Standard Process Urinary Tract Infection

Male And Complicated Uti

Until recently, essentially all cystitis and pyelonephritis studies have been performed in female mice, as the male mouse bladder is not reliably accessible by catheter. Of note, instillation of uropathogens into the urethra of male mice elicits prostatic infection . In a recently developed, new model of UTI, a small abdominal incision is made and bacteria are inoculated via needle into the bladders of male and female mice, permitting direct sex comparisons . This inoculation method recapitulates the IBC cascade of acute cystitis established in studies with catheter-infected females. Interestingly, once anatomic barriers are bypassed in this way, male mice experience more severe infection than females, mirroring epidemiologic data observed clinically in men indeed, male C3H mice uniformly develop severe pyelonephritis and renal abscesses that are seen much less frequently in female mice . This new model opens doors to study sex differences in UTI pathogenesis and host response, as well as sequelae of severe pyelonephritis and abscess formation these latter phenotypes are relevant to febrile UTI in children, following which renal scarring is a common complication.

Availability Of Data And Materials

All data sets will be password protected and only available to project investigators. Data sets, cleaned and blinded of any identifying participant information, as well as the full protocol, will be available after the completion of the trial on request to the contacting author. Data was entered electronically and original study forms will be kept locked at the study site and maintained in storage for a period of 25 years after the completion of the study.

How To Feel Better

If your healthcare professional prescribes you antibiotics:

• Take antibiotics exactly as your healthcare professional tells you.
• Do not share your antibiotics with others.
• Do not save antibiotics for later. Talk to your healthcare professional about safely discarding leftover antibiotics.

Drink plenty of water or other fluids. Your healthcare professional might also recommend medicine to help lessen the pain or discomfort. Talk with your healthcare professional if you have any questions about your antibiotics.

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Compliance And Side Effects

Participants completed a daily journal to record compliance and were asked to bring capsule bottles to each visit in order to count remaining capsules. A bi-weekly email reminder was sent to encourage participation. Side effects were evaluated at each visit and participants were asked to document symptoms in their daily journal.

What Are The Side Effects Of D

Common side effects of D-mannose include:

As D-mannose exits the body in urine, there is also some concern that high doses may injure or impair the kidneys.

Since D-mannose can alter your blood sugar levels, it’s crucial for people with diabetes to take caution when using it.

Not enough is known about the safety of the supplement during pregnancy or breastfeeding, so it should be avoided. Children shouldn’t take D-mannose either.

As a rule, self-treating a UTI with D-mannose or otherwise avoiding or delaying standard care is unadvised as it can lead to serious complications, including a kidney infection and even permanent kidney damage.

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Q2d What Are The Risks And Benefits Associated With Different Systems Interventions

The available data examined the following systems interventions:

We considered CAUTI outcomes, duration of catheterization, recatheterization, and transmission of pathogens when weighing the risks and benefits of different systems interventions. The evidence for this question consists of 1 RCT259 and 19 observational studies.3,25,260-276 The findings of the evidence review and the grades for all important outcomes are shown in Evidence Review Table 2D.

Q2D.1. Multifaceted infection control/quality improvement programs

Low-quality evidence suggested a benefit of multifaceted infection control/quality improvement programs to reduce the risk of CAUTI.3,260-267 This was based on a decreased risk of SUTI, bacteriuria/unspecified UTI, and duration of catheter use with implementation of such programs. Studies evaluated various multifaceted interventions. The studies with significant findings included:

Criteria For Considering Studies For This Review

Types of studies

All RCTs of cranberry juice versus placebo, no treatment or any other treatment. QuasiRCTs were included, but the quality of the studies was taken into account during the analysis and discussion. Both parallel group and crossover design were included.

Types of participants

Inclusion criteria

Studies of susceptible men, women or children as defined below. These categories were analysed separately.

• Participants with a history of recurrent lower UTIs
• Elderly men and women
• Participants with an indwelling catheter
• Participants with an abnormality of the urinary tract
• Children with a first or subsequent UTI.

Exclusion criteria

• Studies of the treatment of asymptomatic or symptomatic UTI .
• Studies of any urinary tract condition not caused by bacterial infection .

Types of interventions

Cranberry juice or a cranberry product taken by participants for at least one month. The amount taken/d, concentration of the juice/cranberry product and length of treatment was also taken into account in subgroup analyses.

Types of outcome measures

Primary outcomes

• Number of UTIs in each group , midstream specimen of urine if possible, or a ‘clean catch’ specimen).

If further studies become available for review, this outcome will also be subgrouped into rate of symptomatic lower UTIs, rate of symptomatic upper UTIs and rate of asymptomatic UTIs. Symptomatic is defined as having one or more or the following symptoms: dysuria, frequency, urgency or fever.

Secondary outcomes

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Sample Size And Statistical Analysis

We estimated that 35% of patients in the control group would present at least one UTI during the 24-week follow-up period . We needed to recruit 126 women to detect a clinically significant difference of 25% between the 2 groups . We estimated that 15% of randomized participants would be lost to follow-up , therefore 148 women needed to be recruited in order for at least 126 participants to complete the 24-week intervention.

The Poisson regression model was used to compare the incidence of symptomatic UTI during the 24-week follow-up. A Kaplan Meier estimate with a log-rank test was used to compare time to first UTI between the two treatment arms. Intention to treat analyses were performed in all randomly assigned subjects with the observation time censored at the date that the participant abandoned or the date of last contact . All statistical analyses were performed using SAS University Edition software .

Nursing Care Plans For Urinary Tract Infection

The following are four example nursing care plans for caring for a patient with a urinary tract infection.

Urinary tract infections can vary from mild to life-threatening. Proper nursing assessment and care can identify infections early and improve patient outcomes. Remember, a variety of nursing diagnoses and planned interventions may be appropriate for a patient suffering from a urinary tract infection.

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Uncomplicated Versus Complicated Uti

A complicated UTI is an infection associated with a condition, such as a structural or functional abnormality of the genitourinary tract, or the presence of an underlying disease this increases the risk of the outcome of a UTI being more serious than expected, as compared to its occurrence in individuals without any identified risk factors . The European Association of Urologys classification system for UTIs, known as ORENUC, is based on the clinical presentation of the UTI and its associated host risk factors . In adults, uncomplicated UTIs fall under categories O, R and partially E, while complicated UTIs are mainly in categories N, U and C.

Molecular Pathogenesis Of Uti

Infection of the urinary tract begins when UPEC, likely introduced after colonization of the periurethral area by gastrointestinal tract flora , accesses and ascends the urethra by an undetermined mechanism. Upon reaching the urinary bladder, UPEC bind to superficial epithelial cells in a type 1 pili-dependent manner . A subset of adherent bacteria are then internalized into facet cells , a dynamic process that likely relies on the normal cycling of apical membrane segments in these cells . Countering this key pathogenic activity, bladder epithelial cells undertake active expulsion of internalized UPEC. Recent data show that UPEC are capable of neutralizing the lysosome, and that this neutralization is sensed by a lysosomal membrane protein termed mucolipin TRP channel 3 , activating pathways that direct exocytosis of UPEC-containing lysosomes . Through a distinct mechanism, activation of Toll-like receptor 4 by internalized UPEC leads to specific ubiquitination of TNF Receptor Associated Factor 3 , enabling its interaction with a guanine-nucleotide exchange factor that directs assembly of the exocyst complex, thereby accomplishing expulsion of intracellular bacteria .

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Study Design And Objectives

To assess the effects of a standardized cranberry extract in sexually active healthy women who present r-UTI, we will undertake a double blind, prospective RCT with 2 arms comparing the mean number of new UTIs during a 6-month period after consumption of a standardized cranberry extract containing 37 mg PACs with a control dose of 2 mg PACs in women presenting r-UTI. This protocol was developed in accordance with the Standard Protocol Items: Recommendations for Interventional Trials Statement. The SPIRIT figure is illustrated in Fig. .

Fig. 1

What The Science Says

E. coli bacteria cause 90 percent of UTIs. Once these bacteria enter the urinary tract, they latch on to cells, grow, and cause infection. Researchers think that D-mannose might work to treat or prevent a UTI by stopping these bacteria from latching on.

After you consume foods or supplements containing D-mannose, your body eventually eliminates it through the kidneys and into the urinary tract.

While in the urinary tract, it can attach to the E. coli bacteria that may be there. As a result, the bacteria can no longer attach to cells and cause infection.

There isnt much research on the effects of D-mannose when taken by people who have UTIs, but a few early studies show that it might help.

A 2013 study evaluated D-mannose in 308 women who had frequent UTIs. D-mannose worked about as well as the antibiotic nitrofurantoin for preventing UTIs over a 6-month period.

In a 2014 study, D-mannose was compared to the antibiotic trimethoprim/sulfamethoxazole for treatment and prevention of frequent UTIs in 60 women.

D-mannose reduced UTI symptoms in women with an active infection. It was also more effective than the antibiotic for preventing additional infections.

A 2016 study tested the effects of D-mannose in 43 women with an active UTI. At the end of the study, most women had improved symptoms.

A lot of different D-mannose products are available. When deciding on which one to use, you should consider three things:

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Blinding And Contamination Bias

The proportion of women who will guess their group allocation correctly will be documented with a short questionnaire at the last visit. To control for contamination bias, any antibiotic therapy during the study period will be declared to the study coordinator and PAC consumption will be measured by FFQ for the 24 h preceding each visit.

Study Participants And Recruitment

This clinical trial aims to enrol sexually active non-pregnant non-lactating women aged 18 years and over presenting culture-confirmed r-UTI . Women will be recruited in the Laval University community in Quebec City, Canada, through list serves and local clinician referrals as well as posters in medical clinics, social media, paid advertising and word of mouth. Women wishing to participate will contact the study coordinator who will explain the research project to them and verify eligibility according to inclusion and exclusion criteria . The risks and benefits of the study will be thoroughly discussed and the consent form will be signed at the first of three visits at the Institute on Nutrition and Functional Foods .

Table 1 Admissibility criteria for the cranberry extract for prevention of recurrent urinary tract infections trial

Potential participants will need to restrain exposure to systemic antimicrobial agents or cranberry derivatives in the two weeks preceding enrolment. Women with anatomical abnormalities of the urinary tract, a history of renal disease or intestinal disease causing malabsorption , or anticoagulant therapy will be excluded. Furthermore, we will exclude women with known allergy or intolerance to cranberries.

Study randomization

Clinical follow-up

Sample size and statistical analysis

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Vaccines Targeting Bacterial Toxins And Proteases

The UPEC pore-forming toxin HlyA has also received attention as a potential vaccine target and was evaluated in a mouse model of pyelonephritis to assess protection against renal damage114,115. Vaccination with HlyA reduced the incidence of renal scaring compared with controls however, it did not protect against UPEC colonization of the kidneys115. In addition, in a mouse model of UTI, vaccination with the P. mirabilis haemolysin, HpmA, did not provide protection against bacterial colonization116. However, vaccination with Pta, an alkaline protease with toxic effects towards epithelial cells, displayed promising results in a mouse model of UTI, protecting against upper UTI, although bacterial burdens in the bladder remained unaffected116. Thus, although haemolysins and proteases might provide effective vaccine targets for preventing upper UTIs, additional studies are needed to determine the effectiveness of these enzymes as targets for vaccines.

Enhancing Healthcare Team Outcomes

UTIs are best managed in an interprofessional fashion, and besides physicians, most nurses will encounter a patient with a UTI. The key to preventing recurrences is patient education. Once a UTI has been diagnosed, the patient should be encouraged to drink more fluids. Sexually active women should try to void right after sexual intercourse as this can help flush the bacteria out of the bladder. Some women with recurrent UTIs may benefit from the prophylactic use of antibiotics. Several other non-medical remedies may help some women with UTIs. Anecdotal reports indicate that using cranberry juice and probiotics may help reduce the severity and frequency of UTIs in some women. Primary clinicians should refer patients with recurrent UTIs to the urologist to rule out reflux and anatomical defects.

Outcomes

The majority of women with a UTI have an excellent outcome. Following treatment with an antibiotic, the duration of symptoms is 2 to 4 days. Unfortunately, nearly 30% of women will have a recurrence of the infection. Morbidity is usually seen in older debilitated patients or those with renal calculi. Other factors linked to recurrence include the presence of diabetes, underlying malignancy, chemotherapy, and chronic catheterization of the bladder. The mortality after a UTI is close to zero.

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Q2c What Are The Risks And Benefits Associated With Different Catheter Management Techniques

The available data examined the following catheter management techniques:

For all comparisons, we considered CAUTI outcomes as well as other outcomes critical to weighing the risks and benefits of different catheter management techniques. The evidence for this question consists of 6 systematic reviews,37,105,106,182-184 56 RCTs,60,61,65-69,143,158,158,185-231 34 observational studies,83,85,88,90,96,102,133,167,178,232-258 and 1 economic analysis.180 The findings of the evidence review and the grades for all important outcomes are shown in Evidence Review Table 2C.

Q2C.1. Antimicrobial prophylaxis

Low-quality evidence suggested no benefit of antimicrobial prophylaxis in patients undergoing long-term catheterization .106,183,192,194,235,238 This was based on a decreased risk of bacteriuria, heterogeneous results for SUTI, and no differences reported for catheter encrustation or adverse events, although data were sparse. One systematic review suggested an increase in antimicrobial resistance with antimicrobial use.

Q2C.2. Urinary antiseptics

Q2C.3. Bladder irrigation

Q2C.4. Antiseptic instillation in the drainage bag

Q2C.5. Periurethral care

Q2C.6. Routine catheter or bag change

Nutritional Supplementation For Recurrent Urinary Tract Infections In Women

Background: Recurrent urinary tract infections , i.e. having three or more infections in 12 months, present a common and serious health problem for women. Long-term prophylactic antibiotic use is one treatment approach though there are currently no consensus treatment strategies for chronic recurrent UTIs which makes development of antibiotic resistant bacterial strains a major concern. Alternatively, nutritional supplements such as those based on cranberry and the sugar d-mannose, have shown some mixed success as a complementary treatment for UTIs. Thus, identification of a multi-ingredient nutritional supplement which could reduce the recurrence of UTIs when applied in conjunction with standard of care would be valuable to the heath and healthcare of women.

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Q1b What Are The Risk Factors For Cauti

To answer this question, we reviewed the quality of evidence for those risk factors examined in more than one study. We considered the critical outcomes for decision-making to be SUTI and bacteriuria. The evidence for this question consists of 11 RCTs59-69 and 37 observational studies.9,50,54,70-103 The findings of the evidence review and the grades for all important outcomes are shown in Evidence Review Table 1B.

Evidence Review Table 1B. What are the risk factors for CAUTI?

1B.1. Following aseptic insertion of the urinary catheter, maintain a closed drainage system. More data are available under Question 2B.

1B.2. Insert catheters only for appropriate indications, and leave in place only as long as needed. More data are available under Question 2C.

1B.3. Minimize urinary catheter use and duration of use in all patients, particularly those at higher risk for CAUTI such as women, the elderly, and patients with impaired immunity.

1B.4. Ensure that only properly trained persons who know the correct technique of aseptic catheter insertion and maintenance are given this responsibility.

1B.5. Maintain unobstructed urine flow. More data are available under Question 2D.