Via practica 5/2017

Recurrent urinary tract infection, treatment options and prophylaxis

Urinary tract infection (UTI) is defined as inflammatory response of the urothelium to microorganism (usually bacteria) invasion and is the result of interaction between the uropathogen and the host. Recurrent UTIs (rUTIs) are recurrences of uncomplicated and/or complicated UTIs, with a frequency of at least three UTIs/year or two UTIs in the last six months. Although rUTIs include both lower tract infection (cystitis) and upper tract infection (pyelonephritis), repeated pyelonephritis should be considered and diagnosed as a possible complicated etiology. Recurrent UTIs are common. Risk factors (age, personal and family history of UTI, atrophic vaginitis due to oestrogen deficiency, cystocoele, etc.) rUTI are known mainly in women. Diagnosis of rUTI should be confirmed by urine culture. An extensive routine workup including cystoscopy, imaging, etc. is not routinely recommended as the diagnostic yield is low. However, it should be performed without delay in atypical cases, for example, if urolithiasis or urinary tract obstruction is suspected. Prevention of rUTIs includes counselling regarding avoidance of risk factors, non-antimicrobial measures and antimicrobial prophylaxis. These interventions should be attempted in this order. There are many non-antimicrobial measures recommended for rUTIs but only a few are supported by well-designed studies. Antimicrobials may be given as continuous low-dose prophylaxis for longer periods, or as post-coital prophylaxis, as both regimens reduce the rate of rUTI. In patients with good compliance, self-diagnosis and self-treatment with a short course regimen of an antimicrobial agent should be considered. Any urological risk factors must be identified and treated. Significant residual urine should be treated optimally, including by clean intermittent catheterization when judged to be appropriate.

Keywords: recurrent UTI, definition, diagnosis, therapy, prevention