Urinary Tract Infections

Very few studies regarding production of virulence factors in different predominant serotypes of uropathogenic Pseudomonas aeruginosa are available and they have not been correlated to in vivo pathogenicity in the urinary tract. This study was carriedout with the objective to analyze the phenotypic characters of uroisolates of P. aeruginosa in vitro and to study the association of these virulence traits with their ability to cause nephropathogenicity in mouse model of ascending urinary tract infection (UTI). Protease, elastase, alginate, haemolysin, pyochelin, pyoverdin and phopholipase C were measured using standard protocols in 18 uroisolates of P. aeruginosa isolated from patients suffering from complicated UTIs. An ascending model of pyelonephritis was established in Swiss Webster (LACA) female mice with these isolates. Quantitative bacterial count and histopathological evaluation of mouse renal tissue was done which were then assessed for a possible association with elaboration...

The case of a patient with emphysematous cystitis who presented with complaints of lower abdominal pain, dysuria, and pneumaturia is presented. The presenting symptoms, differential diagnosis, and radiographic and cystoscopic appearances of emphysematous cystitis, a rare complication of lower urinary tract infection occurring almost exclusively in diabetics, are reviewed. Treatment consists of urinary drainage, prompt initiation of antibiotic therapy, and strict glucose control. The prognosis usually is excellent.

Multi-resistant drug bacteria are an emerging health care concern around the world. A decreased resistance to infection as seen in Chronic Kidney Disease (CKD) and kidney transplanted patients as well as some metabolic abnormalities such as hyperglycemia and glycosuria or clinical conditions such as the neurogenic bladder may indeed portend a great risk of recurrent urinary tract infections (UTI). The common and indiscriminate use of antibiotics often provides the patients with only a transient or partial amelioration of the urinary tract discomforts and increases the risk of multi-resistant drug bacteria selection. Thus a great effort is made in order to develop new antibacterial approaches especially in the setting of multi- antibiotic resistant pathogens. We herein report on some promising yet preliminary results of the use of ozone therapy in UTI.

Acupuncture is widely used in both Eastern and Western countries as a complementary or alternative treatment modality for various diseases. Experimental, but also clinical studies have recently provided evidence that it can be effective in treating multiple sclerosis patients, since it seems to improve motor, as well as, sensory disturbances. It is safe and can have a long-lasting effect, even in patients resistant to conventional treatment.

Urinary tract infections are common in elderly patients. Authors of non systematic literature reviews often recommend longer treatment durations (7-14 days) for older patients than for younger women, but the scientific evidence for such recommendations is not clear. To determine the optimal duration of antibiotic treatment for uncomplicated symptomatic lower urinary tract infections in elderly women. We contacted known investigators and pharmaceutical companies marketing antibiotics used to treat urinary tract infections, screened the reference list of identified articles, reviews and books, and searched the following data bases: MEDLINE, EMBASE, CINAHL, Healthstar, Popline, Gerolit, Bioethics Line, The Cochrane Library, Dissertation Abstracts International, Index to Scientific & Technical Proceedings. All randomized controlled trials in which different treatment durations of oral antibiotics for uncomplicated symptomatic lower urinary tract infections in elderly women were compared...

It is difficult to put research findings into clinical practice by either guidelines or prescription feedback. To study the effect on the quality of prescribing by a combined intervention of providing individual feedback and deriving quality criteria using guideline recommendations in peer review groups. 199 general practitioners in 32 groups were randomised to participate in peer review meetings related to either asthma or urinary tract infections. The dispensing by the participating doctors of antiasthmatic drugs and antibiotics during the year before the intervention period provided the basis for prescription feedback. The intervention feedback was designed to describe the treatment given in relation to recommendations in the national guidelines. In each group the doctors agreed on quality criteria for their own treatment of the corresponding diseases based on these recommendations. Comparison of their prescription feedback with their own quality criteria gave each doctor the pro...

Urinary tract infection (UTI) is the most common nosocomial infection among hospitalised patients. Area-specific monitoring studies aimed to gain knowledge about the type of pathogens responsible for UTIs and their resistance patterns may help the clinician to choose the correct empirical treatment. Recent reports have shown increasing resistance to commonly-used antibiotics. We aimed to study the antibiotic resistance pattern of the urinary pathogens isolated from hospitalised patients. Three urine samples were collected by the mid-stream "clean catch" method from 1,680 clinically-suspected cases of urinary tract infections from inpatients of various clinical departments during one year. The samples were tested microbiologically by standard procedures. Antibiotic susceptibility of the isolated pathogens was tested for commonly-used antibiotics by Kirby-Bauer technique according to NCCLS guidelines. Significant bacteriuria was present in 71.7 percent of the samples, 17 per...

The objective was to assess the possibility of measuring urine creatinine (UCr)-adjusted urinary cell-free (ucf) DNA concentration as a noninvasive screening tool for bladder cancer. Using PicoGreen-based detection, the ucf-DNA/UCr concentration was quantified in urine supernatant specimens from 46 bladder cancer patients and 98 controls and compared to 400-bp real-time PCR-based detection, which detected the amplification of 400-bp beta-actin (named 400-bp ucf-DNA/UCr). The mean concentrations for both PicoGreen and 400-bp ucf-DNA (ng/mL)/UCr (mg/dL) were significantly higher in bladder cancer patients than in controls: 15.28 vs 6.68 (p<0.001, t-test) and 14.98 vs 1.07 (p<0.001), respectively. Among different stages and grades, no significant difference was found between these two methods. The areas under the ROC curves of PicoGreen and 400-bp ucf-DNA/UCr were 0.571 (95% confidence interval, 0.451-0.692) and 0.805 (95% confidence interval, 0.713-0.896), respectively. In 400-b...

SUMMARY Over the last few years, dramatic increases in our knowledge about diffusely adhering Escherichia coli (DAEC) pathogenesis have taken place. The typical class of DAEC includes E. coli strains harboring AfaE-I, AfaE-II, AfaE-III, AfaE-V, Dr, Dr-II, F1845, and NFA-I adhesins (Afa/Dr DAEC); these strains (i) have an identical genetic organization and (ii) allow binding to human decay-accelerating factor (DAF) (Afa/Dr DAF subclass) or carcinoembryonic antigen (CEA) (Afa/Dr CEA subclass). The atypical class of DAEC includes two subclasses of strains; the atypical subclass 1 includes E. coli strains that express AfaE-VII, AfaE-VIII, AAF-I, AAF-II, and AAF-III adhesins, which (i) have an identical genetic organization and (ii) do not bind to human DAF, and the atypical subclass 2 includes E. coli strains that harbor Afa/Dr adhesins or others adhesins promoting diffuse adhesion, together with pathogenicity islands such as the LEE pathogenicity island (DA-EPEC). In this review, the f...

The primary objective is to evaluate the microbial efficacy and biofilm destruction potency of Siddha polyherbal formulation “Sagadevinei’’ and secondary objective is to correlate the ingredients with Siddha principles such as Suvai (Taste) and Panchabootha thathuvam (five elements theory). The In vitro microbial activity of Sagadevinei (SDN) has been carried out through Agar well diffusion method and evaluated the Escherichia coli biofilm destruction potency, by growing of Escherichia coli to form biofilm in coverslip. The coverslip insisted with biofilm were stained by Acridine Orange (AO Staining), and the potency has observed under fluorescent microscope. The result shows significant microbial activity in five common microorganisms and the drug revealed marked potency against E. coli strain. Further bio-film destruction potency of the test drug was also carried out and discussed. There is a huge need for a drug from herbal origin to tackle the situation of a post antibiotic era....

O estudo tem como objetivo analisar pesquisas sobre as infecções hospitalares neonatais prevalentes em unidades de terapia intensiva. Trata-se de uma revisão integrativa da literatura realizada nas bases de dados Medline e ScienceDirect. Foram selecionados 20 artigos que atenderam aos critérios de inclusão da pesquisa: estudos primários, disponíveis na integra de forma eletrônica e publicados no período de 2011 a 2015. Os dados foram processados no software IRAMUTEC e analisados pela
classificação hierárquica descendente, análise de similitude e nuvem de palavras. Os resultados foram apresentados em 04 classes, a saber: 1-O Staphylococcus aureus resistente a meticilina em infecções na Unidade de Terapia Intensiva Neonatal - UTIN; 2- Vigilância
aos casos de infecção em UTIN; 3- Distribuição topográfica das infecções neonatais em UTI; 4- Fatores de risco para
desenvolvimento de infecções em UTIN e 5- Medidas de Prevenção e controle de infecções neonatais em UTI. A prevalência de
infecção em unidade de terapia intensiva é elevada e possui relação com fatores intrínsecos ao neonato, bem como ao ambiente hospitalar. Concluiu-se que há necessidade da adoção de uma política efetiva de prevenção e controle das infecções hospitalares para diminuir os índices de infecções neonatais em unidades de terapia intensiva. Descritores: Unidade de terapia intensiva. Infecção hospitalar. Fatores de risco. Neonatal.

These guidelines refer to diagnosis, antimicrobial treatment and prophylaxis of urinary tract infections in adults and children older than 12 years of age and cover lower urinary tract in females, uncomplicated pyelonephritis, complicated UTI with or without pyelonephritis, asymptomatic bacteriuria and recurrent UTI. These guidelines do not cover sexually transmitted diseases. The guidelines are primarily intended for use by general practitioners and specialists working in primary health care and hospitals. The members of the Working Group for the development of guidelines on antimicrobial treatment and prophylaxis of urinary tract infections were appointed by the Croatian Ministry of Health and Social Welfare. The project was financially supported by the Dutch government and professional assistance was provided by international consultants. The evidence for this guidelines is based on a systematic review of the literature, local antibiotic resistance data, the existing clinical pro...

The goal of the North American Urinary Tract Infection Collaborative Alliance (NAUTICA) study was to determine antibiotic susceptibility to commonly used agents for urinary tract infections against outpatient urinary isolates obtained in various geographic regions in the USA and Canada. Forty-one medical centres (30 from the USA and 11 from Canada) participated, with each centre submitting up to 50 consecutive outpatient midstream urine isolates. Isolates were identified to species level by the standard protocol of each laboratory. Susceptibility testing was determined using the National Committee for Clinical Laboratory Standards (NCCLS) microdilution method. Resistance breakpoints used were those published by the NCCLS, including: ampicillin (resistant ≥32 μg/mL), sulphamethoxazole/trimethoprim (SMX/TMP) (resistant ≥4 μg/mL), nitrofurantoin (resistant ≥128 μg/mL), ciprofloxacin (resistant ≥4 μg/mL) and levofloxacin (resistant ≥8 μg/mL). Of the 1990 isolates collected, 75.1% (1494) were collected from the USA and 24.9% (496) were collected from Canada. The mean age of the patients was 48.3 years (range 1 month to 99 years), and 79.5% and 20.5% of isolates were obtained from women and men, respectively. The most common organisms were Escherichia coli (57.5%), Klebsiella pneumoniae (12.4%), Enterococcus spp. (6.6%), Proteus mirabilis (5.4%), Pseudomonas aeruginosa (2.9%), Citrobacter spp. (2.7%), Staphylococcus aureus (2.2%), Enterobacter cloacae (1.9%), coagulase-negative staphylococci (1.3%), Staphylococcus saprophyticus (1.2%), Klebsiella spp. (1.2%), Enterobacter aerogenes (1.1%) and Streptococcus agalactiae (1.0%). Among all 1990 isolates, 45.9% were resistant to ampicillin, 20.4% to SMX/TMP, 14.3% to nitrofurantoin, 9.7% to ciprofloxacin and 8.1% to levofloxacin. Fluoroquinolone resistance was highest in patients ≥65 years of age. For the 1142 E. coli isolates, resistance rates were: ampicillin 37.7%, SMX/TMP 21.3%, ciprofloxacin 5.5%, levofloxacin 5.1% and nitrofurantoin 1.1%. For all 1990 isolates and for the 1142 E. coli only, resistance rates were significantly higher in US compared with Canadian medical centres. This study reports higher rates of antibiotic resistance in US versus Canadian outpatient urinary isolates and demonstrates the continuing evolution of resistance to antimicrobial agents.

Background: Catheter-associated urinary tract infection (CAUTI) remains a critical threat for patients in intensive care unit (ICU). For prophylaxis, systemic antibiotics are used. It will be helpful to avoid systemic side effects by introducing antibiotics locally through bladder irrigation. Aim of the Work: This study aimed to identify the microorganisms causing CAUTI in ICU patients and determine their resistance patterns with and without practicing a prophylactic bladder irrigation using antibiotic solution. Subjects and Methods: A total of 100 patients admitted to ICU in Tanta University Hospitals were included. After catheterization, patients were divided into: control group (n = 50) who did not receive any bladder wash and test group (n= 50) who received amikacin sulfate bladder wash. Urine samples were collected at certain days and sent for culture and sensitivity. Results: Although the incidence of CAUTI was 30% in the non-irrigated group and 12% in the irrigated one, the difference between both groups was not significant (P-value = 0.499). However, most isolates showed resistance reduction against almost all antibiotics after bladder irrigation. Conclusion: Amikacin sulphate bladder wash reduced CAUTI incidence in ICU patients but to a non-significant level. The more frequent irrigations and more antibiotic concentration could provide a more significant effect.

Background: It has been suggested that diseases that promote isosthenuria predispose to urinary tract infections because of a lack of the common bacteriostatic properties present in concentrated urine.Objectives: The purpose of this study was to assess the clinicopathologic risk factors for positive urine culture outcome in cats with chronic kidney disease (CKD), diabetes mellitus (DM), uncontrolled hyperthyroidism (HT), or lower urinary tract disease (LUTD).Methods: For this retrospective study, medical records of all cats in which a urinalysis and aerobic bacterial urine culture were performed between January 1995 and December 2002 were reviewed. Signalment, body weight, and clinicopathologic data were recorded. Based on the medical records, cats were diagnosed with CKD, DM, HT, or LUTD. Prevalence odds ratios and 95% confidence intervals were calculated using logistic regression. Multivariate models were created for each variable of interest while controlling for the confounding effect of disease group.Results: Six hundred fourteen cats met the criteria for inclusion in the study. Overall, positive urine cultures were identified in 16.9% of cats with CKD, 13.2% of cats with DM, 21.7% of cats with HT, and 4.9% of cats with clinical signs of LUTD. Decreasing urine specific gravity was not associated with positive urine culture when controlled for disease but pyuria, bacteriuria, and hematuria were all associated with positive urine culture outcome. Persians, females, increasing age, and decreasing body weight were all associated with positive urine culture outcome.Conclusions: Performing a urine culture sample based solely on the presence of isosthenuria does not seem warranted. Further studies are warranted to help identify host predisposing factors for urinary bacterial colonization in cats with these diseases.

To determine by retrospective review of 315 percutaneous nephrostomies, performed for pyonephrosis, whether this intervention has major clinical advantages. From 1977 to 1996, under the direct supervision of the senior author of this report (E.K.L.), at seven hospital sites, 315 patients (181 males, 134 females; 17 to 88 years of age) were treated with percutaneous nephrostomy and antibiotic therapy for infected hydronephrosis. Additional or disparate pathogens were identified in 116 (36.8%) of 315 patients, leading to a clinically significant change in, or addition of, antibiotics and/or antifungal agents in 84 (73%) of 116. Most notably, we often found a clinically important disparity between the results of cultures obtained from the nephrostomy and those obtained from bladder-urine specimens. This retrospective review confirms previously reported advantages of percutaneous upper urinary tract drainage as a potentially life-saving adjunct in the treatment of pyonephrosis. Several case studies highlight the advantage of this maneuver in difficult cases involving obstruction due to extensive fungus or debris. In particular, our review focuses attention on the clinically important insight that urine cultures from percutaneous nephrostomy drainage often identify pathogens that differ from those detected in concurrent bladder cultures.

It is difficult to put research findings into clinical practice by either guidelines or prescription feedback. To study the effect on the quality of prescribing by a combined intervention of providing individual feedback and deriving quality criteria using guideline recommendations in peer review groups. 199 general practitioners in 32 groups were randomised to participate in peer review meetings related to either asthma or urinary tract infections. The dispensing by the participating doctors of antiasthmatic drugs and antibiotics during the year before the intervention period provided the basis for prescription feedback. The intervention feedback was designed to describe the treatment given in relation to recommendations in the national guidelines. In each group the doctors agreed on quality criteria for their own treatment of the corresponding diseases based on these recommendations. Comparison of their prescription feedback with their own quality criteria gave each doctor the pro...

Page 1. 6 Renal Disease and Pregnancy Marius Craina, Elena Bernad, Răzvan Niţu, Paul Stanciu, Cosmin Cîtu, Zoran Popa, Corina Şerban and Rodica Mihăescu University of Medicine and Pharmacy “Victor Babeş” Timişoara Romania 1. Introduction ...