Recurrent UTI: Critical review TOG 2019 Flashcards
What is the most common infection in women worldwide?
UTI
1-3% UK GP consultations
Diagnosis UTI
presence of clinical symptoms (dysuria, suprapubic tenderness, urinary urgency and frequency) and the presence of bacteria in urine culture (>105 cfu/ml)
Most common bacteria causing UTI?
E Coli
NNT antibiotic to reduce microbiological recurrence in rUTI?
1.85
Rate of drugs resistant community acquired UTI in children?
43%
How does methenamine work?
Inactive weak base that slowly hydrolyses in urine to form ammonia and formaldehyde.
Formaldehyde as antimicrobial properties.
1 study - 76% less likely to have UTI (poor quality)
Cranberries and D-mannose
Cranberry juice - 2021 Cochrane 2012 - no benefit for rUTI
D-mannose (sugar derived from cranberry juice), NICE non pregnant woman may wish to try D-mannose
Lactobacilli vs Abx in management
Abx had fewer UTI and shorter time to 1st recurrence. But increased rate Abx resistance
Use of estrogen’s in management of UTI
Fall in estrogen causesing pH to rise (alkaline) detrimental to lactobacilli. Better for gram -ve
NICE suggest vaginal estogens can be used in preventing rUTI but systemic oestrogen’s are not.
Use of glycosaminoglycans in treatment rUTI
Supplements to GAG, reduces neutrophil transmigration and inflammation process.
Can replace with synthetic hyaluronic acid (HA) or chondroitin sulphate.
When should rUTI be referred to 2ndary care?
If > 3 UTI in 1 year
What baseline studies should be performed in 2ndary care
Cystoscopy
Renal USS
Voiding studies
If normal studies and post-menopausal
Offer low dose estrogen & FU in 12 months
If further actor UTI cont oestrogen and offer GAG
If normal studies and pre-menopausal
Offer GAG replacemt
4 x weekly installations or 2 x monthly
FU in 12 months
Draw flow diagram
