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Liou N, De T, Urbanski A, Chieng C, Kong Q, David AL, Khasriya R, Yakimovich A, Horsley H. A clinical microscopy dataset to develop a deep learning diagnostic test for urinary tract infection. Sci Data 2024; 11:155. [PMID: 38302487 PMCID: PMC10834944 DOI: 10.1038/s41597-024-02975-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/16/2024] [Indexed: 02/03/2024] Open
Abstract
Urinary tract infection (UTI) is a common disorder. Its diagnosis can be made by microscopic examination of voided urine for markers of infection. This manual technique is technically difficult, time-consuming and prone to inter-observer errors. The application of computer vision to this domain has been slow due to the lack of a clinical image dataset from UTI patients. We present an open dataset containing 300 images and 3,562 manually annotated urinary cells labelled into seven classes of clinically significant cell types. It is an enriched dataset acquired from the unstained and untreated urine of patients with symptomatic UTI using a simple imaging system. We demonstrate that this dataset can be used to train a Patch U-Net, a novel deep learning architecture with a random patch generator to recognise urinary cells. Our hope is, with this dataset, UTI diagnosis will be made possible in nearly all clinical settings by using a simple imaging system which leverages advanced machine learning techniques.
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Affiliation(s)
- Natasha Liou
- Bladder Infection and Immunity Group (BIIG), UCL Centre for Kidney & Bladder Health, Division of Medicine, University College London, Royal Free Hospital Campus, London, UK
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Trina De
- Center for Advanced Systems Understanding (CASUS), Görlitz, Germany
- Helmholtz-Zentrum Dresden-Rossendorf e. V. (HZDR), Dresden, Germany
| | - Adrian Urbanski
- Center for Advanced Systems Understanding (CASUS), Görlitz, Germany
- Helmholtz-Zentrum Dresden-Rossendorf e. V. (HZDR), Dresden, Germany
| | - Catherine Chieng
- Bladder Infection and Immunity Group (BIIG), UCL Centre for Kidney & Bladder Health, Division of Medicine, University College London, Royal Free Hospital Campus, London, UK
| | - Qingyang Kong
- Bladder Infection and Immunity Group (BIIG), UCL Centre for Kidney & Bladder Health, Division of Medicine, University College London, Royal Free Hospital Campus, London, UK
| | - Anna L David
- UCL EGA Institute for Women's Health, Faculty of Population Health Sciences, University College London, London, UK
| | - Rajvinder Khasriya
- Bladder Infection and Immunity Group (BIIG), UCL Centre for Kidney & Bladder Health, Division of Medicine, University College London, Royal Free Hospital Campus, London, UK
- Department of Microbial Diseases, Eastman Dental Institute (EDI), University College London, London, UK
| | - Artur Yakimovich
- Bladder Infection and Immunity Group (BIIG), UCL Centre for Kidney & Bladder Health, Division of Medicine, University College London, Royal Free Hospital Campus, London, UK.
- Center for Advanced Systems Understanding (CASUS), Görlitz, Germany.
- Helmholtz-Zentrum Dresden-Rossendorf e. V. (HZDR), Dresden, Germany.
- Institute of Computer Science, University of Wrocław, Wrocław, Poland.
| | - Harry Horsley
- Bladder Infection and Immunity Group (BIIG), UCL Centre for Kidney & Bladder Health, Division of Medicine, University College London, Royal Free Hospital Campus, London, UK.
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Zilberberg MD, Nathanson BH, Sulham K, Mohr JF, Goodwin M, Shorr AF. Examining the Burden of Potentially Avoidable Heart Failure Hospitalizations. CLINICOECONOMICS AND OUTCOMES RESEARCH 2023; 15:721-731. [PMID: 37795407 PMCID: PMC10547001 DOI: 10.2147/ceor.s423868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/01/2023] [Indexed: 10/06/2023] Open
Abstract
Background Two-thirds of the 1 million annual US CHF hospitalizations are for diuresis only; some may be avoidable. We describe a population of low-severity short-stay (= 4 days) patients admitted for CHF. Methods We conducted a retrospective cohort study within the Premier Healthcare Database, 2016-2021. CHF was defined via an administrative code algorithm. High severity (CHF-H) was marked by cardiogenic shock, the need for respiratory or circulatory support, and/or a Charlson comorbidity index >2. We compared baseline characteristics, processes of care, and outcomes in low-severity (CHF-L) to CHF-H. Results Among 301,672 short-stay CHF patients, 135,304 (44.8%) were CHF-L. Compared to CHF-H, CHF-L was younger (70.5 ± 14.1 vs 72.1 ± 13.6 years, p < 0.001), more commonly female (48.6% vs 45.8%, p < 0.001), and more likely to receive IV ACE-I/ARB agents (0.5% vs 0.4%, p = 0.003). Most other IV medications were more common in CHF-H, and anticoagulation was the most prevalent non-diuretic IV therapy in both groups (23.8% vs 33.3%, p < 0.001). Hospital mortality (0.2% vs 1.5%, p < 0.001) and CHF-related 30-day readmissions (8.1% vs 10.5%, p < 0.001) were lower in CHF-L than CHF-H. Conclusion Among short-stay CHF patients, nearly ½ meet criteria for CHF-L, and are mainly admitted for fluid management. Avoiding these admissions could result in substantial savings.
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Mendes RE, Arends SJR, Streit JM, Critchley I, Cotroneo N, Castanheira M. Contemporary Evaluation of Tebipenem In Vitro Activity against Enterobacterales Clinical Isolates Causing Urinary Tract Infections in US Medical Centers (2019-2020). Microbiol Spectr 2023; 11:e0205722. [PMID: 36625644 PMCID: PMC9927459 DOI: 10.1128/spectrum.02057-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Tebipenem pivoxil is an oral broad-spectrum carbapenem. This study evaluated the activity of tebipenem and comparators against UTI Enterobacterales from US hospitals (2019-2020). 3,576 Enterobacterales causing UTI in 52 centers in 9 US Census Divisions were included. Susceptibility testing followed the CLSI broth microdilution method. Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis with an MIC of ≥2 μg/mL for ceftazidime, ceftriaxone, and/or aztreonam were designated ESBL. Isolates were also grouped based on MDR phenotype. Tebipenem, meropenem, and ertapenem had MIC90 against Enterobacterales of 0.06 μg/mL, 0.06 μg/mL and 0.03 μg/mL, respectively. Low susceptibility results for aztreonam (87.1% susceptible), cefazidime (88.1%), ceftriaxone (84.8%), and other agents were observed. Tebipenem and ertapenem were equally potent (MIC90, 0.015 to 0.03 μg/mL) against E. coli and K. pneumoniae, whereas ertapenem showed an MIC 8-fold lower than tebipenem against P. mirabilis. Oral agents, such as amoxicillin-clavulanate, levofloxacin, and trimethoprim-sulfamethoxazole, showed elevated nonsusceptibility rates in the Middle Atlantic region (26, 45, 47, and 41%, respectively). ESBL prevalence varied from 7% to 16%, except in the Middle Atlantic region (42%). The carbapenems were active against ESBL and MDR isolates (93.7 to 96.8% susceptible). Elevated rates of ESBL in UTI pathogens in US hospitals were noted as well as a uniform in vitro potency (MIC90) of tebipenem and the intravenous carbapenems, regardless of phenotype. IMPORTANCE The occurrence of urinary-tract Enterobacterales pathogens producing ESBL enzymes in community and nosocomial settings continues to increase, as does the coresistance to fluoroquinolones, trimethoprim-sulfamethoxazole and nitrofurantoin often exhibited by these pathogens. This scenario complicates the clinical empirical and guided management of UTI by precluding the use of oral and many intravenous options. Oral options appear compromised even among some ESBL-negative isolates, against which the use of parenteral agents may be required. In addition, the interregional variability of susceptibility results of US UTI pathogens provides a less predictable susceptibility pattern to inform empirical treatment decisions. This study evaluated the in vitro activity of tebipenem against contemporary uropathogens, including those resistant to currently available oral options.
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Lodise TP, Chopra T, Nathanson BH, Sulham K, Rodriguez M. Epidemiology of Complicated Urinary Tract Infections due to Enterobacterales among Adult Patients Presenting in Emergency Departments Across the United States. Open Forum Infect Dis 2022; 9:ofac315. [PMID: 35899279 PMCID: PMC9310258 DOI: 10.1093/ofid/ofac315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/22/2022] [Indexed: 11/22/2022] Open
Abstract
In this multicenter study of adult patients who presented to the emergency department with an Enterobacterales complicated urinary tract infection (cUTI), high rates of resistance and co-resistance to commonly used oral antibiotics (fluoroquinolones, trimethoprim-sulfamethoxazole, nitrofurantoin, and third-generation cephalosporins) were observed.
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Affiliation(s)
- Thomas P Lodise
- Albany College of Pharmacy and Health Sciences , Albany, NY , USA
- Albany College of Pharmacy and Health Sciences , Albany, NY , USA
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TP L, Manjelievskaia J, EH M, Rodriguez M. Retrospective Cohort Study of the 12-Month Epidemiology, Treatment Patterns, Outcomes, and Healthcare Costs Among Adult Patients with Complicated Urinary Tract Infections. Open Forum Infect Dis 2022; 9:ofac307. [PMID: 35891695 PMCID: PMC9308450 DOI: 10.1093/ofid/ofac307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 06/17/2022] [Indexed: 11/12/2022] Open
Abstract
Background Limited data are available in the United States on the 12-month epidemiology, outpatient (OP) antibiotic treatment patterns, outcomes, and costs associated with complicated urinary tract infections (cUTIs) in adult patients. Methods A retrospective observational cohort study of adult patients with incident cUTIs in IBM MarketScan Databases between 2017 and 2019 was performed. Patients were categorized as OP or inpatient (IP) based on initial setting of care for index cUTI and were stratified by age (<65 years vs ≥65 years). OP antibiotic treatment patterns, outcomes, and costs associated with cUTIs among adult patients over a 12-month follow-up period were examined. Results During the study period, 95 322 patients met inclusion criteria. Most patients were OPs (84%) and age <65 years (87%). Treatment failure (receipt of new unique OP antibiotic or cUTI-related ED visit/IP admission) occurred in 23% and 34% of OPs aged <65 years and ≥65 years, respectively. Treatment failure was observed in >38% of IPs, irrespective of age. Across both cohorts and age strata, >78% received ≥2 unique OP antibiotics, >34% received ≥4 unique OP antibiotics, >16% received repeat OP antibiotics, and >33% received ≥1 intravenous (IV) OP antibiotics. The mean 12-month cUTI-related total health care costs were $4697 for OPs age <65 years, $8924 for OPs age >65 years, $15 401 for IPs age <65 years, and $17 431 for IPs age ≥65 years. Conclusions These findings highlight the substantial 12-month health care burden associated with cUTIs and underscore the need for new outpatient treatment approaches that reduce the persistent or recurrent nature of many cUTIs.
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Affiliation(s)
- Lodise TP
- Albany College of Pharmacy and Health Sciences , Albany, NY , USA
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Lodise TP, Nowak M, Rodriguez M. The 30-Day Economic Burden of Newly Diagnosed Complicated Urinary Tract Infections in Medicare Fee-for-Service Patients Who Resided in the Community. Antibiotics (Basel) 2022; 11:antibiotics11050578. [PMID: 35625222 PMCID: PMC9137853 DOI: 10.3390/antibiotics11050578] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 04/20/2022] [Accepted: 04/20/2022] [Indexed: 02/05/2023] Open
Abstract
Introduction: Scant data are available on the 30-day financial burden associated with incident complicated urinary tract infections (cUTIs) in a cohort of predominately elderly patients. This study sought to examine total and cUTI-related 30-day Medicare spending (MS), a proxy for healthcare costs, among Medicare fee-for-service (FFS) beneficiaries who resided in the community with newly diagnosed cUTIs. Methods: A retrospective multicenter cohort study of adult beneficiaries in the Medicare FFS database with a cUTI between 2017 and 2018 was performed. Patients were included if they were enrolled in Medicare FFS and Medicare Part D from 2016 to 2019, had a cUTI first diagnosis in 2017–2018, no evidence of any UTI diagnoses in 2016, and residence in the community between 2016 and 2018. Results: During the study period, 723,324 cases occurred in Medicare beneficiaries who met the study criteria. Overall and cUTI-related 30-day MS were $7.6 and $4.5 billion, respectively. The average overall and cUTI-related 30-day MS per beneficiary were $10,527 and $6181, respectively. The major driver of cUTI-related 30-day MS was acute care hospitalizations ($3.2 billion) and the average overall and cUTI-related 30-day MS per hospitalizations were $16,431 and $15,438, respectively. Conclusion: Overall 30-day MS for Medicare FSS patients who resided in the community with incident cUTIs was substantial, with cUTI-related MS accounting for 59%. As the major driver of cUTI-related 30-day MS was acute care hospitalizations, healthcare systems should develop well-defined criteria for hospital admissions that aim to avert hospitalizations in clinically stable patients and expedite the transition of patients to the outpatient setting to complete their care.
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Affiliation(s)
- Thomas P. Lodise
- Albany College of Pharmacy and Health Sciences, Albany, NY 12208, USA
- Correspondence: ; Tel.: +1-518-694-7292
| | - Michael Nowak
- Spero Therapeutics, Inc., Cambridge, MA 02139, USA; (M.N.); (M.R.)
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Zilberberg MD, Nathanson BH, Sulham K, Shorr AF. Descriptive epidemiology and outcomes of emergency department visits with complicated urinary tract infections in the United States, 2016–2018. J Am Coll Emerg Physicians Open 2022; 3:e12694. [PMID: 35342898 PMCID: PMC8931190 DOI: 10.1002/emp2.12694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 02/03/2022] [Accepted: 02/10/2022] [Indexed: 01/12/2023] Open
Abstract
Objective There are >1 million emergency department visits and 100,000 admissions with urinary tract infection (UTI) annually in the United States. A fraction of total UTI volume, complicated (cUTI) costs the health care system over $3.5 billion per year. We evaluated the contemporary annual burden of emergency department (ED) visits with cUTI. Methods We conducted a cross‐sectional multicenter study within the National Emergency Department database, a 20% stratified sample of all US hospital‐based EDs, 2016–2018, to explore characteristics of visits with a cUTI. We compared cUTI as the principal (PD) versus secondary diagnosis (non‐PD). We applied survey methods to develop national estimates. Results Among 2,379,448 ED cUTI visits (44.8% PD), 40.1% were female (45.1% PD; 36.9% non‐PD) and 62.2% were ≥ 65 years (52.5% PD; 70.2% non‐PD). Mean Charlson score was 2.3 (3.0 PD; 2.1 non‐PD); end‐stage renal disease prevalence was 2.3% (1.4% PD; 3.0% non‐PD). Whereas pyelonephritis occurred in ∼10% of both groups, severe sepsis (7.2% vs 2.0%) and septic shock (7.1% vs 1.8%) were ∼4 times more prevalent among those with cUTI‐non‐PD than cUTI‐PD. Overall, two thirds of all visits ended in hospitalization (44.9% PD; 85.5% non‐PD). Despite similar numbers of visits, the annual national ED bill for cUTI rose from $2.8 billion in 2016 to $3.2 billion in 2018. Conclusion There were over 2 million ED visits with cUTI in 2016–2018. Although <10% met criteria for severe sepsis/septic shock, ∼two thirds were admitted. The aggregate cost for cUTI visits rose by 15% without a substantial increase in volume.
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Affiliation(s)
- Marya D. Zilberberg
- Department of Health Services Research EviMed Research Group, LLC Goshen Massachusetts USA
| | | | - Kate Sulham
- Spero Therapeutics Cambridge Massachusetts USA
| | - Andrew F. Shorr
- Washington Hospital Center Washington District of Columbia USA
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Zilberberg MD, Nathanson BH, Sulham K, Shorr AF. Descriptive Epidemiology and Outcomes of Hospitalizations With Complicated Urinary Tract Infections in the United States, 2018. Open Forum Infect Dis 2022; 9:ofab591. [PMID: 35036460 PMCID: PMC8754377 DOI: 10.1093/ofid/ofab591] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 11/18/2021] [Indexed: 11/26/2022] Open
Abstract
Background Hospitalizations with complicated urinary tract infection (cUTI) in the United States have increased. Though most often studied as a subset of cUTI, catheter-associated UTI (CAUTI) afflicts a different population of patients and carries outcomes distinct from non-CA cUTI (nCAcUTI). We examined the epidemiology and outcomes of hospitalizations in these groups. Methods We conducted a cross-sectional multicenter study within the 2018 National Inpatient Sample (NIS) database, a 20% stratified sample of discharges from US community hospitals, to explore characteristics and outcomes of patients discharged with a UTI diagnosis. We divided cUTI into mutually exclusive categories of nCAcUTI and CAUTI. We applied survey methods to develop national estimates. Results Among 2 837 385 discharges with a UTI code, 500 400 (17.6%, 19.8% principal diagnosis [PD]) were nCAcUTI and 126 120 (4.4%, 63.8% PD) were CAUTI. Though similar in age (CAUTI, 70.1 years; and nCAcUTI, 69.7 years), patients with nCAcUTI had lower comorbidity (mean Charlson, 4.3) than those with CAUTI (mean Charlson, 4.6). Median (interquartile range [IQR]) length of stay (LOS) was 5 (3–8) days in nCAcUTI and 5 (3–9) days in CAUTI. Overall median (IQR) hospital costs were similar in nCAcUTI ($9713 [$5923–$17 423]) and CAUTI ($9711 [$5969–$17 420]). Though low in both groups, hospital mortality was lower in nCAcUTI (2.8%) than in CAUTI (3.4%). Routine discharges home were higher in nCAcUTI (41.5%) than CAUTI (22.1%). Conclusions There are >626 000 hospital admissions with a cUTI, comprising ~1.8% of all annual admissions in the United States; 4/5 are nCAcUTI. Because CAUTI is frequently the reason for admission, preventive efforts are needed beyond the acute care setting.
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Affiliation(s)
| | | | - Kate Sulham
- Spero Therapeutics, Cambridge, Massachusetts, USA
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