Associations between antibiotic prescriptions and recurrent urinary tract infections in female college students

Abstract

Urinary tract infections (UTIs) are common among college-aged women and often recur. Some antibiotics recommended to treat UTIs trigger dysbiosis of intestinal and vaginal microbiomes – where uropathogens originate, though few studies have investigated associations between these therapies with recurrent infections. We retrospectively analysed the electronic medical records of 6651 college-aged women diagnosed with a UTI at a US university student health centre between 2006 and 2014. Women were followed for 6 months for incidence of a recurrent infection. In a secondary analysis, associations in women whose experienced UTI recurrence within 2 weeks were also considered for potential infection relapse. Logistic regression was used to assess associations between infection recurrence or relapse and antibiotics prescribed, in addition to baseline patient characteristics including age, race/ethnicity, region of origin, year of encounter, presence of symptomology, pyelonephritis, vaginal coinfection and birth control consultation. There were 1051 instances of infection recurrence among the 6620 patients, indicating a prevalence of 16%. In the analysis of patient characteristics, Asian women were statistically more likely to experience infection recurrence whereas African American were less likely. No significant associations were identified between the antibiotic administered at the initial infection and the risk of infection recurrence after multivariable adjustment. Treatment with trimethoprim-sulphamethoxazole and being born outside of the USA were significantly associated with increased odds of infection relapse in the multivariate analysis. The results of the analyses suggest that treatment with trimethoprim-sulphamethoxazole may lead to an increased risk of UTI relapse, warranting further study.

Vaginal microbiota affects urinary tract infection risk in women with systemic lupus erythematosus: a pilot cross-sectional study from Thailand

“…Another retrospective study conducted at the University Student Health Center of the University of Florida between 2006 and 2014 revealed that TMP-SMX use as an initial agent in cystitis increased the risk of subsequent UTI events (AOR: 2.14, 95% CI 1.23 to 4.09). 47 This finding may be explained in that increasingly resistant bacteria caused the UTI, which could only be partially treated with TMP-SMX. Unknown effects on the vaginal microbiota may also cause recurrent infections.…”

Pathogenetic Role and Possibilities for Correction of Gut Microbiota Disorders in Urinary Tract Infections

“…Наиболее характерной особенностью течения ИМП у женщин является тенденция к частым рецидивам, возникающим обычно в первые три месяца после перенесённой первичной инфекции, что свидетельствует о недостаточной эффективности современной терапии и профилактики эпизодов данного заболевания [8,10,58]. При этом поведенческие меры, используемые для профилактики, также зачастую оказываются неэффективными [7].…”

“…проведения посевов мочи и визуализационных исследований, неоднократными визитами к врачу, связанными с хроническим и часто рецидивирующим течением ИМП [7][8][9][10]. В основе патогенеза ИМП лежит воспалительная реакция в ответ на бактериальную инвазию эпителия мочевых путей, проявляющаяся симптомами, лейкоцитурией и бактериурией.…”

Intestinal Microbiota Correction in the Treatment and Prevention of Urinary Tract Infection

“…Moreover, there is evidence of an increase in the likelihood of infection recurrence, as well as antibiotic resistance development with the use of antibiotics. 47 , 48 A systematic review showed a dramatic decrease in microbiota diversity after antibiotic therapy. 47 Violations in the IM composition can persist for a long time—up to 6 months or more after treatment discontinuation.…”