1
|
Merenstein DJ, Tancredi DJ, Karl JP, Krist AH, Lenoir-Wijnkoop I, Reid G, Roos S, Szajewska H, Sanders ME. Is there evidence to support probiotic use for healthy people? Adv Nutr 2024:100265. [PMID: 38977065 DOI: 10.1016/j.advnut.2024.100265] [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: 03/26/2024] [Revised: 06/26/2024] [Accepted: 07/02/2024] [Indexed: 07/10/2024] Open
Abstract
Probiotics are typically marketed as foods and dietary supplements, categories for products intended to maintain health in generally healthy populations and which, unlike drugs, cannot claim to treat or cure disease. This review addresses the existing evidence that probiotics are beneficial to healthy people. Our approach was to perform a descriptive review of efficacy evidence that probiotics can prevent urinary, vaginal, gastrointestinal, and respiratory infections, and improve risk factors associated with cardiovascular health or reduce antibiotic use. Other endpoints such as mental, dental or immune health were not specifically addressed. We concluded that there is sufficient evidence of efficacy and safety for clinicians and consumers to consider using specific probiotics for some indications - such as use probiotics to support gut function during antibiotic use - for certain people. However, we did not find a high level of evidence to support recommendations for other endpoints we reviewed for healthy people. Although evidence for some indications is suggestive of preventive benefits of probiotics, additional research is needed.
Collapse
Affiliation(s)
- Daniel J Merenstein
- Georgetown University Medical Center, Department of Family Medicine, Washington, DC, USA
| | | | - J Philip Karl
- Military Nutrition Division, United States Army Research Institute of Environmental Medicine, Natick, MA, USA.
| | - Alex H Krist
- Department of Family Medicine and Population Health, Virginia Commonwealth University.
| | - Irene Lenoir-Wijnkoop
- Department of Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands.
| | - Gregor Reid
- Departments of Microbiology & Immunology and Surgery, Western University, Canada.
| | - Stefan Roos
- Swedish University of Agricultural Sciences, Uppsala BioCenter, The Department of Molecular Sciences, Uppsala, Sweden; BioGaia AB, Stockholm, Sweden.
| | - Hania Szajewska
- The Medical University of Warsaw, Department of Paediatrics, Warsaw, Poland.
| | - Mary Ellen Sanders
- International Scientific Association for Probiotics and Prebiotics, 7119 S. Glencoe Ct., Centennial CO, 80122 USA.
| |
Collapse
|
2
|
Chen YC, Kuo HC. Risk factors of video urodynamics and bladder management for long-term complications in patients with chronic spinal cord injury. Sci Rep 2024; 14:12632. [PMID: 38824225 PMCID: PMC11144236 DOI: 10.1038/s41598-024-63441-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Accepted: 05/29/2024] [Indexed: 06/03/2024] Open
Abstract
This study explores 15-year urological complications in chronic spinal cord injury (SCI) patients and investigates the predictive factors from video-urodynamic study (VUDS) and bladder management. Analyzing 864 SCI patients with a mean 15.6-year follow-up, we assessed complications and utilized multivariate logistic regression for risk evaluation. VUDS factors such as autonomic dysreflexia, detrusor sphincter dyssynergia, vesicourethral reflux (VUR), contracted bladder, and high voiding detrusor pressure significantly increased the likelihood of recurrent urinary tract infections (rUTI). Low bladder compliance, VUR, and contracted bladder notably raised the risk of hydronephrosis, while contracted bladder and detrusor overactivity with detrusor underactivity heightened chronic kidney disease risk. Volitional voiding reduced rUTI and VUR risk, whereas Valsalva maneuver-assisted voiding increased hydronephrosis risk. In conclusion, a contracted bladder identified in VUDS is associated with long-term urological complications in SCI, we propose that patients already experiencing a contracted bladder should prioritize volitional voiding as their preferred bladder management strategy to minimize the risk of additional complications such as rUTI and VUR. These findings unveil previously unexplored aspects in research, emphasizing the need for proactive management strategies in this patient population.
Collapse
Affiliation(s)
- Yu-Chen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Tzu Chi University, No.707 Sec.3, Zhongyang Rd., Hualien City, 970473, Taiwan (R.O.C.).
| |
Collapse
|
3
|
GU X, QIU M, XIE L, CHEN M, DENG Y, ZHANG C, JIAN G, WANG C, WANG Y. Individualized Traditional Chinese Medicine treatment antibiotics for recurrent urinary tract infections: a multicenter, randomized controlled study. J TRADIT CHIN MED 2024; 44:524-529. [PMID: 38767636 PMCID: PMC11077146 DOI: 10.19852/j.cnki.jtcm.20231024.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 06/15/2023] [Indexed: 05/22/2024]
Abstract
OBJECTIVE To systematically assess the effects of individualized Chinese medicines on recurrent urinary tract infections (rUTIs). METHODS This study recruited 230 adult female patients in the remission phase of rUTIs from five hospitals in China. The patients were randomly allocated to two groups: an individualized Chinese medicine group (n = 114) and a control group (n = 116). Patients in the Chinese medicine group received individualized Chinese herbs, which were evaluated for syndrome differentiation. Patients in the control group received antibiotic treatment combined with a Chinese medicine placebo. The duration of treatment was three courses of four weeks each, with a three-month subsequent follow-up. UTI recurrence rate, Traditional Chinese Medicine (TCM) syndrome scores, 36-item Short Form Survey (SF-36) score, and urine secretory immunoglobulin A (SIgA) were measured and analyzed before and after treatment in each group. RESULTS Patients from the Chinese medicine group exhibited significant decreases in both short- and long-term UTI recurrence rates compared with the control group (P < 0.05). The changes in TCM syndrome scores between the Chinese medicine and control groups were significant (P < 0.05). The changes in the average SF-36 quality-of-life scores in the Chinese medicine group were also significantly higher than those in the control group after treatment (P < 0.05). The Chinese medicine group also demonstrated a significant increase in urine SIgA expression. CONCLUSION Taken together, compared to the often-used long-term antimicrobial prophylaxis during the remission stage of rUTIs, treating patients with an individualized Chinese medicine decoction by syndrome differentiation could effectively reduce the recurrence rate, improve the patients' TCM syndrome scores and quality of life, and enhance immunity, which in turn helps to prevent antibiotic resistance.
Collapse
Affiliation(s)
- Xiangchen GU
- 1 Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Meisi QIU
- 2 Department of Nephrology, Rizhao Hospital of Traditional Chinese Medicine, Rizhao 276800, China; Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Lin XIE
- 1 Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Min CHEN
- 1 Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| | - Yueyi DENG
- 3 Department of Nephrology, Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
| | - Changming ZHANG
- 4 Department of Nephrology, Shanghai Municipal Traditional Chinese Medicine Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200071, China
| | - Guihua JIAN
- 5 Department of Nephrology, the Sixth People's Hospital Affiliated Shanghai Jiaotong University, Shanghai 200233, China
| | - Chen WANG
- 6 Department of Nephrology, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Yi WANG
- 1 Department of Nephrology, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China
| |
Collapse
|
4
|
Mossack S, Spellman AM, Lagalbo SA, Santos CA, Peev V, Saltzberg S, Chan E, Olaitan O. Outcomes of Bladder Washout for the Treatment of Recurrent Urinary Tract Infections After Renal Transplantation. Cureus 2024; 16:e58556. [PMID: 38765422 PMCID: PMC11102097 DOI: 10.7759/cureus.58556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 05/22/2024] Open
Abstract
Background Current literature suggests that anywhere from 2.9-27% of renal transplant recipients (RTR) will develop recurrent urinary tract infections (UTIs) (≥2 UTIs over six months or ≥3 UTIs over 12 months). Recurrent UTIs are of particular importance to RTR given its increased risk for allograft fibrosis and overall patient survival. Alternative solutions are needed for the management of recurrent UTIs, especially given the vulnerability of RTR to UTIs. We hypothesize that bladder washout (BW) reduces the incidence and recurrence of UTIs in RTR. Methods This is a retrospective study evaluating the utility of BW procedures on RTR diagnosed with recurrent UTIs between December 2013 and July 2021 at a single center. Results A total of 106 patients were included in the study with a total of 118 BW performed. 69% of patients were successfully treated with BW, meaning they no longer met the criteria for recurrent UTIs (<1 UTI) in the six-month post-BW period. The mean number of UTIs was 2.76 (range 2-7) before the BW and 1.16 (range 0-5) after the BW. On average, there were 1.60 fewer UTIs in the post-BW period compared to the pre-BW period (p<0.0001). There is no statistically significant difference in success rates stratified by bacterial class (p=1) or antimicrobial resistance class (p=0.6937). Conclusion BW decreased the incidence of UTIs in the six-month post-operative period as nearly 70% of patients did not have UTI recurrence. This data provides evidence that BW may have utility in transplant recipients with recurrent UTIs. We hope this will stimulate further prospective randomized studies in this area.
Collapse
Affiliation(s)
| | | | | | - Carlos A Santos
- Infectious Disease, Rush University Medical Center, Chicago, USA
| | - Vasil Peev
- Nephrology, Rush University Medical Center, Chicago, USA
| | | | - Edie Chan
- Transplantation, Rush University Medical Center, Chicago, USA
| | | |
Collapse
|
5
|
Kwak Y, Kim HG, Seok J, Kim S, Kim EM, Kim A. The Critical Role of Intracellular Bacterial Communities in Uncomplicated Recurrent Urinary Cystitis: A Comprehensive Review of Detection Methods and Diagnostic Potential. Int Neurourol J 2024; 28:4-10. [PMID: 38569615 PMCID: PMC10990762 DOI: 10.5213/inj.2448066.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 03/06/2024] [Indexed: 04/05/2024] Open
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections worldwide and are particularly prevalent in women. Recurrent UTIs significantly diminish quality of life due to their symptoms and frequent relapses. Patients often experience immediate relapse following slightly strenuous activities or intense psychological stress. In this review, we explore why infections persist despite the advent of various treatments and suggest strategies to manage recurrent cystitis by targeting the mechanisms of adhesion and infection. Vitamin D levels and the expression of neutrophil gelatinase-associated lipocalin are linked to the recurrence of UTIs. During a UTI, bacteria employ adhesins to invade the urinary tract, adhere to urothelial cells, and then penetrate these cells, where they rapidly multiply to establish intracellular bacterial communities. Bacteria can also form quiescent intracellular reservoirs that escape immune responses and antibiotic treatments, leading to recurrence under certain conditions. The surface proteins of bacteria and D-mannose are crucial in the adhesion of bacteria to the urothelium. Understanding these processes provides valuable insights into potential therapeutic approaches that focus on preventing bacterial attachment and cluster formation. By disrupting the ability of bacteria to adhere to and form clusters on cells, we can better manage recurrent UTIs and improve patient outcomes.
Collapse
Affiliation(s)
- Yeonjoo Kwak
- Department of Stem Cell & Regenerative Biotechnology, Institute of Advanced Regenerative Science, Konkuk University, Seoul, Korea
| | - Hyeong Gon Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Jaekwon Seok
- Department of Stem Cell & Regenerative Biotechnology, Institute of Advanced Regenerative Science, Konkuk University, Seoul, Korea
| | - Sehwan Kim
- Department of Biomedical Engineering, School of Medicine, Dankook University, Cheonan, Korea
| | - Eun-Mee Kim
- Department of Paramedicine, Korea Nazarene University, Cheonan, Korea
| | - Aram Kim
- Department of Urology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
- University of California, Irvine, Beckman Laser Institute and Medical Clinic, Irvine, CA, USA
| |
Collapse
|
6
|
Sharon BM, Arute AP, Nguyen A, Tiwari S, Reddy Bonthu SS, Hulyalkar NV, Neugent ML, Palacios Araya D, Dillon NA, Zimmern PE, Palmer KL, De Nisco NJ. Genetic and functional enrichments associated with Enterococcus faecalis isolated from the urinary tract. mBio 2023; 14:e0251523. [PMID: 37962362 PMCID: PMC10746210 DOI: 10.1128/mbio.02515-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 10/05/2023] [Indexed: 11/15/2023] Open
Abstract
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.
Collapse
Affiliation(s)
- Belle M. Sharon
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Amanda P. Arute
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Amber Nguyen
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Suman Tiwari
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | | | - Neha V. Hulyalkar
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Michael L. Neugent
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Dennise Palacios Araya
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Nicholas A. Dillon
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Philippe E. Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kelli L. Palmer
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
| | - Nicole J. De Nisco
- Department of Biological Sciences, University of Texas at Dallas, Richardson, Texas, USA
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| |
Collapse
|
7
|
Kao CY, Zhang YZ, Yang DC, Chen PK, Teng CH, Lin WH, Wang MC. Characterization of host and escherichia coli strains causing recurrent urinary tract infections based on molecular typing. BMC Microbiol 2023; 23:90. [PMID: 36997841 PMCID: PMC10061793 DOI: 10.1186/s12866-023-02820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/11/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Escherichia coli is the leading pathogen responsible for urinary tract infection (UTI) and recurrent UTI (RUTI). Few studies have dealt with the characterization of host and bacteria in RUTI caused by E. coli with genetically identical or different strains. This study aimed to investigate the host and bacterial characteristics of E. coli RUTI based on molecular typing. RESULTS Patients aged 20 years or above who presented with symptoms of UTI in emergency department or outpatient clinics between August 2009 and December 2010 were enrolled. RUTI was defined as patients had 2 or more infections in 6 months or 3 or more in 12 months during the study period. Host factors (including age, gender, anatomical/functional defect, and immune dysfunction) and bacterial factors (including phylogenicity, virulence genes, and antimicrobial resistance) were included for analysis. There were 41 patients (41%) with 91 episodes of E. coli RUTI with highly related PFGE (HRPFGE) pattern (pattern similarity > 85%) and 58 (59%) patients with 137 episodes of E. coli RUTI with different molecular typing (DMT) pattern, respectively. There was a higher prevalence of phylogenetic group B2 and neuA and usp genes in HRPFGE group if the first episode of RUTI caused by HRPFGE E. coli strains and all episodes of RUTI caused by DMT E. coli strains were included for comparison. The uropathogenic E. coli (UPEC) strains in RUTI were more virulent in female gender, age < 20 years, neither anatomical/ functional defect nor immune dysfunction, and phylogenetic group B2. There were correlations among prior antibiotic therapy within 3 months and subsequent antimicrobial resistance in HRPFGE E. coli RUTI. The use of fluoroquinolones was more likely associated with subsequent antimicrobial resistance in most types of antibiotics. CONCLUSIONS This study demonstrated that the uropathogens in RUTI were more virulent in genetically highly-related E. coli strains. Higher bacterial virulence in young age group (< 20 years) and patients with neither anatomical/functional defect nor immune dysfunction suggests that virulent UPEC strains are needed for the development of RUTI in healthy populations. Prior antibiotic therapy, especially the fluoroquinolones, within 3 months could induce subsequent antimicrobial resistance in genetically highly-related E. coli RUTI.
Collapse
Affiliation(s)
- Cheng-Yen Kao
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Zheng Zhang
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Deng-Chi Yang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pek Kee Chen
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Hao Teng
- Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Hung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
| |
Collapse
|
8
|
Revitt‐Mills SA, Wright EK, Vereker M, O'Flaherty C, McPherson F, Dawson C, van Oijen AM, Robinson A. Defects in DNA double‐strand break repair resensitize antibiotic‐resistant
Escherichia coli
to multiple bactericidal antibiotics. Microbiologyopen 2022; 11:e1316. [PMCID: PMC9500592 DOI: 10.1002/mbo3.1316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Revised: 09/03/2022] [Accepted: 09/03/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Sarah A. Revitt‐Mills
- School of Chemistry and Molecular Bioscience, Molecular Horizons Institute University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| | - Elizabeth K. Wright
- School of Chemistry and Molecular Bioscience, Molecular Horizons Institute University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| | - Madaline Vereker
- School of Chemistry and Molecular Bioscience, Molecular Horizons Institute University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| | - Callum O'Flaherty
- School of Chemistry and Molecular Bioscience, Molecular Horizons Institute University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| | - Fairley McPherson
- School of Chemistry and Molecular Bioscience, Molecular Horizons Institute University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| | - Catherine Dawson
- School of Chemistry and Molecular Bioscience, Molecular Horizons Institute University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| | - Antoine M. van Oijen
- School of Chemistry and Molecular Bioscience, Molecular Horizons Institute University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| | - Andrew Robinson
- School of Chemistry and Molecular Bioscience, Molecular Horizons Institute University of Wollongong Wollongong New South Wales Australia
- Illawarra Health and Medical Research Institute Wollongong New South Wales Australia
| |
Collapse
|
9
|
Li T, Xu Y, Yuan G, Lu W, Jian G, Gong X. Efficacy and safety of tailin formulation combined with continuous low-dose antibiotic therapy in patients with recurrent urinary tract infection: A multicenter, randomized, controlled clinical trial. Front Pharmacol 2022; 13:968980. [PMID: 36188617 PMCID: PMC9515503 DOI: 10.3389/fphar.2022.968980] [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: 06/14/2022] [Accepted: 08/22/2022] [Indexed: 11/13/2022] Open
Abstract
Persistent inflammation associated with recurrent urinary tract infection (rUTI) is a crucial inducement of inflammation-driven renal fibrosis (IDRF). Although continuous low-dose antibiotic therapy (CLAT) is the common treatment for rUTI, its clinical efficacy remains unsatisfactory. Tailin formulation (TLF), a Chinese herbal formulation prescribed for treating rUTI, is effective in alleviating symptoms and reducing recurrence. This study was to evaluate the efficacy and safety of TLF combined with CLAT compared with CLAT used alone in patients with rUTI. In this multicenter, randomized, controlled clinical trial, patients were assigned (1:1) to receive either TLF + CLAT or CLAT for 12 weeks. The primary outcome was the effective rate at week 12 of the treatment. The secondary outcomes were the recurrent rate at week 4 and week 12 post treatment; the post-treatment changes in renal tubular injury markers (urinary N-acetyl-β-d-glucosaminidase (NAG) and β2-microglobulin (β2-MG)), profibrotic factors (urinary monocyte chemoattractant protein-1 (MCP-1) and transforming growth factor beta1 (TGF-β1)), and traditional Chinese medicine (TCM) symptoms, and vital signs indicators and serious adverse events (SAEs) were also monitored throughout the trial. A total of 195 patients were included in the final analysis. The TLF + CLAT group had a higher effective rate and a lower recurrence rate than the CLAT group (p < 0.01). Significant decrease of urinary NAG and β2-MG was observed in the TLF + CLAT group vs. CLAT group (p < 0.01), and similar changes were observed in profibrotic factors (urinary MCP-1 and TGF-β1) (p < 0.05), which indicated that TLF might have potential renal tubular protection and anti-fibrosis effects. Additionally, a positive correlation within a certain range was shown in the correlation analysis of medical history (months) of rUTI patients with urinary MCP-1 (r = 0.50, p < 0.05) and TGF-β1 (r = 0.78, p < 0.01). A significant difference was also observed in TCM symptoms (p < 0.01). There were no obvious adverse reactions that occurred during this study. We conclude that TLF combined with CLAT was superior to CLAT used alone in reducing rUTI recurrence, alleviating the non-infection-related physical symptoms and protecting renal tubular and anti-fibrosis, which suggests this novel therapy might be an available treatment with great promise in treating rUTI.
Collapse
Affiliation(s)
- Tonglu Li
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yingru Xu
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Gang Yuan
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Wen Lu
- Department of Nephrology, Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guihua Jian
- Department of Nephrology, Shanghai Sixth People’s Hospital, Shanghai Jiaotong University, Shanghai, China
| | - Xuezhong Gong
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Xuezhong Gong,
| |
Collapse
|
10
|
Khalid F, Bushra R, Ghayas S, Mushtaque M. Case Report: Urinary Tract Infection in a Diabetic Postmenopausal Woman With Multiple Episodes of Recurrence: An Antimicrobial Susceptibility dispute. Clin Med Insights Case Rep 2022; 15:11795476221112819. [PMID: 35898804 PMCID: PMC9309758 DOI: 10.1177/11795476221112819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 06/06/2022] [Indexed: 11/15/2022] Open
Abstract
Urinary tract infection (UTI) is caused by bacteria growing in urine and affect
kidneys, bladder, ureters, and urethra. Women with diabetes are at high risk of
developing UTI. This is a case of a 60-year-old postmenopausal woman with
uncontrolled type-I diabetes mellitus and hypertension, who presented with an
acute onset of dysuria, burning micturition, and increased frequency. This case
highlights the shortfall in the preliminary management plan of performing
imperative clinical laboratory investigations including urine detailed report
(DR), urine culture and sensitivity(C/S), and plasma glucose testing to initiate
antimicrobial treatment. UTI requires to be treated precisely in diabetic
patients with the help of a comprehensive diagnosis for signs of dysuria,
frequent urination, and pelvic pain. The treatment of UTIs should always begin
with culture and sensitivity analysis while the patient is symptomatic, to
initiate antimicrobial treatment. Comorbidities should be managed appropriately
during treatment to achieve desired therapeutic outcomes.
Collapse
Affiliation(s)
- Farah Khalid
- Department of Pharmacy Practice, Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Rabia Bushra
- Department of Pharmaceutics, Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Sana Ghayas
- Department of Pharmaceutics, Dow College of Pharmacy, Dow University of Health Sciences, Karachi, Pakistan
| | - Madiha Mushtaque
- Department of Pharmaceutics, Faculty of Pharmacy and Pharmaceutical Sciences, University of Karachi, Karachi, Pakistan
| |
Collapse
|
11
|
Sorić Hosman I, Cvitković Roić A, Lamot L. A Systematic Review of the (Un)known Host Immune Response Biomarkers for Predicting Recurrence of Urinary Tract Infection. Front Med (Lausanne) 2022; 9:931717. [PMID: 35860746 PMCID: PMC9289160 DOI: 10.3389/fmed.2022.931717] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/15/2022] [Indexed: 11/24/2022] Open
Abstract
Recurrent urinary tract infections (rUTI) represent a major healthcare and economic burden along with a significant impact on patient’s morbidity and quality of life, even in the absence of well-known risk factors, such as vesicoureteral reflux. Despite numerous attempts to find a suitable therapeutic option, there is no clear benefit of any currently available intervention for prevention of UTI recurrence and its long-term consequences such as hypertension, renal scarring and/or insufficiency. The common treatment practice in many centers around the globe involves the use of continuous low-dose antibiotic prophylaxis, irrespective of various studies indicating increased microbial resistance against the prophylactic drug, leading to prolonged duration and escalating the cost of UTI treatment. Moreover, the rapid appearance of multi-drug resistant uropathogens is threatening to transform UTI to untreatable disease, while impaired host-microbiota homeostasis induced by a long-term use of antibiotics predisposes patients for various autoimmune and infectious diseases. New biomarkers of the increased risk of UTI recurrence could therefore assist in avoiding such outcomes by revealing more specific patient population which could benefit from additional interventions. In this light, the recent findings suggesting a crucial role of urothelial innate immunity mechanisms in protection of urinary tract from invading uropathogens might offer new diagnostic, prognostic and even therapeutic opportunities. Uroepithelial cells detect uropathogens via pattern recognition receptors, resulting in activation of intracellular signaling cascade and transcription factors, which ultimately leads to an increased production and secretion of chemokines, cytokines and antimicrobial peptides into the urinary stream. Emerging evidence suggest that the disturbance of a single component of the urinary tract innate immunity system might increase susceptibility for rUTI. The aim of the current review is to update clinicians and researchers on potential biomarkers of host immune response alterations predisposing for rUTI and propose those well worth exploring further. For this purpose, over a hundred original papers were identified through an extensive PubMed and Scopus databases search. This comprehensive review might enrich the current clinical practice and fill the unmet clinical needs, but also encourage the development of therapeutic agents that would facilitate urinary bacterial clearance by enhancing the host immune response.
Collapse
Affiliation(s)
- Iva Sorić Hosman
- Department of Pediatrics, Zadar General Hospital, Zadar, Croatia
| | - Andrea Cvitković Roić
- Department of Nephrology and Urology, Clinic for Pediatric Medicine Helena, Zagreb, Croatia
- School of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Lovro Lamot
- Division of Nephrology, Dialysis and Transplantation, Department of Pediatrics, University Hospital Centre Zagreb, Zagreb, Croatia
- Department of Pediatrics, University of Zagreb School of Medicine, Zagreb, Croatia
- *Correspondence: Lovro Lamot,
| |
Collapse
|
12
|
Benseler A, McDermott CD. Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection After Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study. Gynecol Obstet Invest 2022; 87:116-123. [PMID: 35354149 DOI: 10.1159/000524266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 03/14/2022] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To determine practice patterns of prescribing prophylactic antibiotics against urinary tract infection (UTI) for urodynamic studies (UDS) and outpatient cystoscopy in women. DESIGN A cross-sectional survey study was conducted of North American female pelvic medicine and reconstructive specialists (FPMRS). METHODS An online survey was used to assess prophylactic prescribing patterns of FPMRS specialists that perform UDS and outpatient cystoscopy. This survey was developed and then electronically disseminated through the American Urogynecologic Society to 699 eligible physicians. RESULTS A total of 138 surveys were completed. Approximately half of physicians did not prescribe any antibiotic prophylaxis for UDS or for cystoscopy (54% and 43%, respectively). For patients with perceived risk factors (recurrent urinary tract infections, immunosuppression, known neurogenic lower urinary tract dysfunction, indwelling catheter use, elevated post void residual/bladder outlet obstruction, genitourinary anomalies, and diabetes), 32% and 41% of physicians prescribed antibiotic prophylaxis for UDS and cystoscopy, respectively. A minority of physicians always prescribed antibiotics for UDS and cystoscopy (13% and 17%, respectively). LIMITATIONS The response rate was a limitation of the study, however, this rate is in keeping with other physician survey studies published within this subspecialty. Selection and response biases may have contributed to the results of this survey study. CONCLUSION There was no uniform approach to urinary tract infection prophylaxis for UDS and outpatient cystoscopy in women which reflects the lack of current guidelines and the low level of evidence on which they are based. This non-uniform practice calls for more research to better define an evidence-based standard of care.
Collapse
Affiliation(s)
- Anouk Benseler
- Department of Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Colleen D McDermott
- Division of Female Pelvic Medicine and Reconstructive Surgery, Department of Obstetrics and Gynecology, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
13
|
Li T, Xu Y, Gong X. Clinical efficacy of Tailin formulation combined with continuous low-dose antimicrobial therapy for recurrent urinary tract infection: study protocol for a multicenter, double-blind, randomized, controlled clinical trial. Trials 2021; 22:901. [PMID: 34895307 PMCID: PMC8665585 DOI: 10.1186/s13063-021-05830-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022] Open
Abstract
Background Given the increasing rates of antimicrobial resistance (AMR), recurrent urinary tract infection (rUTI) is becoming refractory more and more. Antibiotic prophylaxis including continuous low-dose antibiotic therapy (CLAT), is the common treatment for rUTI of the world. However, the presumably adverse reactions caused by CLAT alone should be paid more attention. Studies indicated that Chinese herbal medicine (CHM) might be an available treatment method for rUTI. Tailin formulation (TLF) is a herbal prescription developed for the treatment of rUTI in the 2000s in Shanghai Municipal Hospital of Traditional Chinese Medicine. Our previous studies have shown TLF could prevent urinary tract infection both in pyelonephritis (PN) rat model and in PN patients. Additionally, our published data demonstrated TLF is helpful to reduce the recurrence of rUTI and protect renal tubular function in clinic. In order to find a novel treating project for rUTI to increase the clinical curative effect, we thus try to combine TLF with CLAT to treat rUTI and design an optimized, pragmatically clinical trial to evaluate the efficacy and safety of this project. Methods/design This is a multicenter, double-blind, randomized, controlled clinical trial. We will enroll 200 eligible patients diagnosed with uncomplicated rUTI and then divide them randomly into two groups with a 1:1 ratio: TLF + CLAT group and placebo + CLAT group. This trial consists of two stages, a 12-week period of treatment and a 12-week period of post-treatment follow-up, respectively. The primary outcome will be the recurrence rate at the 12th week of the follow-up period; the second outcomes will be the post-treatment changes in renal and liver function; furthermore, traditional Chinese medicine (TCM) symptoms, non-infection-related physical signs, and subjective symptoms will be scored, and the number of episodes of each subject will be also recorded; meanwhile, vital signs indicators and serious adverse events (SAEs) will be monitored throughout the trial. Discussion This study will provide convictive research-derived data to evaluate clinical efficacy and safety of TLF combined with CLAT for rUTI, and provide an evidence-based recommendation for clinicians. Moreover, post-treatment changes in non-infection-related physical signs and subjective symptoms were included in the efficacy evaluation, which is important and more significant for assessing the clinical benefits for those rUTI patients. Trial registration Chinese Clinical Trial Registry ChiCTR2100041914. Registered on 10 January 2021. Protocol date and version: September 12, 2020; version 1. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05830-4.
Collapse
Affiliation(s)
- Tonglu Li
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, 200071, China
| | - Yingru Xu
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, 200071, China
| | - Xuezhong Gong
- Department of Nephrology, Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai University of Traditional Chinese Medicine, 274 Zhijiang Middle Road, Shanghai, 200071, China.
| |
Collapse
|
14
|
Hernández-Hernández D, Padilla-Fernández B, Ortega-González MY, Castro-Díaz DM. Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults. CURRENT BLADDER DYSFUNCTION REPORTS 2021; 17:1-12. [PMID: 34868442 PMCID: PMC8634747 DOI: 10.1007/s11884-021-00638-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 12/14/2022]
Abstract
Purpose of review Our goal was to summarize recent evidence regarding recurrent urinary tract infections and asymptomatic bacteriuria in different adult populations. Recent findings Several research groups are focused on the description of resident bacterial flora in the bladder and urinary dysbiosis in the microbiome era. Even the definitions might change in light of these discoveries. However, the role of urinary microbiome and bacterial interference has still to be determined. Summary Systematic treatment of asymptomatic bacteriuria is not recommended and even classic indications such as asymptomatic bacteriuria in pregnant women are controversial. In fact, its treatment is associated with a higher probability of symptomatic UTI and a higher prevalence of antibiotic-resistant bacteria. Improving the diagnosis of asymptomatic bacteriuria and optimizing the management of recurrent urinary tract infections, especially through non-antibiotics measures, are needed in order to minimise antimicrobial resistance.
Collapse
Affiliation(s)
| | - Bárbara Padilla-Fernández
- Department of Urology, Complejo Hospitalario Universitario de Canarias, La Laguna, Tenerife Spain.,Departamento de Cirugía, Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
| | | | - David Manuel Castro-Díaz
- Department of Urology, Complejo Hospitalario Universitario de Canarias, La Laguna, Tenerife Spain.,Departamento de Cirugía, Facultad de Medicina, Universidad de La Laguna, Tenerife, Spain
| |
Collapse
|
15
|
Hernández-Chiñas U, Chávez-Berrocal ME, Ahumada-Cota RE, Navarro-Ocaña A, Rocha-Ramírez LM, Pérez-del Mazo Y, Alvarado-Cabello M, Pérez-Soto G, León-Alamilla LA, Acevedo-Monroy SE, Esquiliano D, Raya-Rivera AM, Eslava CA. Prospective Study in Children with Complicated Urinary Tract Infection Treated with Autologous Bacterial Lysates. Microorganisms 2021; 9:1811. [PMID: 34576707 PMCID: PMC8470462 DOI: 10.3390/microorganisms9091811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/21/2021] [Accepted: 08/11/2021] [Indexed: 12/22/2022] Open
Abstract
Antimicrobial bacteria resistance is an important problem in children with recurrent urinary tract infections (rUTI), thus it is crucial to search for alternative therapies. Autologous bacterial lysates (ABL) may be a potential treatment for rUTI. Twenty-seven children with rUTI were evaluated for one year, urine and stool cultures were performed, 10 colonies of each culture were selected and those identified as Escherichia coli were characterized by serology. For patients who presented ≥105 UFC/mL, an ABL was manufactured and administered orally (1 mL/day) for a month. Twelve children were monitored for ≥1-year, 218 urine and 11 stool samples were analyzed. E. coli (80.5%) was the main bacteria isolated from urine and feces (72%). E. coli of classical urinary serotypes (UPEC), O25:H4, O75:HNM, and O9:HNM were identified in patients with persistent urinary infection (pUTI). In 54% of patients treated with ABL, the absence of bacteria was observed in urine samples after 3 months of treatment, 42% of these remained without UTI between 10-12 months. It was observed that the use of ABL controlled the infection for almost 1 year in more than 60% of the children. We consider it necessary to develop a polyvalent immunogen for the treatment and control of rUTI.
Collapse
Affiliation(s)
- Ulises Hernández-Chiñas
- Peripheral Unit of Basic and Clinical Research in Infectious Diseases, Public Health Department, Research Division, Faculty of Medicine Universidad Nacional Autónoma de México, Bacterial Pathogenicity Laboratory, Hemato-Oncology and Research Unit, Children’s Hospital of Mexico Federico Gómez, Dr. Márquez 162, Col. De los Doctores, Mexico City 06720, Mexico; (U.H.-C.); (M.E.C.-B.); (R.E.A.-C.); (S.E.A.-M.)
| | - María E. Chávez-Berrocal
- Peripheral Unit of Basic and Clinical Research in Infectious Diseases, Public Health Department, Research Division, Faculty of Medicine Universidad Nacional Autónoma de México, Bacterial Pathogenicity Laboratory, Hemato-Oncology and Research Unit, Children’s Hospital of Mexico Federico Gómez, Dr. Márquez 162, Col. De los Doctores, Mexico City 06720, Mexico; (U.H.-C.); (M.E.C.-B.); (R.E.A.-C.); (S.E.A.-M.)
| | - Ricardo E. Ahumada-Cota
- Peripheral Unit of Basic and Clinical Research in Infectious Diseases, Public Health Department, Research Division, Faculty of Medicine Universidad Nacional Autónoma de México, Bacterial Pathogenicity Laboratory, Hemato-Oncology and Research Unit, Children’s Hospital of Mexico Federico Gómez, Dr. Márquez 162, Col. De los Doctores, Mexico City 06720, Mexico; (U.H.-C.); (M.E.C.-B.); (R.E.A.-C.); (S.E.A.-M.)
| | - Armando Navarro-Ocaña
- Bacteriology Laboratory, Public Health Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Mexico City 04510, Mexico; (A.N.-O.); (G.P.-S.); (L.A.L.-A.)
| | - Luz M. Rocha-Ramírez
- Unidad de Investigación en Enfermedades Infeccionas, Hospital Infantil de México Federico Gómez, Secretaría de Salud, Dr. Márquez 162, Col. Doctores, Mexico City 06720, Mexico;
| | - Yolanda Pérez-del Mazo
- Bacterial Pathogenicity Laboratory, Hemato-Oncology and Research Unit, Children’s Hospital of Mexico Federico Gómez, Faculty of Medicine Universidad Nacional Autónoma de México, Dr. Márquez 162, Col. De los Doctores, Mexico City 06720, Mexico; (Y.P.-d.M.); (M.A.-C.)
| | - Maribel Alvarado-Cabello
- Bacterial Pathogenicity Laboratory, Hemato-Oncology and Research Unit, Children’s Hospital of Mexico Federico Gómez, Faculty of Medicine Universidad Nacional Autónoma de México, Dr. Márquez 162, Col. De los Doctores, Mexico City 06720, Mexico; (Y.P.-d.M.); (M.A.-C.)
| | - Gabriel Pérez-Soto
- Bacteriology Laboratory, Public Health Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Mexico City 04510, Mexico; (A.N.-O.); (G.P.-S.); (L.A.L.-A.)
| | - Luis A. León-Alamilla
- Bacteriology Laboratory, Public Health Department, Faculty of Medicine, Universidad Nacional Autónoma de México, Avenida Universidad 3000, Ciudad Universitaria, Mexico City 04510, Mexico; (A.N.-O.); (G.P.-S.); (L.A.L.-A.)
| | - Salvador E. Acevedo-Monroy
- Peripheral Unit of Basic and Clinical Research in Infectious Diseases, Public Health Department, Research Division, Faculty of Medicine Universidad Nacional Autónoma de México, Bacterial Pathogenicity Laboratory, Hemato-Oncology and Research Unit, Children’s Hospital of Mexico Federico Gómez, Dr. Márquez 162, Col. De los Doctores, Mexico City 06720, Mexico; (U.H.-C.); (M.E.C.-B.); (R.E.A.-C.); (S.E.A.-M.)
| | - Diego Esquiliano
- Tissue Engineering Laboratory, Children’s Hospital of Mexico Federico Gómez, Dr. Márquez 162, Col. De los Doctores, Mexico City 06720, Mexico;
| | - Atlántida M. Raya-Rivera
- Tissue Engineering Laboratory, Children’s Hospital of Mexico Federico Gómez, Dr. Márquez 162, Col. De los Doctores, Mexico City 06720, Mexico;
| | - Carlos A. Eslava
- Peripheral Unit of Basic and Clinical Research in Infectious Diseases, Public Health Department, Research Division, Faculty of Medicine Universidad Nacional Autónoma de México, Bacterial Pathogenicity Laboratory, Hemato-Oncology and Research Unit, Children’s Hospital of Mexico Federico Gómez, Dr. Márquez 162, Col. De los Doctores, Mexico City 06720, Mexico; (U.H.-C.); (M.E.C.-B.); (R.E.A.-C.); (S.E.A.-M.)
| |
Collapse
|
16
|
Khameneh B, Eskin NAM, Iranshahy M, Fazly Bazzaz BS. Phytochemicals: A Promising Weapon in the Arsenal against Antibiotic-Resistant Bacteria. Antibiotics (Basel) 2021; 10:1044. [PMID: 34572626 PMCID: PMC8472480 DOI: 10.3390/antibiotics10091044] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/16/2021] [Accepted: 08/17/2021] [Indexed: 12/12/2022] Open
Abstract
The extensive usage of antibiotics and the rapid emergence of antimicrobial-resistant microbes (AMR) are becoming important global public health issues. Many solutions to these problems have been proposed, including developing alternative compounds with antimicrobial activities, managing existing antimicrobials, and rapidly detecting AMR pathogens. Among all of them, employing alternative compounds such as phytochemicals alone or in combination with other antibacterial agents appears to be both an effective and safe strategy for battling against these pathogens. The present review summarizes the scientific evidence on the biochemical, pharmacological, and clinical aspects of phytochemicals used to treat microbial pathogenesis. A wide range of commercial products are currently available on the market. Their well-documented clinical efficacy suggests that phytomedicines are valuable sources of new types of antimicrobial agents for future use. Innovative approaches and methodologies for identifying plant-derived products effective against AMR are also proposed in this review.
Collapse
Affiliation(s)
- Bahman Khameneh
- Department of Pharmaceutical Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran;
| | - N. A. Michael Eskin
- Department of Food and Human Nutritional Sciences, Faculty of Agricultural and Food Sciences, University of Manitoba, Winnipeg, MB R3T 2N2, Canada;
| | - Milad Iranshahy
- Department of Pharmacognosy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| | - Bibi Sedigheh Fazly Bazzaz
- Department of Pharmaceutical Control, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran;
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| |
Collapse
|
17
|
Nguyen LN, Cox A. Practice-changing publications in functional urology: A case-based approach. Can Urol Assoc J 2021; 15:E330-E334. [PMID: 34264814 DOI: 10.5489/cuaj.7468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Laura N Nguyen
- Division of Urology, McMaster University, Hamilton, ON, Canada
| | - Ashley Cox
- Department of Urology, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
18
|
Systemic T Cell Subsets and Cytokines in Patients With Homozygous Sickle Cell Disease and Asymptomatic Urinary Tract Infections in Togo. Ochsner J 2021; 21:163-172. [PMID: 34239376 PMCID: PMC8238108 DOI: 10.31486/toj.20.0061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Background: In sickle cell disease (SCD), cytokine expression influences the pivotal pathways that contribute to disease pathogenesis. Additional infection could affect the immune profile of patients with SCD and increase disease mortality. The aim of this study was to investigate the cytokines and T helper cells profile in patients with asymptomatic urinary tract infection and homozygous SCD (HbSS). Methods: From July to September 2018, 22 HbSS subjects were recruited at Centre Hospitalier Universitaire Campus in Lomé, Togo, 12 of whom had urinary tract bacterial infections and 10 of whom were uninfected. Cytokines from plasma were measured by the enzyme-linked immunosorbent assay (ELISA) sandwich method, and immune cell profiles were performed by flow cytometry. The immunogenicity of bacteria-derived antigens isolated from the urine of HbSS subjects with asymptomatic urinary tract infections was studied in a cell culture system, and the induction of the cytokines was measured. Results: The mean age of HbSS subjects with urinary tract infections was 20.33 ± 3.58 years, and the male/female ratio was 0.09 (1:11). HbSS subjects with asymptomatic urinary tract infections had elevated plasma levels of interferon gamma (IFN-γ) and interleukin (IL)-10. CD4+Tbet+IFN-γ+ and CD4+FoxP3+IL-10+ T cell populations were decreased in HbSS subjects with asymptomatic urinary tract infections. Bacterial antigens from HbSS subjects induced the production of IL-10 but not IFN-γ in uninfected volunteer donors (HbAA). Conclusion: Our study demonstrated that patients with SCD and asymptomatic urinary tract infections had elevated IFN-γ and IL-10 levels. This chronic inflammatory condition could be a risk for this group of patients in terms of vaso-occlusive crisis. Systematic cytobacteriologic examination of the urine of HbSS subjects would be of interest.
Collapse
|
19
|
Becerra AM, Parra D, Trujillo CG, Azuero J, García S, Daza F, Plata M. Infección de vías urinarias no complicada en mujeres. UROLOGÍA COLOMBIANA 2021. [DOI: 10.1055/s-0040-1721323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
ResumenLa infección de vías urinarias (IVU) es una patología común, que afecta a gran parte de la población y que generalmente se resuelve con manejo antibiótico. Se compone de una amplia variedad de entidades clínicas que pueden variar desde una cistitis no complicada hasta un shock séptico de origen urinario. Los patógenos etiológicos de la IVU no complicada están ampliamente establecidos y se han mantenido de forma consistente a lo largo del tiempo, siendo la Escherichia coli el microorganismo más predominante. En la actualidad, la resistencia bacteriana a los antibióticos es de gran preocupación y por esa razón, se busca optimizar la terapia antimicrobiana con el fin de disminuir la estancia hospitalaria, la severidad clínica de la infección y los costos a los sistemas de salud. La presente revisión, tiene como objetivo servir como guía para la correcta definición, clasificación, diagnóstico, tratamiento y prevención de la IVU no complicada.
Collapse
Affiliation(s)
- Ana María Becerra
- Departamento de Urología, Hospital Universitario Fundación Santa Fe de Bogotá, Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
| | - Daniel Parra
- Departamento de Urología, Hospital Universitario Fundación Santa Fe de Bogotá, Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
| | - Carlos Gustavo Trujillo
- Departamento de Urología, Hospital Universitario Fundación Santa Fe de Bogotá, Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
| | - Julián Azuero
- Departamento de Urología, Hospital Universitario Fundación Santa Fe de Bogotá, Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
| | - Sandra García
- Departamento de Urología, Hospital Universitario Fundación Santa Fe de Bogotá, Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
| | - Fabián Daza
- Departamento de Urología, Hospital Universitario Fundación Santa Fe de Bogotá, Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
| | - Mauricio Plata
- Departamento de Urología, Hospital Universitario Fundación Santa Fe de Bogotá, Facultad de Medicina, Universidad de Los Andes, Bogotá, Colombia
| |
Collapse
|
20
|
Ebrahimzadeh T, Kuprasertkul A, Neugent ML, Lutz KC, Fuentes JL, Gadhvi J, Khan F, Zhang C, Sharon BM, Orth K, Li Q, Zimmern PE, De Nisco NJ. Urinary prostaglandin E2 as a biomarker for recurrent UTI in postmenopausal women. Life Sci Alliance 2021; 4:4/7/e202000948. [PMID: 33958485 PMCID: PMC8200289 DOI: 10.26508/lsa.202000948] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 04/21/2021] [Accepted: 04/26/2021] [Indexed: 01/11/2023] Open
Abstract
This work uses controlled human cohorts to investigate urinary prostaglandin E2, the product of cyclooxygenase-2, as both a diagnostic and prognostic biomarker of recurrent UTI postmenopausal women. Urinary tract infection (UTI) is one of the most common adult bacterial infections and exhibits high recurrence rates, especially in postmenopausal women. Studies in mouse models suggest that cyclooxygenase-2 (COX-2)–mediated inflammation sensitizes the bladder to recurrent UTI (rUTI). However, COX-2–mediated inflammation has not been robustly studied in human rUTI. We used human cohorts to assess urothelial COX-2 production and evaluate its product, PGE2, as a biomarker for rUTI in postmenopausal women. We found that the percentage of COX-2–positive cells was elevated in inflamed versus uninflamed bladder regions. We analyzed the performance of urinary PGE2 as a biomarker for rUTI in a controlled cohort of 92 postmenopausal women and PGE2 consistently outperformed all other tested clinical variables as a predictor of rUTI status. Furthermore, time-to-relapse analysis indicated that the risk of rUTI relapse was 3.6 times higher in women with above median urinary PGE2 levels than with below median levels. Taken together, these data suggest that urinary PGE2 may be a clinically useful diagnostic and prognostic biomarker for rUTI in postmenopausal women.
Collapse
Affiliation(s)
- Tahmineh Ebrahimzadeh
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Amy Kuprasertkul
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Michael L Neugent
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Kevin C Lutz
- Depatment of Mathematics, University of Texas at Dallas, Richardson, TX, USA
| | - Jorge L Fuentes
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jashkaran Gadhvi
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Fatima Khan
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Cong Zhang
- Depatment of Mathematics, University of Texas at Dallas, Richardson, TX, USA
| | - Belle M Sharon
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| | - Kim Orth
- Department of Molecular Biology, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Howard Hughes Medical Institute, University of Texas Southwestern Medical Center, Dallas, TX, USA.,Department of Biochemistry, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Qiwei Li
- Depatment of Mathematics, University of Texas at Dallas, Richardson, TX, USA
| | - Philippe E Zimmern
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nicole J De Nisco
- Department of Biological Sciences, University of Texas at Dallas, Richardson, TX, USA
| |
Collapse
|
21
|
Yoo JJ, Shin HB, Song JS, Kim M, Yun J, Kim Z, Lee YM, Lee SW, Lee KW, Kim WB, Ryu CB, Park SW, Park SK, Song HY, Kim YH. Urinary Microbiome Characteristics in Female Patients with Acute Uncomplicated Cystitis and Recurrent Cystitis. J Clin Med 2021; 10:jcm10051097. [PMID: 33807946 PMCID: PMC7961880 DOI: 10.3390/jcm10051097] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/26/2021] [Accepted: 03/02/2021] [Indexed: 12/16/2022] Open
Abstract
Traditionally, the diagnostic mainstay of recurrent urinary tract infection has been urinary culture. However, the causative uropathogen of recurrent cystitis has not been well established. Urine DNA next-generation sequencing (NGS) can provide additional information on these infections. Herein, we compared urine NGS results and urine cultures in patients with acute uncomplicated cystitis (AUC) and recurrent cystitis (RC), and evaluated the difference in microbiome patterns in the NGS results. Patients who underwent urine culture and NGS due to AUC or RC were retrospectively reviewed. All urine samples were collected via a transurethral catheter and studied utilizing a type of NGS called 16S ribosomal RNA gene amplification and sequencing. The sensitivity of urine NGS was significantly higher than that of conventional urine culture (69.0% vs. 16.7%, p < 0.05). The detection rate of urine NGS was slightly lower in the RC group than in the AUC group (67.7% vs. 72.7%). Microbiome diversity was significantly higher in the RC group compared to the AUC group (p = 0.007), and the microbiome composition was significantly different between the AUC and RC groups. In the urine NGS results, Pseudomonas, Acinetobacter, and Enterobacteriaceae were found in the AUC group, and Sphingomonas, Staphylococcus, Streptococcus, and Rothia spp. were detected in the RC group. Urine NGS can significantly increase the diagnostic sensitivity compared to traditional urine culture methods, especially in RC patients. AUC and RC patients had significant differences in bacterial diversity and patterns. Therefore, recurrent cystitis might be approached from a different perspective.
Collapse
Affiliation(s)
- Jeong-Ju Yoo
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (J.-J.Y.); (J.Y.); (C.B.R.); (S.-W.P.); (S.K.P.)
| | - Hee Bong Shin
- Department of Laboratory Medicine and Genetics, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea;
| | - Ju Sun Song
- GC Genome, Green Cross Laboratories, Department of Laboratory Medicine, Yongin 16924, Korea; (J.S.S.); (M.K.)
| | - Minjung Kim
- GC Genome, Green Cross Laboratories, Department of Laboratory Medicine, Yongin 16924, Korea; (J.S.S.); (M.K.)
| | - Jina Yun
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (J.-J.Y.); (J.Y.); (C.B.R.); (S.-W.P.); (S.K.P.)
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea;
| | - Yoo Min Lee
- Department of Pediatrics, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea;
| | - Sang Wook Lee
- Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (S.W.L.); (K.W.L.); (W.b.K.)
| | - Kwang Woo Lee
- Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (S.W.L.); (K.W.L.); (W.b.K.)
| | - Woong bin Kim
- Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (S.W.L.); (K.W.L.); (W.b.K.)
| | - Chang Beom Ryu
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (J.-J.Y.); (J.Y.); (C.B.R.); (S.-W.P.); (S.K.P.)
| | - Sung-Woo Park
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (J.-J.Y.); (J.Y.); (C.B.R.); (S.-W.P.); (S.K.P.)
| | - Seong Kyu Park
- Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (J.-J.Y.); (J.Y.); (C.B.R.); (S.-W.P.); (S.K.P.)
| | - Ho-Yeon Song
- Department of Microbiology and Immunology, School of Medicine, Soonchunhyang University, Cheonan 31151, Korea;
| | - Young Ho Kim
- Department of Urology, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Korea; (S.W.L.); (K.W.L.); (W.b.K.)
- Correspondence: ; Tel.: +82-32-621-5463
| | | |
Collapse
|
22
|
Martin-Cruz L, Sevilla-Ortega C, Benito-Villalvilla C, Diez‐Rivero CM, Sanchez-Ramón S, Subiza JL, Palomares O. A Combination of Polybacterial MV140 and Candida albicans V132 as a Potential Novel Trained Immunity-Based Vaccine for Genitourinary Tract Infections. Front Immunol 2021; 11:612269. [PMID: 33552074 PMCID: PMC7858650 DOI: 10.3389/fimmu.2020.612269] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 12/03/2020] [Indexed: 12/16/2022] Open
Abstract
Recurrent urinary tract infections (RUTIs) and recurrent vulvovaginal candidiasis (RVVCs) represent major healthcare problems with high socio-economic impact worldwide. Antibiotic and antifungal prophylaxis remain the gold standard treatments for RUTIs and RVVCs, contributing to the massive rise of antimicrobial resistance, microbiota alterations and co-infections. Therefore, the development of novel vaccine strategies for these infections are sorely needed. The sublingual heat-inactivated polyvalent bacterial vaccine MV140 shows clinical efficacy for the prevention of RUTIs and promotes Th1/Th17 and IL-10 immune responses. V132 is a sublingual preparation of heat-inactivated Candida albicans developed against RVVCs. A vaccine formulation combining both MV140 and V132 might well represent a suitable approach for concomitant genitourinary tract infections (GUTIs), but detailed mechanistic preclinical studies are still needed. Herein, we showed that the combination of MV140 and V132 imprints human dendritic cells (DCs) with the capacity to polarize potent IFN-γ- and IL-17A-producing T cells and FOXP3+ regulatory T (Treg) cells. MV140/V132 activates mitogen-activated protein kinases (MAPK)-, nuclear factor-κB (NF-κB)- and mammalian target of rapamycin (mTOR)-mediated signaling pathways in human DCs. MV140/V132 also promotes metabolic and epigenetic reprogramming in human DCs, which are key molecular mechanisms involved in the induction of innate trained immunity. Splenocytes from mice sublingually immunized with MV140/V132 display enhanced proliferative responses of CD4+ T cells not only upon in vitro stimulation with the related antigens contained in the vaccine formulation but also upon stimulation with phytohaemagglutinin. Additionally, in vivo sublingual immunization with MV140/V132 induces the generation of IgG and IgA antibodies against all the components contained in the vaccine formulation. We uncover immunological mechanisms underlying the potential mode of action of a combination of MV140 and V132 as a novel promising trained immunity-based vaccine (TIbV) for GUTIs.
Collapse
MESH Headings
- Animals
- Antigens, Bacterial/administration & dosage
- Antigens, Bacterial/immunology
- Antigens, Fungal/administration & dosage
- Antigens, Fungal/immunology
- Bacterial Infections/immunology
- Bacterial Infections/metabolism
- Bacterial Infections/microbiology
- Bacterial Infections/prevention & control
- Bacterial Vaccines/administration & dosage
- Bacterial Vaccines/immunology
- CD4-Positive T-Lymphocytes/drug effects
- CD4-Positive T-Lymphocytes/immunology
- Candidiasis, Vulvovaginal/immunology
- Candidiasis, Vulvovaginal/metabolism
- Candidiasis, Vulvovaginal/microbiology
- Candidiasis, Vulvovaginal/therapy
- Cells, Cultured
- Coculture Techniques
- Cytokines/metabolism
- Dendritic Cells/drug effects
- Dendritic Cells/immunology
- Female
- Fungal Vaccines/administration & dosage
- Fungal Vaccines/immunology
- Humans
- Lymphocyte Activation/drug effects
- Mice, Inbred BALB C
- Phenotype
- Urinary Tract Infections/immunology
- Urinary Tract Infections/metabolism
- Urinary Tract Infections/microbiology
- Urinary Tract Infections/prevention & control
- Vaccination
- Vaccines, Combined/administration & dosage
- Vaccines, Combined/immunology
- Mice
Collapse
Affiliation(s)
- Leticia Martin-Cruz
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | - Carmen Sevilla-Ortega
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | - Cristina Benito-Villalvilla
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| | | | - Silvia Sanchez-Ramón
- Department of Clinical Immunology and IdISSC, Hospital Clínico San Carlos, Madrid, Spain
- Department of Immunology, ENT and Ophthalmology, School of Medicine, Complutense University, Madrid, Spain
| | | | - Oscar Palomares
- Department of Biochemistry and Molecular Biology, School of Chemistry, Complutense University, Madrid, Spain
| |
Collapse
|
23
|
Almomani BA, Khasawneh RA, Saqan R, Alnajjar MS, Al-Natour L. Predictive utility of prior positive urine culture of extended- spectrum β -lactamase producing strains. PLoS One 2020; 15:e0243741. [PMID: 33315921 PMCID: PMC7735628 DOI: 10.1371/journal.pone.0243741] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 11/29/2020] [Indexed: 11/18/2022] Open
Abstract
Rising incidence of extended- spectrum beta-lactamase (ESBL) induced urinary tract infections (UTIs) is an increasing concern worldwide. Thus, it is of paramount importance to investigate novel approaches that can facilitate the identification and guide empiric antibiotic therapy in such episodes. The study aimed to evaluate the usability of antecedent ESBL-positive urine culture to predict the pathogenic identity of future ones. Moreover, the study evaluated the accuracy of selected empiric therapy in index episodes. This was a retrospective study that included 693 cases with paired UTI episodes, linked to two separate hospital admissions within 12 month-period, and a conditional previous ESBL positive episode. Pertinent information was obtained by reviewing patients' medical records and computerized laboratory results. Multivariate analysis showed that shorter interval between index and previous episodes was significantly associated with increased chance of ESBL-positive results in current culture (OR = 0.912, 95CI% = 0.863-0.963, p = 0.001). Additionally, cases with ESBL-positive results in current culture were more likely to have underlying urological/surgical condition (OR = 1.416, 95CI% = 1.018-1.969, p = 0.039). Investigations of the accuracy of current empirical therapy revealed that male patients were less accurately treated compared to female patients (OR = 0.528, 95CI% = 0.289-0.963, p = 0.037). Furthermore, surgical patients were treated less accurately compared to those treated in internal ward (OR = 0.451, 95CI% = 0.234-0.870, p = 0.018). Selecting an agent concordant with previous microbiologic data significantly increased the accuracy of ESBL-UTIs therapy (p<0.001). A quick survey of the previous ESBL urine culture results can guide practitioners in the selection of empiric therapy for the pending current culture and thus improve treatment accuracy.
Collapse
Affiliation(s)
- Basima A. Almomani
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
- * E-mail:
| | - Rawand A. Khasawneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| | - Rola Saqan
- Department of Pediatrics and Neonatology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Munther S. Alnajjar
- Department of Biopharmaceutics & Clinical Pharmacy, College of Pharmacy, Al-Ahliyya Amman University, Amman, Jordan
| | - Lara Al-Natour
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
24
|
Pat JJ, Aart TVD, Steffens MG, Witte LPW, Blanker MH. Assessment and treatment of recurrent urinary tract infections in women: development of a questionnaire based on a qualitative study of patient expectations in secondary care. BMC Urol 2020; 20:190. [PMID: 33267816 PMCID: PMC7709265 DOI: 10.1186/s12894-020-00764-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Accepted: 11/27/2020] [Indexed: 11/17/2022] Open
Abstract
Background To develop a questionnaire to facilitate the inventorying of women’s expectations for the assessment and treatment of recurrent urinary tract infection (UTI) in secondary care.
Methods Semi-structured interviews were conducted among women with recurrent UTI referred to our urology department. The interviews were conducted by one interviewer, recorded, transcribed verbatim, and analyzed thematically by two researchers. We first developed 35 questions to identify potential themes, and we then tested them among women with and without recurrent UTI. Changes were made according to the feedback received. Results Six interviews were conducted before saturation was reached. Thematic analysis identified three themes: patient pathway, personal knowledge, and social implications. All respondents had received multiple antibiotic courses but no prophylactic antibiotic therapy, and although all were aware of some preventive measures, they wanted more information about their disease. However, some women were afraid to access information for fear of what they might learn. Recurrent UTI also significantly affected the daily lives all respondents. Some women expressed fears over frequent antibiotic use, and others felt that there must be something wrong with their body to have so many UTIs. Women expected the urologist to provide an explanation and to start adequate therapy for their recurrent UTI. We created a 32-item questionnaire based on these themes Conclusion This study not only developed a questionnaire for use when assessing patient expectations of recurrent UTI management in secondary care but also provided novel insights into the thoughts, opinions, and expectations of women who are referred.
Collapse
Affiliation(s)
- J J Pat
- Department of General Practice, University of Groningen, University Medical Centre, Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands.
| | - T V D Aart
- Department of General Practice, University of Groningen, University Medical Centre, Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| | - M G Steffens
- Department of Urology, ISALA Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - L P W Witte
- Department of Urology, ISALA Clinics, Dokter van Heesweg 2, 8025 AB, Zwolle, The Netherlands
| | - M H Blanker
- Department of General Practice, University of Groningen, University Medical Centre, Groningen, Hanzeplein 1, 9713 GZ, Groningen, The Netherlands
| |
Collapse
|
25
|
Complementary Alternative Medicine Methods Preferred by Women Diagnosed with Urinary Tract Infections. JOURNAL OF CONTEMPORARY MEDICINE 2020. [DOI: 10.16899/jcm.762355] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
26
|
YAZDI S, ALIDOUSTI K, TIRGARI B, JAHANI Y. Effect of integrated health promotion intervention and follow up on health issues (clothing way, food habits, urinary habits, sexual behavior habits) related to urinary tract infection among pregnant women. A randomized, clinical trial. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E194-E199. [PMID: 32803005 PMCID: PMC7419116 DOI: 10.15167/2421-4248/jpmh2020.61.2.1412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 03/27/2020] [Indexed: 11/16/2022]
Abstract
Introduction Urinary tract infection, as an important health element is associated with the risk of many problems in pregnancy and support consulting is effective factor in reducing the problem. Aim of this study is to evaluate the impacts of integrated intervention on life style (clothing way, food habits, urinary habits, sexual behavior habits) Related to Urinary Tract Infection Among Pregnant women. Method This interventional used pretest- posttest design with the control group study was performed on 130 healthy pregnant women. The samples were divided randomly into two groups of 65 people. The first group received two sessions of 45 to 60 minutes Psychoeducational counseling, four telephone follow-up support and training pamphlets and the control group received routine education. The relevant questionnaires were completed by both groups before the intervention and a month later. The data were analyzed with Spss V.22 software. Results Comparing within the groups it was shown that the variables were increased in the experimental group after consulting compared to the conditions before consulting (P < 0.001), however, no increasing was found in the average variables before consulting and after it. Moreover, comparing the variables in two experimental and control groups significant statistical difference was found in different studied areas after consulting (P < 0.0001). Conclusions Psychological counseling and phone follow-up are effective in improving the knowledge, attitude, and performance of pregnant women in preventing the urinary infection Therefor it is recommended these trends to be considered as training programs in order to increase capacity and primary prevention of pregnant women.
Collapse
Affiliation(s)
- S. YAZDI
- Midwifery Department, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - K. ALIDOUSTI
- Midwifery Department, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
- Correspondence: Katayoun Alidousti, Kerman-Haft Bagh Alavi-Pardizeh oloompezeshki, School of Nursing and Midwifery, Midwifery Department, Kerman, Iran - Tel.: 0913242174903431325219 - Fax: 03431325218 - E-mail: -
| | - B. TIRGARI
- Nursing Research Center, Medical Surgical Department, School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Y. JAHANI
- Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| |
Collapse
|
27
|
Tufon KA, Fokam DPY, Kouanou YS, Meriki HD. Case report on a swift shift in uropathogens from Shigella flexneri to Escherichia coli: a thin line between bacterial persistence and reinfection. Ann Clin Microbiol Antimicrob 2020; 19:31. [PMID: 32727466 PMCID: PMC7392695 DOI: 10.1186/s12941-020-00374-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 07/20/2020] [Indexed: 12/24/2022] Open
Abstract
Background Urinary tract infections (UTI) are mostly caused by bacteria. Urine cultures are usually a definitive measure to select the appropriate antibiotics for the elimination of a uropathogen and subsequent recovery from the infection. However, the preferred antibiotics as determined by urine culture and sensitivity may still not eliminate the infection and would require further examination to ascertain the cause of treatment failure which could be unresolved bacteriuria, bacterial persistence, immediate reinfection with a different uropathogen or misdiagnosis. Case presentation A 2-years 7 months-old female was admitted in the Regional hospital of Buea following persistent fever. An auto medication with amoxicillin was reported. Urinalysis was done on the first day and the sediment of the cloudy urine revealed many bacteria and few pus cells. Ceftriaxone was prescribed as empirical treatment and a request for urine and blood culture was made. Three days after admission, the temperature and CRP were 39.0 °C and 96 mg/l, respectively. The urine culture results (> 105 CFU/ml of Shigella flexneri sensitive to ofloxacin) were presented to the doctor on the 4th day of admission. Patient was put on ofloxacin. Three days after, the temperature (38.5 °C) and CRP (24 mg/l) were still elevated. The blood culture result came out negative. A second urine culture was requested which came back positive (> 105 CFU/ml of Escherichia coli resistant to ofloxacin and sensitive to meropenem and amikacin). Ofloxacin was discontinued and the patient put on meropenem and amikacin. The third urine culture recorded no significant growth after 48 h of incubation. The patient was discharged looking healthy once more with a normal body temperature. Conclusion Antibiotics tailored towards the elimination of a particular bacterial species may as well provide a favorable environment for other bacterial species that are resistant to it in the course of treating a UTI episode. This apparent treatment failure may first of all require a second urine culture for confirmation rather than considering the possibilities of a misdiagnosis.
Collapse
Affiliation(s)
- Kukwah Anthony Tufon
- Buea Regional Hospital, Southwest Region, Buea, Cameroon. .,Department of Allied Health, Faculty of Health Science, Biaka University, Buea, Cameroon. .,Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon.
| | - Djike Puepi Yolande Fokam
- Buea Regional Hospital, Southwest Region, Buea, Cameroon.,Department of Internal Medicine and Paediatrics, Faculty of Health Science, University of Buea, Buea, Cameroon
| | | | - Henry Dilonga Meriki
- Buea Regional Hospital, Southwest Region, Buea, Cameroon.,Department of Allied Health, Faculty of Health Science, Biaka University, Buea, Cameroon.,Department of Microbiology and Parasitology, Faculty of Science, University of Buea, Buea, Cameroon
| |
Collapse
|
28
|
Ke QS, Lee CL, Kuo HC. Recurrent urinary tract infection in women and overactive bladder - Is there a relationship? Tzu Chi Med J 2020; 33:13-21. [PMID: 33505873 PMCID: PMC7821830 DOI: 10.4103/tcmj.tcmj_38_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 04/02/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023] Open
Abstract
Overactive bladder (OAB) in women has similar symptomatology with other common urologic diseases such as recurrent urinary tract infection (UTI). Recent evidence showed that chronic low-grade bacterial bladder colonization might exacerbate OAB symptoms and could be the etiology of recurrent UTI. The high prevalence of lower urinary tract dysfunction is associated with OAB. Women with urgency urinary incontinence refractory to antimuscarinic therapy had more bacteria and a more diverse urinary microbiome. The bacterial reside in the superficial urothelial cells to form intracellular bacterial community and outbreak when the host innate immunity is low. Women with recurrent UTI are found to have highly prevalent voiding dysfunction and detrusor overactivity. These functional abnormalities will further damage the urothelial barrier integrity and create vulnerable to uropathogen invasion. The defective urinary microbiota is less common in women with recurrent UTI, suggesting that the normal flora in the urine might inhibit uropathogen growth and invasion. The defective urothelial barrier function, deficient basal proliferation, and deficient maturation might be owing to chronic suburothelial inflammation, resulting in activation of sensory nerves (causing OAB) and failure elimination of intracellular bacterial communities (causing recurrent UTI). Precision diagnosis and multidisciplinary treatment of the underlying pathophysiology of OAB and recurrent UTI is necessary.
Collapse
Affiliation(s)
- Qian-Sheng Ke
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Cheng-Ling Lee
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| | - Hann-Chorng Kuo
- Department of Urology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation and Tzu Chi University, Hualien, Taiwan
| |
Collapse
|
29
|
Oros D, Ceprnja M, Zucko J, Cindric M, Hozic A, Skrlin J, Barisic K, Melvan E, Uroic K, Kos B, Starcevic A. Identification of pathogens from native urine samples by MALDI-TOF/TOF tandem mass spectrometry. Clin Proteomics 2020; 17:25. [PMID: 32581661 PMCID: PMC7310424 DOI: 10.1186/s12014-020-09289-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 06/17/2020] [Indexed: 12/11/2022] Open
Abstract
Background Reliable high-throughput microbial pathogen identification in human urine samples is crucial for patients with cystitis symptoms. Currently employed methods are time-consuming and could lead to unnecessary or inadequate antibiotic treatment. Purpose of this study was to assess the potential of mass spectrometry for uropathogen identification from a native urine sample. Methods In total, 16 urine samples having more than 105 CFU/mL were collected from clinical outpatients. These samples were analysed using standard urine culture methods, followed by 16S rRNA gene sequencing serving as control and here described culture-independent MALDI-TOF/TOF MS method being tested. Results Here we present advantages and disadvantages of bottom-up proteomics, using MALDI-TOF/TOF tandem mass spectrometry, for culture-independent identification of uropathogens (e.g. directly from urine samples). The direct approach provided reliable identification of bacteria at the genus level in monobacterial samples. Taxonomic identifications obtained by proteomics were compared both to standard urine culture test used in clinics and genomic test based on 16S rRNA sequencing. Conclusions Our findings indicate that mass spectrometry has great potential as a reliable high-throughput tool for microbial pathogen identification in human urine samples. In this case, the MALDI-TOF/TOF, was used as an analytical tool for the determination of bacteria in urine samples, and the results obtained emphasize high importance of storage conditions and sample preparation method impacting reliability of MS2 data analysis. The proposed method is simple enough to be utilized in existing clinical settings and is highly suitable for suspected single organism infectious etiologies. Further research is required in order to identify pathogens in polymicrobial urine samples.
Collapse
Affiliation(s)
- Damir Oros
- Department of Biochemical Engineering, Faculty of Food Technology and Biotechnology, Zagreb University, 10000 Zagreb, Croatia
| | - Marina Ceprnja
- Biochemical Laboratory, Special Hospital Agram, Polyclinic Zagreb, 10000 Zagreb, Croatia
| | - Jurica Zucko
- Department of Biochemical Engineering, Faculty of Food Technology and Biotechnology, Zagreb University, 10000 Zagreb, Croatia
| | - Mario Cindric
- Division of Molecular Medicine, Ruder Boskovic Institute, Zagreb, Croatia
| | - Amela Hozic
- Division of Molecular Medicine, Ruder Boskovic Institute, Zagreb, Croatia
| | - Jasenka Skrlin
- Department for Clinical Microbiology and Hospital Infection, University Hospital Dubrava, 10000 Zagreb, Croatia
| | - Karmela Barisic
- Faculty of Pharmacy and Biochemistry, Zagreb University, Zagreb, Croatia
| | - Ena Melvan
- Department of Biological Science, Faculty of Science, Macquarie University, Sydney, Australia
| | - Ksenija Uroic
- Department of Biochemical Engineering, Faculty of Food Technology and Biotechnology, Zagreb University, 10000 Zagreb, Croatia
| | - Blazenka Kos
- Department of Biochemical Engineering, Faculty of Food Technology and Biotechnology, Zagreb University, 10000 Zagreb, Croatia
| | - Antonio Starcevic
- Department of Biochemical Engineering, Faculty of Food Technology and Biotechnology, Zagreb University, 10000 Zagreb, Croatia
| |
Collapse
|
30
|
Behzadi P, Urbán E, Gajdács M. Association between Biofilm-Production and Antibiotic Resistance in Uropathogenic Escherichia coli (UPEC): An In Vitro Study. Diseases 2020; 8:E17. [PMID: 32517335 PMCID: PMC7348726 DOI: 10.3390/diseases8020017] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 06/03/2020] [Accepted: 06/04/2020] [Indexed: 11/17/2022] Open
Abstract
Urinary tract infections (UTIs) are among the most common infections requiring medical attention worldwide. The production of biofilms is an important step in UTIs, not only from a mechanistic point of view, but this may also confer additional resistance, distinct from other aspects of multidrug resistance (MDR). A total of two hundred and fifty (n = 250) Escherichia coli isolates, originating from clean-catch urine samples, were included in this study. The isolates were classified into five groups: wild-type, ciprofloxacin-resistant, fosfomycin-resistant, trimethoprim-sulfamethoxazole-resistant and extended spectrum β-lactamase (ESBL)-producing strains. The bacterial specimens were cultured using eosine methylene blue agar and the colony morphology of isolates were recorded. Antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method and E-tests. Biofilm-formation of the isolates was carried out with the crystal violet tube-adherence method. n = 76 isolates (30.4%) produced large colonies (>3 mm), mucoid variant colonies were produced in n = 135 cases (54.0%), and n = 119 (47.6%) were positive for biofilm formation. The agreement (i.e., predictive value) of mucoid variant colonies in regard to biofilm production in the tube-adherence assay was 0.881 overall. Significant variation was seen in the case of the group of ESBL-producers in the ratio of biofilm-producing isolates. The relationship between biofilm-production and other resistance determinants has been extensively studied. However, no definite conclusion can be reached from the currently available data.
Collapse
Affiliation(s)
- Payam Behzadi
- Department of Microbiology, College of Basic Sciences, Shahr-e-Qods Branch, Islamic Azad University, Tehran 37541-374, Iran;
| | - Edit Urbán
- Department of Public Health, Faculty of Medicine, University of Szeged, 6720 Szeged, Dóm tér 10, Hungary;
- Institute of Translational Medicine, University of Pécs Medical School, 7624 Pécs, Szigeti utca 12, Hungary
| | - Márió Gajdács
- Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, 6720 Szeged, Eötvös utca 6, Hungary
- Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, 1089 Budapest, Nagyvárad tér 4, Hungary
| |
Collapse
|
31
|
O'Toole D. Rapid recommendations: Updates from 2019 guidelines: part 2. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2020; 66:430-432. [PMID: 32532726 PMCID: PMC7292515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Danielle O'Toole
- Practising family physician in Academic Family Medicine and Assistant Professor in the Department of Family Medicine at McMaster University in Hamilton, Ont
| |
Collapse
|
32
|
Increased post-voiding residue and recurrent acute epididymitis: Are they causally related? JOURNAL OF SURGERY AND MEDICINE 2020. [DOI: 10.28982/josam.673237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
33
|
Behzadi P, Urbán E, Matuz M, Benkő R, Gajdács M. The Role of Gram-Negative Bacteria in Urinary Tract Infections: Current Concepts and Therapeutic Options. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2020; 1323:35-69. [PMID: 32596751 DOI: 10.1007/5584_2020_566] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Urinary tract infections (UTIs) are some of the most common infections in human medicine worldwide, recognized as an important public health concern to healthcare systems around the globe. In addition, urine specimens are one of the most frequently submitted samples for culture to the clinical microbiology laboratory, exceeding the number of most of the other sample types. The epidemiology, species-distribution and susceptibility-patterns of uropathogens vary greatly in a geographical and time-dependent manner and it also strongly correlated with the reported patient population studied. Nevertheless, many studies highlight the fact that the etiological agents in UTIs have changed considerably, both in nosocomial and community settings, with a shift towards "less common" microorganisms having more pronounced roles. There is increasing demand for further research to advance diagnostics and treatment options, and to improve care of the patients. The aim of this review paper was to summarize current developments in the global burden of UTI, the diagnostic aspects of these infectious pathologies, the possible etiological agents and their virulence determinants (with a special focus on the members of the Enterobacterales order), current guidelines and quality indicators in the therapy of UTIs and the emergence of multidrug resistance in urinary pathogens.
Collapse
Affiliation(s)
- Payam Behzadi
- Department of Microbiology, College of Basic Sciences Islamic Azad University, Tehran, Iran
| | - Edit Urbán
- Department of Public Health, Faculty of Medicine, University of Szeged, Szeged, Hungary.,Institute of Translational Medicine, University of Pécs, Medical School, Pécs, Hungary
| | - Mária Matuz
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
| | - Ria Benkő
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary.,Central Pharmacy Service, Emergency Department, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Márió Gajdács
- Institute of Medical Microbiology, Faculty of Medicine, Semmelweis University, Budapest, Hungary. .,Department of Pharmacodynamics and Biopharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary.
| |
Collapse
|
34
|
Fallon R, Farrell K, Leon G, Rajan A, Duane S, FitzGerald C, Tierney M, Vellinga A. GPs' attitudes towards the diagnosis and treatment of male urinary tract infections: a qualitative interview study in Ireland. BJGP Open 2019; 3:bjgpopen19X101667. [PMID: 31615788 PMCID: PMC6995865 DOI: 10.3399/bjgpopen19x101667] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Accepted: 07/16/2019] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND In general practice, males represent around 20% of the total number of urinary tract infection (UTI) consultations. The majority of UTI research focuses on the diagnosis and treatment of women with UTIs but there is little evidence on how male UTIs are treated. AIM To better understand GPs' attitudes towards the diagnosis and treatment of male UTIs. This research aimed to support future investigations to determine best practice in diagnosis and treatment of male UTI. DESIGN AND SETTING A qualitative interview study was carried out with 15 GPs across Ireland. METHOD A topic guide was created to ensure consistency in interviews. The interviews were audiorecorded and transcribed verbatim. Transcripts were analysed using thematic analysis. RESULTS Fifteen interviews with GPs were completed. Analysis indicated that GPs' knowledge of guidelines and implementation of them varied widely when deciding a treatment plan for a male presenting with UTI symptoms. There was clear consensus that male UTIs were uncommon and complicated to diagnose. Three GPs reported never treating a male UTI, while others reported treating <5 patients in their careers. There was an assumption that sexually transmitted infections (STI) take precedence in young males when presenting with similar symptoms. The use of antimicrobial treatment guidelines varied widely, in line with the interpretation of the origin and severity of symptoms. CONCLUSION Male UTIs are perceived by GPs as rare and complicated. GPs expressed that patient age, resources, and guidelines available limited their confidence in diagnosing and treating male UTIs.
Collapse
Affiliation(s)
- Róisín Fallon
- Research Assistant, Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Health Research Board Primary Care, Clinical Trials Network, Ireland
| | - Karen Farrell
- Research Assistant, Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Health Research Board Primary Care, Clinical Trials Network, Ireland
| | - Genevieve Leon
- House officer, Grade UD41Department of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Aparna Rajan
- House officer, Grade UD41Department of General Practice, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Sinead Duane
- Post Doctoral Researcher, Health Research Board Trials Methodology Research Network, College of Medicine, Nursing & Health Sciences, National University of Ireland, Galway, Ireland
| | - Christine FitzGerald
- Research Assistant, School of Business and Economics, National University of Ireland, Galway, Ireland
| | - Marie Tierney
- Postdoctoral Researcher, Health Research Board Primary Care Clinical Trials Network, National University of Ireland, Galway, Ireland
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Akke Vellinga
- Epidemiologist and Senior Lecturer, Health Research Board Primary Care Clinical Trials Network, National University of Ireland, Galway, Ireland
- Department of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
| |
Collapse
|
35
|
Latin American consensus on uncomplicated recurrent urinary tract infection-2018. Int Urogynecol J 2019; 31:35-44. [PMID: 31494690 DOI: 10.1007/s00192-019-04079-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 07/29/2019] [Indexed: 12/16/2022]
Abstract
An estimated 20-30% of adult women who experience an initial urinary tract infection (UTI) will have recurrent infection. In these patients, prophylaxis may be considered to improve their quality of life and control overuse of antibiotics. Despite this need, there is currently no Latin American consensus on the treatment and prophylaxis of recurrent UTIs. This consensus, signed by a panel of regional and international experts on UTI management, aims to address this need and is the first step toward a Latin American consensus on a number of urogynecological conditions. The panel agrees that antibiotics should be considered the primary treatment option for symptomatic UTI, taking into account local pathogen resistance patterns. Regarding prophylaxis, immunoactive therapy with the bacterial lysate OM-89 received a grade A recommendation and local estrogen in postmenopausal women grade B recommendation. Lower-grade recommendations include behavior modification and D-mannose; probiotics (Lactobacilli), cranberries, and hyaluronic acid (and derivatives) received limited recommendations; their use should be discussed with the patient. Though considered effective and receiving grade A recommendation, antimicrobial prophylaxis should be considered only following prophylaxis with effective non-antimicrobial measures that were not successful and chosen based on the frequency of sexual intercourse and local pathogen resistance patterns.
Collapse
|
36
|
Ahmed H, Farewell D, Jones HM, Francis NA, Paranjothy S, Butler CC. Antibiotic prophylaxis and clinical outcomes among older adults with recurrent urinary tract infection: cohort study. Age Ageing 2019; 48:228-234. [PMID: 30165433 PMCID: PMC6424374 DOI: 10.1093/ageing/afy146] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/26/2018] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND clinical guidelines recommend antibiotic prophylaxis for preventing recurrent urinary tract infections (UTIs), but there is little evidence for their effectiveness in older adults. METHODS this was a retrospective cohort study of health records from 19,696 adults aged ≥65 with recurrent UTIs. We used prescription records to ascertain ≥3 months' prophylaxis with trimethoprim, cefalexin or nitrofurantoin. We used random effects Cox recurrent event models to estimate hazard ratios (HR) and 95% confidence intervals (CI) for risks of clinical recurrence (primary outcome), acute antibiotic prescribing and hospitalisation. RESULTS of 4,043 men and 15,653 women aged ≥65 with recurrent UTIs, 508 men (12.6%) and 2,229 women (14.2%) were prescribed antibiotic prophylaxis. In men, prophylaxis was associated with a reduced risk of clinical recurrence (HR, 0.49; 95% CI, 0.45-0.54), acute antibiotic prescribing (HR, 0.54; 95% CI, 0.51-0.57) and UTI-related hospitalisation (HR, 0.78; 95% CI, 0.64-0.94). In women, prophylaxis was also associated with a reduced risk of clinical recurrence (HR, 0.57; 95% CI, 0.55-0.59) and acute antibiotic prescribing (HR, 0.61; 95% CI, 0.59-0.62), but estimates of the risk of UTI-related hospitalisation were inconsistent between our main analysis (HR, 1.16; 95% CI, 1.05-1.28) and sensitivity analysis (HR, 0.82; 95% CI, 0.72-0.94). CONCLUSIONS antibiotic prophylaxis was associated with lower rates of UTI recurrence and acute antibiotic prescribing in older adults. To fully understand the benefits and harms of prophylaxis, further research should determine the frequency of antibiotic-related adverse events and the impact on antimicrobial resistance and quality of life.
Collapse
Affiliation(s)
- Haroon Ahmed
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Hywel M Jones
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Nick A Francis
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Neuadd Meirionydd, Heath Park, Cardiff, UK
| | - Christopher C Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, UK
| |
Collapse
|
37
|
Kiss CR, Lau JSY, Yeung A, Woolley I. Infectious diseases physician attitudes to long-term antibiotic use. Int J Clin Pharm 2019; 41:18-21. [PMID: 30656557 DOI: 10.1007/s11096-018-00781-4] [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: 07/31/2018] [Accepted: 12/31/2018] [Indexed: 11/30/2022]
Abstract
Background In Australia, it is not known how much antibiotic prescribing by infectious diseases physicians is long-term, or how confident they are with the evidence behind this practice. Objective Survey Australian infectious diseases physicians to assess attitudes and prescribing practice prescribing prolonged courses of antibiotics. Methods An online questionnaire was distributed to the mailing group for the Australian Society of Infectious Diseases. Responses were collected from 29th October to 12th November 2015. Results The majority of respondents practiced in Australia as Infectious Diseases physicians, microbiologists, or trainees. 88% had prescribed long-term antibiotics. Heterogeneity was noted in the indications for prescription, including recurrent UTIs, cellulitis or chest infections, prosthetic joint infection and vascular graft infection. Beta-lactams antibiotics were prescribed most frequently. 22% of respondents had prescribed rifampicin/fusidic acid most frequently, while 11% could not identify a single antibiotic that they used most frequently, due to the heterogeneity of indications for prescribing. 95% stated that they would stop long-term antibiotic therapy if appropriate, and 74% were willing to enrol their patients into a randomised control trial looking at stopping long-term therapy. Conclusion Most infectious diseases physicians who responded to the survey prescribe long-term antibiotics, with great heterogeneity in the indications for which these antibiotics are prescribed.
Collapse
Affiliation(s)
| | - Jillian S Y Lau
- Department of Infectious Diseases, Alfred Hospital, Prahran, VIC, Australia.,Monash University, Clayton, VIC, Australia
| | | | - Ian Woolley
- Monash Health, Clayton, VIC, Australia. .,Department of Infectious Diseases, Alfred Hospital, Prahran, VIC, Australia. .,Monash University, Clayton, VIC, Australia. .,Monash Infectious Diseases, Monash Medical Centre, 246 Clayton Road, Clayton, VIC, 3168, Australia.
| |
Collapse
|
38
|
Goyal D, Dean N, Neill S, Jones P, Dascomb K. Risk Factors for Community-Acquired Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae Infections-A Retrospective Study of Symptomatic Urinary Tract Infections. Open Forum Infect Dis 2019; 6:ofy357. [PMID: 30775401 PMCID: PMC6366654 DOI: 10.1093/ofid/ofy357] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Revised: 12/10/2018] [Accepted: 01/02/2019] [Indexed: 01/25/2023] Open
Abstract
Background Community-acquired extended-spectrum beta-lactamase–producing Enterobacteriaceae (ESBL) infections are an evolving public health problem. Identifying predictive risk factors may improve patient management. Methods We identified 251 adult inpatients admitted to a 22-hospital system with an ESBL urinary tract infection (UTI) between 2001 and 2016. Cases were matched 1:1 with controls who had a UTI at admission with non-ESBL Enterobacteriaceae. Cases with a history of ESBL infections or hospitalization within 3 months of index admission were excluded. Univariate and multiple logistic regression were used to identify risk factors associated with ESBL UTIs. Results In univariate analysis, history of repeated UTIs, neurogenic bladder, urinary catheter presence at admission, and exposure to outpatient third-generation cephalosporins or fluoroquinolones within 3 months were associated with higher risk of ESBL UTIs. When controlling for severity of illness and comorbid conditions, history of repeated UTIs (adjusted odds ratio [aOR], 6.40; 95% confidence interval [CI], 3.42–12.66; P < .001), presence of urinary catheter at admission (aOR, 2.36; 95% CI, 1.15–4.98; P < .05), and prior antibiotic exposure (aOR, 7.98; 95% CI, 2.92–28.19; P < .001) remained associated with risk of ESBL infection. Conclusions Patients in the community with indwelling urinary catheters, history of recurrent UTIs, or recent antimicrobial use are at higher risk for de novo ESBL Enterobacteriaceae UTIs.
Collapse
Affiliation(s)
- Dheeraj Goyal
- Division of Infectious Diseases, University of Utah Health, Salt Lake City, Utah
| | - Nathan Dean
- Division of Pulmonary and Critical Care Medicine, Intermountain Healthcare, Murray, Utah
| | - Sarah Neill
- Division of Pulmonary and Critical Care Medicine, University of Utah Health, Salt Lake City, Utah
| | - Peter Jones
- Division of Infectious Diseases, Intermountain Healthcare, Murray, Utah
| | - Kristin Dascomb
- Division of Infectious Diseases, Intermountain Healthcare, Murray, Utah
| |
Collapse
|
39
|
Nalliah S, Fong JSH, Yi Thor AY, Lim OH. The use of chemotherapeutic agents as prophylaxis for recurrent urinary tract infection in healthy nonpregnant women: A network meta-analysis. Indian J Urol 2019; 35:147-155. [PMID: 31000921 PMCID: PMC6458811 DOI: 10.4103/iju.iju_378_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION The aim of this systematic review is to compare chemotherapeutic agents commonly used in treating recurrent urinary infection in nonpregnant women by their efficacy, tolerability, adverse effects, and cost employing network meta-analysis. MATERIALS AND METHODS We used three online databases, i.e., PubMed, ScienceDirect, and Cochrane Central Registry of Clinical Trials. Randomized controlled trials (RCTs) on the use of prophylactic chemotherapeutic agents used in treating nonpregnant women with recurrent urinary tract infections (RUTIs) published between 2002 and 2016 were selected. Only published papers in English were assessed for study quality, and meta-analyses were performed using fixed-effects model with NetMetaXL. RESULTS Six RCTs fulfilled the criteria. When all three variables, i.e., efficacy, adverse effects and cost were considered, nitrofurantoin 50 mg once daily for 6 months appears to rank high for prophylaxis against RUTI. When efficacy was the only factor, fosfomycin had the highest superiority compared to D-mannose, nitrofurantoin, estriol, trimethoprim-sulfamethoxazole, and cranberry juice, respectively. However, fosfomycin was also ranked highest by adverse events. When cost alone is considered, nitrofurantoin appeared the most cost-effective agent while placed third for efficacy alone. CONCLUSION Selecting appropriate chemotherapeutic agents for RUTI will need to factor in effectiveness, adverse effects, and cost. While it is difficult to select an ideal drug, evaluation using network analysis may guide choice of medication for best practice.
Collapse
Affiliation(s)
- Sivalingam Nalliah
- Department of Obstetrics and Gynaecology, International Medical University Clinical Campus Seremban, Negeri Sembilan, Malaysia, E-mail:
| | - Joanna Siaw Hui Fong
- Department of Obstetrics and Gynaecology, International Medical University Clinical Campus Seremban, Negeri Sembilan, Malaysia
| | - Alicia Ying Yi Thor
- Department of Obstetrics and Gynaecology, International Medical University Clinical Campus Seremban, Negeri Sembilan, Malaysia
| | - Oon Hooi Lim
- Department of Obstetrics and Gynaecology, International Medical University Clinical Campus Seremban, Negeri Sembilan, Malaysia
| |
Collapse
|
40
|
Abou Heidar NF, Degheili JA, Yacoubian AA, Khauli RB. Management of urinary tract infection in women: A practical approach for everyday practice. Urol Ann 2019; 11:339-346. [PMID: 31649450 PMCID: PMC6798292 DOI: 10.4103/ua.ua_104_19] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
A common health-care problem worldwide, urinary tract infection (UTI), represents a disease of significant impact on every country's economy, being the most common cause of hospitalization among elderly people and the most common cause of antibiotic prescription in primary care. Diagnosing and managing upper and lower UTI have always been a challenge to physicians, given its high prevalence, risk of recurrence and improper treatment, and the fact of worldwide increase in antibiotic resistance, necessitating implementation of a proper antibiotic stewardship. Urinary infections are twice more likely to occur in females compared to males and its prevalence increases with increasing age. The following is a comprehensive review paper about UTI in females, discussing the various factors leading to a complicated infection. The various etiologies and microbiologies of UTI are also highlighted. In addition to various usual antibiotic regimens for treating UTI, a significant number of nonantimicrobial treatment modalities are highlighted and described in this manuscript, including the novel use of intravesical antibiotics and vaccines for suppression treatment. Finally, a pathway is suggested for the proper diagnosis and treatment that ensures antibiotic stewardship in order to decrease long-term complications.
Collapse
Affiliation(s)
- Nassib F Abou Heidar
- Division of Urology, Department of Surgery, American University of Beirut - Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - Jad A Degheili
- Division of Urology, Department of Surgery, American University of Beirut - Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - Aline A Yacoubian
- Division of Urology, Department of Surgery, American University of Beirut - Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon
| | - Raja B Khauli
- Division of Urology, Department of Surgery, American University of Beirut - Medical Center, Riad El-Solh 1107 2020, Beirut, Lebanon.,Adjunct Professor of Urology, University of Massachusetts Medical Center, Lowell, MA, USA
| |
Collapse
|
41
|
The urinary microbiome in patients with refractory urge incontinence and recurrent urinary tract infection. Int Urogynecol J 2018; 29:1775-1782. [PMID: 29946828 PMCID: PMC6244753 DOI: 10.1007/s00192-018-3679-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/28/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary urge incontinence is a chronic, debilitating condition that is difficult to treat. Patients refractory to standard antimuscarinic therapy often experience recurrent urinary tract infections (rUTIs). The microbiota of these refractory patients with rUTI remains unexplored. METHODS A midstream urine (MSU) sample was collected from patients with refractory urge incontinence and coexistent rUTI during acute symptomatic episodes. Culture-based diagnosis was performed using routine microbiological methods. Culture-independent profiling was performed using bacterial 16S RNA profiling. E. coli strain typing was performed by amplicon pyrosequencing of the fimH gene. RESULTS Over 2 years, 39 patients with refractory urge incontinence and coexistent rUTI were studied, yielding 9 severely affected cases. These 9 patients were carefully monitored for a further 2 years, resulting in the collection of 102 MSU samples, 70 of which were diagnosed as UTI (median of 8 UTIs/woman). Culture-independent analysis of 38 of these samples revealed the existence of a diverse urinary microbiota. Strain typing of E. coli identified instances of rUTI caused by the same persisting strain and by new infecting strains. CONCLUSIONS Patients with refractory urge incontinence and coexistent rUTI possess a diverse urinary microbiota, suggesting that persistent bladder colonisation might augment the pathology of their chronic condition.
Collapse
|
42
|
Kreydin E, Welk B, Chung D, Clemens Q, Yang C, Danforth T, Gousse A, Kielb S, Kraus S, Mangera A, Reid S, Szell N, Cruz F, Chartier-Kastler E, Ginsberg DA. Surveillance and management of urologic complications after spinal cord injury. World J Urol 2018; 36:1545-1553. [PMID: 29845320 DOI: 10.1007/s00345-018-2345-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 05/17/2018] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Neurogenic bladder due to spinal cord injury has significant consequences for patients' health and quality of life. Regular surveillance is required to assess the status of the upper and lower urinary lower urinary tracts and prevent their deterioration. In this review, we examine surveillance techniques in neurogenic bladder, describe common complications of this disease, and address strategies for their management. METHODS This work represents the efforts of SIU-ICUD joint consultation on Urologic Management of the Spinal Cord injury. For this specific topic, a workgroup was formed and comprehensive literature search of English language manuscripts regarding neurogenic bladder management was performed using key words of neurogenic bladder. Articles were compiled, and recommendations in the chapter are based on group discussion and follow the Oxford Centre for Evidence-based Medicine system for Levels of Evidence (LOEs) and Grades of Recommendation (GORs). RESULTS At a minimum, patients should undergo an annual history and physical examination, renal functional testing (e.g., serum creatinine), and upper tract imaging (e.g., renal ultrasonography). The existing evidence does not support the use of other modalities, such as cystoscopy or urodynamics, for routine surveillance. Urologic complications in neurogenic bladder patients are common and often more complex than in the general population. CONCLUSIONS There is a shortage of high-quality evidence to support any particular neurogenic bladder surveillance protocol. However, there is consensus regarding certain aspects of regular genitourinary system evaluation in these patients. Proper surveillance allows the clinician to avoid or address common urological complications, and to guide, alter, or maintain appropriate therapeutic regimens for individual patients.
Collapse
Affiliation(s)
- Evgeniy Kreydin
- USC Institute of Urology, 1441 Eastlake Avenue, suite 7414, Los Angeles, CA, 90033, USA
| | - Blayne Welk
- Division of Urology, The University of Western Ontario, London, ON, Canada
| | - Doreen Chung
- Columbia University College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Teresa Danforth
- Jacobs School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Angelo Gousse
- Bladder Health and Reconstructive Urology Institute, Miami, FL, USA
| | | | - Stephen Kraus
- University of Texas, San Antonio, San Antonio, TX, USA
| | - Altaf Mangera
- Department of Urology, Pitié-Salpêtrière, Paris, France
| | | | - Nicole Szell
- Bladder Health and Reconstructive Urology Institute, Miami, FL, USA
| | - Francisco Cruz
- Department of Urology, Hospital de São João, Porto, Portugal
| | | | - David A Ginsberg
- USC Institute of Urology, 1441 Eastlake Avenue, suite 7414, Los Angeles, CA, 90033, USA.
| |
Collapse
|
43
|
Asma B, Vicky L, Stephanie D, Yves D, Amy H, Sylvie D. Standardised high dose versus low dose cranberry Proanthocyanidin extracts for the prevention of recurrent urinary tract infection in healthy women [PACCANN]: a double blind randomised controlled trial protocol. BMC Urol 2018; 18:29. [PMID: 29716563 PMCID: PMC5930667 DOI: 10.1186/s12894-018-0342-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 04/18/2018] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are amongst the most common bacterial infections affecting women. Although antibiotics are the treatment of choice for UTI, cranberry derived products have been used for many years to prevent UTIs, with limited evidence as to their efficacy. Our objective is to assess the efficacy of a cranberry extract capsule standardized in A-type linkage proanthocyanidins (PACs) for the prevention of recurrent urinary tract infection. METHODS We will perform a 1:1 randomized, controlled, double blind clinical trial in women aged 18 years or more who present ≥2 UTIs in 6 months or ≥ 3 UTIs in 12 months. One hundred and forty-eight women will be recruited and randomized in two groups to either receive an optimal dose of cranberry extract quantified and standardized in PACs (2 × 18.5 mg PACs per day) or a control dose (2 × 1 mg PACs per day). The primary outcome for the trial is the mean number of new symptomatic UTIs in women during a 6-month intervention period. Secondary outcomes are: (1) To evaluate the mean number of new symptomatic UTIs with pyuria as demonstrated by a positive leucocyte esterase test; (2) To detect the mean number of new symptomatic culture-confirmed UTIs; (3) To quantify urinary PACs metabolites in women who take a daily dose of 37 mg PACs per day compared to women who take a daily dose of 2 mg per day for 6 months; (4) To characterize women who present recurrent UTI based on known risk factors for recurrent UTI; (5) To describe the side effects of daily intake of cranberry extract containing 37 mg PACs compared to 2 mg PACs. This report provides comprehensive methodological data for this randomized controlled trial. DISCUSSION The results of this trial will inform urologists, gynaecologists, family physicians and other healthcare professionals caring for healthy women with recurrent UTI, as to the benefits of daily use of an optimal dose of cranberry extract for the prevention of recurrent UTI. TRIAL REGISTRATION Clinicaltrials.gov, identifier: NCT02572895 October 8th 2015.
Collapse
Affiliation(s)
- Babar Asma
- Department of Obstetrics and Gynaecology, Laval University, CHU de Québec - Université Laval, 2705, boulevard Laurier, Local A1385, Québec, Québec G1V 4G2 Canada
- Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Quebec City, Quebec G1V 0A6 Canada
| | - Leblanc Vicky
- Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Quebec City, Quebec G1V 0A6 Canada
| | - Dudonne Stephanie
- Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Quebec City, Quebec G1V 0A6 Canada
| | - Desjardins Yves
- Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Quebec City, Quebec G1V 0A6 Canada
| | - Howell Amy
- Rutgers University, 125A Lake Oswego Rd., Chatsworth, NJ 08019 USA
| | - Dodin Sylvie
- Department of Obstetrics and Gynaecology, Laval University, CHU de Québec - Université Laval, 2705, boulevard Laurier, Local A1385, Québec, Québec G1V 4G2 Canada
- Institute of Nutrition and Functional Foods, Laval University, 2440 Hochelaga Boulevard, Quebec City, Quebec G1V 0A6 Canada
| |
Collapse
|
44
|
Morin F, Akhavizadegan H, Kavanagh A, Moore K. Dysfunctional voiding: Challenges of disease transition from childhood to adulthood. Can Urol Assoc J 2018; 12:S42-S47. [PMID: 29681274 DOI: 10.5489/cuaj.5230] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Fannie Morin
- Division of Urology, Department of Surgery, CHU de Québec, Université Laval, Quebec City, QC
| | - Hamed Akhavizadegan
- International Collaboration on Repair Discoveries (ICORD), Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Alex Kavanagh
- International Collaboration on Repair Discoveries (ICORD), Department of Urologic Sciences, University of British Columbia, Vancouver, BC; Canada
| | - Katherine Moore
- Division of Urology, Department of Surgery, CHU de Québec, Université Laval, Quebec City, QC
| |
Collapse
|
45
|
Al Demour S, Ababneh MA. Evaluation of Behavioral and Susceptibility Patterns in Premenopausal Women with Recurrent Urinary Tract Infections: A Case Control Study. Urol Int 2017; 100:31-36. [PMID: 29241191 DOI: 10.1159/000485568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 11/22/2017] [Indexed: 11/19/2022]
Abstract
Recurrent urinary tract infections (UTI) are a major source of morbidity and healthcare costs. Risk factors associated with recurrence rates in premenopausal women can be attributed to patient lifestyle behavior. The aim of this study was to assess hygienic risk factors, determine pathogen distribution, and susceptibility patterns in premenopausal women with recurrent UTI. This was case-control study in which a face-to-face interview was conducted to obtain information from premenopausal women with recurrent UTI. Microbiology cultures and susceptibility results were obtained to analyze pathogen distribution and resistance. In this study, 214 cases and 230 controls were compared and the following practices were associated with increased risk of recurrent UTI in multivariable analysis: washing genitals from back to front (OR 1.64 [95% CI 1.05-2.56]), not voiding within 15 min after intercourse (OR 2.81 [95% CI 1.72-4.66]), not drinking water after intercourse (OR 1.69 [95% CI 1.12-2.58]), using any soap to clean after urination (OR 2.11 [95% CI 1.42-3.17]). Escherichia coli were the most prevalent pathogens isolated (66.4%), followed by Klebsiella spp. (12.6%), Pseudomonas aeruginosa (12.1%), and Proteus spp., (6.6%). This study identified several modifiable sexual and hygienic practices associated with recurrent UTI in premenopausal women. Continuous surveillance of antimicrobial susceptibility patterns is important to overcome resistance.
Collapse
Affiliation(s)
- Saddam Al Demour
- Department of Urology/Special Surgery, Faculty of Medicine, University of Jordan, Amman, Jordan
| | - Mera A Ababneh
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
| |
Collapse
|
46
|
Li X, Chen Y, Gao W, Ye H, Shen Z, Wen Z, Wei J. A 6-year study of complicated urinary tract infections in southern China: prevalence, antibiotic resistance, clinical and economic outcomes. Ther Clin Risk Manag 2017; 13:1479-1487. [PMID: 29184412 PMCID: PMC5687777 DOI: 10.2147/tcrm.s143358] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Urinary tract infections (UTIs) are common nosocomial infections. This study evaluated the prevalence, pathogens, antibiotic resistances, clinical outcomes, and hospitalization costs associated with complicated UTIs in southern China, and risk factors delaying patient discharge. We retrospectively reviewed electronic medical records of 4,284 (61.4% women) complicated UTI-related hospitalizations from 2008 to 2013. Average patient age was 61.1 years and median hospital stay was 11 days. Pathogens were isolated from 1,071 urine and 148 blood specimens. Gram-negative bacteria were the most frequent and included Escherichia coli (48.2%), Klebsiella pneumoniae (9.5%), Pseudomonas aeruginosa (4.9%), and Proteus mirabilis (4.6%), while Enterococcus spp. (14.4%) was the most common Gram-positive bacteria causing UTIs. Both E. coli and K. pneumoniae showed high resistance rates (>45%) to wide-spectrum penicillins, cephalosporins, aztreonam, and ciprofloxacin. Resistances to beta-lactamase inhibitor/beta-lactam antibiotic combination were relatively lower. Imipenem, meropenem, and amikacin had the greatest activity against E.coli and K. pneumoniae. Recurrent infection was a risk factor for mortality. Age, sex, previous surgery, diabetes, and renal insufficiency were significant risk factors for delayed discharge (P<0.01). Response to initial treatment was associated with a lower cost. Initial empiric use of antibiotics least associated with resistance may reduce costs and medical resource usage.
Collapse
Affiliation(s)
- Xiaoyan Li
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou
| | - Yunqin Chen
- R&D Information, AstraZeneca, Pudong.,School of Life Sciences and Biotechnology, Shanghai JiaoTong University, Shanghai, China
| | | | - Hao Ye
- R&D Information, AstraZeneca, Pudong
| | | | - Zehuai Wen
- Key Unit of Methodology in Clinical Research, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou
| | - Jia Wei
- R&D Information, AstraZeneca, Pudong
| |
Collapse
|
47
|
Abstract
A urinary tract infection (UTI) is a collective term for infections that involve any part of the urinary tract. It is one of the most common infections in local primary care. The incidence of UTIs in adult males aged under 50 years is low, with adult women being 30 times more likely than men to develop a UTI. Appropriate classification of UTI into simple or complicated forms guides its management and the ORENUC classification can be used. Diagnosis of a UTI is based on a focused history, with appropriate investigations depending on individual risk factors. Simple uncomplicated cystitis responds very well to oral antibiotics, but complicated UTIs may require early imaging, and referral to the emergency department or hospitalisation to prevent urosepsis may be warranted. Escherichia coli remains the predominant uropathogen in acute community-acquired uncomplicated UTIs and amoxicillin-clavulanate is useful as a first-line antibiotic. Family physicians are capable of managing most UTIs if guided by appropriate history, investigations and appropriate antibiotics to achieve good outcomes and minimise antibiotic resistance.
Collapse
Affiliation(s)
- Chee Wei Tan
- Family Medicine, Changi General Hospital, Singapore
| | | |
Collapse
|
48
|
Dray EV, Clemens JQ. Recurrent urinary tract infections in patients with incomplete bladder emptying: is there a role for intravesical therapy? Transl Androl Urol 2017; 6:S163-S170. [PMID: 28791235 PMCID: PMC5522797 DOI: 10.21037/tau.2017.04.08] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 03/26/2017] [Indexed: 11/06/2022] Open
Abstract
The goal of this review article is to discuss the etiology of recurrent urinary tract infections (UTIs) in individuals with impaired bladder emptying, evaluate existing studies regarding UTI prevention strategies in this population, and explore the published experiences with intravesical therapy for the prevention and treatment of recurrent UTIs in patients performing clean intermittent catheterization (CIC). We will also describe the intravesical antibiotic protocol utilized at our institution.
Collapse
Affiliation(s)
- Elizabeth V Dray
- Department of Urology, University of Michigan Health Science Center, Ann Arbor, Michigan, USA
| | - J Quentin Clemens
- Department of Urology, University of Michigan Health Science Center, Ann Arbor, Michigan, USA
| |
Collapse
|
49
|
Ahmed H, Davies F, Francis N, Farewell D, Butler C, Paranjothy S. Long-term antibiotics for prevention of recurrent urinary tract infection in older adults: systematic review and meta-analysis of randomised trials. BMJ Open 2017; 7:e015233. [PMID: 28554926 PMCID: PMC5729980 DOI: 10.1136/bmjopen-2016-015233] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To address clinical uncertainties about the effectiveness and safety of long-term antibiotic therapy for preventing recurrent urinary tract infections (UTIs) in older adults. DESIGN Systematic review andmeta-analysis of randomised trials. METHOD We searched Medline, Embase, The Cumulative Index to Nursing and Allied Health Literature(CINAHL), and the Cochrane Register of Controlled Trials from inception to August 2016. Eligible studies compared long-term antibiotic therapy with non-antibiotic therapy or placebo in men or women aged over 65, or in postmenopausal women, with recurrent UTIs. RESULTS We did not identify any studies that included older men. Three randomised controlled trials compared long-term antibiotics with vaginal oestrogens (n=150), oral lactobacilli (n=238) and D-mannose powder (n=94) in postmenopausal women. Long-term antibiotics reduced the risk of UTI recurrence by 24% (three trials, n=482; pooled risk ratio (RR) 0.76; 95% CI 0.61 to 0.95, number needed to treat=8.5). There was no statistically significant increase in risk of adverse events (mild adverse events: pooled RR 1.52; 95% CI 0.76 to 3.03; serious adverse events: pooled RR 0.90, 95% CI 0.31 to 2.66). One trial showed 90% of urinary and faecal Escherichia coli isolates were resistant to trimethoprim-sulfamethoxazole after 1 month of prophylaxis. CONCLUSIONS Findings from three small trials with relatively short follow-up periods suggest long-term antibiotic therapy reduces the risk of recurrence in postmenopausal women with recurrent UTI. We did not identify any evidence to inform several clinically important scenarios including, benefits and harms in older men or frail care home residents, optimal duration of prophylaxis, recurrence rates once prophylaxis stops and effects on urinary antibiotic resistance.
Collapse
Affiliation(s)
- Haroon Ahmed
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Freya Davies
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Nick Francis
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Daniel Farewell
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - Christoper Butler
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Shantini Paranjothy
- Division of Population Medicine, Cardiff University School of Medicine, Cardiff, UK
| |
Collapse
|
50
|
Lau JSY, Kiss C, Roberts E, Horne K, Korman TM, Woolley I. Surveillance of life-long antibiotics: a review of antibiotic prescribing practices in an Australian Healthcare Network. Ann Clin Microbiol Antimicrob 2017; 16:3. [PMID: 28100229 PMCID: PMC5241934 DOI: 10.1186/s12941-017-0180-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 01/11/2017] [Indexed: 12/14/2022] Open
Abstract
Background The rise of antimicrobial use in the twentieth century has significantly reduced morbidity due to infection, however it has also brought with it the rise of increasing resistance. Some patients are on prolonged, if not “life-long” course of antibiotics. The reasons for this are varied, and include non-infectious indications. We aimed to study the characteristics of this potential source of antibiotic resistance, by exploring the antibiotic dispensing practices and describing the population of patients on long-term antibiotic therapy. Methods A retrospective cross-sectional study of antibiotic dispensing records was performed at a large university hospital-based healthcare network in Melbourne, Australia. Outpatient prescriptions were extracted from the hospital pharmacy database over a 6 month period in 2014. Medical records of these patients were reviewed to determine the indication for prescription, including microbiology, the intended duration, and the prescribing unit. A descriptive analysis was performed on this data. Results 66,127 dispensing episodes were reviewed. 202 patients were found to have been prescribed 1 or more antibiotics with an intended duration of 1 year or longer. 69/202 (34%) of these patients were prescribed prolonged antibiotics for primary prophylaxis in the setting of immunosuppression. 43/202 (21%) patients were prescribed long-term suppressive antibiotics for infections of thought incurable (e.g. vascular graft infections), and 34/43 (79%) were prescribed by Infectious Diseases doctors. 66/202 (33%) patients with cystic fibrosis were prescribed prolonged courses of macrolides or fluoroquinolones, by respiratory physicians. There was great heterogeneity noted in indications for prolonged antibiotic courses, as well as antibiotic agents utilised. Conclusion Our study found that that continuous antibiotic therapy represented only a small proportion of overall antibiotic prescribing at our health network. Prolonged courses of antibiotics were used mainly to suppress infections thought incurable, but also as primary and secondary prophylaxis and as anti-inflammatory agents. More research is needed to understand the impact of long-term antibiotic consumption on both patients and microbial ecology.
Collapse
Affiliation(s)
- Jillian S Y Lau
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, VIC, Australia
| | - Christopher Kiss
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, VIC, Australia
| | - Erika Roberts
- Monash Health Pharmacy, Monash Health, Clayton, VIC, Australia
| | - Kylie Horne
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, VIC, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, VIC, Australia
| | - Ian Woolley
- Monash Infectious Diseases, Monash University, Monash Health, Clayton, VIC, Australia.
| |
Collapse
|