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Omic H, Eder M. Effect of increasing age and ureteral stent implantation on urinary tract infections after kidney transplantation - update of recent literature. Curr Opin Urol 2024; 34:146-153. [PMID: 38426237 PMCID: PMC10990026 DOI: 10.1097/mou.0000000000001163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
PURPOSE OF REVIEW This review aims to present the recent literature regarding effects of aging and ureteral stent implantation (UrS) on the risk of urinary tract infections (UTIs) in kidney transplant (KTX) recipients. RECENT FINDINGS UTIs in kidney transplant recipients remain a clinical challenge and represent a leading cause of morbidity, hospitalization rates, and mortality. Higher age was described as a significant risk factor for UTIs in several studies including a recent Brazilian analysis, indicating a 3.6%/years of age increase in UTI risk. Subsequently, a large meta-analysis, published in 2023, confirmed the correlation between older age and elevated UTI risk. The Swiss Transplant Cohort Study in 2022, largest of its kind, similarly confirmed a link between advanced age and heightened risk of recurrent UTIs in KTX. A recent prospective study highlighted UrS placement as a modifiable risk factor, emphasizing the need for careful consideration and antibiotic prophylaxis. Additionally, the type of stents played a crucial role, with external stents associated with a 1.69 times higher UTI risk. The challenge of determining optimal UrS removal timing further complicates posttransplant care, with insufficient evidence to guide practices. SUMMARY The aging population of KTX recipients requires a personalized approach to effectively reduce and manage UTIs as one of the most important complications following KTX. Prophylactic stent implantation is successful in lowering ureteral complications, however, is associated with an increased incidence of UTIs. To reduce the increased risk of UTIs, the length of stent insertion requires strict supervision and maintenance.
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Affiliation(s)
- Haris Omic
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
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Ebrahimzadeh T, Basu U, Lutz KC, Gadhvi J, Komarovsky JV, Li Q, Zimmern PE, De Nisco NJ. Inflammatory markers for improved recurrent UTI diagnosis in postmenopausal women. Life Sci Alliance 2024; 7:e202302323. [PMID: 38331474 PMCID: PMC10853434 DOI: 10.26508/lsa.202302323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/10/2024] Open
Abstract
Recurrent urinary tract infection (rUTI) severely impacts postmenopausal women. The lack of rapid and accurate diagnostic tools is a major obstacle in rUTI management as current gold standard methods have >24-h diagnostic windows. Work in animal models and limited human cohorts have identified robust inflammatory responses activated during UTI. Consequently, urinary inflammatory cytokines secreted during UTI may function as diagnostic biomarkers. This study aimed to identify urinary cytokines that could accurately diagnose UTI in a controlled cohort of postmenopausal women. Women passing study exclusion criteria were classified into no UTI and active rUTI groups, and urinary cytokine levels were measured by immunoassay. Pro-inflammatory cytokines IL-8, IL-18, IL-1β, and monocyte chemoattractant protein-1 were significantly elevated in the active rUTI group, and anti-inflammatory cytokines IL-13 and IL-4 were elevated in women without UTI. We evaluated cytokine diagnostic performance and found that an IL-8, prostaglandin E2, and IL-13 multivariable model had the lowest misclassification rate and highest sensitivity. Our data identify urinary IL-8, prostaglandin E2, and IL-13 as candidate biomarkers that may be useful in the development of immunoassay-based UTI diagnostics.
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Affiliation(s)
- Tahmineh Ebrahimzadeh
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Ujjaini Basu
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Kevin C Lutz
- https://ror.org/049emcs32 Department of Mathematics, University of Texas at Dallas, Dallas, TX, USA
| | - Jashkaran Gadhvi
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Jessica V Komarovsky
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
| | - Qiwei Li
- https://ror.org/049emcs32 Department of Mathematics, University of Texas at Dallas, Dallas, TX, USA
| | - Philippe E Zimmern
- https://ror.org/05byvp690 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Nicole J De Nisco
- https://ror.org/049emcs32 Department of Biological Sciences, University of Texas at Dallas, Dallas, TX, USA
- https://ror.org/05byvp690 Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Isali I, Wong TR, Batur AF, Wu CHW, Schumacher FR, Pope R, Hijaz A, Sheyn D. Recurrent urinary tract infection genetic risk: a systematic review and gene network analysis. Int Urogynecol J 2024; 35:259-271. [PMID: 37917182 DOI: 10.1007/s00192-023-05671-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 10/11/2023] [Indexed: 11/04/2023]
Abstract
INTRODUCTION AND HYPOTHESIS The development of recurrent urinary tract infections (rUTIs) is not completely understood. This review is aimed at investigating the connection between genetics and rUTIs and summarizing the results of studies that have documented variations in gene expression among individuals with rUTIs compared with healthy individuals. METHODS A systematic search was conducted in Cochrane, Ovid, and PubMed, limiting the results to articles published between 1 January 2000, and 5 July 2022. Only studies comparing the difference in gene expression between individuals with rUTI and healthy individuals utilizing molecular techniques to measure gene expression in blood or urine samples were included in this systematic review. Gene network and pathways analyses were performed using Cytoscape software, with input data obtained from our systematic review of differentially expressed genes in rUTIs. RESULTS Six studies met our criteria for inclusion. The selected studies used molecular biology methods to quantify gene expression data from blood specimens. The analysis revealed that gene expressions of CXCR1 and TLR4 decreased, whereas CXCR2, TRIF, and SIGIRR increased in patients with rUTI compared with healthy controls. The analysis demonstrated that the most significant pathways were associated with TLR receptor signaling and tolerance, I-kappa B kinase/NF-kappa B signaling, and MyD88-independent TLR signaling. CONCLUSIONS This systematic review uncovered gene expression variations in several candidate genes and identified a number of underlying biological pathways associated with rUTIs. These findings could shift the treatment and prevention strategies for rUTIs.
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Affiliation(s)
- Ilaha Isali
- Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Thomas R Wong
- Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Ali Furkan Batur
- Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Chen-Han Wilfred Wu
- Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
- Department of Genetics and Genome Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Fredrick R Schumacher
- Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
- Department of Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, OH, USA
| | - Rachel Pope
- Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - Adonis Hijaz
- Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA
| | - David Sheyn
- Department of Urology, University Hospitals, Cleveland Medical Center, Cleveland, OH, USA.
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Akhlaghpour M, Haley E, Parnell L, Luke N, Mathur M, Festa RA, Percaccio M, Magallon J, Remedios-Chan M, Rosas A, Wang J, Jiang Y, Anderson L, Baunoch D. Urine biomarkers individually and as a consensus model show high sensitivity and specificity for detecting UTIs. BMC Infect Dis 2024; 24:153. [PMID: 38297221 PMCID: PMC10829179 DOI: 10.1186/s12879-024-09044-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/22/2024] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Current diagnoses of urinary tract infection (UTI) by standard urine culture (SUC) has significant limitations in sensitivity, especially for fastidious organisms, and the ability to identify organisms in polymicrobial infections. The significant rate of both SUC "negative" or "mixed flora/contamination" results in UTI cases and the high prevalence of asymptomatic bacteriuria indicate the need for an accurate diagnostic test to help identify true UTI cases. This study aimed to determine if infection-associated urinary biomarkers can differentiate definitive UTI cases from non-UTI controls. METHODS Midstream clean-catch voided urine samples were collected from asymptomatic volunteers and symptomatic subjects ≥ 60 years old diagnosed with a UTI in a urology specialty setting. Microbial identification and density were assessed using a multiplex PCR/pooled antibiotic susceptibility test (M-PCR/P-AST) and SUC. Three biomarkers [neutrophil gelatinase-associated lipocalin (NGAL), and Interleukins 8 and 1β (IL-8, and IL-1β)] were also measured via enzyme-linked immunosorbent assay (ELISA). Definitive UTI cases were defined as symptomatic subjects with a UTI diagnosis and positive microorganism detection by SUC and M-PCR, while definitive non-UTI cases were defined as asymptomatic volunteers. RESULTS We observed a strong positive correlation (R2 > 0.90; p < 0.0001) between microbial density and the biomarkers NGAL, IL-8, and IL-1β for symptomatic subjects. Biomarker consensus criteria of two or more positive biomarkers had sensitivity 84.0%, specificity 91.2%, positive predictive value 93.7%, negative predictive value 78.8%, accuracy 86.9%, positive likelihood ratio of 9.58, and negative likelihood ratio of 0.17 in differentiating definitive UTI from non-UTI cases, regardless of non-zero microbial density. NGAL, IL-8, and IL-1β showed a significant elevation in symptomatic cases with positive microbe identification compared to asymptomatic cases with or without microbe identification. Biomarker consensus exhibited high accuracy in distinguishing UTI from non-UTI cases. CONCLUSION We demonstrated that positive infection-associated urinary biomarkers NGAL, IL-8, and IL-1β, in symptomatic subjects with positive SUC and/or M-PCR results was associated with definitive UTI cases. A consensus criterion with ≥ 2 of the biomarkers meeting the positivity thresholds showed a good balance of sensitivity (84.0%), specificity (91.2%), and accuracy (86.9%). Therefore, this biomarker consensus is an excellent supportive diagnostic tool for resolving the presence of active UTI, particularly if SUC and M-PCR results disagree.
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Affiliation(s)
- Marzieh Akhlaghpour
- Department of Research and Development, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA
| | - Emery Haley
- Department of Clinical Research, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA
| | - Laura Parnell
- Department of Scientific Writing, Precision Consulting, 6522 Harbor Mist, Missouri City, TX, 77459, USA
| | - Natalie Luke
- Department of Clinical Research, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA
| | - Mohit Mathur
- Department of Medical Affairs, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA
| | - Richard A Festa
- Department of Research and Development, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA
| | - Michael Percaccio
- Department of Research and Development, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA
| | - Jesus Magallon
- Department of Research and Development, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA
| | - Mariana Remedios-Chan
- Department of Research and Development, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA
| | - Alain Rosas
- Department of Research and Development, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA
| | - Jimin Wang
- Department of Statistical Analysis, Stat4Ward, 2 Edgemoor Lane, Pittsburgh, PA, 15238, USA
| | - Yan Jiang
- Department of Statistical Analysis, Stat4Ward, 2 Edgemoor Lane, Pittsburgh, PA, 15238, USA
| | - Lori Anderson
- Department of Writing, L. Anderson Diagnostic Market Access Consulting, 2755 Eagle Street, San Diego, CA, 92103, USA
| | - David Baunoch
- Department of Research and Development, Pathnostics, 15545 Sand Canyon Suite 100, Irvine, CA, 92618, USA.
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Dickson K, Zhou J, Lehmann C. Lower Urinary Tract Inflammation and Infection: Key Microbiological and Immunological Aspects. J Clin Med 2024; 13:315. [PMID: 38256450 PMCID: PMC10816374 DOI: 10.3390/jcm13020315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 12/13/2023] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
The urinary system, primarily responsible for the filtration of blood and waste, is affected by several infectious and inflammatory conditions. Focusing on the lower tract, this review outlines the physiological and immune landscape of the urethra and bladder, addressing key immunological and microbiological aspects of important infectious/inflammatory conditions. The conditions addressed include urethritis, interstitial cystitis/bladder pain syndrome, urinary tract infections, and urosepsis. Key aspects of each condition are addressed, including epidemiology, pathophysiology, and clinical considerations. Finally, therapeutic options are outlined, highlighting gaps in the knowledge and novel therapeutic approaches.
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Affiliation(s)
- Kayle Dickson
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Juan Zhou
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
| | - Christian Lehmann
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Anesthesiology, Pain Management and Perioperative Medicine, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Pharmacology, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Physiology and Biophysics, Dalhousie University, Halifax, NS B3H 4R2, Canada
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Tarek A, Abdalla S, Dokmak NA, Ahmed AA, El-Mahdy TS, Safwat NA. Bacterial Diversity and Antibiotic Resistance Patterns of Community-Acquired Urinary Tract Infections in Mega Size Clinical Samples of Egyptian Patients: A Cross-Sectional Study. Cureus 2024; 16:e51838. [PMID: 38327928 PMCID: PMC10849261 DOI: 10.7759/cureus.51838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/07/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Community-acquired urinary tract infection (UTI) is one of the most common infectious diseases nowadays. Alarming increased levels of antimicrobial resistance are developing globally which limit treatment options and may lead to life-threatening problems. AIM Our study aimed to collect surveillance data on non-hospitalized Egyptian UTI cases and to develop strategies against multidrug-resistant pathogens (MDR). According to our knowledge, this is the first study to screen this high number (15,252 urine samples) in a short period (three months), providing valuable data on resistance profiles in non-hospitalized Egyptian UTI patients. METHODS A total of 15,252 urine samples were collected from different patients. Positive cultures were identified using a semi-quantitative method. Kirby-Bauer's disc diffusion method was used for antibiotic susceptibility testing, the double disc diffusion method was used for extended-spectrum beta-lactamases-producing strains, and the Chi-square test was used for statistical data processing. RESULTS The results showed 61% positive cultures, females accounted for 67.5%. Infants and elderly patients showed the highest positive cultures (74.4% and 69.2%, respectively). Despite Escherichia coli being the most common uropathogen (47.19%), Klebsiella species(24.42%) were the most MDR and extended-spectrum β-lactamase (ESBL)-producing organisms. E. coli and Klebsiella spp. displayed increased resistance to cephalosporins (75% and 81%, respectively). In contrast, both organisms displayed high sensitivity to carbapenems. Unlike Klebsiella spp., E. coli was highly sensitive (92%) to first-line treatment (nitrofurantoin) for UTI. Moreover, trimethoprim/sulfamethoxazole showed higher sensitivity rates compared to other nations. CONCLUSION Despite Escherichia coli being the most often identified bacteria in our isolates Klebsiella spp. displayed higher resistance to the majority of tested antibiotics. Fortunately, trimethoprim/sulfamethoxazole significantly increased sensitivity, especially against E. coli. However, both species showed high rates of cephalosporin resistance. Moreover, It is important to promote Egypt's national action plan for antimicrobial resistance in collaboration with the World Health Organization, especially in the community to minimize the chance of bacterial resistance in the Egyptian community.
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Affiliation(s)
- Amr Tarek
- Microbiology and Immunology, Modern University for Technology and Information (MTI), Cairo, EGY
| | - Salah Abdalla
- Microbiology and Immunology, Suez-Canal University, Ismailia, EGY
| | - Nehal A Dokmak
- Microbiology and Immunology, Modern University for Technology and Information (MTI), Cairo, EGY
| | - Ali A Ahmed
- Microbiology and Immunology, Suez-Canal University, Ismailia, EGY
| | - Taghrid S El-Mahdy
- Microbiology and Immunology, Helwan University, Cairo, EGY
- Microbiology and Immunology, Modern University for Technology and Information (MTI), Cairo, EGY
| | - Nesreen A Safwat
- Microbiology and Immunology, Modern University for Technology and Information (MTI), Cairo, EGY
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7
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Colceriu MC, Aldea PL, Boț (Răchişan) AL, Bulată B, Delean D, Grama A, Mititelu A, Decea RM, Sevastre-Berghian A, Clichici S, Pop TL, Mocan T. The Utility of Noninvasive Urinary Biomarkers for the Evaluation of Vesicoureteral Reflux in Children. Int J Mol Sci 2023; 24:17579. [PMID: 38139407 PMCID: PMC10743802 DOI: 10.3390/ijms242417579] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 12/10/2023] [Accepted: 12/15/2023] [Indexed: 12/24/2023] Open
Abstract
Vesicoureteral reflux (VUR) is one of the most important disorders encountered in pediatric nephrology due to its frequency and potential evolution to chronic kidney disease (CKD). The aim of our study was to identify noninvasive and easy-to-determine urinary markers to facilitate the diagnosis and staging of VUR. We performed a cross-section study including 39 patients with VUR followed over three years (August 2021-September 2023) and 39 children without urinary disorder (the control group). We measured the urinary concentration of interleukin-6 (IL-6), cathelicidin (LL-37), and neutrophil gelatinase-associated lipocalin (NGAL) in VUR and healthy controls. Moreover, we analyzed the correlation between these biomarkers and the presence of renal scars (RS), reflux nephropathy (RN), and CKD. The NGAL concentrations were significantly higher in patients with VUR than in the controls (p = 0.02). Regarding the severity of the reflux, NGAL/creatinine and LL-37/creatinine were positively correlated with severe reflux (p = 0.04, respectively, p = 0.02). In patients with VUR and RS, LL-37/creatinine was significantly lower (p = 0.01). LL-37/creatinine with an AUC of 0.71 and NGAL/creatinine with an AUC of 0.72 could be acceptable diagnostic tests for severe VUR. In conclusion, urinary IL-6, NGAL, and LL-37 could serve as valuable markers for diagnosing and predicting outcomes in patients with VUR and RN.
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Affiliation(s)
- Marius-Cosmin Colceriu
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
| | - Paul Luchian Aldea
- Discipline of Public Health and Management, Department of Community Medicine, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania;
| | - Andreea-Liana Boț (Răchişan)
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (B.B.)
| | - Bogdan Bulată
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (B.B.)
| | - Dan Delean
- Pediatric Nephrology, Dialysis and Toxicology Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania; (B.B.)
| | - Alina Grama
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
- Second Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Alexandra Mititelu
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
| | - Roxana Maria Decea
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
| | - Alexandra Sevastre-Berghian
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
| | - Simona Clichici
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
| | - Tudor Lucian Pop
- Second Pediatric Discipline, Department of Mother and Child, “Iuliu Haţieganu” University of Medicine and Pharmacy, 400177 Cluj-Napoca, Romania (A.G.); (A.M.); (T.L.P.)
- Second Pediatric Clinic, Emergency Clinical Hospital for Children, 400177 Cluj-Napoca, Romania
| | - Teodora Mocan
- Discipline of Physiology, Department of Functional Biosciences, “Iuliu Hațieganu” University of Medicine and Pharmacy, 400006 Cluj-Napoca, Romania; (R.M.D.); (A.S.-B.); (S.C.); (T.M.)
- Nanomedicine Department, Regional Institute of Gastroenterology and Hepatology, 400158 Cluj-Napoca, Romania
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Chen YC, Lee WC, Chuang YC. Emerging Non-Antibiotic Options Targeting Uropathogenic Mechanisms for Recurrent Uncomplicated Urinary Tract Infection. Int J Mol Sci 2023; 24:ijms24087055. [PMID: 37108218 PMCID: PMC10138837 DOI: 10.3390/ijms24087055] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2023] [Revised: 04/06/2023] [Accepted: 04/09/2023] [Indexed: 04/29/2023] Open
Abstract
Urinary tract infections (UTIs) are the most frequent bacterial infections in the clinical setting. Even without underlying anatomic or functional abnormalities, more than 40% of women experience at least one UTI in their lifetime, of which 30% develop recurrent UTIs (rUTIs) within 6 months. Conventional management with antibiotics for rUTIs may eventually lead to the development of multidrug-resistant uropathogens. Targeting of the pathogenicity of rUTIs, the evolution of uropathogenic Escherichia coli (UPEC), and inadequate host defenses by immune responses should be explored to provide non-antibiotic solutions for the management of rUTIs. The adaptive evolution of UPEC has been observed in several aspects, including colonization, attachment, invasion, and intracellular replication to invade the urothelium and survive intracellularly. Focusing on the antivirulence of UPEC and modulating the immunity of susceptible persons, researchers have provided potential alternative solutions in four categories: antiadhesive treatments (i.e., cranberries and D-mannose), immunomodulation therapies, vaccines, and prophylaxis with topical estrogen therapy and probiotics (e.g., Lactobacillus species). Combination therapies targeting multiple pathogenic mechanisms are expected to be a future trend in UTI management, although some of these treatment options have not been well established in terms of their long-term efficacy. Additional clinical trials are warranted to validate the therapeutic efficacy and durability of these techniques.
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Affiliation(s)
- Yu-Chen Chen
- Graduate Institute of Clinical Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Department of Urology, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
- Regenerative Medicine and Cell Therapy Research Center, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - Wei-Chia Lee
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
| | - Yao-Chi Chuang
- Division of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung 833, Taiwan
- Center for Shock Wave Medicine and Tissue Engineering, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833, Taiwan
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Kao CY, Zhang YZ, Yang DC, Chen PK, Teng CH, Lin WH, Wang MC. Characterization of host and escherichia coli strains causing recurrent urinary tract infections based on molecular typing. BMC Microbiol 2023; 23:90. [PMID: 36997841 PMCID: PMC10061793 DOI: 10.1186/s12866-023-02820-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 03/11/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Escherichia coli is the leading pathogen responsible for urinary tract infection (UTI) and recurrent UTI (RUTI). Few studies have dealt with the characterization of host and bacteria in RUTI caused by E. coli with genetically identical or different strains. This study aimed to investigate the host and bacterial characteristics of E. coli RUTI based on molecular typing. RESULTS Patients aged 20 years or above who presented with symptoms of UTI in emergency department or outpatient clinics between August 2009 and December 2010 were enrolled. RUTI was defined as patients had 2 or more infections in 6 months or 3 or more in 12 months during the study period. Host factors (including age, gender, anatomical/functional defect, and immune dysfunction) and bacterial factors (including phylogenicity, virulence genes, and antimicrobial resistance) were included for analysis. There were 41 patients (41%) with 91 episodes of E. coli RUTI with highly related PFGE (HRPFGE) pattern (pattern similarity > 85%) and 58 (59%) patients with 137 episodes of E. coli RUTI with different molecular typing (DMT) pattern, respectively. There was a higher prevalence of phylogenetic group B2 and neuA and usp genes in HRPFGE group if the first episode of RUTI caused by HRPFGE E. coli strains and all episodes of RUTI caused by DMT E. coli strains were included for comparison. The uropathogenic E. coli (UPEC) strains in RUTI were more virulent in female gender, age < 20 years, neither anatomical/ functional defect nor immune dysfunction, and phylogenetic group B2. There were correlations among prior antibiotic therapy within 3 months and subsequent antimicrobial resistance in HRPFGE E. coli RUTI. The use of fluoroquinolones was more likely associated with subsequent antimicrobial resistance in most types of antibiotics. CONCLUSIONS This study demonstrated that the uropathogens in RUTI were more virulent in genetically highly-related E. coli strains. Higher bacterial virulence in young age group (< 20 years) and patients with neither anatomical/functional defect nor immune dysfunction suggests that virulent UPEC strains are needed for the development of RUTI in healthy populations. Prior antibiotic therapy, especially the fluoroquinolones, within 3 months could induce subsequent antimicrobial resistance in genetically highly-related E. coli RUTI.
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Affiliation(s)
- Cheng-Yen Kao
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Zheng Zhang
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Deng-Chi Yang
- Department of Geriatrics and Gerontology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Pek Kee Chen
- Institute of Microbiology and Immunology, College of Life Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Ching-Hao Teng
- Institute of Molecular Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Institute of Basic Medical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Center of Infectious Disease and Signaling Research, National Cheng Kung University, Tainan, Taiwan
| | - Wei-Hung Lin
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ming-Cheng Wang
- Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.1, University Road, Tainan City, 701, Taiwan.
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Dicu-Andreescu I, Penescu MN, Căpușă C, Verzan C. Chronic Kidney Disease, Urinary Tract Infections and Antibiotic Nephrotoxicity: Are There Any Relationships? MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010049. [PMID: 36676673 PMCID: PMC9862113 DOI: 10.3390/medicina59010049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/28/2022]
Abstract
Chronic kidney disease (CKD) has been a constant burden worldwide, with a prevalence of more than 10% of the population and with mortality reaching 1.2 million deaths and 35.8 million disability-adjusted life years (DALYs) in 2017, as it is claimed by the Global Burden of Diseases. Moreover, an increase in its prevalence is expected in the next years due to a rise in the number of people suffering from obesity, diabetes mellitus and hypertension. On the other hand, with cardiovascular morbidity and mortality showing a downward trend, maybe it is time to focus on CKD, to minimize the preventable risk factors involved in its progression toward end-stage kidney disease (ESKD) and to offer a better quality of life. Another major health burden is represented by infectious diseases, particularly urinary tract infections (UTIs), as it is considered that approximately 40-50% of women and 5% of men will have at least one episode during their lifetime. Additionally, CKD consists of a constellation of immunological and metabolical disturbances that lead to a greater risk of UTIs: increased apoptosis of lymphocytes, elevated levels of tumor necrosis factor α and interleukin 6, which lower the function of neutrophils and increased levels of uremic toxins like p-cresyl sulfate and indoxyl sulfate, which alter the adherence and migration of leukocytes to the sites of injury. Moreover, UTIs can lead to a more rapid decline of kidney function, especially in stages G3-G5 of CKD, with all the complications involved. Last, but not least, antibiotherapy is often complicated in this category of patients, as antibiotics can also negatively affect the kidneys. This review will try to focus on the particularities of the urinary microbiome, asymptomatic bacteriuria and UTIs and the subtle balance between the risks of them and the risks of antibiotherapy in the evolution of CKD.
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Affiliation(s)
- Ioana Dicu-Andreescu
- Clinical Department No 3, Internal Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Dr. Carol Davila” Teaching Hospital of Nephrology, Nephrology Department, Cal. Grivitei No 4, Sector 1, 010731 Bucharest, Romania
- Correspondence: ; Tel.: +40-728-070-877
| | - Mircea Niculae Penescu
- Clinical Department No 3, Internal Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Dr. Carol Davila” Teaching Hospital of Nephrology, Nephrology Department, Cal. Grivitei No 4, Sector 1, 010731 Bucharest, Romania
| | - Cristina Căpușă
- Clinical Department No 3, Internal Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Dr. Carol Davila” Teaching Hospital of Nephrology, Nephrology Department, Cal. Grivitei No 4, Sector 1, 010731 Bucharest, Romania
| | - Constantin Verzan
- Clinical Department No 3, Internal Medicine and Nephrology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
- “Dr. Carol Davila” Teaching Hospital of Nephrology, Nephrology Department, Cal. Grivitei No 4, Sector 1, 010731 Bucharest, Romania
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