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Resumen
Las infecciones urinarias recurrentes (IUR) son un problema clínico frecuente, especialmente en mujeres jóvenes sexualmente activas, en embarazadas, en pacientes posmenopáusicas y en pacientes con patología urológica subyacente.
En este capítulo se revisan las IUR basándose en su clasificación: recidivas, que suelen ser precoces (< 1 mes), están causadas por el mismo microorganismo y se asocian con patología urológica subyacente, y reinfecciones, que suelen ser más tardías y causadas por distintos microorganismos (o el mismo que permanecería acantonado en el recto o en las células uroepiteliales).
Se revisa la patogenia de las IUR y se estudian los factores de riesgo asociados a las IUR en mujeres premenopáusicas (generalmente relacionadas con la actividad sexual), en mujeres posmenopáusicas (en las que destaca el papel que desempeña el déficit estrogénico sobre la flora de Lactobacillus vaginal) y en las embarazadas.
Asimismo se realiza una amplia revisión de las distintas estrategias terapéuticas para la prevención de las IUR: autotratamiento de la cistitis, profilaxis antibiótica continua, profilaxis antibiótica poscoital, estrógenos tópicos vaginales, Lactobacillus, arándanos, administración intravesical de cepas avirulentas de Escherichia coli y vacunas, entre otros.
Se incluyen varios algoritmos diagnóstico-terapéuticos basados en el tipo de infección urinaria (recidiva-reinfección), en el colectivo de pacientes implicados (mujeres jóvenes, posmenopáusicas, embarazadas) y número de episodios de IUR.
Palabras clave:
Infecciones urinarias recurrentes
Profilaxis antibiótica en las infecciones urinarias recurrentes
Arándanos e infección urinaria
Lactobacillus intravaginal
Infecciones urinarias recurrentes en mujeres jóvenes sexualmente activas y posmenopáusicas
Profilaxis antibiótica poscoital
Recurrent urinary tract infections (RUTI) are a frequent clinical problem in sexually active young women, pregnant or postmenopausal women and in patients with underlying urological abnormalities.
The present chapter reviews RUTI based on their classification: relapses, which usually occur early (< 1 month), are caused by the same microorganism and are associated with underlying urological abnormalities, and reinfections, which usually occur later and are caused by a new distinct microorganism (or by the same microorganism usually located in the rectum or uroepithelial cells).
The pathogenesis of RUTI is reviewed and the risk factors associated with RUTI in premenopausal women (usually related to sexual activity), postmenopausal women (in whom estrogen deficiency has a significant effect on the vaginal Lactobacillus flora), and in pregnant women are discussed.
Likewise, an extensive review of the distinct therapeutic strategies to prevent RUTI is provided: self-treatment of cystitis, continuous antibiotic prophylaxis, postcoital antibiotic prophylaxis, topical vaginal estrogens, Lactobacillus, cranberry juice, intravesical administration of non-virulent E. coli strains and vaccines, among others. Several diagnostic-therapeutic algorithms are included. These algorithms are based on the type of urinary infection (relapse-reinfection), on the type of patient (young, postmenopausal, or pregnant women) and on the number of episodes of RUTI.
Key words:
Recurrent urinary tract infections
Antibiotic prophylaxis in recurrent urinary infections
Cranberries and urinary infection
Intravaginal lactobacillus
Recurrent urinary infections in young
Sexually active women and postmenopausal women
Prophylaxis
Postcoital antibiotics
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