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Lactobacilli 

could become the standard in preventing

Urinary Tract Infections

 

 

Urinary tract infections are a common problem among women and are responsible for a major part of antibiotic use. However, these medicines can come with unwanted side-effects such as antibiotic resistance. Probiotics have shown to be effective in varied clinical trials to treat bacterial infections. Since a healthy vaginal microbiota is mainly dominated by Lactobacillus species, administering lactobacilli could be a possible treatment to reduce the risk of (recurrent) UTIs.

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Urinary tract infections

Urinary tract infections (UTIs) are amongst the most prevalent bacterial infections in women [1,2,3]. A recurrent UTI (RUTI) can be defined as at least three episodes of UTI in 1 year or two episodes in 6 months. Among one third of women experience at least one UTI during their life, and between 35%-53% will experience a RUTI within a year after the initial one[4]. The standard treatment for UTIs are antibiotics. However, with profylactic use for RUTIs, since they come with side-effects such antibiotic-resistance.

 

 

Escherichia coli, a common inhabitor of the gut, is the primary pathogen involved in UTIs

   Risk factors for a urinary tract infection

COPY Gut microbiota linked to gestational diabetes_1167

Health burden

RUTIs are a significant healthcare problem worldwide for women, and even more so in specific patient populations. Patients with spinal cord injury and neurogenic bladder as well as patients with long-term urinary catheter all share the problem of RUTI and develop resistance to standard antibiotics. Given the enormous burden on patients, as well as the healthcare and economic problems caused by RTUI, the investigation of alternative treatment solutions is of potentially crucial importance for patient benefit and clinical science.

The use of probiotics, especially lactobacilli might be a good candidate for preventive use of UTIs. Since lactobacilli dominate a healthy urogenital flora, restoration of the urogenital flora with lactobacilli, may protect against UTIs. Lactobacilli exert their health-promoting effects through several mechanisms:, they:

 

 Produce lactic acid and bacteriocins that directly kill or inhibit bacterial and viral pathogens

 Form micro-colonies that adhere to the epithelial cell receptors and form a physical barrier against pathogen adhesion

 Stimulate the host immune system

 

Not all lactobacilli can exert the same health effects and therefore,  the bacterial strains for probiotic formulation intended to prevent RUTIs have to be carefully selected based on the characteristics of the strain. 

 

Several, in vitro and in vivo studies support the beneficial effect of some lactobacilli strains on the restoration of the vaginal flora and the prevention of RUTIs [5,6,7]. The evidence suggests that probiotics can be beneficial for preventing RUTIs in women.  As probiotics are already in use in many fermented products, there are no major safety concerns. Especially, latcobacili have GRAS (generally regarded safe to use) status [8]. Probiotics show a promising role in becoming an alternative or complementary treatment option for RUTIs and might in the future replace antibiotics as the standard treatment solution.

 

 

References

  1. Warren JW, Abrutyn E, Hebel JR, Johnson JR, Schaeffer AJ, Stamm WE, et al. Guidelines for antimicrobial treatment of uncomplicated acute bacterial cystitis and acute pyelonephritis in women. Infectious Diseases Society of America (IDSA). Clin Infect Dis 1999;29:745-58
  2. Fihn SD. Clinical practice. Acute uncomplicated urinary tract infection in women. N Engl J Med 2003;349:259-66
  3. Bacheller CD, Bernstein JM. Urinary tract infections. Med Clin North Am 1997;81:719-30
  4. Ikäheimo R, Siitonen A, et al. Recurrence of urinary tract infection in primary care setting: analysis of a 1-year follow-up of 179 women. Clin Infect Dis. 1996;22:91-99.
  5. Borchert D, Sheridan L, Papatsoris A, Faruquz Z, Barua JM, Junaid I, Pati Y, Chinegwundoh F, Buchholz N. Prevention and treatment of urinary tract infection with probiotics: Review and research perspective. Indian J Urol. 2008 Apr;24(2):139-44.
  6. Falagas ME, Betsi GI, Tokas T, Athanasiou S. Probiotics for prevention of recurrent urinary tract infections in women: a review of the evidence from microbiological and clinical studies. Drugs. 2006;66(9):1253-61.
  7. Gupta V, Nag D, Garg P1.Recurrent urinary tract infections in women: How promising is the use of probiotics? Indian J Med Microbiol. 2017 Jul-Sep;35(3):347-354 .     Salminen S, Ouwehand AC, Isolauri E. Clinical application of probiotic bacteria. Int Dairy Jr 1998;8:563-72

 

 

 

 

 

Lactobacilli could become the standard treatment for Urinary Tract Infections

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