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Urinary tract infection (UTI) is one of the most common infections afflicting women. UTI often accompanies vaginal infections and is frequently caused by pathogens originating in the digestive tract. The paper discusses the prevalence of UTI in various patient populations, including postmenopausal, pregnant, diabetic, epileptic, and perioperative female patients. Current UTI treatment and prevention guidelines both for primary and recurring UTIs were reviewed. Antibiotic treatment duration should be minimized, with the exact dosage and time schedule depending on the type of infection. Asymptomatic bacteriuria does not always require antibiotic treatment, because their excessive use may lead to the emergence of antibiotic resistant strains. The role of non-antibiotic prophylaxis of recurrent infections involving immunomodulants (OM-89), probiotics, and behavioural interventions was underlined.
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REVIEW PAPER
DOI: https://doi.org/10.5114/pm.2021.105382
Menopause Rev 2021; 20(1): 40-47
Introduction
Urinary tract infections (UTIs) in women are one of
the most prevalent infections occurring at various stag-
es of life. Women are much more prone to UTIs than
men, mainly due to the female lower urinary tract ana-
tomy and its proximity to the reproductive organs. The
female urethra is relatively short, reducing the distance
for bacterial ingress. Furthermore, it opens into the vul-
var vestibule, i.e. astructure that is also quite prone
to infections, given the prevalence of vulvar vestibu-
litis and vaginitis. In this case, sexual activity as well
excessive use of intimate hygiene products interfering
with natural vaginal microbiome are often to blame.
On the other hand, the proximity of the anus facili-
tates the colonization of both the reproductive organs
and distal parts of the urinary tract by Escherichia coli,
Enterococcus fecalis, and the Streptococcus species. Preg-
nancy and the perinatal period are other characteristic
timepoints marked by frequent urinary tract infections.
The increasing number of caesarean sections and perio-
perative catheterizations are yet another risk factor. In
the post-menopausal period falling oestrogen levels
interfere with the vaginal epithelium, contributing to
its gradual atrophy, while glycogen deficiency reduces
the lactic acid bacteria counts. As aresult, post-meno-
pausal vaginas are often colonized by other bacteria,
mainly Escherichia coli, which may spread and infect
the urinary tract. Pelvic organ prolapse and urinary in-
Urinary tract infection in women
Krzysztof Czajkowski1, Magdalena Broś-Konopielko1, Justyna Teliga-Czajkowska2
1II Faculty and Clinic of Obstetrics and Gynaecology, Medical University of Warsaw, Warsaw, Poland
2Department of Obstetrics and Gynaecology Didactics, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
Abstract
Urinary tract infection (UTI) is one of the most common infections afflicting women. UTI often accompanies
vaginal infections and is frequently caused by pathogens originating in the digestive tract. The paper discusses
the prevalence of UTI in various patient populations, including postmenopausal, pregnant, diabetic, epileptic,
and perioperative female patients. Current UTI treatment and prevention guidelines both for primary and recur-
ring UTIs were reviewed. Antibiotic treatment duration should be minimized, with the exact dosage and time
schedule depending on the type of infection. Asymptomatic bacteriuria does not always require antibiotic treat-
ment, because their excessive use may lead to the emergence of antibiotic resistant strains. The role of non-
antibiotic prophylaxis of recurrent infections involving immunomodulants (OM-89), probiotics, and behavioural
interventions was underlined.
Key words: urinary tract infections, menopause, pregnancy, prevention, treatment.
continence also contribute to frequent UTIs. These are
believed to affect between 30% and 50% of women
above the age of 50 years. It is estimated that every
other woman will have had at least one UTI during
her lifetime [1, 2], with 10–60% of all women having
asymptomatic UTI at least once in their lives [3, 4]. The
infection risk increases with age [5].
Recurring UTIs in women are defined as at least
2 UTIs occurring within a6-month period or at least
3 UTIs in a12-month period. The prevalence of re-
curring UTIs in women is estimated at 25–50% of all
infections [6–9].
Diagnosis
All UTI cases can be classified as either asympto-
matic or symptomatic. An asymptomatic UTI is diag-
nosed based on urinalysis results. Careful sample col-
lection is crucial given the external urethral opening
position in women. The number of leukocytes is the key
criterion utilized in UTI diagnosis; acount > 10 leuko-
cytes/mm3 suggests an infection. In pregnant patients
the cut-off is higher, at > 20 leukocytes/mm3. Sample
contamination by vaginal secretions containing mucus
and lactic acid bacteria may result in erroneous diagno-
sis of multiple mucus threads and abundant bacterial
growth in urine sediment. Sometimes the mucus even
Corresponding author:
dr n. med. Justyna Teliga-Czajkowska, II Katedra iKlinika Położnictwa iGinekologii, Warszawski
Uniwersytet Medyczny, ul. Karowa 2, 00-315 Warszawa, e-mail: jtckcac@gmail.com
Submitted: 19.03.2021
Accepted: 26.03.2021
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yields amistaken diagnosis of proteinuria. Period, post-
partum bleeding, or any other uterine bleeding may
result in sample contamination with red blood cells.
In such cases, adetailed history and abetter-prepared
repeat analysis is necessary. Urinalysis results not ac-
companied by the patient’s symptoms are not suffi-
cient to initiate treatment. Aurine culture can be used
to confirm or disprove ahypothesis of an UTI. The cul-
ture sample should be collected in asterile container
to avoid contamination, preferably from first morning
urine. The presence of 105 colony forming units per
millilitre (CFU/mL) confirms an infection, while an an-
tibiogram will help verify the efficacy of agiven treat-
ment.
In the case of elevated leukocyte values in urine
sediment combined with clinical symptoms, treatment
should be initiated. When dealing with pregnant pa-
tients, it is recommended to take aculture sample at
the start of treatment due to increased risk of prema-
ture birth associated with urinary tract infections as
well as limited antibiotic treatment options compatible
with pregnancy. Typical symptoms will still indicate the
need for treatment. In the absence of abnormal vaginal
discharge and burning sensation in the vulvar vesti-
bule, typical UTI symptoms lead to infection confirma-
tion in as many as 90% of young women [10, 11]. In 15%
of cases, urine cultures are positive in spite of elevated
leukocyte count in the urinalysis [3].
Characteristic patient groups
The main reasons behind the increased prevalence
of urinary tract infections in peri- and postmenopausal
women include hormonal changes (oestrogen insuf-
ficiency) and connective tissue aging (urinary incon-
tinence, pelvic organ prolapse). Factors conducive to
UTIs in the perimenopausal period include urinary in-
continence (impeding proper hygiene), atrophy of vag-
inal mucous membranes (increasing the risk of vaginal
infections that may spread into the urinary tract), and
anterior vaginal prolapse (precluding complete voiding
of the bladder). Prevalence of asymptomatic bacteri-
uria increases in the peri- and postmenopausal period,
reaching levels of 4–19% as compared to 1.5% in pre-
menopausal women [12]. In peri- and postmenopausal
women, oestrogen deficiency may be conducive to both
urinary incontinence and urinary tract infections. Topi-
cal vaginal (but not systemic) application of oestrogens
was proven to significantly reduce the risk of bacte-
riuria (OR = 0.3; 95% CI: 0.13–0.68) [13]. The recom-
mendation of topical oestrogen use in peri- and post-
menopausal patients to prevent UTIs is also included in
guidelines published by research associations [14].
Diabetes constitutes asignificant UTI risk factor for
postmenopausal women [15, 16]. Studies involving ato-
tal of 256,725 females with type 2 diabetes showed sig-
nificantly more prevalent UTI diagnoses starting from
ages 45–49 years onward, with the difference as high
as 100% in the said age range and yet another 80% for
those aged 50–54 years [16]. Another study compared
2 groups of women aged 55–75 years diagnosed with
acute UTI – 901 diabetic patients and 913 controls [15].
Diabetes in postmenopausal women turned out to in-
crease UTI risk twofold (OR = 2.2; 95% CI: 1.5–3.1). Sig-
nificant factors included oral pharmacotherapy or in-
sulin treatment (OR 2.8 and 2.7, respectively) and type
2 diabetes (OR = 2.2). Disease duration and glycaemia
control assessed by glycated haemoglobin HbA1c levels
turned out not to be significant. In patients 57 years
and older, undergoing surgical treatment constitutes
yet another risk factor for UTIs [17].
Diabetes mellitus, uncontrolled in particular, is arisk
factor for both urinary and reproductive tract infections
(involving the vulva, vulvar vestibule, and/or vagina).
Fourteen per cent of women with type 1 diabetes and
23% of women with type 2 diabetes are diagnosed with
UTIs [18]. The most significant risk factors in this group
include glycaemia control and glycosuria. Infections are
also more prevalent in perimenopausal patients with
longer disease duration. In awell-documented trial in-
volving 1357 female patients with type 1 diabetes, in-
creased prevalence was observed for the following: acute
cystitis (OR = 1.46; 95% CI: 1.10–1.95; p = 0.001), acute
vaginitis (OR = 1.20; 95% CI: 1.01–1.42; p = 0.044), and
acute vulvitis (OR = 2.12; 95% CI: 1.56–2.90; p < 0.001)
[10]. In agroup of 241 women with type 1 diabetes, the
most significant risk factors for symptomatic infections
included sexual intercourse, use of oral contraceptives,
and microangiopathy [18]. Urinary incontinence, more
prevalent in diabetic females than in the general pop-
ulation, may be another contributing factor (OR = 1.64;
95% CI: 1.19–2.26; p = 0.001) [10]. In type 2 diabetes,
asymptomatic bacteriuria is more frequent than in
healthy controls (17.5% vs. 10%, p = 0.015). Asympto-
matic bacteriuria may progress to symptomatic UTI in
20% of patients during 6 months [19, 20]. In another
study of 348 women with type 2 diabetes, asympto-
matic bacteriuria also constituted the primary risk fac-
tor for developing asymptomatic infection [18]. It may
also lead to decreased renal function [21]. The available
data suggest that periodic urine cultures in diabetic pa-
tients, in particular those with type 2 diabetes, should
be recommended.
Epileptic patients were also recognized as requiring
more frequent UTI treatment than the general popula-
tion [22], with the problem affecting around 58% wo-
men and 42% diagnosed with epilepsy (p < 0.0001). An
analysis of reasons revealed that the most significant
cause underlying the increased UTI prevalence in this
population were anti-epileptic drugs. Urinary tract in-
fections occurred more frequently in patients using
phenytoin (OR = 1.78; 95% CI: 1.24–2.55; p = 0.001),
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primidone (OR = 1.73; 95% CI: 1.21–2.49; p = 0.002), car-
bamazepine (OR = 1.61; 95% CI: 1.33–1.96; p < 0.0001),
and valproate (OR = 1.52; 95% CI: 1.28–1.82; p < 0.0001),
probably due to their immunomodulating properties.
The said studies suggest the need to carefully plan
thera pies for epileptic patients with recurrent urinary
tract infections.
Another group with elevated UTI risk are patients
with indwelling urinary catheter or those requiring in-
termittent self-catheterization [23]. UTIs occur more
than once a year in 15.4% to 86.6% patients in that
group, with antiseptic product use probably reducing
the risk.
The perioperative period may also be conducive to
urinary tract infections [17]. Age above 57–60 years, dia-
betes, immunosuppressant therapy, obesity, and blood
transfusions due to iatrogenic all constitute additio-
nal risk factors in this case. Preventative administration
of antibiotics to patients catheterized for surgery with
diagnosed asymptomatic bacteriuria significantly re-
duces the risk of progression to symptomatic infection
(RR = 0.20; 95% CI: 0.13–0.31) [24]. Female patients
are catheterized for avast majority of surgeries due to
their reproductive anatomy. In the case of caesarean
sections, the catheter may stay in for afew hours af-
ter block anaesthesia, while with gynaecological proce-
dures it typically stays in for around 24 hours. Surgical
repairs of pelvic organ prolapse are an exception, how-
ever, requiring catheterization for 2–3 days at times.
Pregnancy is accompanied by a series of factors
conducive to urinary tract infections – the urine is
more basic in pregnant women, urine flow obstruction
is more common (especially towards the end of preg-
nancy), as is proteinuria, diabetes, and anaemia. Taking
aurinalysis sample is more difficult, in particular in the
3rd trimester, resulting in protein and bacteria detected
in the samples that do not always signify an infection
– typically these result from sample contamination by
vaginal secretions. Protein may originate from mucus
contamination, but in hypertensive patients it suggests
proteinuria characteristic of preeclampsia. Multiple
bacteria in the field of view when analysing urine se-
diment are typically lactic acid bacteria if the reading
is not accompanied by elevated leukocyte count, with
the latter constituting akey factor for differential diag-
nosis against UTI in apregnant patient. Asymptomatic
urinary tract infections affect 2–8% of pregnant wom-
en [25]. According to other sources, UTIs constitute the
most common infections of pregnancy, diagnosed in as
many as 50–60% of all pregnant women [26]. Research
results suggest an increased prevalence of preterm
birth associated with asymptomatic bacteriuria [27].
UTI is diagnosed more frequently in women with ges-
tation-induced hypertension, and as such it is linked
to increased risk of intrauterine growth restriction,
premature birth, and caesarean section [28]. It must
be remembered, however, that aUTI diagnosis in itself
does not necessitate any specific obstetric intervention.
Recurrent urinary tract infections affect 1 in 4 pregnant
women diagnosed with UTI and lead to pyelonephritis
in 4–5% of cases [25]. UTI in apregnant woman was
also found to constitute asignificant risk factor with
regard to the child’s UTI, at 30% vs. 6.8% (OR = 5.9 at
95% CI: 1.9–18.3; p = 0.001) [29].
Bacteria identification key to therapy
selection
Studies analysing the typology of pathogens cau-
sing urinary tract infections in non-diabetic patients
quote Escherichia coli (69%), Enterococcus sp. (10%),
Klebsiella sp. (4%), Pseudomonas aeruginosa (4%), Pro-
teus sp. (4%), and Staphylococcus sp. (2%) as the most
prevalent bacteria [30, 31]. For diabetic patients, the
most typical pathogens observed were Escherichia coli
(71%), Klebsiella spp (6%), Staphylococcus spp (5%), and
Enterococcus spp (4%) [31]. In pregnant women, urinary
tract infections are usually caused by Escherichia coli
(30.8–90%), bacteria from the Staphylococcus genus
(4.3–32%), Proteus mirabilis (10.2%), Enterococcus fae-
calis (1–8.1%), and Klebsiella pneumoniae (6.1–9.1%)
[25, 26, 32]. In infants, the most common pathogens
included Escherichia coli (65.9%), Klebsiella (14.6%), and
Staphylococci (9.8%) [29].
Antibiotic treatment
French guidelines issued by the French Language
Infectious Pathology Society recommend sequential ad-
ministration of fosfomycin, nitrofurantoin, and quinolo-
nes to treat cystitis, and third-generation cephalospo-
rins to treat pyelonephritis [33].
Antibiotic dosages proposed by international asso-
ciations are included in the Table 1 [14].
Any treatment of pregnant patients with asymp-
tomatic bacteriuria should be targeted, requiring
a urine culture antibiogram prior to treatment initia-
tion. In acute cases treatment should be initiated while
waiting for culture results. Cephalosporins are the drug
of choice in pregnant patients. Kashif et al. [25] suggest
particular caution when treating pregnant women with
nitrofurantoin (because it may cause haemolytic dis-
ease of the foetus), augmentin (necrotizing enterocoli-
tis was observed in foetuses in the 3rd trimester), and
trimethoprim (folic acid antagonist). Between 7 and
10 days after treatment course completion a repeat
urine culture should be taken to confirm treatment ef-
ficacy. Single-dose fosfomycin can be agood treatment
alternative. Ameta-analysis published in 2020 showed
its efficacy to match that of other antibiotics while
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maintaining high safety levels both in pregnant and
non-pregnant patients [34].
Studies by Malmartel et al. [31] analysed the preva-
lence of antibiotic-resistant bacteria causing urinary
tract infections. Resistance to ofloxacin and cefixime
was slightly higher in diabetic patients, see data in
Table 2.
Non-antibiotic prophylactic treatment
immunomodulation
OM-89 is an immunomodulatory drug [11, 36]. It is
effective against Escherichia coli infections, constitu-
ting 70–80% of all urinary tract infections. Women with
recurring urinary tract infections treated with OM-89
for 6 months had atwofold reduced further recurrence
rate (67.3% vs. 32.7%) [37]. Uncontrolled diabetes sig-
nificantly reduced the treatment efficacy, however. In
Table 1. Proposed antibiotic dosage (based on guidelines published by the American Urological Association, Canadian Urological
Association, Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction, and the European Urological Society)
Indication Antibiotic Dosage Treatment duration
Prophylaxis in asymptomatic
bacteriuria; continuous
treatment
Trimethoprim 100 mg 1× aday
Trimethoprim + sulfamethoxazole 40–200 mg 1× aday
40–200 mg 3× aweek
Nitrofurantoin 50–100 mg aday
Cephalexin 125–250 mg 1x aday
Fosfomycin 3 g every 10 days
Prophylaxis in asymptomatic
bacteriuria; periodic treatment
Trimethoprim + sulfamethoxazole 40/200 mg
80/400 mg
Nitrofurantoin 50–100 mg
Cephalexin 250 mg
Uncomplicated cystitis Fosfomycin 3 g For 1 day
Nitrofurantoin 50–100 mg aday For 5 days
Extended-release nitrofurantoin 100 mg 2× aday For 5 days
Pivampicillin 400 mg 3× aday For 3–5 days
Cephalosporins 500 mg 2× aday For 3 days
Trimethoprim + sulfamethoxazole 80/400 mg 2× aday For 3 days
Trimethoprim 100 mg 2× aday For 3–5 days
Complicated cystitis Ciprofloxacin 500–750 mg 2× aday For 7 days
Levofloxacin 750 mg aday For 5 days
Trimethoprim + sulfamethoxazole 160/800 mg 2× aday For 14 days
Cefpodoxime 200 mg 2× aday For 10 days
Ceftibuten 400 mg aday For 10 days
Pyelonephritis, parenteral
therapy
1st line of treatment
Ciprofloxacin 400 mg 2× aday
Levofloxacin 750 mg aday
Cefotaxime 2 g 3x aday
Ceftriaxone 1–2 g aday
Pyelonephritis, parenteral
therapy
2nd line of treatment
Cefepime 1–2 g 2× aday
Piperacillin/tazobactam 2.5–4.5 g 3× aday
Gentamycin 5 mg/kg aday
Amikacin 15 mg/kg aday
Not all antibiotics are available in Poland.
Table 2. Percentage of strains resistant to selected antibiotics
Antibiotic Percentage of resistant strains
In study by
Malmartel [31]
According to
NICE guidelines [23]
Ofloxacin 10.8%
Cefixime 3.8% 9.9%
Trimethoprim,
sulfamethoxazole
16.8% 30.3%
Nitrofurantoin 4.05% 2.5%
Fosfomycin 3.2%
Pivampicillin 7.5%
NICE – National Institute for Health and Care Excellence
amulti-centre double blind study involving 453 women,
a34% reduction of urinary tract infections was observed
after 3 months of initial treatment and a10-day boos-
ter course of OM-89 [30]. The same treatment structure
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was utilized in aretrospective study of 79 patients, with
Escherichia coli identified as the main pathogen in 49%
of the population [11]. Sixty-three per cent of those in-
fected with Escherichia coli and 53% of the whole popu-
lation had apositive response to treatment.
OM-89 efficacy was also confirmed in a study in-
volving menopausal women. Aclinical trial was carried
out with a group of patients aged 66 years on aver-
age. The number of recurrent infections in the group
dropped from 3.4 to 1.8 (areduction of 65%) after the
immunomodulatory treatment [38].
OM-89 oral immunomodulatory treatment for the
prevention of recurring UTIs is recommended both by the
European Association of Urology (EAU) in uncomplicated
UTIs in women (strong evidence, highest recommenda-
tion level, 1a) [12] and by the Polish Association of Urolo-
gy in prevention of recurring urinary tract infections. The
treatment helps reduce the frequency of recurring infec-
tions, patients’ symptoms, antibiotic prescriptions, and
the risk of antibiotic resistance [39]. To prevent recurring
UTIs, OM-89 is administered once aday before ameal,
for atotal of 90 days. The drug can be used in parallel
with antibiotic treatment during the acute phase of an
infection, without prior urine culture results, because it
induces astrong immune response not only to E. coli, but
also to other pathogens causing UTIs.
OM-89 is characterized by the highest level of
evidence of all non-antibiotic methods of UTI preven-
tion [12].
Other non-antibiotic methods
of prevention
In accordance with the 2017 Cochrane database
analysis [40], the impact of probiotics on reducing uri-
nary tract infections in patients with bladder function
disorders requires further research.
In vitro studies have shown that cranberry juice re-
duces adherence of Escherichia coli bacteria to the uri-
nary tract and vaginal epithelium [41, 42]. As aresult,
patients’ symptoms associated with bacterial irritation
should be relieved. Reduced symptom levels, however,
are not equivalent to infection eradication. Prospec-
tive randomized trials with women aged 18–45 years
did not detect any statistically significant difference in
UTI prevalence diagnosed by urine cultures between
groups drinking cranberry juice and those drinking pla-
cebo [43]. Similar conclusions were presented in aCo-
chrane analysis published in 2012 [44].
Treatment of chronic urinary tract infections and
preventing further recurrences is yet another challenge.
D-mannose was found to be efficient in preventing re-
curring UTIs by reducing bacterial adherence to urinary
tract epithelium. Ameta-analysis published in 2020 in-
cluded 8 papers overall, but the final results were based
on data from merely 163 patients [35]. The results are
promising, but further research is necessary to deter-
mine the optimum dosage and treatment duration.
Antibiotic prophylaxis
Some doctors recommend long-term prophylactic
use of antibiotics in women with recurring urinary tract
infections. ACochrane meta-analysis indicated positive
outcomes of prophylactic use of antibiotics in young
women with recurring UTIs [45]. Results published by
Ahmed et al. [46], however, show that long-term antibio-
tic prophylaxis had positive outcomes in patients aged
65 years and above only when continued for more than
2 years. The patients received nitrofurantoin, cephale-
xin, or trimethoprim. The treatment reduced the fre-
quency of recurring symptomatic urinary tract infections
(OR = 0.57; 95% CI: 0.55–0.59) and the need for ad-
ditional antibiotic prescriptions (OR = 0.61; 95% CI:
0.59–0.62). At the same time, asmall but statistically
significant increase of hospitalizations due to UTIs was
observed (OR = 1.16; 95% CI: 1.05–1.28).
According to EAU guidelines, antibiotic prophylaxis
should be introduced when neither behavioural inter-
ventions nor non-antibiotic prevention is successful.
International and domestic
recommendations
According to American Urological Association (AUA),
Canadian Urological Association (CUA), and Society of
Urodynamics (SUFU), Female Pelvic Medicine, and Uro-
genital Reconstruction guidelines, most recommenda-
tions are classified as level B or C [14]. Diagnosis of recur-
ring UTI should always be confirmed by aurine culture.
Prior to treatment initiation, the practitioner should re-
view urinalysis and urine culture results. In case of very
severe symptoms, however, antibiotic treatment may
be initiated while waiting for laboratory test results. As-
ymptomatic bacteriuria should not be treated; it does
not necessitate urinalyses or urine cultures, either. Anti-
biotic treatment of symptomatic UTI (with nitrofuranto-
in, trimethoprim-sulfamethoxazole, and fosfomycin as
the first line of treatment) should follow the results of
an antibiogram. Antibiotic treatment should not exceed
7 days, and it may be administered parenterally when-
ever required. If symptoms recede, no post-treatment
laboratory tests are required. If symptoms persist, are-
peat urine culture should be carried out to guide further
treatment. Topical vaginal administration of oestrogens
is recommended in post- and perimenopausal women
(unless there are contraindications). In accordance with
the WHO plan to counteract inducing excessive antibi-
otic resistance, the aforementioned research associa-
tions permit prophylactic use of cranberry and other
alternative therapies.
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European Association of Urology guidelines are com-
plete with anote providing acurrent literature review
[12]. The strength levels of the recommendations were
also provided. The authors recommend not diagnosing
or treating asymptomatic bacteriuria with the exception
of pregnant patients (weak recommendation) and pa-
tients with discontinuity of mucous membranes of the
bladder (strong recommendation). When considering
an uncomplicated urinary tract infection, the diagnosis
should be based on clinical symptoms in the absence of
vaginal infection. Urinary culture is recommended only
when considering adiagnosis of acute pyelonephritis,
dealing with pregnant patients, and women with uncon-
ventional presentation of symptoms or symptoms not
receding within four weeks after treatment completion.
The first line of treatment should include fosfomycin,
pivampicillin, or nitrofurantoin. Treatment of uncompli-
cated cystitis with aminopenicillins or fluoroquinolones
is not recommended (strong recommendation). The
authors indicated that using test strips to diagnose un-
complicated cystitis carried low strength of evidence.
Diagnosis of recurring UTI must be confirmed by urine
culture with antibiogram. Non-antibiotic prevention of
recurring infections should involve, as the first line of
treatment, behavioural interventions and OM-89 im-
mune system stimulation.
Antibiotic prophylaxis is only recommended in the
case of UTI recurring in spite of non-antibiotic preven-
tion – antibacterial prophylaxis after sexual intercourse,
periodic short-term antibacterial treatment in women
for whom the treatment was successful (strong recom-
mendation). At the same time, the recommendation
to treat postmenopausal women with oestrogens and
introduce behavioural modifications, and the wide use
of imaging technologies in women with uncomplica-
ted cystitis was classified as weak in terms of evidence.
Urinalysis (laboratory based or strip test), urine culture,
and imaging are recommended in all cases of pyelo-
nephritis. The authors of the guidelines recommend
treatment of uncomplicated pyelonephritis with short
courses of fluoroquinolones and hospitalization only in
the case of parenteral antibiotic administration, until
the patient can be converted to an oral route. At the
same time, treatment with nitrofurantoin, fosfomycin,
or pivampicillin is not recommended (strong recom-
mendation). In the case of complicated recurring pyelo-
nephritis, aminoglycosides combined with amoxicillin
or second-generation cephalosporin is recommended.
Another option is intravenous treatment with third-gen-
eration cephalosporin in the case of generalized symp-
toms emerging. Ciprofloxacin is only recommended
for oral treatment of cases that do not require hospi-
talization, or for patients with known allergies to the
other available antibiotics. Ciprofloxacin and other flu-
oroquinolones are contraindicated if the patient has
received them in the past 6 months (strong recommen-
dation). The authors do not recommend routine antibio-
tic treatment in patients after catheter removal.
The British committee National Institute for Health
and Care Excellence guidelines published in 2020 dis-
cuss treatment of lower urinary tract infections [47].
Outside of pregnancy, a3-day treatment course is as ef-
fective as 5-day or 10-day courses. In older women, the
treatment may continue for 3 to 6 days. Nitrofurantoin
or trimethoprim is the recommended first-line treat-
ment, with fosfomycin or pivampicillin constituting the
second line of treatment. Pregnant patients should be
treated for 7 days, making sure that, prior to treatment
initiation, no antibiotic resistance to the selected drug
has been observed in the past. Drugs recommended in
cases of asymptomatic bacteriuria include nitrofuran-
toin, amoxicillin, and cefalexin, and in the case of symp-
tomatic infections – amoxicillin or cefalexin.
Polish guidelines for the diagnosis, treatment and
prevention of urinary tract infections in adults were de-
veloped in 2015 under the National Antibiotic Protec-
tion Program [48]. Asymptomatic bacteriuria requires
treatment with antibiotics only during and before sur-
gery of the urinary system. Treatment of acute uncom-
plicated cystitis in young women can be undertaken
based on clinical symptoms. In such cases the diagnosis
does not require laboratory test results, such as urine
sediment test or urine culture. Most patients may re-
ceive outpatient treatment. According to the guidelines,
evidence-based treatment of uncomplicated cystitis
should not involve fluoroquinolones. These should be
limited to treatment of complicated or severe cases. In
the case of recurrence, aurine culture should be taken
together with evidence-based antibiotic treatment ini-
tiated while waiting for laboratory test results. In the
case of complicated UTIs, the following tests should
be carried out: urinalysis, blood panel, CRP, creatinine
concentration, GRF, and urine culture. Treatment should
be modified in line with antibiogram results. Acute py-
elonephritis diagnosed based on clinical presentation
should always be confirmed by aurine culture, accom-
panied by a blood culture for more severe cases. Ini-
tial evidence-based treatment should be modified to
account for culture results. For pregnant patients, the
authors recommend aurine culture in the first trimes-
ter of pregnancy, to prevent pyelonephritis and prema-
ture birth risk. In the case of cystitis in the patient’s
history, repeat urine cultures should be taken every
1–2 months. Fluoroquinolones are contraindicated
throughout the pregnancy, and co-trimoxazole should
not be used in the first trimester.
Conclusions
Urinary tract infection is one of the most common
infections afflicting women. UTI occurs in females at
any age, with the highest prevalence in pregnant and
M R/P M 20(1) 2021
46
postmenopausal patients. UTI often accompanies vagi-
nal infections and is frequently caused by pathogens
originating in the final section of the digestive tract. An-
tibiotic treatment duration should be minimized, with
the exact dosage and time schedule depending on the
type of infection.
Asymptomatic bacteriuria does not always require
antibiotic treatment, because their excessive use may
lead to the emergence of antibiotic resistant strains.
When dealing with chronic infections and asympto-
matic bacteriuria, alternative treatment to reduce the
risk of recurrence should always be considered.
For recurrent urinary tract infections, non-antibiotic
prevention is recommended as the first line of treat-
ment, based on behavioural interventions and immune
system modulation.
Disclosure
The authors report no conflict of interest.
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... Women are more predisposed to UTIs compared to men, mainly because of the anatomy of the female lower urinary tract and its proximity to the reproductive organs and anus. The female urethra is shorter in length than that of men, which shortens the distance bacteria must travel to enter and proliferate (Czajkowski et al., 2021). ...
... In acute situations, it is necessary to initiate treatment while awaiting culture results. A new urine culture should be performed on day 7 to 10 of treatment to evaluate and confirm that the treatment has been effective (Czajkowski et al., 2021). ...
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Urinary tract infections (UTI) are one of the most common infections in pregnant women, however, the management is not always the most appropriate, causing complications in both mother and child, one of the aspects to consider in this work is low birth weight, which is considered any newborn with less than 2.5 kg regardless of gestational age at birth. There are studies that support the relationship between these two entities, but there are still some challenges to diagnose and treat them correctly. This research work aims to improve the understanding of the relationship between UTIs and low birth weight in a newborn, as well as the various treatments we currently have.
... Recurrent UTIs in women are defined as at least 2 UTIs occurring within a 6 month period or at least 3 UTIs in a 12 month period. The prevalence of recurrent UTIs in women is estimated at 25- [5] 50% of all infections . Most of the community acquired uncomplicated urinary tract infection (80%) is caused by either Escherichia coli or Staphylococcus saprophyticus especially among [6] women under the age of 50 years . ...
... A minority of the participants (6.7%) did not know about it. When asked about the correct urinary microscopic interpretation of UTI ,40% of the 3 participants answered that its 10 CFU/mL uro pathogens on mid stream urine in uncomplicated acute cystitis of women followed by 2 those who answered that its 10 CFU/mL uro pathogens on mid stream 5 urine of men and 22.0% of the participants answered that its 10 CFU/mL uro pathogens on mid stream urine of women On the practice that pregnant women should be recommended for bacteriuria screening in every antenatal care, 68.7% of the participants answered 'yes' while 22.0% disagreed and 9.3% did not know about it. On the management question 27.3% of the participants advised 7 days regimen of Amoxycillin -clavulanate 1 gm PO q 12 hourly for Symptomatic or asymptomatic cystitis among female patients while 25.3% suggested 7 days regimen of Nitrofutantoin 100mg PO Q 12 hourly and 24.0% were of the opinion that 7 days regimen of Cefuroxime 500mg PO Q 12 hourly should be given However 13.3% and 10.0% agreed with all these treatment and none of these treatment respectively. ...
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The play a crucial role for the prevention , management ,referral and follow up of the cases suffering from UTIs. Studies have shown that lack of general physicians' time, lack of depth of knowledge and miscommunication between patients and General physicians and non availability of previous antibiotic therapy has played an adverse effect on the management of UTIs. The present study will be conducted in Al Ahsa region of Saudi Arabia to assess the Knowledge, attitude and practice of the family and general physicians working at different primary health care centers. Materials And Methods: It was a cross sectional survey. The study population was all the physicians working at different ministry of health operated primary health care centers of Al Ahsa region of Saudi Arabia. The study sample was calculated by Epi info software which was at least 150 physicians. The sampling was done by stratified sampling.The data were collected on a pretested, pre designed and self-administered questionnaires which were made available to the participants on google form (online). The collected data were cleared, coded, entered and analyzed by the SPSS version 26. Descriptive statistics were presented using counts, proportions (%), mean ± standard deviation whenever appropriate. The association of demographic characteristics of the participants with the knowledge and practice towards UTI among women was performed using chi square test. .A p-value cut off point of 0.05 at 95% CI was used to determine statistical significance. Results: A total of 150 physicians working at different primary health care centers p participated in this study The mean age of the participants was 36.13 years. The majority of the participants were female (56.0%). Thirty-four percent of the participants were graduate while 44.7% were postgraduate diploma and 21% were postgraduate degree holder. Thirty-four percent of the participants were residents while 45.3% were general physicians and 14.7% were family physician specialist and only 6% were family physician consultant. Majority of the physicians (75.3%) working at the primary health care centers located in the urban area. The mean score of knowledge was 5.84. Majority of the participants (56.7 %() had good know ledge regarding the UTI. The knowledge regarding the Urinary tract infections clinical features, causative organism and epidemiology of the female physicians was significantly higher than their male counterpart (63.10% vs. 48.48, P=0.05). As educational level increased the knowledge regarding UTI also increased. The physician with post graduate degree had higher knowledge than those with diploma and graduate degree (65.62% vs.59.70 vs.47.59, P=0.02).). The family physician specialist had better knowledge regarding UTI than general physician family physician consultant and family physician resident but it was not statistically significant. The mean practice score was 2.38. Fiftysix percent of the physician had poor practice while only 44% had good practice. The good practice score towards the management of UTI was higher among the male physician as compared to their counterpart female but it was not statistically significant (49.23 % vs.40.47% n, P=0.27). The good practice towards the management of UTI was higher among the physician with graduate degree than those with postgraduate diploma and postgraduate degree but it was not statistically significant (60.78% vs.49.25% vs.37.5%, P=0.481). 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... Urinary tract infections (UTIs) are one of the most prevalent infections among women in all age groups. This can be attributed to the female anatomical structure of a shorter urethra that is externally open to the vulvar vestibule close to the vaginal opening [1]. There was an estimated 404.61 million UTI cases and 236,790 deaths due to UTIs in 2019 recorded globally. ...
... Table 2. Top five most prescribed antibiotics and AMR rates among participants exposed to multiple antibiotics. 1 Antibiotics exposure was investigated based on the number of prescriptions given to participants and grouped as follows: 1, 2, 3, 4, and 5 or more antibiotics. TMP-SMX: Trimethoprim-Sulfamethoxazole. ...
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... Yersinia enterocolitica causes enterocolitis (inflammation of the intestine) and ileitis (inflammation of the small intestine) in humans (Fang et al., 2023). Escherichia coli is the most common cause of urinary tract infection, accounting for 90% of urinary tract infections in young women (Czajkowski et al., 2021). ...
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... In available literature, it has been reported that urinary tract infections are rare or uncommon in horses (Frye 2006;Scala et al. 2023). The detection of nitrites in the urine of significantly higher number of female horses when compared to males concurs with earlier reports that urinary tract infections are usually more common in females than males; this has been attributed to the female urinary tract anatomy (shortness of the urethra that makes it easier for bacteria to get into the bladder) and its proximity to the reproductive tract/organs and also to hormonal effects of] high levels of oestrogens that occur in females relative to males (Johnson 1991;Foxman and Brown 2003;Ober et al. 2008;Czajkowski et al. 2021;Deltourbe et al. 2022). ...
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... The sex differences in the affected individuals can be explained by increased prevalence of smoking and peripheral neuropathy in men, which increases risks of amputations (42) and epidemiological prevalence of FG in men (43). The female majority for fractures and urogenital fungal infection can be explained by the overall lower bone mineral density (44), the higher incidence of urogenital fungal infection, and the shorter urethra in women (45). Male patients on SGLT2 inhibitors should be warned of the side effects of FG and amputations, and female patients should be warned of the adverse event of fungal urogenital infections and bone fractures. ...
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... The resulting PCR products were then subjected to electrophoresis on a 2% agarose gel, then gel image was performed using a Gel Doc device from Cleaver Scientific/ Uk, and the PCR bands were observed and photographed under the influence of UV rays at a wavelength of 430 nm. The most common infected was found in female as (58%) rather than male (42%) on the other hand the study found the prevalence of K. pneumonia was increased in male have sexual partners as Polygamy mirage (71.42%) compare with female (6.89%), the present study noticed that the infection in women was in women who were not related to multiple marriages, and one of the reasons that played a major role in the increased infection in women compared to males is the small size of the urethra [12], as well as hormonal fluctuations, particularly in women, can affect the pH balance and natural defenses of the urinary tract, making it more susceptible to bacterial colonization and infection [13]. ...
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Background: Klebsiella pneumoniae is one of the most common causative agents of nosocomial infections. Opportunistic pathogens can generate a thick layer of biofilm as an important virulence factor. Objectives: The current study was aimed in the detection of biofilm formation in Klebsiella pneumoniae pathogenic capability as a common opportunistic pathogen accounting pneumonia, urinary tract infections, with in nosocomial infections. 248 patients with bacterial infections were analyzed. The identification of Klebsiella pneumoniae isolates was performed using selective culture media and biochemical tests. Additionally, biofilm strains were characterized using the Crystal Violet assay and polymerase chain reaction (PCR) techniques. Results: Among the 140 samples collected from various specimens, a total of 100 isolates (43.47%) were identified as Klebsiella pneumoniae culturing and biochemical tests. Out of these isolates, 58 (58%) were obtained from male individuals, while 42 (42%) were obtained from female individuals. Using the phenotypic method, the analysis revealed that 18% isolates were classified as strong biofilm producers, 33% as medium biofilm producers, 49% as weak biofilm producers, and 30 as non-biofilm producers. The frequency of specific genes in the isolates was reported as follows: wzm (47%) and markA (69%). Conclusion: The presence of the markA gene is significant in the context of biofilm formation in Klebsiella pneumoniae strains, as it serves as a marker for distinguishing various types of biofilms.
... It is responsible for roughly 95% of community-acquired UTIs and 80% of simple UTIs. The current paradigm for managing UTIs combines antibiotic medication with lifestyle modifications [2][3]. ...
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Introduction. Prolonged antibiotic usage can lead to modifications in the normal gastrointestinal tract and vaginal microbiome, which contributes to the UTI recurrence. This study aims to assess the impact of non-antibiotic therapies compared to antibiotic interventions in the prevention of recurrent urinary tract infections (UTIs). Methods. A systematic literature search was carried out from the PubMed, Google Scholar, Cochrane, and ScienceDirect databases published from 2013–2023, adjusted for inclusion and exclusion criteria. Keywords and Medical Subject Headings (MeSH) used were urinary tract infection, UTI, recurrent UTI, antibiotics, anti-bacterial agents, antimicrobial versus non antibiotic agents, probiotics, cranberries, D-mannose, vitamins, NSAID, prevention, treatment. The RevMan 5.3 program was used to analyze the risk of recurrent UTIs. Forest plot analysis was used to present relative risk estimates from individual studies and combined meta-analysis results. Results. Six studies were deemed eligible for quantitative synthesis and were included in this meta-analysis. This meta-analysis study showed a large heterogeneity, with p= 0.006 and I²= 85%. Pooled analysis using a fixed effect model showed the development of recurrent UTI was significantly lower in women with symptomatic UTI who were given non-antibiotic interventions compared to antibiotic interventions, with a relative risk of 0.75 (95% confidence interval (CI)= 0.61–0.92). This shows that non-antibiotic interventions significantly reduce the incidence of recurrent UTI compared to antibiotic interventions. Conclusion. Non-antibiotics interventions such as cranberry extract, D-mannose, NSAIDs, and herbal medicines can prevent recurrent UTI, and the results appear to be better or the same as antibiotic interventions. Meta-analyses should consider small numbers of studies with varying study designs and quality as well as small overall sample sizes. Keywords: antibiotics, intervention, non-antibiotics, prevention, recurrent urinary tract infection
... Candida species are an infrequent cause of urinary tract infections (UTIs) in healthy persons but are common in hospital settings or among patients with predisposing illnesses and anatomical abnormalities of the kidney and collecting system [1]. Uri-nary tract infections are more prevalent in women than in males due to the genitourinary system's anatomical structure and closeness to the anus [2]. The clinical appearance of a urinary tract infection depends on the type of causative agent, the severity of the disease, and the immune response of the infected person [3]. ...
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Background. In recent years, there has been a rise in the occurrence of urinary tract infections (UTIs) caused by Candida pathogens. This increase is attributed to the growing resistance of these pathogens to antifungal drugs often used for their treatment. Many virulence factors encoded by virulent genes, which enable opportunistic Candida to invade host tissues and cause infection, for survey the existence of SAP9 andSAP10 genes with determine some virulence factors and antifungal susceptibility profiles among Candida species isolated from women suffering from urinary tract infections. Methods. For this investigation, urine specimens were gathered from female individuals residing in Thi-Qar Province, located in southern Iraq, over the period spanning from December 2022 to March 2023. The identification of all isolates was performed using several laboratory techniques, including assessment of colony characteristics on culture media, Gramme staining, germ tube formation, and analysis of morphological chromatic features on chromogenic agar. The identification was further validated using PCR analysis. All isolates were assessed for their production of extracellular secretory proteinase and hemolysin. Additionally, they were tested for antifungal activity using the disc diffusion method. The DNA was isolated, and the PCR technique was employed to identify the presence of virulence genes (SAP9 and SAP10). Results. A total of 50 Candida species isolates were collected from 150 urine samples. These isolates belonged to four different species within the Candida genus. The most found species was C. albicans, accounting for 54% of the isolates. This was followed by C. krusei at 24%, C. glabrata at 16%, and C. tropicalis at 6%. Proteinase activity was observed in 84% of Candida isolates. All Candida isolates exhibit positive hemolysin production with varying degrees of intensity. Among Candida species showed high resistance to Itraconazole (86%) and Clotrimazole (76%). The prevalence of SAP9 and SAP10 genes among Candida albicans was 62.69% and 100%, respectively. Conclusions. The present study highlights the prevalence of SAP genes and virulence factors with antifungal susceptibility which reflect high pathogenicity of Candida species.
... Diverse etiological agent, bacterial -Escherichia coli, Klebsiella species, Pseudomonas species, Proteus species, and the most common fungal pathogen Candida albicans, are responsible for UTI in young children to all ages adults, especially diabetic women [1]. The extensive use of antibiotics has developed antimicrobial resistance among microorganisms, one of the top 10 global public health threats facing humanity, as declared by the World Health Organization. ...
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Objective: The current study is proposed to evaluate the potential medicinal value of Ulva lactuca an edible green seaweed. The prime objectives of the research were to determine the anti-oxidant, anti-microbial, and anti-cancer properties of the seaweed extracts and green synthesized nanoparticles. Methods: Five different solvent extracts were qualitatively and quantitatively analyzed for phytochemicals. A gas chromatography-mass spectrophotometer (GC-MS) analyzed the metabolite profile of the methanol extract. In-vitro anti-oxidant activity is determined by 1-diphenyl 2-picrylhydrazyl (DPPH) and ABT assay. The Resazurin method tested the anti-microbial activity against two uropathogenic bacteria and one fungal pathogen. HeLa cell line was employed to investigate the anti-cancer potential of the seaweed conjugated nanoparticle. Results: Qualitative analysis revealed the presence of Alkaloids, Phenol, flavonoids, tannins, steroids, carbohydrates, glycosides, amino acids, and proteins. The metabolite profiling of methanol extract was identified by GC-MS analysis. Quantitative estimation exposed total flavonoid content of 2.56±0.30 mg quercetin equivalent/g, total phenolic content −3.66±0.15 mg gallic acid equivalents/g, Tannic acid equivalent – total tannin content (TTC) of 2.90±0.61 mg/g and 3.40±0.30 mg/dL of steroids. EAE, ME, and HE recorded the following IC50 for DPPH −871 μg/mL, 432.264 μg/mL, and 432.273 μg/mL, respectively. In ABTs, AE, ME, and EAE showed the highest activity at IC50 values of 39.090 μg/mL, 104.43 μg/mL, and 252.491 μg/ mL. MIC of Ulva NP against Escherichia coli −250 μg/mL, Candida albicans −500 μg/mL, and Acinetobacter baumannii −1000 μg/mL was depicted. The cytotoxicity nature of UAgNPs is observed in HeLa cell lines. The screening results reveal that the edible green seaweed U. lactuca can be further studied and extended as a potential source of components in controlling Urinary tract infection (UTI) and a drug of choice for cervical cancer. Conclusion: The current study highlights the antimicrobial, antioxidant, and anticancer properties of green seaweed U. lactuca, a potential source of pharmaceutical application.
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Background and aims Asymptomatic bacteriuria (ASB) is more prevalent in diabetes mellitus (DM) patients than non diabetics, but its significance is not fully known. This study was done to estimate the prevalence, clinical profile, risk factors and follow up of ASB in type 2 diabetes (T2D) patients compared with matching healthy controls. Methods Prospective, case-control study involving 400 T2D patients without symptoms of urinary tract infection (UTI) and 200 age and sex matched healthy controls. Apart from clinical and biochemical parameters, samples for urine examination and culture were taken from all the subjects. ASB was defined as ≥10⁵ colony-forming units/ml of one or two organisms in the absence of symptoms of UTI. Results The prevalence of ASB was significantly higher in T2D (17.5%) as compared to controls (10%). E. coli was the most common organism. On multivariate analysis, postmenopausal state, prior history of UTI, uncontrolled diabetes and longer duration of disease were associated with increased risk of ASB. Presence of ASB was significantly associated with symptomatic UTI at the 6-month follow up without deterioration of renal parameters. Conclusions Asymptomatic bacteriuria was more prevalent in people with diabetes than those without diabetes. The presence of ASB may be considered a risk factor for subsequent symptomatic UTI on follow up but has no adverse effect on kidney function.
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Background Antimicrobial agents are among the most commonly prescribed drugs in pregnancy due to the increased susceptibility to infections during pregnancy. Antimicrobials can contribute to different maternal complications. Therefore, it is important to study their patterns in prescription and utilization. The data regarding this issue is scarce in Saudi Arabia. Therefore, the aim of this study is to generate data on the antimicrobial agents that are most commonly prescribed during pregnancy as well as their indications and safety. Methods This is a retrospective study focusing on pregnant women with a known antimicrobial use at Johns Hopkins Aramco Healthcare (JHAH). The sample included 344 pregnant women with a total of 688 antimicrobial agents prescribed. Data was collected on the proportion of pregnant women who received antimicrobial agents and on the drug safety during pregnancy using the risk categorization system of the U.S. Food and Drug Administration (FDA). Results The results showed that urinary tract infections (UTIs) were the most reported (59%) infectious diseases. Around 48% of pregnant women received antimicrobial medications at some point during pregnancy. The top two antimicrobial agents based on prescription frequency were B-lactams (44.6%) and azole anti-fungals (30%). The prescribed drugs in the study were found to be from classes B, C and D under the FDA risk classification system. Conclusion The study revealed a high proportion of antimicrobials prescribed during pregnancy that might pose risks to mothers and their fetuses. Future multicenter studies are warranted to evaluate the rational prescription of antimicrobial medications during pregnancy.
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Vitamin D deficiency is a pandemic problem and an ever-increasing problem in human nutrition and health. Vitamin D (serum 25-hydroxyvitamin D) deficiency causes many health problems such as autoimmune diseases, Crohn’s disease, diabetes, inflammation, asthma, hypertension, and cancer. Vitamin D3 (cholecalciferol) deficiency has been documented as a persistent problem among adults, children, and elderly persons in most of the countries. Our main objective of this study was to determine the hypothesis of the vitamin D deficiency among women with urinary tract infection can be as a risk factor. Vitamin D has a potential role in immune regulation and prevents infection especially in urinary tract infections (UTI). Therefore it has positive regulatory role in both acute and recurrent infection specially in women of reproductive ages, as women at these age group have specific differences in their urinary tract and the reproductive organs anatomy, make them more prone for micro-organisms invasion, The present study was carried out to ascertain relation between serum 25-hydroxyvitamin D levels and UTI in women while contemplating the significance of knowing the risk factors associated with UTI and to avoid serious complications. 75 women with (case group) UTI were differentiated with 35 healthy with no UTI (control group) women in terms of serum 25-hydroxyvitamin D levels in a case control study. The women were between at 17-52 years of age. Using ELISA, Serum 25-hydroxyvitamin D levels were measured. Analysis and comparison of the results were done among the two groups. Vitamin D mean levels in the case group was considerably lower when in comparison with the control group (11.09 ± 7.571 ng/mL vs. 24.08 ± 11.95 ng/mL, P<0.001).
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Introduction: This systematic review and meta-analysis investigated the efficacy and safety of single-dose fosfomycin tromethamine (FT) versus other antibiotic agents in women suffering from lower uncomplicated urinary tract infection (uUTI) and pregnant women with uUTI or asymptomatic bacteriuria (ASB). Methods: MEDLINE, EMBASE and the Cochrane library were searched to identify relevant literature. Twenty-one studies were identified. Nine of the 21 studies enrolled 21 22 patients and were used to compare the clinical resolution of uUTI between non-pregnant and pregnant women. Given that uUTI and ASB are assessed using similar microbiological evaluation methods, all 3103 patients in the identified 21 studies were pooled to determine microbiological resolution between uUTI or ASB patients. Safety outcomes of the treatments were analysed in 15 studies. Results: The results showed that single-dose FT was comparable with other antibiotic agents in clinical resolution of uUTI (OR 0.89; 95% CI 0.71-1.10; P = 0.41) in non-pregnant (P = 0.32) and pregnant women (P = 0.64). Moreover, single-dose FT was equal to other antibiotics in microbiological resolution, and there was no difference in overall microbiological resolution (OR 1.11; 95% CI 0.92-1.34; P = 0.29) among non-pregnant women with uUTI (P = 0.48), pregnant women with uUTI (P = 0.81) and pregnant women with ASB (P = 0.30). There were no serious fosfomycin-related adverse events and most frequent adverse events were mainly gastrointestinal. Conclusion: This meta-analysis suggests that single-dose fosfomycin tromethamine produces equivalent clinical outcomes to comparator antibiotics in terms of clinical efficacy and microbiological efficacy. It is therefore clinically effective and safe for women with uUTI and pregnant women with uUTI or ASB, and has higher patient compliance.
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Objective This systematic review had two aims. First to identify the incidence of urinary tract infection (UTI) and bacteriuria in people undertaking intermittent catheterisation (IC), second to determine the effectiveness of antiseptic cleaning of the meatal area prior to IC in reducing the incidence of UTI and bacteriuria. Design A systematic review was conducted. Methods Medline and the Cumulative Index to Nursing and Allied Health Literature electronic databases were systematically searched between 1st January 1990 and 31st January 2020, to identify studies that reported either the incidence of UTI or bacteriuria or the impact of using antiseptics for meatal cleaning prior to IC on incidence of these same outcomes. Results Twenty-five articles were identified for the first aim, two articles for the second. The proportion of participants experiencing ≥1 UTIs per year ranged from 15.4% to 86.6%. Synthesis of these studies suggest a combined incidence of 44.2% [95%CI 40.2-48.5%] of participants having ≥1 UTIs per year. One of the two studies exploring the benefit of antiseptics in reducing UTI suggest some potential benefit of using chlorhexidine in reducing UTIs. Both studies have significant limitations, making interpretation difficult. Conclusion A large proportion of people undertaking IC in the community have UTIs each year. Evidence on the role of antiseptics in the prevention of UTI for people who undertake IC remains unclear.
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Obstetricians should remain aware of physiological adaptations that the urinary tract undergoes in pregnancy. This altered physiology makes pregnant women susceptible to increased risk of urological complications such as acute infection and urinary retention. Close anatomical proximity between gynaecological and urinary system makes the urinary bladder and ureters prone to iatrogenic injury during caesarean section, and this may result in long term sequalae. This review article provides an overview of presentation and management of common Urogynaecological conditions that may be encountered in pregnancy.
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Aim The aim of this study was to analyze the association between antiseizure medication (ASM) and the risk of urinary tract infections (UTI) in patients with epilepsy treated in general practices in Germany. Methods This study includes a total of 2201 patients (mean age: 61.4) whose first documented UTI diagnosis occurred between January 2015 and December 2019 (index date) and who were prescribed at least one ASM in 1198 general practices in Germany within one year prior to the index date. Based on a case–control design, the association between predefined criteria and UTI was investigated by matching (1:1) controls without UTI to cases with UTI by sex, age, and codiagnoses. Logistic regression models were used to analyze the association between ASM use and UTI risk. Results In the first regression model, phenytoin (PHT), primidone, carbamazepine (CBZ), and valproate (VPA) were associated with an increased risk of UTI. In the second model, these associations were confirmed with effects per prescription for PHT, primidone, CBZ, and VPA use. Additionally, the effect per prescription was significant for oxcarbazepine (OXC), topiramate, and gabapentin. Conclusion The study found that PHT, primidone, CBZ, and VPA in particular are associated with an increased risk of infections of the urinary tract. Oxcarbazepine, topiramate, and gabapentin are also associated with increased risk of UTI, albeit to a less significant extent. In general, the immunological and hematological side effects of these molecules may play an important role in the development of UTI under anticonvulsant therapy.
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Aim: Type 1 diabetes can lead to various long-term complications including macro- and microvascular disorders and osteoporosis. However, published data on the association between type 1 diabetes (T1D) and urinary system and genital tract disorders is limited. The aim of this work was to estimate the prevalence and incidence of urinary system- and genital tract disorders among women with T1D treated in gynecological practices in Germany. Methods: This retrospective cohort study included women aged 16 years or older with T1D diagnosis between January 2015 and December 2018 from 268 gynecological practices in Germany (IMS Disease Analyzer database). T1D patients were matched 1:5 by age and physician with non-diabetic patients. The main outcome of the study was the prevalence of different urinary system, pelvic organ and genital tract disorders documented between the first documentation of T1D diagnosis and the last outpatient visit. All study disorders were included as dependent variables in multivariate logistic regression models, while T1D was applied as an impact variable. In each model, the effect of T1D on the defined disorder was adjusted for all other study disorders. Results: The present study included 1357 women with and 6785 women without T1D (mean age 45.6 years). T1D was significantly associated with acute vulvitis (OR: 2.12 (95% CI: 1.56-2.90), other specified urinary incontinence (OR: 1.64 (95% CI: 1.19-2.26), acute cystitis (OR: 1.46 (95% CI: 1.10-1.95), and absent, scanty and rare menstruation (OR: 1.37 (95% CI: 1.13-1.67). Conclusion: These findings may have implications for the future care of women with T1D. Firstly, the focus should not be on diabetes management alone, but also on identifying and handling additional associated comorbidities including urinary system and genital tract disorders. Secondly, the data suggest that patients with T1D should be asked specifically about symptoms they may be experiencing that are related to the associated disorders identified.
Article
Background Establishing clear risk factors for complications such as Urinary Tract Infection (UTI) following arthroplasty procedures helps guide clinical practice and provides more information to both surgeons and patients. This study aims to assess selected preoperative patient characteristics as risk factors for postoperative UTI following primary Total Hip Arthroplasty (THA) and Total Knee Arthroplasty (TKA). Methods This was a retrospective analysis using CPT codes to investigate the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database for patients who underwent THA or TKA from 2010-2017. Patients were classified for UTI by NSQIP guidelines. Patient samples with all possible covariates were included for multivariate logistic regression analysis and assessed for independent associations. Results In a cohort of 983 (983/119,096; 0.83%) identified patients: ages 57+, preoperative RBC transfusion, perioperative RBC transfusion, bleeding disorders, operative time 110+ minutes, preoperative steroid use, diabetes, pulmonary comorbidities, BMI 30+ were independent risk factors for postoperative UTI after THA. In a cohort of 1503 (1503/189,327; 0.8%) identified patients: ages 60+, preoperative RBC transfusion, perioperative RBC transfusion, anemia, platelets less than 150k, preoperative steroid use, diabetes, and BMI 30+ were independent risk factors for postoperative UTI following TKA. Male sex was associated with a decreased risk of UTI in both THA and TKA. Conclusion This study provides novel evidence on risk factors associated with the development of UTI following THA or TKA. Clinicians should be aware of risk factors in the manifestation of postoperative UTI following primary THA or TKA procedures.
Article
OBJECTIVE We performed a systematic review and meta-analysis to determine whether D-mannose reduces urinary tract infection (UTI) recurrence (i.e. cumulative incidence) in adult women with recurrent UTI compared to other prevention agents. Secondary outcomes included side effects and compliance with D-mannose use. DATA SOURCES Ovid Medline 1946-, Embase 1947-, Scopus 1823-, Cochrane Library, Web of Science 1900-, and Clinicaltrial.gov were searched through 4/15/2020. STUDY ELIGIBILITY CRITERIA Systematic review inclusion: randomized controlled trials (RCTs), prospective cohorts, and retrospective cohorts written in English of women ≥18 years old with recurrent UTI in which D-mannose was utilized as an outpatient prevention regimen. Systematic review exclusion: lab or animal-based research, study protocols only, and conference abstracts. Meta-analysis inclusion: stated D-mannose dose, follow-up time ≥6 months, a comparison arm to D-mannose, and data available from women ≥18 years of age. STUDY APPRAISAL AND SYNTHESIS METHODS: Two independent reviewers made abstract, full text, and data extraction decisions. Study methodologic quality was assessed using the Cochrane Risk of Bias tool. Relative risks (RRs), confidence intervals (CIs), and heterogeneity (I²) were computed. RESULTS Searches identified 776 unique citations. Eight publications met eligibility: 2 using D-mannose only; 6 using D-mannose combined with another treatment. Seven studies were prospective: 2 RCTs, 1 randomized cross-over trial, and 4 prospective cohort studies. One retrospective cohort study was included. Three studies met meta-analysis eligibility (1 RCT, randomized cross-over trial, prospective cohort). Pooled RR of UTI recurrence comparing D-mannose to placebo was 0.23 (95%CI: 0.14-0.37; I²=0%; D-mannose n=125, placebo n=123). Pooled RR of UTI recurrence comparing D-mannose to preventative antibiotics was 0.39 (95%CI: 0.12-1.25; I²=88%; D-mannose n=163, antibiotics n=163). Adverse side effects were reported in 2 studies assessing D-mannose only (one study (n=10) reported none; the other reported a low incidence (8/103 participants) of diarrhea). Two studies reported compliance, which was high. CONCLUSIONS D-mannose appears protective for recurrent UTI (versus placebo) with possibly similar effectiveness as antibiotics. Overall, D-mannose appears well tolerated with minimal side effects – only a small percentage experiencing diarrhea. Meta-analysis interpretation must consider the small number of studies with varied study design and quality and the overall small sample size.