Urinary Tract Infections Management in the Developing Countries

Abstract

Urinary tract infections (UTIs) are one of the most common infectious disease worldwide that affect all age groups and considered as one of the most common reason of receiving antimicrobial therapy. Anatomically, UTIs are classified as lower UTIs, such as cystitis, urethritis, or prostatitis, and upper urinary infection such as pyelonephritis. Clinically, UTIs are category as complicated or uncomplicated urinary infection. Uncomplicated UTIs affect otherwise healthy individuals who have no urinary structural or functional abnormalities. Complicated UTIs occur in patients who have structural and/or functional abnormalities in the urinary tract and may involve kidney or bladder. UTIs are associated with significant disease burden, antimicrobial resistance, and cost especially in the developing countries. Multiple factors affect UTIs and could be linked to increase their prevalence. They can be further categorized into community-acquired risk factors, including gender, age, history of previous urinary infection, sexual activity, pregnant women, diabetes mellitus, immunocompromised state, and socio-economic status; and healthcare-associated risk factors, including indwelling urinary catheters, prolonged hospital stays, and location of healthcare. Management of UTIs depends on several factors, such as severity, complicated or uncomplicated, upper or lower urinary infection, and the setting of bacterial acquisition. Management of UTIs is challenging, especially in the developing countries since the antimicrobial resistance, poor quality of healthcare service, absence of antimicrobial surveillance system, and lack of awareness among general population. Moreover, as a result of COVID-19 outbreak, telehealth has implemented successfully in daily practice in many Middle East countries. However, this practice has many limitations, as some UTIs cases require full examination, and thus telehealth service does not support it. Telehealth may face technical problems, especially in resource-limited countries and that may pose a challenge in UTIs management. Therefore, incorporating the culture and drug susceptibility tests into the daily practice, monitoring of antimicrobial resistance via implementing adequate infection control practice and surveillance system, prohibiting antibiotic dispensing without prescription, and raising public awareness about antibiotics and the consequences of their inappropriate use are recommended to appropriately manage UTIs.