Tract Infections In Women Research Articles

2241. Methenamine for the Prevention of Recurrent UTIs: A Desirability of Outcome Ranking (DOOR) analysis for the Alternative to Prophylactic Antibiotics for the Treatment of Recurrent Urinary Tract Infections in Women (ALTAR) Trial

Abstract Background The Alternative to Prophylactic Antibiotics for the Treatment of Recurrent Urinary Tract Infections in Women (ALTAR) trial demonstrated that twice daily methenamine hippurate was non-inferior to daily low dose antibiotics for the prevention of recurrent UTIs. Non-inferiority trials are frequently misrepresented or misinterpreted by patients and clinicians, and often do not address which treatment approach is preferred. The Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR) superiority methodology has been used as a secondary outcome in selected non-inferiority studies to incorporate antibiotic exposure and clinical outcomes. We applied DOOR/RADAR methodology to the ALTAR trial to evaluate the clinical superiority of methenamine hippurate as compared to antibiotic prophylaxis for the prevention of recurrent UTIs. Methods The first step in the DOOR/RADAR analysis was to generate categories to rank clinical outcomes. Using the data supplement of the ALTAR trial, categories were created by comparing the number of UTIs observed during the study period for the antibiotic versus methenamine groups. Participants were assigned a ranking using both clinical outcome and antibiotic use, with the principle that less antibiotic use is preferred as long as the same clinical outcome is achieved. The Mann-Whitney U test was then used to compare outcomes between these groups. Results The study included 205 patients, with 103 receiving methenamine and 102 receiving low dose antibiotics. The methenamine and antibiotic prophylaxis groups were divided into categories based on number of UTIs observed during study period (Table 1), with the density of the DOOR/RADAR outcomes displayed in Figure 1. Using the Mann-Whitney U test, the probability of a better DOOR score (i.e. more desirable outcome) for a randomly selected patient from the methenamine group compared to the antibiotic group was 58% (p-value 0.045). Number of UTIs by Treatment Group Table 1.Number of UTIs observed during study period between groups receiving methenamine as compared to antibiotic prophylaxis. The most desirable outcome (*) and the least desirable outcome (**) are designated above. Figure 1. The density of DOOR/RADAR outcomes of methenamine as compared to antibiotic prophylaxis group. Conclusion Applying the DOOR/RADAR analysis to the data from the ALTAR trial provides evidence to suggest that there is a higher probability for desirable outcomes in women who receive methenamine hippurate as compared to prophylactic antibiotics for the prevention of UTIs. Disclosures All Authors: No reported disclosures.

The Clinical Trial Outcomes of Cranberry, D-Mannose and NSAIDs in the Prevention or Management of Uncomplicated Urinary Tract Infections in Women: A Systematic Review.

The use of antibiotics in the treatment of UTIs is contributing to resistance. Hence, the outcome of human clinical trials of nonantibiotic remedies for preventing or treating UTI is of significant interest. This systematic review aimed to identify, summarise and evaluate the evidence for the outcomes of different nonantibiotic options including cranberry, D-mannose and non-steroidal anti-inflammatory drugs (NSAIDs). PubMed, Embase and Scopus were searched for manuscripts relating to nonantibiotic treatment of UTI including cranberry, mannose and NSAIDs. After title and abstract screening, data were extracted from 21 papers that were published in English and related to the treatment or prevention of uncomplicated UTI in adult women. We identified twelve papers examining the effects of cranberry, two papers examining D-mannose, two papers examining combination treatments (cranberry and D-mannose) and five manuscripts investigating the effects of NSAIDs. There is low-level evidence, from a small number of studies, supporting the use of D-mannose or combination treatments for potentially preventing UTIs in adult women without producing burdening side effects. However, larger and more randomised double-blinded trials are needed to confirm this. In comparison, the multiple studies of cranberry and NSAIDs produced conflicting evidence regarding their effectiveness.

Retrospective Analysis of the Ureaplasma spp. Prevalence with Reference to Other Genital Tract Infections in Women of Reproductive Age.

Ureaplasma spp. are frequently isolated from the genital tract of women of reproductive age. To date, it remains unclear whether they are commensal or pathogenic. In our study, we assessed the prevalence of Ureaplasma spp. in a group of 1,155 women of childbearing age. In addition, we assessed how often women with positive Ureaplasma spp. develop genital tract co-infections and how the vaginal pH changes. This study showed a relationship between colonization by Ureaplasma spp. and presenting symptoms. In fact, we showed that colonization of the genital tract by Ureaplasma spp. can affect the occurrence of co-infections such as Gardnerella vaginalis. We also observed a relationship between increased pH values and the presence of Ureaplasma spp.

Functional and safety characterization of beneficial vaginal lactic acid bacteria for the design of vaginal hygiene products.

The aim was to complement the evaluation of functional and safety properties of beneficial vaginal lactic acid bacteria to select the most adequate strains as potential probiotics for their inclusion in a vaginal probiotic formula. Twenty-four beneficial vaginal lactic acid bacteria strains previously isolated from healthy women were characterized by applying phenotypical and genetic techniques. The biofilm formation and exopolysaccharide production by the different strains showed a strong influence of the growth medium on the expression of these properties. The evaluated strains evidenced different antibiotic susceptibility patterns by phenotypic tests, while the resistance genes were not always correlated with the phenotypic profiles. None of the evaluated strains showed lecithinase, gelatinase, or β-hemolytic activity. Based on the results obtained, Lactobacillus gasseri CRL 1320 and Lacticaseibacillus rhamnosus CRL 1332 were selected to advance in the design of the products. A wide variability in the properties expressed by beneficial vaginal lactic acid bacteria strains were shown, evidencing a strain-specific and independent behaviour of the species/metabolic group where classified. The selection criteria applied provided a valuable tool for the selection of the best vaginal lactobacilli strains for their inclusion in formulas for vaginal application. Since probiotics are an important tool for improving human health, the designed formula are an excellent alternative to reconstitute the vaginal microbiota and prevent/treat urogenital tract infections in women. The results obtained contribute to deepen the characterization of homologous beneficial vaginal lactic acid bacteria and advance in the design of vaginal probiotic products.

The effect of anal hygiene method in prevention from recurrent lower urinary tract infections in women

Aim: To evaluate the effects stopping the use of water and hands on preventing urinary tract infections (UTI) for a group of female patients having recurrent UTIs (rUTI).
 Material and Method: A retrospective observational study conducted in a tertiary care hospital between February 2017 and March 2018. 273 female patients which had rUTIs without any concomitant risk factors were included. In the study, 2 or more bacteriologically documented UTIs in the last 6 months were accepted as rUTI. The groups of the study defined as using their hands, using water only and using toilet paper (using either one of these two methods and then using toilet paper). Patients were observed for an average time of 10.4 months after stopping the use of water and hands for anal cleansing after defecation. Instead they were all given toilet education and started wiping for anal hygiene.
 Results: There was a statistically significant relationship between previous history of UTI and washing with hands + water (p=0.021). The rate of previous UTIs were significantly higher in the group of patients using their hands for anal washing (69% vs 31%). No relation was found between previous UTI history variable for using toilet paper and flushing with water only (p>0.05). Our results showed a statistically significant decrease of UTIs after stopping the use of water and hands in the patient group who had a previous UTI history (p=0.001).
 Conclusion: We managed to underline that washing with hands for anal cleansing as a risk factor for rUTIs in women. Also showed the positive effect of stopping the use of water and hands for anal cleansing after defecation for prevention from rUTIs. We encourage all clinicians for further studies to investigate this issue in the future.

Recurrent Urinary Tract Infections in Women

Abstract not available Sir Salimullah Med Coll J 2022; 30: 101-102

Methenamine as prophylaxis for recurrent urinary tract infections: an overview of the ALTAR trial

Current recommended treatment for recurrent uncomplicated urinary tract infections in women includes low-dose daily antibiotics. The UK Antimicrobial Resistance Strategy document underlines the importance of non-antibiotic preventive treatments for common infections such as UTIs. The ALTAR trial investigated the clinical effectiveness of one such non-antibiotic treatment, the urinary antiseptic Methenamine Hippurate in the context of a randomised, open-label, pragmatic, two-arm non-inferiority trial with the comparator of daily low-dose antibiotics. Non-inferiority was confirmed in this study and the authors recommend that it should now be considered as a first-line preventive treatment for recurrent uncomplicated urinary tract infections in women.

A post-trial follow-up study of pentosan polysulfate monotherapy on preventing recurrent urinary tract infection in women

For women with recurrent urinary tract infection (UTI), previous U101 study has shown that pentosan polysulfate sodium (PPS) monotherapy for 16 weeks significantly reduced UTI episodes in the treatment group throughout the trial period. In this follow-up study, we aimed to assess whether the effects of PPS would last after completion of the trial to prevent recurrent UTIs. Conducted from 2018 to 2019, the U101 study was a multicenter, prospective, phase 2a, randomized trial, enrolling women with recurrent UTI to study the effects of a 16-week oral PPS monotherapy. After approximately two years, the follow-up was conducted by phone interview, obtaining data including self-reported UTI events, quality of life questionnaire, and adverse events. The primary endpoint of follow-up study was UTI recurrence-free survival and the secondary endpoints were quality of life and adverse events. Approximately two years after completion of the trial, the rate of recurrent UTI was 25% (3 of the 12 patients) in the PPS group and 85.7% (12 of the 14 patients) in the control group. Over the entire follow-up period, the UTI recurrence-free survival was significantly better in the PPS group than in the control group (log-rank test p < 0.001). The quality of life at two years was significantly improved in the PPS when compared to the control group (91.7 vs. 77.5, p < 0.001). No late adverse event was observed after cessation of the treatment. In this study, sixteen weeks of PPS monotherapy in women with recurrent UTI significantly reduced the numbers of recurrent UTI episodes during the 2-year follow-up.

What is new in intermittent self-catherisation?

British Journal of Community NursingVol. 27, No. 10 TreatmentsWhat is new in intermittent self-catherisation?Aysha MendesAysha MendesE-mail Address: [email protected]Freelance Journalist, specialising in Healthcare and PsychologySearch for more papers by this authorAysha MendesPublished Online:4 Oct 2022https://doi.org/10.12968/bjcn.2022.27.10.474AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Bladder and Bowel Community. Intermittent Self Catheterisation. 2017. https://www.bladderandbowel.org/conservative-treatment/intermittent-self-catheterisation/ (accessed 7 September 2022) Google ScholarHarding C, Mossop H, Homer T et al. Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial. BMJ. 2022;376:e068229. https://doi.org/10.1136/bmj-2021-0068229 Medline, Google ScholarNational Institute for Health and Care Excellence. Healthcare-associated infections: prevention and control in primary and community care Clinical guideline [CG139]. 2017. https://www.nice.org.uk/guidance/cg139/chapter/2-Research-recommendations#intermittent-urinary-catheters-catheter-selection (accessed 7 September 2022) Google ScholarPickard R, Chadwick T, Oluboyede Y et al. Continuous low-dose antibiotic prophylaxis to prevent urinary tract infection in adults who perform clean intermittent self-catheterisation: the AnTIC RCT. Health Technol Assess. 2018;22(24):1-102. https://doi.org/10.3310/hta22240. PMID: 29766842 Crossref, Medline, Google Scholar FiguresReferencesRelatedDetails 2 October 2022Volume 27Issue 10ISSN (print): 1462-4753ISSN (online): 2052-2215 Metrics History Published online 4 October 2022 Published in print 2 October 2022 Information© MA Education LimitedPDF download

Chlamydia transmitting from the genital to gastrointestinal tract and inducing tubal disease: Double attack pattern.

Chlamydia trachomatis ( CT ) genital tract infection is insidious, and patients often have no conscious symptoms.Delayed treatment after infection can lead to serious complications. Chlamydia muridarum ( CM ) genital tract infection in female mice can simulate CT genital tract infection in women, which is an ideal model to investigate the pathogenesis of CT . CM plasmid protein pGP3, chromosomal protein TC0237/TC0668, CM -specific CD8 + T cells, TNF-α, and IL-13 can induce genital tract inflammation, CD4 + T cells are responsible for CM clearance. However, tubal inflammation persists after genital tract CM is removed. Genital tract CM can spread spontaneously in vivo and colonize the gastrointestinal (GI) tract, but the GI tract CM cannot reverse spread to the genital tract. The survival time and number of CM transmitted from genital tract to GI tract are positively correlated with the long-term lesion of oviduct, while the CM inoculated directly into the GI tract has no pathogenicity in both the genital and GI tract. The double attack pattern of Chlamydia -induced genital tract inflammatory lesions is as follows: CM infection of oviduct epithelial cells initiates the process of oviduct repair as the first attack. After genital CM spreads to the GI tract, activated chlamydia-specific CD8 + T cells are recruited to the genital tract and secreted pro-fibrotic cytokines such as TNF-α and IL-13. This process is called the second attack which transform tubal repair initiated by the first attack into long-term tubal fibrosis/hydrosalpinx. Elucidating the pathogenic mechanism of Chlamydia infection can provide new ideas for the development of Chlamydia vaccine, which is expected to solve the problems of infertility caused by repeated CT infection in women.

Updates to Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline.

In 2019 the American Urological Association (AUA) released the evidence-based guideline "Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline." Information supporting the guideline came from a 2019 systematic evidence review prepared for the AUA by the Pacific Northwest Evidence-based Practice Center (EPC). The AUA used evidence found for 11 Key Questions (Appendix C) in the EPC's report to derive 16 Guideline Statements. In 2021 the EPC conducted an Update Literature Review (ULR) assessing abstracts from new studies published since the 2019 systematic review. The AUA asked the EPC to further assess a subset of studies included in the ULR report, to support potential changes to the 2019 guideline. A systematic-review utilized research from the Oregon Health & Science University. Pacific Northwest EPC was used to update the 2019 AUA Guideline on rUTI in women with new evidence published through 2021. Updates were made to reflect changes in literature since 2019. Updates include recent publications on antibiotic prophylaxis, non-antibiotic prophylaxis, and estrogen therapy. The presence of rUTI is crucial to the health of patients and its effects must be considered for the welfare of society. This document will undergo updating as the knowledge regarding current treatments and future treatment options continues to expand. .

Innovative medical technologies for the treatment of urinary tract infections in peri- and postmenopausal women

Objectives: to evaluate the effectiveness of Utipro Plus AF for uncomplicated urinary tract infections in women in the peri- and postmenopausal period.Materials and methods. The study included 45 patients aged 48–70 years with verified uncomplicated urinary tract infection. All patients received antimicrobial agents in accordance with approved guidelines. 25 women (main group) also received Utipro Plus AF, 20 women (control group) received only antimicrobial agents. The effectiveness of treatment was assessed on the 6th, 11th, 30th and 75th day of observation. Efficiency criteria were a decrease in the intensity of clinical symptoms, a decrease in the number of relapses, and bacterial sanitation based on the results of urine cultures (≤ 103 CFU/ml). Results. Clinical picture changed dramatically in the patients of the examined groups after treatment. Main group had no urinary incontinence, imperative urges to urinate, the frequency of dysuria disorders decreased by three times in this group, pain in the lower abdomen and burning sensation during urination were 5 times less common. Recurrences of urinary tract infections were noted in both groups by bacteriological and symptomatic criteria, but their frequency was much lower in the group that received Utipro Plus AF in addition to antibiotics. The number of positive results of urine cultures on the 75th day of observation decreased to 16% in the main group, and to 65% in the control group. Recurrences of urinary tract infections according to clinical criteria on the 75th day of observation were verified in 3 patients of the main group and in 12 patients in the control group. Conclusions. The medical product Utipro Plus AF effectively reduces bacteriological and clinical signs of uncomplicated urinary tract infections, which makes its use advisable as an additional agent to antibiotic therapy in women with uncomplicated urinary tract infections in peri- and postmenopausal period.

The emotional impact of urinary tract infections in women: a qualitative analysis

BackgroundWhile many studies address the clinical management of participants with uncomplicated urinary tract infection (uUTI), the emotional impact of uUTIs has been investigated less often. The aim of this qualitative study was to understand the emotional experience of women with uUTIs.MethodsThis was a qualitative, exploratory, in-depth interview-based study conducted among women in the United States (US) and Germany. Women aged ≥ 18 years with at least one uUTI treated with antibiotics in the past year were recruited through a patient community panel and physician referrals. Participants were recruited using purposive sampling to include an equal split of those with 1 or ≥ 2 antibiotics, and an equal split of those treated for a single or recurrent uUTIs (≥ 2 uUTIs in the past year). A structured telephone interview included questions about symptoms, diagnosis, treatment, and retreatment (if any). Each participant was queried about her emotions and the impact of the uUTI on life activities. Thematic analysis of responses was carried out to identify common themes.ResultsA total of 65 participants completed the interview, 40 (61.5%) from the US and 25 (38.5%) from Germany. Major themes that emerged from the analyses included (1) a wide range of negative emotions were experienced due to uUTI symptoms, interference with activities of daily life, and effects on relationships and sleep; (2) varied emotions and understanding related to uUTI treatment and management approaches; (3) treatment failure caused frustration, worry, and anger; and (4) the prospect of recurrent uUTIs provoked dread and helplessness.ConclusionOur research uncovered emotions of helplessness and dread experienced by women in the context of uUTI clinical treatment failure and recurrent uUTIs. Knowing patients’ perspectives on UTI management will help guide the development of patient education and improve shared decision-making.

Guideline of guidelines: management of recurrent urinary tract infections in women.

To compare recurrent urinary tract infection (rUTI) guidelines from major urological and non-urological organisations internationally and identify areas of consensus and discrepancy. PubMed, Google Scholar and the official webpages of major urological, gynaecological, infectious diseases and general practice organisations were searched for rUTI guidelines in March 2022. Nine guidelines were included for review: European Association of Urology, National Institute for Health and Care Excellence (NICE), Society of Obstetricians and Gynaecologists of Canada, American Academy of Family Physicians, Mexican College of Gynaecology and Obstetrics Specialists, Swiss Society of Gynaecology and Obstetrics, Spanish Society of Infectious Diseases and Clinical Microbiology, German Association of Scientific Medical Societies, and the combined American Urological Association/Canadian Urological Association/Society of Urodynamics, Female Pelvic Medicine and Urogenital Reconstruction. The definition and evaluation of rUTIs, and antibiotic prophylaxis strategies, were mostly consistent across guidelines, and emphasised the importance of obtaining urine cultures and limiting cystoscopy and upper tract imaging in women without risk factors. Variable recommendations were noted for symptomatic treatment, self-initiated antibiotics, and antibiotic-sparing preventative strategies such as cranberry, vaginal oestrogen, immunoactive prophylaxis with OM-89, intravesical glycosaminoglycan instillation, and phytotherapeutics. Recent randomised evidence supports the use of methenamine hippurate. Either continuous or post-coital prophylactic antibiotics were supported by all guidelines. None of the guidelines were tailored to the management recurrent complicated UTI. Multiple rUTI guidelines were identified and mostly limited their recommendations to otherwise healthy non-pregnant women with uncomplicated cystitis. Variation was noted, particularly in antibiotic-sparing preventative strategies. Some conflicting recommendations are due to more recent guidelines including updated evidence. Future guidelines should consider recommendations to assist management of complex patient groups, such as recurrent complicated UTI.

Methenamine hippurate compared with antibiotic prophylaxis to prevent recurrent urinary tract infections in women: the ALTAR non-inferiority RCT.

Daily, low-dose antibiotic prophylaxis is the current standard care for women with recurrent urinary tract infection. Emerging antimicrobial resistance is a global health concern, prompting research interest in non-antibiotic agents such as methenamine hippurate, but comparative data on their efficacy and safety are lacking. To assess the clinical effectiveness and cost-effectiveness of methenamine hippurate (Hiprex®; Mylan NV, Canonsburg, PA, USA) compared with current standard care (antibiotic prophylaxis) for recurrent urinary tract infection prevention in adult women. Multicentre, pragmatic, open-label, randomised, non-inferiority trial of 12 months' treatment with the allocated intervention, including an early, embedded qualitative study and a 6-month post-treatment observation phase. The predefined non-inferiority margin was one urinary tract infection per person-year. Eight UK NHS secondary care sites. A total of 240 adult women with recurrent urinary tract infection requiring preventative treatment participated in the trial. A central randomisation system allocated participants 1 : 1 to the experimental (methenamine hippurate: 1 g twice daily) or control (once-daily low-dose antibiotics: 50/100 mg of nitrofurantoin, 100 mg of trimethoprim or 250 mg of cefalexin) arm. Crossover between treatment arms was permitted. The primary clinical outcome was incidence of symptomatic antibiotic-treated urinary tract infection during the 12-month treatment period. Cost-effectiveness was assessed by incremental cost per quality-adjusted life-year gained, extrapolated over the patient's expected lifetime using a Markov cohort model. Secondary outcomes included post-treatment urinary tract infections, total antibiotic use, microbiologically proven urinary tract infections, antimicrobial resistance, bacteriuria, hospitalisations and treatment satisfaction. Primary modified intention-to-treat analysis comprised 205 (85%) randomised participants [102/120 (85%) participants in the antibiotics arm and 103/120 (86%) participants in the methenamine hippurate arm] with at least 6 months' data available. During treatment, the incidence rate of symptomatic, antibiotic-treated urinary tract infections decreased substantially in both arms to 1.38 episodes per person-year (95% confidence interval 1.05 to 1.72 episodes per person-year) for methenamine hippurate and 0.89 episodes per person year (95% confidence interval 0.65 to 1.12 episodes per person-year) for antibiotics (absolute difference 0.49; 90% confidence interval 0.15 to 0.84). This absolute difference did not exceed the predefined, strict, non-inferiority limit of one urinary tract infection per person-year. On average, methenamine hippurate was less costly and more effective than antibiotics in terms of quality-adjusted life-years gained; however, this finding was not consistent over the longer term. The urinary tract infection incidence rate 6 months after treatment completion was 1.72 episodes per year in the methenamine hippurate arm and 1.19 in the antibiotics arm. During treatment, 52% of urine samples taken during symptomatic urinary tract infections were microbiologically confirmed and higher proportions of participants taking daily antibiotics (46/64; 72%) demonstrated antibiotic resistance in Escherichia coli cultured from perineal swabs than participants in the methenamine hippurate arm (39/70; 56%) (p-value = 0.05). Urine cultures revealed that during treatment higher proportions of participants and samples from the antibiotic arm grew E. coli resistant to trimethoprim/co-trimoxazole and cephalosporins, respectively. Conversely, post treatment, higher proportions of participants in the methenamine hippurate arm (9/45; 20%) demonstrated multidrug resistance in E. coli isolated from perineal swabs than participants in the antibiotic arm (2/39; 5%) (p = 0.06). All other secondary outcomes and adverse events were similar in both arms. This trial could not define whether or not one particular antibiotic was more beneficial, and progressive data loss hampered economic evaluation. This large, randomised, pragmatic trial in a routine NHS setting has clearly shown that methenamine hippurate is not inferior to current standard care (daily low-dose antibiotics) in preventing recurrent urinary tract infections in women. The results suggest that antimicrobial resistance is proportionally higher in women taking prophylactic antibiotics. Future research should include evaluation of other non-antibiotic preventative treatments in well-defined homogeneous patient groups, preferably with the comparator of daily antibiotics. This trial is registered as ISRCTN70219762 and EudraCT 2015-003487-36. This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 23. See the NIHR Journals Library website for further project information.

Longitudinal multi-omics analyses link gut microbiome dysbiosis with recurrent urinary tract infections in women.

Recurrent urinary tract infections (rUTIs) are a major health burden worldwide, with history of infection being a significant risk factor. While the gut is a known reservoir for uropathogenic bacteria, the role of the microbiota in rUTI remains unclear. We conducted a year-long study of women with (n = 15) and without (n = 16) history of rUTI, from whom we collected urine, blood and monthly faecal samples for metagenomic and transcriptomic interrogation. During the study 24 UTIs were reported, with additional samples collected during and after infection. The gut microbiome of individuals with a history of rUTI was significantly depleted in microbial richness and butyrate-producing bacteria compared with controls, reminiscent of other inflammatory conditions. However, Escherichia coli gut and bladder populations were comparable between cohorts in both relative abundance and phylogroup. Transcriptional analysis of peripheral blood mononuclear cells revealed expression profiles indicative of differential systemic immunity between cohorts. Altogether, these results suggest that rUTI susceptibility is in part mediated through the gut-bladder axis, comprising gut dysbiosis and differential immune response to bacterial bladder colonization, manifesting in symptoms.

MP02-14 RE-IMAGINING URINARY TRACT INFECTION IN WOMEN: CLUES FROM THE UROBIOME OF ASYMPTOMATIC HEALTHY CONTROLS VS VACCINATED WOMEN WITH RECURRENT URINARY TRACT INFECTION

You have accessJournal of UrologyCME1 May 2022MP02-14 RE-IMAGINING URINARY TRACT INFECTION IN WOMEN: CLUES FROM THE UROBIOME OF ASYMPTOMATIC HEALTHY CONTROLS VS VACCINATED WOMEN WITH RECURRENT URINARY TRACT INFECTION J. Curtis Nickel, R. Christopher Doiron, Kerri-Lynn Kelly, Nicolle Diaz, Caleb D. Phillips, and Craig D. Tipton J. Curtis NickelJ. Curtis Nickel More articles by this author , R. Christopher DoironR. Christopher Doiron More articles by this author , Kerri-Lynn KellyKerri-Lynn Kelly More articles by this author , Nicolle DiazNicolle Diaz More articles by this author , Caleb D. PhillipsCaleb D. Phillips More articles by this author , and Craig D. TiptonCraig D. Tipton More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.14AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: A comparison of the urobiome of healthy controls with no UTI to women with recurrent UTI (rUTI) before and after MV140 vaccination would suggest that our traditional concept of rUTI in women may be more complicated than envisioned. METHODS: Female subjects with rUTI (≥3 UTIs/year) enrolled in the MV140 North American early clinical experience study and age–matched asymptomatic females (about 1:2 ratio) with no UTI or antibiotics in the previous 12 and 3 months respectively provided midstream urine specimens for culture, NGS and quantitative PCR testing (MicroGenDx) at baseline and for the rUTI group, following the 3-month vaccination period. RESULTS: The urobiome of 13 rUTI patients with sterile urine did not differ significantly in number of species (Anova; p = 0.96, Fig 1a) although species composition differed significantly (nested ADONIS; p<0.001, R2=0.068, Figs 1b,c) from 23 age-matched healthy controls. This composition difference was driven by some species more abundant in the rUTI patients (e.g., Finegoldia magna), though other potentially pathogenic species were similarly abundant or more abundant in controls (eg. E. coli and Enterococcus faecalis, respectively). There was no significant change in NGS detected number of species (Anova; p = 0.91, R2 = 0.001, Fig 1a) or species detected (Fig 1c) 3 months after vaccination in the rUTI group. Similarly, there was no difference in qPCR estimated bacterial load following 3-month vaccination period in the rUTI group (Anova; p = 0.83, R2 = 0.001). CONCLUSIONS: The urobiome comparison between healthy and rUTI subjects and lack of impact of a successful vaccine on the urobiome of rUTi patients would suggest that we need to re-look at interaction of bacterial virulence and the local bladder immune mechanisms and even origin of the organisms that cause UTI. This small study suggests that UTI may arise from the patients’ own native urinary microbiome that in healthy individuals may be modulated by local bladder innate immunological mechanisms. In patients with rUTI those deficient mucosal–based mechanisms may be enhanced by an effective vaccine. This possible concept–shift regarding the cause of rUTI in women would have profound management implications. Source of Funding: Inmunotek, MicroGenDx © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e15 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information J. Curtis Nickel More articles by this author R. Christopher Doiron More articles by this author Kerri-Lynn Kelly More articles by this author Nicolle Diaz More articles by this author Caleb D. Phillips More articles by this author Craig D. Tipton More articles by this author Expand All Advertisement PDF DownloadLoading ...

Opportunities of drugs based on D-mannose and herbal components in the treatment and prevention of recurrent lower urinary tract infections in women

BACKGROUND: Recurrent cystitis is a common form of urinary tract infections. In the treatment of this disease antibacterial drugs are usually used. At the same time, there are plant components that can be a worthy substitute for antibiotic therapy.&#x0D; AIM: To evaluate the efficacy and safety of the biologically active complex Cystalis, containing D-mannose, grape seed extract and bearberry extract, in the treatment and prevention of recurrent cystitis in women.&#x0D; MATERIALS AND METHODS: The study included 60 women with recurrent cystitis. All patients answered the Acute Cystitis Symptom Scale (ACSS). The patients were divided into 2 groups of 30 people each. Patients of the 1st group received standard antibiotic therapy for recurrence of cystitis in accordance with the results of bacteriological examination of urine, followed by observation for 6 months. Patients of the second group instead of antibiotic therapy received the biologically active complex Cistalis one capsule (350 mg) 2 times a day for 3 months, followed by observation for 3 months.&#x0D; RESULTS: Before the start of treatment Escherichia coli was detected in 26 patients (86.7%) in the 1st group and in 28 (93.3%) patients in the 2nd group. At a follow-up visit 30 days after the initial examination the total score on the ACSS scale in patients of the 1st group decreased from 6.6 1.4 to 0.03 0.18 points (p 0.001), in patients of the 2nd group from 6.4 1.3 to 0 (p 0.001). The sum of scores in the Quality of Life (QoL) domain in the representatives of the 1st group decreased from 6.3 1.3 to 0 (p 0.001), and in the 2nd group decresead from 5.6 1.0 also to 0 (p 0.001). In patients of both groups, the level of leukocytes and erythrocytes in the urine significantly decreased. During the 6-month follow-up period 8 recurrences of UTIs were registered in patients of the 1st group, and only 2 recurrences in patients of the 2nd group. The probability of developing a recurrence of cystitis in patients of the 2nd group was significantly lower than in patients of the 1st group (2 = 4.603, p = 0.032).&#x0D; CONCLUSIONS: An analysis of the results of the study showed the high efficiency of using the Cystalis complex for the treatment of cystitis and the prevention of its recurrence.

Bacterial vaginosis as a risk factor for lower urinary tract infection in women: case report

Conservative therapy of acute (exacerbation of chronic) cystitis in women in combination with bacterial vaginosis is a task that often causes difficulties for a practicing doctor. Escherichia coli is still the main causative agent of urinary tract infection due to the presence of virulence factors that not only affect the affinity of the pathogen to the urothelium, but also hinder the development of an immune response. At the same time, bacterial vaginosis is a factor that often accompanies and supports inflammation of the lower urinary tract in women. Simultaneous occurrence of the above conditions is a frequent clinical situation. A differential approach is needed to prescribe antimicrobials to patients with urinary tract infection and bacterial vaginosis, as well as the use of safe natural medicines (biologically active additives) in their complex therapy.

Alternative to prophylactic antibiotics for the treatment of recurrent urinary tract infections in women: multicentre, open label, randomised, non-inferiority trial

ObjectiveTo test and compare the efficacy of methenamine hippurate for prevention of recurrent urinary tract infections with the current standard prophylaxis of daily low dose antibiotics.DesignMulticentre, open label, randomised, non-inferiority...