Urinary tract infections in women: etiology and treatment options

Daniele Minardi, Gianluca d'Anzeo, Daniele Cantoro, Alessandro Conti, Giovanni Muzzonigro, Daniele Minardi, Gianluca d'Anzeo, Daniele Cantoro, Alessandro Conti, Giovanni Muzzonigro

Abstract

Urinary tract infections (UTI) are common among the female population. It has been calculated that about one-third of adult women have experienced an episode of symptomatic cystitis at least once. It is also common for these episodes to recur. If predisposing factors are not identified and removed, UTI can lead to more serious consequences, in particular kidney damage and renal failure. The aim of this review was to analyze the factors more commonly correlated with UTI in women, and to see what possible solutions are currently used in general practice and specialized areas, as well as those still under investigation. A good understanding of the possible pathogenic factors contributing to the development of UTI and its recurrence will help the general practitioner to interview the patient, search for causes that would otherwise remain undiscovered, and to identify the correct therapeutic strategy.

Keywords: diagnosis; etiology; treatment; urinary tract infection; women.

References

    1. Ronald A. The etiology of urinary tract infection: Traditional and emerging pathogens. Dis Mon. 2003;49(2):71–82.
    1. Hummers-Pradier E, Kochen MM. Urinary tract infections in adult general practice patients. Br J Gen Pract. 2002;52(482):752–761.
    1. Hill MJ, Drasar BS. The normal colonic bacterial flora. Gut. 1975;16(4):318–323.
    1. Yamamoto S, Tsukamoto T, Terai A, Kurazono H, Takeda Y, Yoshida O. Genetic evidence supporting the fecal-perineal-urethral hypothesis in cystitis caused by Escherichia coli. J Urol. 1997;157(3):1127–1129.
    1. Polito M, Minardi D, Montnari MP, Varaldo PE. Adherence of Gram negative uropathogens to human uroepithelial cells. Eur Urol. 1987;13(1–2):74–78.
    1. Plos K, Lomberg H, Hull S, Johansson I, Svanborg C. Escherichia coli in patients with renal scarring: Genotype and phenotype of Gal alpha 1–4Gal beta-, Forssman- and mannose-specific adhesins. Pediatr Infect Dis J. 1991;10(1):15–19.
    1. Ab Hadi I, Bliss RD, Lennard TW, Welch AR. Primary squamous cell carcinoma of the thyroid gland: A case report and role of radiotherapy. Surgeon. 2007;5(4):249–251.
    1. Zhou G, Mo WJ, Sebbel P, et al. Uroplakin Ia is the urothelial receptor for uropathogenic Escherichia coli: Evidence from in vitro FimH binding. J Cell Sci. 2001;114(Pt 22):4095–4103.
    1. Mulvey MA, Schilling JD, Martinez JJ, Hultgren SJ. Bad bugs and beleaguered bladders: Interplay between uropathogenic Escherichia coli and innate host defenses. Proc Natl Acad Sci U S A. 2000;97(16):8829–8835.
    1. Bishop BL, Duncan MJ, Song J, Li G, Zaas D, Abraham SN. Cyclic AMP-regulated exocytosis of Escherichia coli from infected bladder epithelial cells. Nat Med. 2007;13(5):625–630.
    1. Rupp ME, Soper DE, Archer GL. Colonization of the female genital tract with Staphylococcus saprophyticus. J Clin Microbiol. 1992;30(11):2975–2979.
    1. Wagenlehner FM, Niemetz AH, Weidner W, Naber KG. Spectrum and antibiotic resistance of uropathogens from hospitalised patients with urinary tract infections: 1994–2005. Int J Antimicrob Agents. 2008;31(Suppl 1):S25–S34.
    1. Marcus RJ, Post JC, Stoodley P, et al. Biofilms in nephrology. Expert Opin Biol Ther. 2008;8(8):1159–1166.
    1. Kauffman CA, Vazquez JA, Sobel JD, et al. Prospective multicenter surveillance study of funguria in hospitalized patients. The National Institute for Allergy and Infectious Diseases (NIAID) Mycoses Study Group. Clin Infect Dis. 2000;30(1):14–18.
    1. Rivett AG, Perry JA, Cohen J. Urinary candidiasis: A prospective study in hospitalized patients. Urol Res. 1986;14(3):153–173.
    1. Sobel JD, Vazquez JA. Fungal infections of the urinary tract. World J Urol. 1999;17(6):410–414.
    1. Beutler B, Moresco EM. The forward genetic dissection of afferent innate immunity. Curr Top Microbiol Immunol. 2008;321:3–26.
    1. Fischer H, Yamamoto M, Akira S, Beutler B, Svanborg C. Mechanism of pathogen-specific TLR4 activation in the mucosa: Fimbriae, recognition receptors and adaptor protein selection. Eur J Immunol. 2006;36(2):267–277.
    1. Bergsten G, Samuelsson M, Wullt B, Leijonhufvud I, Fischer H, Svanborg C. PapG-dependent adherence breaks mucosal inertia and triggers the innate host response. J Infect Dis. 2004;189(9):1734–1742.
    1. Ragnarsdottir B, Samuelsson M, Gustafsson MC, Leijonhufvud I, Karpman D, Svanborg C. Reduced toll-like receptor 4 expression in children with asymptomatic bacteriuria. J Infect Dis. 2007;196(3):475–484.
    1. Benson M, Jodal U, Agace W, et al. Interleukin (IL)-6 and IL-8 in children with febrile urinary tract infection and asymptomatic bacteriuria. J Infect Dis. 1996;174(5):1080–1084.
    1. Nielubowicz GR, Mobley HL. Host-pathogen interactions in urinary tract infection. Nat Rev Urol. 2010;7(8):430–441.
    1. Frendeus B, Godaly G, Hang L, Karpman D, Svanborg C. Interleukin-8 receptor deficiency confers susceptibility to acute pyelonephritis. J Infect Dis. 2001;183(Suppl 1):S56–S60.
    1. Lundstedt AC, McCarthy S, Gustafsson MC, et al. A genetic basis of susceptibility to acute pyelonephritis. PLoS One. 2007;2(9):e825.
    1. Mitsumori K, Terai A, Yamamoto S, Yoshida O. Virulence characteristics and DNA fingerprints of Escherichia coli isolated from women with acute uncomplicated pyelonephritis. J Urol. 1997;158(6):2329–2332.
    1. Hooton TM, Stapleton AE, Roberts PL, et al. Perineal anatomy and urine-voiding characteristics of young women with and without recurrent urinary tract infections. Clin Infect Dis. 1999;29(6):1600–1601.
    1. Aroutcheva A, Gariti D, Simon M, et al. Defense factors of vaginal lactobacilli. Am J Obstet Gynecol. 2001;185(2):375–379.
    1. Kirjavainen PV, Pautler S, Baroja ML, et al. Abnormal immunological profile and vaginal microbiota in women prone to urinary tract infections. Clin Vaccine Immunol. 2009;16(1):29–36.
    1. Barrons R, Tassone D. Use of Lactobacillus probiotics for bacterial genitourinary infections in women: A review. Clin Ther. 2008;30(3):453–468.
    1. Raz R. Postmenopausal women with recurrent UTI. Int J Antimicrob Agents. 2001;17(4):269–271.
    1. Hooton TM, Scholes D, Stapleton AE, et al. A prospective study of asymptomatic bacteriuria in sexually active young women. N Engl J Med. 2000;343(14):992–997.
    1. Wullt B, Ragnarsdottir B, Fischer H, Gronberg JH, Lutay N, Svanborg C. Urogenital Infections: EAU- International Consultation on Urological Diseases. 2010.
    1. Hawn TR, Scholes D, Wang H, et al. Genetic variation of the human urinary tract innate immune response and asymptomatic bacteriuria in women. PLoS One. 2009;4(12):e8300.
    1. Hawn TR, Scholes D, Li SS, et al. Toll-like receptor polymorphisms and susceptibility to urinary tract infections in adult women. PLoS One. 2009;4(6):e5990.
    1. Dobrindt U, Blum-Oehler G, Hartsch T, et al. S-Fimbria-encoding determinant sfa(I) is located on pathogenicity island III(536) of uropathogenic Escherichia coli strain 536. Infect Immun. 2001;69(7):4248–4256.
    1. Ziegler T, Jacobsohn N, Funfstuck R. Correlation between blood group phenotype and virulence properties of Escherichia coli in patients with chronic urinary tract infection. Int J Antimicrob Agents. 2004;24(Suppl 1):S70–S75.
    1. Kinane DF, Blackwell CC, Brettle RP, Weir DM, Winstanley FP, Elton RA. ABO blood group, secretor state, and susceptibility to recurrent urinary tract infection in women. Br Med J (Clin Res Ed) 1982;285(6334):7–9.
    1. Hooton TM. Recurrent urinary tract infection in women. Int J Antimicrob Agents. 2001;17(4):259–268.
    1. Haylen BT, Lee J, Husselbee S, Law M, Zhou J. Recurrent urinary tract infections in women with symptoms of pelvic floor dysfunction. Int Urogynecol J. 2009;20(7):837–842.
    1. Patterson TF, Andriole VT. Detection, significance, and therapy of bacteriuria in pregnancy. Update in the managed health care era. Infect Dis Clin North Am. 1997;11(3):593–608.
    1. Hill JB, Sheffield JS, McIntire DD, Wendel GD., Jr Acute pyelonephritis in pregnancy. Obstet Gynecol. 2005;105(1):18–23.
    1. Golan A, Wexler S, Amit A, Gordon D, David MP. Asymptomatic bacteriuria in normal and high-risk pregnancy. Eur J Obstet Gynecol Reprod Biol. 1989;33(2):101–108.
    1. Whalley P. Bacteriuria of pregnancy. Am J Obstet Gynecol. 1967;97(5):723–738.
    1. Krcmery S, Hromec J, Demesova D. Treatment of lower urinary tract infection in pregnancy. Int J Antimicrob Agents. 2001;17(4):279–282.
    1. Nygaard IE, Johnson JM. Urinary tract infection in elderly women. Am Fam Physician. 1996;53(1):175–182.
    1. Raz R, Gennesin Y, Wasser J, et al. Recurrent urinary tract infections in postmenopausal women. Clin Infect Dis. 2000;30(1):152–156.
    1. Raz R, Stamm WE. A controlled trial of intravaginal estriol in postmenopausal women with recurrent urinary tract infections. N Engl J Med. 1993;329(11):753–756.
    1. Nicolle LE. Asymptomatic bacteriuria in the elderly. Infect Dis Clin North Am. 1997;11(3):647–662.
    1. Geerlings SE, Stolk RP, Camps MJ, et al. Asymptomatic bacteriuria may be considered a complication in women with diabetes. Diabetes Mellitus Women Asymptomatic Bacteriuria Utrecht Study Group. Diabetes Care. 2000;23(6):744–749.
    1. Geerlings SE, Stolk RP, Camps MJ, Netten PM, Collet TJ, Hoepelman AI. Risk factors for symptomatic urinary tract infection in women with diabetes. Diabetes Care. 2000;23(12):1737–1741.
    1. Messelink B, Benson T, Berghmans B, et al. Standardization of terminology of pelvic floor muscle function and dysfunction: Report from the pelvic floor clinical assessment group of the International Continence Society. Neurourol Urodyn. 2005;24(4):374–380.
    1. Carlson KV, Rome S, Nitti VW. Dysfunctional voiding in women. J Urol. 2001;165(1):143–147.
    1. Yagci S, Kibar Y, Akay O, et al. The effect of biofeedback treatment on voiding and urodynamic parameters in children with voiding dysfunction. J Urol. 2005;174(5):1994–1997.
    1. Kuo HC. Videourodynamic characteristics and lower urinary tract symptoms of female bladder outlet obstruction. Urology. 2005;66(5):1005–1009.
    1. Minardi D, Parri G, d’Anzeo G, Fabiani A, El Asmar Z, Muzzonigro G. Perineal ultrasound evaluation of dysfunctional voiding in women with recurrent urinary tract infections. J Urol. 2008;179(3):947–951.
    1. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis. 2000;182(4):1177–1182.
    1. Farage M, Bramante M, Otaka Y, Sobel J. Do panty liners promote vulvovaginal candidiasis or urinary tract infections? A review of the scientific evidence. Eur J Obstet Gynecol Reprod Biol. 2007;132(1):8–19.
    1. Smaill F, Vazquez JC. Antibiotics for asymptomatic bacteriuria in pregnancy. Cochrane Database Syst Rev. 2007;2:CD000490.
    1. Grabe M, Bergland-Johansen TE, Botto H, et al. Guidelines on urological infections. Presented at the 25th European Association of Urology Annual Congress; Barcelona, Spain. April 16–20, 2010.
    1. Kahlmeter G. An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: The ECO. SENS Project. J Antimicrob Chemother. 2003;51(1):69–76.
    1. Bjerrum L, Gahrn-Hansen B, Grinsted P. Pivmecillinam versus sulfamethizole for short-term treatment of uncomplicated acute cystitis in general practice: A randomized controlled trial. Scand J Prim Health Care. 2009;27(1):6–11.
    1. Schito GC, Gualco L, Naber KG, et al. Do different susceptibility breakpoints affect the selection of antimicrobials for treatment of uncomplicated cystitis? J Chemother. 2010;22(5):345–354.
    1. Bean DC, Krahe D, Wareham DW. Antimicrobial resistance in community and nosocomial Escherichia coli urinary tract isolates, London 2005–2006. Ann Clin Microbiol Antimicrob. 2008;7:13.
    1. Schito GC, Naber KG, Botto H, et al. The ARESC study: An international survey on the antimicrobial resistance of pathogens involved in uncomplicated urinary tract infections. Int J Antimicrob Agents. 2009;34(5):407–413.
    1. Christensen B. Which antibiotics are appropriate for treating bacteriuria in pregnancy? J Antimicrob Chemother. 2000;46(Suppl A):29–34.
    1. Briggs GG, Freeman RK, Yaffe SJ. Drugs in Lactation. 2nd ed. Philadelphia, PA: Lippicott, Williams & Wilkins; 2002.
    1. Minardi D, d’Anzeo G, Parri G, et al. The role of uroflowmetry biofeedback and biofeedback training of the pelvic floor muscles in the treatment of recurrent urinary tract infections in women with dysfunctional voiding: A randomized controlled prospective study. Urology. 2010;75(6):1299–1304.
    1. Costantini E, Lazzeri M, Bini V, et al. Open-label, longitudinal study of tamsulosin for functional bladder outlet obstruction in women. Urol Int. 2009;83(3):311–315.
    1. Ludwig M, Hoyme U, Weidner W. Recurrent urinary tract infection in women. Long-term antibiotic prophylaxis. Urologe A. 2006;45(4):436–442. German.
    1. Perez-Lopez FR, Haya J, Chedraui P. Vaccinium macrocarpon: An interesting option for women with recurrent urinary tract infections and other health benefits. J Obstet Gynaecol Res. 2009;35(4):630–639.
    1. Howell AB. Bioactive compounds in cranberries and their role in prevention of urinary tract infections. Mol Nutr Food Res. 2007;51(6):732–737.
    1. Howell AB, Botto H, Combescure C, et al. Dosage effect on uropathogenic Escherichia coli anti-adhesion activity in urine following consumption of cranberry powder standardized for proanthocyanidin content: A multicentric randomized double blind study. BMC Infect Dis. 2010;10:94.
    1. Efros M, Bromberg W, Cossu L, Nakeleski E, Katz AE. Novel concentrated cranberry liquid blend, UTI-STAT with Proantinox, might help prevent recurrent urinary tract infections in women. Urology. 2010;76(4):841–845.
    1. Barbosa-Cesnik C, Brown MB, Buxton M, Zhang L, Debusscher J, Foxman B. Cranberry juice fails to prevent recurrent urinary tract infection: Results from a randomized placebo-controlled trial. Clin Infect Dis. 2011;52(1):23–30.
    1. Reid G, Bruce AW, Taylor M. Influence of three-day antimicrobial therapy and lactobacillus vaginal suppositories on recurrence of urinary tract infections. Clin Ther. 1992;14(1):11–16.
    1. Beerepoot MAJTG, Nys S, Vanderwal WM, et al. Lactobacillus rhamnosus GR-1 and L. reuteri RC-14 versus trimethoprim-sulfamethoxazole (TMP/SMX) in the prevention of recurrent urinary tract infections (rUTIs) in postmenopausal women: A randomized double-blind non-inferiority trial. ICAAC. 2009 Abstract L1–1656a.
    1. Ronnqvist PD, Forsgren-Brusk UB, Grahn-Hakansson EE. Lactobacilli in the female genital tract in relation to other genital microbes and vaginal pH. Acta Obstet Gynecol Scand. 2006;85(6):726–735.
    1. Grischke EM, Ruttgers H. Treatment of bacterial infections of the female urinary tract by immunization of the patients. Urol Int. 1987;42(5):338–341.
    1. Petrusic V, Stojanovic M, Zivkovic I, Inic-Kanada A, Dimitrijevic L. Changes in composition of IgM polymers in patients suffering from recurrent urinary bacterial infections after bacterial immunization treatment. Immunol Invest. 2010;39(8):781–795.
    1. Malani AN, Kauffman CA. Candida urinary tract infections: Treatment options. Expert Rev Anti Infect Ther. 2007;5(2):277–284.
    1. Carvalho M, Guimaraes CM, Mayer JR, Jr, Bordignon GP, Queiroz-Telles F. Hospital-associated funguria: Analysis of risk factors, clinical presentation and outcome. Braz J Infect Dis. 2001;5(6):313–318.
    1. Chen SC, Tong ZS, Lee OC, et al. Clinician response to Candida organisms in the urine of patients attending hospital. Eur J Clin Microbiol Infect Dis. 2008;27(3):201–208.
    1. Pappas PG, Kauffman CA, Andes D, et al. Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis. 2009;48(5):503–535.
    1. Sobel JD, Fisher J, Kauffman CA. Guidelines for the treatment of fungal urinary tract infections. Urinogenital Infections: EAU- International Consultation on Urological Diseases; 2010
    1. Tuon FF, Amato VS, Penteado Filho SR. Bladder irrigation with amphotericin B and fungal urinary tract infection – systematic review with meta-analysis. Int J Infect Dis. 2009;13(6):701–706.
    1. Gaonkar TA, Caraos L, Modak S. Efficacy of a silicone urinary catheter impregnated with chlorhexidine and triclosan against colonization with Proteus mirabilis and other uropathogens. Infect Control Hosp Epidemiol. 2007;28(5):596–598.
    1. Kowalczuk D, Ginalska G, Golus J. Characterization of the developed antimicrobial urological catheters. Int J Pharm. 2010;402(1–2):175–183.
    1. Darouiche RO, Mansouri MD, Gawande PV, Madhyastha S. Antimicrobial and antibiofilm efficacy of triclosan and Dispersin B combination. J Antimicrob Chemother. 2009;64(1):88–93.
    1. Jahn P, Preuss M, Kernig A, Seifert-Huhmer A, Langer G. Types of indwelling urinary catheters for long-term bladder drainage in adults. Cochrane Database Syst Rev. 2007;(3):CD004997.
    1. Schumm K, Lam TB. Types of urethral catheters for management of short-term voiding problems in hospitalised adults. Cochrane Database Syst Rev. 2008;(2):CD004013.
    1. Desai DG, Liao KS, Cevallos ME, Trautner BW. Silver or nitrofurazone impregnation of urinary catheters has a minimal effect on uropathogen adherence. J Urol. 2010;184(6):2565–2571.
    1. Reid G, Sharma S, Advikolanu K, Tieszer C, Martin RA, Bruce AW. Effects of ciprofloxacin, norfloxacin, and ofloxacin on in vitro adhesion and survival of Pseudomonas aeruginosa AK1 on urinary catheters. Antimicrob Agents Chemother. 1994;38(7):1490–1495.
    1. Darouiche RO, Smith JA, Jr, Hanna H, et al. Efficacy of antimicrobial-impregnated bladder catheters in reducing catheter-associated bacteriuria: A prospective, randomized, multicenter clinical trial. Urology. 1999;54(6):976–981.
    1. Niel-Weise BS, van den Broek PJ. Urinary catheter policies for long-term bladder drainage. Cochrane Database Syst Rev. 2005;(1):CD004201.
    1. Niel-Weise BS, van den Broek PJ. Antibiotic policies for short-term catheter bladder drainage in adults. Cochrane Database Syst Rev. 2005;(3):CD005428.
    1. Willson M, Wilde M, Webb ML, et al. Nursing interventions to reduce the risk of catheter-associated urinary tract infection: Part 2: Staff education, monitoring, and care techniques. J Wound Ostomy Continence Nurs. 2009;36(2):137–154.
    1. Wang K, Palmer MH. Women’s toileting behaviour related to urinary elimination: Concept analysis. J Adv Nurs. 2010;66(8):1874–1884.
    1. Kuklinski D, Koduri S. Predicting urinary tract infections in a urogynecology population. Urol Nurs. 2008;28(1):56–60.

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