California Northstate University College of Medicine
Introduction: Recurrent UTIs (rUTIs) have an enormous healthcare burden. Many patients continue to experience recurrence of symptoms despite appropriate antibiotic treatment. We aimed to understand the natural history and progression of rUTI in women to determine the influence of patient factors, laboratory findings, and management approaches on recurrence. Methods: Women aged 18-95 diagnosed between 2013-2015 by urogynecologic specialists with rUTI after in-person evaluation were followed for up to three subsequent visits for symptomatic complaints over the year following initial presentation. Patients with complicated UTIs or any history of pyelonephritis were excluded. Patient demographics, comorbidities, laboratory findings, treatments administered, and symptom resolution for each episode was recorded. Results: Of a total of 101 women with rUTI, 70% (70/101) experienced recurrent symptoms within 1 year; 90% of these recurrences included acute dysuria prompting reevaluation. On multivariable logistic regression, only prior pelvic surgery (OR 0.15 [95% CI 0.03-0.8], p=0.02) was associated with lower recurrence rates, while preventative medications (prophylactic or post-coital antibiotics, vaginal estrogen) was the only variable significantly associated with symptomatic resolution (OR 4.85 [95% CI 1.1-22], p = 0.04). Post-menopausal women more commonly experienced symptomatic resolution than pre-menopausal women (OR 20.4 [95% CI 0.83-502], p = 0.06), and a comorbid diagnosis of anxiety or depression was more common in patients whose symptoms did not resolve (OR 0.09 [95% CI 0.01-1.06], p = 0.08), although these trends did not reach statistical significance. Across all symptomatic episodes, 60% of urine cultures did not have microbiological evidence of infection. Only 2/70 (3%) subjects had positive cultures during all symptomatic episodes. There was no correlation between initial culture results and rates of symptomatic resolution or subsequent culture positivity. Conclusions: Spontaneous resolution of symptoms is not the natural history of rUTIs once established. Use of intermittent antibiotics to treat rUTIs is inferior to preventative measures at achieving symptomatic resolution. As most symptomatic episodes displayed negative urine cultures despite symptoms consistent with UTI, future studies will need to determine whether this discrepancy is due to poor sensitivity of standard urine culture or a higher than previously appreciated rate of confounding conditions presenting with similar symptoms as UTI. SOURCE OF Funding: N/A
