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Urinary Tract Infections Management

Works Count: 59338

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This cluster of papers focuses on the epidemiology, mechanisms of infection, treatment options, and antimicrobial resistance of urinary tract infections (UTIs). It covers topics such as catheter-associated UTIs, uropathogenic Escherichia coli, asymptomatic bacteriuria, prevention strategies, the urinary microbiome, and the use of fosfomycin. The papers also discuss clinical practice guidelines for the management of UTIs in different patient populations.

Keywords

Urinary Tract Infections; Epidemiology; Antimicrobial Resistance; Catheter-Associated Infections; Treatment Guidelines; Uropathogenic Escherichia coli; Asymptomatic Bacteriuria; Prevention Strategies; Microbiome; Fosfomycin

Evidence of Uncultivated Bacteria in the Adult Female Bladder

2012-01-26

Alan J. Wolfe , Evelyn Toh , Norio Shibata +7 more

ABSTRACT Clinical urine specimens are usually considered to be sterile when they do not yield uropathogens using standard clinical cultivation procedures. Our aim was to test if the adult female … ABSTRACT Clinical urine specimens are usually considered to be sterile when they do not yield uropathogens using standard clinical cultivation procedures. Our aim was to test if the adult female bladder might contain bacteria that are not identified by these routine procedures. An additional aim was to identify and recommend the appropriate urine collection method for the study of bacterial communities in the female bladder. Consenting participants who were free of known urinary tract infection provided urine samples by voided, transurethral, and/or suprapubic collection methods. The presence of bacteria in these samples was assessed by bacterial culture, light microscopy, and 16S rRNA gene sequencing. Bacteria that are not or cannot be routinely cultivated (hereinafter called uncultivated bacteria) were common in voided urine, urine collected by transurethral catheter (TUC), and urine collected by suprapubic aspirate (SPA), regardless of whether the subjects had urinary symptoms. Voided urine samples contained mixtures of urinary and genital tract bacteria. Communities identified in parallel urine samples collected by TUC and SPA were similar. Uncultivated bacteria are clearly present in the bladders of some women. It remains unclear if these bacteria are viable and/or if their presence is relevant to idiopathic urinary tract conditions.

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Clean, Intermittent Self-Catheterization in the Treatment of Urinary Tract Disease

2016-12-22

Jack Lapides , Ananias C. Diokno , Sherman J. Silber +1 more

No AccessJournal of UrologyCatheterization1 Feb 2017Clean, Intermittent Self-Catheterization in the Treatment of Urinary Tract Disease Jack Lapides, Ananias C. Diokno, Sherman J. Silber, and Bette S. Lowe Jack LapidesJack Lapides … No AccessJournal of UrologyCatheterization1 Feb 2017Clean, Intermittent Self-Catheterization in the Treatment of Urinary Tract Disease Jack Lapides, Ananias C. Diokno, Sherman J. Silber, and Bette S. Lowe Jack LapidesJack Lapides , Ananias C. DioknoAnanias C. Diokno , Sherman J. SilberSherman J. Silber , and Bette S. LoweBette S. Lowe View All Author Informationhttps://doi.org/10.1016/j.juro.2016.10.097AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail References 1 Lapides, J.: Role of hydrostatic pressure and distention in urinary tract infection. In: Progress in Pyelonephritis. Edited by E. H. Kass. Philadelphia: F. A. Davis Co., p. 578, 1965. Google Scholar 2 Mehrotra, R. M. L.: An experimental study of the vesical circulation during distension and in cystitis. J Path Bact., 66: 79, 1953. Google Scholar 3 Lapides, J., Costello, R. T., Jr., Zierdt, D. K. and Stone, T. E.: Primary cause and treatment of recurrent urinary infection in women: preliminary report. J Urol., 100: 552, 1968. Google Scholar 4 Lapides, J. and Costello, R. T., Jr.: Uninhibited neurogenic bladder: a common cause for recurrent urinary infection in normal women. J Urol., 101: 539, 1969. Google Scholar 5 Lapides, J. and Diokno, A. C.: Persistence of the infant bladder as a cause for urinary infection in girls. J Urol., 103: 243, 1970. Google Scholar 6 Schwarz, H.: Renal invasion by E. coli via a mucosal lesion of the sigmoid colon: a demonstration utilizing methods of autoradiography and group-specific serologic typing. Invest Urol., 6: 98, 1968. Google Scholar 7 Campbell, M. F.: Urologic complications of anorectal and colon surgery. Amer J Proctol., 12: 43, 1961. Google Scholar 8 Lapides, J.: Urinary diversion. Surgery, 69: 142, 1971. Google Scholar 9 Guttmann, L. and Frankel, H.: The value of intermittent catheterization in the early management of traumatic paraplegic and tetraplegia. Paraplegia, 4: 63, 1966. Google Scholar © 2002 by American Urological Association, Inc.®FiguresReferencesRelatedDetails Volume 197Issue 2SFebruary 2017Page: S122-S124 Advertisement Copyright & Permissions© 2002 by American Urological Association, Inc.®MetricsAuthor Information Jack Lapides More articles by this author Ananias C. Diokno More articles by this author Sherman J. Silber More articles by this author Bette S. Lowe More articles by this author Expand All Advertisement PDF downloadLoading ...

Postoperative Urinary Retention

2009-05-01

Gabriele Baldini , Hema Bagry , Armen Aprikian +3 more

Urinary retention is common after anesthesia and surgery, reported incidence of between 5% and 70%. Comorbidities, type of surgery, and type of anesthesia influence the development of postoperative urinary retention … Urinary retention is common after anesthesia and surgery, reported incidence of between 5% and 70%. Comorbidities, type of surgery, and type of anesthesia influence the development of postoperative urinary retention (POUR). The authors review the overall incidence and mechanisms of POUR associated with surgery, anesthesia and analgesia. Ultrasound has been shown to provide an accurate assessment of urinary bladder volume and a guide to the management of POUR. Recommendations for urinary catheterization in the perioperative setting vary widely, influenced by many factors, including surgical factors, type of anesthesia, comorbidities, local policies, and personal preferences. Inappropriate management of POUR may be responsible for bladder overdistension, urinary tract infection, and catheter-related complications. An evidence-based approach to prevention and management of POUR during the perioperative period is proposed.

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Etiology and antibiotic resistance patterns of community-acquired urinary tract infections in J N M C Hospital Aligarh, India

2007-01-01

Mohammed Akram , Mohammed Shahid , Asad U. Khan

Urinary tract infections (UTIs) remain the common infections diagnosed in outpatients as well as hospitalized patients. Current knowledge on antimicrobial susceptibility pattern is essential for appropriate therapy. Extended-Spectrum beta-Lactamase (ESBL) … Urinary tract infections (UTIs) remain the common infections diagnosed in outpatients as well as hospitalized patients. Current knowledge on antimicrobial susceptibility pattern is essential for appropriate therapy. Extended-Spectrum beta-Lactamase (ESBL) producing bacteria may not be detected by routine disk diffusion susceptibility test, leading to inappropriate use of antibiotics and treatment failure. The aim of this study was to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from patients with community acquired urinary tract infections (UTIs) at Aligarh hospital in India as well as identification of ESBL producers in the population of different uropathogens.Urinary isolates from symptomatic UTI cases attending to the JN Medical College and hospital at Aligarh were identified by conventional methods. Antimicrobial susceptibility testing was performed by Kirby Bauer's disc diffusion method. Isolates resistant to third generation cephalosporin were tested for ESBL production by double disk synergy test method.Of the 920 tested sample 100 samples showed growth of pathogens among which the most prevalent were E. coli (61%) followed by Klebsiella spp (22%). The majority (66.66%) of the isolates were from female while the remaining were from male. Among the gram-negative enteric bacilli high prevalence of resistance was observed against ampicillin and co-trimoxazole. Most of the isolates were resistant to 4 or more number of antibiotics. Forty two percent of isolates were detected to produce ESBL among which 34.42 % were E. coli isolates.This study revealed that E. coli was the predominant bacterial pathogen of community acquired UTIs in Aligarh, India. It also demonstrated an increasing resistance to Co-trimoxazole and production of extended spectrum beta-lactamase among UTI pathogens in the community. This study is useful for clinician in order to improve the empiric treatment.

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Increasing Prevalence of Antimicrobial Resistance Among Uropathogens Causing Acute Uncomplicated Cystitis in Women

1999-02-24

Kalpana Gupta

ContextGuidelines for the management of acute uncomplicated cystitis in women that recommend empirical therapy in properly selected patients rely on the predictability of the agents causing cystitis and knowledge of … ContextGuidelines for the management of acute uncomplicated cystitis in women that recommend empirical therapy in properly selected patients rely on the predictability of the agents causing cystitis and knowledge of their antimicrobial susceptibility patterns.ObjectiveTo assess the prevalence of and trends in antimicrobial resistance among uropathogens causing well-defined episodes of acute uncomplicated cystitis in a large population of women.DesignCross-sectional survey of antimicrobial susceptibilities of urine isolates collected during a 5-year period (January, May, and September 1992-1996).SettingHealth maintenance organization.PatientsWomen aged 18 to 50 years with an outpatient diagnosis of acute cystitis.Main Outcome MeasuresProportion of uropathogens demonstrating in vitro resistance to selected antimicrobials; trends in resistance over the 5-year study period.ResultsEscherichia coli and Staphylococcus saprophyticus were the most common uropathogens, accounting for 90% of the 4342 urine isolates studied. The prevalence of resistance among E coli and all isolates combined was more than 20% for ampicillin, cephalothin, and sulfamethoxazole in each year studied. The prevalence of resistance to trimethoprim and trimethoprim-sulfamethoxazole rose from more than 9% in 1992 to more than 18% in 1996 among E coli, and from 8% to 16% among all isolates combined. There was a statistically significant increasing linear trend in the prevalence of resistance from 1992 to 1996 amongE coli and all isolates combined to ampicillin (P<.002), and to cephalothin, trimethoprim, and trimethoprim-sulfamethoxazole (P<.001). In contrast, the prevalence of resistance to nitrofurantoin, gentamicin, and ciprofloxacin hydrochloride was 0% to 2% among E coli and less than 10% among all isolates combined, and did not change significantly during the 5-year period.ConclusionsWhile the prevalence of resistance to trimethoprim-sulfamethoxazole, ampicillin, and cephalothin increased significantly among uropathogens causing acute cystitis, resistance to nitrofurantoin and ciprofloxacin remained infrequent. These in vitro susceptibility patterns should be considered along with other factors, such as efficacy, cost, and cost-effectiveness in selecting empirical therapy for acute uncomplicated cystitis in women.

Guideline for Prevention of Catheter-Associated Urinary Tract Infections 2009

2010-02-15

Carolyn V. Gould , Craig A. Umscheid , Rajender Agarwal +2 more

An abstract is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content. An abstract is not available for this content so a preview has been provided. Please use the Get access link above for information on how to access this content.

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Urinary Tract Infections: Disease Panorama and Challenges

2001-03-01

Walter E. Stamm , S. Ragnar Norrby

The major goal of this conference was to review new advances in our undertaking of the pathogenesis of urinary tract infections (UTIs) from the perspective of both the pathogen and … The major goal of this conference was to review new advances in our undertaking of the pathogenesis of urinary tract infections (UTIs) from the perspective of both the pathogen and the host. This initial presentation provided an appropriate context for subsequent discussion by providing an overview of the etiology and epidemiology of UTI, diagnostic and therapeutic approaches, current management strategies, evolution of antimicrobial resistance, and current approaches to prevention.

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Guidelines for Antimicrobial Treatment of Uncomplicated Acute Bacterial Cystitis and Acute Pyelonephritis in Women

1999-10-01

John W. Warren , Elías Abrutyn , J. Richard Hebel +3 more

This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America (IDSA) through its Practice Guidelines Committee. The purpose of this guideline is to … This is part of the series of practice guidelines commissioned by the Infectious Diseases Society of America (IDSA) through its Practice Guidelines Committee. The purpose of this guideline is to provide assistance to clinicians in the diagnosis and treatment of two specific types of urinary tract infections (UTIs): uncomplicated, acute, symptomatic bacterial cystitis and acute pyelonephritis in women. The guideline does not contain recommendations for asymptomatic bacteriuria, complicated UTIs, Foley catheter-associated infections, UTIs in men or children, or prostatitis. The targeted providers are internists and family practitioners. The targeted groups are immunocompetent women. Criteria are specified for determining whether the inpatient or outpatient setting is appropriate for treatment. Differences from other guidelines written on this topic include use of laboratory criteria for diagnosis and approach to antimicrobial therapy. Panel members represented experts in adult infectious diseases and urology. The guidelines are evidence-based. A standard ranking system is used for the strength of the recommendation and the quality of the evidence cited in the literature reviewed. The document has been subjected to external review by peer reviewers as well as by the Practice Guidelines Committee and was approved by the IDSA Council, the sponsor and supporter of the guideline. The American Urologic Association and the European Society of Clinical Microbiology and Infectious Diseases have endorsed it. An executive summary and tables highlight the major recommendations. Performance measures are described to aid in monitoring compliance with the guideline. The guideline will be listed on the IDSA home page at http://www.idsociety.org It will be evaluated for updating in 2 years.

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CATHETER-ASSOCIATED URINARY TRACT INFECTIONS

1997-09-01

John W. Warren

Establishment of a Persistent Escherichia coli Reservoir during the Acute Phase of a Bladder Infection

2001-07-01

Matthew A. Mulvey , Joel D. Schilling , Scott J. Hultgren

ABSTRACT The vast majority of urinary tract infections are caused by strains of uropathogenic Escherichia coli that encode filamentous adhesive organelles called type 1 pili. These structures mediate both bacterial … ABSTRACT The vast majority of urinary tract infections are caused by strains of uropathogenic Escherichia coli that encode filamentous adhesive organelles called type 1 pili. These structures mediate both bacterial attachment to and invasion of bladder epithelial cells. However, the mechanism by which type 1 pilus-mediated bacterial invasion contributes to the pathogenesis of a urinary tract infection is unknown. Here we show that type 1-piliated uropathogens can invade the superficial epithelial cells that line the lumenal surface of the bladder and subsequently replicate, forming massive foci of intracellular E. coli termed bacterial factories. In response to infection, superficial bladder cells exfoliate and are removed with the flow of urine. To avoid clearance by exfoliation, intracellular uropathogens can reemerge and eventually establish a persistent, quiescent bacterial reservoir within the bladder mucosa that may serve as a source for recurrent acute infections. These observations suggest that urinary tract infections are more chronic and invasive than generally assumed.

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Urinary tract infections: epidemiology, mechanisms of infection and treatment options

2015-04-08

Ana L. Flores‐Mireles , Jennifer N. Walker , Michael G. Caparon +1 more

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The etiology of urinary tract infection: traditional and emerging pathogens

2002-07-01

Allan Ronald

Differentiation and developmental pathways of uropathogenicEscherichia coliin urinary tract pathogenesis

2004-01-22

Sheryl S. Justice , Chia‐Suei Hung , Julie A. Theriot +4 more

Uropathogenic Escherichia coli (UPEC) are capable of forming complex intracellular bacterial communities (IBC) within the superficial umbrella cells of the bladders of C3H and BALB/c mice. By using time-lapse fluorescence … Uropathogenic Escherichia coli (UPEC) are capable of forming complex intracellular bacterial communities (IBC) within the superficial umbrella cells of the bladders of C3H and BALB/c mice. By using time-lapse fluorescence videomicroscopy to observe infected mouse bladder explants, we discovered that IBCs formed by uropathogenic E. coli progressed through four distinct developmental stages that differed with respect to growth rate, bacterial length, colony organization, motility, and its eventual dispersal. In the first phase, bacteria in the IBC were nonmotile, rod shaped, and grew rapidly in loosely organized colonies free in the cytoplasm of the bladder superficial umbrella cells. In the second phase, the loose collection of bacteria in the IBC matured into a slower growing, highly organized biofilm-like community consisting of coccoid bacteria that ultimately filled most of the cytoplasm. In the third phase, bacteria in the biofilm-like state in the IBC switched to a motile rod-shaped phenotype allowing detachment from the community and eventual fluxing out of the host cell. During the fourth phase, the bacteria filamented. Filamentation appeared to be in response to a Toll-like receptor 4-mediated innate defense mechanism. Bacteria that fluxed out of the superficial umbrella cells were able to reenter the IBC developmental cascade but with slower kinetics and ultimately a quiescent reservoir was established. Intracellular growth and filamentation provided an advantage to the bacteria in evading infiltrating polymorphonuclear leukocytes. This work has developed a technique to observe live infected organs and revealed a complex differentiation pathway that facilitates bacterial persistence in the urinary tract.

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A Controlled Trial of Intravaginal Estriol in Postmenopausal Women with Recurrent Urinary Tract Infections

1993-09-09

Raul Raz , Walter E. Stamm

Recurrent urinary tract infections are a problem for many postmenopausal women. Estrogen replacement restores atrophic mucosa, lowers vaginal pH, and may prevent urinary tract infections. Recurrent urinary tract infections are a problem for many postmenopausal women. Estrogen replacement restores atrophic mucosa, lowers vaginal pH, and may prevent urinary tract infections.

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Type 1 pilus-mediated bacterial invasion of bladder epithelial cells

2000-06-15

JoséR. Martínez

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Urine Is Not Sterile: Use of Enhanced Urine Culture Techniques To Detect Resident Bacterial Flora in the Adult Female Bladder

2013-12-27

Evann E. Hilt , Kathleen McKinley , Meghan M. Pearce +7 more

ABSTRACT Our previous study showed that bacterial genomes can be identified using 16S rRNA sequencing in urine specimens of both symptomatic and asymptomatic patients who are culture negative according to … ABSTRACT Our previous study showed that bacterial genomes can be identified using 16S rRNA sequencing in urine specimens of both symptomatic and asymptomatic patients who are culture negative according to standard urine culture protocols. In the present study, we used a modified culture protocol that included plating larger volumes of urine, incubation under varied atmospheric conditions, and prolonged incubation times to demonstrate that many of the organisms identified in urine by 16S rRNA gene sequencing are, in fact, cultivable using an expanded quantitative urine culture (EQUC) protocol. Sixty-five urine specimens (from 41 patients with overactive bladder and 24 controls) were examined using both the standard and EQUC culture techniques. Fifty-two of the 65 urine samples (80%) grew bacterial species using EQUC, while the majority of these (48/52 [92%]) were reported as no growth at 10 3 CFU/ml by the clinical microbiology laboratory using the standard urine culture protocol. Thirty-five different genera and 85 different species were identified by EQUC. The most prevalent genera isolated were Lactobacillus (15%), followed by Corynebacterium (14.2%), Streptococcus (11.9%), Actinomyces (6.9%), and Staphylococcus (6.9%). Other genera commonly isolated include Aerococcus , Gardnerella , Bifidobacterium , and Actinobaculum . Our current study demonstrates that urine contains communities of living bacteria that comprise a resident female urine microbiota.

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Urinary tract infection: self-reported incidence and associated costs.

2000-11-01

Betsy Foxman , Robin Barlow , Hannah d’Arcy +2 more

Estimating the Proportion of Healthcare-Associated Infections That Are Reasonably Preventable and the Related Mortality and Costs

2011-01-19

Craig A. Umscheid , Matthew D. Mitchell , Jalpa A. Doshi +3 more

To estimate the proportion of healthcare-associated infections (HAIs) in US hospitals that are "reasonably preventable," along with their related mortality and costs.To estimate preventability of catheter-associated bloodstream infections (CABSIs), catheter-associated … To estimate the proportion of healthcare-associated infections (HAIs) in US hospitals that are "reasonably preventable," along with their related mortality and costs.To estimate preventability of catheter-associated bloodstream infections (CABSIs), catheter-associated urinary tract infections (CAUTIs), surgical site infections (SSIs), and ventilator-associated pneumonia (VAP), we used a federally sponsored systematic review of interventions to reduce HAIs. Ranges of preventability included the lowest and highest risk reductions reported by US studies of "moderate" to "good" quality published in the last 10 years. We used the most recently published national data to determine the annual incidence of HAIs and associated mortality. To estimate incremental cost of HAIs, we performed a systematic review, which included costs from studies in general US patient populations. To calculate ranges for the annual number of preventable infections and deaths and annual costs, we multiplied our infection, mortality, and cost figures with our ranges of preventability for each HAI.As many as 65%-70% of cases of CABSI and CAUTI and 55% of cases of VAP and SSI may be preventable with current evidence-based strategies. CAUTI may be the most preventable HAI. CABSI has the highest number of preventable deaths, followed by VAP. CABSI also has the highest cost impact; costs due to preventable cases of VAP, CAUTI, and SSI are likely less.Our findings suggest that 100% prevention of HAIs may not be attainable with current evidence-based prevention strategies; however, comprehensive implementation of such strategies could prevent hundreds of thousands of HAIs and save tens of thousands of lives and billions of dollars.

DIAGNOSIS AND TREATMENT OF UNCOMPLICATED URINARY TRACT INFECTION

1997-09-01

Thomas M. Hooton , Walter E. Stamm

Increasing Antimicrobial Resistance and the Management of Uncomplicated Community-Acquired Urinary Tract Infections

2001-07-03

Kalpana Gupta , Thomas M. Hooton , Walter E. Stamm

Community-acquired urinary tract infections (UTIs) are among the most common bacterial infections in women. Therapy for these infections is usually begun before results of microbiological tests are known. Furthermore, in … Community-acquired urinary tract infections (UTIs) are among the most common bacterial infections in women. Therapy for these infections is usually begun before results of microbiological tests are known. Furthermore, in women with acute uncomplicated cystitis, empirical therapy without a pretherapy urine culture is often used. The rationale for this approach is based on the highly predictable spectrum of etiologic agents causing UTI and their antimicrobial resistance patterns. However, antimicrobial resistance among uropathogens causing community-acquired UTIs, both cystitis and pyelonephritis, is increasing. Most important has been the increasing resistance to trimethoprim–sulfamethoxazole (TMP–SMX), the current drug of choice for treatment of acute uncomplicated cystitis in women. What implications do these trends have for treatment of community-acquired UTIs? Preliminary data suggest that clinical cure rates may be lower among women with uncomplicated cystitis treated with TMP–SMX when the infecting pathogen is resistant to TMP–SMX. Women with pyelonephritis also have less bacterial eradication and lower clinical cure rates when treated with TMP–SMX for an infection that is resistant to the drug. Therefore, in the outpatient setting, identifying risk factors for TMP–SMX resistance and knowing the prevalence of TMP–SMX resistance in the local community are important steps in choosing an appropriate therapeutic agent. When choosing a treatment regimen, physicians should consider such factors as in vitro susceptibility, adverse effects, cost-effectiveness, and selection of resistant strains. Using a management strategy that takes these variables into account is essential for maintaining the safety and efficacy of treatment for acute UTI.

Bacteriuria and the Diagnosis of Infections of the Urinary Tract

1957-11-01

Edward H. Kass

Pyelonephritis and related infections of the urinary tract are among the most frequently encountered, most frequently undiagnosed, and most difficult to manage of all infections. The lack of clear views … Pyelonephritis and related infections of the urinary tract are among the most frequently encountered, most frequently undiagnosed, and most difficult to manage of all infections. The lack of clear views of the pathogenesis, diagnosis, and treatment of infections of the urinary tract is well recognized.1-3 A few selected data indicate the magnitude of the problem. 1. Pyelonephritis is the commonest disease of the kidneys at autopsy. Active pyelonephritis has been found in 10% to 20% of autopsies in several general hospitals,4-6and healed pyelonephritis occurs about as frequently as does active pyelonephritis.6 2. Pyelonephritis has been implicated, with varying degrees of evidence, in such disorders as hypertension, chronic renal insufficiency, toxemias of pregnancy, various disturbances in electrolyte metabolism, diabetes mellitus, pregnancy, and stone formation. 3. Despite the importance of this group of diseases the diagnosis of infection of the urinary tract is made in only about 20%

Epidemiology of urinary tract infections: Incidence, morbidity, and economic costs

2003-02-01

Betsy Foxman

Epidemiology of urinary tract infections: incidence, morbidity, and economic costs

2002-07-01

Betsy Foxman

Medical and economic impact of extraintestinal infections due to Escherichia coli: focus on an increasingly important endemic problem

2003-04-01

Thomas A. Russo , James R. Johnson

Uncomplicated Urinary Tract Infection

2012-03-14

Thomas M. Hooton

Nitrofurantoin, trimethoprim–sulfamethoxazole, fosfomycin, and pivmecillinam are considered first-line agents for cystitis. Fluoroquinolones should not be routine first-line choices for cystitis, although they are first-line empirical therapy for pyelonephritis. Nitrofurantoin, trimethoprim–sulfamethoxazole, fosfomycin, and pivmecillinam are considered first-line agents for cystitis. Fluoroquinolones should not be routine first-line choices for cystitis, although they are first-line empirical therapy for pyelonephritis.

Urinary Tract Infection Syndromes

2013-12-07

Betsy Foxman

Complicated Catheter-Associated Urinary Tract Infections Due toEscherichia coliandProteus mirabilis

2008-01-01

S. M. Jacobsen , D.J. Stickler , Harry L. T. Mobley +1 more

Catheter-associated urinary tract infections (CAUTIs) represent the most common type of nosocomial infection and are a major health concern due to the complications and frequent recurrence. These infections are often … Catheter-associated urinary tract infections (CAUTIs) represent the most common type of nosocomial infection and are a major health concern due to the complications and frequent recurrence. These infections are often caused by Escherichia coli and Proteus mirabilis. Gram-negative bacterial species that cause CAUTIs express a number of virulence factors associated with adhesion, motility, biofilm formation, immunoavoidance, and nutrient acquisition as well as factors that cause damage to the host. These infections can be reduced by limiting catheter usage and ensuring that health care professionals correctly use closed-system Foley catheters. A number of novel approaches such as condom and suprapubic catheters, intermittent catheterization, new surfaces, catheters with antimicrobial agents, and probiotics have thus far met with limited success. While the diagnosis of symptomatic versus asymptomatic CAUTIs may be a contentious issue, it is generally agreed that once a catheterized patient is believed to have a symptomatic urinary tract infection, the catheter is removed if possible due to the high rate of relapse. Research focusing on the pathogenesis of CAUTIs will lead to a better understanding of the disease process and will subsequently lead to the development of new diagnosis, prevention, and treatment options.

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Detection of Intracellular Bacterial Communities in Human Urinary Tract Infection

2007-12-12

David A. Rosen , Thomas M. Hooton , Walter E. Stamm +2 more

Background Urinary tract infections (UTIs) are one of the most common bacterial infections and are predominantly caused by uropathogenic Escherichia coli (UPEC). While UTIs are typically considered extracellular infections, it … Background Urinary tract infections (UTIs) are one of the most common bacterial infections and are predominantly caused by uropathogenic Escherichia coli (UPEC). While UTIs are typically considered extracellular infections, it has been recently demonstrated that UPEC bind to, invade, and replicate within the murine bladder urothelium to form intracellular bacterial communities (IBCs). These IBCs dissociate and bacteria flux out of bladder facet cells, some with filamentous morphology, and ultimately establish quiescent intracellular reservoirs that can seed recurrent infection. This IBC pathogenic cycle has not yet been investigated in humans. In this study we sought to determine whether evidence of an IBC pathway could be found in urine specimens from women with acute UTI. Methods and Findings We collected midstream, clean-catch urine specimens from 80 young healthy women with acute uncomplicated cystitis and 20 asymptomatic women with a history of UTI. Investigators were blinded to culture results and clinical history. Samples were analyzed by light microscopy, immunofluorescence, and electron microscopy for evidence of exfoliated IBCs and filamentous bacteria. Evidence of IBCs was found in 14 of 80 (18%) urines from women with UTI. Filamentous bacteria were found in 33 of 80 (41%) urines from women with UTI. None of the 20 urines from the asymptomatic comparative group showed evidence of IBCs or filaments. Filamentous bacteria were present in all 14 of the urines with IBCs compared to 19 (29%) of 66 samples with no evidence of IBCs (p < 0.001). Of 65 urines from patients with E. coli infections, 14 (22%) had evidence of IBCs and 29 (45%) had filamentous bacteria, while none of the gram-positive infections had IBCs or filamentous bacteria. Conclusions The presence of exfoliated IBCs and filamentous bacteria in the urines of women with acute cystitis suggests that the IBC pathogenic pathway characterized in the murine model may occur in humans. The findings support the occurrence of an intracellular bacterial niche in some women with cystitis that may have important implications for UTI recurrence and treatment.

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Diagnosis, Prevention, and Treatment of Catheter-Associated Urinary Tract Infection in Adults: 2009 International Clinical Practice Guidelines from the Infectious Diseases Society of America

2010-03-01

Thomas M. Hooton , Suzanne Bradley , Diana D. Cardenas +7 more

Abstract Guidelines for the diagnosis, prevention, and management of persons with catheter-associated urinary tract infection (CA-UTI), both symptomatic and asymptomatic, were prepared by an Expert Panel of the Infectious Diseases … Abstract Guidelines for the diagnosis, prevention, and management of persons with catheter-associated urinary tract infection (CA-UTI), both symptomatic and asymptomatic, were prepared by an Expert Panel of the Infectious Diseases Society of America. The evidence-based guidelines encompass diagnostic criteria, strategies to reduce the risk of CA-UTIs, strategies that have not been found to reduce the incidence of urinary infections, and management strategies for patients with catheter-associated asymptomatic bacteriuria or symptomatic urinary tract infection. These guidelines are intended for use by physicians in all medical specialties who perform direct patient care, with an emphasis on the care of patients in hospitals and long-term care facilities.

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International Clinical Practice Guidelines for the Treatment of Acute Uncomplicated Cystitis and Pyelonephritis in Women: A 2010 Update by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases

2011-02-03

Kalpana Gupta , Thomas M. Hooton , Kurt G. Naber +7 more

Abstract A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update … Abstract A Panel of International Experts was convened by the Infectious Diseases Society of America (IDSA) in collaboration with the European Society for Microbiology and Infectious Diseases (ESCMID) to update the 1999 Uncomplicated Urinary Tract Infection Guidelines by the IDSA. Co-sponsoring organizations include the American Congress of Obstetricians and Gynecologists, American Urological Association, Association of Medical Microbiology and Infectious Diseases–Canada, and the Society for Academic Emergency Medicine. The focus of this work is treatment of women with acute uncomplicated cystitis and pyelonephritis, diagnoses limited in these guidelines to premenopausal, non-pregnant women with no known urological abnormalities or co-morbidities. The issues of in vitro resistance prevalence and the ecological adverse effects of antimicrobial therapy (collateral damage) were considered as important factors in making optimal treatment choices and thus are reflected in the rankings of recommendations.

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Intracellular Bacterial Biofilm-Like Pods in Urinary Tract Infections

2003-07-03

Gregory G. Anderson , Joseph J. Palermo , Joel D. Schilling +3 more

Escherichia coli entry into the bladder is met with potent innate defenses, including neutrophil influx and epithelial exfoliation. Bacterial subversion of innate responses involves invasion into bladder superficial cells. We … Escherichia coli entry into the bladder is met with potent innate defenses, including neutrophil influx and epithelial exfoliation. Bacterial subversion of innate responses involves invasion into bladder superficial cells. We discovered that the intracellular bacteria matured into biofilms, creating pod-like bulges on the bladder surface. Pods contained bacteria encased in a polysaccharide-rich matrix surrounded by a protective shell of uroplakin. Within the biofilm, bacterial structures interacted extensively with the surrounding matrix, and biofilm associated factors had regional variation in expression. The discovery of intracellular biofilm-like pods explains how bladder infections can persist in the face of robust host defenses.

The Female Urinary Microbiome: a Comparison of Women with and without Urgency Urinary Incontinence

2014-07-09

Meghan M. Pearce , Evann E. Hilt , Amy Rosenfeld +7 more

Bacterial DNA and live bacteria have been detected in human urine in the absence of clinical infection, challenging the prevailing dogma that urine is normally sterile. Urgency urinary incontinence (UUI) … Bacterial DNA and live bacteria have been detected in human urine in the absence of clinical infection, challenging the prevailing dogma that urine is normally sterile. Urgency urinary incontinence (UUI) is a poorly understood urinary condition characterized by symptoms that overlap urinary infection, including urinary urgency and increased frequency with urinary incontinence. The recent discovery of the urinary microbiome warrants investigation into whether bacteria contribute to UUI. In this study, we used 16S rRNA gene sequencing to classify bacterial DNA and expanded quantitative urine culture (EQUC) techniques to isolate live bacteria in urine collected by using a transurethral catheter from women with UUI and, in comparison, a cohort without UUI. For these cohorts, we demonstrated that the UUI and non-UUI urinary microbiomes differ by group based on both sequence and culture evidences. Compared to the non-UUI microbiome, sequencing experiments revealed that the UUI microbiome was composed of increased Gardnerella and decreased Lactobacillus. Nine genera (Actinobaculum, Actinomyces, Aerococcus, Arthrobacter, Corynebacterium, Gardnerella, Oligella, Staphylococcus, and Streptococcus) were more frequently cultured from the UUI cohort. Although Lactobacillus was isolated from both cohorts, distinctions existed at the species level, with Lactobacillus gasseri detected more frequently in the UUI cohort and Lactobacillus crispatus most frequently detected in controls. Combined, these data suggest that potentially important differences exist in the urinary microbiomes of women with and without UUI, which have strong implications in prevention, diagnosis, or treatment of UUI. Importance: New evidence indicates that the human urinary tract contains microbial communities; however, the role of these communities in urinary health remains to be elucidated. Urgency urinary incontinence (UUI) is a highly prevalent yet poorly understood urinary condition characterized by urgency, frequency, and urinary incontinence. Given the significant overlap of UUI symptoms with those of urinary tract infections, it is possible that UUI may have a microbial component. We compared the urinary microbiomes of women affected by UUI to those of a comparison group without UUI, using both high-throughput sequencing and extended culture techniques. We identified statistically significant differences in the frequency and abundance of bacteria present. These differences suggest a potential role for the urinary microbiome in female urinary health.

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An international survey of the antimicrobial susceptibility of pathogens from uncomplicated urinary tract infections: the ECOmiddle dotSENS Project

2002-11-28

Gunnar Kahlmeter

The ECO·SENS study is the first international survey to investigate the prevalence and susceptibility of pathogens causing community-acquired acute uncomplicated urinary tract infections (UTIs). Midstream urine samples were taken for … The ECO·SENS study is the first international survey to investigate the prevalence and susceptibility of pathogens causing community-acquired acute uncomplicated urinary tract infections (UTIs). Midstream urine samples were taken for culture and for testing for the presence of leucocytes from 4734 women not older than 65 years presenting with symptoms of acute UTI at 252 community health care centres in 17 countries. Recognized urinary tract pathogens were identified and the susceptibility to 12 antimicrobials determined. Pathogens were present in 3278 (69.2%) patients, Escherichia coli accounting for 77.0% of isolates. In E. coli, 42% of the isolates were resistant to one or more of the 12 antimicrobial drugs investigated. Resistance was most common to ampicillin (29.8%) and sulfamethoxazole (29.1%), followed by trimethoprim (14.8%), trimethoprim/sulfamethoxazole (14.1%) and nalidixic acid (5.4%). Resistance in E. coli to co-amoxiclav, mecillinam, cefadroxil, nitrofurantoin, fosfomycin, gentamicin and ciprofloxacin was <3%. However, co-amoxiclav resistance was apparent in Portugal (9.3%) as was resistance to the quinolones, nalidixic acid and ciprofloxacin, in Portugal (11.6% and 5.8%, respectively) and Spain (26.7% and 14.7%, respectively). Overall, Proteus mirabilis were less resistant to ampicillin (16.1%) and more resistant to trimethoprim (25.5%) than E. coli, whereas Klebsiella spp. were more resistant to ampicillin (83.5%) and fosfomycin (56.7%). 'Other Enterobacteriaceae' were more resistant to the broad spectrum β-lactams (ampicillin 45.9%, co-amoxiclav 21.3% and cefadroxil 24.6%), nitrofurantoin (40.2%) and fosfomycin (15.6%). In Staphylococcus saprophyticus resistance development was rare. Overall, antimicrobial resistance was lowest in the Nordic countries and Austria and highest in Portugal and Spain.

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Engineering out the Risk of Infection with Urinary Catheters

2001-03-01

Dennis G. Maki , Paul Anantharajah Tambyah

Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection. Each year, more than 1 million patients in U.S. acute-care hospitals and extended-care facilities acquire such an infection; the … Catheter-associated urinary tract infection (CAUTI) is the most common nosocomial infection. Each year, more than 1 million patients in U.S. acute-care hospitals and extended-care facilities acquire such an infection; the risk with short-term catheterization is 5% per day. CAUTI is the second most common cause of nosocomial bloodstream infection, and studies suggest that patients with CAUTI have an increased institutional death rate, unrelated to the development of urosepsis. Novel urinary catheters impregnated with nitrofurazone or minocycline and rifampin or coated with a silver alloy-hydrogel exhibit antiinfective surface activity that significantly reduces the risk of CAUTI for short-term catheterizations not exceeding 2-3 weeks.

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The epidemiology of urinary tract infection

2010-12-01

Betsy Foxman

A Prospective Microbiologic Study of Bacteriuria in Patients with Chronic Indwelling Urethral Catheters

1982-12-01

John W. Warren , James H. Tenney , John M. Hoopes +2 more

Journal Article A Prospective Microbiologic Study of Bacteriuria in Patients with Chronic Indwelling Urethral Catheters Get access John W. Warren, John W. Warren Search for other works by this author … Journal Article A Prospective Microbiologic Study of Bacteriuria in Patients with Chronic Indwelling Urethral Catheters Get access John W. Warren, John W. Warren Search for other works by this author on: Oxford Academic PubMed Google Scholar James H. Tenney, James H. Tenney Search for other works by this author on: Oxford Academic PubMed Google Scholar John M. Hoopes, John M. Hoopes Search for other works by this author on: Oxford Academic PubMed Google Scholar Herbert L. Muncie, Herbert L. Muncie Search for other works by this author on: Oxford Academic PubMed Google Scholar William C. Anthony William C. Anthony Search for other works by this author on: Oxford Academic PubMed Google Scholar The Journal of Infectious Diseases, Volume 146, Issue 6, December 1982, Pages 719–723, https://doi.org/10.1093/infdis/146.6.719 Published: 01 December 1982 Article history Received: 14 April 1982 Revision received: 12 July 1982 Published: 01 December 1982

Laboratory Diagnosis of Urinary Tract Infections in Adult Patients

2004-04-15

Michael L. Wilson , Loretta Gaido

Urinary tract infections (UTIs) are among the most common bacterial infections and account for a significant part of the workload in clinical microbiology laboratories. Enteric bacteria (in particular, Escherichia coli) … Urinary tract infections (UTIs) are among the most common bacterial infections and account for a significant part of the workload in clinical microbiology laboratories. Enteric bacteria (in particular, Escherichia coli) remain the most frequent cause of UTIs, although the distribution of pathogens that cause UTIs is changing. More important is the increase in resistance to some antimicrobial agents, particularly the resistance to trimethoprim-sulfamethoxazole seen in E. coli. Physicians distinguish UTIs from other diseases that have similar clinical presentations with use of a small number of tests, none of which, if used individually, have adequate sensitivity and specificity. Among the diagnostic tests, urinalysis is useful mainly for excluding bacteriuria. Urine culture may not be necessary as part of the evaluation of outpatients with uncomplicated UTIs, but it is necessary for outpatients who have recurrent UTIs, experience treatment failures, or have complicated UTIs, as well as for inpatients who develop UTIs.

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Infectious Diseases Society of America Guidelines for the Diagnosis and Treatment of Asymptomatic Bacteriuria in Adults

2005-02-17

Lindsay E. Nicolle , Suzanne Bradley , Richard Colgan +3 more

RECOMMENDATIONS1.The diagnosis of asymptomatic bacteriuria should be based on results of culture of a urine specimen collected in a manner that minimizes contamination (A-II) (table 1).• For asymptomatic women, bacteriuria … RECOMMENDATIONS1.The diagnosis of asymptomatic bacteriuria should be based on results of culture of a urine specimen collected in a manner that minimizes contamination (A-II) (table 1).• For asymptomatic women, bacteriuria is defined as 2 consecutive voided urine specimens with isolation of the same bacterial strain in quantitative counts у10 5 cfu/mL (B-II).• A single, clean-catch voided urine specimen with 1 bacterial species isolated in a quantitative count у10 5 cfu/mL identifies bacteriuria in men (B-III).• A single catheterized urine specimen with 1 bac- terial species isolated in a quantitative count у10 2 cfu/mL identifies bacteriuria in women or men (A-II).2. Pyuria accompanying asymptomatic bacteriuria is not an indication for antimicrobial treatment (A-II).3. Pregnant women should be screened for bacteriuria by urine culture at least once in early pregnancy, and they should be treated if the results are positive (A-I).• The duration of antimicrobial therapy should be

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Partial restoration of the microbiota of cesarean-born infants via vaginal microbial transfer

2016-02-01

María Gloria Domínguez-Bello , Kassandra M. De Jesús-Laboy , Nan Shen +7 more

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Mortality Associated with Nosocomial Urinary-Tract Infection

1982-09-09

Richard Platt , B. Frank Polk , Bridget Murdock +1 more

In a prospective study, 131 of 1458 patients acquired 136 urinary-tract infections (defined as ≥105 colony-forming units per milliliter) during 1474 indwelling bladder catheterizations. Seventy-six patients (25 infected and 51 … In a prospective study, 131 of 1458 patients acquired 136 urinary-tract infections (defined as ≥105 colony-forming units per milliliter) during 1474 indwelling bladder catheterizations. Seventy-six patients (25 infected and 51 noninfected) died during hospitalization; death rates were 19 per cent in infected patients and 4 per cent in noninfected patients. Multiple logistic regression analysis demonstrated that seven of 21 prospectively monitored variables were associated with mortality among the catheterized patients. The adjusted odds ratio for mortality between those who acquired infection and those who did not was 2.8 (95 per cent confidence limits, 1.5 to 5.1). The acquisition of infection was not associated with the severity of underlying disease; among patients who died, infections occurred in 38 per cent of those classified as having nonfatal underlying disease (15 of 39) and in 27 per cent of those classified as having fatal disease (10 of 37). Twelve deaths may have been caused by acquired urinary-tract infections. Two patients had urinary-tract pathogens in premortem blood cultures. Another 10 died with clinical pictures compatible with serious infection, but no diagnostic cultures were performed. We conclude that the acquisition of urinary-tract infection during indwelling bladder catheterization is associated with nearly a threefold increase in mortality among hospitalized patients, but the reason for this association is not yet clear. (N Engl J Med. 1982; 307:637–42.)

Management of Urinary Tract Infections in Adults

1993-10-28

Jane F. Desforges , Walter E. Stamm , Thomas M. Hooton

Urinary tract infections account for more than 7 million visits to physicians' offices and necessitate or complicate well over 1 million hospital admissions in the United States annually1,2. It is … Urinary tract infections account for more than 7 million visits to physicians' offices and necessitate or complicate well over 1 million hospital admissions in the United States annually1,2. It is helpful to categorize adult patients with urinary infection into five groups: young women with acute uncomplicated cystitis, young women with recurrent cystitis, young women with acute uncomplicated pyelonephritis, all adults with complicated urinary infection, and all adults with asymptomatic bacteriuria. This review will highlight recent advances in the treatment of patients in each of these categories, emphasizing cost-effective strategies that may be particularly important in the coming era . . .

Factors Predisposing to Bacteriuria during Indwelling Urethral Catheterization

1974-08-01

Richard A. Garibaldi , John P. Burke , Marion L. Dickman +1 more

Of 405 hospitalized patients with temporary closed sterile urinary-catheter drainage, 95 (23 per cent) acquired bacteriuria. The risk was significantly greater for patients who were female, elderly or critically ill … Of 405 hospitalized patients with temporary closed sterile urinary-catheter drainage, 95 (23 per cent) acquired bacteriuria. The risk was significantly greater for patients who were female, elderly or critically ill (p<0.005 for each with appropriate comparison group). The patients who received systemic antimicrobial agents acquired bacteriuria less frequently than the patients who did not (16 versus 32 per cent —p<0.001). However, the apparent protective effect of antimicrobials occurred only during the first four days in which catheterization was in progress. Breaks in the closed drainage system or improper care of the drainage bag occurred frequently (121 of 405 systems studied) and predisposed to bacteriuria. Bacterial contamination of the drainage bag preceded onset of bacteriuria in 18 per cent of cases. Strict adherence to aseptic care of closed sterile drainage systems can be expected to reduce rates of hospital-acquired, catheter-associated bacteriuria. (N Engl J Med 291:215–219, 1974)

Urinary Tract Infection

2000-11-01

Betsy Foxman , Robin Barlow , Hannah d’Arcy +2 more

UroPathogenic Escherichia coli (UPEC) Infections: Virulence Factors, Bladder Responses, Antibiotic, and Non-antibiotic Antimicrobial Strategies

2017-08-15

Maria Elena Terlizzi , Giorgio Gribaudo , Massimo E. Maffei

Urinary tract infections (UTIs) are one of the most common pathological conditions in both community and hospital settings. It has been estimated that about 150 million people worldwide develop UTI … Urinary tract infections (UTIs) are one of the most common pathological conditions in both community and hospital settings. It has been estimated that about 150 million people worldwide develop UTI each year, with high social costs in terms of hospitalizations and medical expenses. Among the common uropathogens associated to UTIs development, UroPathogenic Escherichia coli (UPEC) is the primary cause. UPEC strains possess a plethora of both structural (as fimbriae, pili, curli, flagella) and secreted (toxins, iron-acquisition systems) virulence factors that contribute to their capacity to cause disease, although the ability to adhere to host epithelial cells in the urinary tract represents the most important determinant of pathogenicity. On the opposite side, the bladder epithelium shows a multifaceted array of host defenses including the urine flow and the secretion of antimicrobial substances, which represent useful tools to counteract bacterial infections. The fascinating and intricate dynamics between these players determine a complex interaction system that needs to be revealed. This review will focus on the most relevant components of UPEC arsenal of pathogenicity together with the major host responses to infection, the current approved treatment and the emergence of resistant UPEC strains, the vaccine strategies, the natural antimicrobial compounds along with innovative anti-adhesive and prophylactic approaches to prevent UTIs.

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Clinical Practice Guideline for the Management of Asymptomatic Bacteriuria: 2019 Update by the Infectious Diseases Society of Americaa

2019-05-02

Lindsay E. Nicolle , Kalpana Gupta , Suzanne Bradley +7 more

Abstract Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America … Abstract Asymptomatic bacteriuria (ASB) is a common finding in many populations, including healthy women and persons with underlying urologic abnormalities. The 2005 guideline from the Infectious Diseases Society of America recommended that ASB should be screened for and treated only in pregnant women or in an individual prior to undergoing invasive urologic procedures. Treatment was not recommended for healthy women; older women or men; or persons with diabetes, indwelling catheters, or spinal cord injury. The guideline did not address children and some adult populations, including patients with neutropenia, solid organ transplants, and nonurologic surgery. In the years since the publication of the guideline, further information relevant to ASB has become available. In addition, antimicrobial treatment of ASB has been recognized as an important contributor to inappropriate antimicrobial use, which promotes emergence of antimicrobial resistance. The current guideline updates the recommendations of the 2005 guideline, includes new recommendations for populations not previously addressed, and, where relevant, addresses the interpretation of nonlocalizing clinical symptoms in populations with a high prevalence of ASB.

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An introduction to the epidemiology and burden of urinary tract infections

2019-01-01

Martha Medina , Edgardo Castillo‐Pino

Urinary tract infections (UTIs) are the most common outpatient infections, with a lifetime incidence of 50-60% in adult women. This is a narrative review aimed at acting as an introduction … Urinary tract infections (UTIs) are the most common outpatient infections, with a lifetime incidence of 50-60% in adult women. This is a narrative review aimed at acting as an introduction to the epidemiology and burden of UTIs. This review is based on relevant literature according to the experience and expertise of the authors. The prevalence of UTI increases with age, and in women aged over 65 is approximately double the rate seen in the female population overall. Etiology in this age group varies by health status with factors such as catheterization affecting the likelihood of infection and the pathogens most likely to be responsible. In younger women, increased sexual activity is a major risk factor for UTIs and recurrence within 6 months is common. In the female population overall, more serious infections such as pyelonephritis are less frequent but are associated with a significant burden of care due to the risk of hospitalization. Healthcare-associated UTIs (HAUTIs) are the most common form of healthcare-acquired infection. Large global surveys indicate that the nature of pathogens varies between the community and hospital setting. In addition, the pathogens responsible for HAUTIs vary according to region making adequate local data key to infection control. UTIs create a significant societal and personal burden, with a substantial number of medical visits in the United States every year being related to UTIs. European data indicate that recurrent infections are related to increased absenteeism and physician visits. In addition, quality of life measures are significantly impacted in women suffering from recurrent UTIs. Data suggest that nonantimicrobial prophylactic strategies offer an opportunity to reduce both the rate of UTIs and the personal burden experience by patients.

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Urinary Tract Infections

2016-04-11

Ernest Jawetz

Cranberries for preventing urinary tract infections

2004-04-19

Ruth Jepson , Lara Mihaljevic , Jonathan C. Craig

Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs).To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations.We … Cranberries have been used widely for several decades for the prevention and treatment of urinary tract infections (UTIs).To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations.We searched MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL in The Cochrane Library) and the Internet. We contacted companies involved with the promotion and distribution of cranberry preparations and checked reference lists of review articles and relevant studies. Date of last search: January 2007.All randomised controlled trials (RCTs) or quasi-RCTs of cranberry products for the prevention of UTIs in all populations.Two authors independently assessed and extracted information. Information was collected on methods, participants, interventions and outcomes (UTIs - symptomatic and asymptomatic, side effects, adherence to therapy). Relative risk (RR) were calculated where appropriate, otherwise a narrative synthesis was undertaken. Quality was assessed using the Cochrane criteria.Ten studies (n = 1049, five cross-over, five parallel group) were included. Cranberry/cranberry-lingonberry juice versus placebo, juice or water was evaluated in seven studies, and cranberries tablets versus placebo in four studies (one study evaluated both juice and tablets). Cranberry products significantly reduced the incidence of UTIs at 12 months (RR 0.65, 95% CI 0.46 to 0.90) compared with placebo/control. Cranberry products were more effective reducing the incidence of UTIs in women with recurrent UTIs, than elderly men and women or people requiring catheterisation. Six studies were not included in the meta-analyses due to methodological issues or lack of available data. However, only one reported a significant result for the outcome of symptomatic UTIs. Side effects were common in all studies, and dropouts/withdrawals in several of the studies were high.There is some evidence that cranberry juice may decrease the number of symptomatic UTIs over a 12 month period, particularly for women with recurrent UTIs. It's effectiveness for other groups is less certain. The large number of dropouts/withdrawals indicates that cranberry juice may not be acceptable over long periods of time. It is not clear what is the optimum dosage or method of administration (e.g. juice, tablets or capsules). Further properly designed studies with relevant outcomes are needed.

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Urinalysis: a comprehensive review.

2005-03-15

Jeff A Simerville , William C. Maxted , John J. Pahira

A complete urinalysis includes physical, chemical, and microscopic examinations. Midstream clean collection is acceptable in most situations, but the specimen should be examined within two hours of collection. Cloudy urine … A complete urinalysis includes physical, chemical, and microscopic examinations. Midstream clean collection is acceptable in most situations, but the specimen should be examined within two hours of collection. Cloudy urine often is a result of precipitated phosphate crystals in alkaline urine, but pyuria also can be the cause. A strong odor may be the result of a concentrated specimen rather than a urinary tract infection. Dipstick urinalysis is convenient, but false-positive and false-negative results can occur. Specific gravity provides a reliable assessment of the patient's hydration status. Microhematuria has a range of causes, from benign to life threatening. Glomerular, renal, and urologic causes of microhematuria often can be differentiated by other elements of the urinalysis. Although transient proteinuria typically is a benign condition, persistent proteinuria requires further work-up. Uncomplicated urinary tract infections diagnosed by positive leukocyte esterase and nitrite tests can be treated without culture.

Renal perfusion in dynamic scans: a key predictor of long-term outcomes in posterior urethral valves

2025-06-25

Mamta Sengar , Ashvin Damdoo , Niyaz Ahmed Khan +4 more | Pediatric Nephrology

Global prevalence and etiologies of urinary tract infection among oncologic patients: a systematic review and meta-analysis

2025-06-25

Muluneh Assefa , Mitkie Tigabie , Azanaw Amare +3 more | World Journal of Urology

Impact of HICPAC Guideline Adherence on Catheter-Associated Urinary Tract Infection Rates: Evidence from a District Hospital in Indonesia

2025-06-25

Dian Nasution , Dona Nababan , Mido Ester J. Sitorus +2 more | Contagion Scientific Periodical Journal of Public Health and Coastal Health

<div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top">Urinary tract infections (UTIs) are among the most common nosocomial infections, particularly affecting hospitalized patients with indwelling urinary catheters. The implementation of the Healthcare Infection … <div><table cellspacing="0" cellpadding="0" align="left"><tbody><tr><td align="left" valign="top">Urinary tract infections (UTIs) are among the most common nosocomial infections, particularly affecting hospitalized patients with indwelling urinary catheters. The implementation of the Healthcare Infection Control Practices Advisory Committee (HICPAC) guidelines aims to reduce the incidence of UTIs through stringent infection control measures in hospital settings. This study aimed to examine the association between the implementation of HICPAC guidelines and the incidence of catheter-associated urinary tract infections (CAUTIs) among inpatients at Permata Hati General Hospital, Muara Bungo Regency, in 2024. A quantitative study using a quasi-experimental design was conducted at Permata Hati General Hospital from October 2024 to February 2025. The study population consisted of nursing staff and all inpatients with urinary catheters. A total of 68 respondents were included, divided equally into two groups: 34 patients before and 34 after the implementation of HICPAC guidelines. Data were collected through medical record reviews and structured questionnaires. Statistical analyses were performed using the Chi-square and Wilcoxon tests. The results showed a statistically significant association between the implementation of HICPAC guidelines and a reduction in CAUTI incidence (p = 0.040). Additionally, significant improvements were observed in nurses’ knowledge, attitudes, and practices following the socialization and application of the guidelines. In conclusion, effective implementation of HICPAC guidelines significantly reduces the risk of CAUTIs in hospitalized patients. Hospitals are encouraged to strengthen nurses' adherence to infection control protocols to minimize the incidence of these infections. </td></tr></tbody></table></div>Keywords: Catheter Associated Urinary Tract Infection, HICPAC Guidelines, Infection Control, Hospitalized Patients, Urinary Catheters

Prevalence and causative pathogens of catheter associated urinary tract infections and compliance of healthcare workers on preventive strategies in selected intensive care units at a tertiary care centre

2025-06-25

J. A. L. U. Kumara , C.G.U.A. Patabendige | Sri Lankan Journal of Infectious Diseases

Introduction: Catheter associated urinary tract infection (CAUTI) is a common cause of healthcare associated infections worldwide. Surveillance on compliance rate of CAUTI prevention strategies would be important for the improvement … Introduction: Catheter associated urinary tract infection (CAUTI) is a common cause of healthcare associated infections worldwide. Surveillance on compliance rate of CAUTI prevention strategies would be important for the improvement of patient care quality.Objectives: Assess the prevalence and causative pathogens of catheter associated urinary tract infections and compliance of healthcare workers on preventive strategies in selected intensive care units (ICU) at a tertiary care centre.Methods: A descriptive cross-sectional study was conducted in the selected intensive care units (medical ICU and neurology ICU) at National Hospital, Sri Lanka (NHSL) from December 2021 to March 2022. Catheterised patients who stayed >48 hours in the ICU (n=146) were included in the study. Urine samples were collected according to the National Healthcare Safety Network (NHSN) criteria, United States of America (USA). Urine specimens were processed according to the standard operating procedures (SOP) and identification of the pathogens and antibiotic sensitivity were performed using an automated identification system (BD PhoenixTM).Results: The average CAUTI rate for the study period was 7.3 per 1000 urethral catheter (UC) days and UC utilisation rate was 0.95. With improving compliance rate for UC prevention strategies, a reduction in CAUTI rate was observed from 7.9 to 1.8 per 1000 UC days. There was a statistically significant association with compliance for CAUTI prevention strategies (all or none method) with the reported CAUTI rate (p= 0.03). Common pathogens isolated in the patients with CAUTI were Escherichia coli (25%) and Enterococcus faecium (25%). Among Gram-negative pathogens, 75% were multi-drug resistant (MDR).Conclusion: Improving the compliance rate for UC associated infection prevention strategies will have positive impact in reducing the CAUTI rate.

Biofilm formation and antimicrobial resistance of Enterobacteriaceae isolated from cancer patients with urinary tract infections

2025-06-25

B. M. Vitharana , D. M. Wahalathantry , Samanmalee Gunasekara +2 more | Sri Lankan Journal of Infectious Diseases

Introduction: The rise of multi-drug resistant (MDR) uropathogenic Enterobacteriaceae in cancer patients is of significant concern, and biofilm formation further increases the risk of MDR infections. This study was designed … Introduction: The rise of multi-drug resistant (MDR) uropathogenic Enterobacteriaceae in cancer patients is of significant concern, and biofilm formation further increases the risk of MDR infections. This study was designed to determine the association between MDR and biofilm formation in coliforms isolated from cancer patients with urinary tract infections (UTIs).Methods: The study was conducted over 50 consecutive days, using coliform isolates obtained from cancer patients with UTI. Bacteria were identified using routine biochemical tests. Antibiotic susceptibility data were obtained from laboratory records. Relevant clinical data of the patients were collected from inpatient clinical records (BHTs). Biofilm formation was assessed by performing tube method (TM) and tissue culture plate (TCP) method.Results: A total of 67 coliform isolates were included in the study. The majority of the isolates were Escherichia coli followed by Klebsiella pneumoniae. 64.2% of the coliforms were MDR. Of the isolates, 62.7% and 67.2% were identified as biofilm formers according to the TM and TCP methods respectively. Biofilm formation was significantly higher in coliforms isolated from cancer patients with urinary catheters (20/24, 83.3%) and those with diabetes mellitus (28/36, 77.8%). Klebsiella sp. had a significantly high (p<0.05) ability (21/26, 80.8%) to form biofilms. Of the biofilm formers, 64.4 % (29/45) were identified as MDR bacteria.Conclusion: E. coli and Klebsiella pneumoniae were the predominant uropathogens. A significant association between biofilm formation and multi-drug resistance was not demonstrated in this study (p>0.05). Urinary catheterisation, type of Enterobacteriaceae species and diabetes mellitus were significantly associated with biofilm formation (p<0.05).

Study of Cystoscopic Findings in Patients Presenting with Lower Urinary Tract Symptoms at a Tertiary Care Centre

2025-06-25

Neeraj Subedi , Krishna Kaji Bhomi , Walid El Ansari +2 more | Nepal Medical College Journal

Lower urinary tract symptoms (LUTS) are a collection of symptoms related to problems with voiding, and storage. They generally arise as a result of abnormalities or inadequate functioning of the … Lower urinary tract symptoms (LUTS) are a collection of symptoms related to problems with voiding, and storage. They generally arise as a result of abnormalities or inadequate functioning of the prostate, urethra, bladder or sphincters. Hospital based cross sectional descriptive study was conducted in the Urology department of a tertiary care hospital in Kathmandu from July 2024 to December 2024. A total of 121 patients underwent cystoscopy during the study period. The mean age of the patient was 53.93±14.752 years and the most common age group was 41- 50 years. Male patients (81.8%) were more than female patients (18.2%). Obstructive symptoms were more common than irritative symptoms. Hematuria was seen in 16 cases (13.2%) and urinary retention was seen 4 cases (3.3%). Benign enlargement of Prostate (BEP) (37.2 %) was the most common finding in cystoscopy followed by urethral stricture (19.8%). A significant association was observed between age categories and cystoscopic findings in patients presenting with LUTS (p=0.028). Among the patients with BEP, there was a significant association between age categories and BEP. Cystoscopy is a very common procedure for patients presenting with LUTS and to evaluate lower urinary tract diseases such as various pathologies of urethra, prostate and bladder.

Assessment, management, and prevention of recurrent uncomplicated UTIs based on the American Urological Association guidelines

2025-06-24

Lisa S. Pair , William E. Somerall | The Nurse Practitioner

Primary care NPs often encounter women with urinary tract infections (UTIs), many of which are recurrent. The American Urological Association's guideline on uncomplicated recurrent UTIs in women provides 16 evidence-based … Primary care NPs often encounter women with urinary tract infections (UTIs), many of which are recurrent. The American Urological Association's guideline on uncomplicated recurrent UTIs in women provides 16 evidence-based guideline statements to assist providers in evaluating and managing this condition. This article explores these guideline statements, offering practical tips to help NPs accurately diagnose and manage these infections.

A case-control study on Chlamydia psittaci pneumonia and legionella pneumonia

2025-06-24

Ying Gao , Lin Yang , Wenlong Zhang +3 more | Frontiers in Medicine

Purpose Atypical pathogens ( Chlamydia psittaci and Legionella ) are often detected by metagenomic next-generation sequencing (mNGS). However, the two atypical pneumonias are difficult to distinguish. The aim of this … Purpose Atypical pathogens ( Chlamydia psittaci and Legionella ) are often detected by metagenomic next-generation sequencing (mNGS). However, the two atypical pneumonias are difficult to distinguish. The aim of this study was to retrospectively analyze the two types of atypical pneumonia and use statistics to find points of differentiation for early diagnosis and timely treatment. Methods This retrospective study included all confirmed cases of two types of atypical pneumonia in our institution. The data collected and analyzed included epidemiological, clinical, laboratory, and radiological features. Results The study included 84 patients, 63 with Chlamydia psittaci (C. psittaci) pneumonia, 21 with Legionella pneumonia. (1) Up to 61.9% of patients with C. psittaci pneumonia and Legionella pneumonia had high fevers. More than 90% of patients with Legionella pneumonia had a cough score ≥ 3. Legionella pneumonia patients experienced more severe coughing, chest tightness and shortness of breath symptoms than C. psittaci pneumonia patients (both, p &lt; 0.01). (2) Consolidation, bronchial insufflation, ground-glass opacities, and pleural effusion are the most common chest CT signs of C. psittaci pneumonia and Legionella pneumonia. Legionella pneumonia was more likely to cause ground-glass opacities in the upper left lobe than C. psittaci pneumonia ( p = 0.05). There was no statistical difference in other CT findings. (3) C. psittaci pneumonia and Legionella pneumonia were identified by leukocytes, lymphocytes ratio, NLR, blood glucose, cough, chest tightness and shortness of breath. They had AUC’ s of 0.810, 0.709, 0.728, 0.724, 0.795, 0.675, and respective 95% CI’ s of 0.716–0.907, 0.60 5–0.832, 0. 566–0.838, 0.604–0.831, 0.696–0.869, 0.574–0.784; all statistically significant (all P &lt; 0.05; &lt; 0.001, 0.003, 0.008, 0.006, &lt; 0.001, 0.017, respectively). (4) 69.8%, 80.9% of each patients took two or more antibiotics simultaneously before diagnosis, but the difference was not statistically significant ( p = 0.32). Some patients received more than four antibiotics, most commonly Legionella pneumonia (23.8%) ( p = 0.01). Conclusion Clinicians should consider atypical pneumonia, particularly C. psittaci and Legionella pneumonia, when patients present with high fever and chest CT scans showing consolidation accompanied by bronchial insufflation, ground-glass opacities, and pleural effusion. Initially, clinicians can differentiate between the two types of pneumonia based on symptoms (e.g., cough severity, chest tightness and shortness of breath), imaging features (e.g., GGO in the left upper lobe), and laboratory markers (e.g., glucose, leukocytes, NLR, and lymphopenia). This allows for the optimization of antibiotic choices and the reduction of unnecessary multidrug combinations, which can improve prognosis and reduce the risk of drug resistance.

A prospective randomised pilot study evaluating the safety of the novel LubriShield™ Foley catheter: a permanently coated indwelling urinary catheter

2025-06-24

Anders Andreasson , Jan Andersson , Henrik Larsson +2 more | Scandinavian Journal of Urology

Objective: Catheter-associated urinary tract infections (CAUTIs) are prevalent healthcare-associated infections, arising from biofilm-forming bacteria. This may be prevented by coating the catheter with an antifouling substance. The novel LubriShield™ Foley … Objective: Catheter-associated urinary tract infections (CAUTIs) are prevalent healthcare-associated infections, arising from biofilm-forming bacteria. This may be prevented by coating the catheter with an antifouling substance. The novel LubriShield™ Foley catheter is coated with a superhydrophilic surface and a covalently bonded antifouling ligand. Preclinical studies revealed that the coating established a persistent local antifouling environment, inhibiting uropathogenic bacteria from forming biofilms. No substance release has been detected from the coating. The coating achieved a 28-fold reduction in surface friction compared to an uncoated catheter. The aim of this study is to assess the clinical safety of the catheter in patients. Materials & methods: In a prospective single-centre randomised study, 30 patients undergoing transurethral resection of bladder tumour were enrolled and randomly assigned to receive either a standard control catheter or the novel LubriShield™ catheter. Urinary cultures were obtained twice. The duration of catheterisation for the patients ranged from 3 to 24 h. The primary outcome was the assessment of device-specific adverse events (AEs). Secondary outcomes included evaluations of pain, irritation and discomfort, measured using the Numeric Rating Scale (NRS) (0–10) via a patient questionnaire. Results: There were no serious adverse events (SAEs) or AEs reported for the coated catheters. Urinary cultures showed no significant differences between the coated and uncoated catheters. Both patients and healthcare professionals rated the NRS equally for the two types of catheters. Conclusions: The novel-coated LubriShield™ catheter was found to be safe for short-term clinical use.

Sulopenem versus Amoxicillin/Clavulanate for the Treatment of Uncomplicated Urinary Tract Infection

2025-06-24

Sailaja Puttagunta , Steven I. Aronin , Jayanti Gupta +3 more | NEJM Evidence

Existing antibiotics for uncomplicated urinary tract infections are becoming less reliably effective owing to increasing antimicrobial resistance. Our objective was to evaluate the safety and efficacy of sulopenem/probenecid for uncomplicated … Existing antibiotics for uncomplicated urinary tract infections are becoming less reliably effective owing to increasing antimicrobial resistance. Our objective was to evaluate the safety and efficacy of sulopenem/probenecid for uncomplicated urinary tract infections. We conducted a double-blind, randomized, controlled, noninferiority trial of 5 days of sulopenem versus amoxicillin/clavulanate for women with uncomplicated urinary tract infection. The primary end point was overall success, defined as combined clinical cure and microbiologic eradication by day 12, evaluated in the microbiologic-modified intent-to-treat population, which comprised all randomly assigned patients who received any trial medication and had a positive urine culture with 105 colony-forming units (CFU)/ml or more of an Enterobacterales uropathogen (e.g., Escherichia coli, Klebsiella species). A total of 2222 patients were enrolled, and the median age was 51 years (interquartile range, 35-62 years). Ninety-one (9.2%) patients in the primary population (microbiologic-modified intent-to-treat population), the combined population of patients with a positive baseline urine culture and without regard to amoxicillin/clavulanate susceptibility, had a baseline pathogen resistant to three or more classes of antibiotics. Overall success in the microbiologic-modified intent-to-treat population occurred in 318 of 522 (60.9%) participants treated with sulopenem versus 260 of 468 (55.6%) participants treated with amoxicillin/clavulanate (difference, 5.4 percentage points; 95% confidence interval [CI], -0.8 to 11.5), meeting criteria for noninferiority. In the primary population with a baseline uropathogen susceptible to amoxicillin/clavulanate, success occurred in 296 of 480 (61.7%) participants treated with sulopenem versus 243 of 442 (55.0%) participants treated with amoxicillin/clavulanate (difference, 6.7 percentage points; 95% CI, 0.3 to 13.0). In the primary population with a baseline uropathogen not susceptible to amoxicillin/clavulanate, success occurred in 22 of 42 (52.4%) patients treated with sulopenem versus 17 of 25 (68.0%) patients treated with amoxicillin/clavulanate (difference, -15.6 percentage points; 95% CI, -37.5 to 9.1]. Treatment-emergent adverse events occurred more frequently with sulopenem compared with amoxicillin/clavulanate, including diarrhea (8.1% vs. 4.1%), nausea (4.3% vs. 2.9%), and headache (2.2% vs. 1.5%). Sulopenem was noninferior to amoxicillin/clavulanate for the treatment of adult women with uncomplicated urinary tract infection, but was associated with more frequent mild adverse events. (Funded by Iterum Therapeutics; REASSURE ClinicalTrials.gov number, NCT05584657.).

Prevalence and Predictors of Urinary Tract Infections Among Patients With Type 2 Diabetes Attending Primary Health Care Centers in Buraidah City, Saudi Arabia

2025-06-24

Laila S Alrashedi , Chandra Sekhar | Cureus

An In Vitro Bladder Model of Catheter-Associated Urinary Tract Infection

2025-06-24

O. E. Clarke , Vicky Bennett , Brian V. Jones | Journal of Visualized Experiments

Managing Individual and Community Risk — Broad-Spectrum Antimicrobial Use

2025-06-24

Alyssa R. Letourneau , Lindsey R. Baden | NEJM Evidence

Prevalence and Antimicrobial Susceptibility Pattern of Bacterial Isolated from Urine Culture in Patient with Acute Uncomplicated Cystitis in Vajira Hospital

2025-06-23

| Journal of the Medical Association of Thailand

Objective: To determine the prevalence and antimicrobial susceptibility pattern of bacteria isolated from urine culture in patients with acute uncomplicated cystitis in Vajira Hospital. Materials and Methods: The cross-sectional study … Objective: To determine the prevalence and antimicrobial susceptibility pattern of bacteria isolated from urine culture in patients with acute uncomplicated cystitis in Vajira Hospital. Materials and Methods: The cross-sectional study included 351 cases of acute uncomplicated cystitis between December 1, 2020, and December 31, 2021, at Vajira Hospital. All parameters and laboratory results were collected from the medical records. Results: Escherichia coli was the most prevalent pathogen at 49.9%, followed by Klebsiella pneumoniae at 7.1% and Proteus mirabilis at 3.4%. Other identified pathogens included Staphylococcus saprophyticus at 1.7%, Streptococcus agalactiae at 1.4%, Corynebacterium at 1.2%, and miscellaneous others at 4%. Cephalosporins, with 52.7%, and fluoroquinolones, with 23.8%, were the most common treatments. Amoxicillin or clavulanic acid was the third most prescribed antibiotic at 10.8%, followed by fosfomycin at 8.0%, ertapenem at 2.0%, and trimethoprim/sulfamethoxazole (TMP/SMX) at 1.4%. Notably, E. coli exhibited high resistance to ampicillin for 73.1%, ciprofloxacin for 69.7%, TMP/SMX for 54.9%, and ceftriaxone for 30.3%. K. pneumoniae showed significant resistance to ampicillin for 88%, ciprofloxacin for 72%, and TMP/SMX for 40%). P. mirabilis demonstrated notable resistance to TMP/SMX for 58.3% and ciprofloxacin for 41.7%. Conclusion: E. coli, K. pneumoniae, and P. mirabilis are the common pathogens in acute uncomplicated cystitis at Vajira Hospital. Given their high resistance to fluoroquinolones and TMP/SMX, alternative treatment options should be considered to address antimicrobial resistance effectively.

Incidence trends and epidemiology of invasive device-associated bacteremia in French nursing home residents, 2020–2024: Insights from the SPIADI Prospective Multicenter Study

2025-06-23

Maris Dussartre , Nicolas Duflot , Anne-Sophie Domelier-Valentin +3 more | European Journal of Clinical Microbiology & Infectious Diseases

Abstract Healthcare-associated bacteremia is associated with increased morbidity and mortality. In nursing homes, these infections remain under-documented. We investigated invasive device-associated bacteremia in residents. We analyzed bacteremias acquired in nursing … Abstract Healthcare-associated bacteremia is associated with increased morbidity and mortality. In nursing homes, these infections remain under-documented. We investigated invasive device-associated bacteremia in residents. We analyzed bacteremias acquired in nursing homes using data from a national surveillance program conducted between 2020 and 2024, involving 1,233 French healthcare institutions. A total of 2,117 bacteremias acquired in the nursing home were recorded. The main sources of infection were the urinary tract (52.1%) and the respiratory tract (11.9%). An invasive device was involved in 20.0% of cases, primarily urinary catheters (386 cases), while bacteremia related to intravascular devices was rare (38 cases). Enterobacterales (64.0%) and Staphylococcus aureus (14.6%) were the most frequently identified pathogens, with multidrug-resistant bacteria detected in 15.2% of nursing home-acquired bacteremias. The incidence rate was 0.009 per 1,000 resident-days, remaining stable over the study period. The study highlights the burden of bacteremias in nursing homes and underscores the importance of targeted infection prevention measures, particularly in relation to urinary catheter management, and long-term intravascular central lines.

ISOLATION OF ESCHERICHIA COLI FROM PREGNANT WOMEN’S URINE AT BINANGA HEALTH CENTER MAMUJU

2025-06-22

Abbas Mahmud , Rizki Dyah Haninggar , Ahmady Ahmady | Meditory The Journal of Medical Laboratory

Background: Urinary tract infections (UTIs) and asymptomatic bacteriuria during pregnancy can have detrimental effects on both maternal and fetal health. These conditions are associated with complications such as acute maternal … Background: Urinary tract infections (UTIs) and asymptomatic bacteriuria during pregnancy can have detrimental effects on both maternal and fetal health. These conditions are associated with complications such as acute maternal illness, low birth weight, preeclampsia, preterm delivery, and intrauterine growth restriction. The causative agents of UTIs are Escherichia coli, Klebsiella sp, and Staphylococcus spp.Objective: to isolate and identify E. coli in the urine samples of pregnant womenMethods: This study employed a descriptive observational design. The research sample included pregnant women attending the Binanga Community Health Center in Mamuju. Urine was cultured in BHIB and incubated at 37°C for 24 hours. Subsequent bacterial isolation was performed by subculturing onto EMBA media and MacConkey agar. Colonies that developed were then analyzed using Gram staining and examined microscopically.Results: Of 25 sample urine samples from pregnant women, 25 were culture-positive on MacConkey Media and EMBA Media. 14 (56%) isolate colored bacteria metallic green on EMBA media that EMBA media is specifically for the growth for E. coli bacteriaConclusions: 56% of the bacterial isolates from the urine samples of pregnant women were indicated as Escherichia coli, based on the presence of metallic green colonies observed on EMBA media

Cross-talk between Pseudomonas aeruginosa and urinary tract infections

2025-06-20

Xiao‐Quan Yu , Yuwen Gong , Junqiang Tian +5 more | World Journal of Urology

Monoclonal antibodies targeting the FimH adhesin protect against uropathogenic E. coli UTI

2025-06-20

Edward D. B. Lopatto , Jesús Santiago-Borges , Denise A. Sanick +7 more | Science Advances

As antimicrobial resistance increases, urinary tract infections (UTIs) are expected to pose an increased burden in morbidity and expense on the health care system, increasing the need for alternative antibiotic-sparing … As antimicrobial resistance increases, urinary tract infections (UTIs) are expected to pose an increased burden in morbidity and expense on the health care system, increasing the need for alternative antibiotic-sparing treatments. Most UTIs are caused by uropathogenic Escherichia coli (UPEC), whereas Klebsiella pneumoniae causes a large portion of non-UPEC UTIs. Both bacteria express type 1 pili tipped with the mannose-binding FimH adhesin critical for UTI pathogenesis. We generated and biochemically characterized 33 murine monoclonal antibodies (mAbs) to FimH. Three mAbs protected mice from E. coli UTI. Mechanistically, we show that this protection is Fc independent and mediated by the ability of these mAbs to sterically block FimH function by recognizing a high-affinity FimH conformation. Our data reveal that FimH mAbs hold promise as an antibiotic-sparing treatment strategy.

High Prevalence of Coagulase Negative Staphylococci Among Outpatient Women with Acute Urinary Tract Infection

2025-06-20

Hayam M. Abbas , Sareaa Maseer Gatya Al-Mayahie | Journal of Wasit for Science and Medicine

Urinary tract infections (UTIs) caused by coagulase-negative staphylococci (CoNS) represent a major public health challenge worldwide. The current research focused on the isolation and identification of CoNS' species from pregnant … Urinary tract infections (UTIs) caused by coagulase-negative staphylococci (CoNS) represent a major public health challenge worldwide. The current research focused on the isolation and identification of CoNS' species from pregnant and nonpregnant outpatient women with acute UTI and measuring their antibiogram. From a total number of 137 positive cultures, a 111 (81.0 %) were identified as Staphylococcus spp., a 70.2 % of them were CoNS. Eight species of CoNS were detected by two multiplex PCR protocols. Staphylococcus epidermidis was the most prevalent (36/137: 26.2 %), followed by S. haemolyticus (26/137: 18.9 %). S. capitis was also isolated (1/137: 0.7 %). Whereas 10.9 % of CoNS remained unidentified. An antibiogram assay was conducted. High resistance was against penicillin (84.6 %) and cefoxitin (60.2 %). Resistance to trimethoprim, gentamicin, norfloxacin, ciprofloxacin, and nitrofurantoin were: 37.1 %, 33.3 %, 20.5 %, 16.6 %, and 8.9 %, respectively. However, there are high prevalence of CoNS as uropathogens. Nitrofurantoin, ciprofloxacin, and norfloxacin are a suitable for the treatment of UTIs caused by CoNS.

Development and validation of a machine learning-based prediction model for urinary calculi recurrence

2025-06-19

J. Guo , Jinhang Zhang , Jinxiao Zhang +3 more | Urolithiasis

An unusual cause of recurrent urinary tract infection in a male patient and diagnostic challenge: a case report

2025-06-19

Said Darwesh , Hilary Chipongo | International Journal of Surgery Case Reports

Does Routine Urine Culture Testing Before Endoscopic Prostate Surgery Decrease Postoperative Urinary Tract Infection? An Analysis of the Veterans Affairs Surgical Quality Improvement Program

2025-06-19

Muhieddine Labban , William J. O’Brien , Kalpana Gupta +1 more | Urology Practice

Endoscopic prostate surgery increases septic morbidity and mortality. While urology guidelines recommend preoperative urine testing, surgeons determine what test to obtain. It remains unknown whether preoperative urine culture (UCX) decreases … Endoscopic prostate surgery increases septic morbidity and mortality. While urology guidelines recommend preoperative urine testing, surgeons determine what test to obtain. It remains unknown whether preoperative urine culture (UCX) decreases postoperative urinary tract infections (UTI) in these patients. A retrospective analysis of a prospectively collected cohort of men who underwent benign prostate endoscopic surgery including transurethral resection of the prostate (TURP), laser enucleation (LEP), laser vaporization, and Redo-TURP was collected via the Veterans Affairs Surgical Quality Improvement Program between 2015-2022. We evaluated patients with postoperative UTI within 30 days of surgery and identified factors associated with preoperative UCX testing. The cohort included 22,825 veterans, with 83.5% undergoing preoperative UCX. Adjusted analysis showed no association between preoperative UCX and postoperative UTI (aOR=0.89; 95%CI [0.72-1.10]; p=0.29). A historically positive UCX within a year before surgery was the strongest factor associated with postoperative UTI (aOR=1.33; 95%CI [1.13- 1.57]; p=0.001). Men who had LEP (vs.TURP) were less likely to have postoperative UTI (aOR=0.56; 95%CI [0.31-0.92]; p=0.031). Factors associated with preoperative UCX testing included men with a historically positive UCX (aOR=1.62; 95%CI [1.51-1.73]; p<0.001) and undergoing LEP (vs. laser vaporization) (aOR=1.83; 95%CI [1.49-2.27]; p<0.001). Routine preoperative UCX testing was not associated with postoperative UTI risk in endoscopic prostate surgery. Veterans with a historically positive UCX were more likely to receive a preoperative UCX but still had higher postoperative UTI risk. It remains unclear if these patients may be better served by broader spectrum periprocedural antibiotics as opposed to culture-directed antibiotics.

Comparing fosfomycin and ciprofloxacin for uncomplicated UTI treatment in adults: better bacterial eradication but non-significant clinical remission—a systematic review and meta-analysis

2025-06-19

Muhammad Usman Hashmi , Yasmeen Sufi , Tosief Zahoor +7 more | International Urology and Nephrology

A Cross-Sectional Study on Spectrum of Bacteria Causing Urinary Tract Infections and Their Sensitivity Pattern in Patients with Lower Urinary Tract Symptoms at Akash Hospital

2025-06-19

A H Lohith , R Chethan , P Prajwal +2 more | International Journal of Science and Research (IJSR)

Clinical insights on efficacy of adjuvant amikacin combined with oral levofloxacin as prophylaxis for transrectal prostate biopsy in patients harboring fluoroquinolone-resistant Escherichia coli in rectal flora

2025-06-19

Shahab E. Saqib , Sadia Siddique , Jyoti Kumari +3 more | International Urology and Nephrology

Supporting safe urinary catheter insertion by promoting ANTT® principles

2025-06-19

Stephen Rowley , Simon Clare , Sarah Gallagher | British Journal of Nursing

The most recent national point prevalence survey on healthcare-associated infections in the NHS in England recorded catheter-associated urinary tract infection as 17.5% of all healthcare-associated infections. Much of this infection … The most recent national point prevalence survey on healthcare-associated infections in the NHS in England recorded catheter-associated urinary tract infection as 17.5% of all healthcare-associated infections. Much of this infection risk is associated with the catheter insertion process. This article explains how a procedure pack that has been specifically designed with Aseptic Non Touch Technique (ANTT®) principles in mind can not only help to ensure practitioners have all the right equipment at hand, but can also sequence a best practice approach to safe urinary catheter insertion by design.

Efficacy and Safety of Fosfomycin Disodium in Patients with Bacterial Infections: A Single-Center, Real-Life Clinical Study

2025-06-19

Fabio Luciano , Lorenzo Bertolino , Fabian Patauner +7 more | Journal of Clinical Medicine

Objectives: Fosfomycin is an old antibiotic that has recently gained attention owing to its preserved activity against multidrug-resistant (MDR) bacteria. Data on its use in real life are limited. Thus, … Objectives: Fosfomycin is an old antibiotic that has recently gained attention owing to its preserved activity against multidrug-resistant (MDR) bacteria. Data on its use in real life are limited. Thus, we evaluated the efficacy and safety of fosfomycin disodium in the context of our hospital clinical practice. Methods: Single-center, retrospective, observational study on 56 patients who received fosfomycin disodium from September 2016 to July 2023, focusing on clinical and microbiological outcomes and adverse events. Results: Included in this study were 56 patients. Fosfomycin disodium was administered for a median duration of 10 days [5-13.5] and was always used in combination with other antibiotics, more frequently with meropenem (16 cases, 28.6%) and colistin (11 cases, 19.6%). It was mostly used for treating pneumonia (41%), followed by bloodstream infections (19.6%), urinary tract infections (16.1%), bone infections (16.1%), and surgical site infections (7.1%). The most common isolated pathogen was Pseudomonas aeruginosa (17%), and polymicrobial infections were detected in 18 patients (32%). Among the isolated bacteria, 36 (44.4%) were MDR. The complete resolution, defined as the disappearance of symptoms, eradication of the causative microorganism, and decrease in CRP levels, was achieved in 39% of cases. During treatment, we observed electrolyte imbalances, in particular a decrease in serum potassium (0.6 mEq/L [0.3-1.1]), calcium (0.7 mEq/L [0.3-1.1]) and magnesium levels (0.3 mg/dL [0.20-0.48]), and an increase in serum sodium levels (4 mEq/dL [2-7]). Changes in potassium and sodium levels were more pronounced in patients with prior kidney dysfunction and heart failure, respectively, and in patients receiving fosfomycin diluted with saline compared with 5% glucose solution (p = 0.04). Conclusions: Fosfomycin is effective in treating complicated infections in comorbid patients when combined with other antimicrobials. During treatment, major electrolyte imbalances occur that require careful monitoring and correction, especially in patients with prior kidney disease.

Effects of Routine Catheterization on Urinary Tract Infection Rates After Minor Gynecologic Surgeries

2025-06-18

Sana Zekri | Obstetrics and Gynecology

Urinary Tract Infections in Elderly Patients in Tripoli, Libya: A Study on Bacterial Isolation and Antimicrobial Susceptibility

2025-06-18

Najla Elyounsi , Fatma Alazabi | Khalij-Libya Journal of Dental and Medical Research

Urinary tract infections (UTIs) are considered the most widespread bacterial infections and among the most common nosocomial infections, second only to lower respiratory tract infections. The risk of developing a … Urinary tract infections (UTIs) are considered the most widespread bacterial infections and among the most common nosocomial infections, second only to lower respiratory tract infections. The risk of developing a UTI increases with age, making UTIs among the most commonly diagnosed infections in elderly people, representing a significant public health problem. This study aimed to isolate and detect the microbial responsible for urinary tract infections in elderly individuals and determine their resistance patterns and sensitivity to antibiotics among Libyan patients in Tripoli city. The study was conducted simultaneously in Alsharik, Eltafoq, and Ibn Al Nafis laboratories in Tripoli, Libya, during July and August 2024. One hundred and one urine samples were collected from elderly participants suffering from UTI symptoms (38 males and 63 females), with ages ranging from 60 to 97 years. Isolation, biochemical identification, and antibiotic susceptibility analyses were performed. Thirteen antibiotics were tested in this study. Among the 101 isolated samples from elderly patients with suspected UTI, females had a higher prevalence of bacterial infections (62.4%) compared to males (37.6%). The highest number of infections was in the 60–69 years age group (45.4%). Gram-negative organisms accounted for 91.1% of isolates compared to Gram-positive organisms. Escherichia coli was the most common organism isolated (43.6%), followed by Klebsiella pneumoniae (29.7%). Most isolates were resistant to Ampicillin (31.7%) and Amoxicillin (23.8%), followed by Tetracycline (10.9%). The Gram-positive organisms Streptococcus pneumoniae, Enterobacter spp., and Staphylococcus aureus were most susceptible to Amoxicillin, Amikacin, and Meropenem, with sensitivity rates of 75%, 66.7%, and 50%, respectively. E. coli was more susceptible to Imipenem (25%), Amikacin (22.7%), and Nitrofurantoin (13.6%), whereas Amoxicillin and Sulfamethoxazole/Trimethoprim showed lower efficacy. Gram-negative bacteria were the main cause of UTIs in the study population, mainly belonging to the E. coli and Klebsiella families. Age and gender were significant factors in determining UTI etiology, and considering these factors can improve the accuracy in identifying causative uropathogens and guide empirical treatment.

Prevalence of Methicillin Resistance Staphylococcus aureus in Clinical Isolates

2025-06-18

Falah Hasan Obayes Al-Khikani , Ali Alhusayni , Sabreen Hamdan Jasim | Bengal Physician Journal

Prostatic Abscess by Morganella morganii

2025-06-18

Minoru Sakakiyama , Kôji Hayashi , Mauro Shugiro Tada +6 more | Cureus

Association between urinary tract infections and anemia among the elderly in India: Insights from the longitudinal aging study

2025-06-18

Dilwar Hussain , Jenica Barnwal | PLOS Global Public Health

Urinary tract infections (UTIs) among the elderly remain an overlooked and important health concern, which can hamper their physical and overall well-being. From an epidemiological perspective, UTIs represent a common … Urinary tract infections (UTIs) among the elderly remain an overlooked and important health concern, which can hamper their physical and overall well-being. From an epidemiological perspective, UTIs represent a common yet preventable infection. This study aimed to examine the association between UTIs and anemia in India, along with other determinants, using data from the Longitudinal Aging Study in India (LASI), Wave 1 (2017–18), among the elderly (aged more than 60). It explores how health, socio-demographic, economic, and regional factors contribute to UTI prevalence, providing insights into the underlying vulnerabilities within this population. Descriptive statistics, variance inflation factor, and multivariate binary logistic regression models were applied to examine the association between UTIs and factors such as anemia, age, gender, education, income, and access to sanitation facilities. Results revealed that about 2.5% of the elderly had UTIs, with higher rates observed in males, those over 80 years old, and individuals who were diabetic or anemic. The study also sheds light upon geographical variations, with the Eastern region having the highest prevalence and Southern India the lowest. Major predictors of UTIs include advancing age, lower income, experience of stroke, diagnosis of hypertension, presence of diabetes, lack of education, and inadequate sanitation, with anemia serving as a significant risk factor. Surprisingly, higher education levels were associated with increased self-reporting of UTIs, likely due to greater awareness. Tackling UTIs and related health concerns among India’s elderly requires targeted interventions strengthening healthcare access, improving sanitation, and promoting public awareness. With a growing aging population, these measures are important to enhancing their well-being and ensuring healthier later years, leading to the achievement of SDG 3.

Role of GuaB, the inosine-5′-monophosphate dehydrogenase of uropathogenic Escherichia coli pathogenicity: a key factor for bladder infection

2025-06-17

Mizuki Shimokawa , Ayako Takita , Kazutomo Suzue +7 more | Microbiology Spectrum

ABSTRACT Uropathogenic Escherichia coli (UPEC) is the primary causative agent of urinary tract infections (UTIs). This bacterium infects the bladder through the urinary tract, and some bacteria ascend to the … ABSTRACT Uropathogenic Escherichia coli (UPEC) is the primary causative agent of urinary tract infections (UTIs). This bacterium infects the bladder through the urinary tract, and some bacteria ascend to the kidneys, leading to more severe conditions such as pyelonephritis and sepsis. The infection of the bladder by UPEC is a critical initial step in the development of UTIs. Once inside the bladder, UPEC forms microcolonies both within and outside bladder epithelial cells, allowing it to persist in the bladder by resisting urine flow, innate immunity, and antimicrobials. In this study, to look for novel factors of UPEC that contribute to bladder infection and persistence, we analyzed proteins expressed at significant levels by UPEC in the bladder using a UTI mouse model. Mass spectrometry detected over 30 candidate proteins, including those already reported to play important roles in bladder infection, such as OmpA, components of the iron acquisition system, and the Tol/Pal system. Among them, GuaB (inosine-5′-monophosphate dehydrogenase) emerged as a key factor for bladder infection. The GuaB mutant showed impaired growth in urine-mimicking conditions and reduced infection efficiency, attributed to decreased GMP production. GuaB expression was upregulated in urine-like conditions, influenced by urea. This highlights GuaB’s role in UPEC pathogenicity. These findings suggest GuaB as a potential target for new therapeutic strategies against UPEC-related UTIs, especially amid growing antimicrobial resistance. IMPORTANCE Uropathogenic Escherichia coli (UPEC) is the most common cause of urinary tract infections (UTIs). UTI caused by UPEC is often recurrent, and repeated use of antimicrobial agents is feared to lead to the spread of drug-resistant strains. In fact, quinolone-resistant and extended spectrum β-lactamase-producing strains have been rapidly increasing since 2000. Therefore, improvement of current treatment methods, including new therapeutic agents against UPEC, is desired. In this study, we analyzed proteins significantly expressed in the bladder of UTI mice by proteomic analysis in order to identify new factors contributing to UPEC infection of the bladder. Among them, we found GuaB (inosine-5′-monophosphate dehydrogenase), which is important for bladder infection. Furthermore, we characterized the role of GuaB in bladder infection and the mechanism by which GuaB induces its expression in urine. Our findings will contribute not only to further understanding of UPEC pathogenesis but also to the development of new antimicrobial strategies.

Asymptomatic Urinary Tract Infection among students at Middle Technical University

2025-06-17

| Muthanna Journal of Pure Science

Asymptomatic urinary tract infections (UTIs), also referred to as asymptomatic bacteriuria, are defined by the presence of bacteria in the urinary tract in the absence of overt symptoms. This condition, … Asymptomatic urinary tract infections (UTIs), also referred to as asymptomatic bacteriuria, are defined by the presence of bacteria in the urinary tract in the absence of overt symptoms. This condition, which is particularly common among female college students, can result in severe infections if left untreated and contribute to antimicrobial resistance when mismanaged. The objective of the investigation is to investigate the prevalence, risk factors, and bacterial etiology of asymptomatic UTIs among students at Middle Technical University in Baghdad, Iraq. Methods: A descriptive cross-sectional study was conducted from February 2023 to May 2024, with 100 students, 49, 51 were males and female respectively within the age range of 18 to 24 years. selected through stratified random sampling. Self-administered questionnaires were utilised to collect data regarding personal history, health practices, and dietary patterns. MacConkey, CLED, and blood agar were employed to culture midstream urine samples, and standard biochemical assays were employed to identify microorganisms. In order to identify bacterial antibodies in serum samples, ELISA was implemented. The statistical analysis identified correlations between UTI positivity and demographic, behavioural, and clinical variables. Results: Asymptomatic bacteriuria was prevalent in 15% of the population, with a higher incidence in females (21.6%) than in males (8.2%). Staphylococcus aureus (33.3%) was the second most frequently identified pathogen, following Escherichia coli (46.7%). On-campus housing, inadequate hand hygiene, holding urine, low water intake, and prior UTI history were found to be risk factors substantially associated with UTI positivity (p [] 0.001). The diagnostic accuracy of ELISA and culture was exceptional, with 100% sensitivity and specificity. Conclusion: This study indicates that students at Middle Technical University, particularly females, have a significant prevalence of asymptomatic urinary tract infections (UTIs). The study identifies inadequate hydration, poor hygiene practices, prolonged urine retention, and campus living conditions as specific risk factors that elevate the likelihood of infection. The necessity for targeted preventive strategies is underscored by the recent emergence of Escherichia coli and Staphylococcus aureus as the predominant uropathogens. The study shown that ELISA and urine culture are very accurate diagnostic methods, which is advantageous as asymptomatic UTIs can be challenging to detect. Regular screening of high-risk people is essential, since untreated asymptomatic bacteriuria may result in symptomatic infections and antibiotic resistance. To diminish the incidence of infections, it is essential to promote educational initiatives that underscore the need of appropriate cleanliness, enough hydration, and prudent antibiotic usage. To enhance treatment and preventative strategies, future research should assess health outcomes over extended durations and analyse bigger population samples.

Impact of Maternal Microbiota Composition on Neonatal Immunity and Early Childhood Allergies: A Systematic Review

2025-06-17

Ayah Nabil Al Jehani , Muhammad Shuaib , Arwa Alsharif +7 more | Pediatric Reports

Background: The maternal microbiota serve as a key regulator of neonatal immune development and early-life health outcomes. This systematic review aims to find out how the makeup of the maternal … Background: The maternal microbiota serve as a key regulator of neonatal immune development and early-life health outcomes. This systematic review aims to find out how the makeup of the maternal microbiota affects newborn immunity and the risk of allergies, identify which microbes are linked to a higher or lower chance of allergies, and assess treatments that could improve newborn immune health. Methods: We conducted a systematic search in PubMed, MEDLINE, and Web of Science, adhering to the PRISMA guidelines. We included randomized controlled trials (RCTs), cohort studies, and observational studies that looked at how the makeup of the maternal microbiota affects newborn immune responses or allergic outcomes in early life. We conducted a systematic search, and the quality of the studies was evaluated using the GRADE system and tools to check for bias (RoB 2, Newcastle-Ottawa Scale, MINORS). Results: We included a total of 74 studies. The main findings showed that having a cesarean delivery and using certain antibiotics during pregnancy increased the risk of allergies, while breastfeeding, taking probiotics, and changing the mother's diet helped to protect against allergies. Maternal stress had a negative association with the microbiota composition (OR = 1.9-2.4) and neonatal immune regulation. Moreover, the study noted significant geographic variation in the microbiota's influence, underscoring the importance of contextualized interventions. Conclusions: The composition of the maternal microbiota has a major impact on neonatal immunity and the risk of early-life allergy. Adverse factors include cesarean birth, antibiotic exposure, and maternal stress, all of which have been associated with alterations in neonatal immunity. More studies are required to validate promising microbiota-targeted strategies and develop evidence-based guidelines to improve maternal and neonatal immune health.

Investigation of Therapeutic Efficacy of Intravesical Tigecycline Administration in Rats with Cystitis Induced by Extensively Drug-Resistant (XDR), Tigecycline-Sensitive Acinetobacter baumannii Strain

2025-06-16

Cihan Yüksel , Işıl Deniz Aliravcı , Murat Koşan +6 more | Antibiotics

This study aimed to evaluate the therapeutic efficacy of intravesical tigecycline administration in a rat model of cystitis induced by a tigecycline-sensitive, extensively drug-resistant (XDR) Acinetobacter baumannii strain. Thirty-six female … This study aimed to evaluate the therapeutic efficacy of intravesical tigecycline administration in a rat model of cystitis induced by a tigecycline-sensitive, extensively drug-resistant (XDR) Acinetobacter baumannii strain. Thirty-six female Wistar albino rats were inoculated intravesically with XDR A. baumannii to induce cystitis. Twenty-four rats that developed infection were divided into four groups: untreated control, saline irrigation, low-dose tigecycline (6.25 mg/kg), and high-dose tigecycline (25 mg/kg). Microbiological clearance was assessed via urine cultures on days 3 and 5. Bladder tissues were analyzed histopathologically and for genotoxicity using the Comet assay. On day 5, microbiological clearance was significantly higher in tigecycline-treated groups compared to controls (p = 0.028). Histopathology revealed significantly more inflammation in the high-dose tigecycline group (p = 0.029). Genotoxicity was observed in both tigecycline groups, independent of dose (p < 0.05). Intravesical tigecycline demonstrated microbiological efficacy against XDR A. baumannii-induced cystitis. However, its inflammatory and genotoxic potential necessitates further preclinical evaluation.

Endoscopic lithotripsy in patients with asymptomatic bacteriuria

2025-06-16

Vigen Malkhasyan , Nariman Gadzhiev , С О Сухих +3 more | Uro-Technology Journal

Cumulative antibiotic exposure is associated with ceftriaxone resistance among patients with urinary source Gram-negative bloodstream infection: A retrospective cohort study

2025-06-16

Aaron J. Tande , Ryan W. Stevens , Dan Ilges +2 more | Clinical Infectious Diseases

Abstract Background We investigated the relationship between cumulative, historical antibiotic therapy and the presence of ceftriaxone-resistant (CRO-R) Enterobacterales bloodstream infections (BSI) from urinary sources. Methods Adult patients established with primary … Abstract Background We investigated the relationship between cumulative, historical antibiotic therapy and the presence of ceftriaxone-resistant (CRO-R) Enterobacterales bloodstream infections (BSI) from urinary sources. Methods Adult patients established with primary care at Mayo Clinic with a first episode of monomicrobial Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca, or Proteus mirabilis BSI from a urinary source from May 2019-May 2023 were included. Antibiotic therapy over the year prior to BSI was quantified as days of therapy (DOT), cumulative modified Antibiotic Spectrum Index (mASI), and cumulative Days of Antibiotic Spectrum Coverage (DASC) using prescription data. Patients with CRO-R urinary pathogens prior to antibiotic therapy assessment were excluded. Results 721 adults had monomicrobial Gram-negative BSI, including 70 patients (9.7%) with a CRO-R pathogen and 651 patients (90.3%) with a ceftriaxone-susceptible (CRO-S) pathogen. In the 12 months prior to BSI, levels of antibiotic DOT, mASI, and DASC were significantly greater among patients with CRO-R BSI than CRO-S BSI (p&lt;0.001). The median time from blood culture collection to appropriate antibiotic therapy was significantly longer in the CRO-R group (24 hours, IQR 16-48) than the CRO-S group (1 hour, IQR 0-2) (p &lt;0.001). Increasing cumulative antibiotic therapy prior to BSI, as quantified by the mASI, was significantly associated with increased risk of 1-year CDI after BSI (P = 0.027). Conclusion Patients with first episode CRO-R Enterobacterales BSI had significantly greater prior antibiotic exposure than patients with CRO-S BSI and experienced significant delay of appropriate therapy. Routine quantitation and reporting of prior antibiotic therapy may improve empiric prescribing.

OVERVIEW OF BACTERIA TYPES AND ANTIBACTERIAL RESISTANCE PATTERNS AMONG PATIENTS WITH URINARY TRACT INFECTIONS

2025-06-15

Iin Novita Nurhidayati Mahmuda , FATHIYYA N. AFFIFAH , TRI AGUSTINA +3 more | International Journal of Applied Pharmaceutics

Objective: This study aimed to characterize bacterial types and antibacterial resistance patterns in UTI patients in Surakarta. Methods: The study was conducted at PKU Muhammadiyah Surakarta Hospital using a descriptive … Objective: This study aimed to characterize bacterial types and antibacterial resistance patterns in UTI patients in Surakarta. Methods: The study was conducted at PKU Muhammadiyah Surakarta Hospital using a descriptive observational design of demographic data and bacterial culture results that were tested for antibiotic resistance with a cross-sectional approach. A total of 56 UTI patients were included through total sampling of inpatients at PKU Muhammadiyah Surakarta Hospital. Patient demographic data were collected from medical records and antibiotic sensitivity test results were performed on urine bacterial culture results with bactec media using a VITEK 2 compact culture machine. Results: Of the 56 patients, 43 were infected with Gram-negative bacteria and 13 with Gram-positive bacteria. Fourteen bacterial species were identified, with non-ESBL Escherichia coli being the most prevalent (33.9%), followed by Klebsiella pneumoniae (10.7%), ESBL strain E. coli (8.9%), Staphylococcus aureus (8.9%), Enterobacter cloacae (8.9%), Streptococcus sp. (7.1%), Pseudomonas aeruginosa (5.4%), and Enterococcus faecalis (5.4%). The remaining species, each representing 1.8% of the cases, included Flavimonas oryzihabitans, Kluyvera sp., Raoultella ornitholytica, Proteus mirabilis, Aeromonas hydrophila, and Staphylococcus epidermidis. Conclusion: This study revealed diverse resistance patterns among different g-positive and g-negative bacterial species against the tested antibiotics based on local bacterial patterns. These findings emphasize the importance of ongoing surveillance and targeted antibiotic strategies in effectively managing UTIs with local antibiotic stewardship management.

Molecular Investigation of Nitrofurantoin Resistance Genes in Escherichia coli Isolates from Urinary Tract Infections

2025-06-15

Zaigham Abbas , Hasan Faisal Hussein Kahya | INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY

This study was conducted to determine the mechanisms of Escherichia coli resistance to the antibiotic nitrofurantoin in clinical isolates from urinary tract infections. One hundred samples were collected from patients … This study was conducted to determine the mechanisms of Escherichia coli resistance to the antibiotic nitrofurantoin in clinical isolates from urinary tract infections. One hundred samples were collected from patients in hospitals in Mosul, Iraq, and isolates were diagnosed using routine laboratory tests. The minimum inhibitory concentration of nitrofurantoin was determined by micro-dilution. Polymerase Chain Reaction (PCR) was performed to detect the 16SrRNA, nfsA, and nfsB genes. The results showed that 13 isolates (35%) were resistant and 9 (24%) were sensitive to nitrofurantoin. The Minimum Inhibitory Concentration (MIC) values for the sensitive isolates ranged between 83.33-166 µg/mL. Deletion mutations were found in the nfsA and nfsB genes, along with several point mutations that resulted in the production of defective enzymes, explaining the resistance to nitrofurantoin. The study concluded that mutations in the nfsA and nfsB loci are the main cause of nitrofurantoin resistance in the strains.

Investigation of Antibiotic Resistance Rates of Bacteria Causing Urinary System Infection

2025-06-14

Fatih Mehmet Akıllı , Beste Akıllı , Bilgehan Ergan | Bozok Tıp Dergisi

Urinary tract infection(UTI) is a prevalent health concern globally. The objective of this project was to evaluate the frequencies of pathogens associated with UTI and their antimicrobial susceptibility patterns, as … Urinary tract infection(UTI) is a prevalent health concern globally. The objective of this project was to evaluate the frequencies of pathogens associated with UTI and their antimicrobial susceptibility patterns, as well as extended-spectrum beta-lactamase(ESBL) rates. Urine culture results between January 2023 and December 2023 were examined retrospectively. Additionally, variables such as age, sex, and medical department were documented. The study included patients aged 18 years or above with pathogenic bacterial growth in their urine cultures. The identification of bacteria and their antibiotic susceptibility was conducted using conventional methods or the VITEK2-Compact system. Of 3135 urine samples considered to be causative agents were evaluated. 2495 Escherichia coli, 404 Klebsiella spp., 117 Proteus mirabilis, 57 Pseudomonas spp., 19 Acinetobacter spp., and 43 other enterobacterales members were detected. ESBL positivity rates were found to be for E. coli 14.9% and for Klebsiella spp. 23.2%. Resistance rates of hospital-acquired infection agents were found to be significantly higher than community-acquired. More than 90% susceptibility to carbapenems and aminoglycosides has been detected. It is beneficial to be aware of the evolution of antibiotic resistance over time, particularly when embarking on empirical therapy. The elevated level of quinolone resistance in hospital-acquired infections can be attributed to its utilisation for a multitude of indications, including pneumonia, gastroenteritis, and urinary tract infections. Our findings indicate that ciprofloxacin, trimethoprim-sulfamethoxazole, and ampicillin are unsuitable for the empirical treatment of UTIs, while nitrofurantoin and fosfomycin represent rational options. We believe that these data will shed light on empirical treatments in our hospital.

Prevalence of Urinary Tract Infections Among Patients Attending Some Selected Hospitals in Akure, Ondo State, Nigeria

2025-06-14

Temidayo Odianosen Faloye , Muftau Kolawole Oladunmoye , F. O. Omoya | Asian Journal of Biological Sciences

Emergency and persistence of Escherichia coli ST131 as community-onset antimicrobial resistant urinary tract infection in Rio de Janeiro, Brazil

2025-06-14

Eduardo Moreira de Castro , Isadora Silva Barcellos , Guilherme Santoro‐Lopes +7 more | The Brazilian Journal of Infectious Diseases

Comment on “Estimating individual risk of catheter-associated urinary tract infections using explainable artificial intelligence on clinical data”

2025-06-13

Ya Zhang , Xiaofang Qi , Wei Geng | American Journal of Infection Control

1474-P: Urinary Microbiome Differences in Postmenopausal Women with Type 2 Diabetes Mellitus

2025-06-13

Ujjaini Basu , Michael L. Neugent , Sara B Papp +4 more | Diabetes

Introduction and Objective: Urinary tract infections (UTIs) pose a significant burden on individuals with Type II Diabetes Mellitus (T2DM). UTIs are not only more prevalent in T2DM patients but also … Introduction and Objective: Urinary tract infections (UTIs) pose a significant burden on individuals with Type II Diabetes Mellitus (T2DM). UTIs are not only more prevalent in T2DM patients but also tend to be more severe. Managing UTIs effectively is crucial to prevent adverse outcomes and improve quality of life. Yet, the biological factors underlying UTI susceptibility associated with T2DM are not well understood. Recent research has highlighted a role for the female urinary microbiome (FUM) in UTI susceptibility. However, if FUM dysbiosis is exacerbated in people with diabetes remains unknown. We hypothesize that differences in FUM composition exist in women with T2DM and that these differences may underlie increased UTI susceptibility. The goal of this study is to define the FUM associated with T2DM in postmenopausal (PM) women with and without UTI. Methods: Following IRB approval and informed consent, urine was collected from 100 PM women passing exclusion criteria of post-void residual &gt;150 mL, immune deficiency, prolapse &gt;stage 2, catheterization, neurogenic bladder, or recent surgery representing four groups: noUTI/noT2DM, UTI/noT2DM, noUTI/T2DM, UTI/T2DM (N=25 each). Genomic DNA was extracted using the Zymo DNA/RNA kit for shotgun metagenomic sequencing on an Illumina NextSeq2000. Trimgalore and KneadData were used for quality control and host read removal, respectively. MetaPhlan 4 was used for read-based taxonomic assignment. Results: Preliminary analysis revealed a prevalence of Lactobacillus spp. in the FUM of noUTI/noT2DM women and an abundance of Gardenerella vaginalis and Fannyhessea vaginae in the noUTI/T2DM group. In women with active UTI, the FUM of patients without T2DM were dominated by one or two uropathogens like Escherichia coli, Klebsiella pneumoniae or Enterococcus faecalis. Conversely, the FUM of UTI patients with T2DM were more polymicrobial with increased species diversity. Conclusion: Urinary microbiomes of PM women with T2DM may harbor more polymicrobial populations compared to non-diabetic counterparts. Disclosure U. Basu: None. M.L. Neugent: None. S.B. Papp: None. C.N. Saenz: None. R.S. Ahmed: None. P.E. Zimmern: None. N.J. De Nisco: None.

Uropathogenic Escherichia coli Associated with Risk of Urosepsis—Genetic, Proteomic, and Metabolomic Studies

2025-06-13

Beata Krawczyk , Paweł Wityk , Magdalena Burzyńska +2 more | International Journal of Molecular Sciences

In the absence of fully effective therapies and preventive strategies against the development of urosepsis, a deeper understanding of the virulence mechanisms of Uropathogenic Escherichia coli (UPEC) strains is needed. … In the absence of fully effective therapies and preventive strategies against the development of urosepsis, a deeper understanding of the virulence mechanisms of Uropathogenic Escherichia coli (UPEC) strains is needed. UPEC strains employ a wide range of virulence factors (VFs) to persist in the urinary tract and bloodstream. UPEC strains were isolated from patients with sepsis and a control group without sepsis. PCR was used to detect 36 genes encoding various groups of virulence and fitness factors. Profiling of both intracellular and extracellular bacterial proteins was also included in our approach. Bacterial metabolites were identified and quantified using GC-MS and LC-MS techniques. The UpaG autotransporter, a trimeric E. coli AT adhesin, was significantly more prevalent in urosepsis strains (p = 0.00001). Iron uptake via aerobactin and the Iha protein also appeared to be predictive of urosepsis (p = 0.03 and p = 0.002, respectively). While some studies suggest an association between S fimbriae and the risk of urosepsis, we observed no such correlation (p = 0.0001). Proteomic and metabolomic analyses indicated that elevated levels of bacterial citrate, malate, coenzyme Q10, pectinesterase (YbhC), and glutamate transport proteins, as well as the regulators PhoP two-component system, CpxR two-component system, Nitrate/nitrite response regulator protein NarL, and the Ferrienterobactin receptor FepA, may play a role in sepsis. These genetic biomarkers, proteins, and metabolites derived from UPEC could potentially serve as indicators for assessing the risk of developing sepsis.

INFECÇÃO URINÁRIA

2025-06-12

GUSTAVO LUIZ SILVA ROCHA COUTO , ARTHUR BARACHO DA FONSECA , LUCAS GAEDE CASTELANI BORZAGLI +1 more | Editora Pasteur eBooks

Prevalence and antibiotics susceptibility of uropathogens isolated from urinary tract of patients at St. Lukes hospital Anua, Uyo

2025-06-11

G Ikon , Nelson Alvis‐Guzmán , Anosike Ignatius Kelechi | Deleted Journal

Urinarytract infections (UTI) are preventablebacterial infections encountered in the hospital and community settings. Despite the wide availability of antibiotics, uropathogens are among thebacterial infectionscommonly encountered with increasing antibiotic resistance.This study … Urinarytract infections (UTI) are preventablebacterial infections encountered in the hospital and community settings. Despite the wide availability of antibiotics, uropathogens are among thebacterial infectionscommonly encountered with increasing antibiotic resistance.This study was carried out to establish the prevalence of bacterial isolates and their drug susceptibility patterns among the study population. A descriptive cross-sectional study was conducted using the outpatients and inpatientspresented with symptoms of UTIat St. Lukes Hospital Anua, Uyo. Purposeful sampling was used to obtain 385 respondents. Midstream urine samples were obtained from respondents using sterile bottles. Bacterial isolates identification was done using biochemical tests while culture and sensitivity pattern of the isolates were determined using disc diffusion method. A questionnaire was administered to the respondents and data associated with risk factors was collected and analyzed at a = 0.05. Out of 385 urine samples, 112 (29%) patients were confirmed positive for UTI. The prevalence of UTI was higher among females (62.1%) compared to males (37.9%). Escherichia coli (55%) was the most predominant followed by Klebsiella pneumoniae (10%), coagulase negative staphylococci (20.9%), Staphylococcus aureus (9.2%) and Proteus mirabilis (5%). The effectiveness of the antibiotics used varied among the isolates, and majority of the Gram positive isolates were sensitive to most antibiotics tested than the Gram negatives.Further 85% of the isolates were observed to be multidrug resistant, limiting treatment of UTIs with routinely used antibiotics. Hence, there is need for constant monitoring of antibiotics resistance for better management of patients on antibiotic treatment. In addition, the collected data could be used to determine the trends in antimicrobial susceptibility patterns and therefore, assists in policy formulation on the currently used antibiotics for management of UTIs.