Antibiotic versus cranberry in the treatment of uncomplicated urinary infection: a randomized controlled trial

SUMMARY OBJECTIVE: This study was designed to determine the effect of cranberry extract used in patients with single urinary tract infections. METHODS: Patients with simple-type urinary tract infections were divided into two groups. Treatment with fosfomycin or cranberry tablet was started. On days 1, 3, and 7 of the treatment, whether there was a decrease in the complaints was evaluated with a Likert-type scale. The recovery status of urinary tract infections and the well-being of patients were compared via antibiotic and cranberry groups. RESULTS: After the treatment, the leukocyte levels of the cranberry users were at the same level as those of the other group, and the rate of well-being and the portion of patients that reported to be "very well" on days 3 and 7 in the cranberry group was significantly higher compared with the fosfomycin group (p<0.05). CONCLUSION: Considering the results of this study, it was determined that the patient's complaints decreased from day 3 and their well-being increased with the use of cranberry only. Specifically, on day 7, the well-being of the cranberry group was higher than that of the fosfomycin group. For this reason, cranberry is a favorable alternative to antibiotics in uncomplicated and simple urinary tract infections.

Diagnosis of urinary tract infection in infants under 3 months with fever without a source: reliability of urinalysis and urine culture / Diagnóstico de infección del tracto urinario en lactantes menores de 3 meses con fiebre sin foco identificado: fiabilidad del análisis de orina y urocultivo

Abstract Background: Urinary tract infection (UTI) is infants´ most common serious bacterial infection. This study aimed to investigate the reliability of urianalysis (UA) to predict UTI, to specify the colony forming units (CFU)/ml threshold for diagnosis, and to identify variables that help suspect bacteremia in infants under 3 months with UTI. Methods: We reviewed clinical records of children under 3 months hospitalized for a fever without source and recorded age, sex, days of fever pre-consultation, temperature and severity at admission, discharge diagnoses, laboratory tests, and treatments. According to the discharge diagnosis, we divided them into UTIs (-) and (+) with or without bacteremia. Results: A total of 467 infants were admitted: 334 with UTI and 133 without UTI. In UTIs (+), the pyuria had a sensitivity of 95.8% and bacteria (+) 88.3%; specificity was high, especially for nitrites (96.2%) and bacteria (+) (92.5%). Positive predictive value (PPV) for nitrites was 95.9%, for bacteria 96.7%, and oyuria 92.5%. Escherichia coli was present in 83.8% of urine and 87% of blood cultures. UTIs with bacteremia had inflammatory urinalysis, urine culture > 100,000 CFU/ml, and higher percentage of C reactive protein (CRP) > 50 mg (p= 0.002); 94.6% of the urine culture had > 50,000 CFU. Conclusions: The pyuria and bacteria (+) in urine obtained by catheterization predict UTI. The cut-off point for diagnosis was ≥ 50,000 CFU/ml. No variables to suspect bacteremia were identified in this study.

Resumen Introducción: La infección del tracto urinario (ITU) es una infección bacteriana grave frecuente en lactantes. El objetivo de este trabajo fue investigar la fiabilidad del análisis de orina (AO) para predecirla, precisar el umbral de unidades formadoras de colonias (UFC)/ml para el diagnóstico y buscar variables que ayuden a sospechar de bacteriemia en lactantes menores de 3 meses con ITU. Métodos: Se revisaron fichas clínicas de lactantes menores de 3 meses hospitalizados por fiebre sin foco evidente, registrando edad, sexo, días de fiebre preconsulta, temperatura y gravedad al ingreso, diagnósticos de egreso, exámenes de laboratorio y tratamientos. Según diagnóstico de egreso, se separaron en ITU (-) y (+), con o sin bacteriemia. Resultados: Ingresaron 467 lactantes: 334 con ITU y 133 sin ITU. En ITU (+), la sensibilidad de la piuria fue de 95.8% y bacterias (+) 88.3%; la especificidad fue alta para nitritos (96.2%) y bacterias (+) (92.5%). El valor predictivo positivo (VPP) fue de 95.9% para nitritos, 96.7% para bacterias y 92.5% para piuria. Escherichia coli se encontró en el 83.8% de los urocultivos (UC) (+) y en el 87% de los hemocultivos (+). Las ITU con bacteriemia presentaron elementos inflamatorios, UC con ≥ 100,000 UFC/ml y mayor porcentaje de proteína C reactiva (PCR) > 50 mg/l (p= 0.002); el 94.6% de los UC (+) tuvo ≥ 50,000 UFC/ml. Conclusiones: La piuria y bacterias (+) en el AO son excelentes para pronosticar ITU en orina obtenida con sonda vesical y el punto de corte para el diagnóstico debe ser ≥ 50,000 UFC/ml. No encontramos señales que ayudaran a sospechar ITU con bacteriemia.

Role of Proteus mirabilis flagella in biofilm formation / Papel de los flagelos de Proteus mirabilis en la formación de biofilms

Abstract Proteus mirabilis (P. mirabilis) is a common etiological agent of urinary tract infec-tions, particularly those associated with catheterization. P. mirabilis efficiently forms biofilms on different surfaces and shows a multicellular behavior called 'swarming', mediated by flagella. To date, the role of flagella in P. mirabilis biofilm formation has been under debate. In this study, we assessed the role of P. mirabilis flagella in biofilm formation using an isogenic allelic replacement mutant unable to express flagellin. Different approaches were used, such as the evaluation of cell surface hydrophobicity, bacterial motility and migration across catheter sections, measurements of biofilm biomass and biofilm dynamics by immunofluorescence and confocal microscopy in static and flow models. Our findings indicate that P. mirabilis flagella play a role in biofilm formation, although their lack does not completely avoid biofilm genera-tion. Our data suggest that impairment of flagellar function can contribute to biofilm prevention in the context of strategies focused on particular bacterial targets.

Resumen Proteus mirabilis (P mirabilis) es un agente etiológico común de infecciones del tracto urinario, en particular de aquellas asociadas con cateterización. P. mirabilis forma biofilms eficientemente en diferentes superficies y muestra un comportamiento multicelular llamado swarming, mediado por flagelos. Hasta el momento, el papel de los flagelos en la formación de biofilms de P. mirabilis ha estado en discusión. En este estudio, se evaluó el papel de los flagelos de P. mirabilis en la formación de biofilms, utilizando una mutante isogénica generada por reemplazo alélico, incapaz de expresar flagelina. Se utilizaron diferentes enfoques, como la evaluación de la hidrofobicidad de la superficie celular, de la movilidad y la migración bacteriana sobre secciones de catéteres y medidas de biomasa y de la dinámica del biofilm mediante inmunofluorescencia y microscopia confocal, tanto en modelos estáticos como de flujo. Nuestros hallazgos indican que los flagelos de P. mirabilis desempeñan un papel en la formación de biofilms, aunque su falta no suprime por completo su generación. Asimismo, evidencian que la interferencia de la función flagelar puede contribuir a evitar la formación de biofilms en el contexto de estrategias centradas en blancos bacterianos particulares.

Abscesos renales: experiencia en un hospital pediátrico de referencia

Introducción: El absceso renal es infrecuente en pediatría, con clínica y laboratorio inespecíficos. Ante su sospecha, es necesario realizar imágenes para establecer diagnóstico. Objetivo: Describir las características clínico-epidemiológicas, microbiológicas, diagnósticas y terapéuticas de abscesos renales en pediatría. Pacientes y Métodos: Estudio retrospectivo, descriptivo, de pacientes internados con absceso renal, en seguimiento por Infectología del Hospital de Niños Ricardo Gutiérrez, durante 9 años. Resultados: 15 pacientes (67% varones), mediana de edad 9 años (rango [r] 0,7-17). Cuatro pacientes con comorbilidades. El síntoma más frecuente fue fiebre seguido por dolor lumbar. El recuento medio de leucocitos en sangre fue de 15.700/mm3 (r: 7.100-45.000) y la PCR de 193 mg/L (r: 1-362). Cuatro pacientes presentaron urocultivo positivo: dos Escherichia coli, uno Klebsiella pneumoniae y E. coli y otro Candida albicans y K. pneumoniae. Ningún paciente presentó bacteriemia. El diagnóstico se confirmó por ecografía. Se realizó drenaje en siete pacientes, con aislamiento de Staphylococcus aureus en dos y Pseudomonas aeruginosa en uno. El tratamiento incluyó terapia combinada en 67%. Mediana de antibioterapia intravenosa fue 16 días (r: 7-49), total de 28 (r: 14-91). Un paciente requirió terapia intensiva y dos, nefrectomía. Conclusión: Los abscesos renales son infrecuentes, con gran morbimortalidad. Sospechar en paciente con infección del tracto urinario (ITU) de evolución tórpida que persiste febril. En nuestro estudio, la alta sensibilidad de la ecografía renal permitió su diagnóstico precoz.

Background: Renal abscesses are infrequent in pediatrics, with nonspecific clinical and laboratory findings. When suspected, imaging is essential to establish the diagnosis. Aim: To describe the clinical-epidemiological, microbiological, diagnostic and therapeutic characteristics of renal abscesses in pediatrics. Methods: Retrospective and descriptive study of hospitalized patients with renal abscess, followed by Infectious Diseases Department of Ricardo Gutiérrez Children's Hospital during 9 years. Statistical analysis: Epi Info 7.2.2.6. Results: 15 patients (67% male), median age 9 years (range [r] 0.7-17) were included. Four patients had underlying disease. The most frequent symptom was fever, with a median duration of 10 days (r:1-36), followed by lumbar pain. The median white blood cell count was 15,700/mm3 (r: 7,100-45,000) and CRP 193mg/L (r: 1-362). Four patients presented positive urine culture: 2 Escherichia coli, 1 Klebsiella pneumoniae and E. coli and 1 Candida albicans and K. pneumoniae. No patient had bacteremia. The diagnosis of abscess was confirmed by ultrasound. Surgical drainage was performed in 7 patients, with isolation of Staphylococcus aureus in 2 and Pseudomonas aeruginosa in 1. Empirical treatment included 3rd generation cephalosporin, combined in 67% of cases. The median of intravenous antibiotic therapy was 16 days (r: 7-49) with a total of 28 days (r:14-91). One patient required transfer to intensive care unit and 2 nephrectomy. Conclusion: Renal abscesses are infrecuent in pediatrics, but they present significant morbidity and mortality. It should be suspected in patients with urinary tract infection (UTI)with torpid evolution that persists with fever without antibiotic response. In our study, the high sensitivity of renal ultrasound allowed early diagnosis.

THERAPEUTIC POTENTIAL OF AROMATIC PLANT LEAF (MENTHA PIPERITA L.) AND FRUIT EXTRACT (FLACOURTIA JANGOMAS LOUR) AGAINST THE UTI BACTERIAL PATHOGENS

Medicinal plants are considered colossal producers of bioactive therapeutics agents. Fruit is an essential part of the human diet and is of great interest because of its richness in phytochemicals. The present study was chosen the objectives are assessment the antibacterial activity against the dominantly affected seven Urinary Tract Infected (UTI) pathogenic bacterial species plant leaf extracts and fruits such as Mentha piperita (L.), Flacourtia jangomas (Lour) Raeusch. Experimental UTI pathogenic organisms named as Alcaligens sp., Kliebsiella sp., E. coli, Proteus sp., Staphylococcus sp., Pseudomonas sp., Hence the current result has been clearly depicted that the methanol extract of Mentha piperita leaf expressed the potential signicant antibacterial activity against the ve UTI pathogenic organisms such as Alcaligens sp., and Klebsirlla sp. Proteus species and Pseudomonas sp., than other two experimental extracts of benzene and ethanol. From the present result clearly noticed three elucidated compounds are act as an antibacterial bio-compounds such Octadecanoic acid methyl ester, 1, 2, 4, 5-tetramethyl Piperone and α-Propyl tetradecanol present in methanol leaf.extract of M. piperita (L.) plant. Similarly F. jangomas (Lou.) fruit extract (methanol).possessed the antibacterial property biologically effective compounds named as Lavandulol, α-Humulene and Terpineol. Therefore, both experimental plant leaf and fruit extract possessed signicant antibacterial activity against the tested seven UTI clinical pathogenic organisms Furthermore nanoparticle study also denoted both experimental methanol extracts of M. piperita (L.), (leaf) F.jangomas (Lour) expressed the signicant nanoparticle production. It was noticed the range between 21.50 to 41.03nm and 60.52 to 19.22nm. for M. piperita (L.) F. jangomas fruit juice extract respectively. From the current research clearly showed that methanol extract of both experimental samples could be act as a potential traditional plant based medicines for urinary tract infected diseases.

Emphysematous pyelonephritis in patient with hemophagocytic lymphohistiocytosis: A case report

Emphysematous pyelonephritis (EPN) and hemophagocytic lymphohistiocytosis (HLH) are rare, fatal illnesses. The presence of both at once in a patient is extremely rare. The number of reported cases of EPN is <800 cases worldwide to date. Contrarily, the prevalence of adults with HLH is estimated to be 1 in every 2000 adults admitted to a tertiary health center. This case report aims to present the case of a 45-year-old woman who was diagnosed with EPN with a history of HLH and was successfully treated with medication alone. In conclusion, the clinical manifestations of EPN are non-specific and need imaging modalities like computed tomography (CT) scans. Treating EPN is based on CT scan classification. Medical treatment was an option for these patients. There is no direct association between EPN and HLH; it is a challenging decision to treat patients with both.

Risk factors for extended-spectrum beta-lactamase- and carbapenem- resistant Enterobacteriaceae in patients with urinary tract infection from a tertiary care hospital

Background: Urinary tract infection (UTI) is a common health problem in both community and nosocomial settings. However, the predisposing factors which are responsible for production of extended spectrum beta-lactamase (ESBL) and carbapenem-resistant Enterobacteriaceae makes the treatment option narrow and cause multidrug resistance. Aim and Objectives: This study demonstrate various risk factors associated with multidrug resistance in Enterobacteriaceae from UTI at tertiary care center in Gujarat. Material and Methods: A retrospective observational study was conducted at a tertiary-care hospital. Urine samples were received from various departments and outpatient department (OPD). Organisms from Enterobacteriaceae group were isolated and identified by various biochemical methods. ESBL and Carbapenemase producing organisms were then processed for Antibiotic susceptibility test as per CLSI guideline. Results: A total of 196 Enterobacteriaceae organisms were isolated from processed urine samples of tertiary care Hospitals. The most prevalent in people aged 45–65 years (36%) followed by those aged 17–30 (22%) years. UTI due to ESBL and Carbapenemase producer are more isolated in female (28%, 11%) as compare to male (16%, 6%). Indoor patients had higher prevalence of ESBL (29%) and carbapenemases (10%) isolation compare to OPD patient (ESBL-15%, Carbapenemases-7%) and among them most common ward was medicine department. The most common predisposing factor was catheterization followed by diabetes mellitus and obstructive uropathy. Conclusion: High prevalence of ESBL and Carbapenemase producing Enterobacteriaceae is found in Indoor patients than OPD patients. Most of these patients are from Medicine department. Catheterization is the most common risk factor associated with ESBL and carbapenemase producing organism.

Urinary tract infection with renal abscess

Renal abscess is very rare among intra-abdominal abscesses in children. Ascending infection is the most common cause in children compared to hematogenous spread in adults and Escherichia coli is the main pathogen. Persisting high-grade fever is an alarming sign to intervene and has to be taken care of. Here, we are presenting the case of a 3-year-old boy with Klebsiella urinary tract infection and E. coli renal abscess of 4 cm size. Contrast-enhanced computed tomography abdomen helped in early intervention and management. The child responded very well to parenteral antibiotics and ultrasound-guided percutaneous aspiration.

A BACTERIOLOGICAL STUDY OF URINARY TRACT INFECTION INVOLVING CULTURAL ANALYSIS

A BACTERIOLOGICAL STUDY OF URINARY TRACT INFECTION INVOLVING CULTURAL ANALYSIS Original Research Paper Estibeiro AS* Associate Professor, Department of Microbiology, Goa Medical College, Bambolim Goa, 403202 *Corresponding Author Background: Urinary Tract Infections are a common occurrence in the community and hospital and are associated with profound morbidity and decreased productivity at work. Timely diagnosis of UTI by cultural analysis is imperative in order to identify the offending agent and to initiate appropriate antimicrobial therapy. Objectives: The present study aimed at evaluating the bacteriological pro?le of UTI employing semiquantitative culture and to determine the antibiogram pattern of the bacteria isolated. The study was conducted on 200 urine samples, collected Methods: from clinically suspected cases of UTI. Semiquantitative analysis was done and antimicrobial sensitivity testing undertaken, as per CLSI guidelines. Signi?cant bacteriuria was observed in 66.5% cases. Gram negative bacilli were Results: predominant pathogens (71.3%), amongst which, Escherichia coli and Klebsiella pneumoniae were the main agents (37.2% and 24.5 % respectively). Gram positive organisms accounted for 28.7% of the total; Enterococcus species being the predominant isolate type (78.04%; 32 out of 41 gram positive pathogens). Overall, Escherichia coli predominated (26.6%), followed by Enterococcus species (22.4%). Gram negative bacilli showed good sensitivity to Imipenem and Aminoglycosides. Gram positive cocci were all sensitive to Vancomycin and Linezolid. A large number of cases were 50 years and above (51%), followed by age groups 21-30 years (17.5%) and 31 to 40 years (16.5%). The Male: Female ratio was 1.2:1, males accounting for 53.5% of the total. Early cultural analysis of UTI cases with identi?cation of the etiological agent and its Conclusion: antibiogram pattern will help in early treatment and use of appropriate antibiotics. This will reduce the use of empirical treatment, morbidity and chronicity

Report-based antibiotic sensitivity pattern of community-acquired urinary tract infection in rural Bengal

Background: Urinary tract infection (UTI), a common bacterial infection managed in general practice, is the second most common cause for antibiotic use in primary care setting. Antibiotic prescription is mostly empirical in UTI and it is imperative to choose one highly sensitive drug against the common pathogens. Aims and Objectives: In this study, it has been tried to find out the magnitude of community-acquired UTI in a rural population of West Bengal, its causative agents, and the sensitivity pattern of urinary isolates to reduce the development of antibiotic resistance. Materials and Methods: This is an observational, cross-sectional study over 1 year in a rural tertiary care hospital in West Bengal. Culture and sensitivity reports generated from diagnosed UTI patients from the different OPDs of the hospital were analyzed. Results: Out of 603 reports analyzed, culture-positive reports were 463. Escherichia coli was identified to be the most predominant (61.7%) followed by Staphylococcus aureus (17.3%). The sensitivity report of the empirically given antibiotics shows that among the oral antibiotics, nitrofurantoin was the most sensitive one (92%) followed by ciprofloxacin (83.1%) and ofloxacin (66%). Among the injectables, amikacin (84.5%) and ceftazidime (81.8%) were the antibiotics having the highest sensitivity. Conclusion: The sensitivity among the uropathogens to the commonly used antibiotics shows higher resistance rate toward norfloxacin, cephalexin, cotrimoxazole, ampicillin, amoxicillin, co-amoxiclav, and cefuroxime. Oral antibiotics such as nitrofurantoin and ciprofloxacin and parenteral antibiotic amikacin have found to be of higher sensitivity among all organisms identified clubbed together.

Cost-minimization analysis of drugs used for empirical treatment of urinary tract infection in a tertiary care hospital

Background: Urinary tract infections (UTIs) are one of the commonly encountered infections and a large number of drugs are indicated in UTI ranging from oral conventional drugs to most advanced injectable drugs. Cost-minimization analysis (CMA) is employed to project the least costly drug when two treatments are shown to be therapeutic equivalents. Aims and Objectives: This study aims to perform a CMA at a tertiary care center to determine the least expensive drug for UTI and to project a cheapest alternative from available options based on the results of CMA. Materials and Methods: This was a cross-sectional study conducted over duration of 3 months in the clinical departments on patients diagnosed to have UTI and prescribed empirical antimicrobial treatment. The approval of Institutional Ethics Committee was sought before beginning the study. Pattern of drug prescription and average cost incurred in the treatment of patients with empirical antimicrobial therapy was calculated. CMA included the projection of the least expensive drug based on average cost incurred per patient in outpatients and inpatients respectively. Results: A total of 59 patients of UTI given empirical treatment were included in the study. Fluoroquinolones and cephalosporins were commonly used drugs for empirical treatment of UTI. Nitrofurantoin (average cost of 11–14 Rs. per patient) can be projected as the cheapest drug for empirical treatment of UTI on outpatient basis as well as a drug to supplement injectables in indoor patients. Injectable ciprofloxacin can be projected as the most inexpensive alternative for empirical treatment of UTI in patients of the inpatient department. Conclusion: Nitrofurantoin for oral treatment and ciprofloxacin in injectable form are cheapest among available alternatives for empirical treatment of UTI. To prevent treatment failures and increase in cost of treatment, correlation of results of CMA with local antimicrobial sensitivity pattern is important.

Microbiological Profile and Antibiogram of Uropathogens Isolate in Tertiary Care Hospital

Introduction: Urinary tract infections (UTIs) are one of the most common bacterial infections in humans, both in the community and the hospital settings. The distribution of antimicrobial susceptibility data of UTI-causing microorganisms changes from time to time and from place to place. The susceptibility data provided by regional microbiology laboratories helps to choose the empirical antimicrobials to treat UTI. Materials and methods: Total 1381 urine were received in Bacteriology section of microbiology department from January 2022 to August 2022. Urine was processed for culture according to standard operating procedures at Microbiology laboratory, tertiary care hospital. Identification and antibiotic sensitivity testing was performed by automated VITEK-2 compact system. Results: In total, 1381 urine were received during the study period, 433(31.35%) cultures yielded significant pathogens and no organisms were isolated in 941 cultures and some sample was contaminate. The most commonly isolated organism were Escherichia coli (38.8%), followed by Candida spp. 88(20.32%), Klebsiellaspp (13.40%), Pseudomonas aeruginosa (12.24%), Gram positive organisms 12(2%) isolated. E. coli were most susceptible to Amikacin (87%), Fosfomycin (83%), colistin (82%), and tigecycline (78.39%). Klebsiella spp were most susceptible to colistin (72%). Nearly, 75% strains of Klebsiella spp were showing resistance to Carbapenems due to Carbapenemase production. Conclusion: Over enthusiastic use of the antibiotic has resulted in the emergence of drug-resistant bacterial strains in patients. The study of antimicrobial susceptibility patterns of uropathogens in a particular area can guide the clinicians in the rational choice of empirical treatment to prevent the misuse of antibiotics.

Giant bladder calculus in a patient with recurrent urinary tract infections / Cálculo vesical gigante em um paciente com infecções urinárias de repetição

A giant bladder stone is rare and is usually defined as "giant" if its weight is over 100g. We describe a 43-year-old man who presented with urinary sepsis, hypotension, abdominal pain, and a vesicocutaneous urinary fistula. Laboratory tests showed hemoglobin 6.6 g/dL, leukocytes 22,700/mm³, creatinine 7.29mg/dL (eGFR 8.8mL/min/1.73m2), urea 181 mg/dL, serum pH 6.99 and bicarbonate 6 meq/L. Abdominal tomography showed bilaterally reduced cortical thickness of the kidneys and a bladder stone of 6x6x11 cm. He was treated with antibiotic therapy, dialysis, and open cystolithotomy. Clinical improvement was observed, despite kidney disease persistence, with chronic dialysis therapy.

Cálculos gigantes na bexiga são raros e são definidos como "gigantes" quando o peso é superior a 100g. Apresentamos um homem de 43 anos com sepse urinária. O exame físico revelou hipotensão, dor abdominal e fístula urinária vesicocutânea. O laboratório mostrou hemoglobina 6,6 g/dL, leucócitos 22.700/mm³, creatinina 7,29 mg/dL (TFGe 8,8mL/min/1,73m2), ureia 181 mg/dL, pH sérico 6,99 e bicarbonato 6 meq/L. A tomografia abdominal mostrou redução da espessura cortical dos rins bilateralmente e cálculo vesical de 6x6x11 cm. Foi tratado com antibioticoterapia, diálise e cistolitotomia aberta. Melhora clínica foi observada, apesar de persistência da doença renal, com terapia dialítica crônica.

Seguimiento de dilatación del tracto urinario neonatal diagnosticada en la evaluación de infección del tracto urinario

Objetivo: Mostrar las características y seguimiento de la dilatación del tracto urinario en recién nacidos con infección del tracto urinario. Métodos: Estudio observacional, descriptivo, realizado desde 1992 hasta 2019, en neonatos ingresados con infección del tracto urinario. A todos se les realizó ultrasonido renal y uretrocistografía miccional. Se analizaron las características clínicas y de radioimagen de presentación en el seguimiento de la dilatación del tracto urinario. Resultados: Se estudiaron 403 pacientes. La mediana de seguimiento fue de 13 meses. El ultrasonido renal resultó positivo para dilatación del tracto urinario en 148 (36,7 %). Predominaron los grados de dilatación ligera (5-10 mm.) sobre grados moderados y severos. En 38 casos (9,4 %) la dilatación del tracto urinario se asoció a reflujo vésico-ureteral. La condición más común fue la dilatación transitoria con una mediana de desaparición de la dilatación 5 meses. Hubo asociación estadística significativa de la desaparición de la dilatación del tracto urinario con el grado de esta y entre aquellos casos calificados de transitoria con los otros portadores de alguna anomalía del tracto urinario que también tuvieron desaparición de la dilatación en algún momento de su evolución. Conclusiones: Cerca de una tercera parte de los neonatos con infección del tracto urinario tuvieron dilatación del tracto urinario en ultrasonido renal, con predominio de grado ligero, como probable expresión de una anomalía del tracto urinario subyacente. Con frecuencia ocurre resolución de la dilatación del tracto urinario en aquellos casos no asociados con anomalía del tracto urinario, habitualmente dentro del primer año de vida.

OBjective: To show the characteristics and follow-up of urinary tract dilatation in neonates with urinary tract infection. Methods: Observational, descriptive study performed from 1992 to 2019, in neonates admitted with urinary tract infection. All underwent renal ultrasound and voiding urethrocystography. The clinical and radioimaging features of presentation were analyzed in the follow-up of urinary tract dilatation, Results: 403 patients were studied. The median follow-up was 13 months. Renal ultrasound was positive for urinary tract dilatation in 148 (36.7%). Mild degrees of dilatation (5-10 mm) predominated over moderate and severe degrees. In 38 cases (9.4%) urinary tract dilatation was associated with vesico-ureteral reflux. The most common condition was transient dilatation with a median disappearance of dilatation 5 months. There was significant statistical association of the disappearance of urinary tract dilatation with the degree of dilatation and between those cases qualified as transient with the other carriers of some urinary tract anomaly who also had disappearance of dilatation at some point in their evolution. Conclusions: About one third of neonates with urinary tract infection had dilatation of the urinary tract on renal ultrasound, predominantly of mild degree, probably expression of an underlying anomaly. Resolution of dilatation frequently occurs in those cases not associated with urinary tract anomaly, usually within the first year of life.

Appraising epidemiology data and antimicrobial resistance of urinary tract infections in critically ill adult patients: a 7-year retrospective study in a referral Brazilian hospital

ABSTRACT BACKGROUND: Urinary tract infections (UTI) are highly preventable and have significant clinical and financial impact on the patient and the health care system. OBJECTIVE: To investigate UTIs in critically ill adult patients and the relationship of antimicrobial consumption and multidrug-resistant isolate. DESIGN AND SETTING: A cohort study performed in a Brazilian tertiary-care university hospital in the city of Uberlandia (MG), located at the Federal University of Uberlandia, southeast region of the country. METHODS: We analyzed a cohort of 363 patients with first episode of UTIs from the adult intensive care unit (ICU), from January 2012 to December 2018. The daily doses of antimicrobial administered were calculated. RESULTS: The incidence rate of UTI was 7.2/1000 patient days, with 3.5/1000 patient-days of bacteriuria, and 2.1/1000 patient-days of candiduria. Of 373 microorganisms identified, 69 (18.4%) were Gram-positive cocci, 190 (50.9%) Gram-negative bacilli, and 114 yeasts (30.7%). Escherichia coli and Candida spp. were the most common. Patients with candiduria had higher comorbidity score (Charlson Comorbidity Index ≥ 3), longer length of stay (P = 0.0066), higher mortality (P = < 0.0001) severe sepsis, septic shock, and were immunocompromised when compared with patients with bacteriuria. We observed correlation between antibiotics consumption and multidrug-resistant (MDR) microorganisms. CONCLUSION: The UTIs incidence was high and was mainly caused by Gram-negative bacteria that were resistant to common antibiotics. We observed increase in the consumption of broad-spectrum antibiotics in ICU correlating with MDR microorganisms. In general, ICU-acquired candiduria may be associated with critical illness and poor prognosis.

Monitoring fluoroquinolone resistance among ESBL-positive and ESBL-negative Escherichia coli strains isolated from urinary tract infections: An alert for empirical treatment

ABSTRACT Background: Bacterial resistance to extended-spectrum beta-lactamases (ESBL) is present worldwide. Empirical antibiotic therapy is often needed, and the use of fluoroquinolones, such as ciprofloxacin and norfloxacin, is common. This study aimed to analyze the urine cultures from 2,680 outpatients in January 2019, 2020, 2021, and 2022, with bacterial counts above 100,000 CFU/mL in which Escherichia coli was the etiological agent. Methods: We monitored the resistance of ESBL-positive and ESBL-negative strains to ciprofloxacin and norfloxacin and evaluated resistance rates. Results: Significantly higher fluoroquinolone resistance rates were observed among ESBL-positive strains in all years studied. Furthermore, a significant increase in the rate of fluoroquinolone resistance was observed between 2021 and 2022 in ESBL-positive and -negative strains, as well as from 2020 to 2021 among the ESBL-positive strains. Conclusions: The data obtained in the present study showed a tendency towards an increase in fluoroquinolone resistance among ESBL-positive and -negative E. coli strains isolated from urine cultures in Brazil. Since empirical antibiotic therapy with fluoroquinolones is commonly used to treat diverse types of infections, such as community-acquired urinary tract infections, this work highlights the need for continuous monitoring of fluoroquinolone resistance among E. coli strains circulating in the community, which can mitigate the frequency of therapeutic failures and development of widespread multidrug-resistant strains.

Risk factors of urinary tract infection after renal transplantation / 现代泌尿外科杂志

【Objective】 To investigate the independent risk factors of urinary tract infection (UTI) in recipients under-going renal transplantation of donation after brain death (DBD), so as to provide a theoretical basis for the prevention and control of postoperative UTI. 【Methods】 A retrospective study was conducted for recipients who received renal transplantation of DBD in our hospital during Jan.2021 and Dec.2021. The recipients were divided into the infection group (n=26) and non-infection group (n=74) according to the incidence of UTI 3 months after operation. The risk factors of UTI were identified with univariate and multivariate analyses. 【Results】 The incidence of UTI was 26%. Univariate analysis showed that gender, postoperative urinary fistula, time of indwelling catheter and time of indwelling double J tube were the influencing factors of UTI (P<0.05). Forward stepwise regression analysis showed time of indwelling double J tube (OR=1.086,95%CI:1.003-1.177,P=0.042) and time of indwelling catheter(OR=4.687,95%CI:2.064-10.645, P<0.010) were the independent risk factors of UTI (P<0.05). 【Conclusion】 The time of indwelling catheter and time of indwelling double J tube are the independent factors of UTI after renal transplantation of DBD.

Risk factors for urinary tract infection after a spinal cord injury / 中华物理医学与康复杂志

Objective:To explore the risk factors for urinary tract infection (UTI) after a spinal cord injury (SCI).Methods:The medical records of 403 SCI patients were analyzed retrospectively. They were divided into UTI group and no-UTI group according to whether they had a UTI at admission. Gender, age, cause of injury, injury level of the spinal cord, voluntary anal contraction, time from injury to admission, American Spinal Injury Association (ASIA) grade, axillary temperature at admission, complications at admission (diabetes, hypertension, fracture of the pelvis, pressure sores or anemia), white blood cell count and urinary bacteria were compared between the two groups. Binary logistic regression was used to highlight the risk factors for a UTI after an SCI.Results:Of the 354 patients included in the final analysis, 62 (17.51%) had a UTI at admission. The regression showed that UTI after an SCI was closely related to an inability to voluntarily contract the anus, anemia, elevated white blood cell count and a high level of bacteria in the urine.Conclusions:Inability to contract the anus, fever, anemia and an elevated white blood cell count are independent indicators of a UTI after an SCI. A temperature ≥37.3°C is a simple indicator of a concentration of bacteria in the urine ≥1266/μL.

Emphysematous cystitis: two cases report / 中华泌尿外科杂志

The 2 patients were both aged females with medical history of diabetes mellitus. The chief complaints were both hyperpyrexia. Laboratory tests presented markedly elevated white blood cells and C-reactive protein, indicating severe systemic infections. Urine culture confirmed the growth of Escherichia coli. CT scan revealed thickened bladder wall with intraluminal and interstitial collections of gas. After the diagnosis of emphysema cystitis was established, conservative treatments including bladder drainage, strict glycemic control and sensitive antibiotics were administered timely. Both of the 2 patients got fully recovery after standard treatment.

Application of ureteral stent in kidney transplantation / 器官移植

Ureteral stricture, urine leakage and other urinary complications are likely to occur after kidney transplantation, which severely affect the function of renal allograft and even lead to renal allograft loss. Ureteral stent plays a critical role in kidney transplantation, which could promote the urine flow from kidney to bladder after kidney transplantation, lower the pressure within the ureter and reduce the risk of early urinary complications. However, it may also cause urinary tract infection, stent-related complications and BK virus infection, etc. Therefore, clinicians should flexibly grasp the indications for ureteral stent removal. In this article, the application, potential adverse reactions and the timing of removal of ureteral stent in the field of kidney transplantation were reviewed, aiming to provide reference for clinical decision-making related to ureteral stent after kidney transplantation.