Linguistic and clinical validation of the acute cystitis symptom score in German-speaking Swiss women with acute cystitis

The incidence, clinical features and outcome of urinary tract infections in geriatric patients: A prospective longitudinal study

Objectives

This study compares the incidence, clinical features, microbial profiles, and outcomes of urinary tract infections (UTIs) in patients aged 65 years and older versus those younger than 65 years.

Methods

A longitudinal cohort of 1,123 patients was divided into Group A (≥65 years, n = 560) and Group B (<65 years, n = 563) and followed for 2 years. The study analyzed UTI incidence, clinical features, microbial profiles, and outcomes, including recurrence and antibiotic resistance.

Results

Over 2 years, Group A had a significantly higher UTI incidence (38.0%) compared with Group B (12.8%) (P <0.0001). Complete recovery was less common in Group A (44.6%) than in Group B (70.83%), whereas recurrent UTIs and antibiotic resistance were more frequent in Group A (43.5% vs 22.2%, P <0.0001 and 11.7% vs 2.78%, P = 0.0017, respectively). Escherichia coli was the most prevalent pathogen in both groups, with Klebsiella and Pseudomonas species more common in recurrent UTIs, particularly in older patients. Risk factors for recurrent UTIs included advanced age, female sex, diabetes, immunosuppression, and renal stones.

Conclusions

These findings highlight the need for age-specific UTI prevention and management strategies that account for microbial resistance patterns and higher recurrence rates in older patients, addressing clinical and microbial challenges.

Patient-reported outcome measures for uncomplicated urinary tract infections in women: a systematic review

PURPOSE

To conduct a systematic review of the quality of existing patient-reported outcome measures (PROMs) for use in women with uncomplicated urinary tract infections (UTIs) applying the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for their use in future research.

METHODS

A systematic literature search was performed in PubMed and Web of Science. Studies reporting on the development and/or validation of any PROMs for uncomplicated UTIs in women were considered eligible. We evaluated the methodological quality of each included study using the COSMIN Risk of Bias Checklist, and further applied predefined criteria for good measurement properties. Finally, we graded the evidence and derived recommendations for the use of the included PROMs.

RESULTS

Data from 23 studies reporting on six PROMs were included. From those, the Acute Cystitis Symptom Score (ACSS) and the Urinary Tract Infection-Symptom and Impairment Questionnaire (UTI-SIQ-8) can be recommended for further use. Both instruments showed sufficient content validity. We further found high-quality evidence for sufficient internal consistency of the UTI-SIQ-8, while this criterion was not assessed for the ACSS due to a formative measurement model. All other PROMs have the potential to be recommended for use, but require further validation.

CONCLUSION

The ACSS and the UTI-SIQ-8 have the potential to be recommended for use in women with uncomplicated UTIs in future clinical trials. For all included PROMs, further validation studies are indicated.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO.

Clinical Validation of the Greek Version of the Acute Cystitis Symptom Score (ACSS)-Part II

The Acute Cystitis Symptom Score (ACSS) is a patient self-reporting questionnaire for the clinical diagnosis and patient-reported outcome (PRO) in women with acute uncomplicated cystitis (AC). The aim of the current study (part II) is the clinical validation of the Greek ACSS questionnaire. After linguistic validation according to internationally accepted guidelines and cognitive assessment (part I), the clinical validation was performed by using the Greek ACSS study version in 92 evaluable female participants including 53 patients with symptoms suspicious of AC and 39 controls. The clinical outcome using the ACSS questionnaire at different points in time after the start of treatment was demonstrated as well. The age (mean ± SD) of the 53 patients (44.7 ± 17.0 years) and 39 controls (49.3 ± 15.9 years) and their additional conditions at baseline visits, such as menstruation, premenstrual syndrome, pregnancy, menopause, diabetes mellitus, were comparable. There was, however, a significant difference (p < 0.001) between patients and controls at baseline visit regarding sum score of the ACSS domains, such as typical symptoms and quality of life. The clinical outcome of up to 7 days showed a fast reduction of the symptom scores and improvement of quality of life. The optimal thresholds for the patient-reported outcome of successful therapy could be established. The linguistically and clinically validated Greek ACSS questionnaire can now be used for clinical or epidemiological studies and also for patients' self-diagnosis of AC and as a PRO measure tool.