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Kaußner Y, Röver C, Heinz J, Hummers E, Debray TPA, Hay AD, Heytens S, Vik I, Little P, Moore M, Stuart B, Wagenlehner F, Kronenberg A, Ferry S, Monsen T, Lindbæk M, Friede T, Gágyor I. Reducing antibiotic use in uncomplicated urinary tract infections in adult women: a systematic review and individual participant data meta-analysis. Clin Microbiol Infect 2022; 28:1558-1566. [PMID: 35788049 DOI: 10.1016/j.cmi.2022.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 06/13/2022] [Accepted: 06/14/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Randomised controlled trials (RCTs) investigated analgesics, herbal formulations, delayed prescription of antibiotics and placebo to prevent overprescription of antibiotics in women with uncomplicated urinary tract infections (uUTI). OBJECTIVES To estimate the effect of these strategies and to identify symptoms, signs or other factors that indicate a benefit from these strategies. DATA SOURCES MEDLINE, EMBASE, Web of Science, LILACS, Cochrane Database of Systematic Reviews and of Controlled Trials, and ClinicalTrials. STUDY ELIGIBILITY CRITERIA, PARTICIPANTS AND INTERVENTIONS RCTs investigating any strategies to reduce antibiotics versus immediate antibiotics in adult women with uUTI in primary care. DATA SYNTHESIS We extracted individual participant data (IPD) if available, otherwise aggregate data (AD). Bayesian random-effects meta-analysis of the AD was used for pairwise comparisons. Candidate moderators and prognostic indicators of treatment effects were investigated using generalised linear mixed models based on IPD. RESULTS We analysed IPD of 3524 patients from eight RCTs and AD of 78 patients. Non-antibiotic strategies increased the rates of incomplete recovery (odds ratio [OR] 3.0; 95% credible interval [CI] 1.7-5.5; Bayesian p-value pB=0.0017; τ=0.6), subsequent antibiotic treatment (OR 3.5 [95% CI 2.1, 5.8; pB=0.0003) and pyelonephritis (OR 5.6; 95% CI 2.3, 13.9; pB=0.0003). Conversely, they decreased overall antibiotic use by 63%. In patients positive for urinary erythrocytes and urine culture were at increased risk for incomplete recovery (OR 4.7; 95% CI 2.1-10.8; pB =0.0010), but no difference was apparent where both were negative (OR 0.8; 95% CI 0.3-2.0; pB =0.667). In patients treated with using non-antibiotic strategies, urinary erythrocytes and positive urine culture were independent prognostic indicators for subsequent antibiotic treatment and pyelonephritis. CONCLUSIONS AND RELEVANCE Compared to immediate antibiotics, non-antibiotic strategies reduce overall antibiotic use but result in poorer clinical outcomes. The presence of erythrocytes and tests to confirm bacteria in urine could be used to target antibiotic prescribing.
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Affiliation(s)
- Yvonne Kaußner
- Department of General Practice, University Medical Center Wuerzburg, Germany.
| | - Christian Röver
- Department of Medical Statistics, University Medical Center Goettingen, Germany.
| | - Judith Heinz
- Department of Medical Statistics, University Medical Center Goettingen, Germany.
| | - Eva Hummers
- Department of General Practice, University Medical Center Goettingen, Germany.
| | - Thomas P A Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, the Netherlands.
| | - Alastair D Hay
- Centre for Academic Primary Care, Bristol Medical School: Population Health Sciences, Bristol BS8 2PS.
| | - Stefan Heytens
- Department of Public Health and Primary Care, University of Ghent, Belgium.
| | - Ingvild Vik
- Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Norway; Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, Norway.
| | - Paul Little
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, UK.
| | - Michael Moore
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, UK.
| | - Beth Stuart
- Primary Care Research Centre, School of Primary Care Population Sciences and Medical Education Unit, Faculty of Medicine, University of Southampton, Aldermoor Health Centre, UK.
| | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen, Germany.
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland.
| | - Sven Ferry
- Department of Clinical Microbiology, Umeå University, Sweden.
| | - Tor Monsen
- Department of Clinical Microbiology, Umeå University, Sweden.
| | - Morten Lindbæk
- Antibiotic Centre of Primary Care, Department of General Practice, Institute of Health and Society, University of Oslo, Norway.
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Goettingen, Germany.
| | - Ildikó Gágyor
- Department of General Practice, University Medical Center Wuerzburg, Germany; Department of General Practice, University Medical Center Goettingen, Germany.
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Antibiotic administration for negative midstream urine culture patients before percutaneous nephrolithotomy. Urolithiasis 2021; 49:505-512. [PMID: 33710365 DOI: 10.1007/s00240-021-01260-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 03/01/2021] [Indexed: 10/21/2022]
Abstract
To investigate how to administrate antibiotics for negative midstream urine culture (UC-) patients prior to percutaneous nephrolithotomy (PCNL), we retrospectively analyzed UC-patients receiving 0 or 3 days of cefuroxime prior to PCNL between July 2017 and May 2020. Patients were further divided into four groups (Group1A = urine with positive both nitrite and white blood cell (N + WBC +) and 0-day pre-operative cefuroxime; Group1B = N + WBC + and 3-day cefuroxime; Group2A = N - WBC + and 0-day cefuroxime; Group2B = N - WBC + and 3-day cefuroxime). All patients routinely received a dose of cefuroxime 30 min prior to the surgery. In addition, Group1B were matched to the Group1A; Group2B were matched to the Group2A at a 1:1 ratio regarding stone burden, the degree of hydronephrosis, stone hardness, age and sex in a sequential order. A total of 560 patients were included (Group1A = 72; Group1B = 72; Group2A = 208; Group2B = 208). The baseline characteristics were equally distributed between the matched-pair groups. Compared to Group1B, Group1A had a significantly higher incidence of SIRS, fever, urosepsis requiring only additional antibiotics, and an increased postoperative hospitalization stay. Compared to Group2B, Group2A had similar rate of infectious complications. In addition, Group1B was associated with a significantly lower rate of positive pelvic urine culture (PUC +) than that of Group1A; whereas, there was similar rate of PUC + between Group2A and Group2B. UC-patients with N + WBC + should be treated with extended period of antibiotic administration, and a single dose of prophylactic antibiotic was sufficient for UC-patients with N - WBC + prior to PCNL. Despite UC, it is suggested to stratify pre-operative antibiotics tailored to individual patients to optimize its application.
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Ruan S, Chen Z, Zhu Z, Zeng H, Chen J, Chen H. Value of preoperative urine white blood cell and nitrite in predicting postoperative infection following percutaneous nephrolithotomy: a meta-analysis. Transl Androl Urol 2021; 10:195-203. [PMID: 33532309 PMCID: PMC7844477 DOI: 10.21037/tau-20-930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 10/20/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND To evaluate to what degree preoperative urine white blood cell (WBC) and urine nitrite (NIT) values are predictive of postoperative infections following percutaneous nephrolithotomy (PCNL). METHODS A systematic literature search was performed of the PubMed, Embase, Cochrane Library, Wanfang Data, National Knowledge Infrastructure (CNKI), and China Science and Technology Journal Database (CSTJ or VIP) online databases to identify relevant studies that examined the predictive value of urine WBC or NIT as risk factors for post-PCNL infection, and the search was finished on February 28, 2020. Two independent reviewers screened the relevant studies, extracted necessary data from the eligible case-control studies (CCS), and assessed the quality of included studies through the Newcastle-Ottawa scale (NOS). RevMan 5.3 software and the Stata 16.0 software were used to complete the statistical analysis of data. Results are expressed as odds ratio (OR) with 95% confidence intervals (CIs). RESULTS According to the statistical analysis of 12 eligible studies involving 6113 patients, positive urine WBC (WBC+: OR =3.86, 95% CI: 3.03-4.91, P<0.001) and positive NIT (NIT+: OR =7.81, 95% CI: 5.44-11.21, P<0.001) in preoperative tests were identified as independent risk factors for postoperative infections following PCNL. CONCLUSIONS In summary, as risk factors for postoperative infections, the presence of preoperative urine WBC+ and NIT+ should be evaluated as part of clinical procedure, in order to reduce infections of PCNL.
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Affiliation(s)
| | | | - Zewu Zhu
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
| | - Huimin Zeng
- Department of Urology, Xiangya Hospital, Central South University, Changsha, China
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Heinz J, Röver C, Furaijat G, Kaußner Y, Hummers E, Debray T, Hay AD, Heytens S, Vik I, Little P, Moore M, Stuart B, Wagenlehner F, Kronenberg A, Ferry S, Monsen T, Lindbaek M, Friede T, Gagyor I. Strategies to reduce antibiotic use in women with uncomplicated urinary tract infection in primary care: protocol of a systematic review and meta-analysis including individual patient data. BMJ Open 2020; 10:e035883. [PMID: 33004385 PMCID: PMC7534728 DOI: 10.1136/bmjopen-2019-035883] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
INTRODUCTION Uncomplicated urinary tract infection (UTI) in women is a common reason to present in general practice and is usually treated with antibiotics to reduce symptom severity and duration. Results of recent clinical trials indicate that non-antibiotic treatment approaches can also be effective. However, it remains unclear which patients would benefit from antibiotic treatment and which can effectively and safely be treated without antibiotics. This systematic review and meta-analysis aims to estimate the effect of treatment strategies to reduce antibiotic use in comparison with immediate antibiotic treatment and to identify prognostic factors and moderators of treatment effects. A further aim is to identify subgroups of patients benefiting from a specific therapy. METHODS AND ANALYSIS A systematic literature search will be performed to identify randomised controlled trials which investigated the effect of treatment strategies to reduce antibiotic use in female adults with uncomplicated UTI compared with immediate antibiotic treatment. Therefore, the primary outcome of the meta-analysis is incomplete recovery. Anonymised individual patient data (IPD) will be collected. Aggregate data will be used for pairwise comparisons of treatment strategies using meta-analysis models with random effects accounting for potential between-study heterogeneity. Potential effect moderators will be explored in meta-regressions. For IPD, generalised linear mixed models will be used, which may be adjusted for baseline characteristics. Interactions of baseline variables with treatment effects will be explored. These models will be used to assess direct comparisons of treatment, but might be extended to networks. ETHICS AND DISSEMINATION The local institutional review and ethics board judged the project a secondary analysis of existing anonymous data which meet the criteria for waiver of ethics review. Dissemination of the results will be via published scientific papers and presentations. Key messages will be promoted for example, via social media or press releases. PROSPERO REGISTRATION NUMBER CRD42019125804.
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Affiliation(s)
- Judith Heinz
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Christian Röver
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Ghefar Furaijat
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
- Department of Emergency Medicine, University Medical Center Goettingen, Goettingen, Germany
| | - Yvonne Kaußner
- Department of General Practice, Julius Maximilians University Wuerzburg Faculty of Medicine, Wuerzburg, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Goettingen, Goettingen, Germany
| | - Thomas Debray
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Alastair D Hay
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Stefan Heytens
- Department of Public Health and Primary Care, University of Ghent, Gent, Belgium
| | - Ingvild Vik
- Department of General Practice, The Antibiotic Centre of Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Emergency General Practice, Oslo Accident and Emergency Outpatient Clinic, Oslo, Norway
| | - Paul Little
- Primary Care Population Sciences and Medical Education Unit, University of Southampton School of Medicine, Southampton, UK
| | - Michael Moore
- Primary Care Population Sciences and Medical Education Unit, University of Southampton School of Medicine, Southampton, UK
| | - Beth Stuart
- Primary Care Population Sciences and Medical Education Unit, University of Southampton School of Medicine, Southampton, UK
| | - Florian Wagenlehner
- Clinic for Urology, Pediatric Urology and Andrology, Justus Liebig University Giessen Faculty of Medicine, Giessen, Germany
| | - Andreas Kronenberg
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Sven Ferry
- Department of Clinical Microbiology, Bacteriology, Umea University, Umea, Sweden
| | - Tor Monsen
- Department of Clinical Microbiology, Bacteriology, Umea University, Umea, Sweden
| | - Morten Lindbaek
- Department of General Practice, The Antibiotic Centre of Primary Care, Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Goettingen, Goettingen, Germany
| | - Ildiko Gagyor
- Department of General Practice, Julius Maximilians University Wuerzburg Faculty of Medicine, Wuerzburg, Germany
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The evaluation of early predictive factors for urosepsis in patients with negative preoperative urine culture following mini-percutaneous nephrolithotomy. World J Urol 2019; 38:2629-2636. [PMID: 31828354 DOI: 10.1007/s00345-019-03050-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To identify early predictive factors for urosepsis secondary to mini-percutaneous nephrolithotomy (MPCNL) in patients with negative preoperative urine culture (UC). METHODS A total of 786 patients with baseline negative UC who underwent MPCNL between January 2017 and June 2019 were retrospectively analyzed. Urosepsis was defined according to the Sepsis-3 definition. Subsequently, perioperative potential risk factors were compared between non-urosepsis and urosepsis groups. RESULTS Despite negative UC in all patients, the rate of positive stone culture (SC) was 16.0%; the rate of pelvic urine culture (PUC) was 7.5%; 23 cases (2.9%) developed urosepsis after MPCNL. Univariate analysis showed that urosepsis was associated with the female gender, BMI, stone burden, diabetes mellitus and preoperative urine test. Multivariate logistic regression analysis suggested that urine test with positive nitrite and white blood cells and leukocyte esterase (N+WBC+LE+) (OR 17.51, 95% CI 6.75-45.38, P < 0.001) and operative time > 120 min (OR 3.53, 95% CI 1.41-8.85, P = 0.007) were independent risk factors for urosepsis. Additionally, receiver operating characteristic curve analysis of N+WBC+LE+ showed that the area under the curve was 0.785 for predicting the occurrence of urosepsis. Further analysis showed that N+WBC+LE+ provided an efficient prediction of SC+/PUC+ (SC+ or PUC+) with 61.7% sensitivity and 97.3% specificity. CONCLUSIONS In spite of the baseline negative preoperative UC, 2.9% of patients developed urosepsis after MPCNL. N+WBC+LE + was determined to be an early and efficient prediction of intraoperative bacterial status and urosepsis following MPCNL. Nevertheless, further studies are needed to confirm the results.
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RE: "Predictors for uroseptic shock in patients who undergo minimally invasive percutaneous nephrolithotomy". Urolithiasis 2018; 46:595-596. [PMID: 29445827 DOI: 10.1007/s00240-018-1045-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 02/10/2018] [Indexed: 10/18/2022]
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Holm A, Cordoba G, Sørensen TM, Jessen LR, Frimodt-Møller N, Siersma V, Bjerrum L. Clinical accuracy of point-of-care urine culture in general practice. Scand J Prim Health Care 2017; 35:170-177. [PMID: 28569603 PMCID: PMC5499317 DOI: 10.1080/02813432.2017.1333304] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To assess the clinical accuracy (sensitivity (SEN), specificity (SPE), positive predictive value and negative predictive value) of two point-of-care (POC) urine culture tests for the identification of urinary tract infection (UTI) in general practice. DESIGN Prospective diagnostic accuracy study comparing two index tests (Flexicult™ SSI-Urinary Kit or ID Flexicult™) with a reference standard (urine culture performed in the microbiological department). SETTING General practice in the Copenhagen area patients. Adult female patients consulting their general practitioner with suspected uncomplicated, symptomatic UTI. MAIN OUTCOME MEASURES (1) Overall accuracy of POC urine culture in general practice. (2) Individual accuracy of each of the two POC tests in this study. (3) Accuracy of POC urine culture in general practice with enterococci excluded, since enterococci are known to multiply in boric acid used for transportation for the reference standard. (4) Accuracy based on expert reading of photographs of POC urine cultures performed in general practice. Standard culture performed in the microbiological department was used as reference standard for all four measures. RESULTS Twenty general practices recruited 341 patients with suspected uncomplicated UTI. The overall agreement between index test and reference was 0.76 (CI: 0.71-0.80), SEN 0.88 (CI: 0.83-0.92) and SPE 0.55 (CI: 0.46-0.64). The two POC tests produced similar results individually. Overall agreement with enterococci excluded was 0.82 (0.77-0.86) and agreement between expert readings of photographs and reference results was 0.81 (CI: 0.76-0.85). CONCLUSIONS POC culture used in general practice has high SEN but low SPE. Low SPE could be due to both misinterpretation in general practice and an imperfect reference standard. Registration number: ClinicalTrials.gov NCT02323087.
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Affiliation(s)
- Anne Holm
- Research Unit for General Practice and Department of General Practice, University of Copenhagen, Copenhagen, Denmark
- CONTACT Anne Holm Department of General Practice, University of Copenhagen, Øster Farimagsgade 5, PO Box 2099, 1014 Copenhagen, Denmark
| | - Gloria Cordoba
- Research Unit for General Practice and Department of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Tina Møller Sørensen
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lisbeth Rem Jessen
- Department of Veterinary Clinical and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Volkert Siersma
- Research Unit for General Practice and Department of General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Lars Bjerrum
- Research Unit for General Practice and Department of General Practice, University of Copenhagen, Copenhagen, Denmark
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Fan J, Wan S, Liu L, Zhao Z, Mai Z, Chen D, Zhu W, Yang Z, Ou L, Wu W. Predictors for uroseptic shock in patients who undergo minimally invasive percutaneous nephrolithotomy. Urolithiasis 2017; 45:573-578. [PMID: 28229195 DOI: 10.1007/s00240-017-0963-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 01/30/2017] [Indexed: 11/26/2022]
Abstract
To identify risk factors that can predict which patient is likely to progress from systemic inflammatory response syndrome (SIRS) to uroseptic shock after minimally invasive percutaneous nephrolithotomy (MPCNL) for the upper urinary tract stones. We retrospectively reviewed 156 patients who suffered infectious complications after MPCNL from March 2014 to February 2016. Perioperative risk factors that could potentially contribute to uroseptic shock were compared to those of patients with only SIRS. 135 of the 156 patients developed to SIRS only, the remaining 21 patients progressed to uroseptic shock. The rate of positive preoperative urine nitrite was significantly higher (p < 0.001), stone diameter was larger (p = 0.015) and operative time was longer (p < 0.001) in uroseptic shock group. Multivariable logistic analysis showed that preoperative urine nitrite (OR 10.570, p = 0.025), stone size (OR 11.512, p = 0.009) and postoperative blood leukopenia (OR 0.009, p < 0.001) were independently related to uroseptic shock. Moreover, ROC curve analysis showed that white blood count threshold within the first 3 h of uroseptic shock was 2.98 × 109/L. The sensitivity and specificity of leukocyte count in predicting uroseptic shock were 90.5 and 92.6%, respectively. Preoperative urine nitrite, stone size and postoperative leukocyte count are statistically linked to uroseptic shock after MPCNL. Leukopenia of less than 2.98 × 109/L within 3 h after MPCNL can be a predictor for uroseptic shock. For patients who have high risk factors for developing uroseptic shock, the white blood count should be measured within 3 h after MPCNL.
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Affiliation(s)
- Junhong Fan
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China
| | - Shawpong Wan
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China
| | - Luhao Liu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China
| | - Zhijian Zhao
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China
| | - Zanlin Mai
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China
| | - Dong Chen
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China
| | - Wei Zhu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China
| | - Zhou Yang
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China
| | - Lili Ou
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China
| | - Wenqi Wu
- Department of Urology, Minimally Invasive Surgery Center, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, Guangdong, China.
- Guangdong Provincial Key Laboratory of Urology, No. 1-3, Kangda Road, Guangzhou, 510230, Guangdong Province, China.
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Fritzenwanker M, Imirzalioglu C, Chakraborty T, Wagenlehner FM. Modern diagnostic methods for urinary tract infections. Expert Rev Anti Infect Ther 2016; 14:1047-1063. [DOI: 10.1080/14787210.2016.1236685] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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