Diagnosis and treatment of cystitis: more questions than answers?


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

Introduction Despite the prevalence of acute cystitis, there are still many unsolved problems of diagnosis and treatment of this disease. Material and methods To determine the nosological structure of dysuria, 126 female patients who sought medical attention for frequent painful urination were examined. To determine the incidence of outpatient visits to an urologist for patients with cystitis, medical records of 6753 patients of municipal outpatient clinic were analyzed. The results of treating cystitis in 85 patients also were evaluated. Results Among 126 patients with dysuria, 31 (24.6%), 42 (33.3%) and 47 (37.3%) patients had acute uncomplicated cystitis, recurrent (chronic) cystitis without the complicating factors and recurrent (chronic) cystitis with complicating factors, respectively. Three (2.4%), 2 (1.6%) and 1 (0.8%) patients had trichomoniasis, urogenital herpes and tuberculosis, respectively. As a result of 6753 visits to the urologist, inflammatory diseases of the genitourinary system were detected in 3194 (47.3%) patients, of which 64.7%, 19.6%, 5.3% and 2.7% had chronic pyelonephritis, chronic cystitis, chronic prostatitis and acute cystitis, respectively. Selecting the optimal drugs increases the treatment effectiveness of acute uncomplicated and chronic cystitis by 6% and 17%, respectively. Conclusions Most of clinical guidelines and scientific publications aimed at acute uncomplicated cystitis, while the proportion of the disease does not exceed 26% among the patients presenting with dysuria, and comprise only 2.7% among outpatient urologist visits for infectious and inflammatory diseases of the urogenital tract. Selecting the optimal drugs increases the treatment effectiveness of acute uncomplicated and chronic cystitis by 6% and 17%, respectively.

Full Text

Restricted Access

About the authors

E. V Kulchavenya

Novosibirsk Tuberculosis Research Institute of Minzdrav of Russia; Novosibirsk State Medical University of Minzdrav of Russia

Email: urotub@yandex.ru
Dr.Med.Sci., Prof., Principal Research Fellow at TB Research Institute, Prof. at Department of Tuberculosis of NSMU

S. Yu Shevchenko

Novosibirsk Tuberculosis Research Institute of Minzdrav of Russia; Novosibirsk State Medical University of Minzdrav of Russia; City Polyclinic № 26, Novosibirsk

Email: urotub@yandex.ru

A. G Cherednichenko

Novosibirsk Tuberculosis Research Institute of Minzdrav of Russia

References

  1. Tandogdu Z., Wagenlehner F.M. Global epidemiology of urinary tract infections. Curr Opin Infect Dis. 2016;29(1):73-9. doi: 10.1097/ QC0.0000000000000228.
  2. Grigoryan L., Zoorob R., Wang H., Trautner B.W. Low Concordance With Guidelines for Treatment of Acute Cystitis in Primary Care. Open Forum Infect Dis. 2015;2(4): 159. doi: 10.1093/ofid/ofV159.
  3. Qiao L.D., Chen S., Yang Y., Zhang K., Zheng B., Guo H.F., Yang B., Niu Y.J., Wang Y., Shi B.K., Yang W.M., Zhao X.K., Gao X.F., Chen M., Tian Y. Characteristics of urinary tract infection pathogens and their in Vitro susceptibility to antimicrobial agents in China: data from a multicenter study. BMJ Open. 2013;3(12):004152. doi: 10.1136/ bmjopen-2013-004152.
  4. Кульчавеня Е.В., Холтобин Д.П. Причины позднего выявления туберкулеза мочевого пузыря. Урология. 2015;3:29-32
  5. Кульчавеня Е.В., Неймарк А.И., Кондратьева Ю.С. Заболевания мочевого пузыря (монография). Германия: Palmarium Academium Publishing. 2013;140 с.
  6. Warren J.W., Abrutyn E., Hebel J.R., Johnson J.R., Schaeffer A.J., Stamm W.E. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis. 1999; 29:745-758.
  7. Sigler M., Leal J.E., Bliven K., Cogdill B., Thompson A. Assessment of appropriate antibiotic prescribing for urinary tract infections in an internal medicine clinic. South Med J. 2015;108(5):300-4. doi: 10.14423/SMJ.0000000000000278.
  8. Гаджиева З.К., Казилов Ю.Б., Аляев Ю.Г., Абоян И.А., Казилов Б.Р. Нарушения мочеиспускания. Все ли мы о них знаем? Урология. 2014;1:20-26
  9. Шевченко С.Ю., Кульчавеня Е.В., Зулин Я.В. Инфекции мочевыводящих путей в структуре поликлинического приема уролога. Медицина и образование в Сибири: эл. ресурс. 2013;5. (http://www.ngmu.ru/cozo/mos/article/ text_full.php?id=1140
  10. Stock I. Nitrofurantoin-clinical relevance in uncomplicated urinary tract infections. Med Monatsschr Pharm. 2014;37(7):242-248.
  11. Sakaan S.A., Twilla J.D., Usery J.B., Winton J.C.,Self T.H.Nitrofurantoin-induced hepatotoxicity: a rare yet serious complication. South Med J. 2014;107(2):107-13. doi: 10.1097/SMJ.0000000000000059.
  12. Sanchez G.V., Baird A.M., Karlowsky J.A., Master R.N., Bordon J.M. Nitrofurantoin retains antimicrobial activity against multidrug-resistant urinary Escherichia coli from US outpatients. J. Antimicrob Chemother. 2014;69(12):3259-62. doi: 10.1093/jac/dku282. Epub 2014 Jul 25.
  13. Синякова Л.А., Косова И. В. Антимикробная терапия неосложненных инфекций мочевых путей. Consilium Medicum. 2014;16(7):29-33
  14. Hirsch E.B., Raux B.R., Zucchi P.C., Kim Y., McCoy C., Kirby J.E., Wright S.B., Eliopoulos G.M. Activity of fosfomycin and comparison of several susceptibility testing methods against contemporary urine isolates. Int J. Antimicrob Agents. 2015;46(6):642-647. doi: 10.1016/j. ijantimicag.2015.08.012. Epub 2015 Sep 30.
  15. Kim H.Y., Lee S.J., Lee D.S., Yoo J.M., Choe H.S. Microbiological Characteristics of Unresolved AcuteUncomplicated Cystitis. Microb Drug Resist. 2016;22(5):387-389.
  16. Qin X., Hu F., Wu S., Ye X., Zhu D., Zhang Y., Wang M. Comparison of adhesin genes and antimicrobial susceptibilities between uropathogenic and intestinal commensal Escherichia coli strains. PLoS One. 2013;8(4):e61169. doi: 10.1371/journal.pone.0061169. Print 2013.
  17. Uzun C., Oncül O., Gümü§ D., Alan S., Dayioglu N., Küçüker MA. Virulence Genes and Antibiotic Susceptibilities of Uropathogenic E. coli Strains. Clin Lab. 2015;61(8):941-950.
  18. Veve M.P., Wagner J.L., Kenney R.M., Grunwald J.L., Davis S.L. Comparison of fosfomycin to ertapenem for outpatient or step-down therapy of extended-spectrum ß-lactamaseurinary tract infections. Int J. Antimicrob Agents. 2016;48(1):56-60. doi: 10.1016/j. ijantimicag.2016.04.014.
  19. Palou J., Angulo J.C., Ramôn de Fata F., Garcia-Tello A., Gonzalez-Enguita C., Boada A., Sanz M. Randomized comparative study for the assessment of a new therapeutic schedule of fosfomycin trometamol in postmenopausal women with uncomplicated lower urinary tract infection. Actas Urol Esp. 2013;37(3): 147-55. doi: 10.1016/j. acuro.2012.06.007. Epub 2012 Sep 17.
  20. Etienne M., Lefebvre E., Frebourg N., Hamel H., Pestel-Caron M., Caron F. Bacyst Study Group.Antibiotic treatment of acute uncomplicated cystitis based on rapid urine test and local epidemiology: lessons from a primary care series. BMC Infect Dis. 2014;14:137. doi: 10.1186/1471-2334-14-137.
  21. Kunishima Y., Sato S., Yamashita A. Clinical Study of Acute Uncomplicated Cystitis. Kansenshogaku Zasshi. 2015;89(5):579-582.
  22. Choi H., Kim Y.H., Bae J.H. Quality oflife and changes in symptom relief in patients withac ute uncomplicated cystitis treated with antibiotics: a prospective, open-label, multicenter, observational study. Eur J. Clin Microbiol Infect Dis. 2015;34(6):1119-24. doi: 10.1007/s10096-015-2329-6. Epub 2015 Feb 6.
  23. Ekwealor P.A., Ugwu M.C.,Ezeobi I., Amalukwe G., Ugwu B.C., Okezie U., Stanley C., Esimone C. Antimicrobial Evaluation of Bacterial Isolates from Urine Specimen of Patients with Complaints of Urinary Tract Infections in Awka. Nigeria. Int J. Microbiol. 2016;2016:9740273. doi: 10.1155/2016/9740273. Epub 2016 Apr 20.
  24. Hooton T.M., Roberts P.L., Cox M.E., Stapleton A.E. Voided midstream urine culture and acute cystitis in premenopausal women. N. Engl J. Med. 2013;369(20):1883-91. doi: 10.1056/NEJMoa1302186.
  25. Hamasuna R., Tanaka K., Hayami H., Yasuda M., Takahashi S., Kobayashi K., Kiyota H., Yamamoto S., Arakawa S., Matsumoto T. Japanese Research Group for UTI (JRGU).Treatment of acute uncomplicated cystitis with faropenem for 3 days versus 7 days: multicentre, randomized, open-label, controlled trial. J. Antimicrob Chemother. 2014;69(6):1675-80. doi: 10.1093/jac/dku014. Epub 2014 Feb 6.
  26. Alidjanov J.F., Abdufattaev U.A., Makhsudov S.A., Pilatz A., Akilov F.A., Naber K.G., Wagenlehner F.M. New self-reporting questionnaire to assess urinary tract infections and differential diagnosis: acute cystitis symptom score. Urol Int. 2014;92(2):230-6. doi: 10.1159/000356177. Epub 2014 Jan 23.
  27. Hayami H., Takahashi S., Ishikawa K., Yasuda M., Yamamoto S., Uehara S., Hamasuna R., Matsumoto T., Minamitani S., Watanabe A., Iwamoto A., Totsuka K., Kadota J., Sunakawa K., Sato J., Hanaki H., Tsukamoto T., Kiyota H., Egawa S., Tanaka K., Arakawa S., Fujisawa M., Kumon H., Kobayashi K., Matsubara A., Naito S., Tatsugami K., Yamaguchi T., Ito S., Kanokogi M., Narita H., Kawano H., Hosobe T., Takayama K., Sumii T., Fujii A., Sato T., Yamauchi T., Izumitani M., Chokyu H., Ihara H., Akiyama K., Yoshioka M., Uno S., Monden K., Kano M., Kaji S., Kawai S., Ito K., Inatomi H., Nishimura H., Ikuyama T., Nishi S., Takahashi K., Kawano Y., Ishihara S., Tsuneyoshi K., Matsushita S., Yamane T., Hirose T., Fujihiro S., Endo K., Oka Y., Takeyama K., Kimura T., Uemura T. Nationwide surveillance of bacterial pathogens from patients with acute uncomplicated cystitis conducted by the Japanese surveillance committee during 2009 and 2010: antimicrobial susceptibility of Escherichia coli and Staphylococcus saprophyticus. J Infect Chemother. 2013;19(3):393-403. doi: 10.1007/s10156-013-0606-9. Epub 2013 May 3.
  28. Жукова И.И., Кульчавеня Е.В., Холтобин Д.П., Брижатюк Е.В., Хомяков В.Т., Осадчий А.В. Туберкулез мочеполовой системы сегодня. Урология. 2013;1:13-16
  29. Кульчавеня Е.В., Брижатюк Е.В. Туберкулез мочевого пузыря: диагностика и лечение. Урология. 2006;3:61-65
  30. Kulchavenya E. Best practice in the diagnosis and management of Urogenital Tuberculosis. Ther Adv Urol. 2013;5(3): 143-51. doi: 10.1177/1756287213476128.
  31. Kulchavenya E., Zhukova I., Kholtobin D. Spectrum of Urogenital Tuberculosis J. Infect Chemother. 2013;19(5):880-883.
  32. Кульчавеня Е.В. Терапия ex juvantibus в дифференциальной диагностике туберкулеза мочеполовой системы. Туберкулез и болезни легких. 2001;2:29-32
  33. Grigoryan L., Trautner B.W., Gupta K. Diagnosis and management of urinary tract infections in the outpatient setting: a review. JAMA. 2014;312(16):1677-84. doi: 10.1001/jama.2014.12842.
  34. Кульчавеня Е.В., Брижатюк Е.В., Хомяков В.Т., Бреусов А.А. Частота возникновения цистита в зависимости от вида контрацепции. Урология. 2013;1:41-42
  35. Kladenskÿ J. Urinary tract infections in women-possibilities of differentiated approach in treatment and prevention. Ceska Gynekol. 2012;77(1):5-9.
  36. Wagenlehner F.M., Naber K.G. Prescribing behavior in urinary tract infection: inadequate implementation of guidelines in clinical practice. Dtsch Arztebl Int. 2012;109(50):876-7. doi: 10.3238/arztebl.2012.0876. Epub 2012 Dec 14.
  37. Кульчавеня Е.В., Бреусов А.А. Эффективность уро-ваксома при рецидивирующих инфекционно-воспалительных заболеваниях мочеполовой системы. Урология. 2011;4:7-11
  38. Кульчавеня Е.В., Бреусов А.А. Отдаленные результаты иммунопрофилактики рецидивов инфекций урогенитального тракта. Вестник урологии. 2013;2:3-8
  39. Wagenlehner F.M., Ballarini S., Pilatz A., Weidner W., Lehr L., Naber K.G. A Randomized, Double-Blind, Parallel-Group, Multicenter Clinical Study of Escherichia coli-Lyophilized Lysate for the Prophylaxis of Recurrent Uncomplicated Urinary Tract Infections. Urol Int. 2015;95(2):167-76. doi: 10.1159/000371894. Epub 2015 Feb 18.
  40. Набер К.Г., Алиджанов Ж.Ф. Существуют ли альтернативные методы антибактериальной терапии и профилактики неосложненных инфекций мочевыводящих путей? Урология. 2014;6:5-14
  41. Кульчавеня Е.В., Бреусов А.А., Брижатюк Е.В., Шевченко С.Ю. Острый цистит - всегда ли нужен антибиотик? Урология. 2016;1:25-28
  42. Naber K.G. New aspects on diagnostics and therapy of uncomplicated cystitis. Urologe A. 2014;53(10): 1489-94. doi: 10.1007/ s00120-014-3564-7.
  43. Vicariotto F. Effectiveness of an association of a cranberry dry extract, D-mannose, and the two microorganisms Lactobacillus plantarum LP01 and Lactobacillus paracasei LPC09 in women affected by cystitis: a pilot study. J. Clin Gastroenterol. 2014;48(1):96-101. doi: 10.1097/ MCG.0000000000000224.
  44. Рафальский В.В. Малев И.В., Рохли-ков И.М., Деревицкий А.В. Рациональная антибактериальная терапия амбулаторных инфекций мочевыводящих путей с учетом данных по резистентности основных уропатогенов в России. Трудный пациент. 2006;9:19-25

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies