ХРОНИЧЕСКИЙ РЕЦИДИВИРУЮЩИЙ ПОСТКОИТАЛЬНЫЙ ЦИСТИТ: СОВРЕМЕННЫЙ ВЗГЛЯД НА ПРОБЛЕМУ

Background: Urinary tract infection (UTI) is one of the most common bacterial diseases in children. This infection can lead to serious complications, such as chronic kidney injury, chronic renal failure, and even hypertension. The aim of this study was to investigate changes in serum levels of interleukin-8 in upper and lower urinary tract infections, and to investigate its association with the type of urinary tract involvement. Methods: This was a cross-sectional and prospective study. The study population consisted of all children aged 3 months to 12 years' old who referred to Amiralmomenin Hospital in Semnan city. By convenience sampling, 57 children were enrolled and received either oral or injectable treatment. Interleukin-8 serum levels were measured before and 3 days after treatment, by ELISA method and using available kits. DMSA scan was performed one week after admission to assess the severity of kidney parenchymal involvement in order to determine and distinguish between lower and upper urinary tract infections. Results: Totally 57 subjects with mean age 21.2 ± 20.76 months were enrolled. Children aged more than 20 months were more likely to have upper urinary tract infection than the other group (P=0.005). In males, the prevalence of upper urinary tract infection was significantly lower (P = 0.049). Children with upper urinary tract infection had a higher interleukin-8 concentration (P=0.001) than the lower urinary tract infection. Conclusion: IL-8 had higher serum concentrations in upper urinary tract infections compared to lower urinary tract infections. As a result, this test can be used as a suitable substitute for DMSA scan, to predict the type of urinary tract infection.

BACKGROUND: Chronic somatic diseases can affect a person’s psychoemotional state. Few publications are dedicated to assessing the quality of life of patients with recurrent lower urinary tract infections (UTIs). Postcoital cystitis is a distinct form of recurrent lower UTI. Since postcoital cystitis is not considered a life-threatening condition, healthcare providers often fail to give it proper attention, which worsens the psychological state of patients suffering from this condition. AIM: To analyze the psychoemotional state of patients with postcoital cystitis, as well as their perception of this condition. To evaluate the effectiveness of postcoital antibiotic prophylaxis and women’s satisfaction with this method. MATERIALS AND METHODS: A retrospective analysis was conducted involving 86 female patients who underwent treatment at City Multidisciplinary Hospital No. 2 from 2018 to 2023. The median age was 30 [25–35] years. The psychoemotional status of the patients was assessed using a survey. Methods of prevention and treatment of postcoital cystitis previously used by the patients were analyzed. Parameters were compared between two groups of patients, depending on the duration of antibiotic use after sexual intercourse. Additionally, the patients were invited to answer questions related to this condition in their own words. RESULTS: Many patients described their experiences in emotionally charged terms. Symptoms of depression or anxiety disorder were reported by 82.6% of the patients. The duration of the condition among the analyzed patients was 6.5 [4–11.25] years. The number of physicians consulted by the patients for postcoital cystitis was 6 [5–10]. Sixty out of 86 women (69.8%) used antibiotic prophylaxis after sexual intercourse. Initially, primary antibiotic prophylaxis was effective in 86.7% of the patients. Among women who used antibiotic prophylaxis for 6 months or longer, the positive effect persisted in 57.6% of cases (р 0.001). CONCLUSIONS: Postcoital cystitis has a multifactorial negative impact on women’s lives, affecting their physical, psychoemotional, and social well-being, and it may also have a negative effect on their sexual partner. The effectiveness of antibiotic prophylaxis decreases over time, and the patients are not willing to use this method for an extended period.

Assessment of antibiotic prescription in acute urinary tract infections in adults

BackgroundAntibiotic resistance threatens public health worldwide, and inappropriate use of antibiotics is one of the main causes. Antibiotic use for asymptomatic bacteriuria (ABU) has been defined as “antibiotics never events”, and urinary tract infection (UTI) is one of the most common infectious diseases for which antibiotics are prescribed in Korea. To establish an effective antimicrobial stewardship strategy, a qualitative assessment of antibiotic use in actual clinical syndrome is necessary.MethodsCases of positive urine cultures (≥105 CFU/ml), performed in inpatient, outpatient, and emergency departments in April 2021 were screened in 26 hospitals located throughout Korea. Cases were classified into ABU, lower UTI, and upper UTI. The appropriateness of antibiotic use was retrospectively evaluated by infectious disease specialists using quality indicators based on the domestic clinical guideline for ABU and UTI.Figure 1.Study flow diagramResultsA total of 2697 cases of ABU or UTI were included. The appropriateness of antibiotic use was assessed in 1157 cases with asymptomatic bacteriuria, 677 and 863 cases with lower and upper UTI (Figure 1). Antibiotics were prescribed in 21.7% (251 of 1157) of ABU without appropriate indication. Of 66 ABU cases with appropriate indication in which prophylactic antibiotics were prescribed, the duration of antibiotics was adequate in only 34.8% (Table 1). For lower UTI, the appropriateness of empirical and definite antibiotics was 77.8% (527 of 677) and 68.0% (353 of 519). In terms of upper UTI, 86.3% (745 of 863) and 78.2% (583 of 746) was appropriate, respectively. The duration of antibiotics was adequate in 65.7% (421 of 641) of lower UTI and 77.9% (592 of 760) in upper UTI (Table 2, 3).ConclusionThis nationwide qualitative assessment of antibiotic use in ABU and UTI revealed that a significant proportion of antibiotics were prescribed inappropriately and, furthermore the duration of antibiotics was prolonged unnecessarily. Interventions for appropriate antibiotic use in ABU and UTI at the national level are required.DisclosuresAll Authors: No reported disclosures.

Japanese guideline for clinical research of antimicrobial agents on urogenital infections: Second edition.

Introduction: Given the potential overlap in risk factors associated with both irritable bowel syndrome (IBS) and lower urinary tract infections (LUTIs), we aimed to identify factors that may contribute to the development of both conditions, as well as recurrent lower urinary tract infections (RLUTIs). Our research also sought to explore overlapping symptoms and interactions between these two disorders. Materials and Methods: The study included young women with a history of urinary tract infections. Participants were divided into three groups: women with sporadic LUTIs (NRLUTIs), women with recurrent LUTIs (RLUTIs), and women with both a history of urinary infections (NRLUTI or RLUTI) and a diagnosis of IBS. The diagnosis of IBS is primarily clinical, relying on symptoms and the exclusion of other gastrointestinal disorders. Data from intestinal microbiota tests were combined with information on patients’ symptom perception, dietary habits, lifestyle, and knowledge regarding their conditions. Results: Abdominal pain, constipation, insufficient knowledge about antibiotic and probiotic use, and nutritionally unbalanced diets were identified as common factors associated with both LUTI-IBS and RLUTI. Conclusions: Our research identified shared risk factors between LUTI, IBS, and RLUTI, suggesting a pathological interdependence between these conditions. Notably, women with RLUTIs often experience gastrointestinal symptoms such as abdominal pain and constipation after consuming foods known to trigger IBS. This highlights that gut dysbiosis is both a risk factor and a potential consequence of RLUTI. The presence of either condition appears to exacerbate the symptoms of the other, further underscoring the intricate connection between RLUTI and IBS in affected individuals.

MANAGEMENT OF URINARY TRACT INFECTIONS: HISTORICAL PERSPECTIVE AND CURRENT STRATEGIES: PART 2— MODERN MANAGEMENT

In women, urinary tract infections (UTIs) rank second in morbidity after acute respiratory viral infections. Therefore, issues of non-antibacterial prevention and treatment of UTIs are of great relevance. Particular interest is focused on evaluating the efficacy of the herbal medicinal product Canephron N in UTI prevention under conditions of rapidly increasing antibiotic resistance among uropathogenic bacterial strains, as well as the growing frequency of microbial associations and multidrug-resistant pathogens. To assess and update data on the efficacy and safety of Canephron N for the prevention of recurrent UTIs in outpatient practice. A total of 72 female patients with a clinical diagnosis of acute cystitis or exacerbation of chronic cystitis, for whom empirical antibiotic therapy (ABT) was indicated according to the Russian clinical guidelines, were enrolled in a multicenter, open, prospective, randomized study. Thirty-six patients were assigned to the main group, receiving ABT in combination with Canephron N (2 tablets three times daily) followed by prophylactic monotherapy with the herbal product for 1 month. Thirty-one patients, receiving ABT only (contact was lost with 5 patients after randomization, and they were excluded from further analysis), were included in the control group. Treatment efficiency and recurrence rates were evaluated for 12 months after completion of therapy. The mean age of the patients was 37,4 years: 35,1 years in the main group and 39,7 years in the control group. Acute cystitis was diagnosed in 36 (53,7%) patients, and recurrent cystitis in 31 (46,2%). When Canephron N was administered at the onset of the disease together with antibiotic therapy and subsequently for one month, recurrences of uncomplicated lower urinary tract infections (LUTIs) within one year were observed in 13,9% of patients, compared with 38,7% in the control group. Among patients with acute cystitis, a recurrent episode during the year occurred in 5% of those treated with ABT and Canephron N, compared with 31,2% in the group without phytotherapy. In patients with recurrent cystitis, the recurrence rate within one year was 25% in the Canephron N group versus 46,7% in the control group. Currently, Canephron N is one of the herbal medicinal products with the most convincing evidence base, a high safety profile, and a broad range of therapeutic effects. The components of this phytomedicine are included in the 2024 Russian Ministry of Health Clinical Guidelines "Cystitis in Women" as an agent for both the prevention and treatment of recurrent cystitis. Our study demonstrated that the combination of antibiotic therapy with Canephron N reduced the recurrence rate by almost threefold (from 38.7% in the control group to 13.9% in the main group) and prolonged the recurrence-free period in both acute and chronic cystitis in outpatient practice. Evidence has been obtained supporting the therapeutic efficiency of Canephron N in the combination treatment and prevention of recurrent UTIs. A positive trend was observed toward improved treatment outcomes and reduced recurrence rates in real clinical practice among patients with uncomplicated cystitis receiving the herbal product in combination with antibiotic therapy.

Recent studies have suggested a connection between low back pain (LBP) and urinary tract infections (UTI). These disturbances could be triggered via visceral-somatic pathways, and there is evidence that kidney mobility is reduced in patients suffering from nonspecific LBP. Manual treatment of the perinephric fascia could improve both kidney mobility and LBP related symptoms. To assess whether manual treatment relieves UTI and reduces pain in patients with nonspecific LBP through improvement in kidney mobility. Records from all patients treated at a single physical therapy center in 2019 were retrospectively reviewed. Patients were included if they were 18 years of age or older, had nonspecific LBP, and experienced at least one UTI episode in the 3months before presentation. Patients were excluded if they had undergone manipulative treatment in the 6months before presentation, if they had one of several medical conditions, if they had a history of chronic pain medication use, and more. Patient records were divided into two groups for analysis: those who were treated with manipulative techniques of the fascia with thrust movement (Group A) vs those who were treated without thrust movement (Group B). Kidney Mobility Scores (KMS) were analyzed using high resolution ultrasound. Symptoms as reported at patients' 1 month follow up visits were also used to assess outcomes; these included UTI relapse, lumbar spine mobility assessed with a modified Schober test, and lumbar spine pain. Of 126 available records, 20 patients were included in this retrospective study (10 in Group A and 10 in Group B), all of whom who completed treatment and attended their 1 month follow up visit. Treatments took place in a single session for all patients and all underwent ultrasound of the right kidney before and after treatment. The mean (±standard deviation) KMS (1.9±1.1), mobility when bending (22.7±1.2), and LBP scores (1.2±2.6) of the patients in Group A improved significantly in comparison with the patients in Group B (mean KMS, 1.1±0.8; mobility when bending, 21.9±1.1; and LBP, 3.9±2.7) KMS, p<0.001; mobility when bending, p=0.003; and LBP, p=0.007). At the 1 month follow up visit, no significant statistical changes were observed in UTI recurrence (secondary outcome) in Group A (-16.5±4.3) compared with Group B (-20.4±7) (p=0.152). Manual treatments for nonspecific LBP associated with UTI resulted in improved mobility and symptoms for patients in this retrospective study, including a significant increase in kidney mobility.

Urinary tract infections (UTIs) are among the most common infections caused by both Gram-negative and Gram-positive bacteria, acquired in the community and hospitals. There are three main groups of UTIs: (i) lower UTIs that affect the urethra or the bladder, (ii) upper UTIs that affect the kidneys, or (iii) asymptomatic bacteriuria (ABU). Group B Streptococcus (GBS) is a Gram-positive bacteria known to cause a variety of infections in neonates, pregnant women, the elderly or immunocompromised individuals. GBS has been estimated to cause 1-2% of all single organism UTIs. GBS has been shown to form biofilms, on abiotic and biotic surfaces, protecting it from killing by antibiotics or host immune cells and promotes host colonisation. Various factors have been shown to affect the biofilm forming ability of GBS. Here we determined that LB supplemented with glucose was the optimal media for biofilm formation by a strong biofilm forming strain. We then investigated the biofilm forming phenotype of 292 clinical GBS isolates that presented with asymptomatic, acute, or recurrent infection. We found that there was no significant difference in the biofilm forming ability across the clinical presentations. We also showed a significant reduction in the biofilm forming ability of a strong biofilm forming strain and its isogenic maeK and maeE mutants in LB supplemented with 1% glucose. A multiplex PCR screen for genes encoding bsaB, pil1, pil2a, and pil2b found that there was no significant difference in the number of strains that had the right sized fragments for all four genes across the three clinical presentations. We also found that there was a significant difference in the proportion of strains that had the right sized fragments for the pil genes across the three different levels of biofilm activity under shaking conditions. High biofilm forming strains had the lowest proportion of strains that possessed all four genes, compared to low and medium biofilm formers. Lastly, we assessed the haemolytic activity of the strains by growing them on tryptic soy agar plates supplemented with 5% horse blood and found that asymptomatic strains had a significantly higher number of strains with high haemolytic activity compared to acute and recurrent strains.

1. Serum bactericidal activity against the homologous organism was determined in patients with urinary tract infections and has been related to the site of infection and to serum antibody titres. 2. A significantly higher number of patients with upper compared to lower urinary infections were found to have either a specific defect in bactericidal activity against the homologous organism or to be infected with organisms inherently resistant to normal serum bactericidal activity. 3. It is suggested that these factors may be important in determining the site of urinary tract infections.

Virulence genotypes and phylogenetic distribution between upper and lower community-onset urinary tract infections caused by Escherichia coli

Comparative Efficacies of Procalcitonin and Conventional Inflammatory Markers for Prediction of Renal Parenchymal Inflammation in Pediatric First Urinary Tract Infection

Objective To compare the efficacy and complications between transurethral resec-tion of the prostate(TURP) and transurethral vaporization-resection of the prostate (TUVRP). Methods 637 cases of benign prostatic hyperplasia(BPH)were divided into 2 groups, 298 cases un-derwent TURP and 339 underwent TUVRP. The maximal flow rates (Qmax) were (9.8±2.3)ml/s, (10.1±2.1) ml/s, the international prostatic symptom scores (IPSS) were 15.3±3.1,15.1±3.7 re-spectively. The surgical outcomes and the complications of the 2 groups were analyzed. Results For the TURP group and TUVRP group, the postoperative Qmax were (19.0±2.9)ml/s and (18.0±2.3) ml/s, both significantly higher than those of preoperation(P<0.01). There was no significant differ-ence between the 2 groups(P0.05). For the TURP group, the mean operation time was (52±16) rain, visual hematuria lasting for (9.0±2.3) d, secondary bleeding in 6 cases (2.0%), lower urinary tract infection in 14 cases(4.7%), 1 month after operation lower urinary tract symptom(LUTS) in 26 case(8.7%), IPSS was 5.0±1.4, contemporary incontinence in 6 cases(2.0%), memberanous sticture 4 cases(1.3%). For the TUVRP group, the mean operation time was (68%19)min, visual hematuria lasting for (12.0±3.6) d, secondary bleeding in 19 cases (5.6%), lower urinary tract infection in 38 cases(11.2%) ,1 month after operation LUTS in 59 cases(17.4%) ,IPSS was 8.0±1.6,contemporary incontinence in 13 cases(3.8%), memberanous stieture in 16 cases (4.7%). There were significant differences between the 2 groups. For the TURP group, blood loss during operation was (126±29) ml, resected tissue weighed (31±8)g, pre- and post-operative serum natium consentration balance was (8±6)mmol/L,TURS developed in 3 cases(1%). For the TUVRP group, blood loss during opera-tion was (122±38)ml, resected tissue weighed (33±9)g,pre- and post-operative serum natium con-sentration balance was (7±7) mmol/L, TURS developed in 2 cases(0.6%). There was no significant differences(P0.05). Conclusions TURP and TUVRP have similar efficacy treating symptomatic BPH. The incidences of complications of TUVRP are slightly higher than those of TURP. Key words: Benign prostatic hyperplasia; Surgical procedures,elective

<title>Abstract</title> Background Urinary tract infections (UTIs) pose a significant global health burden. While vitamin D plays a known role in immune modulation, its association with UTI risk in adult populations remains underexplored. Objectives To investigate the association between serum vitamin D levels and the risk of upper and lower UTIs in adults, and to evaluate the relative risk contributions of comorbid conditions and modifiable risk factors. Methods We conducted a prospective case-control study involving 404 adult participants (203 controls, 73 with upper UTI, 128 with lower UTI). Serum 25(OH)D levels were categorized into deficient, insufficient, and sufficient. Logistic regression was used to calculate adjusted odds ratios (aOR). Absolute Risk Difference (ARD) and Number Needed to Harm (NNH) were <bold>computed.</bold> Results Vitamin D deficiency was significantly associated with both upper UTIs (aOR = 1.85; ARD = 12.9%; NNH = 8) and lower UTIs (aOR = 1.65; ARD = 10.3%; NNH = 10) compared to controls. Additional risk factors included diabetes mellitus (aOR = 1.92), recent antibiotic use (aOR = 2.77), and Foley catheter presence (aOR = 2.34). A causal hypothesis model supports biologic plausibility through impaired antimicrobial defense and barrier integrity. Conclusion Vitamin D deficiency is an independent risk factor for adult UTIs. Routine screening and targeted supplementation may provide a cost-effective adjunct to UTI prevention, particularly among high-risk populations. Future longitudinal studies and randomized controlled trials are warranted to confirm causality and guide implementation.