Mitigation and Management of Urinary Tract Infection in a Urodynamics Clinic
Alison M Mackay, Shahzad Shah.
The prevalence of Urinary Tract Infection (UTI) varies by age, sex, race, pregnancy status, and pathology, with an increasing burden among older adults and those in regions with low socio-demo- graphic indices. UTIs are predominantly caused by bacteria and fungi; e.g. Candida spp.. They can cause and compound Lower Urinary Tract Symptoms (LUTS), and make invasive diagnostic tests like Urodynamics risky in terms of exacerbation. Infection control combines horizontal measures— hand hygiene, aseptic techniques, cleaning protocols—and vertical strategies focusing on specific pathogens. The latter being costlier.
Screening mid-stream urine (MSU) with dipstick tests prior to invasive testing minimises the risks associated with infection. Where pathology or communication limitations make sample collection difficult, alternative methods can be attempted, including: Quick-Wee for infants; supra-pubic tap- ping for spinal cord injury patients; and intermittent catheterization. Traditional MSU culture re- mains the gold standard technique for diagnosing UTI with a cut-off ≥10^5 CFU/ml, reduced to ≥10^4 CFU/ml for paediatric samples obtained by intermittent cathterisation and ≥10^3 CFU/ml for those with indwelling catheters. Advanced technologies like MALDI-TOF-MS and POC lateral flow assays can minimise the delay in obtaining test results and give accurate results including in- formation on any microbes susceptibility to treatment. Urine biomarkers can also aid in diagnosing bladder dysfunctions, highlighting the potential of POC urine testing in the urodynamics clinic.
Treatment guidelines from NICE recommend age and sex-specific antibiotic regimens for sympto- matic bacterial UTIs, with asymptomatic bacteriuria treated only in pregnancy. Fungal UTIs are typically managed with fluconazole, often in hospital settings, but drug resistance is increasing in both kingdoms. Alternative treatment approaches target intracellular bacterial communities or em- ploy innovative therapies such as antimicrobial peptides and photodynamic therapy.
