女性非複雜性泌尿道感染的復發危險因子
陳義昇1, 楊緒棣1 , 楊淳淳2, , 張尚仁1
Evaluating the risk factors for recurrent uncomplicated urinary tract infections in women
Yi-Sheng Chen1, Stephen Shei-Dei Yang1, Chun-Chun Yang2, Shang-Jen Chang1
1 Division of Urology, Taipei Tzu Chi Hospital, New Taipei, Taiwan
2 Division of General Laboratory, Taipei Tzu Chi General Hospital, New Taipei, Taiwan
Purpose: Urinary tract infection (UTI) is a common disease and more than 60 % of women suffered from UTIs during their lifetimes. The recurrence rate of UTI is estimated to be 30-50 % within one year. The study aimed to evaluate the potential risk factors for recurrent UTIs in women at outpatient clinic in a prospective fashion.
Materials and Methods: This prospective study was conducted at Taipei Tzu Chi Hospital, New Taipei City, from July 1, 2016 to June 30, 2019. Women who visited urological clinics with symptoms suggestive of UTIs were invited to fill the questionnaire including baseline characteristics (including age, diabetes, recent sexual activity, menopause or not and history of UTI episodes) and Urinary Tract Symptom Assessment questionnaire (UTISA). Mid stream urine samples of the participants were collected for urine analysis and urine culture. Empirical antibiotic treatment with Cephalexin 500mg/cap 4 times/day for 7 days were prescribed. Participants completed the UTISA score on the day 1 and 3 for follow-up of UTI-related symptoms at home. Urine analysis and UTISA was done at day 7 evaluated the treatment efficacy. Treatment success was defined as bact <100 counts/uL on urine analysis and UTISA <4 at day 7. Phone interviews were done at 12 months post-treatment to inquire if the participants have any episode of UTIs recurrence in the period of time and classifying them into recurrence and non-recurrence group.
Results: Among the 188 eligible patients, 183 patients (age=50.0 ± 15.2 years old ) were included in the analysis. There were 44(24.04%) participants had UTI recurrent episodes during the 12 month follow-up. One hundred and seventy-nine urine cultures (183 urine sample obtained with 4 data missing) yielded 95 (53.07%) Escherichia coli, 42 (23.46%) mixed growth, 8 (4.46%) Proteus mirabilis, 6 (3.35%) Klebsiella pneumonia, and 28 (15.64%) miscellaneous species. Univariate analysis revealed that age (OR=1.0427, 95% CI=1.0159 - 1.0702, P=0.0017), history of childbirth (OR=2.8588, 95% CI=1.2359-6.6128, P=0.0141), menopause (OR=3.6698, 95% CI=1.6375-8.2245, P=0.0016), history of sexual activity within 1 year (OR=0.3769, 95% CI=0.1882-0.7548, P=0.0059), history of UTI episodes within 1 year before this episode of UTI (OR=3.0208, 95% CI=1.1641-7.8388, P=0.0231) and E. coli infection (OR=2.0896, 95% CI=1.0133-4.3090, P=0.046) were significant difference among recurrence and non- recurrence groups. Further multivariate analysis revealed that menopause (OR=4.8878, 95% CI=1.6271-14.6825, P=0.0047), history of UTI episodes within 1 year before this episode of UTI (OR=3.7903, 95% CI=1.2886-11.1485, P=0.0155) and E. coli infection (OR=4.8082, 95% CI=1.5134 - 15.2757, P=0.0078) were significant risk factors for recurrent UTIs during the 12 months follow up. One hundred and fifty-three (83.60%) participants was treated successfully at day 7.
Conclusions:
Menopause, history of UTI symptom within 1 year before this episode of UTI and E-coli infection in 12 months were potential risk factors for recurrent uncomplicated urinary tract infections in women