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Persistence or Reinfection for Recurrent Urinary Tract Infections in Women: Cloudy Boundaries When it comes to Management?

Wu Y and Zimmern PE

Objective: To review current literature on the distinction between bacterial persistence or reinfection in recurrent urinary tract infections (RUTIs) in women and the resultant implications on evaluation and treatment.
Methods: A systematic literature review focusing on studies of non-pregnant women with cystitis was conducted. Studies not in English, not in full-text, and relating to children, men, and pregnant women were excluded.
Results: Between 1995 and 2012, 7 articles were identified from which the type of bacterial persistence/ reinfection status could be clearly established. While some study findings suggest that bacterial reinfection prevails in RUTI, others have concluded that bacterial persistence is quite frequent or dominates (33% to 82%). Recent data on evaluation and treatment also suggest a shift towards less need to distinguish between these two categories.
Conclusions: While current RUTI management strategies hinge on delineating between bacterial persistence or reinfection, for women refractory to antibiotic therapy, one could argue that the boundary between the two groups may be irrelevant as optimal treatment may be the same regardless.Compared to simple urinary tract infections which are exceedingly common in women and relatively easy to treat, recurrent urinary tract infections (RUTIs) provoke treatment challenges, impact on quality of life, and substantial costs. Traditionally, RUTIs have been divided into two broad categories depending on urine culture findings: (1) Bacterial persistence refers to RUTIs caused by the same bacterial strain over and over again while (2) Bacterial reinfection implies a reinfection process from different bacterial strains. In this brief document, we reviewed the existing literature on the prevalence of these two forms of RUTI and briefly discussed the implications for their evaluation and treatment, while adding some newer information from our group and others. We will make the point that the boundaries between these 2 categories cansometimes be blurry and that their management may emerge as being similar in the end.