Acute Cystitis Symptom Score (ACSS): Clinical Validation of the Italian Version.

Girolamo Morelli,Riccardo Morganti,Jakhongir Alidjanov,Tommaso Di Vico,Florian M E Wagenlehner,Riccardo Bartoletti,Adrian Pilatz,Kurt G Naber,Tommaso Cai

doi:10.3390/antibiotics9030104

Abstract

Acute Cystitis Symptom Score (ACSS) is an 18-item self-reporting questionnaire for clinical diagnosis and follow-up of acute uncomplicated cystitis (AUC) in women. The ACSS, originally developed in Uzbek and Russian languages, is now available in several languages. The purpose of the study was to validate the ACSS questionnaire in the Italian language. Linguistic validation was carried out according to Linguistic Validation Manual for Patient-Reported Outcomes Instruments guidelines. Clinical validation was carried out by enrolling one hundred Italian-speaking women. All women were asked to fill in the ACSS questionnaire during their medical visit. Fifty-four women, median age 36 (Inter Quartile Range 28–49), were diagnosed with AUC, while 46 women, median age 38 (IQR 29–45), were enrolled as the control group attending the hospital’s fertility center for couples. The most frequently isolated pathogen in AUC was Escherichia coli (40; 74.0%) followed by Enterococcus faecalis (7; 13.0%) and Staphylococcus saprophyticus (3; 5.6%). Receiver operating characteristic (ROC) curve analysis performed at the first diagnostic visit on a typical symptoms domain cut-off score of 6 revealed a sensitivity of 92.5% and specificity of 97.8%. The Italian version of the ACSS has proved to be a reliable tool with a high accuracy in diagnosis and follow-up in women with AUC. The ACSS may also be useful for clinical and epidemiological studies.

Highlights

Acute uncomplicated cystitis (AUC) is one of the most common and widespread pathological conditions among women of all ages, with a relevant impact on social costs and quality of life [1]. AUC is a benign disease, recurrent episodes are associated with reduction in quality of life, everyday activities, such as social and familiar relationships, leisure time and physical activities, working ability, and psychosexual disorders [2].The guidelines on urological infections of the European Association of Urology (EAU) do not consider urinalysis or other microbiological investigations as necessary in the case of patients withAntibiotics 2020, 9, 104; doi:10.3390/antibiotics9030104 www.mdpi.com/journal/antibioticsAUC at their first episode [3]
Fifty-four female patients diagnosed with acute bacterial, uncomplicated cystitis were consecutively selected in our hospital’s outpatient office, whilst 46 women attending the hospital’s fertility center for couples and not suspected for urinary tract infection (UTI) were considered as the control group
All international guidelines on urological infections recommend the use of empirical treatment on the basis of local epidemiology of bacterial resistance and antibiotic stewardship programs

Summary

Introduction

Acute uncomplicated cystitis (AUC) is one of the most common and widespread pathological conditions among women of all ages, with a relevant impact on social costs and quality of life [1]. AUC is a benign disease, recurrent episodes are associated with reduction in quality of life, everyday activities, such as social and familiar relationships, leisure time and physical activities, working ability, and psychosexual disorders [2].The guidelines on urological infections of the European Association of Urology (EAU) do not consider urinalysis or other microbiological investigations as necessary in the case of patients withAntibiotics 2020, 9, 104; doi:10.3390/antibiotics9030104 www.mdpi.com/journal/antibioticsAUC at their first episode [3]. AUC is a benign disease, recurrent episodes are associated with reduction in quality of life, everyday activities, such as social and familiar relationships, leisure time and physical activities, working ability, and psychosexual disorders [2]. Antibiotic stewardship programs aim to coordinate strategies to enhance health outcomes, decrease the use of broad-spectrum antibiotics, and slow down the increase of antimicrobial resistance [5,6]. For these reasons, usage of broad-spectrum antibiotics should be limited only to individual cases

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