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

Abstract

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 |

Effect of antibiotics on urine leakage in women with refractory detrusor overactivity: A phase IIb randomized trial

“…Post recruitment, and before randomization, all patients underwent a washout period of 2.5 weeks, during which any current anticholinergic therapy was stopped. Randomization was then stratified by age (<70, ≥75), the severity of incontinence (<75 g vs. ≥75 g on 24‐h pad test), voids per day (<9 vs. ≥9 on 3‐day bladder diary), and previous history of recurrent UTI (defined as ≥3 culture‐proven UTI per 12 months or two UTI in 6 months) 14 . Treatment was centrally randomized by a computer‐generated allocation at a telephone call center in the Clinical Trials Unit, with a 2:1 ratio of antibiotic to placebo therapy.…”

Upper urinary tract function of patients with multiple sclerosis

“…UTIs were considered as recurrent if patients had more than 3 UTIs per year. 19 They were considered as lower UTI if the patient did not have concomitant fever and as upper UTI (pyelonephritis) if they did (without perineal pain in men to exclude acute prostatitis). Urodynamics were performed in accordance with International Continence Society (ICS) recommendations.…”

Management of recurrent urinary tract infections in women

“…However, it is clear that patients can develop symptoms of UTI with much lower concentrations of urinary bacteria, and the minimum concentration required to cause UTI or rUTIs has not as yet been defined. 6 Furthermore, it is increasingly recognised that a single threshold is unlikely to be reliable as a universal diagnostic criterion for UTI. 12 For this reason, patients presenting acutely with typical symptoms of a UTI should have a urine sample sent for culture but should still commence antibiotic treatment on a best-guess basis.…”

“…Research into more accurate and rapid UTI diagnostic tests is a key priority. 6 Point-of-care tests to provide rapid diagnosis of bacteriuria in combination with the inflammatory and immune response to infection are being studied. The development of high-throughput DNA sequencing technologies has led to a greater understanding of the complexity of the urinary microbiome and the realisation that urine is not sterile, as traditionally believed.…”

“…It is thought that incomplete or inadequate treatment of an acute UTI may result in the development of chronicity. 6 For this reason, it is imperative that patients are appropriately assessed and managed to ensure rapid resolution of symptoms and the prevention of chronic or rUTIs developing, aiming to utilise non-antibiotic measures only once patients become completely symptom free with initial antibiotic treatment.…”