In most cases, such infections are the result of sexual habits and hygiene (eg, women who are sexually active, especially those using diaphragms and/or spermatocides) [3,7]. Although antibiotic prophylaxis effectively limits UTI recurrence, it increases the risk of antibiotic resistance for both the causative microorganisms and the indigenous flora and risks adverse effects. It therefore should be approached judiciously. Before considering antibiotic prophylaxis for recurrent UTIs, self-care measures should be advised, including ensuring adequate hydration to promote more frequent urination, encouraging urge-initiated voiding and post-coital voiding, the avoidance of spermicidal-containing contraceptives, and, for postmenopausal women with risk factors such as atrophic vaginitis, the prescription of topical vaginal estrogens, as appropriate [8,9]. A clean-catch or catheterized specimen for culture typically reveals >100,000 organisms per milliliter of urine. E. coli is the most common organism in all patient groups, causing approximately 75% of recurrent UTIs, with most other infections caused by E. faecalis, Proteus mirabilis, Klebsiella, or S. saprophyticus particularly in patients with risk factors for complicated UTIs [6,10-12]. Postmenopausal women are at increased risk for recurrent UTI in the presence of urinary incontinence, cystocele, or high postvoid residuals of urine [13,14]. Women who have three or more symptomatic infections over a 12-month period may benefit from prophylaxis [3,4,7]. Imaging is of low yield in patients without underlying risk factors, less than two episodes per year on average, and who respond promptly to appropriate therapy (see Appendix 1) [1,7,15,16]. Current clinical guidelines indicate that imaging should not be routinely obtained in the index patient presenting with recurrent UTIs because aThe University of Texas MD Anderson Cancer Center, Houston, Texas. bPanel Chair, University of Chicago, Chicago, Illinois.
Recurrent Lower Urinary Tract Infections in Females. In most cases, such infections are the result of sexual habits and hygiene (eg, women who are sexually active, especially those using diaphragms and/or spermatocides) [3,7]. Although antibiotic prophylaxis effectively limits UTI recurrence, it increases the risk of antibiotic resistance for both the causative microorganisms and the indigenous flora and risks adverse effects. It therefore should be approached judiciously. Before considering antibiotic prophylaxis for recurrent UTIs, self-care measures should be advised, including ensuring adequate hydration to promote more frequent urination, encouraging urge-initiated voiding and post-coital voiding, the avoidance of spermicidal-containing contraceptives, and, for postmenopausal women with risk factors such as atrophic vaginitis, the prescription of topical vaginal estrogens, as appropriate [8,9]. A clean-catch or catheterized specimen for culture typically reveals >100,000 organisms per milliliter of urine. E. coli is the most common organism in all patient groups, causing approximately 75% of recurrent UTIs, with most other infections caused by E. faecalis, Proteus mirabilis, Klebsiella, or S. saprophyticus particularly in patients with risk factors for complicated UTIs [6,10-12]. Postmenopausal women are at increased risk for recurrent UTI in the presence of urinary incontinence, cystocele, or high postvoid residuals of urine [13,14]. Women who have three or more symptomatic infections over a 12-month period may benefit from prophylaxis [3,4,7]. Imaging is of low yield in patients without underlying risk factors, less than two episodes per year on average, and who respond promptly to appropriate therapy (see Appendix 1) [1,7,15,16]. Current clinical guidelines indicate that imaging should not be routinely obtained in the index patient presenting with recurrent UTIs because aThe University of Texas MD Anderson Cancer Center, Houston, Texas. bPanel Chair, University of Chicago, Chicago, Illinois.