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Engel DR, Wagenlehner FME, Shevchuk O. Scientific Advances in Understanding the Pathogenesis, Diagnosis, and Prevention of Urinary Tract Infection in the Past 10 Years. Infect Dis Clin North Am 2024; 38:229-240. [PMID: 38575493 DOI: 10.1016/j.idc.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Urinary tract infection (UTI) is a very common disease that is accompanied by various complications in the affected person. UTI triggers diverse inflammatory reactions locally in the infected urinary bladder and kidney, causing tissue destruction and organ failure. Moreover, systemic responses in the entire body carry the risk of urosepsis with far-reaching consequences. Understanding the cell-, organ-, and systemic mechanisms in UTI are crucial for prevention, early intervention, and current therapeutic approaches. This review summarizes the scientific advances over the last 10 years concerning pathogenesis, prevention, rapid diagnosis, and new treatment approaches. We also highlight the impact of the immune system and potential new therapies to reduce progressive and recurrent UTI.
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Affiliation(s)
- Daniel R Engel
- Department of Immunodynamics, University Duisburg-Essen, University Hospital Essen, Institute of Experimental Immunology and Imaging, Hufelandstraße 55, 45147 Essen, Germany
| | - Florian M E Wagenlehner
- Justus-Liebig University Giessen, Clinic for Urology, Paediatric Urology and Andrology, Rudolf-Buchheim Straße 7, 35392 Giessen, Germany
| | - Olga Shevchuk
- Department of Immunodynamics, University Duisburg-Essen, University Hospital Essen, Institute of Experimental Immunology and Imaging, Hufelandstraße 55, 45147 Essen, Germany.
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Piontek K, Nestler S, Holm A, Brodersen JB, Apfelbacher C. Content Validity and Psychometric Properties of the German Version of the Holm and Cordoba Urinary Tract Infection Score for Uncomplicated Urinary Tract Infections in Women: Protocol for a Validation Study. JMIR Res Protoc 2024; 13:e49903. [PMID: 38713509 PMCID: PMC11109859 DOI: 10.2196/49903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/09/2024] [Accepted: 01/25/2024] [Indexed: 05/08/2024] Open
Abstract
BACKGROUND Uncomplicated urinary tract infections (UTIs) in women are among the most common bacterial infections in primary care. Given the health threats related to the overuse of antibiotics, alternative options are of increasing importance. Patient-reported outcome measures are valuable tools for including the patients' perspective when evaluating the efficacy of these strategies. Aiming to identify a suitable instrument to measure the severity and bothersomeness of UTI symptoms in women, we performed a systematic review of the literature and identified the Holm and Cordoba Urinary Tract Infection Score (HCUTI), which measures the severity, bothersomeness, and impact of uncomplicated UTIs on daily activities. This instrument showed sufficient content validity but needs translation and further validation before it can be used in German research. OBJECTIVE For use in the German setting, we aim (1) to perform translation and linguistic validation of the HCUTI and (2) to evaluate content validity and psychometric properties of the German version of the HCUTI in a population of women with uncomplicated UTIs. METHODS The HCUTI will be translated and linguistically validated using the dual-panel method. This process involves a bilingual translation panel and a lay panel to check the comprehensibility of the translation. Content validity of the translated questionnaire will be assessed using cognitive interviews according to the criteria for good content validity as recommended by the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) group involving women with uncomplicated UTIs and health care professionals. Subsequent psychometric validation of the German version of the HCUTI in a population of women with uncomplicated UTIs will include the assessment of structural validity, internal consistency, test-retest reliability, construct validity, responsiveness, and interpretability. RESULTS Results of the translation and linguistic validation process and the results of the content validity study were obtained in September 2023 and will be published separately. Data on the psychometric properties of the German version of the HCUTI are anticipated in mid-2024. CONCLUSIONS We expect that data from the content validity study will provide important suggestions for potential modifications of the HCUTI for use in the German setting. The final version of the questionnaire will be used for the assessment of its psychometric properties in a large population of women with uncomplicated UTIs. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) PRR1-10.2196/49903.
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Affiliation(s)
- Katharina Piontek
- Institute of Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Magdeburg, Germany
| | - Sophie Nestler
- Institute of Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Magdeburg, Germany
| | - Anne Holm
- The Centre of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- The Centre of General Practice, University of Copenhagen, Copenhagen, Denmark
- The Research Unit for General Practice, Region Zealand, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty Magdeburg, Magdeburg, Germany
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Simoni A, Schwartz L, Junquera GY, Ching CB, Spencer JD. Current and emerging strategies to curb antibiotic-resistant urinary tract infections. Nat Rev Urol 2024:10.1038/s41585-024-00877-9. [PMID: 38714857 DOI: 10.1038/s41585-024-00877-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/26/2024] [Indexed: 05/23/2024]
Abstract
Rising rates of antibiotic resistance in uropathogenic bacteria compromise patient outcomes and prolong hospital stays. Consequently, new strategies are needed to prevent and control the spread of antibiotic resistance in uropathogenic bacteria. Over the past two decades, sizeable clinical efforts and research advances have changed urinary tract infection (UTI) treatment and prevention strategies to conserve antibiotic use. The emergence of antimicrobial stewardship, policies from national societies, and the development of new antimicrobials have shaped modern UTI practices. Future UTI management practices could be driven by the evolution of antimicrobial stewardship, improved and readily available diagnostics, and an improved understanding of how the microbiome affects UTI. Forthcoming UTI treatment and prevention strategies could employ novel bactericidal compounds, combinations of new and classic antimicrobials that enhance bacterial killing, medications that prevent bacterial attachment to uroepithelial cells, repurposing drugs, and vaccines to curtail the rising rates of antibiotic resistance in uropathogenic bacteria and improve outcomes in people with UTI.
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Affiliation(s)
- Aaron Simoni
- The Kidney and Urinary Tract Center, Nationwide Children's Abigail Wexner Research Institute, Columbus, OH, USA
| | - Laura Schwartz
- The Kidney and Urinary Tract Center, Nationwide Children's Abigail Wexner Research Institute, Columbus, OH, USA
- Department of Pediatrics, Division of Nephrology and Hypertension, Nationwide Children's, Columbus, OH, USA
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Guillermo Yepes Junquera
- Department of Pediatrics, Division of Infectious Diseases, Nationwide Children's, Columbus, OH, USA
| | - Christina B Ching
- The Kidney and Urinary Tract Center, Nationwide Children's Abigail Wexner Research Institute, Columbus, OH, USA
- Department of Urology, Nationwide Children's, Columbus, OH, USA
| | - John David Spencer
- The Kidney and Urinary Tract Center, Nationwide Children's Abigail Wexner Research Institute, Columbus, OH, USA.
- Department of Pediatrics, Division of Nephrology and Hypertension, Nationwide Children's, Columbus, OH, USA.
- The Ohio State University College of Medicine, Columbus, OH, USA.
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Curtis Nickel J, Foley S, Yang B, Casanovas M, Caballero R, Diez-Rivero CM, Lorenzo-Gómez MF. Reducing Recurrent Urinary Tract Infections in Women with MV140 Impacts Personal Burden of Disease: Secondary Analyses of a Randomized Placebo-controlled Efficacy Study. EUR UROL SUPPL 2024; 63:96-103. [PMID: 38585593 PMCID: PMC10995795 DOI: 10.1016/j.euros.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
Background Recurrent urinary tract infection (rUTI) remains a major health burden for women. A randomized, double-blind, placebo-controlled trial (RCT; NCT02543827) reported that female patients with rUTI receiving a sublingual vaccine, MV140, had a reduction in rUTI and increase in UTI-free rate compared with placebo. Objective To determine the impact of MV140 on the personal burden of disease in women with rUTI using secondary endpoint data from the pivotal RCT evaluating MV140. Design setting and participants In the primary RCT, female patients with rUTI enrolled in Spain and UK (from October 2015 to April 2019) were randomized to placebo (6 mo) or MV140 (3 or 6 mo), and followed for 12 mo. Individuals analyzed in this secondary analysis included those in the placebo and 3-mo (recommended dose) groups. Intervention A polybacterial sublingual vaccine, MV140 (four inactivated whole-cell bacteria-Escherichia coli, Klebsiella pneumoniae, Proteus vulgaris, and Enterococcus faecalis), or placebo. Outcome measurements and statistical analysis Symptom severity scoring, antibiotic use, safety, and multiple aspects of quality of life (QoL; Short-Form Questionnaire [SF-36]) were assessed. Results and limitations Compared with the placebo group (n = 76), the 3-mo vaccinated group (n = 74) experienced fewer overall UTI symptoms (mean symptom score 102.2 ± 222.9 vs 194.2 ± 178.8; p = 0.0002), fewer days on antibiotics (12.4 ± 17.7 vs 28.7 ± 25.2; p = 0.0001), and improved total, general, and physical SF-36 QoL improvement (differences in means for total SF-36 score 15.7; 95% confidence interval [CI] 8.80, 22.64; p < 0.0001), with only social function QoL showing no impact (4.07; 95% CI -4.93, 13.08; p = 0.3744). Conclusions Three months of MV140 is associated with a reduction of the personal burden of UTI by reducing overall UTI symptoms and antibiotic use, improving QoL in women with rUTI. Patient summary Three months of MV140 vaccine, which has previously been shown to reduce the risk of urinary tract infection safely, is associated with a reduction in the personal burden of disease.
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Affiliation(s)
| | | | - Bob Yang
- Royal Berkshire Hospital, Reading, UK
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Cai T, Verze P, Arcaniolo D, Pandolfo SD, Smarrazzo F, Manfredi C, Tascini C, Caciagli P, Lanzafame M, De Sio M, Wagenlehner F, Johansen TEB, Palmieri A. Antibiotic Resistance Patterns Among Uropathogens in Female Outpatients Affected by Uncomplicated Cystitis: Focus on Fosfomycin Trometamol. Int J Antimicrob Agents 2023; 62:106974. [PMID: 37739241 DOI: 10.1016/j.ijantimicag.2023.106974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 08/30/2023] [Accepted: 09/15/2023] [Indexed: 09/24/2023]
Abstract
OBJECTIVES To report the resistance rate against fosfomycin trometamol among outpatient women with symptoms related to urinary tract infections over a 6-year period in a multicentre, cross-sectional study. METHODS Urinary samples were collected from three high-volume laboratories from January 2015 to December 2020. The pattern of resistance to fosfomycin was analysed by using the Vitek II automated system. RESULTS A total of 7289 urinary samples were collected and 8321 strains were analysed during the study period. The most commonly isolated uropathogen was Escherichia coli (n = 6583, 79.1%). The mean resistance rate against fosfomycin was 9.7% (range 7.1-11.3). No statistically significant difference was found between the three laboratories (P = 0.53). There was no significant increase in resistance rate during the study period. The mean resistance rate against fosfomycin was higher among extended-spectrum β-lactamase (ESBL)-producing bacteria when compared with non-ESBL-producing strains (10.8% vs. 7.9%; P < 0.001). CONCLUSION Uropathogens isolated from women affected by cystitis remained highly susceptible to fosfomycin. These findings confirm recommendations in international guidelines that advocate fosfomycin trometamol for empirical treatment of uncomplicated cystitis in women.
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Affiliation(s)
- Tommaso Cai
- Department of Urology, Santa Chiara Regional Hospital, Trento, Italy; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Paolo Verze
- Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Davide Arcaniolo
- Department of Urology, University of Naples, Vanvitelli, Naples, Italy
| | - Savio Domenico Pandolfo
- Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Francesco Smarrazzo
- Department of Medicine, Surgery, Dentistry "Scuola Medica Salernitana", University of Salerno, Baronissi, Italy
| | - Celeste Manfredi
- Department of Urology, University of Naples, Vanvitelli, Naples, Italy
| | - Carlo Tascini
- Department of Medicine, Infectious Diseases Clinic, University of Udine, Udine, Italy
| | - Patrizio Caciagli
- Department of Laboratory Medicine, Santa Chiara Regional Hospital, Trento, Italy
| | | | - Marco De Sio
- Department of Urology, University of Naples, Vanvitelli, Naples, Italy
| | - Florian Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University Giessen, Giessen, Germany
| | - Truls E Bjerklund Johansen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Urology, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
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Wanifuchi A, Kyoda Y, Ogasawara T, Kobayashi K, Ito N, Shindo T, Takahashi A, Kunishima Y, Masumori N. Difference in symptom manifestation between postmenopausal and premenopausal women in acute uncomplicated cystitis: A multi-institutional pilot study. Curr Urol 2023; 17:174-178. [PMID: 37448620 PMCID: PMC10337814 DOI: 10.1097/cu9.0000000000000197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 09/19/2022] [Indexed: 04/05/2023] Open
Abstract
Objectives We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy. Materials and methods This study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020. After registration, we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score (CLSS) questionnaire. Results After treatment, pyuria disappeared in 60 of the 66 patients (14 premenopausal and 46 postmenopausal). The CLSS total score (range) changed from 13 (3-29) to 4 (0-18) with a significant improvement in all CLSS items. At baseline, nocturia, urgency, and urgency incontinence were more prominent in postmenopausal women than in premenopausal women. In contrast, baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women. After treatment, the CLSS total score was still higher in postmenopausal women, as reflected by the relatively higher scores for nocturia and urgency, irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups. Conclusions Our results suggest that if storage symptoms persist, they should be carefully interpreted according to menopausal status.
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Affiliation(s)
- Atsushi Wanifuchi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yuki Kyoda
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takuto Ogasawara
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Ko Kobayashi
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Naoki Ito
- Department of Urology, NTT East Sapporo Hospital, Sapporo, Japan
| | - Tetsuya Shindo
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Atsushi Takahashi
- Department of Urology, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | | | - Naoya Masumori
- Department of Urology, Sapporo Medical University School of Medicine, Sapporo, Japan
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Arda E, Alidjanov J, Ates S, Çek M, Piatz A, Wagenlehner FM, Naber KG. Linguistic and clinical validation of the Turkish version of Acute Cystitis Symptom Score for the diagnosis and patient-reported outcome in acute uncomplicated cystitis. Investig Clin Urol 2023; 64:279-288. [PMID: 37341008 DOI: 10.4111/icu.20230010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 06/22/2023] Open
Abstract
PURPOSE The Acute Cystitis Symptom Score (ACSS) was developed as a self-reporting questionnaire for diagnosing and monitoring acute uncomplicated cystitis (AC) in female patients. The study aims at the translation of the ACSS into Turkish from the original Uzbek including its linguistic, cognitive and clinical validation. MATERIALS AND METHODS After forward and backward translation of the ACSS from Uzbek to Turkish and vice versa, the cognitive assessment of the Turkish ACSS was performed on 12 female subjects to achieve the final study version. RESULTS The clinical validation was performed on a total of 120 female respondents including 64 Patients with AC and 56 controls without AC. For clinical diagnosis of AC, the predefined summary score of the typical symptoms of >6 showed high values (95% confidence interval) for sensitivity (0.88 [0.77-0.94]), specificity (0.98 [0.91-1.00]), and diagnostic accuracy (0.93 [0.86-0.97]). All patients were followed up between five to nine days after the baseline visit. Forty-four (68.75%) patients used antimicrobial treatment, whereas the rest (31.25%) preferred non-antimicrobial treatment. The severity scores of the typical symptoms and the quality of life were reduced significantly at follow-up. Using different (favored) thresholds for successful and non-successful treatment a clinical success rate between 54.7% and 64.1% (60.9%) was achieved. CONCLUSIONS After translation from the original Uzbek and cognitive assessment, the Turkish ACSS showed similar good results for clinical diagnosis and patient-reported outcome as in other languages validated so far and could therefore now be used for clinical studies as well as in everyday practice.
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Affiliation(s)
- Ersan Arda
- Department of Urology, Medical Faculty of Trakya University, Edirne, Türkiye
| | - Jakhongir Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Sinan Ates
- Department of Gynaecology, Medical Faculty of Trakya University, Edirne, Türkiye
| | - Mete Çek
- Department of Urology, Medical Faculty of Trakya University, Edirne, Türkiye.
| | - Adrian Piatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
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Piontek K, Donhauser T, Kann G, Fechtner M, Apfelbacher C, Gabes M. Patient-reported outcome measures for uncomplicated urinary tract infections in women: a systematic review. Qual Life Res 2023:10.1007/s11136-023-03358-5. [PMID: 36795285 PMCID: PMC10329060 DOI: 10.1007/s11136-023-03358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2023] [Indexed: 02/17/2023]
Abstract
PURPOSE To conduct a systematic review of the quality of existing patient-reported outcome measures (PROMs) for use in women with uncomplicated urinary tract infections (UTIs) applying the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology, and to derive recommendations for their use in future research. METHODS A systematic literature search was performed in PubMed and Web of Science. Studies reporting on the development and/or validation of any PROMs for uncomplicated UTIs in women were considered eligible. We evaluated the methodological quality of each included study using the COSMIN Risk of Bias Checklist, and further applied predefined criteria for good measurement properties. Finally, we graded the evidence and derived recommendations for the use of the included PROMs. RESULTS Data from 23 studies reporting on six PROMs were included. From those, the Acute Cystitis Symptom Score (ACSS) and the Urinary Tract Infection-Symptom and Impairment Questionnaire (UTI-SIQ-8) can be recommended for further use. Both instruments showed sufficient content validity. We further found high-quality evidence for sufficient internal consistency of the UTI-SIQ-8, while this criterion was not assessed for the ACSS due to a formative measurement model. All other PROMs have the potential to be recommended for use, but require further validation. CONCLUSION The ACSS and the UTI-SIQ-8 have the potential to be recommended for use in women with uncomplicated UTIs in future clinical trials. For all included PROMs, further validation studies are indicated. SYSTEMATIC REVIEW REGISTRATION PROSPERO.
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Affiliation(s)
- Katharina Piontek
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Theresa Donhauser
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Gesina Kann
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Marie Fechtner
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Christian Apfelbacher
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Michaela Gabes
- Institute of Social Medicine and Health Systems Research, Medical Faculty, Otto-von-Guericke University Magdeburg, Leipziger Str. 44, 39120, Magdeburg, Germany
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Newlands AF, Roberts L, Maxwell K, Kramer M, Price JL, Finlay KA. Development and psychometric validation of a patient-reported outcome measure of recurrent urinary tract infection impact: the Recurrent UTI Impact Questionnaire. Qual Life Res 2023; 32:1745-1758. [PMID: 36740638 PMCID: PMC10172217 DOI: 10.1007/s11136-023-03348-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2023] [Indexed: 02/07/2023]
Abstract
PURPOSE Recurrent urinary tract infection (rUTI) is a highly prevalent condition associated with significant poor quality of life outcomes. A patient-reported outcome measure (PROM) of rUTI-associated psychosocial impact is urgently required to supplement clinical evaluation and validate the challenges experienced by patients. This study therefore developed and validated the Recurrent UTI Impact Questionnaire (RUTIIQ). METHODS A rigorous four-stage methodology was followed: (I) concept elicitation through a qualitative survey of the experiences of people with rUTI (N = 1983); (II) Delphi expert screening of the RUTIIQ with expert rUTI clinicians (N = 15); (III) one-to-one cognitive interviews with people experiencing rUTI (N = 28) to evaluate the comprehensiveness and comprehensibility of the RUTIIQ, and (IV) full pilot testing of the RUTIIQ with people experiencing rUTI (N = 240) to perform final item reduction and psychometric analysis. RESULTS Exploratory factor analysis demonstrated a five-factor structure comprising: 'patient satisfaction', 'work and activity interference', 'social wellbeing', 'personal wellbeing', and 'sexual wellbeing', collectively accounting for 73.8% of the total variance in pilot scores. Results from expert clinicians and patients indicated strong item content validity (I-CVI > .75). The internal consistency and test-retest reliability of the RUTIIQ subscales were excellent (Cronbach's α = .81-.96, ICC = .66-.91), and construct validity was strong (Spearman's ρ > .69). CONCLUSION The RUTIIQ is a 30-item questionnaire with excellent psychometric properties, assessing the patient-reported psychosocial impact of living with rUTI symptoms and pain. This new instrument delivers the unique opportunity to enhance patient-centred care through standardised observation and monitoring of rUTI patient outcomes. TRIAL REGISTRATION This study was pre-registered with ClinicalTrials.gov (identifier: NCT05086900).
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Affiliation(s)
- Abigail F Newlands
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 7BE, UK
| | - Lindsey Roberts
- School of Psychology, University of Buckingham, Buckingham, MK18 1EG, UK
| | - Kayleigh Maxwell
- Department of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, FK9 4LA, UK
| | - Melissa Kramer
- Live UTI Free Ltd, Ardeen House, 10-11 Marine Terrace, Dun Laoghaire, Dublin, Ireland
| | - Jessica L Price
- Live UTI Free Ltd, Ardeen House, 10-11 Marine Terrace, Dun Laoghaire, Dublin, Ireland
| | - Katherine A Finlay
- School of Psychology and Clinical Language Sciences, University of Reading, Reading, RG6 7BE, UK.
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Newlands AF, Roberts L, Maxwell K, Kramer M, Price JL, Finlay KA. The Recurrent Urinary Tract Infection Symptom Scale: Development and validation of a patient‐reported outcome measure. BJUI COMPASS 2023; 4:285-297. [PMID: 37025478 PMCID: PMC10071086 DOI: 10.1002/bco2.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 12/24/2022] [Accepted: 12/30/2022] [Indexed: 01/18/2023] Open
Abstract
Objectives This study aimed to develop and validate a tailored patient-reported outcome measure (PROM) evaluating the patient experience of recurrent urinary tract infection (rUTI) symptom severity. This measure was designed to supplement clinical testing methods, allowing full assessment of the patient experience of rUTI symptom burden, while enhancing patient-centred UTI management and monitoring. Subjects and Methods The Recurrent Urinary Tract Infection Symptom Scale (RUTISS) was developed and validated using a three-stage methodology, in accordance with gold-standard recommendations. Firstly, a two-round Delphi study was conducted to gain insights from 15 international expert clinicians working in rUTI, developing an initial pool of novel questionnaire items, assessing content validity and making item refinements. Next, two phases of one-to-one semi-structured cognitive interviews were conducted with a diverse sample of 28 people experiencing rUTI to assess questionnaire comprehensiveness and comprehensibility, making refinements after each phase. Finally, a comprehensive pilot of the RUTISS was conducted with 240 people experiencing rUTI across 24 countries, providing data for psychometric testing and item reduction. Results Exploratory factor analysis indicated a four-factor structure comprising: 'urinary pain and discomfort', 'urinary urgency', 'bodily sensations' and 'urinary presentation', together accounting for 75.4% of the total variance in data. Qualitative feedback from expert clinicians and patients indicated strong content validity for items, which was supported by high content validity indices in the Delphi study (I-CVI > 0.75). Internal consistency and test-retest reliability of the RUTISS subscales were excellent (Cronbach's α = 0.87-0.94 and ICC = 0.73-0.82, respectively), and construct validity was strong (Spearman's ρ = 0.60-0.82). Conclusion The RUTISS is a 28-item questionnaire with excellent reliability and validity, which dynamically assesses patient-reported rUTI symptoms and pain. This new PROM offers a unique opportunity to critically inform and strategically enhance the quality of rUTI management, patient-clinician interactions, and shared-decision making by monitoring key patient-reported outcomes.
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Affiliation(s)
- Abigail F. Newlands
- School of Psychology and Clinical Language Sciences University of Reading Reading UK
| | | | - Kayleigh Maxwell
- Department of Psychology, Faculty of Natural Sciences University of Stirling Stirling UK
| | | | | | - Katherine A. Finlay
- School of Psychology and Clinical Language Sciences University of Reading Reading UK
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Hernández-Hernández D, Ortega-González Y, Padilla-Fernández B, Gutiérrez-Hernández PR, Castro-Díaz DM. Management of Acute Cystitis in the Era of COVID-19. CURRENT BLADDER DYSFUNCTION REPORTS 2023; 18:10-15. [PMID: 36466948 PMCID: PMC9684745 DOI: 10.1007/s11884-022-00677-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2022] [Indexed: 11/24/2022]
Abstract
Purpose of Review No specific guidelines have been developed for acute cystitis management during the COVID-19 pandemic. This review aims to provide up-to-date information about treatment and follow-up in patients with symptoms suggesting lower urinary tract infection. Recent Findings Uncomplicated cystitis does not need microbiological confirmation; thus, clinical diagnosis via telephone interview or questionnaires may be done. When complicated infections are suspected, in-person evaluation or close follow-up is mandatory. Antibiotic treatment is still the gold standard for treatment, although non-pharmacological strategies have also been suggested and further investigations are warranted. Summary Urinary tract infections are still a frequent reason for consultation that needs to be addressed in both primary care and specialized levels. Their management during the pandemic is similar than in precedent years, but telehealth options have emerged which can facilitate diagnosis and treatment.
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Affiliation(s)
- David Hernández-Hernández
- Department of Urology, Hospital Universitario de Canarias, Carretera de Ofra, S/N, 38320 San Cristóbal de La Laguna, Tenerife Spain
| | - Yanira Ortega-González
- Department of Urology, Hospital Universitario de Canarias, Carretera de Ofra, S/N, 38320 San Cristóbal de La Laguna, Tenerife Spain
| | - Bárbara Padilla-Fernández
- Department of Urology, Hospital Universitario de Canarias, Carretera de Ofra, S/N, 38320 San Cristóbal de La Laguna, Tenerife Spain ,Departamento de Cirugía, Universidad de La Laguna, San Cristóbal de La Laguna, Tenerife Spain
| | - Pedro Ramón Gutiérrez-Hernández
- Department of Urology, Hospital Universitario de Canarias, Carretera de Ofra, S/N, 38320 San Cristóbal de La Laguna, Tenerife Spain ,Departamento de Cirugía, Universidad de La Laguna, San Cristóbal de La Laguna, Tenerife Spain
| | - David Manuel Castro-Díaz
- Department of Urology, Hospital Universitario de Canarias, Carretera de Ofra, S/N, 38320 San Cristóbal de La Laguna, Tenerife Spain ,Departamento de Cirugía, Universidad de La Laguna, San Cristóbal de La Laguna, Tenerife Spain
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12
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Medina-Polo J, Arrébola-Pajares A, Corrales-Riveros JG, Alidjanov JF, Lorenzo-Gómez MF, Tapia AMH, Martínez-Berganza ML, Ospina-Galeano IA, Padilla-Fernández B, Pilatz A, Naber KG, Wagenlehner FM. Validation of the Spanish Acute Cystitis Symptoms Score (ACSS) in native Spanish-speaking women of Europe and Latin America. Neurourol Urodyn 2023; 42:263-281. [PMID: 36335613 PMCID: PMC10098495 DOI: 10.1002/nau.25079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 08/29/2022] [Accepted: 10/17/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION AND OBJECTIVES The Acute Cystitis Symptom Score (ACSS) is a patient self-reporting questionnaire for clinical diagnostics and patient-reported outcome (PRO), which may assess the symptoms and the effect on the quality of life in women with acute cystitis (AC). The current study aimed to create a validated Spanish version of the ACSS questionnaire. MATERIAL AND METHODS The process of linguistic validation of the Spanish version of the ACSS consisted of the independent forward and backward translations, revision and reconciliation, and cognitive assessment. Clinical evaluation of the study version of the ACSS was carried out in clinics in Spain and Latin America. Statistical tests included the calculation of Cronbach's α, split-half reliability, specificity, sensitivity, diagnostic odds ratio, positive and negative likelihood ratio, and area under the receiver-operating characteristic curve (AUC). RESULTS The study was performed on 132 patients [age (mean;SD) 45.0;17.8 years] with AC and 55 controls (44.5;12.2 years). Cronbach's α of the ACSS was 0.86, and the split-half reliability was 0.82. The summary scores of the ACSS domains were significantly higher in patients than in controls, 16.0 and 2.0 (p < 0.001), respectively. The predefined cut-off point of ≥6 for a summary score of the "Typical" domain resulted in a specificity of 83.6% and a sensitivity of 99.2% for the Spanish version of the ACSS. AUC was 0.91 [0.85; 0.97]. CONCLUSIONS The validated Spanish ACSS questionnaire evaluates the symptoms and clinical outcomes of patients with AC. It can be used as a patient's self-diagnosis of AC, as a PRO measure tool, and help to rule out other pathologies in patients with voiding syndrome.
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Affiliation(s)
- José Medina-Polo
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, HM Hospitales & ROC Clinic, Madrid, Spain
| | - Ana Arrébola-Pajares
- Department of Urology, Health Research Institute i+12, Hospital Universitario 12 de Octubre, HM Hospitales & ROC Clinic, Madrid, Spain
| | | | - Jakhongir F Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | | | - Ana-María H Tapia
- Department of Urology, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | | | - Bárbara Padilla-Fernández
- Department of Urology, Neurolourology and Functional Urology Unit, Complejo Hospitalario Universitario de Canarias, Tenerife, Spain
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
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13
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Klußmann D, Wagenlehner F. Rezidivierende Harnwegsinfektionen – was tun? Dtsch Med Wochenschr 2022; 147:1140-1145. [DOI: 10.1055/a-1866-9470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Was ist neu?
Nicht antibiotische Therapieregime Neben allgemeiner Aufklärung und Beratung über Risikofaktoren von Harnwegsinfektionen sind vor allem die nichtantibiotischen Therapie-Optionen zur Rezidivreduktion wichtig. Das Ziel hierbei ist es, Resistenzentwicklungen und den entsprechenden unerwünschten Nebenwirkungen von Antibiotika vorzubeugen. Zu den nicht antibiotischen Strategien zählen allen voran eine persönliche Beratung mit Vermittlung von Verhaltensempfehlungen, die Immunoprophylaxe, Phytotherapeutika, sowie eine lokale Östrogensubstitution
Antibiotische Prävention Bei hohem Leidensdruck der Patientinnen ist jedoch nach entsprechender Abwägung auch eine antibiotische Prophylaxe in Betracht zu ziehen. Zusammenfassend sollte eine individuelle Beratung erfolgen und es sollte mit einem multimodalen Therapieansatz behandelt werden.
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Affiliation(s)
- Daniel Klußmann
- Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
| | - Florian Wagenlehner
- Justus-Liebig-Universität Gießen, Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Gießen
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14
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Tóth B, Jávorházy A, Nyirády P, Csupor-Löffler B, Birinyi P, Zhanel G, Naber K, Länger R, Vörhendi N, Gede N, Váncsa S, Hegyi P, Csupor D. Bea rberry in the treatment of acute unco mpl icated cystitis (BRUMI): protocol of a multicentre, randomised double-blind clinical trial. BMJ Open 2022; 12:e057982. [PMID: 35750460 PMCID: PMC9234905 DOI: 10.1136/bmjopen-2021-057982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Bearberry (Arctostaphylos uva-ursi) leaf is available as a treatment of uncomplicated cystitis in several European countries. The antimicrobial activity of its extracts and some of its individual constituents has been observed in vitro; however, the efficacy of bearberry compared with standard antimicrobial therapy has not been assessed yet. OBJECTIVE The objective of the study is to assess the safety and non-inferiority of bearberry as an alternative therapy in the treatment of acute uncomplicated cystitis in comparison with standard antibiotic therapy (fosfomycin). METHODS AND ANALYSIS This is a randomised controlled double-blinded multicentre trial. Eligible patients will be premenopausal women with a sum score of ≥6 for the typical acute uncomplicated cystitis symptoms (frequency, urgency, painful urination, incomplete emptying, suprapubic pain and visible haematuria) reported on the Acute Cystitis Symptom Score (ACSS) typical domain and pyuria. Patients will be randomly assigned to receive 3 g single dose of fosfomycin powder and two placebo tablets three times a day for 7 days or B a single dose of placebo powder and two tablets containing a dry extract of Uvae ursi folium. At least 504 patients (allocated as 1:1) will need to be enrolled to access non-inferiority with a non-inferiority limit of 14% for the primary endpoint.Improvement of symptoms of uncomplicated cystitis (based on the ACSS score) at day 7 is defined as the primary endpoint, whereas several secondary endpoints such as the number and ratio of patients with bacteriuria at day 7, frequency and severity of side effects; recurrence of urinary tract infection, concurrent use of other over the counter (OTC) medications and food supplements will be determined to elucidate more detailed differences between the groups. The number of recurrences and medications taken for treatment will be monitored for a follow-up period of 90 days (80-100 days). ETHICS AND DISSEMINATION This study has been approved by the Scientific and Research Ethics Committee of the Hungarian Medical Research Council (IV/4225-1/2021/EKU). The results will be disseminated by publication of peer-reviewed manuscripts. TRIAL REGISTRATION NUMBER NCT05055544.
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Affiliation(s)
- Barbara Tóth
- Department of Pharmacognosy, University of Szeged, Szeged, Hungary
| | - András Jávorházy
- Urology Clinic, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Nyirády
- Department of Urology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Boglárka Csupor-Löffler
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Péter Birinyi
- Department of Pharmacodynamics, Faculty of Pharmacy, Semmelweis University, Budapest, Hungary
| | - George Zhanel
- Departmental of Medical Microbiology/Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Kurt Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Reinhard Länger
- Austrian Medicines and Medical Devices Agency, Vienna, Austria
| | - Nóra Vörhendi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Noémi Gede
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
| | - Szilárd Váncsa
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Péter Hegyi
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Centre for Translational Medicine, Semmelweis University, Budapest, Hungary
- Division of Pancreatic Diseases, Heart and Vascular Center, Semmelweis University, Budapest, Hungary
| | - Dezső Csupor
- Department of Pharmacognosy, University of Szeged, Szeged, Hungary
- Institute for Translational Medicine, Szentágothai Research Centre, Medical School, University of Pécs, Pécs, Hungary
- Department of Clinical Pharmacy, Faculty of Pharmacy, University of Szeged, Szeged, Hungary
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15
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Intestinal Permeability and Dysbiosis in Female Patients with Recurrent Cystitis: A Pilot Study. J Pers Med 2022; 12:jpm12061005. [PMID: 35743789 PMCID: PMC9225239 DOI: 10.3390/jpm12061005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/02/2022] [Accepted: 06/16/2022] [Indexed: 12/30/2022] Open
Abstract
Recurrent cystitis (RC) is a common disease, especially in females. Anatomical, behavioral and genetic predisposing factors are associated with the ascending retrograde route, which often causes bladder infections. RC seems to be mainly caused by agents derived from the intestinal microbiota, and most frequently by Escherichia coli. Intestinal contiguity contributes to the etiopathogenesis of RC and an alteration in intestinal permeability could have a major role in RC. The aim of this pilot study is to assess gut microbiome dysbiosis and intestinal permeability in female patients with RC. Patients with RC (n = 16) were enrolled and compared with healthy female subjects (n = 15) and patients with chronic gastrointestinal (GI) disorders (n = 238). We calculated the Acute Cystitis Symptom Score/Urinary Tract Infection Symptom Assessment (ACSS/UTISA) and Gastrointestinal Symptom Rating Scale (GSRS) scores and evaluated intestinal permeability and the fecal microbiome in the first two cohorts. Patients with RC showed an increased prevalence of gastrointestinal symptoms compared with healthy controls. Of the patients with RC, 88% showed an increased intestinal permeability with reduced biodiversity of gut microbiota compared to healthy controls, and 68% of the RC patients had a final diagnosis of gastrointestinal disease. Similarly, GI patients reported a higher incidence of urinary symptoms with a diagnosis of RC in 20%. Gut barrier impairment seems to play a major role in the pathogenesis of RC. Further studies are necessary to elucidate the role of microbiota and intestinal permeability in urinary tract infections.
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16
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Parazzini F, Ricci E, Fedele F, Chiaffarino F, Esposito G, Cipriani S. Systematic review of the effect of D‑mannose with or without other drugs in the treatment of symptoms of urinary tract infections/cystitis (Review). Biomed Rep 2022; 17:69. [PMID: 35815191 PMCID: PMC9260159 DOI: 10.3892/br.2022.1552] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/03/2022] [Indexed: 11/06/2022] Open
Abstract
Several studies, reviews and meta-analyses have documented that D-mannose use lowers the risk of recurrent urinary tract infections (UTI), but its role in the treatment of UTI/cystitis-related symptoms is unclear. In particular, no systematic review has analyzed the role of treatment with D-mannose in acute UTI/cystitis. In this paper, we systematically reviewed the published data on the effect of D-mannose, alone or in association with other compounds, on the typical symptoms of UTI/cystitis. PubMed/Medline and EMBASE databases were searched, from 1990 to January 2022, using combinations of the following keywords: ‘urinary tract infections’, ‘cystalgia’, ‘recurrent next urinary tract infection’, ‘cystitis’, ‘mannose’, ‘mannoside’, ‘D-mannose’, ‘bacteriuria’, ‘pyuria’, ‘pyelocystitis’ with the appropriate Boolean modifiers (Limits: Human, English, full article). Studies were selected for the systematic review if they were clinical studies and reported original data, the number of patients using D-mannose alone or in association with other treatments, and the number of patients with symptoms of UTI/cystitis at trial entry and after the follow-up period. A total of seven studies were identified. D-mannose was given alone in two studies, and was associated with cranberry extract, Morinda citrifolia fruit extract, pomegranate extract, fructo-oligosaccharides, lactobacilli, and N-acetylcysteine in the others. All studies reported that symptoms decreased after treatment with D-mannose. Despite the limitations of the studies, the consistent results observed among all studies give support to the general findings that D-mannose may be useful in the treatment of UTI/cystitis symptoms.
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Affiliation(s)
- Fabio Parazzini
- Department of Clinical Sciences and Community Health, University of Milan, School of Medicine and Surgery, I‑20122 Milan, Italy
| | - Elena Ricci
- Department of Clinical Sciences and Community Health, University of Milan, School of Medicine and Surgery, I‑20122 Milan, Italy
| | - Francesco Fedele
- Department of Clinical Sciences and Community Health, University of Milan, School of Medicine and Surgery, I‑20122 Milan, Italy
| | - Francesca Chiaffarino
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, I‑20122 Milan, Italy
| | - Giovanna Esposito
- Department of Clinical Sciences and Community Health, University of Milan, School of Medicine and Surgery, I‑20122 Milan, Italy
| | - Sonia Cipriani
- Gynecology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, I‑20122 Milan, Italy
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17
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Why D-Mannose May Be as Efficient as Antibiotics in the Treatment of Acute Uncomplicated Lower Urinary Tract Infections—Preliminary Considerations and Conclusions from a Non-Interventional Study. Antibiotics (Basel) 2022; 11:antibiotics11030314. [PMID: 35326777 PMCID: PMC8944421 DOI: 10.3390/antibiotics11030314] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 02/22/2022] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
Urinary tract infections (UTIs) are very frequent in women and can be caused by a range of pathogens. High recurrence rates and increasing antibiotic resistance of uropathogens make UTIs a severe public health problem. d-mannose is a monosaccharide that can inhibit bacterial adhesion to the urothelium after oral intake. Several clinical studies have shown the efficacy of d-mannose in the prevention of recurrent UTIs; these also provided limited evidence for the efficacy of d-mannose in acute therapy. A recent prospective, non-interventional study in female patients with acute cystitis reported good success rates for treatment with d-mannose. Here, we present data from a post hoc analysis of this study to compare the cure rate of d-mannose monotherapy with that of antibiotics. The results show that d-mannose is a promising alternative to antibiotics in the treatment of acute uncomplicated UTIs in women.
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18
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Choi JB, Cho KJ, Han KH, Alidjanov JF, Pilatz AME, Wagenlehner FME, Naber KG, Choe HS, Lee SJ. Translation and validation of the Korean version of acute cystitis symptom score. Investig Clin Urol 2022; 63:221-227. [PMID: 35244997 PMCID: PMC8902427 DOI: 10.4111/icu.20210421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 12/18/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
Purpose Acute Cystitis Symptom Score (ACSS) is a simple self-reporting questionnaire initially developed in Uzbek language to help diagnose acute uncomplicated cystitis (AUC). The purpose of this study was to translate the ACSS to Korean and validate the Korean version of ACSS using Korean-speaking women. Materials and Methods The original version of ACSS in Uzbek was translated into the target (Korean) version according to internationally accepted guidelines for the translation and cultural adaptation. Cognitive interviews were then conducted for five women with symptoms of AUC and five women without AUC who were native speakers of the Korean language to investigate the clarity, understandability, and acceptability of the translation. The final Korean version of the ACSS was tested in 50 women (31 AUC patients and 19 controls) for clinical validation. Results Reliability test for 9 questions (6 questions about typical symptoms of AUC, and 3 questions on quality of life) showed high values (Cronbach’s alpha=0.853). The sum score of typical symptoms showed the highest balance for diagnostic sensitivity and specificity (area under the ROC curve=0.935). Sensitivity and specificity to predict AUC were 90.3% and 89.5% at cut-off score 6 of the typical domain. Conclusions The Korean version of the ACSS showed high levels of reliability and validity, similar to other validated versions in different languages. It will play an important role in practice and/or clinical research for diagnosis and treatment efficacy monitoring of Korean-speaking women suffering from AUC.
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Affiliation(s)
- Jin Bong Choi
- Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kang Jun Cho
- Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Kyu Hun Han
- Department of Urology, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jakhongir F. Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Adrian M. E. Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Florian M. E. Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Giessen, Germany
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, School of Medicine, Munich, Germany
| | - Hyun-Sop Choe
- Department of Urology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Ju Lee
- Department of Urology, St. Vincent’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Diagnosis of acute cystitis in primary care: symptom-based versus urinalysis-based diagnosis. Prim Health Care Res Dev 2022; 23:e74. [DOI: 10.1017/s1463423622000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
Aim:
This study aimed to provide insight into the congruity of acute cystitis (AC) diagnosis in women, measured both by the Acute Cystitis Symptom Score (ACSS) questionnaire and urine test(s).
Background:
The ACSS questionnaire was developed as a self-administering tool for assessing urinary symptoms, quality of life (QoL) and treatment outcomes in healthy, nonpregnant female patients.
Methods:
This prospective observational cohort study compared AC diagnosis based on the questionnaire with a GP diagnosis based on dipstick/dipslide test(s). ACSS questionnaire form A (typical and differential symptoms, QoL and relevant conditions) was filled in by the patient group, women suspected for AC visiting a GP practice with a urine sample, and the reference group, women visiting a community pharmacy for any medication. Analyses were performed assuming that the GP diagnosis based on urine test(s) was correct. Divergent result(s) of urine test(s) and ACSS questionnaire were analysed for scores of all individual questionnaire domains. Statistical analyses included descriptive statistics and the positive predictive value (PPV) and the negative predictive value (NPV) of the ACSS questionnaire and the urine test(s).
Findings:
In the patient group, 59 women were included, 38 of whom a GP positively diagnosed for AC. The reference group included 70 women. The PPV of the ACSS questionnaire was 77.3%, and the NPV was 73.3%. Analysis of patient data for divergent results showed that differential symptoms, QoL and relevant conditions explained false-positive and false-negative results. Revised results (most probable diagnosis) based on this analysis showed a PPV and NPV of 88.6% and 73.3% for the ACSS questionnaire and 100% and 76.2% for the urine test(s). For use in primary care, a reduction in false-positive and false-negative results can be achieved by including scores for differential symptoms, QoL and relevant conditions, alongside a total typical symptoms score of 6 or higher.
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20
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Stamatiou K, Samara E, Alidjanov JF, Pilatz AME, Naber KG, Wagenlehner FME. Clinical Validation of the Greek Version of the Acute Cystitis Symptom Score (ACSS)-Part II. Antibiotics (Basel) 2021; 10:antibiotics10101253. [PMID: 34680833 PMCID: PMC8532759 DOI: 10.3390/antibiotics10101253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 10/09/2021] [Accepted: 10/11/2021] [Indexed: 11/16/2022] Open
Abstract
The Acute Cystitis Symptom Score (ACSS) is a patient self-reporting questionnaire for the clinical diagnosis and patient-reported outcome (PRO) in women with acute uncomplicated cystitis (AC). The aim of the current study (part II) is the clinical validation of the Greek ACSS questionnaire. After linguistic validation according to internationally accepted guidelines and cognitive assessment (part I), the clinical validation was performed by using the Greek ACSS study version in 92 evaluable female participants including 53 patients with symptoms suspicious of AC and 39 controls. The clinical outcome using the ACSS questionnaire at different points in time after the start of treatment was demonstrated as well. The age (mean ± SD) of the 53 patients (44.7 ± 17.0 years) and 39 controls (49.3 ± 15.9 years) and their additional conditions at baseline visits, such as menstruation, premenstrual syndrome, pregnancy, menopause, diabetes mellitus, were comparable. There was, however, a significant difference (p < 0.001) between patients and controls at baseline visit regarding sum score of the ACSS domains, such as typical symptoms and quality of life. The clinical outcome of up to 7 days showed a fast reduction of the symptom scores and improvement of quality of life. The optimal thresholds for the patient-reported outcome of successful therapy could be established. The linguistically and clinically validated Greek ACSS questionnaire can now be used for clinical or epidemiological studies and also for patients' self-diagnosis of AC and as a PRO measure tool.
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Affiliation(s)
| | - Evangelia Samara
- Department of Anesthesiology and Pain Management, Tzaneio General Hospital, 18536 Piraeus, Greece;
| | - Jakhongir F. Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35392 Giessen, Germany; (J.F.A.); (A.M.E.P.); (F.M.E.W.)
| | - Adrian M. E. Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35392 Giessen, Germany; (J.F.A.); (A.M.E.P.); (F.M.E.W.)
| | - Kurt G. Naber
- School of Medicine, Technical University of Munich, 81664 Munich, Germany
- Correspondence:
| | - Florian M. E. Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, 35392 Giessen, Germany; (J.F.A.); (A.M.E.P.); (F.M.E.W.)
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21
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Westhoff N, Anokhin A, Patroi P, Neuberger M, Siegel F, Pfalzgraf D. Prospective Evaluation of Antibiotic Management in Ureteral Stent and Nephrostomy Interventions. Urol Int 2021; 106:411-418. [PMID: 34333486 DOI: 10.1159/000517546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Screening for and treating asymptomatic bacteriuria (ABU) or administering antibiotic prophylaxis is recommended during ureteral stent and nephrostomy interventions. This study investigates the frequency of postinterventional infectious complications to gain insight into the need for antibiotics. METHODS Between September 2016 and June 2019, 168 insertions/exchanges of ureteral stents or nephrostomies were recorded in a prospective multicenter study. Patients without a symptomatic UTI did not receive antibiotic treatment/prophylaxis. Asymptomatic patients in whom their urologist already administered an antibiotic treatment served as a comparative group. Follow-up included postinterventional complications within 30 days. Symptoms were assessed by the Acute Cystitis Symptom Score (ACSS) before and after the intervention. Predictors of increasing postinterventional symptoms were analyzed by a multivariable logistic regression model. RESULTS One hundred forty-five interventions were eligible. One hundred twenty-two (84.1%) interventions were performed without antibiotic treatment. Preinterventional ABU was detected in 54.4% and sterile urine in 22.8% (22.8% without culture). Postinterventional infectious complications did not differ between patients with versus without antibiotics. Transurethral interventions aggravate symptoms (p = 0.034) but do not increase infectious complications compared to percutaneous interventions. Patients without diabetes mellitus are at higher risk for increasing symptoms. CONCLUSION Results indicate that peri-interventional antibiotic treatment may be omitted in patients without symptomatic UTI. Symptoms must be differentiated between infectious and procedure-associated origins.
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Affiliation(s)
- Niklas Westhoff
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Alexey Anokhin
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Fifth Department of Internal Medicine (Nephrology/Endocrinology/Rheumatology), University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Paul Patroi
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Manuel Neuberger
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Fabian Siegel
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Biomedical Informatics, Center for Preventive Medicine and Digital Health Baden-Württemberg, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Daniel Pfalzgraf
- Department of Urology and Urosurgery, University Medical Center Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.,Department of Urology, Heilig-Geist-Hospital, Bensheim, Germany
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22
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Alidjanov JF, Khudaybergenov UA, Ayubov BA, Pilatz A, Mohr S, Münst JC, Ziviello Yuen ON, Pilatz S, Christmann C, Dittmar F, Mirsaidov NM, Buch-Heberling M, Naber KG, Bjerklund Johansen TE, Wagenlehner FME. Linguistic and clinical validation of the acute cystitis symptom score in German-speaking Swiss women with acute cystitis. Int Urogynecol J 2021; 32:3275-3286. [PMID: 34170341 PMCID: PMC8227360 DOI: 10.1007/s00192-021-04864-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 05/19/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The Global Prevalence Study of Infections in Urinary tract in Community Setting (GPIU.COM) includes epidemiological aspects of acute cystitis (AC) in women in Germany and Switzerland. The primary study relates to the German version of the Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for self-diagnosis and monitoring the symptomatic course of AC in women. The current study aimed to analyze the validity and reliability of the German ACSS in German-speaking female patients with AC in Switzerland. METHODS Anonymized patient data were collected and analyzed from women with AC at the first visit (diagnosis) and follow-up visits as baseline and controls, respectively. Data from 97 patients with a median age of 41 years underwent analysis. Psychometric and diagnostic characteristics of the ACSS were measured and statistically analyzed. RESULTS Average internal consistency of the ACSS resulted in a Cronbach's alpha (95% CI) of 0.86 (0.83; 0.89) and did not differ significantly between the Swiss and German cohorts. Diagnostic values of the ACSS for the Swiss cohort were relatively lower than for the German cohort, possible due to discrepancies between definitions of UTI in national guidelines. CONCLUSIONS The analysis showed that the German version of the ACSS is also suitable for use in the German-speaking female population of Switzerland. Minor differences in definitions of AC between German and Swiss guidelines explain the observed discrepancies in diagnostic values of the ACSS between cohorts.
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Affiliation(s)
- Jakhongir F Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig University of Giessen, Rudolph-Buchheim str. 7, 35392, Giessen, Hessen, Germany.
| | | | - Bekhzod A Ayubov
- Department of Urological Surgery, Republican Specialized Scientific-Practical Medical Center of Urology, Tashkent, Uzbekistan
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Stefan Mohr
- Department of Obstetrics and Gynecology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Julia C Münst
- Department of Gynaecology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland
| | | | | | - Corina Christmann
- Department of Obstetrics and Gynecology, Cantonal Hospital of Lucerne, Lucerne, Switzerland
| | - Florian Dittmar
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Nodir M Mirsaidov
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Mareike Buch-Heberling
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - Truls E Bjerklund Johansen
- Department of Urology of Oslo University Hospital, University of Oslo, Oslo, Norway.,Institute of Clinical Medicine, University of Aarhus, Aarhus, Denmark
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus Liebig University of Giessen, Giessen, Hessen, Germany
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23
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Alidjanov JF, Overesch A, Abramov-Sommariva D, Hoeller M, Steindl H, Wagenlehner FM, Naber KG. Acute Cystitis Symptom Score questionnaire for measuring patient-reported outcomes in women with acute uncomplicated cystitis: Clinical validation as part of a phase III trial comparing antibiotic and nonantibiotic therapy. Investig Clin Urol 2021; 61:498-507. [PMID: 32869564 PMCID: PMC7458871 DOI: 10.4111/icu.20200060] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 05/12/2020] [Accepted: 05/24/2020] [Indexed: 12/13/2022] Open
Abstract
PURPOSE The Acute Cystitis Symptom Score (ACSS) used in a clinical trial comparing the phytodrug Canephron®N (BNO 1045) with an antibacterial agent (fosfomycin trometamol [FT]) in the treatment of acute uncomplicated cystitis (AC) in women was evaluated as a patient-reported outcome measure in a post hoc analysis. MATERIALS AND METHODS This double-blind, randomized, multicenter, phase III noninferiority trial was performed in 51 centers in Europe. The ACSS questionnaire was used to assess severity and course of symptoms. RESULTS The post hoc analysis included 325 patients treated with BNO 1045 and 332 patients treated with FT (total of 657 patients). The mean sum-scores of the ACSS-typical domain were comparable between groups on day 1 (BNO 1045: 10.2; FT: 10.1), and then decreased on day 4 (BNO 1045: 5.1; FT: 4.5), at end of treatment on day 8 (BNO 1045: 2.1; FT: 2.1), and at late follow-up on day 38 (BNO 1045: 0.8; FT: 0.9). Predefined thresholds using the scoring system of the ACSS could be established and validated to define "clinical cure." CONCLUSIONS Evaluating not only antibacterial but also nonantibacterial agents indicated for the treatment of AC in women, clinical criteria for diagnostics, and measures of patient-reported outcomes are more important as main objectives than microbiological criteria. In this post hoc evaluation, we showed that the ACSS questionnaire, validated in several languages, has the potential to be used as a suitable instrument for diagnostics and patient-reported outcomes in well-designed, international, clinical studies investigating different treatment modalities of uncomplicated urinary tract infections.
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Affiliation(s)
- Jakhongir F Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany
| | | | | | | | | | - Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany
| | - Kurt G Naber
- Department of Urology, Technical University of Munich, Munich, Germany.
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24
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Faßl D, Wagenlehner F. [What to do about recurrent urinary tract infections]. Aktuelle Urol 2021; 52:255-259. [PMID: 33860479 DOI: 10.1055/a-1387-7515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Urinary tract infections are among the most common bacterial infections. A significant proportion of urinary tract infections recur, which leads to impairments in patients' physical intimacy, social contacts and ability to work. The standardised ACSS questionnaire can provide help in establishing a diagnosis and assessing the course of the disease. In addition to general education and counselling on risk factors for urinary tract infections, non-antibiotic treatment options are particularly important for reducing recurrence. This aims to prevent the development of resistance to antibiotics and their undesirable side-effects. Non-antibiotic strategies most notably include personal counselling with communication of behavioural recommendations, immunoprophylaxis, phytotherapeutics and local oestrogen substitution. However, in cases of high patient suffering, antibiotic prophylaxis should also be considered after due deliberation. In summary, individual counselling should take place and treatment should be given in a multimodal therapeutic approach.
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Affiliation(s)
- Daniel Faßl
- Justus Liebig Universität Giessen Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Giessen
| | - Florian Wagenlehner
- Justus Liebig Universität Giessen Fachbereich Medizin, Klinik und Poliklinik für Urologie, Kinderurologie und Andrologie, Giessen
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25
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Alidjanov JF, Naber KG, Pilatz A, Wagenlehner FM. Validation of the American English Acute Cystitis Symptom Score. Antibiotics (Basel) 2020; 9:antibiotics9120929. [PMID: 33352734 PMCID: PMC7766804 DOI: 10.3390/antibiotics9120929] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Revised: 12/12/2020] [Accepted: 12/17/2020] [Indexed: 01/11/2023] Open
Abstract
The diagnosis of acute uncomplicated cystitis (UC) is usually based on clinical symptoms. The study aims to develop and validate the American-English Acute Cystitis Symptom Score (ACSS), a self-reporting questionnaire for diagnosis and patient-reported outcome in women with acute uncomplicated cystitis (UC). After certified translation into American-English and cognitive assessment, the clinical validation of the ACSS was performed embedded in a US phase-II trial. 167 female patients with typical symptoms of UC were included in the study following US Food and Drug Administration (FDA) guidance. At Day 1 (diagnosis), the mean (SD) sum score of the six ACSS typical symptoms reached 10.60 (2.51). Of 100 patients followed-up last time on Day 5 or 6 (End-of-treatment, EoT), 91 patients showed clinical success according to the favored ACSS criteria (sum score of typical symptoms 0.98 (1.94)). There was no correlation between the severity of symptoms on Day 1 or between clinical success rate at EoT and level of bacteriuria on Day 1. The American-English ACSS showed high predictive ability and responsiveness and excellent levels of reliability and validity. It can now be recommended as the new master version in clinical and epidemiological studies, in clinical practice, or for self-diagnosis of women with symptoms of UC.
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Affiliation(s)
- Jakhongir F. Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
- Correspondence: ; Tel.: +49-176-5806-8639
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, 81675 Munich, Germany;
| | - Adrian Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
| | - Florian M. Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Rudolf-Buchheim-Str. 7, 35392 Giessen, Germany; (A.P.); (F.M.W.)
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26
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Di Vico T, Morganti R, Cai T, Naber KG, Wagenlehner FM, Pilatz A, Alidjanov J, Morelli G, Bartoletti R. Acute Cystitis Symptom Score (ACSS): Clinical Validation of the Italian Version. Antibiotics (Basel) 2020; 9:E104. [PMID: 32131404 PMCID: PMC7148481 DOI: 10.3390/antibiotics9030104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 02/20/2020] [Accepted: 02/24/2020] [Indexed: 01/19/2023] Open
Abstract
Acute Cystitis Symptom Score (ACSS) is an 18-item self-reporting questionnaire for clinical diagnosis and follow-up of acute uncomplicated cystitis (AUC) in women. The ACSS, originally developed in Uzbek and Russian languages, is now available in several languages. The purpose of the study was to validate the ACSS questionnaire in the Italian language. Linguistic validation was carried out according to Linguistic Validation Manual for Patient-Reported Outcomes Instruments guidelines. Clinical validation was carried out by enrolling one hundred Italian-speaking women. All women were asked to fill in the ACSS questionnaire during their medical visit. Fifty-four women, median age 36 (Inter Quartile Range 28-49), were diagnosed with AUC, while 46 women, median age 38 (IQR 29-45), were enrolled as the control group attending the hospital's fertility center for couples. The most frequently isolated pathogen in AUC was Escherichia coli (40; 74.0%) followed by Enterococcus faecalis (7; 13.0%) and Staphylococcus saprophyticus (3; 5.6%). Receiver operating characteristic (ROC) curve analysis performed at the first diagnostic visit on a typical symptoms domain cut-off score of 6 revealed a sensitivity of 92.5% and specificity of 97.8%. The Italian version of the ACSS has proved to be a reliable tool with a high accuracy in diagnosis and follow-up in women with AUC. The ACSS may also be useful for clinical and epidemiological studies.
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Affiliation(s)
- Tommaso Di Vico
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy
| | - Riccardo Morganti
- SOD Clinical Trial Statistical Support, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Tommaso Cai
- Urology Unit, S. Chiara Regional Hospital, 38122 Trento, Italy
| | - Kurt G. Naber
- Department of Urology, Technical University of Munich, 80333 Munich, Germany
| | - Florian M.E. Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Adrian Pilatz
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Jakhongir Alidjanov
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, 35390 Giessen, Germany
| | - Girolamo Morelli
- Department of Critical Medicine, University of Pisa, 56126 Pisa, Italy
| | - Riccardo Bartoletti
- Department of Translational Research and New Technologies, University of Pisa, 56126 Pisa, Italy
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27
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Naber KG, Tandogdu Z, Köves B, Bonkat G, Wagenlehner F. UTI − quo vadis? New alternatives to treat uncomplicated urinary tract infections. CLINICAL PHYTOSCIENCE 2019. [DOI: 10.1186/s40816-019-0132-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractUrinary tract infections (UTI) are one of the most common problems in urology clinics. The European Association of Urology (EAU) has been pioneering in its efforts to disseminate the latest clinical findings through the organization of the annual EAU congresses. At this year’s congress (EAU Barcelona 2019), various satellite symposia were organized, focusing on specific issues in the field of urology. "UTI − quo vadis? New alternatives to treat uncomplicated urinary tract infections" was one of the industry-sponsored symposia, organized with the aim of evaluating the current scenario and also throwing light on the paradigm shift in the treatment of acute, uncomplicated lower urinary tract infections (uUTI). Several interlinking topics were presented during this symposium. The topics covered antibiotic resistance, involving a presentation of the current data from the Global Prevalence Study on Infections in Urology (GPIU-study). This discussion was followed by case reports on the impact of antibiotic resistance on the management of patients with UTI/uUTI and treatment options for UTI/uUTI according to current guidelines. The highlight of the symposium was the presentation of very recent data from a gold standard phase III clinical trial (double-blind, double-dummy randomized study), demonstrating the non-inferiority of a herbal medicine (BNO 1045) versus antibiotic therapy (fosfomycin trometamol (FT), as a single dose = 3 g) for the treatment of acute, uncomplicated cystitis.
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28
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Alidjanov JF, Naber KG, Pilatz A, Radzhabov A, Zamuddinov M, Magyar A, Tenke P, Wagenlehner FM. Additional assessment of Acute Cystitis Symptom Score questionnaire for patient-reported outcome measure in female patients with acute uncomplicated cystitis: part II. World J Urol 2019; 38:1977-1988. [PMID: 31549179 PMCID: PMC7363736 DOI: 10.1007/s00345-019-02948-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 09/04/2019] [Indexed: 01/27/2023] Open
Abstract
Purpose Since symptomatic, non-antibiotic therapy has become an alternative approach to treat acute cystitis (AC) in women, suitable patient-reported outcome measures (PROM) are urgently needed. The aim of this part II of a larger non-interventional, case–control study was the additional assessment of the ACSS as a suitable PROM. Methods Data from 134 female patients with diagnosed acute uncomplicated cystitis were included in the current analysis with (1) a summary score of “Typical” domain of 6 and more; (2) at least one follow-up evaluation after the baseline visit; (3) no missing values in the ACSS questionnaire data. Six different predefined thresholds based on the scoring of the ACSS items were evaluated to define “clinical cure”, also considering the draft FDA and EMA guidelines. Results Of the six different thresholds tested, a summary score of the five typical symptoms of 5 and lower with no symptom more than 1 (mild), without visible blood in urine, with or without including QoL issues was favoured, which partially also could be adapted to the draft FDA and EMA guidelines. The overall patient’s clinical assessment (“Dynamic” domain) alone was not sensitive enough for a suitable PROM. Conclusions Scoring of the severity of symptoms is needed not only for diagnosis, but also for PROM to define “clinical cure” of any intervention, which could be combined with QoL issues. Results of the study demonstrated that the ACSS questionnaire has the potential to be used as a suitable PROM and should further be tested in prospective clinical studies. Electronic supplementary material The online version of this article (10.1007/s00345-019-02948-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- J. F. Alidjanov
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - K. G. Naber
- Department of Urology, Technical University of Munich, Munich, Germany
| | - A. Pilatz
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
| | - A. Radzhabov
- Treatment and Diagnostic Center “Olami Tib”, Dushanbe, Tajikistan
- Sankt-Katharinen Hospital, Frankfurt, Germany
| | - M. Zamuddinov
- Department of Urology, Madadi Akbar Clinic, Dushanbe, Tajikistan
| | - A. Magyar
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Budapest, Hungary
| | - P. Tenke
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Budapest, Hungary
| | - F. M. Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
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Ortega Martell JA, Naber KG, Milhem Haddad J, Tirán Saucedo J, Domínguez Burgos JA. Prevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America. Ther Adv Urol 2019; 11:1756287218824089. [PMID: 31105773 PMCID: PMC6502980 DOI: 10.1177/1756287218824089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/03/2018] [Indexed: 12/16/2022] Open
Abstract
The branches of the immune system work in concert to defend against pathogens and
prevent tissue damage due to excessive inflammation. Uropathogens in general,
and uropathogenic Escherichia coli (UPEC) in particular, have
evolved a diverse range of virulence mechanisms to avoid detection and
destruction by the mucosal immune system of the urinary tract. Research towards
a vaccine active against UPEC continues but has yet to be successful. Orally
administered immunomodulatory bacterial lysates both stimulate and modulate the
immune response in the urinary tract via the integrated mucosal
immune system. The 2018 European Association of Urology (EAU) guidelines on
treating acute uncomplicated cystitis recommend aiming for rapid resolution of
symptoms, reduction of morbidity, and prophylaxis against reinfection.
Recommended short-term antibiotic therapy has the advantage of good compliance,
low cost, few adverse events, and low impact on bacterial flora. Antibiotic
treatment of asymptomatic bacteriuria is only indicated during pregnancy and
before invasive interventions. For recurrent infection, prophylaxis using
behavioral modification and counseling should be employed first, then
nonantibiotic prophylaxis, and, finally, low-dose continuous or postcoital
antibiotic prophylaxis. The 2018 EAU guidelines give a strong recommendation for
the oral bacterial lysate immunomodulator OM-89. All other nonantibiotic
prophylactic strategies require more data, except for topical estrogen for
postmenopausal women. For last-resort antibiotic prophylaxis, nitrofurantoin or
fosfomycin trometamol are recommended. Guidelines for Latin America are
currently being drafted, taking into account the unique ethnicity, availability
of medicines, prevalence of antibiotic resistance, and healthcare practices
found throughout the region.
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Affiliation(s)
- José Antonio Ortega Martell
- Universidad Autónoma del Estado de Hidalgo, Carr. Pachuca - Actopan, Campo de Tiro, 42039, Pachuca de Soto, Mexico
| | | | | | - José Tirán Saucedo
- Instituto Mexicano de Infectología, Ginecología y Obstetricia, Universidad de Monterrey, Monterrey, Mexico
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Alidjanov JF, Naber KG, Pilatz A, Radzhabov A, Zamuddinov M, Magyar A, Tenke P, Wagenlehner FM. Evaluation of the draft guidelines proposed by EMA and FDA for the clinical diagnosis of acute uncomplicated cystitis in women. World J Urol 2019; 38:63-72. [PMID: 31004204 PMCID: PMC6954149 DOI: 10.1007/s00345-019-02761-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 12/18/2022] Open
Abstract
Purpose To reassess the diagnostic values of the “draft” guidelines for the clinical diagnosis of acute uncomplicated cystitis (AC), recently proposed by US Food and Drug Administration (FDA) and European Medicines Agency (EMA). Methods The data of 517 female respondents (patients with acute cystitis and controls) derived from the e-USQOLAT database were analyzed and used for the validation of proposed “draft” guidelines of FDA and EMA, compared to the Acute Cystitis Symptom Score (ACSS) questionnaire. The diagnostic values of the proposals concerning signs, symptoms and their severity were assessed and compared. Results The six “typical” symptoms of the ACSS were strongly associated with the diagnosis of AC. The number of positive “typical” symptoms differed significantly between patients and controls: median 5 (IQR 4–6) vs 1 (IQR 0–3) respectively. Scored severity of “typical” symptoms also differed significantly between groups of patients and controls: median (IQR) 10 (7–13) vs 1 (0–4), respectively. The best balance between sensitivity and specificity is shown by the ACSS cut-off value of 6 scores and more of the “Typical” domain, followed by an approach proposed by FDA and EMA, justifying ACSS to be used as a diagnostic criterion for the clinical diagnosis of AC. Conclusions Not only the presence but also the severity of the symptoms is important for an accurate diagnosis of AC. The ACSS, even without urinalysis is at least as favourable as the draft diagnostic proposals by FDA and EMA. The ACSS can be recommended for epidemiological and interventional studies, and allows women to establish self-diagnosis of AC, making the ACSS also cost-effective for healthcare. Electronic supplementary material The online version of this article (10.1007/s00345-019-02761-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jakhongir F Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Rudolph-Buchheim Str.7, 35392, Giessen, Germany.
| | | | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Rudolph-Buchheim Str.7, 35392, Giessen, Germany
| | - Abdukhamid Radzhabov
- Treatment and Diagnostic Center "Olami Tib", J.Rasulov 29 Street., 734060, Dushanbe, Tajikistan.,Sankt-Katharinen Hospital, Seckbacher Landstr. 65E, 60389, Frankfurt, Germany
| | | | - András Magyar
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves út 1, Budapest, 1204, Hungary
| | - Peter Tenke
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves út 1, Budapest, 1204, Hungary
| | - Florian M Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Rudolph-Buchheim Str.7, 35392, Giessen, Germany
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Wagenlehner FM, Abramov-Sommariva D, Höller M, Steindl H, Naber KG. Non-Antibiotic Herbal Therapy (BNO 1045) versus Antibiotic Therapy (Fosfomycin Trometamol) for the Treatment of Acute Lower Uncomplicated Urinary Tract Infections in Women: A Double-Blind, Parallel-Group, Randomized, Multicentre, Non-Inferiority Phase III Trial. Urol Int 2018; 101:327-336. [PMID: 30231252 DOI: 10.1159/000493368] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 08/28/2018] [Indexed: 01/10/2023]
Abstract
INTRODUCTION This randomized, controlled, Phase III non-inferiority clinical trial aimed to determine whether herbal therapy with Canephron® N (BNO 1045) is non-inferior to fosfomycin trometamol (FT) in treating acute lower uncomplicated urinary tract infections (uUTIs). MATERIALS AND METHODS Women aged 18-70 years with typical symptoms of newly diagnosed acute lower uUTIs were randomized to BNO 1045 (n = 325) or FT (n = 334), with corresponding matched placebo. The primary endpoint was the proportion of patients who received additional antibiotics (ABs) to treat uUTIs between Days 1 and 38 ±3. RESULTS Between Days 1 and 38, 238 (83.5%) patients in the BNO 1045 group and 272 (89.8%) patients in the FT group received no additional ABs. At a 15% non-inferiority margin, BNO 1045 was non-inferior to FT in treating uUTIs (non-AB rate difference: -6.26%; 95% CI -11.99 to -0.53%; 2-sided p = 0.0014). Adverse event rates were similar between groups, with higher rates of gastrointestinal disorders in the FT group and pyelonephritis in the BNO 1045 group. During the trial, no patient died or discontinued due to a treatment-related adverse event. CONCLUSIONS BNO 1045 has the potential to reduce outpatient use of ABs for uUTIs and thus may have a significant impact on antimicrobial stewardship strategies. TRIAL REGISTRATION NCT02639520, EudraCT number 2013-004529-99.
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Affiliation(s)
- Florian M Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany
| | | | | | | | - Kurt G Naber
- Technical University of Munich, Straubing, Germany
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Alidjanov JF, Naber KG, Abdufattaev UA, Pilatz A, Wagenlehner FM. Reevaluation of the Acute Cystitis Symptom Score, a Self-Reporting Questionnaire. Part II. Patient-Reported Outcome Assessment. Antibiotics (Basel) 2018; 7:E43. [PMID: 29883423 PMCID: PMC6022869 DOI: 10.3390/antibiotics7020043] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/12/2018] [Accepted: 05/16/2018] [Indexed: 11/16/2022] Open
Abstract
This study aimed to reevaluate the Acute Cystitis Symptom Score (ACSS). The ACSS is a self-reporting questionnaire for the clinical diagnosis of acute uncomplicated cystitis (AC) and the assessment of symptomatic changes after therapy in female patients with AC. The part II of the present study was to reevaluate the utility of the different domains of the ACSS after therapy. The applicability of these domains in assessing changes in symptoms, as a function of time, in this population was investigated. The ACSS was evaluated in 48 female patients (mean age 31.1 ± 10.6) in the Uzbek and Russian languages, who returned after therapy and filled in part B of the ACSS, which corresponds to part A with the additional “Dynamics” domain. Descriptive statistics were used, where suitable. The reduction of typical symptoms and quality of life assessment between first and follow-up visit correlated significantly with answers in the “Dynamics” domain. Success/Cure and Non-success/Failure could be clearly differentiated by the scores obtained in “Typical” and “Quality of Life” domains. The ACSS has proven to be a useful instrument to clinically diagnose AC in women. It is also a suitable instrument for patient-reported outcome measures, with applicability both in daily practice and clinical studies. Slight modifications in the “Dynamics” domain will even increase the applicability.
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Affiliation(s)
- Jakhongir F Alidjanov
- State Institution "Republican Specialized Scientific-Practical Medical Center of Urology", Tashkent 100109, Uzbekistan.
- Clinic of Urology, Pediatric Urology, and Andrology, Justus Liebig University, 35392 Giessen, Germany.
| | - Kurt G Naber
- Department of Urology, School of Medicine, Technical University of Munich, 80333 Munich, Germany.
| | - Ulugbek A Abdufattaev
- State Institution "Republican Specialized Scientific-Practical Medical Center of Urology", Tashkent 100109, Uzbekistan.
| | - Adrian Pilatz
- Clinic of Urology, Pediatric Urology, and Andrology, Justus Liebig University, 35392 Giessen, Germany.
| | - Florian M Wagenlehner
- Clinic of Urology, Pediatric Urology, and Andrology, Justus Liebig University, 35392 Giessen, Germany.
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Kranz J, Schmidt S, Lebert C, Schneidewind L, Mandraka F, Kunze M, Helbig S, Vahlensieck W, Naber K, Schmiemann G, Wagenlehner FM. The 2017 Update of the German Clinical Guideline on Epidemiology, Diagnostics, Therapy, Prevention, and Management of Uncomplicated Urinary Tract Infections in Adult Patients: Part 1. Urol Int 2018; 100:263-270. [PMID: 29342469 DOI: 10.1159/000486138] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Accepted: 12/07/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVES We aimed to update the 2010 evidence- and consensus-based national clinical guideline on the diagnosis and management of uncomplicated urinary tract infections (UTIs) in adult patients. MATERIALS AND METHODS An interdisciplinary group consisting of 17 representatives of 12 medical societies and a patient representative was formed. Systematic literature searches were conducted in MEDLINE, -EMBASE, and the Cochrane Library to identify literature published in 2010-2015. RESULTS We provide 75 recommendations and 68 statements in the updated evidence- and consensus-based national clinical guideline. The diagnostics part covers practical recommendations on cystitis and pyelonephritis for each defined patient group. Clinical examinations, as well as laboratory testing and microbiological pathogen assessment, are addressed. CONCLUSION In accordance with the global antibiotic stewardship initiative and considering new insights in scientific research, we updated our German clinical UTI guideline to promote a responsible antibiotic use and to give clear hands-on recommendations for the diagnosis and management of UTIs in adults in Germany for healthcare providers and patients.
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Affiliation(s)
- Jennifer Kranz
- St.-Antonius-Hospital, Department of Urology and Paediatric Urology, Eschweiler, Germany.,UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany
| | | | | | - Laila Schneidewind
- UroEvidence@Deutsche Gesellschaft für Urologie, Berlin, Germany.,Klinik für Innere Medizin C, Hämatologie/Onkologie, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Falitsa Mandraka
- Department of Obstetrics and Gynecology, Medical Center- University of Freiburg, Freiburg, Germany
| | - Mirjam Kunze
- Department of Infectious Diseases, Laboratory Dr. Wisplinghoff, Cologne, Germany
| | - Sina Helbig
- Department in Division of Infectious Diseases, University Hospital Carl Gustav Carus, TU Dresden, Germany
| | | | - Kurt Naber
- Technical University of Munich, Munich, Germany
| | - Guido Schmiemann
- Institute for Public Health and Nursing Science, Department for Health Services Research, Bremen University, Bremen, Germany
| | - Florian M Wagenlehner
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
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Reevaluation of the Acute Cystitis Symptom Score, a Self-Reporting Questionnaire. Part I. Development, Diagnosis and Differential Diagnosis. Antibiotics (Basel) 2018; 7:antibiotics7010006. [PMID: 30720775 PMCID: PMC5872117 DOI: 10.3390/antibiotics7010006] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 01/08/2018] [Accepted: 01/08/2018] [Indexed: 11/16/2022] Open
Abstract
This study aimed to reevaluate the Acute Cystitis Symptom Score (ACSS). The ACSS is a simple and standardized self-reporting questionnaire for the diagnosis of acute uncomplicated cystitis (AC) assessing typical and differential symptoms, quality of life, and possible changes after therapy in female patients with AC. This paper includes literature research, development and evaluation of the ACSS, an 18-item self-reporting questionnaire including (a) six questions about "typical" symptoms of AC, (b) four questions regarding differential diagnoses, (c) three questions on quality of life, and (d) five questions on additional conditions that may affect therapy. The ACSS was evaluated in 228 women (mean age 31.49 ± 11.71 years) in the Russian and Uzbek languages. Measurements of reliability, validity, predictive ability, and responsiveness were performed. Cronbach's alpha for ACSS was 0.89, split-half reliability was 0.76 and 0.79 for first and second halves, and the correlation between them was 0.87. Mann-Whitney U test revealed a significant difference in scores of the "typical" symptoms between patients and controls (10.50 vs. 2.07, p < 0.001). The optimal threshold score was 6 points, with a 94% sensitivity and 90% specificity to predict AC. The "typical" symptom score decreased significantly when comparing before and after therapy (10.4 and 2.5, p < 0.001). The reevaluated Russian and Uzbek ACSS are accurate enough and can be recommended for clinical studies and practice for initial diagnosis and monitoring the process of the treatment of AC in women. Evaluation in German, UK English, and Hungarian languages was also performed and in other languages evaluation of the ACSS is in progress.
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Editorial Comment. J Urol 2017; 198:114-115. [DOI: 10.1016/j.juro.2017.01.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Holm A, Cordoba G, Siersma V, Brodersen J. Development and validation of a condition-specific diary to measure severity, bothersomeness and impact on daily activities for patients with acute urinary tract infection in primary care. Health Qual Life Outcomes 2017; 15:57. [PMID: 28340586 PMCID: PMC5366156 DOI: 10.1186/s12955-017-0629-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 03/14/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is a common condition in primary care. Patient-reported outcome measures (PROMs) are crucial in the evaluation of interventions to improve diagnosis, treatment and prognosis of UTI. The aim of this study was to identify an existing condition-specific PROM to measure symptom severity, bothersomeness and impact on daily activities for adult patients with suspected urinary tract infection in primary care; or, in the absence of such a PROM, to test items identified from existing PROMs for coverage and relevance in single and group interviews and to psychometrically validate the resulting PROM. METHODS The literature was searched for existing PROMs covering the three domains. Items from the identified PROMs were tested in single and group interviews. The resulting symptom diary was psychometrically validated using the partial credit Rasch model for polytomous items in a cohort of 451 women participating in two studies regarding UTI. RESULTS No existing PROM fulfilled the inclusion criteria. Content validation resulted in one domain concerning symptom severity (18 items), one concerning bothersomeness (18 items), and one concerning impact on daily activities (7 items). Psychometrical validation resulted in four dimensions in each of the first two domains and one dimension in the third domain. CONCLUSIONS Domains were not unidimensional, which meant that we identified dimensions of patient-experienced UTI that differed substantially from those previously found. We recommend that future studies on UTI, in which PROMs are to be used, should ensure high content validity of their outcome measures and unidimensionality of the included dimensions.
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Affiliation(s)
- Anne Holm
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO box 2099, 1014, Copenhagen, Denmark.
| | - Gloria Cordoba
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO box 2099, 1014, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO box 2099, 1014, Copenhagen, Denmark
| | - John Brodersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, PO box 2099, 1014, Copenhagen, Denmark
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Magyar A, Alidjanov J, Pilatz A, Nagy K, Arthanareeswaran VKA, Póth S, Bécsi A, Wagenlehner FME, Naber KG, Tenke P, Köves B. The role of the Acute Cystitis Symptom Score questionnaire for research and antimicrobial stewardship. Validation of the Hungarian version. Cent European J Urol 2017; 71:134-141. [PMID: 29732220 PMCID: PMC5926636 DOI: 10.5173/ceju.2018.1530] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2017] [Revised: 01/17/2018] [Accepted: 01/20/2018] [Indexed: 11/22/2022] Open
Abstract
Introduction The Acute Cystitis Symptom Score (ACSS) is a new self-reporting tool to evaluate the symptoms of uncomplicated acute cystitis (AC) in women. The linguistic and clinical validation process of the Hungarian version used in this study may serve as a guide for the validation of the ACSS in other languages. Material and methods In this prospective cohort study, women with AC (Patients) and those without (Controls) filled in the Hungarian ACSS version, during their visits to physician's office. Statistical analysis included ordinary descriptive values, calculation of reliability, validity, discriminative ability, responsiveness (sensitivity, specificity) and comparative analysis. Results Thirty-one patients were recruited for validation along with 37 controls. Statistical analyses resulted in excellent values of internal consistency, discriminative ability and validity for diagnosis of AC. At the cut-off at a score of 6 in the 'typical' domain, positive and negative predictive values were 97% and 92%, sensitivity and specificity were 90% and 97%, respectively. Conclusions The ACSS has demonstrated benefits for diagnosis and patient-reported outcome assessment. It is objective, fast, and cost-effective, and may help to easily confirm the accurate diagnosis of AC. Therefore, it may be especially important for clinical and epidemiological studies on AC in women.
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Affiliation(s)
- András Magyar
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Jakhongir Alidjanov
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Adrian Pilatz
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | - Károly Nagy
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | | | - Sándor Póth
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - András Bécsi
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Florian M E Wagenlehner
- Department of Urology, Pediatric Urology and Andrology, Justus-Liebig-University, Giessen, Germany
| | | | - Péter Tenke
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
| | - Béla Köves
- Department of Urology, Jahn Ferenc South Pest Teaching Hospital, Köves, Hungary
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Alidjanov JF, Abdufattaev UA, Makhsudov SA, Pilatz A, Akilov FA, Naber KG, Wagenlehner FME. The Acute Cystitis Symptom Score for Patient-Reported Outcome Assessment. Urol Int 2016; 97:402-409. [PMID: 27591987 DOI: 10.1159/000448591] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2015] [Accepted: 07/12/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The Acute Cystitis Symptom Score (ACSS) was developed as a self-reporting questionnaire for clinical diagnosis of acute uncomplicated cystitis (AUC) and symptomatic changes in female patients. The aim of the present study was to assess the utility of the different domains of ACSS including the 'dynamics' domain after therapy. The applicability of these domains in assessing changes in symptoms, as a function of time, in this population was investigated. MATERIALS AND METHODS During the validation process of the ACSS in Uzbek and Russian languages, a subgroup of patients (n = 63) returned after therapy and filled in part B of ACSS. Descriptive statistics were used, where suitable. RESULTS The reduction of typical symptoms and quality of life (QoL) assessment between first and follow-up visit correlated significantly with answers in the 'dynamics' domain. Success/cure and non-success/failure could be clearly differentiated by the scores obtained in 'typical' and 'QoL' domains. CONCLUSION The ACSS has proven to be a useful instrument to clinically diagnose AUC in women. It is also a suitable instrument for patient-reported outcome assessment, with applicability in both daily practice and in clinical studies. Slight modifications in the 'dynamics' domain will even increase the applicability.
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Affiliation(s)
- Jakhongir F Alidjanov
- Clinic of Urology, Pediatric Urology and Andrology, Justus Liebig University, Giessen, Germany
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Alidjanov JF, Pilatz A, Abdufattaev UA, Wiltink J, Weidner W, Naber KG, Wagenlehner F. [German validation of the Acute Cystitis Symptom Score]. Urologe A 2016; 54:1269-76. [PMID: 26113302 DOI: 10.1007/s00120-015-3873-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND The Uzbek version of the Acute Cystitis Symptom Score (ACSS) was developed as a simple self-reporting questionnaire to improve diagnosis and therapy of women with acute cystitis (AC). The purpose of this work was to validate the ACSS in the German language. MATERIALS AND METHODS The ACSS consists of 18 questions in four subscales: (1) typical symptoms, (2) differential diagnosis, (3) quality of life, and (4) additional circumstances. Translation of the ACSS into German was performed according to international guidelines. For the validation process 36 German-speaking women (age: 18-90 years), with and without symptoms of AC, were included in the study. Classification of participants into two groups (patients or controls) was based on the presence or absence of typical symptoms and significant bacteriuria (≥ 10(3) CFU/ml). Statistical evaluations of reliability, validity, and predictive ability were performed. ROC curve analysis was performed to assess sensitivity and specificity of ACSS and its subscales. The Mann-Whitney's U test and t-test were used to compare the scores of the groups. RESULTS Of the 36 German-speaking women (age: 40 ± 19 years), 19 were diagnosed with AC (patient group), while 17 women served as controls. Cronbach's α for the German ACSS total scale was 0.87. A threshold score of ≥ 6 points in category 1 (typical symptoms) significantly predicted AC (sensitivity 94.7%, specificity 82.4%). There were no significant differences in ACSS scores in patients and controls compared to the original Uzbek version of the ACSS. CONCLUSION The German version of the ACSS showed a high reliability and validity. Therefore, the German version of the ACSS can be reliably used in clinical practice and research for diagnosis and therapeutic monitoring of patients suffering from AC.
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Affiliation(s)
- J F Alidjanov
- Department of Outpatient Urology, JSC "Republican Specialized Center of Urology, Tashkent, Uzbekistan
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Chang SJ, Lin CD, Hsieh CH, Liu YB, Chiang IN, Yang SSD. Reliability and Validity of a Chinese Version of Urinary Tract Infection Symptom Assessment Questionnaire. Int Braz J Urol 2016; 41:729-38. [PMID: 26401866 PMCID: PMC4757002 DOI: 10.1590/s1677-5538.ibju.2014.0046] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 01/30/2014] [Indexed: 11/29/2022] Open
Abstract
Objectives: Our study evaluates the reliability and validity of a Chinese version of the Urinary Tract Infection Symptom Assessment questionnaire (UTISA). Material and Methods: Our study enrolled women who were diagnosed with uncomplicated urinary tract infection (uUTI) at clinics. The Chinese version of UTISA was completed upon first visit to the clinic for uUTI and at 1-week follow-up. We enrolled 124 age-matched women without uUTI from the community as the control group. The UTISA consists of 14 items (seven symptom items and seven related to quality of life), with each item scoring 0 to 3. The internal consistency was assessed with Chronbach's alpha test. Factor analysis was used to classify symptoms into latent factors. The predictive validity was analyzed by using logistic regression and Receiver Operating Characteristic (ROC) curve analysis. Results: Mean total symptom scores of the UTISA in the 169 cases and 124 controls were 8.9±4.6 and 1.4±2.4, respectively (p<0.01). The alpha coefficient was 0.77, showing a homogeneous composition of symptoms. At a cut-off value of greater than 3, the UTISA symptom score had good predictive value for uUTI (sensitivity of 87.0%, and specificity of 93.1%). Factor analysis revealed two latent variables: 1) lower urinary tract symptoms and 2) physical symptoms. Among the seven items, we found that urinary frequency (OR=2.6), dysuria (OR=5.0), sense of incomplete emptying (OR=2.0), and hematuria (OR=7.6) were significant predictors for uUTI. Conclusions: The Chinese version of UTISA is reliable to predict uncomplicated UTI in women with an optimal cut-off point at >3.
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Affiliation(s)
- Shang-Jen Chang
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei Taiwan and Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - Chia-Da Lin
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei Taiwan and Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - Cheng-Hsing Hsieh
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei Taiwan and Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - Ying-Buh Liu
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei Taiwan and Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
| | - I-Ni Chiang
- Department of Urology, National Taiwan University Hospital, Taipei, Taiwan
| | - Stephen Shei-Dei Yang
- Division of Urology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei Taiwan and Medical College of Buddhist Tzu Chi University, Hualien, Taiwan
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Bollestad M, Grude N, Lindbaek M. A randomized controlled trial of a diagnostic algorithm for symptoms of uncomplicated cystitis at an out-of-hours service. Scand J Prim Health Care 2015; 33:57-64. [PMID: 25961367 PMCID: PMC4834504 DOI: 10.3109/02813432.2015.1041827] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare the clinical outcome of patients presenting with symptoms of uncomplicated cystitis who were seen by a doctor, with patients who were given treatment following a diagnostic algorithm. DESIGN Randomized controlled trial. SETTING Out-of-hours service, Oslo, Norway. INTERVENTION Women with typical symptoms of uncomplicated cystitis were included in the trial in the time period September 2010-November 2011. They were randomized into two groups. One group received standard treatment according to the diagnostic algorithm, the other group received treatment after a regular consultation by a doctor. SUBJECTS Women (n = 441) aged 16-55 years. Mean age in both groups 27 years. MAIN OUTCOME MEASURES Number of days until symptomatic resolution. RESULTS No significant differences were found between the groups in the basic patient demographics, severity of symptoms, or percentage of urine samples with single culture growth. A median of three days until symptomatic resolution was found in both groups. By day four 79% in the algorithm group and 72% in the regular consultation group were free of symptoms (p = 0.09). The number of patients who contacted a doctor again in the follow-up period and received alternative antibiotic treatment was insignificantly higher (p = 0.08) after regular consultation than after treatment according to the diagnostic algorithm. There were no cases of severe pyelonephritis or hospital admissions during the follow-up period. CONCLUSION Using a diagnostic algorithm is a safe and efficient method for treating women with symptoms of uncomplicated cystitis at an out-of-hours service. This simplification of treatment strategy can lead to a more rational use of consultation time and a stricter adherence to National Antibiotic Guidelines for a common disorder.
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Affiliation(s)
- Marianne Bollestad
- Correspondence: Marianne Bollestad, Stavanger University Hospital, Pb. 8100 Forus, 4068 Stavanger, Norway. E-mail:
| | | | - Morten Lindbaek
- The Antibiotic Centre for Primary Care, University of Oslo, Norway
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Wagenlehner FME, Ballarini S, Pilatz A, Weidner W, Lehr L, Naber KG. 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; 95:167-76. [PMID: 25721866 DOI: 10.1159/000371894] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/30/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND One strategy for managing recurrent uncomplicated urinary tract infections (UTIs) is prevention. This study tested OM-89S, a lyophilized lysate of 18 Escherichia coli strains manufactured using a modified lytic process. METHODS This was a randomized, double-blind trial in 451 female subjects with recurrent uncomplicated UTIs. Period 1 of the study tested 6 mg of OM-89S versus placebo (3 months), plus a 3-month observation. Period 2 of the study was a 3-month treatment period (each monthly cycle consisted of 6 mg of OM-89S daily for 10 days and placebo for 20 days, vs. 50 mg nitrofurantoin daily for 30 days), plus a 3-month observation. RESULTS There was no difference in the mean rate of UTI episodes between the OM-89S (0.66 ± 0.93) and placebo groups (0.63 ± 0.86; p = 0.95) in period 1. Similar findings were obtained for period 2. OM-89S was well-tolerated. CONCLUSIONS Our results did not demonstrate a preventive effect of OM-89S compared to placebo. This may be due to the low number of UTIs that occurred during the study, the high number of protocol violations, and/or the modified manufacturing process used for OM-89S.
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Affiliation(s)
- Florian M E Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus-Liebig University, Giessen, Germany
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Abstract
BACKGROUND Acute uncomplicated cystitis in women is one of the most frequently diagnosed bacterial infections. A clinically symptomatic urinary tract infection must be differentiated from asymptomatic bacteriuria, which is not considered an infection but more a colonization which as a rule should not be treated. Acute cystitis can also be caused by a low number of uropathogenic bacteria, especially Escherichia coli, which is often overlooked during routine bacteriological diagnostics. ANTIBIOTIC THERAPY According to the guidelines the old oral antibiotics (e.g. fosfomycin tromethamine, nitrofurantoin and pivmecillinam) should be prescribed for antimicrobial therapy which are still effective against Escherichia coli in over 90% of cases. ALTERNATIVE THERAPY With new therapeutic concepts the elimination of bacteria is no longer the main aim but treatment of the inflammatory (over) reaction of the host. To establish the significance of these therapeutic options as compared to the standard antibiotic therapy, the results of the ongoing and planned phase 3 studies need to be awaited. Thus, reliable clinical measurement parameters for diagnostics and outcome are needed. The acute cystitis symptom score (ACSS) has now also been developed and validated in the German language. Because of its high reliability, validity and predictive value it can be used not only in daily practice but also for clinical studies for the diagnosis of acute uncomplicated cystitis in women.
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Affiliation(s)
- K G Naber
- , Karl-Bickleder-Straße 44c, 94325, Straubing, Deutschland,
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