Download PDF
Geburtshilfe Frauenheilkd 2004; 64(5): 473-478
DOI: 10.1055/s-2004-817836
Übersicht

Georg Thieme Verlag KG Stuttgart · New York

Rezidivierende Zystitis der Frau

Recurrent Urinary Tract Infection in WomenD. Watermann1 , M. Kunze1
  • 1Universitäts-Frauenklinik Freiburg
Further Information

Publication History

Eingang Manuskript: 3. November 2003 Eingang revidiertes Manuskript: 26. Januar 2004

Akzeptiert: 29. Januar 2004

Publication Date:
05 May 2004 (online)

Also available at
    Permissions and Reprints

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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 3 Grether J K, Nelson K B. Maternal infection and cerebral palsy in infants of normal birth weight.  JAMA. 1997;  278 207-211
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 6 Bailey B L. Urinalysis predictive of urine culture results.  J Fam Pract. 1995;  40 45-50
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 9 Hooton T M. Recurrent urinary tract infection in women.  Int J Antimicrob Agents. 2001;  17 259-268
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 12 Svanborg C, Godaly G. Bacterial virulence in urinary tract infection.  Infect Dis Clin North Am. 1997;  11 513-529
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 14 Dwyer P L, O'Reilly M. Recurrent urinary tract infection in the female.  Curr Opin Obstet Gynecol. 2002;  14 537-543
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 17 Hooton T M. Pathogenesis of urinary tract infections: an update.  J Antimicrob Chemother. 2000;  46 (Suppl 1) 1-7
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 19 Mulvey M A. Adhesion and entry of uropathogenic Escherichia coli.  Cellular Microbiology. 2002;  4 257-271
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 24 Hummers-Pradier E, Kochen M M. DEGAM Leitlinie 1: Brennen beim Wasserlassen. Düsseldorf; Omikron Publishing 2002
    Google Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 29 Lee A J, Maddix D S. Trimethoprim/sulfamethoxazole-induced hypoglycemia in a patient with acute renal failure.  Ann Pharmacother. 1997;  31 727-732
    PubMedGoogle Scholar
  • 30 Schopf E. Skin reactions to co-trimoxazole.  Infection. 1987;  15 (Suppl 5) S254-S258
    CrossrefPubMedGoogle Scholar
  • 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
    Google Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 33 Stapleton A, Stamm W E. Prevention of urinary tract infection.  Infect Dis Clin North Am. 1997;  11 719-733
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 39 Karram M M. Lower Urinary Tract Infection. Ostergard DR, Bent AE Urogynecology and Urodynamics. 4th ed. Baltimore; Williams and Wilkins 1996: 387-408
    Google Scholar
  • 40 Schiotz H A, Guttu K. Value of urinary prophylaxis with methenamine in gynecologic surgery.  Acta Obstet Gynecol Scand. 2002;  81 743-746
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 45 Harkins K J. What's the use of cranberry juice?.  Age Ageing. 2000;  29 9-12
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar
  • 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
    PubMedGoogle Scholar
  • 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
    CrossrefPubMedGoogle Scholar

Dr. med. Dirk Watermann

Universitäts-Frauenklinik

Hugstetter Straße 55

79106 Freiburg

Email: watermann@frk.ukl.uni-freiburg.de

      >