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Tchesnokova V, Larson L, Basova I, Sledneva Y, Choudhury D, Solyanik T, Heng J, Bonilla TC, Pasumansky I, Bowers V, Pham S, Madziwa LT, Holden E, Tartof SY, Ralston JD, Sokurenko EV. Gut resident Escherichia coli profile predicts the eighteen-month probability and antimicrobial susceptibility of urinary tract infections. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2024:2024.04.05.24305377. [PMID: 38645148 PMCID: PMC11030298 DOI: 10.1101/2024.04.05.24305377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Background Community-acquired UTI is the most common bacterial infection managed in general medical practice that can lead to life-threatening outcomes. While UTIs are primarily caused by Escherichia coli colonizing the patient's gut, it is unclear whether the gut resident E. coli profiles can predict the person's risks for UTI and optimal antimicrobial treatments. Thus, we conducted an eighteen-month long community-based observational study of fecal E. coli colonization and UTI in women aged 50 years and above. Methods and Findings We enrolled a total of 1,804 women distributed among age groups 50-59 yo (437 participants), 60-69 yo (632), 70-79 yo (532), and above 80 yo (203), lacking antibiotic prescriptions for at least one year. The provided fecal samples were plated for the presence of E. coli and other enterobacteria resistant to trimethoprim/sulfamethoxazole (TMP/STX), ciprofloxacin (CIP) and 3rd generation cephalosporins (3GC). E. coli was also characterized as belonging to the pandemic multi-drug resistant clonal groups ST131 (subclone H30) and ST1193. Following sample collection, the women were monitored for 18 months for occurrence of UTI.E. coli was cultured from 90.8% fecal samples, with 24.1% containing bacteria resistant to TMP/STX, 19.4% to CIP, and 7.9% to 3GC. In 62.5% samples, only all-susceptible E. coli were present. Overall, there were no age-related differences in resistance prevalence. However, while the total E. coli H30 and ST1193 carriage rates were similar (4.3% and 4.2%, respectively), there was a notable increase of H30 carriage with age (P = .001), while carriage decreased with age for ST1193 (P = .057).Within 18 months, 184 women (10.2%) experienced at least one episode of UTI - 10.9% among the gut E. coli carriers and 3.0% among the non-carriers (P=.0013). The UTI risk among carriers of E. coli H30 but not ST1193 was significantly above average (24.3%, P = .0004). The UTI probability increased with age, occurring in 6.4% of 50-59 yo and 19.7% of 80+ yo (P<.001), with the latter group being especially at high risk for UTI, if they were colonized by E. coli H30 (40.0%, P<.001).E. coli was identified in 88.1% of urine samples, with 16.1% resistant to TMP/STX, 16.1% to CIP, 4.2% to 3GC and 73.1% to none of the antibiotics. Among tested urinary E. coli resistant to antibiotics, 86.1% matched the resistance profile of E. coli in the fecal samples, with the clonotyping and whole genome sequencing confirming the matching strains' identity. Positive predictive value (PPV) of using gut resistance profiles to predict UTI pathogens' susceptibility to TMP/STX, CIP, 3GC and all three antibiotics were 98.4%, 98.3%, 96.6% and 95.3%, respectively. Corresponding negative predictive values (NPV) were 63.0%, 54.8%, 44.4% and 75.8%, respectively. The AUC ROC curve values for the accuracy of fecal diagnostic testing for the prediction of UTI resistance ranged .86-.89. The fecal test-guided drug-bug mismatch rate for empirical (pre-culture) prescription of TMP-SXT or CIP is reduced to ≤2% in 89.6% of patients and 94.8% of patients with an optional 3GC prescription. Conclusion The resistance profile and clonal identity of gut colonizing E. coli, along with the carrier's age, can inform personalized prediction of a patients' UTI risk and the UTI pathogen's antibiotic susceptibility within an 18-month period.
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Affiliation(s)
- Veronika Tchesnokova
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Lydia Larson
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Irina Basova
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Yulia Sledneva
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Debarati Choudhury
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Thalia Solyanik
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Jennifer Heng
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Teresa Cristina Bonilla
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Isaac Pasumansky
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Victoria Bowers
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Sophia Pham
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
| | - Lawrence T. Madziwa
- Kaiser Permanente Washington, 2715 Naches Ave. SW, Renton, WA 98057, USA
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466, USA
| | - Erika Holden
- Kaiser Permanente Washington, 2715 Naches Ave. SW, Renton, WA 98057, USA
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466, USA
| | - Sara Y. Tartof
- Kaiser Permanente Southern California, Department of Research & Evaluation, Pasadena, 100 S Los Robles, Pasadena, CA 91101, USA
- Kaiser Permanente Bernard J. Tyson School of Medicine, Department of Health Systems Science, 100 S Los Robles, Pasadena, CA 91101, USA
| | - James D. Ralston
- Kaiser Permanente Washington, 2715 Naches Ave. SW, Renton, WA 98057, USA
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101-1466, USA
| | - Evgeni V. Sokurenko
- Department of Microbiology, University of Washington School of Medicine, 1705 NE Pacific St., Seattle, WA 98195, USA
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Bilsen MP, Conroy SP, Schneeberger C, Platteel TN, van Nieuwkoop C, Mody L, Caterino JM, Geerlings SE, Köves B, Wagenlehner F, Kunneman M, Visser LG, Lambregts MMC. A reference standard for urinary tract infection research: a multidisciplinary Delphi consensus study. THE LANCET. INFECTIOUS DISEASES 2024:S1473-3099(23)00778-8. [PMID: 38458204 DOI: 10.1016/s1473-3099(23)00778-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 11/15/2023] [Accepted: 12/07/2023] [Indexed: 03/10/2024]
Abstract
The absence of a consensus-based reference standard for urinary tract infection (UTI) research adversely affects the internal and external validity of diagnostic and therapeutic studies. This omission hinders the accumulation of evidence for a disease that imposes a substantial burden on patients and society, particularly in an era of increasing antimicrobial resistance. We did a three-round Delphi study involving an international, multidisciplinary panel of UTI experts (n=46) and achieved a high degree of consensus (94%) on the final reference standard. New-onset dysuria, urinary frequency, and urinary urgency were considered major symptoms, and non-specific symptoms in older patients were not deemed indicative of UTI. The reference standard distinguishes between UTI with and without systemic involvement, abandoning the term complicated UTI. Moreover, different levels of pyuria were incorporated in the reference standard, encouraging quantification of pyuria in studies done in all health-care settings. The traditional bacteriuria threshold (105 colony-forming units per mL) was lowered to 104 colony-forming units per mL. This new reference standard can be used for UTI research across many patient populations and has the potential to increase homogeneity between studies.
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Affiliation(s)
- Manu P Bilsen
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands.
| | - Simon P Conroy
- Medical Research Council Unit for Lifelong Health and Ageing, University College London, London, UK
| | - Caroline Schneeberger
- Center for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Tamara N Platteel
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands
| | - Cees van Nieuwkoop
- Department of Internal Medicine, Haga Teaching Hospital, The Hague, Netherlands; Department of Public Health and Primary Care, The Hague Health Campus, Leiden University Medical Center, The Hague, Netherlands
| | - Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA; Geriatrics Research Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA
| | - Jeffrey M Caterino
- Department of Emergency Medicine, The Ohio State University, Columbus, OH, USA
| | - Suzanne E Geerlings
- Amsterdam UMC, Department of Internal Medicine, Amsterdam Institute for Infection and Immunity, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | - Bela Köves
- Department of Urology, University of Szeged, Szeged, Hungary
| | - Florian Wagenlehner
- Clinic for Urology, Paediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Marleen Kunneman
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, Netherlands; Knowledge and Evaluation Research Unit, Mayo Clinic Rochester, Rochester, MN, USA
| | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
| | - Merel M C Lambregts
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, Netherlands
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O'Toole R, Martinez KA, Rothberg MB, Diiorio G, Stenehjem EA, Ward KE, LaPlante KL. Antibiotics on Demand: Advances in Asynchronous Telemedicine Call for Increased Antibiotic Surveillance. Clin Infect Dis 2024; 78:308-311. [PMID: 37642218 DOI: 10.1093/cid/ciad472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Indexed: 08/31/2023] Open
Abstract
The rapid growth of telehealth services has brought about direct-to-consumer telemedicine platforms, enabling patients to request antibiotics online without a virtual or face-to-face consultation. While telemedicine aims to enhance accessibility, this trend raises significant concerns regarding appropriate antimicrobial use and patient safety. In this viewpoint, we share our first-hand experience with 2 direct-to-consumer platforms, where we intentionally sought inappropriate antibiotic prescriptions for nonspecific symptoms strongly indicative of a viral upper respiratory infection. Despite the lack of clear necessity, requested antibiotic prescriptions were readily transmitted to our local pharmacy following a simple monetary transaction. The effortless acquisition of patient-selected antibiotics online, devoid of personal interactions or consultations, underscores the urgent imperative for intensified antimicrobial stewardship initiatives led by state and national public health organizations in telehealth settings. By augmenting oversight and regulation, we can ensure the responsible and judicious use of antibiotics, safeguard patient well-being, and preserve the efficacy of these vital medications.
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Affiliation(s)
- Rebecca O'Toole
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | | | | | - Gillian Diiorio
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Edward A Stenehjem
- Division of Infectious Diseases, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kristina E Ward
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
| | - Kerry L LaPlante
- College of Pharmacy, University of Rhode Island, Kingston, Rhode Island, USA
- Division of Infectious Diseases, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
- School of Public Health, Brown University, Providence, Rhode Island, USA
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Billups SJ, Fixen D, Johnson K, Wettergreen SA, Schilling LM. Patient Perception and Impact of Home Test Kits on Health Care Utilization for Urinary Tract Infection. Popul Health Manag 2024; 27:44-48. [PMID: 37922423 DOI: 10.1089/pop.2023.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2023] Open
Abstract
Urinary tract infection (UTI) is a common reason for emergency department (ED) utilization that could potentially be treated by a primary care provider (PCP). This study assessed patient perceived value of a home UTI test kit plus educational materials and its impact on ED utilization for a UTI symptom episode. Women aged 18-75 years with Medicaid insurance and a history of 1-3 uncomplicated UTIs in the past year were prospectively identified and randomized to the intervention, intervention plus (intervention plus a patient portal message before its delivery), or standard of care group. A telephone survey was conducted 3-5 months after the mailing. Site of care for each UTI symptom episode was measured 12 months before and 6 months after the intervention. Test kit packages were mailed to 266 intervention individuals, and 150 responded to the telephone survey. Utilization outcomes were compared between a combined intervention group and a control group. Approximately one-third of the intervention patients experienced UTI symptoms within 5 months, and 73% used the test kit. Of those who experienced UTI symptoms, 58% contacted their PCP to seek care and 96% reported that the test kit was helpful. ED utilization was not significantly different in the intervention groups before and after the intervention, nor between the intervention and control groups postintervention. A home UTI test kit plus educational materials mailed to patients with a history of uncomplicated UTI was deemed helpful but did not have a measurable impact on ED utilization.
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Affiliation(s)
- Sarah J Billups
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Danielle Fixen
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Kaci Johnson
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Sara A Wettergreen
- Department of Clinical Pharmacy, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado, USA
| | - Lisa M Schilling
- Department of Medicine, School of Medicine, University of Colorado, Aurora, Colorado, USA
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Gander JC, Goodrich G, McDonald B, McCracken CE, Tavel HM, Davis TL, Weinfield NS, Ritzwoller DP, Roblin DW. Virtual Care and Urinary Tract Infection Management: Comparing Ancillary Service Orders and Patient Order Fulfillments Between Virtual and In-person Encounters During the COVID-19 Pandemic in the United States. Med Care 2023; 61:S21-S29. [PMID: 36893415 PMCID: PMC9994568 DOI: 10.1097/mlr.0000000000001805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND During the COVID-19 pandemic, more health care issues were being managed remotely. Urinary tract infections (UTIs) are being managed more often using telehealth although few reports compare the rate of UTI ancillary service orders placed and fulfilled during these visits. OBJECTIVES We aimed to evaluate and compare the rate of ancillary service orders and order fulfillments in incident UTI diagnoses between virtual and in-person encounters. RESEARCH DESIGN The retrospective cohort study involved 3 integrated health care systems: Kaiser Permanente (KP) Colorado, KP Georgia, and KP Mid-Atlantic States. SUBJECTS We included incident UTI encounters from adult primary care data from January 2019 to June 2021. MEASURES Data were categorized as: prepandemic (January 2019-March 2020), COVID-19 Era 1 (April 2020-June 2020), and COVID-19 Era 2 (July 2020-June 2021). UTI-specific ancillary services included medication, laboratory, and imaging. Orders and order fulfillments were dichotomized for analyses. Weighted percentages for orders and fulfillments were calculated using inverse probability treatment weighting from logistic regression and compared between virtual and in-person encounters using χ2 tests. RESULTS We identified 123,907 incident encounters. Virtual encounters increased from 13.4% prepandemic to 39.1% in COVID-19 Era 2. Ancillary service orders from virtual encounters were not placed as often as in-person encounters. However, the weighted percentage for ancillary service order fulfillment across all services remained above 65.3% across sites and eras, with many fulfillment percentages above 90%. CONCLUSIONS Our study reported a high rate of order fulfillment for both virtual and in-person encounters. Health care systems should encourage providers to place ancillary service orders for uncomplicated diagnoses, such as UTI, to provide enhanced access to patient-centered care.
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Affiliation(s)
- Jennifer C. Gander
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | - Glenn Goodrich
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Bennet McDonald
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | | | - Heather M. Tavel
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO
| | - Teaniese L. Davis
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, GA
| | - Nancy S. Weinfield
- Kaiser Permanente Mid-Atlantic Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
| | | | - Douglas W. Roblin
- Kaiser Permanente Mid-Atlantic Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, MD
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Daumeyer NM, Kreitzberg D, Gavin KM, Bauer TA. Real-world evidence: Telemedicine for complicated cases of urinary tract infection. PLoS One 2023; 18:e0280386. [PMID: 36730176 PMCID: PMC9894494 DOI: 10.1371/journal.pone.0280386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 12/28/2022] [Indexed: 02/03/2023] Open
Abstract
Telemedicine programs for the treatment of urinary tract infections (UTIs) offer an opportunity to reduce burdens on patients and providers. However, these programs are typically restricted to patients with uncomplicated UTIs. This real-world analysis evaluated treatment and resolution rates in a large-scale, national UTI telemedicine program inclusive of patients with uncomplicated and complicated UTIs. We conducted a retrospective analysis of data obtained from a commercially available telemedicine program for the treatment of UTIs among adult women in the US between 2017 and 2021 (n = 51,474). The primary outcomes were the number of women who presented with symptoms of uncomplicated UTI, complicated UTI, and vaginal infection; prescription use and antibiotic type; symptom resolution within seven days after appointment; and treatment failure or relapse. Most patients reported frequent urination (94.4%), urgency (94.5%), and dysuria (97.6%). Those with uncomplicated UTI symptoms represented the majority of patients (61.6%); however, a substantial number of patients (36.5%) also reported at least one symptom associated with a complicated UTI. One-fifth of patients (19.2%) reported at least one co-occurring symptom of vaginal infection or sexually transmitted infection. Across all treated patients, 94.0% received recommended antibiotics according to the clinical protocol. Of the treated patients who provided follow-up data (n = 3,521), 89.7% reported seven-day symptom resolution. Symptom resolution rates were similar between patients with uncomplicated UTI symptoms (90.8%) and complicated UTI symptoms (87.9%), and symptom resolution among all treated patients (89.7%) was similar to reports for in-person standard of care. These findings suggest that large-scale telemedicine programs for the treatment of UTIs can be effective in the treatment of complicated UTIs.
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Affiliation(s)
| | | | - Kathleen M. Gavin
- Everly Health, Inc., Austin, Texas, United States of America
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
| | - Timothy A. Bauer
- Everly Health, Inc., Austin, Texas, United States of America
- University of Colorado Anschutz Medical Campus, Aurora, Colorado, United States of America
- * E-mail:
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van Horrik TM, Laan BJ, van Seben R, Rodenburg G, Heeregrave EJ, Geerlings SE. Shared decision making for women with uncomplicated Cystitis in Primary Care in the Netherlands: a qualitative interview study. BMC PRIMARY CARE 2022; 23:259. [PMID: 36199037 PMCID: PMC9534461 DOI: 10.1186/s12875-022-01867-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 09/14/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are common, especially among women. Antibiotics are commonly used to treat UTIs, but might not always be necessary, for example in the case of uncomplicated UTIs such as cystitis. Shared decision making (SDM) could reduce the risk of unnecessary antibiotic prescriptions for uncomplicated cystitis. We investigated the current management and the use of SDM for uncomplicated cystitis in primary care. METHODS We performed a qualitative semi-structured interview study among 23 women with a history of cystitis, 12 general practitioner (GP) assistants, and 12 GPs in the Netherlands from July to October 2020. All interviews were individually performed by telephone. The data were analyzed through the use of using open and axial coding. RESULTS The GP assistants managed the initial diagnostics and treatment of uncomplicated cystitis in all general practices. Usually, antibiotics were considered the standard treatment of cystitis. In most general practices, SDM was not used in the treatment of uncomplicated cystitis, mainly because of a lack of time. Women reported that they valued being involved in the treatment decision-making process, but they were not always involved. Further, both GP assistants and GPs indicated that SDM would improve the care pathway of uncomplicated UTIs. CONCLUSION In our study, SDM was infrequently used to help women with uncomplicated cystitis. To reduce the use of antibiotics for uncomplicated UTIs, a tailored intervention is needed to implement SDM for the treatment of uncomplicated cystitis in primary care.
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Affiliation(s)
- Tessa M.Z.X.K. van Horrik
- grid.7177.60000000084992262Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Infectious Diseases, Room no. D3-226, Meibergdreef 9, 1105 AZ Amsterdam, North-Holland, the Netherlands
| | - Bart J. Laan
- grid.7177.60000000084992262Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Infectious Diseases, Room no. D3-226, Meibergdreef 9, 1105 AZ Amsterdam, North-Holland, the Netherlands
| | - Rosanne van Seben
- Capgemini Invent, PO box 2575, 3500 GN Utrecht, Utrecht, the Netherlands
| | - Gerda Rodenburg
- grid.5645.2000000040459992XTrauma Centre Southwest Netherlands, Erasmus Medical Centre, Dr. Molewaterplein 40, 3015 GD Rotterdam, South-Holland, the Netherlands
| | - Edwin J. Heeregrave
- grid.511999.cNational Health Care Institute, PO Box 320, 1110 AH Diemen, North-Holland, the Netherlands
| | - Suzanne E. Geerlings
- grid.7177.60000000084992262Department of Internal Medicine, Amsterdam UMC location University of Amsterdam, Infectious Diseases, Room no. D3-226, Meibergdreef 9, 1105 AZ Amsterdam, North-Holland, the Netherlands
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Gonzalez G, Kuhlmann P, Scott V. Patient Engagement in Management of Recurrent Urinary Tract Infections. CURRENT BLADDER DYSFUNCTION REPORTS 2022. [DOI: 10.1007/s11884-022-00663-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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Jent P, Berger J, Kuhn A, Trautner BW, Atkinson A, Marschall J. Antibiotics for Preventing Recurrent Urinary Tract Infection: Systematic Review and Meta-analysis. Open Forum Infect Dis 2022; 9:ofac327. [PMID: 35899289 PMCID: PMC9310516 DOI: 10.1093/ofid/ofac327] [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: 05/02/2022] [Accepted: 07/01/2022] [Indexed: 12/31/2022] Open
Abstract
Recurrent urinary tract infections are a common health problem. The only comprehensive synthesis on antibiotic prophylaxis in the last 15 years has been a guideline-embedded meta-analysis. We conducted a systematic review and meta-analysis of randomized controlled trials published up to October 13, 2020, evaluating patients age ≥12 years with either ≥2 episodes of lower urinary tract infection (UTI) within 6 months or ≥3 in the past year. Placebo or antibiotics were allowed as comparators. Study quality was low. In the 11 placebo-controlled trials, the risk for developing UTI was 85% lower with prophylaxis in comparison with placebo (risk ratio [RR], 0.15; 95% CI, 0.08-0.29). In the 9 head-to-head trials, the efficacy of the antibiotic agents appeared similar: The pooled RR indicated no difference between nitrofurantoin and comparators (RR, 1.01; 95% CI, 0.74-1.37), nor trimethoprim (+/- sulfamethoxazole; RR, 1.34; 95% CI, 0.89-2.03) or norfloxacin and comparators (RR, 1.17; 95% CI, 0.43-1.70). Studies comparing intermittent (postcoital) with continuous strategies revealed intermittent application to be equally effective.
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Affiliation(s)
- Philipp Jent
- Correspondence: Philipp Jent, MD, Department of Infectious Diseases, Inselspital Bern University Hospital, Freiburgstrasse 16p, CH-3010 Bern, Switzerland ()
| | - Julia Berger
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Annette Kuhn
- Department of Gynecology, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center and Section of Health Services Research, Baylor College of Medicine, Houston, Texas, USA
| | - Andrew Atkinson
- Department of Infectious Diseases, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Jonas Marschall
- Division of Infectious Diseases, Department of Internal Medicine, Washington University School of Medicine, St. Louis, Missouri, USA
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Maita H, Kobayashi T, Akimoto T, Matsuoka F, Osawa H, Kato H. Factors associated with children's seasonal influenza diagnosis by their guardians: a prospective observational study in Japan. J Prim Health Care 2022; 14:29-36. [PMID: 35417328 DOI: 10.1071/hc21135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/07/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Children's influenza diagnosis by their guardians has been reported to be highly accurate, but clinical factors that improve the reliability of a guardian's diagnosis are unclear. Aim To determine the accuracy of guardians' influenza diagnosis of their children, investigate clinical factors that improve the diagnostic accuracy, and determine the additional clinical value of the guardian's diagnosis. Methods A prospective observational study was conducted at a primary care clinic in Japan from December 2017 to April 2019. Pre-examination checklists completed by guardians accompanying children aged Results A total of 112 patient pairs of child (median age, 6 years) and guardian (mother, 81.2%; father, 16.1%; grandmother, 1.8%; other, 0.9%) were included in the analysis. The AUC for guardians' influenza diagnosis was higher in mothers (0.72), as well as pairs with children with a history of influenza (0.72), guardians who were aware of the influenza epidemic (0.71), and unvaccinated children (0.76), than in other guardians. After multivariate analysis, the AUC increased significantly from 0.79 to 0.85. Discussion Guardians' influenza diagnosis for their children was highly accurate. We identified factors that improve the accuracy of the guardians' diagnosis and demonstrated that the guardians' diagnosis can support physicians' diagnostic accuracy.
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Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Takashi Akimoto
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | | | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
| | - Hiroyuki Kato
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Aomori, Japan; and Department of General Medicine, Hirosaki University School of Medicine and Hospital, Aomori, Japan
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Garofalo L, Nakama C, Hanes D, Zwickey H. Whole-Person, Urobiome-Centric Therapy for Uncomplicated Urinary Tract Infection. Antibiotics (Basel) 2022; 11:218. [PMID: 35203820 PMCID: PMC8868435 DOI: 10.3390/antibiotics11020218] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 02/04/2023] Open
Abstract
A healthy urinary tract contains a variety of microbes resulting in a diverse urobiome. Urobiome dysbiosis, defined as an imbalance in the microbial composition in the microenvironments along the urinary tract, is found in women with uncomplicated urinary tract infection (UTI). Historically, antibiotics have been used to address UTI. An alternative approach to uncomplicated UTI is warranted as the current paradigm fails to take urobiome dysbiosis into account and contributes to the communal problem of resistance. A whole-person, multi-modal approach that addresses vaginal and urinary tract dysbiosis may be more effective in reducing recurrent UTI. In this review, we discuss strategies that include reducing pathogenic bacteria while supporting commensal urogenital bacteria, encouraging diuresis, maintaining optimal pH levels, and reducing inflammation. Strategies for future research are suggested.
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Affiliation(s)
- Luciano Garofalo
- Department of Child, Family, and Population Health Nursing, University of Washington, Seattle, WA 98195, USA
| | - Claudia Nakama
- National University of Natural Medicine, Portland, OR 97201, USA; (C.N.); (D.H.); (H.Z.)
| | - Douglas Hanes
- National University of Natural Medicine, Portland, OR 97201, USA; (C.N.); (D.H.); (H.Z.)
- Helfgott Research Institute, NUNM, Portland, OR 97201, USA
| | - Heather Zwickey
- National University of Natural Medicine, Portland, OR 97201, USA; (C.N.); (D.H.); (H.Z.)
- Helfgott Research Institute, NUNM, Portland, OR 97201, USA
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Hughes T, Juliebø-Jones P, Saada L, Saeed K, Somani BK. Recurrent urinary tract infections in adults: a practical guide. Br J Hosp Med (Lond) 2021; 82:1-11. [PMID: 34983214 DOI: 10.12968/hmed.2021.0337] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recurrent urinary tract infections are a common problem faced by clinicians across many specialities. For the patient, recurrent urinary tract infections can be burdensome and detrimental to their quality of life. For the clinician, they can be challenging to manage, and the socioeconomic burden on healthcare systems can also be substantial. Investigations serve to rule out any underlying structural or pathological abnormalities. In conjunction with behavioural prevention methods, treatment strategies include antibiotic and non-antibiotic approaches and holistic management approaches. This article provides an overview of the investigation and treatment of urinary tract infections and includes algorithms which can be used in daily clinical practice.
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Affiliation(s)
- Thomas Hughes
- Department of Urology, Guy's and St Thomas' Hospital, London, UK
| | - Patrick Juliebø-Jones
- Department of Urology, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Louis Saada
- Department of Medicine, Guy's and St Thomas' Hospital, London, UK
| | - Kordo Saeed
- Department of Microbiology, Great Western Hospital, Swindon, UK
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Garofalo L, Zwickey H, Bradley R, Hanes D. Naturopathic Management of Urinary Tract Infections: A Retrospective Chart Review. J Altern Complement Med 2021; 27:1116-1123. [PMID: 34424727 PMCID: PMC8713254 DOI: 10.1089/acm.2021.0163] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Introduction: Antibiotic overuse is a significant driver of bacterial resistance. Urinary tract infections (UTIs, cystitis) are the most common condition for which antibiotics are prescribed in the ambulatory setting. Many complementary and integrative approaches to cystitis have been proposed, including probiotics, D-mannose, and several herbal therapies. Trials comparing such therapies with placebo or antibiotics showed mixed, but promising, results. Naturopathy is a system of medicine that has potential to avoid antibiotic use for UTI because of its affinity for nonpharmacologic therapies and its theory that infection is a result of both the immune system's vulnerability and the pathogen's virulence. Methods: The authors conducted a retrospective chart review of cases treated at four naturopathic clinics in the Portland, OR, metro area, where naturopathic doctors (NDs) have a scope of practice consistent with their license as primary care providers. The primary aim was to characterize how NDs treat UTIs in a real-world setting. Secondary aims were to gather preliminary evidence on the types of patient cases receiving such treatments, outcomes of treatments, and associations between presentation and treatment prescriptions. Results: The authors found 82 distinct treatment regimens among 103 individual patients diagnosed with UTI. Most patients received a combination of herbal medicine and behavioral modification (e.g., increase fluid intake), whereas the most common monotherapeutic regimen was antibiotics. Of the 43 patients who were followed up, 15 had no success with nonpharmacologic therapies and required antibiotics. The sample was comparable with national data regarding composition of public versus private insurance, acute versus recurrent/chronic UTI, and percent of cases related to uropathogenic Escherichia coli. Conclusions: NDs practicing in a primary care context frequently prescribe antibiotic and nonantibiotic multimodal therapy for uncomplicated UTI. These results may guide future studies testing complementary and integrative therapies for uncomplicated UTI.
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Affiliation(s)
- Luciano Garofalo
- Department of Child, Family, and Population Health Nursing, School of Nursing, University of Washington, Seattle, WA, USA
| | - Heather Zwickey
- Helfgott Research Institute and National University of Natural Medicine, Portland, OR, USA
- School of Undergraduate and Graduate Studies, National University of Natural Medicine, Portland, OR, USA
| | - Ryan Bradley
- Helfgott Research Institute and National University of Natural Medicine, Portland, OR, USA
- School of Undergraduate and Graduate Studies, National University of Natural Medicine, Portland, OR, USA
- Herbert Wertheim School of Public Health and Human Longevity Sciences, University of California, San Diego, La Jolla, CA, USA
- Australian Research Centre in Complementary and Integrative Medicine, University of Technology Sydney, Ultimo, Australia
- National Centre for Naturopathic Medicine, Southern Cross University, Lismore, Australia
| | - Douglas Hanes
- Helfgott Research Institute and National University of Natural Medicine, Portland, OR, USA
- School of Undergraduate and Graduate Studies, National University of Natural Medicine, Portland, OR, USA
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15
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Zare M, Vehreschild MJGT, Wagenlehner F. Management of uncomplicated recurrent urinary tract infections. BJU Int 2021; 129:668-678. [PMID: 34741796 DOI: 10.1111/bju.15630] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To discuss optimal management of recurrent urinary tract infections (UTIs) in women. About every second woman experiences at least one UTI in her lifetime, of those 30% experience another UTI, and 3% further recurrences. Especially young healthy women without underlying anatomical deficiencies suffer from recurrent UTIs (rUTI), which are associated with significant morbidity and reduction in quality of life. METHODS This is a narrative review, investigating publications dealing with recurrent UTI in women. Risk factors and options for management are discussed. RESULTS The increased susceptibility of women to rUTI is based on the female anatomy in addition to behavioural, genetic, and urological factors. However, why some women are more likely than others to develop and maintain rUTI remains to be clarified. Invasive characteristics of certain uropathogenic Escherichia coli that are able to form extra- and intracellular biofilms and may therefore cause delayed release of bacteria into the bladder, may play a role in this setting. Treatment recommendations for an acute episode of rUTI do not differ from those for isolated episodes. Given the nature of rUTI, different prophylactic approaches also play an important role. Women with rUTI should first be counselled to use non-antibiotic strategies including behavioural changes, anti-adhesive treatments, antiseptics, and immunomodulation, before antibiotic prophylaxis is considered. In addition to the traditional treatment and prophylactic therapies, new experimental strategies are emerging and show promising effects, such as faecal microbiota transfer (FMT), a treatment option that transfers microorganisms and metabolites of a healthy donor's faecal matter to patients using oral capsules, enemas, or endoscopy. Initial findings suggest that FMT might be a promising treatment approach to interrupt the cycle of rUTI. Furthermore, bacteriophages, infecting and replicating in bacteria, have been clinically trialled for UTIs. CONCLUSION Due to the limitation of available data, novel treatment options require further clinical research to objectify the potential in treating bacterial infections, particularly UTIs.
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Affiliation(s)
- Mary Zare
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Maria J G T Vehreschild
- Department of Internal Medicine, Infectious Diseases, University Hospital Frankfurt, Goethe University Frankfurt, Frankfurt am Main, Germany
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Germany
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Ormeño MA, Ormeño MJ, Quispe AM, Arias-Linares MA, Linares E, Loza F, Ruiz J, Pons MJ. Recurrence of Urinary Tract Infections due to Escherichia coli and Its Association with Antimicrobial Resistance. Microb Drug Resist 2021; 28:185-190. [PMID: 34449257 DOI: 10.1089/mdr.2021.0052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
We analyzed the association between antibiotic resistance and recurrent urinary tract infection (rUTI) by Escherichia coli. Susceptibility levels to 14 antimicrobial agents and the presence of extended-spectrum β-lactamases (ESBL) were established using MicroScan. Incidences of multidrug resistant (MDR), extensively drug resistant (XDR), and ESBL-producer isolates as well as rUTIs were estimated. The time to recurrence was established adjusted for number of antibiotic-resistant families and MDR as predictors of interest, respectively. Overall, 8,553 urinary tract infection (UTI) cases related to E. coli, including 963 rITU, were analyzed with levels of resistance >30% in all cases, except for amikacin, nitrofurantoin, and carbapenems. The incidence of rUTI was of 11.3%, being 46.5%, 24.3%, and 42.5% for MDR, XDR, and ESBLs, respectively. Bivariate analysis showed that rUTI was associated with age, gender, resistance to specific antimicrobials, MDR, and XDR. The number of antibiotic families tested as resistant, MDR, XDR, gender, and age were associated with time to recurrence when adjusted for number of antibiotic families, and MDR, gender, and age were related when adjusted for MDR. High rates of antibiotic resistance to the usual antibiotics was observed in E. coli causing UTI, with female sex, age, and antibiotic resistance being risk factors for the development of rUTI.
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Affiliation(s)
| | | | | | | | - Elba Linares
- Servicio de Microbiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Felix Loza
- Servicio de Microbiología, Hospital Nacional Edgardo Rebagliati Martins, Lima, Perú
| | - Joaquim Ruiz
- Escuela de Medicina, Universidad Científica del Sur, Lima, Perú
| | - Maria J Pons
- Escuela de Medicina, Universidad Científica del Sur, Lima, Perú
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Lelie- van der Zande RC, Bouvy ML, Teichert AM. Patterns of recurring dispensing of guideline antibiotics for uncomplicated urinary tract infection in women over a 5-year period: Longitudinal patterns of recurring dispensings of Dutch guideline UTI antibiotics. Fam Pract 2021; 38:286-291. [PMID: 33057611 PMCID: PMC8211143 DOI: 10.1093/fampra/cmaa110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is one of the most prevalent medical conditions among women seeking primary care. About 20-40% of the women have a UTI recurrence during their lifetime. OBJECTIVE To provide insight in the patterns of recurring annual dispensing for antibiotics commonly used for UTI treatment in women, aged 18 years or older, during a 5-year follow-up period in the Netherlands. METHODS The Dutch Foundation of Pharmaceutical statistics collects dispensing data from more than 90% of all community pharmacies. Pharmacies with complete data between years 2011 and 2017 were included. Women of age 18 years or older with a first dispensing of nitrofurantoin, fosfomycin, or trimethoprim in 2012 and a dispensing of any medication in 2017 were selected. For each year between 2013 and 2017, the proportions of women with recurring dispensing of nitrofurantoin, fosfomycin or trimethoprim were calculated and stratified for age categories. RESULTS Within 1517 eligible community pharmacies, 463 821 women, aged 18 years or older, were dispensed one of the antibiotics in 2012, and 239 292 women still visited the same pharmacy in 2017. About 56% of them received at least one recurring dispensing during 5 years of follow-up. Each year, ~20% of the source population had at least one recurring dispensing. Approximately 2% of the source population had at least one recurring dispensing in each year of follow-up. CONCLUSIONS Over the 5-year study period, more than 50% of the source population had at least one recurring dispensing for uncomplicated UTI, most of them with at least 1 year without UTI dispensing in between.
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Affiliation(s)
- Rian C Lelie- van der Zande
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
- KNMP (Royal Dutch Pharmacists Association), The Hague, the Netherlands
| | - Marcel L Bouvy
- Department of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands
| | - and Martina Teichert
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Center, Leiden, the Netherlands
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Survey on general practitioners' and pharmacists' opinions regarding patient-initiated treatment of recurring urinary tract infections. Int J Clin Pharm 2021; 43:1630-1637. [PMID: 34114102 PMCID: PMC8642348 DOI: 10.1007/s11096-021-01295-2] [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: 02/25/2021] [Accepted: 06/04/2021] [Indexed: 12/01/2022]
Abstract
Background The Dutch general practitioners (GP) guideline for urinary tract infections (UTI) recommends patient-initiated treatment for women with recurring UTI. In countries other than the Netherlands, community pharmacists play a role in dispensing antibiotics for recurring UTI without preceding GP consultation. Objective To study GP and pharmacist opinions regarding the desirability of patient-initiated treatment, including potential pharmacist support for, and consequences of, facilitated access to antibiotics. Setting Dutch community pharmacies that cooperate with at least two GPs in their regional primary care network. Method Pharmacists in a postgraduate education program invited their residency pharmacist and 2–3 GPs to anonymously complete an online questionnaire. Questions related to diagnosis, treatment and potential role of the pharmacist. Answers were formulated as multiple-choice or ratings on a 5-point Likert scale. Data were analysed per professional group using descriptive statistics. Answers of pharmacists and GP to corresponding questions were analysed using a Chi-square test (p < 0.05). Main outcome measure Desirability of patient-initiated treatment and supporting role of the pharmacist. Results A total of 170 GPs and 76 pharmacists completed the questionnaires. Of the GPs, 35.1% supported patient-initiated treatment. Of the pharmacists, 69.7% were willing to dispense an antibiotic to a patient without preceding GP consultation after performing a probability check. In total, 65.7% of GPs and 44.7% of pharmacists thought that facilitated access to antibiotics would increase use of antibiotics (p < 0.05). Conclusion Support of GPs for facilitated access to antibiotic treatment by patient-initiated UTI treatment was limited, even with pharmacist support. The majority of pharmacists were willing to dispense an antibiotic after a probability check of an episode of recurring UTI, but both pharmacists and GPs were concerned about overuse of antibiotics.
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Recurrent Urinary Tract Infection in Women: Primary Care Referral Patterns in a Tertiary Care Center. Female Pelvic Med Reconstr Surg 2021; 27:118-120. [DOI: 10.1097/spv.0000000000000752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Eldridge GR, Hughey H, Rosenberger L, Martin SM, Shapiro AM, D'Antonio E, Krejci KG, Shore N, Peterson J, Lukes AS, Starks CM. Safety and immunogenicity of an adjuvanted Escherichia coli adhesin vaccine in healthy women with and without histories of recurrent urinary tract infections: results from a first-in-human phase 1 study. Hum Vaccin Immunother 2020; 17:1262-1270. [PMID: 33325785 PMCID: PMC8078672 DOI: 10.1080/21645515.2020.1834807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Antibiotic resistance among gram-negative bacteria continues to rise globally at an alarming rate. New vaccines that prevent bacterial infections and reduce antibiotic use could provide a potential solution to these problems. This study focused on development of an investigational vaccine to prevent recurrent urinary traction infections (UTI) caused by gram-negative bacteria that use type 1 pili to adhere to, invade, and colonize human bladders. The vaccine antigen is FimH, an adhesin protein on the tip of type 1 pili with a lectin binding domain that enables attachment to glycoproteins on mammalian bladders. This was a phase 1, open-label, dose escalation study evaluating the vaccine in 67 healthy women with and without histories of recurrent UTI. The objectives of the study were to evaluate the safety, tolerability, and immunogenicity of different dosages of the antigen and adjuvant of the vaccine. All dosages were well-tolerated and a low incidence of systemic reactions occurred. No serious adverse events related to the vaccine were reported. The vaccine induced both binding and functional antibodies. The women with histories of recurrent UTI demonstrated greater than 150-fold increases in antibodies against the N-terminal region of FimH. Based on the results of this phase 1 study, this vaccine is proceeding to a double-blind, randomized, placebo-controlled phase 2 study. If this vaccine is successful in future studies, it could potentially prevent millions of recurrent UTI globally and reduce the development of antibiotic resistance.
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Affiliation(s)
| | | | - Lois Rosenberger
- LBR Regulatory and Clinical Consulting Services, Inc, Florence, KY, USA
| | | | | | | | | | - Neal Shore
- Atlantic Urology Clinics, Myrtle Beach, SC, USA
| | | | - Andrea S Lukes
- Women's Wellness Clinic, Carolina Women's Research and Wellness Center (CWRWC), Durham, NC, USA
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Intravesical Antibiotic Administration in the Treatment of Recurrent Urinary Tract Infections: Promising Results From a Case Series. Female Pelvic Med Reconstr Surg 2020; 26:152-154. [PMID: 31990805 DOI: 10.1097/spv.0000000000000810] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Intravesical antibiotic administration for the treatment of recurrent urinary tract infections (UTIs) provides targeted therapy that may be a useful alternative to oral antibiotics. The objective of the study was to assess the rate of UTIs before and after intravesical antibiotic instillations in community-dwelling postmenopausal women with recurrent UTIs. METHODS Patients with recurrent UTI who underwent antibiotic bladder instillations were included. Instillation was performed in the office by trained nursing staff using either gentamycin or tobramycin. Every instillation was preceded by bladder irrigation with sterile water. Retrospective chart review was performed to compare rates of UTIs for 6 months before and after intervention. Descriptive and nonparametric statistics were used for data analysis. RESULTS Twelve patients were evaluated. The average rate of UTIs decreased from a median of 2.5 to 1.5 infections (P = 0.025) after intravesical instillations. The number of pathogen types decreased from a median of 2.5 to 1.5 after therapy (P = 0.025). There was a reduction in bacterial antibiotic resistance after completion of instillations, with an estimated median difference of -5.250 (P = 0.065). There were no adverse effects reported during instillations. CONCLUSIONS Intravesical instillations offer a promising therapy for the treatment of recurrent UTIs in postmenopausal women who failed oral antibiotic therapy. Future prospective studies are needed to further elucidate the clinical utility and long-term benefits of antibiotic instillations.
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Stapleton AE, Wagenlehner FME, Mulgirigama A, Twynholm M. Escherichia coli Resistance to Fluoroquinolones in Community-Acquired Uncomplicated Urinary Tract Infection in Women: a Systematic Review. Antimicrob Agents Chemother 2020; 64:e00862-20. [PMID: 32747356 PMCID: PMC7508571 DOI: 10.1128/aac.00862-20] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 07/25/2020] [Indexed: 02/06/2023] Open
Abstract
Antibiotic resistance is a threat to public health, and uncomplicated urinary tract infections (uUTIs) are an example of this concern. This systematic review (International Prospective Register of Systematic Reviews [PROSPERO] ID: CRD42020156674) is the first to determine the prevalence of Escherichia coli resistance to fluoroquinolones in women with community-acquired uUTI. PubMed and Embase searches were conducted; 38 studies fulfilled eligibility criteria and were included in the systematic review. Within Europe, ciprofloxacin resistance in E. coli isolates varied between countries and increased in some from 2006 to 2008 and 2014 to 2016, specifically in the United Kingdom (0.5% to 15.3%), Germany (8.7% to 15.1%), and Spain (22.9% to 30.8%), although methodologies and settings were often not comparable. In Asia, there was a substantial increase in ciprofloxacin resistance during 2008 to 2014 from 25% to more than 40%. In North America, resistance to ciprofloxacin also increased between 2008 and 2017, from 4% to 12%. Data exploring different age groups did not show a consistent relationship with resistance, whereas two studies found that fluoroquinolone resistance was higher in postmenopausal women than premenopausal women. One study indicated a link between fluoroquinolone resistance and uUTI recurrence. These findings may have implications for the empirical treatment of uUTI with fluoroquinolones globally, but more data are needed to fully understand regional situations and impact patient management.
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Affiliation(s)
- Ann E Stapleton
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington, USA
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
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Moussa M, Abou Chakra M, Dellis A, Moussa Y, Papatsoris A. Pharmacotherapeutic advances for recurrent urinary tract infections in women. Expert Opin Pharmacother 2020; 21:2011-2026. [PMID: 32717156 DOI: 10.1080/14656566.2020.1795128] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Treatment of recurrent Urinary tract infections (UTIs) has become challenging because of the dramatic increase in the rates of recurrent infection andof multidrug-resistant (MDR) infections. AREAS COVERED The authors review recurrent UTIs(rUTI) management in women. EXPERT OPINION Continuous or post-coital prophylaxis with low-dose antimicrobials or intermittent self-treatment has all been demonstrated to be effective in managing rUTIs in women. Intravaginal estrogen therapy , shows potential toward preventing rUTI. Oral vaccine Uro-Vaxom seems to reduce the number of UTIs. There is evidence that other therapies (e.g. cranberry, Methenamine hippurate, oral D-mannose) may decrease the number of symptomatic UTIs. The treatment of CRE-UTIs is focused on a colistin backbone. Carbapenems are considered first-line agents for UTIs caused by ESBL, but their use is associated with increased MDR. The usage of non-carbapenem for the treatment of ESBL UTIs is necessary. Cefepime, Piperacillin-Tazobactam, Ceftolozane-Tazobactam, and Ceftazidime-Avibactam are justified options. Oral therapy with Pivmecillinam, Fosfomycin, and Nitrofurantoin can be used against uncomplicated UTIs due to ESBL infection.
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Affiliation(s)
- Mohamad Moussa
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
| | - Mohamed Abou Chakra
- Department of Urology, Al Zahraa Hospital, University Medical Center, Lebanese University , Beirut, Lebanon
| | - Athanasios Dellis
- Department of Surgery, School of Medicine, Aretaieion Hospital, National and Kapodistrian University of Athens , Athens, Greece.,2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens , Athens, Greece
| | - Yasmin Moussa
- Clinic of Dermatology, Dr Brinkmann, Schult & Samini-Fard , Gladbeck, Germany
| | - Athanasios Papatsoris
- 2nd Department of Urology, School of Medicine, Sismanoglio Hospital, National and Kapodistrian University of Athens , Athens, Greece
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Sihra N, Malde S, Greenwell T, Pakzad M, Kujawa M, Sinclair A. Management of recurrent urinary tract infections in women. JOURNAL OF CLINICAL UROLOGY 2020. [DOI: 10.1177/2051415820939456] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Urinary tract infections are highly prevalent and result in significant patient morbidity as well as large financial costs to healthcare systems. Recurrent urinary tract infections can be challenging for many healthcare professionals, and the repeated use of antibiotics in this patient cohort inevitably contributes to the growing issue of antimicrobial resistance and superbugs. It is essential that these patients are appropriately diagnosed and managed to ensure rapid resolution of symptoms and the prevention of chronic or recurrent urinary tract infections. There are several antibiotic-based options available for the prophylaxis of recurrent urinary tract infections however, in the current era of rising antimicrobial resistance, an awareness of antibiotic stewardship and the use of non-antibiotic alternatives for the treatment and prevention of urinary tract infections is of critical importance. We present a case-based multidisciplinary team discussion to highlight how women with recurrent urinary tract infections should be managed, encouraging the use of non-antibiotic prophylactic measures when suitable. Level of evidence: Level 5
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Factors associated with seasonal influenza self-diagnosis: a prospective observational study in Japan. NPJ Prim Care Respir Med 2020; 30:9. [PMID: 32251292 PMCID: PMC7090047 DOI: 10.1038/s41533-020-0165-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 02/28/2020] [Indexed: 11/08/2022] Open
Abstract
This prospective observational study, conducted at a community clinic in Japan during the influenza season, from December 2017 to April 2018 aimed to investigate the accuracy of factors used for influenza self-diagnosis. Data were collected from pre-examination checklists issued to patients with suspected influenza and electronic medical records. Receiver operating characteristic (ROC) curve analysis was performed using a rapid influenza diagnostic test as the reference standard, and 2 × 2 contingency tables were analysed at each cut-off point. We analysed data from 290 patients (72.8% males, median age: 38 years, interquartile range: 26–50 years). The area under the ROC curve (AUC) for patients who were aware of other patients presumed to have influenza within close proximity was 0.74 (95% confidence interval (CI): 0.66–0.82). The AUCs for patients with a history of influenza, unvaccinated status, cough, or nasal discharge were 0.68 (95% CI: 0.60–0.75), 0.66 (95% CI: 0.59–0.73), 0.67 (95% CI: 0.59–0.75), and 0.70 (95% CI: 0.62–0.78), respectively. The sensitivity, specificity and positive likelihood ratio at a 90% cut-off point was 19.5% (95% CI: 13.5–26.6%), 94.1% (95% CI: 88.7–97.4%) and 3.31 (95% CI: 1.57–6.98). The sensitivity, specificity and negative likelihood ratio at a 10% cut-off point was 95.5% (95% CI: 90.9–98.2%), 9.6% (95% CI: 5.2–15.8%) and 0.48 (95% CI: 0.20–1.16). After multivariate logistic regression analysis, the AUC increased significantly from 0.77 (95% CI: 0.70–0.83) to 0.81 (95% CI: 0.76–0.86) when self-diagnosis-related information was added to basic clinical information. We identified factors that improve the accuracy and validity of influenza self-diagnosis. Appropriate self-diagnosis could contribute to the containment efforts during influenza epidemics and reduce its social and economic burden.
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Management of Urinary Tract Infections in Direct to Consumer Telemedicine. J Gen Intern Med 2020; 35:643-648. [PMID: 31667749 PMCID: PMC7080949 DOI: 10.1007/s11606-019-05415-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 07/16/2019] [Accepted: 07/31/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Urinary tract infections (UTI) are a common reason for seeking care via direct to consumer (DTC) telemedicine, yet patterns of care, including antibiotic prescribing, have not been reported. OBJECTIVE To describe management of UTI in a large nationwide DTC telemedicine platform. DESIGN Cross-sectional observational study. PARTICIPANTS Patients seeking care for or diagnosed with UTI via DTC telemedicine between July 2016 and July 2018. MAIN MEASURES Patient measures included age, sex, geographic region, satisfaction with care, and patient-reported call reason. High-risk patients were defined as males, patients over 65 years, or those diagnosed with pyelonephritis. Physician measures included specialty and geographic region. Antibiotic prescription was assessed overall and by antibiotic type. Variation in antibiotic prescriptions was assessed by patient and physician factors, including geographic region of both parties. KEY RESULTS Of the 20,600 patients diagnosed with a UTI during the study period, 96% were female. Most (84%) stated their call reason was a UTI. Overall, 94% of UTI patients received an antibiotic; 56% got nitrofurantoin, 29% got trimethoprim-sulfamethoxazole, and 10% got a quinolone. Receipt of an antibiotic was associated with higher satisfaction with care (p < 0.001). While nitrofurantoin was the most common antibiotic for all physician regions, antibiotic type varied by physician region. Of the 6% of the study population defined as high risk, 69% received an antibiotic: 72% of males, 91% of women over 65, and 21% of patients diagnosed with pyelonephritis. CONCLUSIONS Management of UTI via DTC telemedicine appears to be appropriate for average-risk patients, and most are able to self-diagnose. Most patients received guideline-concordant care, but over half of high-risk patients received antibiotics. DTC telemedicine offers convenient, low-cost care that is generally appropriate. Efforts should be made to ensure high-risk patients get proper follow-up.
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Terpstra ML, Remmerswaal EBM, van Aalderen MC, Wever JJ, Sinnige MJ, van der Bom-Baylon ND, Bemelman FJ, Geerlings SE. Circulating mucosal-associated invariant T cells in subjects with recurrent urinary tract infections are functionally impaired. IMMUNITY INFLAMMATION AND DISEASE 2020; 8:80-92. [PMID: 32032475 PMCID: PMC7016840 DOI: 10.1002/iid3.287] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 01/12/2020] [Accepted: 01/14/2020] [Indexed: 12/12/2022]
Abstract
Background Urinary tract infection recurrence is common, particularly in women and immunocompromised patients, such as renal transplant recipients (RTRs). Mucosal‐associated invariant T (MAIT) cells play a role in the antibacterial response by recognizing bacterial riboflavin metabolites produced by bacteria such as Escherichia coli. Here, we investigated whether MAIT cells are involved in the pathogenesis of recurrent urinary tract infections (RUTIs). Methods Using multichannel flow cytometry, we characterized the MAIT cell phenotype and function in blood from immunocompetent adults with (n = 13) and without RUTIs (n = 10) and in RTRs with (n = 9) and without RUTIs (n = 10). Results There were no differences in the numbers of MAIT cells between the study groups. MAIT cells in patients with RUTI expressed T‐bet more often than those in controls. MAIT cells from immunocompetent RUTI participants required more antigen‐presenting cells coincubated with E. coli to evoke a similar cytokine and degranulation response than those from controls. This effect was absent in the RTR with RUTI vs RTR control groups, where the overall percentage of MAIT cells that responded to stimulation was already reduced. Conclusion Circulating MAIT cells in immunocompetent individuals with RUTIs respond to bacterial stimuli with reduced efficacy, which suggests that they are involved in the pathogenesis of RUTIs.
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Affiliation(s)
- Matty L Terpstra
- Division of Nephrology, Department of Internal Medicine, Renal Transplant Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.,Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Ester B M Remmerswaal
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Michiel C van Aalderen
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Joyce J Wever
- Division of Nephrology, Department of Internal Medicine, Renal Transplant Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjan J Sinnige
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nelly D van der Bom-Baylon
- Department of Experimental Immunology, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Frederike J Bemelman
- Division of Nephrology, Department of Internal Medicine, Renal Transplant Unit, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Suzanne E Geerlings
- Division of Infectious Diseases, Department of Internal Medicine, Amsterdam Infection and Immunity Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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Flaherty MG, Threats M, Kaplan SJ. Patients' Health Information Practices and Perceptions of Provider Knowledge in the Case of the Newly Discovered Alpha-gal Food Allergy. J Patient Exp 2020; 7:132-139. [PMID: 32128382 PMCID: PMC7036685 DOI: 10.1177/2374373518808310] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Alpha-gal food allergy is a life-threatening, newly discovered condition with limited presence in authoritative information sources. Sufferers seeking diagnosis are likely to encounter clinicians unfamiliar with the condition. OBJECTIVE To understand information practices of individuals diagnosed with alpha-gal allergy, how they obtained diagnosis, and their perceptions of health-care providers' awareness of the condition. METHODS Semistructured interviews with open- and closed-ended questions were completed with a chronological systematic sample of 28 adults (11% of alpha-gal clinic patients at the time) diagnosed with alpha-gal allergy and treated at University of North Carolina Allergy and Immunology Clinic. RESULTS The majority of patients determined they had alpha-gal allergy through nontraditional health information channels. Three-quarters of patients rated their primary care provider as having little to no knowledge. In 25 specialists' encounters, 23 were rated as having little to no knowledge. CONCLUSION With new conditions, information is often available through informal networks before appearing in the vetted medical literature. In this study, social connections were the primary pathway to successful diagnosis. Health practitioners need to develop mechanisms to understand that process.
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Affiliation(s)
- Mary Grace Flaherty
- School of Information and Library Science, University of North Carolina,
Chapel Hill, NC, USA
| | - Megan Threats
- School of Information and Library Science, University of North Carolina,
Chapel Hill, NC, USA
| | - Samantha J. Kaplan
- School of Information and Library Science, University of North Carolina,
Chapel Hill, NC, USA
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Nabi T. Clinical profile and risk factors of recurrent urinary tract infection in patients with type 2 diabetes. INTERNATIONAL JOURNAL OF ACADEMIC MEDICINE 2020. [DOI: 10.4103/ijam.ijam_83_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Hamlin AA, Sheeder J, Muffly TM. Brief versus Thong Hygiene in Obstetrics and Gynecology (B-THONG): A survey study. J Obstet Gynaecol Res 2019; 45:1190-1196. [PMID: 30916426 DOI: 10.1111/jog.13958] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 03/01/2019] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study was to evaluate if thong use is associated with a higher report of urogenital infections, including urinary tract infections, yeast vaginitis and bacterial vaginosis. METHODS A cross-sectional survey regarding underwear preferences and infectious history was designed and distributed to women via a crowdsourcing service. All survey questions related to the last 12 months. Parametric and nonparametric statistical methods were used to compare responses between thong wearers and nonthong wearers. Thong wearers were defined as women who wore a thong equal to or more than 50 % of the time. RESULTS Nine hundred and eighty-six respondents met inclusion criteria and completed the survey; 186 (18.9%) were defined as thong wearers and 800 (81.1%) were defined as nonthong wearers in the last 12 months. Reported rates of urogenital infections in the last 12 months were not significantly different for thong wearers versus nonthong wearers. Thong use was not an independent predictor of any urogenital infection in this study. CONCLUSION In this large cross-sectional study we found that oral sex was the only independent predictor of urinary tract infection and bacterial vaginosis, and that wearing noncotton crotch underwear was associated with yeast vaginitis. Wearing thong underwear was not associated with any urogenital infections. Medical providers should discuss sexual practices and underwear fabric, rather than style, with their patients when there is concern for urogenital infection.
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Affiliation(s)
- Alyssa A Hamlin
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jeanelle Sheeder
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Tyler M Muffly
- Department of Obstetrics and Gynecology, University of Colorado School of Medicine, Aurora, Colorado, USA.,Department of Obstetrics and Gynecology, Denver Health and Hospital Authority, Denver, Colorado, USA
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Seaberg P, Jadoon-Khamash E, Vegunta S. Managing Recurrent Urinary Tract Infections in Postmenopausal Women. J Womens Health (Larchmt) 2018; 27:856-858. [PMID: 30020847 DOI: 10.1089/jwh.2018.7105] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Preston Seaberg
- 1 Mayo Clinic School of Graduate Medical Education, Mayo Clinic Arizona Internal Medicine Residency Program, Mayo Clinic in Arizona , Scottsdale, Arizona
| | - Erum Jadoon-Khamash
- 2 Division of Community Internal Medicine, Mayo Clinic in Arizona , Scottsdale, Arizona
| | - Suneela Vegunta
- 3 Division of Women's Health-Internal Medicine, Mayo Clinic in Arizona , Scottsdale, Arizona
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Caron F, Galperine T, Flateau C, Azria R, Bonacorsi S, Bruyère F, Cariou G, Clouqueur E, Cohen R, Doco-Lecompte T, Elefant E, Faure K, Gauzit R, Gavazzi G, Lemaitre L, Raymond J, Senneville E, Sotto A, Subtil D, Trivalle C, Merens A, Etienne M. Practice guidelines for the management of adult community-acquired urinary tract infections. Med Mal Infect 2018; 48:327-358. [PMID: 29759852 DOI: 10.1016/j.medmal.2018.03.005] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Revised: 12/24/2017] [Accepted: 03/13/2018] [Indexed: 11/19/2022]
Affiliation(s)
- F Caron
- Maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Normandie, CHU de Rouen, 76000 Rouen, France
| | - T Galperine
- Infection Control Program, Geneva University Hospitals, Switzerland
| | - C Flateau
- Immunologie clinique et maladies infectieuses, centre hospitalier Henri-Mondor, 94000 Créteil, France
| | - R Azria
- Cabinet de médecine générale, 95510 Vetheuil, France
| | - S Bonacorsi
- Service de microbiologie, hôpital Robert-Debré, université Paris Diderot, AP-HP, 75019 Paris, France
| | - F Bruyère
- Urologie, CHU deTours, 37000 Tours, France
| | - G Cariou
- Urologie, centre hospitaler Diaconesses, 75012 Paris, France
| | - E Clouqueur
- Gynécologie, CHRU de Lille, 59000 Lille, France
| | - R Cohen
- Néonatologie, centre hospitalier intercommunal de Créteil, 94000 Créteil, France
| | - T Doco-Lecompte
- Maladies infectieuses, hôpitaux universitaires de Genève, Genève, Switzerland
| | - E Elefant
- Centre de référence sur les agents tératogènes, hôpital Armand-Trousseau, Groupe hospitalier Est, AP-HP, 75012 Paris, France
| | - K Faure
- Maladies infectieuses, CHRU de Lille, 59000, France
| | - R Gauzit
- Réanimation, CHU de Cochin, AP-HP, 75014 Paris, France
| | - G Gavazzi
- Clinique de médecine gériatrique, CHU de Grenoble-Alpes, 38700 La Tronche, France
| | - L Lemaitre
- Radiologie, CHRU de Lille, 59000 Lille, France
| | - J Raymond
- Microbiologie, université Paris Descartes, CHU de Cochin, 75014 Paris, France
| | - E Senneville
- Maladies infectieuses, CHRU de Lille, 59000 Lille, France
| | - A Sotto
- Maladies infectieuses, hôpital universitaire Carémeau, 30000 Nîmes, France
| | - D Subtil
- Gynécologie-obstétrique, CHRU Lille, 59000 Lille, France
| | - C Trivalle
- Gérontologie, hôpital Paul-Brousse, 94800 Villejuif, France
| | - A Merens
- Microbiologie, hôpital Inter-armées Begin, 94160 Saint-Mandé, France
| | - M Etienne
- Maladies infectieuses, groupe de recherche sur l'adaptation microbienne (EA2656), université de Normandie, CHU de Rouen, 76000 Rouen, France.
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Maita H, Kobayashi T, Osawa H, Kato H. Self-diagnosis of seasonal influenza in a rural primary care setting in Japan: A cross sectional observational study. PLoS One 2018; 13:e0197163. [PMID: 29746573 PMCID: PMC5944958 DOI: 10.1371/journal.pone.0197163] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 04/27/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To elucidate the accuracy and optimal cut-off point of self-diagnosis and clinical symptoms of seasonal influenza compared with rapid influenza diagnostic tests as the reference standard, we conducted a cross sectional observational study at a rural clinic in Japan. METHODS Data during three influenza seasons (December 2013 to April 2016) were retrospectively collected from the medical records and pre-examination sheets of 111 patients aged >11 years (mean age 48.1 years, men 53.2%) who were suspected of influenza infection and underwent rapid influenza diagnostic testing. Patients' characteristics (age, sex, and past medical history of influenza infection), clinical signs (axillary temperature, pulse rate, cough, joint and muscle pain, and history of fever [acute or sudden, gradual, and absence of fever]), duration from the onset of symptoms, severity of feeling sick compared with a common cold (severe, similar, and mild), self-reported likelihood of influenza (%), and results of rapid influenza diagnostic tests. RESULTS At the optimal cut-off point (30%) for estimation of self-diagnosis of seasonal influenza, the positive likelihood ratio (LR+) was 1.46 (95% confidence interval 1.07 to 2.00) and negative likelihood ratio (LR-) was 0.57 (0.35 to 0.93). At a 10% cut-off point, LR-was 0.33 (0.12 to 0.96). At an 80% cut-off point, LR+ was 2.75 (0.75 to 10.07). As for clinical signs, the combination of acute or sudden onset fever and cough had LR+ of 3.27 (1.68 to 6.35). Absence of cough showed LR-of 0.15 (0.04 to 0.61). CONCLUSIONS Self-diagnosis of influenza using the optimal cut-off point (30%) was not found useful for ruling in or ruling out an influenza diagnosis. However, it could be useful when patients self-report extremely high (80%) or low (10%) probability of having influenza. Clinically useful signs were the combination of history of fever and cough, and absence of cough.
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Affiliation(s)
- Hiroki Maita
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki-shi, Aomori, Japan
- General Medicine, Hirosaki University Graduate School of Medicine, Hirosaki-shi, Aomori, Japan
- * E-mail:
| | - Tadashi Kobayashi
- Department of General Medicine, Hirosaki University School of Medicine & Hospital, Hirosaki-shi, Aomori, Japan
| | - Hiroshi Osawa
- Department of General Medicine, Hirosaki University School of Medicine & Hospital, Hirosaki-shi, Aomori, Japan
| | - Hiroyuki Kato
- Development of Community Healthcare, Hirosaki University Graduate School of Medicine, Hirosaki-shi, Aomori, Japan
- General Medicine, Hirosaki University Graduate School of Medicine, Hirosaki-shi, Aomori, Japan
- Department of General Medicine, Hirosaki University School of Medicine & Hospital, Hirosaki-shi, Aomori, Japan
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Crowley JJ, Laur C, Carter HDE, Jones G, Ray S. Perspectives from the Third International Summit on Medical Nutrition Education and Research. Front Public Health 2018; 6:93. [PMID: 29629367 PMCID: PMC5876281 DOI: 10.3389/fpubh.2018.00093] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 03/12/2018] [Indexed: 11/13/2022] Open
Abstract
Nutrition is an important component of public health and health care, including in education and research, and in the areas of policy and practice. This statement was the overarching message during the third annual International Summit on Medical Nutrition Education and Research, held at Wolfson College, University of Cambridge, United Kingdom, in August 2017. This summit encouraged attendees to think more broadly about the impact of nutrition policy on health and communities, including the need to visualize the complete food system from "pre-farm to post-fork." Evidence of health issues related to food and nutrition were presented, including the need for translation of knowledge into policy and practice. Methods for this translation included the use of implementation and behavior change techniques, recognizing the needs of health-care professionals, policy makers, and the public. In all areas of nutrition and health, clear and effective messages, supported by open data, information, and actionable knowledge, are also needed along with strong measures of impact centered on an ultimate goal: to improve nutritional health and wellbeing for patients and the public.
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Affiliation(s)
- Jennifer Jean Crowley
- Discipline of Nutrition, Faculty of Medical Health Sciences, University of Auckland, Auckland, New Zealand.,NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, United Kingdom
| | - Celia Laur
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, United Kingdom.,Faculty of Applied Health Sciences, School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
| | - Harrison David Edward Carter
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, United Kingdom.,Department of Public Health and Primary Care, School of Clinical Medicine, Institute of Public Health, University of Cambridge, Cambridge, United Kingdom
| | - Glenys Jones
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, United Kingdom
| | - Sumantra Ray
- NNEdPro Global Centre for Nutrition and Health, St John's Innovation Centre, Cambridge, United Kingdom
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Abstract
OBJECTIVE To provide an update of the definition, epidemiology, clinical presentation, investigation, treatment, and prevention of recurrent urinary tract infections in women. OPTIONS Continuous antibiotic prophylaxis, post-coital antibiotic prophylaxis, and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection. Vaginal estrogen and cranberry juice can also be effective prophylaxis alternatives. EVIDENCE A search of PubMed and The Cochrane Library for articles published in English identified the most relevant literature. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date restrictions. VALUES This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). OPTIONS Recurrent urinary tract infections need careful investigation and can be efficiently treated and prevented. Different prophylaxis options can be selected according to each patient's characteristics. RECOMMENDATIONS
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Structure-based discovery of glycomimetic FmlH ligands as inhibitors of bacterial adhesion during urinary tract infection. Proc Natl Acad Sci U S A 2018; 115:E2819-E2828. [PMID: 29507247 PMCID: PMC5866590 DOI: 10.1073/pnas.1720140115] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Treatment of bacterial infections is becoming a serious clinical challenge due to the global dissemination of multidrug antibiotic resistance, necessitating the search for alternative treatments to disarm the virulence mechanisms underlying these infections. Uropathogenic Escherichia coli (UPEC) employs multiple chaperone-usher pathway pili tipped with adhesins with diverse receptor specificities to colonize various host tissues and habitats. For example, UPEC F9 pili specifically bind galactose or N-acetylgalactosamine epitopes on the kidney and inflamed bladder. Using X-ray structure-guided methods, virtual screening, and multiplex ELISA arrays, we rationally designed aryl galactosides and N-acetylgalactosaminosides that inhibit the F9 pilus adhesin FmlH. The lead compound, 29β-NAc, is a biphenyl N-acetyl-β-galactosaminoside with a Ki of ∼90 nM, representing a major advancement in potency relative to the characteristically weak nature of most carbohydrate-lectin interactions. 29β-NAc binds tightly to FmlH by engaging the residues Y46 through edge-to-face π-stacking with its A-phenyl ring, R142 in a salt-bridge interaction with its carboxylate group, and K132 through water-mediated hydrogen bonding with its N-acetyl group. Administration of 29β-NAc in a mouse urinary tract infection (UTI) model significantly reduced bladder and kidney bacterial burdens, and coadministration of 29β-NAc and mannoside 4Z269, which targets the type 1 pilus adhesin FimH, resulted in greater elimination of bacteria from the urinary tract than either compound alone. Moreover, FmlH specifically binds healthy human kidney tissue in a 29β-NAc-inhibitable manner, suggesting a key role for F9 pili in human kidney colonization. Thus, these glycoside antagonists of FmlH represent a rational antivirulence strategy for UPEC-mediated UTI treatment.
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Warmer weather as a risk factor for hospitalisations due to urinary tract infections. Epidemiol Infect 2018; 146:386-393. [PMID: 29307331 DOI: 10.1017/s0950268817002965] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The incidence of urinary tract infections (UTIs) is seasonal, and this seasonality may be explained by changes in weather, specifically, temperature. Using data from the Nationwide Inpatient Sample, we identified the geographic location for 581 813 hospital admissions with the primary diagnosis of a UTI and 56 630 773 non-UTI hospitalisations in the United States. Next, we used data from the National Climatic Data Center to estimate the monthly average temperature for each location. Using a case-control design, we modelled the odds of a hospital admission having a primary diagnosis of UTI as a function of demographics, payer, location, patient severity, admission month, year and the average temperature for the admission month. We found, after controlling for patient factors and month of admission, the odds of a UTI diagnosis increased with higher temperatures in a dose-dependent manner. For example, relative to months with average temperatures of 5-7.5 °C, an admission in a month with an average temperature of 27.5-30 °C has 20% higher odds of a primary diagnosis of UTI. However, in months with extremely high average temperatures (above 30 °C), the odds of a UTI admissions decrease, perhaps due to changes in behaviour. Thus, at a population level, UTI-related hospitalisations are associated with warmer weather.
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Updates in Management of Complicated Urinary Tract Infections: A Focus on Multidrug-Resistant Organisms. Am J Ther 2018. [DOI: 10.1097/mjt.0000000000000683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Epp A, Larochelle A. N° 250-Infection Récurrente Des Voies Urinaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e464-e474. [PMID: 28935070 DOI: 10.1016/j.jogc.2017.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
Urinary tract infection (UTI) is one of the most common bacterial infections, and the incidence in women is much higher than in men. The diagnosis of a UTI can be made based on a combination of symptoms and a positive urine analysis or culture. Most UTIs are uncomplicated UTIs, defined as cystitis in a woman who is not pregnant, is not immunocompromised, has no anatomical and functional abnormalities of the urogenital tract, and does not exhibit signs of tissue invasion and systemic infection. All UTIs that are not uncomplicated are considered to be complicated UTIs. Differentiation between uncomplicated and complicated UTIs has implications for therapy because the risks of complications or treatment failure are increased for patients with a complicated UTI. Asymptomatic bacteriuria (ASB) is defined as the presence of a positive urine culture collected from a patient without symptoms of a UTI. Concerning the complicated UTI, it is possible to make a differentiation between UTI with systemic symptoms (febrile UTI) and UTI in a host, which carries an increased risk to develop complications of this UTI. Febrile UTIs are urosepsis, pyelonephritis, and prostatitis. A complicated host is defined as one that has an increased risk for complications, to which the following groups belong: men, pregnant women, immunocompromised patients, or those who have an anatomical or functional abnormality of the urogenital tract (e.g., spinal cord-injury patients, renal stones, urinary catheter).
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Wagenlehner F, Wullt B, Ballarini S, Zingg D, Naber KG. Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT). Expert Rev Pharmacoecon Outcomes Res 2017; 18:107-117. [PMID: 28737469 DOI: 10.1080/14737167.2017.1359543] [Citation(s) in RCA: 87] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Uncomplicated lower urinary tract infections (UTIs) occur in approximately 50% of women, and 20-30% experience recurrent UTI. Data on UTIs and quality of life (QoL) in Europe are limited. METHODS This was an anonymous, self-administered web-based survey conducted in 5 countries (Germany, Switzerland, Poland, Russia and Italy), on adult women who had experienced recurrent UTI and were affected by acute UTI currently or within 4 weeks of study entry. Questions covered disease course; management; social and economic burden; education, income, and health insurance status. QoL was evaluated using the SF-12v2. RESULTS Participants reported a mean of 5.15 UTI symptoms, ranging from 4.85 - 5.38 in Russia and Germany. There was a mean of 2.78 doctor visits per year (1.74 - 3.71 in Russia and Germany; p < 0.0001). 80.3% of participants had been treated with antibiotics, mean prescriptions ranged from 2.17 (Poland) to 3.36 (Germany) per person per year. A mean of 3.09 days sick leave due to UTIs, and 3.45 days of limited activities, were reported. Although 73.8% of participants had tried prophylaxis recurrence was common and associated with mental stress for a high proportion of women. CONCLUSIONS Our results indicate that recurrent UTIs have a significant impact on QoL of women in Europe.
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Affiliation(s)
- Florian Wagenlehner
- a Clinic for Urology, Pediatric Urology and Andrology , Justus-Liebig University , Giessen , Germany
| | - Björn Wullt
- b Section of MIG , Lund University , Lund , Sweden
| | | | | | - Kurt G Naber
- d Technical University of Munich , Munich , Germany
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Liu SW, Guo J, Wu WK, Chen ZL, Zhang N. Treatment of Uncomplicated Recurrent Urinary Tract Infection with Chinese Medicine Formula: A Randomized Controlled Trial. Chin J Integr Med 2017; 25:16-22. [DOI: 10.1007/s11655-017-2960-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2017] [Indexed: 11/28/2022]
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Abstract
UTI may involve the lower or upper urinary tract and may be uncomplicated or complicated. The emphasis of this chapter is uncomplicated UTI. The diagnosis of uncomplicated cystitis (bladder infection) and pyelonephritis (kidney infection) is usually easily made based on the clinical presentation, whereas the diagnosis in patients with complicated UTI is often more complex. Thus uncomplicated cystitis is usually manifested by dysuria, frequency and/or urgency without fever, and pyelonephritis is usually manifested by fever and back pain/costovertebral angle tenderness. However, pyuria is usually present with UTI, regardless of location, and its absence suggests that another condition may be causing the patient's symptoms. Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens, although antimicrobial resistance continues to increase and can complicate treatment choices in certain areas. Likewise, antimicrobial resistance has complicated our management of uncomplicated pyelonephritis since resistance of uropathogens to the fluoroquinolone class, the mainstay of oral treatment for pyelonephritis, is increasing worldwide, and some of the other agents used for cystitis are not recommended for pyelonephritis due to low tissue levels. The goal of prevention of recurrent cystitis is to minimize the use of antimicrobials and there are several research efforts in progress to develop effective and safe antimicrobial-sparing preventive approaches for this common condition.
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Bergamin PA, Kiosoglous AJ. Non-surgical management of recurrent urinary tract infections in women. Transl Androl Urol 2017; 6:S142-S152. [PMID: 28791233 PMCID: PMC5522788 DOI: 10.21037/tau.2017.06.09] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Accepted: 06/05/2017] [Indexed: 12/20/2022] Open
Abstract
One in three women will experience a clinically significant urinary tract infection (UTI) by age twenty-four and almost half will have at least one in their lifetime. Recurrent UTIs (rUTIs) are defined as having greater than two infections in a 6-month period, or three infections over twelve months, with complete resolution for at least two weeks. These may be due to relapse from incomplete treatment (persistence) or re-infection (new source). It may be difficult to distinguish between the two, where the same organism is cultured. There are several risk factors for rUTIs including an impairment of the body's immune system and virulence factors. Reversible or treatable causes are sought and excluded in the patient's initial review. Patient's with rUTI are often complex and difficult to manage. The long-term management options in women are multimodal and should focus on prevention of relapse and recurrence. Behavioural factors include adequate hydration, care with sexual hygiene, reducing one's body mass index (BMI) and post-void residual (PVR) volume. There are several non-antimicrobial options for rUTIs which have become a multi-billion-dollar business. Unfortunately, there are numerous studies which fail to show any major benefit or having conflicting data. Vaccines are currently being explored as a prevention strategy, delivered through injection, intra-nasal sprays, or vaginal suppositories, which are made from combinations of heat killed uro-pathogenic strains. There are no widely available vaccines at present due to limited clinical success. It is well established that appropriate antibiotic therapy results in higher rates of symptom relief and bacterial eradication in women with uncomplicated cystitis. There are several options for antimicrobial use which have been shown to be highly effective in reducing the risk of rUTI in women. The pain and discomfort of the UTI must be balanced with the cost and risk of developing resistance when using antimicrobials. Continuous prophylaxis, pre- and post-coital voiding, and self-starting are the three commonly accepted options for prophylaxis. The choice between these will depend upon patient preference, cultures and previous pattern of infection. Intra-vesical instillation of hyaluronic acid and chondroitin sulphate have been used for glycosaminoglycan (GAG) layer replenishment for many indications, including interstitial cystitis, overactive bladder syndrome, radiation cystitis and prevention of rUTI. At present, intra-vesical therapies are reserved for only those with the most unresponsive rUTIs. The principles of treating rUTI are to break the cycle and to treat any reversible causes. With our ever-expanding research knowledge, there are now many useful products that may be used for the successful treatment of rUTI. A management plan including a combination of a non-antimicrobial and selective antimicrobial regime for a minimum of six months should be considered. It is a prudent clinician that clearly defines this management plan, with reassurance of a finite period of therapy.
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Affiliation(s)
- Paul A. Bergamin
- Department of Urology, Royal Brisbane and Women’s Hospital, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
| | - Anthony J. Kiosoglous
- Department of Urology, Royal Brisbane and Women’s Hospital, Queensland, Australia
- Queen Elizabeth II Jubilee Hospital, Brisbane, Australia
- School of Medicine, University of Queensland, Brisbane, Australia
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Sundén F, Butler D, Wullt B. Triggered Urine Interleukin-6 Correlates to Severity of Symptoms in Nonfebrile Lower Urinary Tract Infections. J Urol 2017; 198:107-115. [DOI: 10.1016/j.juro.2017.01.070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2017] [Indexed: 01/17/2023]
Affiliation(s)
- Fredrik Sundén
- Department of Surgery, Helsingborg Hospital (FS), Helsingborg, Sweden
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Daniel Butler
- Department of Surgery, Helsingborg Hospital (FS), Helsingborg, Sweden
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
| | - Björn Wullt
- Department of Surgery, Helsingborg Hospital (FS), Helsingborg, Sweden
- Division of Microbiology, Immunology and Glycobiology, Department of Laboratory Medicine, Lund University, Lund, Sweden
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The varied world of diagnosis making. Eur Geriatr Med 2017. [DOI: 10.1016/j.eurger.2017.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Urinary Tract Infections in Women: Pathogenesis, Diagnosis, and Management. CURRENT BLADDER DYSFUNCTION REPORTS 2016. [DOI: 10.1007/s11884-016-0351-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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