About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
About
The Journal "Obstetrics and Gynecology"Journal HistoryAims and ScopePolicies on Conflict of Interest, Human and Animal Rights, and Informed ConsentEditorial ProcessData sharing statementAdvertising PolicyThe Process for Handling Cases Requiring Corrections, Retractions, and Editorial Expressions of ConcernEditorial BoardEditorial CounsilInformation for ProfessionalsNewsContacts
ArchiveEthical StandardsSubscription
For authors
InstructionsInformed consent policyContract offerEASE GuidelinesICJME CriteriaWAME Recommendations on ChatGPT and Chatbots in Relation to Scholarly Publications
Reviewing
Logout
Obstetrics and Gynegology2020№7
Recurrent urinary tract infections in...

Recurrent urinary tract infections in women

DOI
https://dx.doi.org/10.18565/aig.2020.7.151-158

Ermakova E.I.

Academician V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Department of Gynecological Endocrinology, Moscow, Russia
Recurrent urinary tract infections (RUTIs) occur in 10–15% of reproductive-aged women and in 20% of menopausal women. Patients with a confirmed diagnosis of RUTIs in the acute phase are recommended to use antibiotic therapy, the choice of which is based on the results of inoculations, by taking into account the susceptibility of an uropathogen and on those of other laboratory tests. However, the primary goal in the treatment of patients with RUTIs is to prevent relapses. To prevent RUTIs, low-dose antibacterial drugs are used daily or post-coitally for 6–12 months. Randomized clinical trials (RCTs) show that antibiotic prophylaxis is very effective, but has significant disadvantages that limit its widespread use: toxicity (hepatotoxicity, nephrotoxicity, etc.), the development of intestinal and vaginal dysbiosis, and the emergence of resistant strains of microorganisms. Vaccination, the purpose of which is to stimulate systemic and local immune responses against the most common uropathogens is now an important area in the treatment of patients with RUTIs. Numerous RCTs have demonstrated that E. coli-derived cell extract preparations significantly reduce the recurrence of cystitis and improve quality of life in women with RUTIs in different age groups.
Conclusion. Treatment of patients with RUTIs is not limited to the prescription of antibacterial agents in the acute period. The therapy should be performed for a long time and be aimed at preventing subsequent relapses.

Keywords

urethritis
cystitis
recurrent urinary tract infections
post-coital cystitis
urobiome
urovaginal atrophy
genitourinary syndrome of menopause
vaccination against recurrent cystitis
Full text (in Russian)

References

  1. Foxman B. The epidemiology of urinary tract infection. Nat. Rev. Urol. 2010; 7(12): 653-60. https://dx.doi.org/10.1038/nrurol.2010.190.
  2. Laupland K.B., Ross T., Pitout J.D., Church D.L., Gregson D.B. Community-onset urinary tract infections: a population-based assessment. Infection. 2007; 35(3): 150-3.
  3. Haylen B.T., de Ridder D., Freeman R.M., Swift S.E., Berghmans B., Lee J. et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic floor dysfunction. Neurourol. Urodyn. 2010; 29(1): 4-20. https://dx.doi.org/10.1002/nau.20798.
  4. Hooton T.M. Recurrent urinary tract infection in women. Int. J. Antimicrob. Agents. 2001; 17(4): 259-68. https://dx.doi.org/10.1016/s0924-8579(00)00350-2.
  5. Foxman B. Urinary tract infection syndromes: occurrence, recurrence, bacteriology, risk factors, and disease burden. Infect. Dis. Clin. North Am. 2014; 28(1): 1-13. https://dx.doi.org/10.1016/j.idc.2013.09.003.
  6. Mody L., Juthani-Mehta M. Urinary tract infections in older women. JAMA. 2014; 311(8): 844-54. https://dx.doi.org/10.1001/jama.2014.303.
  7. Юренева С.В., Ермакова Е.И., Глазунова А.В. Диагностика и терапия генитоуринарного менопаузального синдрома у пациенток в пери-и постменопаузе (краткие клинические рекомендации). Акушерство и гинекология. 2016; 5: 138-44. [Yureneva S.V., Ermakova E.I., Glazunova A.V. Diagnosis and therapy of genitourinary syndrome of menopause in peri- and postmenopausal patients (brief clinical recommendations) // Akusherstvo i Ginekologiya (Obstetrics and Gynecology). 2016; 5: 34-37. (in Russian)]. https://dx.doi.org/10.18565/aig.2016.5.138-144.
  8. Аляев Ю.Г., Григорян В.А., Гаджиева З.К. Расстройства мочеиспускания. М.: Литтерра; 2006: 130-78. [Alyaev Yu.G., Balan V.E., Grigoryan V.A., Gadzhieva Z.K., Urination disorders // Book: Experience of clinical practice. Moscow; 2006: 130-178. (in Russian)].
  9. Сardozo L., Lose., Vc Clish D., Versi E., de Koning Gans H. A systematic review of estrogens for recurrent urinary tract infections: third report of the hormones and urogenital therapy (HUT) committee. Int. Urogynecol. J. Pelvic Floor Dysfunct. 2001; 12(1): 15-20. https://dx.doi.org/10.1007/s001920170088.
  10. Turnbaugh P.J., Ley R.E., Hamady M., Fraser-Liggett C.M., Knight R., Gordon J.I. The human microbiome project. Nature. 2007; 449(7164): 804-10. https://dx.doi.org/10. 10.1038/nature06244.
  11. Peterson J., Garges S., Giovanni M., McInnes P., Wang L., Schloss J.A. et al. The NIH human microbiome project. Genome Res. 2009; 19(12): 2317-23. https://dx.doi.org/10.1101/gr.096651.109.
  12. Wolfe A.J., Brubaker L. “Sterile urine” and the presence of bacteria. Eur. Urol. 2015; 68(2): 173-4. https://dx.doi.org/10.1016/j.eururo.2015.02.041.
  13. Siddiqui H., Nederbragt A.J., Lagesen K., Jeansson S.L., Jakobsen K.S. Assessing diversity of the female urine microbiota by high throughput sequencing of 16S rDNA amplicons. BMC Microbiol. 2011; 11: 244. https://dx.doi.org/10.1186/1471-2180-1111-1244.
  14. Brubaker L., Wolfe A.J. The new world of the urinary microbiota in women. Am. J. Obstet. Gynecol. 2015; 213(5): 644-9. https://dx.doi.org/10.1016/j.ajog.2015.05.032.
  15. Hilt E.E., McKinley K., Pearce M.M., Rosenfeld A.B., Zilliox M.J., Mueller E.R. et al. Urine is not sterile: use of enhanced urine culture techniques to detect resident bacterial flora in the adult female bladder. J. Clin. Microbiol. 2014; 52(3): 871-6. https://dx.doi.org/10.1128/JCM.02876-13.
  16. Lewis D.A., Brown R., Williams J., White P., Jacobson S.K., Marchesi J.R., Drake M.J. The human urinary microbiome; bacterial DNA in voided urine of asymptomatic adults. Front. Cell. Infect. Microbiol. 2013; 3: 41. https://dx.doi.org/10.3389/fcimb.2013.00041.
  17. Pearce M.M., Hilt E.E., Rosenfeld A.B., Zilliox M.J., Thomas-White K., Fok C. et al. The female urinary microbiome: a comparison of women with and without urgency urinary incontinence. MBio. 2014; 5(4): e01283-14. https://dx.doi.org/10.1128/mBio.01283-14.
  18. Nienhouse V., Gao X., Dong Q., Nelson D.E., Toh E., McKinley K. et al. Interplay between bladder microbiota and urinary antimicrobial peptides: mechanisms for human urinary tract infection risk and symptom severity. PLoS One. 2014; 9: e114185.
  19. Whiteside S.A., Razvi H., Dave S., Reid G., Burton J.P. The microbiome of the urinary tract – a role beyond infection. Nat. Rev. Urol. 2015; 12: 81-90. https://dx.doi.org/10.1038/nrurol.2014.1361.
  20. Fouts D.E., Pieper R., Szpakowski S., Pohl H., Knoblach S., Suh M.J. et al. Integrated next-generation sequencing of 16S rDNA and metaproteomics differentiate the healthy urine microbiome from asymptomatic bacteriuria in neuropathic bladder associated with spinal cord injury. J. Transl. Med. 2012; 10: 174. https://dx.doi.org/10.1186/1479-5876-1110-1174.
  21. Nicolle L.E., Bradley S., Colgan R., Rice J.C., Schaeffer A., Hooton T.M. Infectious diseases society of America guidelines for the diagnosis and treatment of asymptomatic bacteriuria in adults. Clin. Infect. Dis. 2005; 40(5): 643-54. https://dx.doi.org/10.1086/427507.
  22. Najeeb S., Munir T., Rehman S., Hafiz A., Gilani M., Latif M. Comparison of urine dipstick test with conventional urine culture in diagnosis of urinary tract infection. J. Coll. Physicians Surg. Pak. 2015; 25(2): 108-10.
  23. Wu Y.R., Rego L.L., Christie A.L., Lavelle R.S., Alhalabi F., Zimmern P.E. Recurrent urinary tract infections due to bacterial persistence or reinfection in Women-Does This Factor Impact Upper Tract Imaging Findings? J. Urol. 2016; 196(2): 422-8. https://dx.doi.org/10.1016/j.juro.2016.01.111.
  24. Перепанова Т.С., Козлов Р.С., Руднов В.А., Синякова Л.А. Антимикробная терапия и профилактика инфекций почек, мочевыводящих путей и мужских половых органов. Федеральные клинические рекомендации. М.; 2017. [Perepanova T.S., Kozlov R.S., Rudnov V.A., Sinyakova L.A. Antimicrobial therapy and prevention of infections of the kidney, urinary tract and male genitals // Federal Clinical Practice Guidelines. Moscow; 2017. (in Russian)].
  25. Seaberg P., Jadoon-Khamash E., Vegunta S.J. Managing recurrent urinary tract infections in postmenopausal women. Womens Health (Larchmt). 2018; 27(7): 856-8. https://dx.doi.org/10.1089/jwh.2018.7105.
  26. Gupta K., Hooton T.M., Naber K.G., Wullt B., Colgan R., Miller L.G. et al. International clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women: a 2010 update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases. Clin. Infect. Dis. 2011; 52(5): e103-20. https://dx.doi.org/10.1093/cid/ciq257.
  27. Wolfe A.J., Toh E., Shibata N., Rong R., Kenton K., Fitzgerald M. et al. Evidence of uncultivated bacteria in the adult female bladder. J. Clin. Microbiol. 2012; 50(4): 1376-83. https://dx.doi.org/10.1128/JCM.05852-11.
  28. Fisher H., Oluboyede Y., Chadwick T. Continuous low-dose antibiotic prophylaxis for adults with repeated urinary tract infections (AnTIC): a randomised, open-label trial. Lancet Infect. Dis. 2018; 18(9): 957-68. https://dx.doi.org/10.1016/S1473-3099(18)30279-2.
  29. Egrot C., Dinh A., Amarenco G. Antibiotic prophylaxis in urodynamics: Clinical practice guidelines using a formal consensus method. Prog. Urol. 2018; 28(17): 943-52. https://dx.doi.org/10.1016/j.purol.2018.10.001.
  30. Kranz J., Schmidt S., Schneidewind L. Current evidence on nonantibiotic prevention of recurrent urinary tract infection. Eur. Urol. Focus. 2019; 5(1): 17-9. https://dx.doi.org/10.1016/j.euf.2018.09.006.
  31. Kranjčec B., Papeš D., Altarac S. D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial. World J. Urol. 2014. 32(1): 79-84. https://dx.doi.org/10.1007/s00345-013-1091-6.
  32. Fu Z., Liska D., Talan D., Chung M. Cranberry reduces the risk of urinary tract infection recurrence in otherwise healthy women: a systematic review and meta-analysis. J. Nutr. 2017; 147(12): 2282-8. https://dx.doi.org/10.3945/jn.117.254961.
  33. Schwenger E.M., Tejani A., Loewen P.S. Probiotics for preventing urinary tract infections in adults and children. Cochrane Database Syst. Rev. 2015 ; (12) : CD008772. https://dx.doi.org/10.1002/14651858.CD008772.pub2.
  34. Jung C., Brubaker L. The etiology and management of recurrent urinary tract infections in postmenopausal women. Climacteric. 2019; 22(3): 242-9. https://dx.doi.org/10.1080/13697137.2018.1551871.
  35. The NAMS 2017 Hormone Therapy Position Statement Advisory Panel. The 2017 hormone therapy position statement of The North American Menopause Society. Menopause. 2017; 24(7): 728-53. https://dx.doi.org/10.1097/GME.0000000000000921.
  36. Prattley S., Geraghty R., Moore M., Somani B.K. Role of vaccines for recurrent urinary tract infections: a systematic review. Eur. Urol. Focus. 2020; 6(3): 593-604. https://dx.doi.org/10.1016/j.euf.2019.11.002.
  37. Аполихина И.А., Тетерина Т.А. Иммунопрофилактика неосложненных инфекций мочевыводящих путей у женщин: возможности и перспективы. Справочник поликлинического врача. 2012; 4: 16-20. [Apolikhina I.A., Teterina T.A. Immunoprophylaxis of uncomplicated urinary tract infections in women: opportunities and prospects. Spravochnik Policlinicheskogo Vracha (The Polyclinic Physician’s Handbook). 2012; 4: 16-20. (in Russian)].
  38. Schneider H.J. New therapeutic approach for recurrent urinary tract infections. Marked reduction in recurrence rate in women with uncomplicated cystitis – few side effects, high compliance. Der Allgemeinarzt. 1990; 12: 626-33.
  39. Schulman C.C., Corbusier A., Michiels H., Taenzer H.J. Oral immunotherapy of recurrent urinary tract infections: a double-blind placebo-controlled multicenter study. J. Urol. 1993; 150(3): 917-21. https://dx.doi.org/10.1016/s0022-5347(17)35648-3.
  40. Popa G., Lauber K.D., Rothe H., Rugendorff E. Rezidivierende Harnwegsinfektionen in der Postmenopause. Wirksamkeit einer oralen Immuntherapie mit E.-Coli-fraktionen. Münch. Med. Wschr. 1996; 138: 713-6.
  41. Kim K.S., Kim J.Y., Jeong I.G., Paick J.S., Son H., Lim D.J. et al. A prospective multi-center trial of Escherichia coli extract for the prophylactic treatment of patients with chronically recurrent cystitis. J. Korean Med. Sci. 2010; 25(3): 435-9. https://dx.doi.org/10.3346/jkms.2010.25.3.435.
  42. Кульчавеня Е.В., Бреусов А.А. Эффективность Уро-Ваксома при рецидивирующих инфекционно-воспалительных заболеваниях мочеполовой системы. Урология. 2011; 4: 7-11. [Kulchavenya E.V., Breusov A.A. Efficacy of uro-vaxom in recurrent infectious and inflammatory diseases of the urogenital system // Urologiya (Urology). 2011, 7-11. (in Russian)] .
  43. Aziminia N., Hadjipavlou M., Philippou Y., Pandian S.S., Malde S., Hammadeh M.Y. Vaccines for the prevention of recurrent urinary tract infections: a systematic review. BJU Int. 2019; 123(5): 753-68. https://dx.doi.org/10.1111/bju.14606.

Received 11.06.2020

Accepted 17.06.2020

About the Authors

Elena I. Ermakova, PhD, Senior research staff of National Medical Research Center for Obstetrics, Gynecology and Perinatology named after Academician V.I. Kulakov, Member of Russian Menopause Society. Tel.: +7(916)848-37-46. E-mail: ermakova.health@mail.ru.
4, Oparina str., Moscow, 117997, Russian Federation.

For reference: Ermakova E.I. Recurrent urinary tract infections in women.
Akusherstvo i Ginekologiya/ Obstetrics and Gynecology. 2020; 7: 151-158 (in Russian).
https://dx.doi.org/10.18565/aig.2020.7.151-158

Similar Articles

№12 / 2022
Dikke G.B., Gurskaya T.Yu., Prokofievа S.V., Stolnikova I.I., Andreeva A.S., Repina N.B., Yagovkina N.V., Teplykh S.V., Fedorova E.P.
Efficacy and safety of ultra-low dose vaginal estriol in the therapy of genitourinary syndrome of menopause: a phase III multicenter randomized controlled trial
№8 / 2022
Tyutyunnik V.L., Mikhailova O.I., Kan N.E., Mirzabekova D.D.
A comprehensive approach to treating chronic recurrent uncomplicated cystitis during pregnancy
№10 / 2023
Apolikhina I.A., Kazakova S.N., Yarotskaya E.L., Gorbunova E.A., Bychkova A.E.
Linguistic and cultural adaptation and validation of the questionnaire on vulvovaginal symptoms among the patients with vulvovaginal atrophy
№5 / 2024
Ramazanova М.О., Apolikhina I.A., Shershakova E.I.
Modern problems and opportunities in the treatment of genitourinary syndrome of menopause in the context of medical science and technology development
№6 / 2021
Kasyan V.N., Zaitsev A.V., Perepanova T.S., Pivazyan L.G., Grigoryan B.L., Kupriyanov Yu.A. Kasyan G.R., Pushkar D.Yu.
Systematic review of the efficacy and safety of nifuratel for patients with lower urinary tract infection
By continuing to use our site, you consent to the processing of cookies that ensure the proper functioning of the site.