Identification of Risk Factors in Patients with Recurrent Cystitis May Improve Individualized Management

Background/Objectives: Management of acute episodes of lower urinary tract infections (LUTI) depends on whether they are sporadic or recurrent. We aimed to define factors that differentiate patients with acute sporadic cystitis (AC) from those with recurrent cystitis (RC) and thereby improve individualized management. Methods: We performed a post-hoc analysis of data from the prospective, multinational GPIU.COM-Study. Female patients with an acute episode of LUTI completed the Acute Cystitis Symptom Score (ACSS) and underwent routine clinical examination and urine testing (dipstick, culture, susceptibility). Risk factors for recurrence were evaluated using the Lower Urinary Tract Infection Recurrence Risk (LUTIRE) nomogram and the ORENUC classification. AC and RC were compared using a robust stepwise statistical approach. Significant variables were assessed by relative risk (RR), and logistic regression to estimate odds ratios (OR). Results: A total of 106 women were included (AC n=50; RC n=56). Patients with RC more frequently presented with constipation, multiple uropathogens, trace proteinuria, and a severe impact of symptoms on daily activities. Pyuria was inversely associated with RC. Logistic regression identified chronic constipation, severe impact of symptoms on daily activities and multiple uropathogens as independent predictors of RC. Three predictive models showed consistent discrimination, ranging from 0.80 to 0.86. Conclusions: AC and RC showed notable differences in certain symptom profiles, conditions, urinalysis and microbiological findings, with AC patients suggesting stronger innate immunity. Combining high-value predictors from LUTIRE and ORENUC into a comprehensive prognostic algorithm could improve recurrence risk assessment. A refined classification of LUTI with recurrence grading is warranted to guide decision-making and prevention strategies.

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