50 Years of Urinary Tract Infections and Treatments

Has Much Changed?

Brandon Lajiness; Michelle J. Lajiness

Disclosures

Urol Nurs. 2019;39(5):235-239. 

In This Article

Non-pharmacological UTI Treatments

The treatment of complicated and recurrent UTIs has had considerable progress in the last 50 years, secondary to addressing the cause of the UTI when not related to bacteria. The development of less invasive surgical procedures, such as percutaneous drainage and shockwave lithotripsy to relieve obstruction, has allowed more effective treatment of UTI. Over-the-counter and Chinese herbal medications are not typically useful in the treatment of UTI (Brubaker et al., 2018).

Catheterization

When Jack Lapides introduced clean intermittent catheterization (CIC) in 1971, it came to light that bacteria were not the only cause of UTI, but that persistent stagnate urinary residuals were also culprits. While CIC has evolved over the years, the basic principles have not (see the article in this issue by A. Diokno, "A 50-Year Review of Lapides' Clean Intermittent Catheteriztion: A Revolutionary, Life-Saving, Quality-of-Life Improving Tech nique for Bladder Management" (pp. 229–234, 239), again pointing out the treatment of UTI has not significantly changed.

Catheter-associated Urinary Tract Infection (CAUTI)

In 1969, the term catheter-associated urinary tract infection (CAUTI) was not used. The Centers for Medicare & Medicaid Services (CMS) has several recommendations and policies in place relating to CAUTIs because UTIs are the most common type of health care-associated infection reported to the National Healthcare Safety Network (NHSN). Among UTIs acquired in the hospital, approximately 75% are associated with a urinary catheter; between 15% to 25% of hospitalized patients receive urinary catheters during their hospital stay. The most important risk factor for developing a CAUTI is prolonged use of the urinary catheter. Therefore, catheters should only be used for appropriate indications and should be removed as soon as they are no longer needed (CDC, 2019). CAUTI information can be obtained online through multiple resources, including the CDC and CMS; a full discussion is beyond the scope of this article.

Asymptomatic Bacteriuria (ASB)

As with CAUTI, ASB was also an unknown concept 50 years ago. As the use of catheters became more prevalent and the population began to age, certain individuals had bacteria in their urine without associated symptoms. ASB is defined as 100,000 or more colony-forming units (CFU)/mL (≥108 CFU/L) in a voided urine specimen without signs or symptoms attributable to UTI. See Table 3 for recommendations on treatment and screening.

Prevention of UTI

This is another area that has shown some growth over the past 50 years. There was limited, if any, discussion of prevention in the literature in the late 1960s to early 1970s. The goal of prophylaxis is to prevent or suppress future infections. This can be accomplished with the use of antibiotics, vaginal estrogen cream, women, or methenamine salts (Hiprex®). Antibiotics can be used prophylactically once a culture has been negative. There are several different regimens recommended for both post-coital use in females and continuous antibiotic regimens (see Table 4).

Vaginal estrogen cream in women decreases UTI recurrence in hypoestrogenic women (Raz & Stamm, 1993). This regimen was 1 gm vaginally daily for 2 weeks followed by 2 times per week for 8 months. Other studies have determined effectiveness as well, and cream seems to work better than a vaginal estrogen ring. Oral estrogen is not effective.

A 2012 Cochrane review reported that methamine hippurate, an antibiotic that stops the growth of bacteria, was effective in the prevention of UTI. The use of probiotics, cranberry, D-mannose, non-antibiotic intravesical instillations (hyaluronic acid and chondritin sulfate), and vitamin C have limited support in the literature for use, especially with male patients. All require further testing to support use (Brubaker et al., 2018).

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