ArticleLiterature Review

Mild dehydration: A risk factor of urinary tract infection?

Authors:
To read the full-text of this research, you can request a copy directly from the author.

Abstract

Bacterial growth in the urinary tract is usually prevented by host factors including bacterial eradication by urinary and mucus flow, urothelial bactericidal activity, urinary secretory IgA, and blood group antigens in secretions which interfere with bacterial adherence. Bacterial eradication from the urinary tract is partially dependent on urine flow and voiding frequency. Therefore, it seems logical to postulate a connection between fluid intake and the risk of urinary tract infections (UTIs). However, experimental and clinical data on this subject are conflicting. Experimental studies concerning the effect of water intake on susceptibility and course of UTIs were predominantly performed in the 60s and 70s. Despite many open questions, there has been no continuous research in this field. Only few clinical studies producing contradictory results are available on the influence of fluid intake concerning the risk of UTI. One explanation for the inconsistency between the data might be the uncertainty about the exact amounts of fluid intake, which was mostly recorded in questionnaires. So far, there is no definitive evidence that the susceptibility for UTI is dependent on fluid intake. Nevertheless, adequate hydration is important and may improve the results of antimicrobial therapy in UTI. Results of experimental and clinical studies concerning urinary hydrodynamics are the basis for advice given by expert committees to patients with UTI to drink large volumes of fluid, void frequently, and completely empty the bladder. The combination of the behaviourally determined aspects of host defence and not simply increasing fluid intake is important in therapy and prophylaxis of UTI.

No full-text available

Request Full-text Paper PDF

To read the full-text of this research,
you can request a copy directly from the author.

... Botulinum toxin A has been shown to reduce increased CGRP levels in CM patients [17] and to inhibit CGRP release in the bladder of experimental animals [18]. Finally, central brain structures implicated in OAB and CM pathophysiology, such as the prefrontal cortex, hypothalamus, or periaqueductal grey nuclei are common [19]. The association between CM and OAB based on shared pathophysiological mechanisms should be supported by further epidemiological studies. ...
... For OAB, adequate and appropriate fluid intake is advised. Insufficient fluid intake or fluid restriction may play a role in the development of urgency, frequent urination, and urinary tract infections by increasing urine concentration, irritating the bladder mucosa, and reducing the functional capacity of the bladder [19,20]. Studies have shown that the removal of artificial sweeteners and food such as highly spicy foods, citrus fruits, and tomato-containing products from the diet can play a role in the treatment of incontinence [21]. ...
... Similar measures might be beneficial for OAB symptoms. Adequate and appropriate fluid intake serves as a quick washout of irritants from the bladder and produces diluted urine [19,20]. Nuotio et al., in their population-based study involving 1059 women and men between the ages of 60 and 89, found a relationship between smoking and urinary urgency, but it was not confirmed by others [22][23][24]. ...
... Longterm dehydration increases circulatory workload, which can lead to small blood vessel damage in the kidneys and cause chronic kidney disease [13], [14]. When the body is dehydrated, there is less fluid to flush out bacteria from the urinary tract, and that increases the risk of urinary tract infection [15], [16]. ...
... Microwaves have long been used to detect water content in the atmosphere, soil, and materials due to the rotations and vibrations of water molecules being dipole moments. Remote sensing, particularly by satellites or ground radar, utilizes L (1-2 GHz), C (4-8 GHz), X (8-2 GHz), and Ku bands (12)(13)(14)(15)(16)(17)(18) for their relatively low atmospheric attenuation and ability to penetrate the soil to interact with water [43]. For example, the European Space Agency's Soil Moisture and Ocean Salinity mission operates at 1.4 GHz [44], [45], while NASA's Soil Moisture Active Passive mission uses dual frequencies at 1.26 and 1.41 GHz [46], [47]. ...
Article
Full-text available
In this article, the significance, clinical needs, methods and principles for continuous human body hydration level monitoring are reviewed. Maintaining hydrated is critical for physical and mental health. A long-term, continuous, convenient and accurate wearable device that can monitor the whole-body water content to provide real-time feedback is needed, especially for infants, the elderly, and people who have special needs in their tasks and occupations. Noninvasive bioimpedance measurements and microwave sensing techniques suitable for conformable wearables are summarized. Microwave probing with deeper field penetrations into the dermis layer of the skin can provide a better assessment of whole-body water content. Frequency choices for the probing signals, the need for realistic phantoms, and evaluation standards suitable for clinical uses are discussed.
... Acute mild dehydration has been shown to impair vascular function and blood pressure regulation, possibly through impaired endothelial function, increased sympathetic nervous system activation, and worsened orthostatic tolerance [11,14]. Dehydration may also increase risk of poor pregnancy outcomes [15][16][17][18], renal toxicity [12], urolithiasis [19], and urinary tract infections [20]. Despite the reported associations between hydration and health, only 13-51% of Americans meet criteria for adequate hydration, with rates varying across age, sex, and disease status [21]. ...
... This is intriguing because of the link between hydration status and certain infection risks. For example, past research has found that dehydration is associated with increased risk of urinary tract infections [20,75]; it is plausible that suppressed immune function could be a mediating factor in this relationship. Additionally, dehydration is associated with an increased risk of urolithiasis through several physiological mechanisms. ...
Article
Full-text available
Purpose: Suboptimal hydration has been linked to a variety of adverse health outcomes. Few studies have examined the impact of hydration status on immune function, a plausible physiological mechanism underlying these associations. Therefore, we tested how variation in hydration status was associated with circulating pro-inflammatory cytokine levels and ex vivo lipopolysaccharide (LPS)-stimulated pro-inflammatory cytokine production. Methods: Blood samples were obtained from a community sample of healthy middle-to-older-aged adults (N = 72). These samples were used to assess serum osmolality, a biomarker of hydration status, markers of immune function including circulating pro-inflammatory cytokines and stimulated pro-inflammatory cytokine production after 4- and 24- hours of incubation with LPS. Multiple linear regressions were used to test the association between serum osmolality (as a continuous variable) and markers of immune function at baseline and after 4- and 24-hours adjusting for age, sex, and BMI. These models were re-estimated with serum osmolality dichotomized at the cutoff for dehydration (>300 mOsm/kg). Results: While not significantly associated with circulating cytokines (B=-0.03, p=0.09), serum osmolality was negatively associated with both 4-hour (B=-0.05, p=0.048) and 24-hour (B=-0.05, p=0.03) stimulated cytokine production when controlling for age, sex and BMI. Similarly, dehydration was associated with significantly lower cytokine production at both 4-hours (B=-0.54, p=0.02) and 24-hours (B=-0.51, p=0.02) compared to adequate hydration. Conclusion: These findings suggest that dehydration may be associated with suppressed immune function in generally healthy middle-to-older aged community-dwelling adults. Further longitudinal research is needed to more clearly define the role of hydration in immune function.
... Based on this finding, the authors introduced the hypothesis that ACEi may occasionally lead to a decreased glomerular filtration rate (GFR) and the risk of developing UTI may increase as a consequence of lower urine output. They also found that the association between ACEi therapy and UTI antibiotic prescription was stronger among patients with diabetes then those without diabetes, possibly due to diabetes-related renal impairment [13,14,[30][31][32][33]. Nevertheless, this study is also subject to a number of methodological limitations (e.g., using nitrofurantoin prescriptions as a proxy with insufficient sensitivity for UTI) [14,34]. ...
... In line with our observations, no studies are available that indicate that ACEi also increases the occurrence of UTI. Based on a reduced urine output as a result of ACEi treatment it could almost be assumed, that ACEi might increase the frequency of UTI [31,32]. This hypothesis must be questioned, however, since a study has recently been published indicating that loop diuretics can deplete the renal cortico-medullary salt gradient as a major modulator of immune responses. ...
Article
Full-text available
Purpose The aim of this retrospective study was to investigate the impact of a broad spectrum of antihypertensive (AH) medications on urinary tract infections (UTI) of outpatients diagnosed in general practices in Germany. Methods This study included a total of 367,960 patients aged ≥ 18 years newly a diagnosed with UTI in 1274 general practices in Germany between January 2010 and December 2019. The analysis was conducted for five groups representing five AH therapy classes (diuretics (DIU); beta blockers (BB); calcium channel blockers (CCB); ACE inhibitors (ACEi); angiotensin II receptor blockers (ARB)), each containing 73,592 patients. A Cox regression model was used to analyze the association between each antihypertensive drug class and UTI incidence as compared to all other antihypertensive drug classes (as a group). Results The incidence of UTI diagnosis was slightly higher in patients treated with DIU (8.6%), followed by ACEi (8.1%), ARB (7.9%), and CCB (6.5%). Antibiotic therapy for UTI was given in 5.6% of DIU and 4.3% of CCB patients. The incidence of UTI and antibiotic therapy was much higher in women than in men across all therapy classes. No significant increase or decrease in UTI incidence or antibiotic therapy was observed in any of the AH therapy classes investigated. Conclusion The present study did not identify a significant increase or decrease of UTI incidence or antibiotic therapy in patients treated with ACEi, ACB, CCB, beta blockers or diuretics. Across all AH classes studied, the incidence of UTI and antibiotic therapy was higher in women than in men, although not significantly.
... Several potential explanations have been put forth for the apparent seasonality of UTI, including inadvertent prophylaxis from antimicrobials prescribed in winter to treat respiratory infections (Stamm et al., 1991) or changes in sexual partners and the frequency of sexual intercourse, as supported by some evidence that sexually transmitted infections also peak during the summer months (Wright and Judson, 1978;Cornelisse et al., 2016;Shah et al., 2007;Freeman et al., 2009). It has been hypothesized previously that warmer temperatures increase UTI risk through dehydration, resulting in diminished urine production and decreased clearance of urinary pathogens (Eckford et al., 1995;Beetz, 2003). Alternatively, warmer temperatures may promote bacterial proliferation and facilitate transfer of potential uropathogens to the urethra (Anderson, 1983). ...
... These findings are particularly relevant as the magnitude of average daily temperatures are projected to increase as the global climate changes. It has been previously hypothesized that higher temperatures may increase UTI risk through dehydration -even subclinicallyleading to decreased urinary frequency and reduced clearance of potential pathogens from the urethral meatus (Eckford et al., 1995;Beetz, 2003;Nygaard and Linder, 1997). Our findings suggest nuance in this mechanism, as one would expect dehydration -and therefore rates of UTI diagnosis -to increase in a monotonic fashion with rising temperature. ...
Article
Full-text available
Background In the United States (US), urinary tract infections (UTI) lead to more than 10 million office visits each year. Temperature and season are potentially important risk factors for UTI, particularly in the context of climate change. Methods We examined the relationship between ambient temperature and outpatient UTI diagnoses among patients followed from 2015 to 2017 in two California healthcare systems: Kaiser Permanente Southern California (KPSC) and Sutter Health in Northern California. We identified UTI diagnoses in adult patients using diagnostic codes and laboratory records from electronic health records. We abstracted patient age, sex, season of diagnosis, and linked community-level Index of Concentration at the Extremes (ICE-I, a measure of wealth and poverty concentration) based on residential address. Daily county-level average ambient temperature was assembled from the Parameter-elevation Regressions on Independent Slopes Model (PRISM). We implemented distributed lag nonlinear models (DLNM) to assess the association between UTI and lagged daily temperatures. Main analyses were confined to women. In secondary analyses, we stratified by season, healthcare system, and community-level ICE-I. Results We observed 787,186 UTI cases (89% among women). We observed a threshold association between ambient temperature and UTI among women: an increase in daily temperature from the 5th percentile (6.0 ˚C) to the mean (16.2 ˚C) was associated with a 3.2% (95% CI: 2.4, 3.9%) increase in same-day UTI diagnosis rate, whereas an increase from the mean to 95th percentile was associated with no change in UTI risk (0.0%, 95% CI: −0.7, 0.6%). In secondary analyses, we observed the clearest monotonic increase in the rate of UTI diagnosis with higher temperatures in the fall. Associations did not differ meaningfully by healthcare system or community-level ICE-I. Results were robust to alternate model specifications. Discussion Increasing temperature was related to higher rate of outpatient UTI, particularly in the shoulder seasons (spring, autumn).
... 0.01 and 0.05 respectively).These significant responses seen in table4, 5, 6 and figure 1 and 2 can be explained by the use of hydrochlorothiazide (as a diuretic). Bacterial eradication from the urinary tract is partially dependent on urine flow and voiding frequency therefore, it seems logical to postulate a connection between urinary flow and the risk of urinary tract infections (UTIs) (11). However, experimental and clinical data on this subject are conflicting. ...
... However, experimental and clinical data on this subject are conflicting. Experimental studies concerning the effect of water intake and the use of diuretic drugs as adjuvant to the antibiotics on susceptibility and course of UTIs were predominantly performed in the sixties and seventies.Despite many open questions, there has been no continuous researches in this field especially in pediatric age group (11). The traditional herbal remedies e.g. ...
Article
Full-text available
Background: Acute urinary tract infection is a common bacterial infection causing illness in infants and children. At age of seven, 8% of girls and 2% of boys will have at least one episode. Although drinking water and using home remedies are known to help to flush away bacteria and keeps them from sticking to the bladder wall, researches to test the efficacy and safety of hydrochlorothiazide's diuretic effect as adjuvant to the antibiotics in pediatric age groups are lacking, and so this research was to address this subject. Objectives: To assess the effectiveness and the safety of hydrochlorothiazide as adjuvant therapy to the antibiotics in treating acute urinary tract infection in pediatric age group. Type of the study: Case-control prospective study. Methods: The study was done including eight hundred sixty five patients ((In_ & Out_ patients)): The patients included were aged from few hours (neonates) to 16 years old, Those who attended three pediatric hospitals- department of nephrology of:The Central Child Teaching Hospital,Al- Elwyia Pediatric Hospital andIbn Al-Baladi Hospital Results: 215 patients in group 1 ((97.3%)) presented with cystitis and 6 patients ((2.7%)) with pyelonephritis, And In group 2, 243 ((96.4%)) with cystitis and 9 patients ((3.6%)) with pyelonephritis.The urine cultures were negative in ((76.4, 80.1, 85.9,95.0 percentages of patients)) after ((10 days, 1 month, 3 months and 6 months respectively)) in group1 vs. ((60.3, 68.60,75.8,85.3 )) after the same periods in group 2 ((p-value=0.04 at 10 days, 0.03 at 1month, 0.04 at 3 month and 0.02 at 6month)). Conclusions: This research had concluded that 5 days of treatment with antibiotics and hydrochlorothiazide were effective and safe to treat children with urinary tract infection. Hydrochlorothiazide (as a diuretic and hypocalciuric agent) adjuvant to the antibiotics in pediatrics was safe and effective to: Decrease duration of treatment and hospitalization days, Improve clinical responses to antibiotics and Decrease risk of complications of UTI.
... 3(5,64%) respectively. In male the out of 19 Pantoeaspp. appeared on MacConkey agar as circles, middle in size, smooth, punctuate pink colonies with slow ferment lactose . ...
... Urinary tract obstruction is one of the main causes of urinary tract infection, which produces the fortunate environment for the growth of urinary tract pathogens [19] . Patients with structural abnormalities progress UTIs largely from obstruction of the urine flow. ...
... Urinary frequency induces high antibacterial activity through the intrinsic mechanisms of the organism [10]. Therefore, the frequent intake of liquids which result in an increased urinary frequency, elicits a significant reduction of microorganisms in patients with bacteriuria [11]. ...
... This is the first prospective quasi-experimental study in Greece which examines whether the consumption of magnesium-rich bottled water improves the outcomes of patients suffering from recurring UTIs. The literature review indicates that increased water consumption can be beneficial in the prevention of UTIs [9,10,11,12,14,17,18] . In our study, we observed that there was no statistically significant difference in the number of infections of UTIs, throughout a nine-month period, during which the water which was consumed by individuals belonged to group B was enriched with magnesium. ...
... In general, sexual activities or a new sexual partner (especially in the young population) [1,4], previous history of UTI [1,5], functional abnormalities of the urinary tract [6], and diabetes [7] have been suggested as major risk factors for UTI. Limited fluid intake, dehydration, and related decreases in urine production and clearance of urinary pathogens have been also suggested as environmental risk factors for UTI [8]. In addition to them, as an environmental stressor, the relationship between high ambient temperature and UTI has been recently examined in some studies [9][10][11][12]. ...
Article
Full-text available
Background Although urinary tract infection (UTI) is a common and severe public health concern, and there are clear biological mechanisms between UTI and hot temperatures, few studies have addressed the association between hot temperatures and UTI. Methods We designed a time-stratified case-crossover study using a population-representative sample cohort based on the National Health Insurance System (NHIS) in South Korea. We obtained all NHIS-based hospital admissions through the emergency room (ER) due to UTI (using a primary diagnostic code) from 2006 to 2019. We assigned satellite-based reanalyzed daily summer (June to September) average temperatures as exposures, based on residential districts of beneficiaries (248 districts in South Korea). The conditional logistic regression was performed to evaluate the association between summer temperature and UTI outcome. Results A total of 4,436 ER visits due to UTI were observed during the summer between 2006 and 2019 among 1,131,714 NHIS beneficiaries. For 20% increase in summer temperatures (0–2 lag days), the odd ratio (OR) was 1.06 (95% CI: 1.02–1.10) in the total population, and the association was more prominent in the elderly (people aged 65 y or older; OR:1.11, 95% CI: 1.05–1.17), females (OR: 1.12, 95% CI: 1.05–1.19), and people with diabetes history (OR: 1.14, 95% CI: 1.07–1.23). The effect modification by household income was different in the total and elderly populations. Furthermore, the association between summer temperature and UTI increased during the study period in the total population. Conclusions Our results are consistent with the hypothesis that higher summer temperatures increase the risk of severe UTIs, and the risk might be different by sub-populations.
... Dehydration is particularly prevalent in older people and likely presents a strong risk factor for bacterial infections [41]. The direct research into the links between dehydration and UTIs occasionally contradicts due to inconsistencies between exact amounts of liquid and the individual participant's history of UTIs [42,43]. However, it is likely that the fewer voids per day, the concentrated and acidic urine, and the inhibited immune function correlated with dehydration all contribute to the increased susceptibility to UTIs. ...
Article
Full-text available
Background and objective: With over 50% of women suffering from at least one episode of urinary tract infection (UTI) each year and an increasing prevalence of antimicrobial resistance, efforts need to be made to clearly identify the evidence supporting potential non-drug interventions. This study aims to compare the effects of cranberry juice, cranberry tablets, and increased liquids for the management of UTIs. Methods: PubMed, Embase, and Cochrane CENTRAL were searched for randomised controlled trials. The primary outcome was the number of UTIs, and the secondary outcomes were UTI symptoms and antimicrobial consumption. A risk of bias assessment was performed using the Cochrane risk of bias tool, and the certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation. Key findings and limitations: A total of 20 trials (3091 participants) were included, with 18 studies highlighting a 54% lower rate of UTIs with cranberry juice consumption than no treatment and a 27% lower rate than placebo liquid. Cranberry juice also resulted in a 49% lower rate of antibiotic use than placebo liquid and a 59% lower rate than no treatment, based on a network meta-analysis of six studies. The use of cranberry compounds also reduced the prevalence of symptoms associated with UTIs. Conclusions and clinical implications: With moderate to low certainty, the evidence supports the use of cranberry juice for the prevention of UTIs. While increased liquids reduce the rate of UTIs compared with no treatment, cranberry in liquid form provides even better clinical outcomes in terms of reduction in UTIs and antibiotic use and should be considered for the management of UTIs. Patient summary: With the increasing prevalence of antimicrobial-resistant UTIs, alternate non-drug treatment options for its management are required. Available evidence supports the use of cranberry compounds and increases in fluid intake for managing UTIs.
... 9,10 OAB symptoms and urinary incontinence (UI) can be made worse by excessive fluid intake and incontinence, whereas restriction of fluids may promote urinary urgency and frequency due to an increase in urine concentration, which may irritate the bladder mucosa. 11 The daily volume of fluid intake should be approximately 1500 mL or 30 mL/kg per 24 hours. 12 Hashim and Abrams 13 found that OAB symptoms significantly decreased in patients who decreased their fluid intake by 25%. ...
Article
Full-text available
Purpose This study aimed to investigate the effectiveness of the simplified intervention, consisting of fluid and caffeine management alone in older women with overactive bladder symptoms. Patients and Methods A quasi-experimental pretest-posttest design was used. Rural, community-dwelling older women were recruited at four senior centers in South Korea. Of the 63 participants initially enrolled, 34 met the inclusion criteria. One group (n = 15) used fluid and caffeine management alone (FM), and the other group (n = 12) used a combination of fluid and caffeine management and pelvic floor muscle training (FM+PFMT). Urinary symptom-specific health-related quality of life was measured using the Korean version of KHQ. Sleep quality was measured using the Pittsburgh Sleep Quality Index. After the intervention, participants were assessed 4 and 8 weeks. A linear mixed model was used for the analysis. Results The mean age of the participants was 74.44 ± 5.67 years. Among the nine domains of KHQ, impact on life and physical limitations decreased significantly in both groups, without significant between-group differences. Sleep/energy increased in both groups, and the scores in the FM+PFMT group were significantly improved. The number of micturition episodes per day and the quality of sleep did not differ significantly between the two groups. Conclusion A simplified intervention, consisting of fluid and caffeine management alone can be considered as the first-line intervention to improve health-related quality of life in rural, community-dwelling, older women with overactive bladder symptoms. Healthcare providers should consider providing a relatively simple, but equally effective intervention to maximize the adherence and effectiveness.
... Note that certain sport environments such as natural waters and public pools house a higher number of pathogens that can lead to illnesses. In addition, endurance sports may predispose individuals to urinary tract infections due to infrequent voiding and dehydration, particularly in women exercising in hot and humid weather conditions [38][39][40]. One should balance the benefits against potentially unfavorable immunomodulation of strenuous exercise after SOT. ...
Article
Full-text available
An increasing body of randomized controlled trials suggests the safety of engaging in moderate to vigorous intensity exercise training following solid organ transplantation. Fueled by emerging sport events designed for transplant recipients and the ever-growing body of research highlighting the diverse health benefits of physical activity, transplant recipients are now increasingly participating in strenuous and occasionally competitive physical endeavors that largely surpass those evaluated in controlled research settings. This viewpoint article adopts a cautionary stance to counterbalance the prevalent one-sided optimistic perspective regarding posttransplant physical activity. While discussing methodological limitations, we explore plausible adverse impacts on the cardiovascular, immunological, and musculoskeletal systems. We also examine the physiological consequences of exercising in the heat, at high altitude, and in areas with high air pollution. Risks associated with employing performance-enhancing strategies and the conceivable psychological implications regarding physical activity as a tribute to the ‘gift of life’ are discussed. With a deliberate focus on the potential adverse outcomes of strenuous posttransplant physical activity, this viewpoint aims to restore a balanced dialogue on our comprehension of both beneficial and potentially detrimental outcomes of physical activity that ultimately underscores the imperative of well-informed decision-making and tailored exercise regimens in the realm of posttransplant care.
... susceptibility to lower urinary tract symptoms (49). Increased urination promotes bacteria elimination from the urinary tract and bacterial proliferation reduction in the bladder (50)(51)(52). Previous studies have explored the urination behaviors among Chinese women and students in different stages (53)(54)(55), while few studies focused on the elderly. ...
Article
Full-text available
Background Fluid intake in the elderly may influence urination behaviors and further influence their health status. This study investigated the behaviors of fluid intake, urination and their relationships among the elderly in China. Methods Stratified random sampling was used to recruit the elderly participants who met the inclusion criteria from five cities in China. Participants’ total fluid intake (TFI) level was investigated using a validated 7-day 24 h fluid intake questionnaire. Their urination behaviors in real time were also recorded using a validated 7-day 24 h urination behavior record. Results A total of 524 participants completed the study, including 233 males and 291 females. The average age was 69.7 years. The median daily TFI was 1,241 mL, with a frequency of 8.1 times per day. Approximately 73.3% of the participants did not reach the amount of adequate fluid intake (1.7 L for males and 1.5 L for females) recommended in China. Fluid intake in the morning, afternoon, and evening among participants was 594 mL, 305 mL and 342 mL, with a frequency of 3.0 times, 1.7 times, and 2.0 times, respectively. The median urination frequency was 7.4 times per day. The percentage of participants who urinated >7 times during the day was 44.3%. The percentage of participants who urinated ≥1 time at night was 77.5%. Age and BMI were not the main influence factors for fluid intake and urination behaviors. The preliminary analysis showed that higher TFI, plain water intake, dairy products intake, and fluid intake frequency were significantly associated with higher urination frequency (t = 6.553, p < 0.05; t = 5.291, p < 0.05; t = 4.667, p < 0.05; t = 13.413, p < 0.05). Higher fluid intake per time was significantly associated with lower urination frequency (t = −3.562, p < 0.05). Correlations between TFI, fluid intake frequency, fluid intake in night, fluid intake frequency in night and urination at night were also found (r = 0.114, p < 0.05; r = 0.091, p < 0.05; r = 0.146, p < 0.05; r = 0.331, p < 0.05). Conclusion Fluid intake was inadequate in terms of the elderly participants. Participants with higher fluid intake and frequency in night had a greater incidence of nocturia. Thus, correcting fluid intake behaviors can improve urination behavior and promote health. Clinical trial registration https://www.chictr.org.cn/searchprojEN.html, identifier CTR1900023355.
... Access to basic water, sanitation, and hygiene (WaSH) is critical for reducing the spread of enteric and infectious diseases caused by bacteria, viruses, helminths, and protozoa. Studies have shown that WaSH insecurity (or a lack of basic water, sanitation and hygiene services) can increase the prevalence of diarrhoea [1][2][3], chronic dehydration [4,5], urinary tract infections [6][7][8], skin infections [9,10], and increase the risk of respiratory diseases associated with limited access to clean water and hygiene [11][12][13]. While the impacts of WaSH insecurity on physical health have been established in the public health realm, there is limited research on the mental health impacts of WaSH insecurity, especially among people who inject drugs (PWID). ...
Article
Full-text available
Background Water, sanitation, and hygiene (WaSH) insecurity increases the risk of water-related diseases. However, limited research has been conducted on psychosocial distress as it relates to WaSH insecurity, especially among people who inject drugs (PWID). We examined the relationship between WaSH insecurity and related anxiety among PWID living in different housing conditions along the US-Mexico border region. Methods From 2020–2021, a cross-sectional study was conducted among 585 people who injected drugs within the last month in Tijuana (N = 202), San Diego (N = 182), and in both Tijuana and San Diego (N = 201). Participants underwent interviewer-administered surveys related to WaSH access, substance use, and generalized anxiety disorder (GAD-7). Quasi-Poisson regressions were used to assess associations between WaSH insecurity and anxiety in the prior 6-months. Results Participants were 75% male, 42% were unhoused and 91% experienced WaSH insecurity in the prior 6-months. After adjusting for housing status, gender, and age, lack of access to basic drinking water (Adj RR: 1.28; 95% CI: 1.02–1.58), sanitation (Adj RR:1.28; 95% CI: 1.07–1.55), and a daily bath/shower (Adj RR: 1.38; 95% CI: 1.15–1.66) were associated with mild-severe anxiety. The number of WaSH insecurities was independently associated with a 20% increased risk of experiencing anxiety per every additional insecurity experienced (Adj RR: 1.20; CI: 1.12–1.27). We also found a significant interaction between gender and housing status (p = 0.003), indicating that among people experiencing sheltered/unsheltered homelessness, women had a higher risk of mild-severe anxiety compared to men (Adj RR: 1.55; 95% CI: 1.27–1.89). At the same time, among women, those who are unhoused have 37% increased risk of anxiety than those who live in stable housing conditions (Adj RR: 1.37; 95% CI: 1.01–1.89). Conclusion The lack of specific WaSH services, particularly lack of drinking water, toilets, and daily showers were associated with higher levels of anxiety among PWID in the Tijuana-San Diego border region. Women experiencing homelessness were especially vulnerable. WaSH interventions that provide safe, 24-h access may help to reduce anxiety and health risks associated with WaSH insecurity.
... Therefore, the intake of water and hydration status have significant impacts on the health of both mothers and infants. Although the evidence is limited, it suggests that sufficient water intake during pregnancy can help prevent complications, such as oligohydramnios, constipation, and urinary tract infections [10][11][12], while also reducing the risk of adverse outcomes like gestational hypertension, preterm birth, miscarriage, and low birth weight [13,14]. Furthermore, maintaining adequate hydration has significant positive effects on the neurodevelopment and cognitive function of offspring [15,16]. ...
Article
Full-text available
Adequate water intake and optimal hydration status during pregnancy are crucial for maternal and infant health. However, research on water intake by pregnant women in China is very limited. This study mainly aimed to observe the daily total water intake (TWI) of pregnant women and its different sources and to investigate the relationship between their water intake and hydration biomarkers. From October to November 2020, a convenience sample of pregnant women in the second trimester (n = 21) was recruited. Under conditions close to daily life, they undertook a 3-day metabolic trial. Each participant was provided with sufficient bottled water, and the weight of what they drank each time was measured. The intake of other beverages and foods was measured using a combination of weighing and duplicate portion method. Fasting venous blood and 24 h urine samples were collected and analyzed for the hydration biomarkers, including the serum/urine osmolality, urine pH, urine specific gravity, and the concentrations of major electrolytes in urine and serum. The results showed that the mean daily TWI was 3151 mL, of which water from beverages and foods accounted for 60.1% and 39.9%, respectively. The mean total fluid intake (TFI) was 1970 mL, with plain water being the primary contributor (68.7%, r = 0.896). Among the participants, 66.7% (n = 14, Group 1) met the TWI recommendation set by the Chinese Nutrition Society. Further analysis revealed that the TFI, water from beverages and foods, plain water, and milk and milk derivatives (MMDs) were significantly higher in Group 1 than those who did not reach the adequate intake value (Group 2) (p < 0.05). The results of hydration biomarkers showed that the mean 24 h urine volume in Group 1 was significantly higher than that in Group 2 (p < 0.05), while the 24 h urine osmolality, sodium, magnesium, phosphorus, chloride, and creatinine concentrations in Group 1 were significantly lower than those in Group 2 (p < 0.05). However, no significant differences were observed in serum biomarkers. Partial correlation analysis showed that TWI was moderately positively correlated with 24 h urine volume (r = 0.675) and negatively correlated with urine osmolality, sodium, potassium, magnesium, calcium, phosphorus, and chloride concentrations (r = from−0.505 to −0.769), but it was not significantly correlated with serum biomarkers. Therefore, under free-living conditions, increasing the daily intake of plain water and MMDs is beneficial for pregnant women to maintain optimal hydration. The hydration biomarkers in urine are more accurate indicators of water intake and exhibit greater sensitivity compared to serum biomarkers. These findings provide a scientific basis for establishing appropriate water intake and hydration status for pregnant women in China.
... This may be related to increased fluid intake, in particular, has several theoretical methods for reducing the risk of UTIs, ranging from diuresis acting to diluting the concentration of uropathogens, thus reducing the potential for clinical infection; antegrade urine flow is thought to have a 'flushing' effect on uropathogens from the urinary tract, and is also needed for the maintenance of optimal urine pH to decrease the potential for bacterial adhesions to the urothelium. On the contrary, Beetz (2003) in his study titled 'mild dehydration: a risk factor of UTI?' reported that there is no definitive evidence that the susceptibility for UTI is dependent on fluid intake. These variations could be explained by differences in geographical location. ...
Article
Full-text available
Background Urinary tract infections (UTIs) are among the most common bacterial infections that affect pregnant women, which if left untreated can lead to perinatal morbidity and mortality. Aim The study aimed to assess the prevalence of UTIs among pregnant women. Participants and methods A descriptive/exploratory design was adopted. The study was conducted at the Obstetrics and Gynecology Outpatient Clinic of Sohag University Hospital. A convenience sample of 440 pregnant women, irrespective of age, parity, or gestational age, was recruited for the study. Three tools were used to collect data: first, structured interviewing schedule; second, UTI symptomatology tool; and third, laboratory investigation record. The research investigator developed the structured interviewing schedule and UTI symptomatology tool. Results The study results indicated that the mean age of the pregnant women was 22.8±6.2 years. Overall, 37.3% of the pregnant women had secondary education, 75.7% were living in rural area, and 87.3% were housewives. Moreover, 46.3% of the pregnant women were multigravida, whereas 51.6% of them were multiparous. The prevalence of UTIs among the pregnant women was 42.3%. The types of UTIs isolated were symptomatic UTI diagnosed in 59% and asymptomatic UTI was identified in 41% among pregnant women who had UTIs. The prevalence of symptomatic UTIs and asymptomatic UTI among the total pregnant women was 25 and 17.3%, respectively. Synthetic underwear, decreasing fluid intake, multigravidity, occupation, and educational level were risk factors that might affect the incidence of UTIs. Conclusion The prevalence of UTIs among pregnant women was high. Overall, 41% of pregnant women who had UTIs were asymptomatic. Synthetic underwear, decreasing fluid intake, multigravidity, occupation, and educational level were risk factors that might affect the incidence of UTIs. Recommendation It is important to do routine urine analysis for all pregnant women on every visit.
... 45 Long-term decreased urination can lead to the accumulation of urine in the urinary tract, which can increase the risk of UTIs. 46 Severe vomiting is one factor that can decrease urine volume and has been shown to be significantly related to UTIs in one study. 19 However, this was not the case in the study by Alijahan et al. 47 During pregnancy, severe vomiting can also lead to a decrease in fluid intake by the mother, which can affect the mother's urinary system. ...
Article
Full-text available
Objective: Urinary tract infection (UTI) is a prevalent infection during pregnancy that can lead to complications for both the mother and the foetus. The objective of this systematic review and meta-analysis is to determine the global prevalence of UTIs (both symptomatic and asymptomatic) during pregnancy, based on previous studies in this area. Furthermore, this study aims to identify any factors that contribute to hetero-geneity in the prevalence of UTIs during pregnancy. Study design: Systematic review and meta-analysis. Methods: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines on August 8, 2022. To conduct the systematic review and meta-analysis, a search was performed using the keywords "urinary tract system", "UTI", "pregnancy", and "gestation" was performed in several databases, including Web of Science (WoS), PubMed, Scopus, ScienceDirect, Embase, and Google Scholar, without a time limit until September 18, 2022. The analysis was performed using a random-effects model, and the heterogeneity of the studies was assessed using the I 2 index. The Comprehensive Meta-Analysis software (Version 2) was used for data analysis. Results: The systematic review and meta-analysis of 27 studies, which included a total of 30,641 pregnant women, showed an overall prevalence of UTI (both symptomatic and asymptomatic) to be 23.9% (95% confidence interval: 16.2e33.8). Meta-regression analysis was conducted to examine the impact of two factors, namely study sample size and study year, on the heterogeneity of the meta-analysis. The results revealed that an increase in sample size, and the study year was associated with a decrease in the prevalence of UTI in pregnant women (P < 0.05). Conclusion: The results of our study indicate a global prevalence of UTI in pregnant women to be 23.9%. Therefore, it is recommended that all pregnant women undergo regular UTI screening tests and receive prompt treatment if diagnosed with UTI. Early detection and treatment of UTI during pregnancy are crucial to prevent complications that may affect the health of both the mother and the foetus.
... The arsenal of effective antibiotics is rapidly diminishing, and the magnitude of this phenomenon should not be underestimated. UTIs, which account for about 25% of all antibiotic prescriptions, constitute a field with great scope for intervention [7,8]. Long-term antibiotics for rUTIs have long been considered the standard of care to reduce recurrences, but there is a growing concern about the emergence of increasingly resistant strains [9,10]. ...
Article
Full-text available
Recurrent urinary tract infections (rUTIs) are a common condition with high morbidity and negatively impact the quality of life. They account for approximately 25% of all antibiotic prescriptions and are a public health concern in an era of increasing multidrug-resistant organisms (MDROs). Several non-antibiotic treatment strategies have been tried to curb antimicrobial use, and many are effective to some degree, but no experience testing multimodal interventions. We created a “care bundle” consisting of behavioral interventions, vaginal and oral probiotics, D-mannose, and cranberry to be followed for six months. We enrolled women with rUTIs over three years. Changes in urinary tract infections, antibiotic use, chronic symptoms, and quality of life were compared in the six months before and after participation in the study. Forty-seven women were enrolled in the study, six of whom were excluded from the final analysis. We observed a 76% reduction in urinary tract infections (p < 0.001) and a reduction in total antibiotic exposure of more than 90% (p < 0.001); all chronic symptoms showed a trend toward reduction. Adherence to the bundle was high (87.2%). Overall, 80.5% of women experienced an improvement in their quality of life. In our experience, a bundle protocol is effective in reducing recurrences and antimicrobial use in a cohort of women with rUTIs and results in a subjective improvement in chronic symptoms and quality of life. Further research with larger sample size is needed to confirm these findings.
... High fluid intake is considered protective for UTI. 26 In our study, the ...
Article
Full-text available
Aim: Acute pyelonephritis is one of the most common bacterial infections in childhood. This potentially serious condition can lead to renal scarring, loss of kidney function and hypertension. The aim of this study was to identify risk factors associated with pyelonephritis in children without kidney or urinary tract abnormalities. Methods: Medical records of children aged 4-18 diagnosed with 1st time pyelonephritis from 2016-2021 were retrospectively analysed. Children with abnormal kidney ultrasound were excluded. In addition to demographic data, information on bladder and bowel function was extracted together with habits of fluid intake. Results: A total of 105 patients were diagnosed with 1st time pyelonephritis. Of these, 47 % were diagnosed with constipation according to the Rome IV criteria within a mean follow up period of 167 days after their pyelonephritis, which is markedly higher than the estimated prevalence of constipation in the background population. Constipation was positively associated with recurrent urinary tract infection (p = 0.01). Conclusion: Constipation is associated with pyelonephritis and recurrent urinary tract infection in children (primarily girls) 4-18 years of age without evident kidney or urinary tract abnormalities. We recommend systematic evaluation of bowel and bladder function after 1st time pyelonephritis in all children > 4 years.
... Increased temperatures during summer can make people susceptible to dehydration [10]. Dehydration has been considered to increase the risk of UTIs by postponing bacterial removal from the urinary tract, reducing voiding frequency and rates of urine flow [11]. However, results from previous studies regarding the seasonality of UTIs are inconsistent. ...
Article
Full-text available
Background Urinary tract infections (UTIs) affect millions of people of all ages around the world. It constitutes one of the most common conditions encountered in emergency departments (EDs). In this study, we aimed to inquire into the prevalence of UTIs as the hospitalization primary diagnosis through the emergency department and to research the seasonal pattern, accuracy of the diagnostic methods used, and final diagnosis. Methods A retrospective cross-sectional study was undertaken that included all patients admitted with a primary diagnosis of UTIs through the ED over a four-month period (January, April, June, and September) in the emergency department of King Abdulaziz Medical City (KAMC) in Riyadh. The prevalence, diagnostics, and outcomes of UTIs were evaluated, and their association with seasonality was assessed after obtaining data from the Hospital Information System BestCare of King Abdullah National Guard Hospital. The variables that have been collected were analyzed using the Statistical Package for Social Sciences software version 26 (IBM Corp., Armonk, NY, USA). Results A total of 315 patients were admitted with a diagnosis of UTI. The prevalence of UTI among patients admitted through the ED was 10.5% with a significantly higher prevalence noted in January (13.3%) than in April (8.5%) or September (8.8%) (Fisher’s exact test: 0.009 and 0.01, respectively). As would be expected, the cohort was made up of elderly individuals with a mean age of 70.6 years, and the male/female ratio was 1:2. UTI symptoms including dysuria, frequency, urgency, rigors, and loin pain were noted in only 41% of cases or less, and urinalysis was the basis of making the diagnosis (87.9% had positive leukocyte esterase (LE) and 90.5% had positive urine WBC/HPF). Furthermore, 4.4% required urgent treatment, and 3.1% required intensive care unit (ICU) admission. Urine culture was negative in 30.8% of the cases (30.8% false positives among those admitted with UTI). The commonest organisms isolated were Escherichia coli (33%), Klebsiella pneumoniae (14.3%), and Pseudomonas aeruginosa (5.1%). The median length of hospital stay (LOS) was 3.5 days, and the Charlson Comorbidity Index (CCI) score was 5.7. The mean hemoglobin (Hb), creatinine, C-reactive protein (CRP), procalcitonin, and lactic acid were 108 gm/L, 131.3 umol/L, 38.3 mg/L, 0.28 ng/mL, and 2.07 mmol/L, respectively. Conclusion This research found that the prevalence of UTI cases as an admission diagnosis through the emergency department was high, despite some cultures being negative or contaminated, thus probably indicating an increase in the rates of false positives. The admission rate is linked to factors such as oxygen saturation and RDW, but this is not entirely understood. In addition, the study also displayed a seasonal pattern linked to the highest number of confirmed cases in January, while the lowest was in April.
... Earlier, mild dehydration has been suggested to increase the risk of UTI in adults. 40 Recently a systematic review and meta-analysis of 7 randomized trials in adults concluded that increased fluid intake might decrease the overall rate of recurrent UTIs with a rate ratio of 0.46 (95% CI from 0.40 to 0.56). 41 This meta-analysis included several studies where the sort of the fluid might have affected the outcome: for example cranberry juice or D-mannose, but similar effect was achieved also with plain water. ...
Article
Full-text available
Context: The incidence of urinary tract infection (UTI) varies with age, but there is limited evidence on the role of other risk factors. Objective: The aim of this meta-analysis was to investigate the risk factors for UTIs in children. Data sources: PubMed from 1966 to May 2019. Study selection: All studies assessing at least 1 possible risk factor for occurrence or recurrence of UTI with a clear definition of symptomatic UTI in children were eligible. We excluded studies with UTIs related to hospital treatment or severe congenital renal abnormalities. Data extraction: After the quality assessment we extracted data on the given risk factor in children with and without UTI. The data were extracted separately for the occurrence and recurrence of UTIs. Results: We included 24 studies in the meta-analysis. Circumcision decreased the occurrence of UTIs with an odds ratio (OR) of 0.1 [95% confidence interval (CI): 0.06-0.17) and breast-feeding with an OR of 0.4 (CI: 0.19-0.86), both with low heterogeneity. Being overweight or obese increased the risk of UTI (OR: 2.23; CI: 1.37-3.63). Both poor fluid intake (OR: 6.39; CI: 3.07-13.39) and infrequent voiding (OR: 3.54; CI: 1.68-7.46) were associated with recurrent UTIs. Limitations: The design, populations and definitions varied between the studies. Conclusions: Being overweight or obese and having poor fluid intake are modifiable risk factors that increase the risk for UTIs in children. Breast-feeding and circumcision are associated with a decreased occurrence of UTIs.
... premenopausal adults with a history of RUTI. 9 Several studies, including Hooten et al, have assessed the efficacy of increasing water intake for the prevention of RUTI. [9][10][11] No studies, however, have assessed the prevalence with which this strategy or any other nonantibiotic modality is implemented in any subpopulation of patients experiencing RUTI. ...
Article
Full-text available
Purpose To assess patient reliance on various over-the-counter (OTC) modalities used for prevention of recurrent urinary tract infection (RUTI) after electrofulguration (EF). Patients and Methods Following IRB approval, qualifying women were offered a short survey over the phone by a medical researcher to collect information about their use of various OTC modalities for prophylaxis of RUTI. Data was compared between two cohorts, ≥70 years old and <70 years old, using chi-squared and Student’s t-tests. Results From a database of 324 patients, 163 accepted the interview. 17% (28/163) reported current use of cranberry supplements, 10% (16/163) D-mannose supplements, and 42% (69/163) another non-prescription modality for RUTI prophylaxis. The non-geriatric (<70 years old) cohort spent, on average, $80 less annually on cranberry/D-mannose supplements (P=0.043) than the geriatric cohort and were more likely to use non-prescription modalities for the prevention of UTI (52% vs 30%; P=0.0061). Individuals using D-mannose were also much more likely to purchase their product online compared to those using cranberry supplements (85% vs 56%). Across all modalities, the perceived benefit difference in reducing UTI/year ranged from a median of 0 for Pyridium® (phenazopyridine hydrochloride) to four for probiotics, with D-mannose and cranberry at two/year, and those increasing daily fluid consumption at 2.5 fewer UTI/year. Conclusion Continued use of non-prescription modalities for RUTI prophylaxis were common among women with an EF history, but varied based on age groups. Across both age cohorts, annual expenditure and perceived benefit also varied among different OTC prophylactic modalities. Awareness of type and method of OTC modality implementation by patients with RUTI is essential to aligning use with current field recommendations.
... Second, increased temperatures may lead to volume depletion, leading to decreased urinary volume and flow [18]. Decreased urinary flow can hamper the removal of bacteria from the urinary tract, thus increasing the potential for infection [28]. Alternatively, more concentrated urine may increase the likelihood of developing an infection [18]. ...
Article
Full-text available
The seasonal and meteorological factors in predicting infections after urological interventions have not been systematically evaluated. This study aimed to determine the seasonality and the effects of the weather on the risk and severity of infectious complications (IC) after a transrectal ultrasound-guided prostate biopsy (TRUS-Bx). Using retrospectively collected data at the tertiary care hospital in Taiwan, we investigated the seasonal and meteorological differences in IC after TRUS-Bx. The IC included urinary tract infection (UTI), sepsis, and a positive culture finding (PCF). The severity was assessed on the basis of the Common Terminology Criteria for Adverse Events grading system. The prevalences of the infectious complications (UTI, sepsis, PCF and grade ≥ 3 IC) were significantly higher in the summer than in the winter. Monthly temperature and average humidity were significant factors for IC. After adjusting the demographic factors, multivariate regression revealed that UTI, sepsis, PCF, and grade ≥ 3 IC increased by 12.1%, 16.2%, 21.3%, and 18.6% for every 1 °C increase in the monthly average temperature, respectively (UTI: p = 0.010; sepsis: p = 0.046; PCF: p = 0.037; grade ≥ 3 IC: p = 0.021). In conclusion, the development and severity of IC after TRUS-Bx had significant seasonality. These were dose-dependently associated with warmer weather. Infectious signs after TRUS-Bx should be monitored more closely and actively during warm weather.
... For instance, some studies report reduced levels of leukocytes and circulating proinflammatory cytokines (IL-1β, IL-6, and TNF-α) [5,6]. However, prolonged fasting can lead to dehydration which may increase the risk of infection, particularly in warm weather [7]. In addition to altering their daily routine by only eating two meals a day ('suhur' before dawn and 'iftar' after dusk), practising Muslims also attend additional religious gatherings and social parties during Ramadan, thereby sleeping less at night [8][9][10]. ...
Article
Full-text available
Background The effect of fasting on immunity is unclear. Prolonged fasting is thought to increase the risk of infection due to dehydration. This study describes antibiotic prescribing patterns before, during, and after Ramadan in a primary care setting within the Pakistani and Bangladeshi populations in the UK, most of whom are Muslims, compared to those who do not observe Ramadan. Method Retrospective controlled interrupted time series analysis of electronic health record data from primary care practices. The study consists of two groups: Pakistanis/Bangladeshis and white populations. For each group, we constructed a series of aggregated, daily prescription data from 2007 to 2017 for the 30 days preceding, during, and after Ramadan, respectively. Findings Controlling for the rate in the white population, there was no evidence of increased antibiotic prescription in the Pakistani/Bangladeshi population during Ramadan, as compared to before Ramadan (IRR: 0.994; 95% CI: 0.988–1.001, p = 0.082) or after Ramadan (IRR: 1.006; 95% CI: 0.999–1.013, p = 0.082). Interpretation In this large, population-based study, we did not find any evidence to suggest that fasting was associated with an increased susceptibility to infection.
... Many studies revealed that the percentage of adult women with UTI is higher than in men (Dwyer and O'Reilly, 2002;Al-Shamarti, 2010;Al-Shamarti and AL-Muhnna, 2011;Al-Shamarti et al., 2018). Many microbial pathogens are involved in UTI (Sussman, 2002;Beetz, 2003;Al-Shamarti et al., 2018). The most common pathogen is Escherichia coli, and followed by Proteus mirabilis, Staphylococcus saprophyticus, and Klebsiella pneumonia (Mohsin, 2015). ...
Article
Aims: Urinary tract infection (UTI) is a common infection caused by many virulent bacteria. Multidrug resistance (MDR) by bacteria represents a major therapeutic challenge worldwide. MRD bacteria have different mechanisms to avoid antibiotics; one of them is horizontal gene transfer. Such genes, encoding antimicrobial resistance, are easily transferred from one bacterium to another. Magnesium and calcium chloride (MgCl2 and CaCl2) have an effect on the permeability of bacterial cell membrane. We aimed these chemical materials could increase the antibiotics efficiency on multidrug resistance bacteria. 250 UTI specimens were collected to isolate multidrug resistant bacteria. Depending on antibiotics resistance, we selected three species of virulent bacteria: Escherichia coli, Staphylococcus aureus and Proteus mirabilis. Then, we tested the effect of MgCl2 and CaCl2 on their antibiotics resistance. Methodology and results: The results showed that percentage of E. coli in UTI infection is the highest (45%), while Enterococcus faecalis is the lowest (3%). The effect of MgCl2 and CaCl2 on bacterial antibiotics resistance has been tested using different types of antibiotics. The findings showed that MgCl2 has significant effect to aid antibiotics against bacteria. In particular, nalidixic acid has shown more efficiency against E. coli and S. aureus but not P. mirabilis. Using different concentrations of CaCl2 increased the efficiency of gentamycin, amoxicillin and trimethoprim against S. aureus, while has increased the efficiency of ampicillin and nalidixic acid against E. coli. However, CaCl2 has no effect on the efficiency of antibiotics against P. mirabilis. In addition, MgCl2, and CaCl2 had no toxic effects in both T24 and 5637 urinary bladder cell lines. Finally, plasmids were isolated from these species to detect any antimicrobial resistance gene such as qnr-A. Conclusion, significance and impact of study: MDR distribution in the worldwide was increased, we highly recommend the avoidance of the random antibiotic usages. The salts CaCl2 and/or MgCl2 can be used at specific concentration to enhance the antibiotics permeability and therefore to decrease the antibiotic resistance.
... Does a greater flow of urine provide a second type of barrier for ascending bacteria? Unexpectedly, the data are inconsistent (136). For example, a recent meta-analysis of recurrent UTIs (rUTIs) showed that an increase in oral fluids for 12 months produced an inadequate statistical difference with control patients (p = 0.06). ...
Article
Urinary tract infection (UTI) is the most common type of urogenital disease. UTI affects the urethra, bladder, ureter, and kidney. A total of 13.3% of women, 2.3% of men, and 3.4% of children in the United States will require treatment for UTI. Traditionally, bladder (cystitis) and kidney (pyelonephritis) infections are considered independently. However, both infections induce host defenses that are either shared or coordinated across the urinary tract. Here, we review the chemical and biophysical mechanisms of bacteriostasis, which limit the duration and severity of the illness. Urinary bacteria attempt to overcome each of these defenses, complicating description of the natural history of UTI. Expected final online publication date for the Annual Review of Physiology, Volume 84 is February 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
... 62 Although data on the association between UTI and dehydration are contradictory, an adequate hydration is thought to improve the results of antimicrobial therapy for UTI. 63,64 In the metaregression analysis focusing on medication status we found a statistically significant effect of benzodiazepines and drugs with anticholinergic properties on the association between delirium and UTI. However, the association between delirium and drugs from both of these groups has already been described previously. ...
Article
Full-text available
Objective: To determine the associations of delirium with urinary tract infection (UTI) and asymptomatic bacteriuria (AB) in individuals aged 65 and older. Methods: The protocol for this systematic review and meta-analysis was published on PROSPERO (CRD42020164341). Electronic databases were searched for relevant studies, professional associations and experts in the field were additionally contacted. Studies with control groups reporting associations between delirium and UTI as well as delirium and AB in older adults were included. The random effects model meta-analysis was conducted using odds ratios (ORs) with 95% confidence intervals (CIs) as effect size measures. The Newcastle-Ottawa scale was used to rate the studies' quality. Heterogeneity was assessed using the Q and I2 tests. The effects of potential moderators were investigated by both subgroup and meta-regression analyses. The risk of publication bias was evaluated using the funnel plot and Egger's test. Results: Twenty nine relevant studies (16,618 participants) examining the association between delirium and UTI in older adults were identified. The association between delirium and UTI was found to be significant (OR 2.67; 95% CI 2.12-3.36; p < 0.001) and persisted regardless of potential confounders. The association between delirium and AB in older adults in the only eligible study found (192 participants) was insignificant (OR 1.62; 95% CI 0.57-4.65; p = 0.37). All included studies were of moderate quality. Conclusion: The results of this study support the association between delirium and UTI in older adults. Insufficient evidence was found to conclude on an association between delirium and AB in this age group. These findings are limited due to the moderate quality of the included studies and a lack of available research on the association between delirium and AB. Future studies should use the highest quality approaches for defining both delirium and UTI and consider AB in their investigations.
... In a similar mechanism, heat-induced sweating can contribute to concentrated urine, and decreased urinary volume and flow (de Lorenzo and Liaño, 2017). As the eradication of pathogens from the urinary tract is partially dependent on voiding frequency and urine flow (Borg et al., 2017;Beetz, 2003), lower levels of urine production can hamper the removal of pathogens, thus increasing the potential for a UTI. In addition, urinary pathogens are likely to increase in hot weather, and if combined with decreased hydration and less urination, the likelihood of developing a UTI may increase (Simmering et al., 2018). ...
... In a similar mechanism, heat-induced sweating can contribute to concentrated urine, and decreased urinary volume and flow (de Lorenzo and Liaño, 2017). As the eradication of pathogens from the urinary tract is partially dependent on voiding frequency and urine flow (Borg et al., 2017;Beetz, 2003), lower levels of urine production can hamper the removal of pathogens, thus increasing the potential for a UTI. In addition, urinary pathogens are likely to increase in hot weather, and if combined with decreased hydration and less urination, the likelihood of developing a UTI may increase (Simmering et al., 2018). ...
Article
Background The occurrence or exacerbation of kidney disease has been documented as a growing problem associated with hot weather. The implementation of effective prevention measures requires a better understanding of the risk factors that increase susceptibility. To fill gaps in knowledge, this study reviews the current literature on the effects of heat on kidney-disease outcomes (ICD-10 N00-N39), including morbidity and mortality. Methods Databases were systematically searched for relevant literature published between 1990 and 2020 and the quality of evidence evaluated. We performed random effects meta-analysis to calculate the pooled relative risks (RRs) of the association between high temperatures (and heatwaves) and kidney disease outcomes. We further evaluated vulnerability concerning contextual population characteristics. Results Of 2739 studies identified, 91 were reviewed and 82 of these studies met the criteria for inclusion in a meta-analysis. Findings showed that with a 1 °C increase in temperature, the risk of kidney-related morbidity increased by 1% (RR 1.010; 95% CI: 1.009–1.011), with the greatest risk for urolithiasis. Heatwaves were also associated with increased morbidity with a trend observed with heatwave intensity. During low-intensity heatwaves, there was an increase of 5.9% in morbidity, while during high-intensity heatwaves there was a 7.7% increase. There were greater RRs for males, people aged ≤64 years, and those living in temperate climate zones. Similarly, for every 1 °C temperature increase, there was a 3% (RR 1.031; 95% CI: 1.018–1.045) increase in the risk of kidney-related mortality, which also increased during heatwaves. Conclusions High temperatures (and heatwaves) are associated with an elevated risk of kidney disease outcomes, particularly urolithiasis. Preventive measures that may minimize risks in vulnerable individuals during hot spells are discussed.
... A 10-year cohort study (n = 48000 men) done in health professionals reported that fluid consumption is inversely proportional to the risk of bladder cancer [61]. Similar results have been reported for colon cancer, chronic kidney disease, urolithiasis, urinary tract infection, fatal coronary heart disease, venous thromboembolism, and exercise-induced bronchospasm [62][63][64][65][66][67][68][69][70][71]. However, experts believe that we do not require fluid in excess of the amount our body actually signals for. ...
Article
Full-text available
Dipsogenic diabetes insipidus (DDI) is a subtype of primary polydipsia (PP), which occurs mostly in healthy people without psychiatric disease. In contrast, PP is characterized by a polyuria polydipsia syndrome (PPS) associated with psychiatric illness. However, the pathogenesis of DDI is not well established and remains unexplored. In order to diagnose DDI, the patient should exhibit excessive thirst as the main symptom, in addition to no history of psychiatric illness, polyuria with low urine osmolality, and intact urine concentrating ability. Treatment options for DDI remain scarce. On this front, there have been two published case reports with successful attempts at treating DDI patients. The noteworthy commonalities in these reports are that the patient was diagnosed with frequent excessive intake of water due to a belief that drinking excess water would have pathologic benefits. It could therefore be hypothesized that the increasing trend of excessive fluid intake in people who are health conscious could also contribute to DDI. Hence, this review provides an overview of the pathophysiology, diagnosis, and treatment, with a special emphasis on habitual polydipsia and DDI.
... Standard UTI treatment was defined as gentle hydration with intravenous fluids and narrowspectrum antimicrobial medication. 32,33 Exclusion criteria included (a) hospitalization within 30 days of the qualifying admission and (b) prior level of function data, either missing or incomplete, in the EMR. Cases were not excluded based on race, ethnicity, or gender. ...
Article
Full-text available
Background Bed rest during acute hospitalization is associated with new-onset mobility impairments in community-dwelling older adults, resulting in discharge to skilled nursing facilities rather than home. Purpose The purpose of this retrospective study is to determine whether the number of physical therapy (PT) visits is related to discharge disposition following an acute hospitalization for urinary tract infection (UTI) in the older adult population. Methods Medical records over a 3-year period of 523 community-dwelling older adults (65 years and older) admitted from home functionally independent were reviewed. Demographic and patient characteristics, including age, gender, living status, length of stay (LOS), discharge disposition, and the number of PT visits, were collected. Multinomial regression was conducted to determine predictors of disposition. Results The multinomial logistic regression model was statistically significant, χ ² (2) = 6.90, P = .032. Older age, longer LOS with fewer PT visits during acute hospitalization, and a higher comorbidity score were significant predictors of hospital discharge to subacute rehabilitation facilities than those who were able to return home with home health PT. These variables were not predictors of the disposition for younger patients with fewer comorbidities. Limitations Due to the retrospective nature of this study, assessment of potential preexisting levels of frailty, standardized delivery of PT, and level of activity outside of PT could not be performed. Conclusions Reduced frequency of physical therapist intervention for older adults hospitalized with UTI was associated with discharge to rehabilitation in a skilled nursing facility compared with those of similar age with increased PT intervention frequency.
... Dehydration occurs when there is an imbalance of the body's water supply or water intake falls short of water outputs (Adolph, 1947;Sawka, Cheuvront, & Carter, 2005). A number of negative health outcomes are associated with chronic dehydration, including increased risk of urinary tract infections (Beetz, 2003), kidney stones (Embon, Rose, & Rosenbaum, 1990), cognitive performance (Ganio et al., 2011), irritability, and fatigue (Armstrong et al., 2012). Moreover, severe dehydration causes blood to become viscous, a rapid-weak pulse, and ultimately death (Adolph & Dill, 1938;Minot & Blalock, 1940). ...
Article
Water is imperative for nutrition and health, economic productivity, and political stability; it also holds cultural and symbolic meanings and functions. Household water insecurity is an emerging construct that captures lived experiences with water access, use, and acceptability. Although the plausibility of household water insecurity to “get under the skin” and shape human biology is high, these relationships have not been systematically investigated. Therefore, in this article, we set out to examine how household water insecurity and allied concepts affect health and human biology throughout the life course. We first lay out the various ways that water insecurity can act as a deleterious exposure, that is, through problematic quality, excess, and shortage. Next, we posit how water insecurity directly shapes human biology, as well as indirectly, via psychosocial stress precipitating cortisol exposure, with potential intergenerational effects. We highlight a range of established and plausible biological consequences using evidence from human and animal model studies. These include diarrheal prevalence, dehydration, stunting, food insecurity, gut microbiome alteration, malnutrition, psychosocial stress, adverse birth outcomes, lower cognitive function and performance, hypertension, and chronic kidney disease. We also discuss the mechanisms by which household water insecurity may shape human biology across the life course; however, these pathways are just beginning to be understood. Longitudinal studies that simultaneously quantify household water insecurity and biological outcomes using comparable metrics in diverse environments and across generations will provide necessary evidence to establish causal relationships. Given the current global water crisis and its potential health consequences, such studies are urgently needed. This article is categorized under: • Engineering Water > Water, Health, and Sanitation • Science of Water > Water Quality
Article
Aim Urinary tract infections (UTIs) rank among the most prevalent infections in humans, carrying substantial implications for public health. Women experiencing recurrent UTIs are often advised to boost their fluid intake to help eliminate bacteria. In this study, we explored the impact of elevated fluid consumption during UTIs using a mouse model of pyelonephritis. Methods UTI was induced in 8–10 w female BALB/cJ‐mice by surgically injecting Escherichia coli (O6:K13:H1) into the bladder whereafter mice were randomized to gel food (GF) or regular chow. Immune response and infection severity were determined 24‐h post‐infection. In vitro bacterial growth (OD 600 ) was determined in urine from mice or from human volunteers. Results Gel feeding increased urine output (1.40 ± 0.77 μL min ⁻¹ , p < 0.01) and diluted the urine (668.7 ± 177 mOsmol kg ⁻¹ , p < 0.0001) compared to controls on regular chow (urine output: 0.34 ± 0.27 μL min ⁻¹ , osmolality: 1439 ± 473.5 mOsmol kg ⁻¹ ). Mice on GF had a higher risk of pyelonephritis (87.5%) and more severe infections (26.22 ± 9.88 CFU mg ⁻¹ tissue) compared to controls (43.75%; 3.87 ± 3.56 CFU mg ⁻¹ , p < 0.01). Correspondingly, the growth of E. coli was markedly reduced at osmolalities above 1200 mOsmol kg ⁻¹ compared to 600 mOsmol kg ⁻¹ and GF mice had lower urine levels of uromodulin (13.70 ± 1.89 μg mL ⁻¹ , p < 0.01) compared to controls (24.65 ± 2.70 μg mL ⁻¹ ). Conclusion Increased water intake and urine flow in mice will markedly increase the risk of pyelonephritis. The increased risk may reflect reduced urine uromodulin combined with optimized growth conditions for E. coli . The study does not immediately support the notion that established UTIs can be eliminated by increased water intake.
Book
Otoi̇mmun Hastalıklar Ektopi̇k Gebeli̇k Geli̇şi̇mi̇ İçi̇n Bi̇r Ri̇sk Faktör Selçuk KAPLAN Adolesanlarda Endometri̇ozi̇s Hastalığının Yönetim Ayşe Rabia ŞENKAYA Ovaryen PRP Uygulamasının IVF/ICSI Sonuçlar Üzeri̇ne Etki̇si Nefise Nazlı YENİGÜL Tekrarlayan İmplantasyon Başarısızlığında Endometri̇al Hasarlamanın Rolü Rulin DENİZ IVF Tedavi̇leri̇nde Lüteal Faz Desteği Veysel TOPRAK Özcan BUDAK Aşırı Akti̇f Mesane Sendromuna Genel Bakış ve Hastaya Özel Tedavi̇de Yeni̇ Yaklaşım İsmail ALAY Ecem EREN Radyofrekans ile Labi̇oplasti Eser AĞAR Sık Görülen Vaji̇nal Enfeksi̇yonlar ile Yüksek Ri̇skli̇ Human Papi̇lloma Vi̇rus Varlığı Arasındaki̇ İlişkisi Selçuk KAPLAN Embri̇yo Seçi̇m Kri̇terleri Deniz KULAKSIZ
Preprint
Full-text available
Background Although urinary tract infection (UTI) is a common and severe public health concern, and there are clear biological mechanisms between UTI and hot temperatures, few studies have addressed the association between hot temperatures and UTI. Methods We designed a time-stratified case-crossover study using a population-representative sample cohort based on the national health insurance system (NHIS) in South Korea. We obtained all NHIS-based hospital admissions through the emergency room (ER) due to UTI (using a primary diagnostic code) from 2006 to 2019. We assigned satellite-based reanalyzed daily summer (June to September) average temperatures as exposures, based on residential districts of beneficiaries (248 districts in South Korea). The conditional logistic regression was performed to evaluate the association between summer temperature and UTI outcome. Results Among 4,450 ER visits due to UTI were observed during the summer between 2006 and 2019 among 1,131,714 NHIS beneficiaries. For 20% increase in summer temperature (moving average of 0–2 lag days), the odd ratio (OR) was 1.05 (95% CI: 1.02, 1.09) in the total population, and the association was more prominent in the elderly (people aged 65y or older; OR: 1.09, 95% CI: 1.04, 1.15), females (OR: 1.10, 95% CI: 1.04, 1.17), and people with diabetes history (OR: 1.12, 95% CI: 1.05, 1.19). The effect modification by household income was different in the total and elderly populations. Furthermore, the association between summer temperature and UTI increased during the study period in the total population. Conclusions Higher summer temperatures were associated with an increased risk of ER admissions for UTI. The results are consistent with the hypothesis that higher summer temperatures increase the risk of severe UTIs.
Article
Few previous review articles have focused on the associations between inadequate daily water intake (LOW) or urinary biomarkers of dehydration ( U D; low urine volume or high urine osmolality) and multiple diseases. Accordingly, we conducted manual online searches (47 key words) of the PubMed, Embase, and Google Scholar databases with these inclusion criteria: English language, full-text, peer reviewed, no restriction on research design, and three publications minimum. Initially, 3,903 articles were identified based on their titles and abstracts. Evaluations of full length .pdf versions identified 96 studies that were acceptable for inclusion. We concluded that the evidence is insufficient or conflicting for seven disorders or diseases (i.e. suggesting the need for additional clarifying research) and it is lacking for all-cause mortality. Differential characterizations among women and men have been reported in the results of nine studies involving five diseases. Finally, the evidence for associations of LOW or U D is strong for both kidney stones and type 2 diabetes with hyperglycemia. This suggests that great public health value (i.e. reduced disease risk) may result from increased daily water intake—a simple and cost-effective dietary modification.
Article
Full-text available
Partial Nephrectomy in Wilms Tumor: A Rarely Implemented Surgical Method
Article
Full-text available
Activity of Diosmin-Hesperidin in Kidney Ischemia-reperfusion Injury in Rats: Experimental Study
Article
Full-text available
Background. Despite promising results of autologous bone marrow transplantation (BMT) in patients with lymphoma, infectious complications limit its positive outcomes. This study evaluated the incidence and associated factors of the occurrence of febrile neutropenia (FN) following BMT in patients with lymphoma. Material and methods. Overall, 147 lymphoma patients who were candidates for BMT were consecutively included. Clinical and laboratory results were recorded, and after BMT, the occurrence of FN was investigated through the daily evaluation of neutrophil count and body temperature. Results. FN occurred in 91 patients (61.9 %) on average after 12.77 ± 2.45 days after BMT. Lower fluid balance was associated with a higher risk of FN (lowest adjusted odds ratio [OR] at day -2 = 0.602, 95% confidence interval [CI] = 0.299 – 0.870, p value = 0.007). The higher uric acid level was associated with a higher risk of FN (highest adjusted OR at day -10 = 1.617, 95% CI = 1.328 – 1.963, p value = 0.035). LDH also had a positive relationship with FN (highest adjusted OR at day 0 = 1.501, 95% CI = 1.198 – 2.104, p value = 0.004). Conclusion. Adequate hydration of the patients is of paramount importance for preventing FN in patients who receive BMT. Furthermore, uric acid and LDH could be considered in future studies for risk stratification of FN.
Preprint
Full-text available
Backgrounds: To investigate the association between meteorological factors and common uropathogens in children with urinary tract infections (UTIs) and assesses the potential influence of weather conditions on pediatric UTIs. Methods: 2411 data from infants and children with UTIs in a children’s hospital from 2016 to 2021 were retrospectively analyzed. A correlation analysis was conducted to investigate the relationship between the monthly detection number of uropathogens and meteorological factors. Results: Multiple linear stepwise regression analyses showed a positive correlation between monthly average temperature, precipitation volume, sunshine hours, monthly total number of uropathogens, and the number of Escherichia coli and Enterococcus faecalis. Enterococcus faecium was predominant in <12-month-old children, while E. coli was dominant in the 3–18-year age category. E. faecium showed a higher prevalence in girls, while E. faecalis was more prevalent in boys. E. coli exhibited resistance rates of >40% to second- or third-generation cephalosporins in multiple age groups. E. faecium showed high resistance rates to tetracyclines, fluoroquinolones, erythromycin, ampicillin, and penicillin, while Klebsiella pneumoniae displayed higher sensitivity to cephalosporin–sulbactam and sulfamethoxazole, but higher resistance rates to ampicillin, cefazolin and ceftazidime. Conclusions: This study reveals the association between meteorological factors and uropathogens in children with UTIs, as well as the distribution, age-related characteristics, gender differences and antibiotic resistance profiles of pathogenic bacteria. These findings inform the development of targeted strategies for UTI prevention and treatment based on uropathogenic characteristics and meteorological conditions.
Preprint
Full-text available
Recurrent urinary tract infections (rUTIs) are a common condition with high morbidity and a negative impact on quality of life. They account for approximately 25% of all antibiotic prescriptions, posing a public health concern in an era of multi-drug resistant organisms (MDRO) surge. Various non-antibiotic management strategies have been trying to curb antimicrobials use, and many of them are individually effective to some degree, but there is no experience testing multimodal interventions. We created a “bundle of care” consisting of behavioural measures, vaginal and oral probiotics, D-mannose, and cranberry, to be followed for six months; we enrolled women with rUTIs over a three-year period to test it. Changes in rUTIs, antibiotic use, chronic symptoms, and quality of life were compared between the six months before and after enrolment. Forty-seven women were included in the study, six of whom were excluded from the final analysis. We observed a 76% reduction in urinary infections (p < 0.001) and a reduction in overall antibiotic exposure of more than 90% (p < 0.001); all chronic symptoms showed a trend towards reduction. Adherence to bundle was high (87.2%). Altogether, 80.5% of women experienced an improvement in their quality of life. In our experience, a bundle treatment protocol is effective in reducing recurrences and antimicrobial use in a cohort of women with rUTIs and results in subjective improvement in chronic symptoms and quality of life. Further research is needed to confirm these results.
Article
Full-text available
Objective Febrile urinary tract infections, which commonly occur in spina bifida patients, can cause renal dysfunction. To help prevent febrile urinary tract infection occurrence, a better understanding of any seasonal tendencies would be beneficial. Materials and Methods Study points evaluated included: (i) with or without febrile urinary tract infections, (ii) type of urinary management in patients with febrile urinary tract infections, (iii) number of febrile urinary tract infection occurrences, and (iv) season associated with episode. Febrile urinary tract infection was defined by medical records specifically ascribing the term and clinical presentations consistent with the diagnosis. We evaluated febrile urinary tract infection incidence per 1 person, risk odds, expected values, and chi-square analysis. Results This study examined 140 patients (79 males, 61 females). The patient's age at the first visit ranged from 2 days to 43.7 years old (median: 3.0 years old). The observation period was 0.6-43.7 years (median: 11.5 years). (i) Febrile urinary tract infection occurred in 68 cases, (ii) urinary management included: full clean intermittent catheterization: 49 cases, autoaugmented bladder: 15 cases, self-voiding: 8 cases, clean intermittent catheterization + indwelling catheter at night time: 5 cases, self-voiding + clean intermittent catheterization: 4 cases, vesicocutaneostomy: 2 cases, (iii) number of febrile urinary tract infection episodes: 2 times or less: 40 cases, 3-5 times: 20 cases, over 6 times: 8 cases, and (iv) total number of febrile urinary tract infection episodes was 183, with spring: 41, summer: 44, autumn: 37, and winter: 61. Risk odds of the incidence (one season vs. the other season) were spring: 0.870 (P = .425), summer: 0.954 (P = .784), autumn: 0.755 (P = .120), and winter 1.497 (P = .009). Conclusion There is a significantly high incidence of febrile urinary tract infection in spina bifida patients in winter versus the other seasons.
Article
Objectives: : To determine the incidence of bacteremia in patients with DKA. Methods: : We conducted a cross-sectional study of patients aged 18 years and older with a principal diagnosis of DKA or hyperglycemic hyperosmotic syndrome (HHS) who presented to our community hospital between 2008 and 2020. Using medical records from initial visits, we retrospectively calculated the incidence of bacteremia. This was defined as the percentage of subjects with positive blood cultures except for those with contamination. Results: : Among 114 patients with hyperglycemic emergency, two sets of blood cultures were collected in 45 of 83 patients with DKA (54%), and 22 of 31 patients with HHS (71%). The mean age of patients with DKA was 53.7 years (19.1) and 47% were male, while the mean age of patients with HHS was 71.9 years (14.9) and 65% were male. The incidences of bacteremia and blood culture positivity were not significantly different between patients with DKA and those with HHS (4.8% vs. 12.9%, P = 0.21 and 8.9% vs. 18.2%, P = 0.42, respectively). Urinary tract infection was the most common concomitant infection of bacteria, with E. coli as the main causative organism. Conclusion: : Blood cultures were collected in approximately half of the patients with DKA, despite a nonnegligible number of them testing positive in blood culture. Promoting awareness of the need for taking blood culture is imperative for the early detection and management of bacteremia in patients with DKA. Clinical trial registration: UMIN trial ID - UMIN000044097; jRCT trial ID - jRCT1050220185.
Article
Purpose Urinary symptoms are highly prevalent among people with MS. This study aimed to explore the experiences of people with MS and HCPs in managing urinary symptoms and explore their views on using TTNS to treat urinary symptoms. Materials and methods Audio-recorded semi-structured, interviews were employed with people with MS and HCPs. All transcribed interviews were exported to NVivo software (Version 12) and analyzed using a reflexive approach to thematic analysis. Results Four main themes were identified; The wide-ranging negative impacts of urinary symptoms (“It’s limited everything else”), Gaps in urinary services (“Is there somebody like that, sort of specialized in that area?”), Management strategies (“I don’t go too far from the toilet in case I need to use one”), and optimism about TTNS (“Are you giving Me Hope?”). Conclusion Urinary symptoms are common and very troublesome for people with MS. Despite their prevalence, many people with MS continue to suffer in silence. People with MS require skilled multidisciplinary services guided by clinical care pathways to improve service provision and to address urinary symptoms. HCP’s and people with MS are open to the use of TTNS for urinary symptoms and have clear preferences for location and duration of intervention delivery. • Implications for rehabilitation • Urinary symptoms are very common and troublesome for people with multiple sclerosis, yet many continue to suffer in silence. • People with multiple sclerosis lack knowledge about treatment options for urinary symptoms. • There is an on-going need for healthcare provider education on guidelines for screening and managing urinary symptoms in people with MS and the role of specialist urinary service providers. • HCP’s and people with MS are open to the use of TTNS for urinary symptoms.
Article
Modifiable lifestyle-related risk factors are the object of increasing attention, with a view to primary and tertiary prevention, to limit the onset and development of diseases. Also in the urological field there is accumulating evidence of the relationship between urological diseases and lifestyle-related risk factors that can influence their incidence and prognosis. Risk factors such as nutrition, physical activity, sexual habits, tobacco smoking, or alcohol consumption can be modified to limit morbidity and reduce the social impact and the burdensome costs associated with diagnosis and treatment. This review synthesizes the current clinical evidence available on this topic, trying to satisfy the need for a summary on the relationships between the most important lifestyle factors and the main benign urological diseases, focusing on benign prostatic hyperplasia (BPH), infections urinary tract (UTI), urinary incontinence (UI), stones, erectile dysfunction, and male infertility.
Article
Background: The incidence of UTIs is seasonal, peaking in summer months. One possible mechanism for the observed seasonality of UTIs is warmer weather. Materials and methods: We identified all UTI cases located in approximately 400 metropolitan statistical areas (MSAs) in the contiguous United States between 2001 and 2015 using the Truven Health MarketScan databases. A total of 167,078,882 person-years were included in this dataset, and a total of 15,876,030 UTI events were identified by ICD-9 code 599·0. Weather data for each MSA and date were obtained from the National Centers for Environmental Information. We computed the mean temperature during the period zero to seven days prior to the UTI diagnosis. We used a quasi-Poisson generalized linear model. The primary outcome was the number of UTIs each day in an MSA in each age group. Covariates considered included group, day-of-week, year, and the temperature during the previous seven days. Results: Warmer weather increases the risk for UTIs among women treated in outpatient settings in a dose-response fashion. On days when the prior week's average temperature was between 25 and 30°C, the incidence of UTIs was increased by 20-30% relative to when the prior week's temperature was 5 to 7·5°C. Conclusions: The incidence of UTIs increases with the prior week's temperature. Our results indicate that warmer weather is a risk factor for UTIs. Furthermore, as temperatures rise, the morbidity attributable to UTIs may increase.
Article
Carbonic anhydrase II (CA-II) knockout mice (Car2 -/- )have depleted numbers of renal intercalated cells which are increasingly recognized to be innate immune effectors. We compared pyelonephritis susceptibility following reciprocal renal transplantations between Car2 -/- and wild type mice. We examined the effect of pharmacological CA suppression using acetazolamide in an experimental murine UTI model. Car2 -/- vs wild type mice were compared for differences in renal innate immunity. In our transplant scheme, mice only lacking CA-II in the kidney had increased pyelonephritis risk. Mice treated with acetazolamide had lower kidney bacterial burdens at 6-hours post-infection which appeared to be due to tubular flow from diuresis because comparable results were obtained when furosemide was substituted for acetazolamide. Isolated Car2 -/- kidney cells enriched for intercalated cells demonstrate altered intercalated cell innate immune gene expression, notably increased Calgizzarin and Insulin receptor expression. Intercalated cell number and function along with renal tubular flow are determinants of pyelonephritis risk.
Article
Full-text available
This study evaluated the contribution of host defence mechanisms to bacterial clearance from the urinary bladder using an animal model in which rats were infected with Escherichia coli. Factors studied included the effect of hydration status, induced ultrastructural changes to the surface of the bladder mucosa, and the relevance of bacterial replication. Clearance was divided into two phases, primary (0-4 h), and secondary (4-24 h). Ninety-nine per cent of Escherichia coli 075 was cleared during the primary phase from normal, dehydrated and polyuric animals and 93% from anuric animals. Clearance was shown to be dependent on the presence of viable tissue. Bacterial numbers continued to decrease during the secondary phase in normal and dehydrated animals but increased in polyuric and anuric groups. No such rise occurred when rats were inoculated with Escherichia coli E/2/64, a non-replicating mutant. Evidence of ultrastructural changes to the bladder associated with impaired antibacterial properties was found in polyuric and anuric animals. Clearance of particulate matter (killed Candida albicans) however was unaffected by mucus disruption. The study has shown that the clearance of microorganisms from the bladder was unrelated to the voided volume, but is closely associated with the antibacterial activity of the mucosal surface.
Article
Full-text available
Human urine is osmoprotective for enteric bacteria, permitting E. coli to grow with high concentrations of NaCl and other salts and even higher concentrations of sucrose and mannitol but not urea. The active material in urine is soluble in methanol and is precipitated by ammonium reineckate at acid pH. Using gel filtration and high-pressure liquid chromatography, we have identified two major osmoprotective compounds in urine. One is glycine betaine; the other is proline betaine as demonstrated by nuclear magnetic resonance, mass spectrum scanning, and chemical synthesis. Proline betaine has not been described previously to our knowledge in vertebrate tissues. It is known to be a cell volume-regulating agent for marine red algae and the euryhaline mollusk Elysia chloritica. We suggest that the presence of glycine and proline betaines in human urine may reflect an osmoprotective role for the kidney and that they protect bacteria in the urine only fortuitously.
Article
Full-text available
Remis, R. S. (Bureau regional des maladies infectieuses, 980 rue Guy, Montreal, Quebec, Canada H3H 2K3), M. J. Gurwith, D. Gurwith, N. T. Hargrett-Bean, and P. M. Layde. Risk factors for urinary tract infection. Am J Epidemiol 1987;126:685–94. The authors carried out a case-control study in 1982–1983 to investigate the possible influence of behavioral factors on the risk of urinary tract infection. Study participants were college women attending a student health service. Cases were 43 women with culture-confirmed urinary tract infection. There were two control groups: 149 women with upper respiratory infection and 227 women visiting the gynecology clinic. Using each set of controls, the study confirmed that sexual intercourse is a risk factor and that there is a dose-response effect for increasing levels of coital frequency. The study also found that use of the diaphragm was significantly associated with urinary tract infection (odds ratios 3.0, 2.3), an association which remained significant even after controlling for possible confounding by coital frequency. The findings did not show an association with many of the factors commonly believed to be important such as type of clothing worn and volume of fluids consumed.
Article
This single-authored text was first published in 1972 as a pocket-size manual. Dr Kunin's modest goal then was to provide "a practical guide to supplement materials to be found in more standard texts and the recent literature" dealing with urinary tract infections.The third edition (1979) and this latest book reflect the enormous strides made in the understanding and treatment of urinary tract infections during the past decade. Dr Kunin has almost entirely rewritten several chapters and updated the references. There are new or expanded sections dealing with urinary tract infections in the diabetic patient, renal transplant recipients, the elderly, and homosexual men. Infections caused by Staphylococcus saprophyticus and Candida albicans are discussed in much greater detail than in the third edition. There is even a discussion of corynebacterial renal infection in fish!The references are current and easy to locate, listed alphabetically at the end of each chapter under
Article
To the Editor.— We want to commend Adatto et al (241:2525, 1979) on their article "Behavioral Factors and Urinary Tract Infection." We conducted a more limited, but similar, study in a different patient population and made somewhat different observations.We prospectively studied adult women seeking care for symptoms of dysuria, frequency, or urgency in four large ambulatory care centers in New England. Our study group included 23 women with symptoms of dysuria, urinary frequency or urgency, and more than 105 colonies of a single pathogenic organism per milliliter of a clean-catch, midstream urine specimen. We obtained explicit information on self-care behavior from each patient using a self-administered questionnaire and nurse interview.Our control group was composed of 64 ambulatory patients from two of the four study sites, who were seeking care for problems unrelated to urinary or vaginal infection and had had no more than one urinary tract infection
Article
The current diagnosis and management of pediatric urinary tract infection is reviewed along with recent developments in the pathophysiology of urinary infection. We discuss current knowledge of host and bacterial factors and how these influence our management in terms of investigation and treatment.
Article
Voiding and sexual habits of 84 female university students with a history of recurrent urinary infection were compared with those of a control group. There was one highly significant difference between the two groups: 61% of the patients but only 11% of the controls gave a history of regular voluntary deferral of micturition for periods of one hour to longer than six hours. Sexual practices among patients and controls were remarkably similar. A behavioral regimen stressing regular, complete bladder emptying was shown to be effective in preventing reinfection in the patient group. Voluntary urinary retention may play a pathogenic role in women with recurrent urinary tract infection, and its correction may play an important part in the management of urinary tract infection. (JAMA 241:2525-2526, 1979)
Article
Growth of Escherichia coli 06 was compared in concentrated overnight urine and dilute daytime urine. In concentrated urine, 90 per cent of the initial inoculum died during the lag phase and surviving bacteria had a long lag period before they started to grow. Once growth began, these bacteria required fifty-five hours to reach their maximum growth yield. In dilute urine, 75 per cent of the same bacteria survived the lag phase; once growth began, they reached maximum growth yield in only thirteen hours. These observations suggest that concentrated overnight urine serves as a natural defense mechanism against urinary tract infections.
Article
Urinary tract infection remains a common clinical problem. In comparison with the intense research on diagnosis and management, relatively little attention has been focused on the behavioral and genetic factors that may relate to an increased risk of urinary tract infection. Among behavioral risk factors in women, sexual activity and diaphragm spermicide use are clearly associated with increased risk; postcoital voiding and voiding soon after the urge to urinate may be protective factors. Data regarding other behavioral risk factors in women have been inconclusive. In men, identified behavioral risk factors have included rectal intercourse and lack of circumcision. Regarding genetic influences, it appears that a woman's blood group secretor status influences her susceptibility to recurrent urinary tract infection. (C) Lippincott-Raven Publishers.
Article
The majority of urinary tract infections (UTIs) present as bacterial cystitis in women in the sexually active age group. The commonest pathogen is Escherichia coli and the majority of the remainder are due to Staphylococcus saprophyticus. Manu women are prone to recurrent UTIs and these are invariably due to a reinfection with a different organism. After the diagnosis has been made a curative course of treatment should be given, but the approach can be modified if the infection is umcomplicated (normal urinary tract and normal renal function) as opposed to complicated. It is widely believed that traditional dosage regiments for uncomplicated UTIs are extravagant. There is now considerable enthusiasm for the use of either single-sose therapy or for a course of treatment not exceeding 3 days for uncomplicated cystitis. Failure of single-dose therapy is a simple guide to the need for further urinary tract investigation or more internsive therapy. Patients with uncomplciated acute pyelonephritis should be treated for at least 5 days and this may need to be given parenterally if the patient is vomiting. If a woman is having recurrent UTIs it may be necessary to consider long-term, low-dose prophylaxis. The most effective drugs used in this way include nitrofurantoin 50 mg, trimethoprim 100 mg and norflaxacin 200 mg given at night. More recent studies have shown that a dose given alternate nights, 3 nights a week of just after intercourse is just as affective.
Article
In most episodes of urinary tract infection bacteria reach the bladder through the urethra and then may ascend to the kidneys through the ureters. Bacteria periodically enter the female urinary bladder from the urethra in small numbers. Whether infection ensues depends on the virulence and inoculum size of the microorganism and the adequacy of most defense mechanisms. Human urine is frequently inhibitory and sometimes bactericidal for the bacteria that cause urinary tract infection. Inhibition of bacterial growth coupled with voiding serves as a very effective antibacterial defense mechanism. In addition an intrinsic antibacterial defense mechanism has been demonstrated in the rat urinary bladder unrelated to urine flow. The medulla of the kidney is much more susceptible to infection than the cortex mainly related to its high osmolality. Certain abnormalities of the urinary tract interfere with host defense mechanisms and therefore predispose to urinary tract infection or make infection more difficut to eradicate once present. Some of these abnormalities are obstructive or neurological diseases of the urinary tract, vesicoureteral reflux, calculi, certain metabolic, hematologic, and vascular diseases, and pregnancy.
Article
Voiding and sexual habits of 84 female university students with a history of recurrent urinary infection were compared with those of a control group. There was one highly significant difference between the two groups: 61% of the patients but only 11% of the controls gave a history of regular voluntary deferral of micturition for periods of one hour to longer than six hours. Sexual practices among patients and controls were remarkably similar. A behavioral regimen stressing regular, complete bladder emptying was shown to be effective in preventing reinfection in the patient group. Voluntary urinary retention may play a pathogenic role in women with recurrent urinary tract infection, and its correction may play an important part in the management of urinary tract infection.
Article
In rats of both sexes with experimental E. coli infection of the urinary bladder, we evaluated by quantitative bacteriology urinary and kidney tissue infection during low diuresis, during hydropenia, and during water diuresis. Particular attention was given to the question of whether the hypertrophying kidney following contralateral nephrectomy has the same sensitivity to infection ascending from the bladder as a normal kidney. The results showed that water diuresis results in a long-term significant bacteriuria with penetration of microorganisms into the kidney. However, we did not find that infection of a solitary kidney following contralateral nephrectomy was of any greater degree than infection in the kidneys of rats with both kidneys intact.
Article
Introital swabbing was performed on each of 20 premenopausal female volunteers over a 5-day period, 2 swabs being collected each day. During the last 3 days of the 5-day period the volunteers were requested to void every 2 hours. Analysis of our data shows: 1. Perineal bacterial flora varies in number and type of organisms from hour to hour and day day. 2. Quantitative culturing is of little help in distinguishing colonisation of the introitus with urinary pathogens from mere intermittent contamination of the introitus with the same pathogens. 3. Our results suggest that 4 or more consecutive isolates of the potential urinary pathogens from the introitus over a 48-hour period signify colonisation. 4. Frequency of micturition increases the risk of colonisation of the introitus with potential urinary pathogens. The significance of these findings is discussed, in relation to the previous work of other investigators.
Article
Recurrent urinary tract infection (UTI) is a very common medical complaint among women. A large proportion of such recurrence is attributable to a small sub-group of sufferers. Medical factors have proven insufficient to explain all such cases, and a number of psychological factors have been suggested as having a causal role. This study examines the evidence for the effects of behavioural and personality factors. Neuroticism and specific "risky" behaviours are identified as particularly important, being related to both the diagnosis of recurrent UTI and the frequency of infection. These findings suggest that treatment of recurrent, intractable UTI might include a psychological component.
Article
We assessed the agreement between 2 methods of data gathering of particular interest in urology: patient questionnaire and examination vs. frequency-volume charts. One hundred consecutive patients consulting our out-patient clinic were chosen for this study; 88 completed the study. Urinary frequency and bladder capacity were evaluated in each patient by using the above methods. The agreement between different methods of measurement was assessed by determining whether the 2 methods were interchangeable, a condition occurring if results of both methods fall within predetermined limits of variability. The results showed poor agreement between subjectively estimated urinary frequency and chart-determined urinary frequency. Moreover, different methods of measuring bladder capacity (endoscopic vs. chart) gave different results. Since chart-determined data are probably a more valid indication of urinary habits, we suggest that frequency-volume charts should be used more often in the investigation and follow-up of patients with micturition disorders.
Article
In a prospective study of low-dose antibacterial prophylaxis of childhood urinary tract infection (UTI), co-trimoxazole and trimethoprim (TMP) have been compared for efficacy in preventing UTI, for their effect on the rectal flora and for secular selection of TMP-resistant organisms. Between 1979 and 1986, 334 children who had proven infection of an unobstructed urinary tract complied in a regimen of low-dose prophylaxis together with measures to eliminate residual urine for at least 6 months. Of these children, 167 had vesico-ureteric reflux and 27 had renal scarring. There was no difference between the two drugs in compliance, which was very good, or in the occurrence of side-effects, which were minimal. Recurrence rates of further infection were 1 per 22 child years for the 226 children receiving cotrimoxazole and 1 per 18 child years for the 108 receiving TMP. All but one of these urinary pathogens were resistant to TMP and reinfection of the urinary tract generally occurred following lapses in attention to complete bladder emptying. Neither a secular increase in recurrent infections during this period, nor a significant change in the proportions of TMP-resistant faecal coliform organisms, was observed. TMP and co-trimoxazole appeared to be equally effective prophylactic agents.
Article
Growth of Escherichia coli 06 was compared in concentrated overnight urine and dilute daytime urine. In concentrated urine, 90 per cent of the initial inoculum died during the lag phase and surviving bacteria had a long lag period before they started to grow. Once growth began, these bacteria required fifty-five hours to reach their maximum growth yield. In dilute urine, 75 per cent of the same bacteria survived the lag phase; once growth began, they reached maximum growth yield in only thirteen hours. These observations suggest that concentrated overnight urine serves as a natural defense mechanism against urinary tract infections.
Article
Changing concepts regarding the epidemiology, pathogenesis, evaluation, and treatment of urinary tract infection have reduced patient expenditures. An appreciation of the natural history and associated significance of these infections at all ages in both male and female patients is essential for proper evaluation and treatment. Careful classification of the infection with attention to historical aspects allows the clinician to plan a treatment regimen tailored to each patient. When and how these patients are evaluated depend on the statistical likelihood of associated pathology.
Article
This study was designed to prospectively study the effect of health education on the recurrence rate of urinary tract infections in female outpatients. Thirty-four volunteers were randomly assigned to either an experimental education group or a control group. Controls were offered routine patient information provided by practitioners at the outpatient clinic. Members of the experimental group participated in an educational session which addressed urinary tract infections, its risk factors, and behavioral changes which might reduce its recurrence. At follow-up three months after the educational session, the experimental group had a statistically significant (p less than .05) reduction in the recurrence of urinary tract infections.
Article
A 1 yr epidemiologic study of urinary tract infections in hospitalized patients was conducted with computer aid. Twelve per cent of the patients had a urinary tract infection. E. coli comprised 29% of all isolates and was a causative organism in a significantly greater percentage of community acquired infections than hospital acquired infections. Pseudomonas and Serratia organisms were predominantly of nosocomial origin, whereas Streptococcus infections were more frequently present when the patient was admitted. Women had significantly more infections than men and a greater percentage of these were caused by E. coli. Sixty two per cent of the hospital acquired infections were attributed to urinary catheterization. Only 50% of the infections were treated with a correct antibiotic (according to the sensitivity profile) in a proper dose for an adequate duration. Community acquired infections responded better to treatment. The study clarified the epidemiology and etiology of urinary tract infections and has led to improved methods of prevention and treatment.
Article
1. The material consists of 5% consecutive cases of primary (first onset) urinary tract infections appearing from birth up to 16 years of age and which were examined and treated at the Childrens' Hospital in Goteborg. The infections occurred during a seven‐year period within a defined population. The circumstances under which the study was conducted suggest that most symptomatic infections occurring during the study period and for whom the parents sought medical advice, were 2. The total morbidity risk at I 1 years of age of symptomatic UTI was 3.0% for girlsand 1.1 % for boys. These are minimum figures. The morbidity risk is highest during the first month of life and then decreases, more rapidly in boys than in girls. Possible interpretations of the reason for decreasing risk with increasing age of falling ill with a first infection are suggested. The male/female ratio starts at 2.5: 1 during the first month and then successively changes to 1:20.There was no seasonal variation of the time of onset in either sex. 3. Presentation with fever was most common in the first year, after which it slowly decreased. Failure to thrive was a rare symptom. Certain pther age and sex differences in presenting symptoms were recorded. Most infections within the first year of life probablyinvolved the renal parenchyma. 4. The etiology varied with age and sex. If infections reach the urinary tract by theascending route, this could indicate differences in the environmental conditions in the periurethral region and may be a clue to a better understanding of the pathogenesis. 5. Obstructive malformations were found in 10% of boys and 1–2% of girls, and cannotexplain the high frequency of early infantile infections in either sex. 6. Narrowing of the bladder neck was common in males during the first year of life, the frequency declining with age. It disappeared spontaneously during follow‐up of individual cases, and was not regarded as an obstructive malformation. 7. Duplication of the collecting system was seen in 10 % of girls and in 5 % in boys, which is more than expected. The cause and nature of the association between infection and duplication are not known. 8. In 13 % of boys and 4.5 % of girls a reduction of the renal parenchyma was seen either at the first investigation or developed later, probably owing to infection. AlthoughUTI was more frequent in females than in males, the total number of patients with parenchymal damage was equal in both sexes, even during childhood. In boys, the kidneys might bemore vulnerable than in girls. 9. The immediate cure rate after 10 days' therapy was 97%. Recurrences were usually reinfections. 10. Recurrent infections were often difficult to diagnose. Pyuriaand symptoms of UTI were associated with insignificant bacteriuria in 10 % (30 of 300) of suspected recurrences. 11. Susceptibility to recurrence was studied in relation to various parameters. Girlswere at greater risk than boys, and the risk was in both sexes greatest during the first 2–3 months after a previous infection. Boys rarely had a recurrence more than one year after the primary infection, while girls often continued to have recurrences for many years. The risk seemed to increase with the increasing number of previous recurrences. No correlation was found between the frequency of recurrences and age at onset of primary infection or with symptomatology, etiology, reflux, or duration of therapy. 12. The risk of recurrence was many times greater in a patient who had had one infection than in a previously healthy patient. The possibility that the degree of susceptibility to UTI might depend, to some extent, on genetic factors should be examined.
Article
The fate of bacteria in human urine was studied after inoculation of small numbers of Escherichia coli and other bacterial strains commonly implicated in urinary tract infection. Urine from normal individuals was often inhibitory and sometimes bactericidal for growth of these organisms. Antibacterial activity of urine was not related to lack of nutrient material as addition of broth did not decrease inhibitory activity. Antibacterial activity was correlated with osmolality, urea concentration and ammonium concentration, but not with organic acid, sodium, or potassium concentration. Between a pH range of 5.0-6.5 antibacterial activity of urine was greater at lower pH. Ultrafiltration and column chromatography to remove protein did not decrease antibacterial activity. Urea concentration was a more important determinant of antibacterial activity than osmolality or ammonium concentration. Increasing the urea of a noninhibitory urine to equal that of an inhibitory urine made the urine inhibitory. However, increasing osmolality (with sodium chloride) or increasing ammonium to equal the osmolality or ammonium of an inhibitory urine did not increase antibacterial activity. Similarly, dialysis to decrease osmolality or ammonium but preserve urea did not decrease inhibitory activity. Decreasing urea with preservation of ammonium and osmolality decreased antibacterial activity. Removal of ammonium with an ion exchanger did not decrease antibacterial activity, whereas conversion of urea to ammonium with urease and subsequent removal of the ammonium decreased antibacterial activity. Urine collected from volunteers after ingestion of urea demonstrated a marked increase in antibacterial activity, as compared with urine collected before ingestion of urea.
Article
The effect of water restriction and ammonium chloride acidosis on the course of Escherichia coli pyelonephritis was determined in the nonobstructed kidney of the rat. To alter the chemical composition of the renal medulla, water intake was reduced in rats to one-half the normal daily intake. Water restriction increased the incidence of coliform pyelonephritis. Systemic acidosis, produced by giving a 300 mM solution of ammonium chloride, increased urinary osmolality to values comparable to water restriction and also predisposed to pyelonephritis. However, when rats were fed the same solution of ammonium chloride but were allowed access to tap water ad lib., urinary osmolality values were comparable to those observed in normal animals, and susceptibility to pyelonephritis was reduced or eliminated despite a degree of systemic acidosis similar to that observed in rats fed ammonium chloride solution without access to tap water. These results suggest that water diuresis may overcome the inactivation of complement produced by ammonium chloride acidosis and that renal medullary hypertonicity, produced by either water restriction or ammonium chloride acidosis, is a major determinant of this tissue's unique susceptibility to infection.
Article
The effect of water diuresis on the course of enterococcal pyelonephritis was determined in the rat. Unlike most models of renal infection in this species, enterococcal pyelonephritis has been shown to produce chronic and progressive infection, thus mimicking the course of pyelonephritis in man. Pyelonephritis could be prevented and, once established, could be cured by a sustained water diuresis administered for 7 to 14 days. Furthermore, an increase in fluid intake of just three times the normal daily volume, given for only 16 hours each day, decreased urinary osmolality values to levels observed with a sustained water diuresis and protected the medulla of the kidney from progressive infection. The protective effect of water diuresis was associated with the prompt appearance of polymorphonuclear leukocytes in the renal medulla of diuresing animals within 24 hours after bacterial challenge. In contrast, granulocytes were few or absent in the renal medulla of hydropenic rats for at least 48 hours after a similar challenge. Because enterococcal infection is not affected by a specific antibody or by complement, these factors appear to be unimportant in the therapeutic effects of water diuresis. These results provide further evidence that the habitual hypertonicity of the renal medulla is an important determinant of the unique vulnerability of this tissue to infection.
Article
Introital swabbing was done on each of 19 patients with a history of lower urinary tract infection. The swabs were collected during a 5-day period, with 2 swabs being collected each day. We found that 1) introital flora varied in nature and in number from hour to hour and from day to day, 2) repetitive qualitative swabbing was the most accurate method to determine the presence of pathogens in the introitus and 3) there was a relationship between the frequency of micturition and the presence of introital pathogens: a) normal controls became colonized with pathogens as frequency of voiding was increased and b) pathogen carriage was found more commonly in the patient group as compared to the controls and the patient group voided more frequently than the control group. The theoretical implications of this relationship are discussed.
Article
To assess whether the use of simple hydration monitoring can encourage adequate hydration and reduce urinary osmolality and the incidence of urinary tract infections (UTIs) in a population of susceptible pre-menopausal women with recurrent idiopathic urinary infections. The study included 28 pre-menopausal women who had at least two idiopathic UTIs in the previous 6 months. Urinary osmolality was assessed by the patients at each void by a simple hand-held probe, and the readings over 4 months compared. Monthly urine culture was compared between successive 4-month periods in which the probe was or was not used. The study was completed by 17 women. There was a significant shift towards urine of lower osmolality over the 4-month period using the probe (Pearson's chi 2 < 0.001). Significantly fewer urinary tract infections developed during the 4 months using the probe (McNemar's chi 2 = 0.046). The use of the osmolality probe encouraged the subject to maintain adequate hydration. The resulting augmentation of the natural urethral 'washout' mechanism led to lower osmolality urine and a reduction in the incidence of UTIs.
Article
Polymorphonuclear neutrophils (PMN) in freshly voided urines from 20 symptomatic bacteriuric patients were examined. Although the PMN were viable (median 85%), in only 2 cases could phagocytosis of the infecting organisms be demonstrated, even after the addition of serum opsonins. Polymorphonuclear neutrophils from urines of 12 patients were also unable to phagocytose added opsonized Staphylococcus aureus. These urines were found to be of pH < 6.0 and/or osmolality > 700, or < 180 mOsm. However, the phagocytic function of these PMN was restored when transferred to Hanks balanced salt solution (HBSS). By contrast, most PMN in urines of suitable pH (> or = 6.0) and osmolality (between 200 to 700 mOsm.) phagocytosed the opsonized S. aureus. When bacteria cultured from the infected urine were incubated in the same urine and then transferred to HBSS, in 17 of 19 cases opsonization occurred and the organisms were phagocytosed when PMN, isolated from blood, were added. IgG appeared to be the prime opsonin in the urines, and heat-stable opsonins for S. aureus were also present. It is concluded that lack of opsonization is not a major cause of the absence of phagocytosis by urinary PMN. Low pH and adverse osmolality are largely responsible, correction of which may restore PMN function in vivo.
Article
In an attempt to study the epidemiology of infrequent voiding and its associated symptoms, 1613 women aged 20-25, 30-35 or 40-45 years randomly selected among the ordinary female population in Northern Jutland in Denmark were sent a questionnaire. It was to be answered anonymously. The women were asked about voiding frequency, frequency of nocturnal voidings, urinary infections, problems in initiating voiding and urinary leaking symptoms. The response rate was 65.0%. Overall, 7.7% of the women in the 3 groups had a voiding frequency of 3 or less per day. We found that women aged 20-25 had a higher rate of this low voiding frequency than women in the two older groups, (p < 0.001). Women aged 40-45 had a higher rate of urinary leaking symptoms than the two younger groups, (p < 0.02). In all 3 groups, women who voided 3 times or less per day had significantly more urinary infections than those with 4 or more voidings per day, (p < 0.01). The investigation has given some impression of the frequency of the infrequent voiding and the frequency of its associated symptoms.