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Recurrent urinary tract infection in women: Emerging concepts regarding etiology and treatment considerations

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Abstract

Recurrent urinary tract infections are caused by a combination of host factors and bacterial virulence. The patient with symptoms suggestive of recurrent urinary tract infections benefits from cultures to confirm the diagnosis of recurrent infections. The community also benefits because they allow for the tracking of resistant patterns. Once a patient has been diagnosed with recurrent urinary tract infections, there are a number of treatment choices in terms of initial treatment and prophylaxis. Treatment of the acute infection should follow the published guidelines of the Infectious Diseases Society of America taking into account local patterns of resistance. Younger patients can prevent infections by avoiding spermicides and taking cranberry tablets. Older patients may prevent infections by using estrogen and emptying their bladders fully. All patients may benefit from using antibiotic prophylaxis.

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References and Recommended Reading

  1. Stamey TA: Pathogenesis and Treatment of Urinary Tract Infections. Baltimore: Williams & Wilkins; 1980:43–46.

    Google Scholar 

  2. Stamey TA, Sexton CC: The role of vaginal colonization with enterobacteriaceae in recurrent urinary infections. J Urol 1975, 113:214–217.

    PubMed  CAS  Google Scholar 

  3. Scholes D, Hooten TM, Roberts PL, et al.: Risk factors for recurrent urinary tract infection in young women. J Infect Dis 2000, 182:117–1182. This study compared two groups of women with a history of recurrent UTIs with control subjects and compared sexual behavior, voiding patterns, and personal hygiene. The study also examined other genetic and environmental exposures.

    Article  Google Scholar 

  4. Raz R, Gennesin Y, Wasser J, et al.: Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis 2000, 30:152–156.

    Article  PubMed  CAS  Google Scholar 

  5. Kreiger JN: Urinary tract infections: What’s new? J Urol 2002, 168:2351–2358. This is an excellent review of the pathogenesis and therapy of recurrent UTI in women.

    Article  Google Scholar 

  6. Johnson JR, Weissman SJ, Stell AL, et al.: Clonal and pathotypic analysis of archetypal Escherichia Coli cystitis isolate NU14. J Infect Dis 2001, 184:1556–1565.

    Article  PubMed  CAS  Google Scholar 

  7. Kunin CM, Evans C, Bartholomew D, Bates DG: The antimicrobial defense mechanism of the female urethra: a reassessment. J Urol 2002, 168:413–419.

    Article  PubMed  Google Scholar 

  8. Cox CE, Lacy SS, Hinman F Jr: The urethra and its relationship to urinary tract infection.II: the urethral flora of the female with recurrent urinary infection. J Urol 1968, 99:632–638.

    PubMed  CAS  Google Scholar 

  9. Stamm WE, Counts GW, Running KR, et al.: Diagnosis of coliform infection in acutely dysuric women. N Engl J Med 1982, 307:463–468.

    Article  PubMed  CAS  Google Scholar 

  10. Pfaller MA, Koontz FP: Laboratory evaluation of leukocyte esterase and nitrite tests for the detection of bacteriuria. J Clin Microbiol 1985, 21:840–842.

    PubMed  CAS  Google Scholar 

  11. Stern JA, Schaffer AJ: Residual urine in an elderly female population: novel implications for estrogen replacement and impact on recurrent urinary tract infection. J Urol 2002,: 167(suppl 4):6.

    Google Scholar 

  12. Iravani A: Advances in the understanding and treatment of urinary tract infections in young women. Urology 1991, 37:503–511.

    Article  PubMed  CAS  Google Scholar 

  13. Warren JW, Abrutyn E, Hebel JR, et al.: Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 1999, 29:745–758. This is part of a series of practice guidelines commissioned by the Infectious Diseases Society of America (IDSA). The purpose of the guideline, which is evidence-based, is to assist clinicians in the diagnosis and treatment of acute bacterial cystitis and acute pyelonephritis in women. The guideline is listed on the IDSA home page at http://www.idsociety.org and is evaluated biannually.

    PubMed  CAS  Google Scholar 

  14. Brown PD: Antibiotic selection for urinary tract infection: new microbiologic considerations. Curr Infect Dis Rep 1999, 1:384–388.

    Article  PubMed  Google Scholar 

  15. Karlowsky JA, Kelly LJ, Thornsberry C, et al.: Trends in antimicrobial resistance among urinary tract infection isolates of Escherichia coli form female outpatients in the United States. Antimicrobial Agents Chemother 2002, 46:2540–2545.

    Article  CAS  Google Scholar 

  16. Stratton CW: Avoiding fluoroquinolone resistance: strategies for primary care practice. Postgrad Med 1997, 101:247–250, 255.

    PubMed  CAS  Google Scholar 

  17. Pelletier LL, Michalak DP, Carter JZ, et al.: A comparison of MacrobidR in the treatment of acute episodes of uncomplicated lower urinary tract infections. Adv Ther 1992, 9:32–45.

    Google Scholar 

  18. Lee B, Bhuta T, Craig J, Simpson J: Methenamine hippurate for preventing urinary tract infections. Cochrane Database Syst Rev 2002, 1:CD003265.

    PubMed  Google Scholar 

  19. Jebson RG, Mihaljevci L, Craig J: Cranberries for preventing urinary tract infections (Review). Cochrane Database Syst Rev 2000, 2:CD001321.

    Google Scholar 

  20. Kontiokari T, Sundqvist K, Nuutinen M, et al.: Randomized trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women. BMJ 2001, 322:1571–1573.

    Article  PubMed  CAS  Google Scholar 

  21. Howell AB, Foxman B: Cranberry juice and adhesin of antibioticresistant uropathogens. JAMA 2002, 287:3082–3083.

    Article  PubMed  Google Scholar 

  22. Stothers L: A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic cranberry products as prophylaxis against urinary tract infection in women. Can J Urol 2002, 9:1558–1562.

    PubMed  Google Scholar 

  23. Nicolle LW: Urinary tract infection in geriatric and institutionalized patients. Curr Opin Urol 2002, 12:51–55.

    Article  PubMed  Google Scholar 

  24. Raz R, Stamm WE: A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993, 329:753–756.

    Article  PubMed  CAS  Google Scholar 

  25. Cardozo L, Lose G, McClish D, et al.: A systematic review of estrogens for recurrent urinary tract infections: third report of the hormones and urogenital therapy (HUT) committee hormones and urogenital therapy (HUT) committee. Int Urogynecol J Pelvic Floor Dysfunct 2001, 12:15–20.

    Article  PubMed  CAS  Google Scholar 

  26. Brumfitt W, Hamilton-Miller JM: Efficacy and safety profile of long-term nitrofurantoin in urinary infections: 18 years’ experience. J Antimicrob Chemother 1998, 42:363–371.

    Article  PubMed  CAS  Google Scholar 

  27. Harding GK, Buckwold FJ, Marrie TJ, et al.: Prophylaxis of recurrent urinary tract infection in female patients: efficacy of low-dose, thrice-weekly therapy with trimethoprimsulfamethoxazole. JAMA 1979, 242:1975–1977.

    Article  PubMed  CAS  Google Scholar 

  28. Stamm WE, McKevitt M, Roberts PL, et al.: Natural history of recurrent urinary tract infections in women. Rev Infect Dis 1991, 13:77–84.

    PubMed  CAS  Google Scholar 

  29. Orenstein R, Wong ES: Urinary tract infections in adults. Am Fam Physician 1999, 59:1225–1234, 1237.

    PubMed  CAS  Google Scholar 

  30. Bailey RR: Management of lower urinary tract infections. Drugs 1993, 45:139–144.

    Article  PubMed  Google Scholar 

  31. Raz R: A comparison of daily nitrofurantoin prophylaxis to a vaginal pessary containing estriol for the prevention of UTIs in postmenopausal women. Presented at Interscience Conference on Antimicrobial Agents and Chemotherapy. San Diego: September 27–30, 2002.

  32. Cooper B, Jepson R: Recurrent cystitis in non-pregnant women. Clin Evid Concise 2002, 8:390–391.

    Google Scholar 

  33. Schaeffer AJ, Stuppy BA: Efficacy and safety of self-start therapy in women with recurrent urinary tract infections. J Urol 1999, 161:207–211.

    Article  PubMed  CAS  Google Scholar 

  34. Gupta K, Hooton TM, Roberts P, Stamm WE: Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women. Ann Intern Med 2001, 135:9–16.

    PubMed  CAS  Google Scholar 

  35. Uehling DT, Hopkins WJ, Balish E, et al.: Vaginal mucosal immunization for recurrent urinary tract infection: phase II clinical trial. J Urol 1997, 157:2049–2052.

    Article  PubMed  CAS  Google Scholar 

  36. Uehling DT, Hopkins WJ, Beierle LM, et al.: Vaginal mucosal immunization for recurrent urinary tract infection: extended phase II clinical trial. J Infect Dis 2001, 183(suppl):S81-S83.

    Article  PubMed  Google Scholar 

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Gormley, E.A. Recurrent urinary tract infection in women: Emerging concepts regarding etiology and treatment considerations. Curr Urol Rep 4, 399–403 (2003). https://doi.org/10.1007/s11934-003-0015-1

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