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1 Library and Knowledge Services Please find below the results of your literature search request. If you would like the full text of any of the abstracts included, or would like a further search completed on this topic, please let us know. We d appreciate feedback on your satisfaction with this literature search. Please visit and complete the form. Thank you Literature search results Search completed for: Search required by: Search completed on: 19 February 2014 Search completed by: Marilyn Shaw Search details UTIs causes, treatments and diagnosis. UK documents only dealing with adults only over the last year or so. Do not include EPIC 3. Resources searched NHS Evidence; TRIP Database; Cochrane Library; AMED; BNI; CINAHL; EMBASE; HMIC; Health Business Elite; MEDLINE; PsychINFO; Google Scholar; Google Advanced Search Database search terms: utis OR Urinary tract infections : treatment OR diagnosis OR causes Evidence search string(s): Google search string(s): Not searched Summary Only CINAHL has been searched, along with sections of NHS Evidence as only items of general interest were required. In addition, it was impossible to gain access to BNI today! I can return to BNI and/or any other databases if the detail included in this search is not sufficient for your needs. Guidelines and Policy Evidence-based reviews 1

2 R1. Cranberries for preventing urinary tract infections. Citation: Cochrane Database of Systematic Reviews, 01 October 2012, vol./is. /10(0-), X Author(s): Jepson RG; Williams G; Craig JC Abstract: BACKGROUND: Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs). This is the third update of our review first published in 1998 and updated in 2004 and OBJECTIVES: To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations. SEARCH METHODS: We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library) and the Internet. We contacted companies involved with the promotion and distribution of cranberry preparations and checked reference lists of review articles and relevant studies.date of search: July 2012 SELECTION CRITERIA: All randomised controlled trials (RCTs) or quasi-rcts of cranberry products for the prevention of UTIs. DATA COLLECTION AND ANALYSIS: Two authors independently assessed and extracted data. Information was collected on methods, participants, interventions and outcomes (incidence of symptomatic UTIs, positive culture results, side effects, adherence to therapy). Risk ratios (RR) were calculated where appropriate, otherwise a narrative synthesis was undertaken. Quality was assessed using the Cochrane risk of bias assessment tool. MAIN RESULTS: This updated review includes a total of 24 studies (six cross-over studies, 11 parallel group studies with two arms; five with three arms, and two studies with a factorial design) with a total of 4473 participants. Ten studies were included in the 2008 update, and 14 studies have been added to this update. Thirteen studies (2380 participants) evaluated only cranberry juice/concentrate; nine studies (1032 participants) evaluated only cranberry tablets/capsules; one study compared cranberry juice and tablets; and one study compared cranberry capsules and tablets. The comparison/control arms were placebo, no treatment, water, methenamine hippurate, antibiotics, or lactobacillus. Eleven studies were not included in the meta-analyses because either the design was a cross-over study and data were not reported separately for the first phase, or there was a lack of relevant data. Data included in the meta-analyses showed that, compared with placebo, water or not treatment, cranberry products did not significantly reduce the occurrence of symptomatic UTI overall (RR 0.86, 95% CI 0.71 to 1.04) or for any the subgroups: women with recurrent UTIs (RR 0.74, 95% CI 0.42 to 1.31); older people (RR 0.75, 95% CI 0.39 to 1.44); pregnant women (RR 1.04, 95% CI 0.97 to 1.17); children with recurrent UTI (RR 0.48, 95% CI 0.19 to 1.22); cancer patients (RR % CI 0.75 to 1.77); or people with neuropathic bladder or spinal injury (RR 0.95, 95% CI: 0.75 to 1.20). Overall heterogeneity was moderate (I² = 55%). The effectiveness of cranberry was not significantly different to antibiotics for women (RR 1.31, 95% CI 0.85, 2.02) and children (RR % CI 0.32 to 1.51). There was no significant difference between gastrointestinal adverse effects from cranberry product compared to those of placebo/no treatment (RR 0.83, 95% CI 0.31 to 2.27). Many studies reported low compliance and high withdrawal/dropout problems which they attributed to palatability/acceptability of the products, primarily the cranberry juice. Most studies of other cranberry products (tablets and capsules) did not report how much of the 'active' ingredient the product contained, and therefore the products may not have had enough potency to be effective. AUTHORS' CONCLUSIONS: Prior to the current update it appeared there was some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period, particularly for women with recurrent UTIs. The addition of 14 further studies suggests that cranberry juice is less effective than previously indicated. Although some of small studies demonstrated a small benefit for women with recurrent UTIs, there were no statistically significant differences when the results of a much larger study were included. Cranberry products were not significantly different to antibiotics for preventing UTIs in three small studies. Given the large number of dropouts/withdrawals from studies (mainly attributed to the acceptability of consuming cranberry products particularly juice, over long periods), and the evidence that the benefit for preventing UTI is small, cranberry juice cannot currently be recommended for the prevention of UTIs. Other preparations (such as powders) need to be quantified using standardised methods to ensure the potency, and contain enough of the 'active' ingredient, before being evaluated in clinical studies or recommended for use.; [CINAHL Note: The Cochrane Collaboration systematic reviews contain interactive software that allows various calculations in the MetaView.] 2

3 Full Text: Available from Wiley in Cochrane Library, The R2. Methenamine hippurate for preventing urinary tract infections. Citation: Cochrane Database of Systematic Reviews, 01 October 2012, vol./is. /10(0-), X Author(s): Lee BSB; Simpson JM; Craig JC; Bhuta T Abstract: BACKGROUND: Methenamine salts are often used as an alternative to antibiotics for the prevention of urinary tract infection (UTI). This review was first published in Issue 1, 2002 and updated in Issue 4, OBJECTIVES: To assess the benefits and harms of methenamine hippurate in preventing UTI. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library), MEDLINE (from 1950), EMBASE (from 1980), reference lists of articles and abstracts from conference proceedings without language restriction. Manufacturers' of methenamine salts were contacted for unpublished studies and contact was made with known investigators.date of last search: June 2012 SELECTION CRITERIA: Randomised controlled trials (RCT) and quasi-rcts of methenamine hippurate used for the prevention of UTIs in all population groups were eligible. A comparison with a control/no treatment group was a prerequisite for selection. DATA COLLECTION AND ANALYSIS: Two authors independently assessed study quality and extracted data. Statistical analyses were performed using the random effects model and the results expressed as risk ratio (RR) for dichotomous outcomes with 95% confidence intervals (CI). An exploration of heterogeneity and a detailed description of results, grouped by population, was undertaken. MAIN RESULTS: Thirteen studies (2032 participants) were included. Six studies (654 patients) reported symptomatic UTI and eight studies (796 patients) reported bacteriuria. Overall, study quality was mixed. The overall pooled estimates for the major outcome measures were not interpretable because of underlying heterogeneity. Subgroup analyses suggested that methenamine hippurate may have some benefit in patients without renal tract abnormalities (symptomatic UTI: RR 0.24, 95% CI 0.07 to 0.89; bacteriuria: RR 0.56, 95% CI 0.37 to 0.83), but not in patients with known renal tract abnormalities (symptomatic UTI: RR 1.54, 95% CI 0.38 to 6.20; bacteriuria: RR 1.29, 95% CI 0.54 to 3.07). For short-term treatment duration (1 week or less) there was a significant reduction in symptomatic UTI in those without renal tract abnormalities (RR 0.14, 95% CI 0.05 to 0.38). The rate of adverse events was low. AUTHORS' CONCLUSIONS: Methenamine hippurate may be effective for preventing UTI in patients without renal tract abnormalities, particularly when used for short-term prophylaxis. It does not appear to work in patients with neuropathic bladder or in patients who have renal tract abnormalities. The rate of adverse events was low, but poorly described.there is a need for further large well-conducted RCTs to clarify this question, particularly for longer term use for people without neuropathic bladder.; [CINAHL Note: The Cochrane Collaboration systematic reviews contain interactive software that allows various calculations in the MetaView.] Full Text: Available from Wiley in Cochrane Library, The Published research Databases 1. Urinary tract infections and bacterial prostatitis in men. Citation: Current Opinion in Infectious Diseases, 01 February 2014, vol./is. 27/1(97-101), Author(s): Wagenlehner, Florian M E; Weidner, Wolfgang; Pilatz, Adrian; Naber, Kurt G Abstract: PURPOSE OF REVIEW: The purpose of this review is to highlight advances in research on urinary tract infections (UTIs) and bacterial prostatitis in men in the preceding year. RECENT FINDINGS: The antiseptic properties of the prostate secretions might be an important factor for prevention of recurrency. Risk factors for UTI in men include prostate enlargement and urological interventions, such as transrectal prostate biopsy. Preventive treatment of prostate enlargement has been demonstrated to reduce frequency 3

4 of UTI. Ensuing infections after prostate biopsy, such as UTI and bacterial prostatitis, are increasing due to increasing rates of fluoroquinolone resistance. The increasing global antibiotic resistance also significantly affects management of UTI in men, and therefore calls for alternative strategies.apart from prevention of complicating factors leading to UTI, a more thorough understanding of the pathophysiology may play a more important role in the future, to define new targets for treatment. Interesting results that might interfere with the intracellular mucosal bacterial load in the bladder wall have been found in the last years. SUMMARY: UTI in men and bacterial prostatitis are currently underrepresented in the medical literature. Increasing antibacterial resistance calls for novel strategies in the prevention and management of UTI and bacterial prostatitis in men. Full Text: Available from the ULHT Library and Knowledge Services' ejournal collection in Current Opinion in Infectious Diseases 2. An update on prevention and treatment of catheter-associated urinary tract infections. Citation: Current Opinion in Infectious Diseases, 01 February 2014, vol./is. 27/1( ), Author(s): Tenke, Peter; Köves, Béla; Johansen, Truls E B Abstract: PURPOSE OF REVIEW: Catheter-related urinary tract infections (UTIs) are among the most important nosocomial infections. This review summarizes the latest advances in the field of catheter care and the management of catheter-associated UTIs. RECENT FINDINGS: The most efficient methods to prevent catheter-associated UTIs are to avoid unnecessary catheterizations and to remove catheters as soon as possible. The use of different reminder systems and implementation of infection control programs can effectively decrease catheter-associated UTIs, although their introduction can be challenging. There is still no evidence to support the routine use of antimicrobial-impregnated catheters, but the use of hydrophilic-coated catheters for clean intermittent catheterization can effectively reduce infections. Preliminary results with chlorhexidine-coated catheters are promising. In cases of serious catheter-associated UTI in patients with a history of previous antibiotic therapy or healthcare-associated bacteraemia, empirical antibiotic treatment should be initiated with activity against multiresistant uropathogens. Suprapubic catheterization is not superior to urethral catheters in terms of reducing the rate of catheter-related bacteriuria. SUMMARY: A technology to prevent catheter-associated UTIs is still not available; however, there are promising results with new approaches such as the use of reminder systems and infection control programs, which can effectively decrease the rate of catheter-associated UTIs. There is evidence supporting the use of hydrophilic coated catheters for clean intermittent catheterization, but an optimal catheter material or coating still has to be developed. Evidence-based catheter management is crucial for every patient in need of a catheter. Full Text: Available from the ULHT Library and Knowledge Services' ejournal collection in Current Opinion in Infectious Diseases 3. Recurrent urinary tract infection in older women: an evidence-based approach. Citation: British Journal of Community Nursing, 01 August 2013, vol./is. /( ), Author(s): Nazarko, Linda Abstract: Ageing increases the risk of a woman developing a urinary tract infection (UTI). It also increases the risk of misdiagnosis and inappropriate antibiotic therapy being prescribed. Antibiotic therapy has costs as well as benefits and can lead to changes in gut and vaginal flora that further predispose older women to UTI. Antibiotic resistance is growing and those who do have a UTI may experience treatment failure because of resistance to commonly used antibiotics. Accurate diagnosis and effective evidence-based treatment becomes even more crucial in the face of an ageing population and increasing antimicrobial resistance. Furthermore, the need for specific evidence-based guidelines for UTI in older people is increasing. 4

5 Full Text: Available from EBSCOhost in British Journal of Community Nursing 4. Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics? Citation: International Journal of Clinical Practice, 01 May 2012, vol./is. 66/5( ), Author(s): Mishra B; Srivastava S; Singh K; Pandey A; Agarwal J Abstract: Background: Current clinical guidelines for the management of symptoms suggesting urinary tract infection recommend empiric antibiotic therapy. Objective: To determine the diagnostic accuracy of urinary tract symptoms for early identification of urinary tract infection (UTI) in sexually active women when culture results are not available. Method: This was a cross-sectional observational study conducted in a tertiary care hospital between July 2009 and May Subjects comprised 312 women >= 18 year of age who reported to the physician with symptoms suggestive of UTI. A predesigned questionnaire was filled and urine was analysed by microscopic examination and culture. Diagnostic values were calculated against gold standard urine culture results (> 10(2) CFU/ml) and 95% CIs and likelihood ratios are reported. Results: A total of 312 women were enrolled, as culture was contaminated in 36 only 276 women were included in final analysis. Prevalence of UTI was 46.01% amongst symptomatic women. Urgency (p = 0.001), burning sensation during micturition (p = 0.035), dysuria (p = 0.004), frequency of sexual intercourse > 5 per month (p = 0.010) and pyuria (p = 0.000) were significantly associated with culture positivity. Absence of pyuria emerged as best predictor for ruling out UTI even if the woman had symptoms (sensitivity 93.70%, NPV 91.84%, AUC 77.07%, LR- 0.1). The combination of urgency, burning during micturition and pyuria was the best predictor of UTI in our study (sensitivity 85.83%, PPV 71.71%, AUC 78.48%, LR+ 2.97) Conclusion: Symptoms alone have low accuracy when assessed against the reference standard for diagnosing UTI. Empiric treatment of UTI based on symptoms may expose large number of patients to unnecessary antibiotics. Wet mount microscopy for presence of pyuria as a 'near patient test' before starting antibiotics seems a rational approach for management of UTI in symptomatic women. Full Text: Available from International Journal of Clinical Practice in Lincoln County Hospital Professional Library Available from EBSCOhost in International Journal of Clinical Practice Evidence Services library.nhs.uk 5. Uncomplicated UTIs in women. Citation: Nurse Practitioner, 01 May 2012, vol./is. 37/5(41-48), Author(s): Lowe, Nancy K.; Ryan-Wenger, Nancy A. Abstract: Empirical diagnosis and treatment of lower urinary tract infection (UTI) in women is the most common clinical approach due to the urgency of symptoms and cost. This study examines the importance of recognizing common symptoms and accurately diagnosing UTIs in the primary care setting. 6. Toward a simple diagnostic index for acute uncomplicated urinary tract infections. Citation: Annals of Family Medicine, 01 September 2013, vol./is. 11/5( ), Author(s): Knottnerus, Bart J; Geerlings, Suzanne E; Moll van Charante, Eric P; Ter Riet, Gerben Abstract: PURPOSE Whereas a diagnosis of acute uncomplicated urinary tract infection (UTI) in clinical practice comprises a battery of several diagnostic tests, these tests are often studied separately (in isolation from other test results). We wanted to determine the value of history and urine tests for diagnosis of uncomplicated UTIs, taking into account their mutual dependencies and information from preceding tests. METHODS Women with painful and/or frequent micturition answered questions about their signs and symptoms (history) of UTIs and underwent urine tests. A culture was the reference standard (10(3) colony-forming units per milliliter). A diagnostic index was derived using logistic regression with bootstrapped backward selection and parameter-wise shrinkage. Risk thresholds for UTI of 30% and 70% were used to analyze discriminative properties. Six models were compared: (1) history only, (2) history+ urine dipstick, (3) history+ urine 5

6 dipstick + urinary sediment, (4) history+ urine dipstick+ dipslide, and (5) history+ urine dipstick+ urinary sediment+ dipslide; we then added (6) a test only for patients with an intermediate risk (between 30% and 70%) after the preceding test. RESULTS One hundred ninety-six women were included (UTI prevalence 61%). Seven variables were selected from history (3), dipstick (2), sediment (1), and dipslide (1). History correctly classified 56% of patients as having a UTI risk of either <30% or >70%. History and urine dipstick raised this to 73%. The 3 models with the addition of urinary sediment and dipslide, separately and in combination, performed hardly better. The sixth model, in which those at intermediate risk after history and received an additional test, correctly classified 83%. The patient's suspicion of a UTI and a positive nitrite test were the strongest indicators of a UTI. CONCLUSIONS Most women with painful and/or frequent micturition can be correctly classified as having either a low or a high risk of UTI by asking 3 questions: Does the patient think she has a UTI? Is there at least considerable pain on micturition? Is there vaginal irritation? Other women require additional urine dipstick investigation. Sediment and dipslide have little added value. External validation of these recommendations is required before they are implemented in practice. Full Text: Available from EBSCOhost in Annals of Family Medicine 7. Dipstick Urinalysis for the Diagnosis of Acute UTI. Citation: American Family Physician, 15 May 2013, vol./is. 87/10(0-), X Author(s): Simati, Beth; Kriegsman, Bill; Safranek, Sarah Full Text: Available from EBSCOhost in American Family Physician 8. Urinary tract infections in older adults residing in long-term care facilities. Citation: Annals of Long Term Care, 01 April 2012, vol./is. 20/4(33-38), Author(s): Genao, Liza; Buhr, Gwendolen T Abstract: Urinary tract infections (UTIs) are commonly suspected in residents of long-term care (LTC) facilities, and it has been common practice to prescribe antibiotics to these patients, even when they are asymptomatic. This approach, however, often does more harm than good, leading to increased rates of adverse drug effects and more recurrent infections with drug-resistant bacteria. It also does not improve genitourinary symptoms (eg, polyuria or malodorous urine) or lead to improved mortality rates; thus, distinguishing UTIs from asymptomatic bacteriuria is imperative in the LTC setting. This article provides a comprehensive overview of UTI in the LTC setting, outlining the epidemiology, risk factors and pathophysiology, microbiology', diagnosis, laboratory assessment, and management of symptomatic UTI. 9. Trimethoprim and a case of lower urinary tract infection. Citation: Nurse Prescribing, 01 August 2013, vol./is. 11/8( ), Author(s): Nash, Louise Abstract: This article discusses the use of trimethoprim in the treatment of uncomplicated lower urinary tract infections (LUTI) in adult women. It takes the form of a case study and will explore the pharmacological dynamics of the drug, as well as comparing it to others also used in the treatment of LUTI. Trimethoprim is considered the gold standard for treatment and the three-day course has become the usual recommended treatment for non-complex LUTIs and for empirical treatment of cystitis with a 90% eradication rate (Salvatore et al, 2001; Scottish Intercolleguiate Guidance Network, 2006). This article describes the presenting symptoms, possible differentials, treatment, and rationale for the treatment chosen. Full Text: Available from EBSCOhost in Nurse Prescribing 10. History and Physical Examination Plus Laboratory Testing for the Diagnosis of Adult 6

7 Female Urinary Tract Infection. Citation: Academic Emergency Medicine, 01 July 2013, vol./is. 20/7( ), Author(s): Meister, Lisa; Morley, Eric J.; Scheer, Diane; Sinert, Richard; Carpenter, Christopher R. 11. Urinary tract infection. Citation: Critical Care Clinics, 01 July 2013, vol./is. 29/3( ), Author(s): Nicolle, Lindsay E Abstract: The urinary tract is a common source for life-threatening infections. Most patients with sepsis or septic shock from a urinary source have complicated urinary tract infection. This article explains the epidemiology, risk factors, and treatment. Effective management appropriate collection of microbiology specimens, prompt initiation of antimicrobial therapy, source control, and supportive therapy are described. 12. Case study: elderly woman presents with bothersome bladder problems. Citation: Nurse Prescribing, 01 July 2013, vol./is. 11/7( ), Author(s): Nazarko, Linda Abstract: Lower urinary tract symptoms may be incorrectly ascribed to urinary tract infection. mincorrect diagnosis can lead to patients being inappropriately treated with antibiotics. This exposes the person to the hazards of antibiotic therapy and increases antibiotic resistance. It also causes delays in providing appropriate effective treatment. This article uses a case history approach to examine the possible causes of urgency, frequency and nocturia in an older woman. This article aims to enable readers to use an evidence based approach to accurately diagnose and treat lower urinary tract symptoms in older women. Full Text: Available from EBSCOhost in Nurse Prescribing 13. There are some entries on the NHS Evidence site under Clinical Knowledge Summaries which might be worth you have ing a quick look at. For instance:- Urinary tract infection (lower) men Last updated 2010 Urinary tract infection (lower) women Last updated October 2009 There are some updates in the women s section but nothing more recent than the articles I have listed for you in this search document. Each of the sections has within it, Diagnosis, Management, Evidence, References Published Research - Google Scholar From 1 st fifty results: Not searched Published Research - Microsoft Academic Search 7