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Sivanandam SE, Poonkodi M, Venkatesh U, Karthikeyan A, Karthikeyan VS. Solitary tubercular renal cyst in a postpartum lady masquerading as an infected giant renal cyst with urosepsis. INDIAN J PATHOL MICR 2022; 65:170-172. [PMID: 35074988 DOI: 10.4103/ijpm.ijpm_228_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023] Open
Abstract
Renal tuberculosis presenting as renal cyst is rare. Diagnosing renal tuberculosis in pregnancy is usually delayed due to its atypical presentation. We present a 28-year-old postpartum lady who delivered a healthy baby one month back, with history of intermittent fever and chills. She had high spiking fever (102° F), tachycardia (130/min) and computed tomography showed a 16 × 10 cm right renal cyst. Percutaneous drainage was done, 2 litres of thick pus drained and culture was sterile. After three weeks, deroofing and marsupialization of cyst was done. Biopsy revealed granulomatous inflammation composed of epitheliod histiocytes with central incipient necrosis suggestive of tuberculosis. She was treated with anti-tubercular drugs. As the infant was healthy and had no evidence of tuberculosis, no treatment was initiated. The mother is on follow up for 2 years. This case highlights the rare presentation of renal tuberculosis in puerperium.
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Affiliation(s)
| | - Manohar Poonkodi
- Department of Pathology, Sri Narayani Hospital and Research Centre, Vellore, Tamil Nadu, India
| | - Ulaganathan Venkatesh
- Department of Urology, Sri Narayani Hospital and Research Centre, Vellore, Tamil Nadu, India
| | - Aswathaman Karthikeyan
- Department of Urology, Sri Narayani Hospital and Research Centre, Vellore, Tamil Nadu, India
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Olmos-Ortiz A, Olivares-Huerta A, García-Quiroz J, Avila E, Halhali A, Quesada-Reyna B, Larrea F, Zaga-Clavellina V, Díaz L. Cord Serum Calcitriol Inversely Correlates with Maternal Blood Pressure in Urinary Tract Infection-Affected Pregnancies: Sex-Dependent Immune Implications. Nutrients 2021; 13:nu13093114. [PMID: 34578991 PMCID: PMC8467737 DOI: 10.3390/nu13093114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 08/30/2021] [Accepted: 09/02/2021] [Indexed: 11/25/2022] Open
Abstract
Urinary tract infections (UTI) during pregnancy are frequently associated with hypertensive disorders, increasing the risk of perinatal morbidity. Calcitriol, vitamin D3’s most active metabolite, has been involved in blood pressure regulation and prevention of UTIs, partially through modulating vasoactive peptides and antimicrobial peptides, like cathelicidin. However, nothing is known regarding the interplay between placental calcitriol, cathelicidin, and maternal blood pressure in UTI-complicated pregnancies. Here, we analyzed the correlation between these parameters in pregnant women with UTI and with normal pregnancy (NP). Umbilical venous serum calcitriol and its precursor calcidiol were significantly elevated in UTI. Regardless of newborn’s sex, we found strong negative correlations between calcitriol and maternal systolic and diastolic blood pressure in the UTI cohort (p < 0.002). In NP, this relationship was observed only in female-carrying mothers. UTI-female placentas showed higher expression of cathelicidin and CYP27B1, the calcitriol activating-enzyme, compared to male and NP samples. Accordingly, cord-serum calcitriol from UTI-female neonates negatively correlated with maternal bacteriuria. Cathelicidin gene expression positively correlated with gestational age in UTI and with newborn anthropometric parameters. Our results suggest that vitamin D deficiency might predispose to maternal cardiovascular risk and perinatal infections especially in male-carrying pregnancies, probably due to lower placental CYP27B1 and cathelicidin expression.
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Affiliation(s)
- Andrea Olmos-Ortiz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
- Departamento de Inmunobioquímica, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas-Virreyes, Lomas de Chapultepec IV Sección, Miguel Hidalgo, Ciudad de Mexico 11000, Mexico
| | - Alberto Olivares-Huerta
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Janice García-Quiroz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Euclides Avila
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Ali Halhali
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Braulio Quesada-Reyna
- División de Obstetricia, UMAE Hospital de Gineco-Obstetricia No. 4 “Luis Castelazo Ayala”, IMSS, Rio de la Magdalena 289, Tizapán San Ángel, Progreso Tizapán, Álvaro Obregón, Ciudad de Mexico 01090, Mexico;
| | - Fernando Larrea
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
| | - Verónica Zaga-Clavellina
- Departamento de Fisiología y Desarrollo Celular, Instituto Nacional de Perinatología Isidro Espinosa de los Reyes, Montes Urales 800, Lomas-Virreyes, Lomas de Chapultepec IV Sección, Miguel Hidalgo, Ciudad de Mexico 11000, Mexico
- Correspondence: (V.Z.-C.); (L.D.)
| | - Lorenza Díaz
- Departamento de Biología de la Reproducción “Dr. Carlos Gual Castro”, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Av. Vasco de Quiroga No. 15, Belisario Domínguez Sección XVI, Tlalpan, Ciudad de Mexico 14080, Mexico; (A.O.-O.); (A.O.-H.); (J.G.-Q.); (E.A.); (A.H.); (F.L.)
- Correspondence: (V.Z.-C.); (L.D.)
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Abstract
BACKGROUND The patient suffering from urinary sepsis is often accompanied by elevated serum procalcitonin (PCT) levels and a decline in the average platelet count (PLT), which could result in a poor prognosis. This study aimed to evaluate the value of PCT and PLT in determining the severity of urinary sepsis. METHODS A total of 120 urosepsis patients enrolled were divided into a survival group and a death group, respectively, according to their status within 14 days after admission. Changes in PCT and PLT levels between the 2 groups were compared at different time points. A receiver operating characteristic (ROC) curve was eventually obtained to predict the prognostic value of PCT and PLT. RESULTS The PCT levels in the survival group declined gradually after admission, and the PLT decreased at first but increased rapidly in subsequence. The PCT level in the death group, however, declined in a flat-slope trend or was hardly noticeable together with the number of PLT reduced significantly. In particular, it is on the 3rd day that PCT tended to positively correlate with acute physiological and chronic health score II (APACHE II) score (r = 0.730, P < .05), but negatively with PLT (r = 0.472, P < .05). The APACHE II score and PLT (r = 0.612, P < .05) were also negatively correlated with each other. As indicated by the ROC curve, the PCT level on the 3rd day after admission was of great value for the clinical mortality prognosis, and the area under the curve was 0.858. Moreover, PLT also has a high predictive value for prognosis. Area under the curve is 0.951. When the PLT was more than 51 × 109 /L, the sensitivity was up to 90%, and the specificity was 90%. CONCLUSION PLT and PCT levels are closely related to the APACHE II score, which could indicate the severity of urosepsis in patients. The contribution of this study was to confirm that dynamic monitoring of the changes in PCT and PLT helps determine the prognosis of urosepsis patients.
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Affiliation(s)
- Ling Jiang
- Department of Clinical Laboratory Center, Rongcheng Hospital Affiliated to Shandong First Medical University, Rongcheng, P.R. China
| | - Shao-Hua Lin
- Department of Respiratory and Critical Care Medicine, Rongcheng Hospital Affiliated to Shandong First Medical University, Rongcheng, P.R. China
| | - Jun Wang
- Department of Urology, Rongcheng Hospital Affiliated to Shandong First Medical University, Rongcheng, P.R. China
| | - Cun-Kun Chu
- Library Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan, P.R. China
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Gilboe HM, Reiakvam OM, Aasen L, Tjade T, Bjerner J, Ranheim TE, Gaustad P. Rapid diagnosis and reduced workload for urinary tract infection using flowcytometry combined with direct antibiotic susceptibility testing. PLoS One 2021; 16:e0254064. [PMID: 34228764 PMCID: PMC8259986 DOI: 10.1371/journal.pone.0254064] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 06/19/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We evaluated if flowcytometry, using Sysmex UF-5000, could improve diagnosis of urinary tract infections by rapid identification of culture negative and contaminated samples prior to culture plating, thus reducing culture plating workload and response time. We also evaluated if it is possible to reduce the response time for antibiotic susceptibility profiles using the bacteria information flag on Sysmex UF-5000 to differentiate between Gram positive and negative bacteria, followed by direct Antibiotic Susceptibility Testing (dAST) on the positive urine samples. METHODS One thousand urine samples were analyzed for bacteria, white blood cells and squamous cells by flowcytometry before culture plating. Results from flowcytometric analysis at different cut-off values were compared to results of culture plating. We evaluated dAST on 100 urine samples that were analyzed as positive by flowcytometry, containing either Gram positive or Gram negative bacteria. RESULTS Using a cut-off value with bacterial count ≥100.000/mL and WBCs ≥10/μL, flowcytometry predicted 42,1% of samples with non-significant growth. We found that most contaminated samples contain few squamous cells. For 52/56 positive samples containing Gram negative bacteria dAST was identical to routine testing. Overall, there was concordance in 555/560 tested antibiotic combinations. CONCLUSION Flowcytometry offers advantages for diagnosis of urinary tract infections. Screening for negative urine samples on the day of arrival reduces culture plating and workload, and results in shorter response time for the negative samples. The bacteria information flag predicts positive samples containing Gram negative bacteria for dAST with high accuracy, thus Antibiotic Susceptibility Profile can be reported the day after arrival. For the positive samples containing Gram negative bacteria the concordance was very good between dAST and Antibiotic Susceptibility Testing in routine. For positive samples containing Gram positive bacteria the results were not convincing. We did not find any correlation between epithelial cells and contamination.
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Affiliation(s)
| | | | - Linda Aasen
- Department of Microbiology, Fürst Medical Laboratory, Oslo, Norway
| | - Trygve Tjade
- Department of Microbiology, Fürst Medical Laboratory, Oslo, Norway
| | - Johan Bjerner
- Department of Microbiology, Fürst Medical Laboratory, Oslo, Norway
| | | | - Peter Gaustad
- Department of Microbiology, Fürst Medical Laboratory, Oslo, Norway
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Poon JYK, Tang DYY, Siu BWM, Lui SH. Elevated Clozapine Level Following Acute Infection in a Patient with Schizophrenia: a Case Report. East Asian Arch Psychiatry 2020; 30:120-121. [PMID: 33349619 DOI: 10.12809/eaap1954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
We describe a 58-year-old Chinese man with schizophrenia who presented with an elevated clozapine level suspected to be related to acute infection.
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Affiliation(s)
| | | | | | - S H Lui
- Castle Peak Hospital, Hong Kong
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Shaikh KJ, Osio VA, Leeflang MM, Shaikh N. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev 2020; 9:CD009185. [PMID: 32911567 PMCID: PMC8479592 DOI: 10.1002/14651858.cd009185.pub3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND In children with urinary tract infection (UTI), only those with pyelonephritis (and not cystitis) are at risk for developing long-term renal sequelae. If non-invasive biomarkers could accurately differentiate children with cystitis from children with pyelonephritis, treatment and follow-up could potentially be individualized. This is an update of a review first published in 2015. OBJECTIVES The objectives of this review were to 1) determine whether procalcitonin (PCT), C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) can replace the acute DMSA scan in the diagnostic evaluation of children with UTI; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other. SEARCH METHODS We searched MEDLINE, EMBASE, DARE, Web of Science, and BIOSIS Previews through to 17th December 2019 for this review. The reference lists of all included articles and relevant systematic reviews were searched to identify additional studies not found through the electronic search. SELECTION CRITERIA We only considered published studies that evaluated the results of an index test (PCT, CRP, ESR) against the results of an acute-phase 99Tc-dimercaptosuccinic acid (DMSA) scan (conducted within 30 days of the UTI) in children aged 0 to 18 years with a culture-confirmed episode of UTI. The following cut-off values were used for the primary analysis: 0.5 ng/mL for procalcitonin, 20 mg/L for CRP and 30 mm/hour for ESR. DATA COLLECTION AND ANALYSIS Two authors independently applied the selection criteria to all citations and independently abstracted data. We used the bivariate model to calculate pooled random-effects pooled sensitivity and specificity values. MAIN RESULTS A total of 36 studies met our inclusion criteria. Twenty-five studies provided data for the primary analysis: 12 studies (1000 children) included data on PCT, 16 studies (1895 children) included data on CRP, and eight studies (1910 children) included data on ESR (some studies had data on more than one test). The summary sensitivity estimates (95% CI) for the PCT, CRP, ESR tests at the aforementioned cut-offs were 0.81 (0.67 to 0.90), 0.93 (0.86 to 0.96), and 0.83 (0.71 to 0.91), respectively. The summary specificity values for PCT, CRP, and ESR tests at these cut-offs were 0.76 (0.66 to 0.84), 0.37 (0.24 to 0.53), and 0.57 (0.41 to 0.72), respectively. AUTHORS' CONCLUSIONS The ESR test does not appear to be sufficiently accurate to be helpful in differentiating children with cystitis from children with pyelonephritis. A low CRP value (< 20 mg/L) appears to be somewhat useful in ruling out pyelonephritis (decreasing the probability of pyelonephritis to < 20%), but unexplained heterogeneity in the data prevents us from making recommendations at this time. The procalcitonin test seems better suited for ruling in pyelonephritis, but the limited number of studies and the marked heterogeneity between studies prevents us from reaching definitive conclusions. Thus, at present, we do not find any compelling evidence to recommend the routine use of any of these tests in clinical practice.
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Affiliation(s)
- Kai J Shaikh
- Department of Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Victor A Osio
- Department of General Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
| | - Mariska Mg Leeflang
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Nader Shaikh
- General Academic Pediatrics, Children's Hospital of Pittsburgh, Pittsburgh, PA, USA
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7
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Abstract
Patients with stroke have a high risk of infection which may be predicted by age, procalcitonin, interleukin-6, C-reactive protein, National Institute of Health stroke scale (NHSS) score, diabetes, etc. These prediction methods can reduce unfavourable outcome by preventing the occurrence of infection.We aim to identify early predictors for urinary tract infection in patients after stroke.In 186 collected acute stroke patients, we divided them into urinary tract infection group, other infection type groups, and non-infected group. Data were recorded at admission. Independent risk factors and infection prediction model were determined using Logistic regression analyses. Likelihood ratio test was used to detect the prediction effect of the model. Receiver operating characteristic curve and the corresponding area under the curve were used to measure the predictive accuracy of indicators for urinary tract infection.Of the 186 subjects, there were 35 cases of urinary tract infection. Elevated interleukin-6, higher NIHSS, and decreased hemoglobin may be used to predict urinary tract infection. And the predictive model for urinary tract infection (including sex, NIHSS, interleukin-6, and hemoglobin) have the best predictive effect.This study is the first to discover that decreased hemoglobin at admission may predict urinary tract infection. The prediction model shows the best accuracy.
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Affiliation(s)
- Ya-ming Li
- Department of Neurology, Jiading District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences
| | - Jian-hua Xu
- Department of Neurology, Jiading District Central Hospital affiliated to Shanghai University of Medicine & Health Sciences
| | - Yan-xin Zhao
- Department of Neurology, Tenth People's Hospital affiliated to Tongji University, Shanghai, China
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Varela-Patiño M, Lopez-Izquierdo R, Velayos-Garcia P, Alvarez-Manzanares J, Ramos-Sanchez C, Carbajosa-Rodriguez V, Martin-Rodriguez F, Eiros JM. Usefulness of infection biomarkers for diagnosing bacteremia in patients with a sepsis code in the emergency department. Infez Med 2020; 28:29-36. [PMID: 32172258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The objective of this study was to assess the usefulness of the biomarkers lactate, C-reactive protein (CPR) and procalcitonin for the diagnosis of bacteremia in patients with suspected sepsis in the emergency department (ED) and according to the focus of infection. We conducted a retrospective study among patients included in the sepsis code of our ED between November 2013 and December 2017. We analyzed demographic variables, co-morbidity according to the Charlson Index and focus of infection, blood cultures and classification according to Gram staining. We determined the diagnostic performance of the biomarkers quantitatively and calculated the area under the curve (AUC) for global bacteremia and as a function of the focus of infection. We included 653 patients with a median age of 79 years (interquartile range: 66-86), of whom 287 (44.0% were women. The most frequent infectious focus was respiratory (36.1%]. Blood cultures were requested in 87.5% (569 cases). Of the tested samples, 31.3% were positive, of which 63.5% revealed Gram-negative (GN) bacteria. Procalcitonin obtained globally the best AUC 0.70 (95% CI: 0.65-0.75). The values with the best sensitivity and specificity were 2.54 ng/mL for procalcitonin, 4.1 mmol/L for lactate and 156 mg/L for CRP. We found an association between the median procalcitonin value and GN bacteria (6.02; IQR: 1.39-39.40) and Gram-positive bacteria (1.74; IQR: 0.22-15.61). Procalcitonin is the biomarker with the greatest capacity to diagnose bacteremia, particularly in GN infection. Stratification by focus is important since not all biomarkers discriminate in the same way.
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Affiliation(s)
| | - Raul Lopez-Izquierdo
- Emergency Department, University Hospital "Rio Hortega", Valladolid, Spain; Faculty of Medicine, University of Valladolid, Spain
| | | | | | | | | | | | - Jose Maria Eiros
- Microbiology Department, University Hospital "Rio Hortega", Valladolid, Spain
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Fortini A, Faraone A, Bettucchi M, Poggi A, Filetti S, Boccadori C, Sbaragli S. Yield and clinical impact of blood cultures in patients admitted to an internal medicine ward. Infez Med 2020; 28:55-63. [PMID: 32172261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The purpose of this prospective observational study was to evaluate the yield and clinical impact of blood cultures in a 78-bed Internal Medicine ward of a medium-sized Italian acute care hospital. During a two-month study period, 154 (mean age: 75.2 ++ 12.2 years; 94 males) out of 620 (24.8%) hospitalized patients underwent 174 blood cultures and were enrolled in the study. The rate of true-positive cultures was 11.5% (20/174) and the rate of false-positive (contaminants) was 5.7% (10/174). A total of 23 microorganisms (5 multidrug resistant strains), most frequently Escherichia coli (n = 10), Klebsiella pneumoniae (n = 3) and Staphylococcus aureus (n = 3), were isolated. The positivity rate was significantly higher in patients with urinary tract infection (31%) and abdomen infection (26.1%) than in patients with pneumonia (4.9%; p<0.01). Although the positivity rate in patients exposed to antibiotics was lower than in those not exposed, the difference was not statistically significant. Therapy changes due to blood culture positivity were observed in 7.1% of the patients overall. In-hospital death was observed in nine of the 136 patients with negative blood cultures (6.6%) and in none of the 18 patients with positive blood cultures. These results indicate that the yield and clinical impact of blood cultures is quite low in patients admitted to an Internal Medicine ward and suggest the need to improve the adequacy of the indications to perform the test.
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Affiliation(s)
- Alberto Fortini
- Internal Medicine, San Giovanni di Dio Hospital, Firenze, Italy
| | - Antonio Faraone
- Internal Medicine, San Giovanni di Dio Hospital, Firenze, Italy
| | | | - Alice Poggi
- Internal Medicine, San Giovanni di Dio Hospital, Firenze, Italy
| | - Simona Filetti
- Internal Medicine, San Giovanni di Dio Hospital, Firenze, Italy
| | | | - Serena Sbaragli
- Internal Medicine, San Giovanni di Dio Hospital, Firenze, Italy
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10
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Gökçe Ş, Kurugöl Z. Diagnostic Accuracy of the Mean Platelet Volume in the Prediction of Upper Urinary Tract Infections. Clin Lab 2020; 66. [PMID: 32162888 DOI: 10.7754/clin.lab.2019.190647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The studies have reported that mean platelet volume may be a marker in the discrimination of upper and lower urinary tract infections. We investigated whether the mean platelet volume was a reliable indicator in upper and lower urinary tract infections. METHODS One hundred and eighty-two patients between the ages of 1 month and 14 years who were diagnosed with urinary tract infection were included in this study. The mean platelet volume values, clinical and other laboratory characteristics of the groups were compared. The discriminative ability of each biomarker for patients with UUTI was evaluated by drawing receiver operating characteristic (ROC) curves for the biomarkers. All values of p < 0.05 were considered statistically significant. RESULTS The leukocyte count, C-reactive protein, and erythrocyte sedimentation rates of the patients with upper urinary tract infection were significantly higher than the patients with lower urinary tract infections (p < 0.001). However, there was no statistically significant difference in terms of the mean platelet volume values between patients with upper and lower urinary tract infection ([7.2 (1.3) vs. 7.2 (1.6) fL]; p = 0.79, respectively). The value of the area under the curve of MPV's p-value was > 0.05. However, p-values of CRP and ESR were significant in ROC analysis. CONCLUSIONS Our study showed that there was no significant difference in the mean platelet volume values between patients with upper and lower urinary tract infections. The use of mean platelet volume as an indicator of upper urinary tract infection is controversial.
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Sharma J, Singhal J. A child with urosepsis and a bladder with a halo: Questions. Pediatr Nephrol 2020; 35:73-74. [PMID: 31420728 DOI: 10.1007/s00467-019-04323-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Revised: 07/23/2019] [Accepted: 07/26/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jyoti Sharma
- Pediatric Nephrology, KEM Hospital, Sardar Moodliar Road, Pune, Maharashtra, 411011, India.
| | - Jyoti Singhal
- Pediatric Nephrology, KEM Hospital, Sardar Moodliar Road, Pune, Maharashtra, 411011, India
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12
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Kuil SD, Hidad S, Fischer JC, Harting J, Hertogh CM, Prins JM, van Leth F, de Jong MD, Schneeberger C. Sensitivity of point-of-care testing C reactive protein and procalcitonin to diagnose urinary tract infections in Dutch nursing homes: PROGRESS study protocol. BMJ Open 2019; 9:e031269. [PMID: 31401614 PMCID: PMC6701568 DOI: 10.1136/bmjopen-2019-031269] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Suspected urinary tract infection (UTI) ranks among the most common reasons for antibiotic use in nursing homes. However, diagnosing UTI in this setting is challenging because UTI often presents with non-specific symptomatology. Moreover asymptomatic bacteriuria is common in elderly, which complicates attribution of causality to detection of bacteria in urine. These diagnostic challenges contribute to overuse of antibiotics and emergence of antimicrobial resistance in nursing homes. Given the diagnostic challenges, there is a need for point-of-care (POC) diagnostic tests to support clinical rules for diagnosing UTI. Procalcitonin (PCT) and C reactive protein (CRP) are inflammatory blood markers that have been proven useful to support diagnosis and monitoring of (bacterial) respiratory tract infections and sepsis. While limited studies suggest their usefulness in supporting UTI diagnosis, their utility has not been studied in elderly populations for this purpose. METHODS AND ANALYSIS In a 24-month matched prospective study, 'PROGRESS' will assess and compare the sensitivity of rapid POC measurements of blood CRP and PCT levels to support clinical rules for diagnosing UTI in nursing home residents. The primary outcome measure is sensitivity of the POC tests to identify patients with true UTI based on the predefined definition, as derived from receiver operating curves. ETHICS AND DISSEMINATION This study will be conducted in accordance with Good Clinical Practice guidelines and the principles of the Declaration of Helsinki. The study protocol is approved by the Medical Ethical Committee of Amsterdam UMC location VUmc with reference number 2017.350 and National Central Committee on Research involving Human Subjects with reference number NL62067.029.17. TRIAL REGISTRATION NUMBER NTR6467.
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Affiliation(s)
- Sacha D Kuil
- Medical Microbiology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Soemeja Hidad
- Medical Microbiology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Johan C Fischer
- Clinical Chemistry, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Janneke Harting
- Public Health, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Cees Mpm Hertogh
- General Practice and Elderly Care Medicine, Amsterdam UMC Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jan M Prins
- Internal Medicine, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Frank van Leth
- Global Health, Amsterdam Institute for Global Health and Development, Amsterdam, The Netherlands
| | - Menno D de Jong
- Medical Microbiology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
| | - Caroline Schneeberger
- Medical Microbiology, Amsterdam UMC University of Amsterdam, Amsterdam, The Netherlands
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Schauer I, Al-Ali BM, Lüftenegger W, Madersbacher S, Eredics K. Is there a place for indwelling transurethral catheterization in women with febrile urinary tract infection? A prospective randomized trial. World J Urol 2019; 37:849-852. [PMID: 30167830 DOI: 10.1007/s00345-018-2474-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 08/28/2018] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To assess the common practice to transiently place an indwelling transurethral catheter in case of hospitalization of women with febrile urinary tract infections. So far, this intervention has not been scientifically investigated. METHODS Inclusion criteria were female gender, a leucocyte esterase-positive urine dipstick analysis (≥ 250) from urine obtained with a catheter and fever > 38 °C. Patients were randomized 1:1 to either receive an indwelling catheter French 16 or not. The catheter was removed after 24 h without fever (< 37.5 °C). Principal exclusion criteria were a post void residual volume exceeding 50 mL or abnormalities of the urinary tract. Hospital stay and fever in days, the amount of analgetic medication needed and the laboratory parameters WBC and CRP-measured on the day of admission and in predefined intervals thereafter-were study endpoints. RESULTS 75 patients were included in the final analysis, 36 in the catheter group and 39 in the no-catheter group. Mean age was 39.4 ± 17.7 years and 39.8 ± 15.5 years, respectively (p > 0.05). The mean length of catheterisation was 3.6 ± 1.6 days in the catheter group. There were no differences between the two groups regarding duration of hospitalization and fever, or the amount of analgetic medication needed (all p > 0.05). Additionally, there was no difference in time to WBC < 10 G/L or CRP < 100 mg/L (all p > 0.05). CONCLUSIONS This prospective, randomized trial provides no evidence to support routine insertion of an indwelling catheter in women with febrile urinary tract infection requiring hospital admission.
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Affiliation(s)
- Ingrid Schauer
- Department of Urology, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | | | - Werner Lüftenegger
- Department of Urology, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
| | - Stephan Madersbacher
- Department of Urology, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria.
| | - Klaus Eredics
- Department of Urology, Kaiser-Franz-Josef Hospital, Kundratstraße 3, 1100, Vienna, Austria
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Sorli L, Luque S, Li J, Rodríguez E, Campillo N, Fernandez X, Soldado J, Domingo I, Montero M, Grau S, Horcajada JP. Colistin Use in Patients with Chronic Kidney Disease: Are We Underdosing Patients? Molecules 2019; 24:molecules24030530. [PMID: 30717123 PMCID: PMC6384574 DOI: 10.3390/molecules24030530] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 01/29/2019] [Accepted: 01/31/2019] [Indexed: 01/08/2023] Open
Abstract
Colistin is administered as its inactive prodrug colistimethate (CMS). Selection of an individualized CMS dose for each patient is difficult due to its narrow therapeutic window, especially in patients with chronic kidney disease (CKD). Our aim was to analyze CMS use in patients with CKD. Secondary objectives were to assess the safety and efficacy of CMS in this special population. In this prospective observational cohort study of CMS-treated CKD patients, CKD was defined as the presence of a glomerular filtration rate (GFR) < 60 mL/min/m2 for more than 3 months. The administered doses of CMS were compared with those recently published in the literature. Worsened CKD at the end of treatment (EOT) was evaluated with the RIFLE (Risk, Injury, Failure, Loss of kidney function, and End-stage kidney disease) criteria. Colistin plasma concentrations (Css) were measured using high-performance liquid chromatography. Fifty-nine patients were included. Thirty-six (61.2%) were male. The median age was 76 (45–95) years and baseline GFR was 36.6 ± 13.6. The daily mean CMS dosage used was compared with recently recommended doses (3.36 vs. 6.07; p < 0.001). Mean Css was 0.9 (0.2–2.9) mg/L, and Css was <2 mg/L in 50 patients (83.3%). Clinical cure was achieved in 43 (72.9%) patients. Worsened renal function at EOT was present in 20 (33.9%) patients and was reversible in 10 (52.6%). The CMS dosages used in this cohort were almost half those currently recommended. The mean achieved Css were under the recommended target of 2 mg/dL. Despite this, clinical cure rate was high. In this patient cohort, the incidence of nephrotoxicity was similar to those found in other recent studies performed in the general population and was reversible in 52.6%. These results suggest that CMS is safe and effective in patients with CKD and may encourage physicians to adjust dosage regimens to recent recommendations in order to optimize CMS treatments.
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Affiliation(s)
- Luisa Sorli
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
| | - Sonia Luque
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
- Pharmacy Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
| | - Jian Li
- Monash Biomedicine Discovery Institute, Department of Microbiology, Monash University, Clayton, 3800 Victoria, Australia.
| | - Eva Rodríguez
- Nephrology Department, Hospital del Mar, Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB). CEXS-Universitat Pompeu Fabra, 08003, 08003 Barcelona, Spain.
| | - Nuria Campillo
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
- Pharmacy Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
| | - Xenia Fernandez
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
- Pharmacy Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
| | - Jade Soldado
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
| | - Ignacio Domingo
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
| | - Milagro Montero
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
| | - Santiago Grau
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
- Pharmacy Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
| | - Juan P Horcajada
- Infectious Diseases Department, Hospital del Mar, Infectious Pathology and Antimicrobial Research Group (IPAR), Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Universitat Autònoma de Barcelona (UAB), CEXS-Universitat Pompeu Fabra, 08003 Barcelona, Spain.
- Spanish Network for Research in Infectious Diseases (REIPI RD 16/0016/0015), Instituto de Salud Carlos III, 28001 Madrid, Spain.
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Komirenko AS, Riddle V, Gibbons JA, Van Wart S, Seroogy JD. A Phase 1 Study To Assess the Pharmacokinetics of Intravenous Plazomicin in Adult Subjects with Varying Degrees of Renal Function. Antimicrob Agents Chemother 2018; 62:e01128-18. [PMID: 30275092 PMCID: PMC6256775 DOI: 10.1128/aac.01128-18] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 08/29/2018] [Indexed: 12/31/2022] Open
Abstract
Plazomicin is an FDA-approved aminoglycoside for the treatment of complicated urinary tract infections. In this open-label study, 24 adults with normal renal function or mild, moderate, or severe renal impairment (n = 6 per group) received a single 7.5-mg/kg of body weight dose of plazomicin as a 30-min intravenous infusion. Total clearance declined with renal impairment, resulting in 1.98-fold and 4.42-fold higher plazomicin exposures, as measured by the area under the concentration-time curve from 0 h to infinity, in subjects with moderate and severe impairment, respectively, than in subjects with normal renal function. (This study has been registered at ClinicalTrials.gov under identifier NCT01462136.).
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Affiliation(s)
| | | | | | - Scott Van Wart
- Institute for Clinical Pharmacodynamics, Schenectady, New York, USA
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Abstract
The aim of this study was to evaluate the effect of prescribing vitamin D on improving the symptoms of patients diagnosed with urosepsis. The participants were randomly divided into two equal groups (each consisting of 50 patients). The patients in the first group received standard treatment with 300 000 units of injected vitamin with a volume of 1 cc. As for the patients in the second group, they received standard treatment along with 1 cc normal saline injected to them as placebo. Vital signs of the patients were checked every 6 h, while their CBC, EXR, CRP, creatinine, urea, and uric acid were checked 0, 24, 48, and 72 h following the interventions. Calcium, phosphorus, and vitamin D levels were measured 72 h following injection of the medicine. A significant difference was observed between the two groups in terms of the number of WBC's in 24th, 48th, and 72nd hours. A similarly significant difference was reported between the case and control group in terms of the average BUN within 24th, 48th, and 72nd hours. The difference observed between the two groups in terms of average Cr within the 0th, 24th, 48th, and 72nd hours and in terms of days of hospitalization was also significant. Considering these results and keeping in mind the fact that no particular side effects were reported as a result of utilizing muscular injections of vitamin D and the easy and cheap use of this medicine, it can be used in auxiliary treatment of patients with urosepsis.
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Affiliation(s)
- Abolfazl Jokar
- Department of Emergency Medicine, Arak University of Medical Sciences, Arak, Iran
| | - Koorosh Ahmadi
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Taherinia
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
| | - Farshideh Didgar
- Department of Infectious Diseases, Arak University of Medical Sciences, Arak, Iran
| | | | - Mehran Bahramian
- Department of Emergency Medicine, Alborz University of Medical Sciences, Karaj, Iran
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Lee JW, Her SM, Kim JH, Lee KH, Eisenhut M, Park SJ, Shin JI. D-dimer as a marker of acute pyelonephritis in infants younger than 24 months with urinary tract infection. Pediatr Nephrol 2018; 33:631-637. [PMID: 29306986 DOI: 10.1007/s00467-017-3843-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 09/15/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND D-dimer, as well as other biomarkers related to coagulation, is significantly increased during severe bacterial infection and sepsis. The aim of this study was to evaluate the usefulness of serum D-dimer as a biological marker in diagnosing acute pyelonephritis (APN) and in predicting vesicoureteric reflux (VUR) in infants with urinary tract infection (UTI). METHODS We retrospectively analyzed the data of 177 young infants (<2 years) with febrile UTI between 2005 and 2014, grouped as APN and lower UTI groups. Conventional inflammatory markers (white blood cell count (WBC), erythrocyte sedimentation rates (ESR), C-reactive protein (CRP)), and D-dimer were measured. RESULTS The WBC counts (P = 0.002), ESR (P < 0.0001), CRP (P < 0.0001), D-dimer levels (P = 0.006) and the presence of VUR (P < 0.0001) were significantly higher in the APN group than in the lower UTI group. Multiple logistic regression analyses showed that D-dimer (odds ratio [OR]:1.003, 95% CI: 1.001-1.006, P = 0.002) was an independent predictive factor for VUR in young children with UTI. The area under the curve (AUC) value from the receiver operating characteristic (ROC) curve of D-dimer (0.621, P = 0.046, 95% CI: 0.499-0.743) for prediction of VUR was higher than other inflammatory markers, but was inferior to CRP in predicting APN. CONCLUSIONS Our results demonstrate that D-dimer can be used as an inflammatory marker in infants with febrile UTI in addition to other inflammatory markers.
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Affiliation(s)
- Jung Won Lee
- Department of Pediatrics, Ewha Womans University Mokdong Hospital, Ewha Womans University College of Medicine, Seoul, South Korea
| | - Sun Mi Her
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea
| | - Ji Hong Kim
- Department of Pediatrics, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
| | - Keum Hwa Lee
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, South Korea
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Michael Eisenhut
- Department of Pediatrics, Luton & Dunstable University Hospital NHS Foundation Trust, Luton, UK
| | - Se Jin Park
- Department of Pediatrics, Geoje Children's Hospital, Ajou University School of Medicine, Geoje, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, C.P.O. Box 8044, Seoul, 120-752, South Korea.
- Department of Pediatric Nephrology, Severance Children's Hospital, Seoul, South Korea.
- Institute of Kidney Disease Research, Yonsei University College of Medicine, Seoul, Republic of Korea.
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Taubert M, Lückermann M, Vente A, Dalhoff A, Fuhr U. Population Pharmacokinetics of Finafloxacin in Healthy Volunteers and Patients with Complicated Urinary Tract Infections. Antimicrob Agents Chemother 2018; 62:e02328-17. [PMID: 29339394 PMCID: PMC5913927 DOI: 10.1128/aac.02328-17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 01/09/2018] [Indexed: 02/01/2023] Open
Abstract
Finafloxacin is a novel fluoroquinolone with increased antibacterial activity at acidic pH and reduced susceptibility to several resistance mechanisms. A phase II study revealed a good efficacy/safety profile in patients with complicated urinary tract infections (cUTIs), while the pharmacokinetics was characterized by highly variable concentration-versus-time profiles, suggesting the need for an elaborated pharmacokinetic model. Data from three clinical trials were evaluated: 127 healthy volunteers were dosed orally (n = 77) or intravenously (n = 50), and 139 patients with cUTI received finafloxacin intravenously. Plasma (2,824 samples from volunteers and 414 samples from patients) and urine (496 samples from volunteers and 135 samples patients) concentrations were quantified by liquid chromatography-tandem mass spectrometry (LC-MS/MS). NONMEM was used to build a population pharmacokinetic model, and pharmacokinetic/pharmacodynamic relationships were investigated via simulations and logistic regression. A two-compartment model with first-order elimination described the data best (central volume of distribution [Vc] and peripheral volume of distribution [Vp] of 47 liters [20%] and 43 liters [67%], respectively, and elimination clearance and intercompartmental clearance of 21 liters/h [54%] and 2.8 liters/h [57%], respectively [median bootstrap estimates {coefficients of variation}]). Vc increased with body surface area, and clearance was reduced in patients (-29%). Oral absorption was described best by parallel first- and zero-order processes (bioavailability of 75%). No pharmacodynamic surrogate parameter of clinical/microbiological outcome could be identified, which depended exclusively on the MIC of the causative pathogens. Despite the interindividual variability, the present data set does not support covariate-based dose adjustments. Based on the favorable safety and efficacy data, the clinical relevance of the observed variability appears to be limited. (This study has been registered at ClinicalTrials.gov under identifier NCT01928433.).
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Affiliation(s)
- Max Taubert
- Department I of Pharmacology, Clinical Pharmacology Unit, University Hospital Cologne, Cologne, Germany
| | | | | | - Axel Dalhoff
- Institute for Infection Medicine, Christian Albrechts University of Kiel, Kiel, Germany
| | - Uwe Fuhr
- Department I of Pharmacology, Clinical Pharmacology Unit, University Hospital Cologne, Cologne, Germany
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Savardi M, Ferrari A, Signoroni A. Automatic hemolysis identification on aligned dual-lighting images of cultured blood agar plates. Comput Methods Programs Biomed 2018; 156:13-24. [PMID: 29428064 DOI: 10.1016/j.cmpb.2017.12.017] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Revised: 11/16/2017] [Accepted: 12/18/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND AND OBJECTIVE The recent introduction of Full Laboratory Automation systems in clinical microbiology opens to the availability of streams of high definition images representing bacteria culturing plates. This creates new opportunities to support diagnostic decisions through image analysis and interpretation solutions, with an expected high impact on the efficiency of the laboratory workflow and related quality implications. Starting from images acquired under different illumination settings (top-light and back-light), the objective of this work is to design and evaluate a method for the detection and classification of diagnostically relevant hemolysis effects associated with specific bacteria growing on blood agar plates. The presence of hemolysis is an important factor to assess the virulence of pathogens, and is a fundamental sign of the presence of certain types of bacteria. METHODS We introduce a two-stage approach. Firstly, the implementation of a highly accurate alignment of same-plate image scans, acquired using top-light and back-light illumination, enables the joint spatially coherent exploitation of the available data. Secondly, from each segmented portion of the image containing at least one bacterial colony, specifically designed image features are extracted to feed a SVM classification system, allowing detection and discrimination among different types of hemolysis. RESULTS The fine alignment solution aligns more than 98.1% images with a residual error of less than 0.13 mm. The hemolysis classification block achieves a 88.3% precision with a recall of 98.6%. CONCLUSIONS The results collected from different clinical scenarios (urinary infections and throat swab screening) together with accurate error analysis demonstrate the suitability of our system for robust hemolysis detection and classification, which remains feasible even in challenging conditions (low contrast or illumination changes).
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Affiliation(s)
- Mattia Savardi
- Information Engineering Dept., University of Brescia, Brescia, Italy
| | | | - Alberto Signoroni
- Information Engineering Dept., University of Brescia, Brescia, Italy.
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Kawaguchi N, Katsube T, Echols R, Wajima T. Population Pharmacokinetic Analysis of Cefiderocol, a Parenteral Siderophore Cephalosporin, in Healthy Subjects, Subjects with Various Degrees of Renal Function, and Patients with Complicated Urinary Tract Infection or Acute Uncomplicated Pyelonephritis. Antimicrob Agents Chemother 2018; 62:e01391-17. [PMID: 29038272 PMCID: PMC5786804 DOI: 10.1128/aac.01391-17] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 10/05/2017] [Indexed: 12/02/2022] Open
Abstract
Cefiderocol, a novel parenteral siderophore cephalosporin, exhibits potent efficacy against most Gram-negative bacteria, including carbapenem-resistant strains. The aim of this study was to perform a population pharmacokinetic (PK) analysis based on plasma cefiderocol concentrations in healthy subjects, subjects with various degrees of renal function, and patients with complicated urinary tract infection (cUTI) or acute uncomplicated pyelonephritis (AUP) caused by Gram-negative pathogens and to calculate the fraction of the time during the dosing interval where the free drug concentration in plasma exceeds the MIC (fTMIC). Population PK models were developed with three renal function markers, body surface area-adjusted estimated glomerular filtration rate (eGFR), absolute eGFR, and creatinine clearance, on the basis of 2,571 plasma concentrations from 91 subjects without infection and 238 patients with infection. The population PK models with each renal function marker adequately described the plasma cefiderocol concentrations. Clear relationships of total clearance (CL) to all renal function markers were observed. Body weight and disease status (with or without infection) were also significant covariates. The CL in patients with infection was 26% higher than that in subjects without infection. The fTMIC values were more than 75% in all patients (and were 100% in most patients), suggesting that a sufficient exposure to cefiderocol was provided by the tested dose regimens (2 g every 8 h as the standard dose regimen) for the treatment of cUTI or AUP caused by Gram-negative pathogens.
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Affiliation(s)
- Nao Kawaguchi
- Project Management Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Takayuki Katsube
- Project Management Department, Shionogi & Co., Ltd., Osaka, Japan
| | - Roger Echols
- Infectious Disease Drug Development Consulting, LLC, Easton, Connecticut, USA
| | - Toshihiro Wajima
- Project Management Department, Shionogi & Co., Ltd., Osaka, Japan
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Han P, Huang Y, Xie Y, Yang W, Wang Y, Xiang W, Hylands PJ, Legido-Quigley C. Metabolic phenotyping in the mouse model of urinary tract infection shows that 3-hydroxybutyrate in plasma is associated with infection. PLoS One 2017; 12:e0186497. [PMID: 29036204 PMCID: PMC5643114 DOI: 10.1371/journal.pone.0186497] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 10/03/2017] [Indexed: 02/08/2023] Open
Abstract
Urinary tract infection is one of the most common bacterial infections worldwide. Current diagnosis of urinary tract infection chiefly relies on its clinical presentation, urine dipstick tests and urine culture. Small molecules found in bio-fluids related with both infection and recovery would facilitate diagnosis and management of UTI. Mass spectrometry-based fingerprinting of plasma and urine at 3 time points, pre-infection (t = -24h), infection (t = 24h) and post 3-day treatment (t = 112h), were acquired in the following four groups: mice which were healthy, infected but not treated, infected and treated with ciprofloxacin, and infected and treated with Relinqing® granules (n = 6 per group). A metabolomics workflow including multivariate analysis and ROC regression was employed to select metabolic features that correlated with UTI and its treatment. Circa 4,000 molecular features were acquired for each sample. The small acid 3-hydroxybutyrate in plasma was found to be differentiated for urinary tract infection, with an area under the curve = 0.97 (95% confidence interval: 0.93–1.00, accuracy = 0.91, sensitivity = 0.92 and specificity = 0.91). The level of 3-hydroxybutyrate in plasma was depleted after infection with a fold change of -22 (q < 0.0001). Correlation between plasma 3-hydroxybutyrate and urine bacterial number in all groups and time points was r = -0.753 (p < 0.0001). The findings show that 3-hydroxybutyrate is depleted in blood and strongly associated with UTI at both infection and post-treatment stage in a UTI mouse model. Further work is envisaged to assess the clinical potential of blood tests to assist with UTI management.
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Affiliation(s)
- Pei Han
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Yong Huang
- Provincial Key Laboratory of Pharmaceutics in Guizhou Province, School of Pharmacy, Guiyang Medical University, Guiyang, Guizhou, China
| | - Yumin Xie
- Provincial Key Laboratory of Pharmaceutics in Guizhou Province, School of Pharmacy, Guiyang Medical University, Guiyang, Guizhou, China
| | - Wu Yang
- Provincial Key Laboratory of Pharmaceutics in Guizhou Province, School of Pharmacy, Guiyang Medical University, Guiyang, Guizhou, China
| | - Yaoyao Wang
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
| | - Wenying Xiang
- Provincial Key Laboratory of Pharmaceutics in Guizhou Province, School of Pharmacy, Guiyang Medical University, Guiyang, Guizhou, China
| | - Peter J. Hylands
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- * E-mail: (CLQ); (PJH)
| | - Cristina Legido-Quigley
- Institute of Pharmaceutical Science, Faculty of Life Sciences & Medicine, King’s College London, London, United Kingdom
- * E-mail: (CLQ); (PJH)
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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: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [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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Mathieu C, Herrera Marmolejo M, González González JG, Hansen L, Chen H, Johnsson E, Garcia-Sanchez R, Iqbal N. Efficacy and safety of triple therapy with dapagliflozin add-on to saxagliptin plus metformin over 52 weeks in patients with type 2 diabetes. Diabetes Obes Metab 2016; 18:1134-1137. [PMID: 27385192 DOI: 10.1111/dom.12737] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Revised: 06/29/2016] [Accepted: 06/30/2016] [Indexed: 01/10/2023]
Abstract
We previously reported that dapagliflozin versus placebo as add-on to saxagliptin plus metformin resulted in greater reductions in glycated haemoglobin (A1C), fasting plasma glucose (FPG) and body weight (BW) after 24 weeks of treatment in patients with type 2 diabetes (T2D). Here we report results after 52 weeks of treatment. Patients stabilized on open-label metformin and saxagliptin 5 mg/day for 8-16 weeks were randomized to placebo or dapagliflozin 10 mg/day plus open-label saxagliptin plus metformin for 52 weeks. Changes from baseline to week 52 were greater with dapagliflozin versus placebo in A1C (-0.74% vs. 0.07%), FPG (-27 vs. 10 mg/dL) and BW (-2.1 vs. -0.4 kg). More patients achieved A1C <7% with dapagliflozin (29.4%) versus placebo (12.6%). Adverse events were similar with dapagliflozin (66%) and placebo (71%), and hypoglycaemia was rare (≤2%). Genital infections occurred more often with dapagliflozin (6%) than with placebo (1%); frequency of urinary tract infections was similar between the two groups (9% vs. 10%). Triple therapy with dapagliflozin add-on to saxagliptin plus metformin is a durable, effective and well-tolerated intervention for the treatment of T2D.
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Affiliation(s)
- C Mathieu
- Clinical and Experimental Endocrinology, Katholieke Universiteit Leuven, Leuven, Belgium.
| | | | | | - L Hansen
- Global Clinical Research Metabolics, Bristol-Myers Squibb, Princeton, New Jersey, USA
| | - H Chen
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - E Johnsson
- Global Medicines Development, AstraZenca, Gothenburg, Sweden
| | - R Garcia-Sanchez
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
| | - N Iqbal
- Global Medicines Development, AstraZeneca, Gaithersburg, Maryland, USA
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24
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Mussap M, Cataldi L, Plebani M, Fanos V. Laboratory Investigation for the Early Diagnosis and Monitoring of Neonatal Urinary Tract Infections: the Present Situation and Future Perspectives. J Chemother 2016; 18 Spec no 3:9-13. [PMID: 16789365 DOI: 10.1080/1120009x.2006.11782420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M Mussap
- Laboratory Medicine, University Hospital San Martino, Genova, Italy.
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Imran K, Zafar MN, Ozair U, Khan S, Rizvi SAH. Metabolic risk factors in pediatric stone formers: a report from an emerging economy. Urolithiasis 2016; 45:379-386. [PMID: 27744630 DOI: 10.1007/s00240-016-0922-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 09/12/2016] [Indexed: 11/27/2022]
Abstract
The goal of this study was to investigate metabolic risk factors in pediatric stone formers in an emerging economy. A prospective, data collection enrolled 250 children age <1-15 years at our center. Risk factors were evaluated by gender and in age groups <1-5, 6-10 and 11-15 years. Patients were evaluated for demographics, blood and 24 h urine for calcium, magnesium, phosphate, uric acid, electrolytes and additional protein, citrate, ammonia and oxalate in urine. All reported values were two sided and statistical significance was considered at p value ≤0.05. The mean age at diagnosis was 7.50 ± 3.56 years with a male to female ratio of 1.84:1. A family history of urolithiasis was found in 41 (16.4 %), urinary tract infection in 18 (7 %) and chronic diarrhea in 75 (30 %). Hypercalcemia was seen in 37 (14.8 %), hyperuricemia in 23 (9.2 %) and hyperphosphatemia in 6 (2.4 %). Urinary metabolic abnormalities were identified in 248 (98 %) of the cases. Hypocitraturia was found in 207 (82.8 %), hyperoxaluria in 62 (26.4 %), hyperuricosuria in 82 (32.8 %), hypercalciuria in 51 (20.4 %), hyperphosphaturia in 46 (18.4 %), hyperammonuria in 10 (4 %), hypocalciuria in 82 (32.8 %), and hypovolemia in 73 (29.2 %). Risk factors were similar between genders except higher rates of hyponatriuria, hypophosphaturia, and hypocalciuria in females. Hyperuricosuria, hyponatriuria, and hypovolemia were highest in 1-5 years (52, 49, 49 %) as compared to (18, 21, 12 %) those in 11-15 years (p < 0.001), respectively. This study shows that careful metabolic analysis can identify risk factors in 98 % of the children where appropriate metaphylaxis can be undertaken both for treatment and prevention of recurrence.
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Affiliation(s)
- Kiran Imran
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan.
| | - Mirza Naqi Zafar
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Uzma Ozair
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sadia Khan
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Syed Adibul Hasan Rizvi
- Department of Chemical Pathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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26
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Mahajan P, Kuppermann N, Mejias A, Suarez N, Chaussabel D, Casper TC, Smith B, Alpern ER, Anders J, Atabaki SM, Bennett JE, Blumberg S, Bonsu B, Borgialli D, Brayer A, Browne L, Cohen DM, Crain EF, Cruz AT, Dayan PS, Gattu R, Greenberg R, Hoyle JD, Jaffe DM, Levine DA, Lillis K, Linakis JG, Muenzer J, Nigrovic LE, Powell EC, Rogers AJ, Roosevelt G, Ruddy RM, Saunders M, Tunik MG, Tzimenatos L, Vitale M, Dean JM, Ramilo O. Association of RNA Biosignatures With Bacterial Infections in Febrile Infants Aged 60 Days or Younger. JAMA 2016; 316:846-57. [PMID: 27552618 PMCID: PMC5122927 DOI: 10.1001/jama.2016.9207] [Citation(s) in RCA: 154] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
IMPORTANCE Young febrile infants are at substantial risk of serious bacterial infections; however, the current culture-based diagnosis has limitations. Analysis of host expression patterns ("RNA biosignatures") in response to infections may provide an alternative diagnostic approach. OBJECTIVE To assess whether RNA biosignatures can distinguish febrile infants aged 60 days or younger with and without serious bacterial infections. DESIGN, SETTING, AND PARTICIPANTS Prospective observational study involving a convenience sample of febrile infants 60 days or younger evaluated for fever (temperature >38° C) in 22 emergency departments from December 2008 to December 2010 who underwent laboratory evaluations including blood cultures. A random sample of infants with and without bacterial infections was selected for RNA biosignature analysis. Afebrile healthy infants served as controls. Blood samples were collected for cultures and RNA biosignatures. Bioinformatics tools were applied to define RNA biosignatures to classify febrile infants by infection type. EXPOSURE RNA biosignatures compared with cultures for discriminating febrile infants with and without bacterial infections and infants with bacteremia from those without bacterial infections. MAIN OUTCOMES AND MEASURES Bacterial infection confirmed by culture. Performance of RNA biosignatures was compared with routine laboratory screening tests and Yale Observation Scale (YOS) scores. RESULTS Of 1883 febrile infants (median age, 37 days; 55.7% boys), RNA biosignatures were measured in 279 randomly selected infants (89 with bacterial infections-including 32 with bacteremia and 15 with urinary tract infections-and 190 without bacterial infections), and 19 afebrile healthy infants. Sixty-six classifier genes were identified that distinguished infants with and without bacterial infections in the test set with 87% (95% CI, 73%-95%) sensitivity and 89% (95% CI, 81%-93%) specificity. Ten classifier genes distinguished infants with bacteremia from those without bacterial infections in the test set with 94% (95% CI, 70%-100%) sensitivity and 95% (95% CI, 88%-98%) specificity. The incremental C statistic for the RNA biosignatures over the YOS score was 0.37 (95% CI, 0.30-0.43). CONCLUSIONS AND RELEVANCE In this preliminary study, RNA biosignatures were defined to distinguish febrile infants aged 60 days or younger with vs without bacterial infections. Further research with larger populations is needed to refine and validate the estimates of test accuracy and to assess the clinical utility of RNA biosignatures in practice.
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Affiliation(s)
- Prashant Mahajan
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Michigan, Wayne State University, Detroit
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis, School of Medicine, Sacramento
| | - Asuncion Mejias
- Division of Pediatric Infectious Diseases and Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University, Columbus
| | - Nicolas Suarez
- Division of Pediatric Infectious Diseases and Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University, Columbus
| | - Damien Chaussabel
- Benaroya Research Institute, Virginia Mason and Sidra Medical and Research Center, Seattle, Washington, and Doha, Qatar
| | | | - Bennett Smith
- Division of Pediatric Infectious Diseases and Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University, Columbus
| | - Elizabeth R Alpern
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania7Now at Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jennifer Anders
- Department of Pediatrics, Johns Hopkins University, Baltimore, Maryland
| | - Shireen M Atabaki
- Division of Emergency Medicine, Department of Pediatrics, Children's National Medical Center, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Jonathan E Bennett
- Division of Pediatric Emergency Medicine, Alfred I. DuPont Hospital for Children, Nemours Children's Health System, Wilmington, Delaware
| | - Stephen Blumberg
- Department of Pediatrics, Jacobi Medical Center, Albert Einstein College of Medicine, New York, New York
| | - Bema Bonsu
- Section of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Dominic Borgialli
- Department of Emergency Medicine, Hurley Medical Center and University of Michigan, Flint
| | - Anne Brayer
- Departments of Emergency Medicine and Pediatrics, University of Rochester Medical Center, Rochester, New York
| | - Lorin Browne
- Departments of Pediatrics and Emergency Medicine, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee
| | - Daniel M Cohen
- Section of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus
| | - Ellen F Crain
- Division of Pediatric Emergency Medicine, Alfred I. DuPont Hospital for Children, Nemours Children's Health System, Wilmington, Delaware
| | - Andrea T Cruz
- Sections of Emergency Medicine and Infectious Diseases, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston
| | - Peter S Dayan
- Division of Emergency Medicine, Department of Pediatrics, Columbia University College of Physicians & Surgeons, New York, New York
| | - Rajender Gattu
- Division of Emergency Medicine, Department of Pediatrics, University of Maryland Medical Center, Baltimore
| | - Richard Greenberg
- Department of Pediatrics, Primary Children's Medical Center, University of Utah, Salt Lake City
| | - John D Hoyle
- Department of Emergency Medicine, Helen DeVos Children's Hospital of Spectrum Health, Grand Rapids, Michigan22Now with the Departments of Emergency Medicine and Pediatrics, Western Michigan University Homer Stryker, MD, School of Medicine, Kalamazoo
| | - David M Jaffe
- Department of Pediatrics, St Louis Children's Hospital, Washington University, St Louis, Missouri24Now with the Division of Pediatric Emergency Medicine, University of California San Francisco School of Medicine
| | - Deborah A Levine
- Department of Pediatrics, Bellevue Hospital New York University Langone Center, New York
| | - Kathleen Lillis
- Department of Pediatrics, Women and Children's Hospital of Buffalo, State University of New York at Buffalo
| | - James G Linakis
- Department of Emergency Medicine and Pediatrics, Hasbro Children's Hospital and Brown University, Providence, Rhode Island
| | - Jared Muenzer
- Department of Pediatrics, Bellevue Hospital New York University Langone Center, New York28Now with the Department of Emergency Medicine, Phoenix Children's Hospital, Phoenix, Arizona
| | - Lise E Nigrovic
- Department of Pediatrics, Boston Children's Hospital, Harvard University, Boston, Massachusetts
| | - Elizabeth C Powell
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Alexander J Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor
| | - Genie Roosevelt
- Department of Pediatrics, Children's Hospital Colorado, University of Colorado-Denver, Aurora
| | - Richard M Ruddy
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Mary Saunders
- Department of Pediatrics, Children's Hospital of Wisconsin, Medical College of Wisconsin, Milwaukee35Now with Children's Hospital of Colorado, University of Colorado School of Medicine, Aurora
| | - Michael G Tunik
- Department of Pediatrics, Bellevue Hospital, New York University Langone Medical Center, New York
| | - Leah Tzimenatos
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento
| | - Melissa Vitale
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - J Michael Dean
- Department of Pediatrics, University of Utah, Salt Lake City
| | - Octavio Ramilo
- Division of Pediatric Infectious Diseases and Center for Vaccines and Immunity, Nationwide Children's Hospital and The Ohio State University, Columbus
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Tamgumus S, Geoghan J, Coghlan D, Nadeem M. Urinary Tract Infection in Childhood and Inflammatory Markers>. Ir Med J 2016; 109:442. [PMID: 27834092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Acute urinary tract infections are common in children. Our aim was to establish whether peripheral blood tests correlate with urinary culture. We also examined the relationship between peripheral blood results and the length of stay (LOS) in children and adolescents with UTI. We studied 135 patients admitted with UTI, mean (SD) age 3.0 (4.1) years. Of these 135 patients, 16 (11.9%) had combined normal serum WCC, normal neutrophil count and CRP < 5 mg/L. In this group of patients, there was no significant association between LOS and serum WCC, serum neutrophil values, E. coli infection or CRP values (p value 0.51, 0.98, 0.87, 0.82, respectively).
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28
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Abstract
The aim of the study is to determine whether serum 25-hydroxyvitamin D (25(OH)D) deficiency in infants increased odds of urinary tract infection (UTI). A total of 238 infants including 132 patients experiencing a first episode of UTI and 106 controls, aged from 1 to 12 months, were enrolled. Serum 25(OH)D levels were tested through blood sampling. The serum 25(OH)D levels were significantly lower in cases with UTI than controls. The mean serum 25(OH)D levels were 29.09 ± 9.56 ng/mL in UTIs and 38.59 ± 12.41 ng/mL in controls (P < 0.001). Infants with acute pyelonephritis (APN) had lower serum 25(OH)D than those with lower UTI. The multivariate logistic regression analyses showed that serum 25(OH)D < 20 ng/mL (OR 5.619, 95% CI 1.469-21.484, P = 0.012) was positively related to an increased odds of UTI. Vitamin D supplementation (OR 0.298, 95% CI 0.150-0.591; P = 0.001) was associated with a decreased likelihood of UTI. Vitamin D deficiency in infants was associated with an increased odds of UTI. Interventional studies evaluating the role of vitamin D supplementation to reduce the burden of UTI are warranted.
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Affiliation(s)
- Jianhuan Yang
- Department of Pediatric, Zhujiang Hospital of Southern Medical University, Guangzhou
- Department of Pediatric, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang
| | - Guangdao Chen
- Department of Pediatric, Central Hospital of Panyu District, Guangzhou
| | - Dexuan Wang
- Department of Pediatric, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang
| | - Minguang Chen
- Department of Pediatric, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang
| | - Chao Xing
- Department of Clinical Laboratory, The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bin Wang
- Department of Pediatric, Zhujiang Hospital of Southern Medical University, Guangzhou
- Correspondence: Bin Wang, Department of Pediatrics, Zhujiang Hospital of Southern Medical University, Guangzhou, China (e-mail: )
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29
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Lee LHN, White RF, Barr AM, Honer WG, Procyshyn RM. Elevated clozapine plasma concentration secondary to a urinary tract infection: proposed mechanisms. J Psychiatry Neurosci 2016; 41:E67-8. [PMID: 27332768 PMCID: PMC4915939 DOI: 10.1503/jpn.150156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
- Lik Hang N Lee
- From the Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia (Lee, Barr); the Department of Psychiatry, University of British Columbia (White, Honer, Procyshyn); the B.C. Psychosis Program, UBC Hospital (White, Honer, Procyshyn); and the British Columbia Mental Health and Addictions Research Institute (Barr, Honer, Procyshyn), Vancouver, B.C., Canada
| | - Randall F White
- From the Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia (Lee, Barr); the Department of Psychiatry, University of British Columbia (White, Honer, Procyshyn); the B.C. Psychosis Program, UBC Hospital (White, Honer, Procyshyn); and the British Columbia Mental Health and Addictions Research Institute (Barr, Honer, Procyshyn), Vancouver, B.C., Canada
| | - Alasdair M Barr
- From the Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia (Lee, Barr); the Department of Psychiatry, University of British Columbia (White, Honer, Procyshyn); the B.C. Psychosis Program, UBC Hospital (White, Honer, Procyshyn); and the British Columbia Mental Health and Addictions Research Institute (Barr, Honer, Procyshyn), Vancouver, B.C., Canada
| | - William G Honer
- From the Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia (Lee, Barr); the Department of Psychiatry, University of British Columbia (White, Honer, Procyshyn); the B.C. Psychosis Program, UBC Hospital (White, Honer, Procyshyn); and the British Columbia Mental Health and Addictions Research Institute (Barr, Honer, Procyshyn), Vancouver, B.C., Canada
| | - Ric M Procyshyn
- From the Department of Anesthesiology, Pharmacology & Therapeutics, University of British Columbia (Lee, Barr); the Department of Psychiatry, University of British Columbia (White, Honer, Procyshyn); the B.C. Psychosis Program, UBC Hospital (White, Honer, Procyshyn); and the British Columbia Mental Health and Addictions Research Institute (Barr, Honer, Procyshyn), Vancouver, B.C., Canada
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Akirov A, Elis A. The prognostic significance of admission blood glucose levels in patients with urinary tract infection. Diabetes Res Clin Pract 2016; 115:99-105. [PMID: 26838668 DOI: 10.1016/j.diabres.2016.01.025] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2015] [Revised: 01/11/2016] [Accepted: 01/17/2016] [Indexed: 01/08/2023]
Abstract
AIMS Evaluate the association between admission blood glucose (ABG) and short and long-term outcomes following hospitalization for urinary tract infection (UTI). METHODS Single center, retrospective cohort study of patients admitted to medical wards between January 1, 2011 and December 31, 2013 with a diagnosis of UTI. Patients were classified to those with diabetes mellitus (DM) and those without it. ABG levels were classified to categories: ≤70, 70-110, 111-199, ≥200mg/dl. Primary outcome was all-cause mortality within 30-days and 1-year. Secondary outcomes were hospital readmissions within 30-days and 1-year, and survival rates at end of follow-up. RESULTS Cohort included 3405 patients (median age, 78 years; 44% men), 1106 with DM and 2299 without it. Among patients without DM, compared with ABG between 70 and 110mg/dl (n=852, 37%), there was a significant association between ABG and all-cause mortality: hazard ratios (95% CI) with ABG ≤70mg/dl (n=13, 0.6%), 111-199mg/dl (n=1292, 56%), and ≥200mg/dl (n=142, 6%) were: 3.67 (0.89-15.14, p=0.07, 23% mortality (n=3)), 1.85 (1.29-2.64, p<0.001, 7% mortality (n=89)), and 2.94 (1.71-5.07, p<0.0001, 11% mortality (n=15)) at 30-days, and 3.8 (1.87-7.71, 38% mortality (n=5)), 1.35 (1 1.13-1.60, 7% mortality (n=215)), and 2.02 (1.50-2.71, 25% mortality (n=35)) at 1-year (all p<0.001). In patients with DM there was no significant association between ABG and mortality. There was no association between ABG and readmissions in both groups. CONCLUSION There is a significant association between ABG and short and long-term, all-cause mortality in patients without DM, but not in patients with DM, hospitalized for UTI.
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Affiliation(s)
- Amit Akirov
- Department of Internal Medicine C, Beilinson Campus, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Israel.
| | - Avishay Elis
- Department of Internal Medicine C, Beilinson Campus, Rabin Medical Center, Petah Tikva, Israel; Sackler School of Medicine, Tel-Aviv University, Israel
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31
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Ashour W, Al-Anwar AD, Kamel AE, Aidaros MA. Predictors of early infection in cerebral ischemic stroke. J Med Life 2016; 9:163-9. [PMID: 27453748 PMCID: PMC4863508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 04/07/2016] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Infection is the most common complication of stroke. AIM To determine the risk factors and predictors of post-stroke infection (PSI), which developed within 7 days from the onset of acute ischemic stroke. SUBJECTS The study included 60 ischemic stroke patients admitted in the Neurology Department of Zagazig University, Egypt, who were subdivided into: [Non Stroke Associated Infection group (nSAI); 30 patients having stroke without any criteria of infection within 7 days from the onset and Stroke Associated Infection group (SAI); 30 patients having stroke with respiratory tract infection (RTI) or urinary tract infection within 7 days], in addition to 30 healthy sex and age-matching subjects as control. METHODS All the patients had a detailed history taking, thorough clinical general and neurological examination, laboratory tests (Urine analysis & urine culture, blood sugar, lipid profile and serum tumor necrosis factor-alpha (TNF-α) and interleukin (IL)-10), a chest radiography to assess RTI and brain computed tomography (CT) to exclude the hemorrhagic stroke and to confirm the ischemic stroke. RESULTS SAI patients were found to be significantly older with higher baseline blood glucose level. Also the number of patients with tube feeding, lower conscious level, more stroke severity and more large size infarcts were significantly higher in SAI patients. There was a significant elevation in the IL-10, a significant decrease in the TNF-α and a significant decrease in the TNF-α/ IL-10 ratio, in the SAI group. The baseline serum level of IL-10 ≥ 14.5 pg/ ml and size of infarct area > 3.5 cm3 were found to be the independent predictors of PSI. CONCLUSION Patients with older age, tube feeding, lower conscious level, worse baseline stroke severity, large cerebral infarcts in CT scan, and increased IL-10 serum level were more susceptible to infection. The baseline serum level of IL-10 ≥ 14.5 pg/ ml and the size of infarct area > 3.5 cm3 were the independent predictors of PSI.
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Affiliation(s)
- Wmr Ashour
- Department of Neurology, Faculty of Medicine, Zagazig University, Egypt
| | - A D Al-Anwar
- Department of Neurology, Faculty of Medicine, Zagazig University, Egypt
| | - A E Kamel
- Department of Neurology, Faculty of Medicine, Zagazig University, Egypt
| | - M A Aidaros
- Department of Neurology, Faculty of Medicine, Zagazig University, Egypt
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El-Deeb WM, Elmoslemany AM. Acute phase proteins as biomarkers of urinary tract infection in dairy cows: diagnostic and prognostic accuracy. Jpn J Vet Res 2016; 64:57-66. [PMID: 27348889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The aims of this study were to investigate the level of acute phase proteins in dairy cows with urinary tract infection (UTI) and to evaluate their diagnostic and prognostic value. Eighty-four lactating cows with clinical and laboratory evidence of UTI and 15 healthy controls were included in this study. Serum samples were evaluated for the levels of Haptoglobin (Hp), serum amyloid A (SAA), fibrinogen (Fb), α1-Acid glycoprotein (AGP), total protein, and globulin. The diagnostic and prognostic performance of each parameter was evaluated by estimating the area under receiver operating characteristics curve (AUROC). Escherichia coli and Corynebacterium spp. were the primary bacteria associated with UTI. The levels of serum Hp, SAA, Fb, AGP, total protein, and globulin were significantly higher in UTI cows. Successfully treated cows (n = 51) had lower levels of Hp, SAA, AGP, total protein, and globulin than non-responsive cows. Overall, Hp, SAA, Fb, and AGP showed comparable diagnostic accuracy (AUROC ranged from 0.93 to 0.98). Both Hp and SAA showed high accuracy in predicting treatment response (AUROC > 0.95), whereas Fb level was of no prognostic value (AUROC = 0.48). From this study, acute phase proteins levels can be used as markers for UTI in cows and higher levels of Hp, SAA and AGP are related to poor treatment response.
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[THE ROLE OF SYSTEM QUORUM SENSING UNDER CHRONIC UROGENITAL CHLAMYDIA INFECTION]. Klin Lab Diagn 2015; 60:54-7. [PMID: 26841675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
It is established that system quorum sensing (QS) assure social behavior of bacteria in regulation of genes of virulence and generalization of inflectional inflammatory process under chronic urogenital chlamydia infection. The techniques of gas chromatography and mass-spectrometry were applied to detect molecular markers of generalization of infectious process under urogenital chlamydiasis--activators of QS microbes (lactones, quinolones, furan ethers). The developed diagnostic gas chromatography and mass-spectrometry criteria of indexation of molecular markers under chronic urogenital chlamydia infection have high level of diagnostic sensitivity, specificity and prognostic value of positive and negative result. The application of techniques of gas chromatography and mass-spectrometry permits enhancing effectiveness of diagnostic of chronic inflectional inflammatory diseases of urogenital system of chlamydia etiology with identification of prognostic criteria of generalization of infectious process and subsequent prescription of timely and appropriate therapy
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Kenzaka T, Kato K, Kitao A, Kosami K, Minami K, Yahata S, Fukui M, Okayama M. Hyperammonemia in Urinary Tract Infections. PLoS One 2015; 10:e0136220. [PMID: 26292215 PMCID: PMC4546155 DOI: 10.1371/journal.pone.0136220] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2015] [Accepted: 07/31/2015] [Indexed: 01/09/2023] Open
Abstract
Objectives The present study investigated the incidence of hyperammonemia in urinary tract infections and explored the utility of urinary obstruction relief and antimicrobial administration to improve hyperammonemia. Methods This was an observational study. Subjects were patients who were diagnosed with urinary tract infection and hospitalized between June 2008 and June 2009. We measured plasma ammonia levels on admission in patients who were clinically diagnosed with urinary tract infection and hospitalized. We assessed each patient's level of consciousness on admission using the Glasgow Coma Scale (GCS) and performed urine and blood cultures. We also assessed hearing prior to hospitalization using the Eastern Cooperative Oncology Group performance status (ECOG-PS). In cases with high ammonia levels on admission, plasma ammonia and GCS were measured 24 hours and 5–7 days later. Results Sixty-seven candidates were enrolled; of these, 60 cases (89.6%) with bacterial cell counts ≥104 CFU/mL were studied. Five cases (8.3%) presented with high plasma ammonia levels. Cases with hyperammonemia were significantly more likely to present with low GCS scores and urinary retention rate. All five cases received antimicrobial therapy with an indwelling bladder catheter to relieve urinary retention. The case 5 patient died shortly after admission due to complicated aspiration pneumonia; in the remaining cases, plasma ammonia levels were rapidly normalized and the level of consciousness improved. Conclusions The occurrence of hyperammonemia in urinary tract infections is not rare. The cause of hyperammonemia is urinary retention obstruction. Therefore, along with antimicrobial administration, relief of obstruction is important for the treatment of hyperammonemia caused by this mechanism.
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Affiliation(s)
- Tsuneaki Kenzaka
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
- Division of Community Medicine and Career Development, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
- * E-mail:
| | - Ken Kato
- Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan
| | - Akihito Kitao
- Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan
| | - Koki Kosami
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Kensuke Minami
- Division of General Medicine, Center for Community Medicine, Jichi Medical University School of Medicine, Shimotsuke, Japan
| | - Shinsuke Yahata
- Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan
| | - Miho Fukui
- Department of General Medicine, Toyooka Public Hospital, Toyooka, Japan
| | - Masanobu Okayama
- Division of Community Medicine and Medical Education, Kobe University Graduate School of Medicine, Kobe, Japan
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Zarkesh M, Sedaghat F, Heidarzadeh A, Tabrizi M, Bolooki-Moghadam K, Ghesmati S. Diagnostic value of IL-6, CRP, WBC, and absolute neutrophil count to predict serious bacterial infection in febrile infants. Acta Med Iran 2015; 53:408-411. [PMID: 26520627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 10/06/2015] [Indexed: 06/05/2023] Open
Abstract
Since clinical manifestations of most febrile infants younger than three months old are nonspecific, differentiation of Serious Bacterial Infection (SBI) from self-limiting viral illness is a significant challenge for pediatricians. This study was performed to assess the diagnostic value of white blood cell count (WBC), Absolute Neutrophil Count (ANC), Interleukin -6 (IL-6) and C-reactive protein (CRP) level to predict SBI in febrile infants younger than three months old who were hospitalized. This was a diagnostic test validation study. In this prospective study, 195 febrile infants admitted to 17 Shahrivar Hospital underwent a full sepsis workup including blood, urine, cerebrospinal fluid cultures and chest radiography. WBC count, ANC and CRP and Il-6 level were measured in all patients. Serum IL-6 concentration was measured by Enzyme-linked Immunosorbent Assay test. Then diagnostic, values of these tests for predicting SBI was compared with each other. Of total cases, 112 (57.4%) infants were male. SBI was diagnosed in 29 (14.9%) patients. The most common type of SBI was Urinary Tract Infection (UTI). Serum IL-6 (³20pg/dl) had sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of 79/1%, 91.6%,75.4%, 60.3%, respectively and for CRP (³ 10mg/l) values were 81.6%, 89.8%, 78.2%, and 52%,respectively. The predictive values of CRP and IL-6 were higher than WBC and ANC. IL-6 and CRP are more valid and better diagnostic markers for predicting SBI than WBC count and ANC. CRP level seems to be an accessible and cost-effective marker for early diagnosis of SBI. Since by no marker we can totally rule out SBI in febrile infants < three months of age, it is recommended to administer systemic antibiotics until culture results become available.
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Affiliation(s)
- Marjaneh Zarkesh
- Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Fatemeh Sedaghat
- Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Abtin Heidarzadeh
- Department of Social Medicine, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Manizheh Tabrizi
- Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Kobra Bolooki-Moghadam
- Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Soheil Ghesmati
- Pediatrics growth disorders research center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Abstract
BACKGROUND Platelet satellitism is a phenomenon of unknown etiology of aggregating platelets around polymorphonuclear neutrophils and other blood cells which causes pseudothrombocytopenia, visible by microscopic examination of blood smears. It has been observed so far in about a hundred cases in the world. CASE SUBJECT AND METHODS Our case involves a 73-year-old female patient with a urinary infection. Biochemical serum analysis (CRP, glucose, AST, ALT, ALP, GGT, bilirubin, sodium, potassium, chloride, urea, creatinine) and blood cell count were performed with standard methods on autoanalyzers. Serum protein fractions were examined by electrophoresis and urinalysis with standard methods on autoanalyzer together with microscopic examination of urine sediment. Erythrocyte sedimentation rate, blood culture and urine culture tests were performed with standard methods. RESULTS Due to typical pathological values for bacterial urinary infection, the patient was admitted to the hospital. Blood smear examination revealed phenomenon, which has persisted for three weeks after the disease has been cured. Blood smears with EDTA as an anticoagulant had platelet satellitism whereas the phenomenon was not observed in tubes with different anticoagulants (Na, Li-heparin) and capillary blood. DISCUSSION We hypothesize that satellitism was induced by some immunological mechanism through formation of antibodies which have mediated platelets binding to neutrophil membranes and vice versa. Unfortunately we were unable to determine the putative trigger for this phenomenon. To our knowledge this is the second case of platelet satellitism ever described in Croatia.
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Affiliation(s)
- Valentina Vidranski
- Department for Nuclear Medicine and Oncology, University Clinical Hospital Centre Sestre milosrdnice, Zagreb, Croatia
| | - Renata Laskaj
- Department for Medical Biochemistry, Diagnostic Hematology and Cytology, University Hospital for Infectious Diseases Dr. Fran Mihaljevic, Zagreb, Croatia
| | - Dubravka Sikiric
- Department for Medical Biochemistry, Diagnostic Hematology and Cytology, University Hospital for Infectious Diseases Dr. Fran Mihaljevic, Zagreb, Croatia
| | - Visnja Skerk
- Clinical Department for Urinary Tract Infections, University Hospital for Infectious Diseases Dr. Fran Mihaljevic, Zagreb, Croatia
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Abstract
Staphylococcus saprophyticus is a well-known cause of uncomplicated urinary tract infections, especially in young and sexually active women. Presence in blood cultures is rare and often attributed to contamination. When bacteremia is significant, it occurs mostly in patients with hematologic malignancies and is predominantly catheter-related. However, we describe a case of significant bacteremia with S. saprophyticus associated with urinary tract infection after extracorporeal shock wave lithotripsy of an ureterolithiasis in an otherwise healthy patient.
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Wu H, Zhu S, Yu S, Ding G, Xu J, Li T, Qiao L, Chen Y, Yan J, Cheng X, Wan SP, Li G. Early Drastic Decrease in White Blood Count Can Predict Uroseptic Shock Induced by Upper Urinary Tract Endoscopic Lithotripsy: A Translational Study. J Urol 2015; 193:2116-22. [PMID: 25619454 DOI: 10.1016/j.juro.2015.01.071] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2015] [Indexed: 11/20/2022]
Affiliation(s)
- Haiyang Wu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shibin Zhu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Shicheng Yu
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Guoqing Ding
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Jun Xu
- Department of Urology, Huadong Hospital Affiliated to Fudan University, Shanghai, People's Republic of China
| | - Tao Li
- Department of Urology, Fujian Provincial Hospital, Fuzhou, People's Republic of China
| | - Ludong Qiao
- Department of Urology, Tongren Hospital of Peking University, Beijing, People's Republic of China
| | - Yue Chen
- Department of Urology, Ningbo First Hospital, Ningbo, People's Republic of China
| | - Jiajun Yan
- Department of Urology, Shaoxing People's Hospital, Shaoxing, People's Republic of China
| | - Xin Cheng
- Department of Urology, Second Hospital of Jiaxing, Jiaxing, People's Republic of China
| | - Shaw P Wan
- Department of Urology, First People's Hospital of Xiaoshan, Hangzhou, People's Republic of China
| | - Gonghui Li
- Department of Urology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
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Szpila BE, Ozrazgat-Baslanti T, Zhang J, Lanz J, Davis R, Rebel A, Vanzant E, Gentile LF, Cuenca AG, Ang DN, Liu H, Lottenberg L, Marker P, Zumberg M, Bihorac A, Moore FA, Brakenridge S, Efron PA. Successful implementation of a packed red blood cell and fresh frozen plasma transfusion protocol in the surgical intensive care unit. PLoS One 2015; 10:e0126895. [PMID: 26010247 PMCID: PMC4444010 DOI: 10.1371/journal.pone.0126895] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 04/08/2015] [Indexed: 11/19/2022] Open
Abstract
Background Blood product transfusions are associated with increased morbidity and mortality. The purpose of this study was to determine if implementation of a restrictive protocol for packed red blood cell (PRBC) and fresh frozen plasma (FFP) transfusion safely reduces blood product utilization and costs in a surgical intensive care unit (SICU). Study Design We performed a retrospective, historical control analysis comparing before (PRE) and after (POST) implementation of a restrictive PRBC/FFP transfusion protocol for SICU patients. Univariate analysis was utilized to compare patient demographics and blood product transfusion totals between the PRE and POST cohorts. Multivariate logistic regression models were developed to determine if implementation of the restrictive transfusion protocol is an independent predictor of adverse outcomes after controlling for age, illness severity, and total blood products received. Results 829 total patients were included in the analysis (PRE, n=372; POST, n=457). Despite higher mean age (56 vs. 52 years, p=0.01) and APACHE II scores (12.5 vs. 11.2, p=0.006), mean units transfused per patient were lower for both packed red blood cells (0.7 vs. 1.2, p=0.03) and fresh frozen plasma (0.3 vs. 1.2, p=0.007) in the POST compared to the PRE cohort, respectively. There was no difference in inpatient mortality between the PRE and POST cohorts (7.5% vs. 9.2%, p=0.39). There was a decreased risk of urinary tract infections (OR 0.47, 95%CI 0.28-0.80) in the POST cohort after controlling for age, illness severity and amount of blood products transfused. Conclusions Implementation of a restrictive transfusion protocol can effectively reduce blood product utilization in critically ill surgical patients with no increase in morbidity or mortality.
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Affiliation(s)
- Benjamin E. Szpila
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Tezcan Ozrazgat-Baslanti
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Jianyi Zhang
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Jennifer Lanz
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Ruth Davis
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Annette Rebel
- Department of Anesthesia, University of Kentucky College of Medicine, Lexington, KY, 40506, United States of America
| | - Erin Vanzant
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Lori F. Gentile
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Alex G. Cuenca
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Darwin N. Ang
- Department of Surgery, University of South Florida, Tampa, FL, 33612, United States of America
| | - Huazhi Liu
- Department of Surgery, University of South Florida, Tampa, FL, 33612, United States of America
| | - Lawrence Lottenberg
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Peggy Marker
- Department of Nursing, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Marc Zumberg
- Department of Medicine, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Azra Bihorac
- Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Frederick A. Moore
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Scott Brakenridge
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
| | - Philip A. Efron
- Department of Surgery, University of Florida College of Medicine, Gainesville, FL, 32610, United States of America
- * E-mail:
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Frej-Mądrzak M, Teryks-Wołyniec D, Jama-Kmiecik A, Sarowska J, Choroszy-Król I. Diagnosing Chlamydia Trachomatis Urinary Tract Infections--Preliminary Report. ADV CLIN EXP MED 2015; 24:441-5. [PMID: 26467132 DOI: 10.17219/acem/43719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Chlamydia trachomatis is mentioned among the etiologic factors for urinary tract infections. Chlamydias are parasites inside a cell. A very significant problem of C. trachomatis infections is their asymptomatic character. The most frequent infections caused by these bacteria are inflammations of the urethra and bladder; of the vagina, cervix, vaginal cavity and adnexa in women; and of the epididymis, testicles and prostate in men. In the diagnosis of C. trachomatis infections, the following methods are used: immunofluorescent techniques, immunoenzymatic assays, serological examinations and genetic techniques (for example PCR). OBJECTIVES The aim of the study was to detect C. trachomatis among patients with symptoms of non-gonorrheal urethritis using diagnostic serologic methods and direct immunofluorescence. The purpose was to assess the connection between the incidence of urinary tract infections caused by C. trachomatis and symptoms that patients report as well as other data from interviews. MATERIAL AND METHODS Blood serum and urethral smears were taken from each of 57 patients. The ELISA method was used to mark specific IgG and IgGcHSP60 anti-chlamydia antibodies in the blood serum. In the urethral smear, antigens were marked using the direct immunofluorescence method. RESULTS Evidence for urinary tract infection caused by C. trachomatis was found in 15.79% of the examined patients using the immunofluorescence method. In the blood serum, positive results for IgGcHSP60 were obtained in 17.54% of the patients and for IgG in 8.77%. CONCLUSIONS The studies carried out so far suggest that C. trachomatis has a significant role in the etiology of urethritis in adults and children. Other serological tests should be conducted in all the patients in order to study the immune responses in infected individuals and to confirm C. trachomatis infection using genetic methods such as PCR.
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Affiliation(s)
- Magdalena Frej-Mądrzak
- Department of Basic Sciences, Faculty of Health Science, Wroclaw Medical University, Poland
| | - Dorota Teryks-Wołyniec
- Department of Basic Sciences, Faculty of Health Science, Wroclaw Medical University, Poland
| | - Agnieszka Jama-Kmiecik
- Department of Basic Sciences, Faculty of Health Science, Wroclaw Medical University, Poland
| | - Jolanta Sarowska
- Department of Basic Sciences, Faculty of Health Science, Wroclaw Medical University, Poland
| | - Irena Choroszy-Król
- Department of Basic Sciences, Faculty of Health Science, Wroclaw Medical University, Poland
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van der Starre WE, van Nieuwkoop C, Thomson U, Zijderveld-Voshart MSM, Koopman JPR, van der Reijden TJK, van Dissel JT, van de Vosse E. Urinary proteins, vitamin D and genetic polymorphisms as risk factors for febrile urinary tract infection and relation with bacteremia: a case control study. PLoS One 2015; 10:e0121302. [PMID: 25807366 PMCID: PMC4373833 DOI: 10.1371/journal.pone.0121302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2014] [Accepted: 01/30/2015] [Indexed: 12/18/2022] Open
Abstract
Objective/Purpose Febrile urinary tract infection (UTI) is a common bacterial disease that may lead to substantial morbidity and mortality especially among the elderly. Little is known about biomarkers that predict a complicated course. Our aim was to determine the role of certain urinary cytokines or antimicrobial proteins, plasma vitamin D level, and genetic variation in host defense of febrile UTI and its relation with bacteremia. Methods A case-control study. Out of a cohort of consecutive adults with febrile UTI (n = 787) included in a multi-center observational cohort study, 46 cases with bacteremic E.coli UTI and 45 cases with non-bacteremic E.coli UTI were randomly selected and compared to 46 controls. Urinary IL-6, IL-8, LL37, β-defensin 2 and uromodulin as well as plasma 25-hydroxyvitamin D were measured. In 440 controls and 707 UTI patients polymorphisms were genotyped in the genes CXCR1, DEFA4, DEFB1, IL6, IL8, MYD88, UMOD, TIRAP, TLR1, TLR2, TLR5 and TNF. Results IL-6, IL-8, and LL37 are different between controls and UTI patients, although these proteins do not distinguish between patients with and without bacteremia. While uromodulin did not differ between groups, inability to produce uromodulin is more common in patients with bacteremia. Most participants in the study, including the controls, had insufficient vitamin D and, at least in winter, UTI patients have lower vitamin D than controls. Associations were found between the CC genotype of IL6 SNP rs1800795 and occurrence of bacteremia and between TLR5 SNP rs5744168 and protection from UTI. The rare GG genotype of IL6 SNP rs1800795 was associated with higher β-defensin 2 production. Conclusion Although no biomarker was able to distinguish between UTI with or without bacteremia, two risk factors for bacteremia were identified. These were inability to produce uromodulin and an IL6 rs1800795 genotype.
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Affiliation(s)
| | - Cees van Nieuwkoop
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- Department of Internal Medicine, Haga Hospital, the Hague, The Netherlands
| | - Uginia Thomson
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jan Pieter R. Koopman
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Jaap T. van Dissel
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
| | - Esther van de Vosse
- Department of Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
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Shaikh N, Borrell JL, Evron J, Leeflang MMG. Procalcitonin, C-reactive protein, and erythrocyte sedimentation rate for the diagnosis of acute pyelonephritis in children. Cochrane Database Syst Rev 2015; 1:CD009185. [PMID: 25603480 PMCID: PMC7104675 DOI: 10.1002/14651858.cd009185.pub2] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND In children with urinary tract infection (UTI), only those with pyelonephritis (and not cystitis) are at risk for developing long-term renal sequelae. If non-invasive biomarkers could accurately differentiate children with cystitis from children with pyelonephritis, treatment and follow-up could potentially be individualized. OBJECTIVES The objectives of this review were to 1) determine whether procalcitonin, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR) can replace the acute DMSA scan in the diagnostic evaluation of children with UTI; 2) assess the influence of patient and study characteristics on the diagnostic accuracy of these tests, and 3) compare the performance of the three tests to each other. SEARCH METHODS We searched MEDLINE, EMBASE, DARE, Web of Science, and BIOSIS Previews for this review. The reference lists of all included articles and relevant systematic reviews were searched to identify additional studies not found through the electronic search. SELECTION CRITERIA We only considered published studies that evaluated the results of an index test (procalcitonin, CRP, ESR) against the results of an acute-phase DMSA scan (conducted within 30 days of the UTI) in children aged 0 to 18 years with a culture-confirmed episode of UTI. The following cutoff values were used for the primary analysis: 0.5 ng/mL for procalcitonin, 20 mg/L for CRP and 30 mm/h for ESR. DATA COLLECTION AND ANALYSIS Two authors independently applied the selection criteria to all citations and independently abstracted data. We used the bivariate model to calculate pooled random-effects pooled sensitivity and specificity values. MAIN RESULTS A total of 24 studies met our inclusion criteria. Seventeen studies provided data for the primary analysis: six studies (434 children) included data on procalcitonin, 13 studies (1638 children) included data on CRP, and six studies (1737 children) included data on ESR (some studies had data on more than one test). The summary sensitivity estimates (95% CI) for the procalcitonin, CRP, ESR tests at the aforementioned cutoffs were 0.86 (0.72 to 0.93), 0.94 (0.85 to 0.97), and 0.87 (0.77 to 0.93), respectively. The summary specificity values for procalcitonin, CRP, and ESR tests at these cutoffs were 0.74 (0.55 to 0.87), 0.39 (0.23 to 0.58), and 0.48 (0.33 to 0.64), respectively. AUTHORS' CONCLUSIONS The ESR test does not appear to be sufficiently accurate to be helpful in differentiating children with cystitis from children with pyelonephritis. A low CRP value (< 20 mg/L) appears to be somewhat useful in ruling out pyelonephritis (decreasing the probability of pyelonephritis to < 20%), but unexplained heterogeneity in the data prevents us from making recommendations at this time. The procalcitonin test seems better suited for ruling in pyelonephritis, but the limited number of studies and the marked heterogeneity between studies prevents us from reaching definitive conclusions. Thus, at present, we do not find any compelling evidence to recommend the routine use of any of these tests in clinical practice.
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Affiliation(s)
- Nader Shaikh
- Children's Hospital of PittsburghGeneral Academic Pediatrics3414 Fifth Ave, Suite 301PittsburghPAUSA15213
| | - Jessica L Borrell
- Warren Alpert Medical School of Brown University222 Richmond StProvidenceRIUSA02903
| | - Josh Evron
- Tulane University School of Medicine1808 Robert StNew OrleansLAUSA70115
| | - Mariska MG Leeflang
- Academic Medical Center, J1B‐207‐1Department of Clinical Epidemiology and BiostatisticsP.O. Box 22700AMSTERDAMNetherlands1100 DE
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Abstract
OBJECTIVES To report the prevalence of bacteremia by age in a sample of infants<1 year of age with urinary tract infections (UTIs), to compare characteristics of infants with UTIs with and without bacteremia, and to describe treatment courses and 30-day outcomes in infants with UTIs with and without bacteremia. METHODS We used a retrospective cross-sectional design to determine the prevalence of bacteremia in infants with UTIs at our institution. A double cohort design matching for age and gender was used to compare clinical characteristics and outcomes between infants with bacteremic versus nonbacteremic UTIs. RESULTS We identified 1379 UTIs, with blood cultures obtained in 52% of cases. The prevalence of bacteremia was 4.1% (95% confidence interval 3.1%-5.3%) for all UTIs and 8% (95% confidence interval 6.1%-10.2%) for UTIs in which blood culture was obtained. Fifty-five infants with bacteremic UTIs were compared with 110 infants with nonbacteremic UTIs. Except for minor differences in the urinalysis and serum band count, there were no significant differences in clinical presentation between the 2 groups. Bacteremic infants received longer parenteral treatment courses than nonbacteremic infants (mean 6.7 vs 2.4 days, P<.001). Treatment courses in the bacteremic group were variable and predicted by age but not severity of illness. No bacteremic infant had recurrent UTI or bacteremia with the same organism within 30 days of discharge. CONCLUSIONS Treatment was variable but outcomes were excellent in infants with bacteremic UTIs.
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Affiliation(s)
- Heidi K Roman
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California; and
| | - Pearl W Chang
- Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Palo Alto, California
| | - Alan R Schroeder
- Department of Pediatrics, Santa Clara Valley Medical Center, San Jose, California; and
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Gorczyca D, Augustyniak D, Basiewicz-Worsztynowicz B, Karnas-Kalemba W. Serum and urinary MIP-1α and IP-10 levels in children with urinary tract infections. ADV CLIN EXP MED 2014; 23:933-8. [PMID: 25618120 DOI: 10.17219/acem/37341] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Urinary tract infection (UTI) is a common bacterial disease in infants and children, with potentially serious complications, including kidney damage. The aim of this study was to test whether serum and urinary levels of interleukin-6 (IL-6), macrophage inflammatory protein-1a (MIP-1a) and interferon-γ-inducible protein-10 (IP-10) can be used as biomarkers in children with urinary tract infections. MATERIAL AND METHODS The study group consisted of 22 children with UTI and 20 controls. Blood and urine samples were collected in the acute phase and the convalescent phase, on the eighth day after the onset of antibiotic therapy. Serum and urine levels of MIP-1a, IP-10 and IL-6 were measured. RESULTS In children with UTI in the acute phase, serum MIP-1a and IL-6 levels were significantly higher compared to the controls (p<0.05 and p<0.005, respectively). A correlation between the serum levels of the chemokines MIP-1a and IP-10 in the acute phase was found. CONCLUSIONS The findings suggest that the chemokines MIP-1a or IP-10 respond to infection, but they cannot be used as biomarkers for UTI in childhood.
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Affiliation(s)
- Daiva Gorczyca
- 3rd Department and Clinic of Pediatrics, Immunology and Rheumatology of Developmental Age, Wroclaw Medical University, Poland
| | - Daria Augustyniak
- Department of Pathogen Biology and Immunology, Institute of Genetics and Microbiology, Wroclaw Medical University, Poland
| | - Barbara Basiewicz-Worsztynowicz
- 3rd Department and Clinic of Pediatrics, Immunology and Rheumatology of Developmental Age, Wroclaw Medical University, Poland
| | - Wiesława Karnas-Kalemba
- 3rd Department and Clinic of Pediatrics, Immunology and Rheumatology of Developmental Age, Wroclaw Medical University, Poland
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Chiu PF, Wu CL, Huang CH, Liou HH, Chang CB, Chang HR, Chang CC. Lower blood glucose and variability are associated with earlier recovery from renal injury caused by episodic urinary tract infection in advanced type 2 diabetic chronic kidney disease. PLoS One 2014; 9:e108531. [PMID: 25259806 PMCID: PMC4178173 DOI: 10.1371/journal.pone.0108531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/22/2014] [Indexed: 02/07/2023] Open
Abstract
PURPOSE In our previous study, type 2 diabetic chronic kidney disease (CKD) patients with glomerular filtration rates of <30 mL/min upon hospitalization for urinary tract infection (UTI) were at a risk for acute kidney injury. This study aimed to clarify the effect of glucose and its variability on renal outcomes during admission for the treatment of UTI. MATERIALS AND METHODS Based on the date of renal recovery (RIFLE criteria: acute kidney injury occurred within 1-7 days and was sustained over 1 day), we divided these patients into early- (≤9 days, Group A) and late-recovery (>9 days, Group B) groups. The differences in the continuous and categorical variables of the two groups were assessed separately. The mean glucose levels and their variability (using the standard deviation and the coefficient of standard deviation) were compared at the fasting, midday pre-meal, evening pre-meal, and evening post-meal time points during hospitalization. We have organized the manuscript in a manner compliant with the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement. RESULTS Acute kidney injury occurred within the two groups (p = 0.007 and p = 0.001, respectively). The early-morning blood glucose levels (149.7±44.0 mg/dL) and average blood glucose levels (185.6±52.0 mg/dL) were better in Group A (p = 0.01, p = 0.02). Group A patients also had lower glucose variability than Group B at the different time points (p<0.05). Group A also had earlier renal recovery. More relevant pathogens were identified from blood in Group B (p = 0.038). CONCLUSIONS Early-morning fasting and mean blood glucose levels and their variability can be good indicators of severe infection and predictors of renal outcome in type 2 diabetic patients with CKD and UTI.
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Affiliation(s)
- Ping-Fang Chiu
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chia-Lin Wu
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ching-Hui Huang
- Division of Cardiology, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Hung-Hsiang Liou
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Chirn-Bin Chang
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Horng-Rong Chang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Division of Nephrology, Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Chia-Chu Chang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Nephrology Division, Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
- Ph.D. Program for Aging, College of Medicine, China Medical University, Taichung, Taiwan
- * E-mail:
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Karagoz E, Ulcay A. Re: Usefulness of serum procalcitonin level for prediction of vesicoureteral reflux in pediatric urinary tract infection. Iran J Kidney Dis 2014; 8:347-348. [PMID: 25001146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/08/2014] [Accepted: 06/12/2014] [Indexed: 06/03/2023]
Affiliation(s)
- Ergenekon Karagoz
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
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Junuzovic D, Zunic L, Dervisefendic M, Skopljak A, Pasagic A, Masic I. The toxic effect on leukocyte lineage of antimicrobial therapy in urinary and respiratory infections. Med Arch 2014; 68:167-9. [PMID: 25568526 PMCID: PMC4240340 DOI: 10.5455/medarh.2014.68.167-169] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2014] [Accepted: 05/28/2014] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Antimicrobials are widely used in infectious diseases. Only the timely intervention will contribute to the positive outcome of the disease. Unjustified use of antimicrobial prophylaxis may have adverse effects, i.e., result in bacterial resistance to existing antimicrobials, as well as toxic effects on leukocyte lineage and other parameters of the blood. GOAL The goal of this study was to confirm that the antimicrobial therapy of urinary, gynecological and respiratory infections has a toxic effect on leukocyte lineage. Followed by lowered immunity and the emergence of risk for health complications especially in oncology and other immunodeficient patients for whom to apply pharmacotherapy it is necessary to have adequate immunity, or white blood cell count that is greater than 4.0x10(9)/L. MATERIAL AND METHODS A prospective-retrospective study was conducted on a sample of 30 patients in a Primary Health Care Center in Gracanica during the period from March 01, 2013 until April 01, 2014. Testing of this sample was conducted by survey on health status and treatment, or on taking of antimicrobial therapy and other treatment regimens, with the referral diagnosis and determination of leukocytes count in by hematology counter SYSMEX. Results of leukocytes below and close to the lower reference values were statistically analyzed by Students t-test. RESULTS Mean WBC count in the group treated with antimicrobial therapy was 3.687±0.83 x10(9)/L, in the group which during repeated infection did not use the antimicrobial therapy 5.09±1.04 x10(9)/L, and in the control group of healthy subjects 7.178±1.038 x10(9)/L. Statistical analysis with Student's t test indicate highly significant differences between group of patients that used antimicrobial therapy with the group of patient that did not used antimicrobial during repeated infection (t=6.091; p=0.0001), as well as significant differences in mean WBC count of both of these groups and the controls (t=4.984; p=0.0001, and t=8.402, p=0.0001). CONCLUSION Use of antimicrobial drugs leads to serious toxic reactions, or leukopenia. Indications for the use of antimicrobial therapy must be strictly followed, because banal, frequent infections are not indication for antimicrobial therapy. It is necessary to know the types of infection causes. Important is the proper and timely selection of antimicrobial therapy. When selecting the drug we should bear in mind its antimicrobial activity, pharmacokinetic and toxic properties, as well as patient health status. Possible is also the application of preventive medicine as well as other manner of solving infection.
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Affiliation(s)
- Dzelaludin Junuzovic
- Department of Urology, Clinical center of Sarajevo University, Sarajevo, Bosnia and Herzegovina
| | - Lejla Zunic
- Health center Gracanica, Gracanica, Bosnia and Herzegovina
- Faculty of Health sciences, University of Zenica, Zenica, Bosnia and Herzegovina
| | | | - Amira Skopljak
- Department of Family medicine, University of Sarajevo, Bosnia and Herzegovina
| | - Almir Pasagic
- Department of Family medicine, University of Sarajevo, Bosnia and Herzegovina
| | - Izet Masic
- Faculty of Health sciences, University of Zenica, Zenica, Bosnia and Herzegovina
- Department of Family medicine, University of Sarajevo, Bosnia and Herzegovina
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Ollesch J, Heinze M, Heise HM, Behrens T, Brüning T, Gerwert K. It's in your blood: spectral biomarker candidates for urinary bladder cancer from automated FTIR spectroscopy. J Biophotonics 2014; 7:210-221. [PMID: 24395618 DOI: 10.1002/jbio.201300163] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 11/18/2013] [Accepted: 11/29/2013] [Indexed: 06/03/2023]
Abstract
Blood samples of urinary bladder cancer (UBC) patients and patients with urinary tract infection were analysed with advanced automated high throughput Fourier transform infrared (HT-FTIR)-spectroscopy. Thin dried film samples were robotically prepared on multi-well titer plates (MTP) for absorbance measurements in transmission mode. Within the absorbance, 1st and 2nd derivative spectra of serum and two plasma preparations, discriminative patterns were identified and validated using bioinformatic tools. The optimal spectral resolution for data acquisition was determined. An accurate discrimination of the patient groups was achieved with three different independent spectral variable sets. The HT-FTIR blood test may support future clinical diagnostics.
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Affiliation(s)
- Julian Ollesch
- Ruhr-Universität Bochum, Department of Biophysics ND04, Universitätsstraße 150, 44780 Bochum, Germany
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Seo WH, Nam SW, Lee EH, Je BK, Yim HE, Choi BM. A rapid plasma neutrophil gelatinase-associated lipocalin assay for diagnosis of acute pyelonephritis in infants with acute febrile urinary tract infections: a preliminary study. Eur J Pediatr 2014; 173:229-32. [PMID: 23918295 DOI: 10.1007/s00431-013-2112-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 07/16/2013] [Indexed: 12/26/2022]
Abstract
In infants with febrile urinary tract infection (UTI), the accurate rapid diagnosis of acute pyelonephritis (APN) would be valuable because early aggressive treatment reduces the risk of renal scarring. The objective of the study was to evaluate whether rapid plasma neutrophil gelatinase-associated lipocalin (NGAL) assay could be used as a diagnostic biomarker of renal parenchymal injury in infants with acute febrile UTI to distinguish APN at the bedside. This prospective observational study included 47 infants, who were admitted with a first episode of acute febrile UTI. Total UTI group was divided into the Cortical defect (UTI-CD, n = 24) group and Non-cortical defect (UTI-ND, n = 23) group, according to the result of renal scan. For the Control group, 15 infants who presented a febrile episode without any focus of bacterial infection were included. On admission, the median NGAL level (106.5 [60-476] ng/mL) in the UTI-CD group was significantly higher than that (60 [60-196] ng/mL) in the UTI-ND group and that (60 [60-197] ng/mL) in the Control group and was significantly decreased to 60 [60-306] ng/mL after an antibiotic treatment. The area under the receiver operating characteristic curves was 0.748 (95 % CI, 0.610-0.887; P = 0.003) for NGAL levels and 0.724 (95 % CI, 0.579-0.868; P = 0.009) for CRP levels. The best cutoff of NGAL level for detection of APN was founded to be 61.0 ng/mL (sensitivity, 75.0 %; specificity, 78.3 %). Although not a stand-alone test, the rapid determination of plasma NGAL level provides valuable information quickly, concerning the distinction of APN, for determining the clinical course of acute febrile UTI.
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Affiliation(s)
- Won Hee Seo
- Department of Pediatrics, Korea University College of Medicine, #516, Gojan-Dong, Danwon-Gu, Ansan-Si, Gyeonggi-Do, 425-707, South Korea
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Hung C, Marschall J, Burnham CAD, Byun AS, Henderson JP. The bacterial amyloid curli is associated with urinary source bloodstream infection. PLoS One 2014; 9:e86009. [PMID: 24465838 PMCID: PMC3896446 DOI: 10.1371/journal.pone.0086009] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 12/03/2013] [Indexed: 12/20/2022] Open
Abstract
Urinary tract infections are the most common cause of E. coli bloodstream infections (BSI) but the mechanism of bloodstream invasion is poorly understood. Some clinical isolates have been observed to shield themselves with extracellular amyloid fibers called curli at physiologic temperature. We hypothesize that curli fiber assembly at 37°C promotes bacteremic progression by urinary E. coli strains. Curli expression by cultured E. coli isolates from bacteriuric patients in the presence and absence of bacteremia were compared using Western blotting following amyloid fiber disruption with hexafluoroisopropanol. At 37°C, urinary isolates from bacteremic patients were more likely to express curli than those from non-bacteremic patients [16/22 (73%) vs. 7/21 (33%); p = 0.01]. No significant difference in curli expression was observed at 30°C [86% (19/22) vs. 76% (16/21); p = 0.5]. Isolates were clonally diverse between patients, indicating that this phenotype is distributed across multiple lineages. Most same-patient urine and blood isolates were highly related, consistent with direct invasion of urinary bacteria into the bloodstream. 37°C curli expression was associated with bacteremic progression of urinary E. coli isolates in this population. These findings suggest new future diagnostic and virulence-targeting therapeutic approaches.
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Affiliation(s)
- Chia Hung
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Center for Women’s Infectious Diseases Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jonas Marschall
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Center for Women’s Infectious Diseases Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Infectious Diseases, Bern University Hospital, Bern, Switzerland
| | - Carey-Ann D. Burnham
- Department of Pathology & Immunology, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Albert S. Byun
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Center for Women’s Infectious Diseases Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
| | - Jeffrey P. Henderson
- Division of Infectious Diseases, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America
- Center for Women’s Infectious Diseases Research, Washington University School of Medicine, St. Louis, Missouri, United States of America
- * E-mail:
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