Recurrent urinary tract infections in females - a prospective analysis

Abstract

INTRODUCTION: Urinary tract infection (UTI) is the commonest infection in women worldwide. Patients with co-morbidities or predisposing factors are at risk of developing recurrent UTI. They require hospitalisation, since causative organisms acquire resistance to first-line antibiotics and intravenous second-line antibiotics are indicated for complete eradication. Consequently, there is disturbance to lifestyle and loss of productivity for the patient. AIMS: To describe clinical profile and risk factors of female patients with recurrent UTI. Methods: All females admitted to the University Medical Unit at Teaching Hospital, Ragama from April 2011- March 2012, with >2 UTI occurring within the previous 12-months, were recruited. Data was collected using an interviewer-administered questionnaire. Results: 22 patients [mean age 48.8 years (SD+16.8, range 14-73]] fulfilled inclusion criteria. 16 (73%) were post-menopausal.13(59%) had diabetes, with poor control in 12. Other risk factors were constipation (27%), cystocele (14%), urinary calculi (9%) and hydronephrosis (9%). Urine culture was performed before antibiotics in 17(77%). 88% pre-treatment cultures were positive. 11(50%) had pyelonephritis during the current admission. 85% of diabetics had positive cultures compared to non-diabetics (77%) (p=0.55). Escherichia coll was the commonest pathogen (in 67.5%). Pyelonephritis was commoner among diabetics (61%) than non-diabetics (33%) 0=0.193). CONCLUSIONS: Post-menopausal women with poorly controlled diabetes are likely to have pyelonephritis when they develop recurrent UTI. Better glycaemic control, avoiding constipation and early treatment of structural abnormalities will reduce recurrent UTI in the at-risk population.