Urinary tract infection

Cefepime–Taniborbactam in Complicated Urinary Tract Infection

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Abstract

Background

Carbapenem-resistant Enterobacterales species and multidrug-resistant Pseudomonas aeruginosa are global health threats. Cefepime–taniborbactam is an investigational β-lactam and β-lactamase inhibitor combination with activity against Enterobacterales species and P. aeruginosa expressing serine and metallo-β-lactamases.

Methods

In this phase 3, double-blind, randomized trial, we assigned hospitalized adults with complicated urinary tract infection (UTI), including acute pyelonephritis, in a 2:1 ratio to receive intravenous cefepime–taniborbactam (2.5 g) or meropenem (1 g) every 8 hours for 7 days; this duration could be extended up to 14 days in case of bacteremia. The primary outcome was both microbiologic and clinical success (composite success) on trial days 19 to 23 in the microbiologic intention-to-treat (microITT) population (patients who had a qualifying gram-negative pathogen against which both study drugs were active). A prespecified superiority analysis of the primary outcome was performed after confirmation of noninferiority.

Results

Of the 661 patients who underwent randomization, 436 (66.0%) were included in the microITT population. The mean age of the patients was 56.2 years, and 38.1% were 65 years of age or older. In the microITT population, 57.8% of the patients had complicated UTI, 42.2% had acute pyelonephritis, and 13.1% had bacteremia. Composite success occurred in 207 of 293 patients (70.6%) in the cefepime–taniborbactam group and in 83 of 143 patients (58.0%) in the meropenem group. Cefepime–taniborbactam was superior to meropenem regarding the primary outcome (treatment difference, 12.6 percentage points; 95% confidence interval, 3.1 to 22.2; P=0.009). Differences in treatment response were sustained at late follow-up (trial days 28 to 35), when cefepime–taniborbactam had higher composite success and clinical success. Adverse events occurred in 35.5% and 29.0% of patients in the cefepime–taniborbactam group and the meropenem group, respectively, with headache, diarrhea, constipation, hypertension, and nausea the most frequently reported; the frequency of serious adverse events was similar in the two groups.

Conclusions

Cefepime–taniborbactam was superior to meropenem for the treatment of complicated UTI that included acute pyelonephritis, with a safety profile similar to that of meropenem.

Space Bacteria Defy Zero Gravity.

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Astronauts of the future may have a new foe to contend with: space bacteria. Scientists have found that Pseudomonas aeruginosa, a common contaminant of medical equipment and a cause of urinary tract infections, among other diseases, grows better in zero gravity than it does on Earth, even when starved of nutrients. The researchers grew the microbes in simulated urine both in an Earth-bound lab and onboard the space shuttle Atlantis (experimental setup shown) in July 2011. In some of the samples, the team dramatically reduced the concentrations of dissolved phosphate and oxygen to simulate conditions that might exist inside equipment used to recycle urine into water on spacecraft during long-duration flights. When nutrients were plentiful, the growth rates of the bacteria in zero-gconditions—and particularly, the concentrations of cells after 72 hours—were the same as those grown in the lab under normal conditions.

ScienceShot: Space Bacteria Defy Zero Gravity

But in samples with lower concentrations of phosphate and oxygen, the Earth-bound bacteria didn’t grow as quickly as they did when fully nourished, while those cultured in microgravity grew as prolifically as those provided with a full complement of nutrients, the researchers report online today in BMC Microbiology. Reasons for the disparity aren’t clear, the researchers say, but results suggest that bacteria introduced to space stations and spacecraft by people, given enough time, might grow to reach greater concentrations than they do in similar conditions on Earth, even if starved of nutrients. Besides helping scientists better understand the risks of P. aeruginosa colonizing equipment on spacecraft or causing diseases such as urinary tract infections among astronauts, the experiments may improve scientists’ ability to predict whether other species of bacteria might become more virulent in space.

Emphysematous cystitis.

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A 55-year-old man with a history of aortic valve replacement was admitted because of pelvic pain. He had been treated with antibiotics over the past 4 weeks for a presumed lower urinary tract infection with fever. Treatment had been unsuccessful. Both urine and blood cultures grew Enterobacter cloacae. Abdominal radiography showed a thin line of air within the bladder wall, outlining its perimeter .A bacteraemic emphysematous cystitis complicated by prosthetic valve endocarditis was diagnosed, and effective antibiotic treatment was initiated.

PIIS0140673608614841.fx1.lrg

Emphysematous cystitis is a potentially life-threatening condition caused by gas-producing pathogens. This rare form of urinary tract infection typically occurs in middle-aged diabetic women. Contrary to radiological findings, clinical features are non-specific (irritative bladder symptoms, pyuria, haematuria, and, rarely, pneumaturia). Plain abdominal radiography, as well as ultrasonography, may lead to the diagnosis but CT scan is regarded as the procedure of choice, particularly to rule out a vesicocolic fistula. Early diagnosis and management consists of antibiotic therapy, bladder drainage, and sometimes surgery.

Source: Lancet

Antibiotic Prophylaxis After Urinary Catheter Removal Lowers Risk for Symptomatic Urinary Tract Infection.

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But widely applied, this practice undoubtedly would lead to antibiotic-associated adverse events and antibiotic resistance.
Urinary catheterization, which is common in hospitalized patients, is associated with symptomatic urinary tract infections (UTIs). In a meta-analysis of seven trials (6 randomized and 1 nonrandomized) that involved 1520 patients (mostly postsurgical) who underwent short-term catheterization (≤14 days), investigators determined whether administering antibiotic prophylaxis at the time of urinary catheter removal lowers risk for symptomatic UTI.

In all trials, researchers compared antibiotic prophylaxis versus placebo or usual care. Antibiotics used were ciprofloxacin, trimethoprim-sulfamethoxazole, nitrofurantoin, and cefotaxime. Duration of antibiotic prophylaxis ranged from single doses to 3 days. Symptomatic UTIs occurred in 10.5% of control patients and in 4.7% of prophylaxis patients. Hence, antibiotic prophylaxis resulted in a 5.8% absolute risk reduction for symptomatic UTI (number needed to treat to prevent 1 symptomatic UTI, 17).

COMMENT

Although these results suggest that antibiotic prophylaxis at the time of urinary catheter removal prevents symptomatic UTIs, clinicians should be wary of applying these results broadly. If every hospitalized patient with a urinary catheter received prophylaxis, antibiotic use would increase markedly, which undoubtedly also would increase adverse events (e.g., antibiotic-associated side effects, Clostridium difficile infections), antibiotic resistance, and costs.

Source: NEJM

 

Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis.

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Abstract

Objective To determine whether antibiotic prophylaxis at the time of removal of a urinary catheter reduces the risk of subsequent symptomatic urinary tract infection.

Design Systematic review and meta-analysis of studies published before November 2012 identified through PubMed, Embase, Scopus, and the Cochrane Library; conference abstracts for 2006-12 were also reviewed.

Inclusion criteria Studies were included if they examined antibiotic prophylaxis administered to prevent symptomatic urinary tract infection after removal of a short term (≤14 days) urinary catheter.

Results Seven controlled studies had symptomatic urinary tract infection after catheter removal as an endpoint; six were randomized controlled trials (five published; one in abstract form) and one was a non-randomized controlled intervention study. Five of these seven studies were in surgical patients. Studies were heterogeneous in the type and duration of antimicrobial prophylaxis and the period of observation. Overall, antibiotic prophylaxis was associated with benefit to the patient, with an absolute reduction in risk of urinary tract infection of 5.8% between intervention and control groups. The risk ratio was 0.45 (95% confidence interval 0.28 to 0.72). The number needed to treat to prevent one urinary tract infection was 17 (12 to 30).

Conclusions Patients admitted to hospital who undergo short term urinary catheterization might benefit from antimicrobial prophylaxis when the catheter is removed as they experience fewer subsequent urinary tract infections. Potential disadvantages of more widespread antimicrobial prophylaxis (side effects and cost of antibiotics, development of antimicrobial resistance) might be mitigated by the identification of which patients are most likely to benefit from this approach.

Discussion

In our meta-analysis of pooled data from seven studies (six of which were randomized), there were significantly fewer symptomatic urinary tract infections in patients receiving prophylaxis during removal of a urinary catheter than in those not receiving prophylaxis. Our finding in favor of antibiotic prophylaxis, however, must be tempered by possible publication bias toward positive studies, the limitations of the included studies, and practical considerations about encouraging more widespread antibiotic use.

Indwelling urinary catheters pose several risks to patients, including urethral trauma, discomfort, and urinary tract infection.31 In an era of increasingly constrained fiscal resources and evolving antibiotic resistance, evidence based antimicrobial prescribing is essential to promote antimicrobial stewardship.32 Unfortunately, there is no consensus on whether clinicians should prescribe antibiotic prophylaxis to patients when an indwelling urinary catheter is removed.

Conclusions

This meta-analysis of available data indicates an overall benefit of antibiotic prophylaxis at the time of removal of a urinary catheter to prevent subsequent urinary tract infections. The number needed to treat indicates that 17 patients would need to receive prophylaxis to prevent one symptomatic urinary tract infection. We know little, however, about the potential negative consequences of implementing antibiotic prophylaxis in this setting in a wider frame or indeed which types of patients would be most likely to benefit. Increasing antimicrobial resistance, healthcare costs for antibiotics, and the potential for side effects of antibiotic administration are disadvantages that merit careful review. From a public health standpoint, we should be careful not to encourage antibiotic use when it might not be necessary. The healthcare provider of a catheterized patient, however, might consider antibiotic prophylaxis before catheter removal, after taking individual risk factors into account. Future studies should better characterize who is at risk of developing symptomatic urinary tract infection after catheter removal (whether bacteriuric or not) and then examine antibiotic prophylaxis in those at greatest risk.

What is already known on this topic

  • Catheterization of the urinary tract is associated with an increased risk of bacteriuria and symptomatic urinary tract infection
  • Antibiotic administration at the time of removal of a urinary catheter might effectively reduce urinary tract infections, but guidelines for catheter associated infections note insufficient evidence to support this practice
  • Antibiotic prophylaxis at the time of urinary catheter removal in general surgery, prostatectomy, and medical patients effectively reduced the incidence of symptomatic urinary tract infections with a number needed to treat of 17
  • The effect size of antibiotic prophylaxis in this meta-analysis was stable to sensitivity analyses with exclusion of non-randomized trials and two studies in non-surgical patients

What this study adds.

 

Source: BMJ

 

 

e wind: �x �� �� -border-alt:none windowtext 0in; padding:0in’>12 1314 16 Although other studies have examined the links between acute kidney injury and mortality and end stage renal disease in people admitted to hospital with myocardial infarction treated with either invasive or medical management,18 33 these studies have not compared renal outcomes on the basis of treatment strategies.

 

Our findings show that acute kidney injury is a relatively common complication in people with non-ST elevation acute coronary syndrome and chronic kidney disease and increases substantially with lower baseline estimated glomerular filtration rate. However, the difference in the incidence of acute kidney injury between people who receive early invasive management and similar patients treated conservatively is relatively small. Importantly, despite the modestly higher risk of acute kidney injury associated with early invasive management at all levels of estimated glomerular filtration rate, our findings suggest that this strategy is not associated with higher risks of more clinically relevant renal outcomes (including acute dialysis or progression to end stage renal disease), which occurred much less often at all levels of baseline estimated glomerular filtration rate, regardless of treatment strategy. Since early invasive management seemed to be consistently associated with a long term survival advantage at all levels of baseline estimated glomerular filtration rate, these findings (interpreted in light of their consistency with results from randomised trials showing that early invasive management improves long term survival in high risk patients3 4) suggest that restricting or delaying access to invasive coronary procedures may not avoid most cases of clinically relevant acute kidney injury and could deny high risk individuals (including those with pre-existing chronic kidney disease) important benefits.

There are several potential mechanisms for the higher risk of acute kidney injury associated with early invasive management. People who received early invasive management were more likely to receive coronary angiography, percutaneous coronary intervention, coronary artery bypass grafting surgery, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers, placing them at risk of acute kidney injury from contrast exposure, perioperative ischaemia, and haemodynamic effects. Furthermore, patients who received invasive management had a longer hospital stay and more measurements of creatinine during follow-up, which may have increased the probability that acute kidney injury would be ascertained. However, the magnitude of the increased risk associated with invasive management strategies was small, suggesting that patients’ characteristics such as age, comorbidity, pre-existing chronic kidney disease, drug use (including diuretics and inhibitors of the renin angiotensin system), and haemodynamic instability are more important contributors to the risk of acute kidney injury in patients with acute coronary syndrome than whether or not they are managed invasively or medically.

The better survival associated with early invasive management of non-ST elevation acute coronary syndrome in this cohort are in keeping with the clinical benefits of angiography and revascularisation reported in clinical trials, including subgroups with pre-existing chronic kidney disease.2 3 4 Although episodes of acute kidney injury have been linked to an increased risk of end stage renal disease,18 19 34 we did not observe a higher risk of end stage renal disease in people with otherwise similar characteristics who received early angiography despite the higher risk of acute kidney injury, even among strata with lower baseline estimated glomerular filtration rate. Radiocontrast associated acute kidney injury is typically manifested by a small change in serum creatinine levels, rarely leads to acute dialysis, and is usually reversible.10 Our findings suggest that the majority of such additional episodes of acute kidney injury associated with invasive procedures may confer relatively low risks of progression to end stage renal disease, although further studies are needed to help predict those at risk of progressive chronic kidney disease after acute kidney injury.

Conclusion

In conclusion, early invasive management of non-ST elevation acute coronary syndrome is associated with a small increase in the risk of acute kidney injury compared with a conservative management approach but is not associated with higher risks of in-hospital acute kidney injury requiring dialysis or long term risk of end stage renal disease. Given the improvement in cardiovascular outcomes and long term survival observed with early invasive management, these results suggest that invasive treatments should not be withheld solely because of concern they might increase the risk of kidney injury.

What is already known on this topic

  • Acute kidney injury after invasive coronary procedures is associated with adverse outcomes, including end stage renal disease and death
  • Fear of precipitating contrast induced acute kidney injury possibly contributes to underuse of invasive treatments for acute coronary syndrome in people at high risk of kidney disease
  • Comparisons of renal outcomes between people treated with invasive versus conservative management are lacking
  • People who received early invasive management for non-ST segment elevation acute coronary syndrome were modestly more likely to develop acute kidney injury
  • After early invasive management the risks of requiring dialysis and long term risk of end stage renal disease were similar, and patients had better long term survival than those treated conservatively
  • These findings were consistent across varying levels of baseline kidney function, suggesting similar relative risks and benefits of early invasive management in people with and without pre-existing kidney disease

What this study adds

 

Source: BMJ

 

Antibiotic prophylaxis for urinary tract infections after removal of urinary catheter: meta-analysis.

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Abstract

Objective To determine whether antibiotic prophylaxis at the time of removal of a urinary catheter reduces the risk of subsequent symptomatic urinary tract infection.

Design Systematic review and meta-analysis of studies published before November 2012 identified through PubMed, Embase, Scopus, and the Cochrane Library; conference abstracts for 2006-12 were also reviewed.

Inclusion criteria Studies were included if they examined antibiotic prophylaxis administered to prevent symptomatic urinary tract infection after removal of a short term (≤14 days) urinary catheter.

Results Seven controlled studies had symptomatic urinary tract infection after catheter removal as an endpoint; six were randomized controlled trials (five published; one in abstract form) and one was a non-randomized controlled intervention study. Five of these seven studies were in surgical patients. Studies were heterogeneous in the type and duration of antimicrobial prophylaxis and the period of observation. Overall, antibiotic prophylaxis was associated with benefit to the patient, with an absolute reduction in risk of urinary tract infection of 5.8% between intervention and control groups. The risk ratio was 0.45 (95% confidence interval 0.28 to 0.72). The number needed to treat to prevent one urinary tract infection was 17 (12 to 30).

Conclusions Patients admitted to hospital who undergo short term urinary catheterization might benefit from antimicrobial prophylaxis when the catheter is removed as they experience fewer subsequent urinary tract infections. Potential disadvantages of more widespread antimicrobial prophylaxis (side effects and cost of antibiotics, development of antimicrobial resistance) might be mitigated by the identification of which patients are most likely to benefit from this approach.

Conclusions

This meta-analysis of available data indicates an overall benefit of antibiotic prophylaxis at the time of removal of a urinary catheter to prevent subsequent urinary tract infections. The number needed to treat indicates that 17 patients would need to receive prophylaxis to prevent one symptomatic urinary tract infection. We know little, however, about the potential negative consequences of implementing antibiotic prophylaxis in this setting in a wider frame or indeed which types of patients would be most likely to benefit. Increasing antimicrobial resistance, healthcare costs for antibiotics, and the potential for side effects of antibiotic administration are disadvantages that merit careful review. From a public health standpoint, we should be careful not to encourage antibiotic use when it might not be necessary. The healthcare provider of a catheterized patient, however, might consider antibiotic prophylaxis before catheter removal, after taking individual risk factors into account. Future studies should better characterize who is at risk of developing symptomatic urinary tract infection after catheter removal (whether bacteriuric or not) and then examine antibiotic prophylaxis in those at greatest risk.

What is already known on this topic

  • Catheterization of the urinary tract is associated with an increased risk of bacteriuria and symptomatic urinary tract infection
  • Antibiotic administration at the time of removal of a urinary catheter might effectively reduce urinary tract infections, but guidelines for catheter associated infections note insufficient evidence to support this practice
  • Antibiotic prophylaxis at the time of urinary catheter removal in general surgery, prostatectomy, and medical patients effectively reduced the incidence of symptomatic urinary tract infections with a number needed to treat of 17
  • The effect size of antibiotic prophylaxis in this meta-analysis was stable to sensitivity analyses with exclusion of non-randomized trials and two studies in non-surgical patients

What this study adds.

 

Source: BMJ

 

What You Can Learn About Your Health by Analyzing the Color and Smell of Your Urine

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urineStory at-a-glance

  • Urine has been an important diagnostic tool for 6,000 years, as well as having some surprising historical uses
  • You can learn a great deal about your overall health by examining your urine and noting its color, odor, and consistency, your urine can be a powerful window into your overall health
  • Urine color and odor can be altered by your diet, medications, supplements, water consumption, and physical activity
  • Your urine characteristics can also function as an early warning system for serious health problems including urinary stones, infections, kidney problems, metabolic disorders, diabetes, pituitary disorders, and even tumors
  • Frequency of urination is also important; increased urination may suggest infection, overactive bladder, diabetes, or a number of other concerns
  • Suggestions are provided on how much water to consume daily; the common “eight glasses per day” recommendation is overgeneralized, and you should instead pay attention to your body’s own individual cues

Urine can reveal important information about your body’s waste elimination process, providing clues about your overall health status.

Your kidneys serve to filter excess water and water-soluble wastes out of your blood, getting rid of toxins and things that would otherwise build up and cause you to become ill. Many things — from excess protein and sugar to bacteria and yeast — may make their way into your urine.

Instead of ignoring your urine and dashing back to whatever important activity having to pee interrupted, take this golden opportunity to become familiar with your “normal.”

If you notice changes in the way your urine looks or smells, the cause might be something as benign as what you had for dinner last night, such as beets or asparagus. Or, your astuteness may potentially alert you to a serious condition.

If you suspect you have a urinary tract problem, you should consult your physician. One of the first things he or she is likely to do is a urine test. Urine tests have been around for more than 6,000 years1 and are easy, noninvasive tools for quickly assessing your health status2.

Minding Your Pees and Cues

In your lifetime, your kidneys filter more than one million gallons of water, enough to fill a small lake. Amazingly, one kidney can handle the task perfectly well. In fact, if you lose a kidney, your remaining kidney can increase in size by 50 percent within two months, to take over the job of both.3

Urine is 95 percent water and five percent urea, uric acid, minerals, salts, enzymes, and various substances that would cause problems if allowed to accumulate in your body4. Normal urine is clear and has a straw yellow color, caused by a bile pigment called urobilin.

As with your stool, your urine changes color depending on what foods you eat, what medications and supplements you take, how much water you drink, how active you are, and the time of the day.

But some diseases can also change the color and other characteristics of your urine, so it’s important to be alert and informed. With so many variables, you can’t always be sure of what’s causing any particular urine characteristic, short of laboratory testing. However, urine’s character gives you some clues to potential problems that may be developing, giving you time to do something about it.

The following chart outlines some of the most common color variations for urine and their possible origins. The majority of the time, color changes resulting from foods, medications, supplements, or simply dehydration. But there are certain signs that warrant concern.

Color Possible Cause Necessary Action
Yellow/Gold The most typical urine color, indicative of a healthy urinary tract; yellow will intensify depending on hydration; some B vitamins cause bright yellow urine None
Red/Pink Hematuria (fresh blood in the urine) related to urinary tract infection (UTI), kidney stone, or rarely cancer; consumption of red foods such as beets, blueberries, red food dyes, rhubarb; iron supplements; Pepto-Bismol, Maalox, and a variety of other drugs5; classic “port wine” color may indicate porphyria (genetic disorder) ***Consult your physician immediately if you suspect you have blood in your urine
White/Colorless Excessive hydration is most likely. (See Cloudy) Consult your physician only if chronic
Orange Typically a sign of dehydration, showing up earlier than thirst; “holding your bladder” for too long; post-exercise; consuming orange foods (carrots, squash, or food dyes); the drug Pyridium (phenazopyridine); liver or pituitary problem (ADH, or antidiuretic hormone) Drink more water and don’t delay urination; consult physician if orange urine persists despite adequate hydration
Amber More concentrated than orange so severe dehydration related to intense exercise or heat; excess caffeine or salt; hematuria; decreased urine production (oliguria or anuria); metabolic problem; pituitary problem (ADH, or antidiuretic hormone) Consult your physician if problem persists despite adequate hydration
Brown Very dense urine concentration, extreme dehydration; consumption of fava beans; melanuria (too many particles in urine); UTI; kidney stone; kidney tumor or blood clot; Addison’s disease; glycosuria; renal artery stenosis; proteinuria; pituitary problem (ADH, or antidiuretic hormone) Consult your physician if problem persists despite adequate hydration, especially if accompanied by pale stools or yellow skin or eyes
Black RARE: Alkaptonuria, a genetic disorder of phenylalanine and tyrosine metabolism marked by accumulation of homogentisic acid in the blood; poisoning Consult your physician
Green RARE: Unusual UTIs and certain foods (such as asparagus); excessive vitamins Usually benign; consult your physician if it persists, especially if you have pain or burning (dysuria), and/or frequent urination (polyuria), which are symptoms of UTI
Blue RARE: Artificial colors in foods or drugs; bilirubin; medications such as methylene blue; unusual UTIs Usually benign; consult your physician if it persists, especially if you have pain or burning (dysuria), and/or frequent urination (polyuria), which are symptoms of UTI
Cloudy Urinary tract infection, kidney problem, metabolic problem, or chyluria (lymph fluid in the urine), phosphaturia (phosphate crystals), pituitary problem (ADH, or antidiuretic hormone) Consult physician, especially if you have pain or burning (dysuria), and/or frequent urination (polyuria), which are symptoms of UTI
Sediment Proteinuria (protein particles) or albuminuria; UTI; kidney stones; see Cloudy Consult your physician
Foamy Turbulent urine stream; proteinuria (most common causes are diabetes andhypertension) Consult physician if not due to “turbulence”

 

Does Your Urine Smell Like Roses?

If you’re a woman from ancient Rome and your urine smells like roses, you’ve probably been drinking turpentine. This is a high price to pay to woo your suitor with pleasant-smelling pee, as turpentine may kill you! Short of drinking turpentine, there are many common substances that may alter the way your urine smells, which is why it’s helpful to know what’s normal. Urine reflects all of the inner workings of your body and contains a wide variety of compounds and metabolic by-products. Some dogs can actually “smell cancer” in human urine6.

Urine doesn’t typically have a strong smell, but if yours smells pungent (like ammonia), you could have an infection or urinary stones, or you may simply be dehydrated. Dehydration causes your urine to be more concentrated and may have a stronger smell than normal, as do high-protein foods like meat and eggs. Menopause, some sexually transmitted diseases, and certain metabolic disorders may also increase the ammonia smell7. Here are some of the more common reasons your urine’s odor may change:

  • Medications or supplements
  • Certain genetic conditions, such as Maple Syrup Urine Disease, which causes urine to smell sickeningly sweet8
  • Certain foods — most notably asparagus. Asparagus is notorious for causing a foul, eggy or “cabbagy” stench that results from a sulfur compound called methyl mercaptan (also found in garlic and skunk secretions). Only 50 percent of people can smell asparagus pee because they have the required gene. Cutting off the tips of asparagus will reportedly prevent the pungent-smelling pee…but of course, this is the tastiest part!
  • Urinary tract infections
  • Uncontrolled diabetes is known to cause your urine to have a sweet or fruity or, less commonly, a yeasty smell. In the past, doctors diagnosed diabetes by pouring urine into sand to see if it was sweet enough to attract bugs. Other physicians just dipped a finger in and took a taste. Fortunately, today’s physicians have access to far more elegant diagnostic tools.

When You Feel the Urge to Go, GO

Urinary frequency is also important. Peeing six to eight times per day is “average.” You might go more or less often than that, depending on how much water you drink and how active you are. Increased frequency can be caused by an overactive bladder (involuntary contractions), caffeine, a urinary tract infection (UTI), interstitial cystitis, benign prostate enlargement, diabetes, or one of a handful of neurological diseases.9

It is important to pee when you feel the urge. Delaying urination can cause bladder overdistension — like overstretching a Slinky such that it can’t bounce back. You may habitually postpone urination if you find bathroom breaks inconvenient at work, or if you have Paruresis (also known as Shy Bladder Syndrome, Bashful Bladder, Tinkle Terror, or Pee Anxiety), the fear of urinating in the presence of others. Seven percent of the public suffers from this condition.10

How Much Water Should You Drink?

I don’t subscribe to the commonly quoted rule of drinking six to eight glasses of water every day. Your body is capable of telling you what it needs and when it needs it. Once your body has lost one to two percent of its total water, your thirst mechanism kicks in to let you know it’s time to drink — so thirst should be your guide. Or course, if you are outside on a hot, dry day or exercising vigorously, you’ll require more water than usual — but even then, drinking when you feel thirsty will allow you to remain hydrated.

As you age, your thirst mechanism tends to work less efficiently. Therefore, older adults will want to be sure to drink water regularly, in sufficient quantity to maintain pale yellow urine. As long as you aren’t taking riboflavin (vitamin B2, found in most multivitamins), which turns urine bright “fluorescent” yellow, then your urine should be quite pale. If you have kidney or bladder stones or a urinary tract infection, increase your water intake accordingly.

You and Your Urinary System

You should now have a pretty good idea of how important it is to familiarize yourself with what’s normal for your pee. Urine is a window into the inner workings of your body and can function as an “early warning system” for detecting health problems.

The most important factor in the overall health of your urinary tract is drinking plenty of pure, fresh water every day. Inadequate hydration is the number one risk factor for kidney stones, as well as being important for preventing UTIs. To avoid overly frequent bathroom breaks, stay hydrated but not overhydrated. Drink whenever you’re thirsty, but don’t feel you have to drink eight glasses of water per day, every day. If you’re getting up during the night to pee, stop drinking three to four hours before bedtime.

Limit your caffeine and alcohol intake, which can irritate the lining of your bladder. Make sure your diet has plenty of magnesium, and avoid sugar (including fructose and soda) and non-fermented soy products due to their oxalate content. Finally, don’t hold it. As soon as you feel the urge to go, go! Delaying urination is detrimental to the health of your bladder due to overdistension.

Source: mercola.com

 

 

 

 

 

No Relation Between Length of Treatment for UTIs and Early Recurrence in Men.

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How long to continue antibiotics in men with urinary tract infections is still up for debate.

 

Most research to examine length of antibiotic treatment for uncomplicated urinary tract infections (UTIs) has been conducted in women, for whom clinical guidelines are well established. In a retrospective study of 33,336 veterans with uncomplicated UTIs (all outpatients; mean age, 68; median antibiotic-therapy duration, 10 days), researchers explored whether length of antibiotic therapy was associated with recurrence in men. Most patients received ciprofloxacin or trimethoprim-sulfamethoxazole; about one third were treated for 7 days, and the rest were treated for >7 days.

Researchers found 1373 cases of early recurrence (at 30 days; 4% of the cohort) and 3313 cases of late recurrence (at >30 days; 10%). In multivariate analyses, no difference was noted in risk for early recurrence between men who received longer- or shorter-duration initial treatment; risk for late recurrence was significantly higher among those who received longer-duration treatment than among those who received shorter initial courses (11% vs. 8%).

Comment: This retrospective study involved an administrative database that could not capture fully the many factors that influence clinical decision making and that also might be associated with recurrence (i.e., catheter use). However, this study does suggest that the same clinical trials that were conducted in women would be justified in men to develop more precise guidelines on length of treatment.

 

Source: Journal Watch General Medicine

 

 

Botulinum Toxin and Anticholinergic Therapy Yield Similar Outcomes in Urinary Incontinence.

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Oral anticholinergic therapy and injectable onabotulinumtoxinA are similarly efficacious in treating urgency urinary incontinence, according to a New England Journal of Medicine study.

Some 250 women without neurological disease who had moderate-to-severe urgency incontinence were randomized either to a single injection of onabotulinumtoxinA into the detrusor muscle plus a daily oral placebo for 6 months, or to a single injection of saline plus dose-escalation with a daily oral anticholinergic for 6 months.

The primary outcome — the mean number of urgency incontinence episodes — was similarly reduced in the two groups (roughly 3 fewer episodes/day). OnabotulinumtoxinA recipients were twice as likely as anticholinergic recipients to report complete resolution of urgency incontinence (27% vs. 13%). Dry mouth was significantly more common with anticholinergic therapy, whereas urinary tract infections and incomplete bladder emptying requiring catheterization were significantly more common with onabotulinumtoxinA.

The researchers conclude that “the choice between these therapies should take into account the differing regimens and routes of administration and the side-effect profiles.”

Source: NEJM

“The Cranberry Juice ‘Myth’ Most Women Still Believe…”

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Myths, half-truths and urban legends abound… And for this thing that strikes primarily women, this well-known half-truth can be a trap if you don’t know the 360 degree picture. Discover the groundbreaking development

Less-than-Optimal Urinary Tract Health Is a Fact of Life for Many Women…

New and Improved D-Mannose is not a drug. This nutritional supplement occurs naturally in cranberries, peaches, apples, other berries, and some plants.

At some time in their lives, one out of every five women will experience less-than-optimal urinary tract health.  And, it’s not just women who are concerned with urinary tract health – men are, too.

It’s entirely possible that your urinary tract health could be less than optimal… and you don’t even know it. You’ve probably heard of a number of ways to promote optimal urinary tract health naturally. And I bet cranberry juice is one of the things you think can do it the best…

 

Cranberry juice is NOT my recommended choice for promoting urinary tract health because it is high in fructose that can potentially lead you to health issues.

The D-Mannose found naturally in cranberries, other fruits, and some plants, however, is exceptional for helping you promote a healthy urinary tract.*

Cranberry juice has long been thought to help boost your urinary tract health.  And, you’ll be happy to know that studies do indeed show that drinking cranberry juice can help support a healthy urinary tract.

But, this will come as a surprise to many, drinking blueberry, peach, or apple juice could theoretically have the same beneficial effects, too.

However, there’s a BIG problem with cranberry juice as well all of these other juices: SUGAR.

To be more specific, these juices, including cranberry juice, are loaded with fructose, a monosaccharide (simple sugar) that can potentially cause many health problems, including impacting the normal way your urinary tract functions.

You see, if you eat sugars and grains (which also rapidly break down to sugars), it becomes more difficult to maintain a healthy balance of flora. As a result, you’re much more likely to experience less-than-optimal urinary tract health.

So, although cranberry juice can assist your efforts, I would not advise using it in its juice form. It simply has far too much sugar in it.  In a moment, I’m going to expose another way you can get all the benefits of cranberry (and a lot more) that I think you’re going to love.

 

The D-Mannose for New and Improved D-Mannose comes from a simple sugar found naturally in birch and beech trees.

Is it all bad news? Of course not.

There are simple things you can do to help promote a health urinary tract, including:

  • Drink plenty of water every day – this dilutes your urine and helps you regularly flush your system.
  • Urinate when you feel the need. Don’t resist the urge to go.
  • For women, wipe from front to back, and use unscented and unbleached toilet paper as many women react to the dyes and chemicals in other toilet papers.
  • Take showers instead of baths.
  • Cleanse your genital area prior to and after sexual intercourse, or better yet use a bidet.
  • Avoid feminine deodorant sprays, douches, and powders that can lead to irritation of the urethra and genitals.
  • Only use natural cotton sanitary napkins and tampons. 97% of women believe they are made of cotton, but the truth is LESS THAN one percent actually is.

By following these simple, but effective suggestions, you can help support your urinary tract health.

But, what can you do if you already have less-than-optimal urinary tract health or simply want to support your urinary tract health?*

Is there any help out there?

Yes, and I’m really excited to share this groundbreaking new development in urinary tract health with you now…*

D-Mannose with Cran-Gyn DDS®
The Support You Need Is Finally Here*

I’d like to tell you about one of the most advanced urinary tract health formulations available today.*

It’s called D-Mannose with Cran-Gyn DDS and, as you’ll quickly see, I feel it’s hands-down the best supplement you can use to help support your urinary tract … but it does much more, too.*

With its Patent-Pending Triple Action, D-Mannose with Cran-Gyn DDS is a unique combination of DDS® probiotic blend, natural D-Mannose and concentrated Cranberry fruit extract and FOS.

As a natural alternative for women, D-Mannose with Cran-Gyn DDS helps:

  • Support your urinary tract health*
  • Maintain a healthy balance of flora*
  • Promote optimal digestive health*
  • Support your immune system*
  • Contribute to the maintenance of healthy intestinal flora*

This award-winning three-in-one blend works by creating a favorable environment for healthy flora throughout your urinary tract* (see below for more information).   It also helps promote a healthy balance of flora throughout your digestive system.* In simple terms, that means you get more of the good guys.*

And, since we use an innovative compaction technology that puts more “goodness” in every pill than we otherwise could, you don’t have to take a ton of pills to experience the benefits of D-Mannose with Cran-Gyn DDS.

In other words, you can finally experience the ongoing support you’ve always wanted.*

… without worrying about side effects.
… without the worry or fear.

By supporting your urinary tract health and promoting ideal immune and digestive function, you’ll be treating yourself to wellbeing you deserve.* But, I bet you’re wondering… how does it really work?

To find out, we’ll have to uncover…

Cranberry’s Hidden Secret Is Waiting for You

You’ve learned earlier that I don’t recommend cranberry juice because of all the sugar it contains. However, there is a little-known carbohydrate that can be found naturally in cranberry extract, as well as peaches, apples, and other berries and even birch trees that is turning heads everywhere.

It’s called D-Mannose and it’s been mostly ignored … until recently.

That’s because researchers are discovering that it can help support your urinary tract health.*

But it doesn’t stop there.

D-Mannose promotes a healthy balance of flora and – here’s the real winner – it can support urinary tract health.* Although you can find D-Mannose in cranberries, we use a special all-natural D-Mannose harvested from birch trees in D-Mannose with Cran-Gyn DDS.

But, don’t worry… if you’re a cranberry lover, I’ve got great news for you…

Research is showing that – although cranberry juice is filled with what I believe are too many sugars that can lead to other potential health problems – cranberry EXTRACT is another story altogether.  Recent studies suggest that components found in cranberry extract may work the same way as cranberry juice.*

That means you’re getting two ingredients to help support urinary tract health instead of just one with D-Mannose with Cran-Gyn DDS.*

But, what would you say, if I told you that I believe that D-Mannose and cranberry extract alone were just not good enough?

D-Mannose with Cran-Gyn DDS is formulated with a unique combination of DDS® probiotic blend (containing broad spectrum Lactobacillus acidophilus, Bifidobacterium bifidum, Bifidobacterium longum and Bifidobacterium lactis) at 5 billion CFU/g potency.

What’s this mean to you?

Certain probiotic strains, like L. acidophilus, have demonstrated the ability to support a health balance of flora.*  Additionally, studies have also shown that L. acidophilus supports the health of the vaginal and urethral linings.* Plus, it shows positive effects in the support of urinary tract health overall.*

And, since the probiotic strain we use is acid- and bile-resistant, up to 97% of the probiotics reach your intestine after passing through your stomach.*

That means, you can feel confident knowing that you’re doing  something to help support your urinary tract health AND you may also benefit with improved digestive health and support for your immune system.*

Plus, an added benefit, you can use D-Mannose with Cran-Gyn DDS to help boost the “good bacteria” in your gut.* You’ll be especially thankful for this when you help promote your body’s healthy balance of flora.*

D-Mannose with Cran-Gyn DDS offers you the powerhouse solution you’ve been seeking… all in one convenient place to help provide the urinary tract support you want.*

I’m honored to tell you that D-Mannose with Cran-Gyn DDS won the 2010 Best of Supplements award by Better Nutrition, one of the leading health supplement magazines in the USA.

The award recognized Cran-Gyn DDS as an outstanding formulation in the Women’s Health Category based upon extensive input from experts in the field. Manufactured in a NSF-GMP certified facility with strict quality control, you will also be happy to know we demand total transparency throughout the entire quality control process.

The facility is also Kosher and Halal certified.

Plus, this non-GMO product doesn’t contain any major food allergens such as dairy, gluten, wheat, corn, soy, barley, rye, oats, nuts, egg, fish, peanuts, animal fat, or preservatives.

In the final equation, D-Mannose with Cran-Gyn DDS is simply the best product I know of to help support all your urinary tract health needs.*

It’s a three-in-one combination that gives you…

Don’t Forget About Your Urinary Tract Health – Get Yours Today…*

I suggest making sure you always have a supply on hand to support your urinary tract health*:

  • D-Mannose with Cran-Gyn DDS is gentle enough to use as daily.*

Remember, one in five women have less-than-optimal urinary tract health. Take the smart step and order yours today.

  • Imagine how helpful D-Mannose with Cran-Gyn DDS can be.

Get the support you’re seeking with this breakthrough way to support your urinary tract heath.*

So, do yourself a favor and regularly take this product.*

Source: .mercola.com