Management of Recurrent Cystitis in Women: when Prompt Identification of Risk Factors Might Make a Difference

Background: Management of recurrent urinary tract infection (rUTI) is still challenging. A better understanding of the natural history of rUTI could help us reduce antibiotic use and improve antibiotic stewardship. Objective: To describe the effect of risk identification, stratification, and counseling on the natural course of the disease in women with rUTI. Design, setting, and participants: A total of 373 women affected by recurrent cystitis were enrolled in this longitudinal cohort study between December 2014 and December 2019. A systematic and standardized identification of risk factors was per-formed. Intervention: As intervention, risk factors were treated or removed where possible. Patients with nonremovable risk factors were included in the control group. All patients were scheduled for follow-up visits every 6 mo. Outcome measurements and statistical analysis: The main outcome measures were the rate of symptomatic recurrences and improvement in questionnaire results from base-line to the end of the follow-up period. Reduction of antibiotic usage was regarded as a secondary outcome measure. Results and Limitations: Finally, 353 women were analyzed: 196 in the study group and 157 in the control group. At the end of the follow-up period, a statistically significant reduction in the symptomatic recurrence rate was found between the two groups (0.9 +/- 0.2 and 2.6 +/- 0.5; p < 0.001), as well as in quality of life and anxiety according to mean questionnaire results: quality of life (0.88 +/- 0.06 and 0.63 +/- 0.09; p < 0.001) and Spielberger State-Trait Anxiety Inventory-Form Y (32.7 +/- 9.3 and 47.5 +/- 14.3;p < 0.001). The use of antibiotics was significantly lower in the study group: 4410 versus 9821 (p < 0.001). A limitation to consider is the lack of a randomized design for the active approach in the high-risk group. Conclusions: Identification, counseling, and removal of risk factors, where possible, are able to change the natural history of rUTI, by reducing the number of symptomatic epi-sodes and antibiotic use and improving quality of life.