Recurrent Urinary Tract Infections Due to Bacterial Persistence or Reinfection in Women—Does This Factor Impact Upper Tract Imaging Findings?

Yuefeng (Rose) Wu, Lauren L. Rego, Alana L. Christie, Rebecca S. Lavelle, Feras Alhalabi, Philippe E. Zimmern

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Purpose We compared the rates of upper tract imaging abnormalities of recurrent urinary tract infections due to bacterial persistence or reinfection. Materials and Methods Following institutional review board approval we reviewed a prospectively maintained database of women with documented recurrent urinary tract infections (3 or more per year) and trigonitis. We searched for demographic data, urine culture findings and findings on radiology interpreted upper tract imaging, including renal ultrasound, computerized tomography or excretory urogram. Patients with irretrievable images, absent or incomplete urine culture results for review, no imaging performed, an obvious source of recurrent urinary tract infections or a history of pyelonephritis were excluded from analysis. Results Of 289 women from 2006 to 2014 with symptomatic recurrent urinary tract infections 116 met study inclusion criteria. Mean ± SD age was 65.0 ± 14.4 years. Of the women 95% were white and 81% were postmenopausal. Almost a third were sexually active and none had prolapse stage 2 or greater. Of the 116 women 48 (41%) had persistent and 68 (59%) had reinfection recurrent urinary tract infection. Imaging included ultrasound in 52 patients, computerized tomography in 26, ultrasound and computerized tomography in 31, and excretory urogram with ultrasound/computerized tomography in 7. Of the total of 58 imaging findings in 55 women 57 (98%) were noncontributory. One case (0.9%) of mild hydronephrosis was noted in the persistent recurrent urinary tract infection group but it was not related to any clinical parameters. Escherichia coli was the dominant bacteria in 71% of persistent and 47% of reinfection recurrent urinary tract infections in the most recently reported urine culture. Conclusions This study reaffirms that upper tract imaging is not indicated for bacterial reinfection, recurrent urinary tract infections. However, the same conclusion can be extended to recurrent urinary tract infections secondary to bacterial persistence, thus, questioning the routine practice of upper tract studies in white postmenopausal women with recurrent urinary tract infections and trigonitis.

Original languageEnglish (US)
Pages (from-to)422-428
Number of pages7
JournalJournal of Urology
Volume196
Issue number2
DOIs
StatePublished - Aug 1 2016

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Urinary Tract Infections
Tomography
Urography
Urine
Hydronephrosis
Research Ethics Committees
Pyelonephritis
Prolapse
Radiology
Ultrasonography
Demography
Databases
Escherichia coli
Bacteria
Kidney
Infection

Keywords

  • diagnostic imaging
  • Escherichia coli
  • female
  • recurrence
  • urinary tract infections

ASJC Scopus subject areas

  • Urology

Cite this

Recurrent Urinary Tract Infections Due to Bacterial Persistence or Reinfection in Women—Does This Factor Impact Upper Tract Imaging Findings? / Wu, Yuefeng (Rose); Rego, Lauren L.; Christie, Alana L.; Lavelle, Rebecca S.; Alhalabi, Feras; Zimmern, Philippe E.

In: Journal of Urology, Vol. 196, No. 2, 01.08.2016, p. 422-428.

Research output: Contribution to journalArticle

Wu, Yuefeng (Rose) ; Rego, Lauren L. ; Christie, Alana L. ; Lavelle, Rebecca S. ; Alhalabi, Feras ; Zimmern, Philippe E. / Recurrent Urinary Tract Infections Due to Bacterial Persistence or Reinfection in Women—Does This Factor Impact Upper Tract Imaging Findings?. In: Journal of Urology. 2016 ; Vol. 196, No. 2. pp. 422-428.
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abstract = "Purpose We compared the rates of upper tract imaging abnormalities of recurrent urinary tract infections due to bacterial persistence or reinfection. Materials and Methods Following institutional review board approval we reviewed a prospectively maintained database of women with documented recurrent urinary tract infections (3 or more per year) and trigonitis. We searched for demographic data, urine culture findings and findings on radiology interpreted upper tract imaging, including renal ultrasound, computerized tomography or excretory urogram. Patients with irretrievable images, absent or incomplete urine culture results for review, no imaging performed, an obvious source of recurrent urinary tract infections or a history of pyelonephritis were excluded from analysis. Results Of 289 women from 2006 to 2014 with symptomatic recurrent urinary tract infections 116 met study inclusion criteria. Mean ± SD age was 65.0 ± 14.4 years. Of the women 95{\%} were white and 81{\%} were postmenopausal. Almost a third were sexually active and none had prolapse stage 2 or greater. Of the 116 women 48 (41{\%}) had persistent and 68 (59{\%}) had reinfection recurrent urinary tract infection. Imaging included ultrasound in 52 patients, computerized tomography in 26, ultrasound and computerized tomography in 31, and excretory urogram with ultrasound/computerized tomography in 7. Of the total of 58 imaging findings in 55 women 57 (98{\%}) were noncontributory. One case (0.9{\%}) of mild hydronephrosis was noted in the persistent recurrent urinary tract infection group but it was not related to any clinical parameters. Escherichia coli was the dominant bacteria in 71{\%} of persistent and 47{\%} of reinfection recurrent urinary tract infections in the most recently reported urine culture. Conclusions This study reaffirms that upper tract imaging is not indicated for bacterial reinfection, recurrent urinary tract infections. However, the same conclusion can be extended to recurrent urinary tract infections secondary to bacterial persistence, thus, questioning the routine practice of upper tract studies in white postmenopausal women with recurrent urinary tract infections and trigonitis.",
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AB - Purpose We compared the rates of upper tract imaging abnormalities of recurrent urinary tract infections due to bacterial persistence or reinfection. Materials and Methods Following institutional review board approval we reviewed a prospectively maintained database of women with documented recurrent urinary tract infections (3 or more per year) and trigonitis. We searched for demographic data, urine culture findings and findings on radiology interpreted upper tract imaging, including renal ultrasound, computerized tomography or excretory urogram. Patients with irretrievable images, absent or incomplete urine culture results for review, no imaging performed, an obvious source of recurrent urinary tract infections or a history of pyelonephritis were excluded from analysis. Results Of 289 women from 2006 to 2014 with symptomatic recurrent urinary tract infections 116 met study inclusion criteria. Mean ± SD age was 65.0 ± 14.4 years. Of the women 95% were white and 81% were postmenopausal. Almost a third were sexually active and none had prolapse stage 2 or greater. Of the 116 women 48 (41%) had persistent and 68 (59%) had reinfection recurrent urinary tract infection. Imaging included ultrasound in 52 patients, computerized tomography in 26, ultrasound and computerized tomography in 31, and excretory urogram with ultrasound/computerized tomography in 7. Of the total of 58 imaging findings in 55 women 57 (98%) were noncontributory. One case (0.9%) of mild hydronephrosis was noted in the persistent recurrent urinary tract infection group but it was not related to any clinical parameters. Escherichia coli was the dominant bacteria in 71% of persistent and 47% of reinfection recurrent urinary tract infections in the most recently reported urine culture. Conclusions This study reaffirms that upper tract imaging is not indicated for bacterial reinfection, recurrent urinary tract infections. However, the same conclusion can be extended to recurrent urinary tract infections secondary to bacterial persistence, thus, questioning the routine practice of upper tract studies in white postmenopausal women with recurrent urinary tract infections and trigonitis.

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