Clinical characterization and antimicrobial resistance of Escherichia coli in pediatric patients with urinary tract infection at a third level hospital of Quito, Ecuador / Caracterización clínica y resistencia antimicrobiana de Escherichia coli en pacientes pediátricos con infección del tracto urinario en un hospital de tercer nivel en Quito, Ecuador

Abstract: Background: Urinary tract infections (UTI) are among the most common infections in pediatric patients. The main etiopathogenic agent is Escherichia coli. The purpose of this study was to determine the antimicrobial resistance pattern of E. coli in pediatric patients and to understand their main clinical and laboratory manifestations. Methods: Fifty-nine patients were included in the study and classified into two groups: hospitalization (H) and external consultation (EC). Every patient presented urine cultures with the isolation of E. coli that included an antibiogram. Clinical signs and symptoms, urinalysis, complete blood count (CBC) and serum inflammatory markers were analyzed. Results: The most common clinical manifestations were fever (H: 76.5%; EC: 88%), vomiting (H: 32.4%; EC: 32%), hyporexia (H: 20.6%; EC: 16%), abdominal pain (H: 20.6%: EC: 28%), and dysuria (H: 14.7%; EC: 32%). Ten patients (16.95%) presented UTI for extended spectrum beta-lactamase (ESBL) E. coli. Ampicillin, nalidixic acid, and trimethoprim-sulfamethoxazole showed a higher resistance rate, being ampicillin the most significant (H: 88.2%; EC: 92%). Leukocyturia, bacteriuria and urine nitrites were frequent alterations in urinalysis (H: 52.9%; EC: 92%). In ESBL E. coli patients, a positive correlation was found between leukocytes in CBC and C-reactive protein (r = 0.9, p < 0.01). Diarrhea and foul-smelling urine were associated with E. coli resistance. Conclusions: The presence of leukocytes, bacteria, nitrites and the Gram stain are the most common indicators. Nitrofurantoin and phosphomycin are good therapeutic options. However, an antibiogram must be conducted to determine the best therapeutic agent.

Resumen: Introducción: Las infecciones de tracto urinario (ITU) se encuentran entre las más frecuentes en pediatría, siendo Escherichia coli el principal agente etiopatogénico. El objetivo de este estudio fue determinar el patrón de resistencia antimicrobiana de E. coli en pacientes pediátricos y conocer sus principales manifestaciones clínicas y de laboratorio. Métodos: Se incluyeron en el estudio 59 pacientes en dos grupos: hospitalización (H) y consulta externa (CE). En cada uno se realizó un urocultivo y un antibiograma con aislamiento de E. coli. Se analizaron signos y síntomas, uroanálisis, hemograma y marcadores séricos de inflamación. Resultados: Las manifestaciones clínicas más frecuentes fueron fiebre (H: 76.5%; CE: 88%), vómito (H: 32.4%; CE: 32%), hiporexia (H: 20.6%; CE: 16%), dolor abdominal (H: 20.6%: CE: 28%) y disuria (H: 14.7%; CE: 32%). Diez pacientes (16.95%) presentaron ITU por E. coli beta-lactamasa de espectro extendido (BLEE). La ampicilina, ácido nalidíxico y trimetroprim con sulfametoxazol mostraron alta resistencia, siendo ampicilina la más significativa (H: 88.2%, CE: 92%). Leucocituria, bacteriuria y nitritos en orina fueron frecuentes en el uroanálisis. En pacientes con E. coli BLEE se encontró una correlación positiva entre los leucocitos y la proteína C reactiva (r = 0.9, p < 0.01). La diarrea y el mal olor en la orina se asociaron con resistencia de E. coli. Conclusiones: La leucocituria, la bacteriuria, los nitritos y la tinción Gram son los indicadores más frecuentes de ITU. La nitrofurantoina y fosfomicina son buenas opciones terapéuticas. Sin embargo, debe realizarse un antibiograma para determinar el mejor tratamiento.

Infecção do trato urinário na gravidez: aspectos atuais / Urinary tract infection in pregnancy: atual concepts

A infecção do trato urinário caracteriza-se pela invasão e multiplicação de micro-organismos nos rins e nas vias urinárias. Na maioria das vezes, é resultado da colonização da urina por bactérias fecais, que cresceram em meio anaeróbio, sendo a E. coli o patógeno mais comumente envolvido nessas infecções. A ITU é uma das mais comuns infecções bacterianas na mulher, sendo que pelo menos 40 porcento das mulheres adultas têm pelo menos um episódio de ITU em suas vidas. Manifesta-se clinicamente por disúria, polaciúria, urgência miccional e dor no baixo ventre na cistite, arrepios de frio e lombalgia na pielonefrite, ou completa ausência de sintomas na bacteriúria assintomática. O diagnóstico, na maioria das vezes, com exceção da bacteriúria assintomática, é clínico. A gravidez é situação que predispõe ao aparecimento de ITU, devido às mudanças fisiológicas (mecânicas e hormonais) que ocorrem nesse período da vida da mulher. A ITU durante a gravidez pode causar sérias complicações, como o trabalho de parto pré-termo, recém-nascidos de baixo peso, rotura prematura de membranas, restrição de crescimento intraútero, paralisia cerebral, entre outras. O objetivo da presente revisão foi abordar os principais fatores etiológicos, o diagnóstico e a conduta nos casos de ITU durante a gravidez.

Urinary tract infection (UTI) is characterized by the invasion and multiplication of microorganisms in the kidneys and in the urinary tract. Most of the time, it is the result of the urine being colonized by fecal bacteria, developing in anaerobic environment, and E. coli is the most commonly pathogen involved in those infections. UTI is one of the most common bacterial infections in women, and at least 40 percent of adult women have at least one episode of UTI in their lives. Its clinical presentation involves disuria, polaciuria, urinary urgency and pain in the lower womb in cystitis, chills and lombalgia in the kidney infection, or complete absence of symptoms in the asymptomatic bacteriuria. The diagnosis, most of the time, except for asymptomatic bacteriuria, is clinical. Pregnancy is a situation that predisposes to the emergence of UTI, due to the physiologic changes (mechanical and hormonal), that happen in this period of woman's life. UTI during pregnancy can cause serious complications, as preterm labor, low weight newborns, premature rupture of membranes, intra-uterine growth restriction, cerebral palsy, among others. The purpose of this review is to present the main etiological factors, the diagnosis and the conduct while dealing with UTI cases during pregnancy.

Prevalence of asymptomatic bacteriuria in school going children in Pokhara valley.

OBJECTIVES: There were mainly two objectives of the study. One was to detect bacteriuria in school going children in Pokhara valley and the other was to identify the causative organisms in various age groups in children. MATERIALS AND METHODS: This study was carried out in the Microbiology laboratory of The School of Pharmaceutical and Biomedical Sciences, Simalchaur, Pokhara University, Nepal. A total of 502 urine samples of 5 to 13 years children from different schools of Pokhara valley were screened to see asymptomatic bacteriuria during January 2005 to June 2005. A sterile wide mouth container was given to each student to collect mid-stream urine samples. All the urine samples were transported to the Microbiology laboratory within half an hour to one hour. The samples were processed for microscopical examination to observe for turbidity and the presence of protein and sugar by dipstick method, microscopical examination to see pus cells, RBCs, epithelial cells, casts and crystals, culture of urine samples on Blood agar and MacConkey agar to identify the potential pathogens. The antibiotic sensitivity test was performed for those bacteria which were grown on culture. The colony count was evaluated and organisms were identified by biochemical tests. RESULT: Out of 502 samples, 7(1.39%) samples grew the bacterial pathogens that are responsible to cause urinary tract infection. Among them Escherichia coli 4(57.14%) was the predominant bacterial pathogen. CONCLUSION: Study of asymptomatic bacteriuria is important as found in the present study in which Escherichia coli was the most frequently incriminated as the causative agents.

Antibiotic sensitivity and resistance profile of the micro-organisms responsible for urinary tract infection observed in Kashmir, India.

Urinary tract infection happens to be common and is generally treated empirically by general practitioners, for which they need to be aware of the locally prevalent strains and their sensitivity pattern. Since over the last few decades the resistance pattern of urinary isolates has been showing dramatic changes all over the world, it was felt useful to study the existing microbiological pattern of the urinary tract infections in Kashmir valley and to assess the sensitivity profile of the isolated organisms to the generally used antibiotics for empirical therapy in primary health care settings. The retrospective analysis of 324 such samples which were found positive for pathological bacteria by the microbiology laboratory of Government Medical College, Srinagar, Kashmir revealed that 90.12% of the isolates were E. coli followed by klebsiella (7.72%) and staphylococcus (1.24%). Significantly 43.57% of the E. coli exhibited resistance to the commonly used antibiotics, and the most effective in-vitro agents were found to be amikacin followed by gentamicin among the injectables and ciprofloxacin among the orally administered ones. Other useful oral antibiotics were nitrofurantoin, chloramphenicol and nalidixic acid. The organisms showed resistance to currently preferred urinary antibiotics and chemotherapeutic agents like co-trimoxazole, norfloxacin, pefloxacin and cephalexin. Conclusion was that among the orally administered antibiotics ciprofloxacin remains the choice while other quinolones or derivatives have turned ineffective and among the injectables gentamicin is still effective.

Tratamiento profiláctico de la bacteriuria crónica: seguimento a largo plazo / Recurrent bacteriura: a profilaxis therapy

35 mujeres portadoras de bacteriuria crónica con episodios de infección urinaria a repetición, sin patología urinaria agregada fueron ingresadas a un esquema de profilaxis antibiótica con 100 mg. de Macrodantina en dosis única nocturna, durante 24 meses. Se controlaron con urocultivo cada 2 meses hasta 2 años después de finalizada la profilaxis. 29 mujeres (82,8%) negativización su urocultivo y 6 mujeres (17,1%) continuaron con urocultivos positivos. 25 mujeres (71,4%) presentaron intolerancia gástrica a la macrodantina que obligaron al uso concomitante de antiácidos. No hemos tenido casos de fibrosis pulmonar. Concluímos que la profilaxis con Macrodantina es un buen tratamiento para las mujeres con bacteriuria crónica

Infecciones recurrentes del tracto urinario en mujeres: una visión del manejo y tratamiento / Recurrent urinary tract infections in women: a view of the management and treatment

Varios factores mayores han contribuído en mejorar la disponibilidad de técnicas altamente exitosas en el manejo de la infección urinaria recurrente (ITU) en mujeres. Debido a que ITU no puede diagnosticarse solamente por los síntomas, es muy importante una mayor exactitud en las técnicas diagnósticas para establecer si las bacterias en la orina emitida están presentes en la orina vesical. Segundo, es crucial el reconocimiento de que la mayoría de las ITU recurrentes son reinfecciones. Tercero, ha sido observado que la bacteriuria en mujeres es precedida por la colonización de la mucosa introital de la vagina y de la uretra por enterobacterias provenientes de la flora rectal. Un cuarto factor, es el desarrollo de regímenes profilácticos altamente efectivos, incluyendo sulfatoxazol-trimetropin, nitrofurantoina, cinoxacina y cefalexina. En suma, el manejo de pacientes con ITU ha mejorado porque las causas corregibles de la persistencia bacteriana son ahora bién reconocidas y hay una mejor comprensión de los tipos de pacientes con riesgos elevados. Finalmente, nuevos agentes antimicrobianos con farmacoquinética más favorable están disponibles. Una reciente editorial en el Lancet establecía que el manejo de la infección urinaria recurrente (ITU) en mujeres es insatisfactorio. Yo tomo el bando opuesto. En realidad el manejo habitual es tan exitoso que la mayoría de las pacientes mujeres con ITU recurrente puede ser asignada a la supervisión de personal de enfermería para su diagnóstico, tratamiento y seguimiento. ¿Qué observaciones básicas y qué avances de los últimos 25 años han hecho tan satisfactorio el manejo de este problema? Los 8 factores más importantes se discuten en esta presentación

Quimioprofilaxis en bacteriuria crónica sintomática / Chemoprofilaxis in symptomatic chronic bacteriuria

Se presentan 76 pacientes mujeres, todas portadoras de I.T.U. recurrente, con un promedio de 3.6 infecciones por año mujer, 57 de las cuales están sometidas a profilaxis con NF y 19 con TMP - SX logrando disminuir este promedio a 0.12 inf/año/mujer con NF y TMP - SX, las que se usaron en bajas dosis, 100 mg de NF y 80 - 400 de TMP - SX respectivamente. No observamos efectos adversos con estas dosis y tampoco indujimos resistencia cuando durante el tratamiento hubo reinfecciones, la que siempre ocurrió con gérmenes habituales de la flora intestinal. Por estas condiciones, además de su bajo costo y la disponibilidad que hay de ellos en nuestros hospitales, es que proponemos la NF y el TMP - SX como una alternativa eficiente para el manejo de la bacteriuria Crónica Sintomática