FEATURES OF THE COURSE OF URINARY TRACT INFECTIONS IN WOMEN OF CHILDBEARING AGE ON AN OUTPATIENT BASIS
Introduction. Urinary tract infections (UTI) remain one of the most important problems of modern medicine. A third of women diagnosed with UTI are under the age of 24, and half develop at least one episode by the age of 35. 70 % of women will suffer from UTI during their lifetime, and of these, 30% will have recurrent UTI.
Aim: to analyze the features of the clinical course of urinary tract infections in women of fertile age at the outpatient stage.
Materials and methods. Study design: cross-sectional non-randomized open retrospective. The study included 167 women of fertile age with a diagnosis of acute uncomplicated UTI, observed in polyclinics #1, 4, 5 in Karaganda in the period January 2018-October 2019. the research Method is analytical, registration cards were developed, which included data from medical records about the nosological form (cystitis, pyelonephritis, urethritis), anamnestic data, data on the results of clinical diagnostic methods. The inclusion criteria were female patients between 18 and 49 years of age with the above diseases. The exclusion criteria were male gender, age under 18 and over 49 years, pregnancy, asymptomatic bacteriuria, and patients with sexually transmitted infections.
The processing was based on absolute data, part of the data presented was presented in percentage (relative) terms for better perception. Statistical and mathematical data processing was carried out using the Excel application package. The following were determined: M - arithmetic mean value, the value dividing the distribution in half - Me - the median, the most common value of Mo - mode.
Results. An indicator of the incidence of UTI is higher among sexually active, unmarried patients and is dominated by acute cystitis. And the incidence of acute pyelonephritis is slightly higher in married patients - 42%. Acute cystitis was the leader among nosological forms-48%. In 26% of cases, the diagnosis was made on the basis of dysuric disorders, an increase in temperature to 37.6-37.9°C. was found only in 30 %. There were changes in the General blood test – leukocytosis, accelerated ESR) and the General urine test (leukocyturia, bacteriuria) in 98%. Only in 30% of cases, a bacteriological study of urine was performed to determine the etiological factor.
Conclusions. Urinary tract infections were most common in sexually active, unmarried women: acute cystitis took the lead, and in most cases it occurred after intercourse and was clinically manifested by dysuria. Sexually active, married women were more likely to suffer from acute pyelonephritis, which in almost all cases was accompanied by subfebrile temperature, leukocytosis, leukocyturia and bacteriuria
Aizhan R. Beisenayeva 1, https://orcid.org/0000-0002-1473-027X
Gulmira M. Muldaeva 1, https://orcid.org/0000-0002-1289-8503
Bibigul A. Abeuova 1, https://orcid.org/0000-0002-1131-9020
Anel R. Beisenayeva 2, https://orcid.org/0000-0002-6100-7578
Leyla I. Arystan 1, https://orcid.org/0000-0002-9309-4469
Leyla S. Haydargalieva 1, https://orcid.org/0000-0002-6632-2913
1 Department of Family Medicine, 2 Department of Oncology and Radiology,
NJC "Medical University of Karaganda", Karaganda, Republic of Kazakhstan
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4. Bonkat (Chair) G., Bartoletti R.R., Bruyère F., Cai T., Geerlings S.E., Köves B., Schubert S., et al. Guidelines on urological infections. European Association of Urology, 2018. https://uroweb.org/guidelines/ (Дата обращения: 18.12.2019)
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14. Masajtis-Zagajewska A., Kurnatowska I., Wajdlich M., et al. Utility of copeptin and standard inflammatory markers in the diagnostics of upper and lower urinary tract infections // BMC Urol. 2015 Jul 8. № 15. P. 67.
15. National Committee for Clinical Laboratory Standarts. M109- S18 (M2). Eleventh informational Suppl. CLSI. 2012.
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17. Neumann I., Moore P. Pyelonephritis (acute) in non-pregnant women // BMJ Clin Evid. 2014 Nov 4. 2014.pii: 0807.
18. Nicolle L.E. Asymptomatic bacteriuria in the elderly. // Infect Dis Clin North Am, 1997. № 11. P. 647. https://www.ncbi.nlm.nih.gov/pubmed/9378928/ (Дата обращения: 23.12.2019).
19. Pavone M.A., Aguilera Peralta A. Estudio y tratamiento de la pareja en ITU poscoital de la mujer // Nefrologia. 2017. № 37. P. 662–663.
20. Pinson A.G., Philbrick J.T., Lindbeck G.H., et al. Fever in the clinical diagnosis of acute pyelonephritis // Am J Emerg Med. 1997 Mar. №15(2):148. P. 51.
21. Ronald A.R., Nicolle L.E., Stamm E., et al. Urinary tract infection in adults: research priorities and strategies // Int J Antimicrob Agents. 2001 Apr. №17(4):343. P. 8.
22. Safir M.H., Schaeffer A.J. Urinary tract infection: simple and complicated // AUA Update series. 1997. № 16. P.10
23. Schappert S.M. National Ambulatory Medical Care Survey: 1992 summary // Adv Data. 1994 Aug 18. № 253. P. 1-20
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25. Shaikh N., Borrell J.L., Evron J., et al. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children // Cochrane Database Syst Rev. 2015 Jan 20. № 1:CD009185.
26. Simon L., Gauvin F., Amre D.K., et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis // Clin Infect Dis. 2004 Jul 15. №39(2):206. P. 17.
27. Stamm W.E., et al. Management of urinary tract infections in adults // N Engl J Med, 1993. № 329. Р.1328. https://www.ncbi.nlm.nih.gov/pubmed/8413414/ (Дата обращеният: 18.12.2019).
28. Stapleton A.E. The Vaginal Microbiota and Urinary Tract Infection // Microbiol Spectr. 2016. № 4(6). P. 10. doi: 10.1128/microbiolspec.UTI-0025-2016.
29. Stunell H., Buckley O., Feeney J., et al. Imaging of acute pyelonephritis in the adult // Eur Radiol. 2007 Jul. № 17(7):1820. P. 8.
30. Tan C.W., Chlebicki M.P. Urinary tract infections in adults // Singapore Med J. 2016. №57(9). P. 485–490. doi:10.11622/smedj.2016153.
31. Una J. Lee Urinary tract infections in women // BMJ Best Practice. - 2019. P. 13
32. van Buul L.W., et al. The Development of a Decision Tool for the Empiric Treatment of Suspected Urinary Tract Infection in Frail Older Adults: A Delphi Consensus Procedure // J Am Med Dir Assoc. 2018. № 19. P. 757. https://www.ncbi.nlm.nih.gov/pubmed/29910137
33. van Haarst E.P., et al. Evaluation of the diagnostic workup in young women referred for recurrent lower urinary tract infections // Urology. 2001. № 57. P. 1068. https://www.ncbi.nlm.nih.gov/pubmed/23867306/ (Дата обращения: 23.12.2019).
34. Wagenlehner F.M., et al. Uncomplicated urinary tract infections. // Dtsch Arztebl Int. 2011. № 108. P. 415. https://www.ncbi.nlm.nih.gov/pubmed/21776311/ (Дата обращения: 10.12.2019).
35. Wagenlehner F.M., Weidner W., Naber K.G. An update on uncomplicated urinary tract infections in women // Curr Opin Urol. 2009Jul. № 19(4):368. P. 74.
36. Xu R.Y., Liu H.W., Liu J.L., et al. Procalcitonin and C-reactive protein in urinary tract infection diagnosis // BMC Urol. 2014 May 30. №14 P. 45.
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6. Flores-Mireles A.L., Walker J.N., Caparon M., et al. Urinary tract infections: epidemiology, mechanisms of infection and treatment options. Nat Rev Microbiol. 2015 May. №13(5):269. P. 84.
7. Foxman B., et al. Urinary tract infection among women aged 40 to 65: behavioral and sexual risk factors. J Clin Epidemiol, 2001. № 54. Р. 710. https://www.ncbi.nlm.nih.gov/pubmed/11438412/ (accessed: 10.12.2019).
8. Garcia-Ferrer L., Primo J., Juan Escudero J.U., et al. The use of renal ultrasound for adult acute pyelonephritis. Arch Esp Urol. 2007 Jun. № 60(5):519. P. 24.
9. Giesen L.G., Cousins G., et al. Predicting acute uncomplicated urinary tract infection in women: a systematic review of the diagnostic accuracy of symptoms and signs. BMC Fam Pract. 2010 Oct 24. № 11. P. 78.
10. Gupta K., Bhadelia N. Management of urinary tract infections from multidrug-resistant organisms. Infect Dis Clin North Am. 2014. № 28. P.49–59. [PubMed].
11. Hill J.B., et al. Acute pyelonephritis in pregnancy. Obstet Gynecol, 2005. № 105. P. 18. https://www.ncbi.nlm.nih.gov/pubmed/15625136/ (accessed: 18.12.2019).
12. Hooton T.M. Clinical practice. Uncomplicated urinary tract infection // N. Engl. J. Med. 2012. № 366 (11): 1028. P. 37.
13. Hooton T.M., Gupta K. Recurrent urinary tract infection in women. UpToDate. Waltham, MA: 2016. (http://www.uptodate.com/contents/recurrent-urinary-tract-infection-in-women) (accessed: 18.12.2019)
14. Masajtis-Zagajewska A., Kurnatowska I., Wajdlich M., et al. Utility of copeptin and standard inflammatory markers in the diagnostics of upper and lower urinary tract infections. BMC Urol. 2015 Jul 8. № 15. P. 67.
15. National Committee for Clinical Laboratory Standarts. M109- S18 (M2). Eleventh informational Suppl. CLSI. 2012.
16. Neu H.C. Urinary tract infections. Am J Med. 1992 Apr 6. № 92(4A). Р. 63-70.
17. Neumann I., Moore P. Pyelonephritis (acute) in non-pregnant women. BMJ Clin Evid. 2014 Nov 4. 2014.pii: 0807.
18. Nicolle L.E. Asymptomatic bacteriuria in the elderly. Infect Dis Clin North Am, 1997. № 11. P. 647. https://www.ncbi.nlm.nih.gov/pubmed/9378928/ (accessed: 23.12.2019).
19. Pavone M.A., Aguilera Peralta A. Estudio y tratamiento de la pareja en ITU poscoital de la mujer. Nefrologia. 2017. № 37. P. 662–663.
20. Pinson A.G., Philbrick J.T., Lindbeck G.H., et al. Fever in the clinical diagnosis of acute pyelonephritis. Am J Emerg Med. 1997 Mar. №15(2):148. P. 51.
21. Ronald A.R., Nicolle L.E., Stamm E., et al. Urinary tract infection in adults: research priorities and strategies. Int J Antimicrob Agents. 2001 Apr. №17(4):343. P. 8.
22. Safir M.H., Schaeffer A.J. Urinary tract infection: simple and complicated. AUA Update series. 1997. № 16. P. 10
23. Schappert S.M. National Ambulatory Medical Care Survey: 1992 summary. Adv Data. 1994 Aug 18. № 253. P. 1-20
24. Scholes D., et al. Risk factors associated with acute pyelonephritis in healthy women. Ann Intern Med, 2005. № 142. P. 20. https://www.ncbi.nlm.nih.gov/pubmed/15630106/ (accessed: 10.12.2019).
25. Shaikh N., Borrell J.L., Evron J., et al. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev. 2015 Jan 20. № 1:CD009185.
26. Simon L., Gauvin F., Amre D.K., et al. Serum procalcitonin and C-reactive protein levels as markers of bacterial infection: a systematic review and meta-analysis. Clin Infect Dis. 2004 Jul 15. №39(2):206. P. 17.
27. Stamm W.E., et al. Management of urinary tract infections in adults. N Engl J Med, 1993. № 329. Р.1328. https://www.ncbi.nlm.nih.gov/pubmed/8413414/ (accessed: 18.12.2019).
28. Stapleton A.E. The Vaginal Microbiota and Urinary Tract Infection. Microbiol Spectr. 2016. № 4(6). P. 10. doi: 10.1128/microbiolspec.UTI-0025-2016.
29. Stunell H., Buckley O., Feeney J., et al. Imaging of acute pyelonephritis in the adult. Eur Radiol. 2007 Jul. № 17(7):1820. P. 8.
30. Tan C.W., Chlebicki M.P. Urinary tract infections in adults. Singapore Med J. 2016. №57(9). P. 485–490. doi:10.11622/smedj.2016153.
31. Una J. Lee Urinary tract infections in women. BMJ Best Practice. 2019. P. 13
32. van Buul L.W., et al. The Development of a Decision Tool for the Empiric Treatment of Suspected Urinary Tract Infection in Frail Older Adults: A Delphi Consensus Procedure. J Am Med Dir Assoc. 2018. № 19. P. 757. https://www.ncbi.nlm.nih.gov/pubmed/29910137
33. van Haarst E.P., et al. Evaluation of the diagnostic workup in young women referred for recurrent lower urinary tract infections. Urology. 2001. № 57. P. 1068. https://www.ncbi.nlm.nih.gov/pubmed/23867306/ (accessed: 23.12.2019).
34. Wagenlehner F.M., et al. Uncomplicated urinary tract infections. Dtsch Arztebl Int. 2011. № 108. P. 415. https://www.ncbi.nlm.nih.gov/pubmed/21776311/ (accessed: 10.12.2019).
35. Wagenlehner F.M., Weidner W., Naber K.G. An update on uncomplicated urinary tract infections in women. Curr Opin Urol. 2009. Jul. № 19(4):368. P. 74.
36. Xu R.Y., Liu H.W., Liu J.L., et al. Procalcitonin and C-reactive protein in urinary tract infection diagnosis. BMC Urol. 2014 May 30. №14 P. 45.
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Bibliography link
Beisenayeva A.R., Muldaeva G.M., Abeuova B.A., Beisenayeva A.R., Arystan L.I., Haydargalieva L.S. Features of the course of urinary tract infections in women of childbearing age on an outpatient basis // Nauka i Zdravookhranenie [Science & Healthcare]. 2020, (Vol.22) 2, pp. 100-108. doi:10.34689/SH.2020.22.2.012Related publications:
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