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

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.

Fig. 1

Symptoms of urinary infection from the last urinary tract infection episode registered at Day 0 and Day 180—analysis population (N = 575)

Fig. 2

Total HAD score at Day 0 and Day 180—analysis population (N = 575, some data is missing). The HAD questionnaire comprises 14 questions (7 evaluate anxiety and 7 evaluate depression). Each reply has a value of 0–3, giving a possible total score ranging from 0 to 42. Higher scores indicate higher levels of anxiety and depression. HAD hospital anxiety and depression

Fig. 3

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

Fig. 4

Reduction of Leicester scores and number of UTIs between Day 0 and Day 180—Analysis population (N = 575). The Leicester impact scale was divided into four categories: 0–14, 15–20, 21–30, and 31–42. A score of >14 indicated that the patient had some degree of functional or social handicap, a score of >20 was suggestive of a major social or functional handicap, and a score >31 indicated major social and functional handicaps. Asterisk the percentage reduction from Day 0. All statistically significant (P ≤ 0.0001). UTI urinary tract infection