Recurrent urinary tract infections in women: How promising is the use of probiotics?

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Date: July-September 2017
From: Indian Journal of Medical Microbiology(Vol. 35, Issue 3)
Publisher: Elsevier B.V.
Document Type: Article
Length: 6,532 words
Lexile Measure: 2060L

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Byline: Varsha. Gupta, Deepika. Nag, Pratibha. Garg

Urinary tract infections (UTIs) currently rank amongst the most prevalent bacterial infections, representing a major health hazard. UTIs in females usually start as vaginal infections and ascend to the urethra and bladder. Recurrent UTIs (rUTIs) can be defined as at least three episodes of UTI in 1 year or two episodes in 6 months. Various antibiotics have been the mainstay of therapy in ameliorating the incidence of UTIs, but recurrent infections continue to afflict many women. It necessitates the exploitation of alternative antimicrobial therapy. Probiotics have been shown to be effective in varied clinical trials for long-term preventions of rUTI. Because Escherichia coli is the primary pathogen involved in UTIs which spreads from the rectum to vagina and then ascends up the sterile urinary tract, improving the gut or vaginal flora will thus impact the urinary tract. Since a healthy vaginal microbiota is mainly dominated by Lactobacillus species, in this context, exogenously administered probiotics containing Lactobacilli play a pivotal role in reducing the risk of rUTI. The concept of artificially boosting the Lactobacilli numbers through probiotic administration has long been conceived but has been recently shown to be possible. Lactobacilli may especially be useful for women with a history of recurrent, complicated UTIs or on prolonged antibiotic use. Probiotics do not cause antibiotic resistance and may offer other health benefits due to vaginal re-colonisation with Lactobacilli. However, more comprehensive research is still needed, to recommend for probiotics as an alternative to antibiotics.

Urinary Tract Infections

Urinary tract infection (UTI) is an acute, bacterial infection of the urinary tract, which is accounting for around 8 million patient visits annually.[1],[2],[3] It is very common in females where the infection seems to colonise the vagina and ascend into the urinary system.[4] It is estimated that 1 in 3 women will have had a UTI by the age of 26 years.[5] 25%-30% of adult women with the first episode of UTI have a recurrence and the risk factors associated with an increased likelihood of UTI in women include urinary tract obstruction, urinary catheterisation, neurologic malfunction, pregnancy and use of spermicides, a diaphragm or anticholinergic agents.[6] UTIs are generally diagnosed based on the presence of a microorganism with a count of ≥105 CFU/mL in a clean-catch midstream urine specimen.[7] Escherichia coli is the predominant pathogen in UTIs followed by Staphylococcus saprophyticus , Enterococcus faecalis and occasionally Klebsiella pneumoniae and Proteus mirabilis .

Recurrent Urinary Tract Infection in Women

Mabeck found in his study that nearly one-half of the women whose uncomplicated UTIs resolved spontaneously developed a recurrent UTI (rUTI) within the 1st year.[4] A rUTI is common and significant healthcare problem worldwide amongst women and even more so in specific patient populations which include the ones with spinal cord injury and neurogenic bladder as well as patients with long-term urinary catheter. The rUTI is symptomatic UTI, presenting as increased frequency of micturition, dysuria or irritative voiding symptoms and is most commonly caused by reinfection with the original bacterial...

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Gale Document Number: GALE|A511234747