According to EAU, recurrent urinary tract infection is defined as recurrences of uncomplicated and/or complicated UTIs, with a frequency of at least three UTI episodes/year or two in six months. Urinary tract infections (UTIs) remain a significant cause of morbidity in patients with a large financial/manpower burden on health-care systems. Furthermore, with the increasing prevalence of antimicrobial resistance it is valuable to have a multidisciplinary approach to these patients. Recurrent Urinary Tract Infections (rUTIs) are challenging to treat and result in morbid sequelae. Our aim was to assess the treatment outcomes among patients with rUTIs managed in a multidisciplinary complex UTI clinic at a single tertiary care centre over a two- year period.

In view of high financial burden and increasing prevalence of antibiotic resistance associated with UTIs, a multidisciplinary complex UTI clinic, supported by specialist nurses and microbiologists was started in April 2021. A prospectively maintained database of 211 patients [(mean age 58.3 +/- 15.899) and (Male 22(10.4%), Female 189(89.6%)] who were referred to our clinic, within a 2-year period was reviewed. Patient demographics, urine culture and antibiotic sensitivities, investigations performed, and treatment
outcomes were recorded. Pre-treatment and post- treatment QoL (Quality of Life) and post-treatment PGI-I (Patient Global Impression of improvement Scale) Score were measured.

Escherichia Coli (54%) was identified as the most common causative organism. 27% patients had multi-drug resistant organisms. Abnormal Flexible cystoscopy and Renal Tract Imaging was reported in 39 (18.5%) and 41 (19.4%) respectively. All patients received 1 st and 2 nd line treatment, while 61 (28.9%) subsequently required intravesical therapy. Post-treatment, there is significant
improvement in QoL with close to 70% patients reporting good to excellent QoL. 80.5% (170) reported good to excellent improvement on the PGI-I scale with outcome being successful in 185(87.7%) patients. (Results, Table 1)

A dedicated complex UTI clinic service with multidisciplinary treatment approach can be efficient in managing recurrent UTIs.
Over 70% of the patients were managed with 1st and 2nd line management. Setting expectations is very vital. Managing the UTI and improving QoL is the priority over treating the UTI (Especially in patients with irreversible risk factors ). Intravesical antibiotic instillations help in reducing frequency and severity of UTIs also change the antibiotic sensitivity pattern

Besides the above statistical result-based conclusions, this complex UTI clinic service also reinforced that clinical history is crucial and exploring the drug allergies to assess their severity is vital to not miss out on potential treatment options through a risk versus benefit analysis.  MDT approach (involving the microbiologists) adds a different perspective and dimension to management
Stepwise assessment and management is a key in achieving good outcomes.

Continence 12S (2024) 101424
DOI: 10.1016/j.cont.2024.101424