Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT)

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Abstract

Uncomplicated lower urinary tract infections (UTIs) occur in approximately 50% of women, and 20-30% experience recurrent UTI. Data on UTIs and quality of life (QoL) in Europe are limited.

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The etiology of urinary tract infection: traditional and emerging pathogens.

Allan Ronald (2003)

The microbial etiology of urinary infections has been regarded as well established and reasonably consistent. Escherichia coli remains the predominant uropathogen (80%) isolated in acute community-acquired uncomplicated infections, followed by Staphylococcus saprophyticus (10% to 15%). Klebsiella, Enterobacter, and Proteus species, and enterococci infrequently cause uncomplicated cystitis and pyelonephritis. The pathogens traditionally associated with UTI are changing many of their features, particularly because of antimicrobial resistance. The etiology of UTI is also affected by underlying host factors that complicate UTI, such as age, diabetes, spinal cord injury, or catheterization. Consequently, complicated UTI has a more diverse etiology than uncomplicated UTI, and organisms that rarely cause disease in healthy patients can cause significant disease in hosts with anatomic, metabolic, or immunologic underlying disease. The majority of community-acquired symptomatic UTIs in elderly women are caused by E coli. However, gram-positive organisms are common, and polymicrobial infections account for up to 1 in 3 infections in the elderly. In comparison, the most common organisms isolated in children with uncomplicated UTI are Enterobacteriaceae. Etiologic pathogens associated with UTI among patients with diabetes include Klebsiella spp., Group B streptococci, and Enterococcus spp., as well as E coli. Patients with spinal cord injuries commonly have E coli infections. Other common uropathogens include Pseudomonas and Proteus mirabilis.Recent advances in molecular biology may facilitate the identification of new etiologic agents for UTI. The need for accurate and updated population surveillance data is apparent, particularly in light of concerns regarding antimicrobial resistance. This information will directly affect selection of empiric therapy for UTI.

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The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy

Walter LJM Devillé, Joris Yzermans, Nico van Duijn … (2004)

Background Many studies have evaluated the accuracy of dipstick tests as rapid detectors of bacteriuria and urinary tract infections (UTI). The lack of an adequate explanation for the heterogeneity of the dipstick accuracy stimulates an ongoing debate. The objective of the present meta-analysis was to summarise the available evidence on the diagnostic accuracy of the urine dipstick test, taking into account various pre-defined potential sources of heterogeneity. Methods Literature from 1990 through 1999 was searched in Medline and Embase, and by reference tracking. Selected publications should be concerned with the diagnosis of bacteriuria or urinary tract infections, investigate the use of dipstick tests for nitrites and/or leukocyte esterase, and present empirical data. A checklist was used to assess methodological quality. Results 70 publications were included. Accuracy of nitrites was high in pregnant women (Diagnostic Odds Ratio = 165) and elderly people (DOR = 108). Positive predictive values were ≥80% in elderly and in family medicine. Accuracy of leukocyte-esterase was high in studies in urology patients (DOR = 276). Sensitivities were highest in family medicine (86%). Negative predictive values were high in both tests in all patient groups and settings, except for in family medicine. The combination of both test results showed an important increase in sensitivity. Accuracy was high in studies in urology patients (DOR = 52), in children (DOR = 46), and if clinical information was present (DOR = 28). Sensitivity was highest in studies carried out in family medicine (90%). Predictive values of combinations of positive test results were low in all other situations. Conclusions Overall, this review demonstrates that the urine dipstick test alone seems to be useful in all populations to exclude the presence of infection if the results of both nitrites and leukocyte-esterase are negative. Sensitivities of the combination of both tests vary between 68 and 88% in different patient groups, but positive test results have to be confirmed. Although the combination of positive test results is very sensitive in family practice, the usefulness of the dipstick test alone to rule in infection remains doubtful, even with high pre-test probabilities.

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Risk factors for recurrent urinary tract infection in young women.

Timothy Roberts, James A. Stapleton, D Scholes … (2000)

To define host factors associated with an increased risk of recurrent urinary tract infection (RUTI), a case-control study was conducted in 2 populations: university women and health maintenance organization enrollees. Case patients were 229 women 18-30 years old with RUTIs; control subjects were 253 randomly selected women with no RUTI history. In a multivariate model, independent risk factors for RUTI included recent 1-month intercourse frequency (odds ratio [OR], 5.8; 95% confidence interval [CI], 3.1-10.6 for 4-8 episodes), 12-month spermicide use (OR, 1.8; 95% CI, 1.1-2.9), and new sex partner during the past year (OR, 1.9; 95% CI, 1.2-3.2). Two newly identified risk factors were age at first urinary tract infection (UTI)

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Author and article information

Journal

Title: Expert Review of Pharmacoeconomics & Outcomes Research

Abbreviated Title: Expert Review of Pharmacoeconomics & Outcomes Research

Publisher: Informa UK Limited

ISSN (Print): 1473-7167

ISSN (Electronic): 1744-8379

Publication date Created: June 21 2017

Publication date Created: January 02 2018

Publication date (Electronic): July 31 2017

Publication date (Print): January 02 2018

Volume: 18

Issue: 1

Pages: 107-117

Affiliations

[1 ] Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany

[2 ] Section of MIG, Lund University, Lund, Sweden

[3 ] Vifor Pharma, Geneva, Switzerland

[4 ] Technical University of Munich, Munich, Germany

Article

DOI: 10.1080/14737167.2017.1359543

PubMed ID: 28737469

SO-VID: e4d4c8d1-dd48-4709-8a8d-3acd54036e14

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Social and economic burden of recurrent urinary tract infections and quality of life: a patient web-based study (GESPRIT)

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Most cited references 34

The etiology of urinary tract infection: traditional and emerging pathogens.

The urine dipstick test useful to rule out infections. A meta-analysis of the accuracy

Risk factors for recurrent urinary tract infection in young women.

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