During the European Association of Urology (EAU) 2024 meeting, held in Paris between 5 and 8 April, key aspects of managing and preventing urinary tract infections were reviewed. Among the topics presented, 3 areas of knowledge stand out: antibiotic prophylaxis, biomarkers for urinary tract infections and the effect of urinary pH in preventing urinary tract infections.
The abstracts by Zimmern et al. review the influence of urine pH in patients with urinary tract infections. It analysed the associations between potential renal acid load and urine PH in postmenopausal women with recurrent urinary tract infections. The research is based on the possible effect of an acidic urine pH diet as protective against urinary tract infections. The analysis of the Potential Renal Acid Load (PRAL) using a collection of 3-day food diet records (FDR) and urine pH measurements (urine dipstick before each meal and at bedtime) did not report that associations between PRAL intake at a particular meal and either the change in urine pH. However, further evaluation is required about the acidification of urine as diet changes may not be sufficient to have an effect in the prevention of urinary tract infections. Moreover, urine pH may also affect the efficacy of antibiotics.
In patients with recurrent UTIs, the role of persistently elevated urinary inflammatory biomarkers was also evaluated. It is reported that persistent elevated urinary biomarkers neutrophil gelatinase-associated lipocalin (NGAL) and CXCL1 might be useful in predicting women with UTI to have a recurrence within 1 month. Higher urinary levels of NGAL, IL-8, and MCP-1 at baseline of UTI episode are associated with UTI recurrence within 3 months. Another factor evaluated related to urinary tract infections was the urinary metabolome. Two abstracts focus on this topic in postmenopausal women with recurrent UTIs. The analysis of the whole genome metagenomic sequencing (WGMS) of urine can be useful as biomarkers of urobiome ecology. Moreover, some biomarkers for sepsis were evaluated. Several studies from Japan reported that plasma hyaluronan levels - endothelial glycocalyx injury may predict major adverse cardiovascular events in urological sepsis. The authors also concluded according to another research carried out that endothelial glycocalyx injury may be a potential therapeutic target for disseminated intravascular coagulation. The same group reported that the biantennary asialoglycan (G2) of serum immunoglobulin might have a protective role in endothelial glycocalyx injury in urological sepsis.
Several abstracts evaluate antibiotical prophylaxis. The research by Falkensammer et al. is a systematic review that aims to investigate the evidence base for antibiotical prophylaxis in robotic-assisted laparoscopic prostatectomy (RALP). The study reported that concluded that the overall occurrence of postoperative infectious complications varied between 0.6% to 6.6%. However, there is no clear evidence about the indications and type of antimicrobial prophylaxis required in RALP. Therefore, .prospective studies that apply consistent and uniform criteria for measuring infectious complications and antibiotic-related side effects are needed to determine indications on antimicrobial prophylaxis required in RALP. Moreover, a meta-analysis by Jun et al. evaluated the urinary tract infection rates with and without prophylactic antibiotics in transperineal prostate biopsy. It is reported that there is no difference comparing UTI and sepsis rates between antibiotic prophylaxis and no antibiotic prophylaxis groups in transperineal prostate biopsy. However, antibiotic prophylaxis might be needed in high-risk patients for UTIs. Another abstract by Bangma et al. defines risk groups for those with urinary stents/catheters, and hospitalization as risk factors for endocarditis or infections after perineal prostate biopsy.
References:
• Bangma CH, Rietbergen J, Klaver S, Busstra M, Planken E, Pelger R, Andel van G, Aussems P, Venderbos L, Borggreven N, Raaymakers R, Merks B. Reduction of antibiotic use around prostatic biopsy in a prostate cancer network. . 2024 EAU Annual Meeting. 5-8 April 2024.
• Chavez JC, Williams K, Shah A, Christie AL, Zimmern PE. Associations between potential renal acid load and urine PH in postmenopausal women with recurrent UTI. 2024 EAU Annual Meeting. 5-8 April 2024.
• Falkensammer E, Erenler E, Bjerklund Johansen TE, Tzelves L, Schneidewind L, Yuan YY, Koves B, Tandogdu Z. Antimicrobial prophylaxis in robot assisted laparoscopic radical prostatectomy: A systematic review. 2024 EAU Annual Meeting. 5-8 April 2024.
• Jiang YH, Jhang JF, Chang TL, Liu MC, Yang CC, Kuo HC. Persistently elevated urinary in8ammatory biomarkers may predict recurrence of recurrent urinary tract infection in women. 2024 EAU Annual Meeting. 5-8 April 2024.
• Jun DY, Jeong JY, Moon YJ, Cho S, Lee JY, Jung HD. Comparison of urinary tract infection rates with and without prophylactic antibiotics in transperineal prostate biopsy: An updated systematic review and metaanalysis. 2024 EAU Annual Meeting. 5-8 April 2024.
• Momota M, Fujita N, Tobisawa Y, Yoneyama T, Soma O, Noro D, Ito H, Yoshikawa H, Ohyama C, Hatakeyama S. Plasma hyaluronan levels predict major adverse cardiovascular events in urological sepsis. 2024 EAU Annual Meeting. 5-8 April 2024.
