Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_959_Библиотеки_им_академика_М_И_Перельмана

A 55- year- old postmenopausal woman was referred from primary care following a 3- year history of recurrent urinary tract infections (rUTIs). These episodes often pre­sented as infective cystitis with dysuria, increased urinary frequency (including new­onset nocturia), and offensive smelling cloudy urine1 and were usually without any systemic symptoms. She described these infections as occurring approximately six times per year and informed that they were previously responsive to short- course narrow- spectrum antibiotic therapy with either nitrofurantoin or trimethoprim. More recently, she had been requiring longer or multiple antibiotic courses to resolve her symptoms. She had been referred to another hospital 2 years ago with non- visible haematuria and had a full urinary tract evaluation via a renal ultrasound scan, a flexible cystoscopy, and a urine flow study which revealed no structural or functional abnormalities. Her estimated glomerular filtration rate was normal. Serial urine cul­tures obtained over the preceding 12– 18 months had shown a variety of uropathogenic organisms but most often Escherichia coli was isolated. Over the preceding 6 months, the episodes had increased in frequency and the patient reported the feeling of having ‘an almost constant’ urinary tract infection (UTI). Her last two urine cultures had again shown evidence of E. coli exhibiting antimicrobial resistance (AMR) to nitrofurantoin and amoxycillin. She was referred to a specialist rUTI clinic for consideration of pre­ventative treatment.