Results of open prospective study of clinical assessment of efficacy and safety of Nifuratel during exacerbations of recurrent cystitis

The article presents the results of an open prospective study of the clinical assessment of the efficacy and safety of the use of nifuratel during exacerbations of recurrent cystitis. The aim of the program was to assess the change in the duration of the relapse-free course of recurrent cystitis and the effectiveness of the course treatment with Nifuratel-SZ in the treatment of recurrent cystitis. During a non-interventional program, Nifuratel-SZ has been shown to be an effective and well-tolerated drug for the treatment of recurrent uncomplicated lower urinary tract infection.

The Risk of Preterm Birth in Low Risk Pregnant Women with Urinary Tract Infections

Objective Urinary tract infections are among the most common infections during pregnancy. The association between symptomatic lower urinary tract infections during pregnancy and fetal and maternal complications such as preterm birth and low birthweight remains unclear. The aim of this research is to evaluate the association between urinary tract infections during pregnancy and maternal and neonatal outcomes, especially preterm birth. Study Design This study is a secondary analysis of a multicenter prospective cohort study, which included patients between October 2011 and June 2013. The population consists of women with low risk singleton pregnancies. We divided the cohort into women with and without a symptomatic lower urinary tract infection after 20 weeks of gestation. Baseline characteristics and maternal and neonatal outcomes were compared between the two groups. Multivariable logistic regression analysis was used to correct for confounders. The main outcome was spontaneous preterm birth at <37 weeks. Results We identified 4,918 pregnant women eligible for enrollment, of whom 9.4% had a symptomatic lower urinary tract infection during their pregnancy. Women with symptomatic lower urinary tract infections were at increased risk for both preterm birth in general (12 vs. 5.1%, adjusted OR 2.5; 95% CI 1.7–3.5) as well as a spontaneous preterm birth at <37 weeks (8.2 vs. 3.7%, adjusted OR 2.3; 95% CI 1.5–3.5). This association was also present for early preterm birth at <34 weeks. Women with symptomatic lower urinary tract infections during pregnancy are also at increased risk of endometritis (8.9 vs. 1.8%, adjusted OR 5.3; 95% CI 1.4–20) and mastitis (7.8 vs. 1.8%, adjusted OR 4.0; 95% CI 1.6–10) postpartum. Conclusion Low risk women with symptomatic lower urinary tract infections during pregnancy are at increased risk of spontaneous preterm birth. In addition, an increased risk for endometritis and mastitis postpartum was found in women with symptomatic lower urinary tract infection during pregnancy. Key Points

160. Evaluation of an Intervention to Promote Guideline-Concordant Durations of Antibiotic Therapy in Two Urgent Care Centers

Background Antibiotic overuse in urgent cares is common. Despite institutional guidance that recommends ≤ 5 days of therapy for most infections, a prior review found prescribed durations were often longer. This study evaluates the impact of an intervention on guideline-concordant durations of therapy. Methods This quasi-experimental study involved two urgent care centers (UC1 and UC2) in an integrated health care system. Prescriptions were included from January 2017 to May 2021 for patients ≥ 18 years of age for one of the following infections identified by ICD10 code: acute bacterial sinusitis, acute otitis media, cellulitis or skin abscess, COPD exacerbation, lower urinary tract infection, or pneumonia. The intervention was implemented in both urgent cares in January 2020 and included sharing baseline duration of therapy data with site directors and staff, providing in-person education on recommended durations of therapy, engaging peer champions, and posting educational flyers. An institutional smart phone application (app) with treatment recommendations for common infections was in place for the entirety of the study. The primary outcome was the proportion of antibiotic durations that were guideline-concordant during the app only and intervention periods in aggregate and by interrupted time-series analysis. Results On average, 1583 and 3850 antibiotic prescriptions were prescribed per year in UC1 and UC2, respectively. There was a significant increase in the proportion of guideline-concordant antibiotic prescriptions at the two sites by an absolute value of 20% (p&lt; 0.0001) (Table). By interrupted time-series, the change in slope after the intervention was not statistically significant for UC1 (p= 0.11), UC2 (p= 0.73), or combined (p= 0.61); however, there was a significant increase in prescriptions for ≤ 5 days immediately after the intervention in UC1 (p= &lt; 0.001) (Figure). Conclusion This intervention to promote institutional guideline-concordant durations of therapy resulted in a significant increase in the proportion of antibiotic prescriptions for ≤ 5 days. Preventing prolonged durations of therapy is a potentially effective strategy to reduce antibiotic overuse in urgent cares. Disclosures All Authors: No reported disclosures

Emphysematous cystitis with rare findings of subcutaneous emphysema and extraperitoneal pelvic gas: a case report

Emphysematous cystitis is a rare form of lower urinary tract infection with pathognomonic intramural and intraluminal gas. It commonly occurs in elderly females with uncontrolled diabetes mellitus. Subcutaneous emphysema and extraperitoneal pelvic gas are reported as rare presentations of emphysematous cystitis. Here we report emphysematous cystitis occurring in an elderly male with multiple co-morbidities who presented with fulminant sepsis and rare findings of subcutaneous emphysema and extraperitoneal pelvic gas.

Risk factors for treatment failure in women with uncomplicated lower urinary tract infection

Given rising antibiotic resistance and increasing use of delayed prescription for uncomplicated lower urinary tract infections (UTI), patients at risk for treatment failure should be identified early. We assessed risk factors for clinical and microbiological failure in women with lower UTI. This case-control study nested within a randomized clinical trial included all women in the per-protocol population (PPP), those in the PPP with microbiologically confirmed UTI, and those in the PPP with UTI due to Escherichia coli. Cases were women who experienced clinical and/or microbiologic failure; controls were those who did not. Risk factors for failure were assessed using multivariate logistic regression. In the PPP, there were 152 clinical cases for 307 controls. Among 340 women with microbiologically confirmed UTI, 126 and 102 cases with clinical and microbiological failure were considered with, respectively, 214 and 220 controls. Age ≥52 years was independently associated with clinical (adjusted OR 3.01; 95%CI 1.84–4.98) and microbiologic failure (aOR 2.55; 95%CI 1.54–4.25); treatment with fosfomycin was associated with clinical failure (aOR 2.35; 95%CI 1.47–3.80). The association with age persisted among all women, and women with E. coli-related UTI. Diabetes was not an independent risk factor, nor were other comorbidities. Postmenopausal age emerged as an independent risk factor for both clinical and microbiological treatment failure in women with lower UTI and should be considered to define women at-risk for non-spontaneous remission, and thus for delayed antibiotic therapy; diabetes mellitus was not associated with failure.

Anti-inflammatory therapy of lower urinary tract infection in patients with distal urethral diseases

Introduction. Recurrent infection of the lower urinary tract (UTI) is a very common pathology in women of different age groups. This category of urological patients is most often found in the practice of an outpatient urologist. Aim. To study the possibilities of the effect of hydrolytic enzymes on the effectiveness of complex antiinflammatory therapy of chronic infectious and inflammatory diseases of the lower urinary tract in women with pathology of the distal urethra, paraurethral region and on the results of surgical treatment of patients with female hypospadias, paraurethral cysts. Materials and methods. 96 patients with various forms of chronic lower UTI and its complications as a result of diseases of the urethra and paraurethral zone (female hypospadias, hypermobility of the urethra, paraurethral cyst) we was observed. In the course of our study, all the observed patients, were divided into 2 groups. Group I – 40 people (control) patients who received only anti-inflammatory and antibacterial therapy according to the spectrum of the detected pathogen of UTI in combination with surgical treatment, and the group II – 56 patients who received anti-inflammatory and antibacterial therapy according to the spectrum of the detected pathogen of UTI and surgical treatment in combination with enzyme therapy for a course of 14 days. Results. In the II group all patients after discharge from the hospital were monitored for 6 months. Only 1 patient had a relapse of exacerbation of chronic lower urinary tract infection. Enzyme therapy as a component that optimizes anti-inflammatory therapy provides a real chance for earlier relief of the infectious process in these patients and improvement of the results of surgical treatment of paraurethral pathology. Discussion. Chronic recurrent infection of the lower urinary tract in women is often associated with the presence of pathological conditions of the distal urethra in the form of female hypospadias and hypermobility of the urethra, as well as paraurethral pathology in the form of paraurethral cysts. Patients with this pathology need surgical treatment and mandatory complex anti-inflammatory therapy. Enzyme therapy as a component that optimizes anti-inflammatory therapy provides a real chance for earlier relief of the infectious process in these patients and improvement of the results of surgical treatment of paraurethral pathology. Conclusion. The inclusion of hydrolytic enzymes in patients with UTI and with diseases of the distal urethra and paraurethral region in the anti-inflammatory therapy regimen increases the effectiveness of etiotropic therapy and improves the results of surgical treatment of diseases of the distal urethra and paraurethral region.

Symptomatic treatment (using NSAIDS) versus antibiotics in uncomplicated lower urinary tract infection: a meta-analysis and systematic review of randomized controlled trials

Background Current guidelines recommend empiric antibiotics as first-line treatment for uncomplicated UTI. Despite proven benefits in treatment, antibiotic resistance rates remain on the rise. This meta-analysis aims to determine whether non-steroidal anti-inflammatory drugs can serve as an effective and safe option in the treatment of uncomplicated lower UTI among non-pregnant women compared to antibiotics. Methods A systematic literature search in PUBMED, CENTRAL, and ACP databases from inception to April 2021 was conducted to identify randomized controlled trials that compare the use of non-steroidal anti-inflammatory drugs versus antibiotics in non-pregnant women ≥18 years old with uncomplicated lower urinary tract infection. Primary outcomes were symptom resolution of UTI by Day 3 or 4 of intervention, and upper UTI complications. Secondary outcomes include persistence of positive urine culture despite treatment and need for another rescue antibiotic. Random and fixed-effects model for dichotomous data using Mantel-Haenszel and Peto odds method were reported at 95% CI followed by sensitivity analysis for substantial heterogeneity. Results Four RCTs involving 1165 patients were analyzed. The probability of having a symptom resolution by Day 3 or 4 with NSAID use is only less than three-fourths of that with antibiotic treatment (RR: 0.69, 95% CIs [0.55, 0.86], p = 0.0008, I2 = 73%, moderate certainty of evidence). The odds of developing upper UTI complications with use of NSAIDs are 6.49 to 1 for antibiotics (Peto OR: 6.49, 95% CIs [3.02, 13.92], p < 0.00001, I2 = 0%, moderate certainty of evidence). Secondary analysis showed that the NSAID group is 2.77x more likely to have persistence of a positive microbiologic urine culture than the antibiotic group (RR: 2.77, 95% CIs [1.95, 3.94], p < 0.00001, I2 = 36%, moderate certainty of evidence). Treatment with NSAIDs are three times more likely to use a secondary or rescue antibiotic due to persistent or worsening symptoms as compared to antibiotics (RR: 3.16, 95% CIs [2.24, 4.44], p < 0.00001, I2 = 47%, low certainty of evidence). Conclusion Antibiotic treatment was more effective than use of non-steroidal anti-inflammatory drugs for acute uncomplicated lower urinary tract infection with an overall moderate certainty of evidence.