Prophylaxis Of Urinary Tract Infections Research Articles

MP23-14 REDUCING READMISSIONS FOLLOWING RADICAL CYSTECTOMY THROUGH QUALITY IMPROVEMENT

You have accessJournal of UrologyCME1 May 2022MP23-14 REDUCING READMISSIONS FOLLOWING RADICAL CYSTECTOMY THROUGH QUALITY IMPROVEMENT Lee White, Caleb Seufert, Bogdana Schmidt, Peter Dy, Stacy Cox, Mia Singh, Joanne Meneses, and Eila Skinner Lee WhiteLee White More articles by this author , Caleb SeufertCaleb Seufert More articles by this author , Bogdana SchmidtBogdana Schmidt More articles by this author , Peter DyPeter Dy More articles by this author , Stacy CoxStacy Cox More articles by this author , Mia SinghMia Singh More articles by this author , Joanne MenesesJoanne Meneses More articles by this author , and Eila SkinnerEila Skinner More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002562.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Radical cystectomy (RC) for invasive for invasive bladder cancer is a highly morbid surgery. At 21 to 31%, the national 30 day RC readmission rate is significantly higher than for other urologic procedures. Early rehospitalization has become a focus due to the impact on patient experience, high cost, and associated poor downstream health outcomes. Under the auspices of the Stanford Clinical Effectiveness and Leadership Training Program, we set out to reduce the 30-day readmission rate due to infection to 10%, from the current rate at Stanford of 17.9%. METHODS: We determined the baseline readmission rate at Stanford from ACS NSQUIP and billing data, and manual review of all RCs at Stanford from 2018-2020. We identified an ‘intervention bundle’ to reduce cystectomy readmissions: preoperative nutrition referral, enrolling patients in SeamlessMD perioperative education platform, standardized teaching for patients during hospitalization, removal of ureteral stents by postoperative day 4, methenamine urinary tract infection prophylaxis, and outpatient care coordination with followup visit at 3, 10, and 17 days post-discharge. RESULTS: We identified 217 baseline cases from 2018-20 with a readmission rate of 28-32%, of which 18-21% were due to intraabdominal and urinary tract infection. In the 3 months since our intervention, we performed 14 radical cystectomies. 1 patient was admitted to an outside hospital with pain. One patient was admitted with a urinary tract infection. These represent a 14% overall readmission rate and 7% readmission rate for infection. Process measures have also improved. Days to stent removal has improved from 21.3 days to 7.7 days. Days to clinic follow-up improved from 6.3 days to 3.6 days. CONCLUSIONS: Our intervention reduced readmissions from 17.9% to <10%, or an estimated 6-10 prevented readmissions annually, with corresponding impact of $1-1.5M. Insights from this initiative provide a template for improving important clinical metrics using data from chart and literature review. This Quality Improvement initiative included a spectrum of practitioners. Reducing readmission following cystectomy may yield strategies and answers to reduce readmission following other complex and morbid surgeries. These answers can improve the experience for patients at Stanford and beyond. Source of Funding: NA © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e387 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Lee White More articles by this author Caleb Seufert More articles by this author Bogdana Schmidt More articles by this author Peter Dy More articles by this author Stacy Cox More articles by this author Mia Singh More articles by this author Joanne Meneses More articles by this author Eila Skinner More articles by this author Expand All Advertisement PDF downloadLoading ...

Use of Prophylactic Antibiotics to Prevent Urinary Tract Infection after Urodynamic Testing and Cystoscopy in Women: A Practice Pattern Study

Objectives: The objective of the study was to determine practice patterns of prescribing prophylactic antibiotics against urinary tract infection (UTI) for urodynamic studies (UDS) and outpatient cystoscopy in women. Design: A cross-sectional survey study was conducted of North American female pelvic medicine and reconstructive specialists (FPMRS). Methods: An online survey was used to assess prophylactic prescribing patterns of FPMRS that perform UDS and outpatient cystoscopy. This survey was developed and then electronically disseminated through the American Urogynecologic Society to 699 eligible physicians. Results: A total of 138 surveys were completed. Approximately half of physicians did not prescribe any antibiotic prophylaxis for UDS or for cystoscopy (54% and 43%, respectively). For patients with perceived risk factors (recurrent UTIs, immunosuppression, known neurogenic lower urinary tract dysfunction, indwelling catheter use, elevated postvoid residual/bladder outlet obstruction, genitourinary anomalies, and diabetes), 32% and 41% of physicians prescribed antibiotic prophylaxis for UDS and cystoscopy, respectively. A minority of physicians always prescribed antibiotics for UDS and cystoscopy (13% and 17%, respectively). Limitations: The response rate was a limitation of the study; however, this rate is in keeping with other physician survey studies published within this subspecialty. Selection and response biases may have contributed to the results of this survey study. Conclusion: There was no uniform approach to UTI prophylaxis for UDS and outpatient cystoscopy in women which reflects the lack of current guidelines and the low level of evidence on which they are based. This nonuniform practice calls for more research to better define an evidence-based standard of care.

Psychosocial burden of recurrent uncomplicated urinary tract infections.

Introduction: Urinary tract infections (UTI) are a leading cause of bacterial infections in women. Despite acute treatment, 30–50% of women who have a UTI will experience a recurrence within 6–12 months. In this review, the focus will be on the personal psychosocial impacts of recurrent UTI.Methods: A PubMed/MEDLINE literature search was carried out from 2000 to 2020 in order to identify any recent high-quality meta-analyses or systematic reviews on these topics.Results: One systematic review was found appropriate for this manuscript. Concerning impact on quality of life (QoL) and daily activities, a reduced quality of both intimate and social relationships, self-esteem, and capacity for work was found due to recurrent UTI. Social function was substantially more reduced than physical function. In one study, the greatest reduction overall was in mental role functioning, whereas in another study, mental health reductions were not substantially greater than those of physical health. About one third of women suffered from UTI very often or often after sexual intercourse, and more than half of the patients stated that sexual relations were negatively influenced by UTI. Data from the GESPRIT study suggest that prophylaxis for recurrent UTI is underutilized, because less than 40% of the study population were offered prophylaxis after experiencing three UTI per year, despite all surveyed participants being willing to undertake at least one of the prophylactic measures listed in the survey.Conclusions: Little data on the psychosocial impact of recurrent UTI are available. Therefore, future studies must also incorporate QoL assessments as key outcome measures.

Interstitial pneumonitis secondary to long-term nitrofurantoin use with improved clinical course secondary to corticosteroids

Nitrofurantoin is a frequently used antibiotic for treatment and prophylaxis of urinary tract infections in both the inpatient and outpatient settings. However, there have been adverse effects associated with a prolonged course. A notable adverse event reported in the literature is acute lung toxicity. Traditional treatment modalities include cessation of the drug. After this, lung injury often resolves within weeks. Glucocorticoids are an adjunctive therapy that has been used but has not been definitively demonstrated to decrease recovery time or improve other outcomes. Although it is believed that resolution can occur solely with drug cessation there have been individual reports of steroids resulting in rapid improvement. We present two cases of patients who developed interstitial pneumonitis secondary to prolonged nitrofurantoin usage that resolved or improved with combined drug cessation and systemic corticosteroid administration.

Urinary tract infections in women

Urinary tract infections (UTIs) are among the most common bacterial infections that cause by both gram-negative and gram-positive microorganisms. The article is devoted to a review of the literature, clinical guidelines and recommendations about the discussion of UTI management. The classifications of UTI of different medical societies are presented in the manuscript. The modern views on the problem of uncomplicated cystitis – its rate, factors of occurrence, the latest recommendations for diagnostic assessment are described. The therapeutic approaches to the treatment of UTI are presented, based on the advisability of prescribing antimicrobial therapy, and its advantages are demonstrated. The recommendations and schemes for the use of antimicrobial therapy for the treatment of uncomplicated cystitis in both men and women are given. The first-line treatment for uncomplicated cystitis is fosfomycin trometamol. The article presents the pharmacological properties of fosfomycin, indications and features of its use, interactions with other drugs and other types of interactions, advantages, prescription regimens, courses of therapy and doses, treatment of pathology of the genital and urinary systems in pregnant women. Alternative treatment for uncomplicated cystitis is also presented. The concept of “recurrent UTI” is set. The therapy for persistent and intermittent antimicrobial prophylaxis of recurrent UTIs is described according to the latest clinical guidelines of the European Association of Urology for 2021. Strategies such as antimicrobial management programs are presented to improve clinical outcomes, reduce adverse effects and the risk of developing resistance, and provide effective treatment.

Methenamine for Recurrent Urinary Tract Infections in Solid Organ Transplantation.

Recurrent urinary tract infections remain a challenge in solid organ transplant and have a negative impact on morbidity/mortality. The purpose of this program evaluation was to determine the impact of methenamine on recurrent urinary tract infection in kidney and liver-kidney transplant recipients. This retrospective review included patients > 18 years of age who received a kidney or liver-kidney transplant. Patients were divided into the following groups: (1) Methenamine therapy initiation received methenamine for ≥ 180 days or (2) Non-methenamine therapy: did not receive recurrent urinary tract infection prophylaxis. A total of 60 patients were included. When comparing outcomes between methenamine therapy initiation and non-methenamine therapy group, a significant reduction in the rate of recurrent urinary tract infection was reported in the methenamine therapy initiation group (0.6 vs 1.3 per 180 patient days follow-up, P = 0.0005). A significant reduction was also noted with rate of asymptomatic bacteriuria, treatment failures, bacteremia, hospitalizations due to recurrent urinary tract infection, multi-drug resistant organism isolated, and the average duration of antibiotic use. A significant difference in the time to failure of methenamine therapy initiation versus non-methenamine therapy is noted up to 180 patient-days follow-up (RR 1.56, P = 0.0019). This evaluation supported methenamine therapy for recurrent urinary tract infection in kidney and liver-kidney transplant. The most significant impact of methenamine recurrent urinary tract infection was seen in the first 30 days after initiation.

Methenamine Prophylaxis for Recurrent Urinary Tract Infections in a Tertiary Referral Center

Methenamine hippurate (MH) is a urinary antiseptic, indicated for prophylaxis of recurrent urinary tract infections (UTIs) but with only few and limited studies regarding its efficacy. To help address this knowledge gap we reviewed our experience with MH for UTI prophylaxis, focusing on women with recurrent uncomplicated UTIs. The University of Kentucky electronic health record was queried to identify adults who were prescribed MH from the urology clinic between January 2013 and January 2019. Charts were reviewed to assess patient-reported UTI frequency, demographics and relevant health factors. Treatment success was defined as 0-1 UTI in 6 months or 0-2 UTIs in 1 year. Of 670 patients prescribed MH, 508 did not meet inclusion criteria. The most common reasons for exclusion were complicated UTI, no return visit, treatment nonadherence and insufficient followup time. The primary study population was 162 women with recurrent uncomplicated UTIs: 41 premenopausal and 121 postmenopausal. Success rates with MH were 83% and 77%, respectively. Success rates were not significantly associated with age, diabetes, immune suppression, high-tone pelvic floor dysfunction or (if postmenopausal) vaginal estrogen use. Exploratory study of patients using intermittent catheterization showed success in 20 of 30 patients (67%). MH had high success rates for premenopausal and postmenopausal women with recurrent uncomplicated UTIs. Patients using catheters had lower success rates. Prospective trials would strengthen the evidence to guide decisions for treatment and insurance coverage.

Efficacy of Probiotics as Prophylaxis for Urinary Tract Infections in Premenopausal Women: A Systematic Review and Meta-Analysis.

Introduction: Although antibiotic therapy has been the mainstay of prophylaxis and treatment of urinary tract infections (UTIs), antibacterial resistance has led to increased incidence of infections and healthcare spending in both community-acquired and nosocomial UTIs. This has led to an active exploration of alternative remedies for both the prophylaxis and treatment of UTIs, especially in women with recurrent urinary tract infections. Probiotic supplementation is one novel intervention that has been studied as a prophylactic measure in patients with UTIs. The current systematic review and meta-analysis was conducted to evaluate the efficacy of probiotics for prophylaxis in UTIs in premenopausal women.Methods: Detailed search strategies for each electronic database were developed for PubMed, EMBASE, and Scopus to identify relevant literature published between 2001-2021. RevMan 5.3 statistical software was used to analyze data in studies. The random-effects model was used for pooling the data. The risk of bias and study quality were assessed using Cochrane Collaboration’s tool for assessing risk of bias in included studies. The scope of focus for this review was premenopausal adult women with a history of one or more UTI. The intervention consisted of a probiotic regimen for which the goal was to enhance the defensive microflora of the urogenital tract. Studies comparing a probiotic regimen to a placebo regimen were included. These studies’ primary outcome was the proportion of women with at least one symptomatic bacterial UTI in each group (i.e., UTI recurrence rate) in the 12-month period following probiotic intervention. This study extends the work of researchers who systematically investigated the scientific literature on probiotics in the prevention of urinary tract infections with a particular focus on premenopausal women.Results: After screening, three parallel-group randomized-controlled trials (RCTs) were included. We estimated the overall pooled data of these three studies with a total of 284 participants to have met the predefined inclusion criteria and were therefore included in this review. The results demonstrated that probiotics did not have a significant effect in the prophylaxis of UTIs. (Risk Ratio (RR): 0.59 confidence interval (CI): 0.26, 1.33), Heterogeneity: Chi² = 6.63, df = 2 (p = 0.04); I² =70%, Test for overall effect: Z = 1.27 (p = 0.20). Conclusions: Probiotics did not demonstrate a significant benefit in reducing UTI recurrence compared to placebo in premenopausal women. However, more conclusive data is needed to determine the effect that probiotics have on strengthening the urogenital microbial barrier against pathogenic bacteria and protecting against UTI recurrence.

The evolution of recommendations for cranberry use in recurrent urinary tract infections: A systematic review

Abstract. Urinary tract infections (UTI) constitute a major complaint in medical offices worldwide, especially concerning women. Although the efficacy of cranberry in UTI prevention is still controversial it has long been recommended for use in clinical practice. Based on the recommendation evaluation, the present study aimed to conduct a systematic review to assess the efficacy of cranberry prophylaxis in recurrent UTIs in women. Main changes among reviewed publications revolved around the mechanism by which cranberry produce the results observed and once it was established that it relates to bacterial fimbriae-mediated adhesion, most authors now struggle to establish accurate measures to come up with a protocol for its use. Many studies compared cranberry effects to placebo and traditional antibiotic treatment and showed promising results about effectiveness, as well as economic drawbacks. Altogether, cranberries could help to delay ecological resistance to antibiotics as well as protect patients from infections. Further investigation, mainly regarding dosage, is needed to formulate protocols and safely introduce cranberries to clinical practice

Bidirectional Influences of Cranberry on the Pharmacokinetics and Pharmacodynamics of Warfarin with Mechanism Elucidation.

Cranberry is a dietary supplement popularly used for the prophylaxis of urinary tract infection. Interestingly, cranberry–warfarin interactions in clinical reports have shown bidirectional outcomes. (±) Warfarin, a widely prescribed anticoagulant, but with a narrow therapeutic index, contains equal amounts of S- and R-warfarin, of which S-warfarin is more active. The aim of this study was to investigate the effects of different ingestion times of cranberry on the pharmacokinetics and pharmacodynamics of warfarin. Rats were orally administered (±) warfarin (0.2 mg/kg) with and without cranberry (5.0 g/kg) at 0.5 h prior to the warfarin, and at 10 h after the warfarin. The plasma concentrations of S- and R-warfarin were determined by LC/MS. The results indicate that cranberry ingested at 0.5 h before (±) warfarin significantly decreased the systemic exposures of S-warfarin and R-warfarin. Conversely, when cranberry was ingested at 10 h after (±) warfarin, the elimination of S-warfarin was significantly inhibited, and the anticoagulation effect of (±) warfarin was significantly enhanced. The results of the mechanism studies indicate that cranberry activated the breast cancer resistance protein (BCRP), which mediated the efflux transports of S-warfarin and R-warfarin. Moreover, the metabolites of cranberry inhibited cytochrome P450 (CYP) 2C9, the main metabolizing enzyme for S-warfarin. In conclusion, cranberry affected the pharmacokinetics of (±) warfarin in a bidirectional manner by activating the BCRP by CJ during absorption and inhibiting the BCRP and CYP2C9 by CMs during elimination, depending on the ingestion time of CJ. The combined use of cranberry with warfarin should be avoided.

MP25-16 IMPACT OF DURATION OF ANTIBIOTIC PROPHYLAXIS ON UTI RATE AFTER ONABOTULINUMTOXINA INJECTION

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP25)1 Sep 2021MP25-16 IMPACT OF DURATION OF ANTIBIOTIC PROPHYLAXIS ON UTI RATE AFTER ONABOTULINUMTOXINA INJECTION Sarah Martin, Jacqueline Zillioux, Neil Kocher, Raymond Rackley, Sandip Vasavada, Howard Goldman, Katie Propst, Eiftu Haile, and Emily Slopnick Sarah MartinSarah Martin More articles by this author , Jacqueline ZilliouxJacqueline Zillioux More articles by this author , Neil KocherNeil Kocher More articles by this author , Raymond RackleyRaymond Rackley More articles by this author , Sandip VasavadaSandip Vasavada More articles by this author , Howard GoldmanHoward Goldman More articles by this author , Katie PropstKatie Propst More articles by this author , Eiftu HaileEiftu Haile More articles by this author , and Emily SlopnickEmily Slopnick More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002022.16AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are currently no specific guidelines on antibiotic prophylaxis for intravesical OnabotulinumtoxinA (BTX) injection, despite high risk of post-procedural urinary tract infection (UTI). Our objective was to assess the impact of duration of antibiotic prophylaxis on rate of UTI within 30 days of BTX injection. METHODS: A retrospective chart review was performed of patients who received office BTX injection from 2014-2020 with FPMRS providers at a single academic institution. UTI rates within 30 days of BTX were compared between three prophylaxis regimens: no antibiotic, a single dose, or a multiple day course of any antibiotic. UTI was defined as new lower urinary tract symptoms treated either empirically or associated with a positive urine culture. Patients on daily antibiotic prophylaxis for recurrent UTI were excluded. Association of UTI with units of BTX, BMI, history of diabetes, immunosuppresion, neurogenic bladder or recurrent UTI and incidence of new post-procedure urinary retention were also investigated. Statistical analysis was performed with univariate and subsequent multivariable logistic regression analysis to assess for possible confounding factors. RESULTS: A total of 180 patients and 560 cycles of BTX injections were included: 173 (96%) were women with mean age 62.9 years (range 20-95; SD 12.6). The majority received 100U (65%) for a non-neurogenic diagnosis (67%). Overall rates of UTI and urinary retention within 30 days were 11% and 6%, respectively. No antibiotic prophylaxis was given to 79 (14%) patients, 343 (61%) received a single dose, and 138 (25%) received a multiple day regimen (3-7 days). On univariate analysis, UTI incidence was lower with administration of any antibiotic prophylaxis as compared to none: single dose 7.6% vs. 25.3% (OR 0.24, p<0.001), multiple dose 11.0% vs. 25.3% (OR 0.36, p=0.007). There was no difference in UTI rates between single and multiple dose antibiotic regimens (p=0.233). On multivariable logistic regression, use of any antibiotic prophylaxis was associated with a lower incidence of UTI (single OR 0.32, p=0.002; multiple OR 0.42, p=0.042), with no difference between single and multiple dose regimens (p=0.068). History of recurrent UTI (OR 2.3, p=0.024) and de novo post-procedure retention (OR 3.9, p=0.002) were predictors of UTI. CONCLUSIONS: Use of antibiotic prophylaxis for office intravesical BTX injection is associated with a significantly lower incidence of UTI compared to no antibiotic. Importantly, a multiple day regimen was not more effective than a single dose of antibiotics in preventing UTI. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e459-e460 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sarah Martin More articles by this author Jacqueline Zillioux More articles by this author Neil Kocher More articles by this author Raymond Rackley More articles by this author Sandip Vasavada More articles by this author Howard Goldman More articles by this author Katie Propst More articles by this author Eiftu Haile More articles by this author Emily Slopnick More articles by this author Expand All Advertisement PDF downloadLoading ...

Prescribing of long-term antibiotics to adolescents in primary care: a retrospective cohort study.

BackgroundAntibiotic overuse is linked to increased risk of antimicrobial resistance. Long-term antibiotics are commonly used for treating acne and prophylaxis of urinary tract infection. Their contribution to the overall burden of antibiotic use is relatively unknown.AimTo describe the volume of commonly prescribed long-term (≥28 days) antibiotic prescriptions in adolescents and young adults, trends over time, and comparisons with acute prescriptions.Design and settingA retrospective cohort study using UK electronic primary care records.MethodPatients born between 1979 and 1996 and with data in the Care and Health Information Analytics database were included. The main outcome measures were antibiotic prescription rates per 1000 person-years and antibiotic prescription days per person-year between the ages of 11 and 21.ResultsIn total, 320 722 participants received 710 803 antibiotic prescriptions between the ages of 11 and 21 years from 1998 to 2017. Of these 710 803 prescriptions, 191 443 (26.93%) were for long-term antibiotics (≥28 days and ≤6 months in duration). Long-term antibiotics accounted for more than two-thirds (72.48%) of total antibiotic exposure (days per person-year). Total long-term antibiotic prescribing peaked in 2013 at just under 6 days per person-year and declined to around 4 days in 2017.ConclusionAmong adolescents and young adults, exposure to long-term antibiotics (primarily lymecycline used for acne) was much greater than for acute antibiotics and is likely to make an important contribution to antimicrobial resistance. Urgent action is needed to reduce unnecessary exposure to long-term antibiotics in this group. Increasing the use of, and adherence to, effective non-antibiotic treatments for acne is key to achieving this.

Nitrofurantoin 100 mg versus 50 mg prophylaxis for urinary tract infections, a cohort study

ObjectivesGuidelines do not distinguish between 50 mg or 100 mg nitrofurantoin as daily prophylaxis for recurrent urinary tract infection (UTI), although 50 mg might have a better safety profile. Our objective was to compare the effectiveness and safety of both regimens. MethodsData were retrospectively collected from 84 Dutch GP practices between 2013 and 2020. Nitrofurantoin prescriptions of 100 mg and 50 mg every 24 hours in women were included. Cox proportional hazard regression analysis was used to calculate hazard ratios on first episode of UTI, pyelonephritis and (adverse) events. Patients were followed for the duration of consecutive repeated prescriptions, assuming non-informative right censoring, up to 1 year. ResultsNitrofurantoin prophylaxis was prescribed in 1893 patients. Median lengths of follow up were 90 days (interquartile range (IQR) 37–179 days) for 100 mg (n = 551) and 90 days (IQR 30–146 days) for 50 mg (n = 1342) with few differences in baseline characteristics between populations. Under 100 mg and 50 mg, 82/551 (14.9%) and 199/1342 (14.8%) developed UTI and 46/551 (8.3%) and 81/1342 (6.0%) developed pyelonephritis, respectively. Adjusted HRs of 100 mg versus 50 mg were 1.01 (95% CI 0.78–1.30) on first UTI, 1.37 (95% CI 0.95–1.98) on first pyelonephritis episode, 1.82 (95% CI 1.20–2.74) on first consultation for cough, 2.68 for dyspnoea (95% CI 1.11–6.45) and 2.43 for nausea (95% CI 1.03–5.74). ConclusionDaily prophylaxis for recurrent UTI with 100 mg instead of 50 mg nitrofurantoin was associated with an equivalent hazard on UTI or pyelonephritis, and a higher hazard on cough, dyspnoea and nausea. We recommend 50 mg nitrofurantoin as daily prophylaxis.

Compared with Cotrimoxazole Nitroxoline Seems to Be a Better Option for the Treatment and Prophylaxis of Urinary Tract Infections Caused by Multidrug-Resistant Uropathogens: An In Vitro Study

The resistance of uropathogens to various antibiotics is increasing, but nitroxoline remains active in vitro against some relevant multidrug resistant uropathogenic bacteria. E. coli strains, which are among the most common uropathogens, are unanimously susceptible. Thus, nitroxoline is an option for the therapy of urinary tract infections caused by multiresistant bacteria. Since nitroxoline is active against bacteria in biofilms, it will also be effective in patients with indwelling catheters or foreign bodies in the urinary tract. Cotrimoxazole, on the other hand, which, in principle, can also act on bacteria in biofilms, is frequently inactive against multiresistant uropathogens. Based on phenotypic resistance data from a large number of urine isolates, structural characterisation of an MDR plasmid of a recent ST131 uropathogenic E. coli isolate, and publicly available genomic data of resistant enterobacteria, we show that nitroxoline could be used instead of cotrimoxazole for intervention against MDR uropathogens. Particularly in uropathogenic E. coli, but also in other enterobacterial uropathogens, the frequent parallel resistance to different antibiotics due to the accumulation of multiple antibiotic resistance determinants on mobile genetic elements argues for greater consideration of nitroxoline in the treatment of uncomplicated urinary tract infections.

Is it Worth Combining Solidago virgaurea Extract and Antibiotics against Uropathogenic Escherichia coli rods? An In Vitro Model Study.

European goldenrod (Solidago virgaurea L.) has long been applied in traditional medicine and recommended in the prophylaxis of urinary tract infections (UTIs). However, research describing the antibacterial properties of goldenrod is very limited. Therefore, the aim of the study was to determine the effect of S. virgaurea extract on the survival and biofilm formation of uropathogenic Escherichia coli. The interactions between the goldenrod extract and antibiotics used in UTIs were established. The influence of the extract on the duration of the post-antibiotic effects (PAE) and post-antibiotic sub-MIC effects (PASME) of amikacin and ciprofloxacin were determined. Extract composition was analyzed using coupled UHPLC/MS and the spectrophotometric method. The survival of bacteria was established using the serial dilution assay. The crystal violet assay for biofilm quantification was also used. PAE and PASME were investigated using the viable count method. The obtained results indicate that S. virgaurea extract limits the survival of planktonic forms of bacteria and reduces 24-h biofilm. However, the combination of S. virgaurea extract with antibiotics weakens their antibacterial activity and shortens the duration of PAE and PASME. Therefore, when deciding to use a combination of S. virgaurea extract and amikacin/ciprofloxacin, it is necessary to take into account their antagonistic activity.

A survey of clinical practice concerning long-term follow-up of neurogenic lower urinary tract dysfunction due to spinal cord injury in Italy

Context/objective This study aimed to assess the clinical practice for long-term follow-up (FU) of neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) in Italy and compare this practice with the clinical practice in other countries and with the international guidelines. Design Data concerning the long-term urological FU of individuals with SCI were collected using a questionnaire and analyzed by means of descriptive and inferential statistics. Setting Twenty-one Italian centers following SCI patients. Participants One physician at each center (either a permanent staff member or chief). Outcome Measures Questions addressed the treatment of urinary tract infections (UTI), frequency of visits, urinary tract imaging examinations and urodynamic tests (UD), distinguishing between suprasacral and sacral SCI. Results Nineteen out of 21 centers completed the survey. In most centers, patients were recommended to undergo a visit and an ultrasound examination of urinary tract (UT) at least once a year. While the median interval between FU visits was identical (12 months) for individuals with suprasacral and sacral SCI, the two interval distributions were significantly different (suprasacral SCI: min–max 4–18, IQR = 6; sacral SCI: min–max 6–24; IQR = 8.5; P = 0.02), showing people with suprasacral SCI are followed up more often. Approximately 80% of the surveyed centers performed scheduled UD, with a yearly median frequency of 12 months (range 6–36) for patients with suprasacral SCI, as compared to a median frequency of 18 months for sacral SCI (range 0–36, P = 0.04). VideoUD and antibiotic prophylaxis for recurrent UTIs are carried out only by urologists in 63% and 47.4% of the centers, respectively. Overall, Italian centers share common strategies that compare to standards, including yearly visits, yearly UT examinations and stricter follow-up of people with suprasacral SCI, but may not have standard protocols for antibiotic prophylaxis of UTI, and in few cases control visits and UD are carried out too often. Conclusions Even though most Italian centers follow up patients with NLUTD secondary to SCI according to international guidelines, heterogeneity in frequency of FU examinations still exists. A tailored approach to the SCI patient that minimizes unnecessary examinations and groups different tests in a single access could improve patients’ compliance with FU and reduce costs for the Health system.

Role of D-Mannose in the Prevention of Recurrent Uncomplicated Cystitis: State of the Art and Future Perspectives.

Background: Urinary tract infections (UTI) are highly frequent in women, with a significant impact on healthcare resources. Although antibiotics still represent the standard treatment to manage recurrent UTI (rUTI), D-mannose, an inert monosaccharide that is metabolized and excreted in urine and acts by inhibiting bacterial adhesion to the urothelium, represents a promising nonantibiotic prevention strategy. The aim of this narrative review is to critically analyze clinical studies reporting data concerning the efficacy and safety of D-mannose in the management of rUTIs. Methods: A non-systematic literature search, using the Pubmed, EMBASE, Scopus, Web of science, Cochrane Central Register of Controlled Trials, and Cochrane Central Database of Systematic Reviews databases, was performed for relevant articles published between January 2010 and January 2021. The following Medical Subjects Heading were used: “female/woman”, “urinary tract infection”, and “D-mannose”. Only clinical studies, systematic reviews, and meta-analyses reporting efficacy or safety data on D-mannose versus placebo or other competitors were selected for the present review. Evidence was limited to human data. The selected studies were organized in two categories according to the presence or not of a competitor to D-mannose. Results: After exclusion of non-pertinent studies/articles, 13 studies were analyzed. In detail, six were randomized controlled trials (RCTs), one a randomized cross-over trial, five prospective cohort studies, and one a retrospective analysis. Seven studies compared D-mannose to placebo or others drugs/dietary supplements. Six studies evaluated the efficacy of D-mannose comparing follow-up data with the baseline. D-mannose is well tolerated, with few reported adverse events (diarrhea was reported in about 8% of patients receiving 2 g of D-mannose for at least 6 months). Most of the studies also showed D-mannose can play a role in the prevention or rUTI or urodynamics-associated UTI and can overlap antibiotic treatments in some cases. The possibility to combine D-mannose with polyphenols or Lactobacillus seems another important option for UTI prophylaxis. However, the quality of the collected studies was very low, generating, consequently, a weak grade of recommendations as suggested by international guidelines. Data on D-mannose dose, frequency, and duration of treatment are still lacking. Conclusion: D-mannose alone or in combination with several dietary supplements or Lactobacillus has a potential role in the non antimicrobial prophylaxis or recurrent UTI in women. Despite its frequent prescription in real-life practice, we believe that further well-designed studies are urgently needed to definitively support the role of D-mannose in the management of recurrent UTIs in women.

The Benefits and Harms of Antibiotic Prophylaxis for Urinary Tract Infection in Older Adults

The role of antibiotics in preventing urinary tract infection (UTI) in older adults is unknown. We sought to quantify the benefits and risks of antibiotic prophylaxis among older adults. We conducted a matched cohort study comparing older adults (≥66 years) receiving antibiotic prophylaxis, defined as antibiotic treatment for ≥30 days starting within 30 days of a positive culture, with patients with positive urine cultures who received antibiotic treatment but did not receive prophylaxis. We matched each prophylaxis recipient to 10 nonrecipients based on organism, number of positive cultures, and propensity score. Outcomes included (1) emergency department (ED) visit or hospitalization for UTI, sepsis, or bloodstream infection within 1 year; (2) acquisition of antibiotic resistance in urinary tract pathogens; and (3) antibiotic-related complications. Overall, 4.7% (151/3190) of UTI prophylaxis patients and 3.6% (n = 1092/30 542) of controls required an ED visit or hospitalization for UTI, sepsis, or bloodstream infection (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.12-1.57). Acquisition of antibiotic resistance to any urinary antibiotic (HR, 1.31; 95% CI, 1.18-1.44) and to the specific prophylaxis agent (HR, 2.01; 95% CI, 1.80-2.24) was higher in patients receiving prophylaxis. While the overall risk of antibiotic-related complications was similar between groups (HR, 1.08; 95% CI, .94-1.22), the risk of Clostridioidesdifficile and general medication adverse events was higher in prophylaxis recipients (HR [95% CI], 1.56 [1.05-2.23] and 1.62 [1.11-2.29], respectively). Among older adults with UTI, the harms of long-term antibiotic prophylaxis may outweigh their benefits.

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.

Urinary Tract Infection and Pelvic Organ Prolapse—an Association that Needs Further Clarification

This review will summarize the latest evidence regarding an association between urinary tract infection and pelvic organ prolapse. Topics include pelvic organ prolapse, urinary tract infection, surgical and conservative interventions for pelvic organ prolapse, and the risk for urinary tract infection, catheterizations, and prophylaxis for urinary tract infection and pelvic organ prolapse. Although no studies were found regarding mechanistic factors for the association between UTI and POP, or with the degree/severity of prolapse with the risk for UTI, this review adds critical information from various studies recently published addressing topics which of was not mentioned in previous reviews of a similar theme. UTI incidence seems to be increased in POP patients, and reconstructive surgery seems to be connected with the risk of UTI. Future studies exploring mechanistic factors for UTI and POP are needed.