Management of recurrent urinary tract infections in women

2020 ◽  
pp. 205141582093945
Author(s):  
Néha Sihra ◽  
Sachin Malde ◽  
Tamsin Greenwell ◽  
Mahreen Pakzad ◽  
Magda Kujawa ◽  
...  
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Urinary Tract Infections ◽  
Level Of Evidence ◽  
Treatment And Prevention ◽  
Recurrent Urinary Tract Infections ◽  
Patient Morbidity ◽  
Prophylactic Measures ◽  
Repeated Use ◽  
Tract Infections

Urinary tract infections are highly prevalent and result in significant patient morbidity as well as large financial costs to healthcare systems. Recurrent urinary tract infections can be challenging for many healthcare professionals, and the repeated use of antibiotics in this patient cohort inevitably contributes to the growing issue of antimicrobial resistance and superbugs. It is essential that these patients are appropriately diagnosed and managed to ensure rapid resolution of symptoms and the prevention of chronic or recurrent urinary tract infections. There are several antibiotic-based options available for the prophylaxis of recurrent urinary tract infections however, in the current era of rising antimicrobial resistance, an awareness of antibiotic stewardship and the use of non-antibiotic alternatives for the treatment and prevention of urinary tract infections is of critical importance. We present a case-based multidisciplinary team discussion to highlight how women with recurrent urinary tract infections should be managed, encouraging the use of non-antibiotic prophylactic measures when suitable. Level of evidence: Level 5

scholarly journals Determinants of Antimicrobial Resistance in Escherichia coli Strains Isolated from Faeces and Urine of Women with Recurrent Urinary Tract Infections

PLoS ONE ◽  
2012 ◽  
Vol 7 (11) ◽  
pp. e49909 ◽  
Author(s):  
Casper D. J. den Heijer ◽  
Mariëlle A. J. Beerepoot ◽  
Jan M. Prins ◽  
Suzanne E. Geerlings ◽  
Ellen E. Stobberingh
Keyword(s):  
Escherichia Coli ◽  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Urinary Tract Infections ◽  
Recurrent Urinary Tract Infections ◽  
Tract Infections

scholarly journals Treatment of recurrent urinary tract infections in a 60-year-old kidney transplant recipient – last-chance antibiotics and phage therapy

2019 ◽  
Author(s):  
Olga Maria Rostkowska ◽  
Ryszard Międzybrodzki ◽  
Dorota Miszewska-Szyszkowska ◽  
Andrzej Górski ◽  
Magdalena Durlik
Keyword(s):  
Kidney Transplantation ◽  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Kidney Transplant ◽  
Urinary Tract Infections ◽  
Phage Therapy ◽  
Bacteriophage Therapy ◽  
Treatment Methods ◽  
Recurrent Urinary Tract Infections ◽  
Tract Infections

Abstract Background: The article underlines the problem of antimicrobial resistance in transplant departments where wide-spectrum antibiotics must often be used as first line treatment for immunocompromised patients. This applies especially to kidney transplant recipients who suffer from urinary tract infections. Additional means to control infections and support treatment methods are much needed in departments treating transplant patients. Case presentation: This article presents a case of a 60-year-old patient after kidney transplantation repeatedly admitted to the hospital due to recurrent urinary tract infections, including an episode of urosepsis, caused by Klebsiella pneumoniae producing extended-spectrum beta-lactamases (ESBL). Kidney transplantation was performed due to renal insufficiency caused by polycystic kidney disease, without removing of the patient’s own kidneys. As a consequence of numerous episodes of urinary tract infections (12 episodes within 15 months since transplantation), the patient developed chronic infection caused by ESBL-producing K. pneumoniae which showed variable susceptibility to carbapenems and full susceptibility to colistin only. In the meantime, the patient developed accompanying urinary tract infection caused by a vancomycin-resistant Enterococcus faecium and subsequent colonisation of the gastro-intestinal tract by this strain. In an attempt to curb the K. pneumoniae infection, bacteriophage therapy was applied on the experimental basis, coordinated by the Phage Therapy Unit of the Hirszfeld Institute in Wrocław, Poland. Probiotics were also used in an attempt to modify the bacterial gut colonisation. Eventually, the patient fully recovered following nephrectomy of his own left kidney in which cysts were suspected to be the reservoir of bacteria causing recurring infections. In this article we discuss some treatment methods complementary to classic antibiotic therapy, in times when antimicrobial resistance is on the rapid rise. Conclusions: It is necessary to further research methods of decreasing our reliance on antibiotics in view of falling susceptibility to those medicines. Phage therapy or altering patient’s microbiome can give us an edge in tackling infections which today are treated solely with antimicrobials. This would be of great significance to transplant departments.

scholarly journals Bacteriophage therapy: back to the future

2021 ◽  
Vol 23 (1) ◽  
pp. 55-64
Author(s):  
Tamara S. Perepanova ◽  
A.V. Kazachenko ◽  
P.L. Khazan ◽  
Yu.A. Malova
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Urinary Tract Infections ◽  
Phage Therapy ◽  
Published Data ◽  
Clinical Use ◽  
Bacteriophage Therapy ◽  
Treatment And Prevention ◽  
History Of ◽  
Tract Infections

In connection with growing problem of antimicrobial resistance, the search for alternative treatments for infection is popular topic nowadays. This article represents an overview of published data on the therapeutic use of bacteriophages, specifically in urinary tract infections. The history of phage therapy of infectious diseases from the beginning of the 20th century to the present days is presented. The paper also discuss the mechanism of bacteriophages activity, differences between lytic and lysogenic phages, mechanisms of bacterial tolerance to phages and ways of its overcoming are. Authors present their own data on 30 years of clinical use of “bacteriophage cocktails” in the treatment and prevention of urological infection.

scholarly journals Treatment of recurrent urinary tract infections in a 60-year-old kidney transplant recipient – last-chance antibiotics and phage therapy

2019 ◽  
Author(s):  
Olga Maria Rostkowska ◽  
Ryszard Międzybrodzki ◽  
Dorota Miszewska-Szyszkowska ◽  
Andrzej Górski ◽  
Magdalena Durlik
Keyword(s):  
Kidney Transplantation ◽  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Kidney Transplant ◽  
Urinary Tract Infections ◽  
Phage Therapy ◽  
Bacteriophage Therapy ◽  
Treatment Methods ◽  
Recurrent Urinary Tract Infections ◽  
Tract Infections

Abstract Background: The article underlines the problem of antimicrobial resistance in transplant departments where wide-spectrum antibiotics must often be used as first line treatment for immunocompromised patients. This applies especially to kidney transplant recipients who suffer from urinary tract infections. Additional means to control infections and support treatment methods are much needed in departments treating transplant patients. Case presentation: This article presents a case of a 60-year-old patient after kidney transplantation repeatedly admitted to the hospital due to recurrent urinary tract infections, including an episode of urosepsis, caused by Klebsiella pneumoniae producing extended-spectrum beta-lactamases (ESBL). Kidney transplantation was performed due to renal insufficiency caused by polycystic kidney disease, without removing of the patient’s own kidneys. As a consequence of numerous episodes of urinary tract infections (12 episodes within 15 months since transplantation), the patient developed chronic infection caused by ESBL-producing K. pneumoniae which showed variable susceptibility to carbapenems and full susceptibility to colistin only. In the meantime, the patient developed accompanying urinary tract infection caused by a vancomycin-resistant Enterococcus faecium and subsequent colonisation of the gastro-intestinal tract by this strain. In an attempt to curb the K. pneumoniae infection, bacteriophage therapy was applied on the experimental basis, coordinated by the Phage Therapy Unit of the Hirszfeld Institute in Wrocław, Poland. Probiotics were also used in an attempt to modify the bacterial gut colonisation. Eventually, the patient fully recovered following nephrectomy of his own left kidney in which cysts were suspected to be the reservoir of bacteria causing recurring infections. In this article we discuss some treatment methods complementary to classic antibiotic therapy, in times when antimicrobial resistance is on the rapid rise. Conclusions: It is necessary to further research methods of decreasing our reliance on antibiotics in view of falling susceptibility to those medicines. Phage therapy or altering patient’s microbiome can give us an edge in tackling infections which today are treated solely with antimicrobials. This would be of great significance to transplant departments.

scholarly journals Co-Amoxiclav as empiric treatment of UTI in children: importance of surveillance in ensuring optimal empiric treatment choice

2021 ◽  
Author(s):  
James Trayer ◽  
Michael Horgan ◽  
Anna-Rose Prior ◽  
Martin Ryan ◽  
Montasser Nadeem
Keyword(s):  
Urinary Tract Infection ◽  
Urinary Tract ◽  
Antimicrobial Resistance ◽  
Tract Infection ◽  
Urinary Tract Infections ◽  
Symptomatic Urinary Tract Infection ◽  
Susceptibility Data ◽  
Empiric Treatment ◽  
Recurrent Urinary Tract Infections ◽  
Tract Infections

AbstractBackground Urinary tract infections are common and require prompt treatment. Objective To examine the resistance rates of co-amoxiclav in children with urinary tract infection and whether antimicrobial resistance is influenced by other variables. Methods The records and antibiotic susceptibility data of 209 patients admitted with symptomatic urinary tract infection between January 2018 and December 2019 were reviewed. Results We examined 209 patients [mean (SD) age 23.73 (32.86) months], of whom 176 (84.2%) had first urinary tract infection. Escherichia coli was isolated in 190 (90.1%). Uropathogens were sensitive to co-amoxiclav in 47.8% of patients and gentamicin in 95.2%. Combined co-amoxiclav with gentamicin demonstrated antimicrobial sensitivity in 96.2%. Antimicrobial resistance was associated with longer hospital stay (p-value < 0.02). An association was identified between co-amoxiclav resistance and recurrent urinary tract infections. Uropathogens were resistant to co-amoxiclav in 80/176 (45.5%) and 29/33 (87.9%) patients with first and recurrent urinary tract infections, respectively (p-value 0.001). No link was observed between antimicrobial resistance and atypical urinary tract infection. Conclusion Approximately half of children in this cohort had urinary tract infection due to uropathogens resistant to co-amoxiclav. Co-amoxiclav resistance is associate with recurrent infections and longer hospital stays. A combination of co-amoxiclav and gentamicin demonstrates > 96% susceptibility.

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