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Afebril urinvägsinfektion/akut cystit hos kvinnor

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Definition:
En infektion enbart lokaliserad i de nedre urinvägarna (akut cystit), som karaktäriseras av akuta miktionsbesvär i frånvaro av feber och allmänna symtom.
Förekomst:
Omkring hälften av alla kvinnor får en episod med akut cystit under sitt liv.
Symtom:
Är sannolikt vid nytillkomna besvär på akut cystit med minst 2 av följande symtom utan vaginala symtom: sveda vid miktion, täta trängningar och frekventa miktioner.
Kliniska fynd:
I vanliga fall finns inga kliniska fynd. Vid akut cystit finns ingen feber eller allmänpåverkan.
Diagnostik:
Vanligen baseras diagnosen på anamnesen. Andra diagnoser såsom STI, inflammation i vagina/vulva och urogenitalt östrogenbristsyndrom bör övervägas.
Behandling:
Vid lindriga till måttliga besvär rekommenderas exspektans, symtomlindring och ökat vätskeintag. Vid måttliga till svåra besvär kan antibiotikabehandling bli aktuell, antingen direkt eller som recept i reserv.
  1. Läkemedelsverket (2017). Läkemedelsbehandling av urinvägsinfektioner i öppenvård - behandlingsrekommendation.
  2. Infektionsläkarföreningen. Vårdprogram UVI hos vuxna, 2020. (Hämtad 2021-02-12). infektion.net  
  3. Colgan R, Williams M. Diagnosis and treatment og acute uncomplicated cystitis. Am Fam Physician 2011; 84: 771-6. PubMed  
  4. Lala V, Minter DA. Acute Cystitis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; November 20, 2020. PMID:29083726. PubMed  
  5. Colgan R, Keating K, Dougouih M. Survey of symptom burden in women with uncomplicated urinary tract infections. Clin Drug Investig 2004; 24: 55-60. PubMed  
  6. Kodner CM, Gupton EKT. Recurrent urinary tract infections in women: diagnosis and management. Am Fam Physician 2010; 82: 638-43. American Family Physician  
  7. Gupta K, Grigoryan L, Trautner B. Urinary Tract Infection. Ann Intern Med. 2017;167(7):ITC49-ITC64. PMID:28973215. PubMed  
  8. Scholes D, Hooton TM, Roberts PL, Stapleton AE, Gupta K, Stamm WE. Risk factors for recurrent urinary tract infection in young women. J Infect Dis 2000;182:1177-1182. PubMed  
  9. Raz R, Gennesin Y, Wasser J, et al. Recurrent urinary tract infection in postmenopausal women. Clin Infect Dis 2000;30:152-156. PubMed  
  10. Mody L, Juthani-Mehta M. Urinary tract infections in older women: a clinical review. JAMA. 2014 Feb 26;311(8):844-54. PMID: 24570248. PubMed  
  11. Johansen TEB, Weidner W. Understanding chronic pelvic pain syndrome. Curr Opin Urol 2002; 12: 63 - 7. PubMed  
  12. Bent S, Nallamothu BK, Simel DL, et al. Does this woman have an acute uncomplicated urinary tract infection?. JAMA 2002; 287: 2701-10. PubMed  
  13. Gupta K, Hooton TM, Roberts PL, Stamm WE. Patient-initiated treatment of uncomplicated recurrent urinary tract infections in young women. Ann Intern Med 2001;135:9-16. Annals of Internal Medicine  
  14. Car J. Urinary tract infections in women: diagnosis and management in primary care. BMJ 2006; 332: 94-7. PubMed  
  15. Richards D, Toop L, Chambers S, Fletcher L. Response to antibiotics of women with symptoms of urinary tract infection but negative dipstick urine test results: double blind randomised controlled trial. BMJ 2005; 331: 143-46. British Medical Journal  
  16. Folkhälsomyndigheten. Behandlingsrekommendationer för vanliga infektioner i öppenvård. 2019 (hämtad 2021-03-05). www.folkhalsomyndigheten.se  
  17. Devillé WL, Yzermans JC, van Duijn NP, et al. The urine dipstick test useful to rule out infections: a meta-analysis of the accuracy. BMC Urol 2004; 4: 4. PubMed  
  18. Fowler JE Jr, Pulaski ET. Excretory urography, cystography, and cystoscopy in the evaluation of women with urinary-tract infection: a prospective study. N Engl J Med 1981;304:462-465. New England Journal of Medicine  
  19. Little P, Moore MV, Turner S, et al. Effectiveness of five different approaches in management of urinary tract infection: randomised controlled trial. BMJ 2010; 340: c199. BMJ (DOI)  
  20. Kim DK, Kim JH, Lee JY et al. Reappraisal of the treatment duration of antibiotic regimens for acute uncomplicated cystitis in adult women: a systematic review and network meta-analysis of 61 randomised clinical trials. Lancet Infect Dis. 2020 Sep;20(9):1080-1088. PMID:32446327. PubMed  
  21. Huttner A, Verhaegh EM, Harbarth S, et al. Nitrofurantoin revisited: a systematic review and meta-analysis of controlled trials. J Antimicrob Chemother. 2015 Sep;70(9):2456-64.
  22. Folkhälsomyndigheten. Ökning av resistenta bakterier vid urinvägsinfektion behöver följas. 10 juni 2020 (Hämtad 2020-06-23). www.folkhalsomyndigheten.se  
  23. McLellan LK, Hunstad DA. Urinary Tract Infection: Pathogenesis and Outlook. Trends Mol Med. 2016;22(11):946-957. PMID:27692880. PubMed  
  24. Hooton TM, Vecchio M, Iroz A et al. Effect of Increased Daily Water Intake in Premenopausal Women With Recurrent Urinary Tract Infections: A Randomized Clinical Trial. JAMA Intern Med. 2018 Oct 1. PMID: 30285042 PubMed  
  25. Fihn SD. Acute uncomplicated urinary tract infection in women. N Engl J Med 2003; 349: 259-66. PubMed  
  26. Kontiokari T, Sundquist K, Nuutinen M, Pokka T, Koskela M, Uhari M. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women . BMJ 2001; 322: 1571. PubMed  
  27. Lee BS1, Bhuta T, Simpson JM, Craig JC. Methenamine hippurate for preventing urinary tract infections. Cochrane Database Syst Rev. 2012 Oct 17;10:CD003265. doi: 10.1002/14651858.CD003265.pub3. DOI  
  28. Qin X, Coyle ME, Yang L, et al. Acupuncture for recurrent urinary tract infection in women: a systematic review and meta-analysis published online ahead of print, 2020 May 14. BJOG. 2020;10.1111/1471-0528.16315. PMID:32406571. PubMed  
  29. Christiaens TC, De Meyere M, Verschraegen G, Peersman W, Heytens S, De Maeseneer JM. Randomised controlled trial of nitrofurantoin versus placebo in the treatment of uncomplicated urinary tract infection in adult women. Br J Gen Pract. 2002; 52: 729-34. PubMed  
  30. Gharbi M, Drysdale JH, Lishman H, et al. Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study. BMJ 2019; 364: l525. pmid:30814048 PubMed  
  • Remy Waardenburg, specialist i allmänmedicin, medicinsk redaktör Medibas