1
|
Ots T, Gold D, Ziller P, Kuenzer T, Dalpiaz O, Pesto L, Trutnovsky G. Segmental Acupuncture for Prevention of Recurrent Urinary Tract Infections. A Randomised Clinical Trial. Int Urogynecol J 2024; 35:1689-1697. [PMID: 39060726 DOI: 10.1007/s00192-024-05872-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/30/2024] [Indexed: 07/28/2024]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary tract infections (UTIs) are a common medical problem and prophylaxis of recurrent UTIs is an ongoing clinical challenge. In the present study we examined whether acupuncture is able to prevent recurrent UTIs in women. METHODS This multicentre randomised controlled trial, based at a University clinic and private acupuncture clinics, recruited women suffering from recurrent uncomplicated UTIs. Participants were randomised to the acupuncture group or control group. Acupuncture therapy consisted of 12 treatments over a period of 18 weeks, using a set of predefined body and ear acupuncture points. Cranberry products were recommended to all participants as standard of care. RESULTS A total of 137 women were randomised (68 acupuncture, 69 control group) and occurrence of UTIs at 6 and 12 months could be assessed in 123 and 120 women respectively. Acupuncture combined with cranberry slightly increased the proportion of UTI-free women compared with cranberry alone at 6 months (59% vs 46%, p = 0.2). Between 6 and 12 months the proportion of UTI-free women was significantly higher in the acupuncture group (66 vs 45%, p = 0.03). The number of UTIs decreased from baseline to 12 months in both study groups. The number of UTIs at 12 months was significantly lower in the acupuncture group (median difference 1, p = 0.01). CONCLUSIONS Segmental acupuncture may be an effective treatment option for women with recurrent UTIs over a longer follow-up period and may limit antibiotics use. Further studies are needed.
Collapse
Affiliation(s)
- Thomas Ots
- Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Graz, Austria
- Private Acupuncture Clinics, Graz, Austria
| | - Daniela Gold
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | | | - Thomas Kuenzer
- Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Orietta Dalpiaz
- Department of Urology, Medical University of Graz, Graz, Austria
- Department of Urology, Hospital of Leoben, Graz, Austria
| | - Lejla Pesto
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria
| | - Gerda Trutnovsky
- Department of Obstetrics and Gynecology, Medical University of Graz, Auenbruggerplatz 14, 8036, Graz, Austria.
| |
Collapse
|
2
|
Gaitonde S, Kuprasertkul A, Christie AL, Alhalabi F, Crivelli JJ, Zimmern PE. Comparing costs associated with management of antibiotic-recalcitrant recurrent urinary tract infections for one year pre- and post-electrofulguration. Neurourol Urodyn 2024. [PMID: 38989652 DOI: 10.1002/nau.25545] [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: 11/21/2023] [Revised: 05/02/2024] [Accepted: 06/21/2024] [Indexed: 07/12/2024]
Abstract
INTRODUCTION To quantify and compare recurrent urinary tract infection costs between 1 year before and 1 year after electrofulguration. METHODS Following IRB approval, a well-characterized cohort of non-neurogenic women with >3 symptomatic urinary tract infections (UTIs)/year, a negative upper and lower urinary tract evaluation, and inflammatory bladder lesions (cystitis) on office cystoscopy who underwent fulguration of these lesions was analyzed. Cost of visits, imaging, labs, and medications were summed for 1-year pre- and post-fulguration using the Medicare Physician Fee Schedule, local pharmacy pricing, and institutional expenses. Before fulguration, all patients underwent clinic visit, noninvasive flow study, and flexible cystoscopy, and post-fulguration, 6-week follow-up visit and 6-month cystoscopy. RESULTS Ninety-three women met study criteria (mean age 64), with 100% 1-year follow-up. Before fulguration, 73% of patients used daily antibiotic suppression, 6% self-start antibiotics, and 5% postcoital prophylaxis. Some also used vaginal estrogens (17%), urinary analgesics (13%), and cranberry or d-mannose supplements (7%). At 1 year post-fulguration, 82% had 0-1 infections and no cystoscopy evidence of cystitis, while 14% required additional fulguration for new cystitis sites and recurrent infections. Patients had on average 0.7 infections in the 1-year post-fulguration, which was significantly lower than pre-fulguration (p < 0.05). Mean 1-year pre-fulguration cost was $1328 (median $1071, range $291-$5564). Mean 1-year post-fulguration cost was $617 (median $467, range $275-$4580). On average, post-fulguration costs were $710 lower than pre-EF (p < 0.05). CONCLUSION For women with antibiotic-refractory recurrent urinary tract infections and cystoscopy evidence of cystitis, fulguration was associated with a significant reduction in UTI-related costs in the 1-year post-fulguration.
Collapse
Affiliation(s)
- Shivani Gaitonde
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Amy Kuprasertkul
- Division of Urologic Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alana L Christie
- Simmons Comprehensive Cancer Center Biostatistics, Southwestern Medical Center, University of Texas, Dallas, Texas, USA
| | - Feras Alhalabi
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Joseph J Crivelli
- Department of Urology, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
3
|
Salvatore S, Ruffolo AF, Stabile G, Casiraghi A, Zito G, De Seta F. A Randomized Controlled Trial Comparing a New D-Mannose-based Dietary Supplement to Placebo for the Treatment of Uncomplicated Escherichia coli Urinary Tract Infections. Eur Urol Focus 2023:S2405-4569(22)00297-8. [PMID: 36621376 DOI: 10.1016/j.euf.2022.12.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/28/2022] [Accepted: 12/29/2022] [Indexed: 01/09/2023]
Abstract
BACKGROUND The rise in antimicrobial resistance means that alternative approaches for the treatment and prevention of urinary tract infection (UTIs) are required. OBJECTIVE To evaluate the safety and efficacy of a D-mannose-based dietary supplement (D-mannose, citric acid, prebiotic fibers, Astragalus, and dandelion; DAPAD complex) for the treatment of uncomplicated acute E. coli UTIs. DESIGN, SETTING, AND PARTICIPANTS This was a single-center, randomized, double-blind, placebo-controlled trial conducted from April 2021 to October 2021 in Rajalakshmi Hospital and Research Centre (Bangalore, India). The participants were nonmenopausal women with an acute uncomplicated E. coli UTI. UTI was diagnosed according to the presence of at least one urinary symptom and bacteriuria (>100 000 CFU/ml). INTERVENTION The DAPAD complex was administered twice a day for 5 d, with phenazopyridine and alkalizing agents as the standard of care (SOC). The control group received placebo with SOC. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Subjective (clinical resolution/response) and objective (midstream bacteriuria) outcomes were evaluated at the end of therapy (day 6) and at day 35 of follow-up. Adverse events were recorded. Categorical variables were analyzed using χ2 and Fisher's exact tests; a p value <0.05 was considered significant. RESULTS AND LIMITATIONS Seventy women were enrolled and equally randomized to the two groups. Clinical resolution was higher in the DAPAD group at 6 d (34.3% vs 0%; p < 0.0001) and 35 d from baseline (88.6% vs 20%, p < 0.0001). At day 35, no patients in the DAPAD group had moderate or severe symptoms, whereas 25.7% (nine/35) and 11.4% (four/35) of patients in the placebo group had moderate and severe symptoms, respectively. Bacteriological resolution was also higher in the DAPAD group at day 6 (85.7% vs 14.3%; p < 0.0001) and day 35 (100% vs 40%; p < 0.0001). Three mild adverse events (4.26%) unrelated to the investigated product were recorded, all of which were medically treated. CONCLUSIONS The DAPAD complex dietary supplement is effective and safe for treatment of acute uncomplicated E. coli UTIs. PATIENT SUMMARY Our results show that for nonmenopausal women with an uncomplicated Escherichia coli urinary tract infection, those treated with a dietary supplement (containing D-mannose, citric acid, prebiotic fibers, Astragalus, and dandelion) had a higher rate of clinical resolution or response than women who received a placebo.
Collapse
Affiliation(s)
- Stefano Salvatore
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Alessandro Ferdinando Ruffolo
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy.
| | - Guglielmo Stabile
- Department of Medical, Surgical and Health Sciences, Institute for Maternal and Child Health, University of Trieste, IRCCS Burlo Garofolo, Trieste, Italy
| | - Arianna Casiraghi
- School of Medicine, Vita-Salute San Raffaele University, Milan, Italy; Obstetrics and Gynecology Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Gabriella Zito
- Department of Medical, Surgical and Health Sciences, Institute for Maternal and Child Health, University of Trieste, IRCCS Burlo Garofolo, Trieste, Italy
| | - Francesco De Seta
- Department of Medical, Surgical and Health Sciences, Institute for Maternal and Child Health, University of Trieste, IRCCS Burlo Garofolo, Trieste, Italy
| |
Collapse
|
4
|
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.
Collapse
|
5
|
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.
Collapse
|
6
|
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.
Collapse
|
7
|
Pani A, Valeria L, Dugnani S, Senatore M, Scaglione F. Pharmacodynamics of D-mannose in the prevention of recurrent urinary infections. J Chemother 2022; 34:459-464. [PMID: 35416116 DOI: 10.1080/1120009x.2022.2061184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Recurring urinary tract infections (rUTIs) are frequently caused by Escherichia coli, which invades urothelial cells and forms quiescent bacterial reservoirs. D-mannose, an inert monosaccharide, represents a notable agent for rUTI prevention; however, there is no agreement on its dosage. To provide pharmacological basis for an effective dose, we evaluated its ability to inhibit adhesion of E. coli to urothelial cells. E. coli strains isolated from the urine of a woman with recurrent urinary tract infections were selected according to adhesion capacity. Anti-adhesive efficacy and invasion were tested using the TCC-5637 urothelial cell line. The IC50 for the anti-adhesive efficacy and anti-invasion activity of D-mannose were 0.51 mg/ml and 0.30 mg/ml, respectively, both with concentration-dependent inhibition. Lastly, the biofilm interference of D-mannose was evaluated to be 50 mg/ml. D-mannose inhibited the adhesion of E. coli to urothelial cells at high concentrations, whereas inhibition of invasion occurred at much lower concentrations.
Collapse
Affiliation(s)
- Arianna Pani
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Lucini Valeria
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Silvana Dugnani
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Michele Senatore
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, University of Milan, Milan, Italy
| |
Collapse
|
8
|
Chiu K, Zhang F, Sutcliffe S, Mysorekar IU, Lowder JL. Recurrent Urinary Tract Infection Incidence Rates Decrease in Women With Cystitis Cystica After Treatment With d-Mannose: A Cohort Study. Female Pelvic Med Reconstr Surg 2022; 28:e62-e65. [PMID: 35272335 PMCID: PMC8928039 DOI: 10.1097/spv.0000000000001144] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES d-Mannose is a promising nonantibiotic prophylaxis for recurrent urinary tract infection (rUTI). Recurrent UTI is common in postmenopausal women and may be especially prevalent in those with cystitis cystica (CC) lesions found on cystoscopy. Our objectives were to determine whether CC lesions are associated with a higher UTI incidence rate and whether d-mannose reduces this rate in women with CC. METHODS This is a retrospective cohort study of patients with rUTI who underwent cystoscopy at our institution (from which CC status was identified) and who were treated with d-mannose as a single agent for UTI prophylaxis. Participants were required to have at least 1 year of follow-up for UTIs both before and after d-mannose initiation to allow for a pre-post comparison. RESULTS Twenty-seven patients were included in the analysis (13 with CC, 14 without CC). Most patients (88.9%) were postmenopausal. Patients with CC had a higher UTI incidence rate than patients without CC (4.69 vs 2.93 UTIs/year before starting d-mannose prophylaxis, P = 0.021). After initiating d-mannose prophylaxis, the UTI incidence rate decreased significantly in patients with CC (rate decrease = 2.23 UTIs/year, P = 0.0028). This decrease was similar in magnitude to that observed in patients without CC (rate decrease = 1.64 UTIs/year, P = 0.0007; P interaction = 0.58). CONCLUSIONS Patients with rUTI with CC had more frequent UTI episodes than patients without CC. Patients in both groups had fewer UTI episodes after beginning d-mannose prophylaxis. These findings add to the body of literature supporting d-mannose for the prevention of rUTI in women, including those with CC.
Collapse
Affiliation(s)
- Kimberley Chiu
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology
| | - Fan Zhang
- Division of Clinical Research, Department of Obstetrics and Gynecology
| | - Siobhan Sutcliffe
- Division of Public Health Sciences, Department of Surgery, Washington University in St Louis, St Louis, MO
| | - Indira U Mysorekar
- Section of Infectious Diseases, Department of Medicine, Baylor College of Medicine, Houston, TX
| | - Jerry L Lowder
- From the Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology
| |
Collapse
|
9
|
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.
Collapse
|
10
|
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.
Collapse
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
| |
Collapse
|
11
|
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: 56] [Impact Index Per Article: 14.0] [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.
Collapse
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
| |
Collapse
|
12
|
Castro V, Canales JP, Rada G. Are oral oestrogens effective in preventing urinary tract infection in postmenopausal woman. Medwave 2020; 20:e7913. [DOI: 10.5867/medwave.2020.05.7913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 12/20/2017] [Indexed: 11/27/2022] Open
|
13
|
Choudhury RA, Hoeltzel G, Prins K, Chow E, Moore HB, Lawson PJ, Yoeli D, Pratap A, Abt PL, Dumon KR, Conzen KD, Nydam TL. Sleeve Gastrectomy Compared with Gastric Bypass for Morbidly Obese Patients with End Stage Renal Disease: a Decision Analysis. J Gastrointest Surg 2020; 24:756-763. [PMID: 31044345 DOI: 10.1007/s11605-019-04225-w] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/29/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION The use of bariatric surgery has increased for morbidly obese patients with end stage renal disease (ESRD) for whom listing on the waitlist is often restricted until a certain BMI threshold is achieved. Effective weight loss for this population improves access to life-saving renal transplantation. However, it is unclear whether sleeve gastrectomy (SG) vs Roux-en-Y gastric bypass (RYGB) is a more effective therapy for these patients. METHODS A decision analytic Markov state transition model was created to simulate the life of morbidly obese patients with ESRD who were deemed ineligible to be waitlisted for renal transplantation unless they achieved a BMI less than 35 kg/m2. Life expectancy following weight management (MWM), RYGB, and SG were estimated. Base case patients were defined as having a pre-intervention BMI of 45 kg/m2. Sensitivity analysis of initial BMI was performed. Markov parameters were extracted from literature review. RESULTS RYGB improved survival compared with SG and MWM. RYGB patients had higher rates of transplantation, leading to improved mean long-term survival. Base case patients who underwent RYGB gained 1.3 additional years of life compared with patient's who underwent SG and 2.6 additional years of life compared with MWM. CONCLUSIONS RYGB improves access to renal transplantation and thereby increases long-term survival compared with SG and MWM. The use of SG may be incongruent with the goal of improving access to renal transplantation for morbidly obese patients.
Collapse
Affiliation(s)
- Rashikh A Choudhury
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA.
| | - Gerard Hoeltzel
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kas Prins
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Eric Chow
- Department of Medicine- Quantitative Sciences Unit, Stanford University Medical Center, Palo Alto, CA, USA
| | - Hunter B Moore
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Peter J Lawson
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Dor Yoeli
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Akshay Pratap
- Department Surgery, Division of MIS/Bariatric Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Peter L Abt
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kristoffel R Dumon
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | - Kendra D Conzen
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| | - Trevor L Nydam
- Department of Surgery, Division of Transplant Surgery, University of Colorado Hospital, Aurora, CO, USA
| |
Collapse
|
14
|
Petrosillo N, Granata G, Boyle B, Doyle MM, Pinchera B, Taglietti F. Preventing sepsis development in complicated urinary tract infections. Expert Rev Anti Infect Ther 2019; 18:47-61. [PMID: 31795788 DOI: 10.1080/14787210.2020.1700794] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Introduction: Urinary tract infections (UTIs) are the most prevalent infections in the community and the most common reason for antimicrobial prescribing in ambulatory care. A UTI is defined as complicated when urinary tract anatomical abnormalities or urinary devices are present, when it is recurrent and when associated with immunodeficiency. Complicated UTIs (cUTIs) have a higher risk of treatment failure and often require longer antimicrobial treatment courses. cUTIs, especially those which are healthcare-associated, are often due to multidrug resistant organisms (MDROs).Areas covered: This article will review the available evidence in relation to prevention of sepsis in cUTI, evaluating the risk factors associated with sepsis development. Published articles from January 2005 to September 2019 on UTIs and sepsis prevention in complicated UTIs were identified by using MEDLINE (National Library of Medicine Bethesda MD) and by reviewing the references of retrieved articles.Expert opinion: Prevention of sepsis relies on prompt and timely diagnosis of cUTI, early identification of the causative organism, removal of obstructions and source control, proper and adequate empirical/targeted antimicrobial treatment. In particular, source control, i.e. removal of urinary obstructions, infected stents, urinary catheters, nephrostomies, and drainage of hydronephrosis/abscess, is essential for preventing the development and progression of sepsis.
Collapse
Affiliation(s)
- Nicola Petrosillo
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Guido Granata
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| | - Breida Boyle
- Department of Clinical Microbiology, St. James Hospital, Dublin, Ireland and Trinity College Dublin, Ireland
| | - Maeve M Doyle
- Consultant Microbiologist, University Hospital Waterford, Waterford, Ireland.,Ireland and Royal College of Surgeons, University College Cork, Cork, Ireland
| | - Biagio Pinchera
- Clinic of Infectious Diseases, University "Federico II", Naples, Italy
| | - Fabrizio Taglietti
- Systemic and Immunocompromised Host Infection Unit, National Institute for Infectious Diseases "L. Spallanzani", IRCCS, Rome, Italy
| |
Collapse
|
15
|
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.
Collapse
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
| |
Collapse
|
16
|
Financial Burden of Recurrent Urinary Tract Infections in Women: A Time-driven Activity-based Cost Analysis. Urology 2019; 128:47-54. [PMID: 30796990 DOI: 10.1016/j.urology.2019.01.031] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/19/2018] [Accepted: 01/02/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To utilize Time-Driven Activity-Based Costing to quantify costs of managing recurrent urinary tract infections (RUTI) in women. METHODS RUTI was defined as ≥2 UTIs in 6 months or ≥3 UTIs in 12 months. A care-delivery value chain outlined RUTI management (visits, urine studies, and imaging) for acute UTI followed by a form of long-term prevention. Prevention strategies included conservative therapy (Cranberry tablets, d-mannose, or lactobacillus); Estrogen therapy if postmenopausal; Antibiotic use (self-start, postcoital, or continuous regimens); or intravenous antibiotics in case of drug-resistance or intolerance. Costs of each resource were largely obtained from the Medicare Physician Fee Schedule, GoodRx and local pharmacy pricing, and institutional expenses. The capacity cost rate was defined as cost of resources per minute of care. Individual costs were summed to estimate overall expense of initial RUTI workup and annual cost for each long-term prevention strategy. RESULTS Cost of acute RUTI workup ranged from $390 to $730. Acute antibiotics cost ranged from $10 for oral trimethoprim-sulfamethoxazole to $3970 for intravenous Ertapenem. Annually, mean cost of conservative therapy ranged from $50 for d-mannose to $1290 for vaginal estradiol ring, and antibiotic use for self-start $40, postcoital $60, and continuous $190. Capacity cost rate ranged from $0.003/min for urine culture to $80/min for estrogen ring. CONCLUSION Using Time-Driven Activity-Based Costing, costs of RUTI management were efficiently determined. This offers new perspectives for patient counseling and long-term decision making.
Collapse
|
17
|
Bodro M, Linares L, Chiang D, Moreno A, Cervera C. Managing recurrent urinary tract infections in kidney transplant patients. Expert Rev Anti Infect Ther 2018; 16:723-732. [PMID: 30092153 DOI: 10.1080/14787210.2018.1509708] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Recurrent urinary tract infections (UTI) are a common clinical problem in kidney transplant recipients. Due to the complex urological anatomy derived from the implantation of the kidney graft, the spectrum of the disease and the broad underlying pathophysiological mechanisms. Recurrent UTI worsen the quality of life, decrease the graft survival and increase the costs of kidney transplantation. Areas covered: In this review, we describe the definitions, clinical characteristics, pathophysiological mechanisms and microbiology of recurrent urinary tract infections in kidney transplantations. The actual published literature on the management of recurrent urinary tract infections is based on case series, observational cohorts and very few clinical trials. In this review, the available evidence is compiled to propose evidence-based strategies to manage these complex cases. Expert commentary: The management of recurrent urinary tract infections in kidney transplant patients requires a proper diagnosis of the underlying mechanism. Early identification of structural or functional urological abnormalities, potentially amenable for surgical correction, is crucial for a successful management. The use of antibiotics to prevent recurrent infections should be carefully evaluated to avoid side effects and emergence of antibiotic-resistant microorganisms.
Collapse
Affiliation(s)
- Marta Bodro
- a Division of Infectious Diseases , Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona , Barcelona , Spain
| | - Laura Linares
- a Division of Infectious Diseases , Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona , Barcelona , Spain
| | - Diana Chiang
- b Department of Medicine , University of Alberta , Edmonton , Canada
| | - Asuncion Moreno
- a Division of Infectious Diseases , Hospital Clinic of Barcelona - IDIBAPS, University of Barcelona , Barcelona , Spain
| | - Carlos Cervera
- b Department of Medicine , University of Alberta , Edmonton , Canada
| |
Collapse
|
18
|
Baker JH, Qiu J, Grine K. Role of Complementary and Alternative Therapies in Infectious Disease. Prim Care 2018; 45:533-539. [PMID: 30115339 DOI: 10.1016/j.pop.2018.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Complementary and alternative medicine (CAM) is increasingly being used in Western countries despite the lack of conclusive research studies. Several CAM modalities have only shown variable therapeutic efficacy in infectious disease management. Clinicians should be familiar with these therapies in order to advise patients about alternative therapeutic options when treating infections.
Collapse
Affiliation(s)
- Jeffrey H Baker
- Department of Family and Community Medicine, Penn State University College of Medicine, Penn State Hershey Medical Group, 476 Rolling Ridge Drive, #101, State College, PA 16801, USA.
| | - Juan Qiu
- Department of Family and Community Medicine, Penn State University College of Medicine, Penn State Hershey Medical Group, 32 Colonnade Way, State College, PA 16803, USA
| | - Kristen Grine
- Department of Family and Community Medicine, Penn State University College of Medicine, Penn State Hershey Medical Group, 476 Rolling Ridge Drive, #101, State College, PA 16801, USA
| |
Collapse
|
19
|
The therapeutic approach to different forms of cystitis: impact on public health. Urologia 2017; 84:8-15. [PMID: 28862726 DOI: 10.5301/uj.5000262] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 11/20/2022]
Abstract
Interstitial cystitis/bladder pain syndrome, recurrent urinary tract infections and other forms of cystitis significantly impact the quality of life of patients with chronic bladder disorders and impose a considerable economic burden on health systems. Effective management is essential to provide symptom relief and to reduce the negative impact of chronic bladder disorders. Identifying the appropriate pharmacological or non-pharmacological approach is essential, and there is a growing evidence base for the use of intravesical hyaluronic acid and chondroitin sulfate in several bladder conditions, including recurrent urinary tract infections.
Collapse
|
20
|
Wagenlehner F, Wullt B, Ballarini S, Zingg D, Naber KG. Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT). Expert Rev Pharmacoecon Outcomes Res 2017; 18:107-117. [PMID: 28737469 DOI: 10.1080/14737167.2017.1359543] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Uncomplicated lower urinary tract infections (UTIs) occur in approximately 50% of women, and 20-30% experience recurrent UTI. Data on UTIs and quality of life (QoL) in Europe are limited. METHODS This was an anonymous, self-administered web-based survey conducted in 5 countries (Germany, Switzerland, Poland, Russia and Italy), on adult women who had experienced recurrent UTI and were affected by acute UTI currently or within 4 weeks of study entry. Questions covered disease course; management; social and economic burden; education, income, and health insurance status. QoL was evaluated using the SF-12v2. RESULTS Participants reported a mean of 5.15 UTI symptoms, ranging from 4.85 - 5.38 in Russia and Germany. There was a mean of 2.78 doctor visits per year (1.74 - 3.71 in Russia and Germany; p < 0.0001). 80.3% of participants had been treated with antibiotics, mean prescriptions ranged from 2.17 (Poland) to 3.36 (Germany) per person per year. A mean of 3.09 days sick leave due to UTIs, and 3.45 days of limited activities, were reported. Although 73.8% of participants had tried prophylaxis recurrence was common and associated with mental stress for a high proportion of women. CONCLUSIONS Our results indicate that recurrent UTIs have a significant impact on QoL of women in Europe.
Collapse
Affiliation(s)
- Florian Wagenlehner
- a Clinic for Urology, Pediatric Urology and Andrology , Justus-Liebig University , Giessen , Germany
| | - Björn Wullt
- b Section of MIG , Lund University , Lund , Sweden
| | | | | | - Kurt G Naber
- d Technical University of Munich , Munich , Germany
| |
Collapse
|
21
|
Liska DJ, Kern HJ, Maki KC. Cranberries and Urinary Tract Infections: How Can the Same Evidence Lead to Conflicting Advice? Adv Nutr 2016; 7:498-506. [PMID: 27184277 PMCID: PMC4863270 DOI: 10.3945/an.115.011197] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Cranberry has been used traditionally to prevent urinary tract infections (UTIs), primarily among generally healthy women prone to recurrent UTIs. Results from a number of published clinical studies have supported this benefit; however, meta-analyses on cranberry and UTI prevention have reported conflicting conclusions. This article explores the methodological differences that contributed to these disparate findings. Despite similar research questions, the meta-analyses varied in the studies that were included, as well as the data that were extracted. In the 2 most comprehensive systematic reviews, heterogeneity was handled differently, leading to an I(2) of 65% in one and 43% in the other. Most notably, the populations influencing the conclusions varied. In one analysis, populations with pathological/physiological conditions contributed 75.6% of the total weight to the summary risk estimate (RR: 0.86; 95% CI: 0.71, 1.04); another weighted the evidence relatively equally across UTI populations (RR: 0.62; 95% CI: 0.49, 0.80); and a third included only women with recurrent UTIs (RR: 0.53; 95% CI: 0.33, 0.83). Because women with recurrent UTIs are the group to whom most recommendations regarding cranberry consumption is directed, inclusion of other groups in the efficacy assessment could influence clinical practice quality. Therefore, conclusions on cranberry and UTIs should consider differences in results across various populations studied when interpreting results from meta-analyses.
Collapse
Affiliation(s)
| | - Hua J Kern
- Biofortis Innovation Services, Addison, IL; and
| | - Kevin C Maki
- Midwest Center for Metabolic & Cardiovascular Research, Chicago, IL
| |
Collapse
|
22
|
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]
|
23
|
Lüthje P, Brauner A. Novel Strategies in the Prevention and Treatment of Urinary Tract Infections. Pathogens 2016; 5:E13. [PMID: 26828523 PMCID: PMC4810134 DOI: 10.3390/pathogens5010013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 08/05/2015] [Accepted: 01/21/2016] [Indexed: 01/15/2023] Open
Abstract
Urinary tract infections are one of the most common bacterial infections, especially in women and children, frequently treated with antibiotics. The alarming increase in antibiotic resistance is a global threat to future treatment of infections. Therefore, alternative strategies are urgently needed. The innate immune system plays a fundamental role in protecting the urinary tract from infections. Antimicrobial peptides form an important part of the innate immunity. They are produced by epithelial cells and neutrophils and defend the urinary tract against invading bacteria. Since efficient resistance mechanisms have not evolved among bacterial pathogens, much effort has been put into exploring the role of antimicrobial peptides and possibilities to utilize them in clinical practice. Here, we describe the impact of antimicrobial peptides in the urinary tract and ways to enhance the production by hormones like vitamin D and estrogen. We also discuss the potential of medicinal herbs to be used in the prophylaxis and the treatment of urinary tract infections.
Collapse
Affiliation(s)
- Petra Lüthje
- Department of Microbiology, Tumor and Cell Biology, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Stockholm SE-171 76, Sweden.
| | - Annelie Brauner
- Department of Microbiology, Tumor and Cell Biology, Division of Clinical Microbiology, Karolinska Institutet and Karolinska University Hospital, Stockholm SE-171 76, Sweden.
| |
Collapse
|
24
|
Drozdov D, Schwarz S, Kutz A, Grolimund E, Rast AC, Steiner D, Regez K, Schild U, Guglielmetti M, Conca A, Reutlinger B, Ottiger C, Buchkremer F, Haubitz S, Blum C, Huber A, Buergi U, Schuetz P, Bock A, Fux CA, Mueller B, Albrich WC. Procalcitonin and pyuria-based algorithm reduces antibiotic use in urinary tract infections: a randomized controlled trial. BMC Med 2015; 13:104. [PMID: 25934044 PMCID: PMC4427918 DOI: 10.1186/s12916-015-0347-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2015] [Accepted: 04/13/2015] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are common drivers of antibiotic use. The minimal effective duration of antibiotic therapy for UTIs is unknown, but any reduction is important to diminish selection pressure for antibiotic resistance, costs, and drug-related side-effects. The aim of this study was to investigate whether an algorithm based on procalcitonin (PCT) and quantitative pyuria reduces antibiotic exposure. METHODS From April 2012 to March 2014, we conducted a factorial design randomized controlled open-label trial. Immunocompetent adults with community-acquired non-catheter-related UTI were enrolled in the emergency department of a tertiary-care 600-bed hospital in northwestern Switzerland. Clinical presentation was used to guide initiation and duration of antibiotic therapy according to current guidelines (control group) or with a PCT-pyuria-based algorithm (PCT-pyuria group). The primary endpoint was overall antibiotic exposure within 90 days. Secondary endpoints included duration of the initial antibiotic therapy, persistent infection 7 days after end of therapy and 30 days after enrollment, recurrence and rehospitalizations within 90 days. RESULTS Overall, 394 patients were screened, 228 met predefined exclusion criteria, 30 declined to participate, and 11 were not eligible. Of these, 125 (76% women) were enrolled in the intention-to-treat (ITT) analysis and 96 patients with microbiologically confirmed UTI constituted the per protocol group; 84 of 125 (67%) patients had a febrile UTI, 28 (22%) had bacteremia, 5 (4%) died, and 3 (2%) were lost to follow-up. Overall antibiotic exposure within 90 days was shorter in the PCT-pyuria group than in the control group (median 7.0 [IQR, 5.0-14.0] vs. 10.0 [IQR, 7.0-16.0] days, P = 0.011) in the ITT analysis. Mortality, rates of persistent infections, recurrences, and rehospitalizations were not different. CONCLUSIONS A PCT-pyuria-based algorithm reduced antibiotic exposure by 30% when compared to current guidelines without apparent negative effects on clinical outcomes.
Collapse
Affiliation(s)
- Daniel Drozdov
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland. .,Division of Infectious Diseases, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Stefanie Schwarz
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Alexander Kutz
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Eva Grolimund
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Anna Christina Rast
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Deborah Steiner
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Katharina Regez
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Ursula Schild
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Merih Guglielmetti
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Antoinette Conca
- Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Barbara Reutlinger
- Department of Clinical Nursing Science, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Cornelia Ottiger
- Department of Laboratory Medicine, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Florian Buchkremer
- Division of Nephrology, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Sebastian Haubitz
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Claudine Blum
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Andreas Huber
- Department of Laboratory Medicine, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Ulrich Buergi
- Department of Emergency Medicine, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Philipp Schuetz
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Andreas Bock
- Division of Nephrology, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Christoph Andreas Fux
- Division of Infectious Diseases, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Beat Mueller
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland.
| | - Werner Christian Albrich
- Medical University Department, University of Basel, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland. .,Division of Infectious Diseases, Kantonsspital Aarau, Tellstrasse, Aarau, 5001, Switzerland. .,Department of Infectious Diseases and Hospital Epidemiology, Kantonsspital St. Gallen, Rorschacherstrasse 95, St. Gallen, 9007, Switzerland.
| |
Collapse
|
25
|
Efficient and cost-effective alternative treatment for recurrent urinary tract infections and interstitial cystitis in women: a two-case report. Case Rep Med 2014; 2014:698758. [PMID: 25587284 PMCID: PMC4283390 DOI: 10.1155/2014/698758] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 11/28/2014] [Indexed: 11/18/2022] Open
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections affecting women. UTIs are primarily caused by Escherichia coli, which increases the likelihood of a recurrent infection. We encountered two cases of recurrent UTIs (rUTIs) with a positive E. coli culture, not improving with antibiotics due to the development of antibiotic resistance. An alternative therapeutic regimen based on parsley and garlic, L-arginine, probiotics, and cranberry tablets has been given. This regimen showed a significant health improvement and symptoms relief without recurrence for more than 12 months. In conclusion, the case supports the concept of using alternative medicine in treating rUTI and as a prophylaxis or in patients who had developed antibiotic resistance.
Collapse
|
26
|
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]
|
27
|
Cervera C, van Delden C, Gavaldà J, Welte T, Akova M, Carratalà J. Multidrug-resistant bacteria in solid organ transplant recipients. Clin Microbiol Infect 2014; 20 Suppl 7:49-73. [DOI: 10.1111/1469-0691.12687] [Citation(s) in RCA: 110] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2014] [Revised: 05/16/2014] [Accepted: 05/18/2014] [Indexed: 12/23/2022]
|
28
|
Gupta K, Bhadelia N. Editorial commentary: including the X-factor: toward patient-centered prevention of urinary tract infection. Clin Infect Dis 2013; 58:161-3. [PMID: 24065332 DOI: 10.1093/cid/cit648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Kalpana Gupta
- Infectious Diseases, Veterans Affairs Boston Healthcare System, West Roxbury
| | | |
Collapse
|