Novel management of urinary tract infections
Douglas W Storm1, Ashay S Patel, Stephen A Koff
1Department of Urology, Naval Medical Center, San Diego, California, USA.
Insights
New approaches to pediatric urinary tract infections (UTIs) and vesicoureteral reflux are emerging. Research into host-pathogen interactions suggests probiotics may prevent kidney scarring from UTIs.
Area of Science:
- Pediatric Nephrology
- Infectious Diseases
- Microbiology
Background:
- Conventional management of pediatric urinary tract infections (UTIs) and vesicoureteral reflux (VUR) is being re-evaluated.
- Prophylactic antibiotics are traditionally used but recent studies question their efficacy in preventing recurrent UTIs and renal scarring.
Purpose of the Study:
- To review current observations necessitating a shift in UTI and VUR management for children.
- To explore novel strategies for UTI prevention and renal scarring mitigation.
- To investigate the role of host-pathogen interactions in developing alternative approaches.
Main Methods:
- Review of recent studies on pediatric UTIs and VUR.
- Analysis of research on bacterial virulence factors in UTIs.
- Investigation of host-pathogen interactions and their implications for treatment.
Main Results:
- Recent findings challenge the routine use of prophylactic antibiotics for children with VUR.
- Host-pathogen interaction research enables analysis of bacterial virulence.
- Identification of highly virulent bacteria and their gut reservoirs is now possible.
- Probiotics show promise in targeting and eliminating uropathogenic bacteria.
Conclusions:
- Experimental studies link bacterial virulence to UTI patterns.
- A novel probiotic can eradicate uropathogenic bacteria.
- Targeted probiotic prevention of renal injury-inducing UTIs is a potential therapeutic strategy.
Purpose Of Review:
To highlight observations that have suggested the need for changing the conventional approach to the evaluation and management of urinary tract infections (UTIs) and vesicoureteral reflux in children and examine new alternative approaches to prevention of UTI and renal scarring based on research into host-pathogen interaction.
Recent Findings:
Recent studies have questioned the traditional approach of using prophylactic antibiotics to prevent recurrence of UTI and development of renal scarring in children with vesicoureteral reflux. Ongoing research on host-pathogen interactions reveals a promising capability to analyze virulence factors in bacteria causing UTIs in children, identify highly virulent bacteria capable of causing pyelonephritis and renal injury, and to selectively target the gastrointestinal reservoirs of these bacteria for elimination using probiotics.
Summary:
Promising experimental studies correlating bacterial virulence with pattern of UTI and identification and characterization of a newly available probiotic capable of eradicating uropathogenic bacteria make targeted probiotic prevention of renal injury-inducing UTIs a potential therapeutic reality.
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