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Evaluation of hymenal adhesions resection in the treatment of recurrent post-coital cystitis. Prog Urol 2022; 32:1490-1497. [DOI: 10.1016/j.purol.2022.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/25/2022] [Accepted: 09/09/2022] [Indexed: 11/27/2022]
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Asadi A, Lohrasbi V, Abdi M, Mirkalantari S, Esghaei M, Kashanian M, Oshaghi M, Talebi M. The probiotic properties and potential of vaginal Lactobacilli spp. isolated from healthy women against some vaginal pathogens. Lett Appl Microbiol 2022; 74:752-764. [DOI: 10.1111/lam.13660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/26/2022]
Affiliation(s)
- Arezoo Asadi
- Department of Microbiology School of Medicine Iran University of Medical Sciences Tehran Iran
| | - Vahid Lohrasbi
- Department of Microbiology School of Medicine Iran University of Medical Sciences Tehran Iran
| | - Milad Abdi
- Department of Microbiology School of Medicine Iran University of Medical Sciences Tehran Iran
| | - Shiva Mirkalantari
- Department of Microbiology School of Medicine Iran University of Medical Sciences Tehran Iran
| | - Maryam Esghaei
- Department of Virology School of Medicine Iran University of Medical Sciences Tehran Iran
| | - Maryam Kashanian
- Department of Obstetrics & Gynecology Akbarabadi Teaching Hospital, Iran University of Medical Sciences Tehran Iran
| | - Mozhgan Oshaghi
- Department of Lab Sciences Faculty of Allied Medicine Iran University of Medical Sciences Tehran Iran
| | - Malihe Talebi
- Department of Microbiology School of Medicine Iran University of Medical Sciences Tehran Iran
- Microbial Biotechnology Research Centre Iran University of Medical Sciences Shahid Hemmat Highway Tehran Iran
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Moussa M, Abou Chakra M, Dellis A, Moussa Y, Papatsoris A. Pharmacotherapeutic advances for recurrent urinary tract infections in women. Expert Opin Pharmacother 2020; 21:2011-2026. [PMID: 32717156 DOI: 10.1080/14656566.2020.1795128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Treatment of recurrent Urinary tract infections (UTIs) has become challenging because of the dramatic increase in the rates of recurrent infection andof multidrug-resistant (MDR) infections. AREAS COVERED The authors review recurrent UTIs(rUTI) management in women. EXPERT OPINION Continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment has all been demonstrated to be effective in managing rUTIs in women. Intravaginal estrogen therapy , shows potential toward preventing rUTI. Oral vaccine Uro-Vaxom seems to reduce the number of UTIs. There is evidence that other therapies (e.g. cranberry, Methenamine hippurate, oral D-mannose) may decrease the number of symptomatic UTIs. The treatment of CRE-UTIs is focused on a colistin backbone. Carbapenems are considered first-line agents for UTIs caused by ESBL, but their use is associated with increased MDR. The usage of non-carbapenem for the treatment of ESBL UTIs is necessary. Cefepime, Piperacillin-Tazobactam, Ceftolozane-Tazobactam, and Ceftazidime-Avibactam are justified options. Oral therapy with Pivmecillinam, Fosfomycin, and Nitrofurantoin can be used against uncomplicated UTIs due to ESBL infection.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
| | - Mohamed Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
| | - Athanasios Dellis
- Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens , Athens, Greece.,2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens , Athens, Greece
| | - Yasmin Moussa
- Clinic of Dermatology, Dr Brinkmann, Schult & Samini-Fard , Gladbeck, Germany
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens , Athens, Greece
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Sihra N, Malde S, Greenwell T, Pakzad M, Kujawa M, Sinclair A. Management of recurrent urinary tract infections in women. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820939456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Urinary tract infections are highly prevalent and result in significant patient morbidity as well as large financial costs to healthcare systems. Recurrent urinary tract infections can be challenging for many healthcare professionals, and the repeated use of antibiotics in this patient cohort inevitably contributes to the growing issue of antimicrobial resistance and superbugs. It is essential that these patients are appropriately diagnosed and managed to ensure rapid resolution of symptoms and the prevention of chronic or recurrent urinary tract infections. There are several antibiotic-based options available for the prophylaxis of recurrent urinary tract infections however, in the current era of rising antimicrobial resistance, an awareness of antibiotic stewardship and the use of non-antibiotic alternatives for the treatment and prevention of urinary tract infections is of critical importance. We present a case-based multidisciplinary team discussion to highlight how women with recurrent urinary tract infections should be managed, encouraging the use of non-antibiotic prophylactic measures when suitable. Level of evidence: Level 5
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Sattigeri JA, Garg M, Bhateja P, Soni A, Rauf ARA, Gupta M, Deshmukh MS, Jain T, Alekar N, Barman TK, Jha P, Chaira T, Bambal RB, Upadhyay DJ, Nishi T. Synthesis and evaluation of thiomannosides, potent and orally active FimH inhibitors. Bioorg Med Chem Lett 2018; 28:2993-2997. [PMID: 30017316 DOI: 10.1016/j.bmcl.2018.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Revised: 06/05/2018] [Accepted: 06/11/2018] [Indexed: 10/14/2022]
Abstract
FimH is a type I fimbrial lectin located at the tip of type-1 pili of Gram-negative uropathogenic Escherichia coli (UPEC) guiding its ability to adhere and infect urothelial cells. Accordingly, blocking FimH with small molecule inhibitor is considered as a promising new therapeutic alternative to treat urinary tract infections caused by UPEC. Herein, we report that compounds having the S-glycosidic bond (thiomannosides) had improved metabolic stability and plasma exposures when dosed orally. Especially compound 5h showed the potential to inhibit biofilm formation and also to disrupt the preformed biofilm. And compound 5h showed prophylactic effect in UTI model in mice.
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Affiliation(s)
- Jitendra A Sattigeri
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India.
| | - Malvika Garg
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Pragya Bhateja
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Ajay Soni
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Abdul Rehman Abdul Rauf
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Mahendrakumar Gupta
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Mahesh S Deshmukh
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Tarun Jain
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Nidhi Alekar
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Tarani Kanta Barman
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Paras Jha
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Tridib Chaira
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Ramesh B Bambal
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Dilip J Upadhyay
- Daiichi Sankyo India Pharma Pvt Ltd., Village Sarhaul, Sector 18, Udyog Vihar Industrial Area, Gurugram 122015, Haryana, India
| | - Takahide Nishi
- Daiichi Sankyo RD Novare Co., Ltd., 1-16-13, Kitakasai, Edogawa-ku, Tokyo 134-8630, Japan.
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7
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Guzmán ML, Romañuk CB, Sanchez MF, Luciani Giacobbe LC, Alarcón-Ramirez LP, Battistini FD, Alovero FL, Jimenez-Kairuz AF, Manzo RH, Olivera ME. Urinary excretion of ciprofloxacin after administration of extended release tablets in healthy volunteers. Swellable drug-polyelectrolyte matrix versus bilayer tablets. Drug Deliv Transl Res 2017; 8:123-131. [DOI: 10.1007/s13346-017-0442-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
UTI may involve the lower or upper urinary tract and may be uncomplicated or complicated. The emphasis of this chapter is uncomplicated UTI. The diagnosis of uncomplicated cystitis (bladder infection) and pyelonephritis (kidney infection) is usually easily made based on the clinical presentation, whereas the diagnosis in patients with complicated UTI is often more complex. Thus uncomplicated cystitis is usually manifested by dysuria, frequency and/or urgency without fever, and pyelonephritis is usually manifested by fever and back pain/costovertebral angle tenderness. However, pyuria is usually present with UTI, regardless of location, and its absence suggests that another condition may be causing the patient's symptoms. Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens, although antimicrobial resistance continues to increase and can complicate treatment choices in certain areas. Likewise, antimicrobial resistance has complicated our management of uncomplicated pyelonephritis since resistance of uropathogens to the fluoroquinolone class, the mainstay of oral treatment for pyelonephritis, is increasing worldwide, and some of the other agents used for cystitis are not recommended for pyelonephritis due to low tissue levels. The goal of prevention of recurrent cystitis is to minimize the use of antimicrobials and there are several research efforts in progress to develop effective and safe antimicrobial-sparing preventive approaches for this common condition.
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Jhang JF, Kuo HC. Recent advances in recurrent urinary tract infection from pathogenesis and biomarkers to prevention. Tzu Chi Med J 2017; 29:131-137. [PMID: 28974905 PMCID: PMC5615991 DOI: 10.4103/tcmj.tcmj_53_17] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Recurrent urinary tract infection (UTI) might be one of the most common problems in urological clinics. Recent research has revealed novel evidence about recurrent UTI and it should be considered a different disease from the first infection. The pathogenesis of recurrent UTI might include two mechanisms, bacterial factors and deficiencies in host defense. Bacterial survival in the urinary bladder after antibiotic treatment and progression to form intracellular bacterial communities might be the most important bacterial factors. In host defense deficiency, a defect in pathogen recognition and urothelial barrier function impairment play the most important roles. Immunodeficiency and urogenital tract anatomical abnormalities have been considered the essential risk factors for recurrent UTI. In healthy women, voiding dysfunction and behavioral factors also increase the risk of recurrent UTI. Sexual intercourse and estrogen deficiency in postmenopausal women might have the strongest association with recurrent UTI. Traditional lifestyle factors such as fluid intake and diet are not considered independent risk factors now. Serum and urine biomarkers to predict recurrent UTI from the first infection have also attracted a wide attention recently. Current clinical evidence suggests that serum macrophage colony-stimulating factor and urinary nerve growth factor have potential predictive value for recurrent UTI. Clinical trials have proven the efficacy of the oral immunoactive agent OM-89 for the prevention of UTI. Vaccines for recurrent UTI are recommended by the latest guidelines and are available on the market.
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Affiliation(s)
- Jia-Fong Jhang
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Buddhist Tzu Chi General Hospital and Tzu Chi University, Hualien, Taiwan
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Rambaran KA, Seifert CF. Unrecognized Interstitial Lung Disease as a Result of Chronic Nitrofurantoin Use. DRUG SAFETY - CASE REPORTS 2016; 3:13. [PMID: 27778245 PMCID: PMC5078134 DOI: 10.1007/s40800-016-0037-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Drug-induced interstitial lung disease is a rare condition attributed to several medications, including antimicrobial agents such as amphotericin B, anti-inflammatory agents such as methotrexate, biologic agents such as bevacizumab, and cardiovascular agents and chemotherapeutic agents. We describe the case of a 73-year-old female who developed interstitial lung disease following chronic use of nitrofurantoin for a urinary tract infection (UTI). The patient was taking nitrofurantoin 100 mg capsules twice daily for approximately 3 years. She presented to the hospital with complaints of a persistent dry cough that started 2 years previously. Her chest radiograph revealed bilateral reticular opacities and some atelectasis. Computed tomography of the chest demonstrated development of subpleural reticular opacities with minimal honeycombing. The patient had a severe restrictive defect on her pulmonary function tests, with a significant reduction in her carbon monoxide diffusion capacity. Multiple infectious disease and autoimmune tests were negative. Utilizing the algorithm of Naranjo (score of 9), it was determined that chronic use of nitrofurantoin was the definite cause of the patient’s interstitial lung disease. Nitrofurantoin was discontinued and she was treated with oxygen and started on an oral steroid, both of which were continued permanently once discharged. Upon discharge, the patient was maintained on 5 L of oxygen at rest and 10 L of oxygen when ambulating. Unfortunately, her lung disease ultimately resulted in her demise several months after her diagnosis. This case report illustrates the importance of rapid recognition of drug-induced lung injuries and discontinuation of the offending agent.
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Affiliation(s)
- Kerry Anne Rambaran
- School of Pharmacy, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8162, Lubbock, TX, 79430-8162, USA
| | - Charles F Seifert
- School of Pharmacy, Texas Tech University Health Sciences Center, 3601 4th Street, STOP 8162, Lubbock, TX, 79430-8162, USA.
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Taha Neto KA, Nogueira Castilho L, Reis LO. Oral vaccine (OM-89) in the recurrent urinary tract infection prophylaxis: a realistic systematic review with meta-analysis. Actas Urol Esp 2016; 40:203-8. [PMID: 26601727 DOI: 10.1016/j.acuro.2015.04.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Revised: 04/17/2015] [Accepted: 04/17/2015] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To evaluate the efficacy of Escherichia Coli extract (OM-89) in the prophylaxis of recurrent uncomplicated urinary tract infection (UTI) through a contemporary systematic review and meta-analysis. METHODS Inclusion criteria were double-blind randomized trials using orally administrated OM-89, 6mg daily, during three months with a minimum of three months of monitoring. Outcomes were the frequency of bacteriuria in 3 and 6 months, dysuria in 6 months and UTI in 6 months. DATABASES PubMed, MEDLINE, Cochrane Collaboration and their key references. After analysis by three independent reviewers, 15 double-blind randomized trials were identified, 10 papers excluded due to methods flaws and 5 used for data analysis due to double blinding and reporting drop-outs. RESULTS Among 5 selected studies the date of publication ranged from 1985 to 2005, totalizing 396 patients in the OM-89 group and 392 in the control group. Overall, there were 61 dropouts in the control group and 76 in the OM-89 group. As a major limitation there was no appropriate description of their methodologies and none of the studies described conflict of interest or commitment to the pharmaceutical industry. All studies were multi-centric, except for two, which showed no clarity on allocation concealment. All studies show benefit in favor of vaccine. CONCLUSIONS Current literature on prospective randomized controlled trials evaluating the use of oral OM-89 vaccine in the recurrent UTI prophylaxis is of low quality, limited to the first six months only and with variable definition of bacteriuria and UTI. Although all studies show benefit in favor of vaccine, no robust trial was identified, resulting in a high heterogeneity in the data analyzed. Also, publication bias could not be excluded and future higher quality studies are warranted adding intermediate (>12 months) and long-term follow-up.
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Affiliation(s)
- K A Taha Neto
- Faculty of Medicine, Center of Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, São Paulo, Brasil
| | | | - L O Reis
- Faculty of Medicine, Center of Life Sciences, Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, São Paulo, Brasil.
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Lower Levels of Urinary Nerve Growth Factor Might Predict Recurrent Urinary Tract Infections in Women. Int Neurourol J 2016; 20:33-9. [PMID: 27032555 PMCID: PMC4819159 DOI: 10.5213/inj.1630454.227] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 12/04/2015] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To investigate the changes in urinary nerve growth factor (uNGF) levels after acute urinary tract infection (UTI) and to assess the role of uNGF in predicting UTI recurrence in women. METHODS Women with uncomplicated, symptomatic UTIs were enrolled. Cephalexin 500 mg (every 6 hours) was administered for 7-14 days to treat acute UTIs. Subsequently, the patients were randomized to receive either sulfamethoxazole/trimethoprim 800 mg/160 mg daily at bedtime, or celecoxib 200 mg daily for 3 months and were monitored for up to 12 months. NGF levels in the urine were determined at baseline, 1, 4, and 12 weeks after the initiation of prophylactic therapy, and were compared between women with first-time UTIs and recurrent UTIs, sulfamethoxazole/trimethoprim and celecoxib-treated women, and no UTI recurrence and UTI recurrence that occurred during the follow-up period. Twenty women free of UTIs served as controls. RESULTS A total of 139 women with UTI and 20 controls were enrolled in the study, which included 50 women with a first-time UTI and 89 women with recurrent UTIs. Thirty-seven women completed the study. Women with recurrent UTIs (n=23) had a trend of lower uNGF levels than women with first-time UTIs (n=14). During follow-up, 9 women had UTI recurrence. The serial uNGF levels in women with UTI recurrence were significantly lower than those in women who did not have UTI recurrence during the follow-up period. CONCLUSIONS The lower levels of uNGF in women with recurrent UTI and the incidence of UTI recurrence during follow-up suggest that lower uNGF might reflect the defective innate immunity in women with recurrent UTI.
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Urinary Tract Infections in Women: Pathogenesis, Diagnosis, and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0351-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Nader-Macías MEF, Juárez Tomás MS. Profiles and technological requirements of urogenital probiotics. Adv Drug Deliv Rev 2015; 92:84-104. [PMID: 25858665 DOI: 10.1016/j.addr.2015.03.016] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/20/2015] [Accepted: 03/27/2015] [Indexed: 12/14/2022]
Abstract
Probiotics, defined as live microorganisms that, when administered in adequate amounts, confer a health benefit on the host, are considered a valid and novel alternative for the prevention and treatment of female urogenital tract infections. Lactobacilli, the predominant microorganisms of the healthy human vaginal microbiome, can be included as active pharmaceutical ingredients in probiotics products. Several requirements must be considered or criteria fulfilled during the development of a probiotic product or formula for the female urogenital tract. This review deals with the main selection criteria for urogenital probiotic microorganisms: host specificity, potential beneficial properties, functional specifications, technological characteristics and clinical trials used to test their effect on certain physiological and pathological conditions. Further studies are required to complement the current knowledge and support the clinical applications of probiotics in the urogenital tract. This therapy will allow the restoration of the ecological equilibrium of the urogenital tract microbiome as well as the recovery of the sexual and reproductive health of women.
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Lee B, Balavenkataraman A, Sanghavi D, Walter K. Recurrent nitrofurantoin-induced giant cell interstitial pneumonia: Case report and literature review. Respir Med Case Rep 2015; 14:49-52. [PMID: 26029579 PMCID: PMC4356049 DOI: 10.1016/j.rmcr.2015.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Giant cell interstitial pneumonia (GIP) is a rare form of chronic interstitial pneumonia typically associated with hard metal exposure. Only two cases of GIP induced by nitrofurantoin have been reported in the medical literature. We are reporting a case of recurrent nitrofurantoin-induced GIP. Although extremely rare, GIP needs to be included in the differential diagnosis in patients with chronic nitrofurantoin use who present with respiratory illness.
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Affiliation(s)
- Boeun Lee
- Division of Geographic Medicine and Infectious Diseases, Tufts Medical Center, Boston, MA, USA
- Corresponding author. 800 Washington Street, Tufts Medical Center, Boston, MA 02111, USA. Tel.: +1 6176365000; fax: +1 6176361580.
| | | | - Devang Sanghavi
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Kristin Walter
- Department of Internal Medicine, Saint Joseph Hospital, Presence Health, Chicago, IL, USA
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Recurrent urinary tract infections in women. Int Urogynecol J 2014; 26:795-804. [DOI: 10.1007/s00192-014-2569-5] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Accepted: 11/04/2014] [Indexed: 10/24/2022]
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Anti-Adhesion Activity of A2-type Proanthocyanidins (a Cranberry Major Component) on Uropathogenic E. coli and P. mirabilis Strains. Antibiotics (Basel) 2014; 3:143-54. [PMID: 27025740 PMCID: PMC4790394 DOI: 10.3390/antibiotics3020143] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 03/19/2014] [Accepted: 03/24/2014] [Indexed: 11/17/2022] Open
Abstract
Urinary tract infections (UTIs) are relatively common in women and may be classified as uncomplicated or complicated, depending upon the urinary tract anatomy and physiology. Acute uncomplicated cystitis (AUC) occurs when urinary pathogens from the bowel or vagina colonize the periurethral mucosa and reach the bladder. The vast majority of episodes in healthy women involving the same bacterial strain that caused the initial infection are thought to be reinfections. About 90% of AUC are caused by uropathogenic Escherichia coli (UPEC), but Proteus mirabilis also plays an important role. Several studies support the importance of cranberry (Vaccinium macrocarpon) proanthocyanidins in preventing adhesion of P-fimbriated UPEC to uroepithelial cells. In this study, we evaluated the in vitro anti-adhesion activity of A2-linked proanthocyanidins from cranberry on a UPEC and Proteus mirabilis strains and their possible influence on urease activity of the latter. A significant reduction of UPEC adhesion (up to 75%) on the HT1376 cell line was observed vs. control. For the strains of P. mirabilis there was also a reduction of adhesion (up to 75%) compared to controls, as well as a reduction in motility and urease activity. These results suggest that A2-type cranberry proanthocyanidins could aid in maintaining urinary tract health.
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Glover M, Moreira CG, Sperandio V, Zimmern P. Recurrent urinary tract infections in healthy and nonpregnant women. UROLOGICAL SCIENCE 2014; 25:1-8. [PMID: 27499825 PMCID: PMC4973860 DOI: 10.1016/j.urols.2013.11.007] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Recurrent urinary tract infections (RUTI) are prevalent and pose significant clinical challenges. Although the term RUTI has long been vaguely defined, a consensus definition has emerged in recent years. The exact etiology behind RUTI remains under debate, with valid arguments for both ascending reinfections as well as persistent infection inside the bladder. These persistent infections exist in the form of quiescent intracellular reservoirs in the mouse model and may represent a novel concept to explain UTI recurrence in humans. Manageable risk factors such as behavioral patterns alongside nonmanageable risk factors including genetic susceptibility are growing fields of investigation. Acute UTI have been studied through two model bacterial strains: Escherichia coli UTI89 and CFT073. However, the clinical relevance to RUTI of these two strains has not been firmly established. Current treatment strategies for RUTI are limited and remain dominated by antibiotic usage despite variable efficacy. The majority of studies in humans have focused on younger groups of women with little information available about the postmenopausal population despite a heightened risk of RUTI in this age group.
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Costantini E, Zucchi A, Salvini E, Cicalese A, Li Marzi V, Filocamo MT, Bini V, Lazzeri M. Prulifloxacin vs fosfomycin for prophylaxis in female patients with recurrent UTIs: a non-inferiority trial. Int Urogynecol J 2014; 25:1173-8. [PMID: 24554302 DOI: 10.1007/s00192-013-2318-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 12/25/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION AND HYPOTHESIS This multicentre, randomised, non-blinded, parallel group study is designed to assess the null hypothesis that a 3-month prophylactic schedule with fosfomycin is not inferior to prulifloxacin in reducing the number of urinary tract infection episodes during and after prophylaxis in female patients with recurrent urinary tract infections (rUTIs). METHODS One hundred and fifty-two patients with rUTIs who were candidates for prophylaxis therapy were enrolled and randomised to prulifloxacin (group 1) or fosfomycin (group 2). The prophylaxis regimen included a single dose of fosfomycin (one 3-g cachet) per week, or a single dose (600 mg) of prulifloxacin (one tablet) a week for 12 weeks. The inclusion criteria were female patients over 18 years, urine culture responsiveness to drugs at patient recruitment and history of rUTI. Exclusion criteria were pregnancy and counter-indications to this drug therapy. Patients were prospectively randomised. Check-ups were scheduled at 2 weeks, 1 month and 3 months from the beginning of the study and 3, 6, and 12 months after suspension of the therapy. The primary end-points were the reduction of the number of UTIs (negative urine culture) during and after prophylaxis. RESULTS Final data analysis included 67 patients in group 1 and 57 in group 2. Nine out of 76 patients (group 1) and 19 out of 76 (group 2) dropped out. UTI episodes were significantly reduced in number compared with before prophylaxis (p < 0.0001) at all study end-points in both groups. No significant differences were found in disease-free duration, as achieved by the two therapy groups (log-rank test; p = 0.41), in the reduction of UTI episodes during and after prophylaxis, in the adverse effects or improved quality of life. CONCLUSIONS Both drugs provided adequate prophylaxis in patients with rUTIs, with no difference in efficacy.
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Affiliation(s)
- Elisabetta Costantini
- Urology Department, University of Perugia, S. M. Misericordia Hospital, S. Andrea delle Fratte, 06123, Perugia, Italy
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den Heijer CDJ, Beerepoot MAJ, Prins JM, Geerlings SE, Stobberingh EE. Determinants of antimicrobial resistance in Escherichia coli strains isolated from faeces and urine of women with recurrent urinary tract infections. PLoS One 2012; 7:e49909. [PMID: 23166796 PMCID: PMC3500350 DOI: 10.1371/journal.pone.0049909] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2012] [Accepted: 10/15/2012] [Indexed: 11/18/2022] Open
Abstract
For women with recurrent urinary tract infections (rUTI), the contribution of antibiotic use versus patient-related factors in determining the presence of antimicrobial resistance in faecal and urinary Escherichia coli, obtained from the same patient population, has not been assessed yet. Within the context of the 'Non-antibiotic prophylaxis for recurrent urinary tract infections' (NAPRUTI) study, the present study assessed determinants of antimicrobial resistance in E. coli isolated from urinary and faecal samples of women with rUTIs collected at baseline. Potential determinants of resistance were retrieved from self-administered questionnaires. From 434 asymptomatic women, 433 urinary and 424 faecal samples were obtained. E. coli was isolated from 146 (34%) urinary samples and from 336 (79%) faecal samples, and subsequently tested for antimicrobial susceptibility. Multivariable analysis showed trimethoprim/sulfamethoxazole (SXT) use three months prior to inclusion to be associated with urine E. coli resistance to amoxicillin (OR 3.6, 95% confidence interval: 1.3-9.9), amoxicillin-clavulanic acid (OR 4.4, 1.5-13.3), trimethoprim (OR 3.9, 1.4-10.5) and SXT (OR 3.2, 1.2-8.5), and with faecal E. coli resistance to trimethoprim (OR 2.0, 1.0-3.7). The number of UTIs in the preceding year was correlated with urine E. coli resistance to amoxicillin-clavulanic acid (OR 1.11, 1.01-1.22), trimethoprim (OR 1.13, 1.03-1.23) and SXT (OR 1.10, 1.01-1.19). Age was predictive for faecal E. coli resistance to amoxicillin (OR 1.02, 1.00-1.03), norfloxacin and ciprofloxacin (both OR 1.03, 1.01-1.06). In conclusion, in women with rUTI different determinants were found for urinary and faecal E. coli resistance. Previous antibiotic use and UTI history were associated with urine E. coli resistance and age was a predictor of faecal E. coli resistance. These associations could best be explained by cumulative antibiotic use.
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Affiliation(s)
- Casper D. J. den Heijer
- Department of Medical Microbiology, Maastricht University Medical Centre/Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Mariëlle A. J. Beerepoot
- Division of Infectious Diseases, Department of Internal Medicine, Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, The Netherlands
| | - Jan M. Prins
- Division of Infectious Diseases, Department of Internal Medicine, Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, The Netherlands
| | - Suzanne E. Geerlings
- Division of Infectious Diseases, Department of Internal Medicine, Centre for Infection and Immunity Amsterdam (CINIMA), Academic Medical Centre, Amsterdam, The Netherlands
| | - Ellen E. Stobberingh
- Department of Medical Microbiology, Maastricht University Medical Centre/Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
- * E-mail:
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Affiliation(s)
- Baek-Nam Kim
- Department of Internal Medicine, Inje University College of Medicine, Busan, Korea
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