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Antibiotics
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Antibiotic Treatment in Urinary Tract Infections (UTIs)
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Antibiotic Treatment in Urinary Tract Infections (UTIs)

A special issue of Antibiotics (ISSN 2079-6382). This special issue belongs to the section "Antibiotic Therapy in Infectious Diseases".

Deadline for manuscript submissions: closed (30 April 2023) | Viewed by 9688

Special Issue Editor

Dr. Caroline Schneeberger

E-Mail Website
Guest Editor
Rijksinstituut voor Volksgezondheid en Milieu (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
Interests: antimicrobial resistance; Urinary Tract Infections(UTIs); asymptomatic bacteriuria (ASB); diagnostic and antibiotic stewardship

Special Issue Information

Dear Colleagues,

A urinary tract infection (UTI) is one of the most common infections across all age groups, assumed to be treated fairly easily and therefore not seen as a leading cause of preventable death. However, UTIs are getting more difficult or even impossible to treat due to increasing antimicrobial resistance (AMR). In a recent systematic analysis on global burden of AMR published in the Lancet they estimated that in 2019 around 250.000 deaths worldwide were associated with a UTI caused by resistant uropathogens. Therefore, there is an urgent need to investigate alternative treatment strategies; both antibiotic and non-antibiotic options.  

Contrastingly, unnecessary and incorrect use of antibiotics to treat a suspected UTI is a major driver for antimicrobial resistance. More effort should be made to improve correct antibiotic use by for example implementing antibiotic stewardship programs and supportive diagnostic tools. The latter can be effective in populations, like the increasing elderly population, where accurate diagnostic tests are lacking due to the high prevalence of asymptomatic bacteriuria (ASB) (bacteriuria without the presence of infection). Currently used urine tests are not suitable to differentiate between colonization (ASB) and infection (UTI), increasing the risk for overtreatment of ASB. 

Currently all over the world one is trying to develop new antibiotics and explore alternative applications of existing antibiotics. Moreover, one should investigate the possibilities for shorter antibiotic courses like a one-day course with fosfomycin, delayed treatment or “wait and see” strategies, since this may safely decrease antibiotic use. As UTI is a common infection, only a slight decline in antibiotic use, can have substantial effects on the total antibiotic (selective) pressure and AMR. 

The aim of this special issue is to update knowledge on antibiotic treatment strategies for UTI and to provide more insight into the AMR burden caused by UTI. Furthermore, we would like to provide a platform for novel ideas on how to reduce the total amount of antibiotics used to treat UTI. All types of studies are welcome including (systematic) reviews and qualitative research. 

Dr. Caroline Schneeberger
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Antibiotics is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • antibiotics
  • bacteriuria
  • antibiotic stewardship
  • Antimicrobial Resistance (AMR)
  • uropathogenes
  • treatment of UTIs
  • Urinary Tract Infection (UTI)

Published Papers (4 papers)

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Research

10 pages, 568 KiB  
Article
Prescription of Choreito, a Japanese Kampo Medicine, with Antimicrobials for Treatment of Acute Cystitis: A Retrospective Cohort Study
by Toru Sugihara, Jun Kamei, Hideo Yasunaga, Yusuke Sasabuchi and Tetsuya Fujimura
Antibiotics 2022, 11(12), 1840; https://doi.org/10.3390/antibiotics11121840 - 18 Dec 2022
Viewed by 2331
Abstract
Choreito, a Japanese Kampo medicine, is used to treat Japanese female patients for the quick relief of inflammatory symptoms associated with acute cystitis. We evaluated whether Choreito is effective in reducing antibiotic use and the number of clinic visits for these patients. Females [...] Read more.
Choreito, a Japanese Kampo medicine, is used to treat Japanese female patients for the quick relief of inflammatory symptoms associated with acute cystitis. We evaluated whether Choreito is effective in reducing antibiotic use and the number of clinic visits for these patients. Females aged 18–49 years who had acute cystitis for the first time, with no history of medical insurance use within 90 days prior to their visit, and no hospitalizations within the 30 days after their first visit were identified from the JMDC Claims Database between April 2018 and March 2021. For the 30 days after their first visit, patients who were given their first antimicrobial prescriptions with or without Choreito were compared regarding (i) the number of clinic visits, (ii) total antimicrobial prescription days, and (iii) the number of antimicrobial prescriptions adjusted for their age, Charlson comorbidity index, and the COVID-19 pandemic period (after April 2020). For the 319 and 8515 patients with or without a Choreito prescription, respectively, multivariable Poisson regression analyses showed that Choreito was significantly associated with a 5% shortening of a patient’s total antimicrobial prescription days (Beta, 0.950; p = 0.038), whereas no significant difference was observed in the number of clinic visits and antimicrobial prescriptions (p = 0.624 and p = 0.732, respectively). The prescription of Choreito in combination with antimicrobials was associated with a slight reduction in total antimicrobial use for acute cystitis among females. Full article
(This article belongs to the Special Issue Antibiotic Treatment in Urinary Tract Infections (UTIs))
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19 pages, 1745 KiB  
Article
Qualitative Analysis of a Twitter-Disseminated Survey Reveals New Patient Perspectives on the Impact of Urinary Tract Infection
by Marissa Valentine-King, Lindsey Laytner, Casey Hines-Munson, Kiara Olmeda, Barbara Trautner, Sheryl Justice, Christina Ching and Larissa Grigoryan
Antibiotics 2022, 11(12), 1687; https://doi.org/10.3390/antibiotics11121687 - 23 Nov 2022
Cited by 5 | Viewed by 2414
Abstract
Few studies have harnessed social media to explore patients’ experiences with urinary tract infection (UTI); therefore, we captured UTI experiences and future research suggestions through a Twitter-disseminated survey. The survey posed three qualitative questions inquiring about the impact of UTIs, greatest UTI management [...] Read more.
Few studies have harnessed social media to explore patients’ experiences with urinary tract infection (UTI); therefore, we captured UTI experiences and future research suggestions through a Twitter-disseminated survey. The survey posed three qualitative questions inquiring about the impact of UTIs, greatest UTI management hurdle, and research suggestions. We also asked participants to rate how seriously others perceive UTIs and the importance of UTIs in their life (scale: 1–100 (highest)). The study period spanned from January to June 2021. Coding was performed in duplicate, followed by thematic analysis. Of 466 participants from 22 countries, 128 considered their UTIs recurrent (n = 43) or chronic (n = 85). Six major themes emerged: UTIs drastically impact (1) physical and (2) mental health and (3) cause severe limitations in life activities. Patients reported (4) negative clinician interactions and perceived inadequate care, (5) a lack of knowledge and awareness surrounding UTIs, and (6) research gaps in UTI diagnostics and treatment. The participants considered UTIs extremely important (median: 100, IQR: 90–100), but characterized others’ perceptions of them as less serious (median: 20, IQR: 10–30). Our survey revealed a patient population struggling with UTIs, particularly chronic UTIs. Our findings highlight perceived shortcomings in current UTI treatment and diagnostics. Full article
(This article belongs to the Special Issue Antibiotic Treatment in Urinary Tract Infections (UTIs))
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11 pages, 2307 KiB  
Article
Recurrent E. coli Urinary Tract Infections in Nursing Homes: Insight in Sequence Types and Antibiotic Resistance Patterns
by Soemeja Hidad, Boas van der Putten, Robin van Houdt, Caroline Schneeberger and Sacha Daniëlle Kuil
Antibiotics 2022, 11(11), 1638; https://doi.org/10.3390/antibiotics11111638 - 16 Nov 2022
Cited by 5 | Viewed by 1672
Abstract
Introduction: Recurrent urinary tract infections (rUTI) largely contribute to antibiotic use in older adults. Understanding the genetic characteristics of Escherichia coli (E.coli) is needed to identify patients at risk for recurrence. The aim of this study was to obtain a greater understanding of [...] Read more.
Introduction: Recurrent urinary tract infections (rUTI) largely contribute to antibiotic use in older adults. Understanding the genetic characteristics of Escherichia coli (E.coli) is needed to identify patients at risk for recurrence. The aim of this study was to obtain a greater understanding of the genetics of E. coli rUTI in nursing home residents. Methods: This is a secondary analysis of a multicenter Dutch nursing home study (PROGRESS). E. coli strains from residents with a suspected UTI and positive urine culture were analyzed using antimicrobial susceptibility testing and whole-genome sequencing (WGS). Same-strain recurrences were identified by single-nucleotide polymorphism (SNP) analysis. Result: In total, 121 E. coli strains were analyzed using WGS, of which 54 belonged to a rUTI episode. One third of E. coli rUTI episodes were caused by the same strain (n = 18, 33.3%). Same-strain recurrence occurred anywhere between 30 and 434 days after the index UTI, caused by sequence types (ST): ST12, ST23, ST73, ST131, ST453, ST538 and ST2522, in seven nursing home residents. In both single UTI and rUTI, antimicrobial resistance rates were low. Conclusion: Recurrent UTI in nursing home residents are caused by same-strain E. coli as well as due to different E. coli strains or other uropathogens. Same-strain recurrence can occur over 400 days after the index UTI, suggesting that some strains have the ability to colonize the bladder or gut for longer periods. Full article
(This article belongs to the Special Issue Antibiotic Treatment in Urinary Tract Infections (UTIs))
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10 pages, 301 KiB  
Article
Emergence of Fosfomycin Resistance by Plasmid-Mediated fos Genes in Uropathogenic ESBL-Producing E. coli Isolates in Mexico
by Mario Galindo-Méndez, Humberto Navarrete-Salazar, Francisco Baltazar-Jiménez, Eduardo Muñoz-de la Paz, María Fernanda Sánchez-Mawcinitt, Alexis Gómez-Pardo, Elvira Garza-González, Luis Alfredo Ponce-de-León-Garduño, Rafael Franco-Cendejas, Rayo Morfín-Otero, Fabián Rojas-Larios, Juan Pablo Mena-Ramírez, Cecilia Teresita Morales-de-la-Peña, Lourdes García-Mendoza, Elena Victoria Choy-Chang, Laura Karina Avilés-Benítez, Eduardo López-Gutiérrez, Jorge Luis Canizales-Oviedo, Nicolás Eric Barlandas-Rendón, Joyarib Yanelli Maldonado-Anicacio, Alina Aracely Rosales-García and Heidy Leticia Ostos-Cantúadd Show full author list remove Hide full author list
Antibiotics 2022, 11(10), 1383; https://doi.org/10.3390/antibiotics11101383 - 09 Oct 2022
Cited by 7 | Viewed by 2193
Abstract
Fosfomycin is currently a viable option against urinary tract infections, particularly against extended-spectrum β-lactamases (ESBL)-producing E. coli, due to its unique mechanism of action and its low resistance among bacteria. The objective of this study was to investigate two of the three [...] Read more.
Fosfomycin is currently a viable option against urinary tract infections, particularly against extended-spectrum β-lactamases (ESBL)-producing E. coli, due to its unique mechanism of action and its low resistance among bacteria. The objective of this study was to investigate two of the three most common mechanisms of resistance against this antibiotic among 350 ESBL-producing E. coli strains isolated from the urine of Mexican patients. The prevalence of fosfomycin resistance in our study was 10.9% (38/350). Of all resistant isolates analyzed, 23 (60.5%) were identified as fos-producing organisms, with 14 strains carrying fosA3 and 9, fosA1. Additionally, 11 (28.9%) fosfomycin-resistant isolates presented resistance due to impaired antibiotic transport and 8 (21.0%) both mechanisms. No resistance mechanism investigated in the study was found on 12 strains. All 38 confirmed ESBL-producing isolates carried a blaCTX-M subtype, 36 (94.5%) belonged to the O25b-ST131 clone, and all of them were able to transfer the fosfomycin resistance trait to recipient strains horizontally. This is the first study in Mexico demonstrating a plasmid-mediated fosfomycin resistance mechanism among clinical E. coli strains. Since our results suggest a strong association among fos and blaCTX-M genes and ST131 clones in uropathogenic E. coli, plasmid-mediated fosfomycin resistance should be closely monitored. Full article
(This article belongs to the Special Issue Antibiotic Treatment in Urinary Tract Infections (UTIs))
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