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Skrzat-Klapaczyńska A, Matłosz B, Bednarska A, Paciorek M, Firląg-Burkacka E, Horban A, Kowalska JD. Factors associated with urinary tract infections among HIV-1 infected patients. PLoS One 2018; 13:e0190564. [PMID: 29324763 PMCID: PMC5764262 DOI: 10.1371/journal.pone.0190564] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 12/18/2017] [Indexed: 01/11/2023] Open
Abstract
Background Urinary tract infections remain an important yet underinvestigated clinical problem among HIV infected patients. Here we analyze factors associated with its occurrence and the spectrum of bacterial pathogens identified in the group of patients followed at the HIV Out-Patient Clinic in Warsaw. Methods Clinic database collected all medical information on patients routinely followed since 1994 to 2015. All patients with available urine culture were included into analyses, only the first culture was included. In statistical analyses logistic regression models were used to identify factors associated with positive culture. Results In total 608 patients had urine culture performed, 176 (28.9%) were females and 432 (71,1%) were males, 378 (62.2%) registered in care before/in 2007, 258 (42.4%) infected through homosexual contact. Median baseline lymphocyte CD4+ count was 385 (IQR:204–565) cells/μl and median nadir lymphocyte CD4+ count 197 (86–306) cells/μl. One hundred and eighteen patients were actively infected with HCV, as defined by positive real-time PCR. In total 141 (23.2%) patients had positive urine culture, the most common bacterial pathogen was E.coli (58.2%) and E. faecalis (12.8%). Patients with urinary tract infection were more likely to be female (51.8% vs. 22.1%, p<0.0001), infected through other than homosexual mode (80.1% vs. 50.7%, p<0.0001), with lower nadir CD4 count (139 vs. 221 cells/μl, p<0.0001) and lower baseline HIV RNA (4.02 vs. 4.35 log copies/ml, p = 0.01) and less likely to be HCV RNA positive (26.9% vs. 49.2%, p = 0.01). In multivariate regression model being registered before/in 2007 (OR = 2.10; [95%CI: 1.24–3.56]), infected through other than homosexual mode (2.05;[1.18–3.56]) and female gender (2.14;[1.33–3.44]) were increasing and higher nadir CD4+ count decreasing (0.92;[0.85–0.99]) the odds of urinary tract infection. Conclusions We have identified that almost one third of patients had urinary tract infections with non-typical bacterial pathogens. Population with increased odds of urinary tract infections are women, patients infected through other than homosexual contacts and those registered before 2007.
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Affiliation(s)
- Agata Skrzat-Klapaczyńska
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
- * E-mail:
| | - Bartłomiej Matłosz
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
| | - Agnieszka Bednarska
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
| | - Marcin Paciorek
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
| | | | - Andrzej Horban
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
| | - Justyna D. Kowalska
- Medical University of Warsaw, Department for Adult's Infectious Diseases, Warsaw, Poland
- Hospital for Infectious Diseases, HIV Out-Patient Clinic, Warsaw, Poland
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Kang CI, Kim J, Park DW, Kim BN, Ha US, Lee SJ, Yeo JK, Min SK, Lee H, Wie SH. Clinical Practice Guidelines for the Antibiotic Treatment of Community-Acquired Urinary Tract Infections. Infect Chemother 2018; 50:67-100. [PMID: 29637759 PMCID: PMC5895837 DOI: 10.3947/ic.2018.50.1.67] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Indexed: 02/06/2023] Open
Abstract
Urinary tract infections (UTIs) are infectious diseases that commonly occur in communities. Although several international guidelines for the management of UTIs have been available, clinical characteristics, etiology and antimicrobial susceptibility patterns may differ from country to country. This work represents an update of the 2011 Korean guideline for UTIs. The current guideline was developed by the update and adaptation method. This clinical practice guideline provides recommendations for the diagnosis and management of UTIs, including asymptomatic bacteriuria, acute uncomplicated cystitis, acute uncomplicated pyelonephritis, complicated pyelonephritis related to urinary tract obstruction, and acute bacterial prostatitis. This guideline targets community-acquired UTIs occurring among adult patients. Healthcare-associated UTIs, catheter-associated UTIs, and infections in immunocompromised patients were not included in this guideline.
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Affiliation(s)
- Cheol In Kang
- Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jieun Kim
- Division of Infectious Diseases, Department of Internal Medicine, College of Medicine, Hanyang University, Seoul, Korea
| | - Dae Won Park
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea
| | - Baek Nam Kim
- Division of Infectious Diseases, Department of Internal Medicine, Inje University Sanggye-Paik Hospital, Seoul, Korea
| | - U Syn Ha
- Department of Urology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung Ju Lee
- Department of Urology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Suwon, Korea
| | - Jeong Kyun Yeo
- Department of Urology, Inje University College of Medicine, Pusan, Korea
| | - Seung Ki Min
- Department of Urology, National Police Hospital, Seoul, Korea
| | - Heeyoung Lee
- Center for Preventive Medicine and Public Health, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Seong Heon Wie
- Division of Infectious Diseases, Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Bouillon J, Snead E, Caswell J, Feng C, Hélie P, Lemetayer J. Pyelonephritis in Dogs: Retrospective Study of 47 Histologically Diagnosed Cases (2005-2015). J Vet Intern Med 2017; 32:249-259. [PMID: 29197113 PMCID: PMC5787179 DOI: 10.1111/jvim.14836] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 07/02/2017] [Accepted: 08/21/2017] [Indexed: 11/16/2022] Open
Abstract
Background The clinicopathologic aspects of pyelonephritis have not been reported in companion animals. Hypothesis/Objectives To evaluate the prevalence of pyelonephritis diagnosed in dogs in a academic referral population, describe the clinical signs and the diagnostic test results in dogs with pyelonephritis, and identify concurrent disorders in order to determine potential risk factors for pyelonephritis. Animals Forty‐seven dogs with a histopathologic diagnosis of pyelonephritis from the teaching hospitals of three Canadian veterinary colleges. Methods Retrospective case series. Review of medical records and renal histologic sections. Results Pyelonephritis was diagnosed in 0.4–1.3% of the cases at necropsy. Clinical signs included anorexia or inappetence (n = 27, 57%), lethargy (n = 24, 51%), vomiting (n = 17, 36%), and dehydration (n = 12, 25%). Thirty‐five dogs (75%) had concomitant disease(s). Escherichia coli was the most common pathogen isolated (37%). Pyelonephritis was classified as acute (n = 12, 26%), subacute (n = 9, 19%), and chronic (n = 26, 55%) disease; and mild (n = 7, 15%), moderate (n = 11, 24%), and severe (n = 28, 61%). Fever was significantly associated with histopathologically subacute pyelonephritis (P = 0.01). Conclusions In referral hospitals, pyelonephritis has a very low prevalence at necropsy. Nonspecific clinical presentation, concomitant diseases, and high variability in the diagnostic tests results make the antemortem diagnosis of pyelonephritis challenging. Neither the histopathologic stage nor the severity of the pyelonephritis was associated with fever, lumbar pain, or signs of a urinary tract infection (ie, lower urinary tract infection, upper urinary tract infection, or both) except for subacute pyelonephritis which was associated with fever.
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Affiliation(s)
- J Bouillon
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - E Snead
- Western College of Veterinary Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - J Caswell
- Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - C Feng
- School of Public Health, Health Sciences Building E-Wing, 104 Clinic Place, University of Saskatchewan, Saskatoon, SK,, Canada
| | - P Hélie
- Faculty of Veterinary Medicine, Université de Montréal, Saint-Hyacinthe, QC, Canada
| | - J Lemetayer
- Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
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Han P, Huang Y, Xie Y, Yang W, Wang Y, Xiang W, Hylands PJ, Legido-Quigley C. Metabolic phenotyping in the mouse model of urinary tract infection shows that 3-hydroxybutyrate in plasma is associated with infection. PLoS One 2017; 12:e0186497. [PMID: 29036204 PMCID: PMC5643114 DOI: 10.1371/journal.pone.0186497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/03/2017] [Indexed: 02/08/2023] Open
Abstract
Urinary tract infection is one of the most common bacterial infections worldwide. Current diagnosis of urinary tract infection chiefly relies on its clinical presentation, urine dipstick tests and urine culture. Small molecules found in bio-fluids related with both infection and recovery would facilitate diagnosis and management of UTI. Mass spectrometry-based fingerprinting of plasma and urine at 3 time points, pre-infection (t = -24h), infection (t = 24h) and post 3-day treatment (t = 112h), were acquired in the following four groups: mice which were healthy, infected but not treated, infected and treated with ciprofloxacin, and infected and treated with Relinqing® granules (n = 6 per group). A metabolomics workflow including multivariate analysis and ROC regression was employed to select metabolic features that correlated with UTI and its treatment. Circa 4,000 molecular features were acquired for each sample. The small acid 3-hydroxybutyrate in plasma was found to be differentiated for urinary tract infection, with an area under the curve = 0.97 (95% confidence interval: 0.93–1.00, accuracy = 0.91, sensitivity = 0.92 and specificity = 0.91). The level of 3-hydroxybutyrate in plasma was depleted after infection with a fold change of -22 (q < 0.0001). Correlation between plasma 3-hydroxybutyrate and urine bacterial number in all groups and time points was r = -0.753 (p < 0.0001). The findings show that 3-hydroxybutyrate is depleted in blood and strongly associated with UTI at both infection and post-treatment stage in a UTI mouse model. Further work is envisaged to assess the clinical potential of blood tests to assist with UTI management.
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Affiliation(s)
- Pei Han
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Yong Huang
- Provincial Key Laboratory of Pharmaceutics in Guizhou Province, School of Pharmacy, Guiyang Medical University, Guiyang, Guizhou, China
| | - Yumin Xie
- Provincial Key Laboratory of Pharmaceutics in Guizhou Province, School of Pharmacy, Guiyang Medical University, Guiyang, Guizhou, China
| | - Wu Yang
- Provincial Key Laboratory of Pharmaceutics in Guizhou Province, School of Pharmacy, Guiyang Medical University, Guiyang, Guizhou, China
| | - Yaoyao Wang
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Wenying Xiang
- Provincial Key Laboratory of Pharmaceutics in Guizhou Province, School of Pharmacy, Guiyang Medical University, Guiyang, Guizhou, China
| | - Peter J. Hylands
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- * E-mail: (CLQ); (PJH)
| | - Cristina Legido-Quigley
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- * E-mail: (CLQ); (PJH)
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Armelle J. [Recurrent cystisis: No medicine preventive means]. Prog Urol 2017; 27:823-830. [PMID: 29033364 DOI: 10.1016/j.purol.2017.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Revised: 09/04/2017] [Accepted: 09/12/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To estimate from the literature review, the interest of hygienic and behavioural measures and the use of food supplements (herbal) to prevent female urinary tract infection. METHODS Pubmed research was focused on the efficiency of prophylactic measures in recurrent cystisis management. RESULTS Due to many predisposing factors such as anatomical charasteristics, hydration and lifestyle, cystisis is more common in female subjects than in male. The infection is mostly caused by uropathgenic Escherichia coli which is mostly found in the intestine. Recomendations propose a better use of antibiotics that causes undesirable side effects (such as nausea, candidiasis) and favours the development of resistant bacterial strains. Hygienic measures, good hydration, and respecting a good urinary rythm help to protect from new infectious episodes. Food supplements such as cranberry or D-mannose can also interfere with the recurrence of cystisis, by preventing the bacteria sticking to urinary tract epithelia. Their efficency is relative and seems to be dose-dependent. Better tolerated than prophylactic antibiotic treatments, they can increase times of respite. CONCLUSION Using prophylactic treatment still have an interest, even if they are questionable. Moreover, the combination of these methods (diet and lifestyle advice) can be an alternative to long-term prophylactic medical treatment.
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Affiliation(s)
- J Armelle
- Service hospitalisation de jour, clinique de rééducation fonctionnelle Korian Les grands chênes, 40, rue Stéhétin, 33021 Bordeaux, France.
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Urinary Symptoms and Their Associations With Urinary Tract Infections in Urogynecologic Patients. Obstet Gynecol 2017; 130:718-725. [PMID: 28885414 DOI: 10.1097/aog.0000000000002239] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To assess urinary symptoms associated with urinary tract infection (UTI) in a urogynecologic population of women. METHODS In this cohort study, we enrolled 150 urogynecologic patients who completed the validated UTI Symptom Assessment questionnaire and contributed transurethral catheterized urine samples. The primary measure (UTI diagnosis) was defined in three ways. Self-report (a nonculture-based UTI diagnosis) was defined by a yes or no response to the query "Do you think you have a UTI?" Two culture-based UTI diagnoses also were analyzed: standard urine culture (10 colony-forming units [CFU]/mL or greater) and enhanced quantitative urine culture (10 CFU/mL or greater) of any uropathogen. Statistical analyses were performed on patient demographics and urinary symptom prevalence among patient groups. RESULTS Although the presence of the urinary symptoms of frequency and urgency (respectively) differ somewhat between UTI-positive and UTI-negative women (self-report [P=.005 and P<.001], standard urine culture [P=.038 and P=.044], or enhanced quantitative urine culture [P=.059 and P=.098]), the presence of dysuria (pain or burning) during urination was significantly more prevalent in UTI-positive women for all UTI definitions (self-report P<.001, standard urine culture P<.001, and enhanced quantitative urine culture P=.010). Furthermore, women reporting dysuria had higher severity and bother scores for all other urinary symptoms assessed by the UTI Symptom Assessment questionnaire compared with women not reporting dysuria (frequency P=.001, urgency P=.006, dysuria P<.001). CONCLUSION Our findings show that, in women seeking urogynecologic care, the presence of frequency and urgency of urination does not confirm a culture-based UTI diagnosis. Instead, clinicians can more readily detect UTI using the presence of dysuria, which more effectively discriminates UTI-positive and UTI-negative individuals, regardless of the culture-based method used to diagnose UTI.
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Beahm NP, Nicolle LE, Bursey A, Smyth DJ, Tsuyuki RT. The assessment and management of urinary tract infections in adults: Guidelines for pharmacists. Can Pharm J (Ott) 2017; 150:298-305. [PMID: 28894499 DOI: 10.1177/1715163517723036] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Nathan P Beahm
- Faculties of Pharmacy and Pharmaceutical Sciences (Beahm) and Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Lindsay E Nicolle
- Faculties of Pharmacy and Pharmaceutical Sciences (Beahm) and Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Alistair Bursey
- Faculties of Pharmacy and Pharmaceutical Sciences (Beahm) and Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Daniel J Smyth
- Faculties of Pharmacy and Pharmaceutical Sciences (Beahm) and Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta
| | - Ross T Tsuyuki
- Faculties of Pharmacy and Pharmaceutical Sciences (Beahm) and Medicine and Dentistry (Tsuyuki), University of Alberta, Edmonton, Alberta
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Abstract
UTI may involve the lower or upper urinary tract and may be uncomplicated or complicated. The emphasis of this chapter is uncomplicated UTI. The diagnosis of uncomplicated cystitis (bladder infection) and pyelonephritis (kidney infection) is usually easily made based on the clinical presentation, whereas the diagnosis in patients with complicated UTI is often more complex. Thus uncomplicated cystitis is usually manifested by dysuria, frequency and/or urgency without fever, and pyelonephritis is usually manifested by fever and back pain/costovertebral angle tenderness. However, pyuria is usually present with UTI, regardless of location, and its absence suggests that another condition may be causing the patient's symptoms. Treatment of cystitis is usually straightforward with one of several effective short-course antimicrobial regimens, although antimicrobial resistance continues to increase and can complicate treatment choices in certain areas. Likewise, antimicrobial resistance has complicated our management of uncomplicated pyelonephritis since resistance of uropathogens to the fluoroquinolone class, the mainstay of oral treatment for pyelonephritis, is increasing worldwide, and some of the other agents used for cystitis are not recommended for pyelonephritis due to low tissue levels. The goal of prevention of recurrent cystitis is to minimize the use of antimicrobials and there are several research efforts in progress to develop effective and safe antimicrobial-sparing preventive approaches for this common condition.
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Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract. Microbiol Spectr 2017; 4. [PMID: 27227294 DOI: 10.1128/microbiolspec.uti-0012-2012] [Citation(s) in RCA: 200] [Impact Index Per Article: 28.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Gram-positive bacteria are a common cause of urinary-tract infection (UTI), particularly among individuals who are elderly, pregnant, or who have other risk factors for UTI. Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including Aerococcus, Corynebacterium, Actinobaculum, and Gardnerella. The literature strongly suggests that urologic diseases involving Gram-positive bacteria may be easily overlooked due to limited culture-based assays typically utilized for urine in hospital microbiology laboratories. Some UTIs are polymicrobial in nature, often involving one or more Gram-positive bacteria. We herein review the risk factors and recent evidence for mechanisms of bacterial synergy in experimental models of polymicrobial UTI. Recent experimental data has demonstrated that, despite being cleared quickly from the bladder, some Gram-positive bacteria can impact pathogenic outcomes of co-infecting organisms. When taken together, the available evidence argues that Gram-positive bacteria are important uropathogens in their own right, but that some can be easily overlooked because they are missed by routine diagnostic methods. Finally, a growing body of evidence demonstrates that a surprising variety of fastidious Gram-positive bacteria may either reside in or be regularly exposed to the urinary tract and further suggests that their presence is widespread among women, as well as men. Experimental studies in this area are needed; however, there is a growing appreciation that the composition of bacteria found in the bladder could be a potentially important determinant in urologic disease, including susceptibility to UTI.
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Cruz Arévalo A, Gómez JE, Cárdenas AM, Reyes JC, Duarte RA. Predictive factors of infectious complications in patients undergoing prostatectomy. Rev Urol 2017. [DOI: 10.1016/j.uroco.2016.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Pinart M, Kranz J, Jensen K, Proctor T, Naber K, Kunath F, Wagenlehner F, Schmidt S. Optimal dosage and duration of pivmecillinam treatment for uncomplicated lower urinary tract infections: a systematic review and meta-analysis. Int J Infect Dis 2017; 58:96-109. [DOI: 10.1016/j.ijid.2017.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 03/15/2017] [Indexed: 10/19/2022] Open
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Jansåker F, Frimodt-Møller N, Bjerrum L, Dahl Knudsen J. The efficacy of pivmecillinam: 3 days or 5 days t.i.d against community acquired uncomplicated lower urinary tract infections - a randomized, double-blinded, placebo-controlled clinical trial study protocol. BMC Infect Dis 2016; 16:727. [PMID: 27905884 PMCID: PMC5134065 DOI: 10.1186/s12879-016-2022-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/14/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uncomplicated lower urinary tract infections (LUTI) are very common, and presumably around 200,000 female patients are treated for this annually in Denmark. The current Danish national clinical practice guidelines recommend pivmecillinam as a first-line drug (i.e., 400 mg t.i.d. for 3 days). Pivmecillinam is also one of the first-line drugs recommended in the international guidelines for LUTIs (i.e., 400 mg b.i.d. for 5 days). The international recommended duration is based on evidence saying that a 7-day regimen is better than a 3-day regimen. However, no data says that a 5-day regimen is superior to a 3-day regimen. With this study we aim to identify and to compare the efficacy of pivmecillinam 400 mg t.i.d in a 3-day respectively 5-day regimen, against community acquired uncomplicated LUTI, i.e., in women at the age of 18-70 year old. METHOD/DESIGN The general practitioner will at consultation give a suitable patient the opportunity to participate in the study. If the patient will give her consent, a double-blinded kit (i.e., the antibiotic with/without placebo, questionnaires and self-urinary samples) will be given to the patient. We aim for 161 evaluable patients in each arm. DISCUSSION Pivmecillinam is an excellent choice against urinary tract infections and we believe this study will fill in the gaps and strengthen the evidence on the treatment against one of the most common infections in our society. Thus, aiming to provide a more rational and ecological beneficial antimicrobial therapy. TRIAL REGISTRATION EudraCTno.: 2014-001321-32 .
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Affiliation(s)
- Filip Jansåker
- The Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Allé 30, 2650, Hvidovre, Denmark.
| | - Niels Frimodt-Møller
- The Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Lars Bjerrum
- Section of General Practice and Research Unit of General Practice, Department of Public Health, University of Copenhagen, Oester Farimagsgade 5, 1014, Copehangen K, Denmark
| | - Jenny Dahl Knudsen
- The Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre Hospital, Kettegård Allé 30, 2650, Hvidovre, Denmark
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Jiang G, Wang J, Yang Y, Zhang G, Liu Y, Lin H, Zhang G, Li Y, Fan X. Fluorescent turn-on sensing of bacterial lipopolysaccharide in artificial urine sample with sensitivity down to nanomolar by tetraphenylethylene based aggregation induced emission molecule. Biosens Bioelectron 2016; 85:62-67. [DOI: 10.1016/j.bios.2016.04.071] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Revised: 04/16/2016] [Accepted: 04/21/2016] [Indexed: 10/21/2022]
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Kurata S, Noguchi M, Tobu S, Nanri M, Daisuke Y, Takagi N, Nakamura K, Uozumi J. Instructing females to wipe their vulva after bowel movements is unnecessary to prevent cystitis: a short research report. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2016. [DOI: 10.1111/ijun.12120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Saya Kurata
- Department of Urology; Saga University Faculty of Medicine; Saga Japan
| | - Mitsuru Noguchi
- Department of Urology; Saga University Faculty of Medicine; Saga Japan
| | - Shohei Tobu
- Department of Urology; Saga University Faculty of Medicine; Saga Japan
| | - Masaharu Nanri
- Department of Urology; Nanri Urological Hospital; Saga Japan
| | | | - Norito Takagi
- Department of Urology; National Hospital Organization Saga National Hospital; Saga Japan
| | - Koji Nakamura
- Department of Urology; Fujisaki Hospital; Saga Japan
| | - Jiro Uozumi
- Department of Urology; Saga University Faculty of Medicine; Saga Japan
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Fasugba O, Mitchell BG, Mnatzaganian G, Das A, Collignon P, Gardner A. Five-Year Antimicrobial Resistance Patterns of Urinary Escherichia coli at an Australian Tertiary Hospital: Time Series Analyses of Prevalence Data. PLoS One 2016; 11:e0164306. [PMID: 27711250 PMCID: PMC5053592 DOI: 10.1371/journal.pone.0164306] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 09/22/2016] [Indexed: 11/19/2022] Open
Abstract
This study describes the antimicrobial resistance temporal trends and seasonal variation of Escherichia coli (E. coli) urinary tract infections (UTIs) over five years, from 2009 to 2013, and compares prevalence of resistance in hospital- and community-acquired E. coli UTI. A cross sectional study of E. coli UTIs from patients attending a tertiary referral hospital in Canberra, Australia was undertaken. Time series analysis was performed to illustrate resistance trends. Only the first positive E. coli UTI per patient per year was included in the analysis. A total of 15,022 positive cultures from 8724 patients were identified. Results are based on 5333 first E. coli UTIs, from 4732 patients, of which 84.2% were community-acquired. Five-year hospital and community resistance rates were highest for ampicillin (41.9%) and trimethoprim (20.7%). Resistance was lowest for meropenem (0.0%), nitrofurantoin (2.7%), piperacillin-tazobactam (2.9%) and ciprofloxacin (6.5%). Resistance to amoxycillin-clavulanate, cefazolin, gentamicin and piperacillin-tazobactam were significantly higher in hospital- compared to community-acquired UTIs (9.3% versus 6.2%; 15.4% versus 9.7%; 5.2% versus 3.7% and 5.2% versus 2.5%, respectively). Trend analysis showed significant increases in resistance over five years for amoxycillin-clavulanate, trimethoprim, ciprofloxacin, nitrofurantoin, trimethoprim-sulphamethoxazole, cefazolin, ceftriaxone and gentamicin (P<0.05, for all) with seasonal pattern observed for trimethoprim resistance (augmented Dickey-Fuller statistic = 4.136; P = 0.006). An association between ciprofloxacin resistance, cefazolin resistance and ceftriaxone resistance with older age was noted. Given the relatively high resistance rates for ampicillin and trimethoprim, these antimicrobials should be reconsidered for empirical treatment of UTIs in this patient population. Our findings have important implications for UTI treatment based on setting of acquisition.
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Affiliation(s)
- Oyebola Fasugba
- Faculty of Health Sciences, Australian Catholic University, Australian Capital Territory, Australia
- * E-mail:
| | - Brett G. Mitchell
- Faculty of Health Sciences, Australian Catholic University, Australian Capital Territory, Australia
- Faculty of Arts, Nursing and Theology, Avondale College of Higher Education, Wahroonga, New South Wales, Australia
| | - George Mnatzaganian
- College of Science, Health and Engineering, La Trobe Rural Health School, La Trobe University, Victoria, Australia
| | - Anindita Das
- Australian Capital Territory Pathology, Canberra Hospital and Health Services, Garran, Australian Capital Territory, Australia
| | - Peter Collignon
- Australian Capital Territory Pathology, Canberra Hospital and Health Services, Garran, Australian Capital Territory, Australia
- Medical School, Australian National University, Acton, Australian Capital Territory, Australia
| | - Anne Gardner
- Faculty of Health Sciences, Australian Catholic University, Australian Capital Territory, Australia
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Emineke S, Cooper AJ, Fouch S, Birch BR, Lwaleed BA. Diluted honey inhibits biofilm formation: potential application in urinary catheter management? J Clin Pathol 2016; 70:140-144. [DOI: 10.1136/jclinpath-2015-203546] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Revised: 06/21/2016] [Accepted: 06/26/2016] [Indexed: 11/04/2022]
Abstract
AimsBiofilms are ubiquitous and when mature have a complex structure of microcolonies in an extracellular polysaccharide and extracellular DNA matrix. Indwelling medical devices harbour biofilms which have been shown to cause infections and act as reservoirs for pathogens. Urinary catheters are often in place for considerable periods of time and are susceptible to both encrustation and biofilm formation. Strategies for minimising biofilm occurrence underpin an active research area in biomedicine. Manuka honey has, inter alia, well-established antibacterial properties. This study aims to assess the influence of honey on early biofilm formation in an established in vitro model.MethodsAn established model of early biofilm formation using static bacterial cultures in vinyl 96-well plates was used to grow Escherichia coli, strain ATC 25922 and Proteus mirabilis, strain 7002. Planktonic cells were removed and the residual biofilm was stained with crystal violet, which were subsequently eluted and quantified spectrophotometrically. Manuka honey (Unique Manuka Factor 15+) was added either with the bacteria or up to 72 hours after.ResultsBiofilms in this model was developed over 3 days, after which growth stalled. Mixed (1:1) cultures of E. coli and P. mirabilis grew slower than monocultures. In mixed cultures, honey gave a dose-dependent reduction in biofilm formation (between 3.3 and 16.7%w/v). At 72 hours, all concentrations inhibited maximally (p<0.001). Application of honey to cultures after 24 and 48 hours also reduced the adherent bacterial biomass (p<0.05–p<0.01).ConclusionManuka honey at dilutions as low as 3.3% w/v in some protocols and at 10% or above in all protocols tested significantly inhibits bacterial attachment to a vinyl substrate and reduces further early biofilm development. No augmentation of growth over untreated controls was observed in any experiment.
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Teoh P, Basarab A, Pickering R, Ali A, Hayes M, Somani BK. Changing trends in antibiotic resistance for urinary E. coli infections over five years in a university hospital. JOURNAL OF CLINICAL UROLOGY 2016. [DOI: 10.1177/2051415813514578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective We wanted to look at the antibiotic resistance patterns in our university teaching hospital for E. coli cultured from urine to assess the resistance profiles to common antibiotics used in the hospital. Patients and methods Results were obtained of all positive urine cultures between January 2007 and December 2011 both from the hospital and urology department. Trends in susceptibility and resistance data for E. coli to trimethoprim, amoxicillin, ciprofloxacin, gentamicin and nitrofurantoin were examined. Results A total of 40,722 hospital urine specimens were culture positive in the five-year period, of which 15,311 (37.6%) grew E. coli. Across the hospital there was no evidence of change in resistance to trimethoprim over the five-year period (38.1% in 2007 compared to 36.6% in 2011; p = 0.313). The percentage resistance to amoxicillin rose slightly (52.6% to 54.4%), and this was statistically significant (p = 0.011). Overall there was a statistically significant fall in resistance to ciprofloxacin but resistance has remained stable for the last three years (15.5% to 13.5%, p = 0.013). A trend of increasing resistance to gentamicin (p = 0.002) resulted from the 2007 baseline of 3.4% to 4.9% in 2008, but resistance remained stably low thereafter. Resistance to nitrofurantoin fell significantly (from 10.4% to 1.6%; p ≤ 0.0005). Conclusions The number of E. coli-positive urine cultures from hospital in-patients remained broadly stable over this five-year period. Resistance to trimethoprim and amoxicillin remains high. Gentamicin resistance remains low, but the statistically significant rise over the five-year period suggests resistance rates should continue to be carefully monitored. Nitrofurantoin resistance is very low and has significantly decreased. This narrow-spectrum antibiotic should be considered the mainstay for treating uncomplicated urinary tract infections in females.
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Affiliation(s)
| | - Adriana Basarab
- Department of Infection, University Hospital Southampton NHS Trust, UK
| | - Ruth Pickering
- Medical Statistics Group, Faculty of Medicine, University of Southampton, UK
| | - Ahmed Ali
- Department of Urology, University Hospital Southampton NHS Trust, UK
| | - Matthew Hayes
- Department of Urology, University Hospital Southampton NHS Trust, UK
| | - Bhaskar K Somani
- Department of Urology, University Hospital Southampton NHS Trust, UK
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García Méndez KB, Bragagnolo G, O'Callaghan D, Lavigne JP, Keriel A. A high-throughput assay for the measurement of uropathogenic Escherichia coli attachment to urinary bladder cells. Int J Exp Pathol 2016; 97:194-201. [PMID: 27273601 DOI: 10.1111/iep.12181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/24/2016] [Indexed: 12/14/2022] Open
Abstract
Strains of uropathogenic Escherichia coli (UPEC) are the major causative agent of urinary tract infections (UTI), the most common infectious diseases in the world. Their ability to attach and enter into cells in the urinary tract is a limiting step for their pathogenicity. Many studies are thus focussing on these key mechanisms to propose new therapeutic strategies. To facilitate such studies, we developed a fast and high-throughput assay which makes it possible to monitor the interaction of UPEC with cultured human uroepithelial cells. This assay allows measurement of the in vitro association of fluorescently labelled clinical isolates with bladder epithelial cells using flow cytometry in a microplate format. The assay was sensitive enough to detect variations between isolates expressing different adhesins and virulence factors and the inhibitory effect of proanthocyanidins. Thus we have developed a fast and robust assay which allows us to measure variations in the adhesion properties of UPEC to human bladder cells. This novel assay will be valuable for the study of initial steps of pathogenesis in UTI and for the screening or validation of inhibitory molecules.
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Affiliation(s)
- Karellen Beren García Méndez
- U1047, UFR de Médecine, Inserm, Nîmes, Cedex, France.,U1047, Université de Montpellier, Nîmes, Cedex, France
| | - Gabriel Bragagnolo
- U1047, UFR de Médecine, Inserm, Nîmes, Cedex, France.,U1047, Université de Montpellier, Nîmes, Cedex, France
| | - David O'Callaghan
- U1047, UFR de Médecine, Inserm, Nîmes, Cedex, France.,U1047, Université de Montpellier, Nîmes, Cedex, France
| | - Jean-Philippe Lavigne
- U1047, UFR de Médecine, Inserm, Nîmes, Cedex, France.,U1047, Université de Montpellier, Nîmes, Cedex, France.,Service de Microbiologie, CHU Carémeau, Nîmes, Cedex, France
| | - Anne Keriel
- U1047, UFR de Médecine, Inserm, Nîmes, Cedex, France.,U1047, Université de Montpellier, Nîmes, Cedex, France
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Ghosh B, Mukherjee M. Emergence of co-production of plasmid-mediated AmpC beta-lactamase and ESBL in cefoxitin-resistant uropathogenic Escherichia coli. Eur J Clin Microbiol Infect Dis 2016; 35:1449-54. [DOI: 10.1007/s10096-016-2683-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 05/13/2016] [Indexed: 10/21/2022]
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de Ruyck J, Lensink MF, Bouckaert J. Structures of C-mannosylated anti-adhesives bound to the type 1 fimbrial FimH adhesin. IUCRJ 2016; 3:163-7. [PMID: 27158502 PMCID: PMC4856138 DOI: 10.1107/s2052252516002487] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 02/10/2016] [Indexed: 05/24/2023]
Abstract
Selective inhibitors of the type 1 fimbrial adhesin FimH are recognized as attractive alternatives for antibiotic therapies and prophylaxes against Escherichia coli infections such as urinary-tract infections. To construct these inhibitors, the α-d-mannopyranoside of high-mannose N-glycans, recognized with exclusive specificity on glycoprotein receptors by FimH, forms the basal structure. A hydrophobic aglycon is then linked to the mannose by the O1 oxygen inherently present in the α-anomeric configuration. Substitution of this O atom by a carbon introduces a C-glycosidic bond, which may enhance the therapeutic potential of such compounds owing to the inability of enzymes to degrade C-glycosidic bonds. Here, the first crystal structures of the E. coli FimH adhesin in complex with C-glycosidically linked mannopyranosides are presented. These findings explain the role of the spacer in positioning biphenyl ligands for interactions by means of aromatic stacking in the tyrosine gate of FimH and how the normally hydrated C-glycosidic link is tolerated. As these new compounds can bind FimH, it can be assumed that they have the potential to serve as potent new antagonists of FimH, paving the way for the design of a new family of anti-adhesive compounds against urinary-tract infections.
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Affiliation(s)
- Jerome de Ruyck
- Université Lille, CNRS, UMR 8576–UGSF–Unité de Glycobiologie Structurale et Fonctionnelle, 59000 Lille, France
| | - Marc F. Lensink
- Université Lille, CNRS, UMR 8576–UGSF–Unité de Glycobiologie Structurale et Fonctionnelle, 59000 Lille, France
| | - Julie Bouckaert
- Université Lille, CNRS, UMR 8576–UGSF–Unité de Glycobiologie Structurale et Fonctionnelle, 59000 Lille, France
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Donkor ES, Akumwena A, Amoo PK, Owolabi MO, Aspelund T, Gudnason V. Post-stroke bacteriuria among stroke patients attending a physiotherapy clinic in Ghana: a cross-sectional study. Ther Clin Risk Manag 2016; 12:457-62. [PMID: 27051289 PMCID: PMC4803267 DOI: 10.2147/tcrm.s90474] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Infections are known to be a major complication of stroke patients. In this study, we evaluated the risk of community-acquired bacteriuria among stroke patients, the associated factors, and the causative organisms. METHODS This was a cross-sectional study involving 70 stroke patients and 83 age- and sex-matched, apparently healthy controls. Urine specimens were collected from all the study subjects and were analyzed by standard microbiological methods. Demographic and clinical information was also collected from the study subjects. For stroke patients, the information collected also included stroke parameters, such as stroke duration, frequency, and subtype. RESULTS Bacteriuria was significantly higher among stroke patients (24.3%, n=17) than among the control group (7.2%, n=6), with a relative risk of 3.36 (confidence interval [CI], 1.40-8.01, P=0.006). Among the control group, all six bacteriuria cases were asymptomatic, whereas the 17 stroke bacteriuria cases comprised 15 cases of asymptomatic bacteriuria and two cases of symptomatic bacteriuria. Female sex (OR, 3.40; CI, 1.12-10.30; P=0.03) and presence of stroke (OR, 0.24; CI, 0.08-0.70; P=0.009) were significantly associated with bacteriuria. The etiology of bacteriuria was similar in both study groups, and coagulase-negative Staphylococcus spp. were the most predominant organisms isolated from both stroke patients (12.9%) and the control group (2.4%). CONCLUSION Stroke patients in the study region have a significantly higher risk of community-acquired bacteriuria, which in most cases is asymptomatic. Community-acquired bacteriuria in stroke patients appears to have little or no relationship with clinical parameters of stroke such as stroke subtype, duration and frequency.
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Affiliation(s)
- Eric S Donkor
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Accra, Ghana; Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Amos Akumwena
- Department of Medical Microbiology, College of Health Sciences, University of Ghana, Accra, Ghana
| | - Philip K Amoo
- Public Health Unit, Korle-Bu Teaching Hospital, Accra, Ghana
| | - Mayowa O Owolabi
- Department of Medicine, University College Hospital, University of Ibadan, Ibadan, Nigeria
| | - Thor Aspelund
- Icelandic Heart Association Research Institute, Kopavogur, Iceland; Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kopavogur, Iceland; Centre for Public Health Sciences, University of Iceland, Reykjavik, Iceland
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Abstract
Acute uncomplicated urinary tract infection (UTI) is a common clinical problem, accounting for millions of outpatient visits in the USA annually. Although routinely obtaining urine cultures in UTI is not recommended, there are circumstances in which obtaining a pre-therapy culture may be warranted or chosen by clinicians, such as when indicated by the need for careful antimicrobial stewardship. This review focuses on understanding reasons for obtaining a pre-therapy culture, methods of collection, and appropriately interpreting urine culture data.
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Neupane S, Pant ND, Khatiwada S, Chaudhary R, Banjara MR. Correlation between biofilm formation and resistance toward different commonly used antibiotics along with extended spectrum beta lactamase production in uropathogenic Escherichia coli isolated from the patients suspected of urinary tract infections visiting Shree Birendra Hospital, Chhauni, Kathmandu, Nepal. Antimicrob Resist Infect Control 2016; 5:5. [PMID: 26885364 PMCID: PMC4754952 DOI: 10.1186/s13756-016-0104-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 02/09/2016] [Indexed: 11/21/2022] Open
Abstract
Background Escherichia coli is the most predominant causative agent of urinary tract infection (UTI). Recently, increase in drug resistance among the uropathogenic bacteria has caused great problem in treatment of UTI. The main objective of this research is to determine the correlation between biofilm formation and resistance toward different commonly used antibiotics along with extended spectrum beta lactamase production in uropathogenic Escherichia coli. Methods The urine samples collected from the patients suspected of urinary tract infections (visiting Shree Birendra Hospital, Chhauni, Kathmandu, Nepal between July to December 2013) were cultured in cystine lactose electrolyte deficient (CLED) agar by using semi quantitative culture technique. Extended spectrum beta lactamase (ESBL) production was detected by combined disc diffusion technique and biofilm formation was detected by Congo red agar method. Chi-square test was applied and p-value < 0.05 was considered statistically significant. Results Out of 1480 urine samples, E. Coli was isolated from 208 (14.1 %) samples. Of total 69 (33.2 %) ESBL producing uropathogenic strains of E. coli, 20 (29 %) were strong biofilm producers, 22 (31.9 %) were moderate biofilm producers, 11 (15.9 %) were weak biofilm producers and 16 (23.2 %) were biofilm non producers. Whereas among 139 ESBL non producing E. coli, 22 (15.8 %) were strong biofilm producers, 20 (14.4 %) were moderate biofilm producers, 13 (9.4 %) were weak biofilm producers and 84 (60.4 %) were biofilm non producers. Among total 108 biofilm producing E. coli, maximum resistance was observed toward cephalexin followed by amoxicillin and highest susceptibility was seen toward amikacin. Conclusion The ability of biofilm formation was found to be significantly higher in ESBL producing strains of E. coli than that in ESBL non producing strains (p < 0.05). There was higher resistance rate to antimicrobial agents among biofilm producing strains of E. coli than that in biofilm non producing strains. According to our antimicrobial susceptibility pattern for E. coli, to start preliminary treatment for UTI in Nepal, we recommend to use amikacin or nitrofurantoin. Further, for the treatment of the UTI, the antibiotics should be selected on the basis of the urine culture and sensitivity report.
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Affiliation(s)
- Sanjeev Neupane
- Central Department of Microbiology, Tribhuvan University, Kirtipur Kathmandu, Nepal
| | - Narayan Dutt Pant
- Department of Microbiology, Grande International Hospital, Dhapasi Kathmandu, Nepal
| | | | | | - Megha Raj Banjara
- Central Department of Microbiology, Tribhuvan University, Kirtipur Kathmandu, Nepal
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Bergstrom JP. Rapid detection of E. coli cells in urine samples using a self-capacitance touchscreen device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2016; 2015:5545-8. [PMID: 26737548 DOI: 10.1109/embc.2015.7319648] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Escherichia coli is one of the main causes of urinary tract infections (UTIs). E. coli is commonly detected from urine using standard culture method. However, the urine sampling and analysis required for these methods can be costly, time consuming (requires 24 to 48 hours) and labor-intensive. This work proposes a capacitive touch screen sensor concept as possible alternative device for rapid detection of E. coli in urine samples. E. coli solutions prepared at different concentrations and urine samples (with spiked and nor spike E. coli) obtained from healthy women participants, have been analyzed using a capacitance evaluation kit. It has been demonstrated in this study that the use of this evaluation kit provides a low-cost and simple alternative system for detecting E. coli present in urine. Several experimental tests were performed to determine the optimal testing volume, the sensitivity of the sensor, limit of detection and repeatability. The optimal testing volume was 80 microliters and the analytical sensitivity was 17 counts per picofarad (pF). The lowest detectable concentration is around 3.98 × 10(5) CFU/ml. The repeatability (r) was found to be 7.2 or 6.2 % (in r%). The capacitive touch sensor gave promising results that could be used to design and realize a portable diagnostic device for early-stage detection of UTIs.
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Chang UI, Kim HW, Wie SH. Comparison of Second- and Third-Generation Cephalosporin as Initial Therapy for Women with Community-Onset Uncomplicated Acute Pyelonephritis. Yonsei Med J 2015; 56:1266-73. [PMID: 26256969 PMCID: PMC4541656 DOI: 10.3349/ymj.2015.56.5.1266] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Revised: 12/08/2014] [Accepted: 12/08/2014] [Indexed: 11/27/2022] Open
Abstract
PURPOSE This study examined the clinical effectiveness of parenteral cefuroxime and cefotaxime as empirical antibiotics for treating hospitalized women with uncomplicated acute pyelonephritis (APN). MATERIALS AND METHODS This study was based on the clinical and microbiologic data of 255 hospitalized women with APN. Of these 255 women, 144 patients received cefuroxime and 111 received cefotaxime. RESULTS There were no marked differences in the demographic features, clinical characteristics, and treatment duration between the populations of the cefuroxime and cefotaxime groups. The rates of defervescence showed no significant differences in the two groups at 48, 72, 96, and 120 hours. The clinical cure rates observed at the follow-up visit 4 to 14 days after the completion of antimicrobial therapy were not statistically different between the cefuroxime and cefotaxime groups [94.9% (129 of 136) versus 98.0% (100 of 102), respectively; p=0.307], and the microbiological cure rates were also not significantly different [88.3% (91 of 103) versus 95.0% (76 of 80), respectively; p=0.186]. The median hospitalization periods in the cefuroxime and cefotaxime groups were 7 (6-8) and 7 (6-8) days (p=0.157), respectively. Microbiological success rates after 72-96 hours of initial antimicrobial therapy were also not statistically different in the cefuroxime and cefotaxime groups, 89.4% (110 of 123) versus 94.9% (93 of 98; p=0.140). CONCLUSION Cefuroxime, a second-generation cephalosporin, is an appropriate antibiotic option for the initial treatment of uncomplicated APN and its efficacy does not differ from cefotaxime, a third-generation cephalosporin, in the initial parenteral therapy for community-onset APN.
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Affiliation(s)
- U-Im Chang
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyung Wook Kim
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seong-Heon Wie
- Department of Internal Medicine, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
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Characterization and antibiotic susceptibility of Streptococcus agalactiae isolates causing urinary tract infections. INFECTION GENETICS AND EVOLUTION 2015; 34:1-6. [DOI: 10.1016/j.meegid.2015.07.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 06/24/2015] [Accepted: 07/01/2015] [Indexed: 11/22/2022]
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Cho S, Park TS, Nahapetian TG, Yoon JY. Smartphone-based, sensitive µPAD detection of urinary tract infection and gonorrhea. Biosens Bioelectron 2015; 74:601-11. [PMID: 26190472 DOI: 10.1016/j.bios.2015.07.014] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 06/22/2015] [Accepted: 07/08/2015] [Indexed: 01/16/2023]
Abstract
The presence of bacteria in urine can be used to monitor the onset or prognosis of urinary tract infection (UTI) and some sexually-transmitted diseases (STDs), such as gonorrhea. Typically, bacteria's presence in urine is confirmed by culturing samples overnight on agar plates, followed by a microscopic examination. Additionally, the presence of Escherichia coli in a urine sample can be indirectly confirmed through assaying for nitrite (generated by reducing nitrate in urine), however this is not sufficiently specific and sensitive. Species/strains identification of bacteria in a urine sample provides insight to appropriate antibiotic treatment options. In this work, a microfluidic paper analytical device (µPAD) was designed and fabricated for evaluating UTI (E. coli) and STD (Neisseria gonorrhoeae) from human urine samples. Anti-E. coli or anti-N. gonorrhoeae antibodies were conjugated to submicron particles then pre-loaded and dried in the center of each paper microfluidic channel. Human urine samples (undiluted) spiked with E. coli or N. gonorrhoeae were incubated for 5 min with 1% Tween 80. The bacteria-spiked urine samples were then introduced to the inlet of paper microfluidic channel, which flowed through the channel by capillary force. Data confirms that proteins were not filtered by μPAD, which is essential for this assay. Urobilin, the component responsible for the yellow appearance of urine and green fluorescence emission, was filtered by μPAD, resulting in significantly minimized false-positive signals. This filtration was simultaneously made during the μPAD assay and no pretreatment/purification step was necessary. Antibody-conjugated particles were immunoagglutinated at the center of the paper channel. The extent of immunoagglutination was quantified by angle-specific Mie scatter under ambient lighting conditions, utilizing a smartphone camera as a detector. The total μPAD assay time was less than 30s. The detection limit was 10 CFU/mL for both E. coli and N. gonorrhoeae, while commercially available gonorrhea rapid kit showed a detection limit of 10(6) CFU/mL. A commercially available nitrite assay test strip also had a detection limit of 10(6) CFU/mL, but this method is not antibody-based and thus not sufficiently specific. By optimizing the particle concentration, we were also able to extend the linear range of the assay up to 10(7) CFU/mL. The proposed prototype will serve as a low-cost, point-of-care, sensitive urinalysis biosensor to monitor UTI and gonorrhea from human urine.
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Affiliation(s)
- Soohee Cho
- Department of Agricultural and Biosystems Engineering, The University of Arizona, Tucson, AZ 85721-0038, USA
| | - Tu San Park
- Department of Agricultural and Biosystems Engineering, The University of Arizona, Tucson, AZ 85721-0038, USA
| | - Tigran G Nahapetian
- Biomedical Engineering Graduate Interdisciplinary Program, The University of Arizona, Tucson, AZ 85721-0038, USA
| | - Jeong-Yeol Yoon
- Department of Agricultural and Biosystems Engineering, The University of Arizona, Tucson, AZ 85721-0038, USA; Biomedical Engineering Graduate Interdisciplinary Program, The University of Arizona, Tucson, AZ 85721-0038, USA.
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Hisano M, Bruschini H, Nicodemo AC, Gomes CM, Lucon M, Srougi M. The Bacterial Spectrum and Antimicrobial Susceptibility in Female Recurrent Urinary Tract Infection: How Different They Are From Sporadic Single Episodes? Urology 2015; 86:492-7. [PMID: 26163810 DOI: 10.1016/j.urology.2015.05.033] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 04/28/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To analyze and compare the etiological uropathogens and the susceptibility profile findings on urine culture between sporadic cases of community-acquired, uncomplicated urinary tract infection (UTI) and recurrent UTI cases in women. MATERIALS AND METHODS We retrospectively analyzed the clinical data of 1629 women with uncomplicated UTI evaluated at our hospital between January 2007 and December 2012. Patients were divided into 2 groups: (1) no recurrent UTI and (2) recurrent UTI. We analyzed the microbiological findings and compared susceptibility profiles between groups. RESULTS A total of 420 women were included. Group 1 had 233 (55.5%) patients and group 2 had 187 (44.5%). Escherichia coli was the most common agent in both groups (76.4% and 74.3%, respectively; P = .625), whereas Staphylococcus saprophyticus (8.2%) was the second most common in group 1, and Enterococcus faecalis was the second most common in group 2 (8.0%). Nitrofurantoin was the only oral agent that maintained the susceptibility profile in both groups (87.1% and 88.7%, respectively; P = .883). For E coli infections, only nitrofurantoin and amoxicillin/clavulanate maintained susceptibility rates more than 90% in both groups. CONCLUSION UTI episodes in patients with recurrent UTI had similar bacterial spectra, but different susceptibility profiles compared with those from patients with nonrecurrent infections. The susceptibility rate for nitrofurantoin in patients with recurrent UTI remained high and comparable to the observed in patients with sporadic UTI, reinforcing its indication for empirical treatment while waiting for urine culture results.
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Affiliation(s)
- Marcelo Hisano
- Division of Urology, Hospital das Clínicas, University of São Paulo, Brazil
| | - Homero Bruschini
- Division of Urology, Hospital das Clínicas, University of São Paulo, Brazil.
| | | | | | - Marcos Lucon
- Division of Urology, Hospital das Clínicas, University of São Paulo, Brazil
| | - Miguel Srougi
- Division of Urology, Hospital das Clínicas, University of São Paulo, Brazil
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Idayat TG. Antibacterial attributes of extracts of Phyllantus amarus and Phyllantus niruri on Escherichia coli the causal organism of urinary tract infection. ACTA ACUST UNITED AC 2015. [DOI: 10.5897/jpp2014.0332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Carey AJ, Tan CK, Ipe DS, Sullivan MJ, Cripps AW, Schembri MA, Ulett GC. Urinary tract infection of mice to model human disease: Practicalities, implications and limitations. Crit Rev Microbiol 2015; 42:780-99. [PMID: 26006172 DOI: 10.3109/1040841x.2015.1028885] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Urinary tract infections (UTIs) are among the most common bacterial infections in humans. Murine models of human UTI are vital experimental tools that have helped to elucidate UTI pathogenesis and advance knowledge of potential treatment and infection prevention strategies. Fundamentally, several variables are inherent in different murine models, and understanding the limitations of these variables provides an opportunity to understand how models may be best applied to research aimed at mimicking human disease. In this review, we discuss variables inherent in murine UTI model studies and how these affect model usage, data analysis and data interpretation. We examine recent studies that have elucidated UTI host-pathogen interactions from the perspective of gene expression, and review new studies of biofilm and UTI preventative approaches. We also consider potential standards for variables inherent in murine UTI models and discuss how these might expand the utility of models for mimicking human disease and uncovering new aspects of pathogenesis.
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Affiliation(s)
- Alison J Carey
- a Menzies Health Institute Queensland & School of Medical Sciences, Griffith University , Gold Coast , Australia
| | - Chee K Tan
- a Menzies Health Institute Queensland & School of Medical Sciences, Griffith University , Gold Coast , Australia
| | - Deepak S Ipe
- a Menzies Health Institute Queensland & School of Medical Sciences, Griffith University , Gold Coast , Australia
| | - Matthew J Sullivan
- a Menzies Health Institute Queensland & School of Medical Sciences, Griffith University , Gold Coast , Australia
| | - Allan W Cripps
- b Menzies Health Institute Queensland, Griffith University , Gold Coast , Australia , and
| | - Mark A Schembri
- c School of Chemistry and Molecular Biosciences, University of Queensland , Brisbane , Australia
| | - Glen C Ulett
- a Menzies Health Institute Queensland & School of Medical Sciences, Griffith University , Gold Coast , Australia
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Nyirenda MH, Morandi E, Vinkemeier U, Constantin-Teodosiu D, Drinkwater S, Mee M, King L, Podda G, Zhang GX, Ghaemmaghami A, Constantinescu CS, Bar-Or A, Gran B. TLR2 Stimulation Regulates the Balance between Regulatory T Cell and Th17 Function: A Novel Mechanism of Reduced Regulatory T Cell Function in Multiple Sclerosis. THE JOURNAL OF IMMUNOLOGY 2015; 194:5761-74. [DOI: 10.4049/jimmunol.1400472] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 04/19/2015] [Indexed: 01/19/2023]
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Vidal E, Cervera C, Cordero E, Armiñanzas C, Carratalá J, Cisneros JM, Fariñas MC, López-Medrano F, Moreno A, Muñoz P, Origüen J, Sabé N, Valerio M, Torre-Cisneros J. Management of urinary tract infection in solid organ transplant recipients: Consensus statement of the Group for the Study of Infection in Transplant Recipients (GESITRA) of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and the Spanish Network for Research in Infectious Diseases (REIPI). Enferm Infecc Microbiol Clin 2015; 33:679.e1-679.e21. [PMID: 25976754 DOI: 10.1016/j.eimc.2015.03.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 03/30/2015] [Indexed: 12/18/2022]
Abstract
BACKGROUND Urinary tract infections (UTIs) are one of the most common infections in solid organ transplant (SOT) recipients. METHODS Experienced SOT researchers and clinicians have developed and implemented this consensus document in support of the optimal management of these patients. A systematic review was conducted, and evidence levels based on the available literature are given for each recommendation. This article was written in accordance with international recommendations on consensus statements and the recommendations of the Appraisal of Guidelines for Research and Evaluation II (AGREE II). RESULTS Recommendations are provided on the management of asymptomatic bacteriuria, and prophylaxis and treatment of UTI in SOT recipients. The diagnostic-therapeutic management of recurrent UTI and the role of infection in kidney graft rejection or dysfunction are reviewed. Finally, recommendations on antimicrobials and immunosuppressant interactions are also included. CONCLUSIONS The latest scientific information on UTI in SOT is incorporated in this consensus document.
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Affiliation(s)
- Elisa Vidal
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Instituto Maimónides de Investigación en Biomedicina de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain.
| | - Carlos Cervera
- Servicio de Enfermedades Infecciosas, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Elisa Cordero
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - Carlos Armiñanzas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Jordi Carratalá
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, Barcelona, Spain
| | - José Miguel Cisneros
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Microbiología y Medicina Preventiva, Instituto de Biomedicina de Sevilla, Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, Spain
| | - M Carmen Fariñas
- Unidad de Enfermedades Infecciosas, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, IDIVAL, Santander, Spain
| | - Francisco López-Medrano
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Asunción Moreno
- Servicio de Enfermedades Infecciosas, Hospital Clínic-Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universidad de Barcelona, Barcelona, Spain
| | - Patricia Muñoz
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Julia Origüen
- Unidad de Enfermedades Infecciosas, Hospital Universitario 12 de Octubre, Instituto de Investigación Biomédica 12 de Octubre, Departamento de Medicina, Universidad Complutense, Madrid, Spain
| | - Núria Sabé
- Servicio de Enfermedades Infecciosas, Hospital Universitario de Bellvitge, Instituto de Investigación Biomédica de Bellvitge (IDIBELL), Universidad de Barcelona, Barcelona, Spain
| | - Maricela Valerio
- Departamento de Microbiología Clínica y Enfermedades Infecciosas, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Julián Torre-Cisneros
- Unidad Clínica de Gestión de Enfermedades Infecciosas, Instituto Maimónides de Investigación en Biomedicina de Córdoba, Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain
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Value of an aggregate index in describing the impact of trends in antimicrobial resistance for Escherichia coli. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2015; 26:33-8. [PMID: 25798152 PMCID: PMC4353267 DOI: 10.1155/2015/274298] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Typically, rates of resistance to various antibiotics in a given pathogen are assessed for a single drug at a time, in the setting of a particular type of infection. A more cohesive analysis is the drug resistance index, which incorporates resistance to multiple drugs for a given pathogen. The authors of this article developed a drug resistance index for Escherichia coli causing urinary tract infections in British Columbia. BACKGROUND: Drug resistance indexes (DRIs) quantify the cumulative impact of antimicrobial resistance on the likelihood that a given pathogen will be susceptible to antimicrobial therapy. OBJECTIVE: To derive a DRI for community urinary tract infections caused by Escherichia coli in British Columbia for the years 2007 to 2010, and to examine trends over time and across patient characteristics. METHODS: Indication-specific utilization data were obtained from BC PharmaNet for outpatient antimicrobial prescriptions linked to diagnostic information from physician payment files. Resistance data for E coli urinary isolates were obtained from BC Biomedical Laboratories (now part of LifeLabs Medical Laboratory Services). DRIs were derived by multiplying the rate of resistance to a specific antimicrobial by the proportional rate of utilization for that drug class and aggregating across drug classes. Higher index values indicate more resistance. RESULTS: Adaptive-use DRIs remained stable over time at approximately 18% (95% CI 17% to 18%) among adults ≥15 years of age and approximately 28% (95% CI 26% to 31%) among children <15 years of age. Similar results were observed when proportional drug use was restricted to the baseline year (ie, a static-use model). Trends according to age group suggest a U-shaped distribution, with the highest DRIs occurring among children <10 years of age and adults ≥65 years of age. Males had consistently higher DRIs than females for all age groups. CONCLUSIONS: The stable trend in adaptive-use DRIs over time suggests that clinicians are adapting their prescribing practices for urinary tract infections to local resistance patterns. Results according to age group reveal a higher probability of resistance to initial therapy among young children and elderly individuals.
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86
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Dong T, Zhao X. Rapid identification and susceptibility testing of uropathogenic microbes via immunosorbent ATP-bioluminescence assay on a microfluidic simulator for antibiotic therapy. Anal Chem 2015; 87:2410-8. [PMID: 25584656 DOI: 10.1021/ac504428t] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The incorporation of pathogen identification with antimicrobial susceptibility testing (AST) was implemented on a concept microfluidic simulator, which is well suited for personalizing antibiotic treatment of urinary tract infections (UTIs). The microfluidic device employs a fiberglass membrane sandwiched between two polypropylene components, with capture antibodies immobilized on the membrane. The chambers in the microfluidic device share the same geometric distribution as the wells in a standard 384-well microplate, resulting in compatibility with common microplate readers. Thirteen types of common uropathogenic microbes were selected as the analytes in this study. The microbes can be specifically captured by various capture antibodies and then quantified via an ATP bioluminescence assay (ATP-BLA) either directly or after a variety of follow-up tests, including urine culture, antibiotic treatment, and personalized antibiotic therapy simulation. Owing to the design of the microfluidic device, as well as the antibody specificity and the ATP-BLA sensitivity, the simulator was proven to be able to identify UTI pathogen species in artificial urine samples within 20 min and to reliably and simultaneously verify the antiseptic effects of eight antibiotic drugs within 3-6 h. The measurement range of the device spreads from 1 × 10(3) to 1 × 10(5) cells/mL in urine samples. We envision that the medical simulator might be broadly employed in UTI treatment and could serve as a model for the diagnosis and treatment of other diseases.
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Affiliation(s)
- Tao Dong
- Institute of Applied Micro-Nano Science and Technology, Chongqing Engineering Laboratory for Detection, Control and Integrated System, Chongqing Technology and Business University , Nan'an District, Chongqing 400067, China
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87
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Castagna G, Montorsi F, Salonia A. Sexual and bladder comorbidity in women. HANDBOOK OF CLINICAL NEUROLOGY 2015; 130:165-76. [PMID: 26003244 DOI: 10.1016/b978-0-444-63247-0.00010-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Sexual dysfunction in women is defined as disorders of sexual desire, arousal, orgasm, and/or sexual pain, which result in significant personal distress and may have a negative effect on a woman's health and an impact on her quality of life. A comprehensive understanding of the anatomic, neurobiologic, and psychologic mechanisms behind women's sexual function and dysfunction is of paramount importance. This chapter reviews the most frequent comorbid conditions related to urinary tract symptoms (thus including symptoms related to overactive bladder syndrome and urinary incontinence) and sexual dysfunction in women. Likewise, it considers the different disorders from the point of view of daily clinical practice.
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Affiliation(s)
- Giulia Castagna
- Universitá Vita-Salute San Raffaele, Milan, Italy; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Francesco Montorsi
- Universitá Vita-Salute San Raffaele, Milan, Italy; Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Andrea Salonia
- Division of Oncology/Unit of Urology, URI, IRCCS Ospedale San Raffaele, Milan, Italy; Research Doctorate Program in Urology, Magna Graecia University, Catanzaro, Italy.
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Vyas S, Varshney D, Sharma P, Juyal R, Nautiyal V, Shrotriya VP. An overview of the predictors of symptomatic urinary tract infection among nursing students. Ann Med Health Sci Res 2015; 5:54-8. [PMID: 25745578 PMCID: PMC4350064 DOI: 10.4103/2141-9248.149790] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of nosocomial infections for patients admitted to hospitals indeed UTIs are the most frequent bacterial infection in women. AIM The aim was to determine the prevalence of UTI and to identify factors associated with an increased risk of UTI among nursing students. SUBJECTS AND METHODS The cross-sectional study involved 177 unmarried nursing students aged 18-30 years studying in the SRMSIMS, Nursing College Bareilly. A structured questionnaire was used, and study subjects were asked regarding the symptoms of UTI in the previous 3 months. Chi-square test and Univariate Logistic Regression was used to analyze the data. RESULTS The overall prevalence of UTI was found to be 19.8% (35/177). Rural background, inadequate water intake, and unsatisfactory toilet habits were found to be strong predictors of UTI. CONCLUSIONS There is an urgent need to sensitize the nursing students regarding the growing need of the issue so that they themselves become aware in addition to raising the awareness of other high-risk groups.
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Affiliation(s)
- S Vyas
- Department of Community Medicine, HIMS, SRHU, Dehradun, India
| | - D Varshney
- Department of Community Medicine, HIMS, SRHU, Dehradun, India
| | - P Sharma
- Department of Community Medicine, Dr DY Patil Medical College, Pune, India
| | - R Juyal
- Department of Community Medicine, HIMS, SRHU, Dehradun, India
| | - V Nautiyal
- Department of Radiotherapy, HIMS, SRHU, Dehradun, India
| | - VP Shrotriya
- Department of Community Medicine, SRMSIMS, Bareilly, India
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Nitzan O, Elias M, Chazan B, Saliba W. Urinary tract infections in patients with type 2 diabetes mellitus: review of prevalence, diagnosis, and management. Diabetes Metab Syndr Obes 2015; 8:129-36. [PMID: 25759592 PMCID: PMC4346284 DOI: 10.2147/dmso.s51792] [Citation(s) in RCA: 105] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Urinary tract infections are more common, more severe, and carry worse outcomes in patients with type 2 diabetes mellitus. They are also more often caused by resistant pathogens. Various impairments in the immune system, poor metabolic control, and incomplete bladder emptying due to autonomic neuropathy may all contribute to the enhanced risk of urinary tract infections in these patients. The new anti-diabetic sodium glucose cotransporter 2 inhibitors have not been found to significantly increase the risk of symptomatic urinary tract infections. Symptoms of urinary tract infection are similar to patients without diabetes, though some patients with diabetic neuropathy may have altered clinical signs. Treatment depends on several factors, including: presence of symptoms, severity of systemic symptoms, if infection is localized in the bladder or also involves the kidney, presence of urologic abnormalities, accompanying metabolic alterations, and renal function. There is no indication to treat diabetic patients with asymptomatic bacteriuria. Further studies are needed to improve the treatment of patients with type 2 diabetes and urinary tract infections.
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Affiliation(s)
- Orna Nitzan
- Infectious Disease Unit, Ha’emek Medical Center, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Infectious Disease Unit, Padeh-Poriya Medical Center, Afula, Israel
| | - Mazen Elias
- Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Department of Internal Medicine C, Ha’emek Medical Center, Afula, Israel
| | - Bibiana Chazan
- Infectious Disease Unit, Ha’emek Medical Center, Afula, Israel
- Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
| | - Walid Saliba
- Bruce Rappaport Faculty of Medicine, Technion–Israel Institute of Technology, Haifa, Israel
- Department of Internal Medicine C, Ha’emek Medical Center, Afula, Israel
- Correspondence: Walid Saliba, Department of Internal Medicine C, Ha’emek Medical Center, Afula 18101, Israel, Tel +972 4 649 5132, Fax +972 4 649 5134, Email
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Point of care testing for urinary tract infection in primary care (POETIC): protocol for a randomised controlled trial of the clinical and cost effectiveness of FLEXICULT™ informed management of uncomplicated UTI in primary care. BMC FAMILY PRACTICE 2014; 15:187. [PMID: 25425162 PMCID: PMC4251943 DOI: 10.1186/s12875-014-0187-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/04/2014] [Indexed: 11/10/2022]
Abstract
Background Urinary tract infections (UTI) are the most frequent bacterial infection affecting women and account for about 15% of antibiotics prescribed in primary care. However, some women with a UTI are not prescribed antibiotics or are prescribed the wrong antibiotics, while many women who do not have a microbiologically confirmed UTI are prescribed antibiotics. Inappropriate antibiotic prescribing unnecessarily increases the risk of side effects and the development of antibiotic resistance, and wastes resources. POETIC is a randomised controlled trial of a Point Of Care Test (POCT) (Flexicult™) guided UTI management strategy for use in primary care, which may help General Practitioners more effectively decide both whether or not to prescribe antibiotics, and if so, to select the most appropriate antibiotic. Methods/design 614 adult female patients will be recruited from four primary care research networks (Wales, England, Spain, the Netherlands) and individually randomised to either POCT guided care or the guideline-informed ‘standard care’ arm. Urine and stool samples (where possible) will be obtained at presentation (day 1) and two weeks later for microbiological analysis. All participants will be followed up on the course of their illness and their quality of life, using a 2 week self-completed symptom diary. At 3 months, a primary care notes review will be conducted for evidence of further evidence of treatment failures, recurrence, complications, hospitalisations and health service costs. The primary objective is to compare appropriate antibiotic use on day 3 between the POCT and standard care arms using multi-level logistic regression to produce an odds ratio and associated 95% confidence interval. Costs of the two management approaches will be assessed in terms of the primary outcome. Discussion Although the Flexicult™ POCT is used in some countries in routine primary care, it’s clinical and cost effectiveness has never been evaluated in a randomised clinical trial. If shown to be effective, the use of this POCT could benefit individual sufferers and provide evidence for health care authorities to develop evidence based policies to combat the spread and impact of the unprecedented rise of infections caused by antibiotic resistant bacteria in Europe. Trial registration number ISRCTN65200697 (Registered 10 September 2013).
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Cicione A, Cantiello F, Ucciero G, Salonia A, Torella M, De Sio M, Autorino R, Carbone A, Romancik M, Tomaskin R, Damiano R. Intravesical treatment with highly-concentrated hyaluronic acid and chondroitin sulphate in patients with recurrent urinary tract infections: Results from a multicentre survey. Can Urol Assoc J 2014; 8:E721-7. [PMID: 25408813 DOI: 10.5489/cuaj.1989] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION We assess the effectiveness of intravesical instillation of hyaluronic acid (HA) and chondroitin sulphate (CS) as a non-antibiotic treatment option for prophylaxis of recurrent urinary tract infections (UTIs) in female patients. METHODS This was a retrospective cohort study involving 7 European institutions. We included patients with recurrent UTIs who received intravesical instillations of Ialuril (IBSA International) (50 mL HA 1.6% and CS 2% solution) between January 2010 and March 2012. Medication schedule, length of follow-up, recurrence infection time, number of UTIs/patients/year, patient quality of life, subjective symptoms score, and treatment-emergent side effects were recorded and analyzed. RESULTS In total, 157 women (mean age: 54.2 ± 4.1 years) were included in the analysis. All patients had at least 12 months follow-up. After 4 weekly and 5 monthly HA-CS bladder instillations, UTI episodes decreased from 4.13 ± 1.14 to 0.44 ± 0.50 (p = 0.01) at 12 months, while recurrent UTI time prolonged from 94.8 ± 25.1 days to 178.4 ± 37.3 days (p = 0.01) at 12 months. An improvement in symptoms and quality of life was achieved. A medium-depth pain after medication instillation was the most reported side effect. Regression model analysis showed significant risk factors in developing new UTI episodes: being more than 50 years old and having more than 4 UTI episodes per year (OR 3.41; CI 95%; 1.51-7.71, p = 0.003 and OR 3.31; CI 95% 1.51-7.22; p = 0.003, respectively). Retrospective design and lack of a control group represent two main limitations of the study. CONCLUSIONS Restoring glycosaminoglycans bladder layer therapy is a promising non-antibiotic therapy to prevent recurrent UTIs.
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Affiliation(s)
- Antonio Cicione
- Department of Urology & Research Doctorate Urology Program, Magna Graecia University, Catanzaro, Italy
| | - Francesco Cantiello
- Department of Urology & Research Doctorate Urology Program, Magna Graecia University, Catanzaro, Italy
| | - Giuseppe Ucciero
- Department of Urology & Research Doctorate Urology Program, Magna Graecia University, Catanzaro, Italy
| | - Andrea Salonia
- Department of Urology, University Vita-Salute San Raffaele, Milano, Italy
| | - Marco Torella
- Gynaecology Unit, Second University of Naples, Napoli, Italy
| | - Marco De Sio
- Urology Unit, Second University of Naples, Napoli, Italy
| | | | - Antonio Carbone
- Unit of Urology - ICOT, Sapienza University of Rome, Latina, Italy
| | - Martin Romancik
- Department of Urology, St. Cyril and Method University Hospital, Bratislava, Slovakia
| | - Roman Tomaskin
- Department of Urology, Faculty Hospital of Martin (MFN), Martin, Slovakia
| | - Rocco Damiano
- Department of Urology & Research Doctorate Urology Program, Magna Graecia University, Catanzaro, Italy
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Firoozeh F, Saffari M, Neamati F, Zibaei M. Detection of virulence genes in Escherichia coli isolated from patients with cystitis and pyelonephritis. Int J Infect Dis 2014; 29:219-22. [PMID: 25449257 DOI: 10.1016/j.ijid.2014.03.1393] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 03/08/2014] [Accepted: 03/27/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Uropathogenic Escherichia coli (UPEC) is a common cause of ascending urinary tract infections including cystitis and pyelonephritis. The purpose of this study was to investigate virulence genes among Escherichia coli isolated from patients with cystitis and pyelonephritis. METHODS Between December 2012 and June 2013, 150 E. coli isolates from hospitalized patients with pyelonephritis (n = 72) and cystitis (n=78) were collected at Shahid Beheshti Hospital in Kashan. A PCR assay was used to evaluate the presence of virulence genes including pap, hly, aer, sfa, cnf, afa, traT, and pathogenicity island (PAI) markers in isolates. RESULTS Of the total 150 UPEC isolates, 130 (86.7%) were found to carry the virulence genes studied. Nineteen different virulence patterns were identified. The most prevalent virulence pattern was UPEC including traT-PAI operons. The pap, traT, aer, hly, and PAI operons were more prevalent among patients with pyelonephritis than cystitis, and the sfa, afa, and cnf genes were not detected in any of the isolates. CONCLUSIONS Higher virulence gene diversity was found among pyelonephritis UPEC isolates in comparison to cystitis UPEC isolates, showing that UPEC strains that cause pyelonephritis need more virulence factors.
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Affiliation(s)
- Farzaneh Firoozeh
- Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, PO Box 87159-88141, Kashan, I.R. Iran.
| | - Mahmood Saffari
- Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, PO Box 87159-88141, Kashan, I.R. Iran
| | - Foroogh Neamati
- Department of Microbiology and Immunology, School of Medicine, Kashan University of Medical Sciences, PO Box 87159-88141, Kashan, I.R. Iran
| | - Mohammad Zibaei
- Department of Parasitology and Mycology, School of Medicine, Alborz University of Medical Sciences, Karaj, I.R. Iran
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Gołębiewska J, Dębska-Ślizień A, Zadrożny D, Rutkowski B. Acute Graft Pyelonephritis During the First Year After Renal Transplantation. Transplant Proc 2014; 46:2743-7. [DOI: 10.1016/j.transproceed.2014.09.076] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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94
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Kulpakko J, Kopra K, Hänninen P. Time-resolved fluorescence-based assay for rapid detection of Escherichia coli. Anal Biochem 2014; 470:1-6. [PMID: 25233000 DOI: 10.1016/j.ab.2014.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 08/25/2014] [Accepted: 09/04/2014] [Indexed: 11/15/2022]
Abstract
Fast and simple detection of pathogens is of utmost importance in health care and the food industry. In this article, a novel technology for the detection of pathogenic bacteria is presented. The technology uses lytic-specific bacteriophages and a nonspecific interaction of cellular components with a luminescent lanthanide chelate. As a proof of principle, Escherichia coli-specific T4 bacteriophage was used to infect the bacteria, and the cell lysis was detected. In the absence of E. coli, luminescent Eu(3+)-chelate complex cannot be formed and low time-resolved luminescence signal is monitored. In the presence of E. coli, increased luminescence signal is observed as the cellular contents are leached to the surrounding medium. The luminescence signal is observed as a function of the number of bacteria in the sample. The homogeneous assay can detect living E. coli in bacterial cultures and simulated urine samples within 25 min with a detection limit of 1000 or 10,000 bacterial cells/ml in buffer or urine, respectively. The detection limit is at the clinically relevant level, which indicates that the method could also be applicable to clinical settings for fast detection of urine bacteria.
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Affiliation(s)
- Janne Kulpakko
- Laboratory of Biophysics and Medicity Research Laboratories, University of Turku, 20520 Turku, Finland.
| | - Kari Kopra
- Laboratory of Biophysics and Medicity Research Laboratories, University of Turku, 20520 Turku, Finland
| | - Pekka Hänninen
- Laboratory of Biophysics and Medicity Research Laboratories, University of Turku, 20520 Turku, Finland
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95
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Effect of ceftriaxone on the outcome of murine pyelonephritis caused by extended-spectrum-β-lactamase-producing Escherichia coli. Antimicrob Agents Chemother 2014; 58:7102-11. [PMID: 25224003 DOI: 10.1128/aac.03974-14] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Urinary tract infections (UTIs) due to extended-spectrum-β-lactamase (ESBL)-producing Enterobacteriaceae in children are becoming more frequent, and they are commonly treated initially with a second- or third-generation cephalosporin. We developed a murine model of ascending UTI caused by ESBL-producing Escherichia coli. Using this model, we investigated the renal bacterial burden, interleukin-6 (IL-6) expression, and histopathological alterations caused by ESBL- and non-ESBL-producing bacteria after 1, 2, or 6 days with or without ceftriaxone therapy. The renal bacterial burden, IL-6 concentration, and histological inflammatory lesions were not significantly different between mice infected with ESBL- and non-ESBL-producing bacteria without treatment at any of the time points examined. Following ceftriaxone administration, the bacterial burden was eliminated in the kidneys of mice infected with ESBL- and non-ESBL-producing bacteria on the 6th postinfection day. The histological analysis demonstrated that among mice treated with ceftriaxone, those infected with ESBL-producing bacteria had more profound renal alterations than those infected with non-ESBL-producing bacteria on the 6th day (P < 0.001). In comparison, microbiological outcomes did not differ significantly between mice infected with ESBL- and non-ESBL-producing bacteria at any of the time points examined. The effectiveness of ceftriaxone in mice with UTIs due to ESBL-producing E. coli may have therapeutic implications; it is, however, hampered by limited activity on the histopathological lesions, a finding that needs further investigation.
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96
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A capacitive touch screen sensor for detection of urinary tract infections in portable biomedical devices. SENSORS 2014; 14:13851-62. [PMID: 25196109 PMCID: PMC4179013 DOI: 10.3390/s140813851] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 07/02/2014] [Accepted: 07/18/2014] [Indexed: 11/17/2022]
Abstract
Incidence of urinary tract infections (UTIs) is the second highest among all infections; thus, there is a high demand for bacteriuria detection. Escherichia coli are the main cause of UTIs, with microscopy methods and urine culture being the detection standard of these bacteria. However, the urine sampling and analysis required for these methods can be both time-consuming and complex. This work proposes a capacitive touch screen sensor (CTSS) concept as feasible alternative for a portable UTI detection device. Finite element method (FEM) simulations were conducted with a CTSS model. An exponential response of the model to increasing amounts of E. coli and liquid samples was observed. A measurable capacitance change due to E. coli presence and a tangible difference in the response given to urine and water samples were also detected. Preliminary experimental studies were also conducted on a commercial CTSS using liquid solutions with increasing amounts of dissolved ions. The CTSS was capable of distinguishing different volumes of liquids, also giving an exponential response. Furthermore, the CTSS gave higher responses to solutions with a superior amount of ions. Urine samples gave the top response among tested liquids. Thus, the CTSS showed the capability to differentiate solutions by their ionic content.
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97
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Implementing a urinary tract infection clinical practice guideline in an ambulatory urgent care practice. Nurse Pract 2014; 39:50-4. [PMID: 24633639 DOI: 10.1097/01.npr.0000444651.10142.06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A clinical practice guideline for uncomplicated urinary tract infections in an ambulatory urgent care practice was implemented. Aims were to increase the number of first-line antibiotics prescribed to treat uncomplicated urinary tract infections, increase the use of second-line antibiotics prescribed when appropriate, and decrease the number of unnecessary urine cultures.
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98
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Sharma A, Verma R, Ramteke P. Cyperus rotundus: A potential novel source of therapeutic compound against urinary tract pathogens. J Herb Med 2014. [DOI: 10.1016/j.hermed.2014.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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99
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Hisano M, Bruschini H, Nicodemo AC, Srougi M. Uncomplicated Urinary Tract Infections in Women in a Sao Paulo Quaternary Care Hospital: Bacterial Spectrum and Susceptibility Patterns. Antibiotics (Basel) 2014; 3:98-108. [PMID: 27025737 PMCID: PMC4790347 DOI: 10.3390/antibiotics3010098] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Revised: 02/14/2014] [Accepted: 02/21/2014] [Indexed: 11/16/2022] Open
Abstract
Uncomplicated urinary tract infections (UTI) in women are very common. Regular analysis of bacterial flora is important to formulate updated guidelines. The objective of this study is to determine and compare the microbiology of UTIs and their susceptibility patterns in a quaternary care hospital. In a seven-year review, the urine culture results of 480 female patients with uncomplicated UTIs were analyzed. Patients were divided into three groups according to their diagnosis and treatment characteristics: Group 1, cystitis at outpatient basis; group 2, cystitis at the Emergency Unit; and group 3, pyelonephritis. Group 1 included older patients, with a higher incidence of concomitant diabetes mellitus and recurrent UTIs. E. coli was the most common pathogen, responsible for 75.1% of cases, mainly for pyelonephritis (87.3%). Of the oral antimicrobials tested for cystitis, amoxicillin/clavulanate and nitrofurantoin had the highest susceptibility profiles (84.4% and 87.3%, respectively). For E. coli only, their susceptibility profiles were as high as 90.8% and 97.4%, respectively. For pyelonephritis treatment, fluoroquinoles had a susceptibility profile <90%, while ceftriaxone and gentamicin had susceptibility >90%. Uncomplicated UTI treatment is becoming more challenging because the susceptibility profiles of oral antimicrobials are increasingly resistant. In our environment, cystitis can still be managed with nitrofurantoin. Uncomplicated pyelonephritis should be managed with ceftriaxone or gentamicin.
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Affiliation(s)
- Marcelo Hisano
- Division of Urology, Hospital das Clinicas-SP, University of Sao Paulo, 255 Doutor Enéas Carvalho de Aguiar Ave., 7th floor, São Paulo 05403-000, Brazil.
| | - Homero Bruschini
- Division of Urology, Hospital das Clinicas-SP, University of Sao Paulo, 255 Doutor Enéas Carvalho de Aguiar Ave., 7th floor, São Paulo 05403-000, Brazil.
| | - Antonio Carlos Nicodemo
- Infectious Disease Department, Hospital das Clinicas-SP, University of Sao Paulo, 255 Doutor Enéas Carvalho de Aguiar Ave., 4th floor, São Paulo 05403-000, Brazil.
| | - Miguel Srougi
- Division of Urology, Hospital das Clinicas-SP, University of Sao Paulo, 255 Doutor Enéas Carvalho de Aguiar Ave., 7th floor, São Paulo 05403-000, Brazil.
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100
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