The Net Guide: Urinary Tract Infections

MDNG Hospital Medicine, October 2010, Volume 4, Issue 5

The Educated PatientUrinary Tract Infections

This site from the National Kidney Foundation can serve as a starting point for patients who want to obtain information on urinary tract infections (UTIs). Among the topics covered are: how UTIs occur, which patients are most likely to experience UTIs, what are the symptoms, how UTIs are treated, what steps physicians might take if infections don’t recede with treatment, what can be done to prevent recurrent UTIs, and how kidneys might be affected.

Urinary Frequency Symptom Check-Up

Patients experiencing urinary frequency can visit this “interactive medical library” to determine whether they need to seek medical attention. Stephen Schueler, MD, an emergency physician and founder of freeMD, walks patients through a series of questions such as: “Do you have pain or burning during urination?” “Are you urinating more frequently than usual?” “Has your urine become red or pink?” and “Have you been vomiting?” After all questions have been answered, the site provides a list of recommendations, including a listing of the answers that were given, which patients can present to their physician.

Medical WebsitesComplicated Urinary Tract Infection

This offering from the Johns Hopkins Point-of-Care Information Technology Center provides information in bulleted format for clinicians with limited time to obtain information on complicated UTIs. Topics covered include pathogens, clinical, diagnosis, and treatment, which is further divided into three categories: antibiotics, surgical interventions, and prevention of complicated UTI (cUTI). Registered users can also choose from a list of drugs and click on it to find author comments, and access follow-up recommendations for patients with cUTI.

Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults

Don’t be fooled by the appearance of this site; although there is a wealth of data, it is neatly organized and enables users to quickly jump from one section to another. Originally published in Clinical Infectious Disease, this summary of the Infectious Diseases Society of America guidelines covers recommendations for the diagnosis and treatment of asymptomatic bacteriuria in adult populations. Included are recommendations specific to certain groups, including pregnant and diabetic women, elderly patients, patients with spinal cord injuries and indwelling urethral catheters, and immunocompromised patients.

CMEUrinary Tract Infection in Adult WomenCredits: 1.00

Fee: None

Expires: April, 2011

Multimedia: None

This activity is designed to provide guidance for clinicians in implementing a cost-effective management strategy for uncomplicated UTI in women. Key topics that will be covered include telephone management for women with previous UTI, drug regimens that have proven successful, the use of pretreatment cultures for uncomplicated UTI, and recommendations concerning alternate forms of contraception in women with UTI.

Urinary Tract Infection

Credits: 0.25

Fee: None

Expires: April 21, 2012

Multimedia: None

Read the case of a 25-year-old woman presenting with bloody urine and dysuria of 12-hour duration and take a brief quiz to improve your knowledge of the diagnosis of uncomplicated cystitis in women. This educational activity also reviews the most common bacterial cause of UTIs, and treatment of uncomplicated cystitis and asymptomatic bacteriuria.

Clinical TrialsComputer-Assisted Treatment of Urinary Tract Infection in Emergency Departments and Community Health Centers (UTI-Kiosk)Study Type: Interventional

Age/Gender Requirements: 18-64 years (female)

Sponsor: University of California, San Francisco

Purpose: To assess the utility of computer-assisted treatment for uncomplicated, recurrent UTIs for women receiving care in safety net health care facilities, and for certain types of complicated cystitis, such as women with voiding symptoms and one of the following complicating symptoms: fever, flank pain, or symptoms greater than 7 days.

Study for the Treatment of Complicated Urinary Tract Infection and Acute PyelonephritisStudy Type: Interventional

Age/Gender Requirements: 18-85 years (male/female)

Sponsor: Achaogen, Inc.

Purpose: This multi-center study is being conducted to assess the safety and efficacy of two doses of ACHN 490 injection administered IV in patients with complicated UTI or acute pyelonephritis; patients will be randomly assigned to one of three treatment regimens: levofloxacin (750mg daily for 5 days), ACHN-490 injection (15mg daily for 5 days), or ACHN-490 injection (10mg/kg daily for five days).

eAbstractsMeta-analysis of the Significance of Asymptomatic Bacteriuria in Diabetes MellitusJournal: Diabetes Care (October 2011)

Authors: Renko M, Tapanainen P, Tossavainen P, et al

Purpose: Researchers conducted a systematic review and meta-analysis of data to evaluate whether asymptomatic bacteriuria (ASB) is more common in patients with diabetes, and to clarify the clinical significance of ASB in this population.

Results: ASB was present in 12.2 % patients with diabetes compared with 4.5 % of healthy controls, and was more common both in patients with type 1 and 2 diabetes than in controls. Diabetics with ASB were found to experience albuminuria and symptomatic urinary tract infections more often than controls.

Risk Factors for Urinary Tract Infection after Renal Transplantation and Its Impact on Graft Function in Children and Young AdultsJournal: Journal of Urology (October 2010)

Authors: Silva A, Rodig N, Passerotti CP, et al

Purpose: To examine the relationship between pre-transplant and post-transplant UTIs on graft outcome, and the risk factors for post-transplant UTI in children who undergo renal transplantation.

Results: Although no correlation was found between history of UTI (either before or after transplant) and decreased graft function, history pre-transplant UTI was indicative of UTI following transplant. Therefore, patients with urological causes of renal failure may be at increased risk for post-transplant UTI.

Pharma Focus

Macrobid (Nitrofurantoin)

Clinical TrialsNitrofurantoin and Urinary Tract Infections (UTIs)Study Type: Interventional

Age/Gender Requirements: Not listed (female)

Sponsor: University of Pittsburgh

Purpose: To examine the effect of nitrofurantoin prophylaxis in women performing clean, intermittent self-catheterization after surgery for urinary incontinence or pelvic organ prolapse. Participants will be asked to answer questions, keep a brief diary of the experience, and report any symptoms of UTI.

eAbstracts

One Week of Nitrofurantoin Before Percutaneous Nephrolithotomy Significantly Reduces Upper Tract Infection and Urosepsis: A Prospective Controlled Study

Journal: Urology (June 2010)

Authors: Bag S, Kumar S, Taneja N, et al

Purpose: To determine the role of nitrofurantoin prophylaxis in reducing upper tract infection and urosepsis, a complication of percutaneous nephrolithotomy (PNL).

Results: Significantly low positive pelvic urine culture, positive stone culture, endotoxemia, and systemic inflammatory response system were reported in patients receiving nitrofurantoin prophylaxis. Prophylaxis with NFT a week before PNL was shown to be beneficial in the prevention of urosepsis and endotoxemia in patients with larger stones and HDN.