| Abstract (croatian) | Rekurentne infekcije mokraćnog sustava odnose se na pojavu tri ili više epizoda u godinu dana ili dvije ili više epizoda unutar šest mjeseci, a koje su dokazane urinokulturom. Česte su u žena svih dobnih skupina, te tako oko 60% žena ima barem jednu epizodu cistitisa tijekom života, a procjenjuje se da će 20-40% žena koje su imale jednu epizodu cistitisa, vjerojatno imati još jednu, od kojih će 25-50% imati rekurentne infekcije. Predispozicijski čimbenici jednaki su kao i za pojedinačne epizode, a ponešto se razlikuju u žena generativne dobi od onih u menopauzi. Glavni predispozicijski čimbenik u mladih žena je spolni odnos, a u postmenopauzi nedostatak estrogena. Nakon provedene terapije indiciran je neki oblik antimikrobne, a potom i neantimikrobne profilakse, te prenosimo smjernice za liječenje i profilaksu. U Ambulanti za urogenitalne infekcije Klinike za infektivne bolesti "Dr. Fran Mihaljević", Zagreb, u razdoblju od 1.10.2021. do 30.9.2022. bilo je 996 pregleda, a radi rekurentnih infekcija mokraćnog sustava bilo je pregledano 275 žena kroz 503 pregleda. Njih 87,3% imalo je barem jedan predispozicijski čimbenik, od kojih su najčešći bili peri- i postmenopauza, te inkontinencija mokraće.
Antimikrobnu je profilaksu primalo 93,1% bolesnica, najčešće u trajanju od 6 mjeseci (31,3%) i to nitrofurantoinom (72,3%), fosfomicinom (11,7%), te sulfametoksazol/trimetoprimom (9%). Neantimikrobnu je profilaksu uzimalo 26,5% žena, najčešće D-manozu (91,8%). Dokazani recidiv za vrijeme ili nakon profilakse imalo je 16,7% žena, a u njih 32,6% uzročnik je bio
isti kao i tijekom primarne infekcije. S obzirom na učestalost rekurentnih infekcija mokraćnoga sustava, važno je ispravno postavljanje dijagnoze, te indikacije za antimikrobnu profilaksu, kako bi se poboljšala kvaliteta života bolesnica. No, s
obzirom na rastuću rezistenciju mikroorganizama na antibiotike, treba biti racionalan u njihovoj primjeni u profilaktičke svrhe. Stoga su izbor bolesnica za profilaksu i njihovo praćenje ključni. Za ispravno postupanje u svakodnevnom kliničkom radu potrebno je uvijek pratiti najnovije smjernice stručnih društava. |
| Abstract (english) | Recurrent urinary tract infections refer to the occurrence of three or more episodes in one year or two or more episodes within six months that are proven by urine culture. They are common in women of all age groups, so about 60% of women have at least one episode of cystitis during their lifetime. An estimated 20-40% of women who have had one previous cystitis episode are likely to experience an additional episode, 25-50% of whom will experience multiple recurrent episodes.
The predisposing factors are the same as for individual episodes, and they differ somewhat in women of reproductive age from those in menopause. The main predisposing factor in young women is sexual intercourse, and in post menopause estrogen deficiency. After the therapy, some form of antimicrobial and then non-antimicrobial prophylaxis is indicated, and
we convey the guidelines for treatment and prophylaxis. In the Outpatient Clinic for Urogenital Infection of the University Hospital for Infectious Diseases "Dr. Fran Mihaljević", Zagreb, there were 996 examinations in the period from October 1, 2021 until September 30, 2022. 275 women were examined for recurrent urinary tract infections through 503 examinations.
87.3% of them had at least one predisposing factor, the most common ones being peri- and post menopause and urinary incontinence. 93.1% of patients received antimicrobial prophylaxis, most often for 6 months (31.3%), with nitrofurantoin (72.3%), fosfomycin (11.7%), and sulfamethoxazole/trimethoprim (9%) being the most common agents used. Non-antimicrobial prophylaxis was given to 26.5% of women, most often D-mannose (91.8%). 16.7% of women had proven recurrence during or after prophylaxis, and in 32.6% of them the causative agent was the same as during the primary infection. Due to frequent recurrent urinary tract infections, it is important to establish the correct diagnosis and indications for antimicrobial prophylaxis to improve the patients’ quality of life. However, considering the growing resistance of microorganisms to antibiotics, it is necessary to be rational in their use for prophylactic purposes, and the selection of patients for prophylaxis and their monitoring are crucial. Good clinical practice in everyday work requires the necessity of following the latest guidelines of professional associations. |
