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PubMed1976

The dipslide in diagnosis of urinary tract infections.

Urinary tract infections (UTI's) are common in medicine. Symptoms may include fever, chills, frequency, and dysuria. Asymptomatic UTI's are also common, with a prevalence of one percent in school girls and ten percent in pregnant women. Pyuria, dysuria, and frequency may be absent in patients with UTI's or present in patients without UTI's. Therefore, a UTI must be bacteriologically diagnosed as greater than 100,000 organisms/ml, usually of a single organism, in a properly obtained urine specimen. The dipslide is a simple, convenient, inexpensive device for the quantitative diagnosis of a UTI. Culture media are layered on both sides of the dipslide, one medium allowing growth of all organisms and the other medium favoring growth of enterobacteriae. After immersion in a clean catch urine specimen, the dipslide is incubated for 24 hours at 37 C. Each urinary organism forms a colony "dot". The density of colony "dots" can be quantitated easily by comparison with standardized graphs. The dipslide is a highly accurate and sensitive tool that can be used for the diagnosis of UTI's, assessment of antimicrobial effectiveness, follow-up for presence of recurrence or relapse, and screening of high-risk individuals.

Bacteriological Techniques↗
PubMed1993

Serum and urinary cefpodoxime levels and time killing curves performed in the urine of children presenting urinary tract infections.

Since resistance to several oral antimicrobials useful for the treatment of pediatric urinary tract infections (UTI) is overwhelming in Argentina, an in vitro investigation was performed testing 400 isolates obtained from urines of children suffering UTI's, 200 collected in 1990 and 200 in 1991. Their susceptibility against oral antimicrobials marketed in Argentina and appropriate for the treatment of UTI was determined by the agar dilution methods. An increase of the resistance to aminopenicillin combined with beta-lactamase inhibitors and to fluoroquinolones was observed comparing the two periods. Cefpodoxime (CPD), cefixime and fluoroquinolones except norfloxacin were the sole oral antimicrobials showing in vitro activity at the 90 per cent level. Unfortunately fluoroquinolones are not yet approved for pediatric use. Consequently we realized an in vitro and in vivo pharmacokinetic study in order to determine CPD activity against E. coli isolated in UTI cases. Five children (6-10 y) showing E. coli UTI infections received 10 mg/kg/d CPD in a single oral daily dose and were treated up to 10 days, 3 had lower UTI and 2 upper UTI. All patients were clinical and bacteriologically cured. Cultures obtained up to 4 weeks after treatment were negative. CPD serum levels at 2 hours after the first dose of treatment showed a median of 2.7 mg/l (2.3-3.4 range). Bactericidal serum titers at the same time against the patients own strain and an E. coli TEM-1 hyperproducer strain (MIC 4,096 mg/l for ampicillin and 0.5 mg/l for CPD) showed a median value of 1/8 against patients strains and 1/2 against the THP strain.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1993

[Technetium 99m labeled dimercaptosuccinic acid (99m Tc-DMSA) scintigraphy in the diagnosis and follow-up of urinary infections in children].

BACKGROUND: The site of a urinary tract infection (UTI) is located by clinical findings plus imaging techniques. Renal imaging with technetium 99mTc-dimercaptosuccinic acid (99mTc-DMSA) has shown promise but its efficacy for detecting acute pyelonephritis is still debated as is its ability to differentiate between acute, potentially curable disease and scarring, definitive changes. PATIENTS AND METHODS: The files of all the 166 patients that underwent one or two (32 patients) 99mTc-DMSA imaging sessions for UTI in 1989 and 1990 in our department were analysed. The results of this technique were compared with the clinical and laboratory data and with those of other imaging techniques (ultrasonography and retrograde voiding cystourethrogram). The patients (92 girls and 74 boys, mean age: 5 years, range 15 days-17 years) were assigned to one of 3 categories: 1) acute pyelonephritis (27 patients), 2) low UTI (60 patients) and 3) uncertain UTI (79 patients), on the basis of the clinical and laboratory data. RESULTS: The first 99mTc-DMSA imaging was normal in 110 children; changes were unilateral in 45 and bilateral in 11 children. Images suggesting either acute or chronic changes were observed respectively in 19 and 48 children. 4 of the 7 acute changes were normalized on the second radioisotope scanning while 2 became worse; 19 of the 23 chronic changes were unchanged at the second scanning. Radioisotope scanning changes were seen in 81% of the patients classified as acute pyelonephritis and in only 27% of those with lower UTI. Reflux was detected in 56% of abnormal kidneys and in 36% of normal kidneys. The results of radioisotope scanning and ultrasound scan findings were not correlated in 24 patients (19 only abnormal radioisotope imaging, 5 only abnormal ultrasound scan). CONCLUSIONS: DMSA scans are useful for investigating and following UTI. They help to distinguish acute pyelonephritis and lower UTI. It is a reliable method of detecting structural abnormalities and identifying children at risk of progressive renal damage.

Adolescent↗
PubMed1995

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1991). III. Secular changes in susceptibility].

Susceptibilities of Enterococcus faecalis, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 11 hospitals during June 1991 to May 1992 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. The susceptibilities of E. faecalis to cefmenoxime and amikacin has decreased. As for Citrobacter spp., Enterobacter spp., P. mirabilis and Serratia spp., which were detected very few in 1989, 1990 and 1991, their susceptibilities were not observed an obvious change. The susceptibilities of E. coli to minocycline was observed a very clear alteration, that is, in uncomplicated UTIs and complicated UTIs without indwelling catheter, the susceptibilities has decreased. However, the susceptibilities of Klebsiella spp. was not observed an obvious variation. The susceptibilities of P. aeruginosa to quinolones isolated from uncomplicated UTIs has clearly decreased. These data should be considered in clinical treatment of various urinary tract infections.

Anti-Bacterial Agents↗
PubMed1995

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from urinary tract infections (1993). III. Secular changes in susceptibility].

Susceptibilities of Enterococcus faecalis, Staphylococcus aureus, Citrobacter spp., Enterobacter spp., Escherichia coli, Klebsiella spp., Proteus mirabilis, Pseudomonas aeruginosa and Serratia spp. isolated from patients with urinary tract infections (UTIs) in 10 hospitals during June 1993 to May 1994 to various antimicrobial agents were compared with those in the same period of previous years according to a classification, uncomplicated UTIs, complicated UTIs without indwelling catheter, and complicated UTIs with indwelling catheter. The susceptibilities of E. faecalis to chloramphenicol decreased. As for S. aureus, susceptible strains to minocycline (MINO) decreased in complicated UTIs. As for Citrobacter spp., and Enterobacter spp., their susceptibilities were not observed an obvious change. Against E. coli, the activities of cefotiam decreased in complicated UTIs, and aminoglycosides decreased. As for Klebsiella spp., susceptible strains to aminoglycosides decreased. The susceptibilities of P. mirabilis to all drugs except aminoglycosides and MINO were good. The susceptibilities of P. aeruginosa to quinolones isolated from complicated UTIs with indwelling catheter increased, but susceptible strains to aminoglycosides decreased. The susceptibilities of Serratia spp. to MINO has decreased. These data should be considered in clinical treatment of various urinary tract infections.

Anti-Bacterial Agents↗
PubMed1996

[Changes of urinary ulinastatin and serum CRP after elective surgery for gastric cancer].

Urinary ulinastatin (UTI) is elevated in various conditions, such as renal disease, myocardial infarction, neoplasm, leukemia and normal pregnancy. The purpose of the present study is to measure the change of UTI after surgery for gastric cancer and to compare with other acute phase reactants. Urine samples were collected from 7 surgical patients. UTI level was measured by radioimmunoassay and corrected by urinary level of creatinine. UTI levels began to increase from the first postoperative day and reached the maximum level on the third postoperative day. The pattern of UTI correlated with that of serum CRP levels. Meanwhile, when patient was in inflammatory condition postoperatively, UTI increased further and its pattern correlated with that of serum CRP levels. These results suggest that UTI is an acute phase reactant and a sensitive marker indicating the degree of inflammatory condition after surgery.

Acute-Phase Proteins↗
PubMed1996

Technetium-99m-DMSA studies in pediatric urinary infection.

UNLABELLED: Urinary tract infection (UTI) is a common condition in children and may lead to renal scarring with a risk of later hypertension and renal insufficiency. We made a cross-sectional study of the 99mTc-DMSA findings in 496 children referred for following symptomatic UTI to a Department of Nuclear Medicine and we categorized the results, to provide a framework for further study. METHOD: A standard 99mTc-DMSA protocol was used to study 496 children (157 males, 339 females) aged from birth to 14 yr. Findings were classified according to the image appearance and relative function of each kidney. These were related to age, sex, history and timing of UTI and the results on micturating cysto-urethrography (MCU). RESULTS: Images were normal, with function within limits (45%-50% in one kidney), in approximately half the boys and girls studied. The other images were classified as equivocal in 68 children, abnormal unilaterally in 105 and bilaterally in 76, and they were subdivided according to the image appearance. No image changes could be identified that were specifically associated with acute UTI. Diffuse change alone was uncommon. A high proportion of abnormal images was found in infant boys, older girls with recurrent UTI and those children with vesico-ureteric reflux (VUR). Of the bilateral abnormal images, 98% were seen in children with VUR. CONCLUSION: Our findings suggest that infective renal change may be superimposed on underlying congenital lesions (perhaps detectable antenatally) or may be acquired following UTI in the presence of reflux and are thus potentially preventable. This study also suggests that VUR is almost certain to have occurred in a child who has bilateral abnormal 99mTc-DMSA images following UTI and is also commonly present in those with definite unilateral defects.

Adolescent↗
PubMed1996

Scope of urinary pathogens isolated in the Public Health Bacteriology Laboratory, Harare: antibiotic susceptibility patterns of isolates and incidence of haemolytic bacteria.

OBJECTIVES: To determine the scope of urinary pathogens isolated in the Public Health Bacteriology Laboratory, their antibiotic susceptibility patterns and the incidence of haemolytic bacteria in Harare. DESIGN: Prospective study. Patients of different age groups attending various clinics in Parirenyatwa Hospital, Harare, between October 1995 and April 1996 were enrolled for the study. SETTING: A laboratory based study at the Bacteriology Unit, Public Health Laboratories, Harare. SUBJECTS: 1,760 urine specimens obtained from male and female patients suspected of having UTI. RESULTS: Out of a total number of 1,760 urine specimens screened only 473 (26.9pc) were positive for UTI pathogens. Four hundred and nineteen (88.5pc) and 46 (9.7pc) of the 473 positive UTI pathogens were Gram negative and Gram positive bacteria respectively. Eight (1.7pc) of the positive isolates were Candida spp. The commonest pathogen isolated was Escherichia coli (40.5pc), followed by Klebsiella spp. (22.1pc) and Proteus spp. (7.2pc). Of the positive isolates 184 (38.9pc) and seven (1.5pc) were beta- and alpha-haemolytic respectively. Of E. coli isolates 72pc were beta-haemolytic. Sex distribution showed that 53pc and 47pc of the UTI pathogens were isolated from males and females respectively. E. coli was more predominant in females (51.3pc). Antibiotic susceptibility patterns revealed that 100pc of strains of E. coli, Proteus spp., Serratia spp., Salmonella spp., Morganella spp., Staphylococcus aureus and coagulase negative staphylococci (CNS) were sensitive to Ciprofloxacin. Urinary isolates were markedly resistant to Tetracycline, Carbenicillin, Cotrimoxazole, Ampicillin and Nitrofurantoin. Fusidic acid and Clindamycin were active against staphylococcal species. CONCLUSION: We conclude that E. coli is the commonest UTI pathogen and that 72pc of strains were beta-haemolytic. We suggest the use of Ciprofloxacin as the drug of choice for the treatment of UTI caused by both Gram positive and Gram negative UTI pathogens. Nitrofurantoin and Gentamycin are in addition recommended for E. coli while Fusidic acid and Clindamycin may be useful for staphylococcal species.

Adolescent↗
PubMed1997

[Urinary excretion of ulinastatin and NAG after cardiopulmonary bypass].

Although urinary trypsin inhibitor (ulinastatin, UTI) is excreted into urine, its physiological function has not been clarified well. Administration of UTI during surgical procedure was reported to protect renal function from surgical stress. This result suggests participation of UTI excretion in renal tubular function. In this study, the amount of urinary excretion of UTI and that of N-acetyl-beta-D-glucosaminidase (NAG) after cardiopulmonary bypass (CPB) were measured. The urinary UTI excretion increased after surgery and reached the maximum on the third postoperative day. NAG also increased gradually and was three times greater than control on the seventh postoperative day. There was a good correlation between NAG and UTI on the first postoperative day. It is suggested that UTI might correlate with the renal tubular function after CPB.

Acetylglucosaminidase↗
PubMed1997

Mucosal immunity in the urinary tract: changes in sIgA, FSC and total IgA with age and in urinary tract infection.

The incidence of primary urinary tract infection (UTI) is greatest in the first month of life and decreases with age throughout childhood. Secretory immunoglobulin A (sIgA) is an important component of mucosal immunity. The changes in secretory IgA, IgA and free secretory component (FSC) during the first year of life were examined in relation to age, sex and in infants, feeding practice. These constituents were further compared between healthy children and those with acute and recurrent UTI. Urine was collected from 41 healthy infants (16 female: 25 male) at intervals (mean age 1.4, 9.1, 44, 91, 210 and 412 days), 139 healthy children (75 female: 64 male), 29 children with histories of recurrent UTI (25 female: 4 male) and 10 with acute UTI (8 female: 2 male). sIgA, IgA and FSC were measured by enzyme linked immunoassay. In the majority of children sIgA and IgA were undetectable at birth. SIgA and IgA rose significantly during the first year then levelled off throughout childhood. FSC was detectable from birth (geometric mean [mean of logged values]-GOM at day 1.4, 362.2 ng/ml). No sex differences were apparent for any of the three constituents at any age. Breast feeding was associated with higher levels of sIgA and IgA than bottle feeding. This was highly significant at 9.1 days when sIgA and IgA levels of breast fed compared with bottle fed infants were 64.6 ng/ml vs 21.2 and 56.2 ng/ml vs 18.7 ng/ml respectively, giving a GOM ratio of 3.04 for sIgA and 3.0 for IgA (p < 0.001 for both). No significant difference in the three parameters were demonstrable when children with recurrent UTI-with normal or abnormal renal tracts-were compared with controls. Acute UTI resulted in raised sIgA, IgA and FSC compared with controls (GOM ratio of 4.9 [p < 0.002], 4.2 [p < 0.005] and 2.7 [p < 0.001] respectively). The proportion of total IgA present as sIgA (sIgA/total IgA) was not significantly different in the acute vs control groups. Urinary sIgA and IgA may be important for the observed variation with age in infant UTI and the reduced incidence in breast fed infants but does not appear to contribute to the sex associated difference in susceptibility to infection at any age.

Acute Disease↗
PubMed1997

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1995). II. Background of patients].

Clinical background was investigated on patients with urinary tract infections (UTIs) from whom 785 bacterial strains were isolated in 11 hospitals during the period from June, 1995 through May, 1996. 1. Distributions of age and sex of patients and type of infections. Among the patients examined, those with ages 50 years or older were the most frequent (males: 80.5%, females: 69.7%), and, among females, those with ages in the 20's were 12.6%. With regard to types of infections, more than a half of infections among males were of complicated types, but most of infections among females were of uncomplicated types, especially among females of ages less than 60 years. 2. Ages of patients and types of pathogens. The higher the ages of patients, the lesser became the isolation frequencies of Proteus spp. and Serratia spp., but the higher were those of Klebsiella spp. and Pseudomonas spp. 3. Effect of antibiotic use on isolation frequencies of pathogens. Use of antibiotics decreased pathogens isolated from patients with uncomplicated UTIs drastically (237 isolates before antibiotics compared to 33 after). Even isolated pathogens from patients with complicated UTIs decreased drastically with the use of antibiotics when indwelling catheters were not in use (200 isolates before antibiotics compared to 83 after), but when indwelling catheters were in use, antibiotics apparently failed to decrease the isolation frequency. 4. Surgical procedures and types of causative organisms for UTIs. Escherichia coli was the most frequently isolated organism from uncomplicated cases of UTIs. From cases of complicated UTIs without indwelling catheters, Enterococcus faecalis was the most frequently isolated, followed by E. coli, P. aeruginosa and Klebsiella spp. When a surgical procedures were not done, E. coli was isolated most frequently. From cases of complicated UTIs with indwelling catheters, P. aeruginosa, E. faecalis and S. aureus were the organisms that were mainly isolated, with isolation frequencies of 23.9%, 17.3% and 12.7%, respectively. When no surgical procedures were used, isolation frequencies of P. aeruginosa, Klebsiella spp. and E. faecalis were 25.7%, 14.3% and 14.3%, respectively.

Adolescent↗
PubMed1998

[Comparative studies on activities of antimicrobial agents against causative organisms isolated from patients with urinary tract infections (1996). II. Background of patients].

Clinical background was investigated on patients with urinary tract infections (UTIs) from whom 752 bacterial strains were isolated in 10 hospitals during the period from June, 1996 through May, 1997. 1. Distribution of age and sex of patients and type of infections. Among males, those with ages 40 years or older were more frequent, the higher the ages of them. Among females, those with ages in the 60's were the most frequent (24.6%), and those with ages in the 20's, 40's and 50's were about 13%. With regard to type of infections, more than a half of infections among males with ages 30 years or older were of complicated types, but most of infections among females were of uncomplicated types, especially among females of ages less than 60 years. 2. Ages of patients and types of pathogens. The higher the ages of patients, the lesser became the isolation frequencies of Escherichia coli, but the higher were those of Pseudomonas aeruginosa and Klebsiella spp. 3. Effect of antibiotic use on isolation frequencies of pathogens. Use of antibiotics decreased pathogens isolated from patients with uncomplicated UTIs drastically (231 isolates before antibiotics compared to 60 after). Even isolated pathogens from patients with complicated UTIs decreased drastically with the use of antibiotics when indwelling catheters were not in use (193 isolates before antibiotics compared to 75 after), but when indwelling catheters were in use, antibiotics apparently failed to decrease the isolation frequency. 4. Surgical procedures and types of causative organisms for UTIs. From cases of uncomplicated UTIs, E. coli was the most frequently isolated, followed by Enterococcus Faecalis and Klebsiella spp. E. coli was the most frequently isolated organism from complicated UTIs without indwelling catheters. When a surgical procedures were not done, E. coli was isolated most frequently. From cases of complicated UTIs with indwelling catheters, P. aeruginosa, E. coli and E. faecalis were the organisms that were mainly isolated, with isolation frequencies of 23.2%, 15.2, 12.2, respectively. When no surgical procedures were used, isolation frequencies of P. aeruginosa, E. faecalis and Enterobacter spp. were 17.2%, 13.8%, 13.8%, respectively.

Adolescent↗
PubMed1998

Complicated urinary tract infection: analysis of 179 patients.

BACKGROUND: The aim of our study was to investigate the incidence, bacteriology, management and outcome of complicated urinary tract infections (UTIs) at the Veterans General Hospital-Taipei. METHODS: Between June, 1993, and July, 1994, medical records of 2,566 patients admitted to the Division of Urology, Veterans General Hospital-Taipei, were retrospectively reviewed. Of these patient, 1,322 had a diagnosis of benign prostatic hyperplasia (BPH), 607 were admitted for renal stones, 496 for ureteral stones, 75 for transitional cell carcinoma (TCC) of the urinary bladder, 47 for renal tumors and 19 for TCC of the ureter. Among all patients studied, 179 (6.98%) acquired a complicated UTI. Of these, 81 were admitted for BPH, 46 for renal stones, 42 for ureteral stones, five for TCC of the urinary bladder, three for renal tumors and two for TCC of the ureter. RESULTS: Of the 179 patients with complicated UTIs, 155 were men and 24 were women. The urine culture positive rate was 76.0% (136/179) and the most common bacteria were Escherichia coli, Proteus mirabilis and Pseudomonas aeruginosa. The principle mode of treatment included parenteral antibiotics and urinary diversion (percutaneous nephrostomy and Foley catheterization), when necessary. The infection control rate for these complicated UTIs was 96.3% for BPH, 95.5% for renal stone, 97.6% for ureteral stone, 80% for TCC of the urinary bladder, 100% for renal tumor and 100% for TCC of the ureter. Mortality due to complicated UTI was 3.9% (7/179). CONCLUSIONS: We concluded that the prognosis of complicated UTI is good if diagnosis and appropriate treatment are given promptly. Early drainage to relieve obstruction and intravenous antibiotics are initially necessary. Surgical intervention is required to resolve functional or structural abnormalities after the UTI has been controlled.

Adult↗
PubMed1999

Oral vs intravenous ciprofloxacin in the initial empirical management of severe pyelonephritis or complicated urinary tract infections: a prospective randomized clinical trial.

BACKGROUND: There are few data on the efficacy of oral antibiotics in the initial empirical management of severe forms of urinary tract infection (UTI). METHODS: In a multicenter, prospective, randomized trial we compared oral (500 mg twice daily) vs intravenous ciprofloxacin (200 mg twice daily) in the initial empirical management of hospitalized patients with serious forms of UTI. Exclusion criteria were severe sepsis, inability to take oral medication, or the presence of obstruction or renal foci of suppuration. The study population included 66 women with pyelonephritis, 43 patients with community-acquired UTIs, and 32 patients with hospital-acquired UTIs. The frequency of bacteremia was 28 (42%) of 66 in the patients with pyelonephritis and 25 (33%) of 75 in those with complicated UTIs. Seventy-two patients were randomized to treatment with oral and 69 to intravenous ciprofloxacin. RESULTS: There were no infection-related deaths and no patients required an early change of antibiotics because of worsening clinical status during the initial empirical phase of treatment. The mean duration of fever was 1.7 days in patients treated by the oral vs 1.9 days in patients treated by the intravenous route (P = .15). The rates of microbiological failure (3% in the oral vs 2% in the intravenous treatment group) and of unsatisfactory clinical response (4% oral vs 3% intravenous) were low. A treatment change was eventually required in 14% of the patients assigned to the oral and 7% of the patients assigned to the intravenous regimen, mainly because of the isolation of enterococci or ciprofloxacin-resistant organisms in pretherapy urine specimens. CONCLUSIONS: In the hospital setting, oral ciprofloxacin is as effective as the intravenous regimen in the initial empirical management of serious UTIs, including bacteremic forms, in patients without severe sepsis, obstruction, or renal foci of suppuration. The efficacy of the oral regimen indicates a potential use for ciprofloxacin in outpatient treatment of a subset of patients currently hospitalized on account of disease severity.

Administration, Oral↗
PubMed2001

Consequences of asymptomatic bacteriuria in women with diabetes mellitus.

BACKGROUND: Women with diabetes mellitus (DM) have asymptomatic bacteriuria (ASB) more often than women without DM. It is unknown, however, what the consequences of ASB are in these women. OBJECTIVE: To compare women with DM with and without ASB for the development of symptomatic urinary tract infections (UTIs), renal function, and secondary complications of DM during an 18-month follow-up period. METHODS: In this multicenter study we monitored women with DM with and without ASB for the development of symptomatic UTIs, renal function, and secondary complications (ie, retinopathy, neuropathy, microvascular, or macrovascular diseases). Data on the first 18-month follow-up period are presented. RESULTS: At least 1 uncontaminated urine culture was available from 636 women (258 with type 1 DM and 378 with type 2 DM). The prevalence of ASB at baseline was 26% (21% for those with type 1 DM and 29% for those with type 2 DM). Follow-up results were available for 589 (93%) of the 636 women. Of these 589 women, 115 (20%) (14% with type 1 DM and 23% with type 2 DM) developed a symptomatic UTI. Women with type 2 DM and ASB at baseline had an increased risk of developing a UTI during the 18-month follow-up (19% without ASB vs 34% with ASB, P =.006). In contrast, there was no difference in the incidence of symptomatic UTI between women with type 1 DM and ASB and those without ASB (12% with ASB vs 15% without ASB). However, women with type 1 DM and ASB had a tendency to have a faster decline in renal function than those without ASB (relative increase in serum creatinine level 4.6% vs 1.5%, P = 0.2). CONCLUSION: Women with type 2 DM and ASB have an increased risk of developing a symptomatic UTI than those without ASB.

Adolescent↗
PubMed2004

Antibiotics for preventing recurrent urinary tract infection in non-pregnant women.

BACKGROUND: Urinary tract infection (UTI) is a common health care problem. Recurrent UTI (RUTI) in healthy non-pregnant women is defined as three or more episodes of UTI during a twelve month period. Long-term antibiotics have been proposed as a prevention strategy for RUTI. OBJECTIVES: To determine the efficacy (during and after) and safety of prophylactic antibiotics used to prevent uncomplicated RUTI in adult non-pregnant women. SEARCH STRATEGY: We searched MEDLINE (1966-April 2004), EMBASE (1980-January 2003), Cochrane Central Register of Controlled Trials( in The Cochrane Library Issue 1, 2004) and reference lists of retrieved articles SELECTION CRITERIA: Any published randomised controlled trial where antibiotics were used as prophylactic therapy in RUTI. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed trial quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as relative risk (RR) with 95% confidence intervals (CI). MAIN RESULTS: Nineteen studies involving 1120 women were eligible for inclusion. Antibiotic versus antibiotic (10 trials, 430 women): During active prophylaxis the rate range of microbiological recurrence patient-year (MRPY) was 0 to 0.9 person-year in the antibiotic group against 0.8 to 3.6 with placebo. The RR of having one microbiological recurrence (MR) was 0.21 (95% CI 0.13 to 0.34), favouring antibiotic and the NNT was 1.85. For clinical recurrences (CRPY) the RR was 0.15 (95% CI 0.08 to 0.28). The NNT was 1.85. The RR of having one MR after prophylaxis was 0.82 (95% CI 0.44 to 1.53). The RR for severe side effects was 1.58 (95% CI 0.47 to 5.28) and for other side effects the RR was 1.78 (CI 1.06 to 3.00) favouring placebo. Side effects included vaginal and oral candidiasis and gastrointestinal symptoms. Antibiotic versus antibiotic (eight trials, 513 women): These trials were not pooled. Weekly pefloxacin was more effective than monthly. The RR for MR was 0.31(95% CI 0.19 to 0.52). There was no significant difference in MR between continuous daily and postcoital ciprofloxacin. REVIEWERS' CONCLUSIONS: Continuous antibiotic prophylaxis for 6-12 months reduced the rate of UTI during prophylaxis when compared to placebo. After prophylaxis two studies showed nodifference between groups. There were more adverse events in the antibiotic group. One RCT compared postcoital versus continuous daily ciprofloxacin and found no significant difference in rates of UTIs, suggesting that postcoital treatment could be offered to woman who have UTI associated with sexual intercourse.

Antibiotic Prophylaxis↗
PubMed2004

Cranberries for preventing urinary tract infections.

BACKGROUND: Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). The aim of this review is to assess the effectiveness of cranberries in preventing such infections. OBJECTIVES: To assess the effectiveness of cranberry juice and other cranberry products in preventing UTIs in susceptible populations. SEARCH STRATEGY: Electronic databases and the Internet were searched using English and non English language terms; companies involved with the promotion and distribution of cranberry preparations were contacted; reference lists of review articles and relevant trials were searched. Cochrane Central Register of Controlled Trials (CENTRAL - the Cochrane Library, issue 1, 2003) was searched in February 2003. SELECTION CRITERIA: All randomised or quasi randomised controlled trials of cranberry juice/products for the prevention of urinary tract infections in susceptible populations. Trials of men, women or children were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed and extracted information. Information was collected on methods, participants, interventions and outcomes (urinary tract infections (symptomatic and asymptomatic), side effects and adherence to therapy). RR were calculated where appropriate, otherwise a narrative synthesis was undertaken. Quality was assessed using the Cochrane criteria. MAIN RESULTS: Seven trials met the inclusion criteria (four cross-over, three parallel group). The effectiveness of cranberry juice (or cranberry-lingonberry juice) versus placebo juice or water was evaluated in six trials, and the effectiveness of cranberries tablets versus placebo was evaluated in two trials (one study evaluated both juice and tablets). In two good quality RCTs, cranberry products significantly reduced the incidence of UTIs at twelve months (RR 0.61 95% CI:0.40 to 0.91) compared with placebo/control in women. One trial gave 7.5 g cranberry concentrate daily (in 50 ml), the other gave 1:30 concentrate given either in 250 ml juice or in tablet form. There was no significant difference in the incidence of UTIs between cranberry juice versus cranberry capsules (RR 1.11 95% CI:0.49 to 2.50). Five trials were not included in the meta-analyses due to methodological flaws or lack of available data. However, only one reported a significant result for the outcome of symptomatic UTIs. Side effects were common in all trials, and dropouts/withdrawals in several of the trials were high. REVIEWER'S CONCLUSIONS: There is some evidence from two good quality RCTs that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period in women. If it is effective for other groups such as children and elderly men and women is not clear. The large number of dropouts/withdrawals from some of the trials indicates that cranberry juice may not be acceptable over long periods of time. In addition it is not clear what is the optimum dosage or method of administration (e.g. juice or tablets). Further properly designed trials with relevant outcomes are needed.

Beverages↗
PubMed2004

Cranberries for preventing urinary tract infections.

BACKGROUND: Cranberries (particularly in the form of cranberry juice) have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). The aim of this review is to assess the effectiveness of cranberries in preventing such infections. OBJECTIVES: To assess the effectiveness of cranberry juice and other cranberry products in preventing UTIs in susceptible populations. SEARCH STRATEGY: Electronic databases and the Internet were searched using English and non English language terms; companies involved with the promotion and distribution of cranberry preparations were contacted; reference lists of review articles and relevant trials were searched. Cochrane Central Register of Controlled Trials (CENTRAL - the Cochrane Library, issue 1, 2003) was searched in February 2003. SELECTION CRITERIA: All randomised or quasi randomised controlled trials of cranberry juice/products for the prevention of urinary tract infections in susceptible populations. Trials of men, women or children were included. DATA COLLECTION AND ANALYSIS: Two reviewers independently assessed and extracted information. Information was collected on methods, participants, interventions and outcomes (urinary tract infections (symptomatic and asymptomatic), side effects and adherence to therapy). RR were calculated where appropriate, otherwise a narrative synthesis was undertaken. Quality was assessed using the Cochrane criteria. MAIN RESULTS: Seven trials met the inclusion criteria (four cross-over, three parallel group). The effectiveness of cranberry juice (or cranberry-lingonberry juice) versus placebo juice or water was evaluated in six trials, and the effectiveness of cranberries tablets versus placebo was evaluated in two trials (one study evaluated both juice and tablets). In two good quality RCTs, cranberry products significantly reduced the incidence of UTIs at twelve months (RR 0.61 95% CI:0.40 to 0.91) compared with placebo/control in women. One trial gave 7.5 g cranberry concentrate daily (in 50 ml), the other gave 1:30 concentrate given either in 250 ml juice or in tablet form. There was no significant difference in the incidence of UTIs between cranberry juice versus cranberry capsules (RR 1.11 95% CI:0.49 to 2.50). Five trials were not included in the meta-analyses due to methodological flaws or lack of available data. However, only one reported a significant result for the outcome of symptomatic UTIs. Side effects were common in all trials, and dropouts/withdrawals in several of the trials were high. REVIEWERS' CONCLUSIONS: There is some evidence from two good quality RCTs that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period in women. If it is effective for other groups such as children and elderly men and women is not clear. The large number of dropouts/withdrawals from some of the trials indicates that cranberry juice may not be acceptable over long periods of time. In addition it is not clear what is the optimum dosage or method of administration (e.g. juice or tablets). Further properly designed trials with relevant outcomes are needed.

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