conventional mini percutaneous nephrolithotomy in patients with Escherichia coli bacteriuria

To evaluate the safety and efficacy of tubeless percutaneous nephrolithotomy (PCNL) in patients with Escherichia coli (E. coli) bacteriuria. We conducted a retrospective review of 84 patients with E. coli bacteriuria who underwent PCNL. Patients were divided into two groups according to whether a nephrostomy tube is placed at the end of the procedure. Preoperative clinical data, surgical outcomes, and postoperative complications were compared. Then, regression analysis of factors predicting success rate of PCNL in patients with E. coli bacteriuria was performed. After PCNL, residual fragments ≤ 4 mm were considered as success. At baseline, the two groups were similar with regard to age, gender, BMI, underlying disease, hydronephrosis, stone characteristics, and urinalysis. Postoperative fever occurred in 1 patient (3.8%) in the tubeless PCNL group, and in 5 patients (8.6%) in the conventional PCNL group (p > 0.05). There were no significant differences in terms of successful rate, decrease in hemoglobin, pain scores, blood transfusion, and hospitalization expenses. However, the tubeless PCNL group had significantly shorter operative time (60 vs. 70 min, p = 0.033), indwelling time of catheter (2 vs. 4 days, p < 0.001), and hospital stays (3 vs. 5 days, p < 0.001) than the conventional PCNL group. In the analysis of factors predicting success, the stone diameter, stone burden, and operative time were associated with success rate of PCNL. It is safe and effective to perform tubeless PCNL in patients with E. coli bacteriuria. Compared to conventional PCNL, tubeless PCNL accelerates patient recovery and shortens hospital stays.

The rationale for bladder washouts in children with neurogenic bladder

Children with a neurogenic bladder are at risk of developing recurrent urinary tract infections and long-term kidney failure. Due to an altered lower urinary tract, children may be overtreated for simple bacteriuria or undertreated for a potentially severe urinary tract infection. This group of patients represent high users of healthcare, and are at risk of colonization and development of antibiotic resistance. Bladder washouts with non-antibiotic electrochemically activated solutions are a potential new prophylactic option for patients with bladder dysfunction when clean intermittent catheterization has resulted in chronic bacteriuria.

Bacteremia From a Presumed Urinary Source in Hospitalized Adults With Asymptomatic Bacteriuria

Importance

Guidelines recommend withholding antibiotics in asymptomatic bacteriuria (ASB), including among patients with altered mental status (AMS) and no systemic signs of infection. However, ASB treatment remains common.

Objectives

To determine prevalence and factors associated with bacteremia from a presumed urinary source in inpatients with ASB with or without AMS and estimate antibiotics avoided if a 2% risk of bacteremia were used as a threshold to prompt empiric antibiotic treatment of ASB.

Design, Setting, and Participants

This cohort study assessed patients hospitalized to nonintensive care with ASB (no immune compromise or concomitant infections) in 68 Michigan hospitals from July 1, 2017, to June 30, 2022. Data were analyzed from August 2022 to January 2023.

Main Outcomes and Measures

The primary outcome was prevalence of bacteremia from a presumed urinary source (ie, positive blood culture with matching organisms within 3 days of urine culture). To determine factors associated with bacteremia, we used multivariable logistic regression models. We estimated each patient's risk of bacteremia and determined what percentage of patients empirically treated with antibiotics had less than 2% estimated risk of bacteremia.

Results

Of 11 590 hospitalized patients with ASB (median [IQR] age, 78.2 [67.7-86.6] years; 8595 female patients [74.2%]; 2235 African American or Black patients [19.3%], 184 Hispanic patients [1.6%], and 8897 White patients [76.8%]), 8364 (72.2%) received antimicrobial treatment for UTI, and 161 (1.4%) had bacteremia from a presumed urinary source. Only 17 of 2126 patients with AMS but no systemic signs of infection (0.7%) developed bacteremia. On multivariable analysis, male sex (adjusted odds ratio [aOR], 1.45; 95% CI, 1.02-2.05), hypotension (aOR, 1.86; 95% CI, 1.18-2.93), 2 or more systemic inflammatory response criteria (aOR, 1.72; 95% CI, 1.21-2.46), urinary retention (aOR, 1.87; 95% CI, 1.18-2.96), fatigue (aOR, 1.53; 95% CI, 1.08-2.17), log of serum leukocytosis (aOR, 3.38; 95% CI, 2.48-4.61), and pyuria (aOR, 3.31; 95% CI, 2.10-5.21) were associated with bacteremia. No single factor was associated with more than 2% risk of bacteremia. If 2% or higher risk of bacteremia were used as a cutoff for empiric antibiotics, antibiotic exposure would have been avoided in 78.4% (6323 of 8064) of empirically treated patients with low risk of bacteremia.

Conclusions and Relevance

In patients with ASB, bacteremia from a presumed urinary source was rare, occurring in less than 1% of patients with AMS. A personalized, risk-based approach to empiric therapy could decrease unnecessary ASB treatment.

Propolis as an adjunctive therapy for treatment of uncomplicated cystitis in women: A randomized double-blind placebo-controlled trial

The current research is designed to investigate the effect of propolis supplementation on the clinical manifestations in women suffering from uncomplicated cystitis. In this randomized double-blind, placebo-controlled trial, 120 women with uncomplicated cystitis were selected and randomly assigned into two groups to receive two 500 mg capsules of propolis or placebo daily for 7 days along with ciprofloxacin (250 mg). Clinical symptoms including hematuria, urinary frequency, dysuria, suprapubic pain, and urgency, as well as bacteriuria, were assessed before and after the intervention. After supplementation, participants in the intervention group had significantly fewer days of urinary frequency (p < 0.001), dysuria (p = 0.005), and urgency (p = 0.03). However, there was no significant difference between the two groups regarding hematuria and suprapubic pain (p > 0.05). Furthermore, the severity of bacteriuria decreased significantly in both groups. In conclusion, it seems that propolis supplementation in women with uncomplicated cystitis could improve urinary frequency, dysuria, and urgency. However, further clinical trials should be conducted to fully understand the effects of propolis in women suffering from uncomplicated cystitis.

Bacteriology and clinical outcomes of urine mixed bacterial growth in pregnancy

INTRODUCTION AND HYPOTHESIS

The objective was to analyse the risk of significant bacteriuria in repeat urine cultures from pregnant women, following initial mixed bacterial results.

METHODS

This retrospective study examined maternal characteristics and clinical features of women who repeated urine cultures due to previous mixed cultures results.

RESULTS

Of 262 women included, 80 (30.5%) had negative cultures and 125 (47.7%) had mixed bacterial growth in their repeat cultures. Positive results (≥104 CFU/ml of a urinary pathogen) were obtained for 57 women (21.8% [95% CI 17.1-27.0]). For 37 (14.1%), the repeat specimen grew 104-105 CFU/ml of microorganisms; whereas for 20 women (7.6% [95% CI 4.9-11.3]), it grew ≥105 CFU/ml. Among women with positive (>104 CFU/ml) compared with those with negative or mixed growth, rates of urinary symptoms were higher (38.6% vs 23.4%, p=0.028), abnormal dipstick results (49.1% vs 21.0%, p<0.001) and hydronephrosis, as demonstrated by renal ultrasound (12.3% vs 2.0, p=0.003). In a multivariate logistic regression analysis, hydronephrosis was associated with the occurrence of a positive repeat culture (aOR = 10.65, 95% CI 2.07-54.90). The sensitivity and specificity for predicting a repeat urine culture with ≥105 CFU/ml were 12.9% and 94.3% respectively, for urinary symptoms; and 19.7% and 97.4% respectively, for abnormal dipstick results.

CONCLUSIONS

Mixed bacterial growth might represent a true urinary tract infection in a considerable proportion of women who are symptomatic and have an abnormal dipstick urinalysis.

Single-use digital flexible cystoscope for double J removal versus reusable instruments: a prospective, comparative study of functionality, risk of infection, and costs

BACKGROUND

The removal of ureteral stent can be performed with disposable or reusable flexible cystoscopes, but limited comparative data are available on functionality, risk of infections, and costs.

METHODS

We performed a multicentric, prospective, observational study on patients undergoing in-office ureteral stent removal with Isiris-α® or a reusable Storz™ flexible cystoscope. Study endpoints were the functionality and effectiveness of the devices, the rate of postoperative bacteriuria and UTIs, and the costs of the procedure.

RESULTS

A total of 135 patients were included, 80 (59.2%) treated with reusable cystoscopes and 55 (40.8%) with Isiris-α®. No significant baseline differences between groups were detected. Isiris-α® outperformed the reusable device in terms of quality of vision (p 0.001), manoeuvrability (p 0.001), grasper functionality (p < 0.001), and quality of the procedure (p 0.01). Mean procedure time was shorter with Isiris-α® (p < 0.001) due to a shorter instrument preparation time (p < 0.001). No differences were found in terms of perceived patient pain (p 0.34), nor postoperative bacteriuria or symptomatic UTIs. According to our cost analysis, the in-office procedure performed with Isiris-α® was more expensive (+ 137.8€) but was independent from instrument turnover or disinfection. Among limitations of study we acknowledge the lack of randomization, the use of antibiotic prophylaxis in several patients, and the high rate of missing preoperative urine cultures.

CONCLUSIONS

Isiris-α® outperforms reusable cystoscopes for in-office ureteral stent removal in terms of total operative time and quality of the procedure, at the cost of being more expensive. No significant differences in postoperative bacteriuria or symptomatic UTIs were found.

[Experience of using Experience of using NefroBest-N for rehabilitation of patients undergoing radical laparoscopic cystectomy]

AIM

To evaluate the efficacy and safety of NefroBest-N in patients undergoing to the radical cystectomy with neobladder formation.

MATERIALS AND METHODS

A total of 60 patients with invasive bladder cancer aged 56 to 75 years, treated at A.I. Burnazyan SRC FMBC and at the M.A. Podgorbunsky Kuzbass linical Hospital of Emergency Medical Care in 2022, were included in randomized multicenter parallel group study. All patients underwent radical cystectomy with a formation of Studer neobladder. The main group included those who received the drug NefroBest-N, 1 capsule 2 times a day for 90 days. In the control group, only symptomatic therapy according to current standards was administered. The study consisted of a screening period of up to 4 days (Visit 1) and a period of 90+2 days to evaluate the efficiency of therapy, including 3 visits: day 14 (Visit 2), 30+2 days (Visit 3) and 90+2 days (Visit 4). Laboratory examination and imaging studies included biochemistry panel (urea, creatinine, K, Na, CRP), urinalysis (presence of mucus, leukocytes), urine culture (bacteriuria), physical examination, renal and neobladder ultrasound with determination of postvoid residual volume. In addition, evaluation of the quality of life was also performed.

RESULTS

Evaluation of efficacy and safety of NefroBest-N was carried out. Administration of NefroBest-N resulted in a more rapid improvement of urinalysis, including a significant decrease in severity of leukocyturia and amount of mucus. In addition, degree of bacteriuria was reduced according to the urine culture. The quality of life was also improved.

CONCLUSION

NefroBest-N has a favorable efficacy and safety profile. According to our experience, NefroBest-N significantly reduces recovery time and improves the quality of life of patients who have undergone radical cystectomy with a neobladder formation.

Asymptomatic Bacteriuria in Kidney Transplant Recipients-A Narrative Review

Urinary tract infections (UTIs) are the most prevalent complications in kidney transplant (KTx) recipients. The most frequent finding in this group of patients is asymptomatic bacteriuria (ASB). Here, we provide an overview of the available evidence regarding ASB in KTx recipients, including its etiopathology, clinical impact and management. There is a growing body of evidence from clinical trials that screening for and treating ASB is not beneficial in most KTx recipients. However, there are insufficient data to recommend or discourage the use of a "screen-and-treat strategy" for ASB during the first 1-2 months post-transplant or in the case of an indwelling urinary catheter. Despite its frequency, ASB after KTx is still an understudied phenomenon.

[Blebbing of plasma membrane of lymphocytes in infectious complications of urolithiasis]

INTRODUCTION

About 200 thousand operations for urolithiasis are performed annually in Russia, but the frequency of postoperative complications reaches 30%. Infectious complications occur with a frequency of up to 40% in the form of various forms of pyelonephritis, urosepsis is recorded in 3% of patients. The aim of the study determine the intensity of blebbing of the plasma membrane of lymphocytes in infectious complications of urolithiasis.

MATERIALS AND METHODS

A prospective study examined 1,240 patients with urolithiasis. Inflammatory complications were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. Complications of infectious nature were characterized by the development of bacteriuria, serous pyelonephritis, purulent pyelonephritis and urosepsis. During the study, complications of an infectious nature were detected in 148 patients, which amounted to 11,93% of cases. The control group consisted of - 25 persons with urolithiasis and a favorable course of the postoperative period. Lymphocyte membrane condition was evaluated by phase contrast microscopy.

RESULTS

Changes in plasma membrane structure were more frequently reported in patients with postoperative purulent pyelonephritis and urosepsis. When assessing the presence of circulating microparticles, the highest number was recorded in patients with urolithiasis complicated by purulent pyelonephritis or urosepsis - 1318 [982; 2007] and 1531 [1028; 1963], respectively. A relationship was established between the degree of severity of terminal blebbing of the plasma membrane of lymphocytes and the nature of inflammatory complications in urolithiasis.

[Relationship between Asymptomatic Bacteriuria and Vaginal Colonization of Group B Streptococcus in the Third Trimester of Pregnancy]

Objective To reveal the relationship between asymptomatic bacteriuria (ASB) and vaginal colonization of group B Streptococcus in the third trimester of pregnancy.Methods A total of 4287 pregnant women who were followed up from January 2018 to June 2021 were enrolled in this study.The pregnant women with ASB were assigned as the observation group,and those without ASB were matched at a ratio of 1∶4 as the control group.Results Among the 4287 pregnant women,158 (3.69%) pregnant women had ASB,including 28 (17.72%) with group B Streptococcus colonization in the third trimester.Among the 632 pregnant women without ASB (control),44 cases (6.96%) had vaginal colonization of group B Streptococcus in the third trimester.The colonization rate of group B Streptococcus in the pregnant women with ASB was significantly higher than that in the pregnant women without ASB (χ²=17.666,P<0.001).Logistic regression showed that ASB was positively correlated with the vaginal colonization of group B Streptococcus in the third trimester of pregnancy (OR=2.577,95%CI=1.509-4.402,P=0.001).Conclusions ASB is positively correlated with the vaginal colonization of group B Streptococcus in the third trimester.The screening,prevention,and control of ASB in the early trimester is of great significance to reduce the vaginal colonization of group B Streptococcus in the third trimester.

Reduction of intrapartum antibiotic prophylaxis by combining risk factor assessment with a rapid bedside intrapartum polymerase chain reaction testing for group B streptococci

OBJECTIVE

To investigate the impact of administering Intrapartum Antibiotic Prophylaxis (IAP) to laboring women with one or more risk factors for Early Onset Group B Streptococcal neonatal infection (EOGBS) based on the result of a rapid bedside test for Group B Streptococci (GBS).

STUDY DESIGN

Quality assessment study.

METHODS

Three-hundred-sixty-six laboring women admitted to our maternity ward, with one or more risk factors for EOGBS, were prospectively included. Rectovaginal swab-samples were examined bedside by the GenomEra® GBS Polymerase Chain Reaction (PCR) assay upon admission. Time from administration of IAP to delivery was registered. According to national guidelines, one-hundred-two women mandatorily received IAP independent of the PCR test result fulfilling one of the following three risk factors: prior infant with EOGBS, preterm labor before 35 gestational week, temperature ≥ 38 °C during labor. Women with GBS bacteriuria during current pregnancy, rupture of membranes ≥ 18 h IAP, and preterm labor between 35 and 37 gestational week, received IAP solely if the PCR test was positive. Predictive values were calculated for each risk factor.

RESULTS

Previous GBS bacteriuria was strongly associated (PPV = 71%) with a positive GBS PCR test, whilst the corresponding positive percent of ROM > 18 h and of GA 35-37 was only PPV = 16% and 22%, respectively. Seventy-four women, 74/251 (31%), received IAP because they were GBS PCR positive. IAP was thus reduced by about two-thirds compared to the risk-based strategy of offering IAP to all women with one or more risk factors for EOGBS. Two women, 2/254 (0.8%), received inferior care, as they did not receive IAP within the recommended 4 h prior to delivery due to the extra time spend on the test procedure.

CONCLUSION

Bedside intrapartum PCR testing of women with risk factors for EOGBS effectively diminishes use of IAP during labor compared to the present risk factor-based strategy alone. In this project, the extra time spend on the PCR test procedure did not lead to noticeable delay in IAP.

[Modern algorithm of diagnosis and treatment of acute gestational pyelonephritis in a large industrial city]

THE PURPOSE OF THE STUDY

to develop a modern algorithm for the diagnosis and treatment of acute gestational pyelonephritis in a large industrial city and to study the possibilities of phytotherapy as an integral part of this algorithm.

MATERIALS AND METHODS

The study consisted of two stages and included 629 patients treated over 12 years (2010-2021) in Perm city with a population of 1.1 million people. At the first stage, the developed algorithm for the diagnosis and treatment of acute gestational pyelonephritis in 440 pregnant women was tested. A city emergency center for patients with gestational pyelonephritis was created with 3 urologists and related specialists on duty around the clock, what accelerated hospitalization timelines by 2.1 times. The patients underwent a level 1 examination, which included ultrasound examination, urine bacteriology and other methods. Patients in serve condition underwent, a level 2 examination, which included magnetic resonance imaging (MRI), ultrasound Dopplerography (USDG) and extended laboratory tests.

RESULTS

During an urgent examination, acute purulent pyelonephritis was diagnosed in 27 (6.1%) patients who underwent 13 open surgeries (11 organ-preserving, 2 nephroectomies) and 14 minimally invasive (percutaneous nephrostomy, puncture of a kidney abscess) within 2-5 hours from the moment of hospitalization. Serve obstructive pyelonephritis was diagnosed in 286 patients, the passage of urine was restored by the installation of a stent or catheterization of the ureter. Conservative antibacterial therapy was performed in 127 patients with serous non-obstructive pyelonephritis. Positive results of treatment were observed in 439 (99.8%) patients: recovery in 95%, significant improvement in 4.8%, with a mortality rate of 0.2%. Bed-day decreased by 30.4%. At the second stage, a comparative randomized study was conducted during 4 years with 189 pregnant women with acute serous pyelonephritis enrolled. In the group 1 (n=94) patients received standard therapy according to the implemented algorithm, in the group 2 (n=95) patients had 60-day use of Canephron N. In the group 2, treatment results were better: recovery was achieved in 96.8% of patients, improvement in 3.2%, the number of pregnant women with leukocyturia and bacteriuria decreased 4.1 times, which prevented the occurrence of repeated attacks of acute pyelonephritis. Compared with standard therapy, Canephron N increased glomerular filtration by 12,3%, diuresis by 14.2%, increased urea excretion function of the kidneys, sanitized the urinary tract at an earlier timelines, reduced the number of premature births and the birth of dead and premature babies.

CONCLUSION

As a result of the development and implementation of an algorithm for the diagnosis and treatment of acute gestational pyelonephritis and creation of the treatment center for such patients, it was possible to reduce significantly the time of hospitalization and inpatient treatment and achieve good treatment results in 99.8% of patients. The inclusion of long-term phytotherapy with Canephron N in the treatment regimen increased the effectiveness of treatment, improved kidney function in patients, significantly reduced the number of pregnant women with leukocyturia and bacteriuria, and reduced the risk of a repeated attack of pyelonephritis.

Detection of tem-1 and class-1 integrons in multidrug resistant uropathogens from HIV patients with asymptomatic bacteriuria in a Tertiary Care Hospital, SouthWest Nigeria

Background

Human immunodeficiency virus (HIV) infected individuals are at increased risk of asymptomatic bacteriuria (ASB) due to immune suppression. The increasing resistance of uropathogens necessitates the need for regular monitoring of their profile to reduce drug resistance.

Objectives

We determined the prevalence of ASB and the characteristics of antibiotic-resistant uropathogens isolated from HIV patients.

Methods

Mid-stream urine samples from 100 HIV positive and 100 HIV negative healthy individuals were cultured for significant bacteriuria. The isolates were identified by standard techniques and their susceptibility patterns determined by the Kirby-Bauer disc diffusion technique. All the Gram-negative isolates were screened for ESBL production by combined disc method, ESBL genes and class 1 integrons by Polymerase chain reaction.

Results

Nine (9%) HIV positive individuals and 4 (4%) healthy individuals had ASB yielding a total of 13 (6.5%) uropathogens dominated by Escherichia coli (53.9%). All isolates were multidrug resistant. Five isolates harboured both the blaTEM-1 gene and class 1integrons while Serratia liquefaciens produced ampC.

Conclusion

There is a higher burden of ASB characterized by multi-drug resistant uropathogens among HIV patients. Thus emphasizing the need for continuous resistance surveillance and antibiotic stewardship in our environment to reduce drug resistance and prevent treatment failure.

Limited phylogenetic overlap between fluoroquinolone-resistant Escherichia coli isolated on dairy farms and those causing bacteriuria in humans living in the same geographical region

BACKGROUND

Our primary aim was to test whether cattle-associated fluoroquinolone-resistant (FQ-R) Escherichia coli found on dairy farms are closely phylogenetically related to those causing bacteriuria in humans living in the same 50 × 50 km geographical region suggestive of farm-human sharing. Another aim was to identify risk factors for the presence of FQ-R E. coli on dairy farms.

METHODS

FQ-R E. coli were isolated during 2017-18 from 42 dairy farms and from community urine samples. Forty-two cattle and 489 human urinary isolates were subjected to WGS, allowing phylogenetic comparisons. Risk factors were identified using a Bayesian regularization approach.

RESULTS

Of 489 FQ-R human isolates, 255 were also third-generation-cephalosporin-resistant, with strong genetic linkage between aac(6')Ib-cr and blaCTX-M-15. We identified possible farm-human sharing for pairs of ST744 and ST162 isolates, but minimal core genome SNP distances were larger between farm-human pairs of ST744 and ST162 isolates (71 and 63 SNPs, respectively) than between pairs of isolates from different farms (7 and 3 SNPs, respectively). Total farm fluoroquinolone use showed a positive association with the odds of isolating FQ-R E. coli, while total dry cow therapy use showed a negative association.

CONCLUSIONS

This work suggests that FQ-R E. coli found on dairy farms have a limited impact on community bacteriuria within the local human population. Reducing fluoroquinolone use may reduce the on-farm prevalence of FQ-R E. coli and this reduction may be greater when dry cow therapy is targeted to the ecology of resistant E. coli on the farm.

Improved diagnostics of infectious diseases in emergency departments: a protocol of a multifaceted multicentre diagnostic study

BACKGROUND

The major obstacle in prescribing an appropriate and targeted antibiotic treatment is insufficient knowledge concerning whether the patient has a bacterial infection, where the focus of infection is and which bacteria are the agents of the infection. A prerequisite for the appropriate use of antibiotics is timely access to accurate diagnostics such as point-of-care (POC) testing.The study aims to evaluate diagnostic tools and working methods that support a prompt and accurate diagnosis of hospitalised patients suspected of an acute infection. We will focus on the most common acute infections: community-acquired pneumonia (CAP) and acute pyelonephritis (APN). The objectives are to investigate (1) patient characteristics and treatment trajectory of the different acute infections, (2) diagnostic and prognostic accuracy of infection markers, (3) diagnostic accuracy of POC urine flow cytometry on diagnosing and excluding bacteriuria, (4) how effective the addition of POC analysis of sputum to the diagnostic set-up for CAP is on antibiotic prescriptions, (5) diagnostic accuracy of POC ultrasound and ultralow dose (ULD) computerized tomography (CT) on diagnosing CAP, (6) diagnostic accuracy of specialist ultrasound on diagnosing APN, (7) diagnostic accuracy of POC ultrasound in diagnosing hydronephrosis in patients suspected of APN.

METHODS AND ANALYSIS

It is a multifaceted multicentre diagnostic study, including 1000 adults admitted with suspicion of an acute infection. Participants will, within the first 24 hours of admission, undergo additional diagnostic tests including infection markers, POC urine flow cytometry, POC analysis of sputum, POC and specialist ultrasound, and ULDCT. The primary reference standard is an assigned diagnosis determined by a panel of experts.

ETHICS, DISSEMINATION AND REGISTRATION

Approved by Regional Committees on Health Research Ethics for Southern Denmark, Danish Data Protection Agency and clinicaltrials.gov. Results will be presented in peer-reviewed journals, and positive, negative and inconclusive results will be published.

TRIAL REGISTRATION NUMBERS

NCT04661085, NCT04681963, NCT04667195, NCT04652167, NCT04686318, NCT04686292, NCT04651712, NCT04645030, NCT04651244.

The frequency of urinary tract infections and the value of antiseptics in community-dwelling people who undertake intermittent urinary catheterization: A systematic review

BACKGROUND

This systematic review had 2 aims. First to identify the incidence of urinary tract infection (UTI) and bacteriuria in people undertaking intermittent catheterization (IC), second to determine the effectiveness of antiseptic cleaning of the meatal area prior to IC in reducing the incidence of UTI and bacteriuria.

METHODS

A systematic review was conducted. Medline and the Cumulative Index to Nursing and Allied Health Literature electronic databases were systematically searched between January 1, 1990 and January 31, 2020, to identify studies that reported either the incidence of UTI or bacteriuria or the impact of using antiseptics for meatal cleaning prior to IC on incidence of these same outcomes.

RESULTS

Twenty-five articles were identified for the first aim, 2 articles for the second. The proportion of participants experiencing ≥1 UTIs per year ranged from 15.4% to 86.6%. Synthesis of these studies suggest a combined incidence of 44.2% (95%CI 40.2%-48.5%) of participants having ≥1 UTIs per year. One of the 2 studies exploring the benefit of antiseptics in reducing UTI suggest some potential benefit of using chlorhexidine in reducing UTIs. Both studies have significant limitations, making interpretation difficult.

CONCLUSIONS

A large proportion of people undertaking IC in the community have UTIs each year. Evidence on the role of antiseptics in the prevention of UTI for people who undertake IC remains unclear.

Suprapubic catheter placement improves antimicrobial stewardship among Veterans Affairs nursing care facility residents

In a Veterans Affairs nursing facility, suprapubic catheters were associated with significantly fewer urinary tract infections (catheter-associated urinary tract infection) than were indwelling urinary catheters (mean: 0.95 vs 4.5/1,000 device-days, P = .05) among 18 patients with a history of both catheter types. Suprapubic catheters were associated with significantly shorter antibiotic treatment courses for catheter-associated urinary tract infection or asymptomatic bacteriuria (mean: 28.3 vs 88.8 days, P = .02).

Impact of Perioperative Urinary Tract Infection on Surgical Site Infection in Patients Undergoing Primary Hip and Knee Arthroplasty

BACKGROUND

The literature lacks clear consensus regarding the association between postoperative urinary tract infection (UTI) and surgical site infection (SSI). Additionally, in contrast to preoperative asymptomatic bacteriuria, SSI risk in patients with preoperative UTI has been incompletely studied. Therefore, our goal was to determine the effect of perioperative UTI on SSI in patients undergoing primary hip and knee arthroplasty.

METHODS

Using the National Surgical Quality Improvement Program database, all patients undergoing primary hip and knee arthroplasty were identified. Univariate and multivariate regressions, as well as propensity matching, were used to determine the independent risk of preoperative and postoperative UTI on SSI, reported as odds ratios (ORs) with 95% confidence intervals (CIs).

RESULTS

Postoperative UTI significantly increased the risk for superficial wound infection (OR 2.147, 95% CI 1.622-2.842), deep periprosthetic joint infection (PJI) (OR 2.288, 95% CI 1.579-3.316), and all SSIs (superficial and deep) (OR 2.193, 95% CI 1.741-2.763) (all P < .001). Preoperative UTI was not associated with a significantly increased risk of superficial infection (P = .636), PJI (P = .330), or all SSIs (P = .284). Further analysis of UTI present at the time of surgery using propensity matching showed no increased risk of superficial infection (P = 1.000), PJI (P = .624), or SSI (P = .546).

CONCLUSION

Postoperative UTI was associated with SSI, reinforcing the need to minimize factors which predispose patients to the risk of UTI after surgery. The lack of association between preoperative UTI and SSI suggests that hip and knee arthroplasty can proceed without delay, although initiating antibiotic treatment is prudent and future prospective investigations are warranted.

Urinary tract infection in patients with multiple sclerosis: An overview

INTRODUCTION

Multiple sclerosis (MS) is a demyelinating, chronic, inflammatory, and autoimmune disease of the central nervous system (CNS) with axonal degeneration, presenting a progressive and variable course. MS patients usually have complications, such as bladder dysfunction, presence of urinary symptoms, and Urinary Tract infection (UTI), which is one of the three most common non-neurological complications in MS patients.

OBJECTIVE

Analyze the most diverse aspects of UTI in MS patients, focusing on risk factors, prevalence, hospitalization, mortality rates, diagnosis, and treatment of UTIs in this group.

METHODS

A non-systematic review of articles published on PubMed in the last 10 years with the search terms "Urinary Tract Infection" AND "Multiple Sclerosis".

DISCUSSION

MS patients have a high UTI prevalence, mainly due to the occurrence of urinary disorders in these patients. The most common symptoms of UTI in MS patients are urinary urgency, polyuria, nocturia, urinary retention, and incontinence. Escherichia coli, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the most found organisms and treatment is based on antibiotic therapy. Moreover, UTIs can precipitate outbreaks, worsen the disease, causing more damage and a severe neurological condition deterioration. In addition, UTIs in this group are associated with a high hospitalizations rate and a high mortality rate. Therefore, patients in MS outbreaks with urinary symptoms or positive urinalysis must keep corticosteroid therapy and Disease-Modifying Treatments (DMTs). Whether clinically stable or MS relapse patients, the urinalysis and the presence of symptoms must guide the treatment in each group. Moreover, the pharmacological treatment of asymptomatic bacteriuria has no evidence of clinical efficacy. As the treatment of asymptomatic bacteriuria induces a significant increase in more resistant bacterial strains, it is recommended exceptionally in cases of recurrent acute UTIs, prior to handling of the UTI, pregnancy or patients in need of immunosuppression.

CONCLUSION

UTI represents a great risk and concern in MS patients. The high prevalence, hospitalization rate, and mortality rate of UTI in MS is worrying, such as the cause-consequence relationship between UTIs and the use of corticosteroids in outbreaks. Therefore, it is important to be aware of a UTI in this group to make early diagnoses, adequate management, and new infections prevention. Thus, further studies are needed to thoroughly analyze each nuance of this important comorbidity for MS patients.

Bakteriurie bei Hunden mit chronischer Niereninsuffizienz

Harntraktinfektionen (HTI) treten bei Hunden verbreitet auf. In mehreren Studien wurde bei 2,1–14,7 % klinisch unauffälliger Hunde eine positive Urinkultur (PUK) nachgewiesen. Die Ursachen sind vielfältig und die Infektionen treten sowohl primär als auch sekundär auf. Ein höheres Risiko entsteht durch Grunderkrankungen wie Diabetes mellitus oder Hyperadrenokortizismus. Bei Katzen mit chronischer Niereninsuffizienz (CNI) zeigte sich eine erhöhte PUK-Prävalenz (22–29 %). Für Hunde lagen dazu bisher keine Studien vor. Neben der Ermittlung der PUK-Häufigkeit bei Hunden mit CNI wurden in der Studie die Risikofaktoren einer PUK bestimmt und die Zusammenhänge zwischen klinisch-pathologischen Befunden und PUK identifiziert.

[Asymptomatic bacteriuria in pregnancy]

Bacteriuria is a presence of bacteria in urine. It may remain asymptomatic or elicit acute, symptomatic urinary tract infection. In pregnancy, due to physiological changes in the woman organism it increases risk of serious infectious and obstetric complications and therefore requires a different approach than in general population.

[Common errors in management of urinary tract infections]

Urinary tract infections seems to be simple diseases. However, inappropriate diagnostic and therapeutic procedures may lead to serious complications such as systemic infection, while on the other hand contribute to increasing antimicrobial resistance of uropathogens which is a growing threat to global public health. Due to more frequent occurrence of multidrug resistance bacteria, popularization of guidelines and correct schemes among doctors of all specialities. In the following article the commonest errors made by doctors in their clinical practice that seem to cause a lot of problems are shortly reviewed.

[The infective complications of the percutaneous nephrolithotomy]

In the article the main causes of the development of infective complications after percutaneous nephrolithotomy and their predictors described by the different authors are presented. A review of studies, dedicated to analysis of baseline risk factors of postoperative fever, systemic inflammatory response syndrome and/or sepsis was conducted. It was established that stone size and true bacteriuria are reliable risk factors as well as technical features of PCNL and the duration of the surgery. The staghorn and multiple stones increase the postoperative complications rate by three times. Despite low incidence of postoperative sepsis after PCNL, it is the serious complication and the main cause of mortality in a postoperative period. The use of prophylactic antibiotics with consideration of bacteria, isolated from the urinary tract significantly reduces the incidence of the postoperative infectious complications. The scheme of a single injection of the antibiotic 30 minutes before the surgery is effective.

[Efficiency of fosfomycin trometamol for treatment of acute uncomplicated cystitis]

INTRODUCTION

Acute cystitis is the most common type of uncomplicated urinary tract infection. A choice of antibiotics for the treatment depends not only on the spectrum of antimicrobial activity against pathogens, but also on the pharmacokinetic properties, due to high urine concentration after single or double use is needed. In addition, high safety profile and acceptable cost are important. Fosfomycin is one of the drugs whose efficiency in treating of patients with lower urinary tract infection is proved. It has been on the pharmaceutical market for a long time and is widely used in urologic practice. There is a risk of a decreasing of efficiency of fosfomycin, considering sustained downward trend in the sensitivity of uropathogens. This causes a need to monitor the resistance of main uropathogens to fosfomycin. In this article our experience of using of fosfomycin for the treatment of women with acute uncomplicated cystitis is presented.

AIM

to evaluate an efficiency of fosfomycin trometamol for treatment of women with acute uncomplicated cystitis.

MATERIALS AND METHODS

During the period from September to November 2018, we performed an examination and treatment of 57 women with acute uncomplicated cystitis aged from 19 to 40 years. All patients were prescribed 1 sachet of Fosfomycin Esparma (fosfomycin trometamol) after urination. The examinations were carried out on the 1st, 3rd and 7th day, including an evaluation of urination frequency, urgency, nocturia and pain intensity. In addition, urinalysis and urine culture using solid media with determination of the type of pathogens, sensitivity to antibiotics and the level of bacteriuria were also performed.

RESULTS

Baseline, all patients had complaints of pain in the bladder, urethral discomfort and frequent urination, but passing only small amount of urine. All women had leucocyturia and bacteriuria. By the 3rd day after receiving fosfomycin, urinary disturbances persisted in 22.8% patients and 17.5% of women still described pain. Mild leucocyturia was determined in 42% cases. Urine culture was negative. By the 7th day after the start of therapy, all clinical and laboratory data were returned to the normal values in all patients.

CONCLUSION

Based on the results of our study, we recommend the fosfomycin as the first-line treatment of uncomplicated lower urinary tract infection due to broad spectrum, low resistance of uropathogens, high safety profile and good compliancy.

[The effectiveness of complex phytotherapeutic medications in the management of uncomplicated lower urinary tract infections in women]

INTRODUCTION

Lower urinary tract infections (LUTI) are the most common urological diseases. Fosfomycin is one of the antibiotic agents with proven efficacy that are most frequently used to treat UTIs. Despite the high effectiveness of antibiotic therapy with this drug, in some patients, the LUTIs persist or recur. It is advisable to prevent the development of recurrent infections using herbal preparations. The study aimed to evaluate the effectiveness of integrated treatment of women with acute uncomplicated cystitis using the plant-based medication Phytolysin.

MATERIALS AND METHODS

The study comprised 63 women with acute uncomplicated cystitis, who were randomly assigned to two groups. The women in the control group (n = 31) received a single 3-g dose of fosfomycin. In the study group (n = 32), women received a single 3-g dose of fosfomycin and Phytolysin according to the manufacturers instructions three times daily for a month. The examination was performed on admission and on days 3, and 7, and included daily filling out voiding diaries, a 5-point verbal assessment of pain, urinalysis and urine culture. During the next three months, cases of recurrence were registered, and bacteriological analysis of urine was conducted.

RESULTS

On admission, all patients complained of pain in the projection of the urinary bladder, frequent urination in small portions, and a sensation of urethral discomfort. All women had leukocyturia and bacteriuria. By the 3-rd day after taking fosfomycin, both groups showed similar improvement in the clinical manifestations of the disease. All urine cultures were negative. By the 7th day after the initiation of therapy, the patients in the study group had normal laboratory parameters and no clinical manifestation of LUTI, while in the control group leukocyturia (p <0.05) persisted. During a 3-month follow-up, recurrence of LUTI was observed in 6 (19.4%) and 3 (9.4%) patients in the control and study group, respectively. Also, bacteriological studies of urine showed the same pathogen as on admission in 5 (16.1%) and 1 (3.2%) patients of the control and study group, respectively.

CONCLUSION

Phytolysin can be recommended for use in the integrated management of acute uncomplicated cystitis, as well as a means of preventing recurrences of this disease.

[Long-term monitoring of leukocyturia and bacteriuria after acute obstructive pyelonephritis]

The generally accepted standard of antibiotic therapy aimed at causative agent does not exclude the risk of acute obstructive pyelonephritis (AOP) to become chronic after the end of antibiotic therapy, resulting in a high incidence of relapses. To assess the outcomes of the AOP, we undertook a prospective clinical trial. MATERIALS AND METHODS: The study comprised 51 consistently selected patients (12 men and 39 women) with AOP occurred as a result of unilateral ureteric calculus obstruction. Inclusion criteria for the study were as follows: no history of urological diseases, including urinary stones; the first presentation to the urologist with AOP; the level of the bladder bacteriuria before the drainage of the obstructed kidney more or equal 103 CFU/ml. Bladder urine samples were collected for bacteriological examination by catheterization. At one, 3 and 6 months after completion of the treatment of AOP, the patients underwent a general clinical examination, and midstream specimens of urine were collected from the patients for bacteriological analysis to control leukocyturia and bacteriuria. RESULTS: Eradication of causative uropathogens from urine occurred within 6 months in 96.1% of patients, and at that point, leukocyturia persisted in 23.5% of the patients. The decrease in detecting uropathogens in the urine was accompanied by an increase in the frequency of the presence in the urine of other aerobes and anaerobes, i.e., no sterile urine cultures were obtained from any patient. The rates of eradication of uropathogens were associated with the patients age, the duration of the pre-hospital stage of AOP, and the complicated course of AOP.

Pattern of Urinary Antibiograms in a Tertiary Care Hospital of Eastern India

BACKGROUND

Indiscriminate use of antibiotics in urinary tract infections have led to emergence of 'superbugs' worldwide. Periodical review of antibiograms is of utmost importance for optimum patient benefit.

OBJECTIVE

To identify the spectrum of organisms responsible for urinary tract infection and evaluate the pattern of antibiotic sensitivity of the organisms.

METHODS

Urine samples were collected from all consecutive patients getting admitted in the medicine indoor irrespective of symptomatology. The clean-catch technique of midstream urine was used for patients able to void spontaneously while specimens of catheterized patients were obtained prior to catheter change. All samples were sent for routine examination as well as culture sensitivity tests. Descriptive statistical methods were used with the help of SPSS-15th version.

RESULTS

The total number of patients was 262, 160 (60.3%) were male and 102 (39.7%) female. The age of the subjects varied from 18 to 85 years. Significant bacteruria was found in 35.9% patients. The commonest organisms isolated overall were E coli (59.6%) followed by enterococcus spp (14.9%) and Klebsiella (10.6%). Among catheterized subjects apart from E coli (64%), Klebsiella was found to be commoner (12%) than Enterococcus 10%. Most Enterobactereacae showed good response to aminoglycosides, cephoperazone sulbactam and nitrofurantoin. However, organisms like Enterobacter, Citrobacter, Morganella and pseudomonas were poorly responsive to the above and required higher antibiotics like carbapenems, and polymixin B. Staph. aureus was responsive to linezolid and vancomycin only.

CONCLUSIONS

The progression of resistance of common urinary pathogens to higher antibiotics is an inexorable process. Our study reveals that new generation cephalosporins, quinolones and macrolides cannot keep up with the rapidity of emergence of multiresistant strains.

Urinary Catheter Dependent Loops as a Potential Contributing Cause of Bacteriuria: An Observational Study

Urologic studies suggest that urinary catheter dependent loops (tubing low points) may be a contributing cause of bacteriuria and urinary tract infection among catheterized patients. The means by which this type of contaminant transmission occurs, however, remains poorly understood. An observational, cross-sectional study was conducted to provide a foundational look at catheter dependent loops and their possible role in catheter-acquired urinary tract infections, and as a building block for further research.

The urinary sediment in hydronephrosis

Phase contrast microscopy has been used for examination of urinary sediments from 19 patients with hydronephrosis. Casts were seldom seen. A raised number of erythrocytes was seen only in association with catheter, calculi or diabetes. A raised number of leukocytes was seen in patients with bacteriuria. A striking observation was the finding of a great proportion (64%) of histiocyte-like cells in six out of 12 cases in whom a differential count was performed. The proportion of histiocyte-like cells was small (14%) in cases with bacteriuria or history of urinary tract infection.

P-fimbriated Escherichia coli in adults with renal scarring and pyelonephritis

The commonest organism in urinary tract infections (UTI) is Escherichia coli. Pyelonephritogenic E.coli strains possess P-fimbriae which firmly attach to uroepithelial cells by recognition of a carbohydrate structure, alpha-D-Galp-(1-4)-beta-D-Galp, which is confined within all glycosphingolipids related to the human P-blood group antigens. Several investigators have studied virulence properties of E.coli and host resistance in relation to UTI. Uroepithelial cells from children and women with recurrent UTI have an increased capacity to bind E.coli. In contrast to previous studies the present one deals with patients with renal scarring, who constitute the major risk group among patients with UTI. P-fimbriae mediated binding to uroepithelial cells was studied and the risk of recurrent UTI in patients with renal scarring was determined. Ninety per cent of the E.coli isolates from female patients with acute non-obstructive pyelonephritis in this study possess P-fimbriae (I). The fecal E.coli colonies obtained from these patients were P-fimbriated in 55% compared to 11% of the fecal E.coli colonies from healthy controls. The P-blood group distribution in 56 female patients with renal scarring and a history of febrile UTI was the same as in a control group of 39 healthy subjects (II). A history of recurrent and/or early infections did not increase the percentage of the P1 blood group phenotype. Forty-nine female patients with renal scarring were prospectively investigated for the incidence of symptomatic UTI in relation to fecal colonization with P-fimbriated E.coli (III). Fifty-three per cent of the patients had altogether 65 episodes of symptomatic UTI during the three-year follow-up (0.036 infections per month). Eight patients (16%) had nine attacks of acute pyelonephritis and 4/5 of the tested E.coli strains from these patients were P-fimbriated. No relationship was demonstrated between the presence of P-fimbriated E.coli in the fecal flora and the development of subsequent acute pyelonephritis. The binding of P-fimbriated E.coli to uroepithelial cells from 19 female patients with renal scarring was studied with the fluorescence-activated cell sorting (FACS) analysis (IV). The uroepithelial cells from the patients with renal scarring exhibited a significantly higher binding capacity (p less than 0.01) than uroepithelial cells from healthy controls. Furthermore, uroepithelial cells from the patients with renal scarring and kidney insufficiency had a higher availability of P-fimbriae receptors on their uroepithelial cells than cells obtained from patients with renal scarring and normal renal function (r = -0.75, p less than 0.001) (V).(ABSTRACT TRUNCATED AT 400 WORDS)