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Dtsch Med Wochenschr 2022; 147(17): 1140-1145
DOI: 10.1055/a-1866-9470
Klinischer Fortschritt
Urologie

Rezidivierende Harnwegsinfektionen – was tun?

What to do about recurrent urinary tract infections
Daniel Klußmann
  Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
,
Florian Wagenlehner
  Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
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Was ist neu?

Nicht antibiotische Therapieregime Neben allgemeiner Aufklärung und Beratung über Risikofaktoren von Harnwegsinfektionen sind vor allem die nichtantibiotischen Therapie-Optionen zur Rezidivreduktion wichtig. Das Ziel hierbei ist es, Resistenzentwicklungen und den entsprechenden unerwünschten Nebenwirkungen von Antibiotika vorzubeugen. Zu den nicht antibiotischen Strategien zählen allen voran eine persönliche Beratung mit Vermittlung von Verhaltensempfehlungen, die Immunoprophylaxe, Phytotherapeutika, sowie eine lokale Östrogensubstitution

Antibiotische Prävention Bei hohem Leidensdruck der Patientinnen ist jedoch nach entsprechender Abwägung auch eine antibiotische Prophylaxe in Betracht zu ziehen. Zusammenfassend sollte eine individuelle Beratung erfolgen und es sollte mit einem multimodalen Therapieansatz behandelt werden.

Abstract

Urinary tract infections are among the most common bacterial infections. A significant proportion of urinary tract infections recur, which leads to impairments in patientsʼ physical intimacy, social contacts and ability to work. The standardised ACSS questionnaire can provide help in establishing a diagnosis and assessing the course of the disease. In addition to general education and counselling on risk factors for urinary tract infections, non-antibiotic treatment options are particularly important for reducing recurrence. This aims to prevent the development of resistance to antibiotics and their undesirable side-effects. Non-antibiotic strategies most notably include personal counselling with communication of behavioural recommendations, immunoprophylaxis, phytotherapeutics and local oestrogen substitution. However, in cases of high patient suffering, antibiotic prophylaxis should also be considered after due deliberation. In summary, individual counselling should take place and treatment should be given in a multimodal therapeutic approach.

Schlüsselwörter

Harnwegsinfektion - Prävention - rHWI - nichtantibiotische Therapieoptionen - Zystitis

Key words

rUTI - urinary tract infection - cystitis - prevention - non-antibiotic treatment options


Publikationsverlauf

Artikel online veröffentlicht:
28. August 2022

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  • Literatur

  • 1 Wagenlehner F, Schmiemann G. Leitlinienprogramm DGU: Interdisziplinäre S3 Leitlinie: Epidemiologie, Diagnostik, Therapie, Prävention und Management unkomplizierter, bakterieller, ambulant erworbener Harnwegsinfektionen bei erwachsenen Patienten. Langversion 1.1-2, 2017 AWMF Registernummer: 043/044. (Zugriff am: 18.12.20). http://www.awmf.org
    PubMed
  • 2 Fihn SD. Clinical practice. Acute uncomplicated urinary tract infection in women. N Engl J Med 2003; 349: 259-266
    CrossrefPubMedSuche in Google Scholar
  • 3 McLaughlin SP, Carson CC. Urinary tract infections in women. Med Clin North Am 2004; 88: 417-429
    CrossrefPubMedSuche in Google Scholar
  • 4 Giesen LG, Cousins G, Dimitrov BD. et al. Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs. BMC Fam Pract 2010; 11: 78
    CrossrefPubMedSuche in Google Scholar
  • 5 Alidjanov JF, Abdufattaev UA, Makhsudov SA. et al. New self-reporting questionnaire to assess urinary tract infections and differential diagnosis: acute cystitis symptom score. Urol Int 2014; 92: 230-236
    CrossrefPubMedSuche in Google Scholar
  • 6 Alidjanov JF, Pilatz A, Abdufattaev UA. et al. German validation of the Acute Cystitis Symptom Score. Urologe A 2015; 54: 1269-1276
    CrossrefPubMedSuche in Google Scholar
  • 7 Funfstuck R, Stein G, Naber KG. et al. Nephrology-part 3: Urinary tract infections. Med Klin (Munich) 2003; 98: 377-387
    CrossrefPubMedSuche in Google Scholar
  • 8 Graham JC, Galloway A. ACP Best Practice No 167: the laboratory diagnosis of urinary tract infection. J Clin Pathol 2001; 54: 911-919
    CrossrefPubMedSuche in Google Scholar
  • 9 Bonkat G, Bartoletti RR, Bruyère F. et al. EAU Guidelines on Urological Infections. presented at the EAU Annual Congress. Amsterdam the Netherlands: EAU Annual Congress; 2020. ISBN: 978-94-92671-07-3
    Suche in Google Scholar
  • 10 Foxman B, Frerichs RR. Epidemiology of urinary tract infection: I. Diaphragm use and sexual intercourse. Am J Public Health 1985; 75: 1308-1313
    CrossrefPubMedSuche in Google Scholar
  • 11 Hooton TM, Scholes D, Hughes JP. et al. A prospective study of risk factors for symptomatic urinary tract infection in young women. N Engl J Med 1996; 335: 468-474
    CrossrefPubMedSuche in Google Scholar
  • 12 Hooton TM, Scholes D, Stapleton AE. et al. A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med 2000; 343: 992-997
    CrossrefPubMedSuche in Google Scholar
  • 13 Scholes D, Hooton TM, Roberts PL. et al. Risk factors for recurrent urinary tract infection in young women. J Infect Dis 2000; 182: 1177-1182
    CrossrefPubMedSuche in Google Scholar
  • 14 Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med 1993; 329: 753-756
    CrossrefPubMedSuche in Google Scholar
  • 15 de With K, Kern W. Leitlinienprogramm DGI: Interdisziplinäre S3 Leitlinie: Strategien zur Sicherung rationaler Antibiotika-Anwendung im Krankenhaus. Langversion, AWMF Registernummer 092/001 – update 2018. (Zugriff am 21.12.20). https://www.awmf.org
    PubMed
  • 16 Lumsden L, Hyner GC. Effects of an educational intervention on the rate of recurrent urinary tract infections in selected female outpatients. Women Health 1985; 10: 79-86
    CrossrefPubMedSuche in Google Scholar
  • 17 Vahlensieck W, Bauer HW, Piechota HJ. et al. Prophylaxis of recurrent urinary tract infections. Urologe A 2014; 53: 1468-1475
    CrossrefPubMedSuche in Google Scholar
  • 18 Hooton TM, Vecchio M, Iroz A. et al. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. JAMA Intern Med 2018; 178: 1509-1515
    CrossrefPubMedSuche in Google Scholar
  • 19 Kontiokari T, Laitinen J, Jarvi L. et al. Dietary factors protecting women from urinary tract infection. Am J Clin Nutr 2003; 77: 600-604
    CrossrefPubMedSuche in Google Scholar
  • 20 Semins MJ, Shore AD, Makary MA. et al. The impact of obesity on urinary tract infection risk. Urology 2012; 79: 266-269
    CrossrefPubMedSuche in Google Scholar
  • 21 Wagenlehner FM, Vahlensieck W, Bauer HW. et al Primary and secondary prevention of urinary tract infections. Urologe A 2011; 50 : 1248–1250-1242, 1254-1246.
    CrossrefPubMedSuche in Google Scholar
  • 22 Vahlensieck W, Bauer H-W. Vorbeugende Therapie chronisch rezidivierender Harnwegsinfektionen (rHWI). Med Welt 2012; 63: 185-190
    PubMedSuche in Google Scholar
  • 23 Vahlensieck W, Bauer H-W, Hoyme UB. et al. Prophylaxe rezidivierender Harnwegsinfektionen (rHWI). Nieren- und Hochdruckkrankheiten 2007; 36: 501-513
    CrossrefPubMedSuche in Google Scholar
  • 24 Amiri FN, Rooshan MH, Ahmady MH. et al. Hygiene practices and sexual activity associated with urinary tract infection in pregnant women. East Mediterr Health J 2009; 15: 104-110
    CrossrefPubMedSuche in Google Scholar
  • 25 Baerheim A, Laerum E. Symptomatic lower urinary tract infection induced by cooling of the feet. A controlled experimental trial. Scand J Prim Health Care 1992; 10: 157-160
    CrossrefPubMedSuche in Google Scholar
  • 26 Minardi D, dʼAnzeo G, Cantoro D. et al. Urinary tract infections in women: etiology and treatment options. Int J Gen Med 2011; 4: 333-343
    CrossrefPubMedSuche in Google Scholar
  • 27 De Paepe H, Hoebeke P, Renson C. et al. Pelvic-floor therapy in girls with recurrent urinary tract infections and dysfunctional voiding. Br J Urol 1998; 81 (Suppl. 03) 109-113
    CrossrefPubMedSuche in Google Scholar
  • 28 Bauer HW, Rahlfs VW, Lauener PA. et al. Prevention of recurrent urinary tract infections with immuno-active E.coli fractions: a metaanalysis of five placebo-controlled double-blind studies. Int J Antimicrob Agents 2002; 19: 451-456
    CrossrefPubMedSuche in Google Scholar
  • 29 Naber KG, Cho YH, Matsumoto T. et al. Immunoactive prophylaxis of recurrent urinary tract infections: a meta-analysis. Int J Antimicrob Agents 2009; 33: 111-119
    CrossrefPubMedSuche in Google Scholar
  • 30 Beerepoot MA, Geerlings SE, van Haarst EP. et al. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol 2013; 190: 1981-1989
    CrossrefPubMedSuche in Google Scholar
  • 31 Vahlensieck W. Prophylaxemaßnahmen bei rezidivierenden Harnwegsinfektionen. In: Hofstetter A. Urogenitale Infektionen. Berlin, Heidelberg: Springer; 1999: 215-239
    Suche in Google Scholar
  • 32 Aune A, Alraek T, LiHua H. et al. Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult women. Scand J Prim Health Care 1998; 16: 37-39
    CrossrefPubMedSuche in Google Scholar
  • 33 Alraek T, Soedal LI, Fagerheim SU. et al. Acupuncture treatment in the prevention of uncomplicated recurrent lower urinary tract infections in adult women. Am J Public Health 2002; 92: 1609-1611
    CrossrefPubMedSuche in Google Scholar
  • 34 Kranjcec B, Papes D, Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J Urol 2014; 32: 79-84
    CrossrefPubMedSuche in Google Scholar
  • 35 Notelovitz M. Estrogen therapy in the management of problems associated with urogenital ageing: a simple diagnostic test and the effect of the route of hormone administration. Maturitas 1995; 22: S31-S33
    CrossrefPubMedSuche in Google Scholar
  • 36 Fournier A, Berrino F, Clavel-Chapelon F. Unequal risks for breast cancer associated with different hormone replacement therapies: results from the E3N cohort study. Breast Cancer Res Treat 2008; 107: 103-111
    CrossrefPubMedSuche in Google Scholar
  • 37 Lyytinen H, Pukkala E, Ylikorkala O. Breast cancer risk in postmenopausal women using estrogen-only therapy. Obstet Gynecol 2006; 108: 1354-1360
    CrossrefPubMedSuche in Google Scholar
  • 38 Nicolle LE. Prophylaxis: recurrent urinary tract infection in women. Infection 1992; 20 (Suppl. 03) S203-S205 discussion S206-S210
    CrossrefPubMedSuche in Google Scholar
  • 39 Flower A, Bishop FL, Lewith G. How women manage recurrent urinary tract infections: an analysis of postings on a popular web forum. BMC Fam Pract 2014; 15: 162
    CrossrefPubMedSuche in Google Scholar