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PubMed2001

Fluconazole dose recommendation in urinary tract infection.

OBJECTIVE: To identify the most appropriate dose of fluconazole for the treatment of symptomatic fungal urinary tract infection (UTI). DATA SOURCES: Primary literature identified through MEDLINE (1990-June 2000). Key search terms included fluconazole and urinary tract infection. DATA SYNTHESIS: Fluconazole is approved for the treatment of candidal UTIs, but dosage recommendations are not consistent. An evaluation of clinical studies of fluconazole for the treatment of candidal UTI was performed. CONCLUSIONS: Questions remain about the optimal dosing of fluconazole, including the most appropriate dose in non-albicans species of candida as well as the optimal duration of therapy. Until further studies are performed, a fluconazole 200-mg loading dose followed by 100 mg/d for at least four days appears to be the most appropriate dose for the treatment of symptomatic candidal UTI in patients without systemic fungal infection or severe renal failure.

Antifungal Agents↗
PubMed1998

Single-dose treatment of acute cystitis with fosfomycin tromethamine.

OBJECTIVE: To review the clinical pharmacology of fosfomycin tromethamine, a new antimicrobial agent for the treatment of uncomplicated lower urinary tract infections (UTIs). DATA SOURCE: Publications in English on fosfomycin, fosfomycin tromethamine, and fosfomycin trometamol (MEDLINE, 1970-1997), as well as unpublished studies submitted to the Food and Drug Administration (FDA), were reviewed. STUDY SELECTION: Comparative, randomized, controlled studies were used to analyze the efficacy and safety of fosfomycin tromethamine. DATA SYNTHESIS: Fosfomycin tromethamine is an oral antimicrobial indicated for the treatment of uncomplicated lower UTIs. This agent is active in the urine against common uropathogens that are associated with cystitis in women, including organisms resistant to other antibiotics. A single dose of fosfomycin tromethamine is well absorbed and produces therapeutic concentrations in the urine for 2-4 days. Comparative clinical trials suggest that a single dose of fosfomycin tromethamine 3.0 g is as clinically effective as 7- to 10-day treatment regimens of standard agents used to treat UTIs, such as nitrofurantoin, norfloxacin, and trimethoprim/sulfamethoxazole. Fosfomycin tromethamine is well tolerated and appears safe to use during pregnancy. CONCLUSIONS: Fosfomycin tromethamine is the only antimicrobial to be approved by the FDA for single-dose therapy in women with acute cystitis. It is as effective and safe as multidose comparators and appears safe to use during pregnancy. The acquisition cost of this new drug will need to be weighed against the improved compliance and convenience associated with its use in the treatment of uncomplicated UTIs.

Acute Disease↗
PubMed2004

Management of asymptomatic bacteriuria in patients with diabetes mellitus.

OBJECTIVE: To review the literature regarding the management of asymptomatic bacteriuria (ASB) in patients with diabetes mellitus. DATA SOURCES: A MEDLINE (1967-June 2003) and bibliographic search of the English-language literature was conducted using the search terms diabetes mellitus, asymptomatic, bacteriuria, and urinary tract infection. DATA SYNTHESIS: ASB occurs in diabetic women more commonly than in non-diabetics and is associated with an increased risk of symptomatic urinary tract infection (UTI) among patients with type 2 diabetes. Symptomatic UTIs tend to follow a more complicated course in diabetics. Despite these independent observations, antimicrobial therapy has not been shown to reduce symptomatic UTIs, pyelonephritis, or hospitalization for UTI. CONCLUSIONS: Available evidence does not support antimicrobial treatment of ASB among patients with diabetes mellitus.

Anti-Infective Agents, Urinary↗
PubMed1985

Human urinary proteinase inhibitor: inhibitory properties and interaction with bovine trypsin.

The major urinary trypsin inhibitor (UTI) was found to inhibit bovine chymotrypsin and human leucocyte elastase strongly, cathepsin G weakly. No inhibition of porcine pancreatic elastase was observed. The stoichiometry of the inhibition of bovine trypsin by UTI was determined spectrophotometrically to be 1:2 (I/E molar ratio). After incubation of UTI with this enzyme in various molar ratios, two complexes (C1 and C2) could be visualized in alkaline polyacrylamide gel electrophoresis. C1 was isolated by affinity chromatography on Con-A Sepharose. In dodecyl sulfate polyacrylamide gel electrophoresis, C1 was dissociated to give an inhibitory band with the same electrophoretic mobility as native UTI. C2 released an active inhibitory fragment with Mr near 20000. A time-course study demonstrated that at a molar ratio I/E of 1.5:1, the C2 complex appears after two hours of incubation.

Animals↗
PubMed2001

Identifying bacteria in human urine: current practice and the potential for rapid, near-patient diagnosis by sensing volatile organic compounds.

Urinary tract infection (UTI) represents a significant burden for the National Health Service. Extensive research has been directed towards rapid detection of UTI in the last thirty years. A wide range of microbiological and chemical techniques are now available to identify and quantify bacteria in urine. However, there is a clear and present need for near, rapid, sensitive, reliable analytical methods, preferably with low-running costs, that could allow early detection of UTI and other diseases in urine. Here we review the "state of the art" of current practice for the detection of bacteria in urine and describe the advantages of the recent "e-nose" technology as a potential tool for rapid, near-patient diagnosis of UTI, by sensing volatile organic compounds (VOCs).

Bacteria↗
PubMed2000

Imaging after urinary tract infection in male neonates.

OBJECTIVE: To assess the frequency of urinary tract anomalies in male neonates <8 weeks old who presented with urinary tract infection (UTI), and to evaluate a suitable imaging approach after the initial infection. DESIGN: During a period of 4.5 years, from July 1994 through December 1998, 45 male neonates <8 weeks old (range: 5-56 days; mean: 23.77 days) with UTI were hospitalized. All patients had an ultrasound (US) and a voiding cystourethrogram (VCUG), except 1 neonate in whom VCUG was unsuccessful because of technical problems. A dimercaptosuccinic acid (DMSA) scan was recommended to all patients but was performed only in 30 of 45, most of them with an abnormal VCUG. The renal scan was performed at least 4 months after the UTI. RESULTS: Urinary tract abnormalities were observed in 22 of 45 male neonates. Nineteen had vesicoureteral reflux (VUR), 1 had VUR and a double collecting system, 1 had VUR and a posterior urethral valve, and 1 had an ureteropelvic junction stricture. Renal atrophy or scars, as demonstrated by DMSA scan, were detected almost exclusively in neonates with VUR grade 3 and above. Only 1 neonate with VUR grade 1 had a pathologic DMSA, and the US of this male also demonstrated renal atrophy. Escherichia coli was the pathogen in 62% (28 of 45), and 9 boys had bacteremia. CONCLUSION: We suggest that US and VCUG should be performed routinely after the initial UTI in male neonates. Renal scan should be reserved for those cases in which the US suggests renal parenchymal damage or when VCUG detects VUR grade 3 and above.

Chelating Agents↗
PubMedDate not supplied

[Urinary tract infection associated with indwelling bladder catheter: incidence and risk factors].

BACKGROUND: To determine the incidence and risk factors associated with urinary tract infection (UTI) in patients submitted to long-term urinary (bladder) catheterization. One hundred and thirty-six patients who had urinary catheterization during the period of may to december 1993 at an University Hospital in Brazil. MATERIAL AND METHOD: Observational prospective cohort non-controlled study. Patients receiving bladder catheter were followed from insertion to removal of the catheter, looking for the development of a positive culture. Urine cultures were done using conventional media for aerobic organisms and biochemical tests for identification. Material from a urethral meatus swab was also examined for bacteria. Statistical analysis using parametric tests for cathegorical and continuous variables, and multivariate analysis for determination of risk factors for UTI were performed. RESULTS: Incidence of UTI associated with urinary catheter was 11.0%. Univariate analysis showed 3 factos as predictors: the nature of his disease (clinical or surgical) (p = 0.01), stayed during hospitalization in one clinic (p = 0.02) and duration of catheterization (p = 0.00003). In the multivariate analysis only the duration of catheterization was statistically significant. (p = 0.03). CONCLUSIONS: Incidence of UTI associated with urinary catheters in the analysed sample was 11.0%, because in the University Hospital there is a control of the alterable risk. Catheterization duration is an important risk factor for this problem. It is recommended to limit to the minimum the time of catheterization in hospitalized patients.

Adolescent↗
PubMedDate not supplied

Molecular investigation of Escherichia coli strains associated with apparently persistent urinary tract infection in dogs.

Persistent Escherichia coli urinary tract infection (UTI) in dogs is a frustrating clinical problem. Affected dogs often appear to fail to respond to therapy or to reacquire infection shortly after therapy is completed. Urovirulence factors (UVFs) of the infecting E. coli, antibiotic resistance, and tissue colonization may be contributory but have not been evaluated in dogs with persistent E. coli UTI. In this study, the strain types of E. coli in dogs with persistent UTI were evaluated with pulsed-field gel electrophoresis (PFGE) to determine whether persistence was due to acquisition of new isolates or failure to eradicate existing isolates. UVFs in these isolates, assessed by polymerase chain reaction, and antibiograms were correlated with treatment outcome in these dogs. Results documented a mixed pattern: 9 dogs remained chronically infected with 1 or 2 strains, each with distinct reproducible UVFs, but 1 dog was infected with numerous unrelated E. coli strains over time. Two dogs had a mixed pattern, consisting of 1 or more episodes of persistent E. coli infection attributable to a single strain in addition to episodes caused by unrelated strains. Many isolates had no detectable UVFs, highlighting the likely importance of impaired colonization resistance in the affected dogs. Antibiotic resistance was common, often in response to previous treatments, especially with trimethoprim-sulfamethoxazole. Antibiotic resistance patterns differed significantly within PFGE strain types, suggesting lateral acquisition of resistance plasmids or integrons. These results can be used to help guide testing for and management of persistent E. coli UTI in dogs.

Animals↗
PubMed1990

Recurring urinary tract infection: incidence and risk factors.

Urinary tract infection (UTI) is a common infection among young women, with a high recurrence rate. This study documents the six-month incidence of second UTI among a cohort of women with one initial UTI and the factors associated with recurrence. Among the cohort of 113 women, 30 (26.6 percent) experienced at least one culture-confirmed recurrence within the six months following initial infection. The presence of hematuria and urgency as symptoms of initial infection were the strongest predictors of second infection. Behavioral factors associated with initial infection (frequency of sexual intercourse, diaphragm use, and voiding after sexual intercourse) did not distinguish between women who would and would not experience a second UTI during the six-month follow-up period.

Adolescent↗
PubMed2006

Retrospective evaluation of outcomes in patients with overactive bladder receiving tolterodine versus oxybutynin.

PURPOSE: The frequency, relative risk, resource utilization, and costs related to comorbidities associated with overactive bladder (OAB) were studied. METHODS: A retrospective analysis of patients with OAB who initiated treatment with tolterodine extended release (ER), oxybutynin ER, or oxybutynin immediate release (IR) between January 2001 and December 2002 was conducted to evaluate the frequency, relative risk, resource utilization, and costs related to three specific comorbidities associated with OAB: urinary tract infections (UTIs), depression, and fracture. Two patient cohorts (tolterodine ER versus oxybutynin ER and tolterodine ER versus oxybutynin IR) were matched on a 1:1 basis according to their propensity to receive a prescription for tolterodine ER. RESULTS: The frequency and relative risk of UTIs were significantly lower in the tolterodine ER group than in the oxybutynin ER and oxybutynin IR groups. The relative risk of depression was also lower in the tolterodine ER group than the oxybutynin ER and oxybutynin IR groups; however, the differences were only significant in the tolterodine ER versus oxybutynin IR comparison. The utilization of UTI- and depression-related services and the number of antiinfective and antidepressant prescriptions were significantly lower in the tolterodine ER group than in the oxybutynin ER group. UTI- and depression-related costs were generally lower in the tolterodine ER group than in the oxybutynin ER or oxybutynin IR group. CONCLUSION: Treatment of OAB patients with tolterodine ER was associated with reduced frequency, relative risk, medical and pharmacy resource utilization, and incurred costs related to selected OAB-associated comorbidities compared with treatment with oxybutynin ER or oxybutynin IR.

Benzhydryl Compounds↗
PubMed1996

Rational prescribing for postmenopausal urogenital complaints.

Urogenital complaints such as vaginal discomfort, dysuria, dyspareunia, recurrent lower urinary tract infections (UTIs) and urinary incontinence have been reported to affect more than 50% of postmenopausal women. These symptoms cause considerable suffering and an obvious reduction in quality of life for the afflicted individual, as well as being costly in economic terms for the health service. Urinary incontinence alone has been estimated to account for approximately 2% of health care costs in both the US and Sweden. Treatment with low potency estrogens given locally or orally has been shown to alleviate urgency, urge incontinence, frequency, nocturia and dysuria, but there is no conclusive evidence that estrogens alone improve or cure stress incontinence. Estrogen therapy has also been shown to cure or alleviate local urogenital atrophy symptoms, and to induce positive changes in the vaginal bacterial flora of postmenopausal women, which in turn reduces the risk of developing a UTI. There is little or no documentation to support the use of antibiotics in the treatment of local urogenital complaints such as pruritus, vaginal discomfort and discharge, or urinary incontinence in postmenopausal women. Antibiotics are, however, indicated for the treatment of UTIs, and in some cases for prophylactic treatment in women with recurrent UTIs. The number of women with urogenital complaints is expected to increase in the future, as the proportion of elderly women will be greater due to a higher life expectancy. Thus, in the future there will be an even greater need for simple, effective forms of treatment for large numbers of elderly women. Low potency estrogens given topically or orally have been shown to be an effective form of treatment for urogenital symptoms in postmenopausal women.

Drug Prescriptions↗
PubMed2004

[Effect of treatment of lower urinary tract dysfunction on occurrence of urinary tract infections in children with vesicoureteral reflux].

Correlation between lower urinary tract dysfunction, urinary tract infection (UTI) and vesicoureteral reflux (VUR) is complex and well known. The impact of lower urinary tract dysfunction treatment on frequency of UTI in children with VUR was assessed in our study. Lower urinary tract dysfunction was diagnosed in 32 girls and 4 boys; 19 (53%) of them had VUR in 24 kidney units. All patients were on chemo-prophylaxis and were advised how to restore regular voiding and assume normal posture, in order to reach an optimal relaxation of the pelvic floor during voiding. Eight patients (42%) with signs of hyperactive bladder and/or small bladder capacity were administered anticholinergic-oxybutynin (0.2 mg/kg of body weight). Eleven patients (58%) with sign of bladder-sphincter dysfunction and/or residual urine volume over 20% were treated by alfa-blocker-alfuzosin (0.1 mg/kg of body weight). Four children with constipation were advised to use fiber-rich diet. During 12-mount follow-up, none had febrile UTI, and 7 (37%) had 1 to 3 UTI without temperature. In conclusion, conservative treatment of VUR should include chemo-prophylaxes, lower urinary tract dysfunction treatment, and treatment of constipation, what was confirmed by our study as well.

Child↗
PubMed2001

Epidemiologic study of risk factors for lower urinary tract diseases in cats.

OBJECTIVE: To determine proportional morbidity rates (PMR) and risk factors for lower urinary tract diseases (LUTD) in cats. DESIGN: Case-control study. SAMPLE POPULATION: Records of 22,908 cats with LUTD and 263,168 cats without LUTD. PROCEDURE: Data were retrieved from the Purdue Veterinary Medical Data Base. Descriptive statistics and univariate logistic regression analyses were performed to assess whether breed, age, sex, and neutering status were associated with different causes of LUTD. RESULTS: Mean PMR for LUTD irrespective of cause was 8/100 cats (range, 2 to 13/100 cats). Increased risk for urocystolithiasis (Russian Blue, Himalayan, and Persian cats), bacterial urinary tract infections (UTI; Abyssinian cats), congenital urinary tract defects (Manx and Persian cats), and urinary incontinence (Manx cats) was detected. Cats between 2 and < 7 years of age had increased risk for urethral plugs, neurogenic disorders, congenital defects, and iatrogenic injuries. Cats between 4 and < 10 years of age had increased risk for urocystolithiasis, urethral obstructions, and idiopathic LUTD. Cats > or = 10 years of age had increased risk for UTI and neoplasia. Castrated males had increased risk for each cause of LUTD except UTI and incontinence. Spayed females had increased risk for urocystolithiasis, UTI, and neoplasia. Sexually intact females had decreased risk for each cause of LUTD except neurogenic disorders and iatrogenic injuries. CONCLUSION AND CLINICAL RELEVANCE: Specific breed, age, sex, and neutering status may be associated with specific types of feline LUTD. Knowledge of patient risk factors for LUTD may facilitate development of surveillance strategies that enhance earlier detection.

Age Factors↗
PubMed1989

P blood group and proneness to urinary tract infection in Japanese children.

The globoseries of glycolipids are antigens in the P blood group system as well as epithelial cell receptors for uropathogenic Escherichia coli. The P1 blood group is overrepresented in Swedish girls with recurrent pyelonephritis. In this study, Japanese children with urinary tract infection (UTI) were analyzed for P blood group phenotype. Out of 26 children with recurrent UTI, 50% were of the P1 blood group compared to the 31% of P1 individuals in the Japanese population at large (p less than 0.05). Of children defined as having febrile UTI 62% were P1. The P1 blood group was thus significantly enriched (3.5 times) in the children with febrile UTI. These results support the hypothesis that individuals of blood group P1 run an increased risk for recurrent pyelonephritis.

Adolescent↗
PubMed1981

Does antibacterial ointment applied to urethral meatus in women prevent recurrent cystitis?

In a double-blind placebo controlled clinical trial the preventive value of the antibacterial ointment povidone-iodine 10% (Isodine, Betadine) applied to urethral meatus was evaluated in 17 females suffering from recurrent urinary tract infections (UTI). The patients applied povidone-iodine respectively placebo ointment twice daily and before sexual intercourse in two 6-month periods in a cross-over design. No difference was observed in number of UTI during povidone-iodine and placebo prophylaxis. A decrease in the incidence of UTI was seen during application of any ointment. The antibacterial properties of povidone-iodine ointment is unimportant in the prophylaxis of reinfections as also indicated from urethral and periurethral cultures during the study revealing no change in pathogenic bacterial flora. An improved perineal hygiene in the context of application of ointment may be responsible for the reduction in UTI incidence in females with recurrent cystitis.

Administration, Topical↗
PubMed1985

Nalidixic acid and pivmecillinam for treatment of acute lower urinary tract infections.

Women, 15-45 years of age, with symptoms of lower urinary tract infection (UTI) were randomly treated with nalidixic acid (1 g X 3) or pivmecillinam (200-400 mg X 3) for three or seven days, respectively. Therapeutic failure, relapse, or reinfection occurred among 18% of 82 women, even though the isolated strains of gram-negative rods in these patients were susceptible in vitro to the antibiotics used. Therapeutic failure, i.e. no effect or at best only a minor effect on the symptoms, was registered in 10 of 13 cases of UTI caused by Staphylococcus saprophyticus and treated with nalidixic acid, which was consistent with the high minimum inhibitory concentrations (MIC) (128-512 micrograms/ml) of this antibiotic. S. saprophyticus was isolated in 9 of 12 patients during treatment with nalidixic acid. On the other hand, pivmecillinam therapy was clinically effective in 16 of 18 patients with UTI caused by S. saprophyticus, even though the MIC of mecillinam to these strains was considerably higher (8-64 micrograms/ml) than that vis-à-vis gram-negative rods. Thus the clinical effect of pivmecillinam was significantly better than that of nalidixic acid in cases of UTI caused by S. saprophyticus. The organism was not isolated from 14 patients receiving pivmecillinam therapy.

Adolescent↗
PubMed1987

Urinary tract infection in primary health care in northern Sweden. II. Clinical presentation.

In a multipractice prevalence study of uncomplicated urinary tract infection (UTI) in primary health care (PHC), with 355 episodes in 302 individuals during one month, 93% of the episodes occurred in females and Escherichia coli was the dominating causative organism (77%). Most episodes of UTI (84%) were acute and associated with lower (75%), upper (5%) or uncharacteristic symptoms (4%) whereas 16% represented bacteriuria discovered by posttreatment controls. Urgency (77%) and dysuria (70%) were the most common symptoms. Loin pain was highly associated with upper UTI (88%) but was reported also in 23% of episodes of lower UTI. Patient's delay differed between PHC centres and patient categories and was surprisingly long, four weeks in nine per cent and on average 8.4 days.

Adolescent↗
PubMed1992

Factors provoking lower urinary tract infection in women.

Our aim was to evaluate possible risk factors, other than sexual activity, for urinary tract infection (UTI) in women. A case-control study was designed. 50 cases and 50 controls were included. A larger fraction of cases than controls reported that episodes of the following preceded the UTI: voluntary deferred voiding (Odds ratio 5.0, 95% confidence interval 1.7; 20.1), cold hands (4.7, 1.3; 25.3), cold feet (5.8, 2.0; 22.8) and cold buttocks (5.5, 1.2; 51.0). Cold body parts should be further evaluated as a possible risk factor for UTI in UTI-prone women.

Acute Disease↗