Demographic, Clinical, and Treatment Parameters Influencing the Outcome of Acute Cystitis

• Published in: Clinical infectious diseases Vol. 29; no. 1; pp. 113 - 119
• Main Authors: Echols, Roger M., Tosiello, Robert L., Haverstock, Daniel C., Tice, Alan D.
• Format: Journal Article Conference Proceeding
• Language: English
• Published: Chicago, IL The University of Chicago Press 01.07.1999; University of Chicago Press
• Subjects: Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antimicrobials; Bacterial diseases; Bacterial diseases of the urinary system; Bacteriuria; Biological and medical sciences; Clinical Articles; Clinical trials; Colony Count, Microbial; Cystitis; Cystitis - drug therapy; Cystitis - microbiology; Experimentation; Female; Guidelines as Topic; Health outcomes; Human bacterial diseases; Humans; Infectious diseases; Medical sciences; Middle Aged; Outcome and Process Assessment (Health Care); Pathogens; Prognosis; Pyuria; United States; United States Food and Drug Administration; Urinary tract infections; Urine; Human; Urinary system disease; Prognosis; Acute; Treatment efficiency; Urinary tract disease; Infection; Antibiotic; Chemotherapy; Treatment; Risk factor; Bacteriosis; Female; Bladder disease; Antibacterial agent; Predictive factor; Cystitis
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1086/520138

A meta-analysis of six double-blinded clinical trials was undertaken to identify risk factors associated with bacteriologic outcome in 3,108 women with acute cystitis. Eleven antibiotic regimens were used, including ciprofloxacin, ofloxacin, norfloxacin, trimethoprim-sulfamethoxazole, and nitrofurantoin. Entry criteria for all studies were identical. Among 2,409 patients who were defined to be valid for efficacy analysis, pathogens included Escherichia coli (78.6%), Staphylococcus saprophyticus (4.4%), Klebsiella pneumoniae (4.3%), Proteus mirabilis (3.7%), and “other” (9%). Causative bacteria were eradicated at the end of treatment in 93% of patients. The following parameters were associated with successful bacteriologic outcome: not using a diaphragm (P = .0041), treatment for ⩾3 days (P = .0043), pathogen not “other” (P = .0043), symptom duration of <2 days (P = .0096), and African American race (P = .0147). K. pneumoniae (P = .0496) and “other” pathogens (P = .0018) were associated with increased probability of bacteriologic treatment failure. The presence of pyuria (⩾10 WBCs per high-power field) did not correlate with outcome and was inversely correlated with the finding of ⩾105 bacterial colony-forming units per mL of urine (P < .001). This large database identifies new parameters associated with treatment outcomes of acute cystitis and calls into question current clinical trial guidelines.