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Klußmann D, Wagenlehner F. Rezidivierende Harnwegsinfektionen – was tun? Dtsch Med Wochenschr 2022; 147:1140-1145. [DOI: 10.1055/a-1866-9470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Was ist neu?
Nicht antibiotische Therapieregime Neben allgemeiner Aufklärung und Beratung über Risikofaktoren von Harnwegsinfektionen sind vor allem die nichtantibiotischen Therapie-Optionen zur Rezidivreduktion wichtig. Das Ziel hierbei ist es, Resistenzentwicklungen und den entsprechenden unerwünschten Nebenwirkungen von Antibiotika vorzubeugen. Zu den nicht antibiotischen Strategien zählen allen voran eine persönliche Beratung mit Vermittlung von Verhaltensempfehlungen, die Immunoprophylaxe, Phytotherapeutika, sowie eine lokale Östrogensubstitution
Antibiotische Prävention Bei hohem Leidensdruck der Patientinnen ist jedoch nach entsprechender Abwägung auch eine antibiotische Prophylaxe in Betracht zu ziehen. Zusammenfassend sollte eine individuelle Beratung erfolgen und es sollte mit einem multimodalen Therapieansatz behandelt werden.
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Affiliation(s)
- Daniel Klußmann
- Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
| | - Florian Wagenlehner
- Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
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Seneghini M, Albrich WC. [Non-antibiotic Prophylaxis of Infections]. PRAXIS 2022; 111:463-468. [PMID: 35673840 DOI: 10.1024/1661-8157/a003822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Non-antibiotic Prophylaxis of Infections Abstract. The increasing resistance to antibiotics makes the search for non-antibiotic alternatives for the treatment and prevention of - above all - respiratory and urinary tract infections crucial. Potential non-antibiotic approaches include phytopharmaceuticals (Echinacea purpurea, Pelargonium sidoides, cranberry extract), zinc, immunostimulants (OM-85 BV, OM-89), and behavior modifications. Some of these approaches are promising options; however, a high level of evidence is required before specific recommendations for their use can be made.
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Affiliation(s)
- Marco Seneghini
- Klinik für Infektiologie/Spitalhygiene, Kantonsspital St. Gallen, St. Gallen, Schweiz
| | - Werner C Albrich
- Klinik für Infektiologie/Spitalhygiene, Kantonsspital St. Gallen, St. Gallen, Schweiz
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Zare M, Vehreschild MJGT, Wagenlehner F. Management of uncomplicated recurrent urinary tract infections. BJU Int 2021; 129:668-678. [PMID: 34741796 DOI: 10.1111/bju.15630] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To discuss optimal management of recurrent urinary tract infections (UTIs) in women. About every second woman experiences at least one UTI in her lifetime, of those 30% experience another UTI, and 3% further recurrences. Especially young healthy women without underlying anatomical deficiencies suffer from recurrent UTIs (rUTI), which are associated with significant morbidity and reduction in quality of life. METHODS This is a narrative review, investigating publications dealing with recurrent UTI in women. Risk factors and options for management are discussed. RESULTS The increased susceptibility of women to rUTI is based on the female anatomy in addition to behavioural, genetic, and urological factors. However, why some women are more likely than others to develop and maintain rUTI remains to be clarified. Invasive characteristics of certain uropathogenic Escherichia coli that are able to form extra- and intracellular biofilms and may therefore cause delayed release of bacteria into the bladder, may play a role in this setting. Treatment recommendations for an acute episode of rUTI do not differ from those for isolated episodes. Given the nature of rUTI, different prophylactic approaches also play an important role. Women with rUTI should first be counselled to use non-antibiotic strategies including behavioural changes, anti-adhesive treatments, antiseptics, and immunomodulation, before antibiotic prophylaxis is considered. In addition to the traditional treatment and prophylactic therapies, new experimental strategies are emerging and show promising effects, such as faecal microbiota transfer (FMT), a treatment option that transfers microorganisms and metabolites of a healthy donor's faecal matter to patients using oral capsules, enemas, or endoscopy. Initial findings suggest that FMT might be a promising treatment approach to interrupt the cycle of rUTI. Furthermore, bacteriophages, infecting and replicating in bacteria, have been clinically trialled for UTIs. CONCLUSION Due to the limitation of available data, novel treatment options require further clinical research to objectify the potential in treating bacterial infections, particularly UTIs.
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Affiliation(s)
- Mary Zare
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Germany
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Faßl D, Wagenlehner F. [What to do about recurrent urinary tract infections]. Aktuelle Urol 2021; 52:255-259. [PMID: 33860479 DOI: 10.1055/a-1387-7515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urinary tract infections are among the most common bacterial infections. A significant proportion of urinary tract infections recur, which leads to impairments in patients' physical intimacy, social contacts and ability to work. The standardised ACSS questionnaire can provide help in establishing a diagnosis and assessing the course of the disease. In addition to general education and counselling on risk factors for urinary tract infections, non-antibiotic treatment options are particularly important for reducing recurrence. This aims to prevent the development of resistance to antibiotics and their undesirable side-effects. Non-antibiotic strategies most notably include personal counselling with communication of behavioural recommendations, immunoprophylaxis, phytotherapeutics and local oestrogen substitution. However, in cases of high patient suffering, antibiotic prophylaxis should also be considered after due deliberation. In summary, individual counselling should take place and treatment should be given in a multimodal therapeutic approach.
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Affiliation(s)
- Daniel Faßl
- Justus Liebig Universität Giessen Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Giessen
| | - Florian Wagenlehner
- Justus Liebig Universität Giessen Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Giessen
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Marcon J, Stief CG, Magistro G. [Urinary tract infections : What has been confirmed in therapy?]. Internist (Berl) 2017; 58:1242-1249. [PMID: 29038902 DOI: 10.1007/s00108-017-0340-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Urinary tract infections (UTIs) affect approximately 150 million people worldwide per year, causing annual health costs of over three billion dollars just in the USA. Every second woman experiences at least one UTI in her lifetime, with every one in four experiencing recurrence. Uncomplicated infections like single or recurrent cystitis and pyelonephritis can be distinguished from complicated disease. UTIs in men can spread to the male glands, causing prostatitis and epididymitis. Antibiotic therapy is the standard procedure for UTIs. However, the extensive and sometimes irrational use of antibiotics for the treatment of infections has led to an increase in the incidence of multiresistant pathogens in recent years. Therefore, preventive nonantibiotic approaches are of great interest. This article provides an overview of the current management of urological infections as well as an outline of nonantibiotic preventive treatment modalities.
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Affiliation(s)
- J Marcon
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland.
| | - C G Stief
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
| | - G Magistro
- Urologische Klinik und Poliklinik, Klinikum der Universität München - Campus Großhadern, Ludwig-Maximilians-Universität München, Marchioninistr. 15, 81377, München, Deutschland
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Lindstrom TC, Baerheim A, Flataas AS. Behaviour Modification Group-treatment of Children with Recurrent Lower Urinary Tract Infections. Scand J Caring Sci 2013. [DOI: 10.1111/j.1471-6712.2000.tb00594.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Litherland AT. Urinary tract infection: diabetic women's strategies for prevention. ACTA ACUST UNITED AC 2011; 20:791-2, 794-6. [DOI: 10.12968/bjon.2011.20.13.791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anne Torine Litherland
- Gynaecological outpatients ward, Vestfold Hospital HF, Norway and Master's student at Institute of Health & Society, Department of Nursing Science, University of Oslo, Norway
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Kuwahara H, Myers CJ, Samoilov MS. Temperature control of fimbriation circuit switch in uropathogenic Escherichia coli: quantitative analysis via automated model abstraction. PLoS Comput Biol 2010; 6:e1000723. [PMID: 20361050 PMCID: PMC2845655 DOI: 10.1371/journal.pcbi.1000723] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2008] [Accepted: 02/25/2010] [Indexed: 02/06/2023] Open
Abstract
Uropathogenic Escherichia coli (UPEC) represent the predominant cause of urinary tract infections (UTIs). A key UPEC molecular virulence mechanism is type 1 fimbriae, whose expression is controlled by the orientation of an invertible chromosomal DNA element-the fim switch. Temperature has been shown to act as a major regulator of fim switching behavior and is overall an important indicator as well as functional feature of many urologic diseases, including UPEC host-pathogen interaction dynamics. Given this panoptic physiological role of temperature during UTI progression and notable empirical challenges to its direct in vivo studies, in silico modeling of corresponding biochemical and biophysical mechanisms essential to UPEC pathogenicity may significantly aid our understanding of the underlying disease processes. However, rigorous computational analysis of biological systems, such as fim switch temperature control circuit, has hereto presented a notoriously demanding problem due to both the substantial complexity of the gene regulatory networks involved as well as their often characteristically discrete and stochastic dynamics. To address these issues, we have developed an approach that enables automated multiscale abstraction of biological system descriptions based on reaction kinetics. Implemented as a computational tool, this method has allowed us to efficiently analyze the modular organization and behavior of the E. coli fimbriation switch circuit at different temperature settings, thus facilitating new insights into this mode of UPEC molecular virulence regulation. In particular, our results suggest that, with respect to its role in shutting down fimbriae expression, the primary function of FimB recombinase may be to effect a controlled down-regulation (rather than increase) of the ON-to-OFF fim switching rate via temperature-dependent suppression of competing dynamics mediated by recombinase FimE. Our computational analysis further implies that this down-regulation mechanism could be particularly significant inside the host environment, thus potentially contributing further understanding toward the development of novel therapeutic approaches to UPEC-caused UTIs.
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Affiliation(s)
- Hiroyuki Kuwahara
- Ray and Stephanie Lane Center for Computational Biology, Carnegie Mellon University, Pittsburgh, Pennsylvania, United States of America
| | - Chris J. Myers
- Department of Electrical and Computer Engineering, University of Utah, Salt Lake City, Utah, United States of America
| | - Michael S. Samoilov
- QB3: California Institute for Quantitative Biosciences, University of California, Berkeley, Berkeley, California, United States of America
- * E-mail:
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Vahlensieck W, Bauer H. [Prevention and alternative methods for prophylaxis of recurrent urinary tract infections in women]. Urologe A 2006; 45:443-4, 446-50. [PMID: 16541289 DOI: 10.1007/s00120-006-1013-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
General recommendations to prevent recurrent urinary tract infections (rUTI) result in about one-third of patients remaining free of recurrences. Oral and parenteral immunotherapy were effective in several controlled studies for prevention of rUTI. These therapies can be combined with acute antibiotic therapy. Vaginal prophylaxis with oestriol has proven its positive effect without serious gynaecological side effects. Also there is increasing evidence that cranberries prevent rUTI. The exact mode (juice, tablets or preserved berries), dosage and duration of this therapy remain to be defined. There are also promising therapy modalities such as changing bacterial gut flora, general immune response (acupuncture, inpatient rehabilitation) and urine acidity.
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Affiliation(s)
- W Vahlensieck
- Abteilung Urologie-Onkologie-Nephrologie, Klink Wildetal, Mühlenstrasse 8, 34537 Bad Wildungen.
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Abstract
The basis for the diagnostic work-up of recurrent cystitis is formed by taking a precise medical history against the background of knowledge of the pathogenesis of urinary tract infections. The anamnesis should also focus on factors that influence the natural flora (sexual intercourse, hygiene) but additionally include preceding antibiotic treatment and diseases that affect the immune status (diabetes mellitus). Urinalysis is the principal examination among the laboratory diagnostic procedures. The diagnosis is promptly confirmed by immediate analysis of a clean catch midstream urine sample using a counting chamber or a test strip. As a matter of principle, microbiological diagnosis always ensues. Extended diagnostic work-up (urological staging) is aimed at detecting functional and anatomic abnormalities. While these factors only play a subordinate role during the premenopausal phase, they gain in importance during the postmenopausal phase. A key role is also attributed to local estrogen deficiency.
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Affiliation(s)
- T Bruns
- Urologische Praxisgemeinschaft, Blankeneser Bahnhofstrasse 15, 22587 Hamburg.
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Foxman B, Brown P. Epidemiology of urinary tract infections: transmission and risk factors, incidence, and costs. Infect Dis Clin North Am 2003; 17:227-41. [PMID: 12848468 DOI: 10.1016/s0891-5520(03)00005-9] [Citation(s) in RCA: 347] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Uropathogenic E. coli have special features that allow them to take advantage of the bladder environment. There UPEC can grow to substantial numbers in pure culture that are shed frequently into the environment and have a high probability of transmission to other hosts. A better understanding of the transmission system and the host and bacterial factors influencing transmission is essential for the identification of effective prevention strategies. Although the risk of severe morbidity among otherwise healthy populations is low, the incidence is high. Further, the potential impact of antibiotic treatment on the emergence of increasingly antibiotic-resistant UPEC (the resistant mechanisms that may be transmitted to other bowel inhabitants) is high. The benefits of successfully preventing UTI are substantial.
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Affiliation(s)
- Betsy Foxman
- Department of Epidemiology, Center for Molecular and Clinical Epidemiology of Infectious Diseases, University of Michigan School of Public Health, 109 Observatory Street, Ann Arbor, MI 48109-2029, USA.
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Foxman B, Somsel P, Tallman P, Gillespie B, Raz R, Colodner R, Kandula D, Sobel JD. Urinary tract infection among women aged 40 to 65: behavioral and sexual risk factors. J Clin Epidemiol 2001; 54:710-8. [PMID: 11438412 DOI: 10.1016/s0895-4356(00)00352-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We conducted a case-control study to explore the role of health behavior and sexual and medical history on urinary tract infection (UTI) risk among otherwise healthy women aged 40-65. Cases and controls were recruited from nine practices and clinics in Michigan and a single clinic in Israel. In both countries, several factors were reported significantly more frequently among UTI cases than controls: a previous UTI within 12 months, incontinence symptoms, a recent episode of 30-plus minutes of cold hands, feet, back or buttocks, and recent antibiotic use. Cases were less likely than controls to report recent estrogen use, but the results were only statistically significant in Michigan. Sexual activity during the previous 2 weeks and having ceased menses were modestly, but not statistically significantly, protective at both study sites. Risk factors for UTI among women 40-65 differ from those for younger women and these differences cannot be attributed solely to changes in menopausal status.
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Affiliation(s)
- B Foxman
- Department of Epidemiology, University of Michigan School of Public Health, 109 Observatory St., Ann Arbor, MI 48109, USA.
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Alraek T, Aune A, Baerheim A. Traditional Chinese medicine syndromes in women with frequently recurring cystitis: frequencies of syndromes and symptoms. Complement Ther Med 2000; 8:260-5. [PMID: 11098202 DOI: 10.1054/ctim.2000.0399] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Frequently recurrent acute cystitis in adult women is common in Western medicine. In prophylactic treatment, women are treated between attacks of acute cystitis to prevent recurrences. A recent study has shown that acupuncture seems effective for prophylaxis. OBJECTIVES To describe the frequency of traditional Chinese medicine (TCM) syndromes found in females vulnerable to recurrent cystitis, and which symptoms most often form the basis for TCM diagnoses made in this condition. METHODS A descriptive study based on TCM diagnostic methods as used by experienced acupuncturists, and a questionnaire of symptoms used in TCM diagnostics. RESULTS Of 61 women with frequently recurring cystitis, 90% were diagnosed as having either a Spleen/Kidney yang xu/qi xu (54%), or a Liver qi stagnation (36%). Only 10% fell in other diagnostic groups. Of all symptoms noted, only three differed in frequency between the two main diagnostic groups: feeling cold (29/33 vs. 13/22, P<0.05), feeling tired (25/33 vs. 4/22, P<0.001), and having a preference for sweets (10/33 vs. 2/22, P<0.05). CONCLUSION Our findings have implications for TCM-based diagnostic work in females with recurrent cystitis, and also indicate that recurrent cystitis may be used as a case for further TCM research.
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Affiliation(s)
- T Alraek
- Bryggen Medical Centre, Bergen, Norway.
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Kiser WR, Nusbaum MR, Ellis D, Runkle G, Kugler J. Symptomatic lower urinary tract infection induced by cooling of the feet. Scand J Prim Health Care 1993; 11:289-90. [PMID: 8146514 DOI: 10.3109/02813439308994846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
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