The current study was a comparative study which was carried out on the Maternity Hospital situated in Nasiriyah City. The aim was to compare the effects of various strains of the probiotics in preventing the relapse of UTI in women [12].

1. Participants: All together, participants with female gender only 150 were analyzed in the study. This comprised of a study group of 100 women with history of recurrent UTI and 50 of women who reported no history of UTI (control group).

2. Collection Method: Sample was collected in a sterile container, and it entails the use of urine samples. To minimize contamination, participants was told to provide mid-stream urine sample by washing the genital area.

3. Transportation: Collected samples were taken to the laboratory as soon as possible and analysis was done on them within 2 hours.

1. Culturing: In the screening process, the urine samples were cultured on MacConkey agar and Blood agar to find out the bacterial pathogens. Cultures were then incubated at 37°C for one full day that is 24 hours .

2. Identification: The bacterial isolates were eventually identified by biochemical tests and by using gram stain. The following bacterial species were identified: are other bacteria that causes UTI which include escherichia Coli, staphylococcus saprophyticus, Klebsiella pneumoniae and proteus mirabilis.

3. Antibiotic Sensitivity Testing: Susceptibility pattern of the isolates to antibiotics was determined by the disc diffusion method following the instructions of the CLSI.

Probiotics Used: The subjects were split into four groups:

1. Proprietary blend probiotics, strains include Lactobacillus rhamnosus (1 billion CFU daily)

2. Lactobacillus reuteri (one billion colony forming units a day)

3. Lactobacillus: acidophilus at the dose of 1 billion Colony Forming Units per day.

4. Control (inert substance which has got the appearance of probiotics)

Administration: Probiotics and placebo were consumed orally in the second part of the work for the term of 4 weeks.

Self-constructed instructions for the participants of the experiment included the usage of the given supplement on a daily basis.

Primary Outcome: Implementation of UTI preventative measures and decrease in the UTI recurrence rates within a follow up of 6 months.

Secondary Outcomes: Shifts in the bacteria load as well as their resistance to the commonly used antibiotics.

Descriptive Statistics: In this study, simple arithmetic means and standard deviations were used to describe the bacterial species/strains and patterns of resistance.

Comparative Analysis: The UTRR between the probiotic group and placebo group was compared by the Chi-Square test on two proportions test for nominal data.

Effectiveness Analysis: Logistic regression was used to assess the change in the probability of recurrence of UTI based on the study subjects’ age and their past use of antibiotic drugs.

Significance Level: Thus, p<0.05 was used as the level of significance to determine the statically significant outcomes.

Ethical Considerations

This study followed the ethical consideration in accordance with the ethical standards of research formed by the world medical association declaring of Helsinki. The permission to undertake the study was sought and granted from Ethics Committees of the. Bint Al-Huda Hospital, Nasiriyah City

1. Sample Description

A total of 100 urine samples were collected from women with recurrent urinary tract infections (UTIs) at the Maternity Hospital in Nasiriyah City. Additionally, 50 control samples were collected from uninfected women. The samples were collected using sterile containers, with instructions to collect mid-stream urine after cleansing the area to minimize contamination. Samples were cultured on various media and incubated at 37°C for 24 hours.

2. Bacterial Isolates

The bacterial species isolated from the infected samples are summarized in the table1 below:

To this end, this paper examined the impact of different probiotic straits in the prevention of recurrent UTI in women. These studies showed that, compared to placebo, multiple-strain probiotics and especially Lactobacillus rhamnosus and Lactobacillus reuteri decreased the UTI rates by more than half [14]. On the same note, Lactobacillus acidophilus also demonstrated a similar positive impact but it was relatively lower. These results correlate with other studies regarding the work of probiotics in the recurrent UTI treatment. For example, [15] proved that the possibility of UTI recurrences in women is decreased by the use of probiotics [16]. In the same manner, the probability of Lactobacillus rhamnosus and Lactobacillus reuteri being beneficial was agreed other studies demonstrating the effectivity of these strains in supporting the vaginal microbiome and avoiding infections [17] The reduction witnessed in recurrent UTI in line with use of Lactobacillus rhamnosus and Lactobacillus reuteri supports the prevailing literature on the Lr has also been described to prevent uropathogen’s adhesion to the urinary tract tissue Lr has also been reported to play a role in urogenital health through enhancement of immune functions Lret [18]. Otherwise, compared to the positive microorganisms, Lactobacillus acidophilus was less effective, and it may due to the differences in strain characteristics or the action manner [19]. The example is the reported high level of antibiotic resistance among uropathogens in the present study as well as many other investigations, which indicates the necessity of the search for effective treatment strategies [20]. Research has shown that there is growing resistance to some of the common uropathogens in the world thus making it hard to use the traditional antibiotics to treat such infections [21]. Probiotics seem to be something better in this case as they can minimize the use of antibiotics and consequently the problem of resistance [22]. Thus, considering the findings of our study, some limitations should be mentioned. The amount and nature of the data collected should be noted for those who will consult this work; the sample size, though sufficient, may restrict the generality of the conclusions [23]. Also, the applied dose of placebo might not also provide enough contrast between the control and the test group to establish the efficacy of the probiotic in the long-run because the study incorporated only four weeks [24]. Some limitations of the present authors’ work include the relatively small and self-selected sample and relatively short follow-up period in relation to interventions; longer and larger scale investigations should be conducted in the future [25].