Urinary Tract Infection: Prevention, Diagnosis, and Treatment

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Nephrology & Urology".

Deadline for manuscript submissions: closed (27 March 2023) | Viewed by 18246

Special Issue Editor


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Guest Editor
Department of Urology, University Hospital Southampton, NHS Foundation Trust, Southampton, UK
Interests: urinary tract infection; kidney stones; urinary tract symptoms

Special Issue Information

Dear Colleagues,

Urinary tract infections (UTIs) are a common disease. The incidence of UTIs is rising globally due to a selection of multiresistant bacteria not responding to common antibiotics. The effect of UTIs on comorbid or vulnerable adults and children is a known risk factor for urosepsis, which in turn can lead to systemic complications. The aetiology UTIs is mainly related to habits and environmental factors; however, baseline pathology such as immunosuppression or diabetes mellitus can play a role. Kidney stones disease (KSD) and bladder outflow obstruction are often associated with UTIs, and more research is needed to investigate the role of UTIs in recurrent kidney stones formation. The prevention and treatment of UTIs is of paramount importance to prevent serious and life-threatening complications. The aim of this Special Issue is to provide an overview on recent strategies for the prevention, diagnosis, and treatment of recurrent UTIs and related complications. We invite researchers in the field of UTIs to submit an original article or review to this Special Issue (Please note that case reports and short reviews will not be accepted).

Dr. Amelia Pietropaolo
Guest Editor

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Keywords

  • urinary tract infections
  • recurrent UTIs
  • prevention
  • management
  • natural remedies
  • kidney stones
  • sepsis
  • bladder outflow obstruction

Published Papers (7 papers)

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Editorial

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4 pages, 196 KiB  
Editorial
Urinary Tract Infections: Prevention, Diagnosis, and Treatment
by Amelia Pietropaolo
J. Clin. Med. 2023, 12(15), 5058; https://doi.org/10.3390/jcm12155058 - 01 Aug 2023
Cited by 1 | Viewed by 1177
Abstract
Urinary tract infections (UTIs) are common pathologies that can affect patients of every age and background [...] Full article
(This article belongs to the Special Issue Urinary Tract Infection: Prevention, Diagnosis, and Treatment)

Research

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11 pages, 2802 KiB  
Article
A 2-Year Audit on Antibiotic Resistance Patterns from a Urology Department in Greece
by Ioannis Manolitsis, Georgios Feretzakis, Stamatios Katsimperis, Panagiotis Angelopoulos, Evangelos Loupelis, Nikoleta Skarmoutsou, Lazaros Tzelves and Andreas Skolarikos
J. Clin. Med. 2023, 12(9), 3180; https://doi.org/10.3390/jcm12093180 - 28 Apr 2023
Cited by 3 | Viewed by 1175
Abstract
Purpose: The high incidence of urinary tract infections (UTIs), often in nosocomial environments, is a major cause of antimicrobial resistance (AMR). The dissemination of antibiotic-resistant infections results in very high health and economic burdens for patients and healthcare systems, respectively. This study aims [...] Read more.
Purpose: The high incidence of urinary tract infections (UTIs), often in nosocomial environments, is a major cause of antimicrobial resistance (AMR). The dissemination of antibiotic-resistant infections results in very high health and economic burdens for patients and healthcare systems, respectively. This study aims to determine and present the antibiotic resistance profiles of the most common pathogens in a urology department in Greece. Methods: During the period 2019–2020, we included 12,215 clinical samples of blood and urine specimens that tested positive for the following pathogens: Escherichia coli, Enterococcus faecium, Enterococcus faecalis, Proteus mirabilis, Klebsiella pneumoniae, or Pseudomonas aeruginosa, as these are the most commonly encountered microbes in a urology department. Results: The analysis revealed a 22.30% mean resistance rate of E. coli strains with a 76.42% resistance to ampicillin and a 54.76% resistance rate to ciprofloxacin in the two-year period. It also showed an approximately 19% resistance rate of P. mirabilis strains and a mean resistance rate of 46.205% of K. pneumoniae strains, with a decreasing trend during the four semesters (p-value < 0.001), which presented an 80% resistance rate to ampicillin/sulbactam and 73.33% to ciprofloxacin. The resistance to carbapenems was reported to be 39.82%. The analysis revealed a 24.17% mean resistance rate of P. aeruginosa with a declining rate over the two-year period (p-value < 0.001). The P. aeruginosa strains were 38% resistant to fluoroquinolones and presented varying resistance against carbapenems (31.58% against doripenem and 19.79% against meropenem). Regarding the Enteroccocal strains, a 46.91% mean resistance was noted for E. faecium with 100% resistance to ampicillin, and a 24.247% mean resistance rate for E. faecalis strains that were 41% resistant to ciprofloxacin. Both types showed 100% sensitivity to linezolid. Conclusions: The dissemination of antibiotic-resistant pathogens poses the need to implement surveillance programs and, consequently, to develop strategies to prevent the emergence of such pathogens in order to optimize patient outcomes. Full article
(This article belongs to the Special Issue Urinary Tract Infection: Prevention, Diagnosis, and Treatment)
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8 pages, 241 KiB  
Article
Understanding the Role of Ureteral Access Sheath in Preventing Post-Operative Infectious Complications in Stone Patients Treated with Ureteroscopy and Ho:YAG Laser Lithotripsy: Results from a Tertiary Care Referral Center
by Luca Villa, Pietro Dioni, Luigi Candela, Eugenio Ventimiglia, Mario De Angelis, Christian Corsini, Daniele Robesti, Margherita Fantin, Alessia D’Arma, Silvia Proietti, Guido Giusti, Ioannis Kartalas Goumas, Alberto Briganti, Francesco Montorsi and Andrea Salonia
J. Clin. Med. 2023, 12(4), 1457; https://doi.org/10.3390/jcm12041457 - 12 Feb 2023
Cited by 1 | Viewed by 1259
Abstract
Introduction and objectives: The use of ureteral access sheaths (UAS) limits the irrigation-induced increase in intrarenal pressure during ureteroscopy (URS). We investigated the relationship between UAS and rates of postoperative infectious complications in stone patients treated with URS. Materials and methods: Data from [...] Read more.
Introduction and objectives: The use of ureteral access sheaths (UAS) limits the irrigation-induced increase in intrarenal pressure during ureteroscopy (URS). We investigated the relationship between UAS and rates of postoperative infectious complications in stone patients treated with URS. Materials and methods: Data from 369 stone patients treated with URS from September 2016 to December 2021 at a single institution were analyzed. UAS (10/12 Fr) placement was attempted in case of intrarenal surgery. The chi-square test was used to assess the relationship between the use of UAS and fever, sepsis, and septic shock. Univariable and multivariable logistic regression analyses tested the association of patients’ characteristics and operative data and the rate of postoperative infectious complications. Results: Full data collection of 451 URS procedures was available. Overall, UAS was used in 220 (48.8%) procedures. As for postoperative infectious sequalae, we recorded fever (n = 52; 11.5%), sepsis (n = 10; 2.2%), and septic shock (n = 6; 1.3%). Of those, UAS was not used in 29 (55.8%), 7 (70%), and 5 (83.3%) cases, respectively (all p > 0.05). At multivariable logistic regression analysis, performing URS without UAS was not associated with the risk of having fever and sepsis, but it increased the risk of septic shock (OR = 14.6; 95% CI = 1.08–197.1). Moreover, age-adjusted CCI score (for fever-OR = 1.23; 95% CI = 1.07–1.42, sepsis-OR = 1.47; 95% CI = 1.09–1.99, and septic shock-OR = 1.61; 95% CI = 1.08–2.42, respectively), history of fever secondary to stones (for fever-OR = 2.23; 95% CI = 1.02–4.90) and preoperative positive urine culture (for sepsis-OR = 4.87; 95% CI = 1.12–21.25) did emerge as further associated risk factors. Conclusions: The use of UAS emerged to prevent the onset of septic shock in patients treated with URS, with no clear benefit in terms of fever and sepsis. Further studies may help clarify whether the reduction in fluid reabsorption load mediated by UAS is protective against life-threatening conditions in case of infectious complications. The patients’ baseline characteristics remain the main predictors of infectious sequelae in a clinical setting. Full article
(This article belongs to the Special Issue Urinary Tract Infection: Prevention, Diagnosis, and Treatment)
10 pages, 458 KiB  
Article
A Comparative Study of Urinary Tests and Cultures for the Effectiveness of Fosfomycin in Catheter-Related Urinary Tract Infections
by Jung Ki Jo, Dong Seob Kim, Younghun Sim, Soorack Ryu and Kyu Shik Kim
J. Clin. Med. 2022, 11(23), 7229; https://doi.org/10.3390/jcm11237229 - 05 Dec 2022
Cited by 1 | Viewed by 1489
Abstract
As the elderly population increases due to an aging society, the number of patients with catheters is increasing, and treatment for urinary infections is needed. The current study analyzed the effectiveness of fosfomycin, the primary antibiotic used to treat urinary tract infections (UTIs), [...] Read more.
As the elderly population increases due to an aging society, the number of patients with catheters is increasing, and treatment for urinary infections is needed. The current study analyzed the effectiveness of fosfomycin, the primary antibiotic used to treat urinary tract infections (UTIs), in these patients. Patients who received fosfomycin as the primary antibiotic for a UTI were selected, and the results of urine tests and cultures before and after fosfomycin administration were compared and analyzed. The degree of UTI in patients with a catheter was found to be more severe (p = 0.020), and the infecting strains were found to be different depending on whether a catheter was present (p = 0.014). There was a difference in the treatment success rate depending on whether or not a catheter was present (53.6% vs. 70.4%), but it was found that the treatment rate was more than 50% regardless of whether a catheter was present. The bacterial type, as well as the treatment rate based on the bacterium, differed depending on the presence of a catheter. Fosfomycin has a success rate of more than 50%, even in patients with catheters; therefore, it can be considered the primary antibiotic for treating UTIs. Full article
(This article belongs to the Special Issue Urinary Tract Infection: Prevention, Diagnosis, and Treatment)
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Review

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20 pages, 1939 KiB  
Review
Vesicoureteral Reflux and Innate Immune System: Physiology, Physiopathology, and Clinical Aspects
by Marius-Cosmin Colceriu, Paul Luchian Aldea, Andreea-Liana Răchișan, Simona Clichici, Alexandra Sevastre-Berghian and Teodora Mocan
J. Clin. Med. 2023, 12(6), 2380; https://doi.org/10.3390/jcm12062380 - 19 Mar 2023
Cited by 4 | Viewed by 1820
Abstract
Vesicoureteral reflux represents one of the most concerning topics in pediatric nephrology due to its frequency, clinical expression with the potential to evolve into chronic kidney disease, and last but not least, its socio-economic implications. The presence of vesicoureteral reflux, the occurrence of [...] Read more.
Vesicoureteral reflux represents one of the most concerning topics in pediatric nephrology due to its frequency, clinical expression with the potential to evolve into chronic kidney disease, and last but not least, its socio-economic implications. The presence of vesicoureteral reflux, the occurrence of urinary tract infections, and the development of reflux nephropathy, hypertension, chronic kidney disease, and finally, end-stage renal disease represent a progressive spectrum of a single physiopathological condition. For the proper management of these patients with the best clinical outcomes, and in an attempt to prevent the spread of uropathogens’ resistance to antibacterial therapy, we must better understand the physiopathology of urinary tract infections in patients with vesicoureteral reflux, and at the same time, we should acknowledge the implication and response of the innate immune system in this progressive pathological condition. The present paper focuses on theoretical aspects regarding the physiopathology of vesicoureteral reflux and the interconditionality between urinary tract infections and the innate immune system. In addition, we detailed aspects regarding cytokines, interleukins, antimicrobial peptides, and proteins involved in the innate immune response as well as their implications in the physiopathology of reflux nephropathy. New directions of study should focus on using these innate immune system effectors as diagnostic and therapeutic tools in renal pathology. Full article
(This article belongs to the Special Issue Urinary Tract Infection: Prevention, Diagnosis, and Treatment)
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12 pages, 636 KiB  
Review
Which Antibiotic for Urinary Tract Infections in Pregnancy? A Literature Review of International Guidelines
by Mariela Corrales, Elizabeth Corrales-Acosta and Juan Guillermo Corrales-Riveros
J. Clin. Med. 2022, 11(23), 7226; https://doi.org/10.3390/jcm11237226 - 05 Dec 2022
Cited by 4 | Viewed by 7753
Abstract
Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50–60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important [...] Read more.
Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50–60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important and management guidelines have been published worldwide to assist physicians in selecting the right antibiotic for each patient, taking into account the maternal and fetal safety profile. A review of the literature was carried out and all international guidelines giving recommendations about antibiotic treatments for pregnancy-related UTI were selected. The search came back with 13 guidelines from 4 different continents (8 from Europe, 3 from South America, 1 from North America and 1 from Oceania). Our review demonstrated concordance between guidelines with regard to several aspects in the antibiotic treatment of UTI during pregnancy and in the follow-up after treatment. Nonetheless, there are some areas of discordance, as in the case of antenatal screening for bacteriuria and the use of fluoroquinolones in lower or upper UTI. Given the current evidence that we have from international guidelines, they all agree on several key points about antibiotic use. Full article
(This article belongs to the Special Issue Urinary Tract Infection: Prevention, Diagnosis, and Treatment)
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9 pages, 469 KiB  
Review
Are Intravesical Aminoglycosides the New Gold Standard in the Management of Refractory Urinary Tract Infection: A Systematic Review of Literature
by Andrea Ong, Amelia Pietropaolo, George Brown and Bhaskar K. Somani
J. Clin. Med. 2022, 11(19), 5703; https://doi.org/10.3390/jcm11195703 - 27 Sep 2022
Cited by 6 | Viewed by 2643
Abstract
Background: Antibiotic resistance in urinary pathogens is increasingly common, leading to rising cases of complicated urinary tract infections. Conventional antimicrobial treatment may be insufficient in these cases and broad-spectrum systemic antibiotics contribute to the problem. Intravesical aminoglycoside instillation is an alternative treatment option [...] Read more.
Background: Antibiotic resistance in urinary pathogens is increasingly common, leading to rising cases of complicated urinary tract infections. Conventional antimicrobial treatment may be insufficient in these cases and broad-spectrum systemic antibiotics contribute to the problem. Intravesical aminoglycoside instillation is an alternative treatment option that delivers localized and high-dose treatment to the source of infection. This study summarizes the existing evidence for the efficacy and safety of this treatment. Methods: A systematic search was conducted of worldwide literature according to PRISMA methodology and Cochrane standards for systematic review. Studies were included if they reported outcome data for the prevention and reduction in urinary tract infections, eradication of antimicrobial-resistant organisms, or change in sensitivities allowing conventional oral antimicrobial treatment after the administration of intravesical aminoglycoside with or without polymyxin therapy. Results: The search identified 826 articles, of which, 19 were included in the final data analysis and narrative synthesis. A successful outcome was identified in 80.7% (n = 289) of patients treated with aminoglycoside alone and 79.5% (n = 163) treated with an aminoglycoside in combination with polymyxin. Discontinuation was noted in 6.2% of patients. An increase in antimicrobial sensitivity was seen in 15.3% (n = 55) and 16.3% (n = 36) in the aminoglycoside and aminoglycoside/polymyxin groups, respectively. Conclusions: Current evidence supports the use of intravesical aminoglycoside instillation as an efficacious and safe treatment for refractory UTIs. Nevertheless, data is limited, and larger volume studies with longer follow-up periods are required. Full article
(This article belongs to the Special Issue Urinary Tract Infection: Prevention, Diagnosis, and Treatment)
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