Risk factors for urinary tract infection in patients with urolithiasis-primary report of a single center cohort

Epidemiology and risk factors for staphylococcal urinary tract infections in the Moroccan Casablanca area

PURPOSE

This study aimed to ascertain the prevalence and risk factors for developing staphylococcal urinary tract infections (UTIs) in the Casablanca area of Morocco.

METHODS

In Casablanca, Morocco, a retrospective evaluation of 772 UTIs patients was conducted between January 2020 and December 2022. The research included two groups of patients: those with staphylococcal UTIs and those without. Sex, age, chronic illnesses, antibiotic exposure, urinary catheterization, urological surgery, and UTIs history were the risk variables assessed. We employed a logistic regression model to identify the characteristics that were predictive of staphylococcal UTIs.

RESULTS

Eight staphylococcal species were responsible for 16.84% of UTIs in 772 non-repeating individuals. Patients infected with S. saprophyticus (35.38%) were the most common, followed by those infected with S. epidermidis (24.61%), S. aureus (13.85%), and S. hemolyticus (10.78%). Multivariate logistic regression analysis revealed that male sex (95% CI: 0.261-0.563), immunosuppression and immunosuppressive treatments (95% CI: 0.0068-0.64), chronic diseases (95% CI: 0.407-0.965), previous UTIs (95% CI: 0.031-0.228), frequency of urination more than 8 times a day (95% CI:1.04-3.29), frequency of urination once or twice a day (95% CI: 1.05-2.39), and urinary catheterization (95% CI: 0.02-0.22) were the most likely predictors of staphylococcal UTIs. In addition, a larger proportion of patients with staphylococcal UTIs were made aware of the risk factors associated with staphylococcal UTIs (52.31%, χ2 = 4.82, = 0.014).

CONCLUSIONS

This is the first global study to evaluate the predictive factors for acquiring UTIs caused by staphylococci. Monitoring these factors will enable medical authorities to devise effective strategies for managing UTIs and combating antibiotic resistance.

Predictive markers for infections after extracorporeal shockwave lithotripsy in patients with kidney stone based on a large prospective cohort

OBJECTIVE

Infections in patients with kidney stones after extracorporeal shockwave lithotripsy (SWL) is a common clinical issue. However, the associated factors are unclear. Therefore, we aim to develop and validate a predictive model for infections after SWL in patients with kidney stone.

METHODS

Between June 2020 and May 2022, consecutive kidney stone patients were enrolled. Of them, 553 patients comprised the development cohort. One hundred sixty-five patients comprised the validation cohort. The data were prospectively collected. The stepwise selection was applied using the likelihood ratio test with Akaike's information criterion as the stopping rule; A predictive model was constructed through multivariate logistic regression. The performance was evaluated regarding discrimination, calibration, and clinical usefulness.

RESULTS

Predictors of infections after SWL in treating kidney stones included older age (OR = 1.026, p = 0.041), female (OR = 2.066, p = 0.039), higher BMI (OR = 1.072, p = 0.039), lower stone density (OR = 0.995, p < 0.001), and higher grade of hydronephrosis (OR = 5.148, p < 0.001). For the validation cohort, the model showed good discrimination with an area under the receiver operating characteristic curve of 0.839 (95% CI 0.736, 0.941) and good calibration. Decision curve analysis demonstrated that the model was also clinically useful.

CONCLUSION

This study indicated that age, gender, BMI, stone density, and hydronephrosis grade were significant predictors of infections after SWL in treating kidney stones. It provided evidence in optimizing prevention and perioperative treatment strategies to reduce the risk of infection after SWL.

High risk and low prevalence diseases: Infected urolithiasis

INTRODUCTION

Infected urolithiasis is a serious condition that carries with it a high rate of morbidity and mortality.

OBJECTIVE

This review highlights the pearls and pitfalls of infected urolithiasis, including presentation, diagnosis, and management in the emergency department based on current evidence.

DISCUSSION

Although urolithiasis is common and the vast majority can be treated conservatively, the presence of a concomitant urinary tract infection significantly increases the risk of morbidity, to include sepsis and mortality. Identification of infected urolithiasis can be challenging as patients may have symptoms similar to uncomplicated urolithiasis and/or pyelonephritis. However, clinicians should consider infected urolithiasis in toxic-appearing patients with fever, chills, dysuria, and costovertebral angle tenderness, especially in those with a history of recurrent urinary tract infections. Positive urine leukocyte esterase, nitrites, and pyuria in conjunction with an elevated white blood cell count may be helpful to identify infected urolithiasis. Patients should be resuscitated with fluids and broad-spectrum antibiotics. Additionally, computed tomography and early urology consultation are recommended to facilitate definitive care.

CONCLUSIONS

An understanding of infected urolithiasis can assist emergency clinicians in diagnosing and managing this potentially deadly disease.

Emergency treatment of symptomatic ureteral calculi: predictors of prolonged hospital stay

PURPOSE

To assess differences in the length of hospital stay (LOS) in patients who present emergently versus electively for a symptomatic ureteral stone and to explore underlying risk factors.

METHODS

Billing data were analyzed from patients with symptomatic ureteral calculi at our department from 2010 to 2021. Statistical analysis (U test, logistic regression) was performed.

RESULTS

2274 patients (72% male, 28% female) with ureteral stones were analyzed (mean age of 52.9y). 1578 patients (69.4%) presented in an emergency setting and 696 patients (30.6%) electively. Arterial hypertension was seen in 31%, diabetes mellitus in 11% and hyperuricemia in 5% of the whole cohort. 46.5% of emergency patients were desobstructed (DJ/PCN), 35.4% underwent emergency ureteroscopy (URS), 13.4% had spontaneous passage (SP), and 4.8% underwent emergency shock wave lithotripsy (SWL). Of the electively treated patients, 58.6% underwent URS, 21.3% SWL, 18.5% DJ/PCN, and 1.6% had SP. Emergency stone treatment was associated with a significantly longer LOS when compared to primary desobstruction for patients admitted emergently. Also, LOS was significantly longer for each intervention of stone treatment in emergency patients vs. electively treated patients. Arterial hypertension was associated with a 1.8-fold increased risk of a hospital stay longer than 3 days, irrespective of hospital admission mode, whereas metabolic disorders did not influence LOS in this cohort.

CONCLUSION

For emergency patients in contrast to the electively treated patients, the type of procedure had a significant impact on the length of hospital stay. Arterial hypertension is an independent significant risk factor for prolonged hospital stay.

Sanjin Paishi Decoction improves the imbalance of gut microbiota and regulates MAPK signaling pathway to inhibit calcium oxalate stones in rats

INTRODUCTION

Sanjin Paishi Decoction (SJPSD) has positive effects on stone prevention; however, there is a lack of convincing evidence in the prevention of calcium oxalate stones. This study aimed investigates the effect of SJPSD on calcium oxalate stones and to explore its mechanism.

METHODS

The rat model of calcium oxalate stones was established and rats were treated with different doses of SJPSD. The pathological damage of kidney tissues was observed by HE staining, the deposition of calcium oxalate crystals in kidney tissues was examined by Von Kossa staining, and the levels of creatinine (CREA), urea (UREA), calcium (Ca), phosphorus (P), and magnesium (Mg) in serum were analyzed biochemically, the levels of IL-1β, IL-6, and TNF-α in serum were measured by ELISA, and the protein expression of Raf1, MEK1, p-MEK1, ERK1/2, p-ERK1/2, and Cleaved caspase-3 in kidney tissues was analyzed by Western blot. Moreover, the changes in gut microbiota were analyzed by 16S rRNA sequencing.

RESULTS

SJPSD attenuated the pathological damage of renal tissues, reduced the levels of CREA, UREA, Ca, P, and Mg, and inhibited the expression of Raf1, p-MEK1, p-ERK1/2, and Cleaved caspase-3 in renal tissues (P < 0.05). SJPSD treatment affected the composition of intestinal microbiota in rats with calcium oxalate stones.

CONCLUSION

The mechanism of SJPSD inhibition of calcium oxalate stone injury in rats may be related to the inhibition of the MAPK signaling pathway and regulation of gut microbiota imbalance.

Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke

BACKGROUND

Stroke is a major cause of morbidity and mortality worldwide. Urinary tract infection (UTI) is a common post-acute ischemic stroke (AIS) complication. We assessed the incidence, determinant factors, infection characteristics, post-stroke complications, and outcomes of hospitalized AIS patients with UTI.

METHODS

This retrospective cohort study included AIS patients admitted within 7 days of stroke onset. The patients were divided into the UTI group and the non-UTI (control) group. Clinical data were collected and compared between the groups.

RESULTS

There were 342 AIS patients (31 with UTIs and 311 controls). The multivariate analysis showed that an initial National Institutes of Health Stroke Scale (NIHSS) score of ≥ 15 (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.33-18.72) and Foley catheter retention (OR 14.10, 95% CI 3.25-61.28) were risk factors for UTI, whereas smoking (OR 0.08, 95% CI 0.01-0.50), an initial systolic blood pressure (SBP) of > 120 mmHg (OR 0.06, 95% CI 0.01-0.31), and statin use (OR 0.02, 95% CI 0.0006-0.42) were protective factors. Twenty cases (64.5%) were community-acquired and 11 cases (35.3%) were hospital-acquired. Ten patients (32.3%) had catheter-associated UTIs. The most common pathogen was Escherichia coli (13 patients, 41.9%). Post-stroke complications were significantly more common in the UTI group, including pneumonia, respiratory failure, sepsis, brain edema, seizure, symptomatic hemorrhagic transformation, congestive heart failure, atrial fibrillation with a rapid ventricular response, acute kidney injury, and hyponatremia. The median length of stay (LOS) in the UTI group was 12 days versus 3 days in the control group (p < 0.001). The median 3-month modified Rankin Scale score was higher (5 in UTI and 2 in control; p < 0.001) and the median 3-month Barthel Index was lower (0 in UTI and 100 in control; p < 0.001) in the UTI group than in the control group.

CONCLUSIONS

The risk factors for post-AIS UTI included severe stroke (NIHSS score ≥ 15) and urethral catheter indwelling. An initial SBP of > 120 mmHg and statin use were protective factors. The UTI group had significantly worse post-stroke complications, a longer LOS, and worse 3-month outcomes. Smoking was protective, which requires further investigation.

Role of Ureteroscopy (URS) and Stone Treatment in Patients with Recurrent UTIs: Outcomes over a 10-Year Period

Background. The study aimed to assess whether the eradication of kidney stones might result in a substantial reduction in the onset of recurrent UTIs. Methods. We selected all the patients who underwent ureteroscopy (URS) for stone disease between 2012 and 2021, with either a history of recurrent UTIs (rUTIs), urosepsis or pre-operative positive urine culture (UC). Data included patient demographics, microbiological data, stone parameters, stone-free and infection-free rates (SFR and IFR, respectively) at follow-up, defined as fragments <2 mm at imaging and the absence of symptoms and urine-culture-proven UTI. Results. Overall, 178 patients were selected. The median age was 62 years. The median cumulative stone size was 10 mm (7-17.25), and the commonest locations were the lower pole (18.9%) and proximal ureter (14.9%). The overall stone-free rate at follow-up was 89.3%. The IFR at 3 months was 88.3%. As follow-up duration increased, the IFR reduced to 85.4%, 74.2%, 68% and 65% at 6, 12, 18 and 24 months, respectively. Patients who had infection recurrence were more likely to present stone persistence or recurrence compared to those who were infection-free at follow-up (20% vs. 4.4%, p = 0.005). Conclusions. SFR after URS is a significant predicting variable for the likelihood of infection-free status at follow-up in patients with an rUTI or positive UC at the time of URS.

Adverse Clinical Outcomes among Inflammatory Bowel Disease Patients Treated for Urinary Tract Infection

Background: Urinary tract infection (UTI) is the most common urologic complication among patients with inflammatory bowel disease (IBD). However, data regarding UTI outcomes in this population are scarce. We aimed to evaluate adverse outcomes of UTI among patients with IBD. Methods: This was a retrospective cohort study of consecutive adult patients who visited the emergency room (ER) at Sheba Medical Center due to a UTI between 2012 and 2018. Data included demographic and clinical variables. UTI cases were extracted using ICD-10 coding. Results: Of 21,808 (ER) visits with a UTI, 122 were IBD patients (Crohn’s disease—52, ulcerative colitis—70). Contrary to non-IBD subjects, patients with IBD had higher rates of hospitalization, acute kidney injury (AKI) and 30 day-recurrent hospitalization (59.3% vs. 68.9%, p = 0.032; 4.6% vs. 13.9%, p < 0.001; 7.3% vs. 15.6%, p = 0.001, respectively). Among patients with IBD, advanced age (p = 0.005) and recent hospitalization (p = 0.037) were associated with increased risk for hospitalization, while hydronephrosis (p = 0.005), recent hospitalization (p = 0.011) and AKI (p = 0.017) were associated with increased 30-day recurrent hospitalization. Neither immunosuppressants nor biologics were associated with UTI outcomes among patients with IBD. Conclusions: Patients with IBD treated for a UTI had higher rates of hospitalization, AKI and 30-day recurrent hospitalization than non-IBD patients. No association was observed between immunosuppressants or biologics and UTI outcomes.

Ureteral stone with hydronephrosis and urolithiasis alone are risk factors for acute kidney injury in patients with urinary tract infection

To identify whether urolithiasis with or without hydronephrosis has an impact on acute kidney injury (AKI) in patients with urinary tract infection (UTI). This study aimed to identify whether urolithiasis with or without hydronephrosis has an impact on AKI in patients with UTI. This retrospective study enrolled hospitalized UTI patients who underwent imaging in an acute care setting from January 2006 to April 2019. Of the 1113 participants enrolled, 191 (17.2%) had urolithiasis and 76 (6.8%) had ureteral stone complicated with hydronephrosis. Multivariate logistic regression analysis showed that in UTI patients with urolithiasis, the presence of ureteral stone with concomitant hydronephrosis was an independent risk factor for AKI (odds ratio [OR] 2.299, 95% confidence interval [CI] 1.112–4.755, P = 0.025). In addition, urolithiasis was associated with an increased risk for AKI (OR 2.451, 95% CI 1.369–4.389, P = 0.003) in UTI patients without hydronephrosis. The presence of ureteral stone with hydronephrosis increases the risk for AKI of UTI patients with urolithiasis, and urolithiasis remains a risk factor of AKI in UTI patients without hydronephrosis.

Risk of Urolithiasis in Patients With Inflammatory Bowel Disease: A Nationwide Danish Cohort Study 1977-2018

BACKGROUND AND AIMS

Patients with inflammatory bowel disease (IBD) are suggested to be at increased risk of urolithiasis, but the magnitude of risk and the impact of medical and surgical treatment on this risk remain unknown. We therefore aimed to determine overall and treatment-related risk of urolithiasis in patients with IBD in a nationwide population-based cohort study.

METHODS

Using national registers, we identified all patients with IBD and all cases of urolithiasis in Denmark during 1977-2018. We obtained information on all IBD medications and surgical procedures during 1995-2018. IBD cases were matched 1:10 on age and sex to non-IBD individuals.

RESULTS

In total, 2,549 (3%) of 75,236 IBD patients and 11,258 (2%) of 767,403 non-IBD individuals developed urolithiasis, resulting in a 2-fold increased risk of urolithiasis (HR, 2.27; 95% CI, 2.17-2.38) in patients with IBD. The patients were also at increased risk of repetitive urolithiasis events (RR, 1.09; 95% CI: 1.04-1.15) and had increased risk of urolithiasis prior to IBD diagnosis (OR, 1.42; 95% CI: 1.34-1.50). After IBD diagnosis, risk of urolithiasis was associated with anti-TNF therapy and surgery.

CONCLUSION

Patients with IBD had a 2-fold increased risk of urolithiasis after IBD diagnosis and a 42% increased risk prior to IBD diagnosis. Risk was increased in anti-TNF exposed patients, and after surgery, suggesting that IBD severity per se and surgery, with altered intestinal absorption, increase risk of urolithiasis. Since stone formation is associated with adverse outcomes including sepsis, subpopulations of IBD patients, especially those undergoing strong immunosuppression might benefit from additional urolithiasis screening.

Distribution and drug resistance of pathogens causing urinary tract infection in patients with urinary calculi

OBJECTIVE

This study set out to clarify the distribution and drug resistance of pathogens causing urinary tract infection (UTI) in patients with urinary calculi.

METHODS

Pathogens were isolated from urine samples of patients with urinary calculi also complicated with UTIs, during the period from 2015 to 2019, and the samples were cultured for drug sensitivity testing to study the drug resistance of pathogens. The results were analyzed by SPSS 22.0 software.

RESULTS

Gram-negative bacteria were the main pathogens found in patients with urinary calculi complicated with UTI (84.52%). Escherichia coli, Enterococcus faecalis and Monilia albicans were the most common Gram-negative bacteria (48.84%), Gram-positive bacteria (34.78%) and fungus (29.41%), respectively. The UTI rates were higher in female patients than in male patients, and were higher in patients ≥ 60 years old compared with those < 60 years old. Escherichia coli and Klebsiella pneumoniae had the highest resistance to ampicillin and the lowest resistance to imipenem. Enterococcus faecalis Enterococcus Faecium had the highest resistance to penicillin and ampicillin, but the lowest resistance to vancomycin and linezolid.

CONCLUSION

The present study found that the pathogenic bacteria found in patients with urinary calculi complicated with UTI are mainly Gram-negative bacteria; and Escherichia coli is the main pathogenic bacteria causing the infection. Gender and age may be risk factors for urinary calculi complicated with UTI. Antibiotics should be selected reasonably according to the drug resistance pattern of pathogenic bacteria in clinical anti-infection management.

Multiple drug resistance bacterial isolates and associated factors among urinary stone patients at the University of Gondar Comprehensive Specialized Hospital, Northwest Ethiopia

BACKGROUND

The urinary stone and urinary tract infection (UTI) are invariably associated and are frequent causes of morbidity. Date on burden of UTI among urinary stone patients is lacking in Ethiopia. This study was aimed to assess bacterial profile, antimicrobial susceptibility and associated factors among urinary stone patients at the University of Gondar Comprehensive Specialized Hospital.

METHODS

An institution based cross sectional study was conducted. Basic sociodemographic data were collected using a structured questionnaire. Bacterial identification of uropathogens and drug susceptibility testing were done following standard microbiological techniques. The data were entered and analyzed using SPSS version-23. Bivariate and multivariate logistic regressions were used to identify possible associated risk factors. Results with P value < 0.05 was considered statistically significant.

RESULT

A total of 300 urinary stone patients were enrolled. Of these, 153 (51%) were male and 261(87%) were urban residents. The overall prevalence of urinary tract infection was 49 (16.3%) (95% CI 12-21%). A high level of resistance was observed to ampicillin, penicillin and trimethoprim-sulfamethoxazole while majority of isolates were most sensitive to nitrofurantoin and ciprofloxacin. Multi-drug resistant isolates were 16/49 (32.7%), 75% of them being Enterobacteriaceae isolates. More than one-third 9/26 (34.6%) of Gram-negative isolates were Extended Spectrum Beta-Lactamase (ESBL) producing E. coli and K. pneumoniae. Being female, history of urinary tract infection and history of drug use were the independent risk factors.

CONCLUSION

Most of the bacterial isolates from urinary stone patients were resistant to ampicillin, penicillin and trimethoprim-sulfamethoxazole. E. coli and K. pneumoniae were the most common extended spectrum beta-lactamase producing isolates. Sex, history of urinary tract infection and previous drug use were found to be risk factors. Routine diagnosis of urinary stone patients for urinary tract infection should be promoted and further researches are encouraged.

Preoperative Risk Factors for Postoperative Urinary Tract Infection After Primary Total Hip and Knee Arthroplasties

BACKGROUND

Establishing clear risk factors for complications such as urinary tract infection (UTI) after arthroplasty procedures helps guide clinical practice and provides more information to both surgeons and patients. This study aims to assess selected preoperative patient characteristics as risk factors for postoperative UTI after primary total hip and knee arthroplasties (THA and TKA).

METHODS

This was a retrospective analysis using current procedural terminology codes to investigate the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database for patients who underwent THA or TKA from 2010 to 2017. Patients were classified for UTI by NSQIP guidelines. Patient samples with all possible covariates were included for multivariate logistic regression analysis and assessed for independent associations.

RESULTS

In a cohort of 983 identified patients (983 of 119,096; 0.83%): ages 57+ years, preoperative red blood cell (RBC) transfusion, perioperative RBC transfusion, bleeding disorders, operative time 110+ minutes, preoperative steroid use, diabetes, pulmonary comorbidities, body mass index 30+ kg/m² were independent risk factors for postoperative UTI after THA. In a cohort of 1503 identified patients (1503 of 189,327; 0.8%): ages 60+ years, preoperative RBC transfusion, perioperative RBC transfusion, anemia, platelets less than 150k, preoperative steroid use, diabetes, and body mass index 30+ kg/m² were independent risk factors for postoperative UTI after TKA. Male sex was associated with a decreased risk of UTI in both THA and TKA.

CONCLUSION

This study provides novel evidence on risk factors associated with the development of UTI after THA or TKA. Clinicians should be aware of risk factors in the manifestation of postoperative UTI after primary THA or TKA procedures.

Bladder stones associated with vesicovaginal fistula: A case report

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The existence of bladder stones is an uncommon condition that can cause vesico-vaginal fistulas (VVF).

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Almost all the cases resulted in giant bladder stones.

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Here, we report the uncommon case of a giant bladder stone causing VVF.

Introduction

The presentation of bladder stones is the most common manifestation of a lower urinary tract stone. In severe cases, it can cause pressure necrosis and lead to vesico-vaginal fistula (VVF). This case reports a female patient diagnosed with a bladder stone accompanied by VVF.

Presentation of case

A 56-year-old female came to the hospital with complaints of dysuria accompanied by continual urinary incontinence symptoms dating back about a month. During vaginal examination, we found a fistula and a stone. An ultrasound (US) showed a hyperechoic shadow measuring 1.27 × 1.36 cm in the vesica urinary and plain kidney, ureter, and bladder (KUB) x-ray showed the presence of a radiopaque shadow of about 7.5 × 5 cm in the pelvic area. This stone was removed through an open cystolithotomy. Intraoperatively, a fistula of about 1 cm in diameter was found in the trigonum close to the internal meatus. A fistula repair was performed immediately without complications, and the follow-up results were satisfactory.

Conclusion

The presentation of a bladder stone is an uncommon condition that can cause VVF. Therefore, it is important to pay attention to its clinical signs.

Treatment of isolated small renal stones leads to resolution of symptoms and should be routinely offered to patients: retrospective outcomes from a university hospital

INTRODUCTION

Treatment of smaller renal stones and the symptomatic value it offers to patients is often debated. We wanted to analyse surgical outcomes for treatment of small renal stones and whether treatment resulted in symptom resolution.

MATERIALS AND METHODS

All patients who underwent ureterorenoscopy (URS) for isolated symptomatic small renal stones ≤10 mm over a 7-year period were retrospectively included and subdivided into those with stones of ≤7 mm (Group A) and stones of 8-10 mm (Group B). Patients with multiple renal stones, ureteric stones, or combined renal and ureteric stones were excluded. Based on the symptoms, the patient groups were those with pain, urinary tract infection (UTI) and haematuria. Resolution of symptoms was defined as no symptoms during the follow-up period.

RESULTS

A total of 109 patients with a single small renal stone ≤10 mm underwent URS and stone treatment, with mean age of 50 years and a male:female ratio of 1:1.2. The mean operative time was significantly longer in Group B (55.9 min vs 33.07 min, p = 0.001). In total, 97.2% (n = 70) of patients in Group A and 83.7% (n = 31) of patients in Group B were stone free (p = 0.017). Complete resolution of symptoms was seen in 63 (92.6%), 24 (85.7%) and 13 (100%) patients with pain, UTI and haematuria, respectively. There were no statistically significant differences in symptom resolution between patients with stones ≤7 mm and those with stones 8-10 mm in size.

CONCLUSION

Ureteroscopic treatment is a feasible option for small symptomatic stones, since it may lead to symptom resolution. Based on our study we would recommend that patients with symptomatic small renal stones are offered endoscopic treatment.

Bacterial spectrum and antibiotic resistance of urinary tract infections in patients treated for upper urinary tract calculi: a multicenter analysis

The purpose of this study is to collect information on the bacterial resistance to antibiotics of bacteria isolated from urine cultures of patients treated for upper urinary tract calculi. Data of patients with urinary tract infection and urolithiasis were retrospectively reviewed to collect information on age, gender, stone size, location, hydronephrosis, procedure of stone removal and antibiotic treatment, identification and susceptibility of pathogens, symptoms, and infectious complications. A total of 912 patients from 11 centers in 7 countries (Bulgaria, Greece, Italy, North Macedonia, Spain, and Turkey) were studied. Mean age was 54 ± 16 years and M/F ratio 322/590. Out of 946 microbial isolates, the most common were E. coli, Gram-positive, KES group (Klebsiella, Enterobacter, Serratia), Proteus spp., and P. aeruginosa. Carbapenems, piperacillin/tazobactam and amikacin showed low resistance rates to E. coli (2.5%, 7%, and 3.6%) and Proteus spp. (7.7%, 16%, and 7.4%), but higher rates were observed with Klebsiella spp., P. aeruginosa, and Gram-positive. Fosfomycin had resistance rates less than 10% to E. coli, 23% to KES group, and 19% to Gram-positive. Amoxicillin/clavulanate, cephalosporins, quinolones, and TMP/SMX showed high resistance rates to most bacterial strains. High rates of antibiotic resistance were observed in patients candidate to stone treatment from South-Eastern Europe. The empirical use of antibiotics with low resistance rates should be reserved to the most serious cases to avoid the increase of multidrug resistant bacteria. Basing on our results, carbapenems, piperacillin/tazobactam, and amikacin may be a possible option for empiric treatment of urinary stone patients showing systemic symptoms.

Sex differences in the therapy of kidney and ureteral stones

PURPOSE OF REVIEW

Better understanding of sex differences affecting urolithiasis may help us offer tailored treatment strategies to our patients.

RECENT FINDINGS

The incidence of urolithiasis is increasing and the male-to-female ratio has decreased from 3 : 1 to 1.3 : 1 between 1970 and 2000. In women, obesity has a larger effect on the risk of developing urolithiasis [odds ratio (OR) 1.35; 95% confidence interval (CI): 1.33-1.37] compared with men (OR 1.04; 95% CI: 1.02-1.06). Urolithiasis is a risk factor for coronary artery disease in men (risk ratio = 1.23; 95% CI: 1.02-1.49) and for stroke in women (risk ratio = 1.12; 95% CI: 1.03-1.21). Women tolerate cystoscopic stent removal and shock wave lithotripsy better than men. For shock wave lithotripsy menopaused women have reported lower visual analog scale scores than menstruating women (P < 0.001). Female sex was an independent predictor of stone impaction (OR 1.15; 95% CI: 1.03-1.27) and postoperative sepsis after ureteroscopy (OR 2.31; 95% CI: 1.14-4.37).

SUMMARY

The sex gap in urolithiasis is closing. The changing role of women in society and dietary habits can be responsible for this epidemiologic shift. Women show a higher threshold for pain during urologic procedures, but they suffer from infectious complications more than men. Urolithiasis is a risk factor for cardiovascular events in both sexes.

Urolithiasis Is a Risk Factor for Uroseptic Shock and Acute Kidney Injury in Patients With Urinary Tract Infection

Urinary tract infection (UTI) is a common complication in patients with urolithiasis. This study aimed to compare clinical manifestations and treatment outcomes among UTI patients with or without urolithiasis. It also focused on identifying relationships among urolithiasis, uroseptic shock, and acute kidney injury (AKI). This retrospective study enrolled hospitalized UTI patients who underwent imaging in an acute care setting from January 2006 to March 2015. Of 662 participants enrolled, 113 (17.1%) had urolithiasis, 107 (16.2%) developed uroseptic shock, and 184 (27.8%) developed AKI. A multivariate logistic regression analysis showed that in UTI patients, urolithiasis is associated with an increased risk of uroseptic shock (OR 1.80, 95% CI: 1.08-3.02, P = 0.025), AKI (OR 1.95, 95% CI: 1.22-3.12, P = 0.005), and bacteremia (OR 1.68, 95% CI: 1.08-2.64, P = 0.022). Urolithiasis is common in UTI patients and is associated with an increased risk of uroseptic shock and AKI.

Clinical Significance of Twinkling Artifact in the Diagnosis of Urinary Stones

The twinkling artifact is a color Doppler artifact, but it could be used in the confirmation of urinary stones. Conventionally, gray-scale criteria (echogenic foci with acoustic shadowing) is used in the diagnosis of urinary stones, but unfortunately, its reliability is very low. If the color Doppler twinkling artifact is applied in conjunction with other provocative measures, then its overall reliability exceeds 95%. To determine the clinical significance of twinkling artifact in the diagnosis of urinary stones, this cross-sectional observational study was conducted at Gilani Ultrasound Center, Lahore, Pakistan. For the determination of clinical significance, 1350 patients were recruited for this study. All the patients had renal stones of variable size and location. All the patients were evaluated with gray-scale sonographic criteria, and then color Doppler was applied to look for the twinkling artifact. The findings were confirmed with other imaging modalities (i.e., plain X-ray, computed tomography scan, etc., or during patient follow up). Sensitivity and specificity of the gray-scale ultrasound criteria in the detection of urinary stones was 96.1% and 57.9%, respectively, while the sensitivity and specificity of the color Doppler twinkling artifact in the detection of urinary stones was 100.0% and 97.4%, respectively. It was concluded that the application of twinkling artifact is useful in the confirmation of urinary stones, but specifically, it is of great diagnostic value in the small (less than 5 mm) renal stones and stones adjacent to a strong reflector (i.e., ureteric stones or stones in the prostatic urethra).

An evaluation of multidrug-resistant (MDR) bacteria in patients with urinary stone disease: data from a high-volume stone management center

PURPOSE

To investigate the prevalence of MDR bacteria in patients with urinary stones and the risk factors for its formation.

METHODS

A retrospective study was performed among patients with urinary stones in Beijing Tsinghua Changgung Hospital from December 2014 to May 2018. Patients with positive urinary cultures and drug sensitivity results were included. MDR were defined as any bacteria that have resistance to at least one agent in at least three classes of antibiotics. Bacteria distribution and resistance patterns were calculated.

RESULTS

1655 patients with urinary stones were eligible for analysis, among which 367 patients had positive urinary culture, yielding 457 isolates of 45 species. Escherichia coli remained the most common organism with a prevalence of 29.3%, followed by Enterococcus faecalis (12.0%), Proteus mirabilis (10.5%), and Klebsiella pneumonia (6.8%). 44.4% isolates were identified as MDR. The three most common Gram-negative bacteria were Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae, with a MDR rate of 84.33%, 62.5%, and 48.39%, respectively. Drug-resistant rates were different between MDR and non-MDR in ampicillin, cefazolin, ceftriaxone, cefepime, gentamicin, amikacin, and levofloxacin (all with p value < 0.05). In multivariate analysis, indwelling catheters (OR 3.1, 95% CI 1.07-8.98) and antibiotics use in the last 3 months (OR 2.14, 95% CI 1.04-4.38) were significantly associated with MDR formation.

CONCLUSIONS

MDR bacteria were common among patients with urinary stones in our center and achieved high drug-resistant rates in ampicillin, first-generation and part of third-generation cephalosporins, and fluoroquinolones. Indwelling catheters and antibiotics used in the last 3 months were independent risk factors for MDR formation. Tailored antibacterial strategies still should be established according to the local bacterial spectrum and patient condition.