Why D-Mannose May Be as Efficient as Antibiotics in the Treatment of Acute Uncomplicated Lower Urinary Tract Infections—Preliminary Considerations and Conclusions from a Non-Interventional Study

Antibiotics Usage and Avoidance in Germany and Poland: Attitudes and Knowledge of Patients, Physicians, and Pharmacists

Introduction: Antimicrobial resistance poses a significant global health threat, partly due to the overprescription of antibiotics. Understanding prescribers' behaviors and identifying knowledge gaps and misconceptions are essential for addressing antibiotic misuse and inappropriate use. Methods: Through online questionnaires, this study surveyed key stakeholders in outpatient antibiotic use in Germany (DE) and Poland (PL), including patients, physicians, and pharmacists. Results: Despite generally good knowledge about antibiotics, discrepancies exist between physicians' perceptions and patients' actual expectations regarding antibiotic prescriptions. Physicians often misjudge patients' attitudes toward antibiotics, with many patients having a neutral stance. This study found a strong physician interest in non-antibiotic treatments and patient willingness to engage with information about antibiotics. Conclusions: Improved communication between healthcare providers and patients was identified as a potential measure for enhancing antimicrobial stewardship, with education on effective alternative treatments, such as symptomatic therapies, as a likely strategy to reduce antibiotic reliance.

Gaps in knowledge and recurrent urinary tract infections in women

PURPOSE OF REVIEW

The focus of this review is to present recent literature and gaps in knowledge (GIKs) surrounding the current and future treatment and prevention of uncomplicated recurrent urinary tract infections (rUTIs) in women.

RECENT FINDINGS

Recurrent urinary tract infections are common, significantly reduce quality of life, and create a substantial economic burden to the healthcare system. They are disproportionately affecting the postmenopausal women. Antibiotics, which are used for the treatment and prophylaxis of uncomplicated rUTI, have become problematic, as there is a global rise in allergy and resistance to these agents and their use is associated with further antimicrobial resistance. Thus, in recent decades, several alternative, nonantibiotic approaches have been evaluated.

SUMMARY

There is a critical need for a concerted and standardized methodology for diagnosing, treating, and monitoring women with rUTIs. Additionally, novel nonantibiotic alternative treatment and preventive measures for UTIs are desperately required to address the global issue of antibiotic recalcitrance in all age groups, and specifically older women. Research efforts have sought to develop alternative and more effective techniques; many of which appear to be promising, but require additional evaluation and validation through clinical trials.

Aspilia africana (Pers.) C.D. Adams and Manihot esculenta Crantz Exhibit Antibacterial Activity against Resistant Salmonella typhi Strains

Typhoid fever, caused by Salmonella typhi, has plagued underdeveloped countries for many years. Recently, there has been a surge in S. typhi strains identified to be multidrug-resistant in endemic areas. Aspilia africana and Manihot esculenta have been reported to exhibit activity against S. typhi; however, this study aimed to investigate the effect of A. africana and M. esculenta against resistance strains of S. typhi. The leaves of the plants were extracted using distilled water (hot (AQH) and cold (AQC)), methanol (MET), ethyl acetate, and petroleum ether. The extracts were screened in vitro for anti-Salmonella effects against fourteen S. typhi isolates (five multidrug-resistant (MDRST), five ciprofloxacin-resistant (CRST), three nalidixic acid-resistant (NARST), and one sensitive isolate (SS)) using agar well diffusion and microbroth dilution methods. Phytochemical screening showed the presence of tannins, saponins, glycosides, and flavonoids in all polar solvent extracts. Alkaloids were found in all extracts, while triterpenoids were present in all except the aqueous extracts. The AQC of A. africana had the best inhibitory effect on the MDRST and NARST with diameter zones of inhibitions (DZOIs) of 40.0 ± 2.08 mm and 34.0 ± 3.22 mm, respectively. Methanol extract of A. africana had the best inhibitory effect on CRST and SS with DZOIs of 34.0 ± 2.08 and 43.0 ± 3.06 mm, respectively. The AQC and AQH of A. africana and AQH of M. esculenta produced the best MICs and MBCs of 2.5 and 5.0 mg/mL against the MDRST. There was no significant difference in ZOIs of the different solvent extracts against test organisms at p < 0.05. Gas chromatography-mass spectrometry analysis of the extracts showed compounds such as n-hexadecanoic acid, 9,12,15-octadecatrienoic acid (9.55%), and 2H-benzo[F]oxireno[2,3-E]benzofuran-8(9H)-one in the A. Africana extracts and D-mannose, 3-nitrophenyl, methanol acetate (ester), and 9-octadecenamide in the M. esculenta extracts. The leaves of M. esculenta and A. Africana are effective against multidrug-resistant Salmonella isolates.

Biochemical changes in lipid and protein metabolism caused by mannose-Raman spectroscopy studies

Biochemical analysis of human normal bronchial cells (BEpiC) and human cancer lung cells (A549) has been performed by using Raman spectroscopy and Raman imaging. Our approach provides a biochemical compositional mapping of the main cell components: nucleus, mitochondria, lipid droplets, endoplasmic reticulum, cytoplasm and cell membrane. We proved that Raman spectroscopy and Raman imaging can distinguish successfully BEpiC and A549 cells. In this study, we have focused on the role of mannose in cancer development. It has been shown that changes in the concentration of mannose can regulate some metabolic processes in cells. Presented results suggest lipids and proteins can be considered as Raman biomarkers during lung cancer progression. Analysis obtained for bands 1444 cm-1, and 2854 cm-1 characteristic for lipids and derivatives proved that the addition of mannose reduced levels of these compounds. Results obtained for protein compounds based on bands 858 cm-1, 1004 cm-1 and 1584 cm-1 proved that the addition of mannose increases the values of protein in BEpiC cells and blocks protein glycolisation in A549 cells. Noticing Raman spectral changes in BEpiC and A549 cells supplemented with mannose can help to understand the mechanism of sugar metabolism during cancer development and could play in the future an important role in clinical treatment.

Therapeutic strategies for uncomplicated cystitis in women

Uncomplicated cystitis is affecting many women of all ages and has a great impact on the quality of life, especially in women suffering from recurrent, uncomplicated cystitis. By far the most frequent uropathogen, E. coli, may have acquired increasing resistance against a variety of oral antibiotics, which may differ between countries and regions. Therefore, local resistance data are important to be considered. On the other hand, non-antibiotic therapy has also become an option which should be discussed and offered to the patient. In patients suffering from recurrent uncomplicated cystitis, individual risk factors and possible behavioral changes should first be taken into account. Non-antimicrobial prophylactic strategies shown to be successful in well-designed clinical studies are the next options. Long term antibiotic prophylaxis, however, should only be considered as a last option. For some of those patients self-diagnosis and self-treatment may be suitable, e.g. by using a recognized questionnaire.

Genetic and functional enrichments associated with Enterococcus faecalis isolated from the urinary tract

IMPORTANCE

Urinary tract infection (UTI) is a global health issue that imposes a substantial burden on healthcare systems. Women are disproportionately affected by UTI, with >60% of women experiencing at least one UTI in their lifetime. UTIs can recur, particularly in postmenopausal women, leading to diminished quality of life and potentially life-threatening complications. Understanding how pathogens colonize and survive in the urinary tract is necessary to identify new therapeutic targets that are urgently needed due to rising rates of antimicrobial resistance. How Enterococcus faecalis, a bacterium commonly associated with UTI, adapts to the urinary tract remains understudied. Here, we generated a collection of high-quality closed genome assemblies of clinical urinary E. faecalis isolated from the urine of postmenopausal women that we used alongside detailed clinical metadata to perform a robust comparative genomic investigation of genetic factors that may be involved in E. faecalis survival in the urinary tract.

New avenue of diagnostic stewardship: procedural stewardship for recurrent urinary tract infections in female patients

Introduction

Societal guidelines offer a weak recommendation to perform cystoscopy for female patients with recurrent urinary tract infections (rUTI) of advanced age and/or with high-risk features. These guidelines lack the support of robust data and are instead based on expert opinion. In this retrospective cohort study, we aim to determine the utility of cystoscopy in patients with and without high-risk features for rUTI.

Materials and methods

We identified 476 women who underwent cystoscopy for the evaluation of rUTI at a single tertiary academic medical center from May 1, 2015 and March 15, 2021. Patients were excluded if they had a competing indication for cystoscopy. Risk factors, demographic information, cystoscopic findings, and patient outcomes were analyzed.

Results

192 (41.1%) were classified as having complicated UTI. We identified six patients (1.3%) with findings that prompted management to significantly impact patient outcomes. All six patients had high-risk features. 14 patients (3.0%) were found to have mucosal abnormalities prompting biopsy, three of which required general anesthesia. All 14 biopsies were ultimately benign.

Conclusions

Our findings demonstrate a low diagnostic yield and increased risk exposure for women undergoing cystoscopy for the evaluation of complicated rUTI. Additionally, our observations support prior studies indicating that cystoscopy has limited utility in the evaluation of rUTI without high-risk features.

Mannose: a potential saccharide candidate in disease management

There are a plethora of antibiotic resistance cases and humans are marching towards another big survival test of evolution along with drastic climate change and infectious diseases. Ever since the first antibiotic [penicillin], and the myriad of vaccines, we were privileged to escape many infectious disease threats. The survival technique of pathogens seems rapidly changing and sometimes mimicking our own systems in such a perfect manner that we are left unarmed against them. Apart from searching for natural alternatives, repurposing existing drugs more effectively is becoming a familiar approach to new therapeutic opportunities. The ingenious use of revolutionary artificial intelligence-enabled drug discovery techniques is coping with the speed of such alterations. D-Mannose is a great hope as a nutraceutical in drug discovery, against CDG, diabetes, obesity, lung disease, and autoimmune diseases and recent findings of anti-tumor activity make it interesting along with its role in drug delivery enhancing techniques. A very unique work done in the present investigation is the collection of data from the ChEMBL database and presenting the targetable proteins on pathogens as well as on humans. It shows Mannose has 50 targets and the majority of them are on human beings. The structure and conformation of certain monosaccharides have a decisive role in receptor pathogen interactions and here we attempt to review the multifaceted roles of Mannose sugar, its targets associated with different diseases, as a natural molecule having many success stories as a drug and future hope for disease management.

Graphical abstract

Management of Acute Cystitis in the Era of COVID-19

Purpose of Review

No specific guidelines have been developed for acute cystitis management during the COVID-19 pandemic. This review aims to provide up-to-date information about treatment and follow-up in patients with symptoms suggesting lower urinary tract infection.

Recent Findings

Uncomplicated cystitis does not need microbiological confirmation; thus, clinical diagnosis via telephone interview or questionnaires may be done. When complicated infections are suspected, in-person evaluation or close follow-up is mandatory. Antibiotic treatment is still the gold standard for treatment, although non-pharmacological strategies have also been suggested and further investigations are warranted.

Summary

Urinary tract infections are still a frequent reason for consultation that needs to be addressed in both primary care and specialized levels. Their management during the pandemic is similar than in precedent years, but telehealth options have emerged which can facilitate diagnosis and treatment.