Trending Clinical Topic: UTI

Ryan Syrek


March 25, 2022

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At least 50% and up to 80% of all women have an acute urinary tract infection (UTI) in their lifetime. About one quarter have recurrent UTIs, defined as three or more repeat infections within a year or two infections within 6 months. News about potential treatment strategies for women with recurrent UTIs, and other UTI medication-related research, helped drive interest in this week's top trending clinical topic. Recently published results from the ALTAR trial (alternative to prophylactic antibiotics for the treatment of recurrent UTIs in women) may have identified a strategy to help prevent antibiotic resistance (see Infographic).

The study included 240 women aged 18 or older with recurrent UTIs that required prophylactic treatment. Participants were randomly assigned to receive methenamine hippurate (MH) or daily low-dose antibiotics for 12 months, with follow-up for a further 6 months beyond that period. Before the trial, the noninferiority margin was defined as one episode of UTI per person-year. During the 12-month treatment period, the antibiotic group had 90 symptomatic, antibiotic-treated UTIs reported over 101 person-years of follow-up. The MH group had 141 episodes over 102 person-years. This yielded a UTI rate of 0.89 episodes per person-year in the antibiotic group compared with 1.38 in the MH group. In the 6-month post-treatment follow-up period, the UTI incidence rate was 1.19 episodes per person-year in the antibiotic prophylaxis group compared with 1.72 in the MH group. The small difference between the two groups confirmed noninferiority of MH to antibiotic prophylaxis.

Another emerging treatment appears to dramatically reduce the risk for recurrent UTI in women. A sublingually administered collection of inactivated bacteria, given for 3 months, helped keep 56% of women free of UTIs for 1 year compared with 25% of women treated with placebo. All 240 participants had reported at least five uncomplicated UTIs in the previous year. The randomized trial of the experimental treatment, known as MV140, found no clinically concerning adverse effects.

This news likely comes as great relief for the many women who are frustrated by the current standard of care. A recent study involving 29 women divided into six focus groups published online in The Journal of Urology found two main concerns: the negative impact of antibiotics and resentment of the medical profession for the way it manages recurrent UTIs. Some women worried that they were needlessly given an antibiotic for symptoms that might have been caused by another genitourinary condition. Resentment toward practitioners led some to consultations with alternative practitioners, such as herbalists. 

In terms of UTIs in other patient populations, a systematic review found that shorter intravenous (IV) antibiotic courses, with an early switch to oral antibiotics, can be considered for infants aged 90 days or younger with bacteremic or nonbacteremic UTI. The two largest studies on bacteremic UTI found equivalent rates of 30-day recurrence between infants treated with IV antibiotics for 7 days or less or longer than 7 days. In terms of nonbacteremic UTI, the two largest studies found no significant difference in the adjusted 30-day recurrence between those receiving IV antibiotics for 3 days or less vs longer than 3 days.

Elsewhere, a recent study found that the use of a "forgotten antibiotic" called temocillin is associated with less disturbance of intestinal microbiota than cefotaxime in adults with febrile UTI. Temocillin was also associated with significantly lower Enterobacterales proportions, according to researchers. The randomized, multicenter, superiority, open-label phase 4 trial was conducted among 152 adult patients who were admitted to 12 Swedish hospitals and treated for suspected or diagnosed febrile UTI (complicated or uncomplicated), including pyelonephritis. They were randomly assigned 1:1 to either 2 g of temocillin (n = 77) or 1-2 g of cefotaxime (n = 75), both given every 8 hours for 7-10 days. Analysis of the microbiota showed a significantly lower proportion of Enterobacterales with reduced susceptibility to third-generation cephalosporins in the temocillin group compared with the cefotaxime group, (P = .0049).

From new strategies to confront recurrent infections to emerging insights in the treatment of adult and pediatric populations, UTI research generated considerable recent interest, resulting in this week's top trending clinical topic.

Learn more about pathologies and challenges associated with UTIs.


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