Journal of Current Medical Research and OpinionJournal of Current Medical Research and Opinionhttp://www.cmro.in/index.php/jcmro/indexJournal of Current Medical Research and Opinion2589-8779https://doi.org/10.15520/jcmro.v4i01.389RESEARCH ARTICLEAssessment on Preventive Measures of Urinary Tract Infection (UTI) among Adults of South IndiaAssessment on Preventive Measures of Urinary Tract Infection (UTI) among Adults of South IndiaB PSatish Kumar1AMeghanameghana1997a@gmail.com2DasLipika3P RLavanya4JohnsAnwitha5Associate Professor, Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, Mandya, Karnataka, IndiaPharm D Interns, Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, Mandya, Karnataka, IndiaPharm D Interns, Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, Mandya, Karnataka, IndiaPharm D Interns, Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, Mandya, Karnataka, IndiaPharm D Interns, Department of Pharmacy Practice, Sri Adichunchanagiri College of Pharmacy, Adichunchanagiri University, Mandya, Karnataka, India04017552021Abstract
Introduction:Most common bacterial infection affecting about 150 million people every year around the world is urinary tract infection1. Urinary tract infection can be defined as a condition, in which bacteria divide and multiply in the urinary tract and infect the organs included (kidney, ureter, urinary bladder and urethra).
Method: an anonymous questionnaire with 15 questions regarding basic precautions for UTI was formulated using Google forms. The questionnaire was articulated in collaboration with an expert in the field. Simple random sampling was thrown out for choosing the participants. The link to the survey was made reach to the intended participants through email and WhatsApp.
Conclusion: In this study we found out that in 412 participants, more than half of the participants (54.6%) were recurrently suffering from urinary tract infection (UTI) and about 82.7% of participants suffering from UTI are married whereas only 47.6% unmarried population is affected by urinary tract infection.
Most common bacterial infection affecting about 150 million people every year around the world is urinary tract infection1 . Urinary tract infection can be defined as a condition, in which bacteria divide and multiply in the urinary tract and infect the organs included (kidney, ureter, urinary bladder and urethra).2 A diverse population is being affected by urinary tract infection. Different preventive measure for a variety of patients at risk is indicated. Patients for whom prevention of UTI should be indicated are- sexually active individuals, patients with frequent occurrence of UTI (specifically includes pregnant women, premenopausal and postmenopausal women), structural abnormalities of the urinary tract, patients with neurogenic bladder, patients with spinal cord injury, chronic bacterial prostatitis in men and post-renal transplant patient.3 The purpose of indications for prevention is twofold- (a)prevention of bacteria colonizing in the periurethral areas, preventing it from entering the bladder, (b) also avoiding to place a catheter into an already infected space.4
The aim of prophylaxis in urinary tract comprises of decreasing morbidity attributable to severe infectious events, to prevent acute infectious and non-infectious complications of single or recurrent infections and restraining healthcare expenses essential for the management.5
The immune response in the urinary tract is a significant aid for doctors to decrease the frequent occurrence of infections based on pan-resistant and multi-resistant bacteria. The immune system can be viewed exclusively as a defence against the infection, not only for its intricate role in infection control but also a vital role in tissue repair, homeostatic communication with microbiome and elimination of neoplastic cells. Therefore, both the adaptive and innate divisions of immunity need a stimulus to create a response.6
Some preventive measures for UTI include-
Cranberry formulations: Home remedy to prevent UTI includes cranberries. There are two proposed mechanisms, (a) first is the acidification of urine and (b) cranberries contain proanthocyanidins, known to prevent P-fimbriated E Coli from adhering to cells lining the bladder i.e., uroepithelial cells.7, 8
Vaginal estriol: Postmenopausal women often experience vaginal atrophy, characterized by vaginal itching, dryness and dyspareunia. Vaginal estriol preparation may help reduce the incidence of these symptoms.9
Methenamine salts: Hydrolyzation of methenamine salts to ammonia and formaldehyde is responsible for its antibacterial action. The antimicrobial activity in urine is correlated to the urinary concentration of formaldehyde. This is directly dependent on the urinary methenamine concentration, pH of urine and the duration of drug remaining in the bladder.10
Maintaining good hygiene: Practicing good personal hygiene play a pivotal role in preventing UTI. To avoid movement of E Coli bacteria from rectum back in the body, it is always advisable to wipe from front to back after a bowel movement. Changing pads and tampons frequently is also important to prevent UTIs during the menstrual cycle.11
Plenty of Fluid intakes: Drinking plenty of water and other extra fluids can help flush out extra bacteria from the urinary tract. Recommending 6-8 glasses of water per day.12
Frequent urination: If there is a history of recurrent UTIs, frequent urination can decrease the risk of infection. Drinking plenty of fluid will boost the urge of urination, also avoiding bladder irritating foods and fluids (alcohol, caffeinated drinks, spicy food etc). Urinating after and before sex helps to flush out bacteria that might have entered the body during intercourse.12
Use of water-based lubricants: In case vaginal dryness, water-based lubricants must be used. Also avoiding spermicide to prevent frequent UTIs.13
Changing clothes regularly: To prevent UTIs, avoid wearing tight-fitting clothes, thus helping to keep us dry. Also switching to cotton underwear, which inhibits trapping of extra moisture around the urethra.13
To assess the preventive measures of adults (above the age of 18 years) on urinary tract infection, an anonymous questionnaire with 15 questions regarding basic precautions for UTI was formulated using Google forms. The questionnaire was articulated in collaboration with an expert in the field. Simple random sampling was thrown out for choosing the participants. The link to the survey was made reach to the intended participants through email and WhatsApp. The questionnaire was mainly focusing on the participant’s attitude towards UTI preventive measures. Lastly, it was asked if the participant had any query on the UTI. The questionnaire was kept live for four weeks, and the individuals were reminded to fill it up.
Study Design: Observational cohort prospective study.
Sample size
The minimum of 412 sample size was considered using Raosoft software at a 95% confidence interval with a 5% margin of error and with the response rate of 70%.
Inclusion Criteria
Adults of South India (above the age of 18)
Exclusion criteria
People who were not interested to enrol in the study
Study duration: December 2020 to January 2021.
Statistical analysis
Data were moved into Microsoft Excel spreadsheets and validated for its accuracy. Gained data were analysed using the IBM SPSS statistics software for windows, version 22 (Armonk, NY, USA). Numbers and percentages were shaped to assessment categorical and nominal data. Variables used in the study included age, sex, education level and marital status. Besides, the Chi-square (χ2) test was used for the comparison between marital status and the prevalence of urinary tract infection. P < 0.05 was set as the level of significance.
<bold id="strong-12">RESULTS</bold>
Socio-demographic characteristics
A total of 412 respondents enrolled in the study. Of this, 279 (67.7%) were females and 133 (32.3%) were males. The mean age of the respondents was 24.05±8.1 years, where more than half of the participants (66.7%) belongs to the age group 18-25 years and more than half of the participants (66.3%) were a bachelor. Undergraduate (52.7%) and graduated (31.6%) were the majority of participants. All the socio-demographic characteristics are summarized in Table 1.
Sociodemographic characteristics of theparticipants (N=412).
Variables Participants (N) Percentage (%)
Age in years
18-25 275 66.7
26-35 85 20.6
36-45 38 9.2
46-55 12 2.9
56-65 02 0.5
Gender
Female 279 67.7
Male 133 32.3
Marital status
Married 139 33.7
Unmarried 273 66.3
Education
Illiterate 28 6.8
Primary education 12 2.9
Secondary education 25 6.1
Degree 217 52.7
Any higher education 130 31.6
The attitude of the participants for the preventive measures of UTI
The response of the participants for the precaution methods to avoid the chances of UTI was very satisfactory. A good number of participants that is about 82.5% drink plenty of water, which is the foremost step to avoid UTI. Most of the South Indian population urinate at least once in 4 hours to avoid the chances of UTI. 78.4% of participants knew the proper way of cleaning the genital area. Surprisingly 82% of population use cotton underwear to avoid the chances of UTI. The complete information about the attitude of the participants for the preventive measures is detailed in Table 2.
Attitude of the participants towards thepreventive measures of UTI (N=412
Questions Yes No
1.Do you drink plenty of water? 340 72
(82.5%) (17.5%)
2.Do you urinate at least once in 4 hours? 333 79
(80.8%) (19.2%)
3.Did you know, wiping from front to back 323 89
after urinating is the right way to clean the (78.4%) (21.6%)
genital area to avoid urinary tract infection?
4. Did you know that urinating shortly after sex is 298 114
an important method to avoid the chances of UTI? (72.3%) (27.7%)
5. Did you know, using cotton underwear are the 338 74
best way to avoid UTI? (82%) (18%)
6. Did you know that using spermicide condoms 282 130
is at high risk for UTI? (68.4%) (31.6%)
7. Did you aware that alcohol and caffeine are 320 92
the bladder irritating fluids? (77.7%) (22.3%)
Are you frequently experiencing urinary tractinfection?
More than half of the participants (54.6%) are recurrently suffering from urinary tract infection (UTI)
About 82.7% ofparticipants suffering from UTI are married whereas only 47.6% unmarriedpopulation is affected by urinary tract infection.
<bold id="s-ef393a425fe7">DISCUSSION</bold>
Urinary tract infections (UTIs) are common in both in the community and hospital setting. Primary suitable empirical treatment necessitates a good knowledge of epidemiological data. Producing awareness on preventive measures of UTI is an essential step to lessen the burden of UTI in the country. Our study reveals that even though the response to the preventive measures of UTI is satisfactory, more than half of the population that is 54.6% are frequently suffering from urinary tract infection Figure 1.
Our curiosity for the association of marital status with the urinary tract infection, end up with a high percentage of the population who were suffering from recurrent UTI are married and less percentage of unmarried participants are affected by the UTI Figure 2
Ann Stapleton MD and Walter E. Stamm MD conducted a study in which they concluded, recurrent UTI residues as a common clinical issue among women as well as men of all ages. Increased risk to healthy premenopausal and postmenopausal women, seems to be the factors such as estrogen status, and by exogenous exposures or behaviours, such as the continuous use of a diaphragm with spermicide, antimicrobial use, and sexual attitude14.
The study conducted by Ariana L Smith, Jason Brown, Jean F Wyman et.al, recommend an algorithmic method to care that contains education on lifestyle and behavioural alterations and statements definite populations of women with antimicrobial based and nonantibiotic replacements. This methodology comprises the use of vaginal estrogen with or without lactobacillus containing probiotics in postmenopausal women, low dose post-coital antibiotics for persistent urinary tract infection related with sexual activity in premenopausal women, low dose daily antibiotic prophylaxis in premenopausal women with infections not linked to sexual activity, and methenamine hippurate and/or lactobacillus comprising probiotics as nonantibiotic alternatives15.
Limitations
Age of the participants was not equally distributed among all the age categories.
Participants involved were from the same education level.
The unequal number of female and male, married and unmarried participants were enrolled.
<bold id="s-0124abb0ee89">CONCLUSION</bold>
Urinary tract infection is one of the serious upcoming burdens of the country. Since treating urinary tract infection is challenging for doctors, most of the physicians suggest the preventive measures to avoid the chances of the UTI, which our society should accept and follow in daily life. In this study we found out that in 412 participants, more than half of the participants (54.6%) were recurrently suffering from urinary tract infection (UTI) and about 82.7% of participants suffering from UTI are married whereas only 47.6% unmarried population is affected by urinary tract infection.
This study confirms, society’s good attitude towards the precautions of UTI has reduced the disease prevalence but more stress on preventive methods are needed to develop a healthy society. Increased urinary tract infection in the married participants advise married population to stick to the preventive measures to decrease the prevalence.
Financial support: None
Conflict of interest: None
ReferencesFasugbaO.MitchellB.G.McInnesE.KoernerJ.ChengA.C.ChengH.MiddletonS.Increased fluid intake for the prevention of urinary tract infection in adults and children in all settings: a systematic reviewJournal of Hospital Infection2020104168770195-670110.1016/j.jhin.2019.08.016Elsevier BVhttps://dx.doi.org/10.1016/j.jhin.2019.08.016HungKristin J.HudsonPatricia L.BergeratAgnesHeshamHelaiChoksiNamitMitchellCarolineEffect of commercial vaginal products on the growth of uropathogenic and commensal vaginal bacteriaScientific Reports202010162045-2322Springer Science and Business Media LLC10.1038/s41598-020-63652-xhttps://dx.doi.org/10.1038/s41598-020-63652-xStapletonAnnStammWalter E.PREVENTION OF URINARY TRACT INFECTIONInfectious Disease Clinics of North America19971137197330891-552010.1016/s0891-5520(05)70382-2Elsevier BVhttps://dx.doi.org/10.1016/s0891-5520(05)70382-2RazRUrinary tract infection in postmenopausal womenKorean Journal of urology20115212StapletonAnnStammWalter E.PREVENTION OF URINARY TRACT INFECTIONInfectious Disease Clinics of North America1997117197330891-5520Elsevier BV10.1016/s0891-5520(05)70382-2https://dx.doi.org/10.1016/s0891-5520(05)70382-2HowellAmy B.Cranberry Proanthocyanidins and the Maintenance of Urinary Tract HealthCritical Reviews in Food Science and Nutrition2002422732781040-8398, 1549-7852Informa UK Limited10.1080/10408390209351915https://dx.doi.org/10.1080/10408390209351915NajarMSSaldanhaCLBandayKAApproach to urinary tract infectionsIndian Journal of Nephrology2009191291290971-4065Medknow10.4103/0971-4065.59333https://dx.doi.org/10.4103/0971-4065.59333StapletonA ENovel Approaches to Preventing Urinary Tract Infection in Women. WASHINGTON UNIV SEATTLE2001https://apps.dtic.mil/sti/citations/ADB277556HowellAmy B.VorsaNicholiMarderosianAra DerFooLai YeapInhibition of the Adherence of P-FimbriatedEscherichia colito Uroepithelial-Cell Surfaces by Proanthocyanidin Extracts from CranberriesNew England Journal of Medicine199833915108510860028-4793, 1533-440610.1056/nejm199810083391516Massachusetts Medical Societyhttps://dx.doi.org/10.1056/nejm199810083391516StammWalter E.Prevention of urinary tract infectionsThe American Journal of Medicine1984761481540002-9343Elsevier BV10.1016/0002-9343(84)90257-2https://dx.doi.org/10.1016/0002-9343(84)90257-2Ortega MartellJ ANaberK GHaddadMilhemJSaucedoTiránJBurgosDomínguezJ APrevention of recurrent urinary tract infections: bridging the gap between clinical practice and guidelines in Latin America. Therapeutic Advances in Urology20191117562872188240891756287218824089https://doi.org/10.1177/1756287218824089StammW ENorrbyS RUrinary tract infections: disease panorama and challenges. The Journal of infectious diseases2001183HootonThomas M.BradleySuzanne F.CardenasDiana D.ColganRichardGeerlingsSuzanne E.RiceJames C.SaintSanjaySchaefferAnthony J.TambayhPaul A.TenkePeterNicolleLindsay E.Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of AmericaClinical Infectious Diseases2010506256631058-4838, 1537-6591Oxford University Press (OUP)10.1086/650482https://dx.doi.org/10.1086/650482YousifT AComparison of Widal Test In Diagnosis of Typhoid Fever with Blood Culture and Immunochromatographic Test among Patients in Wad Medani Teaching HospitalGezira State, Sudan2012SmithAriana L.BrownJasonWymanJean F.BerryAmandaNewmanDiane K.StapletonAnn E.Treatment and Prevention of Recurrent Lower Urinary Tract Infections in Women: A Rapid Review with Practice RecommendationsJournal of Urology20182006117411910022-5347, 1527-379210.1016/j.juro.2018.04.088Ovid Technologies (Wolters Kluwer Health)https://dx.doi.org/10.1016/j.juro.2018.04.088