Improving the Care and Management of Urinary Tract Infections Through Collaboration

With nearly 150 million people affected by urinary tract infections (UTIs) annually across the globe, UTIs are a major health problem. Both the term ‘UTI’ and the infection’s long-term health effects are wide-ranging.

Many clinical and research specialties are dedicated to UTI management, but these specialties primarily work in separate silos. The Urinary Tract Infection Global Alliance (UTIGA) brings these specialties together, along with patients and caregivers.

“UTIGA is the brainchild of Sheryl Justice, PhD,” says Christina Ching, MD, a pediatric urologist at Nationwide Children’s Hospital. Dr. Justice is a principal investigator at the Abigail Wexner Research Institute at Nationwide Children’s.

Drs. Ching and Justice co-authored a recent commentary on UTIGA published in Nature Reviews.

“At the 2016 Clinical and Scientific Advances in Urinary Tract Infections conference, we asked attendees whether there was a need to establish a professional society to help promote research and patient advocacy in UTIs,” Dr. Justice says.

The response was overwhelmingly positive, spurring UTIGA’s creation.

This new society has several aims, all of which point to achieving consensus on UTI care and management. These aims include promoting evidence-based research on UTI management, fostering professional development and improving patient advocacy and education.

Both human and veterinary health specialties, along with researchers, compose UTIGA. Human health specialties include pediatric nephrology, internal medicine, emergency department, infectious disease and pediatric and adult urology. Veterinary specialties include urology, small animal surgery and internal medicine. Researchers include those studying bacterial genomics and computational biology.

“The veterinary clinicians and researchers are interested in applying the knowledge gained through UTIGA to treating UTIs in companion animals,” Dr. Justice says. Michael Wood, DVM, PhD, DACVIM from the University of Wisconsin has been instrumental in informing the veterinary community about UTIGA.

UTI’s diagnostic and therapeutic challenges frustrate patients and care providers alike. For example, the term ‘UTI’ broadly applies to either a specific condition (e.g., uncomplicated cystitis) or an infection anywhere in the urinary tract. Such imprecise terminology impedes an accurate diagnosis.

Also, Dr. Ching says, “It can be difficult to determine if a patient has a true infection.” Differentiating between infectious and non-infectious bacteria in the urinary tract is challenging, and the clinical signs are often non-specific and highly variable. Pediatric patients, she notes, might be unable to articulate their symptoms adequately.

In addition, current diagnostic tools can’t always identify what puts patients at risk for recurrent UTIs.

“To achieve patient-oriented treatment, we need to understand how each patient is different in their infection,” Dr. Justice says.

Terapeutically, the risk of multi-drug-resistant UTIs is real. Nearly one in five antibiotic prescriptions are for UTIs, Dr. Justice explains. Moreover, urine cultures are not routinely performed to diagnose UTIs.

UTIGA is positioned to address these challenges and ultimately improve patient care. To improve UTI descriptors, UTIGA proposes a new terminology framework based on clinical presentation, anatomy, health sequelae and causative organism.

To address antibiotic resistance, UTIGA plans to fund research to better understand the different types of infections of the urinary tract and non-antibiotic therapies for UTI. This research will evaluate whether these alternative therapies can reduce susceptibility to UTIs and minimize the negative health sequelae, including inflammation-induced renal damage.

For patient advocacy, UTIGA will connect care providers and researchers with patients and caregivers. These connections will help to educate patients and caregivers about UTI and help UTI professionals better understand the infection from a different lens.

To promote professional development, UTIGA plans to foster in-person and virtual mentorship opportunities.

“The society allows us to combine our expertise to synergistically expand networking opportunities and approaches to UTI research and management,” Dr. Justice says.