Sepsis neonatal: Diagnóstico y tratamiento

La sepsis neonatal es causa importante de morbilidad y mortalidad. La OMS reporta que anualmente mueren 2,4 millones de bebés durante el primer mes de vida, siendo la sepsis neonatal una de las principales causas. El objetivo es actualizar en el diagnóstico y tratamiento de la sepsis neonatal. En esta investigación se realizó una revisión de la literatura para sintetizar hallazgos relevantes sobre sepsis neonatal, que se define como afección sistémica, caracterizada por cambios hemodinámicos y otras manifestaciones clínicas, como respuesta desregulada a la infección. La sepsis neonatal precoz se relaciona con factores de riesgo maternos y los microorganismos causantes son del tracto genitourinario materno, mientras que la tardía es causada por gérmenes intrahospitalarios, en neonatos con estancia hospitalaria prolongada y sometidos a procedimientos invasivos. Los signos y síntomas de sepsis neonatal son inespecíficos, lo que hace difícil su diagnóstico, se recomienda identificar factores de riesgo y evaluación clínica minuciosa. Los establecimientos de salud deben realizar vigilancia epidemiológica de gérmenes más frecuentes y sensibilidad antibiótica, para garantizar tratamiento antibiótico adecuado.

Neonatal sepsis is a major cause of morbidity and mortality. The WHO reports that 2.4 million babies die annually during the first month of life, with neonatal sepsis being one of the main causes. The objective is to update the diagnosis and treatment of neonatal sepsis. In this research, a review of the literature was carried out to synthesize relevant findings on neonatal sepsis, which is defined as a systemic condition, characterized by hemodynamic changes and other clinical manifestations, as a deregulated response to infection. Early-onset neonatal sepsis is related to maternal risk factors and the causative microorganisms are from the maternal genitourinary tract, while late-onset sepsis is caused by nosocomial germs, in neonates with prolonged hospital stay and subjected to invasive procedures. The signs and symptoms of neonatal sepsis are nonspecific, which makes its diagnosis difficult, it is recommended to identify risk factors and a thorough clinical evaluation. Health establishments must carry out epidemiological surveillance of the most frequent germs and antibiotic sensitivity, to guarantee adequate antibiotic treatment.

Bacteriuria asintomática en el embarazo. Serie de casos en una clínica privada de Uruapan, Michoacán / Asymptomatic bacteriuria in pregnancy. Cases series in a private clinic in Uruapan Michoacán

Resumen OBJETIVO: Determinar la prevalencia de bacteriuria asintomática, su adecuado tratamiento con base en el reporte del antibiograma de pacientes embarazadas que acudieron a control prenatal en una clínica privada. MATERIALES Y MÉTODOS: Estudio retrospectivo de una serie de casos, descriptivo y transversal efectuado en mujeres embarazadas que acudieron a control prenatal en la consulta externa del Hospital Fray Juan de San Miguel de Uruapan, Michoacán, entre el 1 de enero de 2019 y el 31 de diciembre de 2021. Variables de estudio: edad de las madres, semanas de embarazo, embarazos, bacteriuria, agente causal, antibiótico indicado y respuesta al tratamiento. Para interpretar los resultados obtenidos se aplicaron estadística descriptiva, medidas de tendencia central y de frecuencias simples. RESULTADOS: Se estudiaron 227 embarazadas; de ellas, 49 tuvieron un urocultivo positivo. La prevalencia de bacteriuria asintomática fue de 21.59. Escherichia coli fue el agente causal más reportado. De los urocultivos de control 36 de 37 resultaron negativos y solo 1 de 37 fue positivo. CONCLUSIÓN: La prevalencia de bacteriuria asintomática de este estudio fue de 21.59% y el principal agente etiológico asilado E. coli en la mayoría de los casos, con sensibilidad a nitrofurantoína en la mayoría de los casos.

Abstract OBJECTIVE: To determine the prevalence of asymptomatic bacteriuria, its adequate treatment based on the antibiogram report of pregnant patients who attended prenatal control in a private clinic. MATERIALS AND METHODS: Retrospective study of a case series, descriptive and cross-sectional carried out in pregnant women who attended prenatal control in the outpatient clinic of the Hospital Fray Juan de San Miguel de Uruapan, Michoacán, between January 1, 2019 and December 31, 2021. Study variables: mothers' age, weeks of pregnancy, pregnancies, bacteriuria, causative agent, indicated antibiotic and response to treatment. Descriptive statistics, measures of central tendency and simple frequencies were used to interpret the results obtained. RESULTS: A total of 227 pregnant women were studied; 49 of them had a positive urine culture. The prevalence of asymptomatic bacteriuria was 21.59. Escherichia coli was the most reported causative agent. Of the control urine cultures 36 of 37 were negative and only 1 of 37 was positive. CONCLUSION: The prevalence of asymptomatic bacteriuria in this study was 21.59% and the main etiologic agent was E. coli in most cases, with sensitivity to nitrofurantoin in most cases.

Necessity of asymptomatic bacteriuria screening during pregnancy / 中华围产医学杂志

Asymptomatic bacteriuria (ASB) refers to the presence of one or more species of bacteria in an individual's urine without the symptoms of a urinary tract infection. Previous studies have shown that untreated ASB during pregnancy is associated with adverse pregnancy outcomes. Many international guidelines recommend a single screen-and-treat approach to ASB during pregnancy. Still, this approach has not been proven favorable to pregnancy outcomes in low-risk populations by recent studies. ASB screening is not a routine obstetric examination in clinical practice in China. Given this, this article will review the evidence of ASB screening during pregnancy and analyze the recommendations and existing problems in the guidelines from various academic organizations. Clinical studies should be carried out according to the situation in the region, and the basic risks and treatment benefits of ASB in pregnancy should be analyzed in combination with specific data to establish a proper screening and treatment plan for ASB during pregnancy. Screening for ASB is recommended for pregnant women with high-risk factors at this stage.

Clinical study on the application of nanopore targeted sequencing technology for rapid and accurate detection of pathogens in patients with complicated urinary tract infections / 中华泌尿外科杂志

Objective:To evaluate the clinical value of nanopore targeted sequencing (NTS) in pathogens detection in urinary tract by comparing the results of different tests performed on the same urine sample.Methods:The results of NTS and urine culture test collected from 326 patients in the Department of Urology of People's Hospital of Wuhan University from July 2020 to June 2021 were retrospectively analyzed. There were 224 males and 102 females. The average age was (56.88 ± 14.58)years old. χ 2 test and Student’s test and Wilcoxon's sign rank test were used to analyze the differences of the pathogen detection rate, pathogen types results and detection time consuming between NTS and urine culture. The clinical value of the NTS in rapid detection of urinary pathogens was evaluated. Results:Among 326 hospitalized patients, the urinary tract microbes’ detecting rate of NTS was significantly higher than that of urine culture[67.80%(221/326)vs. 23.93%(78/326), χ2=130.25, P<0.01]. The uropathogens detecting rate of NTS was significantly higher than that of urine culture[54.29%(177/326)vs. 23.31%(76/326), χ2=38.95, P<0.01]. The number of urinary tract microbes detected by NTS was significantly higher than that of urine culture ( Z=11.49, P<0.01), the number of uropathogens was significantly higher than that of urine culture ( Z=9.67, P<0.01). The detection time of NTS and urine culture positive samples was (24.29±2.65) h and (49.28±11.30) h, the difference was statistically significant ( t =39.48, P<0.01). The results obtained by using NTS and urine culture were consistent in 135 (41.41%) samples. In 150 (46.01%) samples, NTS could detect the urinary tract microbes while urine culture cannot find, of which 112 cases (34.36%) were uropathogenic. In 27 cases (8.28%), more pathogens were detected by NTS except those from urine culture. In 6 cases (1.84%) re-detecting NTS after antibiotic therapy, the number of reads of primary uropathogen decreased gradually with the growth of colonizing bacteria or opportunistic pathogens appeared in the end. Re-examinations of urine culture could verify the results of NTS detection on admission in 5 cases (1.53%). NTS in 2 cases (0.61%) could cover the uropathogens of subsequent several urine cultures. Conclusions:NTS has the advantages of rapid, sensitive and comprehensive detection of urinary tract infection pathogens. When urine culture is not yet reported or even negative, NTS already has a certain clinical reference value and can be used as an effective supplement to urine culture, which is conducive to the comprehensive judgment of the patient's condition.

Profile of uropathogens in pregnancy over 5 years from a large tertiary center in South India

Objectives: Urinary tract infections (UTIs) are a common medical problem in both antenatal and postnatal women. Data from India on the demography of these women, microbiology and antimicrobial susceptibility of the causative bacteria, need elucidation. Material and Methods: We performed an observation study that collected data on UTI in antenatal and postnatal women between 2013 and 2017 at our tertiary care center in South India. Antenatally, urine dipstick-positive patients, high-risk, and symptomatic patients submitted urine cultures. Postnatally, all symptomatic patients had urine cultures. This was 20% of all antenatal and postnatal women resulting in 20,203 cultures. Results: Of 20,203 cultures, significant bacteriuria was seen in 9.48% of antenatal and 13.28% of postnatal women. A higher mean age was seen among those with UTI, antenatal 27 (SD 3.5) and postnatal 26.4 (SD 4.7) years versus 23.9 (SD 3.6) with no growth in culture. The mean BMI among antenatal was 28.2 (SD 3.5) and postnatal was 28 (SD 7.4). Most (60%) were primigravida. At delivery, 37% required cesarean sections while 21.2% required instrumental delivery. Recurrent UTI was seen in 25% antenatally and 10% in the postnatal period. Escherichia coli accounted for 66 and 60% of infections among antenatal and postnatal women, respectively. Enterococcus species accounted for 13% in both while Klebsiella species was 4.9 and 7.3%, respectively. Among E. coli, 68.3 and 59.2% of isolates in antenatal and postnatal period were cefpodoxime susceptible. Nearly 75% of ante- and postnatal isolates were susceptible to amoxicillin-clavulanate while 90.2% and 92.5% were susceptible to nitrofurantoin. Enterococci spp. up to 84.4 and 97.1% in ante- and postnatal isolates were susceptible to ampicillin, 64.4 and 77.4% susceptible to high-level gentamicin, and 84 and 95.5% susceptible to nitrofurantoin. Asymptomatic bacteriuria in pregnancy was documented in 2.1% of antenatal outpatients and E. coli was isolated in 74% of these cultures. Conclusion: Importance of microbiological evidence prior to administration of antimicrobials is evidenced by 79% negative cultures in this 5-year cohort. Escherichia coli accounted for 60-66% of significant bacteriuria followed by Enterococcus and Klebsiella species with 30-40% E.coli probable ESBL producers. Nitrofurantoin followed by amoxicillin-clavulanate were found to be the best oral antimicrobial options.

Infección urinaria de presentación atípica: caso clínico y revisión de literatura

Introducción: el síndrome de orina púrpura es una presentación clínica poco frecuente en el ámbito de urgencias, caracterizado por coloración anormal de la orina secundaria a una reacción química de algunos patógenos que producen infección de vías urinarias, siendo más frecuente en pacientes con múltiples comorbilidades y diferentes factores de riesgo. Objetivo: el objetivo de este manuscrito es presentar el caso de un paciente con síntomas atípicos de infección de vías urinarias. Presentación del caso: varón de 88 años de edad, con antecedente de diabetes mellitus no insulino-requiriente, con hiperplasia prostática benigna que ingresó al servicio de urgencias por síntomas irritativos urinarios asociados a uso de sonda vesical, con orina de coloración violeta en bolsa recolectora. El urocultivo reportó la presencia de Proteus vulgaris multisensible, por lo que se decidió dar manejo con cefepima de 1 gr cada ocho horas, con lo cual se obtuvo una adecuada evolución clínica. Discusión y conclusión: el síndrome de la bolsa de orina púrpura es una presentación clínica atípica, pero muy llamativa de la infección urinaria. Esta se genera como resultado de la conversión del triptófano en la dieta en indoxil sulfato que, una vez se elimina por la orina, se transforma en índigo (color violeta) e indirrubina (color rojo), dando este aspecto clínico.

Background: Purple urine syndrome is a rare clinical presentation in the emergency room, characterized by abnormal colouration of the urine secondary to a chemical reaction of some pathogens that cause urinary tract infection, being more frequent in patients with multiple comorbidities and different risk factor's. Purpose: The objective of the article is present the case of a patient with atypical symptoms of urinary tract infection. Clinical case: An 88-year-old male, with a history of non-insulin diabetes mellitus, benign prostatic hyperplasia, who was admitted to the emergency room due to irritative urinary symptoms associated with the use of a urinary catheter, with purple urine in a collection bag. Urine culture reported the presence of multisensitive Proteus vulgaris, for which it was decided to give treatment with Cefepime 1 g every 8 hours, with which it was obtained with adequate clinical evolution. Conclusions: Purple urine bag syndrome is an atypical but very striking clinical presentation of urinary tract infection. This is generated as a result of the conversion of tryptophan in the diet into indoxyl sulfate, which, once it is eliminated in the urine, transforms into indigo (purple color) and indirubin (red color), giving this clinical appearance.

Prevalence of Asymptomatic Bacteriuria Among Pregnant Women Attending a Tertiary Care Hospital in Western India

Introduction: Asymptomatic bacteriuria refers to the presence of bacteria in urine having overall inci-dence during pregnancy ranges between 2%-10%. The study was conducted to assess prevalence of asymptomatic bacteriuria in pregnant women. The study also aimed to find out the most common Path-ogenic organism isolates from urine sample. Methodology: Pregnant women with varying gestational periods attending the tertiary care hospital without any symptoms of UTI were included in the study. Their urine was tested for routine microscopy, culture, and certain biochemical testing. Results: Prevalence rate of asymptomatic bacteriuria was seen 13.8% in pregnant women. Proportion of asymptomatic bacteriuria is highest 14.70% in age group 26-30 year, 23.33% in first trimester. Both gram negative and gram-positive bacteria were isolated, but gram-positive cocci isolates were higher comparatively gram-negative bacilli. Organisms recovered in order of frequency were E. coli, Coagulase Negative Staphylococci (CONS), S. aureus, Klebsiella spp, Acinetobacter spp, Citrobacter spp and Entero-bacter spp. Conclusion: High prevalence of asymptomatic bacteriuria demands routine bacteriological screening of pregnant women. This will help in early treatment of asymptomatic bacteriuria which will help in pre-vention of acute and chronic pyelonephritis.

Factores asociados a infección de vías urinarias luego de una prostatectomía / Factors Associated with Urinary Tract Infection after Prostatectomy

Introducción y Objetivo La cirugía de próstata es un procedimiento frecuente en varones mayores. Existen diferentes técnicas, cuya elección depende de la patología a tratar, de la experiencia del especialista, y de la disponibilidad técnica. Entre sus complicaciones se encuentra la infección del tracto urinario, que ocasiona incremento en morbimortalidad y costos para el sistema de salud. El objetivo principal de este estudio fue evaluar los factores relacionados con la aparición de infección urinaria luego de este tipo de cirugía. Materiales y Métodos Se realizó un estudio de casos y controles en una población de pacientes sometidos a prostatectomía del 2018 hasta principios del 2020 en Medellín, Colombia. Los casos correspondieron a los pacientes que presentaron infección de vías urinarias hasta 30 días tras la prostatectomía. Se estimó la asociación entre casos y controles por medio del cálculo de la razón de disparidad (RD), la cual se ajustó con una regresión logística y con un modelo aditivo generalizado multivariado. Resultados Se identificaron 96 casos incidentes de infección del trato urinario luego de la prostatectomía, con una prevalencia de 8.99%. La frecuencia de solicitud de urocultivo preoperatorio fue de 52,92% (intervalo de confianza del 95% [IC95%]: 48,34­ 57,44%). Las variables independientemente asociadas con la aparición de infección urinaria fueron: solicitud de urocultivo prequirúrgico, número de dosis, y tipo de antibiótico usado para la profilaxis. Particularmente, se encontró como factor protector el uso de aminoglucósidos. En los pacientes con infección urinaria, los principales gérmenes aislados fueron: Eschirichia coli, Pseudomonas aeruginosa, Klepsiella pneumoniae, Enterococos faecalis y Serratia marcescens.

Introduction and Objective Prostate surgery is a common procedure among older men. There are different techniques, and the choice depends on the pathology to be treated, the experience of the specialist, and the technical availability. Among its complications is urinary tract infection, which causes increased morbidity and mortality and costs for the health system. The main objective of the present study was to evaluate the factors related to the onset of urinary tract infection after prostate surgery. Materials and Methods A case-control study was conducted in a population of patients undergoing prostatectomy from 2018 to early 2020 in the city of Medellín, Colombia. The cases corresponded to patients who presented urinary tract infection up to 30 days after prostatectomy. The association between cases and controls was estimated by calculating the odds ratio (OR), which was adjusted with logistic regression and a multivariate generalized additive model. Results We identified 96 incident cases of urinary tract infection after prostatectomy, with a prevalence of 8.99%. The frequency of requests for preoperative urine culture was of 52.92% (95% confidence interval [95%CI]: 48.34 - 57.44). The independently associated variables were: request for preoperative urine culture, number of doses, and type of antibiotic used for prophylaxis. In particular, the use of aminoglycosides in prophylaxis schemes was found to be a protective factor. The main germs isolated were: Eschirichia coli, Pseudomonas aeruginosa, Klepsiella pneumoniae, Enterococos faecalis, and Serratia marcescens. Conclusion The present study shows that factors such as the preoperative request for urine culture and the use of aminoglycosides for surgical prophylaxis influence the probability of developing urinary tract infection after prostatectomy.

Susceptibility to first choice antimicrobial treatment for urinary tract infections to Escherichia coli isolates from women urine samples in community South Brazil

ABSTRACT E. coli is the main pathogen of UTI. It is important to be aware the local epidemiological data for an appropriate initial treatment. Resistance to antimicrobial agents has increased, especially to first-choice antibiotics in the treatment of cystitis. There are few studies on the sensivity profile of community uropathogen in our region. Objective: To characterize antimicrobials the sensitivity profile to E. coli isolated from urocultures of women treated at Basic Health Units and Emergency Care Units of Londrina-Paraná- Brazil during a period of 12 months (June 1, 2016 to June 1, 2017). Methodology: A cross-sectional study was carried out from June 2016 to June 2017. All urine samples collected in the Basic Health Units and Emergency Departments in the city of Londrina (Paraná State, Brazil) were sent to a Central Laboratory where the identification and antimicrobial susceptibility testing were performed. Clinical Laboratory Standards Institute (CLSI) breakpoints were used for the interpretation of susceptibility testing results. Results: 56,555 urine cultures were performed in the period, of which 8,832 were positive, of which 5,377 were women. Of these samples, 4.7% were enterobacteria producing extended-spectrum beta-lactamases (ESBL) and 15.5% resistant to quinolones. TMP- SMX was resistant in more than 30% of the samples in all age groups. Among quinolone-resistant isolates, resistance to cephalothin, ampicillin and sulfamethoxazole-trimethoprim was greater than 60%. Nitrofurantoin was the only antimicrobial that showed 90% of sensitivity. Conclusion: The antimicrobials sensitivity profile was similar to that reported in the literature, with TMP- SMX resistance greater than 30% in the studied samples. Nitrofurantoin maintains high sensitivity rates greater than 90%. Resistance to quinolones increases proportionally with age, as well ESBL.

Prevalence of Bacterial Urinary Tract Infection among patients With Type 2 Diabetes Mellitus on Sodium-Glucose Cotransporter-2 Inhibitors:A prospective real-world setting study / Journal of the ASEAN Federation of Endocrine Societies

Background@#Genitourinary tract infections, mycotic as well as bacterial, as defined by clinical symptoms, are one of the common adverse effects associated with the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in type 2 diabetes mellitus (T2DM) patients in clinical trials. However, Indian data in terms of the prevalence of culture-proven bacterial type of urinary tract infection (UTI), and the causative organism is limited.@*Objective@#This study aimed to determine the prevalence and causative agents of bacterial UTI among patients with T2DM on SGLT2i.@*Methodology@#This was a prospective longitudinal study involving all patients with T2DM who were prescribed with SGLT2i, uncontrolled on other oral anti-diabetic medications, from June 2019 to February 2020. Prevalence of bacterial UTI was evaluated at baseline and 12 weeks after initiation of SGLT2i.@*Results@#A total of 80 patients were started on SGLT2i. One female patient on canagliflozin had significant asymptomatic bacteriuria and the causative agent was Acinetobacter baumannii. One male patient on dapagliflozin had symptomatic UTI with negative urine culture study. Four patients developed genital mycotic infection.@*Conclusion@#In this real-world study, SGLT2i as a class, was well tolerated with favorable safety profile, and risk of developing significant bacteriuria and/or symptomatic UTI was minimal.

Effect of Antibiotic Prophylaxis on Infectious Complications in Patients with Asymptomatic Bacteriuria Undergoing Urologic Surgery / Efecto de la profilaxis antibiótica sobre las complicaciones infecciosas en pacientes con bacteriuria asintomática programados a cirugía urológica

Objectives To identify the effect of duration of surgical antibiotic prophylaxis (SAP) and other variables on infectious postsurgical complications in patients with asymptomatic bacteriuria (ASB) undergoing urological surgery. Methods We conducted an observational study of a cohort of patients with ASB scheduled for urologic surgery at three health service providers in Colombia. The study population comprised all patients with planned urologic surgery who had ASB prior to surgery from April 2018 to January 2019. The intervention evaluated was the duration of preoperative SAP, and the outcome variable was the development of any postoperative infectious complications for up to 30 days after the procedure. Results The present study included 184 patients with ASB scheduled for urologic surgery. The median duration of preoperative SAP (p = 0.49) or of 1 dose SAP (risk ratio [RR] = 1.24; 95% confidence interval [CI]: 0.45­3.39) were not statistically different in patients with postsurgical infectious complications. Infectious complications were more frequent among patients with benign prostatic hyperplasia (RR = 6.57; 95%CI: 1.98­21.76) and hospitalization in the preceding 3 months (RR = 8.32; 95%CI: 2.69­25.71). Conclusion One dose of antimicrobial therapy is sufficient to avoid infectious complications in patients with ASB. There were other factors associated with postsurgical infectious complications, such as benign prostatic hyperplasia and hospitalization in the preceding 3 months.

Objetivos Identificar el efecto de la duración de la profilaxis antibiótica quirúrgica (PAQ) y otras variables sobre las complicaciones infecciosas posquirúrgicas en pacientes con bacteriuria asintomática (BA) sometidos a cirugía urológica. Métodos Se realizó un estudio observacional de una cohorte de pacientes con BA programados para cirugía urológica en tres instituciones de salud en Colombia. La población de estudio comprendió a todos los pacientes programados para cirugía urológica y con BA en el periodo de Abril del 2018 a Enero 2019. La intervención evaluada fue la duración de la PAQ preoperatoria, y la variable de resultado fue el desarrollo de cualquier complicación infecciosa posoperatoria hasta 30 días después del procedimiento. Resultados El estudio incluyó a 184 pacientes con BA programados para cirugía urológica. La mediana de duración de la PAQ preoperatoria (p = 0,49) o 1 dosis de PAQ (razón de riesgo [RR]: 1,24; intervalo de confianza [IC] del 95%: 0,45 a 3,39) no fueron estadísticamente diferentes en pacientes con complicaciones infecciosas posquirúrgicas. Las complicaciones infecciosas fueron más frecuentes entre los pacientes con hiperplasia prostática benigna (RR: 6,57; IC del 95%: 1,98 a 21,76) y hospitalización en los 3 meses anteriores (RR: 8,32; IC del 95%: 2,69 a 25,71). Conclusión Una dosis de terapia antimicrobiana es suficiente para evitar complicaciones infecciosas en pacientes con BA. Hubo otros factores asociados con complicaciones infecciosas posquirúrgicas, como hiperplasia prostática benigna y hospitalización en los tres meses anteriores.

Perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario en una población de Pichincha-Ecuador / Microbial drug resistance profile in adults with urinary tract infection in a population of Pichincha-Ecuador

INTRODUCCIÓN. Las infecciones del tracto urinario son causa de mayor morbilidad en la población adulta y afectan con frecuencia a la mujer. Al ser un problema prevalente, fue fundamental realizar estudios sobre perfiles de susceptibilidad locales para establecer medidas de vigilancia y control de uso de antibióticos. OBJETIVO. Determinar el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario. MATERIALES Y MÉTODOS. Estudio descriptivo, transversal. La población fue de 437 urocultivos y una muestra de 176 positivos con su antibiograma, realizados en el laboratorio del Hospital Básico de Sangolquí entre enero de 2017 hasta abril de 2018. Los criterios de inclusión fueron: pacientes mayores de 15 años de edad de ambos sexos, ambulatorios y hospitalizados, que presentaron urocultivos positivos definidos por una cuenta mayor a 100 000 Unidades Formadoras de Colonia. RESULTADOS. Del 40,27% (176; 437) de urocultivos positivos, la bacteria aislada con frecuencia fue Escherichia coli. 69,31% (122; 176), con resistencia a ampicilina 77,97% (92; 118), trimetropim-sulfametoxazole 62,26% (66; 106), norfloxacino 37,50% (42; 112), ciprofloxacino 35,65 % (41; 115), ampicilina/sulbactam 32,20% (38; 118) y con susceptibilidad a: fosfomicina, ceftriaxona, amikacina y nitrofurantoina. CONCLUSIÓN. Se determinó el perfil de farmacorresistencia microbiana en adultos con infección del tracto urinario; donde Escherichia coli. fue aislada con frecuencia, con susceptibilidad favorable para nitrofurantoína y fosfomicina.

INTRODUCTION. Urinary tract infections are the cause of greater morbidity in the adult population and it often affects women. As it is a prevalent problem, it was essential to carry out studies on local susceptibility profiles to establish surveillance measures and control of antibiotic use. OBJECTIVE. To determine the microbial drug resistance profile in adults with urinary tract infection. MATERIALS AND METHODS. Descriptive, cross-sectional study. The population was 437 urine cultures and a sample of 176 positive with their antibiogram, carried out in the laboratory of the Hospital Básico de Sangolquí between january 2017 and april 2018. Inclusion criteria were: patients older than 15 years of age of both sexes, ambulatory and hospitalized, who presented positive urine cultures defined by a count greater than 100 000 Colony Forming Units. RESULTS. Of the 40,27% (176; 437) of positive urine cultures, the bacterium frequently isolated was Escherichia coli. 69,31% (122; 176), with resistance to ampicillin 77,97% (92; 118), trimethoprim-sulfamethoxazole 62,26% (66; 106), norfloxacin 37,50% (42; 112), ciprofloxacin 35,65% (41; 115), ampicillin / sulbactam 32,20% (38; 118) and with susceptibility to: fosfomycin, ceftriaxone, amikacin and nitrofurantoin. CONCLUSION. The microbial drug resistance profile was determined in adults with urinary tract infection; where Escherichia coli. was frequently isolated, with favorable susceptibility to nitrofurantoin and fosfomycin.

Síndrome de la bolsa de orina púrpura / Purple urine bag syndrome

Resumen El síndrome de la bolsa de orina púrpura es una condición clínica de prevalencia desconocida en Colombia debido al escaso reporte de casos a nivel nacional. Esta entidad se presenta exclusivamente en pacientes portadores de sonda vesical con factores de riesgo asociados como enfermedad renal crónica, patologías neurológicas, residentes de hogares geriátricos, sexo femenino, entre otros. La coloración púrpura de la orina se da en un ambiente urinario alcalino propiciado por bacterias específicas, en donde se genera una reacción de oxidación del indoxil sulfato en índigo e indirrubina por acción de las enzimas fosfatasas/sulfatasas de estos microorganismos, dichos pigmentos se mezclan generando la coloración púrpura en la bolsa urinaria. Se reporta el caso de un paciente masculino de 75 años con un cuadro clásico de síndrome de la bolsa urinaria púrpura, con el propósito de ampliar el conocimiento en la literatura nacional vigente. Adicionalmente, con esta publicación se busca que los profesionales de la salud comprendan los mecanismos fisiopatológicos por los cuales se produce esta entidad para saber abordarla apropiadamente.

Abstract Purple urine bag syndrome is a rare clinical condition, of unknown prevalence, with few reports published in our country that presents exclusively in catheterized patients with multiple risk factors, such as chronic kidney disease, neurological pathologies, residents of nursing homes and affects more females than males. The purple discoloration of urine is generated by indoxyl-sulfate degradation to indigo and indirubin lead by phosphatases/sulphatases enzymes produced by specific bacteria, associated to an alkaline urine environment, those two pigments combine which turns to purple discoloration appreciated in the urinary bag and catheter. The present case report is about a 75-year-old male, which appears with a classic clinical presentation. This case report has the objective, for health care workers, to remember the importance of basic care of urinary catheters, understand the underlying physiopathology and in consequence improve patient care.

Prevalence of asymptomatic bacteriuria in hospitalized patients / Эрүүл мэндийн лаборатори

Description@#Asymptomatic bacteriuria is defined as the presence of 1x105 or more bacteria per milliliter of urine, although there are no signs of UTI [1]. Asymptomatic bacteriuria is quite common and occurs in 1-5% of healthy women before menopause. The incidence of asymptomatic bacteriuria increases in the elderly (men and women) to 4-19%. Asymptomatic bacteriuria is observed in 0.7% -27% of patients with diabetes mellitus, in 2-10% of pregnant women and in 23-89% of patients with spinal cord injury. Asymptomatic bacteriuria is rarely observed in young men and always requires differential diagnosis with chronic bacterial prostatitis[2]. </br> Among the elderly, those in institutionalized settings such as long-term care facilities and hospitals have a higher prevalence of asymptomatic bacteriuria than those living in the community. Therefore, interest in asymptomatic bacteriuria has shifted from the general population to these groups of individuals. The prevalence varies from 2% to 10% in pregnancy and from 15% to 50% in the elderly in long-term care facilities.[3,4]</br> This study was undertaken to determine the prevalence of people asymptomatic bacteriuria in among hospitalized people.@*Purpose@#Investigate cases of asymptomatic bacteriuria among hospitalized individuals and determine antibiotic susceptibility by type of pathogen detected in urine.@*Materials and methods@#This cross-sectional study in the “I” Hospital of UB city, Mongolia. We conducted into the study 133 patients. After obtaining informed consent, a midstream clean-catch urine sample was collected in the same 24 hour time window and was evaluated for urinalysis using a dipstick test and routine culture. A positive urine culture was defined as a single urine sample with microbal growth of >10⁵ colony- forming units of a single organism. We use 5-10% Blood agar, UTI agar, Mackkong agar and Chroma agar for a bacterial growth. Then we did antibiotic susceptibility of the determined pathogen.@*Result@#The average age of the respondents was 55.9±14.6, the youngest was 17 years old and the oldest was 91 years old (CI 95% 53.4-58.5). By age group, 4.5% (n = 6) of people aged 20-30, 21.1% (n = 28) of people aged 31-45, 37.5% (n = 50) of people aged 46-60, and people over 61 years of age 36.8% (n = 49) respectively.Of the respondents, more than 56 or 54.9% (n = 73) were elderly, of which 63.9% (n = 85) were women and 36.1% (n = 48) were men. </br> A total of 36 (27.1%) leukocytes were detected, and 25 (34.2%) more (P-0.05) were detected in people over 56 years of age. The protein detected in 24 (18.0%) people, all over 56 years of age and more defined in men (P-0.01).</br> 80.5% (n = 107) of those surveyed were diagnosed with the pathogens, and 54.9% were elderly (P-0.031). 82.4% of women and 77.1% of men were diagnosed with urinary pathogens. </br> Streptococcus 26%, E.coli 19%, Saprophyticus 13%, Enterococcus 11% and Staphylococcus 11% were detected in the analysis, and Streptococcus and E.coli (19%) accounted for a slightly higher rate of infection.</br> A total of 13 types of pathogens were identified, of which 53.4% were susceptible, 21.7% were moderately sensitive, and 24.9% were non-susceptible.@*Discussion@#According to a study conducted by researchers at the University of Taiwan, the prevalence of asymptomatic UTI-s in the general population is 57.8%. E.Coli was also the most common bacterium in the urine [6]. </br> In our study, there are many cases of E. coli. </br> Study in the United States found that the prevalence of asymptomatic bacteriuria among inpatients was 8.5%, all of them women. The most common pathogens in this study are Enterococcus bacteria. This study found that 1 in 10 people admitted to the hospital may have asymptomatic bacteriuria. [1] @*Conclusion@#</br> 1. Asymptomatic bacteriuria in 80.5% of those surveyed 54.9% were detected in people over 56 years of age. </br> 2. Antibiotic susceptibility of the tested pathogens was determined as 53.4% sensitive, 21.7% moderately sensitive and 24.9% insensitive.

Parámetros diagnósticos en los lactantes con sospecha de infección del tracto urinario

Introducción: La sintomatología de la infección del tracto urinario es variable en la edad pediátrica, por ende, se presentan cuadros clínicos típicos y atípicos diversos debido a múltiples factores estudiados y definidos, que ofrecen dificultad para la confirmación diagnóstica. Objetivo: Identificar la utilidad de los parámetros diagnósticos de la infección urinaria. Métodos: Estudio observacional, analítico, de caso y controles, en lactantes ingresados con sospecha de infección urinaria en el Hospital Pediátrico Universitario "Octavio de la Concepción y de la Pedraja" admitidos en el servicio de clínicas pediátricas. El universo fueron los lactantes con sospecha de infección del tracto urinario y la muestra fue de 191 pacientes que cumplieron con los criterios de inclusión. Las variables utilizadas fueron la edad, el sexo, signos y síntomas, factores clínicos, formas clínicas, parámetros microbiológicos, parámetros clínicos según presencia de criterios de Rochester y escalas de evaluación para infección bacteriana y los parámetros de laboratorio. Resultados: Las variables clínicas más importantes asociadas a una infección urinaria fueron la edad menor de tres meses, la fiebre y el no disfrute de la lactancia materna, mientras que las de laboratorio fueron anemia, leucocitosis, neutrofilia y eritrosedimentación elevada. Conclusiones: Se identifica un conjunto de parámetros clínicos y estudios de laboratorio útiles en la atención médica del niño con infección urinaria. La forma de presentación febril es la característica especial de la enfermedad y las investigaciones hematológicas y del sedimento urinario son fuentes de apoyo diagnóstico.

Introduction: The symptomatology of urinary tract infection is variable in pediatric ages, therefore, there are typical and atypical clinical pictures due to multiple factors studied and defined but that offer difficulty for diagnostic confirmation. Objective: Identify the usefulness of the diagnostic parameters of urinary tract infection. Methods: Observational, analytical, case-control study in infants admitted with suspected urinary tract infection at "Octavio de la Concepción y de la Pedraja" University Pediatric Hospital and admitted to the pediatric clinic service. The total sample were infants with suspected urinary tract infection and the sample was 191 patients who met the inclusion criteria. The variables used were age, sex, signs and symptoms, clinical factors, clinical forms, microbiological parameters, clinical parameters according to the presence of Rochester criteria and evaluation scales for bacterial infection and laboratory parameters. Results: The most important clinical variables associated with a urinary tract infection were: age less than three months, fever and non-enjoyment of breastfeeding; while laboratory variables were: anemia, leukocytosis, neutrophilia and elevated erythrosedimentation. Conclusions: A set of clinical parameters and laboratory studies useful in the medical care of children with urinary tract infection are identified. The form of febrile presentation is the specific characteristic of the disease and hematological and urinary sediment investigations are sources of diagnostic support.

Prevalence of symptomatic urinary tract infection and bacterial spectrum of diabetic and non-diabetic patients at the two teaching hospitals in Enugu, Nigeria

Background: Diabetes mellitus is a group of metabolic disorder characterized by relative or absolute lack of insulin. When this condition is not properly managed, it can lead to complications that make diabetic patients vulnerable to urinary tract infections (UTI). The objectives of this study are to determine the prevalence of microbiologically confirmed UTI and the spectrum of uropathogens in diabetic and non-diabetic patients with clinical features of UTI attending the two tertiary hospitals in Enugu State, Nigeria. Methodology: Clean catch specimen of single mid-stream urine sample was collected from each of 60 (22 males, 38 females) diabetic and 60 (22 males, 38 females) non-diabetic patients enrolled using stratified random sampling method. The samples were cultured on standard microbiological culture media (MacConkey and Blood agar plates) and incubated aerobically at 37◦C for 24 hours. Plates with significant bacteria growth (>105 CFU/ml) were processed further for bacterial identification using conventional biochemical test scheme. Antibiotic susceptibility test (AST) of each isolate to 17 selected antibiotics was performed by the modified disc diffusion method. Results: Of the total 120 patients enrolled, 101 had bacterial pathogens isolated from their voided urine samples; 51 of 60 (85.0%) diabetics and 50 of 60 (83.3%) non-diabetics (p=0.802). Bacteria were isolated in 59.1% (13/22) of diabetic and 54.5% (12/22) of non-diabetic male patients compared to 100% (38/38) isolation rate in diabetic and non-diabetic female patients. The most frequently isolated bacteria in the diabetic patients were Proteus spp (18.6%), Klebsiella spp (16.9%) and Escherichia coli (15.5%) while the most frequently isolated bacteria among the non-diabetic patients were E. coli (30.0%), Proteus spp (26.3%) and Enterobacter spp (14.0%). Apart from Klebsiella spp which was more frequently isolated from the diabetic (16.9%) than non-diabetic patients (6%) (p=0.039), the frequency other bacterial pathogen isolation such as Proteus spp, E. coli, Enterobacter spp, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus spp was not significantly different between the two population groups (p>0.05). The Gram-positive and Gram-negative bacteria were highly sensitive to imipenem in both diabetic and non-diabetic patients, but the isolates from both study groups exhibited low susceptibility to amoxicillin, nitrofuran- toin, cefixime and cefuroxime. Conclusion: Although the overall frequency of bacterial pathogen isolation in the diabetic and non-diabetic patients was not significantly different, females had a higher pathogen isolation rate than the males, and diabetic females had a higher frequency of polymicrobial infections compared to non-diabetic females and the male population. The high antimicrobial resistance of the isolated bacteria pathogens underscores the need for clinical microbiology laboratory testings to optimize the management of UTI in diabetic patients.

Prevalence of and factors associated with significant bacteriuria among pregnant women attending the antenatal clinic of Adeoyo Maternity Hospital, Yemetu, Ibadan, Nigeria

Background: Significant bacteriuria is commonly reported in pregnancy which greatly predisposes pregnant women to urinary tract infection (UTI), one of the commonest health challenges in pregnancy worldwide especially in developing countries such as Nigeria. The objectives of this study are to determine the prevalence of and factors associated with significant bacteriuria among pregnant women attending the antenatal clinic (ANC) of Adeoyo Maternity Hospital, Yemetu, Ibadan, Nigeria, as well as determine the bacterial aetiology and antimicrobial susceptibility patterns of the isolates. Methodology: This is a laboratory-based cross-sectional study of 206 pregnant women between the ages of 15 and 47 years attending the ANC of the hospital, selected by simple random sampling method. Demographic and clinical data were obtained from the subjects using a structured questionnaire. Clean-catch specimen of mid-stream voided urine was collected from each subject participant. Urine samples were processed for culture and isolation of significant bacterial pathogens using standard bacteriological methods, and isolates identified to species level by the combination of colony morphology, Gram reaction, conventional biochemical tests and Analytical Profile Index (API) 20E test kits. Antibiotic susceptibility testing of the isolates to selected antibiotics was performed using the disk diffusion method. Results: The prevalence of significant bacteriuria in the study population was 8.7% (18/206), with 27.8% (5/18) symptomatic and 72.2% (13/18) asymptomatic. All isolated bacteria were Gram-negative with the most frequent being Escherichia coli 9 (50.0%), followed by Klebsiella pneumoniae 6 (33.3%), Pseudomonas aeruginosa 1 (5.6%), Acinetobacter haemolyticus 1 (5.6%) and Enterobacter aerogenes 1 (5.6%). The isolates were most sensitive to gentamicin (100%) and nitrofurantoin (94.4%), while they demonstrated highest resistance to amoxicillin-clavulanic acid (33.3%). Significant bacteriuria was associated with pyuria (p=0.01) and past history of UTI (p=0.004). Conclusions: The high prevalence of asymptomatic significant bacteriuria in this study necessitates the need for screening and treatment of pregnant women for this entity to prevent the subsequent development of UTI that may have grave consequences on pregnancy outcome.

A retrospective study on the prevalence of urinary tract infections in a tertiary care hospital in Sangareddy district of South India

Background: Urinary tract infections (UTI) affect the portion of the urinary tract including kidneys, ureters, bladder, and urethra, and are among the commonly acquired nosocomial infections. Diagnosis based on the culture and sensitivity profile of the organism is highly beneficial for appropriate antimicrobial therapy of the individual.Methods: A retrospective study of culture isolates obtained from urine samples from different departments of a tertiary care hospital was performed in the period January 2018 to March 2020 in the district of Sangareddy, Telangana, India.Results: A total 204 samples of 1886 exhibited significant growth of organisms i.e., ≥105 colony-forming units of bacteria per millilitre (CFU mL-1). The most common pathogen isolated was Escherichia coli (47.05%), followed by Klebsiella pneumoniae (15.68%), Staphylococcus aureus (10.78%), Pseudomonas aeruginosa (10.78%), Enterobacter spp. (7.84%) and, Candida albicans (7.84%). The presence of Gram-negative organisms was found to be more than Gram-positive organisms among the samples cultured. Resistance was found to be more towards Amoxicillin (57.14%), followed by oxacillin (34%), cefotaxime (23.62%), clarithromycin (12.08%), erythromycin (12.08%), azithromycin (9.34%), linezolid (3.84%) and vancomycin (2.19%).Conclusions: Increasing levels of antimicrobial resistance by uropathogens emphasize the importance of therapy based on the culture and sensitivity of the organisms. Many uropathogens exhibit multi-drugs resistance. Regular surveillance and monitoring are useful in controlling the increasing resistance.

Asymptomatic bacteriuria in pregnancy: what is the validity of urine sediment microscopy as a screening tool in a low resource setting?

Background: Asymptomatic bacteriuria in pregnancy should be screened and treated to reduce the risk of morbidity and mortality. Urine culture is the recommended test. In low resource setting with large patient load urine culture in all pregnant patients is not feasible. In this study authors have assessed the validity of urine microscopy in the screening of asymptomatic bacteriuria in pregnancy.Methods: Midstream clean catch urine specimen collected from 675 pregnant women was subjected to urine sediment microscopy and culture. It was considered screen positive if pus cells were >5/HPF. Asymptomatic bacteriuria was diagnosed if there were >/=100000 CFU of a single uropathogen per ml. Results obtained were statistically analysed for the prevalence of asymptomatic bacteriuria, sociodemographic and medical risk factors, causative organisms, antibiotic sensitivity and validity of urine sediment microscopy in detecting asymptomatic bacteriuria.Results: The incidence of asymptomatic bacteriuria in our study was 10.2%. The incidence was higher in the age group between 20-30 years, in gravida 3 and above, in upper lower and lower socioeconomic status, in women with hyperglycemia in pregnancy and anaemia. E. coli was the commonest bacterial isolate in culture positive cases. Bacterial isolates had poor sensitivity for Ampicillin, amoxicillin and nitrofurantoin and good sensitivity for cephalosporins and aminoglycosides. The sensitivity, specificity, positive and negative predictive values for urine microscopy was 43%, 85%, 25% and 93% respectively.Conclusions: This study shows poor sensitivity and positive predictive value and good specificity and negative predictive value.

Consenso Argentino intersociedades de Infección Urinaria 2018-2019 - Parte I / Consenso Argentino Intersociedades de Infección Urinaria 2018-2019 - Parte I

La Sociedad Argentina de Infectología y otras sociedades científicas han actualizado estas recomendaciones utilizando, además de información internacional, la de un estudio multicéntrico prospectivo sobre infecciones del tracto urinario del adulto realizado en Argentina durante 2016-2017. La bacteriuria asintomática debe ser tratada solo en embarazadas, a quienes también se las debe investigar sistemáticamente; los antibióticos de elección son nitrofurantoína, amoxicilina, amoxicilina-clavulánico, cefalexina y trimetoprima-sulfametoxazol. Ante procedimientos que impliquen lesión con sangrado del tracto urinario se recomienda solicitar urocultivo para pesquisar bacteriuria asintomática, y, si resultara positivo, administrar antimicrobianos según sensibilidad desde inmediatamente antes hasta 24 horas luego de la intervención. En mujeres, la cistitis puede ser tratada con nitrofurantoina, cefalexina, o fosfomicina y no se recomienda usar trimetoprima-sulfametoxazol o fluoroquinolonas; en pielonefritis puede emplearse ciprofloxacina, cefixima o cefalexina si el tratamiento es ambulatorio o ceftriaxona, cefazolina o amikacina si es hospitalario. En los hombres, las infecciones del tracto urinario se consideran siempre complicadas. Se recomienda tratamiento con nitrofurantoina o cefalexina por 7 días, o bien monodosis con fosfomicina. Para la pielonefritis en hombres se sugiere ciprofloxacina, ceftriaxona o cefixima si el tratamiento es ambulatorio y ceftriaxona o amikacina si es hospitalario. Se sugiere tratar las prostatitis bacterianas agudas con ceftriaxona o gentamicina. En cuanto a las prostatitis bacterianas crónicas, si bien su tratamiento de elección hasta hace poco fueron las fluoroquinolonas, la creciente resistencia y ciertas dudas sobre la seguridad de estas drogas obligan a considerar el uso de alternativas como fosfomicina.

The Argentine Society of Infectious Diseases and other scientific societies have updated these recommendations based on data on urinary tract infections in adults obtained from a prospective multicenter study conducted in Argentina during 2016-2017. Asymptomatic bacteriuria should be treated only in pregnant women, who should also be systematically investigated; the antibiotics of choice are nitrofurantoin, amoxicillin, clavulanic/amoxicillin, cephalexin and trimethoprim-sulfamethoxazole. In procedures involving injury to the urinary tract with bleeding, it is recommended to request urine culture and, in the presence of bacteriuria, antimicrobial treatment according to sensitivity should be prescribed from immediately before up to 24 hours after the intervention. In women, cystitis can be treated with nitrofurantoin, cephalexin or fosfomycin, while trimethoprim-sulfamethoxazole and fluoroquinolones are not recommended; pyelonephritis can be treated with ciprofloxacin, cefixime or cephalexin in ambulatory women or ceftriaxone, cefazolin or amikacin in those who are hospitalized. In men, urinary tract infections are always considered complicated; nitrofurantoin or cephalexin are recommended for 7 days, alternatively fosfomycin should be given in a single dose. In men, ciprofloxacin, ceftriaxone or cefixime are suggested for pyelonephritis on ambulatory treatment whereas ceftriaxone or amikacin are recommended for hospitalized patients. Acute bacterial prostatitis can be treated with ceftriaxone or gentamicin. Fluoroquinolones were the choice treatment for chronic bacterial prostatitis until recently; they are no longer recommended due to the increasing resistance and recent concerns regarding the safety of these drugs; alternative antibiotics such as fosfomycin are to be considered.