Is prednisone (corticosteroid) associated with frequent urinary tract infections (UTIs)?

Prednisone and Urinary Tract Infections: Association and Risk

Yes, prednisone is associated with an increased risk of urinary tract infections (UTIs) due to its immunosuppressive effects. This association is particularly evident in patients receiving corticosteroid treatment for conditions like alcoholic hepatitis and other inflammatory diseases 1.

Mechanism of Increased UTI Risk

Prednisone increases UTI susceptibility through several mechanisms:

1. Immunosuppression: Corticosteroids induce defects in lymphocyte signaling and impair immune function 1
2. Altered host defense: Compromises the body's ability to fight bacterial colonization
3. Increased bacterial translocation: May promote bacterial overgrowth and translocation 1

Evidence of Association

The European Association for the Study of the Liver (EASL) guidelines specifically note that:

• Serious infections are more frequent in patients treated with prednisolone 1
• A higher proportion of patients receiving prednisolone develop infections compared to those not given prednisolone (10% vs. 6%) 1
• UTIs account for approximately 32% of baseline infections in patients with conditions like alcoholic hepatitis 1

Risk Factors for Prednisone-Associated UTIs

The risk of developing UTIs while on prednisone therapy is heightened by:

• Female gender: Women have anatomically higher risk of UTIs, exacerbated by immunosuppression
• Duration of therapy: Longer courses increase infection risk
• Dose of prednisone: Higher doses generally correlate with greater immunosuppression
• Underlying conditions: Patients with comorbidities have compounded risk

Clinical Implications and Management

For patients requiring prednisone therapy:

• Monitor for UTI symptoms: Dysuria, frequency, urgency, suprapubic pain
• Screening: Consider periodic urinalysis in high-risk patients on long-term therapy
• Prophylaxis: Not routinely recommended but may be considered in select high-risk patients
• Prompt treatment: Early intervention for suspected UTIs to prevent complications

Special Considerations

1. Alcoholic hepatitis patients: Particularly vulnerable population with 28-day cumulative incidence of infection around 20% when treated with corticosteroids 1

2. Transplant and nephrotic syndrome patients: Require careful monitoring as they often receive higher doses and longer courses of prednisone 1, 2

3. Inflammatory bowel disease patients: Guidelines recommend minimizing corticosteroid exposure before elective surgery to reduce infection risk 1

Prevention Strategies

For patients requiring prednisone therapy who are at high risk for UTIs:

• Use the lowest effective dose of prednisone when possible
• Consider steroid-sparing agents when appropriate 1
• Maintain adequate hydration
• Practice good urinary hygiene
• Consider non-antibiotic preventive measures like cranberry products in recurrent cases 3

While prednisone remains an important therapeutic agent for many inflammatory conditions, clinicians should be aware of the increased UTI risk and implement appropriate monitoring and preventive strategies, especially in high-risk populations.