Urinary Tract Infections

Gram Negative Bacteria ◽

First Line ◽

Symptomatic Infection ◽

Treatment Regimens ◽

Recurrent Uti ◽

Treatment And Prevention ◽

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.

Urinary Tract Infections

10.2310/im.1019 ◽

2020 ◽

Author(s):

Sigal Yawetz

Keyword(s):

Urinary Tract ◽

Treatment Guidelines ◽

Gram Negative Bacteria ◽

First Line ◽

Symptomatic Infection ◽

Treatment Regimens ◽

Recurrent Uti ◽

Treatment And Prevention ◽

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.

1168. Role of Extended-Spectrum Cephalosporin-Resistance in Recurrent Enterobacteriaceae Urinary Tract Infections

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1001 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S352-S352

Author(s):

Judith Anesi ◽

Ebbing Lautenbach ◽

Irving Nachamkin ◽

Charles Garrigan ◽

Warren Bilker ◽

...

Keyword(s):

Urinary Tract ◽

Bacterial Resistance ◽

Treatment Regimens ◽

Recurrent Uti ◽

Time To Recurrence ◽

Extended Spectrum ◽

Cox Proportional Hazard Regression ◽

Tract Infections ◽

Community Onset

Abstract Background Recent data have shown an increase in bacterial resistance to first-line antibiotics used to treat community-onset urinary tract infections (UTIs). A better understanding of the clinical outcomes associated with drug-resistant UTIs in the community is needed. We sought to determine the association between community-onset extended-spectrum cephalosporin-resistant (ESC-R) Enterobacteriaceae (EB) UTI and the risk for recurrent UTI. Methods A retrospective cohort study was performed. All patients presenting to the Emergency Departments (EDs) or outpatient practices with EB UTIs between 2010 and 2013 were included. Exposed patients had ESC-R EB UTIs. Unexposed patients had ESC-susceptible EB UTIs and were matched to exposed subjects 1:1 on study year. Multivariable Cox proportional hazard regression analyses were performed to evaluate the association between ESC-R EB UTI and time to recurrent UTI within 12 months. Patients were censored at the time of first recurrent UTI or at the end of follow-up. Results A total of 302 patients with an index community-onset EB UTI were included, with 151 exposed and unexposed. Within 12 months of the index UTI, 163 (54%) patients experienced a recurrent UTI. The median time to recurrence was 69 days (interquartile range 25–183 days). On multivariable analyses, a UTI due to an ESC-R EB was associated with an increased hazard of recurrent UTI (hazard ratio [HR] 1.39, 95% confidence interval [CI] 1.01–1.91, P = 0.04). Other variables that were independently associated with an increased hazard of recurrent UTI included a history of UTI in the 6 months prior to the index UTI (HR 1.59, 95% CI 1.17–2.15, P < 0.01) and presence of a urinary catheter at the time of the index UTI diagnosis (HR 1.59, 95% CI 1.06–2.38, P = 0.03). Conclusion Community-onset UTI due to an ESC-R EB organism is associated with a significantly increased hazard of recurrent UTI within 12 months even after adjusting for baseline factors that predispose patients to UTI recurrence. This study raises the question of whether patients with an ESC-R EB organism may require modified treatment regimens. Further study is needed to better elucidate the cause of recurrence among these patients. Disclosures All authors: No reported disclosures.

Recurrent Urinary Tract Infections

10.2310/obg.19160 ◽

2020 ◽

Author(s):

Lauren N Siff

Keyword(s):

Risk Factors ◽

Urinary Tract ◽

Antimicrobial Prophylaxis ◽

Antimicrobial Treatment ◽

Ct Urography ◽

Recurrent Uti ◽

The Past ◽

Treatment And Prevention ◽

Tract Infections ◽

Work Up

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

Editorial Comment to Role of increasing leukocyturia for detecting the transition from asymptomatic bacteriuria to symptomatic infection in women with recurrent urinary tract infections: A new tool for improving antibiotic stewardship

International Journal of Urology ◽

10.1111/iju.13724 ◽

2018 ◽

Vol 25 (9) ◽

pp. 806-807

Author(s):

Ekaterina Kulchavenya

Keyword(s):

Urinary Tract ◽

Editorial Comment ◽

Antibiotic Stewardship ◽

Symptomatic Infection ◽

Recurrent Urinary Tract Infections ◽

Urinary tract infection

Oxford Handbook of Genitourinary Medicine, HIV, and Sexual Health ◽

10.1093/med/9780198783497.003.0021 ◽

2019 ◽

pp. 267-276

Keyword(s):

Urinary Tract ◽

Diagnostic Tests ◽

The Elderly ◽

Drug Induced ◽

Recurrent Uti ◽

Clinical Presentations ◽

This chapter on urinary tract infections brings up to date advice on the aetiology, diagnosis, and management of urinary tract infections in adults. The microbiology of this common presentation is discussed, together with recent patterns of resistance. Different clinical presentations are highlighted: lower UTI, upper UTI, asymptomatic bacteriuria, pregnancy, catheterized patients, haematuria, the elderly, urethral syndrome, interstitial cystitis and drug-induced cystitis. The role of different diagnostic tests, in particular routine urine culture, is explored. Guidance on the management of different clinical presentations of UTI is given, as well as an outline of the options for reducing the frequency of recurrent UTI in those so predisposed.

Role of increasing leukocyturia for detecting the transition from asymptomatic bacteriuria to symptomatic infection in women with recurrent urinary tract infections: A new tool for improving antibiotic stewardship

International Journal of Urology ◽

10.1111/iju.13723 ◽

2018 ◽

Vol 25 (9) ◽

pp. 800-806 ◽

Cited By ~ 3

Author(s):

Tommaso Cai ◽

Paolo Lanzafame ◽

Patrizio Caciagli ◽

Serena Migno ◽

Liliana Mereu ◽

...

Keyword(s):

Urinary Tract ◽

Antibiotic Stewardship ◽

Symptomatic Infection ◽

Recurrent Urinary Tract Infections ◽

Mechanisms of urinary tract infections and asymptomatic bacteriuria

Pediatrics (Suppl Consilium Medicum) ◽

10.26442/2413-8460_2018.1.106-110 ◽

2018 ◽

pp. 106-110

Author(s):

I.N. Zaharova ◽

◽

E.B. Mumladze ◽

E.B. Machneva ◽

A.N. Kasyanova ◽

...

Keyword(s):

Urinary Tract ◽

Urinary tract infections (UTIs); a leaflet for older adults, and carers: the development of a UTI leaflet for older adults and their carers

British Journal of General Practice ◽

10.3399/bjgp18x696833 ◽

2018 ◽

Vol 68 (suppl 1) ◽

pp. bjgp18X696833 ◽

Cited By ~ 1

Author(s):

Leah Ffion Jones ◽

Emily Cooper ◽

Cliodna McNulty

Keyword(s):

Older Adults ◽

Urinary Tract ◽

Care Home ◽

Theoretical Domains Framework ◽

Antibiotic Use ◽

Primary Care Providers ◽

Care Providers ◽

BackgroundEscherichia coli bacteraemia rates are rising with highest rates in older adults. Mandatory surveillance identifies previous Urinary Tract Infections (UTI) and catheterisation as risk factors.AimTo help control bacteraemias in older frail patients by developing a patient leaflet around the prevention and self-care of UTIs informed by the Theoretical Domains Framework.MethodFocus groups or interviews were held with care home staff, residents and relatives, GP staff and an out of hours service, public panels and stakeholders. Questions explored diagnosis, management, prevention of UTIs and antibiotic use in older adults. The leaflet was modified iteratively. Discussions were transcribed and analysed using Nvivo.ResultsCarers of older adults reported their important role in identifying when older adults might have a UTI, as they usually flag symptoms to nurses or primary care providers. Information on UTIs needs to be presented so residents can follow; larger text and coloured sections were suggested. Carers were optimistic that the leaflet could impact on the way UTIs are managed. Older adults and relatives liked that it provided new information to them. Staff welcomed that diagnostic guidance for UTIs was being developed in parallel; promoting consistent messages. Participants welcomed and helped to word sections on describing asymptomatic bacteriuria simply, preventing UTIs, causes of confusion and when to contact a doctor or nurseConclusionA final UTI leaflet for older adults has been developed informed by the TDF. See the TARGET website www.RCGP.org.uk/targetantibiotics/

Three-Year Trend in Escherichia coli Antimicrobial Resistance among Children’s Urine Cultures in an Italian Metropolitan Area

Children ◽

10.3390/children8070597 ◽

2021 ◽

Vol 8 (7) ◽

pp. 597

Author(s):

Luca Pierantoni ◽

Laura Andreozzi ◽

Simone Ambretti ◽

Arianna Dondi ◽

Carlotta Biagi ◽

...

Keyword(s):

Escherichia Coli ◽

Metropolitan Area ◽

Bacterial Infections ◽

Multidrug Resistant ◽

Resistance Rate ◽

First Line ◽

E Coli ◽

First Line Therapy ◽

Urinary tract infections (UTIs) are among the most common bacterial infections in children, and Escherichia coli is the main pathogen responsible. Several guidelines, including the recently updated Italian guidelines, recommend amoxicillin-clavulanic acid (AMC) as a first-line antibiotic therapy in children with febrile UTIs. Given the current increasing rates of antibiotic resistance worldwide, this study aimed to investigate the three-year trend in the resistance rate of E. coli isolated from pediatric urine cultures (UCs) in a metropolitan area of northern Italy. We conducted a retrospective review of E. coli-positive, non-repetitive UCs collected in children aged from 1 month to 14 years, regardless of a diagnosis of UTI, catheter colonization, urine contamination, or asymptomatic bacteriuria. During the study period, the rate of resistance to AMC significantly increased from 17.6% to 40.2% (p < 0.001). Ciprofloxacin doubled its resistance rate from 9.1% to 16.3% (p = 0.007). The prevalence of multidrug-resistant E. coli rose from 3.9% to 9.2% (p = 0.015). The rate of resistance to other considered antibiotics remained stable, as did the prevalence of extended spectrum beta-lactamases and extensively resistant E. coli among isolates. These findings call into question the use of AMC as a first-line therapy for pediatric UTIs in our population, despite the indications of recent Italian guidelines.