Urinary tract infections can affect all age groups and both genders, but they are most commonly presented in sexually active women. In fact, nearly all women experience urinary infection at least once in a lifetime. If the urinary tract infection reappears multiple times despite using the appropriate treatment, then we are dealing with recurrent urinary tract infections. Most recurrent urinary tract infections are caused by the same infective agent (usually bacteria). According to epidemiological data, urinary tract reinfection reoccurs once in 30% of women during the first six months after the primary infection, and twice in about 3% of women for the same period.
Causes Of Recurrent Urinary Tract Infections
The most common pathogen causing recurrent urinary tract infections is bacteria Escherichia coli, which is found in about 80% of cases. Other agents include Staphylococcus saprophyticus (less than 15%), Enterococcus, Klebsiella, Enterobacter, and Proteus.
These recurrent infections are uncomplicated if the person is otherwise healthy, which means that there are no structural anomalies of urinary tract and no signs of any systemic disease. Uncomplicated recurrent urinary tract infections appear because some of the bacteria still exist in the rectum and anus even though they have been eliminated from the urinary tract. A higher potential for reoccurrence is therefore seen in women who have a shorter distance from the vagina to the anus. The frequency of sexual intercourse also increases the reoccurrence of these infections.
Complicated recurrent urinary tract infections appear because of urinary tract anomalies and metabolic, neurological, and other chronic diseases. Patients with a urinary catheter are very susceptible to infections, and Pseudomonas bacteria is often found in their urine culture. In patients with diabetes mellitus, the most common bacteria are Klebsiella and group B streptococcus.
Diagnosis of recurrent urinary tract infection is very simple, and often does not even require a urine culture. Reoccurrence of one symptom (painful urination, frequent urination, urgency, irritation, discharge, etc.) means reinfection in 50% of cases. If two symptoms are present, the probability is higher than 90%. In unclear cases, urine needs to be cultured in order to isolate the responsible bacteria.
For uncomplicated recurrent urinary tract infections, the treatment should be with antibiotics according to antibiogram. For the majority of cases, the first choice antibiotic is trimethoprim/sulfamethoxazole (Bactrim). In complicated cases, antibiotic treatment should be combined with treatment of the contributing cause (regulation of blood sugar level in diabetic patients, more frequent urinary catheter replacement, etc.).
Prevention with antibiotics in women with frequent reoccurrence of urinary tract infections gives good results sometimes, but there is not clear evidence which drug is the most appropriate and for this purpose and what dosage should be used.
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