What Else Can We Offer Our Patients with Recurrent UTI?

Information, case examples and suggested reading provided and presented by UVA’s Megan Dillman, WHNP-BC, Division of Female Pelvic Medicine and Reconstructive Surgery, at the 2021 Urogynecology for the Advanced Practice Provider Roundtable session in Nashville TN.

What Else Can We Offer Our Patients with Recurrent UTI?

Urogynecology for the Advanced Practice Provider 2021, Nashville TN

Facilitator: J. Megan Dillman, WHNP-BC

Division of Female Pelvic Medicine and Reconstructive Surgery

University of Virginia Health System, Charlottesville, VA

 

Aims and Objectives:

At the conclusion of this round table, participants should be able to:

1. Define and identify patients with recurrent UTI
2. Understand what one can offer as non-estrogen alternatives for UTI prophylaxis for recurrent UTI patients
3. Identify potential risks and benefits of these methods of prophylaxis

Outline

• Definition of recurrent UTI
• Role of estrogen in UTI prevention
  • Who is appropriate for consideration of therapy
  • Safety concerns in special populations
  • Recurrent UTI versus colonization
• Other alternative therapies for prevention of UTI
  • OTC:
    • Cranberry pills
    • D-mannose
    • Probiotics
  • Prescription medications:
    • Methenamine hippurate
    • Low dose prophylaxis

Case example 1:

At an initial visit for recurrent UTI, a 73-year-old postmenopausal female patient presents with 2-year history of frequent positive urine cultures. She has been treated with various courses of antibiotics for cultures that are > or equal to 100,000 cfu/mL.

She has been referred to you for further evaluation. She reports she knows she has a urinary tract infection when she notices that her urine is cloudy, malodorous, and has some increased frequency. She endorses dysuria today but also says she doesn’t always have dysuria when she gets treated for a UTI. She does note general vulvovaginal discomfort and dryness. She denies fever, flank pain, gross hematuria.

Her pelvic exam is normal with the exception of atrophic vulvovaginal tissues. She has no pelvic organ prolapse and her post void residual is WNL.

Her urine dip is positive for leukocytes, nitrites, and blood; it is sent for culture and later returns with a result of >100,000 cfu/mL of E.coli bacteria that is pan-sensitive.

Case example 2:

A 23-year-old healthy patient comes to urgent care with a 2-day history of dysuria, urgency, and frequency. A pelvic exam was done and found to be normal. STD testing was done and also found to be negative for GC/CT and other vaginitis.

Pt had a urine culture taken that was positive for >100,000 cfu/mL of E.coli bacteria that is pan sensitive.

Pt is treated with a 5-day course of nitrofurantoin 100 mg BID and responds well. When she is seen for follow up, she mentions that she gets a UTI fairly frequently, about 4 times a year, and they are often associated with recent intercourse.

 

Suggested Reading/Sources/References

American Urological Association, Canadian Urological Association, Society of Urodynamics, Female Pelvic Medicine & Urogenital Reconstruction. (2019). Recurrent Uncomplicated Urinary Tract Infections in Women: AUA/CUA/SUFU Guideline (2019). https://www.auanet.org/guidelines/guidelines/recurrent-uti

Barea, B., Veeratterapillay, R. & Harding, C. (2020). Nonantibiotic Treatments for Urinary Cystitis: An Update. Current Opinion in Urology, 2020 Nov; 30(6), 845-852. https://doi:10.1097/MOU.0000000000000821

Beerepoot, M. & Geerlings, S. (2016). Non-Antibiotic Prophylaxis for Urinary Tract Infections. Pathogens, 2016 Apr 16; 5(2):36. https://doi:10.3390/pathogens5020036

Brubaker, L., Carberry, C., Nardos, R., Carter-Brooks, C. & Lowder, J. (2018). American Urogynecologic Society Best-Practice Statement: Recurrent Urinary Tract Infection in Adult Women. Female Pelvic Medicine & Reconstructive Surgery, 2018 Sept/Oct; 24(5), 321-335. https://doi:10.1097/SPV.0000000000000550

Crean-Tate, K., Faubion, S., Pederson, H., Vencill, J. & Batur, P. (2020). Management of Genitourinary Syndrome of Menopause in Female Cancer Patients: A Focus on Vaginal Hormonal Therapy. American Journal of Obstetrics and Gynecology, 2020 Feb; 103-113.

 Nicolle, L., Bradley, S., Colgan, R., Rice, J., Schaeffer, A. & Hooton, T. (2005). Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults. Clinical Infectious Diseases, 2005 Mar 1; 40(5), 644-654. https://jstor.org/stable/4463100