Recurrent Urinary Tract Infection in the Gynecologic Practice: Time for Reviewing Concepts and Management

An independent panel of physicians with expert interest in urinary tract infection (UTI), including gynecologists, urologists, molecular biologists, infectologists, immunologists and epidemiologists met in a forum in Panama (Foro en Infeccciones Urinarias Recurrentes - FIUR) to review diagnosis and treatment recommendations for the empiric therapy of uncomplicated UTIs taking into account antibiotic resistance and considering the use of guidelines to promote an optimal practice for recurrent urinary tract infections (RUTIs).

Urinary tract infections are among the most common bacterial infections, and are a frequent complaint of women visiting their gynecologists. The accurate diagnosis and treatment of UTIs play an important role in cost-effective medical care and appropriate antimicrobial utilization.[1] Antimicrobial resistance is a global issue, and concerns have been raised that some infections for which therapy is now available might become untreatable.[2] The widespread empiric use of antibiotics, while convenient, potentially contributes to the development of antimicrobial resistance.[2]

The evolution of antimicrobial resistance in community-acquired Escherichia coli, however, requires a constant reevaluation of the empiric antimicrobial therapy.[2] The variables to be considered in selecting an antimicrobial drug include efficacy, adverse effects, cost, and potential for future resistance.[2] Practitioners always need to balance the antimicrobial selection for an optimal patient outcome with the potential for contributing to further antimicrobial resistance through widespread empiric use. Overly long or improper treatment regimens may also lead to drug resistance.

• References

• 1 Schulz L, Hoffman RJ, Pothof J, Fox B. Top ten myths regarding the diagnosis and treatment of urinary tract infections. J Emerg Med 2016; 51 (01) 25-30
• 2 Nicolle L, Anderson PA, Conly J. , et al. Uncomplicated urinary tract infection in women. Current practice and the effect of antibiotic resistance on empiric treatment. Can Fam Physician 2006; 52: 612-618
• 3 Widmer M, Lopez I, Gülmezoglu AM, Mignini L, Roganti A. Duration of treatment for asymptomatic bacteriuria during pregnancy. Cochrane Database Syst Rev 2015; (11) CD000491
• 4 Milo G, Katchman EA, Paul M, Christiaens T, Baerheim A, Leibovici L. Duration of antibacterial treatment for uncomplicated urinary tract infection in women. Cochrane Database Syst Rev 2005; (02) CD004682
• 5 Vahlensieck W, Perepanova T, Johansen TEB, Tenke P, Naber KG, Wagenlehner FME. Management of uncomplicated recurrent urinary tract infections. Eur Urol Suppl 2016; 15 (04) 95-101
• 6 Haddad JM. , Ed. Manual de uroginecologia e cirurgia vaginal. São Paulo: Federação Brasileira das Associações de Ginecologia e Obstetrícia (FEBRASGO); 2015
• 7 Grabe M, Bjerklund-Johansen TE, Bartoletti R. , et al. Guidelines on urological infections. Arnhem: European Association of Urology; 2015
• 8 Geerlings SE, Beerepoot MA, Prins JM. Prevention of recurrent urinary tract infections in women: antimicrobial and nonantimicrobial strategies. Infect Dis Clin North Am 2014; 28 (01) 135-147
• 9 American College of Obstetricians and Gynecologists. ACOG Practice Bulletin No. 91: Treatment of urinary tract infections in nonpregnant women Obstet Gynecol 2008; 111 (03) 785-794
• 10 Jepson RG, Williams G, Craig JC. Cranberries for preventing urinary tract infections. Cochrane Database Syst Rev 2012; 10: CD001321
• 11 Naber KG, Cho YH, Matsumoto T, Schaeffer AJ. Immunoactive prophylaxis of recurrent urinary tract infections: a meta-analysis. Int J Antimicrob Agents 2009; 33 (02) 111-119
• 12 Beerepoot MA, Geerlings SE, van Haarst EP, van Charante NM, ter Riet G. Nonantibiotic prophylaxis for recurrent urinary tract infections: a systematic review and meta-analysis of randomized controlled trials. J Urol 2013; 190 (06) 1981-1989