Prevention Of Recurrent Urinary Tract Infections Research Articles

Primary vesicoureteral reflux.

Primary vesicoureteral reflux (VUR) is one of the most common urological abnormalities in infants and children. The association of VUR, urinary tract infection (UTI) and renal parenchymal damage is well established. The most serious complications of VUR-associated reflux nephropathy are hypertension and proteinuria with chronic kidney disease. Over the past two decades, our understanding of the natural history of VUR has improved, which has helped to identify patients at increased risk of both VUR and VUR-associated renal injury. The main goals in the treatment of paediatric patients with VUR are the prevention of recurrent UTIs and minimizing the risk of renal scarring and long-term renal impairment. Currently, there are four options for managing primary VUR in infants and children: surveillance or intermittent treatment of UTIs with management of bladder and bowel dysfunction; continuous antibiotic prophylaxis; endoscopic subureteral injection of tissue-augmenting substances; and ureteral reimplantation via open, laparoscopic or robotic-assisted surgery. Current debates regarding key aspects of management include when to perform diagnostic imaging and how to best identify the paediatric patients that will benefit from continuous antibiotic prophylaxis or surgical intervention, including endoscopic injection therapy and minimally invasive ureteral reimplantation. Evolving technologies, such as artificial intelligence, have the potential to assist clinicians in the decision-making process and in the individualization of diagnostic imaging and treatment of infants and children with VUR in the future.

The Molecular Mechanisms and Therapeutic Potential of Cranberry, D-Mannose, and Flavonoids against Infectious Diseases: The Example of Urinary Tract Infections.

The treatment of infectious diseases typically includes the administration of anti-infectives; however, the increasing rates of antimicrobial resistance (AMR) have led to attempts to develop other modalities, such as antimicrobial peptides, nanotechnology, bacteriophages, and natural products. Natural products offer a viable alternative due to their potential affordability, ease of access, and diverse biological activities. Flavonoids, a class of natural polyphenols, demonstrate broad anti-infective properties against viruses, bacteria, fungi, and parasites. Their mechanisms of action include disruption of microbial membranes, inhibition of nucleic acid synthesis, and interference with bacterial enzymes. This review explores the potential of natural compounds, such as flavonoids, as an alternative therapeutic approach to combat infectious diseases. Moreover, it discusses some commonly used natural products, such as cranberry and D-mannose, to manage urinary tract infections (UTIs). Cranberry products and D-mannose both, yet differently, inhibit the adhesion of uropathogenic bacteria to the urothelium, thus reducing the likelihood of UTI occurrence. Some studies, with methodological limitations and small patient samples, provide some encouraging results suggesting the use of these substances in the prevention of recurrent UTIs. While further research is needed to determine optimal dosages, bioavailability, and potential side effects, natural compounds hold promise as a complementary or alternative therapeutic strategy in the fight against infectious diseases.

Effectiveness of Prophylactic Oral and/or Vaginal Probiotic Supplementation in the Prevention of Recurrent Urinary Tract Infections: A Randomized, Double-Blind, Placebo-Controlled Trial.

Widespread antibiotic resistance has sparked interest in the identification of nonantibiotic strategies, particularly probiotics for the prevention of recurrent urinary tract infections (UTIs). We evaluated the effectiveness of prophylactic probiotic supplementation through oral and intravaginal routes in the prevention of recurrent UTIs. This double-blind, placebo-controlled study enrolled 174 premenopausal women with a history of recurrent UTIs and randomized them to 1 of the 4 treatment groups: placebo (G1, oral placebo + vaginal placebo), oral probiotic (G2, oral lactic acid bacteria and bifidobacteria + vaginal placebo), vaginal probiotic (G3, oral placebo + vaginal lactobacilli), and probiotic combination (oral lactic acid bacteria and bifidobacteria + vaginal lactobacilli), for 4 months. Participants were followed up for symptomatic UTIs for 1 year. The primary end points were the number of symptomatic UTIs at 4 months, the proportion of participants with at least 1 symptomatic UTI, and the time to the first symptomatic UTI. The incidence of UTI at 4 months in G1, G2, G3, and G4 was 70.4%, 61.3%, 40.9%, and 31.8%, respectively. The mean number of symptomatic UTI recurrences at 4 months was significantly lower (P < .05) in G3 (1.06) and G4 (1.07) compared with G1 (2.1) and G2 (1.63). Further, the time to first symptomatic UTI (days) was significantly longer (P < .05) in G3 (123.8) and G4 (141.8) compared with G1 (69.3) and G2 (71.9). Probiotic supplementations were well tolerated with no serious adverse events. Prophylactic supplementation with either vaginal probiotics or in combination with oral probiotics demonstrated effectiveness in preventing recurrent symptomatic UTI episodes. Registered at Clinical Trials Registry India (CTRI): CTRI/2014/02/004425 (https://ctri.nic.in).

Overlooked Factors Causing Renal Damage in Vesicoureteric Reflux!

Vesicoureteric reflux (VUR), recurrent urinary tract infection (RUTI), febrile urinary tract infection (FUTI), renal scarring, and renal damage are intimately related. Key factors of renal damage in VUR are suspected to be RUTI and FUTI. Hence, conventional treatments are targeted toward the prevention of RUTI and FUTI. However, literatures have witnessed that control of infection is not sufficient enough. That means we are missing some hidden, enigmatic, or overlooked factors which are essentially responsible for renal damage. We know RUTI occurs from the stasis of urine in system and stasis might occur from obstruction somewhere in system. Moreover, obstruction builds up back pressure in the bladder and ureters, and ultimately in kidneys; that pressure is independently harmful to renal function. Pressure is further harmful if this joins together with infection. We know that RUTI and FUTI along with pressure in the urinary tract are harmful to renal parenchyma. Nevertheless, search for the nexus of obstruction, pressure, stasis, infection, and damage (OPSID) of renal function is not yet focused on in VUR research. In this retrospective study on secondary VUR, we would like to find the overlooked factors or nexus of OPSID associated with VUR causing renal damage. A total of 170 renal units of 135 patients with VUR resulted from the posterior urethral valve and from repaired bladder exstrophy, from March 2005 to April 2019, had adequate data regarding control/correction of obstruction and urodynamic studies. The mean patient's age was 2.8 years (range 1 day-14 years). The diagnosis of VURs was made with postnatal cystogram in patients of the posterior urethral valve and of repaired continent augmented bladder exstrophy. We do cystogram not micturating cystogram following ultrasonography if showing dilated ureter/s. If we find no residual in ureter/s after 30 min in cystogram, we label it as "rise and fall" VUR (raf_VUR), i.e., without obstruction. On the other hand, if there is post void residual in ureter/s for more than 30 min, we label it as "rise and stasis" VUR (ras_VUR) means combination of VUR with uretero vesical junction obstruction (UVJO). Along with this, all patients were followed up with albumin creatinine ratio, creatinine clearance, USG Renometry, DTPA renal scan, uroflowmetry, and urodynamic study (UDS). Repeat cystoscopy, if necessary, was done following UDS for secondary bladder neck incision (BNI) or for repeat BNI if necessary. Mean duration of follow-up was 7.2 years (range 3-14 years). Out of 170 renal units, 132 renal units had VUR without VUJO, i.e., raf_VUR and 38 renal units had ras_VUR. All patients of UVJO were relieved either with anticholinergics or with DJ stenting or by re-implantations. Twenty-nine patients out of 135 had high pressure on UDS, and they needed BNI. We were able to prevent upstaging of chronic kidney disease (USCKD) in all 135 patients. Our tangible goal of treatment in VUR is the prevention of USCKD. We differentiated raf_VUR from ras_VUR with cystogram. Patients with ras_VUR and patients with raf_VUR with high bladder pressure were actively treated. This particular subset VUR was treated with prophylactic antibiotic and surgical corrections. We prevented renal damage by eliminating obstruction and stasis which helped to prevent RUTI and FUTI. Possibly, similar management might also help to manage "primary VUR." Possibly those overlooked factors which are essentially responsible for renal damage are veiled in nexus OPSID of the kidney.

Why d-Mannose May Be as Efficient as Antibiotics in the Treatment of Acute Uncomplicated Lower Urinary Tract Infections-Preliminary Considerations and Conclusions from a Non-Interventional Study.

Urinary tract infections (UTIs) are very frequent in women and can be caused by a range of pathogens. High recurrence rates and increasing antibiotic resistance of uropathogens make UTIs a severe public health problem. d-mannose is a monosaccharide that can inhibit bacterial adhesion to the urothelium after oral intake. Several clinical studies have shown the efficacy of d-mannose in the prevention of recurrent UTIs; these also provided limited evidence for the efficacy of d-mannose in acute therapy. A recent prospective, non-interventional study in female patients with acute cystitis reported good success rates for treatment with d-mannose. Here, we present data from a post hoc analysis of this study to compare the cure rate of d-mannose monotherapy with that of antibiotics. The results show that d-mannose is a promising alternative to antibiotics in the treatment of acute uncomplicated UTIs in women.

Актуальные вопросы инфекции мочевой системы у детей раннего возраста

В статье приведены современные взгляды зарубежных авторов на вопросы распространенности, этиологии и патогенеза, диагностики, лечения и профилактики инфекции мочевой системы (ИМС) у детей раннего возраста (0–3 года). Речь идет о том, что ИМС остается наиболее распространенной инфекцией у детей до 2 лет и занимает 2–3-е место среди всех инфекций детского возраста. ИМС остается глобальной проблемой педиатрии. Диагностика заболевания у детей первых 3 лет жизни не является простым вопросом. Так, в неонатальном периоде симптомы и признаки ИМС неспецифические: температурная нестабильность, нарушение периферического кровообращения, летаргия, раздражительность, апноэ, анорексия, плохое сосание, рвота, длительная желтуха и др. Мочевой синдром у таких детей встречается редко, но считается более специфичным. У новорожденных с ИМС существует высокая вероятность бактериемии, что свидетельствует об актуальности гематогенного пути распространения инфекции. Доказано, что дети с функциональной или анатомической патологией органов мочевой системы, с иммунодефицитом подвержены ИМС. Акцентированы важность своевременной диагностики заболевания и риск факторов ее реализации. В этом смысле имеет значение разработка неинвазивных методов и устройств для сбора мочи у детей с максимально исключенным риском загрязнения образца. Существует насущная необходимость в выявлении более специфических биомаркеров для повышения точности и скорости диагностики ИМС, в современных бактериологических методах культуральной идентификации. Проводится апробация новых неинвазивных методов исследования, таких как МРТ без контраста и ультразвуковая допплеровская методика для тканевой и микрососудистой визуализации соответственно. Некоторые аспекты ИМС остаются дискутабельными. К ним относятся вопросы естественного развития заболевания, оптимальные варианты антибактериального режима, профилактического ведения пациента и др. В последнее время во всем мире устойчивость к противомикробным препаратам возрастает по мере появления организмов, продуцирующих бета-лактамазу с расширенным спектром. Так что следует использовать антибиотик наименее широкого спектра действия с учетом данных локальной чувствительности. Рекуррентная ИМС обычно не приводит к образованию рубцов на почках у детей без структурной почечной аномалии. Таким образом, учитывая побочные эффекты и появление резистентности, рутинная антимикробная профилактика редко оправдывается. В этом смысле уместным становится изучение новых вакцинных композиций и составов для лечения рекуррентной ИМС, в том числе у детей младшего возраста.

Рецидивирующие инфекции мочевой системы: доказательная база и дискутабельные вопросы мероприятий неантибактериальной профилактики

Рецидивирующая инфекция мочевой системы (ИМС) является распространенным, дорогим и обременительным состоянием, которое касается женщин всех возрастных категорий, рас и этнических групп без учета социально-экономического статуса или образовательного уровня. Современные стратегии, направленные на профилактику рецидивирующих ИМС, как и раньше, не являются оптимальными, о чем свидетельствует относительно высокая распространенность данной нозологии у женщин. Цель данной статьи заключалась в освещении и обсуждении как доказательной базы, так и ряда нерешенных вопросов менеджмента рецидивирующих ИМС. Рассмотрены темы, вызывающие клинический интерес: диагностика, возрастные ассоциации, постоянная и интермиттирующая антимикробная профилактика, эффективность современных мероприятий неантимикробной профилактики, потенциальная роль форинала (комплекс D-маннозы и экстракта плодов клюквы) в профилактике рецидивирующих ИМС.

Лактиале Уро в профилактике мочевой инфекции в постменопаузе: результаты исследования LACMUS

Цель: оценить эффективность и безопасность Лактиале Уро, препарата, содержащего два штамма Lactobacilli, экстракт клюквы и витамин А, в предотвращении повторных инфекций мочевых путей (ИМП) у женщин в постменопаузе (исследование LACMUS). Материалы и методы. Это было рандомизированное проспективное многоцентровое исследование. Субъекты получали Лактиале Уро дважды в день в течение 26 недель после выздоровления от ИМП; контрольная группа препарат не получала. Первичной конечной точкой была доля пациентов с повторными эпизодами ИМП в конце исследования. Результаты. Семьдесят семь женщин прошли обследование, в исследование вошли 65, а завершила его 61 пациентка. Через 26 недель у значительно меньшего количества женщин отмечены повторные ИМП при приеме Лактиале Уро по сравнению с теми, кто не получал лечения (9,7 против 23,3 %; P &lt; 0,05). Использование Лактиале Уро обусловливало статистически значимые улучшения, такие как низкие показатели эпизодов ИМП (12,9 против 36,6 %; P &lt; 0,05), более долгое время до первого эпизода ИМП (136 против 27 дней; Р = 0,0038), меньшая продолжительность активного эпизода ИМП (5 против 11 дней; Р = 0,0199) и меньшая длительность антибактериальной терапии активного эпизода ИМП (4 против 10 дней; Р = 0,0462). Выводы. Лактиале Уро был безопасным и эффективным в профилактике повторных ИМП у женщин в постменопаузе. Эти данные требуют дальнейших хорошо разработанных исследований для выяснения возможных преимуществ.

Recurrent Urinary Tract Infections

One in three women has had at least one urinary tract infection (UTI) treated with antibiotics by the age of 24 years, and half of all women experience a UTI in their lifetime with one in four developing recurrence. Recurrent UTI is defined by two or more symptomatic infections in the past 6 months or three or more symptomatic infections in the past 12 months where each UTI follows a complete resolution of the previous UTI. This review describes the risk factors, diagnosis, work-up and treatment, and prevention of recurrent UTIs. Prevention strategies can be divided into antimicrobial and nonantimicrobial strategies. Nonantimicrobial prevention with behavioral changes, cranberry products, or probiotics did not significantly reduce the occurrence of symptomatic UTIs. Compared with placebo, oral estrogens did not reduce UTIs. However, vaginal estrogens do play a role in prevention of recurrence, particularly in postmenopausal women. There are three main strategies for antibiotic prevention: (1) low-dose daily antimicrobial prophylaxis, (2) postcoital antimicrobial prophylaxis, and (3) patient-initiated antimicrobial treatment. All of these strategies decrease infections during prophylaxis period.The choice of regimen should be based on susceptibilities and antibiotic allergy. This review contains 1 figure, 7 tables and 37 references. Keywords: antimicrobial prophylaxis, continuous antibiotics, CT urography, cystoscopy, postcoital prophylaxis, recurrent UTI, risk factors, self-directed therapy, treatment and diagnosis

A Combination of Polybacterial MV140 and Candida albicans V132 as a Potential Novel Trained Immunity-Based Vaccine for Genitourinary Tract Infections.

Recurrent urinary tract infections (RUTIs) and recurrent vulvovaginal candidiasis (RVVCs) represent major healthcare problems with high socio-economic impact worldwide. Antibiotic and antifungal prophylaxis remain the gold standard treatments for RUTIs and RVVCs, contributing to the massive rise of antimicrobial resistance, microbiota alterations and co-infections. Therefore, the development of novel vaccine strategies for these infections are sorely needed. The sublingual heat-inactivated polyvalent bacterial vaccine MV140 shows clinical efficacy for the prevention of RUTIs and promotes Th1/Th17 and IL-10 immune responses. V132 is a sublingual preparation of heat-inactivated Candida albicans developed against RVVCs. A vaccine formulation combining both MV140 and V132 might well represent a suitable approach for concomitant genitourinary tract infections (GUTIs), but detailed mechanistic preclinical studies are still needed. Herein, we showed that the combination of MV140 and V132 imprints human dendritic cells (DCs) with the capacity to polarize potent IFN-γ– and IL-17A–producing T cells and FOXP3+ regulatory T (Treg) cells. MV140/V132 activates mitogen-activated protein kinases (MAPK)-, nuclear factor-κB (NF-κB)- and mammalian target of rapamycin (mTOR)-mediated signaling pathways in human DCs. MV140/V132 also promotes metabolic and epigenetic reprogramming in human DCs, which are key molecular mechanisms involved in the induction of innate trained immunity. Splenocytes from mice sublingually immunized with MV140/V132 display enhanced proliferative responses of CD4+ T cells not only upon in vitro stimulation with the related antigens contained in the vaccine formulation but also upon stimulation with phytohaemagglutinin. Additionally, in vivo sublingual immunization with MV140/V132 induces the generation of IgG and IgA antibodies against all the components contained in the vaccine formulation. We uncover immunological mechanisms underlying the potential mode of action of a combination of MV140 and V132 as a novel promising trained immunity-based vaccine (TIbV) for GUTIs.

Urinary Tract Infections

Urinary tract infection (UTI) is the most common bacterial infection, affecting women far more than men. Aerobic gram-negative bacteria are the most common uropathogens causing UTI, with Escherichia coli remaining the most predominant organism in complicated infections. UTI can result in a variety of infections and inflammations, from asymptomatic bacteriuria to typical symptomatic cystitis to acute pyelonephritis, as well as bacterial prostatitis in men. In general, antimicrobial therapy is warranted for any symptomatic infection of the urinary tract. However, new consensus treatment guidelines for uncomplicated UTI in women, set by the Infectious Diseases Society of America and the European Society for Microbiology of Infection Diseases in 2010, account for the increasing antimicrobial resistance of pathogens and focus on first-line empirical treatment regimens. To reduce the use of antibiotics, treatment and prevention of recurrent UTI may involve several strategies on varying levels of effectiveness; some of the more well-tested options include probiotics, antiseptics, and topical estrogen. Antimicrobial approaches should be reserved for women in whom these options prove to be ineffective. This review contains 7 figures, 10 tables, and 122 references.

Urinary Tract Infections

Urinary tract infection (UTI) is the most common bacterial infection, affecting women far more than men. Aerobic gram-negative bacteria are the most common uropathogens causing UTI, with Escherichia coli remaining the most predominant organism in complicated infections. UTI can result in a variety of infections and inflammations, from asymptomatic bacteriuria to typical symptomatic cystitis to acute pyelonephritis, as well as bacterial prostatitis in men. In general, antimicrobial therapy is warranted for any symptomatic infection of the urinary tract. However, new consensus treatment guidelines for uncomplicated UTI in women, set by the Infectious Diseases Society of America and the European Society for Microbiology of Infection Diseases in 2010, account for the increasing antimicrobial resistance of pathogens and focus on first-line empirical treatment regimens. To reduce the use of antibiotics, treatment and prevention of recurrent UTI may involve several strategies on varying levels of effectiveness; some of the more well-tested options include probiotics, antiseptics, and topical estrogen. Antimicrobial approaches should be reserved for women in whom these options prove to be ineffective. This review contains 7 figures, 10 tables, and 122 references.

A study to evaluate the efficacy of cranberry extract supplements in prevention of recurrent urinary tract infections in female patients

Background: Recurrence of urinary tract infections (UTI) are either due to re infection or relapse. Overall likelihood of developing UTI is approximately 30 times higher in women than men due to their anatomical peculiarities. The objective was to evaluate efficacy of cranberry extract supplementations in prevention of recurrent UTI in female patients, assess the quality of life of patients, medication adherence of patients and effect of patient counselling.Methods: A prospective observational study was carried out for a period of 6 months and samples were taken from the Urology Department of Cosmopolitan Hospital, Trivandrum, Kerala. The selected patients were administered with cranberry extract supplements after their regular Antibiotic therapy and were observed for recurrence for a period of six months. Three follow ups were taken and the betterment was assessed using the score from prepared proforma.Results: 84 patients were analysed and among them we observed and concluded that 86.9% of patients were free of recurrent infection. Study shows that E. coli was the commonest infectious organism causing UTI. In this study the most commonly observed symptom of UTI was lower abdominal pain and the most common co morbidity was DM.Conclusions: Through this study it was concluded that the cranberry extract supplements significantly reduced the recurrence of UTI in women. Since the antibiotic prophylaxis is having the risk of developing resistance and side effects, the cranberry extract supplements can be suggested as a best alternative to antibiotics in recurrent UTI prophylaxis.

A study to evaluate the impact of patient counselling on the quality of life of female patients with recurrent urinary tract infection

Background: Recurrence of urinary tract infections (UTI) are either due to re infection or relapse. Overall likelihood of developing UTI is approximately 30 times higher in women than men due to their anatomical peculiarities and are normally treated with antibiotics. To evaluate effectiveness of patient counselling in prevention of recurrent UTI in female patients to reduce the risk of developing Antibiotic resistance and assess the quality of life of patients.Methods: A prospective observational study was carried out for a period of 6 months and samples were taken from the urology department of cosmopolitan hospital, Trivandrum, Kerala. Patient counseling was given regarding the disease, drugs and lifestyle modifications. A suitably validated KAP questionnaire was provided to each patient at their visits. By using an EQ-5D-5L questionnaire the quality of life of patients were assessed and analyzed.Results: 84 patients were analyzed. After the counseling knowledge level significantly improved to good from 6.9% to 72.4%, the positive attitude level was improved from 35.6 to 57.5% and the practice level was improved to good from 25.3 to 43.7%. The QOL improved to best from 1.2 to 71.4%. After counseling incidence rate was decreased to zero. The mostly observed risk factor was decreased water intake (69%). The common age group observed was 31-50 (41.7%).Conclusions: Patient counseling had an important impact on medication adherence and QOL of female patients with recurrent UTI. Effective patient counseling and better compliance decreased the incidence of recurrence and improved the quality of life of patients.

Understanding the potential of lactobacilli in recurrent UTI prevention

Urinary tract infections (UTIs) are one of the most common infections in women. The only proven preventive strategy for recurrent UTIs is prophylactic antibiotics. Given growing antibiotic resistance, the use of probiotics has been proposed as an alternative to antibiotics. Herein, we discuss the current evidence to support the possibility that exogenous lactobacilli may limit the pathogenicity of uropathogens such as E. coli. Probiotics appear to have a significant potential in prevention of recurrent UTI, however, additional data are needed to understand how they can be effectively used in clinical practice.

Nonantibiotic treatments for urinary cystitis: an update.

Urinary tract infections (UTIs) are one of most common infections in everyday clinical practice. Given the increase in antimicrobial therapy resistance, there has been an increased interest in nonantibiotic treatment options for common infections. A review of the recent literature including on nonantibiotic options for management of UTIs, symptoms of cystitis and prevention of recurrent UTIs. The article provides an overview on alternative therapy to antibiotics in the treatment of cystitis and recurrent UTI prophylaxis, including alkalinization of urine, cranberry products, probiotics, NSAIDS, D-mannose, herbal medicine, methenamine hippurate, oral immunostimulants (immunotherapy), topical oestrogens, vitamins and acupuncture. The last few years of intense research has focused on an effort to find evidence to corroborate potentially efficacious non antibiotic treatments. However, alternative treatments for UTIs have not brought conclusive evidence that antibiotic usage can be replaced completely by nonantibiotic options. The reason for this is largely due to a lack of good-quality randomized controlled trials on this subject.

The influence of smoking on bacterial resistance after vaccine or antibiotic prophylaxis against recurrent urinary tract infections

IntroductionThe influence of tobacco on the microbiological spectrum, resistance-sensitivity pattern and evolution in patients with recurrent urinary tract infections (RUTI) is analyzed. Evaluation of the effect of polyvalent bacterial vaccine on the prevention of RUTI and smoking status. Material and methodsRetrospective multicenter study of 855 women with RUTI receiving suppressive antibiotic treatment or bacterial vaccine between 2009 and 2013. Group A (GA): Antibiotic (n = 495). Subgroups: GA1 non-smoker (n = 417), GA2 smoker (n = 78). Group B (GB): Vaccine (n = 360). Subgroups: GB1 non-smoker (n = 263), GB2 smoker (n = 97). Variables: Age, pre-treatment UTI, disease-free time (DFT), microbial species, sensitivity and resistance. Follow-up at 3, 6 and 12 months with culture and SF-36 questionnaire. ResultsMean age 56.51 years (18–75), similar between groups (p = 0.2257). No difference in the number of pretreatment UTIs (p = 0.1329) or in the distribution of the bacterial spectrum (p = 0.7471). DFT was higher in subgroups B compared with A. Urine cultures in GA1: E. coli 62.71% with 8.10% resistance (33% quinolones; 33% cotrimoxazole; 33% quinolones + cotrimoxazole); in GA2 E. coli 61.53% with 75% resistance (16.66% quinolones; 33.33% quinolones + cotrimoxazole; 16.66% amoxicillin-clavulanate; 16.66% erythromycin + phosphomycin + clindamycin) (p = 0, 0133). There were no differences between patients of GA treated with cotrimoxazole and nitrofurantoin (p = 0.8724). Urine cultures in GB1: E. coli 47.36% with 22.22% resistance (5.55% ciprofloxacin; 5.55% cotrimoxazole; 5.55% ciprofloxacin + cotrimoxazole; 5.55% amoxicillin / clavulanic acid). In GB2 E.coli 70.02% with 61.90% resistances (30.76% quinolones; 30.76% cotrimoxazole; 30.76% quinolones + cotrimoxazole; 17.69% amoxicillin-clavulanic acid) (p = 0,0144). ConclusionsThe development of bacterial resistance is more frequent among women with smoking habits and recurrent urinary infections. This could influence a worse response to preventive treatments, either with antibiotics or vaccines.

Influencia del tabaquismo en la resistencia bacteriana después de la profilaxis frente a infecciones urinarias recurrentes con antibiótico o con vacuna

IntroductionThe influence of tobacco on the microbiological spectrum, resistance-sensitivity pattern and evolution in patients with recurrent urinary tract infections (RUTI) is analyzed. Evaluation of the effect of polyvalent bacterial vaccine on the prevention of RUTI and smoking status. Material and methodsRetrospective multicenter study of 855 women with RUTI receiving suppressive antibiotic treatment or bacterial vaccine between 2009 and 2013. Group A (GA): Antibiotic (n=495); Subgroups: GA1 non-smoker (n=417), GA2 smoker (n=78). Group B (GB): Vaccine (n=360); Subgroups: GB1 non-smoker (n=263), GB2 smoker (n=97). Variables: Age, pre-treatment UTI, disease-free time (DFT), microbial species, sensitivity and resistance. Follow-up at 3, 6 and 12 months with culture and SF-36 questionnaire. ResultsMean age 56.51 years (18-75), similar between groups (P=.2257). No difference in the number of pretreatment UTIs (P=.1329) or in the distribution of the bacterial spectrum (P=.7471). DFT was higher in subgroups B compared with A. Urine cultures in GA1: E. coli 62.71% with 8.10% resistance (33% quinolones; 33% cotrimoxazole; 33% quinolones + cotrimoxazole); in GA2 E. coli 61.53% with 75% resistance (16.66% quinolones; 33.33% quinolones + cotrimoxazole; 16.66% amoxicillin-clavulanate; 16.66% erythromycin + phosphomycin + clindamycin) (P=.0133). There were no differences between patients of GA treated with cotrimoxazole and nitrofurantoin (P=.8724). Urine cultures in GB1: E. coli 47.36% with 22.22% resistance (5.55% ciprofloxacin; 5.55% cotrimoxazole; 5.55% ciprofloxacin + cotrimoxazole; 5.55% amoxicillin/clavulanic acid). In GB2 E. coli 70.02% with 61.90% resistances (30.76% quinolones; 30.76% cotrimoxazole; 30.76% quinolones + cotrimoxazole; 17.69% amoxicillin-clavulanic acid) (P=.0144). ConclusionsThe development of bacterial resistance is more frequent among women with smoking habits and recurrent urinary infections. This could influence a worse response to preventive treatments, either with antibiotics or vaccines.

Prospective Observational Cohort Study of the Efficacy of Bacterial Immune Prophylaxis in the Prevention of Uncomplicated, Recurrent Urinary Tract Infections

Objective: To investigate the long-term prophylactic effect of a vaccine on lower urinary tract infections (UTI) of bacterial and the impact of the intensity of the symptoms on the quality of life (QoL). Methods: Adult female could be enrolled in this study if they had acute UTI at the enrolment visit and bacterial microbiological count of ≥10³ CFU/mL of Escherichia coli. Results: A total of 21 patients were included. Fifteen days after the administration of a vaccine for 3 months, the number of infections dropped almost to zero. Significant differences were observed in the QoL score (p < 0.05). The safety profile was good. Conclusions: In patients diagnosed with recurrent UTI and treated for 3 months with the vaccine the number of UTI episodes fell very quickly (15 days), and patients remained free of episodes and improved their QoL significantly for 1 year. These results suggest that bacterial vaccines are a possible effective alternative in the prevention of recurrent UTI.

Urinary Tract Infections

Urinary tract infection (UTI) is the most common bacterial infection, affecting women far more than men. Aerobic gram-negative bacteria are the most common uropathogens causing UTI, with Escherichia coli remaining the most predominant organism in complicated infections. UTI can result in a variety of infections and inflammations, from asymptomatic bacteriuria to typical symptomatic cystitis to acute pyelonephritis, as well as bacterial prostatitis in men. In general, antimicrobial therapy is warranted for any symptomatic infection of the urinary tract. However, new consensus treatment guidelines for uncomplicated UTI in women, set by the Infectious Diseases Society of America and the European Society for Microbiology of Infection Diseases in 2010, account for the increasing antimicrobial resistance of pathogens and focus on first-line empirical treatment regimens. To reduce the use of antibiotics, treatment and prevention of recurrent UTI may involve several strategies on varying levels of effectiveness; some of the more well-tested options include probiotics, antiseptics, and topical estrogen. Antimicrobial approaches should be reserved for women in whom these options prove to be ineffective. This review contains 7 highly rendered figures, 7 tables, and 120 references.