It’s uncomplicated: Prevention of urinary tract infections in an era of increasing antibiotic resistance

Infections of the urinary tract are commonAU : PleaseconfirmthatallheadinglevUrinary tract infections (UTIs) rank near the top of the long list of medical issues that can affect humans.They are the most common reason for outpatient visits in the United States (US), and clinics around the world see millions of cases annually.UTIs can be broadly categorized as uncomplicated infections that are usually straightforward to resolve, versus complicated UTIs that because of the pathogen, anatomy or health status of the patient, and/or presence of medical devices such as urinary catheters or stents, are more challenging to resolve.Complicated UTIs are associated with formation of antibiotic-tolerant bacterial or fungal biofilm communities on medical devices during prolonged use, and risk is correlated with duration of device placement [1].Although uncomplicated UTIs are relatively simple to treat, they can be recurrent, defined as 2 or more symptomatic infections in 6 months, or 3 in 12 months, often with the same pathogen [2].If inadequately treated, both types of UTIs can progress to severe disease, including kidney damage and sepsis, with the urinary tract being a major source of bloodstream infections [3,4]. Uncomplicated UTIs disproportionately affect womenMore than half of adult women will have an uncomplicated UTI at some point in their lives, and risk is correlated with increasing age, with a prevalence of approximately 20% in those over 65 years [2].Between 20% and 30% of women will experience a recurrence of their initial UTI within 3 to 4 months [5].These numbers are likely an underestimate, because UTIs are not reportable in most jurisdictions.Women are more susceptible than men due to specific anatomical and physiological differences [6].In women, the urethral opening is closer to the anus, a primary source of bacteria that can cause uncomplicated UTIs.The shorter female urethra means bacteria have less distance to travel from the external opening to reach the bladder.Sexual activity can introduce bacteria into the urethra, and women are more likely to get UTIs after intercourse than men [7].Changes in function of the urogenital tract related to pregnancy, menopause, or use of diaphragms or spermicidal agents for birth control can increase the risk for infection [8].For both men and women, conditions that prevent the bladder from emptying completely-including prolapsed uterus or bladder, the presence of kidney or bladder stones, or medical devices-can lead to urine retention and increased infection risk.Elderly adults or people with diseases such as diabetes, in whom immune function is decreased, are also more susceptible to UTIs [4].

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