Optimal Management of Uncomplicated UTI IDSA Guidelines 2010 and EAU Guidelines 2011

GUNAWAN SUBRATA

Medical Doctor, International Speaker, Jakarta, Indonesia.

Introduction

In the USA, UTIs are responsible for over 7 million physician visits annually, including more than 2 million visits for cystitis.¹⁴  Approximately 15% of all community-prescribed antibiotics in the USA are dispensed for UTI, at an estimated annual cost of over US$ 1 billion. Furthermore, the direct and indire­ct costs associated with community-acquir­ed UTIs in the USA alone exceed an estima­ted US$ 1.6 billion.²

40% of all hospital-acquired infections are in the majority of cases, catheter-asso­ciate­d. Bacteruria develops in up to 25% of patients who  require a urinary catheter for > 7 days, with a daily risk of 5%. A single in­serti­on of a catheter into the urinary bladde­r in ambulatory patients results in urinar­y infecti­ons in 1-2% of cases. Indwelling catheters with open-drainage systems results in bacteriuria in almost 100% cases within 3-4 days. The use of a closed-drainage system, including a valve to prevent retrograde flow, delays the onsets of infection, but ultimately does not prevent it.It is thought that bacteria migrate within the mucopurulent space betwe­en the urethra and catheter, and that this leads to the development bacteriuria in almost all patients within about 4 weeks.²

UTI may occur as complicated, sympto­ma­tic infection uncomplicated or asympto­ma­tic bacteriuria. UTI is classified as uncom­pli­ca­ted if it occurs in patients with a structurally, function­ally, anatomicallyand neurologically normal urinary tract, no obstruc­tion, no risk factor such as renal stone, diabetes mellitus, pregnancy, candidiasis, catheter or other di­sea­se known to increase the risk of acquiring infection or of failing therapy.  

Terminology of Cystitis is usually about in­fecti­on in the urinary bladder (vesica urinary) or lower urinary tract with symptoms such as dysuria, polakysuria, frequency, urgency, sometimes suprapubic pain and fever.

 Complicated UTI occurs in patients with structural or functional a  abnormalities within the urinary tract or with underlying diseases known to increase the risks of acquiring infectio­n. In general, infection in men, pregnant women and children may be considered as complicated UTI.

There are three possible ways by which bacteria can invade and spread within the urinary tract: the ascent of microorganisms from the urethra, haematogenous and lymphatic routes.^2,7,8,9,10  This a logic explanation if the frequency of UTI is more frequently in women compared to men and increase the risk of infect­ion after catheterization of the bladder and instrumentation.

In Stroke patients the lower UTIs or cystitis is mostly happened after the use indwelling catheter with open-drainage system result in bacteriuria in almost 100% of cases within 3-4 days. The bacteria migrate/ ascend within the mucopurulent space between the urethra and catheter, and this leads to the develop­ment of bacteriuria.

The change of resistance pattern had been found in the most uropathogens caused changes of empirically approach for selection antimicrobial for lower or upper UTI. Previously, the decision about antimicrobial therapy is based on the characteristic of patien­t and flora spectrum of urinary tract. But with the increased of resistance to Trimethoprim (TMP) or TMP-sulphamethoxazole (TMP-SMX), beta-lactams penicillin and fluoroquinolones in the last decade in all over the world caused the decreased usage of these drugs for treatment of UTI. The direction of therapy has changed to use short courses of antimicrobial. In general, both guidelines on UTI by IDSA (Infectious Disease Society of America) 2010 and EAU (European Association of Urology) 2011 agreed that aims of treatment are rapid disappearance of clinical symptoms, reduction of morbidities due to relapses or reinfection and prophylaxis of reinfections can be satisfactorily realized by short-term antibiotic therapy.^1,2,3,4,36 Short-course regimens or single-dose therapy are desirable because better compliance that they promote, their lower cost of therapy,  fewer side effects, and lower selection of resistan­ce pathogen.^{1,2,3,4,11,16,36}

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