Adherence to European Association of Urology Guidelines and State of the Art of Glycosaminoglycan Therapy for the Management of Urinary Tract Infections: A Narrative Review and Expert Meeting Report

Introduction: Fournier’s Gangrene (FG) has still a mortality rate up to 45%. Several studies identified prognostic factors but there is a knowledge gap concerning procalcitonin (PCT) levels and mortality risk in FG. This study is aimed to assess the role of PCT as prognostic factor in FG. Materials and methods: The medical records of 20 male FG patients admitted at the Department of Urology of “Cattinara” Hospital, University of Trieste between January 2019 and November 2020 were retrospectively reviewed. Clinical, demographic, microbiological data were collected. The Fournier’s Gangrene Severity Index (FGSI) was calculated for each patient. Results: Thirteen (65%) of 20 patients survived. Median age was 58 years (IQR 51–88), 15 patients (75%) had a Charlson Comorbidity Index (CCI) score ⩾2, 1 (5%) equal to 0, 4 to 1 (20%). Median FGSI score was 6 (IQR 2–12) and median PCT 0.8 ng/ml (IQR 0.04–2.12). At multivariate analysis PCT levels >0.05 ng/ml were associated with an increased overall mortality risk (OR 2.14, CI 1.25–4.27, p = 0.002). CCI score ⩾2 (OR 1.51, CI 1.01–2.59, p = 0.04), Streptococcical etiology (OR 3.41, CI 2.49–4.61, p = 0.002) and FGSI score >9 (OR 1.41, CI 1.19–2.21, p = 0.004) were associated with unfavorable outcome. Conclusion: PCT might be a prognostic factor in FG. CCI and FGSI are useful tools in mortality risk stratification. Streptococcical etiology is associated with unfavorable outcome. Further larger clinical trials are pending.

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“…According to guidelines often two or more antibiotics were simultaneously administered in a patient. 9…”

Section: Methodsmentioning

confidence: 99%

Procalcitonin as prognostic factor in patients with Fournier’s gangrene

et al. 2022

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“…Definition of rUTI was presented to participants using the Recurrent UTI Symptom Scale (RUTISS), 23,24 with participants required to report at least two symptomatic episodes of UTI in the past six months or at least three in the past year. 1 Inclusion of participants based on self-report of symptoms reflected recent microbiological findings that standard urine culture misses up to 58% of true infections and published recommendations regarding the need to prioritize patient symptom reporting. [25][26][27] This approach enabled access to the larger, more heterogeneous sample required for item response theory (IRT) analysis.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…Adults meeting the diagnostic criteria for rUTI, 1 with advanced or proficient fluency in English based on the Common European Framework of Reference for Languages, 22 participated in an online cross-sectional survey (N = 389, 96.9% female biological sex; see Table 1 for characteristics). Definition of rUTI was presented to participants using the Recurrent UTI Symptom Scale (RUTISS), 23,24 with participants required to report at least two symptomatic episodes of UTI in the past six months or at least three in the past year.…”

Section: Study Design and Participantsmentioning

confidence: 99%

“…Recurrent urinary tract infection (rUTI) is defined as experiencing two or more UTIs in six months or three or more in a year, 1 and affects more than 100 million people worldwide annually. 2 Given considerable negative impact to a broad range of quality of life (QoL) domains, [3][4][5][6] and significant socioeconomic implications, 4,[7][8][9] there is an urgent need to validate the unique rUTI patient experience and incorporate QoL assessment into clinical management and research.…”

Section: Introductionmentioning

confidence: 99%

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Evaluating the quality of life impact of recurrent urinary tract infection: Validation and refinement of the Recurrent UTI Impact Questionnaire (RUTIIQ)

Newlands,

Kramer,

Roberts

et al. 2024

Neurourology and Urodynamics

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Background and AimsRecurrent urinary tract infection (rUTI) has significant negative consequences for a wide variety of quality of life (QoL) domains. Without adequate validation and assessment of the unique insights of people living with rUTI, clinical results cannot be fully understood. The Recurrent UTI Impact Questionnaire (RUTIIQ), a novel patient‐reported outcome measure of rUTI psychosocial impact, has been robustly developed with extensive patient and clinician input to facilitate enhanced rUTI management and research. This study aimed to confirm the structural validity of the RUTIIQ, assessing its strength and bifactor model fit.MethodsA sample of 389 adults experiencing rUTI (96.9% female, aged 18–87 years) completed an online cross‐sectional survey comprising a demographic questionnaire and the RUTIIQ. A bifactor graded response model was fitted to the data, optimizing the questionnaire structure based on item fit, discrimination capability, local dependence, and differential item functioning.ResultsThe final RUTIIQ demonstrated excellent bifactor model fit (RMSEA = 0.054, CFI = 0.99, SRMSR = 0.052), and mean‐square fit indices indicated that all included items were productive for measurement (MNSQ = 0.52–1.41). The final questionnaire comprised an 18‐item general “rUTI QoL impact” factor, and five subfactor domains measuring “personal wellbeing” (three items), “social wellbeing” (four items), “work and activity interference” (four items), “patient satisfaction” (four items), and “sexual wellbeing” (three items). Together, the general factor and five subfactors explained 81.6% of the common model variance. All factor loadings were greater than 0.30 and communalities greater than 0.60, indicating good model fit and structural validity.ConclusionsThe 18‐item RUTIIQ is a robust, patient‐tested questionnaire with excellent psychometric properties, which capably assesses the patient experience of rUTI‐related impact to QoL and healthcare satisfaction. Facilitating standardized patient monitoring and improved shared decision‐making, the RUTIIQ delivers the unique opportunity to improve patient‐centered care.

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“…The vagina can serve as a reservoir of enteric bacteria and vaginal dysbiosis characterized by a decrease of Lactobacilli and colonization with Escherichia coli ( E. coli ) in the vaginal microbiota can lead to RC ( Pabich et al, 2003 ; Muhleisen and Herbst-Kralovetz, 2016 ; Stapleton, 2016 ). Although the current guidelines recommend antibacterial prophylaxis for women with recurrent UTIs ( Anger et al, 2019 ; Bonkat et al, 2019 ), frequent and long-term use of antimicrobial agents leads to intractable cystitis ( Gupta and Bhadelia, 2014 ). We previously showed that RC can be caused by vaginal dysbiosis and found that changes in the vaginal microbiota during the administration of Lactobacillus crispatus ( L. crispatus )-containing vaginal suppositories prevents RC, and even refractory RC ( Uehara et al, 2006 ; Sadahira et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

Etiology of recurrent cystitis in postmenopausal women based on vaginal microbiota and the role of Lactobacillus vaginal suppository

et al. 2023

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BackgroundThe vaginal microbiota can be altered by uropathogenic bacteria associated with recurrent cystitis (RC), and the vaginal administration of Lactobacillus have suggested certain effects to prevent RC. The relationship between vaginal microbiota and the development of RC has not been elucidated. We aimed to clarify the etiology of RC from vaginal microbiota and importance of vaginal Lactobacillus.MethodsVaginal samples obtained from 39 postmenopausal women were classified into four groups: healthy controls; uncomplicated cystitis; RC; and prevention (prevented RC by Lactobacillus crispatus-containing vaginal suppositories). Principal coordinate analysis and beta-diversity analysis was used to assess 16S rRNA gene sequencing data from the vaginal microbiome.ResultsCluster analysis divided the vaginal bacterial communities among 129 vaginal samples into three clusters (A, B, and C). Fourteen of 14 (100%) samples from the RC group and 51 of 53 (96%) samples from the prevention group were in clusters B and C, while 29 of 38 (76%) samples from the healthy group and 14 of 24 (58%) samples from the uncomplicated cystitis group were in cluster A. The principal coordinate analysis showed that plots in the uncomplicated cystitis group were similar to the healthy group, indicating a large separation between the RC group and the uncomplicated cystitis group. On beta-diversity analysis, there were significant differences between the healthy group and the uncomplicated cystitis group (p = 0.045), and between the RC group and the uncomplicated cystitis group or the healthy group (p = 0.001, p = 0.001, respectively). There were no significant differences between the RC group and the prevention group (p = 0.446). The top six taxa were as follows: Prevotella, Lactobacillus, Streptococcus, Enterobacteriaceae, Anaerococcus, and Bifidobacterium. Among patients with RC, Lactobacillus was undetectable before administration of suppositories, while the median relative abundance of Lactobacillus was 19% during administration of suppositories (p = 0.0211), reducing the average cystitis episodes per year (6.3 vs. 2.4, p = 0.0015).ConclusionThe vaginal microbiota of postmenopausal women with RC is differed from healthy controls and uncomplicated cystitis in terms of lack of Lactobacillus and relatively dominant of Enterobacteriaceae. Vaginal administration of Lactobacillus-containing suppositories can prevent RC by stabilizing vaginal dysbiosis and causing a loss of pathogenic bacteria virulence.

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Adherence to European Association of Urology Guidelines and State of the Art of Glycosaminoglycan Therapy for the Management of Urinary Tract Infections: A Narrative Review and Expert Meeting Report

Cited by 10 publications

References 48 publications

Procalcitonin as prognostic factor in patients with Fournier’s gangrene

Procalcitonin as prognostic factor in patients with Fournier’s gangrene

Evaluating the quality of life impact of recurrent urinary tract infection: Validation and refinement of the Recurrent UTI Impact Questionnaire (RUTIIQ)

Etiology of recurrent cystitis in postmenopausal women based on vaginal microbiota and the role of Lactobacillus vaginal suppository

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