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Park J, Torosis M, Kim JH, Ackerman AL. U.S. primary care physician perceptions on barriers to providing guideline-driven care for UTI and recurrent UTI: a qualitative study. BMC PRIMARY CARE 2024; 25:234. [PMID: 38951826 PMCID: PMC11218267 DOI: 10.1186/s12875-024-02477-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 06/11/2024] [Indexed: 07/03/2024]
Abstract
BACKGROUND Urinary tract infections (UTI) affect almost two-thirds of all women during their lives and many experience recurrent infections. There are evidence-based guidelines from multiple international societies for evaluation and treatment; however, recent claims-based analyses have demonstrated that adherence to these guidelines is poor. This study seeks to understand the barriers experienced by U.S. primary care providers (PCPs) to providing guideline-based care for UTI and recurrent UTI (rUTI). METHODS Semi-structured interviews of 18 PCPs, recruited from the greater Los Angeles area, examined real-world clinical management of UTI/rUTI episodes, decisions to refer to subspecialty care, and resources guiding counseling and management. Grounded theory methodology served to analyze interview transcripts and identify preliminary and major themes. RESULTS Participants expressed the desire to obtain urine cultures for each cystitis episode, but felt pressured to make compromises by patient demands or barriers to care. PCPs had lower thresholds to empirical treatment if patients had a history of rUTIs, were elderly, or declined evaluation. Laboratory data was minimally utilized in clinical decision-making: urinalyses were infrequently considered when interpreting culture data. PCPs treated a broad set of urologic and non-urologic symptoms as UTI, even with negative cultures. PCPs did not feel comfortable initiating UTI prophylaxis, instead seeking specialist evaluation for anatomic causes. They were unaware of management guidelines, typically utilizing UpToDate® as their primary resource. Few evidence-based UTI prevention interventions were recommended by providers. CONCLUSIONS Low availability of succinct and clear professional guidelines are substantial barriers to appropriate UTI/rUTI care. Poor useability of clinical guidance documents results in substantial confusion about the role of preventative measures and additional diagnostic testing. Difficulties in patient access to care providers lead to expectations for presumptive treatment. Future studies are needed to determine if improved educational materials for providers and/or management algorithms can improve guideline concordance of UTI management.
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Affiliation(s)
- Jennifer Park
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Box 951738, Los Angeles, CA, 90095-1738, USA
| | - Michele Torosis
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Box 951738, Los Angeles, CA, 90095-1738, USA
| | - Ja-Hong Kim
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Box 951738, Los Angeles, CA, 90095-1738, USA
- Department of Urology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA
| | - A Lenore Ackerman
- Department of Obstetrics and Gynecology, David Geffen School of Medicine, University of California, Box 951738, Los Angeles, CA, 90095-1738, USA.
- Department of Urology, Division of Pelvic Medicine and Reconstructive Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, 90095, USA.
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Salm J, Salm F, Arendarski P, Kramer TS. High antimicrobial resistance in urinary tract infections in male outpatients in routine laboratory data, Germany, 2015 to 2020. EURO SURVEILLANCE : BULLETIN EUROPEEN SUR LES MALADIES TRANSMISSIBLES = EUROPEAN COMMUNICABLE DISEASE BULLETIN 2022; 27. [PMID: 35904060 PMCID: PMC9336165 DOI: 10.2807/1560-7917.es.2022.27.30.2101012] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Evidence on the distribution of bacteria and therapy recommendations in male outpatients with urinary tract infections (UTI) remains insufficient. Aim We aimed to report frequency distributions and antimicrobial resistance (AMR) of bacteria causing UTI in men and to identify risk factors for resistance of Escherichia coli against trimethoprim (TMP) and ciprofloxacin (CIP). Methods We conducted a retrospective observational study using routinely collected midstream urine specimens from 102,736 adult male outpatients sent from 6,749 outpatient practices to nine collaborating laboratories from all major regions in Germany between 2015 and 2020. Resistance in E. coli was predicted using logistic regression. Results The three most frequent bacteria were E. coli (38.4%), Enterococcus faecalis (16.5%) and Proteus mirabilis (9.3%). Resistance of E. coli against amoxicillin (45.7%), TMP (26.6%) and CIP (19.8%) was common. Multiple drug resistance was high (22.9%). Resistance against fosfomycin (0.9%) and nitrofurantoin (1.9%) was low. Resistance of En. faecalis against CIP was high (29.3%). Isolates of P. mirabilis revealed high resistance against TMP (41.3%) and CIP (16.6%). The CIP and TMP resistance was significantly higher among bacteria derived from recurrent UTI (p < 0.05). Age ≥ 90 years, recurrent UTI and regions East and South were independently associated with AMR of E. coli against TMP and CIP (p < 0.05). Conclusion The most frequent UTI-causing pathogens showed high resistance against TMP and CIP, empirical therapy is therefore likely to fail. Apart from intrinsically resistant pathogens, susceptibility to fosfomycin and nitrofurantoin remains sufficient. Therefore, they remain an additional option for empirical treatment of uncomplicated UTI in men.
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Affiliation(s)
- Jonas Salm
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin School of Public Health, Berlin, Germany.,Institute of Medical Microbiology and Hygiene, Medical Centre - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | | | - Tobias Siegfried Kramer
- LADR Laboratory Group Dr Kramer & Colleagues, Geesthacht, Germany.,Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute for Hygiene and Environmental Medicine, Berlin, Germany
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A Three-Year Look at the Phylogenetic Profile, Antimicrobial Resistance, and Associated Virulence Genes of Uropathogenic Escherichia coli. Pathogens 2022; 11:pathogens11060631. [PMID: 35745485 PMCID: PMC9227886 DOI: 10.3390/pathogens11060631] [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: 03/30/2022] [Revised: 05/19/2022] [Accepted: 05/28/2022] [Indexed: 12/04/2022] Open
Abstract
Uropathogenic Escherichia coli is the most common cause of urinary tract infections, resulting in about 150 million reported annual cases. With multidrug resistance on the rise and the need for global and region surveillance, this investigation looks at the UPEC isolates collected for a 3-year period, with a view of ascertaining their antimicrobial susceptibility patterns and associated virulence determinants. The identification of bacteria isolates, antimicrobial susceptibility, and extended-spectrum beta-lactamases (ESBLs) production was determined with a Vitek 2 Compact Automated System (BioMerieux, Marcy L’Etoile, France). ESBLs were confirmed by the combined disc test (CDT) and basic biochemical test. The isolates were distributed into A (11%), B1 (6%), B2 (62.4%), and D (20.6%). Resistance to the penicillin group was high, between 88% and 100%. Additionally, resistance was high to cephalosporins (100%) in 2017 and 2018. The isolates were all sensitive to tigecycline, while resistance against imipenem and meropenem was low, at 4–12% in 2017 and 2018 and 0% in 2019. The results also showed that ESBL isolates were seen in 2017 and 2018. They were confirmed positive to CTX/CLA (88.5%) and CAZ/CLA (85%). By 2019, the number of resistant isolates reduced, showing only 4% ESBL isolates. Two virulence genes, fimH (46%) and papE/F (15%), were detected among the isolates by PCR. In conclusion, this study found that phylogroups B2 and D carried the most virulence genes as well as MDR and ESBL characteristics, suggesting the UPEC strains to be extraintestinal pathogens responsible for UTIs.
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Occurrence and Genomic Characterization of Clone ST1193 Clonotype 14-64 in Uncomplicated Urinary Tract Infections Caused by Escherichia coli in Spain. Microbiol Spectr 2022; 10:e0004122. [PMID: 35604206 PMCID: PMC9241898 DOI: 10.1128/spectrum.00041-22] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
We conducted a prospective, multicenter, specific pilot study on uncomplicated urinary tract infections (uUTI). One-hundred non-duplicated uropathogenic Escherichia coli (UPEC) from uUTI occurred in 2020 in women attending 15 primary care centers of a single health region of northern Spain were characterized using a clonal diagnosis approach. Among the high genetic diversity showed by 59 different phylogroup-clonotype combinations, 11 clones accounted for 46% of the isolates: B2-ST73 (CH24-30); B2-ST73 (CH24-103); B2-ST131 (CH40-30); B2-ST141 (CH52-5); B2-ST372 (CH103-9); B2-ST404 (CH14-27); B2-ST404 (CH14-807); B2-ST1193 (CH14-64); D-ST69 (CH35-27); D-ST349 (CH36-54), and F-ST59 (CH32-41). The screening of the UPEC status found that 69% of isolates carried ≥ 3 of chuA, fyuA, vat, and yfcV genes. Multidrug resistance to at least one antibiotic of ≥ 3 antimicrobial categories were exhibited by 30% of the isolates, with the highest rates of resistance against ampicillin/amoxicillin (48%), trimethoprim (35%), norfloxacin (28%), amoxicillin-clavulanic acid (26%), and trimethoprim-sulfamethoxazole (24%). None extended-spectrum beta-lactamase/carbapenemase producer was recovered. According to our results, fosfomycin and nitrofurantoin should be considered as empirical treatment of choice for uUTI by E. coli (resistance rates 4% and 2%, respectively). We uncover the high prevalence of the pandemic fluoroquinolone-resistant ST1193 clone (6%) in uUTI, which represents the first report in Spain in this pathology. The genomic analysis showed similar key traits than those ST1193 clones disseminated worldwide. Through the SNP comparison based on the core genome, the Spanish ST1193 clustered with isolates retrieved from the Enterobase, showing high genomic similarity than the global ST1193 described in the United States, Canada and Australia. IMPORTANCE Analyzing the clonal structure and antimicrobial resistance of E. coli isolates implicated in uncomplicated urinary tract infections, one of the most frequent visits managed in primary health care, is of interest for clinicians to detect changes in the dynamics of emerging uropathogenic clones associated with the spread of fluoroquinolone resistance. It can also provide consensus concerning optimal control and antibiotic prescribing.
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Miller LM, Simmons MD, Silver CD, Krauss TF, Thomas GH, Johnson SD, Duhme-Klair AK. Antibiotic-functionalized gold nanoparticles for the detection of active β-lactamases. NANOSCALE ADVANCES 2022; 4:573-581. [PMID: 36132685 PMCID: PMC9419081 DOI: 10.1039/d1na00635e] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 12/02/2021] [Indexed: 06/16/2023]
Abstract
Antimicrobial resistance (AMR) continues to threaten the effective treatment and prevention of bacterial infections. The spread of resistant infections is accelerated by the lack of fast and cost-effective tests for the detection of AMR at the point-of-care. We aimed to address this challenge by developing a diagnostic tool to detect one of the major forms of AMR, the β-lactamase enzymes. Antibiotic-functionalized gold nanoparticles (AuNPs) have been successfully developed for the detection of β-lactamases in challenging biological media, namely undiluted urine. Furthermore, these tools are compatible with samples containing a urine sample preservative (boric acid) or hematuria (blood). The functionalized AuNPs interact with the active β-lactamases, resulting in the hydrolysis of the surface-bound antibiotics, which then inhibits binding of the AuNPs to a capture protein (a penicillin-binding protein) to indicate the presence of active β-lactamases. We successfully integrated the antibiotic-functionalized AuNPs into a new lateral flow assay (LFA), which can be used to detect active β-lactamases down to the detection limit of 11 nM. While we demonstrate the use of antibiotic-functionalized AuNPs in an LFA format to provide a novel method of detecting active β-lactamases, these functionalized AuNPs are amenable to a range of alternative diagnostic technologies and could lead to vital point-of-care diagnostics for the early detection of multi-drug resistant infections.
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Affiliation(s)
- Lisa M Miller
- Department of Chemistry, University of York Heslington York YO10 5DD UK
| | - Matthew D Simmons
- Department of Electronic Engineering, University of York Heslington York YO10 5DD UK
| | - Callum D Silver
- Department of Physics, University of York Heslington York YO10 5DD UK
| | - Thomas F Krauss
- Department of Physics, University of York Heslington York YO10 5DD UK
| | - Gavin H Thomas
- Department of Biology, University of York Heslington York YO10 5DD UK
| | - Steven D Johnson
- Department of Electronic Engineering, University of York Heslington York YO10 5DD UK
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Saengsawang N, Ruang-Areerate T, Kesakomol P, Thita T, Mungthin M, Dungchai W. Development of a fluorescent distance-based paper device using loop-mediated isothermal amplification to detect Escherichia coli in urine. Analyst 2021; 145:8077-8086. [PMID: 33078771 DOI: 10.1039/d0an01306d] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The highly sensitive and selective determination of Escherichia coli (E. coli) in urine was achieved using a SYBR™ safe loop-mediated isothermal amplification (LAMP) method with a distance-based paper device. New primers set specific to multi-copy the 16s rRNA gene of E. coli were designed and used in this study. The detection sensitivity of these primers was higher than in related work and they could be incorporated with a low-cost paper-based device to quantify E. coli in urine at a concentration lower than 101 CFU mL-1. Regarding standard artificial urine, a linear range of a 10-fold dilution of E. coli concentration (105-100 CFU mL-1) with an R-square value (R2) = 0.9823 was observed directly using a fluorescent migratory distance of the 4 μL reaction mixture in the detection zone under blue light without the need for postreaction staining process. Based on the device, E. coli infection could be significantly categorized into 3 groups; none, light, and heavy levels, which is beneficial for UTI diagnosis. Hence, this paper-based device is suitable for use with the SYBR™ Safe-LAMP assay to semi-quantify E. coli, especially in resource-limited settings due to advantages of low cost, simple fabrication and operation, and no requirement for sophisticated instruments, as well as its disposability and portability.
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Affiliation(s)
- Natkrittaya Saengsawang
- Analytical Chemistry, Department of Chemistry, Faculty of Science, King Mongkut's University of Technology Thonburi, Thailand.
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Treatment of uncomplicated UTI in males: a systematic review of the literature. BJGP Open 2020; 5:bjgpopen20X101140. [PMID: 33234514 PMCID: PMC8170603 DOI: 10.3399/bjgpopen20x101140] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/20/2020] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) affect around 20% of the male population in their lifetime. The incidence of UTIs in men in the community is 0.9-2.4 cases per 1000 aged <55 years and 7.7 per 1000 aged ≥85 years. AIM To evaluate the outcomes of randomised controlled trials (RCTs) comparing the effectiveness of different antimicrobial treatments and durations for uncomplicated UTIs in adult males in outpatient settings. METHOD A systematic literature review of RCTs of adult male patients with an uncomplicated UTI treated with oral antimicrobials in any outpatient setting. The outcomes were symptom resolution within 2 weeks of starting treatment, duration until symptom resolution, clinical cure, bacteriological cure, and frequency of adverse events. RESULTS From the 1052 abstracts screened, three provided sufficient information on outcomes. One study compared trimethoprim-sulfamethoxazole for 14 days (21 males) with 42 days (21 males). Fluoroquinolones were compared in the two other RCTs: lomefloxacin (10 males) with norfloxacin (11 males), and ciprofloxacin for 7 days (19 males) and 14 days (19 males). Combining the results from the three RCTs shows that for 75% males with a UTI (76/101) bacteriological cure was reported at the end of the study. Of the 59 patients receiving a fluoroquinolone, 57 (97%) reported bacteriological and clinical cure within 2 weeks after treatment. CONCLUSION The evidence available is insufficient to make any recommendations in relation to type and duration of antimicrobial treatment for male UTIs. Sufficiently powered RCTs are needed to identify best treatment type and duration for male UTIs in primary care.
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Elvers KT, Wilson VJ, Hammond A, Duncan L, Huntley AL, Hay AD, van der Werf ET. Antibiotic-induced changes in the human gut microbiota for the most commonly prescribed antibiotics in primary care in the UK: a systematic review. BMJ Open 2020; 10:e035677. [PMID: 32958481 PMCID: PMC7507860 DOI: 10.1136/bmjopen-2019-035677] [Citation(s) in RCA: 102] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE The gut microbiota influences many aspects of human health. We investigated the magnitude and duration of changes in gut microbiota in response to antibiotics commonly prescribed in UK primary care. METHODS We searched MEDLINE, EMBASE and AMED, all years up to May 2020 including all study designs, collecting and analysing data on the effect of antibiotics prescribed for respiratory and urinary tract infections. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane standard methods. Risk of bias was evaluated using the Critical Appraisal Skills Programme. Narrative synthesis was used to report the themes emerging from the data. MAIN OUTCOME MEASURES Primary outcomes were antibiotic-induced changes in the composition and/or diversity of the gut microbiota. Secondary outcome was the time for the microbiota to return to baseline. RESULTS Thirty-one articles with low or unclear risk of bias showed that antibiotics impact the gut microbiota by causing rapid and diminished levels of bacterial diversity and changes in relative abundances. After cessation of treatment, gut bacteria recover, in most individuals, to their baseline state within a few weeks. Some studies suggested longer term effects from 2 to 6 months. Considerable heterogeneity in methodology makes the studies prone to biases and other confounding factors. Doxycycline was associated with a marked short-term decrease in Bifidobacterium diversity. Clarithromycin decreased the populations of Enterobacteria, and the anaerobic bacteria Bifidobacterium sp and Lactobacillus sp in numbers and diversity for up to 5 weeks. Phenoxymethylpenicillin, nitrofurantoin and amoxicillin had very little effect on the gut microbiome. CONCLUSIONS Despite substantial heterogeneity of the studies and small sample sizes, there is evidence that antibiotics commonly used in primary care influence the composition of the gastrointestinal microbiota. Larger population-based studies are needed to fully understand how antibiotics modulate the microbiota, and to determine if these are associated with (longer term) health consequences. PROSPERO REGISTRATION NUMBER CRD42017073750.
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Affiliation(s)
- Karen T Elvers
- Centre for Academic Primare Care & NIHR Health Protection Research Unit in Behavioural Science and Evaluation, Bristol Medical School, University of Bristol, Bristol, UK
| | - Victoria J Wilson
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Ashley Hammond
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lorna Duncan
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alyson L Huntley
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Alastair D Hay
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Esther T van der Werf
- Centre of Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
- Department of Integrative Medicine, Louis Bolk Institute, Bunnik, The Netherlands
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Baines G, Banjoko A, Brair A, Gray J, Desai N, Cardozo L, Toozs-Hobson P. Antibiotic resistance in urinary tract infections: A re-visit after five years and experience over two sites. Post Reprod Health 2020; 26:91-100. [PMID: 32252595 DOI: 10.1177/2053369120910039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of this study was to repeat a previous audit, performed from 2009 to 2013, for the cohort of 2018 to determine how the resistance rates in urinary pathogens in women over 18 years of age have changed. A secondary aim of the study was to use resistance data from a different UK hospital in the same year to compare differences in resistance rates across different geographic locations. STUDY DESIGN This was a retrospective study of all positive urine cultures grown from female patients attending two different hospitals in the year 2018. Resistance patterns were analysed. RESULTS The resistance rate to co-amoxiclav continues to increase with amoxicillin retaining high resistance patterns. There are some significant differences in resistance patterns between the different locations. CONCLUSION Antimicrobial resistance is a significant problem in the UK particularly in antibiotics used to treat UTI. These patterns can vary across different geographical locations and over time; therefore, up-to-date knowledge of local anti-biotic resistance is essential when making an appropriate prescription choice.
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Affiliation(s)
- Georgina Baines
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Adeolu Banjoko
- Department of Medicine and Surgery, University of Birmingham, Birmingham, UK
| | - Amalia Brair
- Department of Urogynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Jim Gray
- Department of Microbiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Nergish Desai
- Department of Microbiology, King's College Hospital, London, UK
| | - Linda Cardozo
- Department of Urogynaecology, King's College Hospital, London, UK
| | - Philip Toozs-Hobson
- Department of Urogynaecology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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Vaggers S, Puri P, Wagenlehner F, Somani BK. A Content Analysis of Mobile Phone Applications for the Diagnosis, Treatment, and Prevention of Urinary Tract Infections, and Their Compliance with European Association of Urology Guidelines on Urological Infections. Eur Urol Focus 2020; 7:198-204. [PMID: 32088140 DOI: 10.1016/j.euf.2020.02.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 01/23/2020] [Accepted: 02/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Mobile phone applications (apps) for urinary tract infections (UTIs) can help in the management of UTIs. OBJECTIVE To review the apps available for UTIs and check its adherence to the European Association of Urology (EAU) guidelines. DESIGN, SETTING, AND PARTICIPANTS We reviewed all mobile phone apps from the iTunes App Store and Google Play for UTIs and evaluated various aspects of apps, as well as their current and potential usage in screening, prevention, or management. The inclusion criteria were English-language apps for adults with upper or lower tract UTIs. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Each app was sorted into one of the following categories: "informative", "tracker", or "urinalysis"; each app was then checked for its adherence to EAU guidelines based on a 31-point checklist. One point was given for each piece of specific advice provided by the app, with a maximum score of 31. RESULTS AND LIMITATIONS A total of 34 apps were initially identified from the app download platforms, and after exclusions, 11 were evaluated. The apps had a high average user rating of 4.04 (range: 0-5). The median number of downloads was 1000 (range: <100-100 000). The average adherence to the EAU checklist was low at 31.36% (3.3-70%). The app performance for prevention of recurrent UTIs, uncomplicated cystitis, and pyelonephritis was 14.9%, 33.1%, and 41.4%, respectively. CONCLUSIONS Apps to support the management of UTIs could be improved by better adherence to European guidelines and recommendations based on up-to-date evidence, especially for the management of recurrent UTIs. PATIENT SUMMARY In this study, we look at the role of mobile phone applications (apps) in screening, prevention, and management of urinary tract infections and their adherence to European Association of Urology guidelines. We found that apps need to improve with better compliance to European guidelines, especially for the management of recurrent urinary tract infections.
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Affiliation(s)
- Sophie Vaggers
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Prabhleen Puri
- University Hospital Southampton NHS Trust, Southampton, UK
| | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology Justus Liebig University Giessen, Germany
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Pujades-Rodriguez M, West RM, Wilcox MH, Sandoe J. Lower Urinary Tract Infections: Management, Outcomes and Risk Factors for Antibiotic Re-prescription in Primary Care. EClinicalMedicine 2019; 14:23-31. [PMID: 31709399 PMCID: PMC6833446 DOI: 10.1016/j.eclinm.2019.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 07/18/2019] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are major drivers of antibiotic prescribing in primary care. Inappropriate antibiotic prescribing for UTIs likely drives antibiotic resistance. We aimed to describe current investigation and antibiotic treatment to examine opportunities for improved antimicrobial stewardship. METHODS We identified a cohort of all patients with lower UTI diagnosis between 2011 and 2015 in the 390 primary care practices contributing data to ResearchOne in England. We examined investigation, antibiotic treatment and antibiotic re-prescription within 28 days according to guideline-defined patient groups. We assessed risk factors for re-prescription using mixed-effect logistic regression. FINDINGS In total, 494,675 UTIs were diagnosed in 300,354 patients. Median age was 54 years, and 83.3% were women. Same-day antibiotic was prescribed for 85.7% of UTIs; 56.8% were treated with trimethoprim, and urine sampling was undertaken in 25.0%. The antibiotic re-prescription rate was low (17,430, 4.1%) and increased slightly over time in men (from 5.2% in 2011 to 6.2% in 2015). Overall, 21.1% of pre-prescription were for the same antibiotic. The percentage of adults with recurrent UTIs ranged from 1.0% in 18-64 year-old men to 2.6% in women ≥ 65 years. The risk of antibiotic re-prescription increased with age, calendar year, recent antibiotic prescribing and treatment with antibiotic other than trimethoprim or nitrofurantoin. INTERPRETATION Most patients diagnosed with lower UTI in primary care receive same-day empirical antibiotics with little diversity in choice of agent. The antibiotic re-prescription rate is low. Microbiological investigation and re-prescription of the same antibiotic given for the initial episode happened in one quarter of UTIs. FUNDING UK National Health Service Improvement.
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Affiliation(s)
- Mar Pujades-Rodriguez
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, UK
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, UK
- Corresponding author at: Leeds Institute of Health Sciences, University of Leeds, Clarendon Way, Leeds LS2 9NL, UK.
| | - Robert M. West
- Leeds Institute of Health Sciences, School of Medicine, University of Leeds, UK
| | - Mark H. Wilcox
- Leeds Institute of Biomedical and Clinical Sciences, School of Medicine, University of Leeds, UK
| | - Jonathan Sandoe
- Leeds Institute for Data Analytics, School of Medicine, University of Leeds, UK
- Leeds Institute of Biomedical and Clinical Sciences, School of Medicine, University of Leeds, UK
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Risk of Contamination of Voided Urine Specimen in Women With Pelvic Organ Prolapse. Female Pelvic Med Reconstr Surg 2019; 26:488-492. [PMID: 31335480 DOI: 10.1097/spv.0000000000000760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES The primary aim of this study was to determine if urine cultures are more likely to be contaminated in women with pelvic organ prolapse (POP). The secondary aim was to evaluate the test characteristics of a urine dipstick in women with POP. METHODS A retrospective cohort study was conducted of women who presented to the urogynecology clinic between September 1, 2017, and August 31, 2018. Associations between the presence of POP and contaminated urine culture results were estimated using univariable and multivariable analyses. The sensitivity and specificity of a urine dipstick in women with POP were calculated. RESULTS We included 351 women (143 with and 208 without POP). Women with POP were older (65.4 ± 15.8 vs 60.7 ± 11.0 years, P < 0.01), had a lower body mass index (26.6 ± 4.8 vs 29.2 ± 7.7 kg/m, P < 0.01), and were less likely to have recurrent urinary tract infections (3.5% vs 9.6%, P=0.03). Women with POP were more likely to have a contaminated urine culture than women without POP (55.9% vs 40.9%, P < 0.01). Rates of contaminated urine culture were higher in women with stage 3 and 4 prolapse than in women with stage 2 prolapse (59.6% vs 41.0%, P < 0.01). On multivariate analysis, the odds of contaminated urine culture remained higher in women with POP (odds ratio, 1.89; 95% confidence interval, 1.20-2.99). In women with POP, the sensitivity (23.5%) and positive predictive value (66.7%) of a urine dipstick were poor. CONCLUSIONS Women with POP are more likely to provide a contaminated urine culture when collecting a midstream urine specimen.
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Brookes-Howell L, Thomas-Jones E, Bates J, Bekkers MJ, Brugman C, Coulman E, Francis N, Hashmi K, Hood K, Kirby N, Llor C, Little P, Moore M, Moragas A, Rumsby K, Verheij T, Butler C. Challenges in managing urinary tract infection and the potential of a point-of-care test guided care in primary care: an international qualitative study. BJGP Open 2019; 3:bjgpopen18X101630. [PMID: 31366667 PMCID: PMC6662873 DOI: 10.3399/bjgpopen18x101630] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 10/26/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Little is known about clinicians' experiences of using a point-of-care test (POCT) to inform management of urinary tract infection (UTI) in general practice. AIM To explore experiences of using the Flexicult test to inform management of UTI and views on requirements for an optimal POCT to inform successful implementation. DESIGN & SETTING Telephone interviews with 35 primary care clinicians and healthcare professionals in Wales, England, Spain, and the Netherlands, who had participated in a trial of the Flexicult POCT for UTI based on urine culture. METHOD Thematic analysis of semi-structured interviews. RESULTS Most primary care clinicians interviewed agreed on the need for a POCT in UTI management, and that the Flexicult POCT delivered quicker results than laboratory results used in usual care, reassured patients, boosted their confidence in decision-making, and reminded them about antibiotic stewardship. However, clinicians also reported difficulties in interpreting results, limitations on when the Flexicult could be used, and concerns that testing all patients would strain care delivery and prolong patient discomfort when delaying decisions until a non-rapid POCT result was available. An optimal POCT would produce more rapid results, and be reliable and easy to use. Uptake into routine care would be enhanced by: clear guidance on which patients should be tested; training for interpreting 'grey area' results; reiterating that even 'straightforward' cases might be better managed with a test; clear messages about stopping unnecessary antibiotics versus completing a course; and better self-management strategies to accompany implementation of delayed, or non-prescription of, antibiotics. CONCLUSION Primary care clinicians believe that POCT tests could play a useful role in the management of UTI and gave clear recommendations for successful implementation.
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Affiliation(s)
- Lucy Brookes-Howell
- Research Fellow (Qualitative), Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Emma Thomas-Jones
- Research Fellow, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Janine Bates
- Research Associate, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Marie-Jet Bekkers
- Research Associate, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Curt Brugman
- Project Manager, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Elinor Coulman
- Research Associate, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nick Francis
- Professor, Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Khurram Hashmi
- GP Academic Fellow, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Kerenza Hood
- Professor, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Nigel Kirby
- Senior Data Manager, Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Cardiff, UK
| | - Carl Llor
- GP and Researcher, Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
| | - Paul Little
- Professor, Primary Care & Population Sciences, University of Southampton, Southampton, UK
| | - Michael Moore
- Professor, Primary Care & Population Sciences, University of Southampton, Southampton, UK
| | - Anna Moragas
- Project Manager, University Institute in Primary Care Research Jordi Gol, Via Roma Health Centre, Barcelona, Spain
- GP and Associate Professor, University Rovira i Virgili. Primary Healthcare Centre Jaume I, Tarragona, Spain
| | - Kate Rumsby
- Study Manager, Primary Care & Population Sciences, University of Southampton, Southampton, UK
| | - Theo Verheij
- Professor, Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, The Netherlands
| | - Christopher Butler
- Professor of Primary Care, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Duane S, Vellinga A, Murphy AW, Cormican M, Smyth A, Healy P, Moore M, Little P, Devane D. COSUTI: a protocol for the development of a core outcome set (COS) for interventions for the treatment of uncomplicated urinary tract infection (UTI) in adults. Trials 2019; 20:106. [PMID: 30732617 PMCID: PMC6367821 DOI: 10.1186/s13063-019-3194-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 01/11/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Urinary tract infections (UTIs) are the second most common infection presenting in the community. Clinical guidelines and decision aids assist health practitioners to treat a UTI; however, treatment practices vary due to patient needs and context of presentation. Numerous trials have evaluated the effectiveness of treatment interventions for UTI; however, it is difficult to compare the results between trials due to inconsistencies between reported outcomes. Poor choice of outcome measures can lead to impairment of evidence synthesis due to the inability to compare outcomes between trials with similar aims. Transparency in selecting and reporting outcomes can be mitigated through the development of an agreed minimum set of outcomes that should be reported in clinical trials, referred to as a core outcome set (COS). This paper presents the protocol for the development of a COS for interventions in the treatment of uncomplicated UTI in adults. METHODS This COS development consists of three phases. Phase 1 is a systematic review, which aims to identify the core outcomes that have been reported in trials and systematic reviews of interventions treating uncomplicated UTI in adults. Phase 2 consists of a three-round online Delphi survey with stakeholders in the area of treatment interventions for UTI. The aim of this online Delphi survey is to achieve consensus on the importance of the outcomes emerging from Phase 1 of this research. Phase 3 is a consensus meeting to finalise the COS that should be reported in trials evaluating the effectiveness of interventions for the treatment of UTI. DISCUSSION It is hoped that the development of a COS for interventions for the treatment of uncomplicated UTI in adults will be adopted as a minimum set of outcomes that should be reported and measured within this context. If the findings from clinical trials related to treatment interventions for UTI are to impact on policy and practice, it is important that the findings from different treatment interventions are comparable across trials.
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Affiliation(s)
- Sinead Duane
- HRB Trials Methodology Research Network, College of Medicine, Nursing & Health Sciences, National University of Ireland, Galway, Ireland
| | - Akke Vellinga
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
| | - Andrew W. Murphy
- Discipline of General Practice, HRB Primary Care Clinical Trial Network Ireland, College of Medicine, Nursing and Health Sciences, National University of Ireland, Galway, Ireland
| | - Martin Cormican
- Discipline of Bacteriology, School of Medicine, National University of Ireland, Galway, Ireland
| | - Andrew Smyth
- HRB Clinical Research Facility Galway, National University of Ireland, Galway, Ireland
| | - Patricia Healy
- HRB Trials Methodology Research Network, College of Medicine, Nursing & Health Sciences, National University of Ireland, Galway, Ireland
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
| | - Michael Moore
- Primary Care and Population Sciences, Primary Care and Population Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Paul Little
- Primary Care and Population Sciences, Primary Care and Population Sciences, University of Southampton Faculty of Medicine, Southampton, UK
| | - Declan Devane
- HRB Trials Methodology Research Network, College of Medicine, Nursing & Health Sciences, National University of Ireland, Galway, Ireland
- School of Nursing and Midwifery, National University of Ireland, Galway, Ireland
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Uropathogenic Escherichia coli and the related virulence factors. GINECOLOGIA.RO 2019. [DOI: 10.26416/gine.26.4.2019.2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Abstract
OBJECTIVE To provide an update of the definition, epidemiology, clinical presentation, investigation, treatment, and prevention of recurrent urinary tract infections in women. OPTIONS Continuous antibiotic prophylaxis, post-coital antibiotic prophylaxis, and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection. Vaginal estrogen and cranberry juice can also be effective prophylaxis alternatives. EVIDENCE A search of PubMed and The Cochrane Library for articles published in English identified the most relevant literature. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date restrictions. VALUES This update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). OPTIONS Recurrent urinary tract infections need careful investigation and can be efficiently treated and prevented. Different prophylaxis options can be selected according to each patient's characteristics. RECOMMENDATIONS
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Alanazi MQ, Alqahtani FY, Aleanizy FS. An evaluation of E. coli in urinary tract infection in emergency department at KAMC in Riyadh, Saudi Arabia: retrospective study. Ann Clin Microbiol Antimicrob 2018; 17:3. [PMID: 29422058 PMCID: PMC5806437 DOI: 10.1186/s12941-018-0255-z] [Citation(s) in RCA: 57] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2016] [Accepted: 02/01/2018] [Indexed: 11/23/2022] Open
Abstract
Background Urinary tract infection (UTIS) is a common infectious disease in which level of antimicrobial resistance are alarming worldwide. Therefore, this study aims to describe the prevalence and the resistance pattern of the main bacteria responsible for UTIS Escherichia coli (E. coli). Methods Retrospective chart review for patients admitted to emergency department and diagnosed with UTIS at KAMC, in Riyadh, Saudi Arabia between January to March 2008 was performed. Antimicrobial susceptibility to ampicillin, augmentin (amoxicillin/clavulanate), cefazolin, co-trimoxazole (sulfamethoxazole/trimethoprim), ciprofloxacin, and nitrofurantoin, and cefpodoxime was determined for 101 E. coli urinary isolates. Results Escherichia coli was the most prevalent pathogen contributing to UTIS representing 93.55, 60.24, and 45.83% of all pathogen isolated from urine culture of pediatric, adult, and elderly, respectively. High rates of resistance to ampicillin (82.76, 58, and 63.64%) and co-trimoxazole (51.72, 42, and 59.09%), among E. coli isolated from pediatric, adult and elderly respectively. Nitrofurantoin was the most active agent, followed by ciprofloxacin, augmentin and cefazolin. 22.77% of E. coli isolates exhibited multiple drug resistance (MDR). Among 66 and 49 isolates resistant to ampicillin and co-trimoxazole, respectively, 34.84 and 42.85% were MDR. In contrast, all isolates resistant to augmentin and nitrofurantoin were MRD, while 72.7 and 82.4% of isolates resistant to ciprofloxacin and cefazolin were MDR. Conclusions High resistance was observed to ampicillin and co-trimoxazole which commonly used as empirical treatments for UTIS, limiting their clinical use. This necessitates continuous surveillance for resistance pattern of uropathogens against antibiotics.
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Affiliation(s)
- Menyfah Q Alanazi
- Clinical Pharmacy Practice, Drug Policy and Economics Center, King Abdulaziz Medical City, Ministry of National Guard, Health Affairs, Riyadh, 22490, Saudi Arabia.
| | - Fulwah Y Alqahtani
- Department of PharmaceUTIscs, College of Pharmacy, King Saud University, Riyadh, 22452, Saudi Arabia
| | - Fadilah S Aleanizy
- Department of PharmaceUTIscs, College of Pharmacy, King Saud University, Riyadh, 22452, Saudi Arabia
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Ailes EC, Gilboa SM, Gill SK, Broussard CS, Crider KS, Berry RJ, Carter TC, Hobbs CA, Interrante JD, Reefhuis J. Association between antibiotic use among pregnant women with urinary tract infections in the first trimester and birth defects, National Birth Defects Prevention Study 1997 to 2011. ACTA ACUST UNITED AC 2017; 106:940-949. [PMID: 27891788 DOI: 10.1002/bdra.23570] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 08/26/2016] [Accepted: 08/29/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies noted associations between birth defects and some antibiotics (e.g., nitrofurantoin, sulfonamides) but not others (e.g., penicillins). It is unclear if previous findings were due to antibiotic use, infections, or chance. To control for potential confounding by indication, we examined associations between antibiotic use and birth defects, among women reporting urinary tract infections (UTIs). METHODS The National Birth Defects Prevention Study is a multi-site, population-based case-control study. Case infants/fetuses have any of over 30 major birth defects and controls are live-born infants without major birth defects. We analyzed pregnancies from 1997 to 2011 to estimate the association between maternally reported periconceptional (month before conception through the third month of pregnancy) use of nitrofurantoin, trimethoprim-sulfamethoxazole, or cephalosporins and specific birth defects, among women with periconceptional UTIs. Women with periconceptional UTIs who reported penicillin use served as the comparator. RESULTS Periconceptional UTIs were reported by 7.8% (2029/26,068) of case and 6.7% (686/10,198) of control mothers. Most (68.2% of case, 66.6% of control mothers) also reported antibiotic use. Among 608 case and 231 control mothers reporting at least one periconceptional UTI and certain antibiotic use, compared with penicillin, nitrofurantoin use was associated with oral clefts in the offspring (adjusted odds ratio, 1.97 [95% confidence interval, 1.10-3.53]), trimethoprim-sulfamethoxazole use with esophageal atresia (5.31 [1.39-20.24]) and diaphragmatic hernia (5.09 [1.20-21.69]), and cephalosporin use with anorectal atresia/stenosis (5.01 [1.34-18.76]). CONCLUSION Periconceptional exposure to some antibiotics might increase the risk for certain birth defects. However, because individual birth defects are rare, absolute risks should drive treatment decisions.Birth Defects Research (Part A) 106:940-949, 2016.© 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Elizabeth C Ailes
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Suzanne M Gilboa
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Cheryl S Broussard
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Krista S Crider
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Robert J Berry
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Charlotte A Hobbs
- College of Medicine, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Julia D Interrante
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia.,Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
| | - Jennita Reefhuis
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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Epp A, Larochelle A. N° 250-Infection Récurrente Des Voies Urinaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:e464-e474. [PMID: 28935070 DOI: 10.1016/j.jogc.2017.08.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Kim H, Chaurasia AK, Kim T, Choi J, Ha SC, Kim D, Kim KK. Structural and functional study of ChuY from Escherichia coli strain CFT073. Biochem Biophys Res Commun 2016; 482:1176-1182. [PMID: 27919686 DOI: 10.1016/j.bbrc.2016.12.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2016] [Accepted: 12/02/2016] [Indexed: 10/20/2022]
Abstract
The uropathogenic Escherichia coli strain CFT073 contains multiple iron and heme transport systems, which facilitate infection of the host urinary tract. To elucidate the molecular and cellular function of ChuY, a hypothetical gene in the heme degradation/utilization pathway, we solved the crystal structure of ChuY at 2.4 Å resolution. ChuY has high structural homology with human biliverdin and flavin reductase. We confirmed that ChuY has flavin mononucleotide (FMN) reductase activity, using NAD(P)H as a cofactor, and shows porphyrin ring binding affinity. A chuY deletion-insertion strain showed reduced survival potential compared to wild-type and complemented strains in mammalian cells. Current results suggest ChuY acts as a reductase in heme homeostasis to maintain the virulence potential of E. coli CFT073.
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Affiliation(s)
- Hun Kim
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi 16419, South Korea
| | - Akhilesh Kumar Chaurasia
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi 16419, South Korea
| | - Truc Kim
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi 16419, South Korea
| | - Jongkeun Choi
- Department of Cosmetic Science, Chungwoon University, Hongseong, Chungnam 32244, South Korea
| | - Sung Chul Ha
- Pohang Accelerator Laboratory, Pohang, Gyeongbuk 37673, South Korea
| | - Doyoun Kim
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi 16419, South Korea
| | - Kyeong Kyu Kim
- Department of Molecular Cell Biology, Sungkyunkwan University School of Medicine, Suwon, Gyeonggi 16419, South Korea.
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Dolscheid-Pommerich RC, Klarmann-Schulz U, Conrad R, Stoffel-Wagner B, Zur B. Evaluation of the appropriate time period between sampling and analyzing for automated urinalysis. Biochem Med (Zagreb) 2016; 26:82-9. [PMID: 26981022 PMCID: PMC4783094 DOI: 10.11613/bm.2016.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2015] [Accepted: 12/27/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction Preanalytical specifications for urinalysis must be strictly adhered to avoid false interpretations. Aim of the present study is to examine whether the preanalytical factor ‘time point of analysis’ significantly influences stability of urine samples for urine particle and dipstick analysis. Materials and methods In 321 pathological spontaneous urine samples, urine dipstick (Urisys™2400, Combur-10-Test™strips, Roche Diagnostics, Mannheim, Germany) and particle analysis (UF-1000 i™, Sysmex, Norderstedt, Germany) were performed within 90 min, 120 min and 240 min after urine collection. Results For urine particle analysis, a significant increase in conductivity (120 vs. 90 min: P < 0.001, 240 vs. 90 min: P < 0.001) and a significant decrease in WBC (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), RBC (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), casts (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001) and epithelial cells (120 vs. 90 min P = 0.610, 240 vs. 90 min P = 0.041) were found. There were no significant changes for bacteria. Regarding urine dipstick analysis, misclassification rates between measurements were significant for pH (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), leukocytes (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), nitrite (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), protein (120 vs. 90 min P < 0.001, 240 vs. 90 min P<0.001), ketone (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), blood (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001), specific gravity (120 vs. 90 min P < 0.001, 240 vs. 90 min P < 0.001) and urobilinogen (120 vs. 90 min, P = 0.031). Misclassification rates were not significant for glucose and bilirubin. Conclusion Most parameters critically depend on the time window between sampling and analysis. Our study stresses the importance of adherence to early time points in urinalysis (within 90 min).
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Affiliation(s)
| | - Ute Klarmann-Schulz
- Institute of Medical Microbiology, Immunology and Parasitology, University Hospital Bonn, Bonn, Germany; Institute of Medical Biometry, Informatics and Epidemiology (IMBIE), University Hospital Bonn, Bonn, Germany
| | - Rupert Conrad
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany
| | - Birgit Stoffel-Wagner
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
| | - Berndt Zur
- Department of Clinical Chemistry and Clinical Pharmacology, University Hospital Bonn, Bonn, Germany
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Bryce A, Hay AD, Lane IF, Thornton HV, Wootton M, Costelloe C. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis. BMJ 2016; 352:i939. [PMID: 26980184 PMCID: PMC4793155 DOI: 10.1136/bmj.i939] [Citation(s) in RCA: 214] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous antibiotics prescribed in primary care and resistance. DESIGN AND DATA ANALYSIS Systematic review and meta-analysis. Pooled percentage prevalence of resistance to the most commonly used antibiotics in children in primary care, stratified by the OECD (Organisation for Economic Co-operation and Development) status of the study country. Random effects meta-analysis was used to quantify the association between previous exposure to antibiotics in primary care and resistance. DATA SOURCES Observational and experimental studies identified through Medline, Embase, Cochrane, and ISI Web of Knowledge databases, searched for articles published up to October 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Studies were eligible if they investigated and reported resistance in community acquired urinary tract infection in children and young people aged 0-17. Electronic searches with MeSH terms and text words identified 3115 papers. Two independent reviewers assessed study quality and performed data extraction. RESULTS 58 observational studies investigated 77,783 E coli isolates in urine. In studies from OECD countries, the pooled prevalence of resistance was 53.4% (95% confidence interval 46.0% to 60.8%) for ampicillin, 23.6% (13.9% to 32.3%) for trimethoprim, 8.2% (7.9% to 9.6%) for co-amoxiclav, and 2.1% (0.8 to 4.4%) for ciprofloxacin; nitrofurantoin was the lowest at 1.3% (0.8% to 1.7%). Resistance in studies in countries outside the OECD was significantly higher: 79.8% (73.0% to 87.7%) for ampicillin, 60.3% (40.9% to 79.0%) for co-amoxiclav, 26.8% (11.1% to 43.0%) for ciprofloxacin, and 17.0% (9.8% to 24.2%) for nitrofurantoin. There was evidence that bacterial isolates from the urinary tract from individual children who had received previous prescriptions for antibiotics in primary care were more likely to be resistant to antibiotics, and this increased risk could persist for up to six months (odds ratio 13.23, 95% confidence interval 7.84 to 22.31). CONCLUSIONS Prevalence of resistance to commonly prescribed antibiotics in primary care in children with urinary tract infections caused by E coli is high, particularly in countries outside the OECD, where one possible explanation is the availability of antibiotics over the counter. This could render some antibiotics ineffective as first line treatments for urinary tract infection. Routine use of antibiotics in primary care contributes to antimicrobial resistance in children, which can persist for up to six months after treatment.
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Affiliation(s)
- Ashley Bryce
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Alastair D Hay
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Isabel F Lane
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Hannah V Thornton
- Centre for Academic Primary Care, NIHR School for Primary Care Research, School of Social and Community Medicine, University of Bristol, Bristol BS8 2PS, UK
| | - Mandy Wootton
- Specialist Antimicrobial Chemotherapy Unit, Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff CF14 4XW, UK
| | - Céire Costelloe
- NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, London W12 0NN, UK
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Eley R, Judge C, Knight L, Dimeski G, Sinnott M. Illustrations reduce contamination of midstream urine samples in the emergency department. J Clin Pathol 2016; 69:921-5. [DOI: 10.1136/jclinpath-2015-203504] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Accepted: 01/31/2016] [Indexed: 11/04/2022]
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Rezavand N, Veisi F, Zangane M, Amini R, Almasi A. Association between Asymptomatic Bacteriuria and Pre-Eclampsia. Glob J Health Sci 2015; 8:235-9. [PMID: 26925912 PMCID: PMC4965687 DOI: 10.5539/gjhs.v8n7p235] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 12/18/2015] [Indexed: 12/27/2022] Open
Abstract
Asymptomatic bacteriuria is one of the most common and important bacterial infections during pregnancy and can result in progressive infections and endanger maternal as well as fetal health. In this study, we assessed the relationship between asymptomatic bacteriuria and pre-eclampsia. In this case-control study, pregnant women who presented to Imam Reza Hospital in Kermanshah in 2013-14 were studied. The minimum sample size was calculated as 125 pregnant women in each group with a total of 250 subjects. There were 125 women with pre-eclampsia and 125 women without pre-eclampsia (control group). Matching was done for age, gestational age, and parity between case and control groups. Matching was verified by a P value of 0.061 for maternal age and gestational age and 0.77 for parity. The statistical analyses were done by applying the chi-squared test and determining odds ratio (OR) for having bacteriuria in univariate logistic regression as well as multivariate regression with adjusting the effect of maternal age, gestational age, and parity. Pyuria and bacteriuria were significantly more common in pre-eclampsia group than in control group. The results showed that a significant association existed between asymptomatic bacteriuria and pre-eclampsia. The rate of asymptomatic bacteriuria was 6.8 times higher in women with pre-eclampsia compared to those without pre-eclampsia. Further studies are required for better clarification of association between asymptomatic bacteriuria and pre-eclampsia.
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Affiliation(s)
- Negin Rezavand
- Imam Reza Hospital, High Risk Pregnancy Research Center, Kermanshah University of Medical Sciences.
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Bongard E, Frimodt-Møller N, Gal M, Wootton M, Howe R, Francis N, Goossens H, Butler CC. Analytic laboratory performance of a point of care urine culture kit for diagnosis and antibiotic susceptibility testing. Eur J Clin Microbiol Infect Dis 2015; 34:2111-9. [PMID: 26245946 DOI: 10.1007/s10096-015-2460-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/16/2015] [Indexed: 11/24/2022]
Abstract
Currently available point-of-care (POC) diagnostic tests for managing urinary tract infections (UTIs) in general practice are limited by poor performance characteristics, and laboratory culture generally provides results only after a few days. This laboratory evaluation compared the analytic performance of the POC UK Flexicult(™) (Statens Serum Institut) (SSI) urinary kit for quantification, identification and antibiotic susceptibility testing and routine UK National Health Service (NHS) urine processing to an advanced urine culture method. Two hundred urine samples routinely submitted to the Public Health Wales Microbiology Laboratory were divided and: (1) analysed by routine NHS microbiological tests as per local laboratory standard operating procedures, (2) inoculated onto the UK Flexicult(™) SSI urinary kit and (3) spiral plated onto Colorex Orientation UTI medium (E&O Laboratories Ltd). The results were evaluated between the NHS and Flexicult(™ )methods, and discordant results were compared to the spiral plating method. The UK Flexicult(™) SSI urinary kit was compared to routine NHS culture for identification of a pure or predominant uropathogen at ≥ 10(5) cfu/mL, with a positive discordancy rate of 13.5% and a negative discordancy rate of 3%. The sensitivity and specificity were 86.7% [95% confidence interval (CI) 73.8-93.7] and 82.6% (95% CI 75.8-87.7), respectively. The UK Flexicult(™) SSI urinary kit was comparable to routine NHS urine processing in identifying microbiologically positive UTIs in this laboratory evaluation. However, the number of false-positive samples could lead to over-prescribing of antibiotics in clinical practice. The Flexicult(™) SSI kit could be useful as a POC test for UTIs in primary care but further pragmatic evaluations are necessary.
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Affiliation(s)
| | | | - M Gal
- Cardiff University, Cardiff, Wales
| | | | - R Howe
- Public Health Wales, Cardiff, Wales
| | | | - H Goossens
- University of Antwerp, Antwerpen, Belgium
| | - C C Butler
- Cardiff University, Cardiff, Wales.,University of Oxford, Oxford, England
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Töz E, Kurt S, Sahin Ç, Canda MT. Frequency of recurrent urinary tract infection in patients with pelvic organ prolapse. Res Rep Urol 2015; 7:9-12. [PMID: 25671221 PMCID: PMC4315532 DOI: 10.2147/rru.s77061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose The aim of the study was to investigate the existence of a relationship between pelvic organ prolapse (POP) and recurrent urinary tract infection (UTI). Materials and methods The hospital database was searched for women diagnosed with pelvic floor disorders and all medical records were reviewed for recurrent UTI, diagnosed by two or more positive urine cultures taken within 12 months of each other. The control group was created using one-to-one matching for age and menopausal status. The prevalence of recurrent UTI in these patients were compared. Results The mean age of the 210 participants was 54.64±5.15 years. We found no association between POP and recurrent UTI. In the prolapse group, 22 women (21%) had recurrent UTI compared with 19 women (18%) in the control group (P=0.316). Post-void residual (PVR) volumes >50 mL were associated with increased prevalence of recurrent UTI. Conclusion POP is not a risk factor for recurrent UTI, but women with POP are more likely to have high PVR volumes. High PVR volumes increase the risk of recurrent UTI. Clinical examination and ultrasound assessment of PVR should be performed in all women presenting with prolapse and UTI. Elevated PVR is the most significant risk factor, linking POP with recurrent UTI.
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Affiliation(s)
- Emrah Töz
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Sefa Kurt
- Department of Obstetrics and Gynecology, Izmir Dokuz Eylül University, Izmir, Turkey
| | - Çağdaş Sahin
- Department of Obstetrics and Gynecology, Tepecik Training and Research Hospital, Izmir, Turkey
| | - Mehmet Tunç Canda
- Department of Obstetrics and Gynecology, Kent Hospital, Izmir, Turkey
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Distribution and antimicrobial susceptibility pattern of bacterial pathogens causing urinary tract infection in urban community of meerut city, India. ISRN MICROBIOLOGY 2013; 2013:749629. [PMID: 24288649 PMCID: PMC3830820 DOI: 10.1155/2013/749629] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Accepted: 09/12/2013] [Indexed: 11/18/2022]
Abstract
Urinary tract infection is one of the common infections in the Indian community. Distribution and susceptibility of UTI-causing pathogens change according to time and place. This study was conducted to determine the distribution and antimicrobial susceptibility of uropathogens in the Indian community as well as to determine the effect of gender and age on the etiology of bacterial uropathogens. Clean catch midstream urine samples were collected from 288 patients of the age ranging from 15 to ≥48 years. Antimicrobial susceptibility was performed on all isolated bacteria by Kirby Bauer's disc diffusion method. The multiple antibiotic resistance (MAR) index of each antibiotic was calculated. The UTI prevalence was 53.82% in patients; however, the prevalence was significantly higher in females than in males (females: 73.57%; males: 35.14%; P = 0.000). Females within the age group of 26-36 years and elderly males of ≥48 years showed higher prevalence of UTI. Gram negative bacteria (90.32%) were found in high prevalence than Gram positive (9.68%). Escherichia coli (42.58%) was the most prevalent gram negative isolate. Nitrofurantoin (78.71%) was found the most resistant drug among all uropathogens. Tested carbapenems were found the most susceptible drug against isolated uropathogens which showed 92.26% and 84.52% susceptibility, respectively.
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Collier S, Matjiu F, Jones G, Harber M, Hopkins S. A prospective study comparing contamination rates between a novel mid-stream urine collection device (Peezy) and a standard method in renal patients. J Clin Pathol 2013; 67:139-42. [PMID: 23986555 PMCID: PMC3913209 DOI: 10.1136/jclinpath-2013-201686] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION It is imperative that laboratories receive uncontaminated urine samples to avoid giving false-positive results and reduce antimicrobial use. AIM The aim of the study was to investigate a novel urine collection device (Peezy) in a renal outpatient clinic to determine whether it reduced contamination of urine samples. METHODS The novel device was used in 420 renal transplant recipients and the results were compared with 424 matched historical controls, who used the standard method of urine collection. High epithelial cell counts on microscopy and mixed urine cultures were used to identify contaminated samples. RESULTS Peezy increased the rates of both epithelial cells and mixed growths in the urine samples when compared with the historical controls. CONCLUSIONS Further randomised studies in other more generalisable populations need to be performed.
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Affiliation(s)
- S Collier
- Department of Microbiology, Royal Free London NHS Foundation Trust, , London, UK
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Flower A, Lewith G. A prospective case series exploring the role of Chinese herbal medicine in the treatment of recurrent urinary tract infections. Eur J Integr Med 2012. [DOI: 10.1016/j.eujim.2012.05.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Vellinga A, Tansey S, Hanahoe B, Bennett K, Murphy AW, Cormican M. Trimethoprim and ciprofloxacin resistance and prescribing in urinary tract infection associated with Escherichia coli: a multilevel model. J Antimicrob Chemother 2012; 67:2523-30. [PMID: 22729920 DOI: 10.1093/jac/dks222] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Individual and group level factors associated with the probability of antimicrobial resistance of uropathogenic Escherichia coli were analysed in a multilevel model. METHODS Adult patients consulting with a suspected urinary tract infection (UTI) in 22 general practices over a 9 month period supplied a urine sample for laboratory analysis. Cases were patients with a UTI associated with a resistant E. coli. Previous antimicrobial exposure and other patient characteristics were recorded from the medical files. RESULTS Six hundred and thirty-three patients with an E. coli UTI and a full record for all variables were included. Of the E. coli isolates, 36% were resistant to trimethoprim and 12% to ciprofloxacin. A multilevel logistic regression model was fitted. The odds that E. coli was resistant increased with increasing number of prescriptions over the previous year for trimethoprim from 1.4 (0.8-2.2) for one previous prescription to 4.7 (1.9-12.4) for two and 6.4 (2.0-25.4) for three or more. For ciprofloxacin the ORs were 2.7 (1.2-5.6) for one and 6.5 (2.9-14.8) for two or more. The probability that uropathogenic E. coli was resistant showed important variation between practices and a difference of 17% for trimethoprim and 33% for ciprofloxacin was observed for an imaginary patient moving from a practice with low to a practice with high probability. This difference could not be explained by practice prescribing or practice resistance levels. CONCLUSIONS Previous antimicrobial use and the practice visited affect the risk that a patient with a UTI will be diagnosed with an E. coli resistant to this agent, which was particularly important for ciprofloxacin.
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Affiliation(s)
- Akke Vellinga
- Discipline of Bacteriology, NUI Galway, Galway, Ireland.
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Mishra B, Srivastava S, Singh K, Pandey A, Agarwal J. Symptom-based diagnosis of urinary tract infection in women: are we over-prescribing antibiotics? Int J Clin Pract 2012; 66:493-8. [PMID: 22512608 DOI: 10.1111/j.1742-1241.2012.02906.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Current clinical guidelines for the management of symptoms suggesting urinary tract infection recommend empiric antibiotic therapy. OBJECTIVE To determine the diagnostic accuracy of urinary tract symptoms for early identification of urinary tract infection (UTI) in sexually active women when culture results are not available. METHOD This was a cross-sectional observational study conducted in a tertiary care hospital between July 2009 and May 2011. Subjects comprised 312 women ≥ 18 year of age who reported to the physician with symptoms suggestive of UTI. A predesigned questionnaire was filled and urine was analysed by microscopic examination and culture. Diagnostic values were calculated against gold standard urine culture results (> 10(2) CFU/ml) and 95% CIs and likelihood ratios are reported. RESULTS A total of 312 women were enrolled, as culture was contaminated in 36 only 276 women were included in final analysis. Prevalence of UTI was 46.01% amongst symptomatic women. Urgency (p = 0.001), burning sensation during micturition (p = 0.035), dysuria (p = 0.004), frequency of sexual intercourse > 5 per month (p = 0.010) and pyuria (p = 0.000) were significantly associated with culture positivity. Absence of pyuria emerged as best predictor for ruling out UTI even if the woman had symptoms (sensitivity 93.70%, NPV 91.84%, AUC 77.07%, LR- 0.1). The combination of urgency, burning during micturition and pyuria was the best predictor of UTI in our study (sensitivity 85.83%, PPV 71.71%, AUC 78.48%, LR+ 2.97) CONCLUSION Symptoms alone have low accuracy when assessed against the reference standard for diagnosing UTI. Empiric treatment of UTI based on symptoms may expose large number of patients to unnecessary antibiotics. Wet mount microscopy for presence of pyuria as a 'near patient test' before starting antibiotics seems a rational approach for management of UTI in symptomatic women.
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Affiliation(s)
- B Mishra
- Department of Microbiology, CSM Medical University, Lucknow, India
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Olson RP, Haith K. Antibiotic resistance in urinary tract infections in college students. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 2012; 60:471-474. [PMID: 22857139 DOI: 10.1080/07448481.2012.681410] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine resistance to antibiotics of Escherichia coli in uncomplicated urinary tract infections (uUTIs) in female college students. PARTICIPANTS Symptomatic patients presenting to a student health service from September 2008 to December 2009. METHODS Clean catch midstream urine samples were tested for urinalysis (UA) and culture and sensitivity. RESULTS Of 168 students enrolled in the study, 138 had positive UA, and 94 of these grew >100,000 colonies/mL of E. coli. Ampicillin resistance was 31.9%, trimethoprim-sulfamethoxazole (TMP-SMX) resistance 16.0%, ciprofloxacin resistance 4.3%, amoxicillin/clavulanate resistance 3.2%, and nitrofurantoin resistance 1.1%. The sensitivity of UA was 95.4% and the positive predictive value was 87.0% (p ≤ .001). Specificity was 77.5% and negative predictive value 92.9%. CONCLUSIONS In healthy college women with uUTI symptoms, TMP-SMX should not be universally used for empirical therapy, whereas use of ciprofloxacin, amoxicillin/clavulanate, and nitrofurantoin are appropriate.
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Affiliation(s)
- Ronald P Olson
- Duke University Health Service, Duke University, Durham, North Carolina 27710, USA.
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Mithraja MJ, Irudayaraj V, Kiruba S, Jeeva S. Antibacterial efficacy of Drynaria quercifolia (L.) J. Smith (Polypodiaceae) against clinically isolated urinary tract pathogens. Asian Pac J Trop Biomed 2012. [DOI: 10.1016/s2221-1691(12)60143-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Medina-Bombardó D, Jover-Palmer A. Does clinical examination aid in the diagnosis of urinary tract infections in women? A systematic review and meta-analysis. BMC FAMILY PRACTICE 2011; 12:111. [PMID: 21985418 PMCID: PMC3207883 DOI: 10.1186/1471-2296-12-111] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2010] [Accepted: 10/10/2011] [Indexed: 11/22/2022]
Abstract
Background Clinicians should be aware of the diagnostic values of various symptoms, signs and antecedents. This information is particularly important in primary care settings, where sophisticated diagnostic approaches are not always feasible. The aim of the study is to determine the probability that various symptoms, signs, antecedents and tests predict urinary tract infection (UTI) in women. Methods We conducted a systematic search of the MEDLINE and EMBASE databases to identify articles published in all languages through until December 2008. We particularly focused on studies that examined the diagnostic accuracy of at least one symptom, sign or patient antecedent related to the urinary tract. We included studies where urine culture, a gold standard, was preformed by primary care providers on female subjects aged at least 14 years. A meta-analysis of the likelihood ratio was performed to assess variables related to the urinary tract symptoms. Results Of the 1, 212 articles identified, 11 met the selection criteria. Dysuria, urgency, nocturia, sexual activity and urgency with dysuria were weak predictors of urinary tract infection, whereas increases in vaginal discharge and suprapubic pain were weak predictors of the absence of infection. Nitrites or leukocytes in the dipstick test are the only findings that clearly favored a diagnosis of UTI. Conclusions Clinical findings do not aid in the diagnosis of UTI among women who present with urinary symptoms. Vaginal discharge is a weak indicator of the absence of infection. The urine dipstick test was the most reliable tool for detecting UTI.
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Affiliation(s)
- David Medina-Bombardó
- Manacor Health Center, Majorca Primary Care Department, Balearic Institute of Health Manacor, 07500 Manacor, Balearic Islands, Spain.
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Franchi C, Sequi M, Bonati M, Nobili A, Pasina L, Bortolotti A, Fortino I, Merlino L, Clavenna A. Differences in outpatient antibiotic prescription in Italy’s Lombardy region. Infection 2011; 39:299-308. [DOI: 10.1007/s15010-011-0129-1] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2010] [Accepted: 06/06/2011] [Indexed: 10/18/2022]
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Abstract
OBJECTIVE to provide an update of the definition, epidemiology, clinical presentation, investigation, treatment, and prevention of recurrent urinary tract infections in women. OPTIONS continuous antibiotic prophylaxis, post-coital antibiotic prophylaxis, and acute self-treatment are all efficient alternatives to prevent recurrent urinary tract infection. Vaginal estrogen and cranberry juice can also be effective prophylaxis alternatives. EVIDENCE a search of PubMed and The Cochrane Library for articles published in English identified the most relevant literature. Results were restricted to systematic reviews, randomized control trials/controlled clinical trials, and observational studies. There were no date restrictions. VALUES this update is the consensus of the Sub-Committee on Urogynaecology of the Society of Obstetricians and Gynaecologists of Canada. Recommendations were made according to the guidelines developed by the Canadian Task Force on Preventive Health Care (Table 1). OPTIONS recurrent urinary tract infections need careful investigation and can be efficiently treated and prevented. Different prophylaxis options can be selected according to each patient's characteristics.
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Infection récurrente des voies urinaires. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2010. [DOI: 10.1016/s1701-2163(16)34718-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Gorter KJ, Hak E, Zuithoff NPA, Hoepelman AIM, Rutten GEHM. Risk of recurrent acute lower urinary tract infections and prescription pattern of antibiotics in women with and without diabetes in primary care. Fam Pract 2010; 27:379-85. [PMID: 20462975 DOI: 10.1093/fampra/cmq026] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Women with diabetes have an increased risk of urinary tract infections (UTIs), especially recurrences. Aim. To investigate diabetes characteristics associated with the risk of recurrent lower UTIs and the antibiotic prescription pattern. METHODS In an exploratory retrospective study involving 7063 women aged>or=30 years, we studied the incidence of recurrent UTI (relapses and reinfection) in women with (n=340) and without diabetes (n=6618). Multivariable logistic regression and multilevel multinomial logistic analyses were used to determine the adjusted associations between diabetes characteristics and recurrent UTI [odds ratio (OR); 95% confidence interval (CI)] and the influence of diabetes on the pattern of antibiotic prescriptions for UTI, respectively. RESULTS Relapses and reinfections were reported in 7.1% and 15.9% of women with diabetes versus 2.0% and 4.1% of women without diabetes. There was an independent higher risk of recurrent UTI in women with diabetes compared with women without diabetes (OR 2.0; 95% CI 1.4-2.9). Women taking oral blood glucose-lowering medication (OR 2.1; 95% CI 1.2-3.5) or insulin (OR 3.0; 95% CI 1.7-5.1) or who had had diabetes for >or=5 years (OR 2.9; 95% CI 1.9-4.4) or who had retinopathy (OR 4.1; 95% CI 1.9-9.1) were at risk of recurrent UTI. The pattern of antibiotic prescriptions for UTI was not influenced by diabetes. CONCLUSIONS Women with diabetes>or=5 years or with glucose-lowering medication or with retinopathy have an increased risk of recurrent UTI. Diabetes itself does not seem to influence the antibiotic prescription pattern. Research focusing on effective antibiotic treatment of UTI in women at risk of recurrence is needed and may help limit the development of antibiotic resistance.
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Affiliation(s)
- Kees J Gorter
- Department of General Practice, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
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Velasco Arribas M, Rubio Cirilo L, Casas Martín A, Martín Sánchez M, Gamez Díez S, Delgado-Iribarren A, Valverde Cánovas J, García de Casasola G. Adecuación del tratamiento empírico de la infección urinaria en urgencias. Rev Clin Esp 2010; 210:11-6. [DOI: 10.1016/j.rce.2009.06.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2009] [Accepted: 06/29/2009] [Indexed: 11/17/2022]
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Miragliotta G, Di Pierro MN, Miragliotta L, Mosca A. Antimicrobial resistance among uropathogens responsible for community-acquired urinary tract infections in an Italian community. J Chemother 2009; 20:721-7. [PMID: 19129070 DOI: 10.1179/joc.2008.20.6.721] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
This study aimed to establish the pattern of the antimicrobial resistance among the leading uropathogens causing community-acquired UTIs in an area of the region of Apulia, Southern Italy. Twenty-one thousand and two hundred outpatients, 6,893 males and 14,307 females, were enrolled. Urinary isolates were identified by conventional methods and the susceptibility to 18 antimicrobials determined. Recognized uropathogens Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis were isolated from 3175 positive samples, E. coli accounting for 68.04% of positive cultures. Most overall resistance was to ampicillin, while the resistance rate to cephalothin was higher than that of third generation cephalosporins. Although to a different degree, all the bacteria had an overall good susceptibility rate to quinolones as well as to fosfomycin but increased resistance to sulfamethoxazole/trimethoprim. Our results confirm that E. coli is the leading uropathogen and provide information about the antimicrobial susceptibility patterns of the main pathogens causing community-acquired UTIs. These findings should be taken into account to help maintain the safety and efficacy of treatment for community-acquired UTIs.
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Affiliation(s)
- G Miragliotta
- Section of Microbiology, Department of Clinica Medica, Immunologia, Malattie Infettive, University of Bari, Italy.
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Anwer AG, Sandeep PM, Goldys EM, Vemulpad S. Distinctive autofluorescence of urine samples from individuals with bacteriuria compared with normals. Clin Chim Acta 2009; 401:73-5. [DOI: 10.1016/j.cca.2008.11.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Revised: 10/28/2008] [Accepted: 11/12/2008] [Indexed: 10/21/2022]
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Venmans LMAJ, Hak E, Gorter KJ, Rutten GEHM. Incidence and antibiotic prescription rates for common infections in patients with diabetes in primary care over the years 1995 to 2003. Int J Infect Dis 2009; 13:e344-51. [PMID: 19208491 DOI: 10.1016/j.ijid.2008.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Accepted: 12/02/2008] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE To assess changes in incidence and in antibiotic prescription rates for infections of the lower respiratory tract (LRTI) and urinary tract (UTI) in patients with diabetes (DM) over the years 1995 to 2003. METHODS This was a retrospective cohort study as part of the University Medical Center Utrecht General Practitioners Research Network. We included patients with DM aged > or = 45 years. We assessed incidence and antibiotic prescription rates for LRTI and UTI. Incidence rates were calculated as episodes per 1000 person-years. Antibiotic prescription rates were calculated per 100 episodes of LRTI and UTI. RESULTS The study population increased over the years 1995 to 2003. The male-to-female ratio and mean age of the study population remained constant over these years. The incidence rate for LRTI remained stable (13%; p=0.442), and for UTI the incidence rate increased by 40% (p=0.037). Antibiotic prescription rates increased in LRTI by 60% (p<0.001) and in cystitis by 15% (p=0.029). CONCLUSIONS Incidence rates for UTI and antibiotic prescription rates for LRTI in diabetes have increased over the years 1995 to 2003. In particular, attention should be paid to the increasing use of antibiotics in DM patients with LRTI.
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Affiliation(s)
- L M A J Venmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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Antibiotic resistance in urinary isolates of Escherichia coli from college women with urinary tract infections. Antimicrob Agents Chemother 2008; 53:1285-6. [PMID: 19104022 DOI: 10.1128/aac.01188-08] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Of 176 urine isolates from female students positive for Escherichia coli, 29.6% were trimethoprim-sulfamethoxazole resistant and none were nitrofurantoin resistant. Among students with a history of urinary tract infection (UTI) (n = 119), resistance to ciprofloxacin was 11.8%, compared to 1.8% among those without prior UTI. Nitrofurantoin should be considered for empirical therapy of lower tract UTI.
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Inter-observer reliability of three different methods of measuring urethrovesical mobility. Int Urogynecol J 2008; 19:1513-7. [PMID: 18604464 DOI: 10.1007/s00192-008-0671-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 05/30/2008] [Indexed: 10/21/2022]
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Maternal urinary tract infections and selected cardiovascular malformations. ACTA ACUST UNITED AC 2008; 82:464-73. [DOI: 10.1002/bdra.20460] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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