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Rahman KMT, Butzin NC. Counter-on-chip for bacterial cell quantification, growth, and live-dead estimations. Sci Rep 2024; 14:782. [PMID: 38191788 PMCID: PMC10774380 DOI: 10.1038/s41598-023-51014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 12/29/2023] [Indexed: 01/10/2024] Open
Abstract
Quantifying bacterial cell numbers is crucial for experimental assessment and reproducibility, but the current technologies have limitations. The commonly used colony forming units (CFU) method causes a time delay in determining the actual numbers. Manual microscope counts are often error-prone for submicron bacteria. Automated systems are costly, require specialized knowledge, and are erroneous when counting smaller bacteria. In this study, we took a different approach by constructing three sequential generations (G1, G2, and G3) of counter-on-chip that accurately and timely count small particles and/or bacterial cells. We employed 2-photon polymerization (2PP) fabrication technology; and optimized the printing and molding process to produce high-quality, reproducible, accurate, and efficient counters. Our straightforward and refined methodology has shown itself to be highly effective in fabricating structures, allowing for the rapid construction of polydimethylsiloxane (PDMS)-based microfluidic devices. The G1 comprises three counting chambers with a depth of 20 µm, which showed accurate counting of 1 µm and 5 µm microbeads. G2 and G3 have eight counting chambers with depths of 20 µm and 5 µm, respectively, and can quickly and precisely count Escherichia coli cells. These systems are reusable, accurate, and easy to use (compared to CFU/ml). The G3 device can give (1) accurate bacterial counts, (2) serve as a growth chamber for bacteria, and (3) allow for live/dead bacterial cell estimates using staining kits or growth assay activities (live imaging, cell tracking, and counting). We made these devices out of necessity; we know no device on the market that encompasses all these features.
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Affiliation(s)
- K M Taufiqur Rahman
- Department of Biology and Microbiology, South Dakota State University, Brookings, SD, 57006, USA
| | - Nicholas C Butzin
- Department of Biology and Microbiology, South Dakota State University, Brookings, SD, 57006, USA.
- Department of Chemistry, Biochemistry and Physics, South Dakota State University, Brookings, SD, 57006, USA.
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2
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Oftedal TF, Diep DB. Flow cytometric detection of vancomycin-resistant Enterococcus faecium in urine using fluorescently labelled enterocin K1. Sci Rep 2023; 13:10930. [PMID: 37414859 PMCID: PMC10325980 DOI: 10.1038/s41598-023-38114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 07/03/2023] [Indexed: 07/08/2023] Open
Abstract
A urinary tract infection (UTI) occurs when bacteria enter and multiply in the urinary system. The infection is most often caused by enteric bacteria that normally live in the gut, which include Enterococcus faecium. Without antibiotic treatment, UTIs can progress to life-threatening septic shock. Early diagnosis and identification of the pathogen will reduce antibiotic use and improve patient outcomes. In this work, we develop and optimize a cost-effective and rapid (< 40 min) method for detecting E. faecium in urine. The method uses a fluorescently labelled bacteriocin enterocin K1 (FITC-EntK1) that binds specifically to E. faecium and is then detected using a conventional flow cytometer. Using this detection assay, urine containing E. faecium was identified by an increase in the fluorescent signals by 25-73-fold (median fluorescence intensity) compared to control samples containing Escherichia coli or Staphylococcus aureus. The method presented in this work is a proof of concept showing the potential of bacteriocins to act as specific probes for the detection of specific bacteria, such as pathogens, in biological samples.
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Affiliation(s)
- Thomas F Oftedal
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway.
| | - Dzung B Diep
- Faculty of Chemistry, Biotechnology and Food Science, Norwegian University of Life Sciences, Ås, Norway
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3
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Maina J, Mwaniki J, Mwiti F, Kiiru S, Katana J, Wanja F, Mukaya J, Khasabuli O, Asiimwe B, Gillespie S, Stelling J, Mshana S, Holden M, Sabiiti W, Kiiru J. Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals. Access Microbiol 2023; 5:acmi000483.v3. [PMID: 37424559 PMCID: PMC10323778 DOI: 10.1099/acmi.0.000483.v3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/10/2023] [Indexed: 07/11/2023] Open
Abstract
Introduction Culture is the gold-standard diagnosis for urinary tract infections (UTIs). However, most hospitals in low-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and, therefore, rely heavily on dipstick tests for UTI diagnosis. Research gap In many Kenyan hospitals, routine evaluations are rarely done to assess the accuracy of popular screening tests such as the dipstick test. As such, there is a substantial risk of misdiagnosis emanating from inaccuracy in proxy screening tests. This may result in misuse, under-use or over-use of antimicrobials. Aim The present study aimed to assess the accuracy of the urine dipstick test as a proxy for the diagnosis of UTIs in selected Kenyan hospitals. Methods A hospital-based cross-sectional method was used. The utility of dipstick in the diagnosis of UTIs was assessed using midstream urine against culture as the gold standard. Results The dipstick test predicted 1416 positive UTIs, but only 1027 were confirmed positive by culture, translating to a prevalence of 54.1 %. The sensitivity of the dipstick test was better when leucocytes and nitrite tests were combined (63.1 %) than when the two tests were separate (62.6 and 50.7 %, respectively). Similarly, the two tests combined had a better positive predictive value (87.0 %) than either test alone. The nitrite test had the best specificity (89.8 %) and negative predictive value (97.4 %) than leucocytes esterase (L.E) or both tests combined. In addition, sensitivity in samples from inpatients (69.2 %) was higher than from outpatients (62.7 %). Furthermore, the dipstick test had a better sensitivity and positive predictive value among female (66.0 and 88.6 %) than male patients (44.3 and 73.9 %). Among the various patient age groups, the dipstick test's sensitivity and positive predictive value were exceptionally high in patients ≥75 years old (87.5 and 93.3 %). Conclusion Discrepancies in prevalence from the urine dipstick test and culture, the gold standard, indicate dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis. However, considering it is not always possible to perform a culture, especially in low-resource settings, future studies are needed to combine specific UTI symptoms and dipstick results to assess possible increases in the test's sensitivity. There is also a need to develop readily available and affordable algorithms that can detect UTIs where culture is not available.
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Affiliation(s)
- John Maina
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - John Mwaniki
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Franklin Mwiti
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Susan Kiiru
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Japhet Katana
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Fredrick Wanja
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | - Osborn Khasabuli
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
| | | | | | - John Stelling
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Stephen Mshana
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
| | - Matthew Holden
- University of St Andrews, School of Medicine, St Andrews, UK
| | - Wilber Sabiiti
- University of St Andrews, School of Medicine, St Andrews, UK
| | - John Kiiru
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- Ministry of Health, Nairobi, Kenya
| | - HATUA consortium
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
- Jomo Kenyatta University of Agriculture and Technology, Juja, Kenya
- Kentyatta National Hospital, Nairobi, Kenya
- Makerere University, Kampala, Uganda
- University of St Andrews, School of Medicine, St Andrews, UK
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, USA
- Catholic University of Health and Allied Sciences, Mwanza, Tanzania
- Ministry of Health, Nairobi, Kenya
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4
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Imani SM, Osman E, Bakhshandeh F, Qian S, Sakib S, MacDonald M, Gaskin M, Zhitomirsky I, Yamamura D, Li Y, Didar TF, Soleymani L. Liquid NanoBiosensors Enable One-Pot Electrochemical Detection of Bacteria in Complex Matrices. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2023:e2207223. [PMID: 37088731 DOI: 10.1002/advs.202207223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 03/29/2023] [Indexed: 05/03/2023]
Abstract
There is a need for point-of-care bacterial sensing and identification technologies that are rapid and simple to operate. Technologies that do not rely on growth cultures, nucleic acid amplification, step-wise reagent addition, and complex sample processing are the key for meeting this need. Herein, multiple materials technologies are integrated for overcoming the obstacles in creating rapid and one-pot bacterial sensing platforms. Liquid-infused nanoelectrodes are developed for reducing nonspecific binding on the transducer surface; bacterium-specific RNA-cleaving DNAzymes are used for bacterial identification; and redox DNA barcodes embedded into DNAzymes are used for binding-induced electrochemical signal transduction. The resultant single-step and one-pot assay demonstrates a limit-of-detection of 102 CFU mL-1 , with high specificity in identifying Escherichia coli amongst other Gram positive and negative bacteria including Klebsiella pneumoniae, Staphylococcus aureus, and Bacillus subtilis. Additionally, this assay is evaluated for analyzing 31 clinically obtained urine samples, demonstrating a clinical sensitivity of 100% and specify of 100%. When challenging this assay with nine clinical blood cultures, E. coli-positive and E. coli-negative samples can be distinguished with a probability of p < 0.001.
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Affiliation(s)
- Sara M Imani
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
| | - Enas Osman
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
| | - Fatemeh Bakhshandeh
- Department of Engineering Physics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
| | - Shuwen Qian
- Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Sadman Sakib
- Department of Engineering Physics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
| | - Michael MacDonald
- Department of Materials Science and Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
- Institute of Infectious Disease Research, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Mark Gaskin
- Hamilton Regional Laboratory Medicine Program, Hamilton General Hospital, 237 Barton St. East, Hamilton, Ontario, L8L 2×2, Canada
| | - Igor Zhitomirsky
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
- Department of Materials Science and Engineering, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
| | - Deborah Yamamura
- Department of Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4K1, Canada
- Institute of Infectious Disease Research, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Yingfu Li
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
- Department of Biochemistry and Biomedical Sciences, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada
- Institute of Infectious Disease Research, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Tohid F Didar
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
- Department of Mechanical Engineering, McMaster University, Hamilton, ON, L8S 4L7, Canada
- Institute of Infectious Disease Research, McMaster University, Hamilton, ON, L8N 3Z5, Canada
| | - Leyla Soleymani
- School of Biomedical Engineering, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
- Department of Engineering Physics, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L7, Canada
- Institute of Infectious Disease Research, McMaster University, Hamilton, ON, L8N 3Z5, Canada
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Adu-Oppong B, Thänert R, Wallace MA, Burnham CAD, Dantas G. Substantial overlap between symptomatic and asymptomatic genitourinary microbiota states. MICROBIOME 2022; 10:6. [PMID: 35039079 PMCID: PMC8762997 DOI: 10.1186/s40168-021-01204-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Accepted: 11/30/2021] [Indexed: 06/10/2023]
Abstract
BACKGROUND The lack of a definition of urinary microbiome health convolutes diagnosis of urinary tract infections (UTIs), especially when non-traditional uropathogens or paucity of bacteria are recovered from symptomatic patients in routine standard-of-care urine tests. Here, we used shotgun metagenomic sequencing to characterize the microbial composition of asymptomatic volunteers in a set of 30 longitudinally collected urine specimens. Using permutation tests, we established a range of asymptomatic microbiota states, and use these to contextualize the microbiota of 122 urine specimens collected from patients with suspected UTIs diagnostically categorized by standard-of-care urinalysis within that range. Finally, we used a standard-of-care culture protocol to evaluate the efficiency of culture-based recovery of the urinary microbiota. RESULTS The majority of genitourinary microbiota in individals suspected to have UTI overlapped with the spectrum of asymptomatic microbiota states. Longitudinal characterization of the genitourinary microbiome in urine specimens collected from asymptomatic volunteers revealed fluctuations of microbial functions and taxonomy over time. White blood cell counts from urinalysis suggested that urine specimens categorized as 'insignificant', 'contaminated', or 'no-growth' by conventional culture methods frequently showed signs of urinary tract inflammation, but this inflammation is not associated with genitourinary microbiota dysbiosis. Comparison of directly sequenced urine specimens with standard-of-care culturing confirmed that culture-based diagnosis biases genitourinary microbiota recovery towards the traditional uropathogens Escherichia coli and Klebsiella pneumoniae. CONCLUSION Here, we utilize shotgun metagenomic sequencing to establish a baseline of asymptomatic genitourinary microbiota states. Using this baseline we establish substantial overlap between symptomatic and asymptomatic genitourinary microbiota states. Our results establish that bacterial presence alone does not explain the onset of clinical symptoms. Video Abstract.
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Affiliation(s)
- Boahemaa Adu-Oppong
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri USA
| | - Robert Thänert
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri USA
| | - Meghan A. Wallace
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri USA
| | - Carey-Ann D. Burnham
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri USA
- Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO USA
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri USA
| | - Gautam Dantas
- The Edison Family Center for Genome Sciences and Systems Biology, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Molecular Microbiology, Washington University School of Medicine, St. Louis, Missouri USA
- Department of Biomedical Engineering, Washington University, St. Louis, Missouri USA
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Velasco R, Lejarzegi A, Gomez B, de la Torre M, Duran I, Camara A, de la Rosa D, Manzano S, Rodriguez J, González A, Lopes AA, Rivas A, Martinez I, Angelats CM, Moya S, Corral S, Alonso J, Del Rio P, Sancho E, Ruiz Del Olmo I, Nieto I, Vega B, Mintegi S. Febrile young infants with abnormal urine dipstick at low risk of invasive bacterial infection. Arch Dis Child 2021; 106:758-763. [PMID: 33246922 DOI: 10.1136/archdischild-2020-320468] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 11/04/2020] [Accepted: 11/11/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES To develop and validate a prediction rule to identify well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of invasive bacterial infections (IBIs, bacteraemia or bacterial meningitis). DESIGN Ambispective, multicentre study. SETTING The derivation set in a single paediatric emergency department (ED) between 2003 and 2017. The validation set in 21 European EDs between December 2017 and November 2019. PATIENTS Two sets of well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick (either leucocyte esterase and/or nitrite positive test). MAIN OUTCOME Prevalence of IBI in low-risk infants according to the RISeuP score. RESULTS We included 662 infants in the derivation set (IBI rate:5.2%). After logistic regression, we developed a score (RISeuP score) including age (≤15 days old), serum procalcitonin (≥0.6 ng/mL) and C reactive protein (≥20 mg/L) as risk factors. The absence of any risk factor had a sensitivity of 96.0% (95% CI 80.5% to 99.3%), a negative predictive value of 99.4% (95% CI 96.4% to 99.9%) and a specificity of 32.9% (95% CI 28.8% to 37.3%) for ruling out an IBI. Applying it in the 449 infants of the validation set (IBI rate 4.9%), sensitivity, negative predictive value and specificity were 100% (95% CI 87.1% to 100%), 100% (95% CI 97.3% to 100%) and 29.7% (95% CI 25.8% to 33.8%), respectively. CONCLUSION This prediction rule accurately identified well-appearing febrile infants aged ≤90 days with an abnormal urine dipstick at low risk of IBI. This score can be used to guide initial clinical decision-making in these patients, selecting infants suitable for an outpatient management.
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Affiliation(s)
- Roberto Velasco
- Pediatric Emergency Unit, Rio Hortega University Hospital, Valladolid, Spain
| | - Ainara Lejarzegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Borja Gomez
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Mercedes de la Torre
- Pediatric Emergency Department, Hospital Infantil Universitario Nino Jesus, Madrid, Madrid, Spain
| | - Isabel Duran
- Pediatric Emergency Department, Hospital Regional Universitario de Malaga, Malaga, Spain
| | - Amaia Camara
- Pediatric Emergency Department, Donostia Ospitalea, Donostia, Spain
| | - Daniel de la Rosa
- Pediatric Emergency Department, Hospital Universitario Materno Infantil de Canarias, Las Palmas Gran Canaria, Spain
| | - Sergio Manzano
- Pediatric Emergency Department, Geneva University Hospital, Geneva, Switzerland
| | - Jose Rodriguez
- Pediatrics, Virgen de la Arrixaca University Hospital, Murcia, Spain
| | | | - Anne-Aurelie Lopes
- Pediatric Emergency Department, Robert-Debré Mother-Child University Hospital. Sorbonne University, Paris, France
| | - Aristides Rivas
- Pediatric Emergency Department, Gregorio Marañón University Hospital, Madrid, Spain
| | - Isabel Martinez
- Pediatric Emergency Department, Virgen del Rocio University Hospital, Sevilla, Spain
| | | | - Sandra Moya
- Pediatric Emergency Department, Parc Taulí University Hospital, Sabadell, Spain
| | - Sonia Corral
- Pediatrics, Granollers General Hospital, Granollers, Spain
| | - Juan Alonso
- Pediatrics, Hospital San Agustín, Linares, Spain
| | | | - Elena Sancho
- Pediatrics, Hospital de San Jorge, Huesca, Spain
| | | | - Inmaculada Nieto
- Pediatrics, Hospital San Juan de Dios del Aljarafe, Sevilla, Spain
| | - Beatriz Vega
- Pediatrics, Hospital Comarcal de Laredo, Laredo, Spain
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces. University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
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7
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Albarrak M, Alzomor O, Almaghrabi R, Alsubaie S, Alghamdi F, Bajouda A, Nojoom M, Faqeehi H, Rubeea SA, Alnafeesah R, Dolgum S, ALghoshimi M, AlHajjar S, AlShahrani D. Diagnosis and management of community-acquired urinary tract infection in infants and children: Clinical guidelines endorsed by the Saudi Pediatric Infectious Diseases Society (SPIDS). Int J Pediatr Adolesc Med 2021; 8:57-67. [PMID: 34084874 PMCID: PMC8144855 DOI: 10.1016/j.ijpam.2021.03.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 03/01/2021] [Indexed: 10/25/2022]
Abstract
Urinary tract infection (UTI) is the most common bacterial disease in childhood worldwide and may have significant adverse consequences, particularly for young children. In this guideline, we provide the most up-to-date information for the diagnosis and management of community-acquired UTI in infants and children aged over 90 days up to 14 years. The current recommendations given by the American Academy of Pediatrics Practice guidelines, Canadian Pediatric Society guideline, and other international guidelines are considered as well as regional variations in susceptibility patterns and resources. This guideline covers the diagnosis, therapeutic options, and prophylaxis for the management of community-acquired UTI in children guided by our local antimicrobial resistance pattern of the most frequent urinary pathogens. Neonates, infants younger than three months, immunocompromised patients, children recurrent UTIs, or renal abnormalities should be managed individually because these patients may require more extensive investigation and more aggressive therapy and follow up, so it is considered out of the scope of these guidelines. Establishment of children-specific guidelines for the diagnosis and management of community-acquired UTI can reduce morbidity and mortality. We present a clinical statement from the Saudi Pediatric Infectious Diseases Society (SPIDS), which concerns the diagnosis and management of community-acquired UTI in children.
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Affiliation(s)
- May Albarrak
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Omar Alzomor
- Pediatric Infectious Diseases, King Saud Medical City, Riyadh, Saudi Arabia
| | - Rana Almaghrabi
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sarah Alsubaie
- Department of Pediatrics, College of medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Faisal Alghamdi
- Pediatric Emergency, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
- Pediatric Radiology, Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Asrar Bajouda
- Pediatric Infectious Diseases, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maha Nojoom
- Pediatric Radiology, Medical Imaging, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Hassan Faqeehi
- Pediatric Nephrology, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Subhy Abo Rubeea
- Pediatric Urology, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Razan Alnafeesah
- General Pediatric Department, Alyammamh Hospital, Riyadh, Saudi Arabia
| | - Saeed Dolgum
- Pediatric Infectious Diseases, Dr.Suliman ALhabib Hospital, Riyadh, Saudi Arabia
| | - Mohammed ALghoshimi
- General Pediatrics Department, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Sami AlHajjar
- Pediatric Infectious Diseases, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Dayel AlShahrani
- Pediatric Infectious Diseases, Children Specialized Hospital, King Fahad Medical City, Riyadh, Saudi Arabia
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8
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Duicu C, Cozea I, Delean D, Aldea AA, Aldea C. Antibiotic resistance patterns of urinary tract pathogens in children from Central Romania. Exp Ther Med 2021; 22:748. [PMID: 34055063 DOI: 10.3892/etm.2021.10180] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2021] [Accepted: 03/30/2021] [Indexed: 02/07/2023] Open
Abstract
One of the most frequent bacterial infections in children are urinary tract infections (UTIs). In recent years, an increasing incidence of UTIs caused by resistant bacterial strains has been observed, especially with extended-spectrum β-lactamase-producing Enterobacteriaceae that represent about 15% of UTIs. A retrospective study was performed comprising 331 pediatric cases with UTI. Our study aimed to detect the resistance of the uropathogens to common drugs used in UTI treatment. High resistance rates have been recorded for ampicillin, amoxicillin, trimethoprim/sulfamethoxazole (TMP/SMX), cefuroxime, and ciprofloxacin, among E. coli and Klebsiella. The multidrug-resistance (MDR) rate was detected in one-third of the uropathogens, among which more than half were isolated in patients with urinary tract abnormalities. Our study highlighted that nitrofurantoin, ceftriaxone, amikacin and carbapenem may be used for the empirical treatment for febrile or complicated UTI in children. This is the first comprehensive study that evaluates antibiotic resistance in UTIs in children, and their association with urinary tract abnormalities in Romania. As a result of this research, the protocol for initial empiric treatment of infants with febrile or complicated UTI should be modified considering a detailed and ongoing monitoring of local sensitivity of uropathogens to antimicrobial agents.
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Affiliation(s)
- Carmen Duicu
- Department of Pediatrics, 'George Emil Palade' University of Medicine, Pharmacy, Science and Technology, 540142 Târgu Mureş, Romania
| | - Iulia Cozea
- Pediatric Clinic 1, Emergency County Hospital, 540139 Târgu Mureş, Romania
| | - Dan Delean
- Pediatric Nephrology Department, Emergency Clinical Hospital for Children, 400124 Cluj-Napoca, Romania
| | - Andreea Alexandra Aldea
- Neurology Clinic, Clinical Recovery Hospital Cluj-Napoca, 'Iuliu Hatieganu' University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Cornel Aldea
- Pediatric Nephrology Department, Emergency Clinical Hospital for Children, 400124 Cluj-Napoca, Romania
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Mohamed W, Algameel A, Bassyouni R, Mahmoud AET. Prevalence and predictors of urinary tract infection in full-term and preterm neonates. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [DOI: 10.1186/s43054-020-00022-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Early and prompt diagnosis of urinary tract infection (UTI) in neonates has important therapeutic implications. The aim of this study was to evaluate the prevalence of UTI in neonates admitted to a referral neonatal intensive care unit (NICU) and to identify predictors associated with an increased risk of UTI in NICU population.
Results
The prevalence of culture-proven UTI in the studied neonates was 6.67%. Moreover, UTI was more frequent (70%) among full-term neonates. Additionally, both fever and pyuria were the only clinical and laboratory findings that showed significant association with UTI (p < 0.05). Binary logistic regression revealed that neonates with pyuria in urine analysis were 5.44 times more liable to have UTI, while the presence of fever constitutes a risk of only 0.166 (odds ratios were 5.44 and 0.166, respectively). Additionally, sensitivity, specificity, positive predictive value, and negative predictive value of the regression model were 50.0, 94.5, 20.05, and 98.57%, respectively.
Conclusions
We conclude that UTI is not uncommon in full-term neonates admitted in NICU. Additionally, pyuria was significantly related to positive urine culture and its detection in urine analysis increases the likelihood of UTI by 5.44 times.
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Lyons TW, Garro AC, Cruz AT, Freedman SB, Okada PJ, Mahajan P, Balamuth F, Thompson AD, Kulik DM, Uspal NG, Arms JL, Nigrovic LE. Performance of the Modified Boston and Philadelphia Criteria for Invasive Bacterial Infections. Pediatrics 2020; 145:peds.2019-3538. [PMID: 32205466 DOI: 10.1542/peds.2019-3538] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The ability of the decades-old Boston and Philadelphia criteria to accurately identify infants at low risk for serious bacterial infections has not been recently reevaluated. METHODS We assembled a multicenter cohort of infants 29 to 60 days of age who had cerebrospinal fluid (CSF) and blood cultures obtained. We report the performance of the modified Boston criteria (peripheral white blood cell count [WBC] ≥20 000 cells per mm3, CSF WBC ≥10 cells per mm3, and urinalysis with >10 WBC per high-power field or positive urine dip result) and modified Philadelphia criteria (peripheral WBC ≥15 000 cells per mm3, CSF WBC ≥8 cells per mm3, positive CSF Gram-stain result, and urinalysis with >10 WBC per high-power field or positive urine dip result) for the identification of invasive bacterial infections (IBIs). We defined IBI as bacterial meningitis (growth of pathogenic bacteria from CSF culture) or bacteremia (growth from blood culture). RESULTS We applied the modified Boston criteria to 8344 infants and the modified Philadelphia criteria to 8131 infants. The modified Boston criteria identified 133 of the 212 infants with IBI (sensitivity 62.7% [95% confidence interval (CI) 55.9% to 69.3%] and specificity 59.2% [95% CI 58.1% to 60.2%]), and the modified Philadelphia criteria identified 157 of the 219 infants with IBI (sensitivity 71.7% [95% CI 65.2% to 77.6%] and specificity 46.1% [95% CI 45.0% to 47.2%]). The modified Boston and Philadelphia criteria misclassified 17 of 53 (32.1%) and 13 of 56 (23.3%) infants with bacterial meningitis, respectively. CONCLUSIONS The modified Boston and Philadelphia criteria misclassified a substantial number of infants 29 to 60 days old with IBI, including those with bacterial meningitis.
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Affiliation(s)
- Todd W Lyons
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts;
| | - Aris C Garro
- Departments of Pediatrics and Emergency Medicine, Brown University and Rhode Island Hospital, Providence, Rhode Island
| | - Andrea T Cruz
- Sections of Pediatric Emergency Medicine and Pediatric Infectious Diseases, Baylor College of Medicine, Houston, Texas
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital and Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Pamela J Okada
- Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Prashant Mahajan
- Departments of Emergency Medicine and Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan
| | - Fran Balamuth
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Amy D Thompson
- Departments of Pediatrics and Emergency Medicine, Nemours/Alfred I. duPont Hospital for Children, Wilmington, Delaware
| | - Dina M Kulik
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Neil G Uspal
- Department of Pediatrics, University of Washington, Seattle Children's Hospital, Seattle, Washington; and
| | - Joseph L Arms
- Department of Pediatrics, Children's Hospitals and Clinics of Minnesota, Minneapolis, Minnesota
| | - Lise E Nigrovic
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts
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11
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Lorente Romero J, Vázquez López P. Respuesta a las recomendaciones sobre el diagnóstico y tratamiento de la infección urinaria. An Pediatr (Barc) 2020; 92:183-184. [DOI: 10.1016/j.anpedi.2019.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 09/30/2019] [Accepted: 10/04/2019] [Indexed: 11/27/2022] Open
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12
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Piñeiro Pérez R, Martínez Campos L, Cilleruelo Ortega MJ, Piñeiro Pérez R, José Cilleruelo Ortega M, Ares Álvarez J, Baquero-Artigao F, Carlos Silva Rico J, Velasco Zuñiga R, Martínez Campos L, Carazo Gallego B, José Conejo Fernández A, Calvo Rey C, Alfayate Miguélez S, Berghezan Suárez A, García Vera C, José García García J, Herreros Fernández M, Rodrigo Gonzalo de Liria C. «Recomendaciones sobre el diagnóstico y tratamiento de la infección urinaria», respuesta de los autores. An Pediatr (Barc) 2020; 92:184-186. [DOI: 10.1016/j.anpedi.2019.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Accepted: 12/27/2019] [Indexed: 01/05/2023] Open
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13
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Forster CS, Pohl H. Diagnosis of Urinary Tract Infection in the Neuropathic Bladder: Changing the Paradigm to Include the Microbiome. Top Spinal Cord Inj Rehabil 2020; 25:222-227. [PMID: 31548789 DOI: 10.1310/sci2503-222] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Bacteriuria, a non-specific term that refers to the presence of bacteria in the urine, is common in people with neuropathic bladders. However, accurately determining when bacteriuria represents a urinary tract infection (UTI) as opposed to asymptomatic bacteriuria is difficult. There is currently no widely accepted definition of what constitutes a UTI in people with neuropathic bladders. As a result, there is significant variation in care, which likely leads to unnecessary use of antibiotics for bacteriuria. To improve the clinical management of people with neuropathic bladders, it is important to be able to accurately diagnose and treat UTIs. In this article, we review the difficulties associated with accurately diagnosing UTIs and then review proposed definitions. Finally, we discuss the emerging literature of the urinary microbiome and how this may assist in accurately diagnosing UTIs in people with neuropathic bladders.
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Affiliation(s)
| | - Hans Pohl
- Children's National Health System, Washington, DC
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14
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Piñeiro Pérez R, Cilleruelo Ortega MJ, Ares Álvarez J, Baquero-Artigao F, Silva Rico JC, Velasco Zúñiga R, Martínez Campos L, Carazo Gallego B, Conejo Fernández AJ, Calvo C, Alfayate Miguélez S, Berghezan Suárez A, García Vera C, José García García J, Herreros M, Rodrigo Gonzalo de Liria C. Recomendaciones sobre el diagnóstico y tratamiento de la infección urinaria. An Pediatr (Barc) 2019; 90:400.e1-400.e9. [DOI: 10.1016/j.anpedi.2019.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2018] [Revised: 02/19/2019] [Accepted: 02/25/2019] [Indexed: 10/27/2022] Open
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15
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Piñeiro Pérez R, Cilleruelo Ortega MJ, Ares Álvarez J, Baquero-Artigao F, Silva Rico JC, Velasco Zúñiga R, Martínez Campos L, Carazo Gallego B, Conejo Fernández AJ, Calvo C, Alfayate Miguélez S, Berghezan Suárez A, García Vera C, José García García J, Herreros M, Rodrigo Gonzalo de Liria C. Recommendations on the diagnosis and treatment of urinary tract infection. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.anpede.2019.02.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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16
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Abstract
Abstract
Urinary tract infection (UTI) represents one of the most frequent infections with bacterial etiology during childhood. In infants and toddlers with fever without source UTI’ investigation should be carried out, since signs and symptoms are nonspecific. However, obtaining uncontaminated urine samples from these patients can be challenging and time consuming; all current collection methods (clean-catch, plastic collection bag, catheterization, etc) have disadvantages. Criteria for UTI definition are represented by the presence of significant number of a single uropathogen, this number being different depending on the collection method: at least 1000 colony-forming unit (CFU/ml) for catheter samples and at least 100.000 CFU/ml from midstream clean-catch samples or 50.000 CFU/ml and significant pyuria in a symptomatic or febrile child. Accurate diagnosis of UTI is essential to avoid any antibiotic overuse and expensive investigations. UTI caused by resistant bacterial strains has an increasing prevalence in children. In pediatric population, extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) represent the etiology of around 15% of UTIs. Because of limited therapeutic options the reintroduction of some old antimicrobial agents is necessary, therefore Nitrofurantoin and Fosfomycin, can represent alternatives for oral treatment and prophylaxis of UTIs in children or in case of resistance suspicion to other drug classes. It is important to recognize patients at risk, such as children with recurrent UTIs, kidney abnormalities, like vesicoureteral reflux and previous antibiotherapy, in order to recommend adequate empiric treatment, especially against resistant bacteria.
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17
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Kaufman J, Temple-Smith M, Sanci L. Urinary tract infections in children: an overview of diagnosis and management. BMJ Paediatr Open 2019; 3:e000487. [PMID: 31646191 PMCID: PMC6782125 DOI: 10.1136/bmjpo-2019-000487] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 09/10/2019] [Accepted: 09/12/2019] [Indexed: 01/05/2023] Open
Abstract
Urinary tract infections (UTIs) are a common and potentially serious bacterial infection of childhood. History and examination findings can be non-specific, so a urine sample is required to diagnose UTI. Sample collection in young precontinent children can be challenging. Bedside dipstick tests are useful for screening, but urine culture is required for diagnostic confirmation. Antibiotic therapy must be guided by local guidelines due to increasing antibiotic resistance. Duration of therapy and indications for imaging remain controversial topics and guidelines lack consensus. This article presents an overview of paediatric UTI diagnosis and management, with highlights of recent advances and evidence updates.
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Affiliation(s)
- Jonathan Kaufman
- Department of Paediatrics, Western Health, Sunshine Hospital, St Albans, Victoria, Australia.,Health Services Research Group, Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of General Practice, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Meredith Temple-Smith
- Department of General Practice, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Lena Sanci
- Department of General Practice, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
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18
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Roberts KB, Wald ER. The Diagnosis of UTI: Colony Count Criteria Revisited. Pediatrics 2018; 141:peds.2017-3239. [PMID: 29339563 DOI: 10.1542/peds.2017-3239] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/08/2017] [Indexed: 11/24/2022] Open
Affiliation(s)
- Kenneth B Roberts
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; and
| | - Ellen R Wald
- Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
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