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The Management of Recurrent Urinary Tract Infection: Non-Antibiotic Bundle Treatment
Sergio Venturini1, Ingrid Reffo2, Manuela Avolio3
1Department of Infectious Diseases, ASFO Santa Maria degli Angeli Hospital of Pordenone, Pordenone, Italy.
Abstract:
Recurrent urinary tract infections (rUTIs) are a common condition with high morbidity and negatively impact the quality of life. They account for approximately 25% of all antibiotic prescriptions and are a public health concern in an era of increasing multidrug-resistant organisms (MDROs). Several non-antibiotic treatment strategies have been tried to curb antimicrobial use, and many are effective to some degree, but no experience testing multimodal interventions. We created a "care bundle" consisting of behavioral interventions, vaginal and oral probiotics, D-mannose, and cranberry to be followed for six months. We enrolled women with rUTIs over three years. Changes in urinary tract infections, antibiotic use, chronic symptoms, and quality of life were compared in the six months before and after participation in the study. Forty-seven women were enrolled in the study, six of whom were excluded from the final analysis. We observed a 76% reduction in urinary tract infections (p < 0.001) and a reduction in total antibiotic exposure of more than 90% (p < 0.001); all chronic symptoms showed a trend toward reduction. Adherence to the bundle was high (87.2%). Overall, 80.5% of women experienced an improvement in their quality of life. In our experience, a bundle protocol is effective in reducing recurrences and antimicrobial use in a cohort of women with rUTIs and results in a subjective improvement in chronic symptoms and quality of life. Further research with larger sample size is needed to confirm these findings.
Insights
A new multimodal care bundle significantly reduced recurrent urinary tract infections (rUTIs) and antibiotic use by over 76% and 90% respectively. This approach also improved participants' quality of life.
Area of Science:
- Urology
- Infectious Diseases
- Public Health
Background:
- Recurrent urinary tract infections (rUTIs) are prevalent, causing significant morbidity and impacting quality of life.
- rUTIs contribute substantially to antibiotic prescriptions, exacerbating concerns about multidrug-resistant organisms (MDROs).
- Existing non-antibiotic strategies offer partial benefits, but multimodal interventions remain underexplored.
Purpose of the Study:
- To evaluate the efficacy of a novel "care bundle" for managing recurrent urinary tract infections.
- To assess the impact of the multimodal intervention on infection recurrence, antibiotic consumption, chronic symptoms, and quality of life.
Main Methods:
- A prospective study enrolled women diagnosed with rUTIs over three years.
- Participants followed a six-month "care bundle" comprising behavioral changes, probiotics (oral and vaginal), D-mannose, and cranberry.
- Outcomes were compared between the six months preceding and following the intervention period.
Main Results:
- A significant 76% reduction in rUTIs and over 90% decrease in antibiotic exposure were observed (p < 0.001).
- High adherence (87.2%) to the care bundle was reported.
- 80.5% of participants experienced an improved quality of life, with trends toward reduced chronic symptoms.
Conclusions:
- A multimodal "care bundle" effectively reduces rUTI recurrence and antimicrobial use.
- This intervention demonstrates potential for improving chronic symptoms and quality of life in women with rUTIs.
- Further large-scale research is warranted to validate these promising findings.
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