Management Of Cystitis Research Articles

Successful Management of Cystitis in a Male Dog

A 5-year-old male mixed breed dog was brought with complaints of fever, vomiting, inappetence, hematuria for 1 week, dysuria, pollakiuria, pain during urination and pain on palpation in the caudal part of abdomen. Haemato-biochemical analysis showed Hemoglobin 9.1 gm/dL, RBC 4.4 million/µL, WBC 24.75 x 103 /µL, and Neutrophil 85%. Urine culture revealed Staphylococci. In USG, urinary bladder wall was markedly thickened and bladder endothelium lining was highly uneven. In urinalysis report, sanguineous color of urine with pH 7.8 and red blood cell (10 cells/HPF) were there. The management of cystitis was done with fluid therapy, broad-spectrum antibiotic, and supportive therapy for a duration one week. The condition of the dog improved and medicines were continued orally for another 2 weeks.

Traitement de la cystite simple en pharmacie d’officine : regards croisés de pharmaciens d’officine et d’étudiants en 6e année de pharmacie dans le contexte de la dispensation sous protocole

Introduction: The management of cystitis by community pharmacists based on advanced practices (dispensing antibiotic without a medical prescription) is supposed to meet a public health need. The adoption and successful of these new practices need that those involved in the field take ownership. The aim of this study was to explore the perceptions and attitudes of community pharmacists and pharmacy students towards the management of cystitis in community pharmacies in the current context and perspective of advanced practices.Method: A cross-sectional multicentric study involving community pharmacists and pharmacy students in their sixth-year internship was performed. Three questionnaires (one/month) designed by pharmacists were sent by email. These focused on the attitude of dealing with patients suffering from cystitis, their interest in the advanced practice, the identification of risk factors for complications, and their behavior in real-life situations.Results and discussion: Almost all of the respondents had already dealt with requests for antibiotics for cystitis without medical prescription, and 50% of pharmacists had already agreed to do so. 88.5% of pharmacists wanted to implement the considered advanced practice. 25% of respondents considered that a dialogue with the patient allows to identify risk factors for complications. The time frame in which the request was made had an impact on their choice of dispensing. The differences between pharmacists and students highlighted the impact of experience and recent initial training. This new advanced practice seems to be able to provide solutions for cystitis management without removing all the barriers especially in term of regulation.

Advancements in Understanding and Managing Radiation Cystitis: A Comprehensive Review.

This manuscript aims to provide a comprehensive overview of the pathophysiology, risk factors, prevention strategies, and management options for radiation cystitis. Recent studies have shed light on the pathophysiology of radiation cystitis, highlighting the role of inflammation, fibrosis, and vascular damage. Emerging preventive measures like stem cell therapy offer promise, alongside novel treatments such as amniotic bladder therapy and hyperbaric oxygen therapy. This review outlines the latest research on radiation cystitis, covering its pathophysiology, risk factors, prevention, and management. Major findings include insights into the mechanisms of RC development, promising preventive and therapeutic approaches, and the importance of standardized treatment pathways. Future research should focus on identifying genetic risk factors, improving treatment efficacy, and enhancing patient outcomes. This review offers valuable insights for clinicians and researchers, guiding future investigations into radiation cystitis management.

Characterization and Therapeutic Potential of Curcumin-Loaded Cerium Oxide Nanoparticles for Interstitial Cystitis Management.

Oxidative stress resulting from reactive oxygen species (ROS) is often considered to be the leading cause of interstitial cystitis (IC), which is a chronic inflammatory disease. Antioxidants have been proven to have promising therapeutic effects on IC. In this study, we present an antioxidant intervention for IC by introducing curcumin-loaded cerium oxide nanoparticles (Cur-CONPs). Recognizing oxidative stress as the primary contributor to IC, our research builds on previous work utilizing cerium oxide nanoparticles (CONPs) for their outstanding antioxidant and anti-inflammatory properties. However, given the need to effectively relieve acute inflammation, we engineered Cur-CONPs to harness the short-term radical-scavenging antioxidant prowess of curcumin. Through in vitro studies, we demonstrate that the Cur-CONPs exhibit not only robust antioxidant capabilities but also superior anti-inflammatory properties over CONPs alone. Furthermore, in vivo studies validate the therapeutic effects of Cur-CONPs on IC. Mice with IC subjected to the Cur-CONP treatment exhibited improved micturition behaviors, relief from pelvic pain sensitivity, and reduced expression of inflammatory proteins (IL-6, IL-1β, TNF-α, Cox2). These findings suggest that the synergistic antioxidant properties of the Cur-CONPs that combine the sustained antioxidant properties of CONPs and acute anti-inflammatory capabilities of curcumin hold promise as a novel treatment strategy for IC.

Qualitative study on shared decision making in cystitis management in general practice.

Cystitis is commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice. To identify barriers and facilitators for applying SDM in cystitis management in general practice. Qualitative explorative research in general practice with healthcare professionals (HCPs; GPs and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients). Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis. Ten GPs, seven GP assistants, and 15 patients were interviewed. We identified the following three main barriers and one key facilitator: (1) applying SDM is deemed inefficient; (2) HCPs assume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; (3) patients are largely unaware of the various non-antibiotic treatment options for cystitis; and (4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary. SDM is infrequently applied in cystitis treatment in general practice owing to the current focus on efficient cystitis management that omits patient contact, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM, which should be co-created with HCPs and patients, and fit into the current efficient cystitis management.

Uroprotective and pain-relieving effect of dietary supplementation with micronized palmitoyl-glucosamine and hesperidin in a chronic model of cyclophosphamide-induced cystitis.

Feline idiopathic cystitis is a common, chronic-relapsing disorder of the lower urinary tract. In addition to environmental modification/enrichment, long-term and safe treatment targeting specific pathophysiological changes may be of help. In this context, effective dietary interventions hold clinical promise. Palmitoyl-glucosamine (PGA) and hesperidin (HSP) are safe and authorized feed ingredients for animal nutrition under European regulations. The current study aimed to investigate whether a 3:1 mixture of micronized PGA and HSP could represent a novel mechanism-oriented approach to chronic cystitis management. A newly validated rat model of cyclophosphamide (CYP)-induced chronic cystitis was used (40 mg/kg, three intraperitoneal injections every 3rd day). Animals were randomized to orally receive either vehicle or PGA-HSP at a low (72 + 24 mg/kg) or high (doubled) dose for 13 days, starting 3 days before the chronic CYP protocol, with mesna (2-mercaptoethane-sulfonate) being used as a reference drug. Higher PGA-HSP dose was effective at relieving chronic visceral pain, as measured by mechanical allodynia test (von Frey test). The severity of cystitis was also significantly improved, as shown by the reduced sonographic thickening of the bladder wall, as well as the decrease in edema, bleeding and bladder to body weight ratio compared to the vehicle treated group. A significant decrease of MPO activity, MDA level and fibrosis at Masson's trichrome staining was also observed in animals administered PGA-HSP in comparison to vehicle treated ones. The CYP-induced increase in bladder mRNA expression of pro-inflammatory cytokines was also significantly counteracted by the study mixture. Moreover, CYP-induced bladder mast cell accumulation and releasability were significantly decreased by PGA-HSP (even at the low dose), as determined by metachromatic staining, chymase and tryptase immunostaining as well as enzyme-linked immunosorbent assay for histamine and 5-hydoxytriptamine. PGA-HSP is able to block CYP-induced decrease of tight junction proteins, claudin-1 and occludin, thus preserving the urothelial bladder function. Finally, neuroinflammatory changes were investigated, showing that dietary supplementation with PGA-HSP prevented the activation of neurons and non-neuronal cells (i.e., microglia, astrocytes and mast cells) at the spinal level, and counteracted CYP-induced increase of spinal mRNA encoding for pro-inflammatory cytokines. Altogether, the present findings confirm the uroprotective and pain-relieving effect of PGA-HSP and pave the way to potential and relevant clinical applications of the study supplement in feline idiopathic cystitis.

PSIX-9 Activation of Multiple Inflammatory Signaling Pathways May Contribute to the Pathogenesis of Idiopathic Cystitis in Felines

Abstract Feline idiopathic cystitis (FIC) is a common urinary disorder in domestic cats. Clinical signs include straining or failing to urinate, frequent urination, and discolored urine. Inflammation is a key characteristic in the pathogenesis of cystitis. We assessed circulating inflammatory markers in a retrospective study in cats housed in the Hill’s colony diagnosed with cystitis (n = 4; 15.2 to 18.6yr) and in control cats (n = 8; 5.9 to 16.5 yr). Blood samples were collected at end-of-life immediately before necropsy after they had lived their full lives. End-of-life pathology reports indicated inflammation and presence of inflammatory infiltrates in the bladder with some cats also showing renal inflammation. RNA was extracted from blood collected in PAXgene tubes, and gene expression investigated using NanoString nCounter platform. Analysis was performed using the nSolver software. There was a significant increase in IRAK4, a kinase that activates the NFκB pro-inflammatory signaling pathway, in FIC when compared with controls (1.56, P < 0.05). Small molecule inhibitors of IRAK4 are being developed as targets of inflammation. Signaling molecules in the NFκB pathway were also significantly increased including Rel A (p65 subunit; 1.3 fold), NFκB1 (p100 subunit; 1.3 fold), IKBKB (1.29 fold), and TANK (1.46 fold) in FIC cats (all P < 0.05). Another signaling pathway contributing to pro-inflammatory signaling is the JAK/STAT pathway. There was a significant increase in JAK2 (1.65) and STAT3 (1.48). Blockade of JAK2/STAT3 pathway can attenuate cytokine synthesis and reduce inflammation. STAT6 was also significantly increased in FIC cats (1.35). Activation of STAT6, by IL-4 and IL-13, can lead to systemic inflammation. Activation of the complement immune pathway was also seen in FIC. While the complement system is important for an innate immune response, its sustained activation leads to chronic pathological inflammation. There was a significant increase in complement C1s, an initiator of classical complement activation pathway, in FIC cats (1.43; P < 0.05). A late component, complement C7, was also upregulated in FIC (2.01 fold; P < 0.05). C7 binds to the C5b-6 complex which eventually becomes part of the terminal complement complex. Increased abundance of C7 and eventual terminal complement complex are associated with increased inflammation and may be important in the progression of FIC. There was also an increase in PECAM1 in FIC cats (1.87; P < 0.05). Signaling through PECAM1 leads to the activation of neutrophils and monocytes. DUSP1 was also elevated in FIC (2.24; P < 0.05). Increased abundance of DUSP1 is hypothesized to be a predictor of chronic subclinical inflammation in humans with cardiovascular disease. Our results identify activation of pro-inflammatory signaling pathways that may be potential targets for alleviating inflammation in cystitis. Pathogenesis of FIC is likely multi-factorial, and nutritional intervention to attenuate the activation of inflammatory pathways may be an important strategy in the management of cystitis.

Emodin inhibits bladder inflammation and fibrosis in mice with interstitial cystitis by regulating JMJD3.

Interstitial cystitis/bladder pain syndrome (IC/BPS) is a devastating urological chronic pelvic pain condition. In search of a potential treatment, we investigated the effect of emodin on IC/BPS inflammation and fibrosis, and explore the potential mechanism. An experimental model of interstitial cystitis was induced by cyclophosphamide, and human bladder smooth muscle cells were treated with lipopolysaccharide to establish the cell model in vitro. In both models, inflammation- and fibrosis-related indexes were measured after emodin administration. Furthermore, the specific antagonists were used to dig for the mechanisms underlying the response to emodin treatment. Emodin significantly ameliorated management of cystitis, reduced the amount of inflammatory cytokines (tumor necrosis factor-α, monocyte chemoattractant protein-1, interleukin-1β, interleukin-8, and interleukin-6) in models, as well as reducing the synthesis of fibrosis marker including collagen1, collagen3, vimentin, fibronectin and α-smooth muscle actin. Further mechanism studies demonstrated that emodin inhibited inflammatory reaction and fibrosis through blocking lysine-specific demethylase 6B (JMJD3) expression via JAK/STAT, NF-κB and TGF-β/SMAD pathways. Our study reveals the critical role of emodin-JMJD3 signaling in interstitial cystitis by regulating inflammation, fibrosis, and extracellular matrix deposition in cells and tissues, and these findings provide an avenue for effective treatment of patients with cystitis.

Management of Acute Cystitis in the Era of COVID-19.

No specific guidelines have been developed for acute cystitis management during the COVID-19 pandemic. This review aims to provide up-to-date information about treatment and follow-up in patients with symptoms suggesting lower urinary tract infection. Uncomplicated cystitis does not need microbiological confirmation; thus, clinical diagnosis via telephone interview or questionnaires may be done. When complicated infections are suspected, in-person evaluation or close follow-up is mandatory. Antibiotic treatment is still the gold standard for treatment, although non-pharmacological strategies have also been suggested and further investigations are warranted. Urinary tract infections are still a frequent reason for consultation that needs to be addressed in both primary care and specialized levels. Their management during the pandemic is similar than in precedent years, but telehealth options have emerged which can facilitate diagnosis and treatment.

Improved management of cystitis in primary care following the implementation of a simple multifaceted intervention

ObjectiveWe assessed the impact of the implementation of a simple multifaceted intervention aimed at improving management of cystitis in primary care. DesignQuality control before and after study. SitePrimary care centres in Barcelona city provided by the Catalonian Institute of Health. ParticipantsThe multifaceted intervention consisted of (1) creation of a group with a leader in each of the primary care centres, out of hours services, sexual and reproductive centres, and home visit service, (2) session on management of cystitis in each centre, (3) result feedback for professionals, and (4) provision of infographics for professionals and patients with urinary tract infections. Interventions started in November 2020 and ended in the summer of 2021. Main measurementsVariation in the prescription of first-line antibiotics, usage of antibiotics, and request for urine cultures before and after this intervention. ResultsTraining sessions took place in 93% of the centres. The use of first-line therapies cystitis increased by 6.4% after the intervention (95% confidence interval [CI], 5.7–7.1%). The use of nitrofurantoin in recurrent cystitis increased, mainly in out of hours service (8.7%; 95% CI, 5.2–12.2%). Urine cultures were more frequently requested after the intervention for recurrent cystitis in both primary care centres and out of hours services, with a 7.2% increase [95% CI, 5.9–8.5%), but also for uncomplicated urinary tract infections (3.1%; 95% CI, 1.8–4.4%). ConclusionsA low-intensity multifaceted intervention on management of cystitis, with strong institutional support, resulted in a better choice of antibiotic in antibiotic prescribing, but the intervention had less impact on the adequacy of urine cultures.

Assessment of the Compliance of Cystitis Management According to French Recommendations through the Analysis of Prescriptions Collected in Community Pharmacies.

Urinary tract infections, especially cystitis, are common infections; they are the second most prevalent cause of antibiotic prescriptions in community pharmacies. To reduce antimicrobial resistance, guidelines are revised regularly. This study aims to assess compliance between prescriptions collected in community pharmacies and French cystitis guidelines. A treatment is considered compliant if the nature, dosage, and duration of the antibiotics are correct. Only women aged 18–65 years with a diagnosis of cystitis were eligible. The participation of 16 pharmacies resulted in 303 prescriptions. Most infections were classified as uncomplicated cystitis (79.2%), general practitioners were the prescribers in more than 9 out of 10 cases, and fosfomycin trometamol was the antibiotic dispensed for 1 in 2 women. An average compliance of 66% was observed, but with disparities according to the type of cystitis. Two-thirds of cases of uncomplicated cystitis and recurrent cystitis followed the recommendations, whereas only 15% of cystitis cases that were at risk of complication did so. The inclusion of a urine examination in uncomplicated cystitis decreased the overall compliance rate to 5.8%. These results show the essential role played by pharmacists; they are the last line of defence before dispensing antibiotics. They must know the recommendations in order to apply them.

AYURVEDIC MANAGEMENT OF CYSTITIS WITH SPECIAL REFERENCE TO USHNAVATA: A CASE REPORT

Cystitis is a condition of the urinary bladder in which diffuse inflammatory condition occurs, which may be due to an infectious or noninfectious aetiology that results in bleeding from the bladder mucosa. A 45-year-old male patient diagnosed with cystitis with recurrent hematuria was managed with Chiruvilvadi kashayam, Virataradi kashayam, Chandraprabha gulika and Cheriya antrakutaram gulika internally and dhanvantaram thailam pichu, avagaham with karanja, sigru, eranda, nirgundi patra, matra vasthi with pippalyadi anuvasana thailam and ksheeravasthi with gandharvahastadi kashayam. After completion of treatment, there was considerable relief in the primary complaints like foamy urine and low back pain associated with a burning sensation. This case report highlights the role of Ayurveda in the management of cystitis with recurrent hematuria and sheds light for further study on the same.

Fluoroquinolones and Other Antibiotics Redeemed for Cystitis-A Swedish Nationwide Cohort Follow-Up Study (2006-2018).

Background: Antibiotics are commonly prescribed for outpatient management of cystitis. Previous evidence suggests that certain factors likely beyond the infection seem to influence the choice of antimicrobial treatment. However, studies on the specific antibiotic treatments for cystitis are lacking. This study aimed to explore the antibiotic treatments for cystitis using nationwide primary healthcare data and investigate if factors beyond the infection could be associated with fluoroquinolone treatment. Methods: This nationwide follow-up cohort study consisted of 352,507 women with cystitis. The primary aim was to investigate what specific classes of antibiotics were redeemed by patients within five days from the cystitis diagnosis. Each patient could only be included once. Logistic regression models were also used to examine the relationship between fluoroquinolone (FQ) treatment, parity, and sociodemographic factors. Results: In total, 192,065 antibiotic prescriptions were redeemed. Pivmecillinam (58.4%) followed by nitrofurantoin (22.2%), trimethoprim (12.0%), fluoroquinolone (5.6%), and cephalosporins (1.5%) were the most redeemed antibiotics. Sociodemographic factors were weakly associated with fluoroquinolone treatment; young age was inversely associated with fluoroquinolone treatment. Parity and cervical cancer history were not associated with fluoroquinolone treatment. The proportion of fluoroquinolone and trimethoprim treatments decreased over time, while pivmecillinam and nitrofurantoin increased. Conclusions: The treatment trends of antibiotics redeemed within five days from a cystitis diagnosis were similar to the national surveillance program of these antibiotics (not diagnosis linked). Fluoroquinolones were weakly associated with sociodemographic factors, which likely is only of historical relevance.

Therapeutic management of cystitis ascending to acute renal failure in a dog- a case report

A thirteen-year-old spayed female Doberman with a history of incontinence urination, blood at the end of urine stream for about three months. Clinical examination showed normal vital parameters with abnormal urine. Haemogram and serum biochemistry revealed severe anemia, neutrophilia, lymphocytopenia, thrombocytopenia, and elevated Blood Urea Nitrogen and creatinine level, respectively. Ultrasonographic examination revealed thickened bladder wall indicating severe cystitis. The pale yellow, cloudy urine sample and urinary sediments revealed numerous neutrophils, lymphocytes, and epithelial cells. The urine sample was subjected to culture, and an anti-microbial susceptibility test showed the presence of a gram-negative coccobacillus organism. The organism in the urine sample was sensitive to ciprofloxacin, norfloxacin, and chloramphenicol while intermediately sensitive to cefotaxime and amikacin. The animal was diagnosed with cystitis with acute renal failure and was treated with ciprofloxacin, nephrotec, citralka, and advised to feed a special homemade renal diet. The dog has recovered with the given therapy, and renal values were also reduced.

The Comparison of intravesical hyaluronic acid and other modalities for the improvement of interstitial cystitis symptoms: a systematic reviews and meta-analysis

Background: Interstitial cystitis (IC) is a chronic inflammation of the bladder which causes unpleasant sensations. This condition considerably reduces patients' quality of life. Intravesical hyaluronic acid is one of the new interventions for interstitial cystitis management, in which a thorough review and meta-analysis regarding this topic are still limited. This study aimed to compare the efficacy of intravesical hyaluronic acid with other intravesical treatment modalities available to treat interstitial cystitis.Method: Systematic literature searching with the main keywords of "interstitial cystitis" or "bladder pain syndrome" and "intravesical hyaluronic acid" was conducted. The main outcome of this study was pain assessment using a visual analogue scale (VAS) and Interstitial Cystitis Symptoms Index (ICSI), and problem index (ICPI). Meta-analysis was carried out when comparative studies were available. Eleven studies were obtained to assess intravesical hyaluronic acid's effects, including three in the meta-analysis. The intravesical treatments found as a comparison were heparin and chondroitin sulphate.Result: There was significant heterogeneity among studies included in all parameters. The pooled analysis showed no significant difference in VAS reduction, improvement of ICSI and ICPI score (p = 0.11, p = 0.35, and p = 0.28, respectively) between hyaluronic acid and other intravesical treatments.Conclusion: There was no significant difference between hyaluronic acid and other intravesical treatments. However, further research with a larger sample is needed to confirm the best modalities in interstitial cystitis.

Increased Gene Expression of Circulating Pro‐inflammatory Cytokines in Felines with Idiopathic Cystitis

Feline idiopathic cystitis (FIC) is one of the common urinary disorders of domestic cats. Inflammation is a key characteristic in the pathogenesis of cystitis and pro-inflammatory cytokines and chemokines have been hypothesized to contribute to the progression of cystitis. Several cytokines have been reported in the urine and bladder in animal models of cystitis and in humans. Circulating levels of cytokines and chemokines are important biomarkers to assess the presence and severity of FIC and may also be useful as a response variable to assess dietary intervention. We assessed the circulating inflammatory markers in a retrospective study in cats with cystitis (n=6; 9.2-18.6 yr) from blood samples collected at necropsy, as well as in control cats (n=6; 5.9-14.6 yr). While most cats had been diagnosed with idiopathic cystitis during their life-time, two cats also were diagnosed with urinary tract infection. End-of-life pathology reports indicated inflammation and presence of inflammatory infiltrates in the bladder (lamina propria) with some cats also showing renal inflammation. RNA was extracted from blood samples, and we assessed the circulating levels of inflammatory genes using ThermoFisher Scientific Custom TaqMan array plates that were feline-specific, in the blood of cats obtained at the end-of-life. Data were analyzed using the using the ΔΔCt method using HPRT as the housekeeping gene. The levels of circulating mRNA that were increased greater than 1.5-fold in the FIC cats, when compared to controls, included interleukin-4 (>1.96-fold), interleukin-1b (>1.75), bone morphogenetic protein -2 (>1.74), interleukin-8 (CXCL8; >1.73), interleukin-16 (>1.7), and CSF-1 (>1.58). While IL-4 may have some anti-inflammatory effects, an increase in IL-4 can also lead to T-cell proliferation and increased inflammation. An increase in IL-16, a chemoattractant and activator of T-cells, as well as IL-8, indicates an important role of T-cell activation in the pathogenesis and progression of cystitis. Our results identify elevated levels of several pro-inflammatory molecules that may be potential targets for alleviating chronic inflammation associated with cystitis. Nutritional intervention to reduce the levels of selected inflammatory cytokines may be useful in the management of cystitis

General practitioners' clinical practice on the management of cystitis in Normandy, France: A clinical vignettes‐based study

The objective was to measure the quality of clinical practice for the management of cystitis in adult women in general practice by collaborating with quality circles and the regional centre for antibiotic counsel. This descriptive cross-sectional study was performed in 2018 in Normandy, France. A questionnaire composed of clinical vignettes was used to evaluate practices of general practitioners (GPs) with regard to cystitis classified into four categories: simple, at risk of complication, recurrent, and caused by multidrug-resistant bacteria. The 2017 French Infectious Diseases Society's guidelines were used as a reference. A total of 142 GPs participated in the study (45.5% of the solicited). Fosfomycin-trometamol and pivmecillinam were cited as first-line treatments for simple cystitis by 134 (94%) and 38 (27%) participants, respectively. For at risk of complication cystitis, the treatments cited were cefixime by 64 participants (45%), ofloxacin by 50 (35%), pivmecillinam by 49 (35%), fosfomycin-trometamol by 38 (27%), nitrofurantoin by 36 (25%), and amoxicillin-clavulanic acid by 28 (20%). Mean compliance rates were 85% for simple cystitis, 39% for at risk of complication cystitis, 60% for recurrent cystitis and 14% for cystitis caused by multidrug-resistant bacteria. Two criteria had less than 10% of the compliant answers: comprehensive knowledge of cystitis complication risk factors (9%) and positivity thresholds of urine cultures (10%). In this study, diagnostic means, follow-up testing, and simple cystitis treatment (with fosfomycin predominantly mentioned) were broadly compliant. The use of critical antibiotics was too frequent for at risk of complication cystitis. There may be a need to improve the knowledge of professionals on antibiotic resistance and appropriate antibiotic use.

Treatment of Cystitis by Hungarian General Practitioners: A Prospective Observational Study.

Background: Lower urinary tract infections (LUTIs) are amongst the most common community acquired infections with frequent antibiotic prescribing. Objectives: To assess empiric antibiotic choice in different types of lower urinary tract infections. We also aimed to identify determinants of fluoroquinolone prescribing, as well as to determine the rate of short antibiotic courses. The frequencies of executing laboratory tests and recommending analgesics/anti-inflammatory drugs were also assessed. Methods: A prospective observational study was performed in 19 different Hungarian primary care practices. Participating general practitioners (GPs) filled out data sheets for each patient with a suspected urinary tract infection. Details of drug use were evaluated. Comparison of different LUTI groups were made by descriptive statistics and univariate analysis. Possible determinants of fluoroquinolone prescribing were assessed by logistic regression. Results: Data sheets of 372 patients were analyzed. The majority of patients (68.82%) had acute uncomplicated cystitis. While antibiotics were prescribed for almost every patient (uncomplicated cases: 92.58%, complicated cases: 94.83%), analgesics/anti-inflammatory drugs were recommended at a rate of 7.81% in uncomplicated, and 13.79% in complicated cystitis cases. Ciprofloxacin was the most commonly prescribed antibacterial agent in both types of cystitis. Short-term antibiotic therapy was prescribed in one third of relevant cases. Logistic regression found a weak association between fluoroquinolone use and patient’s age and presence of complicating factors. Conclusions: Many aspects of suboptimal cystitis management were identified (e.g. unnecessarily broad spectra agents, too long antibiotic courses). In this study, patient characteristics has weakly influenced fluoroquinolone prescribing. Based on these results there is considerable room for improvement in primary care antibiotic therapy of cystitis in Hungary.

Pharmacological Options for Viral Induced Hemorrhagic Cystitis Management: A Review of the Literature

Background: Viral induced hemorrhagic cystitis (VIHC) is very common among patients who become immunocompromised following organ transplantation. However, there is neither consensus on the standard of care nor clear guidelines to aid in clinical decision making when treatment VIHC. This review discusses currently available pharmacologic agents, presents investigational drug therapies, and outlines alternative treatment options that could be effective against VIHC.Recent findings: Letermovir is a novel antiviral agent approved for CMV prophylaxis in patients post-hematopoietic stem cell transplantation (HSCT). Although no studies have yet been conducted in patients with VIHC, this new antiviral agent shows promise in preventing emergence of CMV in patients after HSCT. Additionally, newer studies addressing the efficacy of brincidofovir, an experimental drug derived from cidofovir, against CMV infection may provide preliminary evidence for brincidofovir’s role in therapy and therefore warrant further investigation.Conclusion: Polyoma BK virus (BKV), cytomegalovirus (CMV), and adenovirus (ADV) are the primary culprits for HC occurrence in patients undergoing renal transplantation or allogeneic HSCT. CMV-associated HC could be prevented or treated by ganciclovir and valganciclovir because these agents’ effectiveness has been clearly established in other non-HC infections related to CMV. ADV-associated HC could be mitigated by brincidofovir and ribavirin, however the high toxicity associated with these agents may be a limiting factor for their use. BKV-associated HC is best managed by cidofovir and leflunomide, but not by fluoroquinolones. Finally, intravesicular instillation should be preferred in patients who experience toxicities associated with systemic use of antivirals.

1333. Developing an Educational Tool to Improve Housestaff Knowledge, Attitudes, and Behavior in Managing Common Infectious Diseases

BackgroundImproving internal medicine (IM) trainees skills in managing common infectious diseases is essential to their development as competent physicians. We currently lack quantitative data of the knowledge and attitudes of IM housestaff regarding their management of common infectious diseases. We applied the knowledge, attitude, and behavior model to a pre-intervention survey aimed to uncover housestaff knowledge gaps and discomfort in managing several of the most commonly encountered infectious diseases at our institution. Using this information, we plan to develop a targeted post-survey intervention to increase self-efficacy and improve antimicrobial prescription practices among trainees.MethodsSurvey questions were based on Infectious Disease Society of America (IDSA) guidelines and developed using an iterative process involving interviews of infectious disease physicians and IM housestaff. We chose to focus on cystitis, pneumonia, and skin and soft-tissue infections. The anonymous survey tool was developed using a secure, online platform, and distributed in January 2018. Participation was voluntary and no remuneration for participation was offered.ResultsOut of 165 survey recipients, 50 trainees (30%) responded. Fifty-eight percent of trainees stated that they possessed only an average level of knowledge regarding the management of cystitis, pneumonia, and cellulitis. While 98% of housestaff confirmed that they utilized additional resources for information, only 24% felt routinely comfortable making decisions without an infectious disease consultation. Ninety-six percent of trainees felt that an institution-specific guide describing the management of common infectious diseases would be highly beneficial.ConclusionTrainees still lack the knowledge and confidence to make decisions regarding the empiric management of cystitis, pneumonia, and skin and soft-tissue infections at our academic medical center. There is a strong desire for an institution-specific educational resource to provide guidance for these decisions. Increasing trainee self-efficacy and improving their antimicrobial prescription practice patterns should be an educational priority. Disclosures All authors: No reported disclosures.