Topic: Urinary Tract Infection

Recurrent UTIs in Women: Ask the Guideline

Recurrent UTIs in Women: Ask the Guideline

by | Jun 2023

Jennifer Anger, MD, MPH, discusses American Urological Association (AUA) guidelines regarding recurrent urinary tract infections (rUTIS) in women. She begins by discussing antimicrobial stewardship and the consideration of collateral damage, explaining antimicrobial resistance among uropathogens has increased dramatically in the past 20 years.

Dr. Anger characterizes the index patient for the 2019 rUTI guideline as an otherwise healthy adult female with an uncomplicated, culture-proven rUTI associated with acute-onset symptoms. She summarizes guideline highlights, including the recommendation that clinicians obtain a complete patient history and perform a pelvic examination in women presenting with rUTIs. Additionally, clinicians should obtain urinalysis, urine culture, and sensitivity with each symptomatic acute cystitis episode prior to initiating treatment for rUTIs.

Dr. Anger outlines first-line therapy (nitrofurantoin, TMP-SMX, and fosfomycin) and explains clinicians should use as short a duration of antibiotics as reasonable for rUTI patients with an acute cystitis episode. For patients with urine cultures resistant to oral antibiotics, clinicians may treat with culture-directed parenteral antibiotics for as short a course as reasonable.

Dr. Anger discusses use, dosing, and duration of prophylactic antibiotics and points out that clinicians may offer cranberry prophylaxis for rUTIs, but explains that studies are lacking in this area. Clinicians should repeat urine culture to guide further management when UTI symptoms persist following antimicrobial therapy.

In peri- and post-menopausal women with rUTIs, clinicians should consider vaginal estrogen therapy to reduce the risk of recurrence. Dr. Anger then highlights the 2022 UTI Guideline Update and explains randomized, controlled trials that contributed evidence to this amendment report.

Read More

Fear and Frustration Among Women with Recurrent UTIs

by | Jan 2022

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

Read More

Fear and Frustration Among Women with Recurrent UTIs

by | Dec 2021

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

Read More

Fear and Frustration Among Women with Recurrent UTIs

by | Nov 2021

In conversation with A. Lenore Ackerman, MD, PhD, Assistant Professor of Urology and Director of Research in the Division of Female Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, Ja-Hong H. Kim, MD, Associate Professor in the Division of Pelvic Medicine and Reconstructive Surgery at the University of California, Los Angeles, and Victoria C. Scott, MD, Associate Program Director of the FPMRS Fellowship at Cedars-Sinai Medical Center, discuss a recent study of the experience of women with recurrent urinary tract infections (rUTIs). Dr. Scott explains that 29 women were recruited to participate in 1 of 6 focus group discussions to investigate the perspective of women suffering from rUTIs. She then lists some preliminary themes from the discussions with the women, including fear of development of antibiotic resistance, widespread knowledge of the collateral damage from antibiotics, concern about taking unnecessary antibiotics, anger at physicians for “throwing” antibiotics at them, a feeling that the medical profession underestimates the impact of rUTIs, a need for research on nonantibiotic options for prevention and treatment, and resentment towards the medical system for not dedicating more research efforts to providing more timely diagnosis. Dr. Scott synthesizes these themes into two emergent concepts: fear about the overuse of antibiotics and frustration at the medical system for not providing alternative treatments or taking rUTI symptoms seriously. Dr. Kim then notes that this initial study has produced two additional studies on the current management of rUTIs that take expert and personal care provider experiences into account. Dr. Ackerman highlights the importance of data capturing that patients are not seeking antibiotics necessarily in the way doctors assume they are, though Dr. Kim does add the caveat that the women in the study were a relatively homogeneous group of college-educated white women. Dr. Ackerman also muses that the attitudes expressed in this study suggest that this population may be interested in a vaccine for rUTIs. Drs. Ackerman, Scott, and Kim conclude by noting that the study made evident the importance to patients with rUTIs of focusing on their experience rather than merely the clearance of bacteria.

Read More
Recurrent UTI in Women: AUA/SUFU Guidelines

Recurrent UTI in Women: AUA/SUFU Guidelines

by | Oct 2020

Una Lee, MD, FPMRS, urologist and researcher at Virginia Mason Medical Center, reviews the 2019 AUA/SUFU guidelines on uncomplicated recurrent urinary tract infection (rUTI) in women, summarizes the evidence underlying these guidelines, and discusses their relevance to clinical scenarios. She first details complications clinicians may experience, such as antibiotic resistant infections and stressed patients. Dr. Lee then discusses the guideline recommendations: clinicians should use first-line therapy; should obtain urinalysis, urine culture, and sensitivity; may offer patient-initiated treatment; should use as short a duration of antibiotics as possible; may offer cranberry prophylaxis for women with rUTIs; should obtain a full patient history; and should not treat asymptomatic bacteriuria. She then argues that although molecular diagnostics are available, the sensitive microorganism detection they provide is associated with overtreatment, overdiagnosis, and confusion due to our current lack of data on which microorganisms are necessary or harmful for a healthy urinary microbiome. Dr. Lee concludes by discussing cranberries and the treatment capabilities of the proanthocyanidins (PACs) they contain, noting that antibiotics are still considered to be more effective, however.

Read More
Covert Pathogenesis in the Urinary Tract

Covert Pathogenesis in the Urinary Tract

by | Jun 2020

In a conversation with A. Lenore Ackerman, MD, PhD, Section Editor of the Next Generation Microbiome and Urologic Infection Learning Center on Grand Rounds in Urology, Nicole M. Gilbert, PhD, an instructor in the Department of Pediatrics at Washington University School of Medicine, discusses her research linking urogenital microbes to recurrent urinary tract infection (rUTI). Although the bladder was long regarded as sterile in the absence of overt infection, recent research suggests that there is a urinary microbiome and that two commonly found bacteria in the bladder are Gardnerella and Lactobacillus, both of which are also common in the vagina. Dr. Gilbert and her colleagues wanted to investigate how those urogenital microbes affect the bladder, and determined that Gardnerella vaginalis causes urothelial exfoliation, a condition that has been associated with rUTI. Because Gardnerella vaginalis appears able to trigger rUTI even when it is cleared out of the bladder within 12 hours, Dr. Gilbert calls it a covert pathogen, and suggests that further research is needed to find stable indicators of repeat exposure to Gardnerella.

Read More
Practical Considerations for the Use of Molecular Diagnostics for Diagnosis and Management of Recurrent UTI

Practical Considerations for the Use of Molecular Diagnostics for Diagnosis and Management of Recurrent UTI

by | Jun 2020

Ngoc-Bich “Nikki” Phan Le, MD, a urologist specializing in female pelvic medicine and reconstructive surgery at the Austin Diagnostic Clinic, and A. Lenore Ackerman, MD, PhD, Assistant Professor of Surgery, Urology, and Pelvic Medicine and Reconstructive Surgery at Cedars-Sinai Medical Center and Section Editor of the Next Generation Microbiome and Urologic Infection Learning Center on Grand Rounds in Urology, discuss how to effectively use molecular diagnostics to help in the process of diagnosing and managing recurrent UTIs. They outline the differences between patients with multiple types of infections over time and those with truly recurrent infections by the same bacterium, and how this difference creates the need for alternatives in initial evaluation. They also specifically detail how the strength of molecular diagnostics is in their ability to detect bacteria missed in cultures, which can help prescribers make better decisions when choosing antibiotics for treatment. Drs. Le and Ackerman conclude by discussing how to proceed with treatment, and how the data presented by molecular diagnostics allow for more precise treatment methods.

Read More
Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline 2019

Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline 2019

by | May 2020

Jennifer T. Anger, MD, MPH, Associate Professor of Urology at Cedars-Sinai Medical Center, discusses recurrent uncomplicated urinary tract infections (UTIs) in women. Dr. Anger chairs the AUA committee on guidelines for infections, and she discusses the rationale behind recent changes to recommendations. She outlines how the thinking about recurrent infections has changed over time, and highlights the collateral damage that a one-size-fits-all antibiotic treatment can cause, noting that the new guidelines emphasize treating individual urinary cultures. She goes on to discuss patient profiles, common symptoms, and what the guidelines recommend for initial work-ups as well as treatments. Dr. Anger further delves into ways to prevent or decrease the risk of UTIs with antibiotic prophylaxis, along with the possible risks of doing so.

Read More
Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline 2019

Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline 2019

by | Apr 2020

Jennifer T. Anger, MD, MPH, Associate Professor of Urology at Cedars-Sinai Medical Center, discusses recurrent uncomplicated urinary tract infections (UTIs) in women. Dr. Anger chairs the AUA committee on guidelines for infections, and she discusses the rationale behind recent changes to recommendations. She outlines how the thinking about recurrent infections has changed over time, and highlights the collateral damage that a one-size-fits-all antibiotic treatment can cause, noting that the new guidelines emphasize treating individual urinary cultures. She goes on to discuss patient profiles, common symptoms, and what the guidelines recommend for initial work-ups as well as treatments. Dr. Anger further delves into ways to prevent or decrease the risk of UTIs with antibiotic prophylaxis, along with the possible risks of doing so.

Read More
Loading

Join the GRU Community

- Why Join? -