Bacterial cystitis in women

Department of Urology, Royal Prince Alfred Hospital, New South Wales, Australia.
Australian family physician (Impact Factor: 0.71). 05/2010; 39(5):295-8.
Source: PubMed


A woman presenting with symptoms suggestive of bacterial cystitis is a frequent occurrence in the general practice setting. One in three women develop a urinary tract infection (UTI) during their lifetime (compared to 1 in 20 men).
In this article we provide an outline of the aetiology, pathogenesis and treatment of bacterial cystitis in the primary care setting. We suggest measures that may assist before urological referral and work through a common clinical scenario.
Bacterial cystitis in unlikely if the urine is both nitrite and leuco-esterase negative. Empirical antibiotics are justified if symptoms are present with positive urinary dipstick, but microscopy, culture and sensitivity of urine is warranted to ensure appropriate empirical therapy and identification of the causative organism. Risk factors for UTI in women include sexual intercourse, use of contraceptive diaphragms and, in postmenopausal women, mechanical and/or physiologic factors that affect bladder emptying such as cystocoele or atrophic vaginitis. Discussion regarding risk factors and UTI prevention is important. Women with recurrent UTIs (defined as three or more episodes in 12 months or two or more episodes in 6 months) should be screened for an underlying urinary tract abnormality (ultrasound) and may benefit from prophylactic therapy. Patients with complex or recurrent UTIs, persistent haematuria, persistent asymptomatic bacteriuria, or urinary tract abnormalities on imaging may benefit from referral to a urologist.

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Available from: Mohan Arianayagam
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    • "UTIs are usually caused by a single pathogen, such as Escherichia coli (80%) or Staphylococcus saprophyticus (10e15%) [1]. Less frequently, Klebsiella pneumoniae, Enterobacter cloacae, Proteus species or Enterococcus species can also be found [3]. "
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    ABSTRACT: Objective: Urinary tract infections (UTIs) are common in the female population and, over a lifetime, about half of women have at least one episode of UTI requiring antibiotic therapy. The aim of the current study was to compare two different strategies for preventing recurrent bacterial cystitis: intravesical instilla- tion of hyaluronic acid (HA) plus chondroitin sulfate (CS), and antibiotic prophylaxis with sulfameth- oxazole plus trimethoprim. Materials and methods: This was a retrospective review of two different cohorts of women affected by recurrent bacterial cystitis. Cases (experimental group) were women who received intravesical in- stillations of a sterile solution of high concentration of HA þ CS in 50 mL water with calcium chloride every week during the 1st month and then once monthly for 4 months. The control group included women who received traditional therapy for recurrent cystitis based on daily antibiotic prophylaxis using sulfamethoxazole 200 mg plus trimethoprim 40 mg for 6 weeks. Results: Ninety-eight and 76 patients were treated with experimental and control treatments, respec- tively. At 12 months after treatment, 69 and 109 UTIs were detected in the experimental and control groups, respectively. The proportion of patients free from UTIs was significantly higher in the experi- mental than in the control group (36.7% vs. 21.0%; p 1⁄4 0.03). Experimental treatment was well tolerated and none of the patients stopped it. Conclusion: The intravesical instillation of HA þ CS is more effective than long-term antibiotic prophy- laxis for preventing recurrent bacterial cystitis.
    Full-text · Article · Oct 2015 · Taiwanese Journal of Obstetrics and Gynecology
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    • "Intractable recurrent cystitis caused by ESBL-producing Escherichia coli is considered a complicated UTI. In this setting, patients may have persistent symptoms and unresolved or persistent bacteriuria, despite empirical oral antibiotic treatments [5,6]. Parenteral carbapenem has recently been considered as the treatment of choice for ESBL-producing bacterial infections [7,8]. "
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    ABSTRACT: To evaluate the clinical outcomes of ertapenem administered as an outpatient parenteral antibiotic therapy for intractable cystitis caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli. We retrospectively reviewed a case series of 3 years of therapeutic experience with ertapenem for intractable recurrent cystitis caused by ESBL-producing E. coli. Ertapenem 1 g/d was parenterally administered to the patients on an outpatient basis until the acquisition of symptomatic improvement and negative conversion of urine culture. Demographic and clinical characteristics of patients, antimicrobial resistance, and clinical response data were analyzed from the patients' medical records. During the course of this study, a total of 383 patients were diagnosed with cystitis, and 24 of them showed ESBL-producing E. coli (6.26%). The mean treatment duration of all patients was 8.5 days. The early clinical and microbiological cure rates 0 to 7 days after the end of treatment were 91.7% (22/24) and 90.9% (20/22), respectively. The late clinical and microbiological cure rates 4 to 6 weeks after the end of treatment were 72.2% (13/18) at both time points. Parenteral ertapenem treatment can be an effective and well-tolerated treatment option for intractable recurrent cystitis by multidrug-resistant ESBL-producing E. coli.
    Full-text · Article · Apr 2014 · Korean journal of urology
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    • "The most common antibacterial drugs in UTIs’ treatment are trimethoprim-sulfamethoxazole, cephalosporins, semi-synthetic penicillins with or without beta-lactamase inhibitors and quinolones [62,63]; however, our results proved that resistance to penicillin, sulfamethoxazole, trimethoprim and cephalotin were 100%, 30.89%, 16.26% and 20.32%, respectively. Oliveira et al. from Brazil [61] reported that 90% of UPEC strains possessed at least one of the resistant genes, the prevalence of them were as follows: traT (76%), aer (41%), PAI (32%), sfa (26%), pap (25%), cnf1 (18%), afa (6%), and hly (5%) and the most common were ampicillin (51%) and trimethoprim-sulfamethoxazole (44%). "
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    ABSTRACT: Background Urinary tract infections (UTIs) are one of the most common bacterial infections with global expansion. These infections are predominantly caused by uropathogenic Escherichia coli (UPEC). Methods Totally, 123 strains of Escherichia coli isolated from UTIs patients, using bacterial culture method were subjected to polymerase chain reactions for detection of various O- serogroups, some urovirulence factors, antibiotic resistance genes and resistance to 13 different antibiotics. Results According to data, the distribution of O1, O2, O6, O7 and O16 serogroups were 2.43%, besides O22, O75 and O83 serogroups were 1.62%. Furthermore, the distribution of O4, O8, O15, O21 and O25 serogroups were 5.69%, 3.25%, 21.13%, 4.06% and 26.01%, respectively. Overall, the fim virulence gene had the highest (86.17%) while the usp virulence gene had the lowest distributions of virulence genes in UPEC strains isolated from UTIs patients. The vat and sen virulence genes were not detected in any UPEC strains. Totally, aadA1 (52.84%), and qnr (46.34%) were the most prevalent antibiotic resistance genes while the distribution of cat1 (15.44%), cmlA (15.44%) and dfrA1 (21.95%) were the least. Resistance to penicillin (100%) and tetracycline (73.98%) had the highest while resistance to nitrofurantoin (5.69%) and trimethoprim (16.26%) had the lowest frequencies. Conclusions This study indicated that the UPEC strains which harbored the high numbers of virulence and antibiotic resistance genes had the high ability to cause diseases that are resistant to most antibiotics. In the current situation, it seems that the administration of penicillin and tetracycline for the treatment of UTIs is vain.
    Full-text · Article · Apr 2013 · Annals of Clinical Microbiology and Antimicrobials
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