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Boeri L, De Lorenzis E, Lucignani G, Turetti M, Silvani C, Zanetti SP, Longo F, Albo G, Salonia A, Montanari E. Oral preparation of hyaluronic acid, chondroitin sulfate, N-acetylglucosamine, and vitamin C improves sexual and urinary symptoms in participants with recurrent urinary tract infections: a randomized crossover trial. J Sex Med 2024; 21:627-634. [PMID: 38721680 DOI: 10.1093/jsxmed/qdae052] [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: 11/26/2023] [Revised: 03/22/2024] [Accepted: 03/31/2024] [Indexed: 07/02/2024]
Abstract
BACKGROUND Intravesical instillation of hyaluronic acid (HA) has been associated with reduced sexual dysfunction in participants with recurrent urinary tract infections (rUTIs), but the efficacy of an oral treatment has never been investigated. AIM To investigate the efficacy of an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C in improving sexual and urinary symptoms in a cohort of reproductive-age participants with rUTI. METHODS In a monocentric randomized crossover pilot trial, participants with rUTI who were referred to our institute between March 2022 and April 2023 were randomized 1:1 in 2 groups: intervention vs control. All participants had an oral preparation of cranberry, D-mannose, propolis extract, turmeric, and Boswellia twice a day for 3 months. The intervention group also included an oral preparation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C once a day for 3 months. Crossover of treatment occurred at 3 months for an additional 3 months. At baseline and 3 and 6 months, participants were evaluated clinically and with the International Prostate Symptom Score (IPSS) and Female Sexual Function Index (FSFI). Descriptive statistics and logistic regression models tested the impact of the intervention on urinary and sexual symptoms at each follow-up assessment. OUTCOMES Improvement in sexual and urinary symptoms as measured by the FSFI and IPSS. RESULTS Overall, 27 (54%) participants had an FSFI score <26.5 at enrollment. At 3 months, FSFI scores were higher in the intervention group vs control (P < .001), but IPSS scores were lower (P = .03). After crossover of treatment, FSFI and IPSS scores remained stable in the intervention group. However, after crossover, the control group showed a significant improvement in IPSS and FSFI scores (all P < .01) vs the 3-month assessment. At last follow-up, urinary and sexual symptoms were comparable between groups. In logistic regression analyses, the intervention group was associated with early improvement in sexual symptoms (odds ratio, 3.9; P = .04) and urinary symptoms (odds ratio, 5.1; P = .01) after accounting for clinical confounders. CLINICAL IMPLICATIONS Combination treatment with HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C is effective if started immediately or even after a few months from symptoms in participants with rUTI. STRENGTHS AND LIMITATIONS The main limitation is the lack of long-term follow-up. CONCLUSION The oral formulation of HA, chondroitin sulfate, N-acetylglucosamine, and vitamin C could be an effective therapy against urinary and sexual distress in participants with rUTI (NCT06268483; ClinicalTrials.gov).
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Affiliation(s)
- Luca Boeri
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Elisa De Lorenzis
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Gianpaolo Lucignani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Matteo Turetti
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Carlo Silvani
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Stefano Paolo Zanetti
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Fabrizio Longo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
| | - Giancarlo Albo
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, 20122, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, 20143, Italy
| | - Emanuele Montanari
- Department of Urology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, 20122, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Milan, 20122, Italy
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Papp SB, Seyan Z, Khan Z, Kenee PRM, Christie AL, Zimmern PE. Systematic Review of the Global Literature on Uncomplicated Recurrent Urinary Tract Infections in Women: Underscoring Major Heterogeneity. Urology 2024:S0090-4295(24)00456-4. [PMID: 38880346 DOI: 10.1016/j.urology.2024.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 04/30/2024] [Accepted: 06/04/2024] [Indexed: 06/18/2024]
Abstract
OBJECTIVE To examine the global literature database on uncomplicated recurrent urinary tract infections (rUTI), this systematic review assesses the availability of rUTI data based on geographic region and elucidates the current state of research and gaps in knowledge. METHODS The databases PubMed, Embase, WHO Global Index Medicus, and SciELO were searched for keywords related to rUTI between 2000 and 2023. Three independent reviewers screened studies restricted to female participants age ≥18 years with uncomplicated rUTIs. Studies were excluded if they did not provide a definition for rUTI or did not cite or report an estimate for rUTI prevalence. The review was registered in PROSPERO and conformed to PRISMA guidelines. RESULTS The search yielded 2947 studies of which 124 were ultimately included. Convenience samples were used for 91% of studies and sample sizes were 30% n <50, 29% n = 50-99, 22% n = 100-199, 36% n ≥200. Most studies were conducted in Europe (41%) or North America (39%), were prospective (52%), at tertiary centers (49%) and included all ages ≥18 (60%). The most common definition for rUTI was 2 UTI/6 m or 3 UTI/1y (62%). Regardless of study location, most studies cited prevalence estimates for rUTI derived from U.S.-based populations. CONCLUSION This study represents the first formal investigation of the global literature base on uncomplicated rUTI. Studies on rUTIs are globally of small scale and definitions used for rUTI are heterogeneous. More studies are needed to ascertain the true prevalence of rUTI outside of North America and Europe.
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Affiliation(s)
- Sara B Papp
- University of Texas Southwestern Medical School, Dallas, TX
| | - Zheyar Seyan
- Texas Tech University Health Sciences Center School of Medicine, Lubbock, TX
| | - Zara Khan
- University of Texas Southwestern Medical School, Dallas, TX
| | | | - Alana L Christie
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX.
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Zhou T, Hao J, Tang Q, Chandarajoti K, Ye W, Fan C, Wang X, Wang C, Zhang K, Han X, Zhou W, Ge Y. Antimicrobial activity and structure-activity relationships of molecules containing mono- or di- or oligosaccharides: An update. Bioorg Chem 2024; 148:107406. [PMID: 38728907 DOI: 10.1016/j.bioorg.2024.107406] [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: 02/27/2024] [Revised: 04/17/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024]
Abstract
Bacterial infections are the second leading cause of death worldwide, and the evolution and widespread distribution of antibiotic-resistance elements in bacterial pathogens exacerbate the threat crisis. Carbohydrates participate in bacterial infection, drug resistance and the process of host immune regulation. Numerous antimicrobials derived from carbohydrates or contained carbohydrate scaffolds that are conducive to an increase in pathogenic bacteria targeting, the physicochemical properties and druggability profiles. In the paper, according to the type and number of sugar residues contained in antimicrobial molecules collected from the literatures ranging from 2014 to 2024, the antimicrobial activities, action mechanisms and structure-activity relationships were delineated and summarized, for purpose to provide the guiding template to select the type and size of sugars in the design of oligosaccharide-based antimicrobials to fight the looming antibiotic resistance crisis.
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Affiliation(s)
- Tiantian Zhou
- School of Traditional Chinese Medicine, Guangdong Pharmaceutical University, E. 280, University town, Waihuan Rd, Panyu, Guangzhou 510006, Guangdong, China; Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China
| | - Jiongkai Hao
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China; Key Laboratory of Veterinary Chemical Drugs and Pharmaceutics, Ministry of Agriculture and Rural Affairs, Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, 200241, China
| | - Qun Tang
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China; Key Laboratory of Veterinary Chemical Drugs and Pharmaceutics, Ministry of Agriculture and Rural Affairs, Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, 200241, China
| | - Kasemsiri Chandarajoti
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat Yai, Songkhla, 90112, Thailand; Drug Delivery System Excellence Center, Faculty of Pharmaceutical Sciences, Prince of Songkla University, Hat‑Yai, Songkhla, 90112, Thailand
| | - Wenchong Ye
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China; Key Laboratory of Veterinary Chemical Drugs and Pharmaceutics, Ministry of Agriculture and Rural Affairs, Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, 200241, China
| | - Chuangchuang Fan
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China; Key Laboratory of Veterinary Chemical Drugs and Pharmaceutics, Ministry of Agriculture and Rural Affairs, Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, 200241, China
| | - Xiaoyang Wang
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China; Key Laboratory of Veterinary Chemical Drugs and Pharmaceutics, Ministry of Agriculture and Rural Affairs, Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, 200241, China
| | - Chunmei Wang
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China; Key Laboratory of Veterinary Chemical Drugs and Pharmaceutics, Ministry of Agriculture and Rural Affairs, Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, 200241, China
| | - Keyu Zhang
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China; Key Laboratory of Veterinary Chemical Drugs and Pharmaceutics, Ministry of Agriculture and Rural Affairs, Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, 200241, China
| | - Xiangan Han
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China; Key Laboratory of Veterinary Chemical Drugs and Pharmaceutics, Ministry of Agriculture and Rural Affairs, Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, 200241, China
| | - Wen Zhou
- Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, 200241, Shanghai, China; Key Laboratory of Veterinary Chemical Drugs and Pharmaceutics, Ministry of Agriculture and Rural Affairs, Shanghai Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Shanghai, 200241, China.
| | - Yuewei Ge
- School of Traditional Chinese Medicine, Guangdong Pharmaceutical University, E. 280, University town, Waihuan Rd, Panyu, Guangzhou 510006, Guangdong, China.
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Fromer DL, Cheng WY, Gao C, Mahendran M, Hilts A, Duh MS, Joshi AV, Mulgirigama A, Mitrani-Gold FS. Likelihood of Antimicrobial Resistance in Urinary E coli Isolates among US Female Patients with Recurrent vs Non-Recurrent Uncomplicated Urinary Tract Infection. Urology 2024:S0090-4295(24)00150-X. [PMID: 38467284 DOI: 10.1016/j.urology.2024.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 02/20/2024] [Accepted: 02/29/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVE To assess the relative likelihood of antimicrobial resistance (AMR) and multi-drug resistance (MDR) among E coli isolates from outpatients with recurrent versus non-recurrent uncomplicated urinary tract infection (uUTI). METHODS In this retrospective observational US cohort study, female outpatients (≥12 years) with uUTI, positive E coli culture, and treated with ≥1 oral antibiotic within ±5 days of diagnosis were grouped into recurrent and non-recurrent uUTI cohorts per their UTI history (past 12 months). AMR to specific drug classes was evaluated at index. Univariable and multivariable logistic regression models estimated the likelihood of not-susceptible E coli isolates (AMR/MDR) among patients with recurrent uUTI versus non-recurrent uUTI. RESULTS Recurrent (N = 12,234) and non-recurrent (N = 68,033) uUTI cohorts had similar distributions (race, ethnicity, region). Patients with recurrent uUTI had a higher prevalence of E coli resistance to trimethoprim-sulfamethoxazole (21.8% vs 18.7%) and fluoroquinolones (14.2% vs 8.6%), and more isolates were extended-spectrum β-lactamase-producing (5.9% vs 4.1%) compared to non-recurrent uUTI patients. Patients with recurrent uUTI had a higher likelihood (odds ratio [95% confidence interval]) of any AMR (1.28 [1.22-1.34]), single drug-class resistance (1.18 [1.12-1.24]), and resistance to 2 (1.53 [1.41-1.67]) or ≥3 drug classes (1.70 [1.48-1.96]) (all P <.001). CONCLUSION This study delineated the likelihood of AMR and MDR among E coli isolates from patients with recurrent versus non-recurrent uUTI. While some treatment guidelines support empiric therapy in recurrent uUTI, the increased likelihood of resistance among these patients suggests that culture and susceptibility testing should be undertaken to inform recurrent uUTI treatment.
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Affiliation(s)
| | | | - Chi Gao
- Analysis Group, Inc., Boston, MA
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Chapman HL, Edwards JT, Hadikusumo Harsono AA, Baecher K, Zhai G, Meyer I, Richter HE. Characteristics Associated With Recurrent Urinary Tract Infections: A Case-Control Study. UROGYNECOLOGY (PHILADELPHIA, PA.) 2024; 30:239-244. [PMID: 38484237 DOI: 10.1097/spv.0000000000001457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/19/2024]
Abstract
IMPORTANCE Recurrent urinary tract infections (rUTIs) affect 2-10% of adult women and are associated with a significant effect on quality of life, daily activities, and mental health. OBJECTIVE The aim of this study was to identify clinical characteristics associated with rUTIs among women seeking care for pelvic floor disorders at an academic tertiary urogynecology clinic. STUDY DESIGN A retrospective case-control study of women presenting to an academic tertiary urogynecology clinic was conducted. Cases were women with rUTIs, defined as ≥2 UTIs in 6 months or ≥3 within 1 year. Controls were women with no culture documented UTIs. Cases were matched 2:1 to controls by age and body mass index. Demographic and clinical characteristics were compared between cases and controls, and bivariate characteristics with P values ≤0.2 were assessed for an independent association with rUTIs by multivariable logistic regression. RESULTS A total of 285 cases with rUTIs were identified, and 150 matched controls had a mean (SD) age of 72 (11.8) years and a body mass index of 29.6 (6.7; calculated as weight in kilograms divided by height in meters squared). Multivariable analysis revealed that prolapse beyond the introitus (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.13-0.60), parity (OR, 1.33; 95% CI, 1.08-1.64), Charlson Comorbidity Index (OR, 1.66; 95% CI, 1.37-2.03), and postvoid residual volume ≥100 mL (OR, 4.05; 95% CI, 2.01, 8.18) were associated with rUTIs. CONCLUSIONS In this ambulatory urogynecologic population, prolapse through the introitus was negatively associated with rUTIs, whereas parity, increased medical comorbidities, and elevated postvoid residual volume were positively associated with rUTI. Future research should seek an increased understanding of these factors associated with rUTI to implement effective preventive strategies.
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Affiliation(s)
- Hannah L Chapman
- From the Department of Obstetrics and Gynecology; University of Alabama at Birmingham, Birmingham, AL
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García-Meniño I, García V, Lumbreras-Iglesias P, Fernández J, Mora A. Fluoroquinolone resistance in complicated urinary tract infections: association with the increased occurrence and diversity of Escherichia coli of clonal complex 131, together with ST1193. Front Cell Infect Microbiol 2024; 14:1351618. [PMID: 38510968 PMCID: PMC10953827 DOI: 10.3389/fcimb.2024.1351618] [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: 12/06/2023] [Accepted: 02/02/2024] [Indexed: 03/22/2024] Open
Abstract
Introduction Urinary tract infections (UTIs) are one of the leading causes of multidrug-resistance (MDR) spread and infection-related deaths. Escherichia coli is by far the main causative agent. We conducted a prospective study on complicated urinary tract infections (cUTIs) i) to monitor the high-risk clones that could be compromising the therapeutic management and ii) to compare the cUTI etiology with uncomplicated infections (uUTIs) occurring in the same period and health area. Methods 154 non-duplicated E. coli recovered from cUTIs in 2020 at the Hospital Universitario Central de Asturias (Spain) constituted the study collection. Results Most cUTI isolates belonged to phylogroup B2 (72.1%) and met the uropathogenic (UPEC) status (69.5%) (≥3 of chuA, fyuA, vat, and yfcV genes). MDR was exhibited by 35.7% of the isolates, similarly to data observed in the uUTI collection. A significant difference observed in cUTI was the higher level of fluoroquinolone resistance (FQR) (47.4%), where the pandemic clonal groups B2-CC131 and B2-ST1193 (CH14-64) comprised 28% of the 154 E. coli, representing 52.1% of the FQR isolates. Other prevalent FQR clones were D-ST69 (CH35-27), D-ST405 (CH37-27), and B2-ST429 (CH40-20) (three isolates each). We uncovered an increased genetic and genomic diversity of the CC131: 10 different virotypes, 8 clonotypes (CH), and 2 STs. The presence of bla CTX-M-15 was determined in 12 (7.8%) isolates (all CC131), which showed 10 different core genome (cg)STs and 2 fimH types (fimH30 and fimH602) but the same set of chromosomal mutations conferring FQR (gyrA p.S83L, gyrA p.D87N, parC p.S80I, parC p.E84V, and parE p.I529L). In addition, the plasmidome analysis revealed 10 different IncF formulae in CC131 genomes. Conclusion We proved here that non-lactose fermenting screening, together with the detection of O25b (rfbO25b), H4 (fliCH4), and H5 (fliCH5) genes, and phylogroup and clonotyping assignation, is a reasonable approach that can be easily implemented for the surveillance of emerging high-risk clones associated with FQR spread in cUTIs, such as the uncommonly reported O25b:H4-B2-ST9126-CC131 (CH1267-30). Since E. coli CC131 and ST1193 are also involved in the community uUTIs of this health area, interventions to eradicate these MDR clones, along with surveillance for other emerging ones, are essential for antibiotic use optimization programs.
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Affiliation(s)
- Isidro García-Meniño
- Laboratorio de Referencia de Escherichia coli (LREC), Dpto. de Microbioloxía e Parasitoloxía, Universidade de Santiago de Compostela (USC), Lugo, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
- Department for Biological Safety, German Federal Institute for Risk Assessment, Berlin, Germany
| | - Vanesa García
- Laboratorio de Referencia de Escherichia coli (LREC), Dpto. de Microbioloxía e Parasitoloxía, Universidade de Santiago de Compostela (USC), Lugo, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
| | - Pilar Lumbreras-Iglesias
- Servicio de Microbiología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
- Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Javier Fernández
- Servicio de Microbiología, Hospital Universitario Central de Asturias (HUCA), Oviedo, Spain
- Grupo de Microbiología Traslacional, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
- Research and Innovation, Artificial Intelligence and Statistical Department, Pragmatech AI Solutions, Oviedo, Spain
- CIBER de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain
- Departamento de Biología Funcional, Universidad de Oviedo, Oviedo, Spain
| | - Azucena Mora
- Laboratorio de Referencia de Escherichia coli (LREC), Dpto. de Microbioloxía e Parasitoloxía, Universidade de Santiago de Compostela (USC), Lugo, Spain
- Instituto de Investigación Sanitaria de Santiago de Compostela (IDIS), Santiago de Compostela, Spain
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Mititelu M, Olteanu G, Neacșu SM, Stoicescu I, Dumitrescu DE, Gheorghe E, Tarcea M, Busnatu ȘS, Ioniță-Mîndrican CB, Tafuni O, Belu I, Popescu A, Lupu S, Lupu CE. Incidence of Urinary Infections and Behavioral Risk Factors. Nutrients 2024; 16:446. [PMID: 38337730 PMCID: PMC10856807 DOI: 10.3390/nu16030446] [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: 12/28/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/12/2024] Open
Abstract
This evaluation of the impact of behavioral risk factors on the incidence of urinary infections was based on a questionnaire in which 1103 respondents, predominantly women (883), participated. From the statistical processing of the data, it was observed that 598 of the respondents were of normal weight; the rest, more than half, were underweight or overweight (χ2 = 32.46, p < 0.001), with male respondents being predominantly overweight or obese (169 out of a total of 220). Most of the respondents were young (χ2 = 15.45, p < 0.001), under the age of 45 (840). According to the processed data, it was found that respondents in the age group of 26-35 years showed the greatest vulnerability to recurrent urinary infections, while the age group of 18-25 years recorded the highest number of responses related to the rare presence or even absence of episodes of urinary infections. A body weight-related vulnerability was also noted among the respondents; the majority of obese people declared that they face frequent episodes of urinary infections. Regarding diet quality, 210 respondents reported an adherence to an unhealthy diet, 620 to a moderately healthy diet, and 273 to a healthy diet. Of the respondents who adhered to a healthy diet, 223 were women (χ2 = 2.55, p = 0.279). There was a close connection between diet quality and the frequency of urinary infections: from the statistical processing of the data, it was observed that the highest percentage of respondents who rarely (57.14%) or never got urinary infections (29.30%) were among those who adhered to a healthy diet, and the highest percentage of those who declared that they often got urinary infections were among those with increased adherence to an unhealthy diet (χ2 = 13.46, p = 0.036). The results of this study highlight a strong impact of obesity, reduced consumption of fruit and vegetables, and sedentary lifestyle on the risk of recurring urinary infections.
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Affiliation(s)
- Magdalena Mititelu
- Department of Clinical Laboratory and Food Safety, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (M.M.); (G.O.)
| | - Gabriel Olteanu
- Department of Clinical Laboratory and Food Safety, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020956 Bucharest, Romania; (M.M.); (G.O.)
| | - Sorinel Marius Neacșu
- Department of Pharmaceutical Technology and Bio-Pharmacy, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020945 Bucharest, Romania
| | - Iuliana Stoicescu
- Department of Chemistry and Quality Control of Drugs, Faculty of Pharmacy, Ovidius University of Constanta, 900470 Constanta, Romania;
| | - Denisa-Elena Dumitrescu
- Department of Organic Chemistry, Faculty of Pharmacy, Ovidius University of Constanta, 900470 Constanta, Romania;
| | - Emma Gheorghe
- Department of Preclinical Sciences I—Histology, Faculty of Medicine, Ovidius University of Constanta, 900470 Constanta, Romania
| | - Monica Tarcea
- Department of Community Nutrition and Food Safety, G.E. Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, 540142 Mures, Romania;
| | - Ștefan Sebastian Busnatu
- Department of Cardio-Thoracic Pathology, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania;
| | - Corina-Bianca Ioniță-Mîndrican
- Department of Toxicology, Faculty of Pharmacy, Carol Davila University of Medicine and Pharmacy, 020945 Bucharest, Romania;
| | - Ovidiu Tafuni
- Department of Preventive Medicine, Nicolae Testemițanu State University of Medicine and Pharmacy from the Republic of Moldova, MD-2004 Chisinau, Moldova;
| | - Ionela Belu
- Department of Pharmaceutical Technology, Faculty of Pharmacy, University of Medicine and Pharmacy of Craiova, 200638 Craiova, Romania;
| | - Antoanela Popescu
- Department of Pharmacognosy, Faculty of Pharmacy, Ovidius University of Constanta, 900470 Constanta, Romania;
| | - Sergiu Lupu
- Department of Navigation and Naval Transport, Faculty of Navigation and Naval Management, Mircea cel Batran Naval Academy, 900218 Constanta, Romania;
| | - Carmen Elena Lupu
- Department of Mathematics and Informatics, Faculty of Pharmacy, Ovidius University of Constanta, 900001 Constanta, Romania;
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Capstick A, Palermo F, Zakka K, Fletcher-Lloyd N, Walsh C, Cui T, Kouchaki S, Jackson R, Tran M, Crone M, Jensen K, Freemont P, Vaidyanathan R, Kolanko M, True J, Daniels S, Wingfield D, Nilforooshan R, Barnaghi P. Digital remote monitoring for screening and early detection of urinary tract infections. NPJ Digit Med 2024; 7:11. [PMID: 38218738 PMCID: PMC10787784 DOI: 10.1038/s41746-023-00995-5] [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: 08/18/2023] [Accepted: 12/11/2023] [Indexed: 01/15/2024] Open
Abstract
Urinary Tract Infections (UTIs) are one of the most prevalent bacterial infections in older adults and a significant contributor to unplanned hospital admissions in People Living with Dementia (PLWD), with early detection being crucial due to the predicament of reporting symptoms and limited help-seeking behaviour. The most common diagnostic tool is urine sample analysis, which can be time-consuming and is only employed where UTI clinical suspicion exists. In this method development and proof-of-concept study, participants living with dementia were monitored via low-cost devices in the home that passively measure activity, sleep, and nocturnal physiology. Using 27828 person-days of remote monitoring data (from 117 participants), we engineered features representing symptoms used for diagnosing a UTI. We then evaluate explainable machine learning techniques in passively calculating UTI risk and perform stratification on scores to support clinical translation and allow control over the balance between alert rate and sensitivity and specificity. The proposed UTI algorithm achieves a sensitivity of 65.3% (95% Confidence Interval (CI) = 64.3-66.2) and specificity of 70.9% (68.6-73.1) when predicting UTIs on unseen participants and after risk stratification, a sensitivity of 74.7% (67.9-81.5) and specificity of 87.9% (85.0-90.9). In addition, feature importance methods reveal that the largest contributions to the predictions were bathroom visit statistics, night-time respiratory rate, and the number of previous UTI events, aligning with the literature. Our machine learning method alerts clinicians of UTI risk in subjects, enabling earlier detection and enhanced screening when considering treatment.
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Affiliation(s)
- Alexander Capstick
- Imperial College London, London, UK.
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK.
| | - Francesca Palermo
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Kimberley Zakka
- University College London, London, UK
- Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Nan Fletcher-Lloyd
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Chloe Walsh
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Tianyu Cui
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Samaneh Kouchaki
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
- University of Surrey, London, UK
| | - Raphaella Jackson
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Martin Tran
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Michael Crone
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Kirsten Jensen
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Paul Freemont
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Ravi Vaidyanathan
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Magdalena Kolanko
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Jessica True
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Sarah Daniels
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - David Wingfield
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
| | - Ramin Nilforooshan
- Imperial College London, London, UK
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK
- University of Surrey, London, UK
- Surrey and Borders Partnership NHS Foundation Trust, Leatherhead, UK
| | - Payam Barnaghi
- Imperial College London, London, UK.
- UK Dementia Research Institute, Care Research and Technology Centre, London, UK.
- University College London, London, UK.
- Great Ormond Street Hospital NHS Foundation Trust, London, UK.
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9
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Raphael E, Inamdar PP, Belmont C, Shariff-Marco S, Huang AJ, Chambers HF. Spatial clusters of extended-spectrum beta-lactamase-producing Escherichia coli causing community-onset bacteriuria due to repeat infections: cluster analysis from a large urban medical center, San Francisco, 2014-2020. Antimicrob Resist Infect Control 2023; 12:115. [PMID: 37858209 PMCID: PMC10588154 DOI: 10.1186/s13756-023-01320-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 10/10/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-E. coli) may occur as outbreaks due to common-source exposures. Yet, it is currently unknown if they cluster geographically as would be expected as part of an outbreak. METHODS We collected electronic health record data on all patients living in San Francisco with culture-documented community-onset E. coli bacteriuria in a safety-net public healthcare system from January 2014 to March 2020 (diagnosed < 48 h after hospital admission or in outpatient clinical settings without a hospitalization in the past 90 days). We assessed the presence of spatial clusters of (1) ESBL-E. coli bacteriuria episodes, and (2) individuals with any ESBL-E. coli bacteriuria episode, with Global and Local Moran's I. We evaluated differences in prevalence of bacteriuria recurrence by ESBL-production by Poisson regression. RESULTS Out of 4,304 unique individuals, we identified spatial clusters of ESBL-E. coli bacteriuria episodes (n = 461) compared to non-ESBL-E. coli bacteriuria episodes (n = 5477; Global Moran's p < 0.001). Spatial clusters of individuals with any bacteriuria caused by ESBL-E. coli were not identified (p = 0.43). Bacteriuria recurrence was more likely to occur with ESBL-E. coli (odds ratio [OR] 2.78, 95% confidence interval [95% CI] 2.10, 3.66, p < 0.001), particularly after an initial ESBL-E. coli bacteriuria episode (OR 2.27, 95% CI 1.82, 2.83, p < 0.001). CONCLUSION We found spatial clusters of ESBL-E. coli bacteriuria episodes. However, this was partly explained by clustering within individuals more than between individuals, as having an ESBL-E. coli bacteriuria was associated with recurrence with ESBL-E. coli. These findings may help better tailor clinical treatment of patients with recurrent urinary tract infections after an initial episode caused by ESBL-E. coli.
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Affiliation(s)
- Eva Raphael
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
- Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA.
- Global Health and Clinical Sciences, 550 16th Street, Box 0560, San Francisco, CA, 94143, USA.
| | - Pushkar P Inamdar
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Cheyenne Belmont
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA
| | - Alison J Huang
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
- Department of Urology, University of California, San Francisco, San Francisco, CA, USA
| | - Henry F Chambers
- Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Papp SB, Christie AL, Zimmern PE. Characteristics of Nationwide Urinary Tract Infection (UTI) Visits by Age and Type II Diabetes Status in Women. Cureus 2023; 15:e46000. [PMID: 37900369 PMCID: PMC10601984 DOI: 10.7759/cureus.46000] [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: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
Background Through a national database search of office visits, we studied the contribution of two known risk factors for urinary tract infections (UTIs) in women: age and type 2 diabetes mellitus (T2DM). Methodology The National Ambulatory Medical Care Survey (NAMCS) database was queried for visits including a UTI diagnosis and a urine culture order. Data were included for all visits involving adult women for available years, 2014-2016 and 2018. Data on demographics, reason for visit, T2DM status, UTI workup, and UTI treatment were collected. Patients with Alzheimer's disease or chronic kidney disease were excluded. Descriptive statistics were displayed as weighted means with standard errors for continuous variables. The effect of age was compared based on a 65-year-old cutoff. Results One hundred sixty-seven surveyed visits were analyzed for the years 2014-2016 and 2018, representing an estimated 7.4 million visits nationwide. Women ≥65 years were more likely to be white, non-Hispanic/non-Latino, from the Midwest or West, from metropolitan areas, and on Medicare/Medicaid than their younger counterparts. T2DM and urinalysis rates did not significantly vary between the two age groups (7.7% vs. 14.6%, P = 0.3; 78% vs. 76%, P = 0.9, respectively). For urinalysis rates between patients with and without T2DM, there was no significant difference in the <65-year-old group (80% vs. 78%, P = 0.9) or the ≥65-year-old group (93% vs. 73%, P = 0.12). Antibiotic prescription rates were also similar for T2DM and non-T2DM patients (67% vs. 75%, P = 0.7). Conclusions Through a national database analysis, we reported the demographic and visit differences aged <65 years and ≥65 years who sought care for UTIs in the United States over a four-year period. T2DM rates and urinalysis did not vary between age groups, and urinalysis rates and antibiotic prescription rates did not vary between T2DM and non-T2DM groups in an age-dependent matter. More research is needed to understand the demographic makeup and risk factors of UTI patients across the nation.
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Affiliation(s)
- Sara B Papp
- Department of Urology, University of Texas (UT) Southwestern Medical Center, Dallas, USA
| | - Alana L Christie
- Department of Urology, University of Texas (UT) Southwestern Medical Center, Dallas, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas (UT) Southwestern Medical Center, Dallas, USA
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11
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Wang F, Wang X, Shi Y, Li L, Zheng Y, Liu H, Zeng M, Jiang F, Wu Z. Development of a risk nomogram predicting urinary tract infection in patients with indwelling urinary catheter after radical surgery for cervical cancer. Prog Urol 2023; 33:492-502. [PMID: 37634960 DOI: 10.1016/j.purol.2023.08.017] [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: 12/22/2022] [Revised: 07/06/2023] [Accepted: 08/01/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND Cervical cancer (CC) patients receiving indwelling catheterization after radical hysterectomy (RH) are vulnerable to urinary tract infection (UTI). However, no model or method is available to predict the risk of UTIs. Therefore, our aim was to develop and verify a risk model to predict UTI for patients receiving indwelling catheterization after radical cervical cancer surgery (ICa-RCCS). METHODS We first collected clinical information of 380 patients receiving ICa-RCCS from January 2020 to December 2021 as a training cohort to develop the risk nomogram. UTI was then evaluated using 19 UTI predictor factors. The least absolute shrinkage and selection operator (LASSO) method was utilized for the extraction characteristics. Multivariable logistic regression analysis was then conducted to create the risk model for UTI prediction. The consistency coefficient and calibration curve were utilized to assess the model's fit accuracy. We performed bootstrapping with 1000 random samples for internal validation of the model, and decision curve analysis (DCA) for clinical application. RESULTS Predictors in the risk nomogram included indwelling catheterization duration, whether it is secondary indwelling catheterization, history of UTIs, age, and history of chemotherapy before surgery. The risk nomogram presented good discrimination and calibration (C-index: 0.810, 95% CI: 0.759-0.861). During interval validation, the model reached a high C-index up to 0.7930. DCA revealed the clinical utility of predictive model for UTI. Clinical benefit was initiated at the decision threshold≥3%. CONCLUSION We developed a novel UTI nomogram incorporating the age, history of chemotherapy before surgery, indwelling catheterization duration, whether it is secondary indwelling catheterization, and history of UTI to predict UTI risk for patients receiving ICa-RCCS. LEVEL OF EVIDENCE B: 3a.
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Affiliation(s)
- Fang Wang
- Chong Qing Three Gorges Medical College, Chongqing, China
| | - Xiaoli Wang
- The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - YuanXiang Shi
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Ling Li
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Yu Zheng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Huaying Liu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Min Zeng
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China
| | - Feng Jiang
- Department of Neonatology, Obstetrics and Gynecology Hospital of Fu dan University, Shanghai, China.
| | - Zhimin Wu
- Department of Gynecology and Obstetrics, Third Military Medical University Southwest Hospital Chongqing, Chongqing, China.
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12
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Lee YK, Kuo HC. Effectiveness of Platelet-Rich Plasma Injections as Prophylaxis for Recurrent Urinary Tract Infection in Women. J Clin Med 2023; 12:4129. [PMID: 37373821 DOI: 10.3390/jcm12124129] [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: 03/21/2023] [Revised: 05/04/2023] [Accepted: 06/13/2023] [Indexed: 06/29/2023] Open
Abstract
PURPOSE To investigate the therapeutic efficacy of intravesical platelet-rich plasma (PRP) injections as prophylaxis for adult women with recurrent urinary tract infection (rUTI). METHODS This proof-of-concept study enrolled 63 women with rUTI in PRP treatment and control groups after achieving control of the most recent urinary tract infection (UTI) episode. The treatment group included 34 women who received 4 monthly intravesical PRP injections. The control group was made up of 30 women who received continuous antibiotic treatment for 3 months. After the completion of PRP or antibiotic treatment, outpatient follow-up was continued for up to 12 months. Treatment was considered successful if ≤2 UTI episodes occurred during a period of 12 months or ≤1 UTI episode within 6 months; otherwise, the outcome was considered a treatment failure. The frequency of symptomatic UTI episodes before and after PRP treatment was compared with that of the controls. Regression analysis was used to determine the association between potential predictors for a failed treatment outcome. RESULTS At the study endpoint, 33 PRP and 25 control group patients were available for analysis. After four PRP injections, the frequency of rUTI episodes per month was significantly decreased compared with baseline (0.46 ± 0.27 vs. 0.28 ± 0.30, p = 0.047). The PRP treatment success rate was 51.5% (17 of 33) for the PRP group versus 48% (12 of 25) for the control group. The PRP treatment success group had significantly higher voided volume, lower post-void residual volume, and higher voiding efficiency than the PRP treatment failure group. A higher baseline voiding efficacy ≥0.71 was significantly associated with a successful outcome (OR 16.56; p = 0.049). CONCLUSIONS The study results revealed that repeat intravesical PRP injections decreased the recurrence rate of UTI within 1 year in women with rUTI. The treatment success rate with intravesical PRP injections for rUTI was about 51.5%, whereas for women with prolonged antibiotic treatment, it was 48.0%. A baseline VE ≥ 0.71 was associated with a better treatment outcome with PRP injections.
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Affiliation(s)
- Yu-Khun Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Buddhist Tzu Chi University, Hualien 970, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Buddhist Tzu Chi University, Hualien 970, Taiwan
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13
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Raphael E, Inamdar PP, Belmont C, Shariff-Marco S, Huang A, Chambers H. Spatial clusters of extended-spectrum beta-lactamase-producing Escherichia coli causing community-onset bacteriuria due to repeat infections: cluster analysis from a large urban medical center, San Francisco, 2014-2020. RESEARCH SQUARE 2023:rs.3.rs-2949551. [PMID: 37292942 PMCID: PMC10246249 DOI: 10.21203/rs.3.rs-2949551/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background Urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL-E. coli) may occur as outbreaks due to common-source exposures. Yet, it is currently unknown if they cluster geographically as would be expected as part of an outbreak. Methods We collected electronic health record data on all patients living in San Francisco with culture-documented community-onset E. coli bacteriuria in a safety-net public healthcare system from January 2014 to March 2020 (diagnosed < 48 hours after hospital admission or in outpatient clinical settings without a hospitalization in the past 90 days). We assessed the presence of spatial clusters of (1) ESBL-E. coli bacteriuria episodes, and (2) individuals with any ESBL-E. coli bacteriuria episode, with Global and Local Moran's I. We evaluated differences in prevalence of bacteriuria recurrence by ESBL-production by Poisson regression. Results Out of 4,304 unique individuals, we identified spatial clusters of ESBL-E. coli bacteriuria episodes (n = 461) compared to non-ESBL-E. coli bacteriuria episodes (n = 5477; Global Moran's p < 0.001). Spatial clusters of individuals with any bacteriuria caused by ESBL-E. coli were not identified (p = 0.43). Bacteriuria recurrence was more likely to occur with ESBL-E. coli (odds ratio [OR] 2.78, 95% confidence interval [95% CI] 2.10, 3.66, p < 0.001), particularly after an initial ESBL-E. coli bacteriuria episode (OR 2.27, 95% CI 1.82, 2.83, p < 0.001). Conclusion We found spatial clusters of ESBL-E. coli bacteriuria episodes. However, this was partly explained by clustering within individuals more than between individuals, as having an ESBL-E. coli bacteriuria was associated with recurrence with ESBL-E. coli.
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14
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Churchill K. The management of recurrent urinary tract infections within a nurse-led urology team. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2023; 32:S6-S12. [PMID: 37173081 DOI: 10.12968/bjon.2023.32.9.s6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The aim of this article is to share experience and learning of managing recurrent urinary tract infections (UTIs) within a specialist urology nurse-led team based at a district general hospital. It looks at current practice and supporting evidence for how to manage and treat recurrent UTIs in both male and female patients. Two case studies are presented to illustrate the management strategies and outcomes, demonstrating a planned approach that informs the design of a local management guideline to organise patients' care.
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Affiliation(s)
- Kevin Churchill
- Clinical Nurse Specialist, Bladder and Bowel Care Team, Royal Devon University Healthcare NHS Trust, Exeter
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15
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d-Mannose for Recurrent Urinary Tract Infection Prevention in Postmenopausal Women Using Vaginal Estrogen: A Randomized Controlled Trial. UROGYNECOLOGY (HAGERSTOWN, MD.) 2023; 29:367-377. [PMID: 36808931 DOI: 10.1097/spv.0000000000001270] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
IMPORTANCE Further research is needed to determine whether d-mannose plus vaginal estrogen therapy (VET) is beneficial over VET alone for recurrent urinary tract infection (rUTI) prevention. OBJECTIVE The aim of this study was to evaluate d-mannose efficacy for rUTI prevention in postmenopausal women using VET. STUDY DESIGN We conducted a randomized controlled trial comparing d-mannose (2 g/d) with control. Participants were required to have a history of uncomplicated rUTIs and to remain on VET throughout the trial. They were followed up 90 days for incident UTIs. Cumulative UTI incidences were calculated by the Kaplan-Meier method and compared by Cox proportional hazards regression. For the planned interim analysis, P < 0.001 was considered statistically significant. Futility analysis was performed by generating post hoc conditional power for multiple scenarios. RESULTS We evaluated 545 patients for frequent/recurrent UTIs from March 1, 2018, to January 18, 2020. Of these women, 213 had culture-proven rUTIs, 71 were eligible, 57 enrolled, 44 began their planned 90-day study period, and 32 completed the study. At interim analysis, the overall cumulative UTI incidence was 46.6%; 41.1% in the treatment arm (median time to first UTI, 24 days) and 50.4% in the control arm (median, 21 days); hazard ratio, 0.76; 99.9% confidence interval, 0.15-3.97. d-Mannose was well tolerated with high participant adherence. Futility analysis suggested the study lacked power to detect the planned (25%) or observed (9%) difference as statistically significant; the study was halted before conclusion. CONCLUSIONS d-Mannose is a well-tolerated nutraceutical, but further research is needed to determine whether d-mannose in combination with VET has a significant, beneficial effect beyond VET alone in postmenopausal women with rUTIs.
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Ribeiro-Filho LA, Braz NDSF, Suartz CV, Balsimelli AP, Hirasaki F, Miranda E, Siqueira M, Mitre AI, Gomes CM, Nahas WC. Transvaginal ultrasonography for trigonitis diagnosis in women. Int J Urol 2023. [PMID: 36808752 DOI: 10.1111/iju.15161] [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: 08/01/2022] [Accepted: 01/24/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVE Chronic trigonitis (CT) is usually diagnosed through cystoscopy which is invasive and expensive. Thus, an accurate non-invasive diagnostic method is necessary. The objective of this study is to determine the efficacy of transvaginal bladder ultrasound (TBU) for CT diagnosis. METHODS Between 2012 and 2021, 114 women (17-76 years old) with recurrent urinary tract infection (RUTI) and history of antibiotic resistance were evaluated with TBU by a single ultrasonographer. As a control group, TBU was performed in 25 age-matched women with no previous history of UTI, urological or gynecological conditions. All patients with RUTI had undergone a cystoscopy with biopsy for diagnostic confirmation at the time of trigone cauterization. RESULTS Thickening of trigone mucosa (>3 mm) was detected in all patients with RUTI and represented the most relevant criteria for trigonitis diagnosis on TBU. Other TBU findings in CT are: irregular and interrupted mucosa lining (96.4%), free debris in the urine (85.9%), increased blood flow at doppler (81.5%), mucosa shedding and tissue flaps. Biopsy showed CT with erosive pattern (58%) or non-keratinizing metaplasia (42%). Diagnostic agreement index between TBU and cystoscopy was 100%. In the control group, normal trigone mucosa is ultrasonographically regular, continuous, with thickness ≤3 mm and there is no debris in the urine. CONCLUSIONS TBU proved to be an efficient, inexpensive and minimally invasive method to diagnose CT. To our knowledge, this is the first article that reports the use of transvaginal ultrasound as an alternative method for diagnosing trigonitis.
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Affiliation(s)
| | | | - Caio Vinicius Suartz
- Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Amaury Padilha Balsimelli
- Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Felipe Hirasaki
- Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Eduardo Miranda
- Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Matheus Siqueira
- Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Anuar Ibrahim Mitre
- Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - Cristiano Mendes Gomes
- Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
| | - William Carlos Nahas
- Division of Urology, Hospital das Clínicas, University of São Paulo Medical School, São Paulo, Brazil
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17
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Shionone Relieves Urinary Tract Infections by Removing Bacteria from Bladder Epithelial Cells. Cell Microbiol 2023. [DOI: 10.1155/2023/3201540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
In clinical practice, urinary tract infections (UTIs) are second only to respiratory infections in terms of infectious diseases. In recent years, drug resistance of Escherichia coli (E. coli) has increased significantly. The therapeutic effects of Shionone on UTI were assessed by modelling UTI in SD rats and SV-HUC-1 cells with E. coli solution. After treatment of Shionone, the UTI rat model showed a decrease in wet weight/body weight of bladder, as well as a reduction in cellular inflammatory infiltration of bladder tissue and a decrease in urinary levels of IL-6, IL-1β, and TNF-α. In addition, the levels of proinflammatory factors were significantly reduced in a dose-dependent manner in UTI cell model treated with different doses of Shionone (5, 10, and 20 μg/kg). The results of immunofluorescence analysis in both in vivo and in vitro experiments revealed that Shionone reduced bacterial load and the number of E. coli colonies growing on the plates was greatly reduced. These results suggested that Shionone has a good therapeutic effect on UTI, achieved by reducing bacterial load in bladder epithelial cells. The data presented here provide a basis for further research into the treatment of UTI.
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Barakat B, Gauger U, Rehme C, Hadaschik B, Wolff I, Hijazi S. Diagnosis of female urethral diverticulum using pelvic floor ultrasound and comparison with voiding cystourethrogram (imaging study). Int Urogynecol J 2023; 34:563-569. [PMID: 36098788 DOI: 10.1007/s00192-022-05340-0] [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: 06/02/2022] [Accepted: 08/05/2022] [Indexed: 01/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study was to evaluate the sensitivity and specificity of pelvic floor ultrasound (PFUS) in the diagnostic work-up of female urethral diverticulum (UD) and to compare results of PFUS with voiding cystourethrogram (VCUG). METHODS We retrospectively reviewed our database of patients, who received VCUG and PFUS for the diagnosis of UD. A total of 196 consecutive female patients with a minimum of one symptom, such as a lower urinary tract symptom (LUTS), postmicturition dribble, dyspareunia and recurrent urinary tract infection (UTI) who underwent initial diagnostics with VCUG and PFUS were selected. Diagnostic performance of both procedures, which included size, complexity, echogenicity. and content were compared. RESULTS Recurrent UTI and LUTS were the most common symptoms, which were present in 165 (84%) and 163 patients (83%) respectively. Final diagnosis of UD was based on PFUS and VCUG findings in 69 (35%) and 58 (30%) cases respectively. Based on our study cohort, the sensitivity of PFUS in detecting UD was significantly higher than that of VCUG: 94% (IQR: 89-97) versus 78% (IQR: 73-85, p<0.01), with a trend toward higher specificity: 100% (IQR: 94-100) versus 84% (IQR: 78-84, p=0.05). Enabling direct UD visualisation, PFUS was associated with a positive predictive value (PPV) of 100% (IQR: 97-100) and a negative predictive value (NPV) of 88% (IQR: 78-95), whereas VCUG had an inferior accuracy with a PPV of 84 (IQR: 80-84) and a NPV of 68 (IQR: 62-79). CONCLUSIONS In clinical practice, VCUG has a lower sensitivity than PFUS. Based on these results, we recommend the usage of dynamic PFUS as part of a non-invasive work-up.
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Affiliation(s)
- Bara Barakat
- Department of Urology and Pediatric Urology, Hospital Viersen, Hoserkirchweg 63, 41747, Viersen, Germany.
| | | | - Christian Rehme
- Department of Urology and Pediatric Urology, University Hospital Essen, Essen, Germany
| | - Boris Hadaschik
- Department of Urology and Pediatric Urology, University Hospital Essen, Essen, Germany
| | - Ingmar Wolff
- Department of Urology, University Medicine Greifswald, Greifswald, Germany
| | - Sameh Hijazi
- Department of Urology, Hospital Ibbenbüren, Ibbenbüren, Germany
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19
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Mondal S, Noori MT, Pal DK. Sexual dysfunction in female patients of reproductive age group with recurrent urinary tract infection—a cross-sectional study. AJOG GLOBAL REPORTS 2022; 2:100083. [DOI: 10.1016/j.xagr.2022.100083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
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20
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GÜNAYDIN B, KESKİN SK. The effect of anal hygiene method in prevention from recurrent lower urinary tract infections in women. JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1163316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: To evaluate the effects stopping the use of water and hands on preventing urinary tract infections (UTI) for a group of female patients having recurrent UTIs (rUTI).
Material and Method: A retrospective observational study conducted in a tertiary care hospital between February 2017 and March 2018. 273 female patients which had rUTIs without any concomitant risk factors were included. In the study, 2 or more bacteriologically documented UTIs in the last 6 months were accepted as rUTI. The groups of the study defined as using their hands, using water only and using toilet paper (using either one of these two methods and then using toilet paper). Patients were observed for an average time of 10.4 months after stopping the use of water and hands for anal cleansing after defecation. Instead they were all given toilet education and started wiping for anal hygiene.
Results: There was a statistically significant relationship between previous history of UTI and washing with hands + water (p=0.021). The rate of previous UTIs were significantly higher in the group of patients using their hands for anal washing (69% vs 31%). No relation was found between previous UTI history variable for using toilet paper and flushing with water only (p>0.05). Our results showed a statistically significant decrease of UTIs after stopping the use of water and hands in the patient group who had a previous UTI history (p=0.001).
Conclusion: We managed to underline that washing with hands for anal cleansing as a risk factor for rUTIs in women. Also showed the positive effect of stopping the use of water and hands for anal cleansing after defecation for prevention from rUTIs. We encourage all clinicians for further studies to investigate this issue in the future.
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A post-trial follow-up study of pentosan polysulfate monotherapy on preventing recurrent urinary tract infection in women. Sci Rep 2022; 12:16733. [PMID: 36202908 PMCID: PMC9537304 DOI: 10.1038/s41598-022-21100-y] [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: 04/01/2022] [Accepted: 09/22/2022] [Indexed: 11/08/2022] Open
Abstract
For women with recurrent urinary tract infection (UTI), previous U101 study has shown that pentosan polysulfate sodium (PPS) monotherapy for 16 weeks significantly reduced UTI episodes in the treatment group throughout the trial period. In this follow-up study, we aimed to assess whether the effects of PPS would last after completion of the trial to prevent recurrent UTIs. Conducted from 2018 to 2019, the U101 study was a multicenter, prospective, phase 2a, randomized trial, enrolling women with recurrent UTI to study the effects of a 16-week oral PPS monotherapy. After approximately two years, the follow-up was conducted by phone interview, obtaining data including self-reported UTI events, quality of life questionnaire, and adverse events. The primary endpoint of follow-up study was UTI recurrence-free survival and the secondary endpoints were quality of life and adverse events. Approximately two years after completion of the trial, the rate of recurrent UTI was 25% (3 of the 12 patients) in the PPS group and 85.7% (12 of the 14 patients) in the control group. Over the entire follow-up period, the UTI recurrence-free survival was significantly better in the PPS group than in the control group (log-rank test p < 0.001). The quality of life at two years was significantly improved in the PPS when compared to the control group (91.7 vs. 77.5, p < 0.001). No late adverse event was observed after cessation of the treatment. In this study, sixteen weeks of PPS monotherapy in women with recurrent UTI significantly reduced the numbers of recurrent UTI episodes during the 2-year follow-up.
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Andretta E, Longo R, Balladelli M, Sgarabotto C, Sgarabotto D. Intravesical Gentamicin: An Option for Therapy and Prophylaxis against Recurrent UTIs and Resistant Bacteria in Neurogenic Bladder Patients on Intermittent Catheterization. Antibiotics (Basel) 2022; 11:1335. [PMID: 36289993 PMCID: PMC9598998 DOI: 10.3390/antibiotics11101335] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 07/14/2022] [Accepted: 08/10/2022] [Indexed: 08/01/2023] Open
Abstract
This is a retrospective study of our experience with Gentamicin intravesical instillation as therapy and prophylaxis in patients with lower urinary tract infections (UTIs) undergoing clean intermittent catheterization because of a neurogenic bladder. It is an alternative therapy when all other systemic treatments have failed as it is still an off-label prescription.
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Affiliation(s)
| | | | | | | | - Dino Sgarabotto
- Abano Infectious Diseases Outpatient Clinic, 35031 Padova, Italy
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Rui L, Lindbaek M, Gjelstad S. Preventive effect of methenamine in women with recurrent urinary tract infections - a case-control study. Scand J Prim Health Care 2022; 40:331-338. [PMID: 36369890 PMCID: PMC9848284 DOI: 10.1080/02813432.2022.2139363] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is the most common bacterial infection in women. In Norwegian general practice, methenamine has been prescribed for many years as long-term prevention and accounted for 20% of the total antibiotic prescribing in 2015, as measured in defined daily dosages (DDDs). The efficacy of methenamine is unknown. If shown to be effective, this drug may become an important preventive against UTI. OBJECTIVE To examine whether methenamine is preventive against recurrent UTI in women. DESIGN Data for all antibiotics used for UTIs dispensed from all pharmacies from 2005 to 2015 were collected from the Norwegian prescription database (NorPD). SUBJECTS Women aged ≥ 40 years with recurrent UTI, defined as ≥3 courses of UTI antibiotic/year, were included. MAIN OUTCOME MEASURES Patients using methenamine (cases) and those not using methenamine (controls) were compared. The numbers of UTI prescriptions during the 2 years before and after inclusion were analysed. Results: The yearly prevalence for recurrent UTI was 2.4% in women ≥ 40 years. The change in antibiotic use from 2 years before to 2 years after inclusion in the study differed significantly between groups: 44.6 and 34.9% reductions in the number of antibiotic prescriptions for UTI in the methenamine and control groups, respectively. The decrease in UTI antibiotic prescriptions (58.9%) was greater in patients with a higher consumption of antibiotics before starting methenamine. CONCLUSIONS Methenamine seems to be effective against recurrent UTI over the time span studied. The effect seems to be greater in patients with the highest number of recurrent UTIs. Key pointsMethenamine has been used for many years for prevention of recurrent UTI, but no studies have demonstrated a significant preventive effect of long time use.This study shows that methenamine seems to be effective for prevention in patients having recurrent UTI over 2 years or more.The effect seems to be larger in patients with a high number of UTIs over 2 years.
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Affiliation(s)
- Linda Rui
- Department of General Practice, Antibiotic Centre for Primary Care, Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Morten Lindbaek
- Department of General Practice, Antibiotic Centre for Primary Care, Institute for Health and Society, University of Oslo, Oslo, Norway
- CONTACT Morten Lindbaek Department of General Practice, Antibiotic Centre for Primary Care, Institute for Health and Society, University of Oslo, Oslo, Norway
| | - Svein Gjelstad
- Department of General Practice, Antibiotic Centre for Primary Care, Institute for Health and Society, University of Oslo, Oslo, Norway
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Jent P, Berger J, Kuhn A, Trautner BW, Atkinson A, Marschall J. Antibiotics for Preventing Recurrent Urinary Tract Infection: Systematic Review and Meta-analysis. Open Forum Infect Dis 2022; 9:ofac327. [PMID: 35899289 PMCID: PMC9310516 DOI: 10.1093/ofid/ofac327] [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: 05/02/2022] [Accepted: 07/01/2022] [Indexed: 12/31/2022] Open
Abstract
Recurrent urinary tract infections are a common health problem. The only comprehensive synthesis on antibiotic prophylaxis in the last 15 years has been a guideline-embedded meta-analysis. We conducted a systematic review and meta-analysis of randomized controlled trials published up to October 13, 2020, evaluating patients age ≥12 years with either ≥2 episodes of lower urinary tract infection (UTI) within 6 months or ≥3 in the past year. Placebo or antibiotics were allowed as comparators. Study quality was low. In the 11 placebo-controlled trials, the risk for developing UTI was 85% lower with prophylaxis in comparison with placebo (risk ratio [RR], 0.15; 95% CI, 0.08-0.29). In the 9 head-to-head trials, the efficacy of the antibiotic agents appeared similar: The pooled RR indicated no difference between nitrofurantoin and comparators (RR, 1.01; 95% CI, 0.74-1.37), nor trimethoprim (+/- sulfamethoxazole; RR, 1.34; 95% CI, 0.89-2.03) or norfloxacin and comparators (RR, 1.17; 95% CI, 0.43-1.70). Studies comparing intermittent (postcoital) with continuous strategies revealed intermittent application to be equally effective.
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Affiliation(s)
- Philipp Jent
- Correspondence: Philipp Jent, MD, Department of Infectious Diseases, Inselspital Bern University Hospital, Freiburgstrasse 16p, CH-3010 Bern, Switzerland ()
| | - Julia Berger
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annette Kuhn
- Department of Gynecology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Marschall
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Feasibility and Research Insights From a Randomized Controlled Trial for Recurrent Urinary Tract Infection Prevention in Postmenopausal Women Using Vaginal Estrogen Therapy. Female Pelvic Med Reconstr Surg 2022; 28:e163-e170. [PMID: 35421017 DOI: 10.1097/spv.0000000000001171] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of the study was to inform feasibility parameters (eligibility, enrollment, and retention) for a recurrent urinary tract infection (rUTI) prevention randomized controlled trial (RCT). METHODS We assessed feasibility parameters of an RCT of postmenopausal women with uncomplicated rUTIs using vaginal estrogen. Participants were randomized to either d-mannose or a control arm. All participants were required to be using vaginal estrogen and to have a negative urine culture before 90-day trial participation. An RCT exit survey and separate survey for UTI patients (N = 196) were added to inform feasibility parameters and patient preferences for rUTI prevention and study participation after slower enrollment than anticipated. RESULTS At the time of interim and subsequent futility analyses, 545 patients had been evaluated for frequent/recurrent UTIs from March 1, 2018, to January 18, 2020. Of these, 213 (39.1%) had culture-proven rUTIs and 71 (33.3% of those with culture-proven rUTIs) were eligible for the RCT. Reasons for ineligibility included complicated UTIs, premenopausal/perimenopausal status, or existing UTI prevention regimen. Of the 71 eligible participants, 57 (80.3%) enrolled, and 44 began their planned 90-day study period (77.2%; 80.0% after excluding 2 participants awaiting negative urine cultures at the time of analysis). The study was halted before conclusion. Study retention (76.0%-83.7%) was slightly lower than expected. Urinary tract infection survey patients demonstrated significant interest in rUTI research participation. CONCLUSIONS We learned several important lessons that can benefit future research. Many patients with frequent/recurrent UTIs are interested in research, but rigorous eligibility criteria and referral urine culture documentation made recruitment challenging.
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Grigoryan L, Mulgirigama A, Powell M, Schmiemann G. The emotional impact of urinary tract infections in women: a qualitative analysis. BMC Womens Health 2022; 22:182. [PMID: 35585572 PMCID: PMC9118576 DOI: 10.1186/s12905-022-01757-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Accepted: 05/05/2022] [Indexed: 11/21/2022] Open
Abstract
Background While many studies address the clinical management of participants with uncomplicated urinary tract infection (uUTI), the emotional impact of uUTIs has been investigated less often. The aim of this qualitative study was to understand the emotional experience of women with uUTIs. Methods This was a qualitative, exploratory, in-depth interview-based study conducted among women in the United States (US) and Germany. Women aged ≥ 18 years with at least one uUTI treated with antibiotics in the past year were recruited through a patient community panel and physician referrals. Participants were recruited using purposive sampling to include an equal split of those with 1 or ≥ 2 antibiotics, and an equal split of those treated for a single or recurrent uUTIs (≥ 2 uUTIs in the past year). A structured telephone interview included questions about symptoms, diagnosis, treatment, and retreatment (if any). Each participant was queried about her emotions and the impact of the uUTI on life activities. Thematic analysis of responses was carried out to identify common themes. Results A total of 65 participants completed the interview, 40 (61.5%) from the US and 25 (38.5%) from Germany. Major themes that emerged from the analyses included (1) a wide range of negative emotions were experienced due to uUTI symptoms, interference with activities of daily life, and effects on relationships and sleep; (2) varied emotions and understanding related to uUTI treatment and management approaches; (3) treatment failure caused frustration, worry, and anger; and (4) the prospect of recurrent uUTIs provoked dread and helplessness. Conclusion Our research uncovered emotions of helplessness and dread experienced by women in the context of uUTI clinical treatment failure and recurrent uUTIs. Knowing patients’ perspectives on UTI management will help guide the development of patient education and improve shared decision-making. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-022-01757-3.
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Affiliation(s)
- Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA.
| | - Aruni Mulgirigama
- Global Specialty and Primary Care, GlaxoSmithKline, Brentford, Middlesex, UK
| | - Marcy Powell
- Safety and Medical Governance, GlaxoSmithKline, Research Triangle, NC, USA
| | - Guido Schmiemann
- Department for Health Services Research, Institute of Public Health and Nursing Research, University of Bremen, Bremen, Germany
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Ormeño MA, Ormeño MJ, Quispe AM, Arias-Linares MA, Linares E, Loza F, Ruiz J, Pons MJ. Recurrence of Urinary Tract Infections due to Escherichia coli and Its Association with Antimicrobial Resistance. Microb Drug Resist 2021; 28:185-190. [PMID: 34449257 DOI: 10.1089/mdr.2021.0052] [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: 01/15/2023] Open
Abstract
We analyzed the association between antibiotic resistance and recurrent urinary tract infection (rUTI) by Escherichia coli. Susceptibility levels to 14 antimicrobial agents and the presence of extended-spectrum β-lactamases (ESBL) were established using MicroScan. Incidences of multidrug resistant (MDR), extensively drug resistant (XDR), and ESBL-producer isolates as well as rUTIs were estimated. The time to recurrence was established adjusted for number of antibiotic-resistant families and MDR as predictors of interest, respectively. Overall, 8,553 urinary tract infection (UTI) cases related to E. coli, including 963 rITU, were analyzed with levels of resistance >30% in all cases, except for amikacin, nitrofurantoin, and carbapenems. The incidence of rUTI was of 11.3%, being 46.5%, 24.3%, and 42.5% for MDR, XDR, and ESBLs, respectively. Bivariate analysis showed that rUTI was associated with age, gender, resistance to specific antimicrobials, MDR, and XDR. The number of antibiotic families tested as resistant, MDR, XDR, gender, and age were associated with time to recurrence when adjusted for number of antibiotic families, and MDR, gender, and age were related when adjusted for MDR. High rates of antibiotic resistance to the usual antibiotics was observed in E. coli causing UTI, with female sex, age, and antibiotic resistance being risk factors for the development of rUTI.
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Affiliation(s)
| | | | | | | | - Elba Linares
- Servicio de Microbiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Felix Loza
- Servicio de Microbiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Joaquim Ruiz
- Escuela de Medicina, Universidad Científica del Sur, Lima, Perú
| | - Maria J Pons
- Escuela de Medicina, Universidad Científica del Sur, Lima, Perú
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Viereck V, Gamper M, Walser C, Fesslmeier D, Münst J, Zivanovic I. Combination therapy with botulinum toxin and bulking agent-An efficient, sustainable, and safe method to treat elderly women with mixed urinary incontinence. Neurourol Urodyn 2021; 40:1820-1828. [PMID: 34342363 PMCID: PMC9292298 DOI: 10.1002/nau.24757] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 11/10/2022]
Abstract
Aims To evaluate the efficacy, sustainability and safety of combined botulinum toxin and polyacrylamide hydrogel (PAHG) therapy to treat urgency and stress components of therapy‐refractory mixed urinary incontinence (MUI) in an elderly study population. Methods Fifty‐five women with therapy‐refractory MUI were treated with botulinum toxin and PAHG in one surgical procedure. Urgency urinary incontinence (UUI) and stress urinary incontinence (SUI) outcomes were separately assessed after 4 and 12 months by objective UUI episodes/24 h and cough test, subjective impact of UUI and SUI on quality of life, and subjective International Consultation on Incontinence Questionnaire‐Urinary Incontinence Short Form (ICIQ‐UI SF). MUI outcome was calculated by combining UUI and SUI outcomes. Complications were monitored throughout the study. Results At 4 months, objective cure rates were 73%, 53%, and 42%, and subjective cure rates were 71%, 52%, and 50% for SUI, UUI, and MUI. At 12 months, objective cure rates were 73%, 56%, 50% and subjective cure rates were 78%, 42%, and 40% for SUI, UUI, and MUI. The ICIQ‐UI SF score decreased by 9.0 and 8.7 points after 4 and 12 months. All complications were transient and included 22% clean intermittent catheterization immediately after surgery, 33% postvoid residual volumes >100 ml at 14 days, and 13% symptomatic urinary tract infection within the first postoperative month. Conclusions The combination of botulinum toxin and PAHG is effective, sustainable and safe to treat therapy‐refractory MUI, even in an elderly and frail study population. Patients benefit from the short surgical procedure without the need for general anaesthesia or discontinuation of anticoagulation.
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Affiliation(s)
- Volker Viereck
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Marianne Gamper
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Claudia Walser
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Debra Fesslmeier
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Julia Münst
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
| | - Irena Zivanovic
- Department of Gynecology and Obstetrics, Cantonal Hospital Frauenfeld, Frauenfeld, Switzerland
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Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a randomized clinical trial. Int Urogynecol J 2021; 33:571-580. [PMID: 34115162 DOI: 10.1007/s00192-021-04849-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 05/08/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to find an alternative treatment to a low-dose antibiotic for the prevention of recurrent urinary tract infections (UTI) and to evaluate the difference in rates of reinfection within 1 year when treated with methenamine hippurate for prophylaxis compared with trimethoprim. METHODS We present a non-blinded randomized trial comparing methenamine hippurate with trimethoprim for the prevention of recurrent UTI at 12 months after starting treatment. Women over 18 who had at least two culture-positive UTI in the prior 6 months or three in the prior year were included. Ninety-two patients met enrollment criteria and were randomized to receive daily prophylaxis with methenamine hippurate or trimethoprim for a minimum of 6 months. Both intent-to-treat and per-protocol analyses if patients received the alternative drug after randomization were analyzed using Student's t test, Mann-Whitney U test, Kaplan-Meier curves, log-rank test, and a logistic and multivariate regression model. The primary outcome of this study was culture-proven UTI recurrence by 12 months after initiating prophylaxis. RESULTS In the intent-to-treat analysis, we found no difference between groups in recurrent UTI, with a 65% (28 out of 43) recurrence in the trimethoprim group versus 65% (28 out of 43) in the methenamine hippurate group (p = 1.00). In the per-protocol analysis, 65% (26 out of 40) versus 65% (30 out of 46) of patients had UTI recurrences in the trimethoprim group versus the methenamine hippurate group (p = 0.98). CONCLUSIONS Methenamine hippurate may be an alternative for the prevention of recurrent UTI, with similar rates of recurrence and adverse effects to trimethoprim.
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Correlation between symptoms and imaging findings including pelvic floor ultrasound to improve the symptom-based diagnosis of female urethral diverticulum (CHECK-UD study). Int Urogynecol J 2021; 33:2267-2274. [PMID: 33871666 DOI: 10.1007/s00192-021-04770-6] [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] [Received: 12/04/2020] [Accepted: 03/16/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The objective was to establish a model to predict the presence of a female urethral diverticulum (UD) based on symptoms. METHODS A prospective CHECK-UD study (check of female urethral diverticulum) was conducted. Female patients presenting with symptoms such as lower urinary tract symptoms (LUTS), postmicturition dribble or urinary incontinence (UI), dyspareunia or pain in the pelvic area, and recurrent urinary tract infection (UTI) treated between 2015 and 2020 were included. The association between each symptom variable and the positive finding of UD was evaluated by multivariate logistic regression adjusting for age, body mass index (BMI), vaginal deliveries, previous surgery for SUI, previous pelvic surgery, and microscopic hematuria. A predictive model for the presence of UD was then created. RESULTS In total, 189 female patients with a minimum of one symptom were enrolled. Pelvic floor ultrasound revealed the presence of UD in 66 out of 189 (34.92%). Of the four symptoms, the combinations "LUTS + postmicturition dribble + UTI," "postmicturition dribble + LUTS," and "UTI + LUTS" were most significantly related to positive findings and had a higher positive prognostic value for the diagnosis of UD than each individual symptom alone (OR = 13.78 [95% CI: 6.95-16.35], p < 0.001; OR = 9.94 [95% CI: 4.60-12.2], p < 0.05; and OR = 5.78 [95% CI: 1.58-6.98] p = 0.05) respectively. CONCLUSION Based on our model, the combination "LUTS + postmicturition dribble + UTI" seems to be the most sensitive combination of clinical symptoms predicting the positive finding of UD. This model could be used for patient counseling and for the identification of patients with UD.
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Ara B, Urmi UL, Haque TA, Nahar S, Rumnaz A, Ali T, Alam MS, Mosaddek ASM, Rahman NAA, Haque M, Islam S. Detection of mobile colistin-resistance gene variants ( mcr-1 and mcr-2) in urinary tract pathogens in Bangladesh: the last resort of infectious disease management colistin efficacy is under threat. Expert Rev Clin Pharmacol 2021; 14:513-522. [PMID: 33691556 DOI: 10.1080/17512433.2021.1901577] [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: 02/05/2023]
Abstract
Background: Currently, colistin-resistant pathogens emerged has become a global health concern. This study assessed the distribution of mcr-1 to mcr-5 variants with the phenotypic colistin-resistance in bacterial isolates from urinary tract infection (UTI) patients in Bangladesh.Methods: A cross-sectional study was conducted between April 2017 and March 2018 to enroll uncomplicated UTI patients, and 142 urine samples were analyzed. Uropathogens were identified using the API-20E biochemical panel and 16s rRNA gene sequencing. Polymerase chain reactions detected the mcr gene variants in the UTI isolates. The phenotypic colistin-susceptibility was determined by the Kirby-Bauer disc-diffusion method and the minimal inhibitory concentration (MIC) measurement.Results: The combined carriage of mcr-1 and mcr-2 genes in 11.4% (14/123) of urinary tract pathogens. The mcr-positive pathogens include five Escherichia coli, three Klebsiella pneumoniae, three Pseudomonas putida, two Enterobacter cloacae, and one Enterobacter hormaechei. The mcr-positive variant showed significantly higher phenotypic colistin resistance with MIC between >16 µg/mL and >128 µg/mL (p< 0.001). Over 85% of colistin-resistant isolates showed MDR phenomena.Conclusions: The emergence of the clinical MDR pathogens with resistance to a highly selective drug may lead to a lack of treatment options for the infectious diseases and spread of infection to the unaffected cohorts.
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Affiliation(s)
- Bayasrin Ara
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Umme Laila Urmi
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Tanjum Ara Haque
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Shamsun Nahar
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Adity Rumnaz
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | - Tamanna Ali
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
| | | | | | - Nor Azlina A Rahman
- Department of Physical Rehabilitation Sciences, Kulliyyah of Allied Health Sciences, International Islamic University Malaysia, Kuantan, Malaysia
| | - Mainul Haque
- Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kuala Lumpur, Malaysia
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Dhaka, Bangladesh
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Burton CS, Gonzalez G, Vaculik K, Khalil C, Zektser Y, Arnold C, Almario CV, Spiegel BMR, Anger JT. Female Lower Urinary Tract Symptom Prevention and Treatment Strategies on Social Media: Mixed Correlation With Evidence. Urology 2021; 150:139-145. [PMID: 32673678 PMCID: PMC9354551 DOI: 10.1016/j.urology.2020.06.056] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Revised: 05/21/2020] [Accepted: 06/28/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To evaluate the level of evidence behind recommendations on social media for disease prevention in five lower urinary tract symptoms. MATERIALS AND METHODS We conducted a digital analysis of anonymous online posts on social media sites collected by a social media data mining service. One thousand posts about pelvic organ prolapse, stress urinary incontinence, overactive bladder, urinary tract infection, and interstitial cystitis/bladder pain syndrome were randomly selected. We analyzed these posts for recommendations regarding the prevention and treatment of these diseases, which were then compared to recommendations in available clinical guidelines and assessed for level of evidence. RESULTS A total of 158 of 1000 posts contained 239 prevention strategies. For pelvic organ prolapse, there were 41 strategies identified, 25 (61%) of which had no evidence. For urinary tract infection 14 of 58 (29%) had no evidence, including recommendations for dietary modifications and urinary alkalization. For overactive bladder 8 of 28 (29%) had level 4 or no evidence. For stress urinary incontinence, 12 of 34 (36%) of prevention strategies had no evidence, such as laser rejuvenation and bladder training. Interstitial cystitis had the highest number of prevention strategies, and most were low or nonevidence based (70/79, 89%). CONCLUSION Prevention and treatment strategies are common in online discussions of pelvic floor disorders, but at least one third of these recommendations have no evidential support. There is a role for further online education and social media engagement by health care specialists to promote evidence-based practices.
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Affiliation(s)
- Claire S Burton
- Department of Urology, David Geffen School of Medicine, UCLA, Los Angeles, CA
| | - Gabriela Gonzalez
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Kristina Vaculik
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Yuliya Zektser
- David Geffen School of Medicine, University of California, Los Angeles, CA
| | - Corey Arnold
- Medical Imaging Informatics, Department of Radiology, UCLA, Los Angeles, CA
| | | | - Brennan M R Spiegel
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA
| | - Jennifer T Anger
- Department of Surgery, Division of Urology, Cedars-Sinai Medical Center, Los Angeles, CA.
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Role of D-Mannose in the Prevention of Recurrent Uncomplicated Cystitis: State of the Art and Future Perspectives. Antibiotics (Basel) 2021; 10:antibiotics10040373. [PMID: 33915821 PMCID: PMC8066587 DOI: 10.3390/antibiotics10040373] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 03/25/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTI) are highly frequent in women, with a significant impact on healthcare resources. Although antibiotics still represent the standard treatment to manage recurrent UTI (rUTI), D-mannose, an inert monosaccharide that is metabolized and excreted in urine and acts by inhibiting bacterial adhesion to the urothelium, represents a promising nonantibiotic prevention strategy. The aim of this narrative review is to critically analyze clinical studies reporting data concerning the efficacy and safety of D-mannose in the management of rUTIs. METHODS A non-systematic literature search, using the Pubmed, EMBASE, Scopus, Web of science, Cochrane Central Register of Controlled Trials, and Cochrane Central Database of Systematic Reviews databases, was performed for relevant articles published between January 2010 and January 2021. The following Medical Subjects Heading were used: "female/woman", "urinary tract infection", and "D-mannose". Only clinical studies, systematic reviews, and meta-analyses reporting efficacy or safety data on D-mannose versus placebo or other competitors were selected for the present review. Evidence was limited to human data. The selected studies were organized in two categories according to the presence or not of a competitor to D-mannose. RESULTS After exclusion of non-pertinent studies/articles, 13 studies were analyzed. In detail, six were randomized controlled trials (RCTs), one a randomized cross-over trial, five prospective cohort studies, and one a retrospective analysis. Seven studies compared D-mannose to placebo or others drugs/dietary supplements. Six studies evaluated the efficacy of D-mannose comparing follow-up data with the baseline. D-mannose is well tolerated, with few reported adverse events (diarrhea was reported in about 8% of patients receiving 2 g of D-mannose for at least 6 months). Most of the studies also showed D-mannose can play a role in the prevention or rUTI or urodynamics-associated UTI and can overlap antibiotic treatments in some cases. The possibility to combine D-mannose with polyphenols or Lactobacillus seems another important option for UTI prophylaxis. However, the quality of the collected studies was very low, generating, consequently, a weak grade of recommendations as suggested by international guidelines. Data on D-mannose dose, frequency, and duration of treatment are still lacking. CONCLUSION D-mannose alone or in combination with several dietary supplements or Lactobacillus has a potential role in the non antimicrobial prophylaxis or recurrent UTI in women. Despite its frequent prescription in real-life practice, we believe that further well-designed studies are urgently needed to definitively support the role of D-mannose in the management of recurrent UTIs in women.
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Scaglione F, Musazzi UM, Minghetti P. Considerations on D-mannose Mechanism of Action and Consequent Classification of Marketed Healthcare Products. Front Pharmacol 2021; 12:636377. [PMID: 33762956 PMCID: PMC7982833 DOI: 10.3389/fphar.2021.636377] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 02/05/2021] [Indexed: 01/07/2023] Open
Abstract
Urinary tract infections (UTIs) are very common disorders that affect adult women. Indeed, 50% of all women suffer from UTIs at least one time in their lifetime; 20-40% of them experience recurrent episodes. The majority of UTIs seems to be due to uropathogenic Escherichia coli that invades urothelial cells and forms quiescent bacterial reservoirs. Recurrences of UTIs are often treated with non-prescribed antibiotics by the patients, with increased issues connected to antibiotics resistance. D-mannose, a monosaccharide that is absorbed but not metabolized by the human body, has been proposed as an alternative approach for managing UTIs since it can inhibit the bacterial adhesion to the urothelium. This manuscript discusses the mechanisms through which D-mannose acts to highlight the regulatory aspects relevant for determining the administrative category of healthcare products placed on the market. The existing literature permits to conclude that the anti-adhesive effect of D-mannose cannot be considered as a pharmacological effect and, therefore, D-mannose-based products should be classified as medical devices composed of substances.
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Affiliation(s)
- Francesco Scaglione
- Department of Oncology and Hemato-Oncology, Università Degli Studi Di Milano, Milan, Italy
- Clinical Pharmacology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Umberto M. Musazzi
- Department of Pharmaceutical Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Paola Minghetti
- Department of Pharmaceutical Sciences, Università Degli Studi Di Milano, Milan, Italy
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Chavez JA, Christie AL, Zimmern PE. Favorable Outcomes of Repeat Electrofulguration Procedures in Women With Antibiotic-refractory Recurrent Urinary Tract Infections. Urology 2020; 146:83-89. [PMID: 32871138 DOI: 10.1016/j.urology.2020.08.030] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/12/2020] [Accepted: 08/17/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the efficacy of repeat endoscopic electrofulguration in women with antibiotic-refractory, recurrent urinary tract infections (RUTIs) with persistent symptoms after 1 electrofulguration. METHODS An institutional review board-approved, prospectively maintained database of non-neurogenic women with RUTIs, persistent symptoms and endoscopic findings of bladder wall inflammation after 1 electrofulguration, and minimum 6 months follow-up was reviewed. Endoscopic success was defined as complete resolution of previous lesions without new lesions seen during office cystoscopy 6 months after second electrofulguration. Clinical success was defined as no urinary tract infections at last follow-up; improvement as 1-2 treated infections/year; and failure as ≥3 treated infections/year, daily antibiotic suppression, or another electrofulguration (third or fourth). RESULTS From 2006 to 2018, 58/70 (83%) women with median age 70 years and median follow-up 26 months were included, and 53/58 had endoscopic data 6 months postsecond electrofulguration. Endoscopic success was noted in 26 (49%), and 21/26 had <3 UTIs within the last year of follow-up, vs 2/27 (7%) with endoscopic failure (P = .001). Among those with clinical failure, 6/30 (20%) remained on suppressive antibiotics, 9/30 (30%) required intravenous antibiotic courses, and 2 proceeded to cystectomy. Of 24 women who underwent a third electrofulguration, 11/24 (46%) were clinically successful or improved at median 22 months follow-up. Urine cultures from the year of last follow-up revealed extended-spectrum beta lactamase producing strains (50%) and strains resistant to >3 antibiotics (43%). CONCLUSION Women with persistent RUTIs following 1 electrofulguration may benefit from a second or even third procedure.
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Affiliation(s)
| | - Alana L Christie
- Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, TX
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Lenger SM, Bradley MS, Thomas DA, Bertolet MH, Lowder JL, Sutcliffe S. D-mannose vs other agents for recurrent urinary tract infection prevention in adult women: a systematic review and meta-analysis. Am J Obstet Gynecol 2020; 223:265.e1-265.e13. [PMID: 32497610 DOI: 10.1016/j.ajog.2020.05.048] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2019] [Revised: 05/23/2020] [Accepted: 05/28/2020] [Indexed: 01/11/2023]
Abstract
OBJECTIVE We performed a systematic review and meta-analysis to determine whether D-mannose reduces urinary tract infection recurrence (ie, cumulative incidence) in adult women with recurrent urinary tract infection compared with other prevention agents. Secondary outcomes included side effects and compliance with D-mannose use. DATA SOURCES Ovid Medline 1946-, Embase 1947-, Scopus 1823-, Cochrane Library, Web of Science 1900-, and ClinicalTrials.gov were searched through 4/15/2020. STUDY ELIGIBILITY CRITERIA Systematic review inclusion: randomized controlled trials, prospective cohorts, and retrospective cohorts written in English of women ≥18 years old with recurrent urinary tract infection in which D-mannose was utilized as an outpatient prevention regimen. Systematic review exclusion: lab or animal-based research, study protocols only, and conference abstracts. Meta-analysis inclusion: stated D-mannose dose, follow-up time ≥6 months, a comparison arm to D-mannose, and data available from women ≥18 years of age. STUDY APPRAISAL AND SYNTHESIS METHODS Two independent reviewers made abstract, full text, and data extraction decisions. Study methodologic quality was assessed using the Cochrane Risk of Bias tool. Relative risks, confidence intervals, and heterogeneity were computed. RESULTS Searches identified 776 unique citations. Eight publications met eligibility: 2 using D-mannose only; 6 using D-mannose combined with another treatment. Seven studies were prospective: 2 randomized controlled trials, 1 randomized cross-over trial, and 4 prospective cohort studies. One retrospective cohort study was included. Three studies met meta-analysis eligibility (1 randomized controlled trial, 1 randomized cross-over trial, and 1 prospective cohort). Pooled relative risk of urinary tract infection recurrence comparing D-mannose to placebo was 0.23 (95% confidence interval, 0.14-0.37; heterogeneity=0%; D-mannose n=125, placebo n=123). Pooled relative risk of urinary tract infection recurrence comparing D-mannose to preventative antibiotics was 0.39 (95% confidence interval, 0.12-1.25; heterogeneity=88%; D-mannose n=163, antibiotics n=163). Adverse side effects were reported in 2 studies assessing D-mannose only (1 study (n=10) reported none; the other reported a low incidence (8/103 participants) of diarrhea). Two studies reported compliance, which was high. CONCLUSION D-mannose appears protective for recurrent urinary tract infection (vs placebo) with possibly similar effectiveness as antibiotics. Overall, D-mannose appears well tolerated with minimal side effects-only a small percentage experiencing diarrhea. Meta-analysis interpretation must consider the small number of studies with varied study design and quality and the overall small sample size.
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Affiliation(s)
- Stacy M Lenger
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO.
| | - Megan S Bradley
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Division of Urogynecology and Reconstructive Pelvic Surgery, University of Pittsburgh, Pittsburgh, PA
| | - Debbie A Thomas
- Becker Library, Washington University School of Medicine, St. Louis, MO
| | - Marnie H Bertolet
- Departments of Epidemiology, Biostatistics, and the Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, PA
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University School of Medicine, St. Louis, MO
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, MO
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Ke QS, Lee CL, Kuo HC. Recurrent urinary tract infection in women and overactive bladder - Is there a relationship? Tzu Chi Med J 2020; 33:13-21. [PMID: 33505873 PMCID: PMC7821830 DOI: 10.4103/tcmj.tcmj_38_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Overactive bladder (OAB) in women has similar symptomatology with other common urologic diseases such as recurrent urinary tract infection (UTI). Recent evidence showed that chronic low-grade bacterial bladder colonization might exacerbate OAB symptoms and could be the etiology of recurrent UTI. The high prevalence of lower urinary tract dysfunction is associated with OAB. Women with urgency urinary incontinence refractory to antimuscarinic therapy had more bacteria and a more diverse urinary microbiome. The bacterial reside in the superficial urothelial cells to form intracellular bacterial community and outbreak when the host innate immunity is low. Women with recurrent UTI are found to have highly prevalent voiding dysfunction and detrusor overactivity. These functional abnormalities will further damage the urothelial barrier integrity and create vulnerable to uropathogen invasion. The defective urinary microbiota is less common in women with recurrent UTI, suggesting that the normal flora in the urine might inhibit uropathogen growth and invasion. The defective urothelial barrier function, deficient basal proliferation, and deficient maturation might be owing to chronic suburothelial inflammation, resulting in activation of sensory nerves (causing OAB) and failure elimination of intracellular bacterial communities (causing recurrent UTI). Precision diagnosis and multidisciplinary treatment of the underlying pathophysiology of OAB and recurrent UTI is necessary.
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Affiliation(s)
- Qian-Sheng Ke
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Cheng-Ling Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
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Qin X, Coyle ME, Yang L, Liang J, Wang K, Guo X, Zhang AL, Mao W, Lu C, Xue CC, Liu X. Acupuncture for recurrent urinary tract infection in women: a systematic review and meta-analysis. BJOG 2020; 127:1459-1468. [PMID: 32406571 DOI: 10.1111/1471-0528.16315] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Increasing antibiotic resistance has motivated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (rUTI). OBJECTIVES To conduct a systematic review of the current state of evidence of acupuncture for uncomplicated rUTI in women. SEARCH STRATEGY Nine databases (PubMed, Embase, CENTRAL, CINAHL, AMED, CBM, CNKI, CQVIP, Wanfang) were searched from inception to February 2019. SELECTION CRITERIA Randomised controlled trials (RCTs) evaluating the effects of acupuncture and related therapies for prophylaxis or treatment of uncomplicated rUTI in women were included. DATA COLLECTION AND ANALYSIS Risk of bias was assessed, and the quality and strength of evidence evaluated using the GRADE framework. Results were reported as risk ratios (RR) for dichotomous outcomes or mean differences (MD) for continuous outcomes, with 95% confidence intervals (CI). MAIN RESULTS Five RCTs involving 341 participants were included. Methodological quality of studies and strength of the evidence were low to moderate. The chance of achieving a composite cure with acupuncture therapies was greater than that with antibiotics (three studies, 170 participants, RR 1.92, 95% CI 1.31-2.81, I2 = 38%). The risk of UTI recurrence was lower with acupuncture than with no treatment (two studies, 135 participants, RR 0.39, 95% CI 0.26-0.58, I2 = 0%) and sham acupuncture (one study, 53 participants, RR 0.45, 95% CI 0.22-0.92). CONCLUSIONS Acupuncture appeared to be beneficial for treatment and prophylaxis of rUTIs, noting the limitations of the current evidence. Given the growing challenge of antibiotic resistance, there is a need for high-quality RCTs of non-pharmacological interventions such as acupuncture. TWEETABLE ABSTRACT This review found that acupuncture may improve treatment and prevent recurrence of urinary tract infection in women.
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Affiliation(s)
- X Qin
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - M E Coyle
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - L Yang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - J Liang
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - K Wang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - X Guo
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - A L Zhang
- China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - W Mao
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - C Lu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - C C Xue
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China.,China-Australia International Research Centre for Chinese Medicine, School of Health and Biomedical Sciences, RMIT University, Melbourne, VIC, Australia
| | - X Liu
- The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangdong Provincial Academy of Chinese Medical Sciences and The Second Clinical College, Guangzhou University of Chinese Medicine, Guangzhou, China
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Harding C, Rantell A, Cardozo L, Jacobson SK, Anding R, Kirschner-Hermanns R, Greenwell T, Swamy S, Malde S, Abrams P. How can we improve investigation, prevention and treatment for recurrent urinary tract infections - ICI-RS 2018. Neurourol Urodyn 2020; 38 Suppl 5:S90-S97. [PMID: 31821632 DOI: 10.1002/nau.24021] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/13/2019] [Accepted: 03/04/2019] [Indexed: 01/27/2023]
Abstract
BACKGROUND Recurrent urinary tract infection (rUTI) is a chronic condition and has a significant impact on health-related quality of life. The commonly used definition for rUTI is greater than three episodes in a year or more than two in 6 months. Current diagnostic methods have been used worldwide for over five decades, despite well evidenced criticism. Enhanced culture techniques demonstrate that the microbiome of the bladder is far more complex than previously thought and begs a reappraisal of our current testing. Treatment of rUTI is based on a small number of antibiotic trials with some evidence showing a reduction in the number of positive cultures, but one must be cautious in interpreting the results and weigh against the risk of generation of antimicrobial resistance (AMR). AIM The International Consultation on Incontinence-Research Society think tank reviewed the literature with a view to improving investigation, prevention and treatment of rUTI. METHODS A multidisciplinary team of experts were invited to present evidence regarding the current diagnostic methods, recent advances related to bladder biome mapping and current treatment strategies, including antibiotic and nonantibiotic options. Current guidelines regarding antibiotic stewardship and concerns regarding AMR were discussed. DISCUSSION Outcome of the think tank discussions are summarised with a set of recommendations to inform future research. Particular consideration is given to bacterial survival in the bladder after treatment as well as defects in urothelial barrier function which may play a significant part in the failure to eradicate UTI.
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Affiliation(s)
- Chris Harding
- Department of Urology, Freeman Hospital, Newcastle-upon-Tyne, UK
| | - Angela Rantell
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Susan Kim Jacobson
- Infection Sciences, Severn Pathology, North Bristol NHS Trust, Bristol, UK
| | - Ralf Anding
- Department of Neuro-Urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V, Bonn, Germany
| | - Ruth Kirschner-Hermanns
- Department of Neuro-Urology/Urology, University Clinic, Friedrich Wilhelms University Bonn and Neurological Rehabilitation Center "Godeshöhe" e.V, Bonn, Germany
| | - Tamsin Greenwell
- Department of Urology, University College London Hospital, London, UK
| | - Sheela Swamy
- Division of Medicine, University College London, London, UK
| | - Sachin Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Paul Abrams
- Southmead Hospital, Bristol Urological Institute, Bristol, UK
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Recurrent bladder cystitis: who takes the role? World J Urol 2020; 38:2755-2760. [PMID: 32338305 DOI: 10.1007/s00345-020-03192-1] [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: 12/19/2019] [Accepted: 03/30/2020] [Indexed: 10/24/2022] Open
Abstract
PURPOSE In this review, we discuss how the approach should be throughout the symptomatic and diagnostic process of recurrent bladder cystitis. METHODS AND RESULTS The available literature regarding recurrent bladder cystitis in the PubMed database has been reviewed. While urinary tract infections (UTIs) are amongst the most commonly seen diseases in society, the probability of having a UTI in women within a year is 15%. Within a lifetime, it is above 50%. In addition to the related comorbidities and decreased quality of life, the resulting cost constitutes a serious burden on national economies. Recurrent UTI (rUTI) refers to a group of patients who have suffered from a UTI at least three times in the last 12 months or at least two times during the previous 6 months and have diminished quality of life. During this chronic and bothersome process, it is also complicated as to who is going to make the diagnosis of patients and by whom treatment or follow-up will be provided. CONCLUSION Although there is no clear answer to this issue in the literature, the urologist might be the moderator of this chronic process as the physician who most frequently faces this condition in daily practice, is most aware of the uroanatomy as well as the pathophysiology and performs relevant operations in cases of necessity. At this point, rather than limiting the evaluation and treatment to a single specialty, it is crucial to solve the problem by using a multidisciplinary approach.
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Zhu M, Wang S, Zhu Y, Wang Z, Zhao M, Chen D, Zhou C. Behavioral and dietary risk factors of recurrent urinary tract infection in Chinese postmenopausal women: a case-control study. J Int Med Res 2020; 48:300060519889448. [PMID: 31840544 PMCID: PMC7783248 DOI: 10.1177/0300060519889448] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 10/29/2019] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE The present study aimed to examine the behavioral and dietary risk factors of recurrent urinary tract infection (RUTI) in postmenopausal patients in China. METHODS We performed a population-based case-control study with 193 postmenopausal women with RUTI and 193 age-matched healthy female controls with no history of RUTI. The study was conducted between January 2016 and June 2018 in Changzhou, China. Data were collected using an interviewer-based questionnaire, including information on demographics, lifestyle behavior, and habitual diet. Conditional logistic regression analysis was conducted to examine the risk factors associated with RUTI. RESULTS Wiping from back to front after toilet use, sedentary behavior >6 hours/day, delayed voiding, and chronic constipation were associated with an increased risk of RUTI. Drinking more than three cups of green tea per month showed an inverse association with RUTI. However, there was no evidence of dose dependency for overall consumption. Additionally, the three-cup association involved a small proportion of cases and may reflect statistical artifact. CONCLUSIONS Wiping from back to front after toilet use, sedentary behavior, delayed voiding, and chronic constipation are associated with an increased risk of RUTI in postmenopausal women.
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Affiliation(s)
- Meifeng Zhu
- Department of Nephrology, Changzhou Affiliated Hospital of
Nanjing University of Chinese Medicine, Changzhou, Jiangsu, China
- Department of Febrile Disease, Basic Medicine College, Nanjing
University of Chinese Medicine, Nanjing, Jiangsu, China
| | - Shenju Wang
- Department of Nephrology, Changzhou Affiliated Hospital of
Nanjing University of Chinese Medicine, Changzhou, Jiangsu, China
| | - Ying Zhu
- Department of Nephrology, Changshu Hospital Affiliated to
Nanjing University of Chinese Medicine, Changshu, Jiangsu, China
| | - Zhixia Wang
- Department of Obstetrics and Gynecology, The Affiliated BenQ
Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Min Zhao
- Department of Nephrology, Changzhou Affiliated Hospital of
Nanjing University of Chinese Medicine, Changzhou, Jiangsu, China
| | - Dai Chen
- Department of Nephrology, Changzhou Affiliated Hospital of
Nanjing University of Chinese Medicine, Changzhou, Jiangsu, China
| | - Chunxiang Zhou
- Department of Febrile Disease, Basic Medicine College, Nanjing
University of Chinese Medicine, Nanjing, Jiangsu, China
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Honsbeek M, Tjon-A-Tsien A, Stobberingh E, de Steenwinkel J, Melles DC, Lous J, Richardus JH, Voeten H. Low antimicrobial resistance in general practice patients in Rotterdam, the city with the largest proportion of immigrants in the Netherlands. Eur J Clin Microbiol Infect Dis 2020; 39:929-935. [PMID: 31907762 PMCID: PMC7182613 DOI: 10.1007/s10096-019-03804-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/20/2019] [Indexed: 01/09/2023]
Abstract
Antimicrobial resistance (AMR) is an increasing problem. The prevalence of antimicrobial resistance in general practice patients is expected to be relatively high in Rotterdam, the Dutch city with the largest proportion non-Western immigrants. The aim of this study was to assess the prevalence of antibiotic-resistant uropathogens (Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis) in general practices in Rotterdam, and to find a possible association between the prevalence of antibiotic-resistant E. coli and age, gender, and socioeconomic status (SES). A retrospective analysis was performed of urine samples from general practice patients in 2016. The prevalence of AMR in uropathogens was compared with national resistance data, as was the prevalence of highly and multidrug resistant and extended spectrum β-lactamase (ESBL) producing E. coli and K. pneumoniae. Univariate logistic regression was used to study associations between antibiotic-resistant E. coli and age, gender, and SES area score. No clinically relevant differences were observed in the prevalence of antibiotic-resistant uropathogens in Rotterdam compared with the national prevalence. For E. coli and K. pneumoniae, the prevalence was 3.6% for ESBL production (both pathogens together), while the prevalence ranged between 4.2%-5.0% for high resistance and between 1.2%-3.3% for multidrug resistance. Ciprofloxacin-resistant E. coli was significantly associated with higher age. Although Rotterdam has a high percentage of non-western immigrants and a low SES, AMR is low among general practice patients. This indicates that adherence to national guidelines in general practice enables maintenance of low AMR, even in high-risk populations.
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Affiliation(s)
- Maaike Honsbeek
- Municipal Public Health Service Rotterdam-Rijnmond, Schiedamsedijk 95, 3011 EN, Rotterdam, The Netherlands.,Department of Health Care, University of Applied Sciences Leiden, Leiden, The Netherlands
| | - Aimée Tjon-A-Tsien
- Municipal Public Health Service Rotterdam-Rijnmond, Schiedamsedijk 95, 3011 EN, Rotterdam, The Netherlands
| | - Ellen Stobberingh
- Department of Medical Microbiology, CAPHRI, Maastricht University, Maastricht, The Netherlands
| | - Jurriaan de Steenwinkel
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Damian C Melles
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Medical Microbiology, Meander Medical Centre, Amersfoort, the Netherlands
| | - Jan Lous
- Medical Laboratory for Primary Care, Star-SHL, Rotterdam, The Netherlands
| | - Jan Hendrik Richardus
- Municipal Public Health Service Rotterdam-Rijnmond, Schiedamsedijk 95, 3011 EN, Rotterdam, The Netherlands.,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hélène Voeten
- Municipal Public Health Service Rotterdam-Rijnmond, Schiedamsedijk 95, 3011 EN, Rotterdam, The Netherlands. .,Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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Sun J, Deering RW, Peng Z, Najia L, Khoo C, Cohen PS, Seeram NP, Rowley DC. Pectic Oligosaccharides from Cranberry Prevent Quiescence and Persistence in the Uropathogenic Escherichia coli CFT073. Sci Rep 2019; 9:19590. [PMID: 31862919 PMCID: PMC6925298 DOI: 10.1038/s41598-019-56005-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 12/04/2019] [Indexed: 11/26/2022] Open
Abstract
Urinary tract infections (UTIs) caused by Escherichia coli create a large burden on healthcare and frequently lead to recurrent infections. Part of the success of E. coli as an uropathogenic bacterium can be attributed to its ability to form quiescent intracellular reservoirs in bladder cells and its persistence after antibiotic treatment. Cranberry juice and related products have been used for the prevention of UTIs with varying degrees of success. In this study, a group of cranberry pectic oligosaccharides (cPOS) were found to both inhibit quiescence and reduce the population of persister cells formed by the uropathogenic strain, CFT073. This is the first report detailing constituents of cranberry with the ability to modulate these important physiological aspects of uropathogenic E. coli. Further studies investigating cranberry should be keen to include oligosaccharides as part of the ‘active’ cocktail of chemical compounds.
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Affiliation(s)
- Jiadong Sun
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, 02881, USA.,Laboratory of Bioorganic Chemistry, National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, 20814, USA
| | - Robert W Deering
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, 02881, USA
| | - Zhiyuan Peng
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, 02881, USA
| | - Laila Najia
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, 02881, USA
| | - Christina Khoo
- Ocean Spray Cranberries, Inc., One Ocean Spray Drive, Lakeville-Middleboro, MA, 02349, USA
| | - Paul S Cohen
- Department of Cell and Molecular Biology, University of Rhode Island, Kingston, RI, 02881, USA
| | - Navindra P Seeram
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, 02881, USA
| | - David C Rowley
- Department of Biomedical and Pharmaceutical Sciences, College of Pharmacy, University of Rhode Island, Kingston, RI, 02881, USA.
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Tseng CS, Chang SJ, Meng E, Chang HC, Lee YJ. The efficacy of pentosan polysulfate monotherapy for preventing recurrent urinary tract infections in women: A multicenter open-label randomized controlled trial. J Formos Med Assoc 2019; 119:1314-1319. [PMID: 31813658 DOI: 10.1016/j.jfma.2019.11.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 09/23/2019] [Accepted: 11/12/2019] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND/PURPOSE Pentosan polysulfate sodium (PPS), a semi-synthetic polysaccharide that adheres to bladder mucosa, is effective in treating interstitial cystitis. We evaluated the clinical benefit of PPS for the prevention of recurrent urinary tract infection (UTI) in women. METHODS We conducted a multicenter, open-label, prospective, phase II, randomized controlled trial enrolling women with recurrent UTI ≥ 2 times in the past 6 months or ≥ 3 times in the past 12 months. Patients received oral PPS monotherapy for 16 weeks in treatment group. All patients were followed every 28 days until UTI recurrence or up to 112 days. The primary endpoint was the UTI recurrence-free survival. Adverse events were recorded as secondary endpoint. RESULTS A total of 26 women were eligible for analysis. In the PPS group, none (0%) of the 12 patients had UTI recurrence during the study period. However, 9 (64%) of 14 patients had UTI recurrence in the control group. The UTI recurrence-free survival was significantly higher in the PPS group than in the control group (log-rank test p = 0.0004). One adverse event which led to discontinuation of the trial regimen was regarded as irrelevance of PPS treatment. The limitation was the small number of cases. CONCLUSION Among women with recurrent UTI, 16-week PPS monotherapy significantly reduced UTI recurrence when compared with the control group.
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Affiliation(s)
- Chi-Shin Tseng
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Shang-Jen Chang
- Department of Urology, Taipei Tzu Chi Hospital, New Taipei, Taiwan
| | - En Meng
- Division of Urology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hong-Chiang Chang
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan
| | - Yuan-Ju Lee
- Department of Urology, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan.
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Scarneciu I, Bungau S, Lupu AM, Scarneciu CC, Bratu OG, Martha O, Tit DM, Aleya L, Lupu S. Efficacy of instillation treatment with hyaluronic acid in relieving symptoms in patients with BPS/IC and uncomplicated recurrent urinary tract infections - Long-term results of a multicenter study. Eur J Pharm Sci 2019; 139:105067. [DOI: 10.1016/j.ejps.2019.105067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/05/2019] [Accepted: 09/05/2019] [Indexed: 12/27/2022]
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Flower A, Harman K, Willcox M, Stuart B, Moore M. The RUTI trial: A feasibility study exploring Chinese herbal medicine for the treatment of recurrent urinary tract infections. JOURNAL OF ETHNOPHARMACOLOGY 2019; 243:111935. [PMID: 31082512 DOI: 10.1016/j.jep.2019.111935] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 04/18/2019] [Accepted: 05/03/2019] [Indexed: 06/09/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Chinese herbal medicine (CHM) is a widely used traditional intervention that may have a role to play in addressing the global problem of antimicrobial resistance in conditions such as recurrent urinary tract infections (RUTIs). AIM OF THE STUDY To evaluate the feasibility of administering standardised and individualised formulations of CHM for RUTIs as a Clinical Trial of an Investigational Medicinal Product (CTIMP) within primary care of the UKs National Health Service (NHS). MATERIALS AND METHODS Regulatory approval was applied for a placebo controlled, double blinded randomised controlled feasibility trial comparing a) standardised CHM vs placebo administered via General practitioners, and b) individualised CHM vs placebo administered by an experienced CHM practitioner. Primary feasibility outcomes included: gaining regulatory approval, recruitment, randomisation, retention, safety and the relevance of outcomes measures. RESULTS Regulatory approval for testing CHM as a CTIMP was successfully obtained. Recruitment to the trial was slow and non-NHS self help networks were required to find participants for the individualised arm (n = 31). Retention and data collection in the standardised arm (n-30) were problematic, but these were acceptable in the individualised arm. The use of a daily symptom diary was not a suitable outcome measure for women with continuous infection. Other measures showed promising preliminary data for the individualised arm on improvement in symptoms, and reduction in antibiotic use during and after the trial. CONCLUSION CHM can fulfil the demanding requirements of a CTIMP study but it may not be feasible at this point in time to recruit and treat via NHS primary care. However acceptable rates of recruitment and retention via self-help groups and promising preliminary results in the individualised arm suggest it would be worth testing this approach in a full trial.
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Affiliation(s)
- Andrew Flower
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
| | - Kim Harman
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
| | - Merlin Willcox
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
| | - Beth Stuart
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
| | - Michael Moore
- Primary Care & Population Science, Faculty of Medicine, University of Southampton, UK.
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Tambunan MP, Rahardjo HE. Cranberries for women with recurrent urinary tract infection: a meta-analysis. MEDICAL JOURNAL OF INDONESIA 2019. [DOI: 10.13181/mji.v28i3.3299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Cranberries are the most widely used nonantibiotic prophylaxis for recurrent urinary tract infection (rUTI) in women; however, their efficacy still remains uncertain. Hence, this meta-analysis was aimed to assess the effectiveness, safety, and adherence of cranberry as a prophylactic drug for treating rUTI.
METHODS Literature search was conducted using PubMed, EBSCO, Science Direct, Scopus, Cochrane, and Google Scholar. Studies were screened for duplication, inclusion and exclusion criteria, and then reviewed by two authors independently. This included all randomized controlled trials of cranberry derivatives versus placebo and antibiotic prophylaxis. Cochrane risk-of-bias assessment tools were used to evaluate the quality of the study. Quantitative analysis was performed using the Review Manager 5.0 software.
RESULTS Nine studies were included. Among 1,542 participants, cranberry consumption reduced incidence of rUTI in women compared with placebo (p = 0.02). The subgroup analysis revealed that only cranberry capsules were superior to placebo (relative risk [RR] = 0.67, 95% confidence interval [CI] = 0.45–0.98), but not for cranberry juice (RR = 0.85, 95% CI: 0.7–1.04). Antibiotics had better outcome than cranberry for rUTI (RR = 0.83, 95% CI = 0.70–0.98). Most of the participants experienced minor adverse events such as rash and gastrointestinal symptoms. There was also a good adherence rate, ranging from 90.3–99% monthly dose.
CONCLUSIONS Cranberry, especially cranberry capsule consumption, had a significant effect in reducing the incidence of rUTI compared with placebo, with good adherence rates, and minor adverse events. In contrast, although antibiotic use had a greater efficacy, it was associated with a higher risk of severe adverse events.
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Koradia P, Kapadia S, Trivedi Y, Chanchu G, Harper A. Probiotic and cranberry supplementation for preventing recurrent uncomplicated urinary tract infections in premenopausal women: a controlled pilot study. Expert Rev Anti Infect Ther 2019; 17:733-740. [PMID: 31516055 DOI: 10.1080/14787210.2019.1664287] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: To assess efficacy and safety of Bio-Kult Pro-Cyan (BKPro-Cyan), a product containing two strains of Lactobacilli plus cranberry extract, for preventing recurrent UTIs in pre-menopausal adult women.Methods: This was a randomized, double-blind, placebo-controlled pilot study. Subjects received BKPro-Cyan or placebo twice-daily for 26 weeks. The primary endpoint was the proportion of subjects with recurrent UTI at the end of the study.Results: 115 subjects were screened; 90 were enrolled; 81 completed the study. After 26 weeks, a significantly lower number of women experienced recurrent UTIs with BKPro-Cyan compared to placebo (9.1 vs 33.3%; P = 0.0053). BKPro-Cyan produced statistically significant improvements compared to placebo for multiple secondary endpoints, including: greater number of subjects who experienced no UTIs (90 vs 67%; P < 0.05); longer time to first UTI (174 vs 90 days; P = 0.001); shorter duration of active UTI (5 vs 12 days; P = 0.009); Fewer subjects requiring antibiotics (3 vs 11; P < 0.05); and shorter median duration of antibiotic treatment (4 vs 7 days; P = 0.09).Conclusions: BKPro-Cyan was safe and effective for preventing recurrent UTI in pre-menopausal adult women. These findings support the need for further well-designed trials to clarify the benefits that may be achieved.
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Affiliation(s)
- Parshottam Koradia
- Dept of Clinical Research, BAPS Pramukh Swami Hospital , Ahmedabad , India
| | - Shital Kapadia
- Dept of Obstetrics and Gynecology, B.J. Medical College and Civil Hospital , Ahmedabad , India
| | - Yamini Trivedi
- Department of Obstetrics & Gynaecology, AMCMET L.G. General Hospital , Ahmedabad , India
| | - Gajendrasinh Chanchu
- Department of Data operations, QED Clinical Services Ind Pvt Limited , Ahmedabad , Gujarat , India
| | - Ashton Harper
- Medical Affairs Department, ADM Protexin Ltd , Somerset , UK
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