Recurrent Urinary Tract Infection

Lovatsis, Danny; Walter, Jens-Erik; Easton, William; Epp, Annette; Farrell, Scott A.; Girouard, Lise; Gupta, C. K.; Harvey, Marie-Andrée; Larochelle, Annick; Robert, Magali; Ross, Sue; Schachter, Joyce; Schulz, Jane; Wilkie, David; Ehman, William; Domb, Sharon; Gagnon, Andrée; Hughes, Owen; Konkin, Jill; Lynch, Joanna; Marshall, Cindy

doi:10.1016/s1701-2163(16)34717-x

Cited by 123 publications

(104 citation statements)

References 70 publications

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“…18,19 Risk factors for RUTI in sexually-active premenopausal women are the onset of symptoms shortly after sexual intercourse, the use of spermicides for contraception, taking on new sexual partners, the age of the first UTI, a maternal history of UTI and voiding dysfunction. 5,8,20,21 Many other factors have been thought to predispose women to RUTIs, such as voiding patterns preand post-coitus, wiping technique, wearing tight undergarments, deferred voiding habits and vaginal douching; nevertheless, there has been no proven association. 22 Medical conditions such as pregnancy, DM and immunosuppression increase a woman's risk of RUTI by facilitating the access of uropathogens overcoming normal host defense mechanisms.…”

Section: Epidemiology and Pathophysiologymentioning

confidence: 99%

Recurrent Urinary Tract Infections Management in Women : A Review = الإلتهابات المتكررة للمسالك البولية عند النساء و طرق علاجها : مراجعة

Al‐Badr

Al‐Shaikh

2013

SQUMJ

163

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U rinary tract infections (UTIs) occur more often in women than in men, at a ratio of 8:1. Approximately 50-60% of women report at least one UTI in their lifetime, and one in three will have at least one symptomatic UTI necessitating antibiotic treatment by age 24. [1][2][3] Normally, the urinary tract is sterile, but bacteria may rise from the perianal region, possibly leading to UTI. Pathogens in the bladder may stay silent or can cause irritative symptoms like urinary frequency and urgency, and 8% of women may have asymptomatic bacteriuria. If bacteria enter the blood stream, they could cause severe complications, including septicaemia, shock and, rarely, death. 4,5 The definition of recurrent urinary tract infection (RUTI) is three UTIs with three positive urine cultures during a 12-month period, or two infections during the previous 6 months. [5][6][7][8] This article provides an up-to-date review of the epidemiology, pathophysiology, risk factors, diagnosis, management and prevention of RUTIs in women. Classification of Urinary Tract InfectionsUTIs are classified into 6 categories. The first category is an uncomplicated infection; this is when the urinary tract is normal, both structurally and physiologically, and there is no associated disorder that impairs the host defense mechanisms. The second category is an complicated infection; this is Escherichia coli is the organism that causes UTIs in most patients. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis. Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics.

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Section: Epidemiology and Pathophysiologymentioning

confidence: 99%

Recurrent Urinary Tract Infections Management in Women : A Review = الإلتهابات المتكررة للمسالك البولية عند النساء و طرق علاجها : مراجعة

Al‐Badr

Al‐Shaikh

2013

SQUMJ

163

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“…One predstavljaju poseban problem, jer oko 20% do 35% žena nakon prve infekcije mokraćnih puteva ima ponovnu infekciju, a 10% žena ima tri do pet infekcija godišnje [18,19].…”

Section: Rekurentne Infekcije Mokraćnih Putevaunclassified

“…Izvor je najčešće flora debelog creva, a ne skriveni fokus. Velika većina rekurentnih infekcija su reinfekcije [1,3,18].…”

Section: Rekurentne Infekcije Mokraćnih Putevaunclassified

“…One su češće kod žena sa porodičnom anamnezom o urinarnim infekcijama, seksualno aktivnih žena, posebno onih koje koriste spermicide ili su skoro promenile seksualnog partnera, ali i žene u menopauzi imaju veću sklonost ka ovim infekcijama [2,3,18]. Navodi se da nastanku rekurentnih infekcija doprinosi neredovno pražnjenje mokraćne bešike, izbegavanje pražnjenja bešike posle koitusa, tesan donji veš, nepravilno brisanje posle mokrenja ili defekacije, iako za sve ovo nema pouzdanih dokaza [18,20]. Neki medicinski uslovi doprinose nastanku rekurentnih infekcija mokraćnoh puteva kao što su trudnoća, dijabetes, imunosupresivna terapija [20].…”

Section: Rekurentne Infekcije Mokraćnih Putevaunclassified

“…Postkoitalna antimikrobna profilaksa se pokazala podjednako efikasnom kao i kontinuirana profilaksa [18,27,28] Ofloxacin 100 mg Tabela 2. Antimikrobna profilaksa: izbor i doza lekova za kontinuiranu i postkoitalnu profilaksu jedne doze antibiotika unutar 2 sata od koitusa (Tabela 2).…”

Section: Mere Profilakse Rekurentnih Infekcija Mokraćnih Putevaunclassified

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Rekurentne infekcije mokraćnih puteva: antimikrobna i imunoaktivna profilaksa

Djukanović

2015

Biomedicinska istraž.

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Kratak sadržajInfekcije mokraćnih puteva su najčešće bakterijske vanbolničke infekcije od kojih češće oboljevaju žene, а оko 20% do 35% žena nakon prve ima ponovnu infekciju mokraćnih puteva. Rekurentnom infekcijom mokraćnih puteva se smatra infekcija koje se ponavljala najmanje tri puta u prethodnoj godini. Faktori rizika za rekurentne infekcije mokraćnih puteva su menopauza, pozitivna porodična anamneza o urinarnim infekcijama, seksualna aktivnost, promena seksualnog partnera, korišćenje spermicida, kao i deficit lokalnog imuniteta. U svim slučajevima u kojima se dokaže da se radi o renfekcijama neophodno je da se primene mere profilakse.Profilaksa se može sprovoditi antimikrobnim lekovima i drugim metodama i sredstvima. Antimikrobni lekovi se primenjuju kontinuirano ili postkoitalno u trajanju od godinu dana, a kod motivisanih bolesnica može se primeniti samozapočinjanje antimikrobne terapije pri recidivu infekcije.Ostale ne-antimikrobne mere profilakse obuhvataju vaginalnu primenu estrogena kod žena u postmenopauzi koje nisu na hormonskoj supstitucionoj terapiji estrogenima, vaginalnu primenu laktobacila, imunoprofilaksu, kao i korišćenje produkata brusnice, izbegavanje primene spermicida, izbegavanje kupanja u kadi i penama. Imunoaktivna profilaksa (vakcine) rekurentnih infekcija mokraćnih puteva je uvedena sa ciljem da se stimuliše lokalni imunski odgovor protiv uropatogenih bakterija. Vakcine su sastavljene ili od umrtvljenih uropatogenih bakterija ili od liofilizovanih proteina membrane uropatogenih bakterija. Da bi se prevazišla velika antigenska varijabilnost uropatogenih bakterija i njihovi različiti mehanizmi virulencije, brojna eksprimentalna istraživanja su usmerena ka proizvodnji vakcina protiv pojedinih komponenti virulencije bakterija, kao i vakcina protiv genetski modifikovanih sojeva bakterija.Postojanje brojnih mera profilakse govori o njihovoj nedovoljnoj efikasnosti, a kombinovano i uporno sprovođenje proverenih mera predstavlja, za sada, jedini način za sprečavanje recidiva infekcije.Ključne reči: rekurentne infekcije mokraćnih puteva, profilaksa, vakcine UvodInfekcija mokraćnih puteva je naziv koji označava prodor mikroorganizama u prethodno sterilan mokraćni sistem, njihovo razmnožavanje i održavanje koje izaziva zapaljenje kao odgovor domaćina. One predstavljaju ne samo ozbiljan zdravstveni nego

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Urinary Tract Infections in Older Women

Mody

Juthani‐Mehta

2014

JAMA

271

166

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IMPORTANCE Asymptomatic bacteriuria and symptomatic urinary tract infections (UTIs) in older women are commonly encountered in outpatient practice. OBJECTIVE To review management of asymptomatic bacteriuria and symptomatic UTI and review prevention of recurrent UTIs in older community-dwelling women. EVIDENCE REVIEW A search of Ovid (Medline, PsycINFO, Embase) for English-language human studies conducted among adults aged 65 years and older and published in peer-reviewed journals from 1946 to November 20, 2013. RESULTS The clinical spectrum of UTIs ranges from asymptomatic bacteriuria, to symptomatic and recurrent UTIs, to sepsis associated with UTI requiring hospitalization. Recent evidence helps differentiate asymptomatic bacteriuria from symptomatic UTI. Asymptomatic bacteriuria is transient in older women, often resolves without any treatment, and is not associated with morbidity or mortality. The diagnosis of symptomatic UTI is made when a patient has both clinical features and laboratory evidence of a urinary infection. Absent other causes, patients presenting with any 2 of the following meet the clinical diagnostic criteria for symptomatic UTI: fever, worsened urinary urgency or frequency, acute dysuria, suprapubic tenderness, or costovertebral angle pain or tenderness. A positive urine culture (≥105 CFU/mL) with no more than 2 uropathogens and pyuria confirms the diagnosis of UTI. Risk factors for recurrent symptomatic UTI include diabetes, functional disability, recent sexual intercourse, prior history of urogynecologic surgery, urinary retention, and urinary incontinence. Testing for UTI is easily performed in the clinic using dipstick tests. When there is a low pretest probability of UTI, a negative dipstick result for leukocyte esterase and nitrites excludes infection. Antibiotics are selected by identifying the uropathogen, knowing local resistance rates, and considering adverse effect profiles. Chronic suppressive antibiotics for 6 to 12 months and vaginal estrogen therapy effectively reduce symptomatic UTI episodes and should be considered in patients with recurrent UTIs. CONCLUSIONS AND RELEVANCE Establishing a diagnosis of symptomatic UTI in older women requires careful clinical evaluation with possible laboratory assessment using urinalysis and urine culture. Asymptomatic bacteriuria should be differentiated from symptomatic UTI. Asymptomatic bacteriuria in older women should not be treated.

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Recurrent Urinary Tract Infection

Cited by 123 publications

References 70 publications

Recurrent Urinary Tract Infections Management in Women : A Review = الإلتهابات المتكررة للمسالك البولية عند النساء و طرق علاجها : مراجعة

Recurrent Urinary Tract Infections Management in Women : A Review = الإلتهابات المتكررة للمسالك البولية عند النساء و طرق علاجها : مراجعة

Rekurentne infekcije mokraćnih puteva: antimikrobna i imunoaktivna profilaksa

Urinary Tract Infections in Older Women

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