Sporadic compared to recurrent urinary tract infections: Considerations for urogynecologic patients

Abstract

Aims: To describe the uropathogens and antimicrobial resistance patterns in women with singular, sporadic urinary tract infection (UTI) vs those with recurrent UTI (rUTI) in a urogynecologic population. Methods: This was a cross-sectional analysis of women treated for a UTI by a urogynecologic provider in a 1-year timeframe. Subjects were divided into two groups: (a) sporadic UTI-no history of rUTI and a single infection in the study timeframe and (b) rUTI-history of rUTI and ≥2 UTIs in the study timeframe. Our primary outcome was the difference in uropathogens between groups. Secondary aims were to investigate host characteristics associated with recurrent Escherichia coli infections and resistant uropathogens in the rUTI cohort. Results: We had 265 women with 163 (61.5%) in the sporadic UTI group and 102 (38.5%) in the rUTI group. The most common uropathogens were E. coli (57.3%) and Klebsiella (11.7%). In the rUTI group, only 27 of 102 (26.5%) had all E. coli infections. There were differences between groups regarding age (P = .03) and proportion of neurogenic bladder (P = .01), intermittent self-catheterization (P < .01), antibiotic suppression (P < .01), and vaginal estrogen therapy (P < .01). In the rUTI cohort, there were no risk factors that were significantly associated with recurrent E.coli UTIs and vaginal estrogen therapy was associated with a higher odds of sensitive uropathogens (adjusted odds ratio, 3.12; confidence interval, 1.28-7.56). Conclusions: In those with rUTI, it was uncommon to have recurring E. coli UTIs and consistently sensitive uropathogens. Pretreatment urine cultures are important to verify causative uropathogens in this population.

Factors Associated With a Positive Urine Culture in Women Seeking Urogynecologic Care for Urinary Tract Infection Symptoms

“…In women affected by urge urinary incontinence and other urogynecologic diagnoses, the diagnosis of UTI can be challenging given overlapping symptoms, 14 which makes this population a particularly interesting cohort to examine. [8][9][10] Given the mean age of 66.5years, some of these data may not be generalizable to a younger population with reported UTI symptoms. There was a high proportion of patients with a history of rUTI included this study, which may limit the generalizability of these data to a group with spontaneous UTIs.…”

“…The strengths of this study include its prospective design and inclusion of a large group of female patients seen specifically at an academic urogynecology practice for treatment of UTI symptoms. In women affected by urge urinary incontinence and other urogynecologic diagnoses, the diagnosis of UTI can be challenging given overlapping symptoms, 14 which makes this population a particularly interesting cohort to examine 8–10 . Given the mean age of 66.5 years, some of these data may not be generalizable to a younger population with reported UTI symptoms.…”

“…7 It is clear that menopause is a predominant risk factor for rUTI and that the pathophysiology of a single, sporadic UTI in premenopausal women is very different than that of rUTI in older women. 8 Given the symptom overlap between overactive bladder and genitourinary syndrome of menopause, the diagnosis of acute UTI in symptomatic older women should be made using a combination of symptom assessment and urine diagnostic studies. 9,10 Identifying factors associated with positive urine cultures may help to determine which patients would be best served by empiric antibiotics rather than culture-directed antibiotic administration.…”

“…A case-control study involving healthy postmenopausal women found that urinary incontinence, presence of cystocele, a higher urinary postvoid residual volume, history of UTI before menopause, and nonsecretor status were all strongly associated with recurrent UTI (rUTI) 7 . It is clear that menopause is a predominant risk factor for rUTI and that the pathophysiology of a single, sporadic UTI in premenopausal women is very different than that of rUTI in older women 8 . Given the symptom overlap between overactive bladder and genitourinary syndrome of menopause, the diagnosis of acute UTI in symptomatic older women should be made using a combination of symptom assessment and urine diagnostic studies 9,10 …”

Empiric antimicrobial treatment in women with recurrent urinary tract infection

“…To the Editor, In a recent article, Bradley et al 1 compared the bacterial spectrum and antibiotic susceptibility patterns of women with sporadic urinary tract infections (UTI; n = 163) with women with recurrent UTIs (rUTI; n = 102). Their main goal was to use these data to direct empiric therapy or guidance on the necessity of pretreatment urine cultures in the urogynecologic population.…”