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PubMed2001

The optimal form of urinary drainage after acute retention of urine.

OBJECTIVE: To assess the outcome of different forms of urinary drainage, particularly for urinary tract infection (UTI), operative findings and patient preference, in patients treated for acute urinary retention (AUR). PATIENTS AND METHODS: A feasibility trial was conducted of men presenting with AUR; after a short period of indwelling catheterization (IDC) patients were taught how to use clean intermittent self-catheterization (CISC). Patients who failed this were re-catheterized and taught to manage a valve, or failing this a leg bag, and then discharged home. The patients were followed to assess the occurrence of spontaneous voiding, UTI, findings at prostatectomy and patient satisfaction. RESULTS: The CISC group (34 men) had a higher rate of spontaneous voiding than the IDC group (16 men; 56% vs 25%). The incidence of UTI was 32% in the CISC and 75% in the IDC group. At TURP, 20% in the CISC group had a UTI, compared with 69% in the IDC group. Patients using CISC preferred it and had fewer complications than the IDC group. The CISC group had a similar ability to manage and similar acceptance of their method of drainage as the IDC group. CONCLUSION: CISC is managed and accepted well by patients who can use the technique and results in fewer UTIs. It should be considered in patients who present with AUR, and it may delay surgery.

Acute Disease↗
PubMed2002

The outcome of voiding dysfunction managed with clean intermittent catheterization in neurologically and anatomically normal children.

OBJECTIVE: To describe the tolerability and efficacy of clean intermittent catheterization (CIC) in the management of dysfunctional voiding in patients who are neurologically and anatomically normal. PATIENTS AND METHODS: The medical records were reviewed in 23 patients (16 girls, mean age 9 years, range 6-14.5, and seven males, mean age 8 years, range 5-20.5) with urinary incontinence and/or urinary tract infection (UTI) who were offered CIC because they had a large postvoid residual urine volume (PVR). All had extensive instruction before starting CIC. All patients underwent urodynamic studies, and urinary and fecal elimination habits were recorded. Detrusor hyperactivity, when present, was treated with anticholinergic medication. The follow-up evaluation included tolerance of CIC, continence status and the incidence of UTI. Behavioural modification or biofeedback training was not used in any patient. RESULTS: Of the 23 patients, 13 presented with both UTI and urinary incontinence, five with incontinence only, four with UTI only, one with frequency and no incontinence, and one with haematuria. Associated symptoms included frequency/urgency, constipation or soiling, and straining to void or incomplete emptying (in nine each), and infrequent voiding in six. CIC was performed within 2 days by 15 patients, while four others required up to 2 weeks to master CIC. However, three of the four patients (all older girls) who needed 2 weeks to learn the technique did not tolerate CIC and discontinued it within 3 weeks. Four other adolescents (three girls and one boy) refused to learn CIC. Of the 16 patients remaining on CIC only three had cystitis; no patient had a febrile UTI. Once successfully instituted, all patients became continent while on CIC. Six boys (mean follow-up 4 months) had a marked decrease in their PVR. CIC was discontinued in three girls who voided normally to emptiness within 6 months of starting CIC; they remained dry and infection-free 16 months (two) and 6 years later. CONCLUSION: CIC is a viable therapeutic option for the treatment of dysfunctional voiding, associated with a large PVR, in the absence of any neurological abnormality. CIC is well tolerated in the sensate patient and provides a means for expeditiously achieving continence and improving bladder emptying cost-effectively.

Adolescent↗
PubMed2003

Management of urinary tract infection in patients with spinal cord injuries.

Urinary tract infection (UTI) is responsible for major morbidity and mortality in spinal cord injury (SCI) patients. Several factors appear to be responsible for an increased risk of infection in the neurogenic bladder. Incomplete voiding, elevated intravesical pressure and catheter use contribute to an increased risk of symptomatic urinary tract infection. Frequent exposure to antibiotics increases the risk of infection by resistant organisms. UTIs interfere with rehabilitation, and may lead to secondary urologic complications. The classic symptoms of UTI are unreliable indicators in SCI patients with neurogenic bladder. Lack of pyuria reasonably predicts the absence of UTI in SCI patients. Asymptomatic bacteriuria need not be treated with antibiotics. Symptomatic UTI warrants therapy in all patients.

Bacteriuria↗
PubMed1998

Detection of urinary tract infections by reduction of nitroblue tetrazolium.

BACKGROUND: Nitroblue tetrazolium (NBT) reduction to formazan has been used as a marker for nitric oxide synthase (NOS). Since inducible NOS activity is elevated in urine from patients with urinary tract infections (UTIs), we investigated the accuracy of NBT reduction as an early predictor of UTIs and quantified the relationship between inducible NOS and NBT. METHODS: Urine samples from 434 patients were screened for the presence of UTIs with leukocyte-esterase and nitrite dipsticks and with NBT reduction. The rapid screening results from each test were compared to urine culture results. In addition, NBT reduction parameters were measured in urine pellet at 595 nm after incubation with one of four factors: NOS cofactors, NOS inhibitors, NADH, or superoxide dismutase/catalase. RESULTS: As a urine screening test for UTIs, NBT reduction was more sensitive with a higher negative predictive accuracy than the nitrite dipstick. NBT reduction also was more specific with a higher positive predictive accuracy and negative predictive accuracy than the leukocyte-esterase dipstick. In infected urine pellet, both NADPH, a NOS cofactor, and NADH increased NBT reduction. Superoxide dismutase/catalase decreased NBT reduction. CONCLUSIONS: Although NOS may not be the only NBT reducing enzyme, rapid, visible reduction of NBT is induced in urine from patients with UTIs.

Adolescent↗
PubMed2000

Randomized multi-centre trial of the effects of a catheter coated with hydrogel and silver salts on the incidence of hospital-acquired urinary tract infections.

Catheters coated with hydrogel and silver salts have been proposed to prevent hospital-acquired urinary tract infections (UTI). We carried out a randomized, prospective, double-blind multi-centre trial to compare those catheters with classical urinary tract catheters. We included in the study 199 patients requiring urethral catheterization for more than three days: 109 in group 1 (classical catheter) and 90 in group 2 (catheter coated with hydrogel and silver salts). Urine from the patients was tested for 10 days after the insertion of the catheter (reactive dipsticks each day and diagnostic urinalysis every two days). The UTI associated with catheterization was defined on the basis of bacterial and cytological criteria (>10(5)cfu bacteria per mL and >10 leucocytes per mm(3)). Twenty-two UTIs were recorded: 13 in group 1 and nine in group 2. The cumulative incidence of UTI associated with catheterization was 11.1% overall, 11.9% for group 1 and 10% for group 2; the odds ratio was 0.82 (95% confidence interval: 0.30 to 2. 20); the cumulative incidence for UTI, calculated by the Kaplan-Meier method was 36.3 overall, 35.2 in group 1 and 36.0 in group 2; the overall incidence density was 19 per thousand days of catheterization, 21 in group 1 and 18 in group 2. The differences between the two groups were not significant. Overall, we feel that there is not enough evidence to conclude that catheters coated with silver salts and hydrogel give greater protection than classical catheters and to recommend widespread use.

Coated Materials, Biocompatible↗
PubMed2000

Renal expression of monocyte chemotactic protein-1 and epidermal growth factor in children with obstructive hydronephrosis.

BACKGROUND/PURPOSE: The authors studied the potential role of ureteropelvic junction obstruction (UPJ-O) in causing progressive renal damage in children through the renal expression of epidermal growth factor (EGF) and monocyte chemotactic protein-1 (MCP-1) mRNA. METHODS: Renal tissues were harvested from 11 children with UPJ-O and from 10 normal kidneys to study the renal expression of EGF and MCP-1 detected by means of in situ hybridization. Five of the patients were found to have a history of urinary tract infection (UTI). RESULTS: Children with UPJ-O had marked reduction of EGF gene expression when compared with controls. Interstitial expression of MCP-1 mRNA was present in all UPJ-O cases. Both EGF and MCP-1 expression did not correlate with age, with differential renal function, and with renal thickness measured through MAG3 renal scan. Children with a history of UTI had a more severe reduction of the renal thickness of the affected kidney compared with those without UTI. MCP-1 expression was higher and EGF more reduced in children with a history of UTI. CONCLUSIONS: Our results suggest a potential role of EGF and MCP-1 in the pathogenesis of renal damage and growth failure in UPJ-O, especially in children with UTI. These important functional changes begin early in life, possibly during fetal life.

Adolescent↗
PubMed2006

[Efficacy and safety profile of a herbal drug containing nasturtium herb and horseradish root in acute sinusitis, acute bronchitis and acute urinary tract infection in comparison with other treatments in the daily practice/results of a prospective cohort study].

PATIENTS AND METHODS: In a prospective cohort study from 251 centers in Germany patients with age of 4 years or above who were treated due to acute sinusitis, bronchitis or urinary tract infections (UTI) in the period from 1st March 2004 - 30th July 2005, were elected. They were included in the study analysis, if they had no exclusion criteria (severe diseases, need for antibiotic therapy, participation in another trial) and came to the final investigation. The patients were treated either with the nasturtium herb and horseradish root containing herbal drug Angocin Anti-Infekt N (test group, n = 1223) or with standard antibiotic therapy (control group, n = 426). Treatment, dosage and treatment duration were determined by the physician in accordance with the patient. 536 subjects (408 test, 128 control patients) suffered from acute sinusitis, 634 subjects (469 test, 165 control patients) from acute bronchitis and 479 subjects (346 test, 133 control patients) from UTI. At study start and end the severity of the symptoms were judged by the investigator and quantified with 4 scores (0 = no symptom, 3 severe symptom). During the treatment information on use of medication, concomitant procedures and adverse events (AEs) in a patient diary. At the end of the study (disease free or after 7-14 days) the patient returned to the investigator, who recorded the vital parameters, finally judged the treatment efficacy and potential persisting symptoms on the basis of score values. Primary efficacy criterion was the change of the complaints quantified by the change of the relative symptom score averaged over all symptoms and related to the baseline value. RESULTS: In patients with acute sinusitis the mean relative reduction of the averaged symptom score was 81.3% for the test group and 84.6% for the control group, in patients with acute bronchitis the mean reduction was 78.3% for the test group and 80.3% for the control group, in patients with UTI 81.2% for the test group and 87.9% for the control group. The 95% confidence interval for the difference of the expected reductions between test and control group was -8.5% to 1.8% for acute sinusitis, 7.6% to 3.6% for acute bronchitis and -13.1% to -0.1% for UTI. Non-inferiority of the test treatment, i.e. if the lower limit of the 95% confidence interval is greater than 10%, could be stated for acute sinusitis and bronchitis. In UTI the non-inferiority level was exceeded only by 3%. Complementary procedures were less in the test group than in the control group. For 1.5 % of test patients and 6.8% of control patients AEs were observed CONCLUSION: Therapy with the herbal drug in the indications acute sinusitis, acute bronchitis und acute urinary tract infection is - with regard to its efficacy comparable to the treatment with standard antibiotics. The application of supportive procedures and the administration of concurrent medication were less expressed in the group treated with the herbal drug. In the above mentioned indications the group treated with the herbal drug displayed a clear advantageous safety profile compared to the group treated with standard antibiotics.

Adult↗
PubMed2003

Addressing antibiotic resistance.

Management of uncomplicated urinary tract infections (UTIs) has traditionally been based on 2 important principles: the spectrum of organisms causing acute UTI is highly predictable (Escherichia coli accounts for 75% to 90% and Staphylococcus saprophyticus accounts for 5% to 15% of isolates), and the susceptibility patterns of these organisms have also been relatively predictable. As a result, empiric therapy with short-course trimethoprim-sulfamethoxazole (TMP-SMX) has been a standard management approach for uncomplicated cystitis.However, antibiotic resistance is now becoming a major factor not only in nosocomial complicated UTIs, but also in uncomplicated community-acquired UTIs. Resistance to TMP-SMX now approaches 18% to 22% in some regions of the United States, and nearly 1 in 3 bacterial strains causing cystitis or pyelonephritis demonstrate resistance to amoxicillin. Fortunately, resistance to other agents, such as nitrofurantoin and the fluoroquinolones, has remained low, at approximately 2%. Preliminary data suggest that the increase in TMP-SMX resistance is associated with poorer bacteriologic and clinical outcomes when TMP-SMX is used for therapy. As a result, these trends have necessitated a change in the management approach to community-acquired UTI. The use of TMP-SMX as a first-line agent for empiric therapy of uncomplicated cystitis is only appropriate in areas where TMP-SMX resistance prevalence is <10% to 20%. In areas where resistance to TMP-SMX exceeds this rate, alternative agents need to be considered.

Adult↗
PubMed2003

Incidence of urinary tract infections in patients with short-term indwelling urethral catheters: a comparison between a 3-day urinary drainage bag change and no change regimens.

BACKGROUND: The current practice of caring for hospitalized patients with indwelling urethral catheters in Siriraj Hospital is to change the drainage bag every 3 days. In an extensive medical literature search, no evidence was noted to support this practice. OBJECTIVE: The purpose of this study was to compare the incidence of catheter-associated urinary tract infections (UTI) in hospitalized patients with indwelling catheters who receive a drainage bag change every 3 days with the incidence of UTI in patients who receive no bag change. DESIGN: This study was a randomized controlled trial. Participants and study procedures: Of the patients at Siriraj Hospital, 153 with an indwelling urinary catheter for at least 3 days were randomized to a 3-day drainage bag change or a no change regimen. A urine sample was obtained from each patient for culture every 7 days, on the day the catheter was removed, or the day the patient was suspected of having a UTI. RESULTS: Of the 153 study patients, 79 were randomized to the 3-day bag change regimen, and 74 patients were in the no-change group. Both groups were comparable for all baseline characteristics. The incidence of symptomatic UTI was 13.9% in the 3-day drainage bag change group and 10.8% in the no change group (P =.7). The incidence of asymptomatic UTI was 36.7% in the 3-day bag change group and 36.5% in the no change group (P =.9). CONCLUSION: There is no evidence for the necessity of a bag change every 3 days at Siriraj Hospital; the urine bag can be left longer than 3 days. However, the appropriate frequency of urinary drainage bag change needs additional study because the sample size in this study does not rule out a false-negative result.

Adolescent↗
PubMed2000

Recurrence of urinary tract infections in adult patients with community-acquired pyelonephritis caused by E. coli: a 1-year follow-up.

In a prospective study, 42 women were followed for recurrence of urinary tract infections (UTIs) for 1 y after an index episode of community-acquired pyelonephritis caused by Escherichia coli. Altogether, 26 repeat episodes were detected. Of these, 20 occurred at least 1 month after the index episode and were regarded as recurrences. In all, 40%, (17 of 42) of the women had recurrences. An earlier history of UTI increased the risk of recurrence: 52%, of the 29 women with previous UTI had at least 1 recurrence, compared with 15%, of the 13 patients without previous UTI. E. coli caused the majority (73%) of the recurrences. Genotype comparisons by RAPD-PCR analysis between E. coli isolates from a patient showed that 75%. of the original and recurrent strains were genetically non-identical. Of the 54 E. coli strains, 42 were carrying genes coding for G adhesins of P fimbriae: 40 isolates carried class II, I class III and 1 carried both class II and III G adhesin genes. Each of the virulence-associated factors (genes for G adhesins, MRHA, haemolysin, type 1C fimbriae, and O and K antigens) was evenly distributed among E. coli isolates of index episodes, independent of the recurrences. The index isolates, however, had more virulence-associated factors than did the isolates from the recurrences which were mainly due to lower UTIs.

Adult↗
PubMed2003

Renal pelvic wall thickening in childhood urinary tract infections--evidence of acute pyelitis or vesicoureteral reflux?

OBJECTIVE: The aim of this study was to determine whether renal pelvic wall thickening in active childhood urinary tract infections (UTIs), as demonstrated using ultrasound, is caused by acute pyelitis or by vesicoureteral reflux (VUR)-related chronic changes. MATERIAL AND METHODS: A total of 41 children with at least unilateral renal pelvic wall thickening as demonstrated using ultrasound during the acute stage of UTI, and confirmed using voiding cystourethrography (VCUG), were analyzed. All cases underwent ultrasound studies at 6 months follow-up. RESULTS: Using ultrasound, 50 halves of the pelvis showed renal pelvic wall thickening. In 27 (54%), ipsilateral VUR could be demonstrated using VCUG. The sensitivity, specificity and positive predictive value of renal pelvic wall thickening for predicting ipsilateral VUR were 79.4%, 52.1% and 54%, respectively. Only 2 (7%) cases presented with wall thickening at 6 months follow-up. Most of the thickening recovered after clinical improvement, although VUR became persistent in half the cases. CONCLUSIONS: Renal pelvic wall thickening is an abnormal finding in the acute stage of childhood UTI and predominantly indicates acute pyelitis rather than VUR-related chronic changes. Renal pelvic wall thickening is not sufficiently predictive of VUR in acute UTI, although it does provide evidence of upper UTI.

Acute Disease↗
PubMed2000

Urinary tract infections, antibiotic resistance and sales of antimicrobial drugs--an observational study of uncomplicated urinary tract infections in Icelandic women.

OBJECTIVES: To analyse the antimicrobial susceptibility pattern of bacteria causing symptomatic but otherwise uncomplicated lower urinary tract infections (UTI) in primary health care and the sales of antimicrobial drugs. SETTING: Primary health care in Akureyri District, Northern Iceland, with about 17400 inhabitants. PATIENTS: A total of 516 episodes of symptomatic but otherwise uncomplicated lower UTI in women 10 to 69 years of age. MAIN OUTCOME MEASURES: Number of verified UTI, bacterial species, antimicrobial susceptibility pattern, and total sales of antimicrobial drugs. RESULTS: Escherichia coli was by far the most common cause of UTI (83%), followed by Staphylococcus saprophyticus (7%). Infections caused by E. coli resistant to ampicillin accounted for 36% of cases, with the corresponding figures for sulfafurazol being 37%, cephalothin 45%, trimethoprim 13% and mecillinam 14%. Only 1% of the strains were resistant to nitrofurantoin. The total use of antimicrobial drugs was 17.4 DDD/1000 inhabitants/day. CONCLUSIONS: The resistance of bacteria causing uncomplicated UTI to common antimicrobials is high and must be taken into account when selecting treatment strategies. High consumption of antibiotics in the community indicates possible association.

Adolescent↗
PubMed2003

Vesicoureteric reflux and reflux nephropathy as seen at a tertiary care adult nephrology service in India--an analysis of 86 patients.

Clinical features and risk factors for renal failure in patients with reflux nephropathy (RN) as seen in an adult nephrology service are likely to be different than those seen in a pediatric service. There are only a few studies on adults with vesicoureteric reflux (VUR) and RN and data on RN as seen in developing countries is still evolving. Retrospective analysis of records of patients diagnosed to have VUR by conventional micturating cystourethrogram over a 13 year period, as seen in the adult nephrology services of this tertiary care hospital in north India was carried out. Results are presented as mean +/- 2 SD. Unpaired t-test was used to compare means, chi-square test to define associations, and logistic regression analysis was done to define risk factors. Out of 86 patients diagnosed to have VUR, 69 (80.2%) were males and 22 (25.6%) were children. The mean age at presentation was 24.3 +/- 14.5 years and at onset of symptoms was 19.64 +/- 14.8 years. Sixty-nine (80.2%) patients had chronic renal failure (CRF) at presentation, including 33 (38.4%) patients who already had end stage renal failure (ESRF) at presentation in whom reflux was diagnosed during routine pretransplant evaluation and these constituted 5.5% of all ESRF patients. The clinical features at presentation were hypertension in 51 (59.3%), recurrent urinary tract infection (UTI) in 31 (36.1%), history of stones in 7 (8.1%), and gross hematuria in 4 (4.7%). Patients with history of recurrent UTI were more likely to be females (p < 0.01) and to present without renal failure (p < 0.05). Proteinuria > 1 g/day was significantly associated (p < 0.02) with hypertension at presentation. Patients who presented with renal failure were more likely to be males (p < 0.05), not to have history of recurrent UTI (p < 0.05), have proteinuria > 1 g/day (p < 0.02) and higher grades (grades IV and V) of reflux (p < 0.05). On logistic regression analysis, higher age of onset (odds ratio 4.6, p < 0.03), proteinuria > 1 g/day (odds ratio 3.8, p < 0.05), and male gender (odds ratio 3.5, p < 0.05) were significant risk factors for presentation for the first time with renal failure. The clinical features and course of VUR and RN as seen in India are different from those reported from elsewhere. The vast majority of patients in India are males and almost two thirds do not have a past history of UTI. Renal failure is present in more than three fourths of patients when a diagnosis of reflux is made and one third of all patients present with ESRD. Patients with a prior history of UTI are more commonly females and are less likely to have renal failure at presentation. Higher age of onset of symptoms, proteinuria > 1 g/day and male gender were risk factors for the development of renal failure. It is likely that these asymptomatic patients remain undetected during childhood, presenting late only after having incurred severe renal damage.

Adolescent↗
PubMed2003

The use of ultrasonography in evaluating adults with febrile urinary tract infection.

BACKGROUND: Urinary tract infection (UTI) is a common disease. Controversy exists about the role of radiological evaluation in the patient with urinary tract infection. MATERIALS AND METHODS: From April 2001 to December 2001, patients with febrile UTI admitted to Chang Gung Memorial Hospital, Chiayi were prospectively evaluated by ultrasonography. The inclusion criteria of febrile UTI was a body temperature of more than 38 degrees C with a bacterial count of 10(3) or more per mL in a freshly voided midstream or catheterized urine. RESULTS: A total of 94 patients were evaluated and all patients recovered. Major abnormal sonograms were present in 17 (18%) of the patients. A history of urolithiasis and a duration of fever > or = 3 days after admission were statistically significant clinical parameters in predicting major abnormal sonogram. Although diabetes mellitus was not statistically significant in predicting major abnormal sonogram, diabetic patients had 2.5 times the likelihood of major structural abnormalities than nondiabetic patients. CONCLUSION: Ultrasonographic study of patients with febrile UTI should be limited only to those with a duration of fever > or = 3 days and a history of urolithiasis. Ultrasonographic study should also be considered in febrile UTI patients with diabetes mellitus.

Adult↗
PubMed2002

Recurrent urinary tract infections in infancy: relapses or reinfections?

Seventeen infants with an index episode of pyelonephritis caused by Escherichia coli were monitored for 18 months for recurrent urinary tract infections (UTIs). All the infants had at least 1 recurrent UTI caused by the same pathogen. Twenty-six recurrent UTI episodes were recorded. The 40 E. coli strains available were analyzed by multiplex polymerase chain reaction for 3 alleles (classes I-III) of the papG gene and by pulsed-field gel electrophoresis (PFGE) after genomial digestion by XbaI. Of the 17 index strains, 12 (71%) carried the papG gene; 67% of these strains had class II alleles. In recurrent UTI isolates, the papG-positive E. coli appeared in 16 (70%) of 23 isolates. The proportion of all recurrent isolates available that represented a strain previously encountered (indistinguishable or highly similar in PFGE) in the same infant was 65%. Our results suggest that most recurrent UTIs in infants are endogenous relapses rather than reinfections caused by new organisms.

Adhesins, Escherichia coli↗
PubMed2002

Molecular epidemiology of 3 putative virulence genes for Escherichia coli urinary tract infection-usp, iha, and iroN(E. coli).

This study describes the epidemiological association of 3 putative genes for virulence of uropathogenic Escherichia coli; uropathogenic specific protein (usp), a Vibrio cholerae zot gene homologue; IrgA homologue adhesin (iha), a nonhemagglutinating adhesin; and iroN(E. coli), a catechole siderophore receptor homologue. We compared the relative frequency in urinary tract infection (UTI) isolates (n=508), compared with non-UTI isolates (n=416). iroN(E. coli) occurred 2.1-3.6 times more frequently in UTI isolates than in rectal isolates (P=1.1x10-18 to P=2.7x10-5) and was associated with several uropathogenic virulence genes found on pathogenicity islands. usp occurred more frequently in isolates from patients with pyelonephritis (P=3.6x10-9), in periurethral isolates (P=.001), and in isolates from patients with UTI who were aged 40-65 years (P=.004), when compared with the rectal isolates; iha was not associated with UTI in this study.

Adolescent↗
PubMed2003

Effectiveness of estriol-containing vaginal pessaries and nitrofurantoin macrocrystal therapy in the prevention of recurrent urinary tract infection in postmenopausal women.

We compared the efficacy and safety of estriol-containing vaginal pessary use with those of oral nitrofurantoin macrocrystal (NM) therapy for preventing urinary tract infection (UTI) in postmenopausal women with recurrent UTI. Over a period of 9 months, 86 women received an estriol-containing vaginal pessary (0.5 mg estriol) twice weekly, and 85 women received NM (100 mg) once daily. We recorded 124 episodes of UTI in women who received estriol-releasing pessaries and 48 episodes of UTI in women treated with NM (P=.0003). Twenty-eight women (32.6%) who received estriol had no episodes of UTI versus 41 women (48.2%) in the NM group. There was a significant increase in the number of superficial cells in women who received estriol, whereas in the NM group, no such changes occurred. However, there was no change in the extent of Lactobacillus colonization and in the vaginal pH in women who received estriol. Use of an estriol-containing pessary is less effective than oral NM therapy in the prevention of bacteriuria in postmenopausal women because of its failure to restore the population of lactobacilli and to reduce the vaginal pH in these women.

Aged↗
PubMed1997

Antecedent antimicrobial use increases the risk of uncomplicated cystitis in young women.

To examine whether antecedent antimicrobial use influenced subsequent relative risk of urinary tract infection (UTI) in premenopausal women, data were analyzed from two cohorts of women observed prospectively for 6 months to determine risk factors for UTI. Using a Cox proportional hazards model to adjust for covariates, we found that 326 women in a University cohort and 425 women in a health-maintenance organization cohort were at increased risks for UTI (2.57 [95% confidence interval (CI), 1.24-5.32] and 5.83 [95% CI, 3.17-10.70], respectively) if antimicrobials had been taken during the previous 15-28 days but not during the previous 3, 7, or 14 days. The increased risks were noted both for women whose antimicrobial use was for treatment of a previous UTI and for women who received antimicrobials for other illnesses. These results suggest that recent antimicrobial use increases a woman's risk of UTI, perhaps by altering the indigenous urogenital flora and predisposing to vaginal colonization with uropathogens.

Adolescent↗