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Hello urologists, gynaecologists, primary care doctors and all of you that have to deal with urinary tract infections. Urinary tract infection management and prevention is one of the activities on a routine basis for all caregivers.

This Newsletter intends to review the last recommendation for managing and preventing urinary infections. Our focus is reducing the number of infections, avoiding antibiotic use when not indicated to prevent resistance and reviewing the evidence about non-antibiotic measures to prevent infections.

During the congress of the Spanish Association of Urology (AEU) 2023, held in Granada-Jaen between 24 and 26 May, key aspects of managing and preventing urinary tract infections were reviewed. Among the topics presented, 3 areas of knowledge stand out: antibiotic prophylaxis, the use of immunoprophylaxis and the effect of urinary pH on the effectiveness of antibiotic treatment.

Antibiotic prophylaxis

3 min

Antibiotic prophylaxis in different outpatient urological procedures such as cystoscopies, urodynamic studies and prostate biopsies has been reviewed: A study carried out at the Hospital General Universitario de Valencia on a total of 318 patients shows that there are no differences in terms of infectious complications depending on the administration of antibiotic prophylaxis before the procedure. The result of the culture before cystoscopy is a factor influencing the risk of urinary tract infection after the procedure. The Hospital Universitario 12 de Octubre reviewed antibiotic prophylaxis in patients undergoing a urodynamic study on 177 patients showing an infection rate of 5.8% in those receiving antibiotherapy and 7% in those without antibiotherapy (p=0.755). The need for prophylaxis should be assessed in patients with urodynamic alterations, as they are associated with a higher risk of infection: 8.7% in those with lower urinary tract obstruction (p=0.425); 7.1% if detrusor acontractility and 10% if poor accommodation.

The antibiotic prophylaxis in patients undergoing prostate biopsy via the perineal route was also reviewed, including 121 patients from the Hospital Universitario Río Hortega in Valladolid, with a total of one positive urine culture prior to prostate biopsy and no urine infection after prostate biopsy via perineal route, demonstrating the low incidence of infections after prostate biopsy via perineal route, making it necessary to consider and evaluate the need for antibiotic prophylaxis in patients undergoing this procedure.

The effect of urinary pH on the effectiveness of antibiotic treatment

1 min

The Hospital Universitario la Fe in Valencia presents a review on pH and antibiotic effectiveness to determine the best urinary pH for each family of antibiotics and evaluate whether pH changes bacterial susceptibility to antibiotics through a systematic review. This review includes in vitro and in vivo studies of one or more bacterial species investigating the effect of antibiotics at different pH values. Randomised clinical trials in uncomplicated UTIs were also included, choosing antibiotics based on urinary pH or using the antibiotic together with urinary pH modifiers (L-methionine) vs. an antibiotic and a placebo. The antibiotics with the best alkaline profile are most of the fluoroquinolones, aminoglycosides and trimethoprim. The acid antibiotics are fosfomycin, tetracycline, nitrofurantoin and some beta-lactams. Thus, they conclude that pH modifies in vitro antibiotic efficacy, so they suggest performing urine cultures and antibiograms in acidic and alkaline media to define the bacterial susceptibility profile.

The use of immunoprophylaxis

2 min

Two studies evaluate the usefulness of immunoprophylaxis in the management of recurrent urinary tract infections. A series from the Hospital Universitario la Fe in Valencia carried out a study in 70 patients with neurogenic bladder who received autovaccination for 3 months, observing a significant reduction in hospital admissions of 1.20 (95% CI 0.53-1.87) as well as a significant reduction in emergency room visits of 4.67 (95% CI 3.24-6.09). Dr Ramírez Sevilla of the Hospital Sant Joan de Déu de Martorell presents a revaccination protocol on a series of 1.116 patients showing that patients with more than 5 infections per year have a higher probability of reinfection after immunoprophylaxis, and revaccination is indicated in these patients.

References

Gras Martinez, RM; Rechi Sierra, K; Povo Martín, I; Diranzo Garcia, M; Beltrán Puig, M; Martínez Martínez, F; Soler Aparisi, M; López Alcina, E. Study on the use of antibiotic prophylaxis before the use of flexible cystoscope in our centre. LXXXVI AEU National Urology Congress. Granada-Jaén. 2023. 24-26 May 2023 Presentation: Virtual Poster 167. Juste Álvarez, S.; Medina Polo, J.; Teigell Tobar, J.; Peña Vallejo, E.; Caro González, M. P.; Calzas Montalvo, C.; De la Calle Moreno, A.; González Ginel, I.; Rayo Encinas, C.; Arrébola Pajares, A. Rodríguez Antolín, A. Antibiotic prophylaxis before urodynamic studies: are antibiotics necessary to reduce infections and for which patients would prophylaxis be most beneficial? LXXXVI AEU National Urology Congress. Granada-Jaén. 2023. 24-26 May 2023 Presentation: Virtual Poster 169. Tapia Herrero, A.M.; Gómez Martínez, M.L.; Miralles Ayuso, S.; Portilla Mediavilla, L.; Sánchez Estébanez, E.; González Martín, E.; Aderghal Chikhaoui, A.; Macarro López De La Torre, G.; Poza Del Val, M.; Cepeda Delgado, M. Infection in prostate fusion biopsy. LXXXVI AEU National Congress of Urology. Granada-Jaén. 2023. 24 to 26 May 2023 Presentation: Virtual Poster 174 Ordaz Jurado, D.G.; Dagà Martínez, O.; Budia Alba, A.; Pérez-Lanzac, A.; Fernández Gómez, J.M.; Jordán De Luna, C. Urinary pH and antibiotics, how to choose wisely. A systematic review. LXXXVI AEU National Congress of Urology. Granada-Jaén. 2023. 24-26 May 2023 Presentation: Virtual Poster 175. Ortiz Salvador, J.B.; Colet, O.; Bolon Marset, J; Quereda-Flores, F; Bevia-Romero, A.J.; Espinosa Vaño, J; Castillo- Antón, D.J.; Moran Pascual, E; Martinez Cuenca, E; Arlandis Guzman, S; Broseta Rico, E; Bonillo Garcia, B; Budia Alba, A. Immunoprophylaxis with autovaccine reduces hospital admissions and emergency department visits in patients with neurogenic bladder. LXXXVI AEU National Congress of Urology. Granada-Jaén. 2023. 24-26 May 2023 Presentation: Virtual Poster 175. Ramírez Sevilla, C.; Gómez Lanza, E.; Llopis Manzanera, J.; Cetina Herrando, A.; Puyol Pallàs, M. Algorithm of action in the active immunoprophylaxis of recurrent ITUs: the efficacy study in 1116 patients can help us in re-vaccination. LXXXVI AEU National Congress of Urology. Granada-Jaén. 2023. May 24 to 26, 2023 Presentation: Virtual Poster 173.