TOP LINE:

The prevalence of recurrent urinary tract infections (rUTIs) and the use of antibiotics for prevention are substantial among women in Wales, particularly those aged over 57 years. High levels of resistance to two recommended antibiotics have been observed, suggesting that more frequent urine cultures may better guide the choice of antibiotics for treatment and prophylaxis.

METHODOLOGY:

• The researchers conducted a retrospective cross-sectional study using a large patient database in Wales to describe the characteristics and urine profiles of women with rUTIs between 2010 and 2022.
• They created two cohorts: one with 92,213 women (mean age 60 years) who suffered from rUTIs, defined as two or more acute episodes within 6 months or three or more acute episodes within 12 months.
• Another cohort of 26,862 women (mean age 71 years) were prescribed prophylactic antibiotics. This was defined as three or more consecutive prescriptions for the same urinary tract infection-specific antibiotic (trimethoprim, nitrofurantoin, or cefalexin) with intervals of 21 to 56 days between prescriptions.
• Urine culture results during the 12 months prior to diagnosis of rUTI and 18 months prior to initiation of prophylactic antibiotic treatment, as well as all urine culture results within 7 days of acute UTI, were analyzed to evaluate antibiotic resistance patterns.

TAKE AWAY:

• Overall, 6% of women had chronic urinary tract infections, 1.7% of whom were prescribed prophylactic antibiotics, with this proportion increasing sharply after the age of 57.
• Almost half of the women (49%) who were prescribed a prophylactic antibiotic had a rUTI diagnosed in the 18 months prior to treatment initiation.
• This study found that 80.8% of women with rUTIs had a documented urine culture result in the 12 months prior to diagnosis.
• More than half (64%) of women taking prophylactic antibiotics had urine culture results documented before starting treatment, and 18% of women prescribed trimethoprim developed resistance to the antibiotic.

IN PRACTICE:

“More frequent urine cultures at the time of diagnosis of rUTI and prophylactic antibiotic treatment may allow for better antibiotic decision-making,” the authors write.

SOURCE:

The study was led by Leigh Sanyaolu, BSc (Hons), MRCS, MRCGP, PGDip, a GP in the Division of Population Medicine and PRIME Centre Wales at Cardiff University in Cardiff, Wales, and published online in British Journal of General Medicine.

RESTRICTIONS:

The fact that the study relied on electronic health records may have led to coding errors and missing data. Diagnosis of urinary tract infections may have been difficult in older women with increasing frailty, as they may have less specific symptoms and asymptomatic bacteriuria, which can be misdiagnosed as urinary tract infection.

DISCLOSURE:

This work was supported by Health and Care Research Wales. The authors declared no conflicts of interest.

Several editorial tools, including AI, were used to create this article. Human editors reviewed the content before publication.