Definition of Recurrent Urinary Tract Infections in Women: Which One to Adopt?

Malik, Rena D.; Wu, Yuefeng

doi:10.1097/spv.0000000000000509

Cited by 54 publications

(40 citation statements)

References 26 publications

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“…Following Institutional Review Board approval, we queried a database of women with antibiotic-refractory RUTIs (defined as 3 or more symptomatic urinary tract infections (UTIs) treated with antibiotics over 1 year [7]) and an office cystoscopy demonstrating inflammatory bladder lesions, who subsequently underwent EF. Only patients who exhibited findings of VC on cystoscopy were included in this study.…”

Section: Methodsmentioning

confidence: 99%

Vesicular Cystitis: A Chronic Cystitis Variant Often Unresponsive to Antibiotics and Electrofulguration

Crivelli

2020

Urol Int

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Objective: The aim of the study was to report on the presentation and outcomes of vesicular cystitis (VC), a chronic cystitis exhibiting translucent bladder mucosal vesicles, among women with antibiotic-refractory recurrent urinary tract infections (RUTIs). Methods: An analysis of our Institutional Review Board-approved series on antibiotic-refractory RUTIs was performed, selecting for documented VC lesions on cystoscopy. All patients had RUTIs defined as ≥3 urinary tract infections/year with positive urine culture. All patients were extensively treated with antibiotics with no resolution of RUTIs and were offered electrofulguration (EF) of VC lesions under anesthesia as a last resort. All patients had a 6-month post-EF office cystoscopy documenting persistence or resolution of the lesions, and a clinical outcome assessment based on RUTI frequency. Results: Of 482 patients, 18 (3.7%) treated during 2011–2017 met the study criteria. VC was most commonly found over the dome/anterior wall (7/18, 38%) and as pancystitis (7/18, 38%). There was often concomitant cystitis cystica of the trigone (8/18, 44%). At post-EF cystoscopy, persistence of VC was noted in 10/18 (56%) patients; 6/18 (33%) underwent repeat EF and an additional 3/18 (17%) were retreated due to new lesions after initial resolution. Two (11%) patients required simple cystectomy and urinary diversion due to RUTIs refractory to all interventions. Within a median follow-up of 2.8 years after EF, clinical cure was observed in 5/18 (28%), improvement in 10/18 (56%), and failure in 3/18 (17%) patients. Conclusions: Among women with antibiotic-refractory RUTIs, VC is an infrequent and persistent form of cystitis with a predilection for non-trigonal bladder surfaces, whose management is challenging.

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Section: Methodsmentioning

confidence: 99%

Vesicular Cystitis: A Chronic Cystitis Variant Often Unresponsive to Antibiotics and Electrofulguration

Crivelli

2020

Urol Int

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“…In keeping our definition for RUTI, namely three or more symptomatic infections per year, we classified patients as the following: (i) clinically successful or cured if there were no further UTIs; (ii) improved if there were one to two UTIs per year; or (iii) failed if there were three or more UTIs per year. 21 All patients had regularly scheduled follow up ay our clinic, and were asked to call to document any new symptoms as well as positive cultures or antibiotic courses from outside providers. As such, all known dates of antibiotic prescriptions and positive cultures were recorded, along with the organisms grown, colony counts and any antibiotic resistances.…”

Section: Postoperative Uti Statusmentioning

confidence: 99%

Electrofulguration in the advanced management of antibiotic‐refractory recurrent urinary tract infections in women

Crivelli

Alhalabi

2019

Int J of Urology

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Objective To evaluate the long‐term efficacy of electrofulguration in women with recurrent urinary tract infections. Methods After institutional review board approval, a retrospective study of women who underwent electrofulguration alone was carried out. All patients had recurrent urinary tract infections defined as three or more urinary tract infections/year, and a preoperative office cystoscopy showing inflammatory lesions, categorized by location: urethra, bladder neck, trigone and beyond the trigone. All lesions were cauterized during outpatient electrofulguration under anesthesia. On 6‐month postoperative office cystoscopy, endoscopic success was defined as resolution of all lesions previously seen and no new lesions. The primary outcome was urinary tract infections/year, with urinary tract infection defined as antibiotic treatment for urinary tract infection‐like symptoms and/or for positive urine culture. Clinical cure was defined as no further urinary tract infections, clinical improvement as less than three urinary tract infections/year, and clinical failure as three or more urinary tract infections/year. Results Of 95 women who met the study criteria between 2004 and 2016, 62 (65%) were endoscopically successful, and 33 (35%) were endoscopic failures based on postoperative cystoscopy. Among all patients, over a median follow‐up period of 4.9 years, the median number of urinary tract infections/year was 0.8. Endoscopically successful patients had fewer urinary tract infections/year compared with endoscopic failures (0.6 vs 0.9, P = 0.03). Clinically, 14 (15%) patients were cured, 69 (73%) were improved and 12 (13%) failed. Compared with clinically improved patients, clinical failures were more likely to have infections with multiple organisms (92% vs 35%, P < 0.001) and highly resistant organisms (92% vs 23%, P < 0.001). Conclusions In our experience, nearly two‐thirds of women with recurrent urinary tract infection can be successfully treated with electrofulguration, and >80% experience long‐term clinical cure or improvement in urinary tract infections.

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“…This is not only from a physical/psychological perspective with an increase in limitations of daily activities and stress but also from a social/economic standpoint with an increase in doctor visits, and medical absenteeism . Recurrent infection is difficult to define, as at present there are 14 different definitions in the existing literature and no consensus has been agreed . However, many researchers use the definition of more than three proven UTIs in 12 months or more than two in 6 months .…”

Section: Introductionmentioning

confidence: 99%

“…1 Recurrent infection is difficult to define, as at present there are 14 different definitions in the existing literature and no consensus has been agreed. 2 However, many researchers use the definition of more than three proven UTIs in 12 months or more than two in 6 months. 3 It is reported that 20% to 30% of women who have had one UTI will develop a second and 25% of these will go on to develop a third and further recurrences.…”

Section: Introductionmentioning

confidence: 99%

How can we improve investigation, prevention and treatment for recurrent urinary tract infections – ICI‐RS 2018

Harding

Rantell

Cardozo

et al. 2019

Neurourology and Urodynamics

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Background: Recurrent urinary tract infection (rUTI) is a chronic conditionand has a significant impact on health-related quality of life. The commonly used definition for rUTI is greater than three episodes in a year or more than two in 6 months. Current diagnostic methods have been used worldwide for over five decades, despite well evidenced criticism. Enhanced culture techniques demonstrate that the microbiome of the bladder is far more complex than previously thought and begs a reappraisal of our current testing. Treatment of rUTI is based on a small number of antibiotic trials with some evidence showing a reduction in the number of positive cultures, but one must be cautious in interpreting the results and weigh against the risk of generation of antimicrobial resistance (AMR).Aim: The International Consultation on Incontinence-Research Society think tank reviewed the literature with a view to improving investigation, prevention and treatment of rUTI. Methods: A multidisciplinary team of experts were invited to present evidence regarding the current diagnostic methods, recent advances related to bladder biome mapping and current treatment strategies, including antibiotic and nonantibiotic options. Current guidelines regarding antibiotic stewardship and concerns regarding AMR were discussed. Discussion: Outcome of the think tank discussions are summarised with a set of recommendations to inform future research. Particular consideration is given to bacterial survival in the bladder after treatment as well as defects in urothelial barrier function which may play a significant part in the failure to eradicate UTI. K E Y W O R D S antimicrobial resistance, urinary tract infection Neurourology and Urodynamics. 2019;38:S90-S97. wileyonlinelibrary.com/journal/nau S90 |

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Definition of Recurrent Urinary Tract Infections in Women: Which One to Adopt?

Abstract: This review of major RUTI definition recommendations by expert individuals and specialty societies underlines the lack of uniformity and the need for a more robust and generally agreeable RUTI definition for use in clinical and academic practice.

Cited by 54 publications

References 26 publications

Vesicular Cystitis: A Chronic Cystitis Variant Often Unresponsive to Antibiotics and Electrofulguration

Vesicular Cystitis: A Chronic Cystitis Variant Often Unresponsive to Antibiotics and Electrofulguration

Electrofulguration in the advanced management of antibiotic‐refractory recurrent urinary tract infections in women

How can we improve investigation, prevention and treatment for recurrent urinary tract infections – ICI‐RS 2018

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