Urinary tract infection in women

Prevalence of recurrent urinary tract infections and its associated factors in female staff of reproductive age group in a medical college in central Kerala: a cross-sectional study

AIM

To study the prevalence of recurrent urinary tract infections (UTIs) and its associated factors in female staff of reproductive age group in a medical college in central Kerala.

INTRODUCTION

Recurrent UTIs can be defined as ≥ 3 episodes of UTIs within a period of 12 months. Females with recurrent UTIs have lower health-related quality of life compared to the general population; the incidence of UTI in women of reproductive age group is very common. This study focused on female employees of reproductive age group in a private medical college.

METHODS

A cross-sectional study was done among female staff of reproductive age group in a private medical college in central Kerala, with a sample size of 417. All female staff (18-49 years) were given a questionnaire and asked to fill it out. All those who filled out the questionnaire were included in the study according to both inclusion and exclusion criteria. Data entry and analysis were performed via Microsoft Excel 2019 and SPSS version 22.0.

RESULT

Our study of 417 participants revealed a prevalence of recurrent UTIs of 22.30% (95% CI = 18.3- 26.3%). Recurrent UTI was significantly associated with daily water intake, urination frequency, holding urine, foul-smelling vaginal discharge, constipation, pre-coital urination, and pre- and post-intercourse vaginal hygiene. Also, occupation was found to be significantly associated with recurrent UTI, with cleaning staff having higher odds.

CONCLUSION

Our study found the prevalence of recurrent UTI in 417 population as 22.30%. Prevention of recurrent UTI requires a daily intake of > 2 L of water and personal & sexual hygiene. Reducing recurrent UTIs enhances quality of life. Educating female staff is crucial.

Novel MOF-based vanadium and 2,2 -bipyridine-4,4 -dicarboxylic acid as phenomenal dye adsorbent and antimicrobial agent

In this study, a new MOF (metal-organic framework) based on vanadium and 2,2-bipyridine-4,4-dicarboxylic acid (V/BP-MOF) was synthesized. Synthesized V/BP-MOF was introduced as a strong adsorbent of Congo Red (CR) and an effective agent in eliminating microbial species. In the investigation of CR absorption activity, several factors such as concentration of V/BP-MOF, pH, time, and temperature were investigated. Antimicrobial evaluations were carried out on Common bacterial strains in wastewater and values of MIC (minimum inhibitory concentration) and MBC (Minimum Bactericidal Concentration) were reported. The V/BP-MOF was confirmed and characterized by EA, EDS, EDS mapping, FT-IR, XRD, TGA, BET, SEM, and TEM. In checking the characteristics of V/BP-MOF, size, specific surface area, and thermal stability were obtained, respectively, 68 nm, 325 m2/g, and 320°C. The highest adsorption of CR, at 94%, was obtained at natural pH, ambient temperature, and after 150 min. In kinetic studies, a correlation coefficient of 0.99 was observed with the pseudo-second-order kinetic model, while in isotherm studies, a correlation coefficient of 0.97 was observed with the Freundlich isotherm model. In the biological evaluations, the best inhibition was against Escherichia coli, and MIC and MBC were observed as 4 μg/mL and 2 μg/mL, respectively. As a general result, V/BP-MOF can be introduced as a potent absorbent agent of CR dye and antimicrobial properties. Therefore, the compound synthesized in this study can be introduced as a suitable option for the wastewater treatment industry, with multiple capabilities including the removal of chemical pollutants and pathogenic agents.

Impact of Urinary Tract and Vaginal Infections on the Physical and Emotional Well-being of Women

Urinary Tract Infection (UTI) is a common bacterial infection that can affect various parts of the urinary system, with symptoms including frequent urination, painful urination, and lower back pain. UTIs are more common in women due to their shorter urethra, and they can lead to serious complications if left untreated. Vaginitis is an inflammation or infection of the vagina caused by factors like bacteria, fungi (Candida), or protozoa (Trichomonas). Symptoms include vaginal itching, abnormal discharge, and discomfort during urination or sexual activity. Treatment depends on the underlying cause and may involve antifungal or antimicrobial medications. Vaginal infections, such as bacterial vaginosis, yeast infections, trichomoniasis, cervicitis, and atrophic vaginitis, can have various physical, emotional, sexual, and social impacts on the lives of women. These impacts may include discomfort, embarrassment, reduced sexual satisfaction, social isolation, and emotional distress. Support and resources for managing these infections include healthcare providers who can diagnose and prescribe treatment, pharmacies that provide medications and guidance, telemedicine for remote consultations and prescriptions, support groups for emotional and informational support, and online resources for reliable information. They offer a sense of community, information sharing, and emotional support, making it easier for individuals to manage their vaginitis and related concerns. Utilizing these resources can contribute to a more informed and empowered approach to vaginal infection prevention and treatment.

Prevalence of Antimicrobial Resistance Among the WHO's AWaRe Classified Antibiotics Used to Treat Urinary Tract Infections in Diabetic Women

Background and Objectives: Diabetes is linked to a higher risk of urinary tract infections (UTIs) in women, often leading to recurrent antibiotic treatments. Frequent antibiotic use for UTIs can contribute to antimicrobial resistance (AMR), a critical public health threat that increases treatment failure. This study investigated the prevalence of AMR and its associated factors among women with UTIs, comparing those with and without diabetes. Results: The study population had a mean age of 52 years (SD = 23) for the women without diabetes and 68 years (SD = 14) for those with diabetes. Resistance was highest for cefazolin and levofloxacin in the Access and Watch antibiotic groups, while ciprofloxacin was the most frequently prescribed antibiotic. AMR prevalence was 35.7% among the women with diabetes and 21.3% among those without. After adjustment, AMR was significantly associated with both uncomplicated diabetes (OR 1.14, 95% CI 1.08-1.21) and complicated diabetes (OR 1.54, 95% CI 1.45-1.64), as well as with higher numbers of prescribed antibiotics (OR 277.39, 95% CI 253.79-303.17). Methods: Using a cross-sectional cohort from the Physionet database, we analyzed data on 116,902 female participants treated for UTIs, including their antibiotic exposure, diabetes status, comorbidities, and hospital admission details. Antimicrobials were classified per the WHO's AWaRe criteria. The primary outcome was AMR identified in urine cultures, and the association with diabetes status was evaluated using multivariable logistic regression. Conclusions: Our findings highlight the need for focused antimicrobial stewardship in women with diabetes to reduce the AMR rates in this vulnerable group.

Epidemiology and Antimicrobial Resistance Profiles of Bacterial Isolates from Clinical Specimens at Felege Hiwot Comprehensive Specialized Hospital in Ethiopia: Retrospective Study

Background: Bacterial infections constitute a large portion of infectious disorders. The location of culture-positive specimens and profiles of antibiotic resistance for common pathogens have been the focal points of subsequent investigations. Methodology: The diagnosis of microbiology was carried out using traditional culture techniques. In accordance with Clinical and Laboratory Standards Institute guidelines, the Kirby–Bauer disk diffusion method was employed for antimicrobial susceptibility analysis. The data were extracted from WHONET 2022 software version 22.5.5 and analyzed using SPSS software. Results: In total, 2489 pathogens were isolated from 2073 patients in three consecutive years. About 768 (34.9%) of the isolates were from the neonatal intensive care unit and the pediatric wards, and 63.2% isolates were from blood specimens. The ESKAPE pathogens were predominant (67%). About 100 Enterobacteriaceae family member bacteria were resistant to carbapenem drugs, and 320 isolates of this family were expected to be beta lactamase producers. A total of 120 methicillin-resistant S. aureus isolates were also identified. Conclusions: Among the isolates, ESKAPE pathogens accounted for the greatest proportion. Most isolates were from the neonatal intensive care unit. A significant number of multidrug-resistant, extreme drug-resistant, and pandrug-resistant isolates were identified in the present study.

Clinical characteristics and nomogram model for predicting the risk of recurrence of complicated urinary tract infection in pediatric patients

Complicated urinary tract infection (cUTI) has higher incidences of antibiotic resistance, recurrence, chronicity, and progression. There exist differences in the immune functions, anatomical structures and physiological functions of urinary tract system between children and adults. In addition, the immature stage of hygiene habit development and the inability to express discomfort accurately all contribute to cUTI recurrence in pediatric patients. cUTI recurrence in children can lead to serious consequences such as growth and development delay, renal scars, and progression to end-stage kidney diseases. Despite the high incidence of cUTI recurrence, no predictive model currently exists to guide targeted intervention in pediatric patients. This study aimed to establish a nomogram to predict the risk of cUTI recurrence in children, thereby facilitating targeted prevention and treatment strategies in pediatric patients. The nomogram was developed based on a retrospective cohort that included 421 pediatric patients with cUTI at West China Second University Hospital from January 2020 to August 2023. The patients were randomly divided into a training set and a validation set in a 3:1 ratio. Logistic regression analysis was used to identify risk factors and construct the nomogram for predicting the risk of cUTI recurrence, followed by validation and performance analysis. Of the 421 children with cUTI, the recurrence rate of cUTI was 68.4% (288 cases) during an average follow-up duration of 22.9 months. The nomogram comprised female gender, history of urinary tract surgery, Escherichia coli in urine culture, renal dysfunction, and vesicoureteral reflux as predictors of cUTI recurrence in pediatric patients. The model showed favorable performance with C-index values of 0.735 and 0.750 in the training dataset and the validation dataset, respectively. The decision curve analysis revealed that the nomogram might be clinically useful. The reliable nomogram would be beneficial for clinicians to identify children with high risks of cUTI recurrence for targeted intervention.

Association between body mass index and urinary tract infections: A cross-sectional investigation of the PERSIAN Guilan cohort study

Introduction

There is a relationship between excess body weight and the risk of a number of infectious diseases, including urinary tract infections (UTIs). This study aimed to investigate the correlation between body mass index (BMI) and UTIs among Prospective Epidemiological Research Studies of the Iranian Adults (PERSIAN) Guilan Cohort Study (PGCS) population.

Methods

This cross-sectional study was conducted on 10,520 individuals aged 35-70 years from PGCS. The demographical data and clinical characteristics of the participants were recorded. Microscopic examination of the urine samples was performed to detect the presence of bacteria or white blood cells (WBC) as indicators of infection. UTI was defined as the presence of bacteria in the urine (Few, moderate, and many) and a value of ≥10 WBC/high power field (HPF) by light microscopy.

Results

The prevalence of UTIs in this study was 8.8%, with a higher incidence in females compared to males (12.2% vs. 4.7%, p < 0.001). Among participants, the prevalence of UTIs across different weight categories was as follows: underweight/normal weight, 7.1%; overweight, 8.1%; and obesity, 10.9%. According to the unadjusted model, subjects with obesity were at significantly higher odds for UTIs than subjects with underweight/normal BMI (OR = 1.62, 95% CI: 1.35-1.93, p < 0.001). However, this association was no longer significant after adjusting for demographic and clinical variables.

Conclusion

The findings of this study provide evidence supporting a higher prevalence of UTIs among individuals with obesity.

Investigation of Releasing Chamomile Essential Oil from Inserts with Cellulose Agar and Microcrystalline Cellulose Agar Films Used in Biotextronics Systems for Lower Urinary Tract Inflammation Treatment

Lower urinary tract inflammation is a very common problem which occurs particularly in women. That is why the idea of a biotextronics system for preventive and supportive treatment came to be. The system is a kind of a therapeutic clothing in the form of underwear integrated with a four-layer pantiliner with biological active compounds (from chamomile essential oil) immobilized on the insert with a cellulose agar or microcrystalline cellulose agar film. In this research, the outer part of the insert was investigated for its ability to release compounds with antibacterial and anti-inflammatory activity under the temperature of the treatment (40 °C). The research was conducted on the day of the insert preparation (day 0) and also after 7, 14, 28, and 56 days to test the ability of the insert to be stored without changing its properties. The results showed that even after 56 days of storage, there are compounds released that are known to have antibacterial activity, such as α-bisabolol. The system requires further tests involving bacteria; however, chamomile essential oil seems to be good substrate for biotextronics systems for preventive and supportive treatment of lower urinary tract inflammations.

A retrospective analysis of the incidence and risk factors of perioperative urinary tract infections after total hysterectomy

INTRODUCTION

Perioperative urinary tract infections (PUTIs) are common in the United States and are a significant contributor to high healthcare costs. There is a lack of large studies on the risk factors for PUTIs after total hysterectomy (TH).

METHODS

We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively.

RESULTS

PUTIs were found in 9087 patients overall, showing a 2.0% incidence. There were substantial differences in the incidence of PUTIs based on age group (P < 0.001). Between the two groups, there was consistently a significant difference in the type of insurance, hospital location, hospital bed size, and hospital type (P < 0.001). Patients with PUTIs exhibited a significantly higher number of comorbidities (P < 0.001). Unsurprisingly, patients with PUTIs had a longer median length of stay (5 days vs. 2 days; P < 0.001) and a higher in-hospital death rate (from 0.1 to 1.1%; P < 0.001). Thus, the overall hospitalization expenditures increased by $27,500 in the median ($60,426 vs. $32,926, P < 0.001) as PUTIs increased medical costs. Elective hospitalizations are less common in patients with PUTIs (66.8% vs. 87.6%; P < 0.001). According to multivariate logistic regression study, the following were risk variables for PUTIs following TH: over 45 years old; number of comorbidities (≥ 1); bed size of hospital (medium, large); teaching hospital; region of hospital(south, west); preoperative comorbidities (alcohol abuse, deficiency anemia, chronic blood loss anemia, congestive heart failure, diabetes, drug abuse, hypertension, hypothyroidism, lymphoma, fluid and electrolyte disorders, metastatic cancer, other neurological disorders, paralysis, peripheral vascular disorders, psychoses, pulmonary circulation disorders, renal failure, solid tumor without metastasis, valvular disease, weight loss); and complications (sepsis, acute myocardial infarction, deep vein thrombosis, gastrointestinal hemorrhage, pneumonia, stroke, wound infection, wound rupture, hemorrhage, pulmonary embolism, blood transfusion, postoperative delirium).

CONCLUSIONS

The findings suggest that identifying these risk factors can lead to improved preventive strategies and management of PUTIs in TH patients. Counseling should be done prior to surgery to reduce the incidence of PUTIs.

THE MANUSCRIPT ADDS TO CURRENT KNOWLEDGE

In medical practice, the identification of risk factors can lead to improved patient prevention and treatment strategies. We conducted a retrospective study using a national inpatient sample (NIS) of 445,380 patients from 2010 to 2019 to analyze the risk factors and annual incidence of PUTIs associated with TH perioperatively. PUTIs were found in 9087 patients overall, showing a 2.0% incidence. We found that noted increased length of hospital stay, medical cost, number of pre-existing comorbidities, size of the hospital, teaching hospitals, and region to also a play a role in the risk of UTI's.

CLINICAL TOPICS

Urogynecology.

Prevalence of urinary tract infections in pregnant women and antimicrobial resistance patterns in women in Riyadh, Saudi Arabia: a retrospective study

BACKGROUND

Urinary tract infections (UTIs) are one of the most common health problems worldwide and mainly affect women. This study aimed to evaluate the prevalence of UTIs in pregnant women and determine the antimicrobial resistance patterns of bacterial pathogens isolated from pregnant and nonpregnant women in Riyadh, Saudi Arabia.

METHODS

This retrospective cohort study was conducted at an academic medical center in Riyadh, Saudi Arabia, from January to June 2022. The study included all urine cultures performed for adult women during the study period. We excluded urine culture performed for women on antibiotics prescribed for any infection, children, and men. Using the SPSS (version 27) package, descriptive statistics and chi-square tests were used to analyze the data, and p < 0.05 was considered to indicate statistical significance.

RESULTS

A total of 2,418 urine cultures performed during the study period were included (985 and 1,433 for pregnant and nonpregnant women, respectively). The overall prevalence of UTIs in pregnant women was 5% (95% CI 3.6-6.4); 10 (1%) women were symptomatic, and 40 (4%) women were asymptomatic. Of the entire cohort, 244 (10.1%) women were diagnosed with UTIs based on bacterial cultures. The predominant bacteria in both pregnant and nonpregnant women were Escherichia coli (134, 54.9%), followed by Klebsiella pneumoniae (48, 19.6%). The antibiotic susceptibility criteria for Escherichia coli and Klebsiella pneumoniae were as follows: nitrofurantoin (94% and 18.8%, respectively), amoxicillin-clavulanic acid (82.8% and 70.8%, respectively), ciprofloxacin (65.7% and 83.3%, respectively), trimethoprim-sulfamethoxazole (65.7% and 79.2%, respectively) and cephalothin (47% and 68.8%, respectively).

CONCLUSION

Compared to the findings of other similar studies, the prevalence of UTIs was lower in pregnant women. This may be because the patient population was composed of healthy and educated women who received prenatal education and underwent prenatal assessment as per institutional guidelines. Nitrofurantoin and amoxicillin-clavulanic acid are recommended for use as an empirical therapy for UTIs in pregnant and nonpregnant women because bacteria have the least amount of resistance to these drugs.

Post-Toilet Wiping Style Is Associated With the Risk of Urinary Tract Infection in Women

INTRODUCTION

Urinary tract infection (UTI) has a lifetime incidence of ≥50% in women. A wide variety of clinical, physiological, and lifestyle risk factors for UTI have been identified, but the exact relationship between post-toilet anal and perineal hygiene practices, especially the wiping direction with toilet paper, and UTI risks has not been investigated yet. Therefore, this study cross-sectionally investigated the post-toilet wiping habit and lifetime UTI events in the general population.

METHODS

Individuals who visited two hospitals in Japan between April 2020 and March 2023 were initially recruited. Self-reported questionnaires regarding post-toilet wiping habits and past UTI events were collected, and their relationship was investigated in males and females. Subgroup analyses by age were further performed to estimate the impact of age on the relationship.

RESULTS

A total of 294 individuals (141 males and 153 females) agreed to participate and answered the question of post-toilet wiping direction. The number of individuals with post-toilet wiping with the arm from the front between the legs was 32 (23%) in males and 68 (44%) in females. The lifetime UTI events were more frequent in females than in males (p<0.0001). The impact of post-toilet wiping with the arm from the front between the legs on UTI events, adjusting for the age and history of diabetes mellitus, was not statistically significant both in males and females (p≥0.10 for both). Meanwhile, when the relationship was evaluated by different age groups, wiping habits from the front and UTI were significantly associated with each other in middle-aged women aged 40-59, whereas they were not in younger and older age groups.

CONCLUSION

Approximately 40-50% of women performed post-toilet wiping with the arm from the front between the legs. This post-toilet wiping habit was suggested to be a potential risk of UTI in women, especially in middle-aged subgroups, and may be better to be changed to wiping from behind.

Prevalence, antibiotic resistance pattern for bacteriuria from patients with urinary tract infections

Background and Aims

Antibiotic resistance presents a significant global public health challenge, particularly for urinary tract infections (UTIs), and is notably severe in developing countries. Surveillance of the antimicrobial susceptibility patterns of UTI-causing bacteria is crucial for effective treatment selection. This study aimed to analyze these patterns in bacteria isolated from the urine samples of patients at Mughda Medical College Hospital, Dhaka, Bangladesh.

Methods

A retrospective study (January 2019 to December 2020) at Mugdha Medical College and Hospital, Dhaka, examined clinical and laboratory data from patients with positive urine cultures (≥105 CFU/mL). The study classified patients into four age groups: children (1-<18 years), young adults (18-<33 years), middle-aged adults (33-50 years), and old adults (>50 years). The standard Kirby-Bauer method was used to assess antibiotic sensitivity to 28 common antibiotics.

Results

Among 243 positive urine cultures in both community- and hospital-acquired UTIs, Escherichia coli was the most common uropathogen (65.84%), followed by Klebsiella spp. (12.34%), Enterococcus spp. (8.23%), and other types of bacteria.

Conclusion

Old adults are particularly vulnerable to UTIs, with E. coli being the predominant causative agent in the study region. The observed antimicrobial resistance patterns underscore the necessity of judicious antibiotic selection to effectively treat UTIs across different age groups.

Comparison of polymerase chain reaction and next-generation sequencing with conventional urine culture for the diagnosis of urinary tract infections: A meta-analysis

The limitations of conventional urine culture methods can be avoided by using culture-independent approaches like polymerase chain reaction (PCR) and next-generation sequencing (NGS). However, the efficacy of these approaches in this setting is still subject to contention. PRISMA-compliant searches were performed on MEDLINE/PubMed, EMBASE, Web of Sciences, and the Cochrane Database until March 2023. The included articles compared PCR or NGS to conventional urine culture for the detection of urinary tract infections (UTIs). RevMan performed meta-analysis, and the Cochrane Risk of Bias Assessment Tool assessed study quality. A total of 10 selected studies that involved 1,291 individuals were included in this meta-analysis. The study found that PCR has a 99% sensitivity and a 94% specificity for diagnosing UTIs. Furthermore, NGS was shown to have a sensitivity of 90% for identifying UTIs and a specificity of 86%. The odds ratio (OR) for PCR to detect Gram-positive bacteria is 0.50 (95% confidence interval [CI] 0.41-0.61), while the OR for NGS to detect Gram-negative bacteria is 0.23 [95% CI 0.09-0.59]. UTIs are typically caused by Gram-negative bacteria like Escherichia coli and Gram-positive bacteria like Staphylococci and Streptococci. PCR and NGS are reliable, culture-free molecular diagnostic methods that, despite being expensive, are essential for UTI diagnosis and prevention due to their high sensitivity and specificity.

Propolis as an adjunctive therapy for treatment of uncomplicated cystitis in women: A randomized double-blind placebo-controlled trial

The current research is designed to investigate the effect of propolis supplementation on the clinical manifestations in women suffering from uncomplicated cystitis. In this randomized double-blind, placebo-controlled trial, 120 women with uncomplicated cystitis were selected and randomly assigned into two groups to receive two 500 mg capsules of propolis or placebo daily for 7 days along with ciprofloxacin (250 mg). Clinical symptoms including hematuria, urinary frequency, dysuria, suprapubic pain, and urgency, as well as bacteriuria, were assessed before and after the intervention. After supplementation, participants in the intervention group had significantly fewer days of urinary frequency (p < 0.001), dysuria (p = 0.005), and urgency (p = 0.03). However, there was no significant difference between the two groups regarding hematuria and suprapubic pain (p > 0.05). Furthermore, the severity of bacteriuria decreased significantly in both groups. In conclusion, it seems that propolis supplementation in women with uncomplicated cystitis could improve urinary frequency, dysuria, and urgency. However, further clinical trials should be conducted to fully understand the effects of propolis in women suffering from uncomplicated cystitis.

Fluorescent polymer as a biosensing tool for the diagnosis of microbial pathogens

Diseases and diagnoses are predominant in the human population. Early diagnosis of etiological agents plays a vital role in the treatment of bacterial infections. Existing standard diagnostic platforms are laborious, time-consuming, and require trained personnel and cost-effective procedure, though they are producing promising results. These shortcomings have led to a thirst for rapid diagnostic procedures. Fluorescence-based diagnosis is one of the efficient rapid diagnostic methods that rely on specific and sensitive bacterial detection. Emerging bio-sensing studies on conducting polymers (CPs) are gaining popularity in medical diagnostics due to their promising properties of high fluorescence efficiency, good light stability, and low cytotoxicity. Poly[2-methoxy-5-(2'-ethylhexyloxy)-1,4-phenylenevinylene] (MEH-PPV), is the first identified soluble polymer and model material for understanding the fundamental photophysics of conventional CPs. In this present study, MEH-PPV is used as a fluorescent dye for direct pathogen detection applications by interacting with the microbial cell surface. An optimized concentration of MEH-PPV solution used to confirm the presence of selective bacterial structures. The present study endeavours towards bacterial detection based on the emission from bacteria due to interfacial interaction between polymer and bacterial surface.

A personalized prediction model for urinary tract infections in type 2 diabetes mellitus using machine learning

Patients with type 2 diabetes mellitus (T2DM) are at higher risk for urinary tract infections (UTIs), which greatly impacts their quality of life. Developing a risk prediction model to identify high-risk patients for UTIs in those with T2DM and assisting clinical decision-making can help reduce the incidence of UTIs in T2DM patients. To construct the predictive model, potential relevant variables were first selected from the reference literature, and then data was extracted from the Hospital Information System (HIS) of the Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital for analysis. The data set was split into a training set and a test set in an 8:2 ratio. To handle the data and establish risk warning models, four imputation methods, four balancing methods, three feature screening methods, and eighteen machine learning algorithms were employed. A 10-fold cross-validation technique was applied to internally validate the training set, while the bootstrap method was used for external validation in the test set. The area under the receiver operating characteristic curve (AUC) and decision curve analysis (DCA) were used to evaluate the performance of the models. The contributions of features were interpreted using the SHapley Additive ExPlanation (SHAP) approach. And a web-based prediction platform for UTIs in T2DM was constructed by Flask framework. Finally, 106 variables were identified for analysis from a total of 119 literature sources, and 1340 patients were included in the study. After comprehensive data preprocessing, a total of 48 datasets were generated, and 864 risk warning models were constructed based on various balancing methods, feature selection techniques, and a range of machine learning algorithms. The receiver operating characteristic (ROC) curves were used to assess the performances of these models, and the best model achieved an impressive AUC of 0.9789 upon external validation. Notably, the most critical factors contributing to UTIs in T2DM patients were found to be UTIs-related inflammatory markers, medication use, mainly SGLT2 inhibitors, severity of comorbidities, blood routine indicators, as well as other factors such as length of hospital stay and estimated glomerular filtration rate (eGFR). Furthermore, the SHAP method was utilized to interpret the contribution of each feature to the model. And based on the optimal predictive model a user-friendly prediction platform for UTIs in T2DM was built to assist clinicians in making clinical decisions. The machine learning model-based prediction system developed in this study exhibited favorable predictive ability and promising clinical utility. The web-based prediction platform, combined with the professional judgment of clinicians, can assist to make better clinical decisions.

Urinary Tract Infection in Children: A Narrative Review

This study investigates the susceptibility of different age groups and genders to urinary tract infections (UTIs) in pediatric populations, focusing on anatomical and behavioural factors. A systematic review of clinical data explores manifestations, accurate diagnosis methods, and antibiotic treatment regimens. Escherichia coli is a prevalent uropathogen, and the study addresses concerns about antibiotic resistance. The research aims to close knowledge gaps, influence guidelines, and enhance public health initiatives. Factors influencing UTI prevalence, such as age, gender, and structural abnormalities, are discussed. The review follows a robust search methodology, presenting a Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) flow diagram. The included studies cover a wide range of topics related to pediatric UTIs, including aetiology, treatment, prevention, and diagnostic approaches. The study emphasizes the importance of understanding and addressing pediatric UTIs for effective management and prevention.

The Extent of Antibiotic Dispensing in Self-Medication Encounters in Sudan: A Simulated Patient Study Focusing on Cefixime Sale

Background

Antibiotics play an important role in decreasing morbidity and mortality worldwide. However, inappropriate use of them by patients or healthcare professionals contributes to their resistance rendering them less efficacious. Community pharmacists (CPs) have a significant part in reducing antibiotic resistance. Therefore, this study aimed to investigate the dispensing of antibiotics without prescription in community pharmacies with an emphasis on cefixime dispensing.

Methods

A cross-sectional, simulated patient (SP) study was conducted in the Khartoum locality. A total of 238 community pharmacies were randomly chosen using simple random sampling. One scenario of uncomplicated urinary tract infection was designed, and six female pharmacy students who were trained to act as SPs presented the scenario. Descriptive statistics were applied to report the study outcomes.

Results

In the 238 pharmacy visits, at least one antibiotic was dispensed without a prescription in 69.3% of the simulated visits. Among the dispensed antibiotics, ciprofloxacin was the most dispensed antibiotic followed by cefixime representing 51.5% and 41.8%, respectively, of total dispensed antibiotics. Cefixime was dispensed as a first choice by CPs in 29% of the visits, and in the rest of the visits, only 37.3% of CPs refused to dispense cefixime after SP demand.

Conclusion

The findings revealed a high rate of antibiotics dispensing without prescription by CPs in Khartoum state, and cefixime was obtained with ease before and after the patient's demand. Urgent corrective actions such as imposing strict regulations, monitoring pharmacists' practice, and endorsing educational programs for pharmacists are needed to prevent inappropriate antibiotic dispensing practices.

Presence of fimH and iss type 1, 2 and 3 genes in uropathogenic Escherichia coli isolates recovered from an apex medical institute in North India

PURPOSE

To detect the presence of fimH and iss type 1, 2 and 3 genes in uropathogenic Escherichia coli (UPEC) isolates recovered from patients coming to the out patient department (OPD) of our hospital.

METHODS

E. coli isolates recovered from patients who had symptoms of urinary tract infection (UTI) were processed for the presence of fimH and iss genes. DNA was extracted using an in house method after which conventional PCR using forward and reverse primers targeting the four genes was carried out. The amplified products were electrophoresed and visualized in a gel documentation imager. Relevant demographic details of the patients were recorded on a pre-designed pro-forma and antimicrobial susceptibility testing of the isolates was done by disc diffusion method.

RESULTS

fimH was present in 87.5% of UPEC isolates whereas iss type 1 was seen in 7.3%, type 2 in 4.2% and iss type 3 in 71.9% isolates. Age of the patients ranged from 3 months to 82 ​yrs (mean 43.5 SD ​± ​18.20). UTI was more common in females (60.2%) as compared to males patients (39.8%). Dysuria (66.7%) was the most common symptom in the studied subjects and diabetes mellitus (42.6%) the most common co-morbidity. A total of 56.5% patients gave a history of prior antibiotic intake. The UPEC isolates were resistant to most of the antibiotics tested. However all the isolates were sensitive to polymyxin B and colistin. Fosfomycin resistance was seen in 9.5% of the UPEC isolates harbouring fimH gene.

CONCLUSION

This is the first study that highlights the presence of iss type 3 gene in UPEC isolates along with the fimH and iss type 1 and 2 genes. The results of this study can serve as a stepping stone for future in depth research into the significance of the iss genes in causing UTI.

Curcumin-sulfobutyl-ether beta cyclodextrin inclusion complex: preparation, spectral characterization, molecular modeling, and antimicrobial activity

Urinary tract infections (UTIs) caused by Gram-negative bacteria E. coli is responsible for 80-90% of uncomplicated cases in women. The increased prevalence of antibiotic resistance has made the management of UTIs more challenging. Plant-derived compounds have long been used to treat various diseases, and constitute an alternative to antibiotic resistance. Curcumin (CUR), a naturally occurring polyphenolic phytoconstituent obtained from Curcuma longa is endowed with diverse medicinal properties. The present study aims to form a complex of CUR with Sulfobutyl ether-β-cyclodextrin (SBEβCD) to overcome the poor solubility and bioavailability of CUR and to evaluate the antimicrobial activity of CUR-SBEβCD. Phase solubility studies and spectral characterization showed the entrapment of CUR in the SBEβCD cavity. In silico docking studies performed to investigate the complexation process of CUR with SBEβCD, revealed that the methoxy group and OH group of CUR interacted with SBEβCD. The cytotoxicity and HET-CAM assays confirmed that CUR-SBEβCD was non-irritant. The prepared complex investigated with the disc diffusion method showed antimicrobial activity with a zone of inhibition (ZOI) of 13 mm against Escherichia coli (E. coli) and 11.5 mm against Staphylococcus aureus (S. aureus) whereas CUR alone did not show any ZOI. It can be concluded that prepared CUR-SBEβCD demonstrated superior antimicrobial activity and therefore can be a promising alternative for the treatment of UTIs.Communicated by Ramaswamy H. Sarma.

Antimicrobial susceptibility of Escherichia coli isolated from diabetic patients in Mogadishu, Somalia

Background

Urinary tract infections (UTIs) are a major concern for diabetic patients due to the impact of diabetes on the urinary tract and immune system. Escherichia coli is the most common pathogen causing UTIs in diabetic patients and is known for its resistance. This study aimed to assess the antimicrobial susceptibility of Escherichia coli strains isolated from diabetic patients in Mogadishu, Somalia.

Methods

This descriptive cross-sectional study was conducted at Ummah Hospital in Mogadishu, Somalia, from November 2021 to April 2022. Clean catch mid-stream urine specimens were collected from each participant and uropathogens were identified using standard techniques. The samples were cultured on CLED agar and antibiotic susceptibility patterns were determined using the Kirby-Bauer disk diffusion method. Data analysis was performed using SPSS version 20.

Results

The overall prevalence of uropathogens among diabetic patients was 236/350 (67.5%) with Escherichia coli being the most common organism. According to multivariate logistic regression, the results showed that Female diabetic patients had a significantly higher likelihood of developing UTIs compared to males (AOR = 2.5, 95% CI: 1.357-4.522, p = 0.003). The duration of diabetes, history of previous UTIs, and previous antibiotic use were also significantly associated with UTIs. All isolates were found to be resistant to Cefotaxime (100%). In addition, high resistance rates were observed with ofloxacin (91%), ciprofloxacin (77.8%), amikacin (60.9%), ceftriaxone (58.3%), and cefepime (51.8%). The most sensitive antibiotics were colistin and imipenem (99.6 and 88.6%, respectively), followed by gentamycin (70%).

Conclusion

This study found a high prevalence of uropathogens and increased multi-drug resistance. Continuous surveillance is needed to monitor uropathogen prevalence and resistance rates, guiding treatment recommendations, rational prescription programs, and policy decisions.

Discovery of novel 1,3,5-triazines as potent antibacterial agent against urinary tract infection-causing clinical isolates of Escherichia coli via inhibition of DNA Gyrase

A novel series of 1,3,5-triazine-phenylthiazole-pyrazole derivatives were synthesized and subsequently tested for Escherichia coli DNA Gyrase inhibitory activity where they showed excellent inhibitory activity. The top-three ranked DNA gyrase inhibitor (4e, 4g and 4h) were further subjected to antibacterial and anti-biofilm activity against clinical isolates of resistant E. coli strains obtained from Urinary Tract Infection (UTI) patients (CREC81, CREC106, CREC163). Compound 4h was identified as most potent antibacterial agent in the above study. The compound 4h was further evaluated in murine model of E. coli UTI in BALB/c mice infected by transurethral injection of CREC106 strain. Results of the study suggest that compound 4h reduces bacterial load of CREC106 in the treated mice and found approximately equipotent to Novobiocin as standard.

Which Antibiotic for Urinary Tract Infections in Pregnancy? A Literature Review of International Guidelines

Urinary tract infection (UTI) is considered to be a major problem in pregnant women. It is also one of the most prevalent infections during pregnancy, being diagnosed in as many as 50-60% of all gestations. Therefore, UTI treatment during pregnancy is extremely important and management guidelines have been published worldwide to assist physicians in selecting the right antibiotic for each patient, taking into account the maternal and fetal safety profile. A review of the literature was carried out and all international guidelines giving recommendations about antibiotic treatments for pregnancy-related UTI were selected. The search came back with 13 guidelines from 4 different continents (8 from Europe, 3 from South America, 1 from North America and 1 from Oceania). Our review demonstrated concordance between guidelines with regard to several aspects in the antibiotic treatment of UTI during pregnancy and in the follow-up after treatment. Nonetheless, there are some areas of discordance, as in the case of antenatal screening for bacteriuria and the use of fluoroquinolones in lower or upper UTI. Given the current evidence that we have from international guidelines, they all agree on several key points about antibiotic use.

Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis

Risk factors and consequences of urinary tract infection (UTI) post-kidney transplant have been variously reported by studies that were heterogenous in immunosuppressants and prophylactic protocols. We aimed to clarify the risks and consequences of UTI in kidney transplant recipients with post-transplantation cotrimoxazole prophylaxis in the context of modern immunosuppression. This retrospective cohort included kidney transplant recipients receiving tacrolimus, mycophenolate, prednisolone, and cotrimoxazole for bacterial UTI prophylaxis. Recipients were categorized into non-UTI and UTI groups. Asymptomatic bacteriuria (ASB) was screened in the first 3 months and was evaluated for association with UTI. Of 348 kidney transplant recipients, 129 were in the UTI group and 219 in the non-UTI group. UTI risk factors were female sex, body mass index ≥ 25 kg/m², human leukocyte antigen mismatch, and panel reactive antibody ≥ 50%. Recipients with recurrent UTI had inferior allograft function compared with non-UTI recipients. Patient survival was significantly lower in recipients with UTI in the first post-transplant month. Higher degree of immunosuppressions was associated with recurrent UTI and drug-resistant organisms. In conclusion, UTI continues to negatively affect graft function and survival of kidney transplant recipients. Treating ASB in the first 3 months did not reduce the UTI incidence in the first transplantation year.

In Vitro and In Vivo Evaluation of a Nano-Tool Appended Oilmix (Clove and Tea Tree Oil) Thermosensitive Gel for Vaginal Candidiasis

The main objective of the proposed work was the development of a thermosensitive gel (containing clove and tea tree oil) for the management of vaginal candidiasis. Both oils have been recommended to be used separately in a topical formulation for vaginal candidiasis. Incorporating two natural ingredients (clove and tea tree oil) into a product give it a broad antimicrobial spectrum and analgesic properties. The two oils were mixed together at a 3:1 ratio and converted into o/w nanoemulsion using the aqueous titration method and plotting pseudo ternary phase diagrams. Further transformations resulted in a gel with thermosensitive properties. To determine the final formulation's potential for further clinical investigation, in vitro analyses (viscosity measurement, MTT assay, mucoadhesion, ex vivo permeation) and in vivo studies (fungal clearance kinetics in an animal model) were conducted. The current effort leveraged the potential of tea tree and clove oils as formulation ingredients and natural therapeutic agents for vaginal infections. Its synergy generated a stable and effective thermosensitive gel that can be utilized for recurrent candidiasis and other infections.

Can We Identify Patients in Danger of Complications in Retrograde Intrarenal Surgery?-A Retrospective Risk Factors Analysis

Retrograde intrarenal surgery (RIRS) is an innovative and effective method of kidney stones treatment, as it had great influence on the development of endoscopy in urology. The increasing prevalence of urolithiasis together with the rapid development of endourology leads to a rise in the number of procedures related to the disease. Flexible ureteroscopy is constantly being improved, especially regarding the effectiveness and safety of the procedure. The purpose of this study is to evaluate intraoperative and early post-operative complications of RIRS in the treatment of kidney stones. A retrospective analysis of medical records was performed. A series was comprised of 207 consecutive operations performed from 2017 to 2020. Complications occurred in 19.3% (n = 40) of patients. Occurrence according to the Clavien-Dindo scale was: 11.1% for grade I, 5.8% for grade II and 2.4% for grade IV. Infectious complications included SIRS (5.3%, n = 11) and sepsis (2.4%, n = 5). Statistical analysis revealed a correlation between acute post-operative infections and positive midstream urine culture, history of chronic or recurrent urinary tract infections, and increased body mass index (BMI). Furthermore, a significant correlation was observed between pain requiring the use of opioids with BMI over 25. Consequently, history of urinary tract infections, positive pre-operative urine culture, and increased BMI are considered risk factors and require appropriate management.

How to avoid drug resistance during treatment and prevention of urinary tract infections

Urinary tract infections (UTIs), defined as the presence of bacteria above the bladder sphincter, are among the most common infectious diseases. They remain a significant cause of antibiotic prescription worldwide. The incidence is much higher among women, especially of reproductive age, than among men. If the infection occurs at least 3 times a year or twice within 6 months, it is classified as recurrent urinary tract infection (rUTI). Among the causal pathogens, the vast majority are Gram-negative bacteria, the most common of which is Escherichia coli. Recommended treatment regimens differ depending on the diagnosed disease entity and the patient's clinical situation. Empirical antibiotic therapy is most often used. The first-line treatment in patients with acute simple cystitis include nitrofurantoin, trimethoprim-sulfamethoxazole, or fosfomycin. Beta-lactams and fluoroquinolones should be considered as a second-line agent. In particular cases (pregnancy or rUTIs) targeted treatment, based on the results of urine culture and antibiogram, is implemented. During pregnancy recommended treatment includes administration of cephalosporins (e.g. cefuroxime) or nitrofurantoin. In patients with uncomplicated pyelonephritis fluoroquinolones should be considered as the first-line regimen. In the case of rUTIs, there are no uniform guidelines for prophylactic management. Repeated administration of antibiotics due to infections leads to a growing problem of drug resistance. Most recommendations suggest not to use antibiotic prophylaxis routinely. Growing evidence favours non-antibiotic prophylaxis regimens for recurrent UTIs. Until now only one product - oral immunostimulant OM-89 - has been sufficiently investigated. Wider implementation of immunoprophylaxis in the future may reduce possible side effects of inappropriate antibiotic consumption.

Recurrent Urinary Tract Infections and Asymptomatic Bacteriuria in Adults

Purpose of review

Our goal was to summarize recent evidence regarding recurrent urinary tract infections and asymptomatic bacteriuria in different adult populations.

Recent findings

Several research groups are focused on the description of resident bacterial flora in the bladder and urinary dysbiosis in the microbiome era. Even the definitions might change in light of these discoveries. However, the role of urinary microbiome and bacterial interference has still to be determined.

Summary

Systematic treatment of asymptomatic bacteriuria is not recommended and even classic indications such as asymptomatic bacteriuria in pregnant women are controversial. In fact, its treatment is associated with a higher probability of symptomatic UTI and a higher prevalence of antibiotic-resistant bacteria. Improving the diagnosis of asymptomatic bacteriuria and optimizing the management of recurrent urinary tract infections, especially through non-antibiotics measures, are needed in order to minimise antimicrobial resistance.

Effects of Itxasol© Components on Gene Expression in Bacteria Related to Infections of the Urinary Tract and to the Inflammation Process

Urinary tract infections (UTIs) represent a health problem of the first magnitude since they affect large segments of the population, cause increased mortality and comorbidity, and have a high incidence of relapse. Therefore, UTIs cause a major socioeconomic concern. Current antibiotic treatments have various limitations such as the appearance of resistance to antibiotics, nephrotoxicity, and side effects such as gastrointestinal problems including microbiota alterations that contribute to increasing antibiotic resistance. In this context, Itxasol© has emerged, approved as an adjuvant for the treatment of UTIs. Designed with biomimetic principles, it is composed of arbutin, umbelliferon, and N-acetyl cysteine. In this work, we review the activities of these three compounds concerning the changes they produce in the expression of bacterial genes and those related to inflammation as well as assess how they are capable of affecting the DNA of bacteria and fungi.

Antibiotic resistance pattern of uropathogenic Escherichia coli isolated from children with symptomatic urinary tract infection in Moscow, Russia

Background and Aim: Uropathogenic Escherichia coli (UPEC) is commonly involved in urinary tract infections (UTIs), which are generally treated with antibiotics. However, the emergence of multidrug-resistant (MDR) strains of UPEC has made the treatment difficult. There is thus a need to continuously assess their sensitivity to antibiotics. This study aimed to determine the antibiotic resistance patterns and MDR phenotypes of UPEC strains isolated from children diagnosed with UTIs at the Russian Children's Clinical Hospital in Moscow, Russia. Materials and Methods: Kirby–Bauer's disc diffusion method was used to study the sensitivity to antibiotics of 106 UPEC isolates from urine specimens from children (aged from 9 months to 18 years old) diagnosed with UTIs. The results were interpreted in accordance with the Clinical and Laboratory Standards Institute guidelines and the correlations of variables with the degree to which each antibiotic inhibited the UPEC strains in terms of diameter on the disc were determined using Spearman's rank correlation test. A t-test and principal component analysis were performed to visualize the correlations of the susceptibility of UPEC to antibiotics with the age and sex of the patients. Statistical significance was set at p≤0.05. Results: Among the 106 UPEC strains tested, none (0%) showed resistance to fosfomycin (FO), while 84 (79.2%) were resistant (R) to at least one antibiotic. The highest rates of resistance were observed to amoxicillin (69.8%), ampicillin (62.3%), cefazolin (39.6%), trimethoprim (TR) (37.7%), ceftriaxone (34.9%), and tetracycline (33.0%). Interestingly, 22 (20.8%) strains were R to imipenem. UPEC isolates from males aged 1-6 years were more R to antibiotics than those from the other groups, with the exception of TR, to which UPEC isolates from females aged 13-18 years old were less sensitive (S). The multidrug-resistance (MDR) index ranged between 0.00 and 0.75 and we found that more than a quarter of UPEC (31/106) had an MDR index ≥0.5 and only 22 (20.7%) strains were S to all antibiotics tested (MDR index=0). Finally, Spearman's rank correlation test showed that, with the exception of FO, there were correlations between the inhibition diameters of all other antibiotics. Conclusion: FO is the only antibiotic to which all UPECs were S and may be suggested as the first line of treatment for UPEC. Further research is needed to continue monitoring antibiotic resistance and to investigate the genetic features associated with such resistance observed in this study.

A Natural Alternative Treatment for Urinary Tract Infections: Itxasol©, the Importance of the Formulation

Genito-urinary tract infections have a high incidence in the general population, being more prevalent among women than men. These diseases are usually treated with antibiotics, but very frequently, they are recurrent and lead to the creation of resistance and are associated with increased morbidity and mortality. For this reason, it is necessary to develop new compounds for their treatment. In this work, our objective is to review the characteristics of the compounds of a new formulation called Itxasol© that is prescribed as an adjuvant for the treatment of UTIs and composed of β-arbutin, umbelliferon and n-acetyl cysteine. This formulation, based on biomimetic principles, makes Itxasol© a broad-spectrum antibiotic with bactericidal, bacteriostatic and antifungal properties that is capable of destroying the biofilm and stopping its formation. It also acts as an anti-inflammatory agent, without the adverse effects associated with the recurrent use of antibiotics that leads to renal nephrotoxicity and other side effects. All these characteristics make Itxasol© an ideal candidate for the treatment of UTIs since it behaves like an antibiotic and with better characteristics than other adjuvants, such as D-mannose and cranberry extracts.