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) 2024, held in Palma de Mallorca, Spain, in May 2024, key aspects of managing and preventing urinary tract infections were reviewed. Among the topics presented, three areas of knowledge stood out: antibiotic prophylaxis, the use of immunoprophylaxis, and the effect of urinary pH on the effectiveness of antibiotic treatment.

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Research conducted at the Hospital Universitario Central de Asturias evaluated the importance of urine culture before urological surgery. The study included 402 patients, 72 of whom reported a positive urine culture. The correct treatment of asymptomatic bacteriuria is associated with a lower incidence of infectious complications after surgery; therefore, urine culture must be performed before surgery involving the urinary tract. Another study carried out at the Hospital Universitario 12 de Octubre in Madrid evaluated the utility and indications of antimicrobial prophylaxis before cystoscopy. The research included 260 patients who were randomized to receive antibiotic prophylaxis with one dose of Fosfomycin or no prophylaxis. The incidence of urinary tract infections was 2% for both groups, with a higher incidence in women and those with difficulties performing the cystoscopy.

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Antimicrobial stewardship programs were also reviewed with a focus on urological departments. It has been demonstrated that these programs are associated with lower consumption of antibiotics. A review conducted at the Complexo Hospitalario Universitario de Pontevedra in 2022 reported that 1,262 out of 10,279 (12%) cultures contained extended-spectrum beta-lactamase (ESBL) producing bacteria; 78% of these were E. coli, 20% Klebsiella pneumoniae, and 20% Proteus mirabilis. Additionally, carbapenem-resistant microorganisms were reported in 130 cultures, primarily related to Klebsiella pneumoniae. It is also concerning that 42% of ESBL-producing bacteria were collected in a community setting. Another study by Hospital Gregorio Marañón in Madrid evaluated the resistance patterns of microorganisms isolated from patients in the urological department, reporting a high percentage (over 25%) with resistance to fluoroquinolones.

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Two studies evaluated the usefulness of non-antibiotic measures in the prevention of recurrent urinary tract infections, focusing on immunoprophylaxis. The research primarily included women with a median number of six urinary tract infections before treatment. Non-antibiotic treatment is effective in terms of decreasing the number of urinary tract infections and improving the quality of life. Therefore, it is important to correctly evaluate patients with recurrent urinary tract infections to assess risk factors for infection. In our opinion, non-antibiotic measures should be selected as primary preventive measures in patients with recurrent urinary tract infections, including the assessment of urine pH, adherence to the urothelial layer, and the use of probiotics. Moreover, when symptomatic infection occurs, the antibiotic treatment should be selected according to the microbiological and resistance patterns of the area, considering other factors such as urine pH that may affect the efficacy of the antibiotics

References

• López-Tello Blázquez A, Modrego Ulecia L, Castilla Barbosa AF, Pérez Vera IA, Luza Dueñas A, Curiel Elizondo A, Rayo Radilla MA, Alguero Menéndez R, García Tejero D, Fernández-Plaza Prieto I, Sacristán González R, Quintás Blanco A, Pérez Haro MLl, Tamargo Díaz E, Moya Martín C, Fernández Gómez JM. Is preoperative urine culture important in our patients? LXXXVII AEU National Urology Congress. Palma de Mallorca. 2024. 12-14 June 2024 Presentation: Virtual Poster 208.
• Pérez Fuentes D, Salamanca Rivera E, Federero Martínez J, Fernández Del Castillo SS, Martín Campano F, Trompiz Ibarlucéa M, Gallardo Prado D, González Cáliz C, Montaño Pérez JA, Castiñeiras Fernández J. Maximising Resources in Urology: Cost-effectiveness of the implementation of an Antibiotic Use Optimisation Programme (PROA) on an in-patient ward. LXXXVII AEU National Urology Congress. Palma de Mallorca. 2024. 12-14 June 2024 Presentation: Virtual Poster 209.
• Alonso Bartolomé MB, Gómez De Vicente JM, Toribio Vázquez C, Martínez Pérez S, López Pérez E, García Matres MJ, Bravo Marín S, García Astillero V, Alonso Bartolomé S, Yebes Alonso AJ, Ayllón Blanco H, Solano Hernández, P, Gómez Villanueva A, Casanova Martín C, Martínez Piñeiro L. Cross-sectional study on the subjective assessment of the treatment of recurrent cystitis with Uromune autovaccine. AEU National Urology Congress. Palma de Mallorca. 2024. 12-14 June 2024 Presentation: Virtual Poster 211.
• Martín Rodríguez R, González Albarrán C, Medina Polo J, Caro González MP, Calzas Montalvo C, Juste-Álvarez S, De La Calle Moreno A, Gonzalez Ginel I, Rayo Encinas C, Guerrero Ramos F, Gomez Del Cañizo C, Hernández Arroyo M, Teigell Tobar J, Rodríguez Antolín A. Is it necessary to use antibiotic prophylaxis prior to cystoscopy routinely? A randomised comparative study. AEU National Urology Congress. Palma de Mallorca. 2024. 12-14 June 2024 Presentation: Virtual Poster 214.
• Ruibal Gago L, Sousa Iglesias A, Siles Hinojosa P, Echeverria Cruz C, Núñez Otero JJ, Chaves Santamaria M, Plaza Alonso C, González Dacal JA, Zarraonandia Andraca A, Fernández Yáñez A, Fernández Baltar C, López López B, Novo Gómez N, Rodríguez Núñez H. Mechanisms of antimicrobial resistance in urine culture samples in the Pontevedra and Salnés health area. AEU National Urology Congress. Palma de Mallorca. 2024. 12-14 June 2024 Presentation: Virtual Poster 215.