Zusammenfassung
Chronisch rezidivierende Infektionen der Harnblase sind bei Frauen häufig und können
eine erhebliche Belastung darstellen. Ihr Auftreten ist mit im Alter häufiger vorkommenden
Risikofaktoren assoziiert. Diese umfassen anatomische und funktionelle Veränderungen,
welche die lokale Abwehrlage des Urogenitaltraktes beeinträchtigen (z. B. Atrophie
der Schleimhäute, Zystozelen, Restharn, Oligurie). Eine weitere Ursache kann die Besiedelung
mit einem besonders virulenten, persistierenden Erreger sein.
Die Diagnose wird anhand der typischen Klinik und mithilfe von Streifentests und Urinkultur
gestellt.
Die Therapie und Prophylaxe des chronisch rezidivierenden Harnwegsinfektes beinhaltet
die Elimination von Risikofaktoren. Die kontinuierliche oder intermittierende Antibiotikatherapie
hat eine besondere Bedeutung. Zur Prophylaxe von rezidivierenden Harnwegsinfektionen
stellt Trimethoprim die Substanz der ersten Wahl dar. Die Beeinflussung der Rezidivhäufigkeit
ist auch durch Verhaltensänderung und unterstützende Maßnahmen wie lokale Hormonsubstitution
und Ansäuern des Urins möglich. Alternative Therapien, vor allem mit pflanzlichen
Präparaten, Bakterienextrakten und Akupunktur, zeigen viel versprechende Ergebnisse.
Sie sind zurzeit aber noch nicht ausreichend untersucht, um eine Empfehlung auf einer
rationalen Basis aussprechen zu können.
Abstract
Recurrent urinary tract infections (RUTI) are very common in women and substantially
affect the quality of life of these patients. RUTI is strongly associated with predisposing
risk factors occurring especially in elderly women, including functional or anatomical
changes such as mucosal atrophy, cystocele, increased post-void residual volume and
oliguria. The colonization of the vaginal and periurethral mucosa with virulent, persistent
bacteria represents an additional cause for RUTI.
The clinical symptoms together with dipstick urine analysis and urine culture lead
to the diagnosis.
Therapy and prophylaxis of RUTI are based on the elimination of the mentioned risk
factors. Long-term or intermittent antibiotic treatment are pertinent therapeutic
options. The first choice antibiotic regimen for prophylaxis of RUTI is trimethoprim.
Behavioral changes and supportive measures such as acidification of the urine or local
hormone therapy also reduce the incidence rates of RUTI. In addition, alternative
therapeutic approaches including herbal or bacterial extracts and acupuncture showed
promising effects, but need further evaluation.
Schlüsselwörter
Chronische rezidivierende Harnwegsinfektion - Zystitis
Key words
Recurrent urinary tract infection
Literatur
- 1
Barnett B J, Stephens D S.
Urinary tract infection: an overview.
Am J Med Sci.
1997;
314
245-249
- 2
Ikaheimo R, Siitonen A, Heiskanen T, Karkkainen U, Kuosmanen P, Lipponen P, Makela P H.
Recurrence of urinary tract infection in a primary care setting: analysis of a 1-year
follow-up of 179 women.
Clin Infect Dis.
1996;
22
91-99
- 3
Grether J K, Nelson K B.
Maternal infection and cerebral palsy in infants of normal birth weight.
JAMA.
1997;
278
207-211
- 4
McDermott S, Callaghan W, Szwejbka L, Mann H, Daguise V.
Urinary tract infections during pregnancy and mental retardation and developmental
delay.
Obstet Gynecol.
2000;
96
113-119
- 5
Baerheim A, Laerum E.
Home-voided urine specimens in women. Diagnostic agreement with clean-catch midstream
specimens.
Scand J Prim Health Care.
1990;
8
207-211
- 6
Bailey B L.
Urinalysis predictive of urine culture results.
J Fam Pract.
1995;
40
45-50
- 7
Hiraoka M, Hida Y, Hori C, Tuchida S, Kuroda M, Sudo M.
Rapid dipstick test for diagnosis of urinary tract infection.
Acta Paediatr Jpn.
1994;
36
379-382
- 8
Stamm W E, Counts G W, Running K R, Fihn S, Turck M, Holmes K K.
Diagnosis of coliform infection in acutely dysuric women.
N Engl J Med.
1982;
307
463-468
- 9
Hooton T M.
Recurrent urinary tract infection in women.
Int J Antimicrob Agents.
2001;
17
259-268
- 10
Arav-Boger R, Leibovici L, Danon Y L.
Urinary tract infections with low and high colony counts in young women. Spontaneous
remission and single-dose vs multiple-day treatment.
Arch Intern Med.
1994;
154
300-304
- 11
Kunin C M, White L V, Hua T H.
A reassessment of the importance of “low-count” bacteriuria in young women with acute
urinary symptoms.
Ann Intern Med.
1993;
119
454-460
- 12
Svanborg C, Godaly G.
Bacterial virulence in urinary tract infection.
Infect Dis Clin North Am.
1997;
11
513-529
- 13
Navas-Nacher E L, Dardick F, Venegas M F, Anderson B E, Schaeffer A J, Duncan J L.
Relatedness of Escherichia coli colonizing women longitudinally.
Mol Urol.
2001;
5
31-36
- 14
Dwyer P L, O'Reilly M.
Recurrent urinary tract infection in the female.
Curr Opin Obstet Gynecol.
2002;
14
537-543
- 15
Beyer I, Mergam A, Benoit F, Theunissen C, Pepersack T.
Management of urinary tract infections in the elderly.
Z Gerontol Geriatr.
2001;
34
153-157
- 16
Mulvey M A, Lopez-Boado Y S, Wilson C L, Roth R, Parks W C, Heuser J, Hultgren S J.
Induction and evasion of host defenses by type 1-piliated uropathogenic Escherichia
coli.
Science.
1998;
282
1494-1497
- 17
Hooton T M.
Pathogenesis of urinary tract infections: an update.
J Antimicrob Chemother.
2000;
46 (Suppl 1)
1-7
- 18
Foxman B, Zhang L, Tallman P, Palin K, Rode C, Bloch C, Gillespie B, Marrs C F.
Virulence characteristics of Escherichia coli causing first urinary tract infection
predict risk of second infection.
J Infect Dis.
1995;
172
1536-1541
- 19
Mulvey M A.
Adhesion and entry of uropathogenic Escherichia coli.
Cellular Microbiology.
2002;
4
257-271
- 20
Nowicki B, Selvarangan R, Nowicki S.
Family of Escherichia coli Dr adhesins: decay-accelerating factor receptor recognition
and invasiveness.
J Infect Dis.
2001;
183 (Suppl 1)
S24-27
- 21
Sheinfeld J, Schaeffer A J, Cordon-Cardo C, Rogatko A, Fair W R.
Association of the Lewis blood-group phenotype with recurrent urinary tract infections
in women.
N Engl J Med.
1989;
320
773-777
- 22
Hooton T M, Scholes D, Hughes J P, Winter C, Roberts P L, Stapleton A E, Stergachis A,
Stamm W E.
A prospective study of risk factors for symptomatic urinary tract infection in young
women.
N Engl J Med.
1996;
335
468-474
- 23
Suman E, Gopalkrishna Bhat K, Hegde B M.
Bacterial adherence and immune response in recurrent urinary tract infection.
Int J Gynaecol Obstet.
2001;
75
263-268
- 24 Hummers-Pradier E, Kochen M M. DEGAM Leitlinie 1: Brennen beim Wasserlassen. Düsseldorf;
Omikron Publishing 2002
- 25
Keenan T D, Eliott J C, Bishop V, Peddie B A, Bailey R R.
Comparison of trimethoprim alone with co-trimoxazole and sulphamethizole for treatment
of urinary tract infections.
N Z Med J.
1983;
96
341-342
- 26
Trimethoprim Study Group .
Comparison of trimethoprim at three dosage levels with co-trimoxazole in the treatment
of acute symptomatic urinary tract infection in general practice.
J Antimicrob Chemother.
1981;
7
179-183
- 27
Lacey R W, Lord V L, Gunasekera H K, Leiberman P J, Luxton D E.
Comparison of trimethoprim alone with trimethoprim sulphamethoxazole in the treatment
of respiratory and urinary infections with particular reference to selection of trimethoprim
resistance.
Lancet.
1980;
1
1270-1273
- 28
Hunziker T, Kunzi U P, Braunschweig S, Zehnder D, Hoigne R.
Comprehensive hospital drug monitoring (CHDM): adverse skin reactions, a 20-year survey.
Allergy.
1997;
52
388-393
- 29
Lee A J, Maddix D S.
Trimethoprim/sulfamethoxazole-induced hypoglycemia in a patient with acute renal failure.
Ann Pharmacother.
1997;
31
727-732
- 30
Schopf E.
Skin reactions to co-trimoxazole.
Infection.
1987;
15 (Suppl 5)
S254-S258
- 31 Naber K G, Bergman B, Bishop M C, Bjerklund-Johansen T E, Botto H, Lobel B, Jimenez-Cruz F,
Selvaggi F P. Guideline of the European Association of Urology: Urinary Tract Infections
- Male Genital Tract Infections. http://www.uroweb.org/files/uploaded_files/uti_mgti.pdf
. 2001
- 32
Brumfitt W, Hamilton-Miller J M.
Efficacy and safety profile of long-term nitrofurantoin in urinary infections: 18
years' experience.
J Antimicrob Chemother.
1998;
42
363-371
- 33
Stapleton A, Stamm W E.
Prevention of urinary tract infection.
Infect Dis Clin North Am.
1997;
11
719-733
- 34
Gupta K, Hooton T M, Roberts P L, Stamm W E.
Patient-initiated treatment of uncomplicated recurrent urinary tract infections in
young women.
Ann Intern Med.
2001;
135
9-16
- 35
Raz R, Stamm W E.
A controlled trial of intravaginal estriol in postmenopausal women with recurrent
urinary tract infections.
N Engl J Med.
1993;
329
753-756
- 36
Brown J S, Vittinghoff E, Kanaya A M, Agarwal S K, Hulley S, Foxman B. Heart and Estrogen/Progestin
Replacement Study Research Group .
Urinary tract infections in postmenopausal women: effect of hormone therapy and risk
factors.
Obstet Gynecol.
2001;
98
1045-1052
- 37
Oliveria S A, Klein R A, Reed J I, Cirillo P A, Christos P J, Walker A M.
Estrogen replacement therapy and urinary tract infections in postmenopausal women
aged 45 - 89.
Menopause.
1998;
5
4-8
- 38
Gupta K, Stapleton A E, Hooton T M, Roberts P L, Fennell C L, Stamm W E.
Inverse association of H2O2-producing lactobacilli and vaginal Escherichia coli colonization
in women with recurrent urinary tract infections.
J Infect Dis.
1998;
178
446-450
- 39 Karram M M.
Lower Urinary Tract Infection. Ostergard DR, Bent AE Urogynecology and Urodynamics. 4th ed. Baltimore; Williams
and Wilkins 1996: 387-408
- 40
Schiotz H A, Guttu K.
Value of urinary prophylaxis with methenamine in gynecologic surgery.
Acta Obstet Gynecol Scand.
2002;
81
743-746
- 41
Castello T, Girona L, Gomez M R, Mena Mur A, Garcia L.
The possible value of ascorbic acid as a prophylactic agent for urinary tract infection.
Spinal Cord.
1996;
34
592-593
- 42
Hetey S K, Kleinberg M L, Parker W D, Johnson E W.
Effect of ascorbic acid on urine pH in patients with injured spinal cords.
Am J Hosp Pharm.
1980;
37
235-237
- 43
Stothers L.
A randomized trial to evaluate effectiveness and cost effectiveness of naturopathic
cranberry products as prophylaxis against urinary tract infection in women.
Can J Urol.
2002;
9
1558-1562
- 44
Kontiokari T, Sundqvist K, Nuutinen M, Pokka T, Koskela M, Uhari M.
Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the
prevention of urinary tract infections in women.
BMJ.
2001;
322
1571
- 45
Harkins K J.
What's the use of cranberry juice?.
Age Ageing.
2000;
29
9-12
- 46
Schulman C C, Corbusier A, Michiels H, Taenzer H J.
Oral immunotherapy of recurrent urinary tract infections: a double-blind placebo-controlled
multicenter study.
J Urol.
1993;
150
917-921
- 47
Tammen H.
Immunobiotherapy with Uro-Vaxom in recurrent urinary tract infection. The German Urinary
Tract Infection Study Group.
Br J Urol.
1990;
65
6-9
- 48
Bauer H W, Rahlfs V W, Lauener P A, Blessmann G S.
Prevention of recurrent urinary tract infections with immuno-active E. coli fractions:
a meta-analysis of five placebo-controlled double-blind studies.
Int J Antimicrob Agents.
2002;
19
451-456
- 49
Trautner B W, Hull R A, Darouiche R O.
Escherichia coli 83, 972 inhibits catheter adherence by a broad spectrum of uropathogens.
Urology.
2003;
61
1059-1062
- 50
Darouiche R O, Donovan W H, Del Terzo M, Thornby J I, Rudy D C, Hull R A.
Pilot trial of bacterial interference for preventing urinary tract infection.
Urology.
2001;
58
339-344
- 51
Hull R, Rudy D, Donovan W, Svanborg C, Wieser I, Stewart C, Darouiche R.
Urinary tract infection prophylaxis using Escherichia coli 83, 972 in spinal cord
injured patients.
J Urol.
2000;
163
872-877
- 52
Aune A, Alraek T, LiHua H, Baerheim A.
Acupuncture in the prophylaxis of recurrent lower urinary tract infection in adult
women.
Scand J Prim Health Care.
1998;
16
37-39
Dr. med. Dirk Watermann
Universitäts-Frauenklinik
Hugstetter Straße 55
79106 Freiburg
eMail: watermann@frk.ukl.uni-freiburg.de
