Recurring Cystitis: How Can We Do Our Best to Help Patients Help Themselves?

Sarah Ben Hadj Messaoud,Véronique Mondain,Elisa Demonchy

doi:10.3390/antibiotics11020269

Sarah Ben Hadj Messaoud, Véronique Mondain + Show 1 more

Open Access

https://doi.org/10.3390/antibiotics11020269

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Abstract

Recurrent cystitis (RC) has rarely been studied; its management varies and research on a holistic approach of these patients is scarce. We attempted to characterize patients suffering from RC and investigated their current care pathways, aiming to offer customized and autonomous management. In this paper, we present a descriptive, single-center, cross-sectional study of women presenting with RC at an infectious disease (ID) clinic. A questionnaire was developed and was completed by ID physicians during patient visits. From October 2016 to January 2019, 202 women were included (mean age 59 years). Sexual intercourse, stress and diarrhoea/digestive symptoms were reported as trigger factors by 35%, 34% and 19% of patients, respectively. A majority (54%) were at risk for complications and were those more exposed to inappropriate antibiotic prescriptions. In total, 56% of women suffered from more than 10 episodes/year and 48% suffered from relapses, mainly due to E. coli. Genitourinary syndrome of menopause (GSM) was a frequent complaint (74.5% of women). Fluoroquinolones and 3rd generation cephalosporins were prescribed in 38% and 30% of women, respectively. Most women wished for non-antimicrobial approaches and autonomy. Patients require comprehensive, tailored care in order to benefit from a broader range of treatment options in compliance with recommendations.

Highlights

In France, in 2016, urinary tract infections (UTI) were estimated to account for a third of all antibiotic prescriptions, most of which were provided by general practitioners (GP) [1]
The present study, aimed to identify these patients’ profiles and to describe their care pathways as a preliminary step, prior to suggesting a customized management strategy to be subsequently assessed. This was a single-centre cross-sectional study conducted on patients who presented with recurrent cystitis at the infectious diseases department outpatient clinic of Nice University Hospital between 19 October 2016 and 15 January 2019
The questionnaire was given to the patient as she arrived at the outpatient clinic, allowing her the time to reflect on the questions relating to recurring cystitis (RC)

Summary

Introduction

In France, in 2016, urinary tract infections (UTI) were estimated to account for a third of all antibiotic prescriptions, most of which were provided by general practitioners (GP) [1].That year, the societal cost of UTI in France was estimated at €58 million, of which 25%were associated with negative cultures [2].In the USA, the prevalence rate for these infections in women is over 50%, with approximately 3% developing recurring cystitis (RC), i.e., at least four episodes a year [3].To our knowledge, research on RC in France has, until now, been limited. In France, in 2016, urinary tract infections (UTI) were estimated to account for a third of all antibiotic prescriptions, most of which were provided by general practitioners (GP) [1]. The societal cost of UTI in France was estimated at €58 million, of which 25%. Case definition and diagnosis are not clear-cut, as clinical and biological factors and/or overall risk factors are not considered. This results in a monolithic approach involving iterative antibiotic treatment courses, leading to emergence of antimicrobial-resistant bacteria and significant side-effects [6]. Women in many countries appear unhappy with the way RC is managed [7]

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