Recurrent Uncomplicated Urinary Tract Infections in Women: A Review

Abstract

Recurrent urinary tract infections most often present with symptoms of irritative voiding. In most cases, they are caused by reinfection with a previously isolated organism. Patients with one or more symptoms of uncomplicated recurrent urinary tract infection should undergo thorough examination and screening for underlying comorbidities that increase susceptibility. When frequent reinfections, empiric treatment relapse, persistent infections, or risk factors for complicated infections are encountered, patients may benefit from urodynamics, cystoscopy, renal ultrasound, intravenous urogram, or voiding cystourethrogram to evaluate for anatomic, functional, or metabolic abnormalities affecting the urinary tract (e.g., stones, stricture, obstruction, vesicoureteral reflux, lesions, detrusor underactivity). These patients may benefit from culture-guided empiric treatment and further evaluation by urology, nephrology, or infectious disease specialists. In patients with a history of uncomplicated urinary tract infections, empiric treatment guided by local antimicrobial resistance may efficiently treat a suspected recurrence. After successful treatment of the acute infection, postcoital prophylaxis, continuous prophylaxis, or self-start empiric treatment may be selected based on frequency of recurrent infections, temporal relation to intercourse, and patient characteristics. Ancillary measures such as probiotics, cranberry products, or local estrogen replacement may also be considered. This article will review the current definition, epidemiology, pathogenesis, diagnosis, work-up, treatment, treatment side effects, and prevention of recurrent urinary tract infections in women. A suggested algorithm for evaluation and treatment based on current literature is provided.

Is Female Gender as Harmful as Bacteria? Analysis of Hospital Admissions for Urinary Tract Infections in Elderly Patients

“…5 Moreover, we could not diagnose recurrent UTI; in fact, we could not establish if UTI was caused by reinfection with previously isolated organism. 32 …”

Clinical outcome after endoscopic therapy for occult vesicoureteral reflux in females: preliminary results of a retrospective case series

“…The treatment of females who suffer from recurrent febrile UTIs, but do not show VUR on standard VCUG, is controversial, and different algorithms for the evaluation, prophylaxis and therapy of recurrent UTIs in women appear in the current literature [8,9]. Occult VUR has to be assumed as the most probable aetiology and can be suspected in the presence of concomitant renal scarring or abnormal ureteral orifices on cystoscopy.…”

Cranberry-containing products are associated with a protective effect against urinary tract infections

“…Urinary tract infection (UTI) is a common clinical problem that often recurs, leading to the institution of preventive measures for recurrent UTI (rUTI) 1 2. Antimicrobial prophylaxis is highly effective, but risks adverse effects and induction of resistance 1 2.…”