater reliability for diet analysis was 91% accurate for foods and beverage matching and nutrient analysis. Mean standard deviation of urine pH readings within study participants was 0.4 (95% CI: 0.4, 0.5). An association was noted between total calories and fat consumed at breakfast and an increase in time to lunch. Calories consumed were unaffected across seasons or during the COVID-19 pandemic. Water intake during summer was significantly lower than that during fall and winter (both, p < 0.001). The patients who reported drinking water had a significantly lower average urine pH than women who did not report drinking water (5.8 vs. 6.2; p = 0.026). Conclusion In this cohort of postmenopausal women with RUTIs, in-depth analysis of our current FDR findings led to several actionable items, which will improve our current food diet self-reporting process by our patients.
Collapse
Affiliation(s)
| | - Alana L. Christie
- Simmons Comprehensive Cancer Center Biostatistics, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Philippe E. Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
11
|
Iacovelli V, Ficarra V, Maestroni UV, Tutolo M, Finazzi Agrò E. Open questions on lower urinary tract infections: Results of a Delphi consensus study. Neurourol Urodyn 2024; 43:915-924. [PMID: 38213058 DOI: 10.1002/nau.25385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 12/21/2023] [Indexed: 01/13/2024]
Abstract
BACKGROUND AND OBJECTIVE This is a Delphi study that aims to explore expert consensus regarding open questions in current literature evidence on lower urinary tract infections (UTIs). This manuscript deals with adults and analyzed the most recent guidelines and meta-analysis on the topic. METHODS A panel of leading urologists and urogynaecologists participated in a consensus-forming project using a Delphi method to reach consensus on gray zone issues on recurrent lower UTIns (rUTIs), asymptomatic bacteriuria (AB) in pregnant women, and catheter-associated UTIs (CAUTI) in adults. All the panelists were invited to participate the four phases consensus. Consensus was defined as ≥75% agreement. An ordinal scale (0-10) was used. A systematic literature review was analyzed for diagnostic workup and prevention of rUTIs, AB, and CAUTI. RESULTS In total, 37 experts participated. All panelists participated in the four phases of the consensus process. Consensus was reached if ≥75% of the experts agreed on the proposed topic. Online meetings and a face-to-face consensus meeting was held in Milan in March 2023. Formal consensus was achieved for 12/13 items. CONCLUSIONS This manuscript is a Delphi survey of experts that showed interest on some debated points on rUTIs, AB in pregnancy, and prevention of CAUTI. There is still little data on nonantibiotic prevention of UTIs and CAUTI; quite old studies have been reported on AB in pregnancy. The emerging problem of antibiotic resistance is relevant and nonantibiotic prophylaxis may play a role in its prevention.
Collapse
Affiliation(s)
- Valerio Iacovelli
- Urology Unit, San Carlo di Nancy General Hospital - GVM Care and Research, Rome, Italy
| | - Vincenzo Ficarra
- Gaetano Barresi Department of Human and Paediatric Pathology, Urologic Section, University of Messina, Messina, Italy
| | | | - Manuela Tutolo
- Division of Oncology, Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Urology Unit, University of Rome Tor Vergata, Rome, Italy
| |
Collapse
|
12
|
Armstrong LE, Bergeron MF, Muñoz CX, Kavouras SA. Low daily water intake profile-is it a contributor to disease? Nutr Health 2024:2601060241238826. [PMID: 38515347 DOI: 10.1177/02601060241238826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/23/2024]
Abstract
Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration (UD; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or UD is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake-a simple and cost-effective dietary modification.
Collapse
Affiliation(s)
- Lawrence E Armstrong
- Human Performance Laboratory and Department of Nutritional Sciences, University of Connecticut, Storrs, CT, USA
| | - Michael F Bergeron
- Performance Health, WTA Women's Tennis Association, St. Petersburg, FL, USA
- Hydration Health Center and Department of Health Sciences, University of Hartford, West Hartford, CT, USA
| | - Colleen X Muñoz
- Hydration Health Center and Department of Health Sciences, University of Hartford, West Hartford, CT, USA
| | - Stavros A Kavouras
- Hydration Science Lab, College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
13
|
Song Y, Zhang Y, Liu Y, Zhang J, Lu J, Wang X, Zhang N, Ma G. Analysis on fluid intake and urination behaviors among the elderly in five cities in China: a cross-sectional study. Front Nutr 2024; 10:1280098. [PMID: 38249613 PMCID: PMC10797079 DOI: 10.3389/fnut.2023.1280098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Background Fluid intake in the elderly may influence urination behaviors and further influence their health status. This study investigated the behaviors of fluid intake, urination and their relationships among the elderly in China. Methods Stratified random sampling was used to recruit the elderly participants who met the inclusion criteria from five cities in China. Participants' total fluid intake (TFI) level was investigated using a validated 7-day 24 h fluid intake questionnaire. Their urination behaviors in real time were also recorded using a validated 7-day 24 h urination behavior record. Results A total of 524 participants completed the study, including 233 males and 291 females. The average age was 69.7 years. The median daily TFI was 1,241 mL, with a frequency of 8.1 times per day. Approximately 73.3% of the participants did not reach the amount of adequate fluid intake (1.7 L for males and 1.5 L for females) recommended in China. Fluid intake in the morning, afternoon, and evening among participants was 594 mL, 305 mL and 342 mL, with a frequency of 3.0 times, 1.7 times, and 2.0 times, respectively. The median urination frequency was 7.4 times per day. The percentage of participants who urinated >7 times during the day was 44.3%. The percentage of participants who urinated ≥1 time at night was 77.5%. Age and BMI were not the main influence factors for fluid intake and urination behaviors. The preliminary analysis showed that higher TFI, plain water intake, dairy products intake, and fluid intake frequency were significantly associated with higher urination frequency (t = 6.553, p < 0.05; t = 5.291, p < 0.05; t = 4.667, p < 0.05; t = 13.413, p < 0.05). Higher fluid intake per time was significantly associated with lower urination frequency (t = -3.562, p < 0.05). Correlations between TFI, fluid intake frequency, fluid intake in night, fluid intake frequency in night and urination at night were also found (r = 0.114, p < 0.05; r = 0.091, p < 0.05; r = 0.146, p < 0.05; r = 0.331, p < 0.05). Conclusion Fluid intake was inadequate in terms of the elderly participants. Participants with higher fluid intake and frequency in night had a greater incidence of nocturia. Thus, correcting fluid intake behaviors can improve urination behavior and promote health. Clinical trial registration https://www.chictr.org.cn/searchprojEN.html, identifier CTR1900023355.
Collapse
Affiliation(s)
- Yongye Song
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Yue Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Yan Liu
- YIDO AI Technology (Shandong) Co., Ltd., Jinan, China
| | - Jianfen Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, Beijing, China
| | - Junbo Lu
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Xing Wang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
| | - Na Zhang
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, Beijing, China
| | - Guansheng Ma
- Department of Nutrition and Food Hygiene, School of Public Health, Peking University, Beijing, China
- Laboratory of Toxicological Research and Risk Assessment for Food Safety, Peking University, Beijing, China
| |
Collapse
|
14
|
Tufanaru C, Surian D, Scott AM, Glasziou P, Coiera E. The 2-week systematic review (2weekSR) method was successfully blind-replicated by another team: a case study. J Clin Epidemiol 2024; 165:111197. [PMID: 37879542 DOI: 10.1016/j.jclinepi.2023.10.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/14/2023] [Accepted: 10/19/2023] [Indexed: 10/27/2023]
Abstract
OBJECTIVE To assess the replicability of a 2-week systematic review (index 2weekSR) created with the assistance of automation tools using the fidelity method. METHODS A Preferred Reporting Items for Systematic reviews and Meta-Analyses compliant SR protocol was developed based on the published information of the index 2weekSR study. The replication team consisted of three reviewers. Two reviewers blocked off time during the replication. The total time to complete tasks and the meta-analysis results were compared with the index 2weekSR study. Review process fidelity scores (FSs) were calculated for review methods and outcomes. Barriers to completing the replication were identified. RESULTS The review was completed over 63 person-hours (11 workdays/15 calendar days). A FS of 0.95 was achieved for the methods, with 3 (of 8) tasks only partially replicated, and an FS of 0.63 for the outcomes, with 6 (of 7) only partially replicated and one task was not replicated. Nonreplication was mainly caused by missing information in the index 2weekSR study that was not required in standard reporting guidelines. The replication arrived at the same conclusions as the original study. CONCLUSION A 2weekSR study was replicated by a small team of three reviewers supported by automation tools. Including additional information when reporting SRs should improve their replicability.
Collapse
Affiliation(s)
- Catalin Tufanaru
- Australian Institute of Health Innovation, Level 6, Macquarie University, 75 Talavera Road, North Ryde, New South Wales 2109, Australia
| | - Didi Surian
- Australian Institute of Health Innovation, Level 6, Macquarie University, 75 Talavera Road, North Ryde, New South Wales 2109, Australia.
| | - Anna Mae Scott
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, Queensland 4226, Australia
| | - Paul Glasziou
- Institute for Evidence-Based Healthcare, Bond University, 14 University Drive, Robina, Queensland 4226, Australia
| | - Enrico Coiera
- Australian Institute of Health Innovation, Level 6, Macquarie University, 75 Talavera Road, North Ryde, New South Wales 2109, Australia
| |
Collapse
|
15
|
Corse TD, Rahmani LD, Hasley HL, Kim K, Harrison R, Fromer DL. New avenue of diagnostic stewardship: procedural stewardship for recurrent urinary tract infections in female patients. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e231. [PMID: 38156218 PMCID: PMC10753495 DOI: 10.1017/ash.2023.507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 12/30/2023]
Abstract
Introduction Societal guidelines offer a weak recommendation to perform cystoscopy for female patients with recurrent urinary tract infections (rUTI) of advanced age and/or with high-risk features. These guidelines lack the support of robust data and are instead based on expert opinion. In this retrospective cohort study, we aim to determine the utility of cystoscopy in patients with and without high-risk features for rUTI. Materials and methods We identified 476 women who underwent cystoscopy for the evaluation of rUTI at a single tertiary academic medical center from May 1, 2015 and March 15, 2021. Patients were excluded if they had a competing indication for cystoscopy. Risk factors, demographic information, cystoscopic findings, and patient outcomes were analyzed. Results 192 (41.1%) were classified as having complicated UTI. We identified six patients (1.3%) with findings that prompted management to significantly impact patient outcomes. All six patients had high-risk features. 14 patients (3.0%) were found to have mucosal abnormalities prompting biopsy, three of which required general anesthesia. All 14 biopsies were ultimately benign. Conclusions Our findings demonstrate a low diagnostic yield and increased risk exposure for women undergoing cystoscopy for the evaluation of complicated rUTI. Additionally, our observations support prior studies indicating that cystoscopy has limited utility in the evaluation of rUTI without high-risk features.
Collapse
Affiliation(s)
- Tanner D. Corse
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Linda Dayan Rahmani
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Hunter L. Hasley
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Katherine Kim
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
| | - Robert Harrison
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Debra L. Fromer
- Department of Urology, Hackensack Meridian School of Medicine, Nutley, NJ, USA
- Department of Urology, Hackensack University Medical Center, Hackensack, NJ, USA
| |
Collapse
|
16
|
McMichael D, Gillen P, McGeary C, Sartaj M, Patterson L. Investigating the impact of an online hydration intervention in care homes using the COM-B model: a mixed methods study. BMC Geriatr 2023; 23:822. [PMID: 38066418 PMCID: PMC10704796 DOI: 10.1186/s12877-023-04515-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 11/24/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Antimicrobial resistance is a serious threat to public health. To reduce antimicrobial resistance, interventions to reduce gram-negative infections, specifically urinary tract infections, are vital. Early evidence suggests increased fluid intake is linked with a reduction in UTIs and subsequently has potential to reduce antibiotic usage. Care homes have a high prevalence of UTIs and provide an opportunity in a closed setting to deliver an intervention focused on increasing fluid intake, where it is supported and monitored by health care workers. The study aimed to evaluate the impact and feasibility of an online staff focused intervention over a 30 day period to increase the hydration of care home residents with a view to reducing the burden of AMR in this setting. METHODS The study was a pre and post intervention with a sequential explanatory mixed methods design. The intervention was delivered online in 3 care homes, containing 3 main components underpinned by the COM-B model including hydration training, 7 structured drinks rounds and a hydration champion to change behaviour of care home staff. A pre and post questionnaire assessed the impact of the intervention on staff and data was collected on fluid intake, drinks rounds delivered to residents, UTIs, antibiotic used to treat UTIs, falls and hospitalisation. Descriptive statistics summarised and assessed the impact of the study. Focus groups with care home staff provided qualitative data which was thematically analysed. RESULTS Staff increased in self-perceived knowledge across the six components of hydration care. 59% of residents had an increase in median fluid intake post intervention. During the time of the intervention, a 13% decrease in UTIs and antibiotic usage to treat UTIs across the 3 care homes was recorded, however falls and hospitalisations increased. Themes arising from focus groups included the role of information for action, accessibility of online training, online training content. CONCLUSIONS This study demonstrates that a brief, low cost, online multi-component intervention focused on care home staff can increase the fluid intake of residents. A reduction in UTIs and antibiotic consumption was observed overall. Empowering care home staff could be a way of reducing the burden of infection in this setting.
Collapse
Affiliation(s)
- Danielle McMichael
- Public Health Agency, 12-22 Linenhall Street, Belfast, BT2 8BS, Northern Ireland.
| | - Patricia Gillen
- Ulster University, Shore Rd, Newtownabbey, BT37 0QB, Northern Ireland
- Health and Social Care Trust, Rosedale, 10 Moyallen Road, Gilford, BT63 5JX, Northern Ireland
| | - Caroline McGeary
- Public Health Agency, 12-22 Linenhall Street, Belfast, BT2 8BS, Northern Ireland
| | - Muhammad Sartaj
- Public Health Agency, 12-22 Linenhall Street, Belfast, BT2 8BS, Northern Ireland
| | - Lynsey Patterson
- Public Health Agency, 12-22 Linenhall Street, Belfast, BT2 8BS, Northern Ireland
- Centre for Public Health, Institute of Clinical Sciences, Royal Victoria Hospital, Queen's University Belfast, Belfast, BT12 6BA, Northern Ireland
| |
Collapse
|
17
|
Zemdegs J, Iroz A, Vecchio M, Roze S, Lotan Y. Water intake and recurrent urinary tract infections prevention: economic impact analysis in seven countries. BMC Health Serv Res 2023; 23:1197. [PMID: 37924070 PMCID: PMC10623695 DOI: 10.1186/s12913-023-10234-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND To estimate the economic impact of preventing urinary tract infections (UTI) by increasing water intake among women with recurrent UTI and low fluid intake across seven countries: France, United Kingdom, Spain, United States of America, Mexico, China and Australia. METHODS A Markov model was developed to compare costs and outcomes of UTIs associated with low fluid intake in women versus a strategy of primary prevention by increasing water intake. Model inputs were based on randomized controlled trial data which found that increasing water intake by 1.5 L/day decreased the risk of developing cystitis by 48% in women with low fluid intake and recurrent UTI. A time horizon of 10 years was used; outcomes were from the payer perspective and included both direct and indirect costs, reported in 2019 United States dollars ($). Discounting rates varied by country. Scenarios of increasing levels of compliance to the increased water intake strategy were evaluated. RESULTS The total cost of one UTI episode, including diagnostics, treatment and complications, ranged from $2164 (Mexico) to $7671 (Australia). Assuming 80% compliance with the increased water intake strategy over a 10-year time horizon, the number of UTIs prevented ranged from 435,845 (Australia) to 24150,272 (China), resulting in total savings of 286 million (Australia) to $4.4 billion (China). Across all countries, increased water intake resulted in lower cost and fewer UTIs compared with low water intake. CONCLUSION Preventing recurrent UTIs by increasing water intake would reduce both the clinical and economic burden associated with UTI. Public, healthcare professionals and patients should be made aware about the preventive positive impact of appropriate water intake on UTIs.
Collapse
Affiliation(s)
- Juliane Zemdegs
- Danone Global Research and Inovation Center, Gif-Sur-Yvette, France
| | - Alison Iroz
- Danone Global Research and Inovation Center, Gif-Sur-Yvette, France
| | | | | | - Yair Lotan
- Department of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390, USA.
| |
Collapse
|
18
|
Kucheria A, Kanabar S, Blick C, Yang B. A practical guide on the non-antibiotic options available in the prevention of recurrent urinary tract infections in women. Urologia 2023; 90:683-688. [PMID: 37606220 DOI: 10.1177/03915603231193060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
Abstract
Urinary Tract infection (UTI) is one of the most common infections worldwide, patients present to multiple different specialities in the community, primary and secondary care. Antibiotics are considered standard first line therapy in the treatment of urinary tract infections, however there is an alarming rise in global antibiotic resistance rates, so much so that the World Health Organisation has labelled antibiotic resistance as one of the biggest challenges to public health in our lifetime, publishing a global action plan to tackle this challenge. As a result, there is an increasing need to discover non-antibiotic alternatives, recently a number of novel therapies have been introduced into clinical practice. These are divided into oral, topical, intravesical and immunomodulation therapies. The aim of this paper is to summarise the current non-antibiotic treatments as a practical guide to utilise in patient care.
Collapse
Affiliation(s)
- Anushree Kucheria
- Department of Urology, Royal Berkshire Hospital, Reading, Berkshire, UK
| | - Sagar Kanabar
- Department of Urology, Royal Berkshire Hospital, Reading, Berkshire, UK
| | - Christopher Blick
- Department of Urology, Royal Berkshire Hospital, Reading, Berkshire, UK
| | - Bob Yang
- Department of Urology, Royal Berkshire Hospital, Reading, Berkshire, UK
| |
Collapse
|
19
|
Bavanandan S, Keita N. Urinary Tract Infection Prevention and Treatment. Semin Nephrol 2023; 43:151468. [PMID: 38403525 DOI: 10.1016/j.semnephrol.2023.151468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Urinary tract infections are the most common bacterial infections encountered by health care professionals. In women, the lifetime incidence of urinary tract infections may be up to 40% to 50%, of whom a further 40% may have recurrent infections. Urinary tract infections are associated with significant morbidity and potential mortality-they may be complicated by frequent recurrences, kidney damage, sepsis, and preterm birth, as well as collateral damage of antimicrobial use, which includes Clostridium difficile colitis and selection of drug-resistant organisms. There are personal costs such as reduced quality of life in patients affected by recurrent urinary tract infections, and societal impacts resulting from absenteeism and health care costs. In this review, we discuss the definitions and classifications, pathogenesis, and current principles of management and prevention of urinary tract infections. Semin Nephrol 43:x-xx © 2023 Elsevier Inc. All rights reserved.
Collapse
Affiliation(s)
- Sunita Bavanandan
- Department of Nephrology, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
| | - Niakhaleen Keita
- Department of Nephrology, National Hospital Dalal Jamm, Dakar, Senegal.
| |
Collapse
|
20
|
Venturini S, Reffo I, Avolio M, Basaglia G, Del Fabro G, Callegari A, Tonizzo M, Sabena A, Rondinella S, Mancini W, Conte C, Crapis M. The Management of Recurrent Urinary Tract Infection: Non-Antibiotic Bundle Treatment. Probiotics Antimicrob Proteins 2023:10.1007/s12602-023-10141-y. [PMID: 37584833 DOI: 10.1007/s12602-023-10141-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/11/2023] [Indexed: 08/17/2023]
Abstract
Recurrent urinary tract infections (rUTIs) are a common condition with high morbidity and negatively impact the quality of life. They account for approximately 25% of all antibiotic prescriptions and are a public health concern in an era of increasing multidrug-resistant organisms (MDROs). Several non-antibiotic treatment strategies have been tried to curb antimicrobial use, and many are effective to some degree, but no experience testing multimodal interventions. We created a "care bundle" consisting of behavioral interventions, vaginal and oral probiotics, D-mannose, and cranberry to be followed for six months. We enrolled women with rUTIs over three years. Changes in urinary tract infections, antibiotic use, chronic symptoms, and quality of life were compared in the six months before and after participation in the study. Forty-seven women were enrolled in the study, six of whom were excluded from the final analysis. We observed a 76% reduction in urinary tract infections (p < 0.001) and a reduction in total antibiotic exposure of more than 90% (p < 0.001); all chronic symptoms showed a trend toward reduction. Adherence to the bundle was high (87.2%). Overall, 80.5% of women experienced an improvement in their quality of life. In our experience, a bundle protocol is effective in reducing recurrences and antimicrobial use in a cohort of women with rUTIs and results in a subjective improvement in chronic symptoms and quality of life. Further research with larger sample size is needed to confirm these findings.
Collapse
Affiliation(s)
- Sergio Venturini
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Ingrid Reffo
- Department of Anaesthesia and Intensive Care, ASFO Santa Maria dei Battuti Hospital of San Vito al Tagliamento (Pordenone), Pordenone, Italy.
| | - Manuela Avolio
- Department of Microbiology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Giancarlo Basaglia
- Department of Microbiology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Giovanni Del Fabro
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Astrid Callegari
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Maurizio Tonizzo
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Anna Sabena
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Stefania Rondinella
- Department of Internal Medicine, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Walter Mancini
- Department of Nephrology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Carmina Conte
- Department of Nephrology, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| | - Massimo Crapis
- Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy
| |
Collapse
|
21
|
Bakhoum CY, Garimella PS. The Role of Water in Uromodulin Regulation: A Deeper Dive. Clin J Am Soc Nephrol 2023; 18:985-987. [PMID: 37418253 PMCID: PMC10564335 DOI: 10.2215/cjn.0000000000000233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Affiliation(s)
- Christine Y. Bakhoum
- Section of Nephrology, Department of Pediatrics, Yale University, New Haven, Connecticut
| | - Pranav S. Garimella
- Division of Nephrology and Hypertension, University of California San Diego, San Diego, California
| |
Collapse
|
22
|
Čeprnja M, Hadžić E, Oros D, Melvan E, Starcevic A, Zucko J. Current Viewpoint on Female Urogenital Microbiome-The Cause or the Consequence? Microorganisms 2023; 11:1207. [PMID: 37317181 DOI: 10.3390/microorganisms11051207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 06/16/2023] Open
Abstract
An increasing amount of evidence implies that native microbiota is a constituent part of a healthy urinary tract (UT), making it an ecosystem on its own. What is still not clear is whether the origin of the urinary microbial community is the indirect consequence of the more abundant gut microbiota or a more distinct separation exists between these two systems. Another area of uncertainty is the existence of a link between the shifts in UT microbial composition and both the onset and persistence of cystitis symptoms. Cystitis is one of the most common reasons for antimicrobial drugs prescriptions in primary and secondary care and an important contributor to the problem of antimicrobial resistance. Despite this fact, we still have trouble distinguishing whether the primary cause of the majority of cystitis cases is a single pathogen overgrowth or a systemic disorder affecting the entire urinary microbiota. There is an increasing trend in studies monitoring changes and dynamics of UT microbiota, but this field of research is still in its infancy. Using NGS and bioinformatics, it is possible to obtain microbiota taxonomic profiles directly from urine samples, which can provide a window into microbial diversity (or the lack of) underlying each patient's cystitis symptoms. However, while microbiota refers to the living collection of microorganisms, an interchangeably used term microbiome referring to the genetic material of the microbiota is more often used in conjunction with sequencing data. It is this vast amount of sequences, which are truly "Big Data", that allow us to create models that describe interactions between different species contributing to an UT ecosystem, when coupled with machine-learning techniques. Although in a simplified predator-prey form these multi-species interaction models have the potential to further validate or disprove current beliefs; whether it is the presence or the absence of particular key players in a UT microbial ecosystem, the exact cause or consequence of the otherwise unknown etiology in the majority of cystitis cases. These insights might prove to be vital in our ongoing struggle against pathogen resistance and offer us new and promising clinical markers.
Collapse
Affiliation(s)
- Marina Čeprnja
- Biochemical Laboratory, Special Hospital Agram, Polyclinic Zagreb, 10000 Zagreb, Croatia
| | - Edin Hadžić
- Department of Biochemical Engineering, Faculty of Food Technology and Biotechnology, Zagreb University, 10000 Zagreb, Croatia
| | - Damir Oros
- Department of Biochemical Engineering, Faculty of Food Technology and Biotechnology, Zagreb University, 10000 Zagreb, Croatia
| | - Ena Melvan
- Department of Biological Science, Faculty of Science, Macquarie University, Sydney, NSW 2109, Australia
| | - Antonio Starcevic
- Department of Biochemical Engineering, Faculty of Food Technology and Biotechnology, Zagreb University, 10000 Zagreb, Croatia
| | - Jurica Zucko
- Department of Biochemical Engineering, Faculty of Food Technology and Biotechnology, Zagreb University, 10000 Zagreb, Croatia
| |
Collapse
|
23
|
Alrosan S, Al Mse'adeen M, Alkhawaldeh IM, Mishael J, Aljarab'ah N, Aljarajreh M, Yamin M, Abu-Jeyyab M. An Audit to Reevaluate the Adherence to the Guidelines in Patients With Urinary Tract Infection at the Al-Karak Hospital in Jordan. Cureus 2023; 15:e39509. [PMID: 37366451 PMCID: PMC10290742 DOI: 10.7759/cureus.39509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Background Urinary tract infection (UTI) is a common and costly health problem that affects millions of people worldwide. The proper management of UTI requires adherence to clinical guidelines that are based on the best available evidence. However, compliance with these guidelines in real-world practice is often suboptimal. Objective This study is aimed to audit and reevaluate the adherence to the guidelines in UTI patients at Al-Karak Hospital, Jordan. Methods A retrospective cohort study was conducted. The first loop included 50 patients who presented with symptoms of simple uncomplicated UTI and were treated at the clinic during a three-month period. The second loop included a reevaluation of the first loop's findings after implementing changes to the clinical practice based on the initial audit results. Results The main factors that influenced the adherence were the type of UTI, the presence of comorbidities, the duration of hospitalization, and the antibiotic choice. At the first loop, the audit findings identified that the 100% standard National Institute for Health and Care Excellence (NICE) guidelines met the reach of 20 (40%) of the 50 patients. A revaluation of the audit findings identified that the 100% standard NICE guidelines met the reach of 36 of the 50 (72%) patients. Conclusion The study concluded that there is a need to improve adherence to the guidelines in UTI patients at the Al-Karak Hospital and suggested some recommendations to achieve this goal.
Collapse
Affiliation(s)
- Sallam Alrosan
- Internal Medicine, Saint Luke's Health System, Kansas City, USA
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Stair SL, Palmer CJ, Lee UJ. Evidence-based review of nonantibiotic urinary tract infection prevention strategies for women: a patient-centered approach. Curr Opin Urol 2023; 33:187-192. [PMID: 36862100 DOI: 10.1097/mou.0000000000001082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023]
Abstract
PURPOSE OF REVIEW There is a growing interest in nonantibiotic prevention strategies for recurrent urinary tract infections (rUTIs). Our objective is to provide a focused, pragmatic review of the latest evidence. RECENT FINDINGS Vaginal estrogen is well tolerated and effective for preventing rUTI in postmenopausal women. Cranberry supplements at sufficient doses are effective in preventing uncomplicated rUTI. Methenamine, d -mannose, and increased hydration all have evidence to support their use, although the evidence is of somewhat variable quality. SUMMARY There is sufficient evidence to recommend vaginal estrogen and cranberry as first-line rUTI prevention strategies, particularly in postmenopausal women. Prevention strategies can be used in series or in tandem, based on patient preference and tolerance for side effects, to create effective nonantibiotic rUTI prevention strategies.
Collapse
Affiliation(s)
- Sabrina L Stair
- Section of Urology and Renal Transplantation, Virginia Mason Medical Center, 1100 Ninth Avenue, C7-URO, Seattle, Washington, USA
| | | | | |
Collapse
|
25
|
Mitsutake S, Ishizaki T, Edahiro A, Kitamura A, Hirata T, Saito A. The effects of dental visits on the occurrence of acute hospitalization for systemic diseases among patients aged 75 years or older: A propensity score-matched study. Arch Gerontol Geriatr 2023; 107:104876. [PMID: 36516734 DOI: 10.1016/j.archger.2022.104876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/03/2022] [Accepted: 11/22/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Although several studies examined the association between oral status and the risk of systemic diseases, few have examined whether dental visits affect the occurrence of acute hospitalization due to systemic diseases. This study examined the effects of dental visits on preventing the occurrence of acute hospitalization due to systemic diseases in adults aged ≥ 75 years, in order to optimize the healthcare system for older adults. METHODS This propensity-score-matched retrospective cohort study was conducted using medical insurance claims data from Hokkaido, Japan. We analyzed 432,292 adult outpatients aged ≥ 75 years between September 2016 and February 2017 (baseline period). The exposure variable was visits to the dental office during the baseline period. The primary outcome variable was the occurrence of acute hospitalization due to pneumonia, urinary tract infections, cerebrovascular diseases, or coronary heart diseases between March 2017 and March 2019. RESULTS Among the 432,292 patients before propensity score matching, 149,639 (34.6%) had visited the dental office. One-to-one propensity score matching produced 149,289 matched pairs adjusted for the differences in all covariables (age, sex, copayment rate, annual health checkup, chronic diseases, and residential area). In these matched pairs, the risk ratio of the occurrence of acute hospitalization due to pneumonia, urinary tract infections, and cerebrovascular diseases was lower among patients who had visited dental office than among those who did not. CONCLUSIONS Dental visits appeared to be effective in preventing acute hospitalization due to systemic diseases, thus, dental care services would be an important component of healthcare for older adults.
Collapse
Affiliation(s)
- Seigo Mitsutake
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Tatsuro Ishizaki
- Human Care Research Team, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan.
| | - Ayako Edahiro
- Research Team for Promoting Independence and Mental Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Akihiko Kitamura
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, Tokyo, Japan
| | - Takumi Hirata
- Institute for Clinical and Translational Science, Nara Medical University, Nara, Japan
| | - Atsushi Saito
- Department of Peridontology, Tokyo Dental College, Tokyo, Japan
| |
Collapse
|
26
|
Seal AD, Colburn AT, Johnson EC, Péronnet F, Jansen LT, Adams JD, Bardis CN, Guelinckx I, Perrier ET, Kavouras SA. Total water intake guidelines are sufficient for optimal hydration in United States adults. Eur J Nutr 2023; 62:221-226. [PMID: 35943601 DOI: 10.1007/s00394-022-02972-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 07/19/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Recent studies suggest that 24-h urine osmolality (UOsm) for optimal water intake should be maintained < 500 mmol·kg-1. The purpose of this study was to determine the total water intake (TWI) requirement for healthy adults to maintain optimal hydration as indicated by 24-h urine osmolality < 500 mmol·kg-1. METHODS Twenty-four-hour UOsm was assessed in 49 men and 50 women residing in the United States (age: 41 ± 14 y, body mass index: 26.3 ± 5.2 kg·m-2). TWI was assessed from 7-day water turnover, using a dilution of deuterium oxide, corrected for metabolic water production. The diagnostic accuracy of TWI to identify UOsm < 500 mmol·kg-1 was evaluated using receiver operating characteristic (ROC) analysis in men and women separately. RESULTS Twenty-four-hour UOsm was 482 ± 229 and 346 ± 182 mmol·kg-1 and TWI was 3.57 ± 1.10 L·d-1 and 3.20 ± 1.27 L·d-1 in men and women, respectively. ROC analysis for TWI detecting 24-h UOsm < 500 mmol·kg-1 in men yielded an area under the curve (AUC) of 77.4% with sensitivity, specificity, and threshold values of 83.3%, 64.5%, and 3.39 L·d-1, respectively. The AUC was 82.4% in women with sensitivity, specificity, and threshold values of 85.7%, 72.1%, and 2.61 L·d-1. CONCLUSION Considering threshold values in men and women of 3.4 L·d-1 and 2.6 L·d-1, respectively, maintaining TWI in line with National Academy of Medicine guidelines of 3.7 L·d-1 in men and 2.7 L·d-1 in women should be sufficient for most individuals in the United States to maintain 24-h UOsm < 500 mmol·kg-1.
Collapse
Affiliation(s)
- Adam D Seal
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA, USA
| | - Abigail T Colburn
- Hydration Science Lab, Arizona State University, College of Health Solutions, Phoenix, AZ, USA
| | - Evan C Johnson
- Human Integrated Physiology Laboratory, University of Wyoming, Laramie, WY, USA
| | - François Péronnet
- École de Kinésiologie et des Sciences de l'Activité Physique, University of Montreal, Montreal, QC, Canada
| | - Lisa T Jansen
- Department of Dietetics and Nutrition, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - J D Adams
- Department of Health and Human Performance, College of Charleston, Charleston, SC, USA
| | - Costas N Bardis
- Section of Sports Medicine and Biology of Physical Activity, School of Physical Education and Sport Science, University of Athens, Athens, Greece
| | | | | | - Stavros A Kavouras
- Hydration Science Lab, Arizona State University, College of Health Solutions, Phoenix, AZ, USA.
| |
Collapse
|
27
|
Wang R, Scutari T, Tunitsky-Bitton E. Implementation of a Clinical Protocol to Reduce Urinary Tract Infections Among Women With Urinary Retention After Pelvic Reconstructive Surgery: A Prospective Quality Improvement Study. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:134-140. [PMID: 36565922 DOI: 10.1016/j.jogc.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE We implemented and assessed a clinical practice quality improvement protocol aimed at decreasing postoperative urinary tract infections (UTIs) among patients with transurethral catheters. METHODS This was a quality improvement study with pre- and post-intervention comparisons. Patients requiring postoperative transurethral catheters underwent 3 interventions: (1) shortening the time from surgery to repeat voiding trials to 3-5 days for pelvic reconstructive surgeries and to 1-3 days for mid-urethral slings, (2) avoiding routine urine cultures at the time of voiding trials, and (3) recommending 2 L of water intake daily until 3 days after the voiding trial. The primary outcome was the percentage of patients receiving antibiotics for UTIs within 6 weeks. Secondary outcomes included rates of failing office voiding trials, UTI symptoms/cultures, adherence to hydration, and health care resource utilization. RESULTS We included 31 patients before and 40 patients after the intervention. The 2 cohorts had similar demographic and clinical characteristics. Among patients requiring catheterization, rates of antibiotic treatment for UTIs decreased from 65% to 40% after the intervention (P = 0.04). UTI symptoms and urine cultures sent for analysis decreased significantly (P = 0.04 and P = 0.005, respectively). There was high adherence (84%) to increased hydration. Rates of failing office voiding trials remained similar. The number of phone calls decreased by 43% (P = 0.003), and there was no increase in office or emergency department visits. Multivariate regression showed that UTIs were 2.04 times more likely before than after the intervention. CONCLUSION Our quality improvement intervention was practical to implement and effective in reducing postoperative UTIs among patients with urinary catheters.
Collapse
Affiliation(s)
- Rui Wang
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT.
| | - Taylor Scutari
- University of Connecticut School of Medicine, Farmington, CT
| | - Elena Tunitsky-Bitton
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Hartford Hospital, Hartford, CT
| |
Collapse
|
28
|
Incidence and Causative Organisms of Bacteriuria in Children With Cancer: A 9-Year Experience in a Tertiary Pediatric Center. J Pediatr Hematol Oncol 2023; 45:21-24. [PMID: 35972935 DOI: 10.1097/mph.0000000000002524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 06/13/2022] [Indexed: 02/03/2023]
Abstract
Although infection is common in patients with cancer, the distribution of causative agents and the proportion of resistant bacteria in patients with urinary tract infection remain unknown. The aim of this study was to describe the incidence, the causative agents, and the proportion of antimicrobial resistance in bacteria cultured from urine of hospitalized children with cancer. A single-center retrospective chart review of patients with cancer admitted between 2012 and 2020 was performed to identify patients with positive urine culture. Overall, 61 (0.9%) of 7107 patients were identified to have positive urine cultures. Among them, 25 patients (41%) had symptomatic bacteriuria. The most common pathogenic bacterium among all patients was Escherichia coli ( E. coli ) (n=15, 25%), followed by Enterococcus sp. (n=14, 23%), Klebsiella sp. (n=12, 20%), and Pseudomonas aeruginosa ( P. aeruginosa ) (n=12, 20%). Extended spectrum β-lactamases-producing E. coli and Extended spectrum β-lactamases-producing Klebsiella pneumoniae were detected in 1 patient (2%) and 4 patients (7%), respectively. No multidrug-resistant P. aeruginosa and vancomycin-resistant Enterococcus were detected. The incidence of bacteriuria was found to be low in children with cancer. The distribution of causative agents of bacteriuria in children with solid tumors and hematologic diseases may be different from that in previously healthy children.
Collapse
|
29
|
Seid M, Markos M, Aklilu A, Manilal A, Zakir A, Kebede T, Kulayta K, Endashaw G. Community-Acquired Urinary Tract Infection Among Sexually Active Women: Risk Factors, Bacterial Profile and Their Antimicrobial Susceptibility Patterns, Arba Minch, Southern Ethiopia. Infect Drug Resist 2023; 16:2297-2310. [PMID: 37095780 PMCID: PMC10122500 DOI: 10.2147/idr.s407092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 04/07/2023] [Indexed: 04/26/2023] Open
Abstract
Background Globally, urinary tract infections (UTIs) are a common health issue among women. Investigating risk factors associated with culture-proven UTIs and the antimicrobial resistance profile of uropathogens would provide insight into planning prevention and control measures. Objective To identify the risk factors associated with UTIs among sexually active women and determine antimicrobial susceptibility patterns of uropathogenic bacterial isolates. Methods A case-control study was conducted from February to June 2021, involving 296 women (62 case group and 234 control group in a ratio of 4:1). Cases were defined as culture-confirmed UTIs, and controls were non-UTIs. A semi-structured questionnaire was used to collect demographic, clinical, and behavioral data. The antimicrobial susceptibility test was done by the Kirby-Bauer disc diffusion method. The data were analyzed using SPSS version 25. Bivariable and multivariable logistic regressions were used to identify risk factors, and the strength of association was measured by adjusted odds ratios and a 95% confidence interval used at P-values < 0.05. Results The results revealed that recent coitus and frequency of coitus more than three times per week (P=0.001) were independent predictors of UTIs. Swabbing from back to front, a history of UTI and a delay in voiding were also independent predictors (P < 0.05). On the other hand, a daily water intake of 1 to 2 litres reduced the risk of UTI (P= 0.001). The predominant uropathogenic isolate was Escherichia coli (35.48%). Over 60% of isolates were resistant to cotrimoxazole, penicillin, cephalosporin, and fluoroquinolones. The most effective antibiotics included piperacillin-tazobactam, aminoglycosides, carbapenem, and nitrofurantoin. 85% and 50% of isolates were MDR and ESBL producers, respectively. Conclusion The finding indicates the importance of public intervention targeting the identified risk factors and the resistance phenotype to reduce the burden of UTIs with antimicrobial resistance in the study area.
Collapse
Affiliation(s)
- Mohammed Seid
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
- Correspondence: Mohammed Seid, Email
| | - Mesafint Markos
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Addis Aklilu
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Aseer Manilal
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | - Abdurezak Zakir
- Department of Medical Laboratory Science, College of Medicine and Health Sciences, Arba Minch University, Arba Minch, Ethiopia
| | | | - Kebede Kulayta
- Department of Medical Laboratory Science, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
| | - Gessila Endashaw
- Department of Nursing, Arba Minch University, Arba Minch College of Health Sciences, Arba Minch, Ethiopia
| |
Collapse
|
30
|
Pothoven R. Management of urinary tract infections in the era of antimicrobial resistance. Drug Target Insights 2023; 17:126-137. [PMID: 38124759 PMCID: PMC10731245 DOI: 10.33393/dti.2023.2660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
Urinary tract infections (UTIs) are among the most common infections globally, imposing a substantial personal and economic burden on individuals and health resources. Despite international health concerns and sustained public awareness campaigns about the emergence of resistant microorganisms through the inappropriate therapeutic use of antimicrobial agents, the problem of antimicrobial resistance (AMR) is worsening, and AMR in UTIs represents a critical global healthcare issue. This narrative review summarizes evidence-based scientific material, recommendations from the current medical literature, and the latest clinical guidelines on antibiotic and antibiotic-sparing strategies for managing urological infections, including practical approaches to improve the management of patients with acute and recurrent UTIs (rUTIs) in routine clinical practice. Novel emerging therapies and prophylaxis options are described as potential alternatives to overcome the abuse and overuse of antibiotics and the practical application of the guideline recommendations and issues relating to best practice in managing UTIs.
Collapse
Affiliation(s)
- Ria Pothoven
- Florence and Andros Gynos Klinieken, The Hague, The Netherlands
| |
Collapse
|
31
|
Rogerson G, Whelan M, Gibson R. A systematic review of measurement methods used to estimate fluid and beverage intake in free-living, working-age adults. J Hum Nutr Diet 2022. [PMID: 36514191 DOI: 10.1111/jhn.13127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 12/05/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Beverage intake in employees is important to quantify due to the potential of dehydration to increase the risk of errors and reduced work performance. This systematic review aimed to (1) characterise existing fluid intake measurement tools used in the workplace setting or among free-living, healthy adults of working age and (2) report the current validation status of available assessment tools for use in a UK setting. METHODS Three electronic databases were searched for publications measuring beverage intake using a defined tool or method. Additional studies were identified by hand from trial registers, grey literature and reference lists. Eligibility was determined using predefined inclusion/exclusion criteria. Study quality was assessed using a modified Strengthening the Reporting of Observational Studies in Epidemiology framework. Narrative synthesis was performed. RESULTS The review identified 105 studies. The most frequently reported beverage assessment methods were total diet diaries/records (n = 22), fluid specific diaries/records (n = 18), food and fluid frequency questionnaires (n = 17), beverage-specific frequency questionnaires (n = 23) and diet recalls (n = 11). General dietary measurement tools (measuring beverages as part of total diet) were used in 60 studies, and 45 studies used a beverage-specific tool. This review identified 18 distinct dietary assessment tools, of which 6 were fluid/beverage specific. Twelve tools published relative validity for a beverage-related variable and seven tools for total daily fluid intake (from whole diet or from beverages only). CONCLUSIONS Several fluid intake assessment tools were identified; however, few have been fully evaluated for total beverage intake, and none in a UK working population.
Collapse
Affiliation(s)
- Georgia Rogerson
- Department of Nutritional Sciences, King's College London, London, UK
| | - Megan Whelan
- Department of Nutritional Sciences, King's College London, London, UK
| | - Rachel Gibson
- Department of Nutritional Sciences, King's College London, London, UK
| |
Collapse
|
32
|
Finney EL, Pagura EJ, MacLachlan LS. Efficacy and Safety of Alternative Treatments for the Prevention of Recurrent Urinary Tract Infections. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00678-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
|
33
|
Current Bladder Dysfunction Reports: Antibiotic Overuse in Office-Based Lower Urinary Tract Procedures. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00672-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
34
|
Dolci A, Vanhaecke T, Qiu J, Ceccato R, Arboretti R, Salmaso L. Personalized prediction of optimal water intake in adult population by blended use of machine learning and clinical data. Sci Rep 2022; 12:19692. [PMID: 36385111 PMCID: PMC9669042 DOI: 10.1038/s41598-022-21869-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 10/04/2022] [Indexed: 11/17/2022] Open
Abstract
Growing evidence suggests that sustained concentrated urine contributes to chronic metabolic and kidney diseases. Recent results indicate that a daily urinary concentration of 500 mOsm/kg reflects optimal hydration. This study aims at providing personalized advice for daily water intake considering personal intrinsic (age, sex, height, weight) and extrinsic (food and fluid intakes) characteristics to achieve a target urine osmolality (UOsm) of 500 mOsm/kg using machine learning and optimization algorithms. Data from clinical trials on hydration (four randomized and three non-randomized trials) were analyzed. Several machine learning methods were tested to predict UOsm. The predictive performance of the developed algorithm was evaluated against current dietary guidelines. Features linked to urine production and fluid consumption were listed among the most important features with relative importance values ranging from 0.10 to 0.95. XGBoost appeared the most performing approach (Mean Absolute Error (MAE) = 124.99) to predict UOsm. The developed algorithm exhibited the highest overall correct classification rate (85.5%) versus that of dietary guidelines (77.8%). This machine learning application provides personalized advice for daily water intake to achieve optimal hydration and may be considered as a primary prevention tool to counteract the increased incidence of chronic metabolic and kidney diseases.
Collapse
Affiliation(s)
- Alberto Dolci
- grid.433367.60000 0001 2308 1825Health, Hydration and Nutrition Science Department, Danone Research, Route Départementale 128, 91767 Palaiseau, France
| | - Tiphaine Vanhaecke
- grid.433367.60000 0001 2308 1825Health, Hydration and Nutrition Science Department, Danone Research, Route Départementale 128, 91767 Palaiseau, France
| | - Jiqiong Qiu
- grid.433367.60000 0001 2308 1825Health, Hydration and Nutrition Science Department, Danone Research, Route Départementale 128, 91767 Palaiseau, France
| | - Riccardo Ceccato
- grid.5608.b0000 0004 1757 3470Department of Management and Engineering, University of Padova, Vicenza, Italy
| | - Rosa Arboretti
- grid.5608.b0000 0004 1757 3470Department of Civil, Environmental and Architectural Engineering, University of Padova, Padua, Italy
| | - Luigi Salmaso
- grid.5608.b0000 0004 1757 3470Department of Management and Engineering, University of Padova, Vicenza, Italy
| |
Collapse
|
35
|
Vento KA, Koskan A, Lynch H, Kavouras S, Johnston C, Wardenaar FC. Effect of increased water intake on uropathogenic bacterial activity of underhydrated menstruating young adult women: A randomized crossover trial. Nutr Health 2022:2601060221129159. [PMID: 36221988 DOI: 10.1177/02601060221129159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Females are prone to urinary tract infections (UTIs) due to estrogen fluctuations affecting vaginal flora. While menstruating, increased fluid consumption to support urination frequency and void volume may be important, as the urethra and urinary tract are more predisposed to bacteria, particularly UTI pathogens. Aim: This study aimed to investigate the impact of hydration on urinary tract health during menstruation among underhydrated premenopausal women. Methods: Thirteen females participated in a 60-day 2 × 2 randomized crossover trial to evaluate the effectiveness of consuming ≥2.2 L of total beverage fluid intake, with 1.9 L being water, (intervention, INT) and maintaining habitual fluid intake (control, CON) on two subsequent menses. Participants completed fluid and urination diaries at days 2 and 5 after the onset of bleeding (day 1) to determine the fluid amount consumed and urination frequency. Urine concentration was assessed in afternoon (days 2 and 5) and uropathogenic bacterial activity in first-morning (days 3 and 6) urinations. General linear models assessed differences in bacterial and hydration outcomes. Results: The intervention led to a 62% mean total fluid increase, INT 3.0 ± 1.1 L and CON 1.9 ± 0.9 L, p < 0.001, η 2 = 0.459. Urination frequency was greater and urine concentration less in the INT to CON, all ps < 0.05, η 2 range = 0.023-0.019. Only four cultures detected uropathogenic bacteria, with no patterns between conditions or days, making it difficult to determine the intervention's effectiveness. Conclusion: Fluid intake increased, and hydration status improved. No differences in uropathogenic bacterial activity were seen between the hydration and control conditions.
Collapse
Affiliation(s)
- Kaila A Vento
- 465849College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Alexis Koskan
- 465849College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Heidi Lynch
- College of Health Sciences, 7116Point Loma Nazarene University, San Diego, CA, USA
| | - Stavros Kavouras
- 465849College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Carol Johnston
- 465849College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| | - Floris C Wardenaar
- 465849College of Health Solutions, Arizona State University, Phoenix, AZ, USA
| |
Collapse
|
36
|
Renko M, Salo J, Ekstrand M, Pokka T, Pieviläinen O, Uhari M, Tapiainen T. Meta-analysis of the Risk Factors for Urinary Tract Infection in Children. Pediatr Infect Dis J 2022; 41:787-792. [PMID: 35788126 PMCID: PMC9508987 DOI: 10.1097/inf.0000000000003628] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/26/2022] [Indexed: 02/04/2023]
Abstract
CONTEXT The incidence of urinary tract infection (UTI) varies with age, but there is limited evidence on the role of other risk factors. OBJECTIVE The aim of this meta-analysis was to investigate the risk factors for UTIs in children. DATA SOURCES PubMed from 1966 to May 2019. STUDY SELECTION All studies assessing at least 1 possible risk factor for occurrence or recurrence of UTI with a clear definition of symptomatic UTI in children were eligible. We excluded studies with UTIs related to hospital treatment or severe congenital renal abnormalities. DATA EXTRACTION After the quality assessment we extracted data on the given risk factor in children with and without UTI. The data were extracted separately for the occurrence and recurrence of UTIs. RESULTS We included 24 studies in the meta-analysis. Circumcision decreased the occurrence of UTIs with an odds ratio (OR) of 0.1 [95% confidence interval (CI): 0.06-0.17) and breast-feeding with an OR of 0.4 (CI: 0.19-0.86), both with low heterogeneity. Being overweight or obese increased the risk of UTI (OR: 2.23; CI: 1.37-3.63). Both poor fluid intake (OR: 6.39; CI: 3.07-13.39) and infrequent voiding (OR: 3.54; CI: 1.68-7.46) were associated with recurrent UTIs. LIMITATIONS The design, populations and definitions varied between the studies. CONCLUSIONS Being overweight or obese and having poor fluid intake are modifiable risk factors that increase the risk for UTIs in children. Breast-feeding and circumcision are associated with a decreased occurrence of UTIs.
Collapse
Affiliation(s)
- Marjo Renko
- From the Department of Pediatrics, University of Eastern Finland, Institute of Clinical Medicine, Yliopistonranta, Kuopio, Finland
- Department of Pediatrics, Kuopio University Hospital, Puijonlaaksontie, Kuopio, Finland
| | - Jarmo Salo
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Kajaanintie, Oulu, Finland
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Kajaanintie, Oulu, Finland
| | - Milka Ekstrand
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Kajaanintie, Oulu, Finland
| | - Tytti Pokka
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Kajaanintie, Oulu, Finland
| | - Oskari Pieviläinen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Kajaanintie, Oulu, Finland
| | - Matti Uhari
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Kajaanintie, Oulu, Finland
| | - Terhi Tapiainen
- PEDEGO Research Unit (Research Unit for Pediatrics, Dermatology, Clinical Genetics, Obstetrics and Gynecology), University of Oulu, Kajaanintie, Oulu, Finland
- Department of Pediatrics and Adolescent Medicine, Oulu University Hospital, Kajaanintie, Oulu, Finland
| |
Collapse
|
37
|
Klußmann D, Wagenlehner F. Rezidivierende Harnwegsinfektionen – was tun? Dtsch Med Wochenschr 2022; 147:1140-1145. [DOI: 10.1055/a-1866-9470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Was ist neu?
Nicht antibiotische Therapieregime Neben allgemeiner Aufklärung und Beratung über Risikofaktoren von Harnwegsinfektionen sind vor allem die nichtantibiotischen Therapie-Optionen zur Rezidivreduktion wichtig. Das Ziel hierbei ist es, Resistenzentwicklungen und den entsprechenden unerwünschten Nebenwirkungen von Antibiotika vorzubeugen. Zu den nicht antibiotischen Strategien zählen allen voran eine persönliche Beratung mit Vermittlung von Verhaltensempfehlungen, die Immunoprophylaxe, Phytotherapeutika, sowie eine lokale Östrogensubstitution
Antibiotische Prävention Bei hohem Leidensdruck der Patientinnen ist jedoch nach entsprechender Abwägung auch eine antibiotische Prophylaxe in Betracht zu ziehen. Zusammenfassend sollte eine individuelle Beratung erfolgen und es sollte mit einem multimodalen Therapieansatz behandelt werden.
Collapse
Affiliation(s)
- Daniel Klußmann
- Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
| | - Florian Wagenlehner
- Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
| |
Collapse
|
38
|
Sims JNL, Holland JJ, Anderson T, Adams WM. Daily Fluid Intake Behaviors and Associated Health Effects Among Australian and United States Populations. Front Sports Act Living 2022; 4:898720. [PMID: 35755610 PMCID: PMC9218248 DOI: 10.3389/fspor.2022.898720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/06/2022] [Indexed: 11/13/2022] Open
Abstract
Minimal data exist exploring intercontinental differences in fluid intake (FI) beliefs and behaviors and the impact on fluid intake practices (i.e., fluid intake volume, beverage type, and timing of fluid intake). Therefore, this study explored the impact that FI beliefs and behaviors had on FI practices among emerging adults living in the United States (USA) and Australia (AUS). A total of 489 individuals (74.5% female; USA, 79.4%; age, 25 ± 6 years completed a 23-item survey between November 2020 and June 2021). Participants detailed their FI practices. FI beliefs were evaluated to determine their contribution to FI behaviors across the day. Multinomial and multiple linear regression analyses explored the association of daily FI beliefs and behaviors across multiple domains. Independent sample t-tests and chi-square analyses were conducted to compare FI practices, beliefs, and behaviors between individuals in the USA and AUS. FI behaviors were significantly different between countries, with the USA more likely to consume fluids to meet a total target volume (β = 1.150, p = 0.036) and consume fluid at the same time as structured daily activities (β = 0.773, p = 0.046) compared to FI alongside food intake. However, there were no differences in the types of beverage consumed (juice, sugar-sweetened beverages, tea, and coffee), total fluid volume, and physical activity (PA) between countries (p > 0.05). Beverage consumption was higher among USA than AUS residents for water, beer, and wine (p < 0.05). Total fluid consumption was greater among males (3,189 ± 2,407 ml) than females (2,215 ± 1,132 ml; β = 3.61, p < 0.001), individuals who regularly consumed fluid during the day to meet a targeted volume (β = 1,728.5, p < 0.001), and those who regularly consumed fluid as a habitual behavior (β = 3.97, p < 0.001) compared to those individuals who only consumed fluid alongside mealtimes (β = 1,041.7, p < 0.001). FI behaviors differed between the USA and AUS; however, total volume consumed, type of beverage consumed, and FI beliefs were similar. FI practices and behaviors appear to be individualized and context-specific among the studied populations.
Collapse
Affiliation(s)
- Jesse N. L. Sims
- Hydration, Environment, and Thermal Stress Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Justin J. Holland
- School of Exercise and Nutrition Sciences, Faculty of Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Travis Anderson
- Hydration, Environment, and Thermal Stress Lab, Department of Kinesiology, University of North Carolina at Greensboro, Greensboro, NC, United States
| | - William M. Adams
- Division of Sports Medicine, United States Olympic & Paralympic Committee, Colorado Springs, CO, United States
- United States Coalition for the Prevention of Illness and Injury in Sport, Colorado Springs, CO, United States
- *Correspondence: William M. Adams
| |
Collapse
|
39
|
Kenee PRM, Christie AL, Zimmern PE. Cranberry Supplement, D-Mannose, and Other OTC Modalities for Prevention of Recurrent UTI in Women Post-Electrofulguration. Int J Womens Health 2022; 14:643-653. [PMID: 35535150 PMCID: PMC9078870 DOI: 10.2147/ijwh.s355469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/23/2022] [Indexed: 11/25/2022] Open
Abstract
Purpose To assess patient reliance on various over-the-counter (OTC) modalities used for prevention of recurrent urinary tract infection (RUTI) after electrofulguration (EF). Patients and Methods Following IRB approval, qualifying women were offered a short survey over the phone by a medical researcher to collect information about their use of various OTC modalities for prophylaxis of RUTI. Data was compared between two cohorts, ≥70 years old and <70 years old, using chi-squared and Student’s t-tests. Results From a database of 324 patients, 163 accepted the interview. 17% (28/163) reported current use of cranberry supplements, 10% (16/163) D-mannose supplements, and 42% (69/163) another non-prescription modality for RUTI prophylaxis. The non-geriatric (<70 years old) cohort spent, on average, $80 less annually on cranberry/D-mannose supplements (P=0.043) than the geriatric cohort and were more likely to use non-prescription modalities for the prevention of UTI (52% vs 30%; P=0.0061). Individuals using D-mannose were also much more likely to purchase their product online compared to those using cranberry supplements (85% vs 56%). Across all modalities, the perceived benefit difference in reducing UTI/year ranged from a median of 0 for Pyridium® (phenazopyridine hydrochloride) to four for probiotics, with D-mannose and cranberry at two/year, and those increasing daily fluid consumption at 2.5 fewer UTI/year. Conclusion Continued use of non-prescription modalities for RUTI prophylaxis were common among women with an EF history, but varied based on age groups. Across both age cohorts, annual expenditure and perceived benefit also varied among different OTC prophylactic modalities. Awareness of type and method of OTC modality implementation by patients with RUTI is essential to aligning use with current field recommendations.
Collapse
Affiliation(s)
- Parker R M Kenee
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, 75290-9110, USA
| | - Alana L Christie
- Simmons Comprehensive Cancer Center Biostatistics, UT Southwestern Medical Center, Dallas, TX, 75390-8852, USA
| | - Philippe E Zimmern
- Department of Urology, UT Southwestern Medical Center, Dallas, TX, 75290-9110, USA
| |
Collapse
|
40
|
Jelly P, Verma R, Kumawat R, Choudhary S, Chadha L, Sharma R. Occurrence of urinary tract infection and preventive strategies practiced by female students at a tertiary care teaching institution. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:122. [PMID: 35677263 PMCID: PMC9170194 DOI: 10.4103/jehp.jehp_750_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/24/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Urinary tract infections (UTIs) are more common in females than males and predominantly based on their unhealthy practices in their day to day lives. This study is trying to assess the occurrence of UTI and strategies used by female student to prevent UTI. MATERIALS AND METHODS A cross-sectional descriptive study carried out in a tertiary care teaching institute. A total of 338 conveniently selected B. Sc. Nursing and MBBS Medical students were surveyed. The data were collected by using a pretested, a self-structured questionnaire related to occurrence and practices to prevent UTI along with necessary demographic details. Descriptive (frequency, percentage, mean and standard deviation) and inferential (Chi-square test) statistics was used to compute the data. RESULTS The result of this study shows that 10.05% female students reported of having UTI. The proportion was higher in nursing students (67.6%) than medical (32.4%) but did not show a significance difference (P = 0.61). Age, duration of hostel life, and marital status were significantly associated with the status of UTI (P = 0.001). To prevent UTI, students were using commercial product with Tea Tree Oil, soap, drinking 3-4 l water/day, increased frequency of peri-wash during menstruation period, and use of Citrus Fruits. The use of western toilet was also significantly associated with status of UTI (P = 0.04). CONCLUSION The occurrence of UTI was more among nursing students. Most of the perineal hygienic practices by the female students were associated with occurrence of UTI; hence, it is necessary to emphasize on preventive practices to minimize re-occurrence.
Collapse
Affiliation(s)
- Prasuna Jelly
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajni Verma
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Reena Kumawat
- Department of Medicine, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Suman Choudhary
- Department of Microbiology, Nursing Service, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Lisa Chadha
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rakesh Sharma
- College of Nursing, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| |
Collapse
|
41
|
Ghoniem G, Moskowitz D, Nguyen C. Urological Care After Spinal Cord Injury. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022. [DOI: 10.1007/s40141-022-00347-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
42
|
[24/f-Discomfort when passing water and pain above the symphysis : Preparation for the medical specialist examination: part 141]. Internist (Berl) 2022; 63:237-241. [PMID: 35294569 DOI: 10.1007/s00108-022-01290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2022] [Indexed: 10/18/2022]
|
43
|
Mitrosz-Gołębiewska K, Rydzewska-Rosołowska A, Kakareko K, Zbroch E, Hryszko T. Water - A life-giving toxin - A nephrological oxymoron. Health consequences of water and sodium balance disorders. A review article. Adv Med Sci 2022; 67:55-65. [PMID: 34979423 DOI: 10.1016/j.advms.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 08/24/2021] [Accepted: 12/15/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND This article aims to reveal misconceptions about methods of assessment of hydration status and impact of the water disorders on the progression of kidney disease or renal dysfunction. MATERIALS AND METHODS The PubMed database was searched for reviews, meta-analyses and original articles on hydration, volume depletion, fluid overload and diagnostic methods of hydration status, which were published in English. RESULTS Based on the results of available literature the relationship between the amount of fluid consumed, and the rate of progression of chronic kidney disease, autosomal dominant polycystic kidney disease, and kidney stones disease was discussed. Selected aspects of the assessment of the hydration level in clinical practice based on physical examination, laboratory tests, and imaging are presented. The subject of in-hospital fluid therapy is discussed. Based on available randomized studies, an attempt was made to assess, which fluids should be selected for intravenous treatment. CONCLUSIONS There is some evidence for the beneficial effect of increased water intake in preventing recurrent cystitis and kidney stones, but there are still no convincing data for chronic kidney disease and autosomal dominant polycystic kidney disease. Further studies are needed to clarify the aforementioned issues and establish a reliable way to assess the volemia and perform suitable fluid therapy.
Collapse
Affiliation(s)
- Katarzyna Mitrosz-Gołębiewska
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland.
| | - Alicja Rydzewska-Rosołowska
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Kakareko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| | - Edyta Zbroch
- Department of Internal Medicine and Hypertension, Medical University od Bialystok, Bialystok, Poland
| | - Tomasz Hryszko
- 2nd Department of Nephrology and Hypertension with Dialysis Unit, Medical University of Bialystok, Bialystok, Poland
| |
Collapse
|
44
|
|
45
|
Are the Diagnosis and Treatment of Acute Cystitis in the Premenopausal, Pregnant, and Postmenopausal Women the Same? A Review of the Literature. Obstet Gynecol Surv 2022; 77:174-187. [PMID: 35275216 DOI: 10.1097/ogx.0000000000000993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Acute cystitis is a common condition diagnosed in women. The diagnosis and treatment of this condition change throughout a woman's life. Understanding the differences in diagnosis and treatment in premenopausal, pregnant, and postmenopausal woman increases the likelihood of treatment success and decreases risk of complications from untreated or suboptimally treated infections. Objective The aim of this review is to describe the incidence, risk factor, pathophysiology, diagnosis, and management of acute cystitis and the similarities and differences of these aspects of the condition in the premenopausal, pregnant, and postmenopausal woman. Evidence Acquisition A PubMed, Web of Science, and CINAHL search was undertaken with the years 1990 to 2020 searched. Results There were 393 articles identified, with 103 being the basis of review. Multiple risk factors for acute cystitis have been identified and are largely consistent throughout a woman's lifetime with few exceptions. The diagnoses by group with common diagnostic tools, such as urinalysis, vary in specificity and sensitivity between these groups. Management also varies between groups, with pregnancy having specific limitations related to drug safety in regard to possible fetal effects posed by certain medications commonly used to treat acute cystitis. Conclusions Acute cystitis not only varies in presentation throughout a woman's lifespan, but also in appropriate diagnosis and treatment. Treatment of acute cystitis does have some commonalities between the groups; however, there are contraindications unique to each group. These differences are paramount to not only ensuring appropriate treatment but also treatment success. Relevance Acute cystitis is a common condition with different diagnostic and management recommendations throughout a woman's lifespan.
Collapse
|
46
|
Abstract
Urinary tract infection (UTI) is the most common type of urogenital disease. UTI affects the urethra, bladder, ureter, and kidney. A total of 13.3% of women, 2.3% of men, and 3.4% of children in the United States will require treatment for UTI. Traditionally, bladder (cystitis) and kidney (pyelonephritis) infections are considered independently. However, both infections induce host defenses that are either shared or coordinated across the urinary tract. Here, we review the chemical and biophysical mechanisms of bacteriostasis, which limit the duration and severity of the illness. Urinary bacteria attempt to overcome each of these defenses, complicating description of the natural history of UTI.
Collapse
Affiliation(s)
| | - Anne-Catrin Uhlemann
- Department of Medicine and Pathology and Urology, Columbia University, New York, NY, USA;
| | - Jonathan Barasch
- Department of Medicine and Pathology and Urology, Columbia University, New York, NY, USA;
| |
Collapse
|
47
|
Garofalo L, Nakama C, Hanes D, Zwickey H. Whole-Person, Urobiome-Centric Therapy for Uncomplicated Urinary Tract Infection. Antibiotics (Basel) 2022; 11:218. [PMID: 35203820 PMCID: PMC8868435 DOI: 10.3390/antibiotics11020218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
A healthy urinary tract contains a variety of microbes resulting in a diverse urobiome. Urobiome dysbiosis, defined as an imbalance in the microbial composition in the microenvironments along the urinary tract, is found in women with uncomplicated urinary tract infection (UTI). Historically, antibiotics have been used to address UTI. An alternative approach to uncomplicated UTI is warranted as the current paradigm fails to take urobiome dysbiosis into account and contributes to the communal problem of resistance. A whole-person, multi-modal approach that addresses vaginal and urinary tract dysbiosis may be more effective in reducing recurrent UTI. In this review, we discuss strategies that include reducing pathogenic bacteria while supporting commensal urogenital bacteria, encouraging diuresis, maintaining optimal pH levels, and reducing inflammation. Strategies for future research are suggested.
Collapse
Affiliation(s)
- Luciano Garofalo
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA 98195, USA
| | - Claudia Nakama
- National University of Natural Medicine, Portland, OR 97201, USA; (C.N.); (D.H.); (H.Z.)
| | - Douglas Hanes
- National University of Natural Medicine, Portland, OR 97201, USA; (C.N.); (D.H.); (H.Z.)
- Helfgott Research Institute, NUNM, Portland, OR 97201, USA
| | - Heather Zwickey
- National University of Natural Medicine, Portland, OR 97201, USA; (C.N.); (D.H.); (H.Z.)
- Helfgott Research Institute, NUNM, Portland, OR 97201, USA
| |
Collapse
|
48
|
Seneghini M, Albrich WC. [Non-antibiotic Prophylaxis of Infections]. PRAXIS 2022; 111:463-468. [PMID: 35673840 DOI: 10.1024/1661-8157/a003822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Non-antibiotic Prophylaxis of Infections Abstract. The increasing resistance to antibiotics makes the search for non-antibiotic alternatives for the treatment and prevention of - above all - respiratory and urinary tract infections crucial. Potential non-antibiotic approaches include phytopharmaceuticals (Echinacea purpurea, Pelargonium sidoides, cranberry extract), zinc, immunostimulants (OM-85 BV, OM-89), and behavior modifications. Some of these approaches are promising options; however, a high level of evidence is required before specific recommendations for their use can be made.
Collapse
Affiliation(s)
- Marco Seneghini
- Klinik für Infektiologie/Spitalhygiene, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - Werner C Albrich
- Klinik für Infektiologie/Spitalhygiene, Kantonsspital St. Gallen, St. Gallen, Schweiz
| |
Collapse
|
49
|
Warzecha D, Pietrzak B, Urban A, Wielgoś M. How to avoid drug resistance during treatment and prevention of urinary tract infections. PRZEGLAD MENOPAUZALNY = MENOPAUSE REVIEW 2021; 20:217-221. [PMID: 35069075 PMCID: PMC8764957 DOI: 10.5114/pm.2021.111715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 10/18/2021] [Indexed: 11/25/2022]
Abstract
Urinary tract infections (UTIs), defined as the presence of bacteria above the bladder sphincter, are among the most common infectious diseases. They remain a significant cause of antibiotic prescription worldwide. The incidence is much higher among women, especially of reproductive age, than among men. If the infection occurs at least 3 times a year or twice within 6 months, it is classified as recurrent urinary tract infection (rUTI). Among the causal pathogens, the vast majority are Gram-negative bacteria, the most common of which is Escherichia coli. Recommended treatment regimens differ depending on the diagnosed disease entity and the patient's clinical situation. Empirical antibiotic therapy is most often used. The first-line treatment in patients with acute simple cystitis include nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin. Beta-lactams and fluoroquinolones should be considered as a second-line agent. In particular cases (pregnancy or rUTIs) targeted treatment, based on the results of urine culture and antibiogram, is implemented. During pregnancy recommended treatment includes administration of cephalosporins (e.g. cefuroxime) or nitrofurantoin. In patients with uncomplicated pyelonephritis fluoroquinolones should be considered as the first-line regimen. In the case of rUTIs, there are no uniform guidelines for prophylactic management. Repeated administration of antibiotics due to infections leads to a growing problem of drug resistance. Most recommendations suggest not to use antibiotic prophylaxis routinely. Growing evidence favours non-antibiotic prophylaxis regimens for recurrent UTIs. Until now only one product - oral immunostimulant OM-89 - has been sufficiently investigated. Wider implementation of immunoprophylaxis in the future may reduce possible side effects of inappropriate antibiotic consumption.
Collapse
Affiliation(s)
- Damian Warzecha
- 1 Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Bronisława Pietrzak
- 1 Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Urban
- 1 Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| | - Mirosław Wielgoś
- 1 Department of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
50
|
Zare M, Vehreschild MJGT, Wagenlehner F. Management of uncomplicated recurrent urinary tract infections. BJU Int 2021; 129:668-678. [PMID: 34741796 DOI: 10.1111/bju.15630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To discuss optimal management of recurrent urinary tract infections (UTIs) in women. About every second woman experiences at least one UTI in her lifetime, of those 30% experience another UTI, and 3% further recurrences. Especially young healthy women without underlying anatomical deficiencies suffer from recurrent UTIs (rUTI), which are associated with significant morbidity and reduction in quality of life. METHODS This is a narrative review, investigating publications dealing with recurrent UTI in women. Risk factors and options for management are discussed. RESULTS The increased susceptibility of women to rUTI is based on the female anatomy in addition to behavioural, genetic, and urological factors. However, why some women are more likely than others to develop and maintain rUTI remains to be clarified. Invasive characteristics of certain uropathogenic Escherichia coli that are able to form extra- and intracellular biofilms and may therefore cause delayed release of bacteria into the bladder, may play a role in this setting. Treatment recommendations for an acute episode of rUTI do not differ from those for isolated episodes. Given the nature of rUTI, different prophylactic approaches also play an important role. Women with rUTI should first be counselled to use non-antibiotic strategies including behavioural changes, anti-adhesive treatments, antiseptics, and immunomodulation, before antibiotic prophylaxis is considered. In addition to the traditional treatment and prophylactic therapies, new experimental strategies are emerging and show promising effects, such as faecal microbiota transfer (FMT), a treatment option that transfers microorganisms and metabolites of a healthy donor's faecal matter to patients using oral capsules, enemas, or endoscopy. Initial findings suggest that FMT might be a promising treatment approach to interrupt the cycle of rUTI. Furthermore, bacteriophages, infecting and replicating in bacteria, have been clinically trialled for UTIs. CONCLUSION Due to the limitation of available data, novel treatment options require further clinical research to objectify the potential in treating bacterial infections, particularly UTIs.
Collapse
Affiliation(s)
- Mary Zare
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Germany
| |
Collapse
|