Treatment of Urinary Tract Infections and Antibiotic Stewardship

Abstract

Urinary tract infections affect >30% of people around the world. Empirical treatments are currently used for several infections, but appropriate criteria for the rational use of antibiotics should be focused to prevent bacterial resistance phenomena and the increased risk of difficult to-treat infections. Relevant information concerning risk factors and different levels of severity as well as appropriate microbiological interpretation of pathogens have been included and discussed. Moreover, the optimal clinical approach to asymptomatic bacteriuria and recurrent infection episodes has been evaluated, with appropriate suggestions for antibiotic treatment. The prevalence of antibiotic resistance is worsening, probably because of the increasing number of multidrug-resistant bacterial strains and the indiscriminate use of broad-spectrum antibiotics and empirical treatments, inducing increased treatment costs and hospitalizations. Antibiotic stewardship should be introduced in clinical practice to avoid the risk of infection episodes in which the urologist cannot risk systemic inflammatory response syndrome or sepsis. For these reasons, adequate indications for the rational use of antibiotic treatment have been described and discussed, including when and how empirical treatments should be used in current clinical practice.

Patient summary

The prevalence of antibiotic resistance is worsening likely because of the increasing number of multidrug-resistant bacterial strains and the indiscriminate use of broad-spectrum antibiotics. Antibiotic stewardship should be introduced in clinical practice to avoid the risk of infection episodes in which the urologist cannot risk systemic inflammatory response syndrome or sepsis.

Introduction

Urinary tract infections (UTIs) are one of the most common causes (>20%) of outpatient visits to general practitioners. The total cost of treatment of UTIs in the United States is similar to costs for angina pectoris and Crohn's disease. Women are more frequently affected by UTIs than men due to risk factors such as age, urethral length, marital status and frequency of sexual intercourse, alterations in menstrual cycle, concomitant bowel diseases, and lower genitourinary tract morphodynamic alterations; however, idiopathic recurrent infections have also been described nonpregnant premenopausal women. In any case, women more often undergo antibiotic treatment for UTIs than men.

Epidemiologic studies indicate that approximately 33% of women will have at least one UTI episode during their lifetime when antibiotic treatment will be necessary [1]. Episodes of recurrence within 6 mo of the first event will occur in 20–50% of cases [2], [3]. Each episode of UTI is normally characterized by symptoms for 6.1 d, reduction of daily activities for 2.4 d, and absence from work for 1.2 d [4]. UTI should be considered a social problem that reduces the patient's quality of life and interferes with relational and occupational activities.