2024 WAAW丨Dr. Pengfei Shen: Why Urinary Tract Infections Trouble Women？

Editor's Note: The third week of every November marks World Antimicrobial Awareness Week (WAAW). This year, WAAW adopts the theme: "Educate, Advocate, Act," aiming to raise public awareness about antimicrobial drugs, advocate for their appropriate use, and encourage action to combat antimicrobial resistance (AMR). In response to this call, Oncology Frontier invited Dr. Pengfei Shen from West China Hospital of Sichuan University to provide an informative overview of female urinary tract infections (UTIs), exploring why women are more prone to these infections, common symptoms, frequently used antibiotics, and the importance of responsible medication use to prevent antibiotic resistance.

Why Are Women More Prone to UTIs?

Dr. Pengfei Shen: UTIs are inflammatory conditions caused by pathogenic microorganisms (primarily bacteria) growing and reproducing in the urinary tract. These infections can occur anywhere along the urinary tract, including the kidneys, ureters, bladder, and urethra. Women are particularly susceptible due to their unique anatomical and lifestyle factors.

Firstly, women have a shorter and wider urethra compared to men, making it easier for bacteria from external areas (such as the perineum, vaginal opening, or anus) to ascend into the urinary tract and cause infections in the bladder, ureters, or even kidneys. In contrast, the longer and more curved male urethra acts as a natural barrier against bacterial invasion.

Secondly, the female urethral opening is located close to the vaginal and anal openings, both of which are common reservoirs for bacteria. During menstruation, pregnancy, or in cases of gynecological inflammation, vaginal secretions and blood can contaminate the urethral opening, providing bacteria with a pathway for infection.

Certain lifestyle habits also play a significant role in the development of UTIs in women. For instance, inadequate water intake can result in concentrated urine with reduced flow, creating an environment conducive to bacterial growth. Prolonged sitting, lack of exercise, and wearing tight-fitting clothing can impair urinary tract function and increase infection risk.

Other contributing factors include prolonged catheter use, urinary stones, urinary tract strictures, and systemic conditions such as diabetes. Older women are particularly vulnerable due to decreased physical function and weakened immunity, which exacerbate the risk of recurrent infections.

What Are the Common Symptoms of UTIs?

Dr. Pengfei Shen: UTIs present with a range of symptoms, commonly including frequent urination, urgency, pain during urination, and various forms of discomfort during voiding. These symptoms can significantly impact a patient’s quality of life.

• Frequent Urination: Characterized by an increased frequency of urination, often with small volumes each time. This results from bacterial growth in the bladder, which irritates the bladder wall and creates a constant urge to urinate.
• Urgency: A sudden, strong need to urinate, sometimes leading to involuntary leakage before reaching the bathroom. This is also caused by bladder irritation.
• Painful Urination: A burning sensation or pain during urination, often due to bacterial proliferation in the urethra causing inflammation and swelling of the mucosa.
• Visible Hematuria: Some patients may observe blood in their urine, a result of bacteria damaging the urinary mucosa and causing ruptured blood vessels.

Severe cases can lead to complications such as pyelonephritis (kidney infection), which may manifest as high fever, chills, and flank pain. If untreated, pyelonephritis can progress to sepsis, a life-threatening condition requiring immediate medical intervention.

Which Antibiotics Are Commonly Used to Treat UTIs?

Dr. Pengfei Shen: The primary antibiotics used to treat UTIs include penicillins, cephalosporins, and fluoroquinolones. However, the specific choice depends on the patient’s condition and results from urine cultures and sensitivity tests.

• Penicillins: These classic antibiotics work by inhibiting bacterial cell wall synthesis, leading to bacterial death. However, increasing resistance has diminished their effectiveness in some cases.
• Cephalosporins: Derived from penicillins, these antibiotics have a broader spectrum and stronger bactericidal activity. They are often used for moderate to severe UTIs, particularly those caused by resistant bacteria.
• Fluoroquinolones: Synthetic antibiotics that inhibit bacterial DNA synthesis. They have excellent tissue penetration and lower resistance rates, making them widely used for UTI treatment.

Other antibiotics, such as aminoglycosides and sulfonamides, are available for specific scenarios but are not first-line treatments. Their use is typically reserved for cases requiring tailored therapies based on bacterial resistance patterns.

How Can We Ensure Responsible Antibiotic Use to Prevent Resistance?

Dr. Pengfei Shen: Responsible antibiotic use is critical in combating bacterial resistance. In treating UTIs, the following principles should be adhered to:

1. Strict Adherence to Prescriptions: Patients must follow their doctor’s instructions to take antibiotics on time, at the correct dosage, and for the full course of treatment. This ensures efficacy and minimizes the risk of resistance. Patients should not reduce dosages or stop medication prematurely, as this can lead to incomplete eradication of bacteria and resistance development.
2. Performing Sensitivity Testing: Conducting sensitivity tests helps determine which antibiotics the bacteria are susceptible to, enabling more targeted and effective treatment while reducing resistance risks.
3. Promoting Hygiene and Immunity: Patients should maintain good personal hygiene and adopt habits to boost immunity, such as keeping the perineal area clean and dry, changing underwear frequently, avoiding tight-fitting and synthetic clothing, exercising regularly, eating a balanced diet, and maintaining a positive mindset.
4. Strengthening Stewardship: Healthcare providers must prescribe and guide antibiotic use strictly according to established principles, avoiding overuse and misuse. Educating patients about responsible antibiotic use is also essential to enhance awareness and compliance.
5. Monitoring and Research: Continuous monitoring of resistant bacteria and developing new antibiotics are vital to addressing resistance trends and challenges. Research efforts should focus on both understanding resistance mechanisms and creating innovative therapeutic agents to stay ahead of evolving bacterial resistance.

Dr. Pengfei Shen

• Associate Professor, Master’s Supervisor, Doctor of Medicine
• Reserve Leader of Academic and Technical Expertise, Sichuan Province
• Senior Visiting Scholar, MD Anderson Cancer Center, USA

Expertise:

Minimally invasive and standardized treatment of urological tumors, including kidney cancer, prostate cancer, bladder cancer, and adrenal tumors. Specializes in laparoscopic and robotic surgery for kidney and prostate cancer, as well as individualized treatment for advanced cases.

Academic Roles:

• Member, Minimally Invasive and Robotics Section, Urology Division, Chinese Medical Doctor Association
• Member, Ultrasound Imaging Section, Cross-Strait Medicine Exchange Association
• Vice Chair, Youth Committee, Urological Oncology Division, Sichuan Anti-Cancer Association
• Standing Member, Urology Division, Sichuan Health Promotion Association
• Member, Urological Oncology Division, Sichuan Tumor Society
• Member, Urology Division, Sichuan Rehabilitation Medical Association
• Member, Youth Committee, Urology Section, Sichuan Medical Association
• Deputy Chair, Kidney Cancer Group, Urology Section, Chengdu Medical Association
• Editor, Genitourinary Oncology, Frontiers in Oncology

Professor Shen has made significant contributions to the field through academic research, clinical practice, and the promotion of best practices in urological oncology.