The burning issue of urinary tract infections

Abstract

Urinary tract infections (UTIs) are among the most common bacterial infections globally, affecting approximately 150 million people each year. They are typically treated with antibiotics, but rising antimicrobial resistance has become a critical concern in their management. While most UTIs are uncomplicated and manageable in community settings, complicated cases may lead to severe complications such as pyelonephritis, abscesses, or sepsis. Misdiagnosis, particularly in older adults and those with catheters, can lead to unnecessary antibiotic use and exacerbate resistance. Current guidelines recommend a clinical assessment and urine culture before initiating antibiotics, especially in men, pregnant women, and patients with catheterization.

The increasing prevalence of antibiotic-resistant pathogens, particularly Escherichia coli, poses a significant challenge to effective UTI treatment. Resistance is more common in patients with recurrent infections, recent hospitalizations, or those using long-term catheters. As a response, alternative non-antibiotic preventive therapies are being explored. These include D-mannose, methenamine hippurate (Hiprex), vaginal estrogen therapy, CO₂ vaginal laser treatments, GAG layer replacement via intravesical instillations, and immunomodulators like Uro-vaxom® and Uromune®. Early studies show promising results in reducing UTI recurrence rates with these alternatives.

This review underscores the need for personalized diagnosis and treatment strategies based on clinical presentation and microbial culture, as well as the importance of antibiotic stewardship. With antibiotic resistance on the rise, integrating non-antibiotic options into UTI prevention protocols could offer effective, sustainable solutions to reduce infection rates and preserve antibiotic efficacy for future generations.

Duffield, E., Yang, B., & Foley, S. (2018, September 1). The burning issue of urinary tract infections. Urology News