Prophylactic Antibiotics for Urinary Tract Infections after Urodynamic Studies: A Meta-Analysis.

AIM: We aimed to perform a meta-analysis to determine whether antibiotic prophylaxis reduces the incidence of urinary tract infections (UTIs) after urodynamic studies (UDS). METHODS: We conducted a systematic search of PubMed, Web of Science, Ovid, Elsevier, ClinicalKey, Embase, Cochrane Library, Medline, and Wiley Online Library. Randomized controlled trials (RCTs) comparing the effectiveness of prophylactic antibiotics with placebo or no treatment in preventing UTI after UDS were included. Two reviewers extracted data independently, and RevMan 5.3 software was used to analyze relative risk (RR) with 95% confidence intervals (CI). Heterogeneity was assessed by the Q test and I 2 test. RESULTS: The final meta-analysis included 1829 patients in 13 RCTs. Compared with the placebo or no treatment group, prophylactic antibiotics could significantly reduce the risk of bacteriuria (RR = 0.42, 95% CI: 0.30-0.60) and the risk of symptomatic UTI (RR = 0.65, 95% CI: 0.48-0.88). In addition, there was no statistically significant difference in the risk of adverse events (RR = 4.93, 95% CI: 0.61-40.05). No significant heterogeneity or publication bias was found in this study. CONCLUSIONS: Current evidence showed that prophylactic antibiotics could reduce the risk of asymptomatic bacteriuria and symptomatic UTI after UDS without increasing the incidence of adverse events.

What is the role of covert infection in detrusor overactivity, and other LUTD? ICI-RS 2013.

A think tank was convened at the fourth ICI-RS meeting, which took place June 5-7, 2013 in Bristol UK, to consider current evidence and controversies surrounding the possible role of 'covert infection' in the pathophysiology of refractory detrusor overactivity (DO) and other lower urinary tract disorders (LUTD). The topic was chosen because several authors from different centers worldwide have recently published evidence which supports this concept. However, to date there is inconsistency regarding terminology and microbiological definitions, which were discussed by the participants. The mechanisms whereby infection/inflammation could actually promote aberrant detrusor contractions in the human remain controversial, and are more fully described in this report. Future requirements for research into this topic were outlined.

Are prophylactic antibiotics necessary for urodynamic study?

The aim of this study was to assess the efficacy of prophylactic fosfomycin tromethamine (FT) and ciprofloxacin in preventing bacteriuria caused by urodynamic studies (UDS). A total of 426 adult patients presenting for UDS were enrolled the study. A midstream urine sample was taken 72 hours before and 5 days after the procedure. All patients underwent a standard UDS. The 411 patients who had sterile urine before intervention were included in the study. Patients were randomized into three groups. Group1 received no prophylaxis (n = 133), Group 2 (n = 141) received oral ciprofloxacin (500 mg) 1 hour before the procedure, and Group 3 (n = 137) received a single dose of FT approximately 12 hours before the procedure. Bacteriuria was evaluated for each group. Bacteriuria was detected in 3 (2.3%), 6 (4.3%) and 3 patients (1.6%) in Group 1, Group 2, and Group 3, respectively. The most common identified microorganism was Escherichia coli (E coli) in 6 patients (50%). Among the E coli group, extended spectrum beta-lactamase producing E coli was seen in 2 patients (33.3%). Univariate analysis demonstrated that a history of urogenital operation (p < 0.01) and female gender (p < 0.01) were significant risk factors for bacteriuria. On multiple logistic regression analysis, the past urogenital operation history was the only significant independent risk factor for significant bacteriuria after UDS (OR = 14, 95% CI = 1.82-23.8, p = 0.01). The prevalence of bacteriuria after UDS was relatively low in the current study population. Therefore, for most patients, it may be unnecessary to use preventive prophylactic antibiotics. However, our results suggest that in patients with a previous history of urologic surgery, the risk for significant bacteriuria is increased and the use of prophylaxis should be considered.

Quimioprofilaxis en la infección del tracto urinario / Chemoprophylaxis in urinary tract infection

No disponible

Tamm-horsfall protein protects against urinary tract infection by proteus mirabilis.

PURPOSE: Proteus mirabilis is a common cause of urinary tract infection. We determined the role of Tamm-Horsfall protein as a host defense factor against the cystitis and pyelonephritis caused by P. mirabilis. MATERIALS AND METHODS: We generated Tamm-Horsfall protein gene knockout mice using homologous recombination. We introduced P. mirabilis transurethrally into the bladder of Tamm-Horsfall protein deficient (THP(-/-)) and genetically similar WT (THP(+/+)) mice. We cultured urine to quantitate the degree of bacteriuria. We examined bladders and kidneys grossly and histomorphometrically to determine the intensity of inflammation. RESULTS: THP(-/-) mice had more severe bacteriuria and cystitis than THP(+/+) mice. THP(-/-) mice had more pyelonephritic abscesses than THP(+/+) mice. The severity of histological pyelonephritis on semiquantitative histomorphometric analysis appeared to be greater in THP(-/-) mice. The difference between the 2 groups approached but did not attain statistical significance (p = 0.053). CONCLUSION: Tamm-Horsfall protein acts as a host defense factor against P. mirabilis induced urinary tract infection.

Asymptomatic bacteriuria in patients with diabetes mellitus in Ile-Ife, South-West, Nigeria.

OBJECTIVES: To investigate the prevalence and associates of asymptomatic bacteriuria (ASB) in a sample of Nigerian diabetic patients. DESIGN: Cross-sectional descriptive and analytic study. SETTING: The Wesley Guild Hospital and Ife State Hospital, both units of Obafemi Awolowo University Teaching Hospitals Complex, Ile-Ife, Nigeria. SUBJECTS: One hundred and thirty five diabetic patients and 57 non-diabetic patients as controls. MAIN OUTCOME MEASURES: Demographic parameters of participants were recorded. Significant bacteriuria was determined for each of the mid-stream urine specimen obtained from all the subjects. Organisms isolated were identified and evaluated for antibiotic susceptibility patterns. RESULTS: There was a significant difference in the prevalence of ASB in the two groups. Prevalence of ASB was 16% and 3.5% in the diabetic patients and control respectively (p=0.03). Demographic parameters except age were not related to the presence of ASB. ASB was found in 54.4% of diabetic patients with poor glycaemia control compared with 2.9% in diabetics with good glycaemia control (p = 0.006). Organisms associated with ASB were Staphylococcus aureus, Klebsiella sp, Escherichia coli and Enterococcus faecalis, however the most predominant was Staphylococcus aureus. These organisms were largely resistant to the common antibiotics tested such as cotrimoxazole and gentamicin but susceptible to nitrofurantoin. CONCLUSIONS: The prevalence of ASB is high in diabetic patients and poor glucose control can be considered a predisposing factor.

Frequency, risk factors, and responsible pathogenic microorganisms of asymptomatic bacteriuria in patients with type 2 diabetes mellitus.

Urinary tract infection is a serious problem in diabetic patients, and asymptomatic bacteriuria (ASB) in these patients is a risk factor for pyelonephritis and renal dysfunction. In the present study, we investigated the relationships between age, body mass index, duration of diabetes, HbA1c level, glucosuria, glomerular filtration rate and microalbuminuria in type 2 diabetic patients with ASB. One hundred and twenty-three patients with type 2 diabetes mellitus were included in the study. The patients were divided into two groups according to ASB; Group I consisted of 22 patients with ASB, and Group II of 101 patients without ASB. There were no significant differences between the groups in regard to age, body mass index, creatinine clearance or microalbuminuria, while there were significant differences in HbA1c, duration of diabetes mellitus, glucosuria and pyuria (P < 0.05). The most commonly isolated microorganism was Escherichia coli. The present study identified the duration of diabetes, high HbA1c, glucosuria and pyuria as risk factors for ASB in type 2 diabetic patients.

Reagent strip testing for antenatal screening and first meaningful of asymptomatic bacteriuria in pregnant women.

OBJECTIVE: To evaluate the diagnostic performance of reagent strip test as a screening test for asymptomatic bacteriuria (ABU) in pregnant women. MATERIAL AND METHOD: Three hundred and sixty asymptomatic pregnant women who attended their first antenatal appointment at Rajavithi Hospital from August 1st to October 31st, 2005 were enrolled Those with symptoms of urinary tract infection within one month, those who had been prescribed antibiotics during the previous 7 days, and those with medical or obstetric complications, vaginal bleeding and a history of urinary tract diseases were excluded Urine specimens were collected by clean-catched midstream urine technique for urine dipstick and culture. RESULTS: The prevalence of ABU was 10.0% The urine dipstick nitrite leukocyte esterase and combined test had a sensitivity of 16.7%, 75.0% and 16.7%, specificity of 99.1%, 67.9% and 99.4%, positive predictive value of 66.7%, 20.6% and 75.0%, negative predictive value of 91.5, 96.1% and 91.5%, accuracy of 90.8%, 68.6% and 91.1%, respectively. CONCLUSION: Reagent strip testing indicated a fair sensitivity for routine antenatal screening for asymptomatic bacteriuria in pregnant women

Diabetes mellitus and female lower urinary tract symptoms: a review.

Diabetes mellitus (DM) has reached epidemic proportions world wide. Many chronic complications of DM, including neuropathy, retinopathy and nephropathy, have been well studied and although urologic complications have been recognized since 1935, little is known about DM as a pathophysiological risk factor for development of lower urinary tract symptoms (LUTS) in women. Diabetic nephropathy, a life-threatening condition, has received considerable attention in the last few years. Diabetic cystopathy, on the other hand, has received far less attention despite having a significant impact on quality of life, and with significant individual health risks. Initial studies suggested that long standing DM causes paralysis of the detrusor muscle leading to voiding difficulties and this has been the received wisdom regarding diabetic cystopathy for many years. In this review, we discuss what is currently known about lower urinary tract function and urinary incontinence in diabetic females, with a critical analysis of the available evidence and suggest areas for future research.

Association between Escherichia coli bacteriuria and renal function in women: long-term follow-up.

BACKGROUND: We sought to investigate whether Escherichia coli bacteriuria is associated with a decline in renal function or with the development of end-stage renal failure after long-term follow-up. METHODS: We performed a full cohort analysis for women who participated in 2 population-based studies. The baseline cohort consisted of women who collected morning midstream urine samples that were stored. In the cohort study, the presence of E coli bacteriuria was subsequently determined by real-time polymerase chain reaction. After a mean +/- SD follow-up of 11.5 +/- 1.7 years, blood samples were drawn from 490 women. In the nested case-control study, cases comprised all women who underwent kidney therapy (hemodialysis or renal transplantation) between participation in the baseline cohort study and a mean +/- SD of 13.8 +/- 7.4 years later. RESULTS: The mean +/- SD age at baseline was 45.0 +/- 3.2 years, and 48 women (10%) had E coli bacteriuria. After 11.5 years, the mean +/- SD creatinine clearance (Cockroft-Gault formula) was similar between the 2 groups (87 +/- 21 mL/min [1.5 +/- 0.4 mL/s] and 85 +/- 18 mL/min [1.4 +/- 0.3 mL/s] for women who had and those who did not have bacteriuria, respectively). In the nested case-control study, the prevalence of E coli bacteriuria was 14% among cases and control subjects. The odds ratio corrected for age for the development of end-stage renal failure in the presence of E coli bacteriuria at baseline was 1.1 (95% confidence interval, 0.4-2.8; P = .86). CONCLUSION: Escherichia coli bacteriuria is not associated with a decline in renal function or with the development of end-stage renal failure in a population of generally healthy women during 12 to 14 years of follow-up.

Asymptomatic bacteriuria Escherichia coli strain 83972 carries mutations in the foc locus and is unable to express F1C fimbriae.

Escherichia coli is the most common organism associated with asymptomatic bacteriuria (ABU). In contrast to uropathogenic E. coli (UPEC), which causes symptomatic urinary tract infection (UTI), very little is known about the mechanisms by which these strains colonize the urinary tract. Bacterial adhesion conferred by specific surface-associated adhesins is normally considered as a prerequisite for colonization of the urinary tract. The prototype ABU E. coli strain 83972 was originally isolated from a girl who had carried it asymptomatically for 3 years. This study characterized the molecular status of one of the primary adhesion factors known to be associated with UTI, namely F1C fimbriae, encoded by the foc gene cluster. F1C fimbriae recognize receptors present in the human kidney and bladder. Expression of the foc genes was found to be up-regulated in human urine. It was also shown that although strain 83972 contains a seemingly intact foc gene cluster, F1C fimbriae are not expressed. Sequencing and genetic complementation revealed that the focD gene, encoding a component of the F1C transport and assembly system, was non-functional, explaining the inability of strain 83972 to express this adhesin. The data imply that E. coli 83972 has lost its ability to express this important colonization factor as a result of host-driven evolution. The ancestor of the strain seems to have been a pyelonephritis strain of phylogenetic group B2. Strain 83972 therefore represents an example of bacterial adaptation from pathogenicity to commensalism through virulence factor loss.

[Hospital-acquired urinary tract infections]. / Hospitalines slapimo taku infekcijos.

Urinary tract infections are responsible for 40-60% of all hospital-acquired infections. Increased age of patients and comorbid diseases render hospitalized patients more susceptible to infection. Almost 80% of hospital-acquired urinary tract infections are associated with urinary catheters, and only 5-10% of urinary infections are caused by invasive manipulations in the urogenital tract. Pathogens of hospital-acquired urinary tract infections are frequently multi-resistant, and antibiotic therapy can only be successful when the complicating factors are eliminated or urodynamic function is restored. For treatment of complicated hospital-acquired urinary tract infections, the antibiotics must exhibit adequate pharmacodynamic and pharmacokinetic properties: high renal clearance of unmetabolized form with good antimicrobial activity in both acidic and alkaline urine. For selection of empirical treatment of hospital-acquired urinary tract infections, it is necessary to evaluate localization of infection, its severity, possible isolates, and the most frequent pathogens in the department where patient is treated. The best choice for the starting the antimicrobial therapy is the cheapest narrow-spectrum effective antibiotic in the treatment of urinary tract infection until microbiological evaluation of pathogens will be received. Adequate management of urinary tract infections lowers the rate of complications, requirements for antibacterial treatment, selection of multi-resistant isolates and is cost effective.

The influence of prepartal bacteriuria on the reproductive performance of the sow.

UNLABELLED: In a Slowakian indoor pig production unit, with high prevalence of vaginal-vulval discharges, the sows were subjected one day prefarrowing to urine analysis. Sows suffering urinary tract infection (UTI) were assigned to an UTI group (group 1, n = 384), the remaining sows were classified as free of UTI and were assigned to group 2 (n = 1099). Total born litter size, liveborn litter size, weaning litter size and the occurrence of periparturient diseases, reasons for sow cullings at weaning, subsequent weaning to estrus intervals, conceptions- and farrowing rate, next total born- and lifeborn litter size and the occurrence of periparturient diseases were evaluated. UTI having sows had smaller (p < 0.05) total born litter size (11.71 +/- 1.11) when compared to the healthy animals (12.97 +/- 1.25). Liveborn litter size was significantly (p < 0.01) lower in group 1 (10.21 +/- 0.81 vs. group 2: 11.31 +/- 1.21). The occurrence of periparturient diseases revealed highly significant (p < 0.001) differences between the groups (group one 26.24% vs. group two 4.64%). Weaning litter size showed significant (p < 0.05) differences between group 1 (9.21 +/- 1.02) and 2 (10.11 +/- 0.37). More (p < 0.05) sows were culled post-weaning in the UTI group, compared to the healthy animals. Causes of post-weaning cullings differed between the groups: all sows of the group one had the pathological signs of swine urogenital disease at culling, while the majority of sows of the group 2 were culled due to locomotor problems and chronic mastitis. Subsequent weaning to estrus intervals, conceptions-, and farrowing rate and next total born litter size differed significantly (p < 0.05) between the groups, next lifeborn litter size (p < 0.01) and the occurrence of periparturient diseases (p < 0.001) were high significantly better in the healthy than in the UTI suffering group of sows. IMPLICATIONS: antepartal UTI might be the sign of swine urogenital disease and might negatively influence the sows reproductive performance.

Management of asymptomatic bacteriuria in patients with diabetes mellitus.

OBJECTIVE: To review the literature regarding the management of asymptomatic bacteriuria (ASB) in patients with diabetes mellitus. DATA SOURCES: A MEDLINE (1967-June 2003) and bibliographic search of the English-language literature was conducted using the search terms diabetes mellitus, asymptomatic, bacteriuria, and urinary tract infection. DATA SYNTHESIS: ASB occurs in diabetic women more commonly than in non-diabetics and is associated with an increased risk of symptomatic urinary tract infection (UTI) among patients with type 2 diabetes. Symptomatic UTIs tend to follow a more complicated course in diabetics. Despite these independent observations, antimicrobial therapy has not been shown to reduce symptomatic UTIs, pyelonephritis, or hospitalization for UTI. CONCLUSIONS: Available evidence does not support antimicrobial treatment of ASB among patients with diabetes mellitus.

Tamm-Horsfall protein knockout mice are more prone to urinary tract infection: rapid communication.

BACKGROUND: Human colon contains many bacteria that commonly colonize the perineum and frequently enter the urinary tract. Uropathogenic Escherichia coli are the most common cause of urinary tract infection. Type 1 fimbriated E. coli have been associated with cystitis, and P fimbriated E. coli with pyelonephritis. Factors involved in clearing bacteria from the urinary tract are poorly understood. Tamm-Horsfall protein (THP), the most abundant protein in mammalian urine, has been postulated to play a role in defense against urinary tract infection but definitive proof for this idea has been lacking. METHODS: In this study, we generated THP gene knockout mice by the technique of homologous recombination, and examined if the THP-deficient (THP-/-) mice were more prone to urinary tract infection. Various strains of E. coli expressing type 1 or P fimbriae were introduced transurethrally into the bladders of the THP-/- and genetically similar wild-type (THP+/+) mice. Urine, bladder, and kidney tissues were obtained from the mice and cultured for bacterial growth. RESULTS: THP-/- mice inoculated with type 1 fimbriated E. coli had a longer duration of bacteriuria, and more intense colonization of the urinary bladder in comparison with THP+/+ mice. When inoculated with a P fimbriated strain of E. coli, the THP-/- mice showed no difference in kidney bacterial load when compared with the THP+/+ mice. CONCLUSION: These findings support the idea that THP serves as a soluble receptor for type 1 fimbriated E. coli and helps eliminate bacteria from the urinary tract.

Effect of urinary tract infection on ureteropelvic junction obstruction in a rat model.

OBJECTIVES: When a partially obstructed kidney becomes infected, more rapid and extreme renal parenchymal damage appears to occur than might result from either infection or obstruction alone. Previously, we showed that either bacteriuria or partial obstruction in congenital unilateral hydronephrosis causes elevated renal pelvic pressures in a rat model. In this same model, we examined the combined effects of partial upper tract obstruction and bacteriuria on renal pelvic and bladder pressures. METHODS: Female rats from an inbred colony in which more than one half are born with unilateral obstructive hydronephrosis were studied. Type 1 piliated Escherichia coli was instilled into the bladder. Two to 6 days later, the bladder and renal pelvic pressures were measured during varying urinary flows (less than 2 to more than 30 mL/kg/hr). All animals were killed and the kidneys and bladder grossly and histologically assessed. Hydronephrosis was determined at pathologic examination. RESULTS: Eight rats had congenital unilateral hydronephrosis; five were normal. Acute inflammation was found in all bladder and renal specimens. In hydronephrotic, infected kidneys, the renal pelvic pressures exceeded those in nonhydronephrotic, infected kidneys at all urinary flow rates. Bladder capacity and pressures did not differ between the two groups. CONCLUSIONS: This model demonstrates that the combination of infection and obstructive hydronephrosis in this model causes renal pelvic pressure elevation that is higher than that associated with either infection or obstructive hydronephrosis alone. These data demonstrate the compound effect that infection and obstruction may have on the kidney and offers an explanation for why this clinical situation is more likely to be associated with greater renal parenchymal injury than either alone.

Urinary tract infection and patient satisfaction after flexible cystoscopy and urodynamic evaluation.

OBJECTIVES: To investigate the incidence of symptomatic and asymptomatic bacteriuria and to assess patient satisfaction after flexible cystoscopy (FC) and urodynamic (UD) evaluation in a prospective survey. The incidence of urinary tract infection after FC and UD studies and the use of prophylactic antibiotics are issues of debate. The tolerability and acceptance of FC and UD studies by patients have not been thoroughly documented. It would be helpful to be able to give such information to patients before performing these procedures. METHODS: A total of 215 nonconsecutive patients seen as outpatients for FC and UD studies to evaluate various indications were studied. A midstream urine sample was taken before and 48 hours after the procedures. Patients were given a questionnaire that inquired about the presence of lower urinary tract symptoms before and 48 hours after the procedures. The self-administered questionnaire included questions to assess patients' tolerance of the procedures and how it compared with their expectations. RESULTS: Of the 201 patients analyzed (FC 103, UD studies 98), 9 patients (4. 5%) developed significant bacteriuria within 48 hours of FC and UD studies. Only 2 patients with significant bacteriuria reported newly developed symptoms within 48 hours. In a subgroup of 25 patients who were given prophylactic antibiotics for various reasons, 6 (24%) reported new symptoms, although none developed significant bacteriuria. The association between patients who had preprocedure pyuria (n = 7) and the development of significant growth after the procedure (n = 6) was significant (P <0.01). In response to the patient-satisfaction questionnaire, 166 (82.5%) reported that the procedure was not as bad as they expected, and 200 (99.5%) said that they would undergo the test again if necessary. CONCLUSIONS: FC and UD studies are safe, well-tolerated procedures. The addition of prophylactic antibiotics in these procedures is unnecessary, unless specific indications are present.