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Recurrent Lower Urinary Tract Infections Have a Detrimental Effect on Patient Quality of Life: a Prospective, Observational Study.

Renard J, Ballarini S, Mascarenhas T, Zahran M, Quimper E, Choucair J, Iselin CE - Infect Dis Ther (2014)

Bottom Line: For each parameter, the comparison between Day 0 and Day 180 was performed using Wilcoxon signed-rank test for quantitative data.At the end of the study (Day 180), the mean number of UTI decreased by 59.3% (P ≤ 0.0001), the total HAD score decreased by 32.1% (P ≤ 0.0001), and the mean Leicester score decreased by 44.0% (P ≤ 0.0001) from baseline.This study showed that rUTI had a negative impact on patients' QoL and that effective alternative prophylaxis significantly improved their QoL.

View Article: PubMed Central - PubMed

Affiliation: University Hospital of Geneva, Geneva, Switzerland.

ABSTRACT

Introduction: This study investigated the effects of recurrent urinary tract infections (rUTI) and the impact of prophylaxis on rUTI and patients' quality of life (QoL).

Methods: Altogether, 575 patients affected by rUTI were included in a 6-month observational study. QoL was assessed using the Hospital Anxiety and Depression (HAD) and the Leicester scales. Statistical analyses were performed using SAS(®) Version 8.2 software (SAS Institute Inc., Cary, NC, USA). The significance level was set at 5%. Spearman correlation was used to assess the degree of correlation between infectious episodes and HAD and Leicester scores. For each parameter, the comparison between Day 0 and Day 180 was performed using Wilcoxon signed-rank test for quantitative data.

Results: In total, 61.9% of patients suffering from rUTI exhibited some degree of depression at baseline (Day 0). Alternative oral non-antimicrobial prophylactic treatment for rUTI [Escherichia coli lyophilized bacterial lysate (OM-89)] was administered to 94.4% of patients (1 capsule a day for 90 days), followed by a 3-month treatment-free period. At the end of the study (Day 180), the mean number of UTI decreased by 59.3% (P ≤ 0.0001), the total HAD score decreased by 32.1% (P ≤ 0.0001), and the mean Leicester score decreased by 44.0% (P ≤ 0.0001) from baseline. There was a correlation trend between the reduction in the numbers of UTI at the end of the study compared to the 6 months prior to study entry and the reduction in the anxiety, depression, total HAD scores, activity, feeling, and total Leicester scores registered from Day 0 to Day 180, suggesting a lessening of emotional problems, and social and functional handicaps with decreasing UTI incidence.

Conclusions: This study showed that rUTI had a negative impact on patients' QoL and that effective alternative prophylaxis significantly improved their QoL.

No MeSH data available.


Related in: MedlinePlus

Evolution of HAD subscales and global score, and number of urinary infection episodes between Day 0 and Day 180—analysis population (N = 575). The HAD subscales (anxiety score and depression score) were divided into three ranges to assess the presence of anxiety or depression: 0–7 normal, 8–10 possibly indicative of anxiety or depression, and ≥11 probable presence of anxiety or depression. A score of at least 8 on either the anxiety subscale or depression subscale indicated an emotional disorder. Asterisk the percentage reduction from Day 0. All statistically significant (P ≤ 0.0001). HAD hospital anxiety and depression
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Fig3: Evolution of HAD subscales and global score, and number of urinary infection episodes between Day 0 and Day 180—analysis population (N = 575). The HAD subscales (anxiety score and depression score) were divided into three ranges to assess the presence of anxiety or depression: 0–7 normal, 8–10 possibly indicative of anxiety or depression, and ≥11 probable presence of anxiety or depression. A score of at least 8 on either the anxiety subscale or depression subscale indicated an emotional disorder. Asterisk the percentage reduction from Day 0. All statistically significant (P ≤ 0.0001). HAD hospital anxiety and depression

Mentions: At baseline, the HAD score revealed that 177 (32%), 153 (27.7%), and 12 (2.2%) patients exhibited mild, moderate, and severe levels of depression, respectively. The mean HAD anxiety subscale score was 10.3 (SD = 4.1, range 0–21), and the mean HAD depression subscale score was 6.4 (SD = 3.6, range 0–18). In total, 342 patients (61.8%) had at least minor emotional disorders, 165 (29.9%) of whom presented with a high anxious-depressive state. At Day 180, the proportion of patients with possibly clinically relevant anxiety/depression levels (mild to severe anxiety or depression) decreased. The difference was more significant for the anxiety score, with a total reduction of 38.5% from Day 0 to Day 180 (Table 1). The total HAD score at Day 180 indicated a 30.9% increase in patients with a normal score (below 14), and a total decrease of 31% in patients experiencing mild to severe anxiety or depression (total HAD scores between 15 and 42; Fig. 2). At Day 180, the mean HAD anxiety subscale score was 6.6 (SD = 3.7), the mean HAD depression score was 4.8 (SD = 3.5), and the total HAD score was 11.4 (SD = 6.5), representing a statistically significant decrease in total HAD score of 32.1% from baseline (P ≤ 0.0001). The mean number of urinary episodes was 2.7 (SD = 1.2) on Day 0, and 1.1 (SD = 1.1) on Day 180, showing a statistically significant decrease of 59.3% from baseline (P ≤ 0.0001). Thus, there was a correlation trend between the reduction in the numbers of UTIs from Day 0 to Day 180 and the reduction in the anxiety, depression, and total HAD scores, suggesting a lessening of emotional problems with decreasing UTI incidence (Fig. 3).Table 1


Recurrent Lower Urinary Tract Infections Have a Detrimental Effect on Patient Quality of Life: a Prospective, Observational Study.

Renard J, Ballarini S, Mascarenhas T, Zahran M, Quimper E, Choucair J, Iselin CE - Infect Dis Ther (2014)

Evolution of HAD subscales and global score, and number of urinary infection episodes between Day 0 and Day 180—analysis population (N = 575). The HAD subscales (anxiety score and depression score) were divided into three ranges to assess the presence of anxiety or depression: 0–7 normal, 8–10 possibly indicative of anxiety or depression, and ≥11 probable presence of anxiety or depression. A score of at least 8 on either the anxiety subscale or depression subscale indicated an emotional disorder. Asterisk the percentage reduction from Day 0. All statistically significant (P ≤ 0.0001). HAD hospital anxiety and depression
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4363217&req=5

Fig3: Evolution of HAD subscales and global score, and number of urinary infection episodes between Day 0 and Day 180—analysis population (N = 575). The HAD subscales (anxiety score and depression score) were divided into three ranges to assess the presence of anxiety or depression: 0–7 normal, 8–10 possibly indicative of anxiety or depression, and ≥11 probable presence of anxiety or depression. A score of at least 8 on either the anxiety subscale or depression subscale indicated an emotional disorder. Asterisk the percentage reduction from Day 0. All statistically significant (P ≤ 0.0001). HAD hospital anxiety and depression
Mentions: At baseline, the HAD score revealed that 177 (32%), 153 (27.7%), and 12 (2.2%) patients exhibited mild, moderate, and severe levels of depression, respectively. The mean HAD anxiety subscale score was 10.3 (SD = 4.1, range 0–21), and the mean HAD depression subscale score was 6.4 (SD = 3.6, range 0–18). In total, 342 patients (61.8%) had at least minor emotional disorders, 165 (29.9%) of whom presented with a high anxious-depressive state. At Day 180, the proportion of patients with possibly clinically relevant anxiety/depression levels (mild to severe anxiety or depression) decreased. The difference was more significant for the anxiety score, with a total reduction of 38.5% from Day 0 to Day 180 (Table 1). The total HAD score at Day 180 indicated a 30.9% increase in patients with a normal score (below 14), and a total decrease of 31% in patients experiencing mild to severe anxiety or depression (total HAD scores between 15 and 42; Fig. 2). At Day 180, the mean HAD anxiety subscale score was 6.6 (SD = 3.7), the mean HAD depression score was 4.8 (SD = 3.5), and the total HAD score was 11.4 (SD = 6.5), representing a statistically significant decrease in total HAD score of 32.1% from baseline (P ≤ 0.0001). The mean number of urinary episodes was 2.7 (SD = 1.2) on Day 0, and 1.1 (SD = 1.1) on Day 180, showing a statistically significant decrease of 59.3% from baseline (P ≤ 0.0001). Thus, there was a correlation trend between the reduction in the numbers of UTIs from Day 0 to Day 180 and the reduction in the anxiety, depression, and total HAD scores, suggesting a lessening of emotional problems with decreasing UTI incidence (Fig. 3).Table 1

Bottom Line: For each parameter, the comparison between Day 0 and Day 180 was performed using Wilcoxon signed-rank test for quantitative data.At the end of the study (Day 180), the mean number of UTI decreased by 59.3% (P ≤ 0.0001), the total HAD score decreased by 32.1% (P ≤ 0.0001), and the mean Leicester score decreased by 44.0% (P ≤ 0.0001) from baseline.This study showed that rUTI had a negative impact on patients' QoL and that effective alternative prophylaxis significantly improved their QoL.

View Article: PubMed Central - PubMed

Affiliation: University Hospital of Geneva, Geneva, Switzerland.

ABSTRACT

Introduction: This study investigated the effects of recurrent urinary tract infections (rUTI) and the impact of prophylaxis on rUTI and patients' quality of life (QoL).

Methods: Altogether, 575 patients affected by rUTI were included in a 6-month observational study. QoL was assessed using the Hospital Anxiety and Depression (HAD) and the Leicester scales. Statistical analyses were performed using SAS(®) Version 8.2 software (SAS Institute Inc., Cary, NC, USA). The significance level was set at 5%. Spearman correlation was used to assess the degree of correlation between infectious episodes and HAD and Leicester scores. For each parameter, the comparison between Day 0 and Day 180 was performed using Wilcoxon signed-rank test for quantitative data.

Results: In total, 61.9% of patients suffering from rUTI exhibited some degree of depression at baseline (Day 0). Alternative oral non-antimicrobial prophylactic treatment for rUTI [Escherichia coli lyophilized bacterial lysate (OM-89)] was administered to 94.4% of patients (1 capsule a day for 90 days), followed by a 3-month treatment-free period. At the end of the study (Day 180), the mean number of UTI decreased by 59.3% (P ≤ 0.0001), the total HAD score decreased by 32.1% (P ≤ 0.0001), and the mean Leicester score decreased by 44.0% (P ≤ 0.0001) from baseline. There was a correlation trend between the reduction in the numbers of UTI at the end of the study compared to the 6 months prior to study entry and the reduction in the anxiety, depression, total HAD scores, activity, feeling, and total Leicester scores registered from Day 0 to Day 180, suggesting a lessening of emotional problems, and social and functional handicaps with decreasing UTI incidence.

Conclusions: This study showed that rUTI had a negative impact on patients' QoL and that effective alternative prophylaxis significantly improved their QoL.

No MeSH data available.


Related in: MedlinePlus