#07 Click here to see the previous editions November 18, 2023
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Welcome to UTI News! In this newsletter, we will cover the most important hot topics in the field of urinary tract infections every two months. Stay tuned for updates and insights on this important topic.

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Hello urologists, gynaecologists, primary care doctors and all of you who 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. Scientific support of the evidence and practice guidelines recommendations will be the key to all the information in the Newsletter.

The focus of this issue is the revision of three articles. The main topic reviewed is the effect of urine pH in the characteristics of patients with and without urinary tract infections. The relation with urinary microbiome is also review as there is a great interest in this field. Moreover, the efficacy of L-methionine in the prevention of urinary tract infections is reviewed, including a group of patients with high risk of urinary tract infections, those recipients with a kidney transplant.

img Predictors of ertapenem therapeutic efficacy in the treatment of urinary tract infections (UTIs) in hospitalized adults: the importance of renal insufficiency and urinary pH.
Cunha BA, Giuga J, Gerson S Eur J Clin Microbiol Infect Dis (2016) 35:673–679. DOI 10.1007/s10096-016-2586-z
img 2'
https://pubmed.ncbi.nlm.nih.gov/26873378/ img

Urinary tract infections are the cause of up to 40% of healthcare-associated infections. In hospitalized patients, urinary catheters are one of the main risk factors for urinary tract infections. Although most of the infections in hospitalized patients and those related to urinary catheters are considered complicated urinary tract infections, in many cases may be treated orally. However, urine culture is required as the isolation of extended-spectrum ß-lactamase (ESBL) Gram-negative bacilli (GNB) is increased and proper antibiotic treatment is required, such as ertapenem.

The present research evaluated the efficacy of ertapenem in the management of urinary tract infections in hospitalized adults with urinary catheters. Moreover, factors that affect the efficacy were assessed. Renal insufficiency is defined as Creatinine Clearance (CrCl) < 50 ml/min ) and it was associated with decreased efficacy of ertapenem to get the clearance of the urine bacteria. Moreover, the effect of urinary pH was also evaluated.

In patients with an acid urinary pH ertapenem was highly effective in eliminating bacteriuria, and the time to negative urine cultures (TTNC) was less than 3 days. TTNC longer than >3 days was reported in patients with decreased renal function and alkaline urinary pH. The study evaluated 45 adults with urinary tract infections and urinary catheters. CrCl < 50 ml/min and alkaline urine pH were associated with TTNC longer than 3 days.

Therefore, ertapenem used in the presence of renal insufficiency and alkaline urine to urinary tract infections due to gram-negative bacilli in patients with urinary catheters is associated with a longer duration of antibiotic therapy. Therefore, urine pH has an important effect on the efficacy of antibiotics in the management of urinary tract infections. Moreover, strategies that affect urine pH must be evaluated in order to have better knowledge to optimize the management of urinary tract infections.

img Recurrent uncomplicated urinary tract infections: definitions and risk factors
Cai T
GMS Infect Dis. 2021;9:Doc03. DOI: 10.3205/id000072
img 2'
https://pubmed.ncbi.nlm.nih.gov/34113535/v img

Recurrent uncomplicated urinary tract infections (UTI) are a highly prevalence diagnosis in women with a great impact on patients’ quality of life. Patients with at least two urinary tract infections in 6 months or three in one year, is considered that suffer from recurrent UTIs.

The present article focused on the literature revision in order to assess risk factors for recurrence urinary tract infections. The main factors related to a higher incidence of urinary tract infections are sexual intercourse, spermicide use, having a new sex partner, having a mother with a history of UTI, having had UTI during childhood, and asymptomatic bacteriuria treatment. Moreover, other risk factors such as reduced fluid intake, habitual and post-coital delayed urination, wiping from back to front after defecation, douching and wearing occlusive underwear, as well as irregular bowel function should be considered. In menopausal women, the most important risk factors to consider are atrophic vaginitis due to estrogen deficiency, cystocele, increased post-void urine volume and functional status deterioration.

The discussion gives a clear recommendation that asymptomatic bacteriuria should not be treated routinely as antibiotic treatment is associated with a higher incidence of infections and more frequent isolation of non-E. coli microorganisms. Moreover, it is also stated that the prevention of recurrent urinary infections must primary rely on non-antibiotic maneuvers.

The article includes a nomogram that could be interesting for identifying women at high risk of symptomatic recurrence that can be suitable candidates for a prophylactic strategy.

img Psychosocial burden of recurrent uncomplicated urinary tract infections
Naber KG, Tirán-Saucedo J, Wagenlehner FME, RECAP group. GMS Infect Dis. 2022;10:Doc01. c
img 2'
https://pubmed.ncbi.nlm.nih.gov/35463815/ img

Recurrent urinary tract infections (UTIs) are one of the main causes for seek medical attention for primary care attention and in urology. It is estimated that 30–50% of women who have a UTI will experience a recurrence within 6–12 months. Traditionally recurrent UTI is viewed as a condition with low morbidity. However, urinary tract infections have an impact in daily life and also affect the quality of life.

The present research focus on psychosocial impacts of recurrent UTI. A literature search was carried out in order to identify the impact of recurrent urinary tract infections in quality of life, daily activities, the potential effect reducing intimate and social relationships, self-esteem, and capacity for work. It was reported that about one third of women suffered from UTI very often or often after sexual intercourse, and more than half of the patients stated that sexual relations were negatively influenced by UTI. Moreover, the European GESPRIT study (GErmany, Switzerland, Poland, Russia and ITaly) study used a self-administered online survey which assessed course of disease; social and economic burden; disease management and QoL effects of UTIs.

It was reported that symptoms related to UTIs limited activities approximately 2.5 to 4 days for each episode of infection. Regarding the percentage and number of medical visits, there is a great heterogeneity from women who did not have medical visit to up to 10% with more than ten visits per year. The study also showed that social function was substantially more reduced than physical function. The research also reported that prophylaxis for recurrent UTI is underutilized, in many cases than prophylaxis after experiencing UTIs were not offered.

The study concludes that there is little data on the psychosocial impact and the Quality-of-life assessment in patients with recurrent UTI. Measures such as the Acute Cystitis Symptom Score, are recommended in order to assess quality of life in patients with recurrent UTIS. It is necessary further research in order to improve the management of UTIs and also focus on the quality of life and psychological consequences of UTIs.

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