Topic: Urinary Tract Infection

Recurrent UTI in Women: AUA/SUFU Guidelines

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.

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Covert Pathogenesis in the Urinary Tract

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.

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

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.

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

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.

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

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.

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Stressing About the Bladder: Neurovisceral Interactions in Persistent Pelvic Pain Syndromes

Larissa V. Rodriguez, MD, discusses the role of environmental stress in lower urinary tract symptoms (LUTS) and interstitial cystitis (IC) and the development of the Multidisciplinary Approach to the Study of Chronic Pelvic Pain (MAPP) Research Network. She explains how the neurovisceral interactions involved in processing, emotion, and attention affect bladder function, and how studying this link help develop future treatment options.

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