Review
Immunology
Jonathan Josephs-Spaulding, Thoger Jensen Krogh, Hannah Clara Rettig, Mark Lyng, Mariam Chkonia, Silvio Waschina, Simon Graspeuntner, Jan Rupp, Jakob Moller-Jensen, Christoph Kaleta
Summary: This article discusses the ecological interactions of human urogenital microbial communities, the mechanism of imbalance between microbial ecology and host physiology. A greater understanding of environmental mechanisms and microbial ecology is needed for the treatment and management of UTIs. The use of next generation and systems level methods is recommended to elucidate the systemic consequences of rUTIs.
FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY
(2021)
Article
Immunology
Michael W. Dunne, Steven Aronin, Anita F. Das, Karthik Akinapelli, Jeanne Breen, Michael T. Zelasky, Sailaja Puttagunta
Summary: This study compared the clinical and microbiological responses of different treatment regimens in patients with complicated urinary tract infections, and the results showed that sulopenem was not superior to the comparator regimen.
CLINICAL INFECTIOUS DISEASES
(2023)
Article
Microbiology
David Melnick, Angela K. Talley, Vipul K. Gupta, Ian A. Critchley, Paul B. Eckburg, Kamal A. Hamed, Nivedita Bhatt, Gary Moore, Daren Austin, Christopher M. Rubino, Sujata M. Bhavnani, Paul G. Ambrose
Summary: The clinical relevance of bacteriuria after antibiotic treatment of complicated urinary tract infections is controversial. This study evaluated the impact of urine pharmacokinetics on the timing of recurrent bacteriuria in a clinical trial comparing oral tebipenem pivoxil hydrobromide and intravenous ertapenem. The prolonged urinary clearance and dwell time of ertapenem were associated with a temporal difference in the repopulation of bladder urine with bacteria following treatment, potentially confounding efficacy assessment.
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
(2023)
Article
Emergency Medicine
Bennett D. Sorensen, Joshua R. Lupton, Laura E. Chess, Michael J. Hildebrand, Mohamud R. Daya
Summary: This study evaluated the clinical practices of ordering urine cultures for cUTI patients and patient outcomes in an academic hospital setting. The study found that about 30% of patients did not receive urine cultures among a total of 398 cUTI encounters. Patients who received urine cultures had higher rates of admission and longer hospital stays compared to those who did not.
AMERICAN JOURNAL OF EMERGENCY MEDICINE
(2023)
Review
Infectious Diseases
Joanna Marantidis, Rachael Sussman
Summary: While urinary tract infections (UTIs) are common, their management is challenging due to the variety of presentations and severity. The definition of complicated UTIs (cUTIs) lacks consensus, resulting in global differences in management. Patients with cUTIs often have other comorbidities requiring urgent intervention. Antimicrobial resistance (AMR) is a major challenge in treating cUTIs. A multidisciplinary approach, including regulatory frameworks, provider education, and public awareness campaigns, is crucial to limiting unnecessary treatments for asymptomatic bacteriuria (ASB) and uncomplicated UTIs.
INFECTION AND DRUG RESISTANCE
(2023)
Article
Microbiology
Nadine Rouphael, Patricia Winokur, Michael C. Keefer, Jessica Traenkner, Ana Drobeniuc, Yohei Doi, Sonal Munsiff, Vance G. Fowler, Scott Evans, Randolph E. Oler, Bonifride Tuyishimire, Marina Lee, Varduhi Ghazaryan, Henry F. Chambers
Summary: Concerns over resistance and safety have been identified in the current treatment regimen for complicated urinary tract infections. Fosfomycin is a drug that is routinely used for the treatment of uncomplicated cystitis. This study shows that fosfomycin could be an oral alternative as step-down therapy for the treatment of complicated urinary tract infections, with a clinical cure rate comparable to levofloxacin but a lower microbiological success rate 3 weeks from start of antibiotics.
Article
Immunology
Nadia Kadry, Mukil Natarajan, Edward Bein, Peter Kim, John Farley
Summary: In clinical trials for complicated urinary tract infection, some participants show clinical success but still have microbiological persistence in the urine, which increases the risk of future clinical failure. Current guidelines recommend assessing both clinical and microbiological responses after therapy, but discordant outcomes raise questions about the utility of the microbiological endpoint. Analysis of participant data from 13 clinical trials shows that discordant outcomes at the test of cure visit are associated with an increased risk of late clinical failure, suggesting the importance of microbiological outcomes in the endpoint.
CLINICAL INFECTIOUS DISEASES
(2023)
Review
Infectious Diseases
Yveline Ansaldi, Begona Martinez de Tejada Weber
Summary: Urinary tract infections (UTIs) during pregnancy can have significant consequences for both the mother and the baby. Treating asymptomatic bacteriuria (ASB) can reduce the risk of low birth weight and preterm birth. Further research is needed to understand the complications of ASB and to explore preventive measures.
CLINICAL MICROBIOLOGY AND INFECTION
(2023)
Article
Immunology
Noah Wald-Dickler, Todd C. Lee, Soodtida Tangpraphaphorn, Susan M. Butler-Wu, Nina Wang, Tyler Degener, Carolyn Kan, Matthew C. Phillips, Edward Cho, Catherine Canamar, Paul Holtom, Brad Spellberg
Summary: This study compared the efficacy of fosfomycin and ertapenem for outpatient treatment of complicated urinary tract infections (cUTIs). The results suggest that fosfomycin may be a reasonable stepdown from intravenous antibiotics for cUTI.
OPEN FORUM INFECTIOUS DISEASES
(2022)
Article
Urology & Nephrology
Monique H. Vaughan, Jialiang Mao, Lisa A. Karstens, Li Ma, Cindy L. Amundsen, Kenneth E. Schmader, Nazema Y. Siddiqui
Summary: The study found associations between anaerobic bacteria in the urinary microbiome and postmenopausal recurrent UTI, suggesting a need for further investigation.
JOURNAL OF UROLOGY
(2021)
Article
Immunology
Wei Zhang, Chun-Yu Yan, Shu-Rui Li, Ting-Ting Fan, Shan-Shan Cao, Bin Cui, Meng-Ying Li, Bo-Yuan Fan, Bo Ji, Li Wang, Fei Cui, Jia Cui, Lei Wang, Yue Guan, Jing-Wen Wang
Summary: Extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae are a significant threat to human health, especially in the context of complicated urinary tract infections (cUTIs). This retrospective cohort study compared the treatment outcomes of cUTIs in adults using piperacillin-tazobactam (PTZ) and meropenem. The results showed that the clinical cure rate was similar in both groups, but the PTZ group had a shorter duration of antibiotic use, effective therapy, and hospitalization.
FRONTIERS IN CELLULAR AND INFECTION MICROBIOLOGY
(2023)
Review
Medicine, General & Internal
Tomislav Mestrovic, Mario Matijasic, Mihaela Peric, Hana Cipcic Paljetak, Anja Baresic, Donatella Verbanac
Summary: The current research focuses on the relationship between gut microbiota and the development of bacteriuria and UTI, as well as the potential impact of vaginal dysbiosis and urinary microbiome perturbations on infections. Further research and exploration are needed to understand and potentially utilize these findings for the diagnosis and treatment of UTIs.
Article
Immunology
Thomas P. Lodise, Teena Chopra, Brian H. Nathanson, Katherine Sulham, Mauricio Rodriguez
Summary: This multicenter study observed high rates of resistance and co-resistance to commonly used oral antibiotics in adult patients with Enterobacterales complicated urinary tract infection (cUTI) who presented to the emergency department.
OPEN FORUM INFECTIOUS DISEASES
(2022)
Article
Urology & Nephrology
Hamza Sakhi, Olivier Join-Lambert, Anna Goujon, Thibault Culty, Paul Loubet, Julien Dang, Sylvain Drouot, Hubert de Bayser, Christophe Michaud, Louise Ghislain, Thomas Stehle, Christophe Legendre, Dominique Joly, Paul Meria, Mohamad Zaidan
Summary: Encrusted pyelitis and cystitis are rare disorders characterized by calcification of the urinary tract walls, mainly composed of struvite and calcium carbonate-apatite. Clinical presentation includes subacute urinary tract infection with hematuria, while biologic features show struvite crystals and alkaline urine. Treatment with antibiotics and urinary acidification can reduce calcifications, but may be associated with significant adverse events such as Gram-negative bacilli urinary tract infections.
KIDNEY INTERNATIONAL REPORTS
(2021)
Review
Infectious Diseases
Faiza Morado, Darren W. Wong
Summary: Urinary tract infection is a common bacterial infection with challenges in diagnosis. To limit unnecessary testing and antibiotic use, various diagnostic stewardship initiatives involving multidisciplinary approaches and education of healthcare providers are effective in decreasing inappropriate testing and prescribing.
