2. Urinary Tract Infection
= presence of infectious pathogens
Belong to the most frequent bacterial
illnesses, which concern female
Foxman B. Epidemiology of urinary tractinfections: Incidence, morbidity
and economic costs. Am J Med 2002;113(Suppl. 1A): 5S–13S
3. Frequency in female
• 8% girls before puberty
• 0,5 episodes/woman´s year with beginning of
sexual activity („honeymoon cystitis“)
• Later 0,1 episodes/year
• Recurrence rate 25-35% in the first 3-6
months after AB Therapy
Ronald A.:The etiology of urinary tract infection: Traditional
and emerging pathogens. Am J Med 2002;113: 14S–19S
4. Frequency in female
• 12% recurrence after first infection
• 48% recurrence after second infection
e.g. Austria
• 50.000 women with 1 recurrence/year
• 25.000 woman 2 and more recurrences/year
Ronald A.:The etiology of urinary tract infection: Traditional
and emerging pathogens. Am J Med 2002;113: 14S–19S
5. Spectrum of causative organisms
• Over 90% caused by E. coli.
• Staphylococcus saprophyticus
• Enterococcus
• Soor.
• Pseudomonas, Klebsiella, other gram-negative
Germs and Staphylococcus aureus
• Chlamydia, Gonococcus, Mycobakteria
(Tuberkulosis!), Adeno- und Herpesvirus.
6. Glycocalix
• Covers the epithelia of the bladder
• Protects the bladder against toxic urine
components.
• Blocks the adhaesion of bacteria to the
epithelia
Poggi MM, Johnstone PAS, Conner RJ. Glycosaminoglycan
content of human bladders: a method of analysis using coldcup
biopsies. Urol Oncol 2000;5: 234–7
7. Damage of the GAG-Layer
e.g. metabolites of E.coli
interstitial cystitis
conventional UTI
Idea: Reduction of symptoms by
reconstitution of GAG-Layers
Daha LK, Riedl CR, Hohlbrugger G, Knoll M, Engelhardt PF, Pflüger H.:
Comparative assessment of maximal bladder capacity, 0.9% NaCl versus
0.2 MKCl, for diagnosis of interstitial cystitis: prospective controlled
study. J Urol 2003;170: 807–9
8. Reconstitution of GAG-Layers
through „Epithelial coating“ techniques by
means of intravesical instillation of
– Hyaluronic acid
– Pentosan Polysulfat
– Heparin
Morales A, Emerson L, Nickel JC, Lundie M. Intravesical
hyaluronic acid in the treatment of refractory interstitial
cystitis. J Urol 1996; 156: 45–8
Constantinidis et al: Prevention of recurrent bacterial cystitis
by intravesical administration of hyaluronic acid: a pilot study.
BJU Int. 2004 Jun;93(9):1262-6
9. Aim of the study
Evaluation of the effect of intravesical
instillation of Hyaluronacid on the rate
of recurrence of uncomplicated urinary
tract infections
10. Study design
Number of Patients: 20
Inclusion criteria:
• Age 18 – 40
• Documented recurrent UTI´s including date of the infection,
Germ spectrum, antibiotic therapy.
• Cystography
• No current UTI at the beginning of the therapy
Exclusion criteria:
• Urogenital congenital and acquired defects (e.g.: ureterduplication,
ureterocele, neurogene dysfunction, bladder
cancer, ureter divertikel, uretero vaginal fistula, etc..)
• Existence of a interstitial cystitis
• Use of spermizide substances
• Intra Uterin Device
• Pregnancy
13. Application
• Depletion of the bladder
• Desinfection of the introitus
• Slow instillation of cystistat (used volume 50ml) with
sterile single use catheter lubricated with instillation
gel
• No urination for at least 2 hours
Side effects:
- mild to modest pain during application of the catheter
(92%)
- Mild to moderate crampy discomfort or burning up to
2 days after treatment (34%)
15. Patients
• Number of patients: 22
• Mean age: 31,6 years
• Number of instillations: 191
no serious side effects
Drop out 9%
16. Results
• Before treatment:
– 3 to 5 UTI´s a year treated with antibiotics (positive
culture)
– Number of infections (mean): 3,35/12 months
(min. 3, max. 5)
• Study period:
– 1 to 2 UTI´s a year treated with antibiotics (positive
culture)
– Number of infections (mean): 0,5/12 months
(min. 1, max. 2)
– Mean time to recurrence: 30,4 weeks (7 pat.)
17. Results
• Recurrence rate: 35% - 7 patients out of 20
• 3 pat. with 2 UTI in observation period
• 3 pat. with 1 UTI in observation period
• 1 pat. with 1 UTI in treatment period
• Drop-out rate : 9%
- Interstitial cystitis during treatment
- Lost in follow up
19. Recurrence of UTI after Cystistat
0 1 2 3 4 5 6 7 8 9 10 11 12
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
No UTI
Recurrence
20. Conclusion
• Good results in female with chronic UTI
• Reduced acceptance due to method of
application
• Good acceptance in ongoing treatment
21. Antibiotic therapy of UTI
Simple UTI: 3 day regimen
• First line antibiotics:
– Trimethoprimsulfat-Sulfat 2x960 mg
– Nitrofurantoin 3x50mg
– Fosfomycin 1x3g Singleshot
• Second line antibiotics:
– Fluorchinolone (Norfloxacin 2x400 mg, Ofloxacin 2x200 mg
and Ciprofloxacin 2x250 mg)
– Amoxicillin 2x2g
– Cephalosporin 2x1g
Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ,
Stamm WE. Guidelines for antimicrobial treatment of
uncomplicated acute bacterial cystitis and acute
pyeonephritis in women. Infectious Diseases Society of
America (IDSA). Clin Infect Dis 1999;29:745–58.
