UTI and The Marketing Farce


Urinary tract infections are a severe health crisis caused by various pathogens, but most commonly by Escherichia coli, Klebsiella pneumonia, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. The antimicrobial resistance of these pathogenic bacteria threatens to increase UTIs’ economic burden significantly.

Urinary tract infections are some most common bacterial infections, affecting 150 million people each year worldwide [1]. There were 10.5 million UTI symptoms in the United States and 2–3 million emergency department visits [2,3]. The societal costs of UTI infections are US$3.5 billion/year in the US alone. These infections are a significant concern for morbidities in infant boys, females, and older men; this includes:

  • Recurrences
  • Renal damage in young children
  • Pyelonephritis with sepsis
  • Pre-term birth & complications caused by regular antimicrobial use

Categorization of UTIs:

Urinary Tract Infections are categorized as uncomplicated or complicated.

Uncomplicated UTIs: This is generally known to affect individuals who are otherwise healthy and have no structural or neurological urinary tract abnormalities [4, 5]. These infections are differentiated into lower UTIs and upper UTIs. Many risk factors are associated with cystitis, including female gender, sexual activity, a prior UTI, diabetes, vaginal infection, obesity and genetic susceptibility.

Complicated UTIs: This is the one associated with factors compromising on the urinary tract or host defence. This also includes urinary obstruction and urinary retention caused by neurological disease, renal failure, immunosuppression, renal transplantation, pregnancy, & presence of foreign bodies.

Many children and infants get urinary tract infections (UTIs) in their first six months. The most common bacterial infection in children below two years, both in hospital and community settings, UTIs are more common in boys during this period. There are cases where we have understood that UTIs can progress to renal scarring in early infancy, mainly when associated with congenital urinary tract anomalies [8].

In general, 40% of women develop a urinary tract infection (UTI) at some point in their lives. Among young adult women in Singapore, 4% are affected, and the incidence increases to 7% among 50-year-old females. One in three women has their first episode of UTI before the age of 24 years, with almost half experiencing at least one episode during their lifetime. UTI is common in sexually active young women but may also affect elderly and catheterized patients. [9]

Recurrent UTI

Recurrent UTIs are symptomatic infections that follow the resolution of an earlier episode, usually after appropriate treatment. They are often found among young, healthy women even after having anatomically & physiologically normal urinary tracts. Common risk factors are:

Sexual intercourse

A new sexual partner

Use of spermicide

A mother with a history of UTI

History of UTI before menopause

History of UTI during childhood

Urinary incontinence

Atrophic vaginitis due to oestrogen deficiency

Cystocele

Increased post-void urine volume

Recurrent UTIs are diagnosed without performing a urine culture, which is only essential for its management [10].

Asymptomatic bacteriuria

Asymptomatic bacteriuria does not cause renal disease or damage. Several studies have shown that treatment for ABU increases the risk of subsequent symptomatic UTIs. This is why it is not recommended except in diagnostic and some therapeutic procedures [11].

Diagnosis

In a patient with lower urinary tract symptoms, a focused history and urine dipstick analysis are reasonable alternatives to urine cultures for the diagnosis of acute uncomplicated cystitis. Urinary cultures are recommended in patients with risk factors for complicated UTIs and the following situations: (a) symptoms that do not resolve or recur within 2–4 weeks after completion of treatment; (b) suspected pyelonephritis; (c) women who present with atypical symptoms; (d) pregnant women; and (e) male patients with suspected UTI [12].

Management

The choice of management option for uncomplicated UTIs depends on several factors, including whether it is complex or simple. Simple, uncomplicated cystitis is well treated using oral antibiotics. Studies prove that when treated with antibiotics, UTIs are better when compared to those treated with a placebo. In managing pyelonephritis, clinicians must correctly differentiate between acute uncomplicated forms and complicated, often obstructive forms of UTI that require appropriate early imaging. Early appropriate treatment can prevent urosepsis.

Patients with previous urologic procedures, recent or long-term catheterization, current or long-term antibiotics and hospitalization often have complicated UTIs. These patients are more likely to present with Escherichia coli (E. coli) and the Proteus, Klebsiella, Pseudomonas, Serratia and Enterococci genus than in uncomplicated UTIs. Treatment strategies depend on the severity of the illness, and hospitalization is often necessary.

In uncomplicated UTIs, E. coli is the predominant uropathogen isolated in acute, community-acquired uncomplicated UTIs in adults and children [13].

The recommended initial empirical oral antimicrobial therapy for mild and moderate acute uncomplicated pyelonephritis is ciprofloxacin 500 mg twice/daily, followed by co-trimoxazole 960 mg twice daily for 10–14 days.

Referral to a specialist is recommended in given cases:

If you have bothersome lower urinary tract symptoms that have not responded to conservative management or drug treatment. If you have recurrent or persistent UTIs, retention, or renal impairment suspected to be caused by lower urinary tract dysfunction and if you have alleged urological cancer, you should consider taking this medicine.

UTIs in infants under three months with a possible UTI and those in children and infants aged three months or above with acute pyelonephritis/upper UTI should be treated quickly. [14]

UTIs with the following characteristics are worthy of being treated with antibiotics: (a) failed medical therapy (documented); (b) severe symptoms; (c) evidence of retention or inflammation in the bladder; & (d) abnormalities detected on ultrasonography like calculi or bladder tumour.

Patients with recurrent UTIs (defined as ≥ 3 UTIs in 12 months) with the following characteristics: (a) risk factors for complicated UTIs are present; (b) a surgically correctable cause is suspected, and (c) a diagnosis of UTI is uncertain should be considered for prophylactic antibiotic therapy.

UTIs are the most common bacterial infections encountered by general physicians, and most uncomplicated UTIs are treated in the outpatient setting with appropriate antibiotics.

Differentiating uncomplicated UTIs into simple & complicated using the European Association of Urology’s ORENUC classification aids in appropriate clinical management for better outcomes.

Uncomplicated lower-tract UTIs are treated with appropriate oral antibiotics without needing urine culture. [15]

A complicated urinary tract infection is associated with a condition, such as a structural/functional abnormality of the genitourinary tract, increasing the risk of this condition becoming an even more severe health problem. Patients at risk of developing such a problem should receive care from a urologist to prevent this from happening.

All males with UTIs and all infants aged under three months with a possible UTI should be reviewed by a urologist.

The Marketing Curses on Consumers:

Many marketing techniques have been used to scare and fool people into purchasing products to avoid useless UTIs that don’t serve any purpose. The first trap is to use words like “natural” or “all-natural” to make people think that the product is better for their health; it is not. It’s not uncommon for companies to use this strategy when they want to get away with selling something that’s not healthy for them. Another tactic is using fear as a tool. For example, the company may say you will get an infection if you don’t take their product. This can be very effective because many people are afraid of getting sick or getting a disease, especially when they’re young and not yet immune to such infections. Another strategy is claiming that their product will help prevent UTIs or treat them if they occur. The problem with this type of marketing is that there’s no proof that these claims are valid—and when there isn’t proof, it makes it difficult for people who may not know much about health issues like UTIs to trust these claims based on what they hear from advertisements like this one. Sprays and wipes that secure you from UTIs are generally said to help avoid UTIs from toilet seats. This is vertical misinformation spread as UTIs have nothing to do with toilet seats. After all, we squat over the seat and not rub around it or dance on the seat! There is no point of contact for the bacteria to enter the urethra, so there is no scope of infection. So, the products are making an absolute fool out of clients who purchase them out of fear!

Caution:

Some people are in the habit of hovering and peeing when using public toilets. It is recommended not to get into this practice as it puts excessive pressure on the pelvic floor muscles, weakening your lower body organs. 

It is always better to understand your body, its mechanism, how these bacteria attack it, and how the body’s defence mechanism works. Believe me; this is the best way to live a healthy life and make the most out of this beautiful creation called HUMAN BODY!

 

References and Sources:

  1. https://pubmed.ncbi.nlm.nih.gov/11171002/
  2. https://pubmed.ncbi.nlm.nih.gov/21614897/
  3. https://pubmed.ncbi.nlm.nih.gov/21139641/
  4. https://pubmed.ncbi.nlm.nih.gov/22417256/
  5. https://pubmed.ncbi.nlm.nih.gov/20647992/
  6. https://pubmed.ncbi.nlm.nih.gov/18945392/
  7. https://pubmed.ncbi.nlm.nih.gov/23378123/
  8. https://pubmed.ncbi.nlm.nih.gov/26075187/
  9. https://pubmed.ncbi.nlm.nih.gov/12113866/
  10. https://pubmed.ncbi.nlm.nih.gov/22031610/
  11. https://pubmed.ncbi.nlm.nih.gov/15714408/
  12. https://pubmed.ncbi.nlm.nih.gov/12113866/
  13. https://pubmed.ncbi.nlm.nih.gov/20842992/
  14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6751349/
  15. https://pubmed.ncbi.nlm.nih.gov/29271734

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