Urological Survey Infection and Inflammation of the Genitourinary Tract Re: The Influence of Urinary pH on Antibiotic Efficacy against Bacterial Uropathogens L. Yang, K. Wang, H. Li, J. D. Denstedt and P. A. Cadieux Division of Urology, Department of Surgery, No. 4 West China Teaching Hospital and Department of Urology, West China Hospital, Sichuan University, Chengdu, P.R. China, and Division of Urology, Department of Surgery, and Department of Microbiology and Immunology, Western University and Lawson Health Research Institute, London, Ontario, Canada Urology 2014; 84: 731.e1ee7.
Abstract available at http://jurology.com/ Editorial Comment: These authors nicely explore the relationship between pH and the efficacy of various antimicrobial agents. Several agents were more effective at higher pH (greater than 7), such as quinolones, aminoglycosides, trimethoprim/sulfamethoxazole and macrolides, while others were more effective at lower pH, including the commonly used agents nitrofurantoin and betalactams. While my sense is that for most people with uncomplicated infections these data will not be clinically significant, there are certainly individuals with complex medical comorbidities (including renal tubular acidosis, renal failure, chronic obstructive pulmonary disease and uncontrolled diabetes) where urinary pH can be significantly affected. Additionally infections in these individuals may have more severe consequences. Thus, in select cases knowledge of urine pH and its effect on antimicrobial sensitivity may be much more important. Edward M. Schaeffer, MD, PhD
Re: The Humoral Pattern Recognition Molecule PTX3 is a Key Component of Innate Immunity against Urinary Tract Infection S. Jaillon, F. Moalli, B. Ragnarsdottir, E. Bonavita, M. Puthia, F. Riva, E. Barbati, M. Nebuloni, L. Cvetko Krajinovic, A. Markotic, S. Valentino, A. Doni, S. Tartari, G. Graziani, A. Montanelli, Y. Delneste, C. Svanborg, C. Garlanda and A. Mantovani Department of Veterinary Pathology, Hygiene and Public Health, Pathology Unit, L. Sacco Department of Clinical Sciences, and Department of Biotechnology and Translational Medicine, University of Milan and Humanitas Clinical Research Center, Milan, et de la Recherche Me dicale, Centre de Recherche en Cance rologie Nantes-Angers, Angers, Italy, Institut National de la Sante France, Section of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden, and University Hospital for Infectious Diseases, Zagreb, Croatia Immunity 2014; 40: 621e632.
Abstract available at http://jurology.com/ Editorial Comment: There are several anatomical and biological features of the urinary tract that innately resist infection. These include such factors as antegrade urine flow, urine pH and Tamm-Horsfall proteins. The authors describe a role for the pentraxin 3 (PTX3) molecule in augmenting the host immune response to urinary tract infections. Pentraxin 3 is a soluble pattern recognition molecule that acts as a “primitive antibody” against bacteria. It is secreted by innate immune cells (neutrophils, monocytes, etc) and by the urothelium. The authors propose a mechanism whereby PTX3 enhances phagocytosis and bacterial clearance. Interestingly they also 0022-5347/15/1931-0151/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.10.017 Vol. 193, 151-153, January 2015 Printed in U.S.A.
www.jurology.com
j
151
GERIATRICS
152
state that polymorphisms in PTX3 loci in humans correlate with susceptibility to bacterial infection. Certainly this finding may explain why some individuals are more prone to urinary tract infections. Clearly much work needs to be done on PTX3, although this study represents exciting progress in the field. Edward M. Schaeffer, MD, PhD
Geriatrics Re: Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities M. A. Caljouw, W. B. van den Hout, H. Putter, W. P. Achterberg, H. J. Cools and J. Gussekloo Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands J Am Geriatr Soc 2014; 62: 103e110.
Abstract available at http://jurology.com/ Editorial Comment: The use of cranberry juice or supplements as a natural method to prevent urinary tract infection (UTI) remains popular, although scientific data on the clinical efficacy have been mixed. The authors of this randomized, double-blind, placebo controlled study examined the use of cranberry capsules to prevent UTI in a cohort of 928 older adults living in nursing home facilities in The Netherlands. Twice daily doses of the cranberry or placebo capsules were administered for 12 months, and stratified analysis was performed comparing those with a high baseline rate of UTI to those with few prior infections. Two definitions of UTI, ie clinical UTI based only on symptoms or dipstick urinalysis and UTI based on the combination of symptoms and positive urine culture, were used as outcome measures. Overall infection rates based on the clinical definition were lower in the treatment group compared to controls, although statistically significant differences were observed among those older adults with high baseline UTI prevalence. There was no difference between the groups based on the strict definition including positive urine cultures. The results indicate that selective use of cranberry supplements may be warranted in elderly nursing home residents who have a high baseline rate of UTIs. Tomas L. Griebling, MD, MPH
Suggested Reading Afshar K, Strothers L, Scott H et al: Cranberry juice for the prevention of pediatric urinary tract infection: a randomized controlled trial. J Urol, suppl., 2012; 188: 1584.
Re: Cost-Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infection in Long-Term Care Facilities: Economic Evaluation with a Randomized Controlled Trial W. B. van den Hout, M. A. Caljouw, H. Putter, H. J. Cools and J. Gussekloo Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands J Am Geriatr Soc 2014; 62: 111e116.
Abstract available at http://jurology.com/
Abstract available at http://jurology.com/ Editorial Comment: These authors nicely explore the relationship between pH and the efficacy of various antimicrobial agents. Several agents were more effective at higher pH (greater than 7), such as quinolones, aminoglycosides, trimethoprim/sulfamethoxazole and macrolides, while others were more effective at lower pH, including the commonly used agents nitrofurantoin and betalactams. While my sense is that for most people with uncomplicated infections these data will not be clinically significant, there are certainly individuals with complex medical comorbidities (including renal tubular acidosis, renal failure, chronic obstructive pulmonary disease and uncontrolled diabetes) where urinary pH can be significantly affected. Additionally infections in these individuals may have more severe consequences. Thus, in select cases knowledge of urine pH and its effect on antimicrobial sensitivity may be much more important. Edward M. Schaeffer, MD, PhD
Re: The Humoral Pattern Recognition Molecule PTX3 is a Key Component of Innate Immunity against Urinary Tract Infection S. Jaillon, F. Moalli, B. Ragnarsdottir, E. Bonavita, M. Puthia, F. Riva, E. Barbati, M. Nebuloni, L. Cvetko Krajinovic, A. Markotic, S. Valentino, A. Doni, S. Tartari, G. Graziani, A. Montanelli, Y. Delneste, C. Svanborg, C. Garlanda and A. Mantovani Department of Veterinary Pathology, Hygiene and Public Health, Pathology Unit, L. Sacco Department of Clinical Sciences, and Department of Biotechnology and Translational Medicine, University of Milan and Humanitas Clinical Research Center, Milan, et de la Recherche Me dicale, Centre de Recherche en Cance rologie Nantes-Angers, Angers, Italy, Institut National de la Sante France, Section of Microbiology, Immunology and Glycobiology, Institute of Laboratory Medicine, Lund University, Lund, Sweden, and University Hospital for Infectious Diseases, Zagreb, Croatia Immunity 2014; 40: 621e632.
Abstract available at http://jurology.com/ Editorial Comment: There are several anatomical and biological features of the urinary tract that innately resist infection. These include such factors as antegrade urine flow, urine pH and Tamm-Horsfall proteins. The authors describe a role for the pentraxin 3 (PTX3) molecule in augmenting the host immune response to urinary tract infections. Pentraxin 3 is a soluble pattern recognition molecule that acts as a “primitive antibody” against bacteria. It is secreted by innate immune cells (neutrophils, monocytes, etc) and by the urothelium. The authors propose a mechanism whereby PTX3 enhances phagocytosis and bacterial clearance. Interestingly they also 0022-5347/15/1931-0151/0 THE JOURNAL OF UROLOGY® © 2015 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION
AND
RESEARCH, INC.
http://dx.doi.org/10.1016/j.juro.2014.10.017 Vol. 193, 151-153, January 2015 Printed in U.S.A.
www.jurology.com
j
151
GERIATRICS
152
state that polymorphisms in PTX3 loci in humans correlate with susceptibility to bacterial infection. Certainly this finding may explain why some individuals are more prone to urinary tract infections. Clearly much work needs to be done on PTX3, although this study represents exciting progress in the field. Edward M. Schaeffer, MD, PhD
Geriatrics Re: Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infections in Vulnerable Older Persons: A Double-Blind Randomized Placebo-Controlled Trial in Long-Term Care Facilities M. A. Caljouw, W. B. van den Hout, H. Putter, W. P. Achterberg, H. J. Cools and J. Gussekloo Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands J Am Geriatr Soc 2014; 62: 103e110.
Abstract available at http://jurology.com/ Editorial Comment: The use of cranberry juice or supplements as a natural method to prevent urinary tract infection (UTI) remains popular, although scientific data on the clinical efficacy have been mixed. The authors of this randomized, double-blind, placebo controlled study examined the use of cranberry capsules to prevent UTI in a cohort of 928 older adults living in nursing home facilities in The Netherlands. Twice daily doses of the cranberry or placebo capsules were administered for 12 months, and stratified analysis was performed comparing those with a high baseline rate of UTI to those with few prior infections. Two definitions of UTI, ie clinical UTI based only on symptoms or dipstick urinalysis and UTI based on the combination of symptoms and positive urine culture, were used as outcome measures. Overall infection rates based on the clinical definition were lower in the treatment group compared to controls, although statistically significant differences were observed among those older adults with high baseline UTI prevalence. There was no difference between the groups based on the strict definition including positive urine cultures. The results indicate that selective use of cranberry supplements may be warranted in elderly nursing home residents who have a high baseline rate of UTIs. Tomas L. Griebling, MD, MPH
Suggested Reading Afshar K, Strothers L, Scott H et al: Cranberry juice for the prevention of pediatric urinary tract infection: a randomized controlled trial. J Urol, suppl., 2012; 188: 1584.
Re: Cost-Effectiveness of Cranberry Capsules to Prevent Urinary Tract Infection in Long-Term Care Facilities: Economic Evaluation with a Randomized Controlled Trial W. B. van den Hout, M. A. Caljouw, H. Putter, H. J. Cools and J. Gussekloo Department of Medical Decision Making, Leiden University Medical Center, Leiden, The Netherlands J Am Geriatr Soc 2014; 62: 111e116.
Abstract available at http://jurology.com/
