Prospective study of the epidemiology of urinary tract infections at short term and mid-term after initiation of intermittent self-catheterisation.

INTRODUCTION: Self-catheterisation (CIsC) is the gold standard treatment for bladder emptying disorders. A frequent complaint of patients undergoing CIsC is urinary tract infection (UTI). However, the epidemiology of UTIs remains poorly documented, particularly in the urological population. The aim of our study was to establish the epidemiology of infectious complications of CIsC. METHOD: A prospective, descriptive cohort study was carried out on a population educated in CIsC in a urology outpatient department of a university hospital. RESULTS: From January 1, 2019 to November 15, 2020, 411 patients completed a CIsC education session. Sixty patients could be included and integrated for analysis. The mean age was 58.6±16.3years. Among the patients, 68% had a neurological pathology. The most common bacteria found was Escherichia coli. The incidence of total UTIs within the first 6weeks was 18%. After a mean follow-up of 15±6.5months, the median number of UTIs was 0 [0; 4]. The mean interval between two infectious episodes was 9±6.7months. Only one patient met the criteria for recurrent UTI. Febrile UTIs affected 7% of patients. CONCLUSION: Self-catheterisation has a low infectious morbidity, occurring mainly in the first few weeks after its introduction.

Outcome of small versus big capacity Hautmann neobladder reconstruction: A prospective randomized study - a 5-year follow up.

BACKGROUND: Orthotopic urinary diversion is the preferred diversion after cystectomy. Neobladder reconstruction with a longer ileum segment (60 cm) is advantageous for obtaining a large capacity and continence at the beginning; however, the long-term risk of residual urine, chronic infection, and the need for intermittent catheterization is more pronounced with the neobladder constructed with a longer ileal segment compared to the neobladder tailored from the shorter ileal segment. OBJECTIVE: To establish the differences in the functional outcome of a shorter (< 45 cm) and longer (⩾ 45 cm) ileal segment usage in the reconstruction of the Hautmann ileal neobladder following the radical cystectomy. METHODS: Between July 2013 and September 2015, 121 patients with muscle-invasive bladder cancer underwent radical cystectomy and Hautmann ileal neobladder reconstruction. Patients were divided into two groups, depending on the length of the ileum used for the diversion creation: < 45 cm of the ileum was used in the first group and ⩾ 45 cm in the second group. Five-year follow-up was performed at 1, 3, 6, and 9 months and 1 and 5 years. The main measured outcomes were functional outcomes and the quality of life. The evaluation included clinical, laboratory, and QLQ-C30 questionnaires. Statistical analysis was performed using descriptive statistics, Mann-Whitney U test, Kolmogorov-Smirnov test, ANOVA, and chi-squared tests. RESULTS: Patients with a smaller neobladder had a better quality of life, and higher global health status scale score. Thirteen early and 21 late complications developed in 10 and 17 patients, respectively. There were significant differences in the need for clean intermittent self-catheterization (CIC) between the two groups: smaller-volume pouch patients had statistically decreased need for CIC in 5 year follow-up compared to larger-volume pouch patients (χ2 test = 8.245; df = 1; P= 0.004). Eighteen percent of patients with smaller neobladders had urinary tract infections in 5 years, compared to 35% with larger neobladders (χ2 test = 4.447; df = 1; P= 0.034). CONCLUSION: Minimizing the length of the ileal segment needed for Hautmann neobladder reconstruction is feasible and provides better long-term results than larger-volume neobladders.

In house-development of a rapid immunochromatographic test for the detection of Escherichia coli in urine samples.

Urinary tract infections (UTIs) are a common health concern. Urine culture is the "gold standard" for UTI diagnosis but takes 48h. Rapid methods like dipstick tests are used as point-of-care tests. However, their sensitivity and specificity are variable. In this work, a rapid immunochromatographic test (IT) for detecting Escherichia coli in urine was developed, and its performance was evaluated in urine samples from patients with suspected UTI. The "universal lateral flow assay kit" was employed using an E. coli capture antibody. One hundred and five (105) urine samples were analyzed using the IT, dipstick test, and urine culture. The sensitivity of the IT was 74.5%, specificity 88.9%, positive predictive value (PPV) 86.3%, and negative predictive value (NPV) 78.7%. The combination of the IT with the dipstick test increases sensitivity to 94.1%, specificity to 66.7%, PPV to 72.7%, and NPV to 92.3%. Using the IT for detecting E. coli in urine could be a valuable technique for UTI screening, showing better specificity and diagnostic precision but lower sensitivity than the dipstick test. Based on these results, we propose that the combined use of both screening techniques would allow a rapid and more precise diagnosis of UTI, rationalizing the indication for empirical antibiotics.

Analysis of Bacterial Stent Colonization: The Role of Urine and Device Microbiological Cultures.

In this study, we explored the incidence of double J (JJ) contamination of patients who underwent an endourological procedure for urinary stones and ureteral stenosis. We developed a prospective study between January 2019 and December 2021. Ninety-seven patients, 54 male and 43 female, were enrolled. Urine culture was taken during four steps: before stent insertion, a sample from selective renal pelvis catheterization, a sample two days after the JJ insertion and finally, after the stent removal procedure. At the time of the stent removal, 1 cm of proximal and distal ends were cut off and placed in the culture for bacterial evaluation. Cohen's kappa coefficient value (k) and concordance rates of microbiological culture results were evaluated. The study group comprised 56% of male patients. Proximal and distal stent cultures were positive in 81 and 78 patients. The concordance rate of microbiological cultures between proximal and distal double J stent is 88% (k 0.6). The most common pathogens isolated from urine and stent cultures were Enterococcus spp. in 52 cases and Klebsiella spp. in 27 cases.

Sensibilidad de Escherichia coli frente a fosfomicina, en infecciones urinarias provenientes de personas con discapacidad que acudieron a la Secretaría Nacional por los Derechos Humanos de las Personas con Discapacidad-SENADIS / Susceptibility of Escherichia coli against fosfomycin in urinary tract infections from people with disabilities who attended SENADIS

INTRODUCCIÓN: Fosfomicina es un antimicrobiano de amplio espectro utilizado para el tratamiento de las infecciones urinarias bajas; tiene actividad sobre bacilos gramnegativos y cocos grampositivos, así también sobre microorganismos multirresistentes, además de ofrecer una alternativa terapéutica de administración vía oral en dosis única, alcanzando una efectividad de 90%. OBJETIVO: Conocer la sensibilidad in vitro de Escherichia coli frente a fosfomicina, en infecciones urinarias provenientes de personas con discapacidad. MATERIAL Y MÉTODO: Estudio observacional, descriptivo, prospectivo, en el que se incluyó un total de 273 muestras de urocultivo, de pacientes de ambos sexos que acudieron a SENADIS, y que en el momento de la consulta presentaban síntomas de infección del tracto urinario, por lo que se les solicitó el análisis de orina simple y cultivo. De las muestras procesadas en el laboratorio de microbiología, que fueron positivas con crecimiento bacteriano significativo, se procedió a la identificación bacteriana y a la realización del antibiograma según las recomendaciones de CLSI. RESULTADOS: De estas 273 muestras, 91 fueron positivas para diferentes uropatógenos, 62/91 (68%) resultaron ser E. coli. De estas cepas de E. coli, 59/62 (95%) mostraron sensibilidad in vitro a fosfomicina. Comentario: Aunque el número de muestra obtenido es pequeño y no extrapolable ampliamente, pretendemos extender el trabajo por un tiempo más para compararlo más adelante. CONCLUSIONES: Se observa que fosfomicina presenta buena actividad in vitro frente a cepas de E. coli aisladas de urocultivo, pudiendo representar una buena alternativa terapéutica a ser utilizada en la población en estudio.

BACKGROUND: Fosfomycin is a broad-spectrum antibiotic used for the treatment of lower urinary tract infections, it is active against gramnegative bacilli and grampositive cocci, as well as against multi-resistant microorganism, in addition to offering a therapeutic alternative for oral administration in a single dose, reaching an effectiveness of 90%. AIM: To study the susceptibility of Escherichia coli to fosfomycin in urinary tract infections, of isolated strains obtained from patients with disabilities. METHODS: It is an observational, descriptive, prospective study in which a total of 273 urine culture samples of patients of both sexes who attended the SENADIS were included, and who at the time of the consultation presented symptoms of urinary tract infection. The urine positive cultures with significant bacterial growth were performed to determine its bacterial identification and the antibiogram according to CLSI recommendations. RESULTS: Of these 273 samples, 91 samples were positive for different uropathogens, with 62/91 (68%) being positive for E. coli. Of these E. coli strains, 59/62 (95%) showed in vitro susceptibility to fosfomycin. Comment: Although the number of samples obtained is small and it cannot be extrapolated, we pretend to extend the work for a while longer to be able to compare it later. CONCLUSION: Fosfomycin has good activity in vitro against E. coli isolated from urine culture in our institution, representing a good alternative to be used in our study population

Can COVID-19 pandemic surveillance reduce nosocomial urinary infections in urologic surgery?

INTRODUCTION: Since COVID-19 pandemic spread, strict preventive measures were adopted to reduce the risk of transmission. Antiseptic dispensers for hand hygiene were diffusely available for patients and hospital staff. To investigate the prophylactic role played by the strict antiseptic rules adopted during pandemic, the rates of nosocomial urinary infections in 2019 and 2020 were compared. MATERIALS AND METHODS: Patients' clinical pre-operative characteristics, symptoms, fever, and laboratory data were recorded pre- and post-operatively. Urological surgery was classified in five categories: 1. major surgery 2. upper urinary tract endoscopy, 3. lower urinary tract endoscopy, 4. minor surgery, and 5. Nephrostomy and ureteral stenting. Clavien-Dindo complication score was used. Statistical analysis was performed with R 3.4.2 software. RESULTS: Out of 495 patients, 383 (57.1%) underwent surgical intervention in pre-pandemic March-May 2019 period and 212 (42.9%) in the same pandemic 2020 interval. Preoperatively, 40 (14.1%) and 11 (5.2%) and 77 (27.3%) and 37 (17.5%) patients had fever (p < 0.003) and leukocytosis (p < 0.02), in 2019 and 2020 respectively. Urine culture was positive in 29 (10.2%) and 13 (6.2%) patients respectively (p = 0.22). Post-operatively, 54 (19.1%) and 22 (10.4%) patients and 17 (6.1%) and 2 (0.6%) patients showed fever (p < 0.003) and positive urineculture (p < 0.03), in 2019 and 2020 respectively. DISCUSSION AND CONCLUSION: Preoperative and post-operative clinical and laboratory signs of nosocomial urinary infection showed a statistically significant lower incidence during the pandemic period in 2020. This observation could be ascribed to the strong preventive measures, to the medical staff high adherence to hygiene and the diffuse availability of hand sanitizers.

Immunoproteomic and immunoinformatic approaches identify secreted antigens and epitopes from Staphylococcus saprophyticus.

Urinary tract infections (UTIs) are common human infections that compromise women's health around the world, even though they can affect men and women of all ages. Bacterial species are the primary causative agents of UTIs, while Staphylococcus saprophyticus, a gram-positive bacterium, is especially important for uncomplicated infections in young women. Despite the number of antigenic proteins identified in Staphylococcus aureus and other bacteria of the genus, there is no immunoproteomic study in S. saprophyticus. In this context, since pathogenic microorganisms secrete important proteins that interact with hosts during infection, the present work aims to identify the exoantigens from S. saprophyticus ATCC 15305 by immunoproteomic and immunoinformatic approaches. We identified 32 antigens on the exoproteome of S. saprophyticus ATCC 15305 by immunoinformatic tools. By using 2D-IB immunoproteomic analysis, it was possible to identify 3 antigenic proteins: transglycosylase IsaA, enolase and the secretory antigen Q49ZL8. In addition, 5 antigenic proteins were detected by immunoprecipitation (IP) approach, where the most abundant were bifunctional autolysin and transglycosylase IsaA proteins. The transglycosylase IsaA was the only protein detected by all the tools approaches used in this study. In this work it was possible to describe a total of 36 S. saprophyticus exoantigens. Immunoinformatic analysis allowed the identification of 5 exclusive linear B cell epitopes from S. saprophyticus and 5 epitopes presenting homology with other bacteria that cause UTIs. This work describes, for the first time, the profile of exoantigens secreted by S. saprophyticus and can contribute to the identification of new diagnostic targets of UTIs, as well as to develop vaccines and immunotherapies against bacterial urinary infections.

Presence and Relevance of Emerging Microorganisms in Clinical Genitourinary Samples.

Microorganisms responsible for genitourinary infections increasingly include species other than conventional etiological agents that are of clinical and pathogenic relevance and therapeutic interest. This cross-sectional descriptive study selected samples from clinical genitourinary episodes between January 2016 and December 2019 in which emerging microbiological agents were detected. The patients' epidemiological characteristics, clinical presentation, antibiotic treatment, and outcome were studied to identify their pathogenic role. The emerging microorganisms most frequently detected in urinary tract infections were Streptococcus bovis (58.5%) and Gardnerella spp. (23.6%) in females and S. bovis (32.3%), Aerococcus urinae (18.6%), and Corynebacterium spp. (16.9%) in males, while the most frequently detected in genital infections were S. viridans (36.4%) in females and C. glucuronolyticum (32.2%) and Gardnerella spp. (35.6%) in males. All cases in female children were produced by S. bovis. Symptomatic episodes were more frequent with Aerococcus spp. and S. bovis and the presence of leukocytosis more frequent with Aerococcus spp. Quinolones and doxycycline were most often prescribed antibiotics for genital infections and quinolones and amoxicillin-clavulanic acid for urinary infections. Urinary infection by Aerococcus spp. was more frequent in males of advanced age, Corynebacterium spp. was more frequent in permanent vesical catheter carriers, and episodes of asymptomatic bacteriuria by Gardnerella spp. were more frequent in patients with kidney transplant and chronic consumers of corticosteroid therapy. Lactobacillus spp. should be considered in urinary infections of patients of advanced age and with a previous antibiotic load. Genital infection by Gardnerella spp. was significantly associated with a history of risky sexual relations.

Consensus for the treatment of upper urinary tract infections during pregnancy / Consenso para el tratamiento de la infección de vías urinarias altas durante la gestación

Objectives: To generate evidence-based recommendations through formal consensus regarding the treatment of upper urinary tract infections during gestation. Materials and methods: Experts in microbiology, public health, internal medicine, infectious diseases, obstetrics, maternal fetal medicine and obstetric and gynecological infections participated in the consensus development group. The group also included professionals with training in clinical epidemiology, systematic data search, and representatives from the Health Secretariat and the Bogota Obstetrics and Gynecology Association. The participants disclosed their conflicts of interest. Starting with a clinical question, outcomes were graded and a systematic search was conducted in the Medline via PubMed, Embase, Lilacs, and Bireme databases. The search was expanded to include institutional repositories and antimicrobial resistance surveillance systems, with no language or date restrictions. The search was updated on October 1, 2022. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to assess the quality of the evidence and determine the strength of the recommendations. Finally, the RAND/UCLA (Research and Development/University of California Los Angeles) methodology was applied for the formal consensus. This document was reviewed by academic peers before publication. Results: The following are the consensus recommendations. Recommendation 1. The initial management of pregnant women with upper urinary tract infections (UTIs) should be approached in a hospital setting. Recommendation 2. The use of second generation cephalosporins is the suggested first option for empirical antimicrobial management in pregnant women with upper UTI in order to improve the rates of clinical and microbiological cure. Recommendation 3. Because of the risk-benefit balance, the use of aminoglycosides is suggested as a second option for empirical antimicrobial treatment in pregnant women presenting with upper UTIs in the second and third trimester. Recommendation 4. The use of third-generation cephalosporins is suggested as the third option for empirical antimicrobial treatment in pregnant women with upper UTIs given that the risk of inducing microbial resistance is high with this group of antibiotics. Recommendation 5. The use of carbapenems is suggested as a first option in pregnant women with upper UTIs and a history of infections caused by microorganisms with resistance to third or fourth-generation cephalosporins. Recommendation 6. The use of aminoglycosides or fourth-generation cephalosporins is suggested as a second option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third-generation cephalosporins, taking risk-benefit into account. Recommendation 7. The use of piperacillin/tazobactam is suggested as a third option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third or fourthgeneration cephalosporins. Recommendation 8. Getting a urine culture is recommended in pregnant women with upper UTIs before initiating empirical antimicrobial treatment. Recommendation 9. In pregnant women with upper UTIs, it is suggested to modify therapy in accordance with the results of the sensitivity test when the culture report shows resistance to the antimicrobial agent initiated empirically. Recommendation 10. In pregnant women hospitalized due to upper UTIs, it is suggested to switch to oral antimicrobial therapy after at least 48 hours of modulation of the systemic inflammatory response and the clinical signs of infection, and when tolerance to oral intake is adequate. Recommendation 11. In pregnant women with upper UTIs with no complications secondary to the primary infection, it is recommended to administer antibiotic therapy for a period of 7 to 10 days. Conclusions: It is expected that with this Colombian upper UTI consensus variability in clinical practice will be reduced. It is recommended that groups doing research in maternal fetal medicine assess the implementation and effectiveness of these recommendations.

Objetivos: generar recomendaciones informadas en la evidencia, a través de un consenso formal, orientadas al tratamiento de la infección de vías urinarias altas durante la gestación. Materiales y métodos: en el grupo desarrollador participaron expertos temáticos en microbiología, salud pública, medicina interna, infectología, obstetricia, medicina materno-fetal e infectología ginecobstétrica. También hicieron parte profesionales con entrenamiento en epidemiología clínica, búsqueda sistemática de la información, representantes de la Secretaría de Salud y la Asociación Bogotana de Obstetricia y Ginecología. Los participantes presentaron sus conflictos de interés. A partir de una pregunta clínica se realizó la graduación de los desenlaces y una búsqueda sistemática que abarcó las bases de datos Medline vía PubMed, Embase, Lilacs, Bireme. La pesquisa se amplió a repositorios institucionales y reportes de vigilancia de resistencia antimicrobiana, sin restricción de idioma o fecha, la búsqueda se actualizó el 1 de octubre de 2022. Se utilizó la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para valorar la calidad de la evidencia y establecer la fuerza de las recomendaciones.Finalmente, se utilizó la metodología RAND/ UCLA (Research and Development/University of California Los Angeles) para el consenso formal. Este documento fue revisado por pares académicos previo a su publicación. Resultados: el consenso formuló las siguientes recomendaciones. Recomendación 1. Se sugiere que el manejo inicial de la gestante con infección de vías urinarias (IVU) altas se realice de forma intrahospitalaria. Recomendación 2. Como primera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de segunda generación con el fin de mejorar la tasa de cura clínica y microbiológica. Recomendación 3. Como segunda opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas en el segundo y tercer trimestre se realice con aminoglucósidos dado su balance riesgo-beneficio. Recomendación 4. Como tercera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de tercera generación, debido a que el riesgo de inducción de resistencia microbiana es alto con este grupo de antibióticos. Recomendación 5. Como primera opción, en mujeres gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de carbapenémicos. Recomendación 6. Como segunda opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera generación se sugiere el uso de aminoglucósidos o cefalosporinas de cuarta generación teniendo en cuenta el riesgo-beneficio. Recomendación 7. Como tercera opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de piperacilina/tazobactam. Recomendación 8. En gestantes con IVU altas se recomienda realizar urocultivo previo al inicio de tratamiento antimicrobiano empírico. Recomendación 9. En gestantes con IVU altas, cuando el urocultivo reporte resistencia al antimicrobiano iniciado de forma empírica, se sugiere modificar la terapia guiada por los resultados del antibiograma. Recomendación 10. En la gestante hospitalizada por IVU altas se sugiere realizar el cambio de terapia antimicrobiana a vía oral cuando la paciente tenga, al menos, 48 horas de modulación de respuesta inflamatoria sistémica y de los signos clínicos de infección, así como adecuada tolerancia a vía oral. Recomendación 11. En gestantes con IVU altas, sin complicaciones secundarias a la infección primaria, se recomienda que la terapia antibiótica se administre de 7 a 10 días. Conclusiones: se espera que este consenso colombiano de IVU altas reduzca la variabilidad en la práctica clínica. Se recomienda a los grupos de investigación en medicina materno fetal e infectología evaluar la implementación y efectividad de las recomendaciones emitidas.

Permanent urethral catheter - a good servant, but bad master: Guidelines for prevention, diagnosis, and treatment of catheter-associated urinary tract infections.

Catheter-associated urinary tract infections (CAUTI) are among the most common healthcare-associated infections, which increase morbidity, mortality, prolong the length of hospitalization and have a significant impact on the cost of treatment. The most efficient preventive method is removing catheters as soon as possible and avoid unnecessary catheterizations. Treatment of asymptomatic bacteriuria is not recommended. In cases of serious CAUTI, vigorous antibiotic therapy covering multidrug-resistant uropathogens should be initiated. These recommendations are intended for all medical specialties to improve the care of patients with indwelling catheters in the prevention, diagnosis, and treatment of CAUTI in primary care and subsequent long-term care.

Consenso para el tratamiento de la infección de vías urinarias altas durante la gestación / Consensus for the treatment of upper urinary tract infections during pregnancy

Objetivos: Generar recomendaciones informadas en la evidencia, a través de un consenso formal, orientadas al tratamiento de la infección de vías urinarias altas durante la gestación. Materiales y métodos: En el grupo desarrollador participaron expertos temáticos en microbiología, salud pública, medicina interna, infectología, obstetricia, medicina materno-fetal e infectología ginecobstétrica. También hicieron parte profesionales con entrenamiento en epidemiología clínica, búsqueda sistemática de la información, representantes de la Secretaría de Salud y la Asociación Bogotana de Obstetricia y Ginecología. Los participantes presentaron sus conflictos de interés. A partir de una pregunta clínica se realizó la graduación de los desenlaces y una búsqueda sistemática que abarcó las bases de datos Medline vía PubMed, Embase, Lilacs, Bireme. La pesquisa se amplió a repositorios institucionales y reportes de vigilancia de resistencia antimicrobiana, sin restricción de idioma o fecha, la búsqueda se actualizó el 1 de octubre de 2022. Se utilizó la metodología GRADE (Grading of Recommendations Assessment, Development and Evaluation) para valorar la calidad de la evidencia y establecer la fuerza de las recomendaciones. Finalmente, se utilizó la metodología RAND/ UCLA (Research and Development/University of California Los Angeles) para el consenso formal. Este documento fue revisado por pares académicos previo a su publicación. Resultados: El consenso formuló las siguientes recomendaciones. Recomendación 1. Se sugiere que el manejo inicial de la gestante con infección de vías urinarias (IVU) altas se realice de forma intrahospitalaria. Recomendación 2. Como primera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de segunda generación con el fin de mejorar la tasa de cura clínica y microbiológica. Recomendación 3. Como segunda opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas en el segundo y tercer trimestre se realice con aminoglucósidos dado su balance riesgo-beneficio. Recomendación 4. Como tercera opción, se sugiere que el tratamiento antimicrobiano empírico de la gestante con IVU altas se realice con el uso de cefalosporinas de tercera generación, debido a que el riesgo de inducción de resistencia microbiana es alto con este grupo de antibióticos. Recomendación 5. Como primera opción, en mujeres gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de carbapenémicos. Recomendación 6. Como segunda opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera generación se sugiere el uso de aminoglucósidos o cefalosporinas de cuarta generación teniendo en cuenta el riesgo-beneficio. Recomendación 7. Como tercera opción, en gestantes con IVU altas y antecedente de infección por microorganismos con resistencia a cefalosporinas de tercera o cuarta generación se sugiere el uso de piperacilina/tazobactam. Recomendación 8. En gestantes con IVU altas se recomienda realizar urocultivo previo al inicio de tratamiento antimicrobiano empírico. Recomendación 9. En gestantes con IVU altas, cuando el urocultivo reporte resistencia al antimicrobiano iniciado de forma empírica, se sugiere modificar la terapia guiada por los resultados del antibiograma. Recomendación 10. En la gestante hospitalizada por IVU altas se sugiere realizar el cambio de terapia antimicrobiana a vía oral cuando la paciente tenga, al menos, 48 horas de modulación de respuesta inflamatoria sistémica y de los signos clínicos de infección, así como adecuada tolerancia a vía oral. Recomendación 11. En gestantes con IVU altas, sin complicaciones secundarias a la infección primaria, se recomienda que la terapia antibiótica se administre de 7 a 10 días. Conclusiones: se espera que este consenso colombiano de IVU altas reduzca la variabilidad en la práctica clínica. Se recomienda a los grupos de investigación en medicina materno fetal e infectología evaluar la implementación y efectividad de las recomendaciones emitidas.

Objectives: To generate evidence-based recommendations through formal consensus regarding the treatment of upper urinary tract infections during gestation. Materials and methods: Experts in microbiology, public health, internal medicine, infectious diseases, obstetrics, maternal fetal medicine and obstetric and gynecological infections participated in the consensus development group. The group also included professionals with training in clinical epidemiology, systematic data search, and representatives from the Health Secretariat and the Bogota Obstetrics and Gynecology Association. The participants disclosed their conf licts of interest. Starting with a clinical question, outcomes were graded and a systematic search was conducted in the Medline via PubMed, Embase, Lilacs, and Bireme databases. The search was expanded to include institutional repositories and antimicrobial resistance surveillance systems, with no language or date restrictions. The search was updated on October 1, 2022. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) methodology was used to assess the quality of the evidence and determine the strength of the recommendations. Finally, the RAND/UCLA (Research and Development/University of California Los Angeles) methodology was applied for the formal consensus. This document was reviewed by academic peers before publication. Results: The following are the consensus recommendations. Recommendation 1. The initial management of pregnant women with upper urinary tract infections (UTIs) should be approached in a hospital setting. Recommendation 2. The use of second generation cephalosporins is the suggested first option for empirical antimicrobial management in pregnant women with upper UTI in order to improve the rates of clinical and microbiological cure. Recommendation 3. Because of the risk-benefit balance, the use of aminoglycosides is suggested as a second option for empirical antimicrobial treatment in pregnant women presenting with upper UTIs in the second and third trimester. Recommendation 4. The use of third-generation cephalosporins is suggested as the third option for empirical antimicrobial treatment in pregnant women with upper UTIs given that the risk of inducing microbial resistance is high with this group of antibiotics. Recommendation 5. The use of carbapenems is suggested as a first option in pregnant women with upper UTIs and a history of infections caused by microorganisms with resistance to third or fourth-generation cephalosporins. Recommendation 6. The use of aminoglycosides or fourth-generation cephalosporins is suggested as a second option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third-generation cephalosporins, taking risk-benefit into account. Recommendation 7. The use of piperacillin/tazobactam is suggested as a third option in pregnant women with upper UTIs and a history of infection caused by microorganisms with resistance to third or fourth-generation cephalosporins. Recommendation 8. Getting a urine culture is recommended in pregnant women with upper UTIs before initiating empirical antimicrobial treatment. Recommendation 9. In pregnant women with upper UTIs, it is suggested to modify therapy in accordance with the results of the sensitivity test when the culture report shows resistance to the antimicrobial agent initiated empirically. Recommendation 10. In pregnant women hospitalized due to upper UTIs, it is suggested to switch to oral antimicrobial therapy after at least 48 hours of modulation of the systemic inflammatory response and the clinical signs of infection, and when tolerance to oral intake is adequate. Recommendation 11. In pregnant women with upper UTIs with no complications secondary to the primary infection, it is recommended to administer antibiotic therapy for a period of 7 to 10 days. Conclusions: It is expected that with this Colombian upper UTI consensus variability in clinical practice will be reduced. It is recommended that groups doing research in maternal fetal medicine assess the implementation and effectiveness of these recommendations.

The Use and Effectiveness of Ceftazidime-Avibactam in Real-World Clinical Practice: EZTEAM Study.

INTRODUCTION: Ceftazidime-avibactam has proven activity against multidrug-resistant (MDR) bacteria in clinical trials and real-world studies. This study was conducted to describe the patterns of use of ceftazidime-avibactam (including indications and associated antibiotics), and the effectiveness and safety of ceftazidime-avibactam in real-world clinical practice. METHODS: This non-interventional medical chart review study was conducted in 11 countries across the European and Latin American (LATAM) regions. Consecutive patients treated in clinical practice with at least one dose of ceftazidime-avibactam for an approved indication per country label since 01 January 2018 (or launch date in the country if posterior) were enrolled. Effectiveness analyses were conducted in patients treated with ceftazidime-avibactam for at least 72 h. RESULTS: Of the 569 eligible patients enrolled, 516 (90.7%) were treated for at least 72 h (354 patients from Europe and 162 patients from LATAM); 390 patients (75.7%) had switched from another antibiotic line for Gram-negative coverage. Infection sources were intra-abdominal, urinary, respiratory, bloodstream infections, and other infections (approximately 20% each). K. pneumoniae was the most common microorganism identified in the latest microbiological evaluation before starting ceftazidime-avibactam (59.3%). Two-thirds of microorganisms tested for susceptibility were MDR, of which 89.3% were carbapenem-resistant. The common MDR mechanisms for K. pneumoniae were carbapenemase (33.9%), oxacillinase 48 (25.2%), extended-spectrum beta-lactamase (21.5%), or metallo-beta-lactamase (14.2%) production. Without prior patient exposure, 17 isolates (mostly K. pneumoniae) were resistant to ceftazidime-avibactam. Treatment success was achieved in 77.3% of patients overall (88.3% among patients with urinary infection), regardless of first or second treatment line. In-hospital mortality rate was 23.1%. Adverse events were reported for six of the 569 patients enrolled. CONCLUSION: This study provides important real-world evidence on treatment patterns, effectiveness, and safety of ceftazidime-avibactam in clinical practice through its recruitment in the European and LATAM regions. Ceftazidime-avibactam is one of the antibiotics to consider for treatment of MDR bacteria. TRIAL REGISTRATION: ClinicalTrials.gov identifier, NCT03923426.

Congenital anterior urethral diverticulum in a young man: A case report and review of the literature.

Congenital anterior urethral diverticulum is a rare entity that can occur at any age but exceptionally in adults. Its diagnosis is suspected clinically by obstructive symptoms of the lower urinary tract most often associated with a penoscrotal ball. Its management consists of a diverticulectomy associated or not with a urethroplasty depending on the size of the diverticulum. We discuss through a case report the clinical and therapeutic aspects of this rare entity.

Bacterial Isolates from Urinary Tract Infection in Dogs and Cats in Portugal, and Their Antibiotic Susceptibility Pattern: A Retrospective Study of 5 Years (2017-2021).

There are growing concerns regarding the rise of antimicrobial-resistant bacteria in companion animals. This study aimed to bring new insights into the current scenario of Portugal's antimicrobial resistance bacteria isolated from companion animals with urinary tract infections and is the first to be performed during a long period on a large scale. Of a total of 17472 urine samples analyzed, 12,166 (69.6%) (CI 12,200-12,200) were negative for bacterial growth, and 5306 (30.4%) (95% CI 5310-5310) had bacterial growth. Of the culture-positive samples, 5224 (96.6%) (95% CI 5220-5220) were pure cultures and 82 (3.2%) (95% CI 81.9-82.1) had mixed growth. Escherichia coli was the most frequently isolated bacteria (n=2360, 44.5%) (95% CI 2360-2360), followed by Proteus mirabilis (n=585, 11%) (95% CI 583-583), Enterococcus faecium (n=277, 5.2%) (95% CI 277-277) and Staphylococcus pseudintermedius (n=226, 4.3%) (95% CI 226-226). The overall susceptibility rates were low for erythromycin (45.3%) and clindamycin (51.3%), and high for aminoglycosides (96.3%), carbapenems (92.4%), trimethoprim-sulfamethoxazole (81.2%), and quinolones (79.9%). E. coli also showed considerable resistance to amoxicillin-clavulanic acid. The rates of multidrug-resistant bacteria are still high compared to the northern countries of Europe. This study's findings show the emergence of antibiotic resistance in the antibiotic agents commonly used in the treatment of UTIs in dogs and cats in Portugal.

Resistência antimicrobiana na infecção urinária em unidade de terapia intensiva / Antimicrobial resistance in urinary tract infection in the intensive care unit / Resistencia a los antimicrobianos en la infección del tracto urinario en la unidad de cuidados intensivos

A infecção do trato urinário (ITU) nada mais é do que o acometimento das vias urinárias por microrganismo. Entre as infecções hospitalares de maior incidência está a infecção do trato urinário, acometendo mais mulheres do que homens. Uma das possíveis causas dessa infecção, em pacientes na unidade de terapia intensiva (UTI), é o uso de cateter vesical. Seu tratamento inadequado pode ocasionar uma pielonefrite, podendo adentrar à circulação sanguínea, gerando uma infecção sistêmica e levar o paciente a óbito. A resistência antimicrobiana é uma das principais dificuldades encontrada em UTI sendo considerado um problema de saúde pública. O objetivo deste trabalho foi realizar um breve relato, baseado na literatura, sobre a resistência antimicrobiana na infecção urinária em unidade de terapia intensiva adulta. Em ambientes hospitalares o principal microrganismo causador de ITU é Escherichia coli, sendo 55,5% das culturas positivas estão associadas a procedimentos invasivos, como as sondas vesicais de demora, como consequência este é o microrganismo que mais apresenta resistência aos antimicrobianos utilizados como a ampicilina, trimetoprima e ciprofloxacino. O uso indiscriminado de antibióticos deixa em evidência a necessidade de análise criteriosa da real necessidade de qual antimicrobianos usar, tempo de uso e forma correta de administração. Portanto é necessária a ação dos profissionais de saúde frente a atenção ao paciente, desde a higiene das mãos, uso do cateter, quando necessário observar a real necessidade do uso do antimicrobianos e que esse seja feito após cultura e antibiograma.

Urinary tract infection (UTI) is nothing more than the involvement of the urinary tract by a microorganism. Among the hospital infections with the highest incidence is urinary tract infections, affecting more women than men. One of the possible causes of this infection in patients in the intensive care unit (ICU) is the use of a bladder catheter. Its inadequate treatment can cause pyelonephritis, which can enter the bloodstream, generating a systemic infection and leading the patient to death. Antimicrobial resistance is one of the main difficulties encountered in ICUs and is considered a public health problem. The objective of this study was to present a brief report, based on the literature, on antimicrobial resistance in urinary tract infections in an adult intensive care unit. In hospital environments, the main microorganism that causes UTI is Escherichia coli, and 55.5% of positive cultures are associated with invasive procedures, such as indwelling urinary catheters, as a consequence, this is the microorganism that is most resistant to antimicrobials used, such as ampicillin, trimethoprim and ciprofloxacin. The indiscriminate use of antibiotics highlights the need for a careful analysis of the real need for which antimicrobials to use, time of use, and correct form of administration. Therefore, it is necessary for the action of health professionals in the care of the patient, from the hygiene of the professional to, the use of the catheter, when necessary to observe the real need for the use of antimicrobials and that this is done after culture and antibiogram.

La infección del tracto urinario (ITU) no es más que la afectación de las vías urinarias por un microorganismo. Entre las infecciones hospitalarias con mayor incidencia se encuentra la infección del tracto urinario, que afecta más a mujeres que a hombres. Una de las posibles causas de esta infección en pacientes en la unidad de cuidados intensivos (UCI) es el uso de una sonda vesical. Su tratamiento inadecuado puede causar pielonefritis, la cual puede ingresar al torrente sanguíneo, generando una infección sistémica y llevando al paciente a la muerte. La resistencia a los antimicrobianos es una de las principales dificultades encontradas en las UCI y se considera un problema de salud pública. El objetivo de este estudio fue presentar un breve informe, basado en la literatura, sobre la resistencia antimicrobiana en infecciones del tracto urinario en una unidad de cuidados intensivos de adultos. En ambientes hospitalarios, el principal microorganismo causante de ITU es Escherichia coli, y el 55,5% de los cultivos positivos están asociados a procedimientos invasivos, como sondas vesicales permanentes, por lo que este es el microorganismo más resistente a los antimicrobianos utilizados, como la ampicilina. ., trimetoprima y ciprofloxacino. El uso indiscriminado de antibióticos pone de relieve la necesidad de un análisis cuidadoso de la necesidad real de qué antimicrobianos utilizar, el momento de uso y la forma correcta de administración. Por lo tanto, es necesaria la actuación de los profesionales de la salud en el cuidado del paciente, desde la higiene del profesional, uso del catéter, cuando sea necesario observar la necesidad real del uso de antimicrobianos y que este se realice previo cultivo y antibiograma.

Renal papillary necrosis with urinary tract obstruction: A case report.

BACKGROUND: Renal papillary necrosis (RPN) is a rare disease. It is difficult to distinguish RPN with urinary tract obstruction from upper urinary tract occupying lesions. We reported a case of RPN and made a definite diagnosis largely based upon its endoscopic characteristics. CASE SUMMARY: A 75-year-old woman presented with right flank pain, visible hematuria and a body temperature greater than 39 ℃. Laboratory investigations revealed leukocytosis with 12.7 × 10/L white blood cells and 93.6% neutrophils. Blood creatinine was 333 umol/L. Ultrasonography showed hydronephrosis of the right kidney and a right distal ureteric lesion. After urgent placement of right ureteral double J stent and treatment with antibiotics, the patient's symptoms and the blood abnormalities improved rapidly. Computed tomography urography showed the presence of multiple occupying lesions in the right pelvis. The endoscopic ureteroscopy revealed that renal papillary necrosis and the subsequent migration of sloughed papillae into the upper ureter and calyces. The sloughed papillae appeared like "cottons", which were whitish, soft, and irregularly-shaped without blood supply. In addition, the necrotic and sloughed renal papillae were removed by flexible ureteroscopy to prevent further obstruction. Pathological examination found that infarcted renal papillae were associated with inflammatory exudation. Three months after discharge, follow-up computed tomography urography showed no obvious lesions in the renal pelvis. CONCLUSION: This case revealed the endoscopic features of RPN. In addition, flexible ureteroscopy proves to be vital in diagnosis and treatment of RPN.

Difficulties in the diagnosis and management of eight infants with secondary pseudohypoaldosteronism.

BACKGROUND: Type 1 pseudohypoaldosteronism (PHA1) is a rare condition characterized by the resistance of the kidney to the effect of aldosterone. Secondary PHA1 is a syndrome that is most often related to urinary tract anomalies (UTAs) and/or urinary tract infections (UTIs). A similar pattern of electrolyte impairment is seen in congenital adrenal hyperplasia (CAH) and secondary PHA1, and CAH is a condition that requires urgent treatment. In our study, eight patients aged between 15 days and 8 months (seven males and one female) were included in the evaluation. It was aimed to evaluate cases of secondary PHA1 in our clinic and to identify the problems encountered in diagnosis and follow-up. METHODS: The records of the patients who presented to our hospital between February 2010 and 2021 were retrieved and retrospectively scanned. RESULTS: In all cases, hyponatremia, hyperkalemia, hyperaldosteronism, and hyperreninemia were detected. Other biochemical and hormonal tests were normal. Leukocytosis was detected in urine analysis, and urine cultures were productive. UTA was detected in five cases. Nine episodes of PHA1 occurred in eight patients and fungal infections were responsible for causing two episodes. Four episodes of PHA1 needed mineralocorticoid treatment. On the third day, serum electrolytes normalized. Fludrocortisone treatment was continued for 1 week. In one case, UTIs were repeated with PHA1, but in the follow-up, there were no additional problems. CONCLUSIONS: Secondary PHA1 should be kept in mind when hyponatremia and hyperkalemia are seen, especially in infants aged under 3 months or older, up to 8 months, who present with non-specific symptoms. Fungal infections should not be forgotten in UTI etiology because PHA1 episodes can be initiated. If CAH is suspected, mineralocorticoid treatment should be rapidly initiated.

Prostatic malakoplakia: clinicopathological assessment of a multi-institutional series of 49 patients.

Prostatic malakoplakia (MP) is rare, with only case reports and small series (< five patients) available in the literature. In this study we analysed an international multi-institutional series of 49 patients with prostatic MP to more clearly define its clinicopathological features. The median age was 67 years and the median serum prostate-specific antigen (PSA) was 7.5 ng/ml. MP was clinically manifest in most cases (28 of 45 patients with data available, 62%). Of 43 patients with detailed clinical history available, 21 (49%) had concurrent or metachronous malignancies (including prostate cancer). Diabetes or insulin resistance was present in 11 patients (26%). Additionally, three patients had a history of solid organ transplantation and one had HIV. Of note, six of 34 patients (18%) without concurrent prostate cancer had an abnormal digital rectal examination and/or lesions on magnetic resonance imaging (MRI) with prostate imaging reporting and data system (PIRADS) scores 4-5. The initial diagnosis was made on core biopsies (25 of 49, 51%), transurethal resection specimens (12 of 49, 24%), radical prostatectomies (10 of 49, 20%), Holmium-laser enucleation (one of 49, 2%) and cystoprostatectomy (one of 49, 2%). Tissue involvement was more commonly diffuse or multifocal (40 of 49, 82%). Von Kossa and periodic acid-Schiff stains were positive in 35 of 38 (92%) and 26 of 27 lesions (96%), respectively. Of note, two cases were received in consultation by the authors with a preliminary diagnosis of mesenchymal tumour/tumour of the specialised prostatic stroma. The present study suggests that prostatic MP is often associated with clinical findings that may mimic those of prostate cancer in a subset of patients. Moreover, MP may be found incidentally in patients with concurrent prostate cancer.

Covert postpartum urinary retention: causes and consequences (PAREZ study).

INTRODUCTION AND HYPOTHESIS: Increased post-voiding residual volume (PVRV), known as covert postpartum urinary retention (PUR), is an asymptomatic condition with unknown long-term adverse effects. The objectives were to determine the frequency of this phenomenon 3 days after delivery and to examine the associated risk factors and consequences of the increased residuum on women´s health 6 weeks postpartum. METHODS: We carried out a prospective observational study including a total of 926 primiparous women, giving birth to singletons. All participants underwent ultrasound determination of PVRV on day 3 postpartum. Then, risk factors were determined using logistic regression analysis. After 6 weeks, participants were invited to return for PVRV determination and to complete urogynecological and general health questionnaires. Using these data, the consequences of increased PVRV were determined. RESULTS: A total of n=90 women were diagnosed with abnormal PVRV. Mean age in the studied population was 30.4 years, BMI prior to delivery 27.8, weight of the newborn 3,420 g, and percentage of cesarean sections 15.9%. Gestational week (p=0.043), vaginal tear (p=0.032), and induction of labor (p=0.003) were risk factors for covert PUR. Puerperal incidence of urinary tract infection was 1.1% (6 out of 526) and of urinary incontinence 29.2% (155 out of 530), with no differences between the groups. In the second examination, covert PUR was no longer present, and the values of residual urine decreased for all patients in the case group. No statistically significant differences were observed in questionnaire scores in general health and wellbeing perceptions between the groups. CONCLUSIONS: We have found a few significant obstetrical-pediatric risk factors for abnormal PVRVs. Data from the follow-up suggest that covert PUR has no impact on morbidity and quality of life 6 weeks postpartum. Therefore, abnormal PVRV is a self-limited phenomenon with a tendency toward self-correction. Our findings support those of previous studies that advocate against screening for asymptomatic retention in the postpartum period, despite some similar previous recommendations.