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Sample records for causing urinary tract

  1. Two Cases of Urinary Tract Infection Caused by Propionimicrobium lymphophilum.

    PubMed

    Williams, Glynne D

    2015-09-01

    The first case reports involving Propionimicrobium lymphophilum, a rarely encountered anaerobic Gram-positive non-spore-forming rod, are presented here as urinary tract infections. Initial detection of these bacteria required urine Gram stains. Comparison of the type strain to the two isolates by various methods is depicted and includes antimicrobial susceptibility data. PMID:26135862

  2. Two Cases of Urinary Tract Infection Caused by Propionimicrobium lymphophilum

    PubMed Central

    2015-01-01

    The first case reports involving Propionimicrobium lymphophilum, a rarely encountered anaerobic Gram-positive non-spore-forming rod, are presented here as urinary tract infections. Initial detection of these bacteria required urine Gram stains. Comparison of the type strain to the two isolates by various methods is depicted and includes antimicrobial susceptibility data. PMID:26135862

  3. Neonatal Staphylococcus lugdunensis urinary tract infection.

    PubMed

    Hayakawa, Itaru; Hataya, Hiroshi; Yamanouchi, Hanako; Sakakibara, Hiroshi; Terakawa, Toshiro

    2015-08-01

    Staphylococcus lugdunensis is a known pathogen of infective endocarditis, but not of urinary tract infection. We report a previously healthy neonate without congenital anomalies of the kidney and urinary tract who developed urinary tract infection due to Staphylococcus lugdunensis, illustrating that Staphylococcus lugdunensis can cause urinary tract infection even in those with no urinary tract complications. PMID:26177232

  4. Urinary Tract Infections (For Kids)

    MedlinePlus

    ... time. And when you do, phew! Your pee smells bad. These changes occur because bacteria have caused an infection somewhere in your urinary tract. Let's find out more. What Exactly Is a Urinary Tract? Your urinary tract is actually a system made up of these main parts: two kidneys ...

  5. Feline Lower Urinary Tract Disease

    MedlinePlus

    ... gland) can cause lower urinary tract disease in cats. Although they are much less common causes, FLUTD ... your veterinarian about the best diet for your cat. Many commercial diets are acceptable, but some urinary ...

  6. [A case of urinary tract infection caused by Flavimonas oryzihabitans].

    PubMed

    Topkaya, Aynur E; Ozakkaş, Fatma; Aksungar, Fehime B; Tülbek, Yaşar

    2007-01-01

    Flavimonas oryzihabitans is an uncommon bacterial species isolated from clinical specimens. In this report, a 53 years old female patient who had been followed up with the diagnosis of rectum cancer and renal failure for five and two years, respectively, was presented. F. oryzihabitans was isolated from the urine culture of the patient, and the clinical response to ofloxacin therapy was excellent even the urinary catheter has not been removed. Although this pathogen is mostly community aquired, it was found resistant to most of the antimicrobial agents tested. Since it was susceptible to fluoroquinolones and carbapenems, these antibiotics could be the drug of choice for the treatment of infections caused by F. oryzihabitans. The aim of this presentation was to withdraw attention to this bacterium which is thought to be the first urine isolate in our country.

  7. [A case of urinary tract infection caused by Flavimonas oryzihabitans].

    PubMed

    Topkaya, Aynur E; Ozakkaş, Fatma; Aksungar, Fehime B; Tülbek, Yaşar

    2007-01-01

    Flavimonas oryzihabitans is an uncommon bacterial species isolated from clinical specimens. In this report, a 53 years old female patient who had been followed up with the diagnosis of rectum cancer and renal failure for five and two years, respectively, was presented. F. oryzihabitans was isolated from the urine culture of the patient, and the clinical response to ofloxacin therapy was excellent even the urinary catheter has not been removed. Although this pathogen is mostly community aquired, it was found resistant to most of the antimicrobial agents tested. Since it was susceptible to fluoroquinolones and carbapenems, these antibiotics could be the drug of choice for the treatment of infections caused by F. oryzihabitans. The aim of this presentation was to withdraw attention to this bacterium which is thought to be the first urine isolate in our country. PMID:17427563

  8. A Comparison Between Foley and Nelatone Urinary Catheters in Causing Urinary Tract Infection in Animal Models

    PubMed Central

    Nouri, Saeed; Sharif, Mohammad Reza; Hosseinpour, Mehrdad; Farokhi, Shima; Sharif, Mohammad Hossein

    2015-01-01

    Background: Urinary catheterization is one of the main measures used to treat and care for hospitalized patients. Several complications have been attributed to the presence of latex with routine Foley catheters. Therefore, some studies have recommended that Nelatone catheters be substituted for the ordinary Foley catheters to prevent these complications. Objectives: This study aimed to compare the rates of urinary tract infection (UTI) in rabbits catheterized either with Foley or with Nelatone catheters. Materials and Methods: A randomized controlled trial was conducted on 60 rabbits that were randomly assigned to three groups of twenty. The first group was catheterized using Nelatone catheter; the second group was catheterized using Foley catheter and the third group was studied without performing any catheterization. After seven days, urine samples were collected using suprapubic aspiration and were sent to the laboratory for culture. Descriptive statistics were calculated. Moreover, chi-square and Fisher’s exact tests were used for data analysis. Results: At the end of the study, four cases in the Nelatone group and 12 cases in the Foley group presented with UTI (P = 0.01). No positive urine cultures were found in the control group. Conclusions: The Nelatone catheters, compared with the Foley ones, had a lower risk of UTI in the long term use. Verifying this claim by further studies can have an important role in reducing UTIs in patients using urinary catheters. PMID:25830158

  9. Continuous versus intermittent levofloxacin treatment in complicated urinary tract infections caused by urinary obstruction temporarily relieved by foreign body insertion.

    PubMed

    Tenke, Peter; Kovacs, Bela; Benkõ, Ria; Ashaber, David; Nagy, Elizabeth

    2006-08-01

    This study was one of the first to examine the in vivo levofloxacin adsorption to stent surfaces. The results demonstrated the ability of this antibiotic to adsorb to the conditioning film and to the surface of the inserted device, and showed that 1-2 weeks after the discontinuation of antibiotic administration some amount of the antibiotic still could be detected on them. The second aim of the investigation was to determine whether continuous or intermittent levofloxacin treatment is advantageous for the patients who have acute complicated urinary tract infection (UTI) caused by urinary obstruction. The results did not show any clinical or microbiological advantages of the continuous therapy.

  10. Anterior Urethral Valve: A Rare But an Important Cause of Infravesical Urinary Tract Obstruction

    PubMed Central

    Parmar, Jitendra P.; Mohan, Chander; Vora, Maulik P.

    2016-01-01

    Summary Background Urethral valves are infravesical congenital anomalies, with the posterior urethral valve (PUV) being the most prevalent one. Anterior urethral valve (AUV) is a rare but a well-known congenital anomaly. AUV and diverticula can cause severe obstruction, whose repercussions on the proximal urinary system can be important. Few cases have been described; both separately and in association with urethral diverticulum. The presentation of such a rare but important case led us to a report with highlighting its classic imaging features. Case Report We present a case report of AUV with lower urinary tract symptoms in a 6-year-old boy with complaints of a poor stream of urine and strain to void. Unique findings were seen on Retrograde Urethrography (RGU) and Voiding Cysto-Urethrography (VCUG), i.e. linear incomplete filling defect in the penile urethra and associated mild dilatation of the anterior urethra ending in a smooth bulge. On cysto-urethroscopy the anterior urethral valve was confirmed and fulguration was done. Conclusions Congenital anterior urethral valve is an uncommon but important cause of infravesical lower urinary tract obstruction that is more common in male urethra. It can occur as an isolated AUV or in association with diverticulum and VATER anomalies. Early diagnosis and management of this rare condition is very important to prevent further damage, infection and vesicoureteral reflux. AUV may be associated with other congenital anomalies of the urinary system; therefore a full evaluation of the urinary system is essential. PMID:27231492

  11. [A Case of Hyperammonemia Caused by Urinary Tract Infection Due to Urease-Producing Bacteria].

    PubMed

    Emura, Masahiro; Tsuchihashi, Kazunari; Shimizu, Yosuke; Kanamaru, Sojun; Matoba, Shun; Ito, Noriyuki

    2016-08-01

    We present here a rare case of hyperammonemia without liver dysfunction or portal-systemic shunting. The patient was an 80-year-old woman with a history of neurogenic bladder. She was admitted to a nearby hospital for vomiting, diarrhea and consciousness disturbance. Two days after admission, she was transferred to our hospital because of persistant consciousness disturbance. Laboratory data revealed hyperammonemia, but there was no indication of liver dysfunction. Moreover abdominal computed tomography did not reveal any clear finding of liver disease or portal-systemic shunting, but we noted multiple large bladder diverticula. Antibiotic therapy, tracheal intubation, ventilator management and bladder catheterization were performed. The patient's level of consciousness improved rapidly. Urinary culture revealed Bacteroides ureolyticus (urease-producing bacteria). The patient was diagnosed with hyperammonemia and a urinary tract infection due to urease-producing bacteria. Thus, physicians should be aware that obstructive urinary tract infections due to urease-producing bacteria can also be the cause of hyperammonemia. PMID:27624109

  12. Urinary tract infections and Candida albicans

    PubMed Central

    Behzadi, Payam; Behzadi, Elham

    2015-01-01

    Introduction Urinary tract candidiasis is known as the most frequent nosocomial fungal infection worldwide. Candida albicans is the most common cause of nosocomial fungal urinary tract infections; however, a rapid change in the distribution of Candida species is undergoing. Simultaneously, the increase of urinary tract candidiasis has led to the appearance of antifungal resistant Candida species. In this review, we have an in depth look into Candida albicans uropathogenesis and distribution of the three most frequent Candida species contributing to urinary tract candidiasis in different countries around the world. Material and methods For writing this review, Google Scholar –a scholarly search engine– (http://scholar.google.com/) and PubMed database (http://www.ncbi.nlm.nih.gov/pubmed/) were used. The most recently published original articles and reviews of literature relating to the first three Candida species causing urinary tract infections in different countries and the pathogenicity of Candida albicans were selected and studied. Results Although some studies show rapid changes in the uropathogenesis of Candida species causing urinary tract infections in some countries, Candida albicans is still the most important cause of candidal urinary tract infections. Conclusions Despite the ranking of Candida albicans as the dominant species for urinary tract candidiasis, specific changes have occurred in some countries. At this time, it is important to continue the surveillance related to Candida species causing urinary tract infections to prevent, control and treat urinary tract candidiasis in future. PMID:25914847

  13. Antiseptic and antibiotic resistance in Gram-negative bacteria causing urinary tract infection.

    PubMed Central

    Stickler, D J; Thomas, B

    1980-01-01

    A collection of 802 isolates of Gram-negative bacteria causing urinary tract infections was made from general practice, antenatal clinics, and local hospitals. The organisms were tested for their sensitivity to chlorhexidine, cetrimide, glutaraldehyde, phenyl mercuric nitrate, a phenolic formulation, and a proprietary antiseptic containing a mixture of picloxydine, octyl phenoxy polyethoxyethanol, and benzalkonium chloride. Escherichia coli, the major species isolated, proved to be uniformly sensitive to these agents. Approximately 10% of the total number of isolates, however, exhibited a degree of resistance to the cationic agents. These resistant organisms were members of the genera Proteus, Providencia, and Pseudomonas; they were also generally resistant to five, six, or seven antibiotics. It is proposed therefore that an antiseptic policy which involves the intensive use of cationic antiseptics might lead to the selection of a flora of notoriously drug-resistant species. PMID:6769972

  14. Endemic and Epidemic Lineages of Escherichia coli that Cause Urinary Tract Infections

    PubMed Central

    Tabor, Helen; Tellis, Patricia; Vincent, Caroline; Tellier, Pierre-Paul

    2008-01-01

    Women with urinary tract infections (UTIs) in California, USA (1999–2001), were infected with closely related or indistinguishable strains of Escherichia coli (clonal groups), which suggests point source dissemination. We compared strains of UTI-causing E. coli in California with strains causing such infections in Montréal, Québec, Canada. Urine specimens from women with community-acquired UTIs in Montréal (2006) were cultured for E. coli. Isolates that caused 256 consecutive episodes of UTI were characterized by antimicrobial drug susceptibility profile, enterobacterial repetitive intergenic consensus 2 PCR, serotyping, XbaI and NotI pulsed-field gel electrophoresis, multilocus sequence typing, and phylogenetic typing. We confirmed the presence of drug-resistant, genetically related, and temporally clustered E. coli clonal groups that caused community-acquired UTIs in unrelated women in 2 locations and 2 different times. Two clonal groups were identified in both locations. Epidemic transmission followed by endemic transmission of UTI-causing clonal groups may explain these clusters of UTI cases. PMID:18826822

  15. Urinary Tract Infections

    MedlinePlus

    ... body's drainage system for removing wastes and extra water. It includes two kidneys, two ureters, a bladder, and a urethra. Urinary tract infections (UTIs) are the second most common type of infection in the body. You may have a UTI if you notice ...

  16. Mutations in TBX18 Cause Dominant Urinary Tract Malformations via Transcriptional Dysregulation of Ureter Development.

    PubMed

    Vivante, Asaf; Kleppa, Marc-Jens; Schulz, Julian; Kohl, Stefan; Sharma, Amita; Chen, Jing; Shril, Shirlee; Hwang, Daw-Yang; Weiss, Anna-Carina; Kaminski, Michael M; Shukrun, Rachel; Kemper, Markus J; Lehnhardt, Anja; Beetz, Rolf; Sanna-Cherchi, Simone; Verbitsky, Miguel; Gharavi, Ali G; Stuart, Helen M; Feather, Sally A; Goodship, Judith A; Goodship, Timothy H J; Woolf, Adrian S; Westra, Sjirk J; Doody, Daniel P; Bauer, Stuart B; Lee, Richard S; Adam, Rosalyn M; Lu, Weining; Reutter, Heiko M; Kehinde, Elijah O; Mancini, Erika J; Lifton, Richard P; Tasic, Velibor; Lienkamp, Soeren S; Jüppner, Harald; Kispert, Andreas; Hildebrandt, Friedhelm

    2015-08-01

    Congenital anomalies of the kidneys and urinary tract (CAKUT) are the most common cause of chronic kidney disease in the first three decades of life. Identification of single-gene mutations that cause CAKUT permits the first insights into related disease mechanisms. However, for most cases the underlying defect remains elusive. We identified a kindred with an autosomal-dominant form of CAKUT with predominant ureteropelvic junction obstruction. By whole exome sequencing, we identified a heterozygous truncating mutation (c.1010delG) of T-Box transcription factor 18 (TBX18) in seven affected members of the large kindred. A screen of additional families with CAKUT identified three families harboring two heterozygous TBX18 mutations (c.1570C>T and c.487A>G). TBX18 is essential for developmental specification of the ureteric mesenchyme and ureteric smooth muscle cells. We found that all three TBX18 altered proteins still dimerized with the wild-type protein but had prolonged protein half life and exhibited reduced transcriptional repression activity compared to wild-type TBX18. The p.Lys163Glu substitution altered an amino acid residue critical for TBX18-DNA interaction, resulting in impaired TBX18-DNA binding. These data indicate that dominant-negative TBX18 mutations cause human CAKUT by interference with TBX18 transcriptional repression, thus implicating ureter smooth muscle cell development in the pathogenesis of human CAKUT. PMID:26235987

  17. Urinary tract endometriosis.

    PubMed

    Koszczuk, J C; Foglietti, M; Perez, J F; Dono, F V; Thomas, R J

    1989-01-01

    Although endometriosis is a common gynecologic pathologic phenomenon, involvement of the urinary tract is relatively rare. The clinical presentation and course of urinary system disease is extremely variable, as illustrated by the seven cases presented in this report. Therapy primarily is surgical, but a thorough understanding of the disease process and a complete knowledge of the patient's history and desires for fertility conservation are necessary to plot the most appropriate treatment course. Bladder involvement is more common, and usually less devastating, than either ureteral or kidney involvement. No signs, symptoms, or physical findings are pathognomonic, and the clinician must maintain a high index of suspicion in all cases of advanced pelvic endometriosis.

  18. Postcircumcision urinary tract infection.

    PubMed

    Cohen, H A; Drucker, M M; Vainer, S; Ashkenasi, A; Amir, J; Frydman, M; Varsano, I

    1992-06-01

    The possible association of urinary tract infection (UTI) with ritual circumcision on the eighth day of life was studied by analyzing the epidemiology of urinary tract infections during the first year of life in 169 children with UTI (56 males and 113 females) born in Israel from 1979 to 1984. Forty-eight percent of the episodes of UTI occurring in males appeared during the 12 days following circumcision, and the increased incidence during that period was highly significant. The median age of the males at the time of the UTI was 16 days, compared with seven months in females. Ritual Jewish circumcision as practiced in Israel may be a predisposing factor for UTI during the 12-day period following that procedure.

  19. Bacterial Uropathogens Causing Urinary Tract Infection and Their Resistance Patterns Among Children in Turkey

    PubMed Central

    Yilmaz, Yunus; Tekkanat Tazegun, Zuhal; Aydin, Emsal; Dulger, Mahmut

    2016-01-01

    Background Urinary tract infection (UTI) is a common problem in infants and children, as well as adults. Objectives The aim of this study was to assess the most common bacterial uropathogens, their susceptibility, and resistance to antibiotics in children with UTI. Materials and Methods This study included 7,365 urine samples sent from various departments to the Kars state hospital microbiology laboratory between January 2012 and May 2014. Bacterial isolation from clinical samples was made using standard microbiological methods. Antibiotic susceptibilities were determined by disk diffusion, according to CLSI recommendations. Results Bacterial growth was obtained in 1,373 samples (18.5%). The percentage distributions of the isolates were as follows: Escherichia coli, 940 (68.5%); Proteus spp, 183 (13.3%); Staphylococcus spp, 85 (6.2%); Enterococcus spp, 65 (4.7%); Klebsiella, 62 (4.5%); Pseudomonas aeruginosa, 21 (1.5%); and other Gram-negative bacteria and Gram-positive bacteria, 17 (1.2%). UTIs were more prevalent, after two years of age, among females than males (P < 0.001). Conclusions The identification of the most common microorganisms causing infectious diseases and regional resistance patterns is important in order to determine the antimicrobial policies and infection control guidelines of hospitals. PMID:27621929

  20. Enteroaggregative Escherichia coli O78:H10, the Cause of an Outbreak of Urinary Tract Infection

    PubMed Central

    Scheutz, Flemming; Andersen, Rebecca L.; Menard, Megan; Boisen, Nadia; Johnston, Brian; Hansen, Dennis S.; Krogfelt, Karen A.; Nataro, James P.; Johnson, James R.

    2012-01-01

    In 1991, multiresistant Escherichia coli O78:H10 strains caused an outbreak of urinary tract infections in Copenhagen, Denmark. The phylogenetic origin, clonal background, and virulence characteristics of the outbreak isolates, and their relationship to nonoutbreak O78:H10 strains according to these traits and resistance profiles, are unknown. Accordingly, we extensively characterized 51 archived E. coli O78:H10 isolates (48 human isolates from seven countries, including 19 Copenhagen outbreak isolates, and 1 each of calf, avian, and unknown-source isolates), collected from 1956 through 2000. E. coli O78:H10 was clonally heterogeneous, comprising one dominant clonal group (61% of isolates, including all 19 outbreak isolates) from ST10 (phylogenetic group A) plus several minor clonal groups (phylogenetic groups A and D). All ST10 isolates, versus 25% of non-ST10 isolates, were identified by molecular methods as enteroaggregative E. coli (EAEC) (P < 0.001). Genes present in >90% of outbreak isolates included fimH (type 1 fimbriae; ubiquitous in E. coli); fyuA, traT, and iutA (associated with extraintestinal pathogenic E. coli [ExPEC]); and sat, pic, aatA, aggR, aggA, ORF61, aaiC, aap, and ORF3 (associated with EAEC). An outbreak isolate was lethal in a murine subcutaneous sepsis model and exhibited characteristic EAEC “stacked brick” adherence to cultured epithelial cells. Thus, the 1991 Copenhagen outbreak was caused by a tight, non-animal-associated subset within a broadly disseminated O78:H10 clonal group (ST10; phylogenetic group A), members of which exhibit both ExPEC and EAEC characteristics, whereas O78:H10 isolates overall are phylogenetically diverse. Whether ST10 O78:H10 EAEC strains are both uropathogenic and diarrheagenic warrants further investigation. PMID:22972830

  1. Urinary Tract Endometriosis.

    PubMed

    Kołodziej, Anna; Krajewski, Wojciech; Dołowy, Łukasz; Hirnle, Lidia

    2015-01-01

    Recently, occurrence of urinary tract endometriosis (UTE) is more frequently diagnosed. According to literature, it refers to approximately 0.3 to even 12% of all women with endometriosis. The pathogenesis of UTE has not been clearly explained so far. The actually proposed hypotheses include embryonic, migration, transplantation, and iatrogenic theory. Most frequently UTE affects bladder, less often ureters and kidneys. One-third of patients remains asymptomatic or exhibits only minor manifestations. In symptomatic patients main complaints include dysuria, urinary urgency, and/or frequency, painful micturition, and burning sensation in the urethra and discomfort in the retropubic area. Treatment of UTE is challenging and can be pharmacological, surgical or can be a combination of both methods. In this paper we present a review of the literature concerning the UTE, its diagnosis and treatment. PMID:26341760

  2. The erratic antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections.

    PubMed

    Ahmed, Iftkhar; Sajed, Muhammad; Sultan, Aneesa; Murtaza, Iram; Yousaf, Sohail; Maqsood, Bushra; Vanhara, Petr; Anees, Mariam

    2015-01-01

    Increasing trend of antibiotic resistance and expression of Extended Spectrum Beta Lactamases (ESBLs) are serious threats for public health as they render the treatment ineffective. Present study was designed to elucidate the antibiotic-susceptibility patterns of ESBL and non-ESBL producing E. coli and K. pneumoniae causing urinary tract infections so that the ineffective antibiotics could be removed from the line of treatment. The bacterial isolates obtained from the urine of patients visiting a tertiary health care facility were cultured for strain identification using API20E. Antimicrobial susceptibility and ESBL detection were done by Kirby-bauer diffusion technique. Almost 53.4 % isolates of E. coli and 24.5 % isolates of K. pneumoniae were found to be ESBL producers. The ESBL producing bacteria were found to be more resistant towards various antibiotics. The most effective drugs against E. coli ESBL isolates were imipenem (99.54 %), ampicillin-sulbactam (97.48 %), piperacillin-tazobactam (96.86 %), fosfomycin (94.51 %), amikacin (92.26 %) and nitrofurantoin (90.68 %). The most effective drugs against K. pneumoniae ESBL isolates were imipenem (97.62 %), piperacillin-tazobactam (95.35 %), ampicillin-sulbactam (90.48 %) and amikacin (88.37 %). The antibiotics having the highest resistance, particularly by the ESBL producers were amoxicillin clavulanic acid, sulphamethoxalzole/ trimethoprim, cefuroxime, cefpirome, ceftriaxone and ciprofloxacin. Most of the isolates showed multi drug resistance (MDR). High frequency of ESBL producing E. coli and K. pneumoniae were observed as compared to previous data. Penicillins, cephalosporins and some representatives of fluoroquinolones were least effective against the common UTIs and are recommended to be removed from the line of treatment.

  3. The erratic antibiotic susceptibility patterns of bacterial pathogens causing urinary tract infections

    PubMed Central

    Ahmed, Iftkhar; Sajed, Muhammad; Sultan, Aneesa; Murtaza, Iram; Yousaf, Sohail; Maqsood, Bushra; Vanhara, Petr; Anees, Mariam

    2015-01-01

    Increasing trend of antibiotic resistance and expression of Extended Spectrum Beta Lactamases (ESBLs) are serious threats for public health as they render the treatment ineffective. Present study was designed to elucidate the antibiotic-susceptibility patterns of ESBL and non-ESBL producing E. coli and K. pneumoniae causing urinary tract infections so that the ineffective antibiotics could be removed from the line of treatment. The bacterial isolates obtained from the urine of patients visiting a tertiary health care facility were cultured for strain identification using API20E. Antimicrobial susceptibility and ESBL detection were done by Kirby-bauer diffusion technique. Almost 53.4 % isolates of E. coli and 24.5 % isolates of K. pneumoniae were found to be ESBL producers. The ESBL producing bacteria were found to be more resistant towards various antibiotics. The most effective drugs against E. coli ESBL isolates were imipenem (99.54 %), ampicillin-sulbactam (97.48 %), piperacillin-tazobactam (96.86 %), fosfomycin (94.51 %), amikacin (92.26 %) and nitrofurantoin (90.68 %). The most effective drugs against K. pneumoniae ESBL isolates were imipenem (97.62 %), piperacillin-tazobactam (95.35 %), ampicillin-sulbactam (90.48 %) and amikacin (88.37 %). The antibiotics having the highest resistance, particularly by the ESBL producers were amoxicillin clavulanic acid, sulphamethoxalzole/ trimethoprim, cefuroxime, cefpirome, ceftriaxone and ciprofloxacin. Most of the isolates showed multi drug resistance (MDR). High frequency of ESBL producing E. coli and K. pneumoniae were observed as compared to previous data. Penicillins, cephalosporins and some representatives of fluoroquinolones were least effective against the common UTIs and are recommended to be removed from the line of treatment. PMID:26648826

  4. Type 1 Fimbriae Contribute to Catheter-Associated Urinary Tract Infections Caused by Escherichia coli

    PubMed Central

    Maierl, Mario; Jörger, Michael; Krause, Robert; Berger, Daniela; Haid, Andrea; Tesic, Dijana; Zechner, Ellen L.

    2014-01-01

    Biofilm formation on catheters is thought to contribute to persistence of catheter-associated urinary tract infections (CAUTI), which represent the most frequent nosocomial infections. Knowledge of genetic factors for catheter colonization is limited, since their role has not been assessed using physicochemical conditions prevailing in a catheterized human bladder. The current study aimed to combine data from a dynamic catheterized bladder model in vitro with in vivo expression analysis for understanding molecular factors relevant for CAUTI caused by Escherichia coli. By application of the in vitro model that mirrors the physicochemical environment during human infection, we found that an E. coli K-12 mutant defective in type 1 fimbriae, but not isogenic mutants lacking flagella or antigen 43, was outcompeted by the wild-type strain during prolonged catheter colonization. The importance of type 1 fimbriae for catheter colonization was verified using a fimA mutant of uropathogenic E. coli strain CFT073 with human and artificial urine. Orientation of the invertible element (IE) controlling type 1 fimbrial expression in bacterial populations harvested from the colonized catheterized bladder in vitro suggested that the vast majority of catheter-colonizing cells (up to 88%) express type 1 fimbriae. Analysis of IE orientation in E. coli populations harvested from patient catheters revealed that a median level of ∼73% of cells from nine samples have switched on type 1 fimbrial expression. This study supports the utility of the dynamic catheterized bladder model for analyzing catheter colonization factors and highlights a role for type 1 fimbriae during CAUTI. PMID:24336940

  5. Type 1 fimbriae contribute to catheter-associated urinary tract infections caused by Escherichia coli.

    PubMed

    Reisner, Andreas; Maierl, Mario; Jörger, Michael; Krause, Robert; Berger, Daniela; Haid, Andrea; Tesic, Dijana; Zechner, Ellen L

    2014-03-01

    Biofilm formation on catheters is thought to contribute to persistence of catheter-associated urinary tract infections (CAUTI), which represent the most frequent nosocomial infections. Knowledge of genetic factors for catheter colonization is limited, since their role has not been assessed using physicochemical conditions prevailing in a catheterized human bladder. The current study aimed to combine data from a dynamic catheterized bladder model in vitro with in vivo expression analysis for understanding molecular factors relevant for CAUTI caused by Escherichia coli. By application of the in vitro model that mirrors the physicochemical environment during human infection, we found that an E. coli K-12 mutant defective in type 1 fimbriae, but not isogenic mutants lacking flagella or antigen 43, was outcompeted by the wild-type strain during prolonged catheter colonization. The importance of type 1 fimbriae for catheter colonization was verified using a fimA mutant of uropathogenic E. coli strain CFT073 with human and artificial urine. Orientation of the invertible element (IE) controlling type 1 fimbrial expression in bacterial populations harvested from the colonized catheterized bladder in vitro suggested that the vast majority of catheter-colonizing cells (up to 88%) express type 1 fimbriae. Analysis of IE orientation in E. coli populations harvested from patient catheters revealed that a median level of ∼73% of cells from nine samples have switched on type 1 fimbrial expression. This study supports the utility of the dynamic catheterized bladder model for analyzing catheter colonization factors and highlights a role for type 1 fimbriae during CAUTI.

  6. Urinary tract infections.

    PubMed

    Wang, Alina; Nizran, Parminder; Malone, Michael A; Riley, Timothy

    2013-09-01

    Clinical presentation helps differentiate between upper and lower urinary tract infections (UTIs). UTIs are classified as either complicated or uncomplicated. A complicated UTI is associated with an underlying condition that increases the risk of failing therapy. Primary laboratory tests for UTIs consist of urinalysis and urine culture. The most common pathogen for uncomplicated cystitis and pyelonephritis is Escherichia coli. Nitrofurantoin, fosfomycin, and trimethoprim-sulfamethoxazole are first-line therapies for acute uncomplicated cystitis. Decisions regarding antibiotic agents should be individualized based on patients' allergies, tolerability, community resistance rates, cost, and availability.

  7. Urinary tract infection in children after cardiac surgery: Incidence, causes, risk factors and outcomes in a single-center study.

    PubMed

    Kabbani, Mohamed S; Ismail, Sameh R; Fatima, Anis; Shafi, Rehana; Idris, Julinar A; Mehmood, Akhter; Singh, Reetam K; Elbarabry, Mahmoud; Hijazi, Omar; Hussein, Mohamed A

    2016-01-01

    Nosocomial urinary tract infection (UTI) increases hospitalization, cost and morbidity. In this cohort study, we aimed to determine the incidence, risk factors, etiology and outcomes of UTIs in post-operative cardiac children. To this end, we studied all post-operative patients admitted to the Pediatric Cardiac Intensive Care Unit (PCICU) in 2012, and we divided the patients into two groups: the UTI (UTI group) and the non-UTI (control group). We compared both groups for multiple peri-operative risk factors. We included 413 children in this study. Of these, 29 (7%) had UTIs after cardiac surgery (UTI group), and 384 (93%) were free from UTIs (control group). All UTI cases were catheter-associated UTIs (CAUTIs). A total of 1578 urinary catheter days were assessed in this study, with a CAUTI density rate of 18 per 1000 catheter days. Multivariate logistic regression analysis demonstrated the following risk factors for CAUTI development: duration of urinary catheter placement (p<0.001), presence of congenital abnormalities of kidney and urinary tract (CAKUT) (p<0.0041) and the presence of certain syndromes (Down, William, and Noonan) (p<0.02). Gram-negative bacteria accounted for 63% of the CAUTI. The main causes of CAUTI were Klebsiella (27%), Candida (24%) and Escherichia coli (21%). Resistant organisms caused 34% of CAUTI. Two patients (7%) died in the UTI group compared with the one patient (0.3%) who died in the control group (p<0.05). Based on these findings, we concluded that an increased duration of the urinary catheter, the presence of CAKUT, and the presence of syndromes comprised the main risk factors for CAUTI. Gram-negative organisms were the main causes for CAUTI, and one-third of them found to be resistant in this single-center study. PMID:26829892

  8. Evaluation of the antibacterial potential of Petroselinum crispum and Rosmarinus officinalis against bacteria that cause urinary tract infections

    PubMed Central

    Petrolini, Fernanda Villas Boas; Lucarini, Rodrigo; de Souza, Maria Gorete Mendes; Pires, Regina Helena; Cunha, Wilson Roberto; Martins, Carlos Henrique Gomes

    2013-01-01

    In this study we evaluated the antibacterial activity of the crude hydroalcoholic extracts, fractions, and compounds of two plant species, namely Rosmarinus officinalis and Petroselinum crispum, against the bacteria that cause urinary tract infection. The microdilution method was used for determination of the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The crude hydroalcoholic extract of R. officinalis displayed in vitro activity against Gram-positive bacteria, with satisfactory MBC for the clinical isolate S. saprophyticus. The fractions and the pure compound rosmarinic acid did not furnish promising results for Gram-negative bacteria, whereas fractions 2, 3, and 4 gave encouraging results for Gram-positive bacteria and acted as bactericide against S. epidermidis as well as E. faecalis (ATCC 29212) and its clinical isolate. R. officinalis led to promising results in the case of Gram-positive bacteria, resulting in a considerable interest in the development of reliable alternatives for the treatment of urinary infections. PMID:24516424

  9. Evaluation of the antibacterial potential of Petroselinum crispum and Rosmarinus officinalis against bacteria that cause urinary tract infections.

    PubMed

    Petrolini, Fernanda Villas Boas; Lucarini, Rodrigo; de Souza, Maria Gorete Mendes; Pires, Regina Helena; Cunha, Wilson Roberto; Martins, Carlos Henrique Gomes

    2013-01-01

    In this study we evaluated the antibacterial activity of the crude hydroalcoholic extracts, fractions, and compounds of two plant species, namely Rosmarinus officinalis and Petroselinum crispum, against the bacteria that cause urinary tract infection. The microdilution method was used for determination of the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC). The crude hydroalcoholic extract of R. officinalis displayed in vitro activity against Gram-positive bacteria, with satisfactory MBC for the clinical isolate S. saprophyticus. The fractions and the pure compound rosmarinic acid did not furnish promising results for Gram-negative bacteria, whereas fractions 2, 3, and 4 gave encouraging results for Gram-positive bacteria and acted as bactericide against S. epidermidis as well as E. faecalis (ATCC 29212) and its clinical isolate. R. officinalis led to promising results in the case of Gram-positive bacteria, resulting in a considerable interest in the development of reliable alternatives for the treatment of urinary infections.

  10. Microfluidic system for the identification of bacterial pathogens causing urinary tract infections

    NASA Astrophysics Data System (ADS)

    Becker, Holger; Hlawatsch, Nadine; Haraldsson, Tommy; van der Wijngaart, Wouter; Lind, Anders; Malhotra-Kumar, Surbi; Turlej-Rogacka, Agata; Goossens, Herman

    2015-03-01

    Urinary tract infections (UTIs) are among the most common bacterial infections and pose a significant healthcare burden. The growing trend in antibiotic resistance makes it mandatory to develop diagnostic kits which allow not only the determination of a pathogen but also the antibiotic resistances. We have developed a microfluidic cartridge which takes a direct urine sample, extracts the DNA, performs an amplification using batch-PCR and flows the sample over a microarray which is printed into a microchannel for fluorescence detection. The cartridge is injection-molded out of COP and contains a set of two-component injection-molded rotary valves to switch between input and to isolate the PCR chamber during thermocycling. The hybridization probes were spotted directly onto a functionalized section of the outlet microchannel. We have been able to successfully perform PCR of E.coli in urine in this chip and perform a fluorescence detection of PCR products. An upgraded design of the cartridge contains the buffers and reagents in blisters stored on the chip.

  11. Characterization and antibiotic susceptibility of Streptococcus agalactiae isolates causing urinary tract infections.

    PubMed

    Piccinelli, Giorgio; Biscaro, Valeria; Gargiulo, Franco; Caruso, Arnaldo; De Francesco, Maria Antonia

    2015-08-01

    Streptococcus agalactiae (GBS) has been implicated in urinary tract infections but the microbiological characteristics and antimicrobial susceptibility of these strains are poorly investigated. In this study, 87 isolates recovered from urine samples of patients who had attended the Spedali Civili of Brescia (Italy) and had single organism GBS cultured were submitted to antimicrobial susceptibility testing, molecular characterization of macrolide and levofloxacin resistance, PCR-based capsular typing and analysis of surface protein genes. By automated broth microdilution method, all isolates were susceptible to penicillin, cefuroxime, cefaclor, and ceftriaxone; 80%, 19.5% and 3.4% of isolates were non-susceptible to tetracycline, erythromycin, and levofloxacin, respectively. Macrolide resistance determinants were iMLS(B) (n=1), cMLS(B) (n=10) and M (n=5), associated with ermTR, ermB and mefA/E. Levofloxacin resistance was linked to mutations in gyrA and parC genes. Predominant capsular types were III, Ia, V, Ib and IX. Type III was associated with tetracycline resistance, while type Ib was associated with levofloxacin resistance. Different capsular type-surface protein gene combinations (serotype V-alp2, 3; serotype III-rib; serotype Ia-epsilon) were detected. A variety of capsular types are involved in significant bacteriuria. The emergence of multidrug resistant GBS may become a significant public health concern and highlights the importance of careful surveillance to prevent the emergence of these virulent GBS. PMID:26144658

  12. Approach to urinary tract infections

    PubMed Central

    Najar, M. S.; Saldanha, C. L.; Banday, K. A.

    2009-01-01

    Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of both community-acquired and nosocomial infections for patients admitted to hospitals. For better management and prognosis, it is mandatory to know the possible site of infection, whether the infection is uncomplicated or complicated, re-infection or relapse, or treatment failure and its pathogenesis and risk factors. Asymptomatic bacteriuria is common in certain age groups and has different connotations. It needs to be treated and completely cured in pregnant women and preschool children. Reflux nephropathy in children could result in chronic kidney disease; otherwise, urinary tract infections do not play a major role in the pathogenesis of end-stage renal disease. Symptomatic urinary tract infections occur most commonly in women of child-bearing age. Cystitis predominates, but needs to be distinguished from acute urethral syndrome that affects both sexes and has a different management plan than UTIs. The prostatitis symptoms are much more common than bacterial prostatic infections. The treatment needs to be prolonged in bacterial prostatitis and as cure rates are not very high and relapses are common, the classification of prostatitis needs to be understood. The consensus conference convened by National Institute of Health added two more groups of patients, namely, chronic prostatitis/chronic pelvic pain syndrome and asymptomatic inflammatory prostatitis, in addition to acute and chronic bacterial prostatitis. Although white blood cells in urine signify inflammation, they do not always signify UTI. Quantitative cultures of urine provide definitive evidence of UTI. Imaging studies should be done 3-6 weeks after cure of acute infection to identify abnormalities predisposing to infection or renal damage or which may affect management. Treatment of cystitis in women should be a three-day course and if

  13. Rapid identification of major Escherichia coli sequence types causing urinary tract and bloodstream infections.

    PubMed

    Doumith, M; Day, M; Ciesielczuk, H; Hope, R; Underwood, A; Reynolds, R; Wain, J; Livermore, D M; Woodford, N

    2015-01-01

    Escherichia coli sequence types (STs) 69, 73, 95, and 131 are collectively responsible for a large proportion of E. coli urinary tract and bloodstream infections, and they differ markedly in their antibiotic susceptibilities. Here, we describe a novel PCR method to rapidly detect and distinguish these lineages. Three hundred eighteen published E. coli genomes were compared in order to identify signature sequences unique to each of the four major STs. The specificities of these sequences were assessed in silico by seeking them in an additional 98 genomes. A PCR assay was designed to amplify size-distinguishable fragments unique to the four lineages and was validated using 515 E. coli isolates of known STs. Genome comparisons identified 22 regions ranging in size from 335 bp to 26.5 kb that are unique to one or more of the four predominant E. coli STs, with two to 10 specific regions per ST. These regions predominantly harbor genes encoding hypothetical proteins and are within or adjacent to prophage sequences. Most (13/22) were highly conserved (>96.5% identity) in the genomes of their respective ST. The new assay correctly identified all 142 representatives of the four major STs in the validation set (n = 515), with only two ST12 isolates misidentified as ST95. Compared with MLST, the assay has 100% sensitivity and 99.5% specificity. The rapid identification of major extraintestinal E. coli STs will benefit future epidemiological studies and could be developed to tailor antibiotic therapy to the different susceptibilities of these dominant lineages. PMID:25355761

  14. Bacteremic Urinary Tract Infection Caused by Multidrug-Resistant Enterobacteriaceae Are Associated With Severe Sepsis at Admission

    PubMed Central

    Lee, Yi-Chien; Hsiao, Chih-Yen; Hung, Miao-Chiu; Hung, Sheng-Che; Wang, Hung-Ping; Huang, Yun-Jhong; Wang, Jann-Tay

    2016-01-01

    Abstract The purpose of this study is to compare the clinical features and treatment outcomes among patients with bacteremic urinary tract infection (UTI) caused by multidrug-resistant (MDR) and non-MDR Enterobacteriaceae and to identify whether MDR pathogens were independently associated with severe sepsis or septic shock at presentation. The clinical data of adult patients visiting and being treated at Chia-Yi Christian Hospital due to bacteremic UTI caused by Enterobacteriaceae from January 2006 to August 2015 were retrospectively analyzed. A total of 585 patients were enrolled. Among them, 220 (37.6%) were caused by the MDR Enterobacteriaceae. A total of 206 patients (35.2%) developed severe sepsis or septic shock at presentation. Patients in the MDR group tend to be male and have a past history of gout, recurrent UTI, prior hospitalization, hydronephrosis, renal stone, ureteral stone, indwelling urinary catheter, newly development of renal dysfunction, severe sepsis or septic shock, intensive care unit (ICU) admission, receipt of ineffective empirical therapy, longer hospital stay, and higher in-hospital mortality (2.7% vs 1.9%, P = 0.569). Using multivariate logistic regression analysis, it is revealed that independent predictors associated with severe sepsis or septic shock at presentation were liver cirrhosis (OR 2.868; 95% CI 1.439–5.716; P = 0.003), indwelling urinary catheter (OR 1.936; 95% CI 1.238–3.027; P = 0.004), and MDR Enterobacteriaceae (OR 1.447; 95% CI 1.002–2.090; P = 0.049). Multidrug resistance was associated with the development of severe sepsis or septic shock upon presentation among patients with bacteremic UTI caused by Enterobacteriaceae. Therefore, empirical antibiotics therapy for patients with UTI presented with severe sepsis and/or septic shock should be more broad-spectrum to effectively cover MDR Enterobacteriaceae. PMID:27196480

  15. Postoperative Morganella morganii endophthalmitis associated with subclinical urinary tract infection.

    PubMed

    Tsanaktsidis, Gina; Agarwal, Smita A; Maloof, Anthony J; Chandra, Jay; Mitchell, Paul

    2003-05-01

    We report a case of Morganella morganii acute endophthalmitis following clear corneal phacoemulsification cataract surgery in which a coincident asymptomatic chronic urinary tract infection was detected postoperatively. Morganella morganii is a gram-negative bacillus that inhabits the gastrointestinal tract and is part of the normal fecal flora. It is an opportunistic pathogen usually encountered in postoperative and nosocomial settings, causing urinary tract and wound infections. Chronic urinary tract infection may be a risk factor for postoperative endophthalmitis. A dipstick urinalysis before elective cataract surgery in elderly patients with a history of recurrent urinary tract infections may be considered.

  16. Reduction of Urinary Tract Infections Caused By Urethral Catheter through the Implementation of Hydrophobic Coating and Geometrical Modifications

    NASA Astrophysics Data System (ADS)

    Gare, Aya

    2013-11-01

    Catheter-Associated Urinary Tract Infection (CAUTI) is the most common nosocomial infection in the U.S. healthcare system. The obstruction of urine caused by confined air bubbles result in the development of urinary back-flow and stagnation, wherein microbial pathogens could multiply rapidly and colonization within catheters become commonplace. Infections can be prevented by aseptic insertion and the maintenance of a closed drainage system, keeping high infection control standards, and preventing back-flow from the catheter bag. The goal of this study is to assess the effectiveness of a simple, low cost, modification that may be implemented into current catheter designs to reduce the incidence of CAUTI. Using the principle of transmission of fluid-pressure and the Young-Laplace equation for capillary pressure difference, this research focuses on improving the liquid flow in the presence of confined bubbles to prevent stagnation and reflux of bacteria-ridden urine into the body. Preliminary experiments are performed on a variety of tubes with hydrophobic-coating the interior, as well as geometrically modifying the tubes. Proof-of-Concept Prototype tubes are used to represent the drainage system of the catheter structure.

  17. [Ultrasound diagnostics of upper urinary tract calculi].

    PubMed

    Belyĭ, L E

    2006-01-01

    The review is dedicated to ultrasonography of the upper urinary tract in patients with nephrolithiasis. Ultrasonographic semiotics of urolithiasis, the ability of unlrasonography to detect nephrolithiasis, and methods of the optimization of these diagnostic techniques in patients with upper urinary tract calculi are covered. The author discusses difficulties that may be faced while differentiating between nephrolithiasis and such conditions as spongious kidney, nephrocalcinosis, calcification of renal papillae, cysts, tumors, and vascular walls, as well as other kinds of renal calcification, associated with ultrasonographic acoustic path phenomenon. The advantages and disadvantages of ultrasonography in cases of X-ray urolithiasis are evaluated in the paper. The article describes hardships in ultrasound visualization of ureteral calculi causing acute upper urinary tract obstruction, and the ways of getting over them.

  18. Urinary tract infections: treatment/comparative therapeutics.

    PubMed

    Olin, Shelly J; Bartges, Joseph W

    2015-07-01

    Urinary tract infection (UTI) occurs when there is compromise of host defense mechanisms and a virulent microbe adheres, multiplies, and persists in a portion of the urinary tract. Most commonly, UTI is caused by bacteria, but fungi and viruses are possible. Urine culture and sensitivity are the gold standards for diagnosis of bacterial UTI. Identifying the location of infection (eg, bladder, kidney, prostate) as well as comorbidities (eg, diabetes mellitus, immunosuppression) is essential to guide the diagnostic and therapeutic plan. Antimicrobial agents are the mainstay of therapy for bacterial UTI and selected ideally based on culture and sensitivity.

  19. In vitro studies on medicinal plants used against bacterial diabetic foot ulcer (BDFU) and urinary tract infected (UTI) causing pathogens.

    PubMed

    Subbu Lakshmi, S; Chelladurai, G; Suresh, B

    2016-09-01

    The pus samples from diabetic foot ulcer patients and urine samples from urinary tract infected patients were collected and inoculated in nutrient agar plates. The colonies showing different morphologies were streaked on selective agar plates. The antibacterial assay of selected commercial antibiotics was tested against the foot ulcer and urinary tract isolates. The result revealed that most of the organisms were found to be resistant against the antibiotics. Screening of antibacterial activity of selected plants, methanol extracts of plants were prepared and tested against foot ulcer pathogens. Among the plants used, the methanolic extract Tragia involucrata was very effective against the foot ulcer pathogens and to separate the compounds present in the methanolic extract of T. involucrata, when it was subjected to column chromatography. The fractions obtained were further checked for their antibacterial property and fraction 1 which inhibited the pathogens, were subjected to thin layer chromatography and the structure of the particular phytochemical compound was elucidated by NMR study. The spices were tested for their antibacterial property against the urinary tract pathogens. Among the spices tested; Allium sativum inhibited the growth of the pathogens isolated from urinary tract infection. It can be concluded that the plants extract can be used to discover natural products that may serve as lead for the development of new pharmaceuticals addressing the major therapeutic needs. PMID:27605764

  20. Urinary Tract Infection (UTI) Caused by Fusarium proliferatum in an Agranulocytosis Patient and a Review of Published Reports.

    PubMed

    Su, Huilin; Zhang, Qiangqiang; Li, Li; Zhao, Ying; Zhu, Junhao; Zhu, Min

    2016-02-01

    Infections caused by Fusarium species are increasing in frequency among immunocompromised hosts, but urinary tract infection (UTI) due to Fusarium proliferatum has not been reported in the literature so far. We describe a case of UTI caused by F. proliferatum in a 47-year-old man who was diagnosed with rectal cancer and metastasis. He underwent radical resection of rectal carcinoma and local resection of hepatic metastases. After the first adjuvant chemotherapy, the patient presented the obvious high fever, severely diarrhea and progressive decline of the white blood cell count. The direct microscopic examination of fungi in urine was positive, and the fungal cultures showed white, cotton-like colony. After the DNA sequencing, it was identified as F. proliferatum. We gave the patient itraconazole and other antibiotics to fight the infection. A month later, the temperature dropped to normal and the results of the direct microscopic examination and culture of fungi in urine turn negative. The itraconazole is effective against F. proliferatum.

  1. Urinary Tract Infections (For Teens)

    MedlinePlus

    ... more serious infection that reaches the kidneys. continue Bacteria Are to Blame UTIs are usually caused by ... as soon as possible. previous continue Battling the Bacteria Only your health care provider can treat urinary ...

  2. Epidemiological factors associated with ESBL- and non ESBL-producing E. coli causing urinary tract infection in general practice.

    PubMed

    Hertz, Frederik Boëtius; Schønning, Kristian; Rasmussen, Steen Christian; Littauer, Pia; Knudsen, Jenny Dahl; Løbner-Olesen, Anders; Frimodt-Møller, Niels

    2016-01-01

    The purpose of the study was to evaluate how use of antibiotics precedes the presence of ESBL-producing E.coli in general practice. The authors performed a triple-case-control study where three case groups were individually compared to a single control group of uninfected individuals. Urine samples were prospectively collected and retrospective statistical analyses were done. This study included 98 cases with urinary tract infection (UTI) caused by ESBL-producing E. coli, 174 with antibiotic-resistant (non-ESBL) E. coli, 177 with susceptible E. coli and 200 with culture negative urine samples. Case groups had significantly higher use of antibiotics than the control group within 30 days before infection (p < 0.0001). The ESBL group had significantly more hospital admissions than the other case groups (p < 0.05). Hospital admission was an independent risk factor for community onset UTI by ESBL-producing E. coli. Exposure to antibiotics was a risk factor for UTI with E. coli, while prior antibiotic usage was not an indisputable predictor for infection with ESBL-producing E.coli in general practice. PMID:26523346

  3. Epidemiological factors associated with ESBL- and non ESBL-producing E. coli causing urinary tract infection in general practice.

    PubMed

    Hertz, Frederik Boëtius; Schønning, Kristian; Rasmussen, Steen Christian; Littauer, Pia; Knudsen, Jenny Dahl; Løbner-Olesen, Anders; Frimodt-Møller, Niels

    2016-01-01

    The purpose of the study was to evaluate how use of antibiotics precedes the presence of ESBL-producing E.coli in general practice. The authors performed a triple-case-control study where three case groups were individually compared to a single control group of uninfected individuals. Urine samples were prospectively collected and retrospective statistical analyses were done. This study included 98 cases with urinary tract infection (UTI) caused by ESBL-producing E. coli, 174 with antibiotic-resistant (non-ESBL) E. coli, 177 with susceptible E. coli and 200 with culture negative urine samples. Case groups had significantly higher use of antibiotics than the control group within 30 days before infection (p < 0.0001). The ESBL group had significantly more hospital admissions than the other case groups (p < 0.05). Hospital admission was an independent risk factor for community onset UTI by ESBL-producing E. coli. Exposure to antibiotics was a risk factor for UTI with E. coli, while prior antibiotic usage was not an indisputable predictor for infection with ESBL-producing E.coli in general practice.

  4. Recurrent Urinary Tract Infections Management in Women

    PubMed Central

    Al-Badr, Ahmed; Al-Shaikh, Ghadeer

    2013-01-01

    Urinary tract infections (UTIs) are one of the most frequent clinical bacterial infections in women, accounting for nearly 25% of all infections. Around 50–60% of women will develop UTIs in their lifetimes. Escherichia coli is the organism that causes UTIs in most patients. Recurrent UTIs (RUTI) are mainly caused by reinfection by the same pathogen. Having frequent sexual intercourse is one of the greatest risk factors for RUTIs. In a subgroup of individuals with coexisting morbid conditions, complicated RUTIs can lead to upper tract infections or urosepsis. Although the initial treatment is antimicrobial therapy, use of different prophylactic regimens and alternative strategies are available to reduce exposure to antibiotics. PMID:23984019

  5. Recent Advances in Urinary Tract Reconstruction for Neuropathic Bladder in Children

    PubMed Central

    Lopes, Roberto I.; Lorenzo, Armando

    2016-01-01

    Neuropathic bladder usually causes several limitations to patients’ quality of life, including urinary incontinence, recurrent urinary tract infections, and upper urinary tract damage. Its management has significantly changed over the last few years. The aim of our paper is to address some salient features of recent literature dealing with reconstructive procedures in pediatric and adolescent patients with lower urinary tract dysfunction. PMID:26962441

  6. Neural Control of the Lower Urinary Tract

    PubMed Central

    de Groat, William C.; Griffiths, Derek; Yoshimura, Naoki

    2015-01-01

    This article summarizes anatomical, neurophysiological, pharmacological, and brain imaging studies in humans and animals that have provided insights into the neural circuitry and neurotransmitter mechanisms controlling the lower urinary tract. The functions of the lower urinary tract to store and periodically eliminate urine are regulated by a complex neural control system in the brain, spinal cord, and peripheral autonomic ganglia that coordinates the activity of smooth and striated muscles of the bladder and urethral outlet. The neural control of micturition is organized as a hierarchical system in which spinal storage mechanisms are in turn regulated by circuitry in the rostral brain stem that initiates reflex voiding. Input from the forebrain triggers voluntary voiding by modulating the brain stem circuitry. Many neural circuits controlling the lower urinary tract exhibit switch-like patterns of activity that turn on and off in an all-or-none manner. The major component of the micturition switching circuit is a spinobulbospinal parasympathetic reflex pathway that has essential connections in the periaqueductal gray and pontine micturition center. A computer model of this circuit that mimics the switching functions of the bladder and urethra at the onset of micturition is described. Micturition occurs involuntarily in infants and young children until the age of 3 to 5 years, after which it is regulated voluntarily. Diseases or injuries of the nervous system in adults can cause the re-emergence of involuntary micturition, leading to urinary incontinence. Neuroplasticity underlying these developmental and pathological changes in voiding function is discussed. PMID:25589273

  7. Antimicrobial Stewardship and Urinary Tract Infections

    PubMed Central

    Abbo, Lilian M.; Hooton, Thomas M.

    2014-01-01

    Urinary tract infections are the most common bacterial infections encountered in ambulatory and long-term care settings in the United States. Urine samples are the largest single category of specimens received by most microbiology laboratories and many such cultures are collected from patients who have no or questionable urinary symptoms. Unfortunately, antimicrobials are often prescribed inappropriately in such patients. Antimicrobial use, whether appropriate or inappropriate, is associated with the selection for antimicrobial-resistant organisms colonizing or infecting the urinary tract. Infections caused by antimicrobial-resistant organisms are associated with higher rates of treatment failures, prolonged hospitalizations, increased costs and mortality. Antimicrobial stewardship consists of avoidance of antimicrobials when appropriate and, when antimicrobials are indicated, use of strategies to optimize the selection, dosing, route of administration, duration and timing of antimicrobial therapy to maximize clinical cure while limiting the unintended consequences of antimicrobial use, including toxicity and selection of resistant microorganisms. This article reviews successful antimicrobial stewardship strategies in the diagnosis and treatment of urinary tract infections. PMID:27025743

  8. Cranberries and lower urinary tract infection prevention.

    PubMed

    Hisano, Marcelo; Bruschini, Homero; Nicodemo, Antonio Carlos; Srougi, Miguel

    2012-01-01

    Lower urinary tract infections are very common diseases. Recurrent urinary tract infections remain challenging to treat because the main treatment option is long-term antibiotic prophylaxis; however, this poses a risk for the emergence of bacterial resistance. Some options to avoid this risk are available, including the use of cranberry products. This article reviews the key methods in using cranberries as a preventive measure for lower urinary tract infections, including in vitro studies and clinical trials.

  9. Extended-spectrum ß-Lactamase-producing Enterobacteriaceae as a Common Cause of Urinary Tract Infections in Sri Lanka

    PubMed Central

    Vidanagama, Dhammika; Tippalagama, Rashmi; Lewkebandara, Rashmi; Joyce, Maria; Nicholson, Bradly P.; Nagahawatte, Ajith; Bodinayake, Champica K.; De Silva, Aruna Dharshan; Woods, Christopher W.

    2016-01-01

    Background Extended-spectrum ß-lactamase-producing Enterobacteriaceae (ESBL-PE) are increasingly reported as pathogens in urinary tract infections (UTIs). However, in Sri Lanka, the clinical and molecular epidemiology of ESBL-PE implicated in UTIs has not been well described. Materials and Methods We conducted prospective, laboratory-based surveillance from October to December 2013 at a tertiary care hospital in southern Sri Lanka and enrolled patients ≥1 year of age with clinically relevant UTIs due to ESBL-PE. Isolate identity, antimicrobial drug susceptibility, and ESBL production were determined. Presence of ß-lactamase genes, bla SHV, bla TEM, and bla CTX-M, was identified by polymerase chain reaction. Results During the study period, Enterobacteriaceae were detected in 184 urine samples, with 74 (40.2%) being ESBL producers. Among 47 patients with ESBL-PE who had medical records available, 38 (80.9%) had clinically significant UTIs. Most UTIs (63.2%) were community acquired and 34.2% were in patients with diabetes. Among 36 cultured ESBL-PE isolates, significant susceptibility (>80%) was only retained to amikacin and the carbapenems. The group 1 bla CTX-M gene was present in 90.0% of Escherichia coli isolates and all Klebsiella pneumoniae and Enterobacter cloacae isolates. The bla SHV and bla TEM genes were more common in K. pneumoniae (75% and 50%) and E. cloacae (50% and 50%) isolates than in E. coli (10% and 20%) isolates, respectively. Conclusion The majority of UTIs caused by ESBL-PE were acquired in the community and due to organisms carrying the group 1 CTX-M ß-lactamase. Further epidemiologic studies of infections due to ESBL-PE are urgently needed to better prevent and treat these infections in South Asia. PMID:27704730

  10. Advances in Urinary Tract Endoscopy.

    PubMed

    Berent, Allyson C

    2016-01-01

    The use of endoscopy in veterinary medicine has become the mainstay of diagnosis and treatment in the subspecialty of small animal urology over the past decade. This subspecialty is termed endourology. With the common incidence of urinary tract obstructions, stones disease, renal disease, and urothelial malignancies, combined with the recognized invasiveness and morbidity associated with traditional surgical techniques, the use of endoscopic-assisted alternatives using interventional endoscopic techniques has become appealing to both owners and clinicians. This article provides a brief overview of some of the most common urologic procedures being performed in veterinary medicine. PMID:26440205

  11. Urinary tract infections in adults

    PubMed Central

    Wei Tan, Chee; Chlebicki, Maciej Piotr

    2016-01-01

    A urinary tract infection (UTI) is a collective term for infections that involve any part of the urinary tract. It is one of the most common infections in local primary care. The incidence of UTIs in adult males aged under 50 years is low, with adult women being 30 times more likely than men to develop a UTI. Appropriate classification of UTI into simple or complicated forms guides its management and the ORENUC classification can be used. Diagnosis of a UTI is based on a focused history, with appropriate investigations depending on individual risk factors. Simple uncomplicated cystitis responds very well to oral antibiotics, but complicated UTIs may require early imaging, and referral to the emergency department or hospitalisation to prevent urosepsis may be warranted. Escherichia coli remains the predominant uropathogen in acute community-acquired uncomplicated UTIs and amoxicillin-clavulanate is useful as a first-line antibiotic. Family physicians are capable of managing most UTIs if guided by appropriate history, investigations and appropriate antibiotics to achieve good outcomes and minimise antibiotic resistance. PMID:27662890

  12. Urinary tract infections in adults.

    PubMed

    Tan, Chee Wei; Chlebicki, Maciej Piotr

    2016-09-01

    A urinary tract infection (UTI) is a collective term for infections that involve any part of the urinary tract. It is one of the most common infections in local primary care. The incidence of UTIs in adult males aged under 50 years is low, with adult women being 30 times more likely than men to develop a UTI. Appropriate classification of UTI into simple or complicated forms guides its management and the ORENUC classification can be used. Diagnosis of a UTI is based on a focused history, with appropriate investigations depending on individual risk factors. Simple uncomplicated cystitis responds very well to oral antibiotics, but complicated UTIs may require early imaging, and referral to the emergency department or hospitalisation to prevent urosepsis may be warranted. Escherichia coli remains the predominant uropathogen in acute community-acquired uncomplicated UTIs and amoxicillin-clavulanate is useful as a first-line antibiotic. Family physicians are capable of managing most UTIs if guided by appropriate history, investigations and appropriate antibiotics to achieve good outcomes and minimise antibiotic resistance. PMID:27662890

  13. Antibacterial Activity of Barringtonia acutangula against Selected Urinary Tract Pathogens.

    PubMed

    Sahoo, S; Panda, P K; Mishra, S R; Parida, R K; Ellaiah, P; Dash, S K

    2008-09-01

    Barringtonia acutangula (L.) Gaertn belonging to family Barringtoniaceae was investigated to evaluate In vitro antibacterial activity of aqueous, ethanolic, petroleum ether and chloroform extracts against Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus faecalis and Escherichia coli the major urinary tract infection causing pathogens were tested by disc diffusion assay method and the minimum inhibitory concentration was evaluated. Ethanol (95%) extract exhibited broader spectrum of inhibition followed by chloroform, petroleum ether and aqueous extracts against the urinary tract pathogens under test. An attempt has been made to compare the activity of extracts with standard antibiotics against selected urinary tract infection causing pathogens. PMID:21394275

  14. Antibacterial Activity of Barringtonia acutangula against Selected Urinary Tract Pathogens

    PubMed Central

    Sahoo, S.; Panda, P. K.; Mishra, S. R.; Parida, R. K.; Ellaiah, P.; Dash, S. K.

    2008-01-01

    Barringtonia acutangula (L.) Gaertn belonging to family Barringtoniaceae was investigated to evaluate In vitro antibacterial activity of aqueous, ethanolic, petroleum ether and chloroform extracts against Staphylococcus aureus, Pseudomonas aeruginosa, Klebsiella pneumoniae, Enterococcus faecalis and Escherichia coli the major urinary tract infection causing pathogens were tested by disc diffusion assay method and the minimum inhibitory concentration was evaluated. Ethanol (95%) extract exhibited broader spectrum of inhibition followed by chloroform, petroleum ether and aqueous extracts against the urinary tract pathogens under test. An attempt has been made to compare the activity of extracts with standard antibiotics against selected urinary tract infection causing pathogens. PMID:21394275

  15. Urinary Tract Infection as a Preventable Cause of Pregnancy Complications: Opportunities, Challenges, and a Global Call to Action

    PubMed Central

    Gilbert, Nicole M.; O'Brien, Valerie P.; Hultgren, Scott; Macones, George; Lewis, Warren G.

    2013-01-01

    The urinary tract is a common site of infection in humans. During pregnancy, urinary tract infection (UTI) is associated with increased risks of maternal and neonatal morbidity and mortality, even when the infection is asymptomatic. By mapping available rates of UTI in pregnancy across different populations, we emphasize this as a problem of global significance. Many countries with high rates of preterm birth and neonatal mortality also have rates of UTI in pregnancy that exceed rates seen in more developed countries. A global analysis of the etiologies of UTI revealed familiar culprits as well as emerging threats. Screening and treatment of UTI have improved birth outcomes in several more developed countries and would likely improve maternal and neonatal health worldwide. However, challenges of implementation in resource-poor settings must be overcome. We review the nature of the barriers occurring at each step of the screening and treatment pipeline and highlight steps necessary to overcome these obstacles. It is our hope that the information compiled here will increase awareness of the global significance of UTI in maternal and neonatal health and embolden governments, nongovernmental organizations, and researchers to do their part to make urine screening and UTI treatment a reality for all pregnant women. PMID:24416696

  16. Urinary tract infection as a preventable cause of pregnancy complications: opportunities, challenges, and a global call to action.

    PubMed

    Gilbert, Nicole M; O'Brien, Valerie P; Hultgren, Scott; Macones, George; Lewis, Warren G; Lewis, Amanda L

    2013-09-01

    The urinary tract is a common site of infection in humans. During pregnancy, urinary tract infection (UTI) is associated with increased risks of maternal and neonatal morbidity and mortality, even when the infection is asymptomatic. By mapping available rates of UTI in pregnancy across different populations, we emphasize this as a problem of global significance. Many countries with high rates of preterm birth and neonatal mortality also have rates of UTI in pregnancy that exceed rates seen in more developed countries. A global analysis of the etiologies of UTI revealed familiar culprits as well as emerging threats. Screening and treatment of UTI have improved birth outcomes in several more developed countries and would likely improve maternal and neonatal health worldwide. However, challenges of implementation in resource-poor settings must be overcome. We review the nature of the barriers occurring at each step of the screening and treatment pipeline and highlight steps necessary to overcome these obstacles. It is our hope that the information compiled here will increase awareness of the global significance of UTI in maternal and neonatal health and embolden governments, nongovernmental organizations, and researchers to do their part to make urine screening and UTI treatment a reality for all pregnant women.

  17. The Value of Urodynamic Study for Diagnosing the Causes of Lower Urinary Tract Symptoms in Male Patients: A Study From Iran

    PubMed Central

    Heydari, Fatemeh; Rezadoust, Bentolhoda; Abbaszade, Shahin; Jahan Afrouz, Eidi; Ghadian, Alireza

    2016-01-01

    Background Most disorders of the lower urinary tract are functional, so diagnoses are typically based on urodynamic findings. Treatment is likely to fail if the pathology is not correctly diagnosed. Objectives There are various diagnostic tests for lower urinary tract symptoms (LUTS). In this study, we evaluated the value of urodynamic testing to diagnose the causes of lower urinary symptoms in male patients. Patients and Methods Urodynamic tests were performed in 407 patients referred to the urology clinic in Baqiyatallah in 2014 with complaints of LUTS, and the diagnosis was based on the findings of the tests. Results The mean age of patients in this study was 50.88 years, and most patients were in their third decade (20 - 30 years of age). Urinary frequency (28.8%), enuresis (22.22%), and incontinence (16.12%) were the most common complaints. The most prevalent disorder was bladder sensation disorder. Conclusions Patients made various complaints, and several pathologies were diagnosed, which emphasizes the importance of using urodynamic tests for subsequent medical approaches as a non-invasive, accessible, and inexpensive tool. PMID:27703952

  18. Urinary tract infections in renal transplant recipients.

    PubMed

    Alangaden, George

    2007-11-01

    Urinary tract infection (UTI) is the most common infectious complication after renal transplantation. Although Escherichia coli remains the most common cause of UTI, Enterococcus spp and drug-resistant Enterobacteriaceae have emerged as important uropathogens in these patients. As a result, symptomatic UTIs warrant pathogen-specific antibiotic therapy guided by culture and susceptibility data. In the early transplant period, prophylaxis of UTI with trimethoprim-sulfamethoxazole is generally effective. Until the natural history and optimal management of asymptomatic bacteruria are better defined, therapy of asymptomatic bacteruria is generally unnecessary. PMID:17999883

  19. Iatrogenic Urinary Tract Injuries: Etiology, Diagnosis, and Management

    PubMed Central

    Esparaz, Anthony M.; Pearl, Jeffrey A.; Herts, Brian R.; LeBlanc, Justin; Kapoor, Baljendra

    2015-01-01

    Iatrogenic injury to the urinary tract, including the kidneys, ureters, bladder, and urethra, is a potential complication of surgical procedures performed in or around the retroperitoneal abdominal space or pelvis. While both diagnostic and interventional radiologists often play a central and decisive role in the identification and initial management of a variety of iatrogenic injuries, discussions of these injuries are often directed toward specialists such as urologists, obstetricians, gynecologists, and general surgeons whose procedures are most often implicated in iatrogenic urinary tract injuries. Interventional radiologic procedures can also be a source of an iatrogenic urinary tract injury. This review describes the clinical presentation, risk factors, imaging findings, and management of iatrogenic renal vascular and urinary tract injuries, as well as the radiologist's role in the diagnosis, treatment, and cause of these injuries. PMID:26038626

  20. Urinary tract complications with rectal surgery.

    PubMed Central

    Beahrs, J R; Beahrs, O H; Beahrs, M M; Leary, F J

    1978-01-01

    The possibility of urinary tract injury should always be considered in the course of anterior resection or combined abdominoperineal resection of the lower colon and rectum. Controlled studies of ureteral and other injuries and fistulas cannot be made; but fortunately, unanticipated damage to the lower urinary tract does not occur often. The surgeon operating in the pelvis should be aware of the problems rarely encountered and should be capable of their management. If a urologic surgeon is available, consultation often is desirable. Prompt intraoperative recognition is most important so remedial procedures can be carried out immediately. Delay in recognition and treatment jeopardizes the patient's course and the function of the urinary tract. Postoperative urinary tract infections should be diagnosed early so prompt treatment can be instituted. PMID:646493

  1. Congenital urinary tract obstruction: the long view.

    PubMed

    Chevalier, Robert L

    2015-07-01

    Maldevelopment of the collecting system resulting in urinary tract obstruction (UTO) is the leading identifiable cause of CKD in children. Specific etiologies are unknown; most cases are suspected by discovering hydronephrosis on prenatal ultrasonography. Congenital UTO can reduce nephron number and cause bladder dysfunction, which contribute to ongoing injury. Severe UTO can impair kidney growth in utero, and animal models of unilateral ureteral obstruction show that ischemia and oxidative stress cause proximal tubular cell death, with later development of interstitial fibrosis. Congenital obstructive nephropathy, therefore, results from combined developmental and obstructive kidney injury. Because of inadequacy of available biomarkers, criteria for surgical correction of upper tract obstruction are poorly established. Lower tract obstruction requires fetal or immediate postnatal intervention, and the rate of progression of CKD is highly variable. New biomarkers based on proteomics and determination of glomerular number by magnetic resonance imaging should improve future care. Angiotensin inhibitors have not been effective in slowing progression, although avoidance of nephrotoxins and timely treatment of hypertension are important. Because congenital UTO begins in fetal life, smooth transfer of care from perinatologist to pediatric and adult urology and nephrology teams should optimize quality of life and ultimate outcomes for these patients. PMID:26088076

  2. Bacteremic Urinary Tract Infection Caused by Multidrug-Resistant Enterobacteriaceae Are Associated With Severe Sepsis at Admission: Implication for Empirical Therapy.

    PubMed

    Lee, Yi-Chien; Hsiao, Chih-Yen; Hung, Miao-Chiu; Hung, Sheng-Che; Wang, Hung-Ping; Huang, Yun-Jhong; Wang, Jann-Tay

    2016-05-01

    The purpose of this study is to compare the clinical features and treatment outcomes among patients with bacteremic urinary tract infection (UTI) caused by multidrug-resistant (MDR) and non-MDR Enterobacteriaceae and to identify whether MDR pathogens were independently associated with severe sepsis or septic shock at presentation.The clinical data of adult patients visiting and being treated at Chia-Yi Christian Hospital due to bacteremic UTI caused by Enterobacteriaceae from January 2006 to August 2015 were retrospectively analyzed.A total of 585 patients were enrolled. Among them, 220 (37.6%) were caused by the MDR Enterobacteriaceae. A total of 206 patients (35.2%) developed severe sepsis or septic shock at presentation. Patients in the MDR group tend to be male and have a past history of gout, recurrent UTI, prior hospitalization, hydronephrosis, renal stone, ureteral stone, indwelling urinary catheter, newly development of renal dysfunction, severe sepsis or septic shock, intensive care unit (ICU) admission, receipt of ineffective empirical therapy, longer hospital stay, and higher in-hospital mortality (2.7% vs 1.9%, P = 0.569). Using multivariate logistic regression analysis, it is revealed that independent predictors associated with severe sepsis or septic shock at presentation were liver cirrhosis (OR 2.868; 95% CI 1.439-5.716; P = 0.003), indwelling urinary catheter (OR 1.936; 95% CI 1.238-3.027; P = 0.004), and MDR Enterobacteriaceae (OR 1.447; 95% CI 1.002-2.090; P = 0.049).Multidrug resistance was associated with the development of severe sepsis or septic shock upon presentation among patients with bacteremic UTI caused by Enterobacteriaceae. Therefore, empirical antibiotics therapy for patients with UTI presented with severe sepsis and/or septic shock should be more broad-spectrum to effectively cover MDR Enterobacteriaceae. PMID:27196480

  3. Impact of therapy and strain type on outcomes in urinary tract infections caused by carbapenem-resistant Klebsiella pneumoniae

    PubMed Central

    van Duin, David; Cober, Eric; Richter, Sandra S.; Perez, Federico; Kalayjian, Robert C.; Salata, Robert A.; Evans, Scott; Fowler, Vance G.; Kaye, Keith S.; Bonomo, Robert A.

    2015-01-01

    Objectives Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an important healthcare-associated pathogen. We evaluated the impact of CRKP strain type and treatment on outcomes of patients with CRKP bacteriuria. Patients and methods Physician-diagnosed CRKP urinary tract infection (UTI)—defined as those patients who received directed treatment for CRKP bacteriuria—was studied in the multicentre, prospective Consortium on Resistance against Carbapenems in Klebsiella pneumoniae (CRaCKle) cohort. Strain typing by repetitive extragenic palindromic PCR (rep-PCR) was performed. Outcomes were classified as failure, indeterminate or success. Univariate and multivariate ordinal analyses to evaluate the associations between outcome, treatment and strain type were followed by binomial analyses. Results One-hundred-and-fifty-seven patients with physician-diagnosed CRKP UTI were included. After adjustment for CDC/National Healthcare Safety Network (NHSN)-defined UTI, critical illness and receipt of more than one active antibiotic, patients treated with aminoglycosides were less likely to fail therapy [adjusted OR (aOR) for failure 0.34, 95% CI 0.15–0.73, P = 0.0049]. In contrast, patients treated with tigecycline were more likely to fail therapy (aOR for failure 2.29, 95% CI 1.03–5.13, P = 0.0425). Strain type data were analysed for 55 patients. The predominant clades were ST258A (n = 18, 33%) and ST258B (n = 26, 47%). After adjustment for CDC/NHSN-defined UTI and use of tigecycline and aminoglycosides, infection with strain type ST258A was associated with clinical outcome in ordinal analysis (P = 0.0343). In multivariate binomial models, strain type ST258A was associated with clinical failure (aOR for failure 5.82, 95% CI 1.47–28.50, P = 0.0113). Conclusions In this nested cohort study of physician-diagnosed CRKP UTI, both choice of treatment and CRKP strain type appeared to impact on clinical outcomes. PMID:25492391

  4. Lower urinary tract development and disease

    PubMed Central

    Rasouly, Hila Milo; Lu, Weining

    2013-01-01

    Congenital Anomalies of the Lower Urinary Tract (CALUT) are a family of birth defects of the ureter, the bladder and the urethra. CALUT includes ureteral anomalies such as congenital abnormalities of the ureteropelvic junction (UPJ) and ureterovesical junction (UVJ), and birth defects of the bladder and the urethra such as bladder-exstrophy-epispadias complex (BEEC), prune belly syndrome (PBS), and posterior urethral valves (PUV). CALUT is one of the most common birth defects and is often associated with antenatal hydronephrosis, vesicoureteral reflux (VUR), urinary tract obstruction, urinary tract infections (UTI), chronic kidney disease and renal failure in children. Here, we discuss the current genetic and molecular knowledge about lower urinary tract development and genetic basis of CALUT in both human and mouse models. We provide an overview of the developmental processes leading to the formation of the ureter, bladder, and urethra, and different genes and signaling pathways controlling these developmental processes. Human genetic disorders that affect the ureter, bladder and urethra and associated gene mutations are also presented. As we are entering the post-genomic era of personalized medicine, information in this article may provide useful interpretation for the genetic and genomic test results collected from patients with lower urinary tract birth defects. With evidence-based interpretations, clinicians may provide more effective personalized therapies to patients and genetic counseling for their families. PMID:23408557

  5. A novel case of Raoultella planticola urinary tract infection.

    PubMed

    Olson, D S; Asare, K; Lyons, M; Hofinger, D M

    2013-02-01

    Raoultella species are Gram-negative, non-motile bacilli primarily considered to be environmental bacteria (Bagley et al.; Curr Microbiol 6:105-109, 1981). R. planticola has rarely been documented as a cause of human infections and has never been reported to cause urinary tract infections. We report the first case of R. planticola cystitis.

  6. Botulinum toxin for the lower urinary tract.

    PubMed

    Chuang, Yao-Chi; Kuo, Hann-Chorng; Chancellor, Michael B

    2010-04-01

    Botulinum toxins (BoNTs) are known for their ability to potently and selectively modulate neurotransmission for successful long-term treatment of muscle hypercontractility. Recent studies suggest that BoNT has effects on modulation of sensory processing, inflammation and glandular function. Urologists and urogynaecologists have become interested in the potential application of BoNTs in patients with lower urinary tract symptoms, including detrusor and sphincter overactivity, bladder hypersensitivity, interstitial cystitis/painful bladder symptoms and benign prostatic hyperplasia. We review the biological action of BoNT in bladder and prostate, and present the techniques and results of the clinical studies with BoNT in the lower urinary tract.

  7. Nosocomial urinary tract infections: A review.

    PubMed

    Iacovelli, Valerio; Gaziev, Gabriele; Topazio, Luca; Bove, Pierluigi; Vespasiani, Giuseppe; Finazzi Agrò, Enrico

    2014-01-01

    Nosocomial urinary tract infections are a common complication in healthcare systems worldwide. A review of the literature was performed in June 2014 using the Medical Literature Analysis and Retrieval System Online (MEDLINE) database, through either PubMed or Ovid as a search engine, to identify publications regarding nosocomial urinary tract infections (NUTIs) definition, epidemiology, etiology and treatment.According to current definitions, more than 30% of nosocomial infections are urinary tract infections (UTIs). A UTI is defined 'nosocomial' (NUTI) when it is acquired in any healthcare institution or, more generally, when it is related to patient management. The origin of nosocomial bacteria is endogenous (the patient's flora) in two thirds of the cases. Patients with indwelling urinary catheters, those undergoing urological surgery and manipulations, long-stay elderly male patients and patients with debilitating diseases are at high risk of developing NUTIs. All bacterial NUTIs should be treated, whether the patient is harboring a urinary catheter or not. The length of treatment depends on the infection site. There is abundance of important guidance which should be considered to reduce the risk of NUTIs (hand disinfection with instant hand sanitizer, wearing non-sterile gloves permanently, isolation of infected or colonized catheterized patients). Patients with asymptomatic bacteriuria can generally be treated initially with catheter removal or catheter exchange, and do not necessarily need antimicrobial therapy. Symptomatic patients should receive antibiotic therapy. Resistance of urinary pathogens to common antibiotics is currently a topic of concern. PMID:25451882

  8. Recurrent urinary tract infections in children.

    PubMed Central

    Johnson, H. W.; Lirenman, D. S.; Anderson, J. D.; Nielsen, W. R.

    1993-01-01

    Urinary tract infections are common in children and present in various ways. Diagnosis is based on findings of pyuria and bacteriuria. Management includes adequate and timely investigation, appropriate antibiotics, treatment of underlying contributing factors, and follow-up advice. Images p1625-a p1628-a p1629-a PMID:8348023

  9. Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract.

    PubMed

    Kline, Kimberly A; Lewis, Amanda L

    2016-04-01

    Gram-positive bacteria are a common cause of urinary-tract infection (UTI), particularly among individuals who are elderly, pregnant, or who have other risk factors for UTI. Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including Aerococcus, Corynebacterium, Actinobaculum, and Gardnerella. The literature strongly suggests that urologic diseases involving Gram-positive bacteria may be easily overlooked due to limited culture-based assays typically utilized for urine in hospital microbiology laboratories. Some UTIs are polymicrobial in nature, often involving one or more Gram-positive bacteria. We herein review the risk factors and recent evidence for mechanisms of bacterial synergy in experimental models of polymicrobial UTI. Recent experimental data has demonstrated that, despite being cleared quickly from the bladder, some Gram-positive bacteria can impact pathogenic outcomes of co-infecting organisms. When taken together, the available evidence argues that Gram-positive bacteria are important uropathogens in their own right, but that some can be easily overlooked because they are missed by routine diagnostic methods. Finally, a growing body of evidence demonstrates that a surprising variety of fastidious Gram-positive bacteria may either reside in or be regularly exposed to the urinary tract and further suggests that their presence is widespread among women, as well as men. Experimental studies in this area are needed; however, there is a growing appreciation that the composition of bacteria found in the bladder could be a potentially important determinant in urologic disease, including susceptibility to UTI.

  10. Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract

    PubMed Central

    Kline, Kimberly A.; Lewis, Amanda L.

    2015-01-01

    Gram-positive bacteria are a common cause of urinary tract infection (UTI), particularly among individuals who are elderly, pregnant, or who have other risk factors for UTI. Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including Aerococcus, Corynebacterium, Actinobaculum, and Gardnerella. The literature strongly suggests that urologic diseases involving Gram-positive bacteria may be easily overlooked due to limited culture-based assays typically utilized for urine in hospital microbiology laboratories. Some UTIs are polymicrobial in nature, often involving one or more Gram-positive bacteria. We herein review the risk factors and recent evidence for mechanisms of bacterial synergy in experimental models of polymicrobial UTI. Recent experimental data has demonstrated that, despite being cleared quickly from the bladder, some Gram-positive bacteria can impact pathogenic outcomes of co-infecting organisms. When taken together, the available evidence argues that Gram-positive bacteria are important uropathogens in their own right, but that some can be easily overlooked because they are missed by routine diagnostic methods. Finally, a growing body of evidence demonstrates that a surprising variety of fastidious Gram-positive bacteria may either reside in or be regularly exposed to the urinary tract and further suggests that their presence is widespread among women, as well as men. Experimental studies in this area are needed; however, there is a growing appreciation that the composition of bacteria found in the bladder could be a potentially important determinant in urologic disease, including susceptibility to UTI. PMID:27227294

  11. Gram-Positive Uropathogens, Polymicrobial Urinary Tract Infection, and the Emerging Microbiota of the Urinary Tract.

    PubMed

    Kline, Kimberly A; Lewis, Amanda L

    2016-04-01

    Gram-positive bacteria are a common cause of urinary-tract infection (UTI), particularly among individuals who are elderly, pregnant, or who have other risk factors for UTI. Here we review the epidemiology, virulence mechanisms, and host response to the most frequently isolated Gram-positive uropathogens: Staphylococcus saprophyticus, Enterococcus faecalis, and Streptococcus agalactiae. We also review several emerging, rare, misclassified, and otherwise underreported Gram-positive pathogens of the urinary tract including Aerococcus, Corynebacterium, Actinobaculum, and Gardnerella. The literature strongly suggests that urologic diseases involving Gram-positive bacteria may be easily overlooked due to limited culture-based assays typically utilized for urine in hospital microbiology laboratories. Some UTIs are polymicrobial in nature, often involving one or more Gram-positive bacteria. We herein review the risk factors and recent evidence for mechanisms of bacterial synergy in experimental models of polymicrobial UTI. Recent experimental data has demonstrated that, despite being cleared quickly from the bladder, some Gram-positive bacteria can impact pathogenic outcomes of co-infecting organisms. When taken together, the available evidence argues that Gram-positive bacteria are important uropathogens in their own right, but that some can be easily overlooked because they are missed by routine diagnostic methods. Finally, a growing body of evidence demonstrates that a surprising variety of fastidious Gram-positive bacteria may either reside in or be regularly exposed to the urinary tract and further suggests that their presence is widespread among women, as well as men. Experimental studies in this area are needed; however, there is a growing appreciation that the composition of bacteria found in the bladder could be a potentially important determinant in urologic disease, including susceptibility to UTI. PMID:27227294

  12. [Congenital anomalies of the kidney and urinary tract. A vision for the paediatrician].

    PubMed

    Palacios Loro, M L; Segura Ramírez, D K; Ordoñez Álvarez, F A; Santos Rodríguez, F

    2015-12-01

    The congenital abnormalities of kidney and urinary tract (CAKUT) are disorders with a high prevalence in the general population, with urinary tract dilations being the most frequent. CAKUT also account for the most important cause of chronic kidney disease in childhood. This paper focuses on the role of the primary care paediatrician in the diagnosis, assessment, and follow-up of children with CAKUT, with special emphasis on the associated urinary tract infections, the progression toward chronic renal failure, and the genetic basis.

  13. Urinary Tract Infection and Neurogenic Bladder.

    PubMed

    McKibben, Maxim J; Seed, Patrick; Ross, Sherry S; Borawski, Kristy M

    2015-11-01

    Urinary tract infections (UTIs) are frequent, recurrent, and lifelong for patients with neurogenic bladder and present challenges in diagnosis and treatment. Patients often present without classic symptoms of UTI but with abdominal or back pain, increased spasticity, and urinary incontinence. Failure to recognize and treat infections can quickly lead to life-threatening autonomic dysreflexia or sepsis, whereas overtreatment contributes to antibiotic resistance, thus limiting future treatment options. Multiple prevention methods are used but evidence-based practices are few. Prevention and treatment of symptomatic UTI requires a multimodal approach that focuses on bladder management as well as accurate diagnosis and appropriate antibiotic treatment. PMID:26475949

  14. Frequency of bacteria causing urinary tract infections and their antimicrobial resistance patterns among pediatric patients in Western Iran from 2007-2009.

    PubMed

    Yasemi, M; Peyman, H; Asadollahi, K; Feizi, A; Soroush, S; Hematian, A; Jalilian, F A; Emaneini, M; Alikhani, M Y; Taherikalani, M

    2014-01-01

    Urinary Tract infections ( UTIs) are among the most common infections in infants and neonates. The aim of the current study was to evaluate the frequency of bacteria causing UTI and their relevant drug resistance patterns among infants and neonates hospitalized in Ilam province, Western Iran during 2007-2009. A total of 220 cases of UTI were enrolled in this cross-sectional retrospective study. A standard checklist was used for demographic and clinical data to be collected from their health records. Data was then analyzed using SPSS version 16.0. More than two-thirds (64.8%) of the cases were female. E. coli (44.5%), Klebsiella spp., (18.6%), Enterobacter spp., (15%) and Staphylococcus spp. (12.7%) were the most common microorganisms isolated from UTIs, respectively. High rates of resistance to tetracycline, ampicillin, and nalidixic acid were observed among these isolates. Similar to other studies, E. coli was the most common bacteria causing UTI and showed a high rate of resistance against most of the antimicrobial agents. Determining the antimicrobial sensitivity can be helpful for physicians in choosing an appropriate treatment for patients suffering from UTI, and also to reduce the complications related to serious UTI.

  15. Treatment of urinary tract stones.

    PubMed

    Wickham, J E

    1993-11-27

    Replacement of open surgery with minimally invasive techniques for treating stones in the renal tract has greatly reduced patients' morbidity and mortality and the period of hospitalisation and convalescence. Extracorporeal shockwave lithotripsy does not require anaesthesia and requires little analgesia so that treatment can be given on an outpatient basis, and there is no wound to heal. Only a small puncture site is needed for percutaneous endoscopic lithotomy, and with the advent of prophylactic antibiotics there are few complications. Of renal stones, about 85% can now be successfully treated by extracorporeal lithotripsy alone, and almost all of the stones too large or hard for lithotripsy can be treated endoscopically, with ultrasonic or electrohydraulic probes being used to fragment the stone. Stones in the upper and lower thirds of the ureter can be treated by extracorporeal lithotripsy, but stones in the middle third, which cannot normally be visualised to allow focusing of the shockwaves, usually require ureteroscopy. Nearly all bladder stones can be treated by transurethral endoscopy with an electrohydraulic probe. Only the largest renal tract stones still require open surgery.

  16. High rate of per oral mecillinam treatment failure in community-acquired urinary tract infections caused by ESBL-producing Escherichia coli.

    PubMed

    Søraas, Arne; Sundsfjord, Arnfinn; Jørgensen, Silje Bakken; Liestøl, Knut; Jenum, Pål A

    2014-01-01

    A population-based study was performed to investigate the efficacy of mecillinam treatment of community-acquired urinary tract infections (CA-UTI) caused by extended-spectrum β-lactamase (ESBL) producing Escherichia coli. The study was conducted in South-Eastern Norway. Data from patients with CA-UTI caused by ESBL-producing and non-producing (random controls) E. coli were collected through interviews, questionnaires, medical records and the Norwegian Prescription Database. Treatment failure was defined as a new antibiotic prescription appropriate for UTI prescribed within two weeks after the initial antimicrobial therapy. Multivariable logistic regression analysis was performed to identify treatment agents and patient- or bacterial traits associated with treatment failure. A total of 343 patients (mean age 59) were included, of which 158 (46%) were treated with mecillinam. Eighty-one patients (24%, mean age 54) had infections caused by ESBL producing E. coli, and 41 of these patients (51%) received mecillinam as the primary treatment. Mecillinam treatment failure was observed in 18 (44%) of patients infected by ESBL-producing strains and in 16 (14%) of patients with a CA-UTI caused by ESBL non-producing strains. Multivariable analysis showed that ESBL status (odds ratio (OR) 3.2, 95% confidence interval (CI) 1.3-7.8, p = 0.009) and increased MIC of mecillinam (OR 2.0 for each doubling value of MIC, CI 1.4-3.0, p<0.001) were independently associated with mecillinam treatment failure. This study showed a high rate of mecillinam treatment failure in CA-UTIs caused by ESBL producing E. coli. The high failure rate could not be explained by the increased MIC of mecillinam alone. Further studies addressing the use of mecillinam against ESBL-producing E. coli, with emphasis on optimal dosing and combination therapy with β-lactamase inhibitors, are warranted.

  17. THE TREATMENT OF URINARY TRACT CALCULI

    PubMed Central

    Leadbetter, Wyland F.

    1958-01-01

    From review of recent information relative to calculus formation in the kidney, the conclusion reached that we do not yet understand, despite much effort, the basic physicochemical mechanisms involved. Since this is so, it has seemed best to the author for the present to rely, in treating patients with renal stones, on simple therapeutic concepts, which, if carefully and conscientiously applied, produce good results. The concepts are the elimination of known causes such as parathyroid adenomas and obstructive lesions, elimination or at least treatment of infections, diminution of urinary components which form the basis of calculi by limiting the oral intake or absorption from the gastrointestinal tract and maintenance of a dilute urine of desired pH. A plan for preoperative study is suggested to allow planned therapy. Indications for operative removal of calculi as well as some points of technique are discussed. It is emphasized that surgical removal of a calculus is but an incident in the care of patients with calculi and that treatment during the postoperative period and followup therapy is most important if success is to be achieved. Reports of cases to illustrate the application of these concepts are presented. ImagesFigure 1Figure 2Figure 3Figure 4Figure 5Figure 6Figure 7Figure 8Figure 9Figure 10Figure 11Figure 12Figure 13Figure 14Figure 15Figure 16 PMID:13523394

  18. Urinary tract infection in renal transplantation

    PubMed Central

    Giessing, Markus

    2012-01-01

    Introduction Urinary tract infection (UTI), especially recurrent UTI, is a common problem, occurring in >75% of kidney transplant (KTX) recipients. UTI degrades the health-related quality of life and can impair graft function, potentially reducing graft and patient survival. As urologists are often involved in treating UTI after KTX, previous reports were searched to elucidate underlying causes, risk factors and treatment options, as well as recommendations for prophylaxis of UTI after KTX. Methods Pubmed/Medline was searched and international guidelines and recommendations for prevention and treatment of UTI after KTX were also assessed. Results Most studies on UTI after KTX have a small sample, and are descriptive and retrospective. Many transplant- and recipient-related risk factors have been identified. While asymptomatic bacteriuria is often treated, even though some studies advise against it, symptomatic UTI should be treated empirically after collecting urine for microbiological analysis, to avoid the development of transplant pyelonephritis with a high chance of urosepsis. The duration of treatment has not been determined in studies and recommendations refer to the treatment of complicated UTI in the non-transplant population. Prophylaxis has not been the focus of studies either. Conclusion UTI after KTX is still largely an under-represented field of study, despite many recipients developing UTI after KTX. Prospective studies on this topic are urgently needed. PMID:26558020

  19. Proteus mirabilis and Urinary Tract Infections

    PubMed Central

    Schaffer, Jessica N.; Pearson, Melanie M.

    2015-01-01

    Proteus mirabilis is a Gram-negative bacterium which is well-known for its ability to robustly swarm across surfaces in a striking bulls’-eye pattern. Clinically, this organism is most frequently a pathogen of the urinary tract, particularly in patients undergoing long-term catheterization. This review covers P. mirabilis with a focus on urinary tract infections (UTI), including disease models, vaccine development efforts, and clinical perspectives. Flagella-mediated motility, both swimming and swarming, is a central facet of this organism. The regulation of this complex process and its contribution to virulence is discussed, along with the type VI-secretion system-dependent intra-strain competition which occurs during swarming. P. mirabilis uses a diverse set of virulence factors to access and colonize the host urinary tract, including urease and stone formation, fimbriae and other adhesins, iron and zinc acquisition, proteases and toxins, biofilm formation, and regulation of pathogenesis. While significant advances in this field have been made, challenges remain to combatting complicated UTI and deciphering P. mirabilis pathogenesis. PMID:26542036

  20. Pharmacology of the lower urinary tract

    PubMed Central

    Hennenberg, Martin; Stief, Christian G.; Gratzke, Christian

    2014-01-01

    Pharmacology of the lower urinary tract provides the basis for medical treatment of lower urinary tract symptoms (LUTS). Therapy of LUTS addresses obstructive symptoms (frequently explained by increased prostate smooth muscle tone and prostate enlargement) in patients with benign prostate hyperplasia (BPH) and storage symptoms in patients with overactive bladder (OAB). Targets for medical treatment include G protein-coupled receptors (α1-adrenoceptors, muscarinic acetylcholine receptors, β3-adrenoceptors) or intracellular enzymes (5α-reductase; phosphodiesterase-5, PDE5). Established therapies of obstructive symptoms aim to induce prostate smooth muscle relaxation by α1-blockers or PDE5 inhibitors, or to reduce prostate growth and volume with 5α-reductase inhibitors. Available options for treatment of OAB comprise anitmuscarinics, β3-adrenoceptor agonists, and botulinum toxin A, which improve storage symptoms by inhibition of bladder smooth muscle contraction. With the recent approval of β3-antagonists, PDE inhibitors, and silodosin for therapy of LUTS, progress from basic research of lower urinary tract pharmacology was translated into new clinical applications. Further targets are in preclinical stages of examination, including modulators of the endocannabinoid system and transient receptor potential (TRP) channels. PMID:24744518

  1. Bacteriophage-Mediated Control of a Two-Species Biofilm Formed by Microorganisms Causing Catheter-Associated Urinary Tract Infections in an In Vitro Urinary Catheter Model

    PubMed Central

    Lehman, Susan M.

    2014-01-01

    Microorganisms from a patient or their environment may colonize indwelling urinary catheters, forming biofilm communities on catheter surfaces and increasing patient morbidity and mortality. This study investigated the effect of pretreating hydrogel-coated silicone catheters with mixtures of Pseudomonas aeruginosa and Proteus mirabilis bacteriophages on the development of single- and two-species biofilms in a multiday continuous-flow in vitro model using artificial urine. Novel phages were purified from sewage, characterized, and screened for their abilities to reduce biofilm development by clinical isolates of their respective hosts. Our screening data showed that artificial urine medium (AUM) is a valid substitute for human urine for the purpose of evaluating uropathogen biofilm control by these bacteriophages. Defined phage cocktails targeting P. aeruginosa and P. mirabilis were designed based on the biofilm inhibition screens. Hydrogel-coated catheters were pretreated with one or both cocktails and challenged with approximately 1 × 103 CFU/ml of the corresponding pathogen(s). The biofilm growth on the catheter surfaces in AUM was monitored over 72 to 96 h. Phage pretreatment reduced P. aeruginosa biofilm counts by 4 log10 CFU/cm2 (P ≤ 0.01) and P. mirabilis biofilm counts by >2 log10 CFU/cm2 (P ≤ 0.01) over 48 h. The presence of P. mirabilis was always associated with an increase in lumen pH from 7.5 to 9.5 and with eventual blockage of the reactor lines. The results of this study suggest that pretreatment of a hydrogel urinary catheter with a phage cocktail can significantly reduce mixed-species biofilm formation by clinically relevant bacteria. PMID:25487795

  2. Bacteriophage-mediated control of a two-species biofilm formed by microorganisms causing catheter-associated urinary tract infections in an in vitro urinary catheter model.

    PubMed

    Lehman, Susan M; Donlan, Rodney M

    2015-02-01

    Microorganisms from a patient or their environment may colonize indwelling urinary catheters, forming biofilm communities on catheter surfaces and increasing patient morbidity and mortality. This study investigated the effect of pretreating hydrogel-coated silicone catheters with mixtures of Pseudomonas aeruginosa and Proteus mirabilis bacteriophages on the development of single- and two-species biofilms in a multiday continuous-flow in vitro model using artificial urine. Novel phages were purified from sewage, characterized, and screened for their abilities to reduce biofilm development by clinical isolates of their respective hosts. Our screening data showed that artificial urine medium (AUM) is a valid substitute for human urine for the purpose of evaluating uropathogen biofilm control by these bacteriophages. Defined phage cocktails targeting P. aeruginosa and P. mirabilis were designed based on the biofilm inhibition screens. Hydrogel-coated catheters were pretreated with one or both cocktails and challenged with approximately 1×10(3) CFU/ml of the corresponding pathogen(s). The biofilm growth on the catheter surfaces in AUM was monitored over 72 to 96 h. Phage pretreatment reduced P. aeruginosa biofilm counts by 4 log10 CFU/cm2 (P≤0.01) and P. mirabilis biofilm counts by >2 log10 CFU/cm2 (P≤0.01) over 48 h. The presence of P. mirabilis was always associated with an increase in lumen pH from 7.5 to 9.5 and with eventual blockage of the reactor lines. The results of this study suggest that pretreatment of a hydrogel urinary catheter with a phage cocktail can significantly reduce mixed-species biofilm formation by clinically relevant bacteria. PMID:25487795

  3. New possibility for providing protection against urinary tract infection caused by Pseudomonas aeruginosa by non-adjuvanted flagellin 'b' induced immunity.

    PubMed

    Sabharwal, Neha; Chhibber, Sanjay; Harjai, Kusum

    2014-12-01

    In the present study we demonstrated a novel protective role of Pseudomonas aeruginosa PAO1 flagellin 'b' in prevention of urinary tract infection (UTI). P. aeruginosa is motile via single polar flagellum made up of polymerized flagellin proteins. It is a serious nosocomial pathogen causing UTIs. Predisposing factors include instrumentation and catheterization which enhance colonization with P. aeruginosa, leading to ascending infection. Hence for a newer, safer and effective approach, the present study focussed on the prophylaxis using bacterial flagellin, isolated and purified (PCR sequencing and MALDI-TOF) from P. aeruginosa PAO1 strain, which triggers immune response [both non-specific and specific (active and passive)] as defense against infection. Administration of flagellin 'b' via intraperitoneal route enhanced the clearance of homologous as well as heterologous bacteria (P. aeruginosa uroisolate carrying flagellin 'a') in renal tissue, decreased the levels of malondialdehyde (MDA) and reverted structural integrity of renal tissue to near normal in female LACA mice. Immunization suppressed the production of pro-inflammatory cytokines [interleukin-1β (IL-1β) and tumor necrosis factor alpha (TNF-α)] and activated humoral immune response. Anti-flagellin antibodies (quantified by ELISA) helped in the clearance of bacterial load by opsonophagocytosis. Adoptive transfer of antisera also protected mice from PAO1 challenge, indicating protective role of antibodies. In conclusion, this is the first report that describes flagellin as a potential prophylactic agent which downregulates inflammation and curbs UTIs.

  4. New possibility for providing protection against urinary tract infection caused by Pseudomonas aeruginosa by non-adjuvanted flagellin 'b' induced immunity.

    PubMed

    Sabharwal, Neha; Chhibber, Sanjay; Harjai, Kusum

    2014-12-01

    In the present study we demonstrated a novel protective role of Pseudomonas aeruginosa PAO1 flagellin 'b' in prevention of urinary tract infection (UTI). P. aeruginosa is motile via single polar flagellum made up of polymerized flagellin proteins. It is a serious nosocomial pathogen causing UTIs. Predisposing factors include instrumentation and catheterization which enhance colonization with P. aeruginosa, leading to ascending infection. Hence for a newer, safer and effective approach, the present study focussed on the prophylaxis using bacterial flagellin, isolated and purified (PCR sequencing and MALDI-TOF) from P. aeruginosa PAO1 strain, which triggers immune response [both non-specific and specific (active and passive)] as defense against infection. Administration of flagellin 'b' via intraperitoneal route enhanced the clearance of homologous as well as heterologous bacteria (P. aeruginosa uroisolate carrying flagellin 'a') in renal tissue, decreased the levels of malondialdehyde (MDA) and reverted structural integrity of renal tissue to near normal in female LACA mice. Immunization suppressed the production of pro-inflammatory cytokines [interleukin-1β (IL-1β) and tumor necrosis factor alpha (TNF-α)] and activated humoral immune response. Anti-flagellin antibodies (quantified by ELISA) helped in the clearance of bacterial load by opsonophagocytosis. Adoptive transfer of antisera also protected mice from PAO1 challenge, indicating protective role of antibodies. In conclusion, this is the first report that describes flagellin as a potential prophylactic agent which downregulates inflammation and curbs UTIs. PMID:25455605

  5. Intranasal immunization with fusion protein MrpH·FimH and MPL adjuvant confers protection against urinary tract infections caused by uropathogenic Escherichia coli and Proteus mirabilis.

    PubMed

    Habibi, Mehri; Asadi Karam, Mohammad Reza; Shokrgozar, Mohammad Ali; Oloomi, Mana; Jafari, Anis; Bouzari, Saeid

    2015-04-01

    Urinary tract infections (UTIs) caused by Uropathogenic Escherichia coli (UPEC) and Proteus mirabilis are among the most common infections in the world. Currently there are no vaccines available to confer protection against UTI in humans. In this study, the immune responses and protection of FimH of UPEC with MrpH antigen of P. mirabilis in different vaccine formulations with and without MPL adjuvant were assessed. Mice intranasally immunized with the novel fusion protein MrpH·FimH induced a significant increase in IgG and IgA in serum, nasal wash, vaginal wash, and urine samples. Mice immunized with fusion MrpH·FimH also showed a significant boost in cellular immunity. Addition of MPL as the adjuvant enhanced FimH and MrpH specific humoral and cellular responses in both systemic and mucosal samples. Vaccination with MrpH·FimH alone or in combination with MPL showed the highest efficiency in clearing bladder and kidney infections in mice challenged with UPEC and P. mirabilis. These findings may indicate that the protection observed correlates with the systemic, mucosal and cellular immune responses induced by vaccination with these preparations. Our data suggest MrpH·FimH fusion protein with or without MPL as adjuvant could be potential vaccine candidates for elimination of UPEC and P. mirabilis. These data altogether are promising and these formulations are good candidates for elimination of UPEC and P. mirabilis.

  6. Genital and Urinary Tract Defects

    MedlinePlus

    ... not survive pregnancy. Babies who do survive need dialysis and a kidney transplant very soon after birth. ... are painful, infected, bleeding or causing a blockage Dialysis. This treatment filters your blood to rid your ...

  7. Plumbing the depths of urinary tract obstruction by using murine models

    PubMed Central

    2009-01-01

    Urinary tract obstruction leads to obstructive nephropathy, which in turn, frequently results in renal failure. Congenital urinary tract obstruction can be traced back to errors during the organogenesis of the urinary system. A fundamental understanding of the causes of urinary tract obstruction and the developmental processes involved are critical for improving the diagnostic and therapeutic strategies for this disease. A number of laboratories, including ours, have been using genetically engineered and spontaneously occurring mouse models to study the primary causes and the pathogenesis of urinary tract obstruction. These studies have shown that urinary tract obstruction is a very heterogeneous disease that can be caused by a diverse set of factors targeting multiple levels of the urinary system. Accumulating evidence also indicates that the development of the urinary tract requires the integration of progenitor cells of diverse embryonic origins, leading to the formation of multiple junctions prone to developmental errors. In addition, the high sensitivity of the pyeloureteral peristaltic machinery to disturbance affecting the structural or functional integrity of its components also contributes to the high incidence rate of urinary tract obstruction. PMID:19568351

  8. Reconstruction of radiation-induced injuries of the lower urinary tract.

    PubMed

    Ballek, Nathaniel K; Gonzalez, Christopher M

    2013-08-01

    This article presents an overview of reconstruction of lower urinary tract injury caused by radiation therapy for prostate cancer. Discussions include cause, patient evaluation, reconstructive techniques, and outcomes following repair.

  9. The Genetics of Urinary Tract Infections and the Innate Defense of the Kidney and Urinary tract.

    PubMed

    Ambite, Ines; Rydstrom, Gustav; Schwaderer, Andrew L; Hains, David S

    2016-03-01

    The urinary tract is a sterile organ system. Urinary tract infections (UTIs) are common and often serious infections. Research has focused on uropathogen, environment, and host factors leading to UTI pathogenesis. A growing body of evidence exists implicating genetic factors that can contribute to UTI risks. In this review, we highlight genetic variations in aspects of the innate immune system critical to the host response to uropathogens. This overview includes genetic variations in pattern recognition receptor molecules, chemokines/cytokines, and neutrophil activation. We also comprehensively cover murine knockout models of UTI, genetic variations involved in renal scarring as a result of ascending UTIs, and asymptomatic bacteriuria. PMID:27617139

  10. Urothelial cancer of the urinary bladder: can lessons learned be applied to the upper urinary tract?

    PubMed

    Krabbe, Laura M; Hutchinson, Ryan C; Margulis, Vitaly

    2016-08-01

    Even though urothelial cancer may occur anywhere in the urinary tract, it is most commonly found in the urinary bladder. Due to its higher incidence, this disease is studied in the bladder much more frequently than in the upper urinary tract. The question that arises is, to what extent can concepts and treatment paradigms derived from lower tract disease be applied to urothelial carcinoma of the upper urinary tract? This review aims at providing an overview of established care concepts in urothelial carcinoma of the bladder and applicability of these findings to tumors of the upper urinary tract.

  11. Clinical and bacteriological efficacy of amikacin in the treatment of lower urinary tract infection caused by extended-spectrum beta-lactamase-producing Escherichia coli or Klebsiella pneumoniae.

    PubMed

    Ipekci, Tumay; Seyman, Derya; Berk, Hande; Celik, Orcun

    2014-12-01

    Urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing bacteria have become a growing problem limiting therapeutic options. The aim of this study was to investigate the clinical and microbiological efficacy of amikacin treatment in adult patients with lower UTIs due to ESBL-producing Escherichia coli (Ec) or Klebsiella pneumonia (Kp). We conducted a retrospective study of 36 outpatients aged >18 years with dysuria or problems with frequency or urgency in passing urine; pyuria and a positive urine culture (10(5) cfu/ml) for ESBL producing Ec or Kp which is also resistant to nitrofurantoin, fosfomycin, quinolones and trimethoprim/sulfamethoxazole, between January 2013 and February 2014. Patients received intramuscular amikacin 15 mg/kg/day for 10 days. Clinical success was defined as disappearance of symptoms. Bacteriological success was defined as sterile control urine cultures. 58.3% of patients were female. Age range was 18-89 years. All of the patients had at least one complicating factor. 77.8% of the isolates were E. coli. Clinical success rate was 97.2%. Overall bacteriological success rates were 91.7% on the 3 day of treatment, 97.1% at the end of the treatment and 94.1% on the 7-10 days after treatment. After 28-32 days following the treatment, reinfection was found in 12% whereas relapse was not determined. Nephrotoxicity was developed in one patient. The clinicians should keep in mind that amikacin treatment is an efficient and safe alternative treatment option before the carbapenem treatment especially in patients with lower UTIs caused by ESBL-producing Ec or Kp that are resistant to all oral antibiotics.

  12. Lower urinary tract symptoms in men

    PubMed Central

    Hollingsworth, John M

    2014-01-01

    Benign prostatic hyperplasia (BPH) is a highly prevalent and costly condition that affects older men worldwide. Many affected men develop lower urinary tract symptoms, which can have a negative impact on their quality of life. In the past, transurethral resection of the prostate (TURP) was the mainstay of treatment. However, several efficacious drug treatments have been developed, which have transformed BPH from an acute surgical entity to a chronic medical condition. Specifically, multiple clinical trials have shown that α adrenoceptor antagonists can significantly ameliorate lower urinary tract symptoms. Moreover, 5α reductase inhibitors, alone or combined with an α adrenoceptor antagonist, can reverse the natural course of BPH, reducing the risk of urinary retention and the need for surgical intervention. Newer medical regimens including the use of antimuscarinic agents or phosphodiesterase type 5 inhibitors, have shown promise in men with predominantly storage symptoms and concomitant erectile dysfunction, respectively. For men who do not adequately respond to conservative measures or pharmacotherapy, minimally invasive surgical techniques (such as transurethral needle ablation, microwave thermotherapy, and prostatic urethral lift) may be of benefit, although they lack the durability of TURP. A variety of laser procedures have also been introduced, whose improved hemostatic properties abrogate many of the complications associated with traditional surgery. PMID:25125424

  13. Assessment of infective urinary tract disorders.

    PubMed

    Sixt, R; Stokland, E

    1998-06-01

    Urinary tract infection (UTI) is common in children, particularly in the youngest age groups. There is a risk for progressive deterioration of renal function in these children if aggravating factors such as gross reflux and/or outflow obstruction of the urinary tract are present. In this review the pros and cons of available scintigraphic and radiological imaging techniques for the work-up of these children are presented. Ultrasound can be used in the acute phase to exclude obstruction but can not reliably show transient or permanent parenchymal lesions. The presence of reflux can be established with X-ray or direct nuclide cystography. The X-ray technique gives good morphological information and has a grading system with prognostic relevance. Both techniques are invasive and great care must be taken to keep the radiation burden down with the X-ray technique. Indirect nuclide cystography following a renographic study is non-invasive but has a lower sensitivity than direct techniques. More experience is needed with the indirect technique to evaluate the consequences of its apparently low sensitivity. Urography has a limited place in the acute work-up of urinary tract infection but can be used to look for renal scarring 1-2 years after an acute pyelonephritis. The 99mTc dimercaptosuccinic acid (DMSA) scan can be used during the acute UTI to show pyelonephritic lesions with good accuracy and/or during the follow-up after six months to show permanent lesions. The acute DMSA scan can be omitted. An early treatment is more important than an early scan! PMID:9695664

  14. Study on Bacterial Strains Causing Blood and Urinary Tract Infections in the Neonatal Intensive Care Unit and Determination of Their Antibiotic Resistance Pattern

    PubMed Central

    Rajabi, Zahra; Soltan Dallal, Mohammad Mehdi

    2015-01-01

    Background: Infections are considered as one of the main factors of neonatal mortality, especially in developing countries. Blood and urine infections are one of the most prevalent infectious factors among the infants. On the other hand, resistance against antimicrobial factors is one of the major problems in the world, and it is important to be informed about antibiotic resistance pattern of microorganisms for treatment of infections. Objectives: The aim of this study was to examine the bacterial strains causing blood and urinary tract infections in Neonatal Intensive Care Unit (NICU) and determine their antibiotic resistance pattern. Materials and Methods: In this study, the microorganisms of 150 blood and urine samples of infants hospitalized in NICUs of Imam Hussein Hospital, Children Hospital Center and Bahrami Hospital in Tehran, Iran, were collected during seven months, and the antimicrobial resistance patterns of the isolates were studied by the Kirby-Bauer test. Results: During the seven-month study on 105 samples, including 85 (81%) urine samples and 20 (19%) blood samples, 81 samples (77.1%) were Gram-negative and 24 (22.9%) were Gram-positive organisms. Klebsiella pneumoniae (30.5%) was the most common Gram-negative microorganisms and Staphylococcus epidermidis (11.4%) was the most prevalent Gram-positive microorganisms. The most antimicrobial susceptibility in Gram-negative microorganisms was shown to ciprofloxacin (84.2%) and in Gram- positive ones was shown to vancomycin (83.3%). Conclusions: This results of the study show that the most contamination in NICUs is from Gram-negative bacteria and ciprofloxacin is the most effective antibiotic for treatment. Thus, the control of infections in NICUs in hospitals is very important. PMID:26468359

  15. Resistance profile for pathogens causing urinary tract infection in a pediatric population, and antibiotic treatment response at a University Hospital, 2010-2011

    PubMed Central

    Vélez Echeverri, Catalina; Serrano, Ana Katherina; Ochoa-García, Carolina; Rojas Rosas, Luisa; María Bedoya, Ana; Suárez, Margarita; Hincapié, Catalina; Henao, Adriana; Ortiz, Diana; Vanegas, Juan José; Zuleta, John Jairo; Espinal, David

    2014-01-01

    Introduction: Urinary tract infection (UTI) is one of the most common bacterial infections in childhood and causes acute and chronic morbidity and long-term hypertension and chronic kidney disease. Objectives: To describe the demographic characteristics, infectious agents, patterns of antibiotic resistance, etiologic agent and profile of susceptibility and response to empirical treatment of UTI in a pediatric population. Methods: This is a descriptive, retrospective study. Results: Included in the study were 144 patients, 1:2.06 male to female ratio. The most common symptom was fever (79.9%) and 31.3% had a history of previous UTI. 72.0% of the patients had positive urine leukocyte count (>5 per field), urine gram was positive in 85.0% of samples and gram negative bacilli accounted for 77.8% for the total pathogens isolated. The most frequent uropathogens isolated were Escherichia coli and Klebsiella pneumoniae. Our E.coli isolates had a susceptibility rate higher than 90% to most of the antibiotics used, but a resistance rate of 42.6% to TMP SMX and 45.5% to ampicillin sulbactam. 6.3% of E. coli was extended-spectrum beta-lactamases producer strains. The most frequent empirical antibiotic used was amikacin, which was used in 66.0% of the patients. 17 of 90 patients who underwent voiding cistouretrography (VCUG) had vesicoureteral reflux. Conclusion: This study revealed that E. coli was the most frequent pathogen of community acquired UTI. We found that E. coli and other uropathogens had a high resistance rate against TMP SMX and ampicillin sulbactam. In order to ensure a successful empirical treatment, protocols should be based on local epidemiology and susceptibility rates. PMID:24970958

  16. Managing lower urinary tract symptoms in men.

    PubMed

    MacKenzie, Kenneth R; Aning, Jonathan J

    2016-04-01

    Male lower urinary tract symptoms (LUTS) are common and increase in prevalence with age. Up to 90% of men aged 50 to 80 may suffer from troublesome LUTS. Men may attend expressing direct concern about micturition, describing one or more LUTS and the related impact on their quality of life. Frequently men may present for other medical or urological reasons such as concern regarding their risk of having prostate cancer or erectile dysfunction but on taking a history bothersome LUTS are identified. Men may present late in the community with urinary retention: the inability to pass urine. A thorough urological history is essential to inform management. It is important to determine whether men have storage or voiding LUTS or both. All patients must have a systematic comprehensive examination including genitalia and a digital rectal examination. Investigations performed in primary care should be guided by the history and examination findings, taking into account the impact of the LUTS on the individual's quality of life. Current NICE guidelines recommend the following to be performed at initial assessment: frequency volume chart (FVC); urine dipstick to detect blood, glucose, protein, leucocytes and nitrites; and prostate specific antigen. Men should be referred for urological review if they have: bothersome LUTS which have not responded to conservative management or medical therapy; LUTS in association with recurrent or persistent UTIs; urinary retention; renal impairment suspected to be secondary to lower urinary tract dysfunction; or suspected urological malignancy. All patients not meeting criteria for immediate referral to urology can be managed initially in primary care. Based on history, examination and investigation findings an individualised management plan should be formulated. Basic lifestyle advice should be given regarding reduction or avoidance of caffeinated products and alcohol. The FVC should guide advice regarding fluid intake management and all

  17. Urinary tract infections in the infant.

    PubMed

    Arshad, Mehreen; Seed, Patrick C

    2015-03-01

    Urinary tract infection (UTI) in an infant may be the first indication of an underlying renal disorder. Early recognition and initiation of adequate therapy for UTI is important to reduce the risk of long-term renal scarring. Ampicillin and gentamicin are traditionally the empiric treatment of choice; however, local antibiotic resistance patterns should be considered. Maternal antibiotics during pregnancy also increase the risk of resistant pathogens during neonatal UTI. Long-term management after the first UTI in infants remains controversial because of lack of specific studies in this age group and the risk-benefit issues for antibiotic prophylaxis between reduced recurrent disease and emergent antibiotic resistance.

  18. Endoscopic management of upper urinary tract stones.

    PubMed Central

    Tolley, D. A.; Buist, T. A.

    1986-01-01

    In a two year period from March 1983, 157 patients with upper urinary tract stones were managed primarily by endoscopy. Of 90 patients with renal stones, extraction was achieved in 91% of patients with complete extraction in 76%. Of the remaining patients with ureteric stones, successful extraction was achieved in 75%. Ten patients required open surgery which was for failed extraction in 9. Morbidity is low with a mean hospital stay of 4.7 days for patients with kidney stones, and of 3.7 days for patients undergoing extraction of ureteric stones. Images Fig. 2 PMID:3954313

  19. Reducing urinary tract infections in catheterised patients.

    PubMed

    Howe, Pam; Adams, John

    2015-01-20

    Urinary tract infections in catheterised patients continue to present a challenge in reducing healthcare-associated infection. In this article, an infection prevention and control team in one NHS trust reports on using audit results to focus attention on measures to reduce bacterial infections. Educational initiatives have an important role in reducing infection, but there is no single solution to the problem. Practice can be improved using a multi-targeted approach, peer review and clinical audit to allow for shared learning and experiences. These, along with informal education in the clinical area and more formal classroom lectures, can ultimately lead to improved patient outcomes.

  20. Covert operations of uropathogenic Escherichia coli within the urinary tract.

    PubMed

    Bower, Jean M; Eto, Danelle S; Mulvey, Matthew A

    2005-01-01

    Entry into host cells is required for many bacterial pathogens to effectively disseminate within a host, avoid immune detection and cause disease. In recent years, many ostensibly extracellular bacteria have been shown to act as opportunistic intracellular pathogens. Among these are strains of uropathogenic Escherichia coli (UPEC), the primary causative agents of urinary tract infections (UTIs). UPEC are able to transiently invade, survive and multiply within the host cells and tissues constituting the urinary tract. Invasion of host cells by UPEC is promoted independently by distinct virulence factors, including cytotoxic necrotizing factor, Afa/Dr adhesins, and type 1 pili. Here we review the diverse mechanisms and consequences of host cell invasion by UPEC, focusing also on the impact of these processes on the persistence and recurrence of UTIs.

  1. Diagnostic Work-Up of Lower Urinary Tract Symptoms.

    PubMed

    Hecht, Sarah L; Hedges, Jason C

    2016-08-01

    The goal of work-up of lower urinary tract symptoms is to establish the severity and cause of lower urinary tract symptoms and to predict with certainty which patients will respond to which treatments. Clinical guidelines exist to guide urologists in decision-making. All patients need a medical history with a validated symptom score, a physical examination, and a urinalysis. Prostate-specific antigen, postvoid urine residual, and peak urine flow rate provide additional information at little cost. For more invasive testing high-level data are lacking and guidelines defer to the urologist. Even the most extensive work-up is imperfect, and thus the attempt to balance costs with benefits of invasive testing. PMID:27476123

  2. Covert Operations of Uropathogenic Escherichia coli within the Urinary Tract

    PubMed Central

    Bower, Jean M.; Eto, Danelle S.; Mulvey, Matthew A.

    2008-01-01

    Entry into host cells is required for many bacterial pathogens to effectively disseminate within a host, avoid immune detection and cause disease. In recent years, many ostensibly extracellular bacteria have been shown to act as opportunistic intracellular pathogens. Among these are strains of uropathogenic Escherichia coli (UPEC), the primary causative agents of urinary tract infections (UTIs). UPEC are able to transiently invade, survive and multiply within the host cells and tissues constituting the urinary tract. Invasion of host cells by UPEC is promoted independently by distinct virulence factors, including cytotoxic necrotizing factor, Afa/Dr adhesins, and type 1 pili. Here we review the diverse mechanisms and consequences of host cell invasion by UPEC, focusing also on the impact of these processes on the persistence and recurrence of UTIs. PMID:15569242

  3. Urinary tract infection in a rural community of Nigeria

    PubMed Central

    Oladeinde, Bankole Henry; Omoregie, Richard; Olley, Mitsan; Anunibe, Joshua A.

    2011-01-01

    Aim: To determine the prevalence of urinary tract infection (UTI) in Okada, a rural community in Nigeria, and the effect of age and gender on its prevalence as well as the etiologic agents and the susceptibility profile of the bacterial agents. Patients and Method: Clean-catch midstream urine was collected from 514 patients (49 males and 465 females). The urine samples were processed and microbial isolates identified. Susceptibility testing was performed on all bacterial isolates. Result: The prevalence of urinary tract infection was significantly higher in females compared to males (female vs. male: 42.80% vs. 10.20%; OR = 6.583. 95% CI = 2.563,16.909; P < 0.0001). Age had no effect on the prevalence of UTI. Escherichia coli was the most prevalent isolate generally and in females, while Staphylococcus aureus was the predominant isolate causing urinary tract infection in males. The flouroquinnolones were the most active antibacterial agents. Conclusion: An overall prevalence of 39.69% was observed in this study. Females had a 3 to 17 fold increase risk of acquiring UTI, than their male counterpart. Escherichia coli were the predominant isolates causing UTI. PMID:22540069

  4. Urinary tract infection following ritual Jewish circumcision.

    PubMed

    Goldman, M; Barr, J; Bistritzer, T; Aladjem, M

    1996-11-01

    Circumcision seems to reduce the overall incidence of urinary tract infections (UTI), although a few studies have suggested that ritual circumcision may be a predisposing factor for UTI within the first 2 weeks following the procedure. The aim of this study was to investigate a possible causal relationship between ritual circumcision and UTI. The study comprised 82 infants with UTI, 55 females and 27 males under the age of 1 year. All males were circumcised on the eighth day of life. The median age of infection was 0.75 and 7.0 months for males and females, respectively. Fifty-two percent (14/27) of UTI episodes were diagnosed within the 2 weeks following circumcision. A significantly lower incidence in Escherichia coli-induced UTI was observed in males compared to females, 67% and 93%, respectively. Similarly, the incidence of E. coli-induced UTI was also significantly lower in males presenting within 2 weeks following circumcision (57%) compared to infants presenting prior or more than 2 weeks following the procedure (92%). Positive blood cultures of an identical microorganism were observed in 6/27 males compared to 2/55 females. The incidence of urinary tract malformations and their severity were similar in both sexes. We conclude that the high incidence of UTI following a ritual Jewish circumcision, as well as the relatively high preponderance of bacteria other than E. coli, may suggest a causal relationship between circumcision and UTI.

  5. Estrogens and Male Lower Urinary Tract Dysfunction

    PubMed Central

    Wynder, Jalissa L.; Nicholson, Tristan M.; DeFranco, Donald B.

    2016-01-01

    Benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) are common clinical problems in urology and affect the majority of men at some time during their lives. The development of BPH/LUTS is associated with an increased ratio of estrogen to androgen levels, and this ratio, when mimicked in a variety of animals, induces BPH and lower urinary tract dysfunction (LUTD). While the precise molecular etiology remains unclear, estrogens have been implicated in the development and maintenance of BPH. Numerous endogenous and exogenous estrogens exist in humans. These estrogens act via multiple estrogen receptors to promote or inhibit prostatic hyperplasia and other BPH-associated processes. The prostate is an estrogen target tissue, and estrogens directly and indirectly affect growth and differentiation of prostate. The precise role of estrogen action directly affecting prostate growth and differentiation in the context of BPH is an understudied area and remains to be elucidated. Estrogens and selective estrogen receptor modulators (SERMs) have been shown to promote or inhibit prostate proliferation illustrating their potential roles in the development of BPH as therapy. More work will be required to identify estrogen signaling pathways associated with LUTD in order to develop more efficacious drugs for BPH treatment and prevention. PMID:26156791

  6. Anatomy and Physiology of the Urinary Tract: Relation to Host Defense and Microbial Infection

    PubMed Central

    HICKLING, DUANE R.; SUN, TUNG-TIEN; WU, XUE-RU

    2015-01-01

    The urinary tract exits to a body surface area that is densely populated by a wide range of microbes. Yet, under most normal circumstances, it is typically considered sterile, i.e., devoid of microbes, a stark contrast to the gastrointestinal and upper respiratory tracts where many commensal and pathogenic microbes call home. Not surprisingly, infection of the urinary tract over a healthy person’s lifetime is relatively infrequent, occurring once or twice or not at all for most people. For those who do experience an initial infection, the great majority (70% to 80%) thankfully do not go on to suffer from multiple episodes. This is a far cry from the upper respiratory tract infections, which can afflict an otherwise healthy individual countless times. The fact that urinary tract infections are hard to elicit in experimental animals except with inoculum 3–5 orders of magnitude greater than the colony counts that define an acute urinary infection in humans (105 cfu/ml), also speaks to the robustness of the urinary tract defense. How can the urinary tract be so effective in fending off harmful microbes despite its orifice in a close vicinity to that of the microbe-laden gastrointestinal tract? While a complete picture is still evolving, the general consensus is that the anatomical and physiological integrity of the urinary tract is of paramount importance in maintaining a healthy urinary tract. When this integrity is breached, however, the urinary tract can be at a heightened risk or even recurrent episodes of microbial infections. In fact, recurrent urinary tract infections are a significant cause of morbidity and time lost from work and a major challenge to manage clinically. Additionally, infections of the upper urinary tract often require hospitalization and prolonged antibiotic therapy. In this chapter, we provide an overview of the basic anatomy and physiology of the urinary tract with an emphasis on their specific roles in host defense. We also highlight the

  7. What I Need to Know about My Child's Urinary Tract Infection

    MedlinePlus

    ... is changed from liquid to solid. The bacterium Escherichia coli (E. coli) causes most UTIs. The urinary tract ... stih-PAY-shuhn) diarrhea (DY-uh-REE-uh) Escherichia coli (esh-uh-RIK-ee-uh) (KOH-ly) kidneys ( ...

  8. Vesicoureteric reflux and urinary tract infection in children

    PubMed Central

    Blumenthal, I

    2006-01-01

    An association between vesicoureteric reflux (VUR) and renal damage was found in 1960. In 1973, the term reflux nephropathy (RN) was first used to describe the renal damage caused by VUR. Follow up studies show that about 10%–20% of children with RN develop hypertension or end stage renal disease. It is now evident that there is a sex difference in the development of RN. In most males with RN, the kidneys are congenitally abnormal. In females it is an acquired condition, the most severe damage being sustained by recurrent urinary tract infections (UTIs). The purpose of current UTI guidelines is to identify VUR or any other abnormality of the urinary tract. Since the advent of routine antenatal ultrasonography, there is no longer a need to identify an abnormality of the urinary tract after the first reported UTI. Routine investigations are not required. Recurrent UTIs and a family history of VUR need further evaluation. There is also an urgent need to establish the long term value of prophylactic antibiotics in children with VUR. PMID:16397077

  9. Preventing urinary tract infections in early childhood.

    PubMed

    Williams, Gabrielle J; Craig, Jonathan C; Carapetis, Jonathan R

    2013-01-01

    Urinary tract infection (UTI) is common in children, causes them considerable discomfort, as well as distress to parents and has a tendency to recur. Approximately 20% of those children who experience one infection will have a repeat episode. Since 1975, 11 trials of long-term antibiotics compared with placebo or no treatment in 1,550 children have been published. Results have been heterogeneous, but the largest trial demonstrated a small reduction (6% absolute risk reduction, risk ratio 0.65) in the risk of repeat symptomatic UTI over 12 months of treatment. This effect was consistent across sub groups of children based upon age, gender, vesicoureteric reflux status and number of prior infections. Trials involving re-implantation surgery (and antibiotics compared with antibiotics alone) for the sub-group of children with vesicoureteric reflux have not shown a reduction in repeat UTI, with the possible exception of a very small benefit for febrile UTI. Systematic reviews have shown that circumcision reduces the risk of repeat infection but 111 circumcisions would need to be performed to prevent one UTI in unpredisposed boys. Given the need for anaesthesia and the risk of surgical complication, net clinical benefit is probably restricted to those who are predisposed (such as those with recurrent infection). Many small trials in complementary therapies have been published and many suggest some benefit, however inclusion of children is limited. Only three trials involving 394 children for cranberry products, two trials with a total of 252 children for probiotics and one trial with 24 children for vitamin A are published. Estimates of efficacy vary widely and imprecision is evident. Multiple interventions to prevent UTI in children exist. Of those, long-term low dose antibiotics has the strongest evidence base, but the benefit is small. Circumcision in boys reduces the risk substantially, but should be restricted to those at risk. There is little evidence of benefit of

  10. Comparative in vitro activity of cefditoren and other antimicrobials against Enterobacteriaceae causing community-acquired uncomplicated urinary tract infections in women: a Spanish nationwide multicenter study.

    PubMed

    Cuevas, Oscar; Cercenado, Emilia; Gimeno, Mercedes; Marín, Mercedes; Coronel, Pilar; Bouza, Emilio

    2010-07-01

    Cefditoren is a third-generation orally administered cephalosporin with a broad spectrum of activity against Gram-positive and Gram-negative bacterial species. After an oral 400-mg single dose, the mean concentrations in urine are 186.5 mg/L at 2 to 4 h and 12.7 mg/L at 8 to 12 h, and it is a potential drug to be used in the treatment of urinary tract infection (UTI). We performed a multicenter nationwide study in Spain in order to determine the in vitro activity of cefditoren and other comparative agents against Enterobacteriaceae causing community-acquired uncomplicated UTI in women. From June 2008 to March 2009, 89 institutions participated in the study. A total of 2152 Enterobacteriaceae were collected and sent to a coordinating laboratory where identification and antimicrobial susceptibility testing was performed against 20 antimicrobials using an automated microdilution method (MicroScan; Siemens, Sacramento, CA). Cefditoren MICs were determined by the broth microdilution method (Clinical and Laboratory Standards Institute guidelines) using the same inoculum. Microorganisms isolated were Escherichia coli (81.8%), Klebsiella pneumoniae (7.9%), Proteus mirabilis (5.2%), and others (5.1%). A total of 51 isolates (2.4%) were extended-spectrum beta-lactamase (ESBL) producers, 3 (0.1%) produced plasmidic AmpC enzymes, and 64 (2.9%) produced chromosomal AmpC. The MIC(50)/MIC(90) (mg/L) of cefditoren against all isolates was 0.12/0.5. Cefditoren inhibited 96.5% of isolates at 1 mg/L and was uniformly active against all isolates with the exception of strains producing ESBLs or AmpC enzymes. The MIC(50)/MIC(90) of other antimicrobials were ampicillin (AMP) >16/>16, amoxicillin/clavulanic acid (A/C) 2, trimethoprim/sulfamethoxazole (SxT) 4/76, and fosfomycin (FOS)

  11. [Association between chronic urinary tract infection and primary biliary cirrhosis].

    PubMed

    Xu, Y; Wang, J B; Wang, S

    2016-06-01

    The etiology of primary biliary cirrhosis (PBC) remains unclear, and at present, this disease is considered to be caused by the combined effect of genetic factors, infection, autoimmunity, and environmental factors. Since infection is the major cause for PBC, scholars have been focusing on the association between chronic microbial infection. Studies have shown that Escherichia coli is the most common bacterium for urinary tract infection (UTI), and recurrent UTI has been confirmed to be a risk factor for the development and progression of autoimmune liver diseases and is closely associated with PBC. This article investigates the association between UTI and PBC and possible mechanisms. PMID:27465958

  12. [Congenital anomalies of the kidney and urinary tract. A vision for the paediatrician].

    PubMed

    Palacios Loro, M L; Segura Ramírez, D K; Ordoñez Álvarez, F A; Santos Rodríguez, F

    2015-12-01

    The congenital abnormalities of kidney and urinary tract (CAKUT) are disorders with a high prevalence in the general population, with urinary tract dilations being the most frequent. CAKUT also account for the most important cause of chronic kidney disease in childhood. This paper focuses on the role of the primary care paediatrician in the diagnosis, assessment, and follow-up of children with CAKUT, with special emphasis on the associated urinary tract infections, the progression toward chronic renal failure, and the genetic basis. PMID:26497631

  13. Do cranberries help prevent urinary tract infections?

    PubMed

    Hutchinson, Janet

    Cranberries are widely used in the treatment and prevention of urinary tract infections (UTIs) and for those at risk of such infections. With the growing resistance to antibiotics, cranberries can be viewed as a useful non-pharmaceutical remedy (Lavender, 2000). The initial studies that looked at the effects of cranberries on urine showed that the excretion of hippuric acid from the berries helped the urine to remain acidic, which could explain why they could be used to treat and prevent infection (Harkin, 2000). Recent studies argue that cranberries prevent Escherichia coli (E. coli) from adhering to uroepithelial cells in the bladder (Howell and Foxman, 2002). Cranberries contain a group of compounds, called proanthocyanidins, which are condensed tannins (Gray, 2002; Lowe and Fagelman, 2001; Kuzminski, 1996). These are thought to be the key factors in inhibiting E. coli adherence.

  14. Urinary tract infection in individuals with spinal cord lesion.

    PubMed

    Biering-Sørensen, Fin

    2002-01-01

    Urinary tract infection is the most frequently reported secondary impairment in individuals with spinal cord lesion. The most prevalent risk indicator is an indwelling catheter. Hydrophilic catheters for clean intermittent catheterization may induce lower rates of bacteriuria and long-term urethral complications. Due to chronic bacterial infection within biofilms, an antibacterial treatment based on a urinary culture of bacteria in the urine and its antimicrobial susceptibility may fail to eradicate catheter-associated urinary tract infection. No commercially available drugs are sufficiently active against the bacteria in a mature biofilm. Biomaterials may be modified to decrease the formation of a biofilm. Silver alloy catheters are effective in preventing urinary tract infection when indwelling urinary catheterization is necessary. The risk of systemic argyria in long-term use needs to be evaluated. Suprapubic cystostomy drainage in patients with neurogenic bladder is preferred to an indwelling urethral catheter. In cases of recurring urinary tract infection in patients with a permanent urinary catheter, it may be beneficial to change the catheter every 1 or 2 weeks. There is some evidence that cranberry products may prevent urinary tract infection. In the future, bacterial interference and vaccination may be a possibility for prevention of urinary tract infection.

  15. Urinary tract infection in the neurogenic bladder

    PubMed Central

    Vigil, Humberto R.

    2016-01-01

    There is a high incidence of urinary tract infection (UTI) in patients with neurogenic lower urinary tract function. This results in significant morbidity and health care utilization. Multiple well-established risk factors unique to a neurogenic bladder (NB) exist while others require ongoing investigation. It is important for care providers to have a good understanding of the different structural, physiological, immunological and catheter-related risk factors so that they may be modified when possible. Diagnosis remains complicated. Appropriate specimen collection is of paramount importance and a UTI cannot be diagnosed based on urinalysis or clinical presentation alone. A culture result with a bacterial concentration of ≥103 CFU/mL in combination with symptoms represents an acceptable definition for UTI diagnosis in NB patients. Cystoscopy, ultrasound and urodynamics should be utilized for the evaluation of recurrent infections in NB patients. An acute, symptomatic UTI should be treated with antibiotics for 5–14 days depending on the severity of the presentation. Antibiotic selection should be based on local and patient-based resistance patterns and the spectrum should be as narrow as possible if there are no concerns regarding urosepsis. Asymptomatic bacteriuria (AB) should not be treated because of rising resistance patterns and lack of clinical efficacy. The most important preventative measures include closed catheter drainage in patients with an indwelling catheter and the use of clean intermittent catheterization (CIC) over other methods of bladder management if possible. The use of hydrophilic or impregnated catheters is not recommended. Intravesical Botox, bacterial interference and sacral neuromodulation show significant promise for the prevention of UTIs in higher risk NB patients and future, multi-center, randomized controlled trials are required. PMID:26904414

  16. Reducing urinary tract infections in catheterized patients.

    PubMed

    Hardyck, C; Petrinovich, L

    1998-12-01

    To compare the effectiveness of two drainage systems in controlling urinary tract infections (UTIs), 65 elderly home care patients with indwelling urinary catheters participated in a retrospective intervention study. The patients first used a Foley drainable bag (DB) system, followed by a nondrainable one (NDB). Both systems used a Foley catheter. Data were obtained from physicians, nurses, caregivers, and patients regarding the number of UTIs and hospitalizations that occurred when using each system. Using the DB, 65 patients had 1,395 UTIs, 27 of which required hospitalization. Using the NDB, 2 patients had 71 UTIs, 2 of which required hospitalization. The cost for the non-hospitalization UTIs with DBs was estimated at $1,153,665 compared to $57,890 with NDBs. The hospital costs with DBs were estimated at $274,170 and $15,540 with NDBs. Because DBs were used longer than NDBs (mean = 44.4 months and 8.8 months, respectively), patients who used each bag for the same period of time were compared. When these patients used NDBs they had significantly fewer UTIs (56, with one hospitalization for 7 days) than when they used DBs (242, with 10 hospitalizations for 37 days). Although the cost of purchasing the non-replaceable NDBs is greater, the use of NDBs drastically reduced levels of infection as well as the overall cost to maintain catheterized patients.

  17. Enterococcal urinary tract infections in a university hospital: clinical studies.

    PubMed

    Barros, Milton; Martinelli, Reinaldo; Rocha, Heonir

    2009-08-01

    Although urinary tract infections (UTI) represent the most common infection caused by enterococci, some aspects remain to be fully clarified. The aim of this study was to determine the clinical characteristics present in UTI caused by Enterococcus spp. in patients followed up at the Prof. Edgard Santos Teaching Hospital of the Federal University of Bahia. All patients consecutively examined between 1997 and 2005, who received a diagnosis of UTI caused by Enterococcus spp. were included in the study. UTI was defined as the presence of > or = 10(5) colony-forming units per mL of urine. Standard microbiological techniques were used. During the study period, 6.2% of the urine cultures were positive for Enterococcus spp. The mean age of the patients was 48.9 years and 57% were male. At initial evaluation, 13% of the patients had complaints suggestive of UTI. Nineteen patients had a history consistent with obstructive uropathy and 26 with neurogenic bladder. At final evaluation, UTI was the diagnosis in 48 patients. In 36 patients (29%), the primary diagnosis was related to urogenital diseases, consisting of obstructive uropathy in 23 of these cases, while in 32 patients (25.8%) primary diagnosis was related to neurologic diseases, frequently neurogenic bladder. UTI caused by Enterococcus spp. is not infrequent, is usually associated with few or no symptoms and occurs in sick patients who have anatomical or functional obstructive uropathy associated or not with urinary tract catheterization or instrumentation. The diagnosis of enterococcal UTI may indicate a urinary tract abnormality yet to be diagnosed. PMID:20231994

  18. A current perspective on geriatric lower urinary tract dysfunction

    PubMed Central

    Jung, Ha Bum; Kim, Hyung Jee

    2015-01-01

    Lower urinary tract dysfunction-such as urinary incontinence (UI), detrusor overactivity, and benign prostatic hyperplasia-is prevalent in elderly persons. These conditions can interfere with daily life and normal functioning and lead to negative effects on health-related quality of life. UI is one of the most common urologic conditions but is poorly understood elderly persons. The overall prevalence of UI increases with age in both men and women. Elderly persons often neglect UI or dismiss it as part of the normal aging process. However, UI can have significant negative effects on self-esteem and has been associated with increased rates of depression. UI also affects quality of life and activities of daily living. Although UI is more common in elderly than in younger persons, it should not be considered a normal part of aging. UI is abnormal at any age. The goal of this review is to provide an overview of the cause, classification, evaluation, and management of geriatric lower urinary tract dysfunction. PMID:25874039

  19. Urinary tract infections in adult general practice patients.

    PubMed Central

    Hummers-Pradier, Eva; Kochen, Michael M

    2002-01-01

    Urinary tract infections (UTIs) are symptomatic infections of the urinary tract, mainly caused by the bacterium Escherichia coli. One in two women suffers from a UTI at least once in her life. The young and sexually active are particulaly affected, but it is also seen in elderly, postmenopausal women. The likelihood of recurrence is high. Diagnosis is made with regard to typical complaints and the presence of leucocytes and nitrites in the urine. A culture is unnecessary in most cases. Uncomplicated UTI should be distinguished from complicated UTI, which has a risk of severe illness. The treatment of choice--short-term therapy with trimethoprim or nitrofurantoin--is successful in over 80% of the cases. Co-trimoxazol fluoroquinolones or cephalsporins are not considered first-choice drugs. There are indications that general practitioners' (GPs') management of UTI is not always optimal, specifically concerning diagnostic tests, the application of second-choice antibiotics, and the length of prescribed treatment courses. Many points relevant to GPs requirefurther research, such as epidemiology and resistance of urinary pathogens in the community and natural history of UTI, as well as optimal management in elderly or complicated patients and men. PMID:12236281

  20. [Urinary tract infections. Therapeutic failures and course monitoring (author's transl)].

    PubMed

    Abdou, M A

    1979-10-19

    The proportion of reinfections and relapses in urinary tract infections amounts to about 35-70%. Hydrokinetic conditions (e.g. size of bladder, frequency of micturition, rate of multiplication of the pathogens, adhesiveness of bacteria) not seldom lead to a discrepancy between the in vivo response of the pathogen to the chemotherapeutic agent and the corresponding MIC determined in vitro. Ten causes for the therapeutic failure are discussed in greater detail. Monitoring the course in good time with due regard to the risks is essential. A scheme for microbiological monitoring investigations before beginning therapy, during treatment and after discontinuing the medicament, as well as for long term therapy is suggested.

  1. Urinary tract infections: epidemiology, mechanisms of infection and treatment options

    PubMed Central

    Flores-Mireles, Ana L.; Walker, Jennifer N.; Caparon, Michael; Hultgren, Scott J.

    2015-01-01

    Urinary tract infections (UTIs) are a severe public health problem and are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections. In this Review, we discuss how basic science studies are elucidating the molecular details of the crosstalk that occurs at the host–pathogen interface, as well as the consequences of these interactions for the pathophysiology of UTIs. We also describe current efforts to translate this knowledge into new clinical treatments for UTIs. PMID:25853778

  2. [Urinary tract infections. Therapeutic failures and course monitoring (author's transl)].

    PubMed

    Abdou, M A

    1979-10-19

    The proportion of reinfections and relapses in urinary tract infections amounts to about 35-70%. Hydrokinetic conditions (e.g. size of bladder, frequency of micturition, rate of multiplication of the pathogens, adhesiveness of bacteria) not seldom lead to a discrepancy between the in vivo response of the pathogen to the chemotherapeutic agent and the corresponding MIC determined in vitro. Ten causes for the therapeutic failure are discussed in greater detail. Monitoring the course in good time with due regard to the risks is essential. A scheme for microbiological monitoring investigations before beginning therapy, during treatment and after discontinuing the medicament, as well as for long term therapy is suggested. PMID:117322

  3. Urinary tract infections: epidemiology, mechanisms of infection and treatment options.

    PubMed

    Flores-Mireles, Ana L; Walker, Jennifer N; Caparon, Michael; Hultgren, Scott J

    2015-05-01

    Urinary tract infections (UTIs) are a severe public health problem and are caused by a range of pathogens, but most commonly by Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis and Staphylococcus saprophyticus. High recurrence rates and increasing antimicrobial resistance among uropathogens threaten to greatly increase the economic burden of these infections. In this Review, we discuss how basic science studies are elucidating the molecular details of the crosstalk that occurs at the host-pathogen interface, as well as the consequences of these interactions for the pathophysiology of UTIs. We also describe current efforts to translate this knowledge into new clinical treatments for UTIs. PMID:25853778

  4. Pediatric urinary tract infections: current controversies.

    PubMed

    MacNeily, A E

    2001-06-01

    Few topics in pediatric urology engender such vigorous debate as the who, when, how, and why related to the investigation of pediatric urinary tract infections (UTIs). Further controversy stems from management of the underlying pathology. This article first discusses the patient characteristics that are important in the evaluation of pediatric patients with UTIs, and the indications for screening tests (such as voiding cystourethrograms, ultrasound, dimercaptosuccinic acid renal scintigraphy, and intravenous pyelography). Following this, the author reviews what is known about three controversial aspects about the management of these patients. First, although the role of the prepuce in pediatric UTI is well established, the role of routine circumcision is not. Second, the natural history and etiology of antenatally detected vesicoureteral reflux (VUR) has provoked us to view the concept of "primary reflux" in a new light. Third, although the way to diagnose vesicoureteral reflux is generally agreed upon, the utility of our surgical management in view of long-term follow-up is less clear.

  5. Use of antioxidants in urinary tract infection

    PubMed Central

    Allameh, Zahra; Salamzadeh, Jamshid

    2016-01-01

    Pyelonephritis is an inflammatory process, and oxidative stress plays a major role in it. Anti-inflammatory or antioxidant therapy given concomitantly with antibiotics should lower the risk of postpyelonephritic scarring. As the lack of review studies in the use of antioxidants in urinary tract infections was detected, this study was designed. We conducted a review of available articles in PubMed and Google Scholar with a simple review, using keywords of “antioxidant” and “pyelonephritis” with all their possible synonyms and combinations. Only interventional studies were collected. There were neither limitations on time, nor the location of the study, type of subjects, administration rout of the antioxidant drug, and the antioxidant drug used. After studying the abstracts or in some cases the full text of articles, they were categorized based on the type of antioxidant, type and number of subjects, rout of administration, dosing, duration of treatment, year of publication of the paper, and the results. A total of 66 articles published from 1991 to 2015 were found by studying just the title of the papers. Studying the abstracts reduced this number to 51 studies. Antioxidants used for this condition were Vitamins A, E, and C, cytoflavin, caffeic acid phenethyl ester, ebselen, allopurinol, melatonin, N-acetylcysteine, oleuropein, montelukast, oxytocin, ozon, dapsone, pentoxifyllin, tadalafil, bilirubin, cranberry, meloxicam, L-carnitine, colchicine, perfluoran, methylprednisolone, and dexamethasone. Studies show that antioxidants are capable of reducing oxidative stress and can be used effectively along with antibiotics to reduce the scar formation. PMID:27162800

  6. Use of antioxidants in urinary tract infection.

    PubMed

    Allameh, Zahra; Salamzadeh, Jamshid

    2016-01-01

    Pyelonephritis is an inflammatory process, and oxidative stress plays a major role in it. Anti-inflammatory or antioxidant therapy given concomitantly with antibiotics should lower the risk of postpyelonephritic scarring. As the lack of review studies in the use of antioxidants in urinary tract infections was detected, this study was designed. We conducted a review of available articles in PubMed and Google Scholar with a simple review, using keywords of "antioxidant" and "pyelonephritis" with all their possible synonyms and combinations. Only interventional studies were collected. There were neither limitations on time, nor the location of the study, type of subjects, administration rout of the antioxidant drug, and the antioxidant drug used. After studying the abstracts or in some cases the full text of articles, they were categorized based on the type of antioxidant, type and number of subjects, rout of administration, dosing, duration of treatment, year of publication of the paper, and the results. A total of 66 articles published from 1991 to 2015 were found by studying just the title of the papers. Studying the abstracts reduced this number to 51 studies. Antioxidants used for this condition were Vitamins A, E, and C, cytoflavin, caffeic acid phenethyl ester, ebselen, allopurinol, melatonin, N-acetylcysteine, oleuropein, montelukast, oxytocin, ozon, dapsone, pentoxifyllin, tadalafil, bilirubin, cranberry, meloxicam, L-carnitine, colchicine, perfluoran, methylprednisolone, and dexamethasone. Studies show that antioxidants are capable of reducing oxidative stress and can be used effectively along with antibiotics to reduce the scar formation. PMID:27162800

  7. TRP channels in lower urinary tract dysfunction

    PubMed Central

    Franken, J; Uvin, P; De Ridder, D; Voets, T

    2014-01-01

    Lower urinary tract dysfunction (LUTd) represents a major healthcare problem. Although it is mostly not lethal, associated social disturbance, medical costs, loss of productivity and especially diminished quality of life should not be underestimated. Although more than 15% of people suffer from a form of LUTd to some extent, pathophysiology often remains obscure. In the past 20 years, transient receptor potential (TRP) channels have become increasingly important in this field of research. These intriguing ion channels are believed to be the main molecular sensors that generate bladder sensation. Therefore, they are intensely pursued as new drug targets for both curative and symptomatic treatment of different forms of LUTd. TRPV1 was the first of its class to be investigated. Actually, even before this channel was cloned, it had already been targeted in the bladder, with clinical trials of intravesical capsaicin instillations. Several other polymodally gated TRP channels, particularly TRPM8, TRPA1 and TRPV4, also appear to play a prominent role in bladder (patho)physiology. With this review, we provide a brief overview of current knowledge on the role of these TRP channels in LUTd and their potential as molecular targets for treatment. Linked Articles This article is part of a themed section on the pharmacology of TRP channels. To view the other articles in this section visit http://dx.doi.org/10.1111/bph.2014.171.issue-10 PMID:24895732

  8. Urinary tract infection in women - self-care

    MedlinePlus

    UTI - self-care; Cystitis - self-care; Bladder infection - self-care ... BATHING AND HYGIENE To prevent future urinary tract infections, you should: Choose sanitary pads instead of tampons, which some doctors believe make infections more likely. Change your ...

  9. Biotypes of Gardnerella vaginalis isolated from urinary tract.

    PubMed

    González-Pedraza Avilés, A; Ortíz-Zaragoza, M C; Inzunza-Montiel, A E; Ponce-Rosas, E R

    1996-01-01

    A modified scheme is proposed for biotyping Gardnerella vaginalis isolated from urinary tract of symptomatic and asymptomatic women based on detection of hippurate hydrolysis, beta-galactosidase (ONPG) and lipase, and fermentation of arabinose, galactose and xylose. Thirty biotypes were found among 73 strains. The distribution of biotypes was similar in both populations but the biotypes 1H, 5G and 7G were found more frequently in women without symptoms of urinary tract infection.

  10. Salmonella-related urinary tract infection in an elderly patient

    PubMed Central

    Klosterman, Scott Anthony

    2014-01-01

    An elderly female patient with an uncomplicated urinary tract infection from Salmonella newport is presented. Radiological and laboratory studies were performed because of her systemic and exposure risk factors as well as prior urinary tract abnormalities. While this patient was successfully treated as an outpatient with oral antibiotics, complications and recurrence are common and deserve close follow-up with repeat urine cultures at a minimum. Further laboratory and radiological testing should be guided by patient gender, risk factors and recurrence. PMID:25193813

  11. Catheter-related urinary tract infection.

    PubMed

    Nicolle, Lindsay E

    2005-01-01

    Indwelling urinary catheters are used frequently in older populations. For either short- or long-term catheters, the infection rate is about 5% per day. Escherichia coli remains the most common infecting organism, but a wide variety of other organisms may be isolated, including yeast species. Bacteria tend to show increased resistance because of the repeated antimicrobial courses. Urinary tract infection (UTI) usually follows formation of biofilm on both the internal and external catheter surface. The biofilm protects organisms from both antimicrobials and the host immune response. Morbidity from UTI with short-term catheter use is limited if appropriate catheter care is practised. In patients with long-term catheters, fever from a urinary source is common with a frequency varying from 1 per 100 to 1 per 1000 catheter days. Long-term care facility residents with chronic indwelling catheters have a much greater risk for bacteraemia and other urinary complications than residents without catheters. Asymptomatic catheter-acquired UTI should not be treated with antimicrobials. Antimicrobial treatment does not decrease symptomatic episodes but will lead to emergence of more resistant organisms. For treatment of symptomatic infection, many antimicrobials are effective. Wherever possible, antimicrobial selection should be delayed until culture results are available. Whether to administer initial treatment by an oral or parenteral route is determined by clinical presentation. If empirical therapy is required, antimicrobial selection is based on variables such as route of administration, anticipated infecting organism and susceptibility, and patient tolerance. Renal function, concomitant medications, local formulary and cost may also be considered in selection of the antimicrobial agent. The duration of therapy is usually 10-14 days, but patients who respond promptly and in whom the catheter must remain in situ may be treated with a shorter 7-day course to reduce

  12. 2,3,6-triaminopyridine, a metabolite of the urinary tract analgesic phenazopyridine, causes muscle necrosis and renal damage in rats.

    PubMed

    Munday, R; Manns, E

    1998-01-01

    Some aromatic polyamines form very stable free radicals and readily undergo autoxidation with concomitant formation of 'active oxygen' species. These substances cause necrosis of striated muscle in rats, and it has been suggested that this is due to free radical formation and disruption of energy production through their oxidation via the cytochrome c/cytochrome oxidase system of mitochondria. 2,3,6-Triaminopyridine, which is structurally related to the myotoxic amines and likewise undergoes autoxidation and disrupts mitochondrial metabolism, is a metabolite of the widely used urinary analgesic phenazopyridine. When administered to rats, triaminopyridine caused extensive necrosis of skeletal muscle and a lesser degree of damage to heart muscle. It also induced vacuolation and necrosis of distal tubules of the kidney, associated with tubular dilatation and cast formation. Both muscle damage and renal tubular necrosis have been reported following use or abuse of phenazopyridine, and it is likely that triaminopyridine is responsible for both of these effects.

  13. Gas in the urinary tract: its aetiology and management.

    PubMed

    Christmas, T J

    1988-01-01

    Gas within the urinary tract may be an incidental finding or it may be detected in the course of investigating a patient with urinary or abdominal symptoms. In the immediate postoperative period it is unlikely to be of any significance, but at any other time it is a sign of serious underlying pathology. In this article its aetiology and management are discussed.

  14. Spectrum of Renal and Urinary Tract Diseases in Kashmiri Children

    PubMed Central

    Kumar, Virender; Bano, Rifat Ara; Wani, Khursheed Ahmed; Ahmed, Javed; Ahmed, Kaisar

    2016-01-01

    Introduction Definite paucity of data pertaining to spectrum of renal and urinary tract diseases in our state and in various parts of India forms the basis of this study. Available data has emphasized more on specific clinical syndromes and chronic renal diseases rather than over all spectrums of renal and urinary tract diseases, that too in adult population. Aim The present study a retrospective analysis, forms one of the basic data of paediatric nephrology and urology related disorders in our state. Materials and Methods Retrospective analysis of the case records of all the hospitalized patients with renal and urinary tract diseases between 2012 and 2013 were performed. Case records were analysed and categorized into various groups like; Urinary Tract Infections (UTI), Acute Kidney Injury (AKI), Acute Glomerulonephritis (AGN), Nephrotic Syndrome (NS), haematuria, Polycystic Kidney Disease (PCKD), Posterior Urethral Valve (PUV), Vesicoureteric Reflux (VUR), Chronic Kidney Disease (CKD), Congenital Anomalies of Kidney and Urinary Iract (CAKUT) and others. These groups were divided into subgroups to get more insight about the pattern of these diseases. Results Out of 28114 patients hospitalized between 2012 and 2013 years, 447 (232 males and 215 females) patients were diagnosed of renal and urinary tract diseases which forms 1.58% the total admitted patients. Among these patients 32.9% (147/447) were diagnosed Acute Kidney Injury (AKI); 24.1% (108/447): Urinary Tract Infection (UTI); 9.6% (43/447): Acute Glomerulonephritis (AGN); 5.6% (25/447): bilateral hydronephrosis with UTI; 4.47% (20/447): nephrotic syndrome (NS); 3.5% (16/447): haematuria; and 4% (18/447) were having CAKUT (Congenital Anomalies Of Kidney And Urinary Tract). In addition to this there were 17 cases of Renal Tubular Acidosis (RTA), 3 cases of Barter syndrome and one case of Liddle syndrome. Conclusion A substantial number of children are hospitalized with renal and urinary tract diseases with

  15. Specific pharmacokinetic aspects of the urinary tract.

    PubMed

    Korstanje, Cees; Krauwinkel, Walter

    2011-01-01

    This chapter reviews the evidence for "specific" pharmacokinetics playing a role in currently marketed drugs intended to treat lower urinary tract (LUT) symptoms. Principles of drug targeting include intrinsic properties of drugs or organs as well as drug formulations to modify drug release or to create confinement of drug presence. Prodrugs and specific formulations to deliver high drug concentrations at the site(s) of action as well as other ways to manipulate drug distribution to achieve enrichment in target tissues are considered. In overactive bladder (OAB), specific formulations for oxybutynin have been introduced to reduce the level of side effects of the active drug. Extended release tablet formulations and a topical gel formulation have been introduced, with efficacy similar to immediate release (IR) tablets, but with a reduction in anticholinergic adverse effects. However, these modifications have not led to outstanding performance parameters compared to other anticholinergic drugs marketed as IR formulations. Urinary excretion is discussed as potential mechanism for targeting LUT symptoms, but no strong indications appear to exist that this mechanism would contribute for currently available drugs. Intravesical administration of drugs is not a preferred option and only considered for drugs like botulinum toxin, where the inconvenient application compensates for a reasonable degree of long-term efficacy in severe refractory OAB. Alpha acid glycoprotein binding is discussed as a potential factor to influence drug tissue distribution, and it is concluded that there is reasonable evidence that for tamsulosin this mechanism is responsible for the difference in free fraction of the drug observed in plasma and prostate, which could contribute to its relative absence of blood pressure effects in patients with LUT symptoms related to benign prostate hyperplasia (LUTS-BPH). The principle of irreversible inhibition of type II 5α-reductase as a tool to develop drugs

  16. [Urinary tract abnormalities with anorrectal malformations (author's transl)].

    PubMed

    Nogués, A; Ceres, M L; Olagüe, R; Andrés, V; Lanuza, A

    1978-01-01

    Thirty five patients with anorrectal malformations are reviewed. These are divided in high and low anomalies according to some simple clinical data, better than the drawing of reference lines to determinate the height of puborrectalis muscle. Malformations were associated in 13 cases with urinary tract estructural anomalies and in four cases with isolated vesico-ureteral reflux. Diagnosis of urinary tract infection was made in 14 patients, 12 of them with recto-urinary fistula. A point is made about the complete and early exploration of all these patients to prevent irreparable renal damage that could be developed. PMID:655503

  17. Multidrug resistance in pediatric urinary tract infections.

    PubMed

    Gaspari, Romolo J; Dickson, Eric; Karlowsky, James; Doern, Gary

    2006-01-01

    Urinary tract infections (UTIs) represent a common infection in the pediatric population. Escherichia coli is the most common uropathogen in children, and antimicrobial resistance in this species complicates the treatment of pediatric UTIs. Despite the impact of resistance on empiric antibiotic choice, there is little data on multidrug resistance in pediatric patients. In this paper, we describe characteristics of multidrug-resistant E. coli in pediatric patients using a large national database of uropathogens antimicrobial sensitivities. Antimicrobial susceptibility patterns to commonly prescribed antibiotics were performed on uropathogens isolated from children presenting to participating hospitals between 1999 and 2001. Data were analyzed separately for four pediatric age groups. Single and multidrug resistance to ampicillin, amoxicillin-clavulanate, cefazolin, ciprofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole (TMP-SMX) were performed on all specimens. There were a total of 11,341 E. coli urine cultures from 343 infants (0-4 weeks), 1,801 toddlers (5 weeks-24 months), 6,742 preteens (2-12 years), and 2,455 teens (13-17 years). E. coli resistance to ampicillin peaked in toddlers (52.8%) but was high in preteens (52.1%), infants (50.4%), and teens (40.6%). Resistance to two or more antibiotics varied across age groups, with toddlers (27%) leading preteens (23.1%), infants (21%), and teens (15.9%). Resistance to three or more antibiotics was low in all age groups (range 3.1-5.2%). The most common co-resistance in all age groups was ampicillin/TMP-SMZ. In conclusion, less than half of all pediatric UTIs are susceptible to all commonly used antibiotics. In some age groups, there is a significant percentage of co-resistance between the two most commonly used antibiotics (ampicillin and TMP-SMZ).

  18. Multidrug resistance in pediatric urinary tract infections.

    PubMed

    Gaspari, Romolo J; Dickson, Eric; Karlowsky, James; Doern, Gary

    2006-01-01

    Urinary tract infections (UTIs) represent a common infection in the pediatric population. Escherichia coli is the most common uropathogen in children, and antimicrobial resistance in this species complicates the treatment of pediatric UTIs. Despite the impact of resistance on empiric antibiotic choice, there is little data on multidrug resistance in pediatric patients. In this paper, we describe characteristics of multidrug-resistant E. coli in pediatric patients using a large national database of uropathogens antimicrobial sensitivities. Antimicrobial susceptibility patterns to commonly prescribed antibiotics were performed on uropathogens isolated from children presenting to participating hospitals between 1999 and 2001. Data were analyzed separately for four pediatric age groups. Single and multidrug resistance to ampicillin, amoxicillin-clavulanate, cefazolin, ciprofloxacin, nitrofurantoin, and trimethoprim-sulfamethoxazole (TMP-SMX) were performed on all specimens. There were a total of 11,341 E. coli urine cultures from 343 infants (0-4 weeks), 1,801 toddlers (5 weeks-24 months), 6,742 preteens (2-12 years), and 2,455 teens (13-17 years). E. coli resistance to ampicillin peaked in toddlers (52.8%) but was high in preteens (52.1%), infants (50.4%), and teens (40.6%). Resistance to two or more antibiotics varied across age groups, with toddlers (27%) leading preteens (23.1%), infants (21%), and teens (15.9%). Resistance to three or more antibiotics was low in all age groups (range 3.1-5.2%). The most common co-resistance in all age groups was ampicillin/TMP-SMZ. In conclusion, less than half of all pediatric UTIs are susceptible to all commonly used antibiotics. In some age groups, there is a significant percentage of co-resistance between the two most commonly used antibiotics (ampicillin and TMP-SMZ). PMID:16922629

  19. Role of scintigraphy in urinary tract infection

    SciTech Connect

    Conway, J.J.

    1988-10-01

    There is controversy regarding the role of radiological imaging for urinary tract infection (UTI). The gold standard has been the intravenous pyelogram (IVP). Yet, the IVP has a very limited value with only about 25% of children with pyelonephritis demonstrating abnormalities. Ultrasound (US) has recently been advocated as a replacement for the poorly sensitive and poorly specific IVP. However, comparative studies between US and IVP indicate only an equivalent sensitivity and specificity. Cortical scintigraphy with Technetium-99m glucoheptonate (99mTc GH) or 99mTc dimercaptosuccinic acid (99mTc DMSA) has also been advocated as a means of differentiating parenchymal (pyelonephritis) from nonparenchymal (lower UTI) involvement in UTI. The clinical presentation may be misleading especially in the infant and child in whom an elevated temperature, flank pain, shaking chills, or an elevated sedimentation rate are often lacking. The clinician attempts to localize the site of infection for it has a direct bearing upon the therapy. A collecting system infection can often be eradicated with a single oral dose of an appropriate antibiotic, whereas renal parenchymal involvement requires IV therapy for an extended interval. Cortical scintigraphy can localize the site of infection with a high degree of accuracy. Recent studies report a sensitivity of 86% and specificity of 81% of pyelonephritis. This is in contrast to the IVP with a sensitivity of only 24% and US with a sensitivity of only 42%. The scintigraphic appearance of parenchymal infection of the kidney is a spectrum of minimal to gross defects reflecting the degree of histologic involvement that spans from a mild infection to frank abscess. Cortical scintigraphy can be used to monitor the evolution of scarring following infection. Cortical scintigraphy with 99mTc DMSA or 99mTc GH is the method of choice for the initial evaluation of UTI. 37 references.

  20. Nosocomial urinary tract infections caused by extended-spectrum beta-lactamase uropathogens: Prevalence, pathogens, risk factors, and strategies for infection control

    PubMed Central

    Bouassida, Khaireddine; Jaidane, Mehdi; Bouallegue, Olfa; Tlili, Ghassen; Naija, Habiba; Mosbah, Ali Tahar

    2016-01-01

    Introduction: Our goal was to investigate the prevalence and antibiogram pattern of extended spectrum beta-lactamase (ESBL) production among uropathogens using isolates from urine samples collected at the Department of Urology in the Sahloul Hospital, Tunisia We also aimed to identify the risk factors for nosocomial urinary tract infections (UTIs) in patients who underwent transurethral resection of the prostate (TURP) and the measures for infection control. Methods: Laboratory records of a five-year period from January 2004 to December 2008 were submitted for retrospective analysis to determine the incidence of ESBL infections. A total of 276 isolates were collected. A case-control study involving comparisons between two groups of patients who underwent TURP was performed to determine the risk factors for ESBL infection. Group 1, designated case subjects, included 51 patients with nosocomial UTI after TURP. Group 2, designated control subjects, consisted of 58 randomly selected patients who underwent TURP without nosocomial UTI in the same period. Factors suspected to be implicated in the emergence of ESBL infection were compared between the two groups in order to identify risk factors for infection. A univariate regression analysis was performed, followed by a multivariate one. Results: The annual prevalence of ESBL infection ranged from 1.3–2.5%. After performing univariate and multivariate regression analysis, the main risk factors for ESBL infections were identified as: use of antibiotics the year preceding the admission, duration of catheter use, and bladder washout (p=0.012, p=0.019, and p<0.001. Conclusions: Urologists have to perform a good hemostasis, especially in endoscopic resections, in order to avoid bladder irrigation and bladder washout and to reduce the time of bladder catheterization, which is a strong risk factor of nosocomial UTIs. PMID:27330585

  1. Evaluation of the in vitro growth of urinary tract infection-causing gram-negative and gram-positive bacteria in a proposed synthetic human urine (SHU) medium.

    PubMed

    Ipe, Deepak S; Ulett, Glen C

    2016-08-01

    Bacteriuria is a hallmark of urinary tract infection (UTI) and asymptomatic bacteriuria (ABU), which are among the most frequent infections in humans. A variety of gram-negative and gram-positive bacteria are associated with these infections but Escherichia coli contributes up to 80% of cases. Multiple bacterial species including E. coli can grow in human urine as a means to maintain colonization during infections. In vitro bacteriuria studies aimed at modeling microbial growth in urine have utilized various compositions of synthetic human urine (SHU) and a Composite SHU formulation was recently proposed. In this study, we sought to validate the recently proposed Composite SHU as a medium that supports the growth of several bacterial species that are known to grow in normal human urine and/or artificial urine. Comparative growth assays of gram-negative and gram-positive bacteria E. coli, Pseudomonas aeruginosa, Proteus mirabilis, Streptococcus agalactiae, Staphylococcus saprophyticus and Enterococcus faecalis were undertaken using viable bacterial count and optical density measurements over a 48h culture period. Three different SHU formulations were tested in various culture vessels, shaking conditions and volumes and showed that Composite SHU can support the robust growth of gram-negative bacteria but requires supplementation with 0.2% yeast extract to support the growth of gram-positive bacteria. Experiments are also presented that show an unexpected but major influence of P. mirabilis towards the ability to measure bacterial growth in generally accepted multiwell assays using absorbance readings, predicted to have a basis in the release of volatile organic compound(s) from P. mirabilis during growth in Composite SHU medium. This study represents an essential methodological validation of a more chemically defined type of synthetic urine that can be applied to study mechanisms of bacteriuria and we conclude will offer a useful in vitro model to investigate the

  2. Evaluation of the in vitro growth of urinary tract infection-causing gram-negative and gram-positive bacteria in a proposed synthetic human urine (SHU) medium.

    PubMed

    Ipe, Deepak S; Ulett, Glen C

    2016-08-01

    Bacteriuria is a hallmark of urinary tract infection (UTI) and asymptomatic bacteriuria (ABU), which are among the most frequent infections in humans. A variety of gram-negative and gram-positive bacteria are associated with these infections but Escherichia coli contributes up to 80% of cases. Multiple bacterial species including E. coli can grow in human urine as a means to maintain colonization during infections. In vitro bacteriuria studies aimed at modeling microbial growth in urine have utilized various compositions of synthetic human urine (SHU) and a Composite SHU formulation was recently proposed. In this study, we sought to validate the recently proposed Composite SHU as a medium that supports the growth of several bacterial species that are known to grow in normal human urine and/or artificial urine. Comparative growth assays of gram-negative and gram-positive bacteria E. coli, Pseudomonas aeruginosa, Proteus mirabilis, Streptococcus agalactiae, Staphylococcus saprophyticus and Enterococcus faecalis were undertaken using viable bacterial count and optical density measurements over a 48h culture period. Three different SHU formulations were tested in various culture vessels, shaking conditions and volumes and showed that Composite SHU can support the robust growth of gram-negative bacteria but requires supplementation with 0.2% yeast extract to support the growth of gram-positive bacteria. Experiments are also presented that show an unexpected but major influence of P. mirabilis towards the ability to measure bacterial growth in generally accepted multiwell assays using absorbance readings, predicted to have a basis in the release of volatile organic compound(s) from P. mirabilis during growth in Composite SHU medium. This study represents an essential methodological validation of a more chemically defined type of synthetic urine that can be applied to study mechanisms of bacteriuria and we conclude will offer a useful in vitro model to investigate the

  3. Secondary or Transient Pseudohypoaldosteronism Associated With Urinary Tract Anomaly and Urinary Infection: A Case Report.

    PubMed

    Krishnappa, Vinod; Ross, Jonathan H; Kenagy, David N; Raina, Rupesh

    2016-09-01

    Hyponatremia with hyperkalemia in infancy is a rare presentation, but may be due to aldosterone deficiency or end organ resistance to its action. There are few cases associating this condition with urinary tract infections or anatomic abnormalities that predispose to infection. Clinicians should have a high index of suspicion in diagnosing secondary pseudohypoaldosteronism (PHA) due to its often atypical presentation. We describe ten month-old infant who presented with this condition and was found to have urinary tract infection complicating unilateral urinary tract anomaly, which may have strong association with renal tubular resistance to aldosterone. PMID:27516976

  4. Vaccination approaches for the prevention of urinary tract infection.

    PubMed

    Moriel, Danilo G; Schembri, Mark A

    2013-01-01

    Urinary tract infections (UTIs) are one of the most common infectious diseases of humans, with approximately 150 million cases estimated to occur globally every year. UTIs usually start as a bladder infection (cystitis), but can develop into acute kidney infection (pyelonephritis) and even infection of the bloodstream (urosepsis). The high frequency of UTIs in community and nosocomial settings places an enormous burden on healthcare systems worldwide. Multiple different pathogens cause UTI, with uropathogenic E. coli (UPEC) the most common etiological agent. UTIs caused by these pathogens are increasingly associated with antibiotic resistance, thus severely reducing treatment options and significantly increasing UTI-associated morbidity and mortality. In this review we present an overview of the recent advances in vaccine research targeted towards the prevention of UPEC-mediated UTI. In the context of multidrug resistance, we conclude that vaccination represents a viable approach for the prevention of chronic and recurrent UTI.

  5. Global prevalence of antibiotic resistance in paediatric urinary tract infections caused by Escherichia coli and association with routine use of antibiotics in primary care: systematic review and meta-analysis

    PubMed Central

    Hay, Alastair D; Lane, Isabel F; Thornton, Hannah V; Wootton, Mandy; Costelloe, Céire

    2016-01-01

    Objectives To systematically review studies investigating the prevalence of antibiotic resistance in urinary tract infections caused by Escherichia coli in children and, when appropriate, to meta-analyse the relation between previous antibiotics prescribed in primary care and resistance. Design and data analysis Systematic review and meta-analysis. Pooled percentage prevalence of resistance to the most commonly used antibiotics in children in primary care, stratified by the OECD (Organisation for Economic Co-operation and Development) status of the study country. Random effects meta-analysis was used to quantify the association between previous exposure to antibiotics in primary care and resistance. Data sources Observational and experimental studies identified through Medline, Embase, Cochrane, and ISI Web of Knowledge databases, searched for articles published up to October 2015. Eligibility criteria for selecting studies Studies were eligible if they investigated and reported resistance in community acquired urinary tract infection in children and young people aged 0-17. Electronic searches with MeSH terms and text words identified 3115 papers. Two independent reviewers assessed study quality and performed data extraction. Results 58 observational studies investigated 77 783 E coli isolates in urine. In studies from OECD countries, the pooled prevalence of resistance was 53.4% (95% confidence interval 46.0% to 60.8%) for ampicillin, 23.6% (13.9% to 32.3%) for trimethoprim, 8.2% (7.9% to 9.6%) for co-amoxiclav, and 2.1% (0.8 to 4.4%) for ciprofloxacin; nitrofurantoin was the lowest at 1.3% (0.8% to 1.7%). Resistance in studies in countries outside the OECD was significantly higher: 79.8% (73.0% to 87.7%) for ampicillin, 60.3% (40.9% to 79.0%) for co-amoxiclav, 26.8% (11.1% to 43.0%) for ciprofloxacin, and 17.0% (9.8% to 24.2%) for nitrofurantoin. There was evidence that bacterial isolates from the urinary tract from individual children who had received

  6. Comparing between results and complications of doing voiding cystourethrogram in the first week following urinary tract infection and in 2-6 weeks after urinary tract infection in children referring to a teaching hospital

    PubMed Central

    Yousefichaijan, Parsa; Dorreh, Fatemeh; Shahsavari, Someyeh; Pakniyat, Abdolghader

    2016-01-01

    Introduction: Urinary tract infection is the most common genitourinary disease in children so about 40% of the children with urinary tract infection suffering from reflux that caused some consequences such as pyelonephritis and kidney parenchymal injury. Objectives: This research was conducted to compare the timing of voiding cystourethrogram (VCUG) in children with urinary tract infection in first week and after the first week of urinary tract infection. Patients and Methods: This research is a case-control study that both case and control groups include 208 children from 1 month to 12 years old with the complain of urinary tract infection. In case group, the VCUG was performed at the first week of infection and in control group, the VCUG was performed after the first week of infection. Results: complication such as dysuria was observed in two-thirds of children who VCUG was performed during first week after urinary tract infection. Parents stress in case group was more than the other (P=0.015). For overall, the incidence of reflux in case and control groups was 49.5% and 50%, respectively. The mean of reflux grading in right kidney in case group was lower than control group resulting in significant differences between two groups. Conclusion: According to higher grade of stress in parents and complications due to VCUG at the first week of urinary tract infection, it is suggested that VCUG be conducted on selective patients in the hospital at the first week of urinary tract infection and during hospitalization. PMID:27689111

  7. Development of an Intranasal Vaccine To Prevent Urinary Tract Infection by Proteus mirabilis

    PubMed Central

    Li, Xin; Lockatell, C. Virginia; Johnson, David E.; Lane, M. Chelsea; Warren, John W.; Mobley, Harry L. T.

    2004-01-01

    Proteus mirabilis commonly infects the complicated urinary tract and is associated with urolithiasis. Stone formation is caused by bacterial urease, which hydrolyzes urea to ammonia, causing local pH to rise, and leads to the subsequent precipitation of magnesium ammonium phosphate (struvite) and calcium phosphate (apatite) crystals. To prevent these infections, we vaccinated CBA mice with formalin-killed bacteria or purified mannose-resistant, Proteus-like (MR/P) fimbriae, a surface antigen expressed by P. mirabilis during experimental urinary tract infection, via four routes of immunization: subcutaneous, intranasal, transurethral, and oral. We assessed the efficacy of vaccination using the CBA mouse model of ascending urinary tract infection. Subcutaneous or intranasal immunization with formalin-killed bacteria and intranasal or transurethral immunization with purified MR/P fimbriae significantly protected CBA mice from ascending urinary tract infection by P. mirabilis (P < 0.05). To investigate the potential of MrpH, the MR/P fimbrial tip adhesin, as a vaccine, the mature MrpH peptide (residues 23 to 275, excluding the signal peptide), and the N-terminal receptor-binding domain of MrpH (residues 23 to 157) were overexpressed as C-terminal fusions to maltose-binding protein (MBP) and purified on amylose resins. Intranasal immunization of CBA mice with MBP-MrpH (residues 23 to 157) conferred effective protection against urinary tract infection by P. mirabilis (P < 0.002). PMID:14688082

  8. Urinary tract infections: bacteriology and antibiotic resistance patterns.

    PubMed

    Mashouf, Rasoul Yousefi; Babalhavaeji, Hooshang; Yousef, Javad

    2009-07-01

    The aim of this study was to identify the bacteria causing community acquired urinary tract infections (UTI) and detection of antibiotics resistance of isolates in 912 children below 18 years in the west of Iran. Data were analyzed for 4 age groups: infants, toddlers, preteens and teens. Fourteen antibiotics were tested by gel-diffusion method. Of 912 patients, 34.2% had positive bacterial cultures. The most common isolates were E. coli (57.4 %), K. pneumoniae (9.7 %), S. aureus (5.8%) and A. baumannii (2.2%). Most isolates showed high resistance against ampicillin, cotrimoxazole, nalidixic acid, tobramycin and nitrofurantoin. Klebsiella isolates showed more resistance against tested antibiotics than E. coli isolates.

  9. Update on childhood urinary tract infection and vesicoureteral reflux.

    PubMed

    Bell, Lorraine E; Mattoo, Tej K

    2009-07-01

    Urinary tract infection (UTI) is a leading cause of serious bacterial infection in young children. Vesicoureteral reflux (VUR), a common pediatric urologic disorder, is believed to predispose to UTI, and both are associated with renal scarring. The complex interaction of bacterial virulence factors and host defense mechanisms influence renal damage. However, some renal parenchymal abnormalities associated with VUR are noninfectious in origin. Long-term, renal parenchymal injury may be associated with hypertension, pregnancy complications, proteinuria, and renal insufficiency. Optimal management of VUR and UTI is controversial because of the paucity of appropriate randomized controlled trials; there is a need for well-designed studies. The recently launched Randomized Intervention for children with VesicoUreteral Reflux (RIVUR) study hopefully will provide insight into the role of antimicrobial prophylaxis of UTI in children with VUR.

  10. Urinary tract infections in women: etiology and treatment options

    PubMed Central

    Minardi, Daniele; d’Anzeo, Gianluca; Cantoro, Daniele; Conti, Alessandro; Muzzonigro, Giovanni

    2011-01-01

    Urinary tract infections (UTI) are common among the female population. It has been calculated that about one-third of adult women have experienced an episode of symptomatic cystitis at least once. It is also common for these episodes to recur. If predisposing factors are not identified and removed, UTI can lead to more serious consequences, in particular kidney damage and renal failure. The aim of this review was to analyze the factors more commonly correlated with UTI in women, and to see what possible solutions are currently used in general practice and specialized areas, as well as those still under investigation. A good understanding of the possible pathogenic factors contributing to the development of UTI and its recurrence will help the general practitioner to interview the patient, search for causes that would otherwise remain undiscovered, and to identify the correct therapeutic strategy. PMID:21674026

  11. Urinary tract infections: bacteriology and antibiotic resistance patterns.

    PubMed

    Mashouf, Rasoul Yousefi; Babalhavaeji, Hooshang; Yousef, Javad

    2009-07-01

    The aim of this study was to identify the bacteria causing community acquired urinary tract infections (UTI) and detection of antibiotics resistance of isolates in 912 children below 18 years in the west of Iran. Data were analyzed for 4 age groups: infants, toddlers, preteens and teens. Fourteen antibiotics were tested by gel-diffusion method. Of 912 patients, 34.2% had positive bacterial cultures. The most common isolates were E. coli (57.4 %), K. pneumoniae (9.7 %), S. aureus (5.8%) and A. baumannii (2.2%). Most isolates showed high resistance against ampicillin, cotrimoxazole, nalidixic acid, tobramycin and nitrofurantoin. Klebsiella isolates showed more resistance against tested antibiotics than E. coli isolates. PMID:19430071

  12. Streptozocin-Induced Diabetic Mouse Model of Urinary Tract Infection▿

    PubMed Central

    Rosen, David A.; Hung, Chia-Suei; Kline, Kimberly A.; Hultgren, Scott J.

    2008-01-01

    Diabetics have a higher incidence of urinary tract infection (UTI), are infected with a broader range of uropathogens, and more commonly develop serious UTI sequelae than nondiabetics. To better study UTI in the diabetic host, we created and characterized a murine model of diabetic UTI using the pancreatic islet β-cell toxin streptozocin in C3H/HeN, C3H/HeJ, and C57BL/6 mouse backgrounds. Intraperitoneal injections of streptozocin were used to initiate diabetes in healthy mouse backgrounds, as defined by consecutive blood glucose levels of >250 mg/dl. UTIs caused by uropathogenic Escherichia coli (UTI89), Klebsiella pneumoniae (TOP52 1721), and Enterococcus faecalis (0852) were studied, and diabetic mice were found to be considerably more susceptible to infection. All three uropathogens produced significantly higher bladder and kidney titers than buffer-treated controls. Uropathogens did not have as large an advantage in the Toll-like receptor 4-defective C3H/HeJ diabetic mouse, arguing that the dramatic increase in colonization seen in C3H/HeN diabetic mice may partially be due to diabetic-induced defects in innate immunity. Competition experiments demonstrated that E. coli had a significant advantage over K. pneumoniae in the bladders of healthy mice and less of an advantage in diabetic bladders. In the kidneys, K. pneumoniae outcompeted E. coli in healthy mice but in diabetic mice E. coli outcompeted K. pneumoniae and caused severe pyelonephritis. Diabetic kidneys contained renal tubules laden with communities of E. coli UTI89 bacteria within an extracellular-matrix material. Diabetic mice also had glucosuria, which may enhance bacterial replication in the urinary tract. These data support that this murine diabetic UTI model is consistent with known characteristics of human diabetic UTI and can provide a powerful tool for dissecting this infection in the multifactorial setting of diabetes. PMID:18644886

  13. Chronic bladder ischemia and oxidative stress: new pharmacotherapeutic targets for lower urinary tract symptoms.

    PubMed

    Nomiya, Masanori; Andersson, Karl-Erik; Yamaguchi, Osamu

    2015-01-01

    Chronic bladder ischemia is potentially a common cause of lower urinary tract symptoms in the elderly. Epidemiological studies have shown a close association between lower urinary tract symptoms and vascular risk factors for atherosclerosis, and investigations using transrectal color Doppler ultrasonography have shown a negative correlation between decreased lower urinary tract perfusion and International Prostate Symptom Score in elderly patients with lower urinary tract symptoms. Bladder blood flow is also known to decrease in men with bladder outlet obstruction as a result of benign prostatic hyperplasia. Studies in animal models suggest that chronic bladder ischemia and repeated ischemia/reperfusion during a micturition cycle might produce oxidative stress, leading to denervation of the bladder and the expression of tissue-damaging molecules in the bladder wall, which could be responsible for the development of bladder hyperactivity progressing to bladder underactivity. The effects of drugs with different mechanisms of action; for example, α1-adrenoceptor antagonists, phosphodiesterase type 5 inhibitors, free radical scavengers and β3-adrenoceptor agonist, have been studied in animal models of chronic bladder ischemia. The drugs, representing different treatment principles for increasing blood flow and decreasing oxidative stress, showed protective effects not only on urodynamic parameters, but also on negative effects on muscle contractility and on detrimental structural bladder wall changes. Improvement of lower urinary tract perfusion and control of oxidative stress can be considered new therapeutic strategies for treatment of bladder dysfunction induced by chronic ischemia.

  14. Urinary incontinence, catheters, and urinary tract infections: an overview of CMS tag F 315.

    PubMed

    Newman, Diane K

    2006-12-01

    The majority of nursing home residents experience some type of urinary incontinence. Other bladder-related disorders (eg, urinary retention and urinary tract infection) also are common in long-term care facilities. Efforts to manage urological conditions such as the use of indwelling catheters and absorbent products, perineal hygiene and care, toileting, and bladder rehabilitation are areas of concern and have become the subject of revised regulations. The intent of recent changes to the Centers for Medicare and Medicaid Services surveyor guidance for incontinence and urinary catheters is to ensure that: 1) incontinent residents are identified, assessed, and provided appropriate treatment, 2) indwelling catheters are not used without medical justification and removed as soon as clinically warranted, and 3) residents receive appropriate care to prevent urinary tract infections. Nursing homes must implement policies, procedures, and programs to help restore bladder function and continence in order to improve quality-of-life for nursing home residents.

  15. Virulence factors in Escherichia coli urinary tract infection.

    PubMed Central

    Johnson, J R

    1991-01-01

    Uropathogenic strains of Escherichia coli are characterized by the expression of distinctive bacterial properties, products, or structures referred to as virulence factors because they help the organism overcome host defenses and colonize or invade the urinary tract. Virulence factors of recognized importance in the pathogenesis of urinary tract infection (UTI) include adhesins (P fimbriae, certain other mannose-resistant adhesins, and type 1 fimbriae), the aerobactin system, hemolysin, K capsule, and resistance to serum killing. This review summarizes the virtual explosion of information regarding the epidemiology, biochemistry, mechanisms of action, and genetic basis of these urovirulence factors that has occurred in the past decade and identifies areas in need of further study. Virulence factor expression is more common among certain genetically related groups of E. coli which constitute virulent clones within the larger E. coli population. In general, the more virulence factors a strain expresses, the more severe an infection it is able to cause. Certain virulence factors specifically favor the development of pyelonephritis, others favor cystitis, and others favor asymptomatic bacteriuria. The currently defined virulence factors clearly contribute to the virulence of wild-type strains but are usually insufficient in themselves to transform an avirulent organism into a pathogen, demonstrating that other as-yet-undefined virulence properties await discovery. Virulence factor testing is a useful epidemiological and research tool but as yet has no defined clinical role. Immunological and biochemical anti-virulence factor interventions are effective in animal models of UTI and hold promise for the prevention of UTI in humans. Images PMID:1672263

  16. Intestinal reconstruction of the lower urinary tract as a prerequisite for renal transplantation.

    PubMed

    Djakovic, Nenad; Wagener, Nina; Adams, Judith; Gilfrich, Christian; Haferkamp, Axel; Pfitzenmaier, Jesco; Toenshoff, Burkhard; Schmidt, Jan; Hohenfellner, Markus

    2009-06-01

    OBJECTIVE To report a two-stage protocol for children in whom bladder reconstruction was followed by kidney transplantation, as about a quarter of children requiring a kidney transplantation show significant lower urinary tract dysfunction, and consequently their bladder is unsuitable for a kidney transplant. PATIENTS AND METHODS Twelve children (median age 9.5 years, range 4.2-16.8) with end-stage renal disease had a lower urinary tract reconstruction before kidney transplantation. The cause of bladder dysfunction and renal failure included posterior urethral valves in five, neuropathic bladder in two, prune-belly syndrome in two, anal-rectum and urethral atresia syndrome in one, primary obstructive uropathy in one and caudal regression syndrome in one. Two children were diverted with an ileal conduit; four had a bladder augmentation, and four had a bladder augmentation with additional continent cutaneous stoma. A continent urinary reservoir was constructed in one boy, and one boy had a Mitrofanoff-only procedure. Subsequently, 11 children were transplanted. RESULTS The graft survival rate was 11 of 12 at 1 year and eight of 12 at 5 years. No patient lost the graft related to the reconstructed lower urinary tract. During the median (range) follow-up of 5.4 (1.6-12.5) years all but one child had free drainage of the upper urinary tract. All 10 children who did not have an ileal conduit are continent. CONCLUSION Reconstruction of the lower urinary tract followed by renal transplantation is a safe and efficient approach. It has the advantage of restoring the lower urinary tract before immunosuppressive therapy, and supplies the best possible reservoir for a transplanted kidney. PMID:19076129

  17. The Prevalence, Etiologic Agents and Risk Factors for Urinary Tract Infection Among Spinal Cord Injury Patients

    PubMed Central

    Togan, Turhan; Azap, Ozlem Kurt; Durukan, Elif; Arslan, Hande

    2014-01-01

    Background: Urinary tract infections (UTIs) are important causes of morbidity and mortality in patients with spinal cord injury and 22% of patients with acute spinal cord injury develop UTI during the first 50 days. Objectives: The aim of this study was to determine the prevalence, etiologic agents and risk factors for asymptomatic bacteriuria and symptomatic urinary tract infections in patients with spinal cord injury. Patients and Methods: This was a prospective investigation of spinal cord injury patients with asymptomatic bacteriuria and symptomatic urinary tract infections in Baskent University Medical Faculty Ayas Rehabilitation Center and Ankara Physical Therapy and Rehabilitation Center between January 2008 and December 2010. The demographic status, clinical and laboratory findings of 93 patients with spinal cord injury were analyzed in order to determine the risk factors for asymptomatic or symptomatic bacteriuria Results: Sixty three (67.7%) of 93 patients had asymptomatic bacteriuria and 21 (22.6%) had symptomatic urinary tract infection. Assessment of the frequency of urinary bladder emptying methods revealed that 57 (61.3%) of 93 patients employed permanent catheters and 24 (25.8%) employed clean intermittent catheterization. One hundred and thirty-five (48.0%) of 281 strains isolated form asymptomatic bacteriuria attacks and 16 (66.6%) of 24 strains isolated from symptomatic urinary tract infection attacks, totaling 151 strains, had multidrug resistance (P > 0.05). One hundred (70.4%) of 142 Escherichia coli strains and 19 (34.5%) of 55 Klebsiella spp strains proliferated in patients with asymptomatic bacteriuria; 8 (80%) of 10 E. coli strains and 4 (80%) of 5 Klebsiella spp. strains were multidrug resistant. Conclusions: The most common infectious episode among spinal cord injury patients was found to be urinary tract ınfection. E. coli was the most common microorganism isolated from urine samples. Antibiotic use in the previous 2 weeks or 3 months

  18. Bioactive compounds in cranberries and their role in prevention of urinary tract infections.

    PubMed

    Howell, Amy B

    2007-06-01

    Cranberry (Vaccinium macrocarpon Ait.) ingestion has long been associated with prevention of urinary tract infections. The beneficial mechanism was historically thought to be due to the fruit acids causing a bacteriostatic effect in the urine. However, recently, a group of proanthocyanidins (PACs) with A-type linkages were isolated from cranberry which exhibit bacterial antiadhesion activity against both antibiotic susceptible and resistant strains of uropathogenic P-fimbriated Escherichia coli bacteria. The link between cranberry ingestion and maintenance of urinary tract health as well as the structural diversity, pharmacokinetics, quantification, and bacterial antiadhesion bioactivity of the A-linked cranberry PACs are reviewed.

  19. Microbial diversity in biofilm infections of the urinary tract with the use of sonication techniques.

    PubMed

    Holá, Veronika; Ruzicka, Filip; Horka, Marie

    2010-08-01

    Infections of the urinary tract account for >40% of nosocomial infections; most of these are infections in catheterized patients. Bacterial colonization of the urinary tract and catheters causes not only the particular infection but also a number of complications, for example blockage of catheters with crystallic deposits of bacterial origin, generation of gravels and pyelonephritis. Infections of urinary catheters are only rarely single-species infections. The longer a patient is catheterized, the higher the diversity of biofilm microbial communities. The aims of this study were to investigate the microbial diversity on the catheters and to compare the ability to form biofilm among isolated microbial species. The next aim was to discriminate particular causative agents of infections of the urinary tract and their importance as biofilm formers in the microbial community on the urinary catheter. We examined catheters from 535 patients and isolated 1555 strains of microorganisms. Most of the catheters were infected by three or more microorganisms; only 12.5% showed monomicrobial infection. Among the microorganisms isolated from the urinary catheters, there were significant differences in biofilm-forming ability, and we therefore conclude that some microbial species have greater potential to cause a biofilm-based infection, whereas others can be only passive members of the biofilm community.

  20. Antibiotic Resistance in Urinary Tract Infections in College Students

    ERIC Educational Resources Information Center

    Olson, Ronald P.; Haith, Karen

    2012-01-01

    Objective: To determine resistance to antibiotics of "Escherichia coli" in uncomplicated urinary tract infections (uUTIs) in female college students. Participants: Symptomatic patients presenting to a student health service from September 2008 to December 2009. Methods: Clean catch midstream urine samples were tested for urinalysis (UA) and…

  1. The Diagnosis, Evaluation and Treatment of Acute and Recurrent Pediatric Urinary Tract Infections

    PubMed Central

    Becknell, Brian; Schober, Megan; Korbel, Lindsey; Spencer, John David

    2015-01-01

    Urinary tract infection is one of the most common bacterial infections encountered by pediatricians. Currently, the diagnosis and management of acute urinary tract infection and recurrent urinary tract infection in children remains controversial. Recently published guidelines and large clinical trials have attempted to clarify UTI diagnostic and management strategies. In this manuscript, we review the diagnosis and management of acute and recurrent urinary tract infection in the pediatric population. PMID:25421102

  2. Randomised trial of cranberry-lingonberry juice and Lactobacillus GG drink for the prevention of urinary tract infections in women

    PubMed Central

    Kontiokari, Tero; Sundqvist, Kaj; Nuutinen, M; Pokka, T; Koskela, M; Uhari, M

    2001-01-01

    Objective To determine whether recurrences of urinary tract infection can be prevented with cranberry-lingonberry juice or with Lactobacillus GG drink. Design Open, randomised controlled 12 month follow up trial. Setting Health centres for university students and staff of university hospital. Participants 150 women with urinary tract infection caused by Escherichia coli randomly allocated into three groups. Interventions 50 ml of cranberry-lingonberry juice concentrate daily for six months or 100 ml of lactobacillus drink five days a week for one year, or no intervention. Main outcome measure First recurrence of symptomatic urinary tract infection, defined as bacterial growth ⩾105 colony forming units/ml in a clean voided midstream urine specimen. Results The cumulative rate of first recurrence of urinary tract infection during the 12 month follow up differed significantly between the groups (P=0.048). At six months, eight (16%) women in the cranberry group, 19 (39%) in the lactobacillus group, and 18 (36%) in the control group had had at least one recurrence. This is a 20% reduction in absolute risk in the cranberry group compared with the control group (95% confidence interval 3% to 36%, P=0.023, number needed to treat=5, 95% confidence interval 3 to 34). Conclusion Regular drinking of cranberry juice but not lactobacillus seems to reduce the recurrence of urinary tract infection. What is already known on this topicUp to 60% of women will have a urinary tract infection and a third of them will have several recurrencesVaccinium berries and products containing lactobacilli may affect the coliform bacteria that cause urinary tract infectionWhat this study adds50 ml of cranberry-lingonberry juice concentrate daily reduced recurrences of symptomatic urinary tract infection by about half compared with the control groupLactobacillus GG drink had no effect on recurrenceSelf treatment with cranberry juice may reduce the need for antimicrobials for recurrent urinary

  3. Isolation and characterization of an atypical Listeria monocytogenes associated with a canine urinary tract infection

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Listeria monocytogenes, a well-described cause of encephalitis and abortion in ruminants and of food-borne illness in humans, is rarely associated with disease in companion animals. A case of urinary tract infection associated with an atypical, weakly hemolytic L. monocytogenes strain is described i...

  4. [Tumor markers of urinary tract carcinoma].

    PubMed

    Kikuchi, Haruhito

    2004-04-01

    The tumor markers for malignant tumors arisen from urinary system including prostate cancer were reviewed. As for renal cell carcinoma there was no good marker used in routine test level at present. In the diagnosis of urothelial (transitional cell) carcinoma, mainly bladder cancer, 3 methods (urinary BTA, NMP22 and BFP) are used now in Japan. They all seem to be not fully sufficient in respect of the specificity. In foreign countries, new tests such as urinary telomerase and BLCA-4 are used and have been evaluated. On the diagnosis of prostate cancer, serum total PSA is well established and used. Various PSA relation markers have been advocated for the differentiation between benign prostate hypertrophy and carcinoma in so called "gray zone" level of total PSA. In methods based on the molecular forms of PSA, the ratio of free PSA to total PSA (f/T) is widely use, and proPSA is a test that is expected. Other approaches such as volume of index PSA, age specific PSA reference range and PSA velocity are also in practical application. Human glandular kallikrein 2, which belong to the human kallikrein family as well as PSA, is expected as a tumor specific marker.

  5. [Gynaecological and obstetrical aspects of recurrent urinary tract infections].

    PubMed

    Hoyme, U B; Schneede, P

    2006-04-01

    The microbial colonization of vulva, vagina and cervix uteri represents the reservoir for recurrent urinary tract infection. All bacterial species of normal cutaneous or gastrointestinal flora can be found in the external genital tract even under physiological conditions. The higher concentration of microbes adds to the predisposition for urinary tract infection in cases of dysbiosis or inflammation, apart from specific infection by Trichomonas vaginalis, Neisseria gonorrhoeae or Chlamydia trachomatis. The specific immunological interaction between bacteria and host, i.e. between virulence factors and intrinsic defense, appears to be the major mechanism paving the way for recurrent infection. The elimination of predisposing factors is the clue for successful therapy as well as for prevention of recurrence. PMID:16586054

  6. [Fistulas of the lower urinary tract in children].

    PubMed

    Tonegatti, Luca; Scarpa, Maria-Grazia; Goruppi, Ilaria; Olenik, Damiana; Rigamonti, Waifro

    2015-01-01

    A lower urinary tract fistula consist in an abnormal connection between bladder, urethra and adjacent abdominal organs or skin. There are several types of urinary fistulas in paediatric age and they may be congenital or acquired. Etiology may be due to embriological defects, infectious processes, malignant tumours, pelvic irradiation as well as complications following surgical procedures, especially postsurgical repair of hypospadia or epispadia. Clinical presentation depends on the type of fistula and diagnosis is based on signs, symptoms and radiological or endoscopic examinations. We performed PubMed research using terms such as lower urinary fistulae, urology and paediatrics and we consulted medical texts. We reviewed selected articles and used the relevant ones to perform our study concentrating on classification, diagnosis and treatment of different types of fistulas. Paediatric lower urinary fistulas are an uncommon pathology, but the knowledge of their etiology and classification is important to recognise them and lead the physician to an appropriate treatment, which is surgical in most cases.

  7. Botanical medicines for the urinary tract.

    PubMed

    Yarnell, Eric

    2002-11-01

    Four important categories of urologic herbs, their history, and modern scientific investigations regarding them are reviewed. Botanical diuretics are discussed with a focus on Solidago spp (goldenrod) herb, Levisticum officinale (lovage) root, Petroselinum crispus (parsley) fruit, and Urtica dioica (stinging nettle) herb. Urinary antiseptic and anti-adhesion herbs, particularly Arctostaphylos uva-ursi (uva-uri) leaf, Juniperus spp (juniper) leaf, and Vaccinium macrocarpon (cranberry) fruit are reviewed. The antinephrotoxic botanicals Rheum palmatum (Chinese rhubarb) root and Lespedeza capitata (round-head lespedeza) herb are surveyed, followed by herbs for symptoms of benign prostatic hyperplasia, most notably Serenoa repens (saw palmetto) fruit, Urtica dioica root, and Prunus africana (pygeum) bark.

  8. Septic Shock Secondary to a Urinary Tract Infection with Pediococcus Pentosaceus.

    PubMed

    Han, Amneet; Mehta, Jeet; Pauly, Rebecca R

    2016-01-01

    We present a case of a urinary tract infection secondary to Pediococcus pentosaceus causing septic shock and acute kidney injury in a 70-year-old male. We demonstrate successful treatment with a 10-day course of piperacillin/tazobactam. Recently, Pediococci have been found to be the cause of opportunistic infections in humans. This has posed a challenge to treating infections caused by this species because it has been found to be resistant to multiple antibiotics, including glycopeptides. PMID:27443041

  9. Radionuclide imaging of the urinary tract

    SciTech Connect

    Velchik, M.G.

    1985-11-01

    This article describes the role of nuclear medicine in the evaluation of the genitourinary tract. The technical aspects of radionuclide imaging (radiopharmaceuticals, radiation dosimetry, instrumentation, and method) are briefly presented, and each of the indications for renal scintigraphy--including the evaluation of differential renal function, hypertension, obstruction, renal transplants, masses, trauma, congenital anomalies, vesicoureteral reflux, and infection--are discussed. The relative advantages and disadvantages of radionuclide imaging with respect to alternative radiographic examinations (such as intravenous urography, ultrasonography, CT, angiography, and magnetic resonance imaging) are emphasized wherever applicable. 136 references.

  10. An overview of the literature on congenital lower urinary tract obstruction and introduction to the PLUTO trial: percutaneous shunting in lower urinary tract obstruction.

    PubMed

    Morris, R Katie; Kilby, Mark D

    2009-02-01

    Congenital lower urinary tract obstruction (LUTO) comprises a heterogeneous group of pathologies causing obstruction to the urethra, the most common being posterior urethral valves. Such pathology is often associated with high perinatal mortality and varying degrees of perinatal and infant morbidity. A high proportion of LUTO may be visualised during routine second trimester (and first trimester) ultrasound giving rise to the possibility of determining individual fetal prognosis and treatments such as vesico-amniotic shunting, with a view to altering pathogenesis. The aims of the percutaneous shunting in low urinary tract obstruction (PLUTO) trial are to determine the effectiveness of these treatments and accuracy of the investigations with the primary outcome measures being perinatal mortality and postnatal renal function. PMID:19281572

  11. An overview of the literature on congenital lower urinary tract obstruction and introduction to the PLUTO trial: percutaneous shunting in lower urinary tract obstruction.

    PubMed

    Morris, R Katie; Kilby, Mark D

    2009-02-01

    Congenital lower urinary tract obstruction (LUTO) comprises a heterogeneous group of pathologies causing obstruction to the urethra, the most common being posterior urethral valves. Such pathology is often associated with high perinatal mortality and varying degrees of perinatal and infant morbidity. A high proportion of LUTO may be visualised during routine second trimester (and first trimester) ultrasound giving rise to the possibility of determining individual fetal prognosis and treatments such as vesico-amniotic shunting, with a view to altering pathogenesis. The aims of the percutaneous shunting in low urinary tract obstruction (PLUTO) trial are to determine the effectiveness of these treatments and accuracy of the investigations with the primary outcome measures being perinatal mortality and postnatal renal function.

  12. Urinary Tract Stones and Osteoporosis: Findings From the Women's Health Initiative.

    PubMed

    Carbone, Laura D; Hovey, Kathleen M; Andrews, Christopher A; Thomas, Fridtjof; Sorensen, Mathew D; Crandall, Carolyn J; Watts, Nelson B; Bethel, Monique; Johnson, Karen C

    2015-11-01

    Kidney and bladder stones (urinary tract stones) and osteoporosis are prevalent, serious conditions for postmenopausal women. Men with kidney stones are at increased risk of osteoporosis; however, the relationship of urinary tract stones to osteoporosis in postmenopausal women has not been established. The purpose of this study was to determine whether urinary tract stones are an independent risk factor for changes in bone mineral density (BMD) and incident fractures in women in the Women's Health Initiative (WHI). Data were obtained from 150,689 women in the Observational Study and Clinical Trials of the WHI with information on urinary tract stones status: 9856 of these women reported urinary tract stones at baseline and/or incident urinary tract stones during follow-up. Cox regression models were used to determine the association of urinary tract stones with incident fractures and linear mixed models were used to investigate the relationship of urinary tract stones with changes in BMD that occurred during WHI. Follow-up was over an average of 8 years. Models were adjusted for demographic and clinical factors, medication use, and dietary histories. In unadjusted models there was a significant association of urinary tract stones with incident total fractures (HR 1.10; 95% CI, 1.04 to 1.17). However, in covariate adjusted analyses, urinary tract stones were not significantly related to changes in BMD at any skeletal site or to incident fractures. In conclusion, urinary tract stones in postmenopausal women are not an independent risk factor for osteoporosis. PMID:25990099

  13. Urinary Tract Stones and Osteoporosis: Findings From the Women's Health Initiative.

    PubMed

    Carbone, Laura D; Hovey, Kathleen M; Andrews, Christopher A; Thomas, Fridtjof; Sorensen, Mathew D; Crandall, Carolyn J; Watts, Nelson B; Bethel, Monique; Johnson, Karen C

    2015-11-01

    Kidney and bladder stones (urinary tract stones) and osteoporosis are prevalent, serious conditions for postmenopausal women. Men with kidney stones are at increased risk of osteoporosis; however, the relationship of urinary tract stones to osteoporosis in postmenopausal women has not been established. The purpose of this study was to determine whether urinary tract stones are an independent risk factor for changes in bone mineral density (BMD) and incident fractures in women in the Women's Health Initiative (WHI). Data were obtained from 150,689 women in the Observational Study and Clinical Trials of the WHI with information on urinary tract stones status: 9856 of these women reported urinary tract stones at baseline and/or incident urinary tract stones during follow-up. Cox regression models were used to determine the association of urinary tract stones with incident fractures and linear mixed models were used to investigate the relationship of urinary tract stones with changes in BMD that occurred during WHI. Follow-up was over an average of 8 years. Models were adjusted for demographic and clinical factors, medication use, and dietary histories. In unadjusted models there was a significant association of urinary tract stones with incident total fractures (HR 1.10; 95% CI, 1.04 to 1.17). However, in covariate adjusted analyses, urinary tract stones were not significantly related to changes in BMD at any skeletal site or to incident fractures. In conclusion, urinary tract stones in postmenopausal women are not an independent risk factor for osteoporosis.

  14. Urinary Tract Effects of HPSE2 Mutations

    PubMed Central

    Stuart, Helen M.; Roberts, Neil A.; Hilton, Emma N.; McKenzie, Edward A.; Daly, Sarah B.; Hadfield, Kristen D.; Rahal, Jeffery S.; Gardiner, Natalie J.; Tanley, Simon W.; Lewis, Malcolm A.; Sites, Emily; Angle, Brad; Alves, Cláudia; Lourenço, Teresa; Rodrigues, Márcia; Calado, Angelina; Amado, Marta; Guerreiro, Nancy; Serras, Inês; Beetz, Christian; Varga, Rita-Eva; Silay, Mesrur Selcuk; Darlow, John M.; Dobson, Mark G.; Barton, David E.; Hunziker, Manuela; Puri, Prem; Feather, Sally A.; Goodship, Judith A.; Goodship, Timothy H.J.; Lambert, Heather J.; Cordell, Heather J.; Saggar, Anand; Kinali, Maria; Lorenz, Christian; Moeller, Kristina; Schaefer, Franz; Bayazit, Aysun K.; Weber, Stefanie; Newman, William G.

    2015-01-01

    Urofacial syndrome (UFS) is an autosomal recessive congenital disease featuring grimacing and incomplete bladder emptying. Mutations of HPSE2, encoding heparanase 2, a heparanase 1 inhibitor, occur in UFS, but knowledge about the HPSE2 mutation spectrum is limited. Here, seven UFS kindreds with HPSE2 mutations are presented, including one with deleted asparagine 254, suggesting a role for this amino acid, which is conserved in vertebrate orthologs. HPSE2 mutations were absent in 23 non-neurogenic neurogenic bladder probands and, of 439 families with nonsyndromic vesicoureteric reflux, only one carried a putative pathogenic HPSE2 variant. Homozygous Hpse2 mutant mouse bladders contained urine more often than did wild-type organs, phenocopying human UFS. Pelvic ganglia neural cell bodies contained heparanase 1, heparanase 2, and leucine-rich repeats and immunoglobulin-like domains-2 (LRIG2), which is mutated in certain UFS families. In conclusion, heparanase 2 is an autonomic neural protein implicated in bladder emptying, but HPSE2 variants are uncommon in urinary diseases resembling UFS. PMID:25145936

  15. Antibacterial perineal washing for prevention of recurrent urinary tract infections.

    PubMed

    Cass, A S; Ireland, G W

    1985-05-01

    Antibacterial ointment applied to the urethral meatus in females with recurrent urinary tract infections (UTIs) has been reported to decrease the incidence of UTIs. The value of perineal washing with the antibacterial lotion, hexachlorophene, in preventing urinary tract infections was determined in 56 females with recurrent UTIs. Of three groups of females one group used hexachlorophene perineal washings morning and night, another group used hexachlorophene perineal washings and an oral antibacterial daily (nitrofurantoin or trimethoprim-sulfamethoxazole), and the third group used the oral antibacterials daily alone. The infections per patient were 3.4 with hexachlorophene washings, 0.5 with hexachlorophene washing and oral antibacterials daily, and 0.9 with oral antibacterials alone. These results suggest that hexachlorophene perineal washing was not effective in preventing UTI in females.

  16. Children with urinary tract infection; a critical diagnostic pathway.

    PubMed

    Brindle, M J

    1990-02-01

    A protocol for the radiological investigation of children with urinary tract infection was introduced in a district general hospital in 1985. Every boy, and every girl under 5 years was investigated after one documented infection, and every girl over 5 years after two infections. Each child had an abdominal radiograph and a sonar scan of the urinary tract. Four years later the results were assessed by reviewing the radiology file or contacting the general practitioner of each of the first 200 children examined. Ten of 15 children diagnosed as not normal on screening and investigated further had an abnormality confirmed. Four of 25 children thought normal on screening had minor abnormalities shown on further examination. The results are assessed in the light of a review of recent literature and indicate that this screening protocol is efficient and effective.

  17. Upper urinary tract urothelial carcinoma with intratubular spread

    PubMed Central

    Sarungbam, Judy; Kurtis, Boaz; Phillips, John; Cai, Dongming; Zhang, David; Humayun, Islam; Yang, Ximing; Zhong, Minghao

    2014-01-01

    Upper urinary tract urothelial cell carcinomas (UUT-UCs) are uncommon and are defined as urothelial carcinoma involving the urinary tract from the renal calyces, renal pelvis to the distal ureter. One well-known an peculiar histopathological finding in UUT-UC is urothelial carcinoma with intratubular spread (retrograde spread within renal tubules). However, this special feature has not been systematically studied. We therefore collected a total of 53 consecutive cases of upper urinary tract urothelial carcinomas (UUT-UCs), and studied the clinical and pathological features of intratubular spread (IS). A cocktail stain comprised of antibodies PAX8 and p63 together with PAS was validated and employed to facilitate the study of intratubular spread. Seventeen cases (31.5%) showed intratubular spread demonstrated by either H&E stain and/or the cocktail stain. All of the 17 cases wit intratubular spread had tumor involvement of the renal calyx; the majority of these (14/17, 82.4%) were high grade urothelial carcinoma and the remainder (3/17, 17.6%) were low grade. 4 of 17cases (23.5%) were non-invasive. We classified intratubular spread into 4 different types, based on histopathological patterns: pagetoid, typical, florid, and secondary invasion from intratubular spread. In conclusion, study shows intratubular spread of urothelial carcinoma is fairly common phenomenon in UUT-UC and is associated with a variety of clinical-pathological features. High grade UUT-UC tends to have more extensive intratubular spread and secondary invasion into renal parenchyma. Distinct morphological characteristics as well as the staining pattern from a unique cocktail stain help to identify and evaluate intratubular spread of urothelial carcinoma. Recognizing these different types of intratubular spreading (IS) is crucial for accurate staging of some upper urinary tract urothelial carcinomas (UUT-UCs). PMID:25374911

  18. Contemporary issues with pharmacotherapy for lower urinary tract symptoms.

    PubMed

    Osman, N; Chapple, C R

    2014-05-01

    Two articles appeared in the November 2012 edition of the journal evaluating aspects relating to the use of two important pharmacotherapeutic classes for lower urinary tract symptoms (LUTS) in real life clinical practice. LUTS is a non-specific term that encompasses urine storage, voiding and postmicturition symptoms. LUTS is a common bothersome problem affecting both men and women with a comparable prevalence in age-matched patients of both sexes that increases with ageing. PMID:24750526

  19. Identification of urinary tract pathogens after 3-hours urine culture by MALDI-TOF mass spectrometry.

    PubMed

    Haiko, Johanna; Savolainen, Laura E; Hilla, Risto; Pätäri-Sampo, Anu

    2016-10-01

    Complicated urinary tract infections, such as pyelonephritis, may lead to sepsis. Rapid diagnosis is needed to identify the causative urinary pathogen and to verify the appropriate empirical antimicrobial therapy. We describe here a rapid identification method for urinary pathogens: urine is incubated on chocolate agar for 3h at 35°C with 5% CO2 and subjected to MALDI-TOF MS analysis by VITEK MS. Overall 207 screened clinical urine samples were tested in parallel with conventional urine culture. The method, called U-si-MALDI-TOF (urine short incubation MALDI-TOF), showed correct identification for 86% of Gram-negative urinary tract pathogens (Escherichia coli, Klebsiella pneumoniae, and other Enterobacteriaceae), when present at >10(5)cfu/ml in culture (n=107), compared with conventional culture method. However, Gram-positive bacteria (n=28) were not successfully identified by U-si-MALDI-TOF. This method is especially suitable for rapid identification of E. coli, the most common cause of urinary tract infections and urosepsis. Turnaround time for identification using U-si-MALDI-TOF compared with conventional urine culture was improved from 24h to 4-6h. PMID:27503535

  20. Urinary Tract Infection among Renal Transplant Recipients in Yemen

    PubMed Central

    Gondos, Adnan S.; Al-Moyed, Khaled A.; Al-Robasi, Abdul Baki A.; Al-Shamahy, Hassan A.; Alyousefi, Naelah A.

    2015-01-01

    Urinary tract infection (UTI) is the most common complication following kidney transplantation (KT), which could result in losing the graft. This study aims to identify the prevalence of bacterial UTI among KT recipients in Yemen and to determine the predisposing factors associated with post renal transplantation UTI. A cross sectional study included of 150 patients, who underwent KT was conducted between June 2010 and January 2011. A Morning mid-stream urine specimen was collected for culture and antibiotic susceptibility test from each recipient. Bacterial UTI was found in 50 patients (33.3%). The prevalence among females 40.3% was higher than males 29%. The UTI was higher in the age group between 41–50 years with a percentage of 28% and this result was statistically significant. Predisposing factors as diabetes mellitus, vesicoureteral reflux, neurogenic bladder and polycystic kidney showed significant association. High relative risks were found for polycystic kidney = 13.5 and neurogenic bladder = 13.5. The most prevalent bacteria to cause UTI was Escherichia coli represent 44%, followed by Staphylococcus saprophyticus 34%. Amikacin was the most effective antibiotic against gram-negative isolates while Ciprofloxacin was the most effective antibiotic against Staphylococcus saprophyticus. In conclusion, there is high prevalence of bacterial UTI among KT recipients in Yemen. Diabetes mellitus, vesicoureteral reflux, neurogenic bladder, polycystic kidney and calculi were the main predisposing factors. PMID:26657128

  1. Urinary Tract Infection among Renal Transplant Recipients in Yemen.

    PubMed

    Gondos, Adnan S; Al-Moyed, Khaled A; Al-Robasi, Abdul Baki A; Al-Shamahy, Hassan A; Alyousefi, Naelah A

    2015-01-01

    Urinary tract infection (UTI) is the most common complication following kidney transplantation (KT), which could result in losing the graft. This study aims to identify the prevalence of bacterial UTI among KT recipients in Yemen and to determine the predisposing factors associated with post renal transplantation UTI. A cross sectional study included of 150 patients, who underwent KT was conducted between June 2010 and January 2011. A Morning mid-stream urine specimen was collected for culture and antibiotic susceptibility test from each recipient. Bacterial UTI was found in 50 patients (33.3%). The prevalence among females 40.3% was higher than males 29%. The UTI was higher in the age group between 41-50 years with a percentage of 28% and this result was statistically significant. Predisposing factors as diabetes mellitus, vesicoureteral reflux, neurogenic bladder and polycystic kidney showed significant association. High relative risks were found for polycystic kidney = 13.5 and neurogenic bladder = 13.5. The most prevalent bacteria to cause UTI was Escherichia coli represent 44%, followed by Staphylococcus saprophyticus 34%. Amikacin was the most effective antibiotic against gram-negative isolates while Ciprofloxacin was the most effective antibiotic against Staphylococcus saprophyticus. In conclusion, there is high prevalence of bacterial UTI among KT recipients in Yemen. Diabetes mellitus, vesicoureteral reflux, neurogenic bladder, polycystic kidney and calculi were the main predisposing factors.

  2. Urinary Tract Infection among Renal Transplant Recipients in Yemen.

    PubMed

    Gondos, Adnan S; Al-Moyed, Khaled A; Al-Robasi, Abdul Baki A; Al-Shamahy, Hassan A; Alyousefi, Naelah A

    2015-01-01

    Urinary tract infection (UTI) is the most common complication following kidney transplantation (KT), which could result in losing the graft. This study aims to identify the prevalence of bacterial UTI among KT recipients in Yemen and to determine the predisposing factors associated with post renal transplantation UTI. A cross sectional study included of 150 patients, who underwent KT was conducted between June 2010 and January 2011. A Morning mid-stream urine specimen was collected for culture and antibiotic susceptibility test from each recipient. Bacterial UTI was found in 50 patients (33.3%). The prevalence among females 40.3% was higher than males 29%. The UTI was higher in the age group between 41-50 years with a percentage of 28% and this result was statistically significant. Predisposing factors as diabetes mellitus, vesicoureteral reflux, neurogenic bladder and polycystic kidney showed significant association. High relative risks were found for polycystic kidney = 13.5 and neurogenic bladder = 13.5. The most prevalent bacteria to cause UTI was Escherichia coli represent 44%, followed by Staphylococcus saprophyticus 34%. Amikacin was the most effective antibiotic against gram-negative isolates while Ciprofloxacin was the most effective antibiotic against Staphylococcus saprophyticus. In conclusion, there is high prevalence of bacterial UTI among KT recipients in Yemen. Diabetes mellitus, vesicoureteral reflux, neurogenic bladder, polycystic kidney and calculi were the main predisposing factors. PMID:26657128

  3. Potential Misclassification of Urinary Tract-Related Bacteremia Upon Applying the 2015 Catheter-Associated Urinary Tract Infection Surveillance Definition From the National Healthcare Safety Network.

    PubMed

    Greene, M Todd; Ratz, David; Meddings, Jennifer; Fakih, Mohamad G; Saint, Sanjay

    2016-04-01

    The Centers for Disease Control and Prevention recently updated the surveillance definition of catheter-associated urinary tract infection to include only urine culture bacteria of at least 1 × 10(5) colony-forming units/mL. Our findings suggest that the new surveillance definition may fail to capture clinically meaningful catheter-associated urinary tract infections.

  4. Potential Misclassification of Urinary Tract-Related Bacteremia Upon Applying the 2015 Catheter-Associated Urinary Tract Infection Surveillance Definition From the National Healthcare Safety Network.

    PubMed

    Greene, M Todd; Ratz, David; Meddings, Jennifer; Fakih, Mohamad G; Saint, Sanjay

    2016-04-01

    The Centers for Disease Control and Prevention recently updated the surveillance definition of catheter-associated urinary tract infection to include only urine culture bacteria of at least 1 × 10(5) colony-forming units/mL. Our findings suggest that the new surveillance definition may fail to capture clinically meaningful catheter-associated urinary tract infections. PMID:26778287

  5. A rare case of paediatric pelvic ring injury with lower urinary tract obstruction secondary to a combat blast mechanism.

    PubMed

    Mamczak, Christiaan N; Malish, Dean; Boonstra, Onno

    2013-07-01

    Paediatric pelvic ring fractures are rare, and typically the result of high-energy mechanisms that yield other potentially fatal visceral and solid organ injuries. Specific pelvic fracture patterns have been associated with injury to the lower urinary tract, with the most severe involving laceration of the bladder or transection of the urethra. We report a unique case of paediatric pelvic ring disruption causing an isolated obstruction of the lower urinary tract without laceration or discontinuity. Although most paediatric pelvic fractures are managed non-operatively, we postulate that significant ring deformity contributing to urinary retention be considered an indication for open surgical treatment. PMID:23746855

  6. Staphylococcus saprophyticus Bacteremia originating from Urinary Tract Infections: A Case Report and Literature Review.

    PubMed

    Hur, Jaehyung; Lee, Anna; Hong, Jeongmin; Jo, Won-Yong; Cho, Oh-Hyun; Kim, Sunjoo; Bae, In-Gyu

    2016-06-01

    Staphylococcus saprophyticus is a common pathogen of acute urinary tract infection (UTI) in young females. However, S. saprophyticus bacteremia originating from UTI is very rare and has not been reported in Korea. We report a case of S. saprophyticus bacteremia from UTI in a 60-year-old female with a urinary stone treated successfully with intravenous ciprofloxacin, and review the cases of S. saprophyticus bacteremia reported in the literature. Thus, the microorganism may cause invasive infection and should be considered when S. saprophyticus is isolated from blood cultures in patients with UTI.

  7. Staphylococcus saprophyticus Bacteremia originating from Urinary Tract Infections: A Case Report and Literature Review

    PubMed Central

    Lee, Anna; Hong, Jeongmin; Jo, Won-yong; Cho, Oh-Hyun; Kim, Sunjoo

    2016-01-01

    Staphylococcus saprophyticus is a common pathogen of acute urinary tract infection (UTI) in young females. However, S. saprophyticus bacteremia originating from UTI is very rare and has not been reported in Korea. We report a case of S. saprophyticus bacteremia from UTI in a 60-year-old female with a urinary stone treated successfully with intravenous ciprofloxacin, and review the cases of S. saprophyticus bacteremia reported in the literature. Thus, the microorganism may cause invasive infection and should be considered when S. saprophyticus is isolated from blood cultures in patients with UTI. PMID:27433385

  8. Staphylococcus saprophyticus Bacteremia originating from Urinary Tract Infections: A Case Report and Literature Review.

    PubMed

    Hur, Jaehyung; Lee, Anna; Hong, Jeongmin; Jo, Won-Yong; Cho, Oh-Hyun; Kim, Sunjoo; Bae, In-Gyu

    2016-06-01

    Staphylococcus saprophyticus is a common pathogen of acute urinary tract infection (UTI) in young females. However, S. saprophyticus bacteremia originating from UTI is very rare and has not been reported in Korea. We report a case of S. saprophyticus bacteremia from UTI in a 60-year-old female with a urinary stone treated successfully with intravenous ciprofloxacin, and review the cases of S. saprophyticus bacteremia reported in the literature. Thus, the microorganism may cause invasive infection and should be considered when S. saprophyticus is isolated from blood cultures in patients with UTI. PMID:27433385

  9. Can Urinary Nitrite Results Be Used to Conduct Antimicrobial Option for Urinary Tract Infection in Children?

    PubMed Central

    Mahyar, Abolfazl; Ayazi, Parviz; Froozesh, Mahta; Daneshi-Kohan, Mohammad-Mahdi; Barikani, Ameneh

    2012-01-01

    Objective This study was performed to determine the relationship between urinary nitrite results and bacterial resistance to antimicrobial drugs in urinary tract infection of children. Methods In a cross-section study 119 children younger than 12 years with urinary tract infection were evaluated in Qazvin children's hospital. Patients were divided into negative and positive nitrite groups depending on urinary nitrite test result. Rates of antibiotic resistance in the two groups were compared. Findings Sixty seven patients were in the negative nitrite group and 52 in the positive nitrite group. Resistance rates to ceftriaxone, trimethoprim sulfamethoxazole, ampicillin, gentamicin, amikacin, nalidixic acid, cephalothin and nitrofurantoin in the nitrite negative group were 7.5%, 31.3%, 50.7%, 11.9%, 9%, 3%, 14.9% and 11.9%, respectively. These values in the nitrite positive group were 21.2%, 28.8%, 63.5%, 7.7%, 5.8%, 1.9%, 9.6%, and 3.8%, respectively (P>0.05). Conclusion This study showed that there is no correlation between urinary nitrite results and bacterial resistance to antimicrobial drugs. Therefore, it seems that physicians should not adjust antibiotic therapy for UTI based on nitrite results. PMID:23056892

  10. Epidemiology and antimicrobial susceptibility profiles of pathogens causing urinary tract infections in the Asia-Pacific region: Results from the Study for Monitoring Antimicrobial Resistance Trends (SMART), 2010-2013.

    PubMed

    Jean, Shio-Shin; Coombs, Geoffrey; Ling, Thomas; Balaji, V; Rodrigues, Camilla; Mikamo, Hiroshige; Kim, Min-Ja; Rajasekaram, Datin Ganeswrie; Mendoza, Myrna; Tan, Thean Yen; Kiratisin, Pattarachai; Ni, Yuxing; Weinman, Barry; Xu, Yingchun; Hsueh, Po-Ren

    2016-04-01

    A total of 9599 isolates of Gram-negative bacteria (GNB) causing urinary tract infections (UTIs) were collected from 60 centres in 13 countries in the Asia-Pacific region from 2010-2013. These isolates comprised Enterobacteriaceae species (mainly Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Klebsiella oxytoca, Enterobacter cloacae and Morganella morganii) and non-fermentative GNB species (predominantly Pseudomonas aeruginosa and Acinetobacter baumannii). In vitro susceptibilities were determined by the agar dilution method and susceptibility profiles were determined using the minimum inhibitory concentration (MIC) interpretive breakpoints recommended by the Clinical and Laboratory Standards Institute in 2015. Production of extended-spectrum β-lactamases (ESBLs) amongst E. coli, K. pneumoniae, P. mirabilis and K. oxytoca isolates was determined by the double-disk synergy test. China, Vietnam, India, Thailand and the Philippines had the highest rates of GNB species producing ESBLs and the highest rates of cephalosporin resistance. ESBL production and hospital-acquired infection (isolates obtained ≥48 h after admission) significantly compromised the susceptibility of isolates of E. coli and K. pneumoniae to ciprofloxacin, levofloxacin and most β-lactams, with the exception of imipenem and ertapenem. However, >87% of ESBL-producing E. coli strains were susceptible to amikacin and piperacillin/tazobactam, indicating that these antibiotics might be appropriate alternatives for treating UTIs due to ESBL-producing E. coli. Fluoroquinolones were shown to be inappropriate as empirical therapy for UTIs. Antibiotic resistance is a serious problem in the Asia-Pacific region. Therefore, continuous monitoring of evolutionary trends in the susceptibility profiles of GNB causing UTIs in Asia is crucial. PMID:27005459

  11. Anatomy and histology of the lower urinary tract.

    PubMed

    Pradidarcheep, Wisuit; Wallner, Christian; Dabhoiwala, Noshir F; Lamers, Wouter H

    2011-01-01

    The function of the lower urinary tract is basically storage of urine in the bladder and the at-will periodic evacuation of the stored urine. Urinary incontinence is one of the most common lower urinary tract disorders in adults, but especially in the elderly female. The urethra, its sphincters, and the pelvic floor are key structures in the achievement of continence, but their basic anatomy is little known and, to some extent, still incompletely understood. Because questions with respect to continence arise from human morbidity, but are often investigated in rodent animal models, we present findings in human and rodent anatomy and histology. Differences between males and females in the role that the pelvic floor plays in the maintenance of continence are described. Furthermore, we briefly describe the embryologic origin of ureters, bladder, and urethra, because the developmental origin of structures such as the vesicoureteral junction, the bladder trigone, and the penile urethra are often invoked to explain (clinical) observations. As the human pelvic floor has acquired features in evolution that are typical for a species with bipedal movement, we also compare the pelvic floor of humans with that of rodents to better understand the rodent (or any other quadruped, for that matter) as an experimental model species. The general conclusion is that the "Bauplan" is well conserved, even though its common features are sometimes difficult to discern.

  12. Urinary tract infections in infants and children: Diagnosis and management.

    PubMed

    Robinson, Joan L; Finlay, Jane C; Lang, Mia Eileen; Bortolussi, Robert

    2014-06-01

    Recent studies have resulted in major changes in the management of urinary tract infections (UTIs) in children. The present statement focuses on the diagnosis and management of infants and children >2 months of age with an acute UTI and no known underlying urinary tract pathology or risk factors for a neurogenic bladder. UTI should be ruled out in preverbal children with unexplained fever and in older children with symptoms suggestive of UTI (dysuria, urinary frequency, hematuria, abdominal pain, back pain or new daytime incontinence). A midstream urine sample should be collected for urinalysis and culture in toilet-trained children; others should have urine collected by catheter or by suprapubic aspirate. UTI is unlikely if the urinalysis is completely normal. A bagged urine sample may be used for urinalysis but should not be used for urine culture. Antibiotic treatment for seven to 10 days is recommended for febrile UTI. Oral antibiotics may be offered as initial treatment when the child is not seriously ill and is likely to receive and tolerate every dose. Children <2 years of age should be investigated after their first febrile UTI with a renal/bladder ultrasound to identify any significant renal abnormalities. A voiding cystourethrogram is not required for children with a first UTI unless the renal/bladder ultrasound reveals findings suggestive of vesicoureteral reflux, selected renal anomalies or obstructive uropathy. PMID:25332662

  13. The potential of photo-deposited silver coatings on Foley catheters to prevent urinary tract infections.

    PubMed

    Cooper, Ian Richard; Pollini, Mauro; Paladini, Federica

    2016-12-01

    Catheter-associated urinary tract infection (CAUTI) represents one of the most common causes of morbidity and mortality. The resistance demonstrated by many microorganisms to conventional antibiotic therapies and the increasing health-care costs have recently encouraged the definition of alternative preventive strategies, which can have a positive effect in the management of infections. Antimicrobial urinary catheters have been developed through the photo-chemical deposition of silver coatings on the external and luminal surfaces. The substrates are exposed to ultraviolet radiation after impregnation into a silver-based solution, thus inducing the in situ synthesis of silver particles. The effect of the surface treatment on the material was investigated through scanning electron microscopy (SEM) and silver ion release measurements. The ability of microorganisms commonly associated with urinary tract infections was investigated in terms of bacterial viability, proliferation and biofilm development, using Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis as target organisms. The silver coatings demonstrated good distribution of silver particles to the substrate, and proved an effective antibacterial capability in simulated biological conditions. The low values of silver ion release demonstrated the optimum adhesion of the coating. The results indicated a good potential of silver-based antimicrobial materials for prevention of catheter-associated urinary tract infection. PMID:27612730

  14. The potential of photo-deposited silver coatings on Foley catheters to prevent urinary tract infections.

    PubMed

    Cooper, Ian Richard; Pollini, Mauro; Paladini, Federica

    2016-12-01

    Catheter-associated urinary tract infection (CAUTI) represents one of the most common causes of morbidity and mortality. The resistance demonstrated by many microorganisms to conventional antibiotic therapies and the increasing health-care costs have recently encouraged the definition of alternative preventive strategies, which can have a positive effect in the management of infections. Antimicrobial urinary catheters have been developed through the photo-chemical deposition of silver coatings on the external and luminal surfaces. The substrates are exposed to ultraviolet radiation after impregnation into a silver-based solution, thus inducing the in situ synthesis of silver particles. The effect of the surface treatment on the material was investigated through scanning electron microscopy (SEM) and silver ion release measurements. The ability of microorganisms commonly associated with urinary tract infections was investigated in terms of bacterial viability, proliferation and biofilm development, using Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis as target organisms. The silver coatings demonstrated good distribution of silver particles to the substrate, and proved an effective antibacterial capability in simulated biological conditions. The low values of silver ion release demonstrated the optimum adhesion of the coating. The results indicated a good potential of silver-based antimicrobial materials for prevention of catheter-associated urinary tract infection.

  15. Colonization with Escherichia coli Strains among Female Sex Partners of Men with Febrile Urinary Tract Infection

    PubMed Central

    Sandberg, Torsten; Scheutz, Flemming; Clabots, Connie; Johnston, Brian D.; Thuras, Paul; Johnson, James R.

    2015-01-01

    Of 23 unique Escherichia coli strains from 10 men with febrile urinary tract infections (UTIs) and their female sex partners, 6 strains (all UTI causing) were shared between partners. Molecularly, the 6 shared strains appeared more virulent than the 17 nonshared strains, being associated with phylogenetic group B2, sequence types ST73 and ST127, and multiple specific virulence genes. This indicates that UTIs are sometimes sexually transmitted. PMID:25832302

  16. Development of a Vaccine against Escherichia coli Urinary Tract Infections

    PubMed Central

    Mobley, Harry L. T.; Alteri, Christopher J.

    2015-01-01

    Urinary tract infection (UTI) is the second most common infection in humans after those involving the respiratory tract. This results not only in huge annual economic costs, but in decreased workforce productivity and high patient morbidity. Most infections are caused by uropathogenic Escherichia coli (UPEC). Antibiotic treatment is generally effective for eradication of the infecting strain; however, documentation of increasing antibiotic resistance, allergic reaction to certain pharmaceuticals, alteration of normal gut flora, and failure to prevent recurrent infections represent significant barriers to treatment. As a result, approaches to prevent UTI such as vaccination represent a gap that must be addressed. Our laboratory has made progress toward development of a preventive vaccine against UPEC. The long-term research goal is to prevent UTIs in women with recurrent UTIs. Our objective has been to identify the optimal combination of protective antigens for inclusion in an effective UTI vaccine, optimal adjuvant, optimal dose, and optimal route of delivery. We hypothesized that a multi-subunit vaccine elicits antibody that protects against experimental challenge with UPEC strains. We have systematically identified four antigens that can individually protect experimentally infected mice from colonization of the bladder and/or kidneys by UPEC when administered intranasally with cholera toxin (CT) as an adjuvant. To advance the vaccine for utility in humans, we will group the individual antigens, all associated with iron acquisition (IreA, Hma, IutA, FyuA), into an effective combination to establish a multi-subunit vaccine. We demonstrated for all four vaccine antigens that antigen-specific serum IgG represents a strong correlate of protection in vaccinated mice. High antibody titers correlate with low colony forming units (CFUs) of UPEC following transurethral challenge of vaccinated mice. However, the contribution of cell-mediated immunity cannot be ruled out and

  17. Development of a Vaccine against Escherichia coli Urinary Tract Infections.

    PubMed

    Mobley, Harry L T; Alteri, Christopher J

    2015-12-31

    Urinary tract infection (UTI) is the second most common infection in humans after those involving the respiratory tract. This results not only in huge annual economic costs, but in decreased workforce productivity and high patient morbidity. Most infections are caused by uropathogenic Escherichia coli (UPEC). Antibiotic treatment is generally effective for eradication of the infecting strain; however, documentation of increasing antibiotic resistance, allergic reaction to certain pharmaceuticals, alteration of normal gut flora, and failure to prevent recurrent infections represent significant barriers to treatment. As a result, approaches to prevent UTI such as vaccination represent a gap that must be addressed. Our laboratory has made progress toward development of a preventive vaccine against UPEC. The long-term research goal is to prevent UTIs in women with recurrent UTIs. Our objective has been to identify the optimal combination of protective antigens for inclusion in an effective UTI vaccine, optimal adjuvant, optimal dose, and optimal route of delivery. We hypothesized that a multi-subunit vaccine elicits antibody that protects against experimental challenge with UPEC strains. We have systematically identified four antigens that can individually protect experimentally infected mice from colonization of the bladder and/or kidneys by UPEC when administered intranasally with cholera toxin (CT) as an adjuvant. To advance the vaccine for utility in humans, we will group the individual antigens, all associated with iron acquisition (IreA, Hma, IutA, FyuA), into an effective combination to establish a multi-subunit vaccine. We demonstrated for all four vaccine antigens that antigen-specific serum IgG represents a strong correlate of protection in vaccinated mice. High antibody titers correlate with low colony forming units (CFUs) of UPEC following transurethral challenge of vaccinated mice. However, the contribution of cell-mediated immunity cannot be ruled out and

  18. Development of a Vaccine against Escherichia coli Urinary Tract Infections.

    PubMed

    Mobley, Harry L T; Alteri, Christopher J

    2015-01-01

    Urinary tract infection (UTI) is the second most common infection in humans after those involving the respiratory tract. This results not only in huge annual economic costs, but in decreased workforce productivity and high patient morbidity. Most infections are caused by uropathogenic Escherichia coli (UPEC). Antibiotic treatment is generally effective for eradication of the infecting strain; however, documentation of increasing antibiotic resistance, allergic reaction to certain pharmaceuticals, alteration of normal gut flora, and failure to prevent recurrent infections represent significant barriers to treatment. As a result, approaches to prevent UTI such as vaccination represent a gap that must be addressed. Our laboratory has made progress toward development of a preventive vaccine against UPEC. The long-term research goal is to prevent UTIs in women with recurrent UTIs. Our objective has been to identify the optimal combination of protective antigens for inclusion in an effective UTI vaccine, optimal adjuvant, optimal dose, and optimal route of delivery. We hypothesized that a multi-subunit vaccine elicits antibody that protects against experimental challenge with UPEC strains. We have systematically identified four antigens that can individually protect experimentally infected mice from colonization of the bladder and/or kidneys by UPEC when administered intranasally with cholera toxin (CT) as an adjuvant. To advance the vaccine for utility in humans, we will group the individual antigens, all associated with iron acquisition (IreA, Hma, IutA, FyuA), into an effective combination to establish a multi-subunit vaccine. We demonstrated for all four vaccine antigens that antigen-specific serum IgG represents a strong correlate of protection in vaccinated mice. High antibody titers correlate with low colony forming units (CFUs) of UPEC following transurethral challenge of vaccinated mice. However, the contribution of cell-mediated immunity cannot be ruled out and

  19. Antibiotic prophylaxis in children with relapsing urinary tract infections: review.

    PubMed

    Mangiarotti, P; Pizzini, C; Fanos, V

    2000-04-01

    Recurrent urinary tract infections (UTIs) are observed in 30-50% of children after the first UTI. Of these, approximately 90% occur within 3 months of the initial episode. The basic aim of antibiotic prophylaxis in children with malformative uropathy and/or recurrent UTIs, is to reduce the frequency of UTIs. The bacteria most frequently responsible for UTI are gram-negative organisms, with Escherichia coli accounting for 80% of urinary tract pathogens. In children with recurrent UTIs and in those treated with antibiotic prophylaxis there is a greater incidence of UTI due to Proteus spp., Klebsiella spp. and Enterobacter spp., whereas Pseudomonas spp., Serratia spp. and Candida spp. are more frequent in children with urogenital abnormalities and/or undergoing invasive instrumental investigations. Several factors are involved in the pathogenesis of UTI, the main ones being circumcision, periurethral flora, micturition disorders, bowel disorders, local factors and hygienic measures. Several factors facilitate UTI relapse: malformative uropathies, particularly of the obstructive type; vesico-ureteric reflux (VUR); previous repeated episodes of cystitis and/or pyelonephritis (3 or more episodes a year), even in the absence of urinary tract abnormalities; a frequently catheterized neurogenic bladder; kidney transplant. The precise mechanism of action of low-dose antibiotics is not yet fully known. The characteristics of the ideal prophylactic agent are presented in this review, as well as indications, dosages, side effects, clinical data of all molecules. While inappropriate use of antibiotic prophylaxis encourages the emergence of microbial resistance, its proper use may be of great value in clinical practice, by reducing the frequency and clinical expression of UTIs and, in some cases such as VUR, significantly helping to resolve the underlying pathology.

  20. Risk Factors for Recurrent Urinary Tract Infection and Renal Scarring

    PubMed Central

    Shaikh, Nader; Pohl, Hans; Gravens-Mueller, Lisa; Ivanova, Anastasia; Zaoutis, Lisa; Patel, Melissa; deBerardinis, Rachel; Parker, Allison; Bhatnagar, Sonika; Haralam, Mary Ann; Pope, Marcia; Kearney, Diana; Sprague, Bruce; Barrera, Raquel; Viteri, Bernarda; Egigueron, Martina; Shah, Neha; Hoberman, Alejandro

    2015-01-01

    OBJECTIVES: To identify risk factors for recurrent urinary tract infection (UTI) and renal scarring in children who have had 1 or 2 febrile or symptomatic UTIs and received no antimicrobial prophylaxis. METHODS: This 2-year, multisite prospective cohort study included 305 children aged 2 to 71 months with vesicoureteral reflux (VUR) receiving placebo in the RIVUR (Randomized Intervention for Vesicoureteral Reflux) study and 195 children with no VUR observed in the CUTIE (Careful Urinary Tract Infection Evaluation) study. Primary exposure was presence of VUR; secondary exposures included bladder and bowel dysfunction (BBD), age, and race. Outcomes were recurrent febrile or symptomatic urinary tract infection (F/SUTI) and renal scarring. RESULTS: Children with VUR had higher 2-year rates of recurrent F/SUTI (Kaplan-Meier estimate 25.4% compared with 17.3% for VUR and no VUR, respectively). Other factors associated with recurrent F/SUTI included presence of BBD at baseline (adjusted hazard ratio: 2.07 [95% confidence interval (CI): 1.09–3.93]) and presence of renal scarring on the baseline 99mTc-labeled dimercaptosuccinic acid scan (adjusted hazard ratio: 2.88 [95% CI: 1.22–6.80]). Children with BBD and any degree of VUR had the highest risk of recurrent F/SUTI (56%). At the end of the 2-year follow-up period, 8 (5.6%) children in the no VUR group and 24 (10.2%) in the VUR group had renal scars, but the difference was not statistically significant (adjusted odds ratio: 2.05 [95% CI: 0.86–4.87]). CONCLUSIONS: VUR and BBD are risk factors for recurrent UTI, especially when they appear in combination. Strategies for preventing recurrent UTI include antimicrobial prophylaxis and treatment of BBD. PMID:26055855

  1. [Nitrofurantoin--clinical relevance in uncomplicated urinary tract infections].

    PubMed

    Stock, Ingo

    2014-07-01

    The nitrofuran derivative nitrofurantoin has been used for more than 60 years for the antibacterial therapy of uncomplicated urinary tract infections (UTI). Despite its long application, this antibiotic retained good activity against Escherichia coli and some other pathogens of uncomplicated urinary tract infections such as Staphylococcus saprophyticus and Enterococcus species. Nitrofurantoin therapy has been shown to be accompanied by numerous adverse drug effects. Among these, there are also serious side effects such as pulmonary reactions and polyneuropathy, which mainly occur in long-term use. Recent studies, however, have shown a good efficacy and tolerability of short-term nitrofurantoin therapy comparable to previous established standard therapeutic regimens applying cotrimoxazole or quinolones. Because of these data and the alarming resistance rates of uropathogenic Escherichia coli to cotrimoxazole and quinolones that have been increased markedly in several countries, the clinical significance ofnitrofurantoin has been raised again. In many current treatment guidelines, e. g., the international clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women published by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases, nitrofurantoin has been recommended as one first-line antibiotic of empiric antibacterial treatment of uncomplicated cystitis in otherwise healthy women. In Germany, however, nitrofurantoin should only be applied if more effective and less risky antibiotics cannot be used. Nitrofurantoin is contraindicated in the last three months of pregnancy and in patients suffering from renal impairment of each degree. Despite compatibility concerns, nitrofurantoin has also been recommended for the re-infection prophylaxis of recurrent uncomplicated urinary tract infections in Germany and several other countries.

  2. [Nitrofurantoin--clinical relevance in uncomplicated urinary tract infections].

    PubMed

    Stock, Ingo

    2014-07-01

    The nitrofuran derivative nitrofurantoin has been used for more than 60 years for the antibacterial therapy of uncomplicated urinary tract infections (UTI). Despite its long application, this antibiotic retained good activity against Escherichia coli and some other pathogens of uncomplicated urinary tract infections such as Staphylococcus saprophyticus and Enterococcus species. Nitrofurantoin therapy has been shown to be accompanied by numerous adverse drug effects. Among these, there are also serious side effects such as pulmonary reactions and polyneuropathy, which mainly occur in long-term use. Recent studies, however, have shown a good efficacy and tolerability of short-term nitrofurantoin therapy comparable to previous established standard therapeutic regimens applying cotrimoxazole or quinolones. Because of these data and the alarming resistance rates of uropathogenic Escherichia coli to cotrimoxazole and quinolones that have been increased markedly in several countries, the clinical significance ofnitrofurantoin has been raised again. In many current treatment guidelines, e. g., the international clinical practice guidelines for the treatment of acute uncomplicated cystitis and pyelonephritis in women published by the Infectious Diseases Society of America and the European Society for Microbiology and Infectious Diseases, nitrofurantoin has been recommended as one first-line antibiotic of empiric antibacterial treatment of uncomplicated cystitis in otherwise healthy women. In Germany, however, nitrofurantoin should only be applied if more effective and less risky antibiotics cannot be used. Nitrofurantoin is contraindicated in the last three months of pregnancy and in patients suffering from renal impairment of each degree. Despite compatibility concerns, nitrofurantoin has also been recommended for the re-infection prophylaxis of recurrent uncomplicated urinary tract infections in Germany and several other countries. PMID:25065160

  3. Urinary tract infection in the setting of vesicoureteral reflux

    PubMed Central

    Garcia-Roig, Michael L.; Kirsch, Andrew J.

    2016-01-01

    Vesicoureteral reflux (VUR) is the most common underlying etiology responsible for febrile urinary tract infections (UTIs) or pyelonephritis in children. Along with the morbidity of pyelonephritis, long-term sequelae of recurrent renal infections include renal scarring, proteinuria, and hypertension. Treatment is directed toward the prevention of recurrent infection through use of continuous antibiotic prophylaxis during a period of observation for spontaneous resolution or by surgical correction. In children, bowel and bladder dysfunction (BBD) plays a significant role in the occurrence of UTI and the rate of VUR resolution. Effective treatment of BBD leads to higher rates of spontaneous resolution and decreased risk of UTI. PMID:27408706

  4. Minimally invasive approaches to upper urinary tract urolithiasis.

    PubMed

    Wignall, Geoffrey R; Canales, Benjamin K; Denstedt, John D; Monga, Manoj

    2008-08-01

    The surgical management of urolithiasis is an ever-changing discipline that presents unique challenges to the urologist. This article reviews the current minimally invasive treatment options for upper urinary tract urolithiasis. First it examines several factors that influence stone-free rates, including Hounsfield units of calculi, obesity, and lower pole factors. Surgical management of ureteral calculi is reviewed along with a discussion of stone management in high-risk patients including those who are pregnant. Surgical technique of shockwave lithotripsy, ureteroscopy, percutaneous nephrolithotomy, and laparoscopy is discussed in depth, with attention paid to possible variations in technique.

  5. Extracorporeal shockwave lithotripsy monotherapy for paediatric urinary tract calculi.

    PubMed

    Thornhill, J A; Moran, K; Mooney, E E; Sheehan, S; Smith, J M; Fitzpatrick, J M

    1990-06-01

    The role of extracorporeal shockwave lithotripsy (ESWL) in the management of paediatric urinary tract calculi was evaluated. The study group included 22 children (13 male, 9 female) with an age range of 2 to 13 years. The renal calculi, including staghorn and ureteric calculi, varied in size from 0.3 to 5 cm. Overall stone clearance at 3 months was 79% with a low incidence of complications (2 children required nephrostomy drainage for sepsis). ESWL is a non-invasive method of managing even complex stones in children of all ages, irrespective of size or position.

  6. Urinary tract stone disease: are all problems solved?

    PubMed

    Tiselius, Hans-Göran

    2013-02-01

    During the past four decades there have been dramatic developments in the methods used for active stone removal from the urinary tract, and the need for open surgery has been almost entirely replaced by extracorporeal shockwave lithotripsy, percutaneous surgery, ureteroscopy and retrograde intrarenal surgery. Residual fragments and the pronounced risk of recurrent stone formation remain important problems for the future development of urolithology and for the optimal low-risk management of this large group of patients. It is emphasized that all aspects of the care of patients with stone disease are the responsibility of the urologist.

  7. Impact of shockwave lithotripsy on upper urinary tract calculi.

    PubMed

    Riehle, R A; Näslund, E B; Fair, W; Vaughan, E D

    1986-10-01

    Extracorporeal shock wave lithotripsy (ESWL) currently is performed in selected urologic centers to treat over 80 per cent of patients with symptomatic upper urinary tract calculi. This noninvasive technique utilizing shockwaves to disintegrate stones into sand-sized particles allows the patient to pass the particles with spontaneous urination and replaces most surgery or percutaneous endoscopy for stone removal. However, stone-free success rates must be individualized depending on stone position, stone size, and composition. Lithotripsy of renal stones prior to migration and proximal ureteral stones early in their symptomatic course may alter significantly the incidence of distal ureteral calculi requiring hospitalization, cystoscopy, or ureteroscopy.

  8. Management of Recurrent Urinary Tract Infections in Healthy Adult Women

    PubMed Central

    Hickling, Duane R; Nitti, Victor W

    2013-01-01

    Recurrence after urinary tract infection (rUTI) is common in adult women. The majority of recurrences are believed to be reinfection from extraurinary sources such as the rectum or vagina. However, uropathogenic Escherichia coli are now known to invade urothelial cells and form quiescent intracellular bacterial reservoirs. Management of women with frequent symptomatic rUTI can be particularly vexing for both patients and their treating physicians. This review addresses available and promising management strategies for rUTI in healthy adult women. PMID:24082842

  9. The effects of cranberries on preventing urinary tract infections.

    PubMed

    Shin, Cha-Nam

    2014-02-01

    Despite considerable controversy about their effects, cranberries in various forms have been used widely for several decades to prevent as well as treat urinary tract infections (UTIs). The purpose of this article is to present a review of research-based information regarding the ability of cranberries to prevent UTIs in adults at risk for UTIs. Current evidence suggests that cranberries decrease bacterial adherence to uroepithelial cells and thus decrease the incidence of UTIs without adverse effects in most individuals. Thus clinicians may safely advise patients that cranberries are helpful in preventing UTIs. Cranberries may be a viable adjunct to antibiotics for patients with repeated UTIs.

  10. Urinary tract infection in the setting of vesicoureteral reflux.

    PubMed

    Garcia-Roig, Michael L; Kirsch, Andrew J

    2016-01-01

    Vesicoureteral reflux (VUR) is the most common underlying etiology responsible for febrile urinary tract infections (UTIs) or pyelonephritis in children. Along with the morbidity of pyelonephritis, long-term sequelae of recurrent renal infections include renal scarring, proteinuria, and hypertension. Treatment is directed toward the prevention of recurrent infection through use of continuous antibiotic prophylaxis during a period of observation for spontaneous resolution or by surgical correction. In children, bowel and bladder dysfunction (BBD) plays a significant role in the occurrence of UTI and the rate of VUR resolution. Effective treatment of BBD leads to higher rates of spontaneous resolution and decreased risk of UTI. PMID:27408706

  11. Endoluminal pharmacologic stimulation of the upper urinary tract.

    PubMed

    Jakobsen, Jørn Skibsted

    2013-05-01

    The experiments performed in this PhD thesis were conducted at the Institute of Experimental Surgery, Skejby Hospital, Aarhus, Denmark and at the Laboratory of Animal Science, Odense University Hospital, Denmark. The thesis is based on 3 peer review articles published in international journals and a review. Diagnostic or therapeutic endoscopic upper urinary tract procedures are usually characterised as minimal invasive procedures and associated with a low complication rate. Most often fever or pain are seen and sometimes septicaemia. However, mucosa lesion or even ureteric ruptures are known complications. Research has suggested that high renal pelvic pressures generated during these procedures, might contribute to per-/postoperative complications seen, and even possible renal parenchymal damage. Nevertheless, local administration (endoluminal) of a relaxant drug has not previously been tried in order to lower renal pelvic pressure. The purposes of this thesis were to examine the effect of local administration (endoluminal) of the nonspecific β-adrenergic agonist ISOproterenol (ISO) on: 1) The normal pressure flow relation in porcine ureter, 2) The effect of endoluminal ISO perfusion during flexible ureterorenoscopy, 3) The pressure flow relation during semirigid ureterorenoscopy and 4) The cardiovascular system. Among other receptor-types β-adrenergic receptor are located in the upper urinary tract and the activation thereof mediates smooth muscle relaxation. We have shown - in an animal experimental model - that ISO added to the irrigation fluid had significant impact on the renal pelvic pressures generated during upper urinary tract endoscopy. ISO significantly and dose dependently reduced the normal pressure flow relations by approximately 80% without concomitant cardiovascular side effects or measurable plasma levels of ISO. During flexible ureterorenoscopy 0.1 µg/ml ISO added to the irrigation fluid significantly reduced renal pelvic pressure during

  12. Drug and Vaccine Development for the Treatment and Prevention of Urinary Tract Infections.

    PubMed

    O'Brien, Valerie P; Hannan, Thomas J; Nielsen, Hailyn V; Hultgren, Scott J

    2016-02-01

    Urinary tract infections (UTI) are among the most common bacterial infections in humans, affecting millions of people every year. UTI cause significant morbidity in women throughout their lifespan, in infant boys, in older men, in individuals with underlying urinary tract abnormalities, and in those that require long-term urethral catheterization, such as patients with spinal cord injuries or incapacitated individuals living in nursing homes. Serious sequelae include frequent recurrences, pyelonephritis with sepsis, renal damage in young children, pre-term birth, and complications of frequent antimicrobial use including high-level antibiotic resistance and Clostridium difficile colitis. Uropathogenic E. coli (UPEC) cause the vast majority of UTI, but less common pathogens such as Enterococcus faecalis and other enterococci frequently take advantage of an abnormal or catheterized urinary tract to cause opportunistic infections. While antibiotic therapy has historically been very successful in controlling UTI, the high rate of recurrence remains a major problem, and many individuals suffer from chronically recurring UTI, requiring long-term prophylactic antibiotic regimens to prevent recurrent UTI. Furthermore, the global emergence of multi-drug resistant UPEC in the past ten years spotlights the need for alternative therapeutic and preventative strategies to combat UTI, including anti-infective drug therapies and vaccines. In this chapter, we review recent advances in the field of UTI pathogenesis, with an emphasis on the identification of promising drug and vaccine targets. We then discuss the development of new UTI drugs and vaccines, highlighting the challenges these approaches face and the need for a greater understanding of urinary tract mucosal immunity. PMID:26999391

  13. Neuromodulation for the Treatment of Lower Urinary Tract Symptoms.

    PubMed

    Yamanishi, Tomonori; Kaga, Kanya; Fuse, Miki; Shibata, Chiharu; Uchiyama, Tomoyuki

    2015-09-01

    Neuromodulation therapy incorporates electrical stimulation to target specific nerves that control lower urinary tract symptoms (LUTS). The objectives of this article are to review the mechanism of action, the type of neuromodulation, and the efficacy of neuromodulation mainly according to the results of randomized controlled trials. Neuromodulation includes pelvic floor electrical stimulation (ES) using vaginal, anal and surface electrodes, interferential therapy (IF), magnetic stimulation (MS), percutaneous tibial nerve stimulation, and sacral nerve stimulation (SNS). The former four stimulations are used for external periodic (short-term) stimulation, and SNS are used for internal, chronic (long-term) stimulation. All of these therapies have been reported to be effective for overactive bladder or urgency urinary incontinence. Pelvic floor ES, IF, and MS have also been reported to be effective for stress urinary incontinence. The mechanism of neuromodulation for overactive bladder has been reported to be the reflex inhibition of detrusor contraction by the activation of afferent fibers by three actions, i.e., the activation of hypogastric nerve, the direct inhibition of the pelvic nerve within the sacral cord and the supraspinal inhibition of the detrusor reflex. The mechanism of neuromodulation for stress incontinence is contraction of the pelvic floor muscles through an effect on the muscle fibers as well as through the stimulation of pudendal nerves. Overall, cure and improvement rates of these therapies for urinary incontinence are 30-50, and 60-90% respectively. MS has been considered to be a technique for stimulating nervous system noninvasively. SNS is indicated for patients with refractory overactive bladder and urinary retention.

  14. Bartter syndrome type III and congenital anomalies of the kidney and urinary tract: an antenatal presentation.

    PubMed

    Westland, Rik; Hack, Wilfried W; van der Horst, Henricus J R; Uittenbogaard, Lukas B; van Hagen, Johanna M; van der Valk, Paul; Kamsteeg, Erik J; van den Heuvel, Lambert P; van Wijk, Joanna A E

    2012-12-01

    Bartter syndrome encompasses a variety of inheritable renal tubular transport disorders characterized by hypokalemia and hypochloremic metabolic alkalosis. Bartter syndrome Type III is caused by genetic alterations in the chloride channel kidney B (CLCNKB) gene and often presents in the first 2 years of life, known as classic Bartter syndrome. However, in rare cases Bartter syndrome Type III has an antenatal presentation with polyhydramnios, premature delivery and severe dehydration in the first weeks of life. Associations between congenital anomalies of the kidney and urinary tract and Bartter syndrome are extremely rare. This case report presents a girl with Bartter syndrome Type III due to a homozygous CLCNKB mutation and bilateral congenital anomalies of the kidney and urinary tract. In addition, we describe the antenatal presentation as well as its perinatal management.

  15. Escherichia coli mediated urinary tract infections: are there distinct uropathogenic E. coli (UPEC) pathotypes?

    PubMed

    Marrs, Carl F; Zhang, Lixin; Foxman, Betsy

    2005-11-15

    A variety of virulence genes are associated with Escherichia coli mediated urinary tract infections. Particular sets of virulence factors shared by bacterial strains directing them through a particular pathogenesis process are called a "pathotype." Comparison of co-occurrence of potential urinary tract infection (UTI) virulence genes among different E. coli isolates from fecal and UTI collections provides evidence for multiple pathotypes of uropathogenic E. coli, but current understanding of critical genetic differences defining the pathotypes is limited. Discovery of additional E. coli genes involved in uropathogenesis and determination of their distribution and co-occurrences will further define UPEC pathotypes and allow for a more detailed analysis of how these pathotypes might differ in how they cause disease.

  16. Comparative study of ceftibuten and cefixime in the treatment of complicated urinary tract infections.

    PubMed

    Ho, M W; Wang, F D; Fung, C P; Liu, C Y

    2001-09-01

    Between August 1996 and May 1998, a total of 62 patients who had complicated urinary tract infections treated at the Taipei Veterans General Hospital were enrolled into this study. This prospective, randomized, open-labeled trial aimed at comparing the efficacy and safety of ceftibuten and cefixime, prescribed each at a dose of 200 mg twice daily, in treating complicated urinary tract infection. Seventeen patients were later excluded from the analysis because of resistant pathogens (7 patients), uncomplicated urinary tract infection (6), initial culture negative for bacteria (3), and infective endocarditis (1). The remaining 45 patients were categorized into ceftibuten (n=23; mean age, 71.3 years) and cefixime (n=22; mean age, 62.8 years) treatment groups. No significant difference in demographic data and clinical characteristics was found between the 2 groups. The clinical efficacy rate (78.3% vs 77.3%, p=0.9) and bacteriological eradication rate (52.2% vs 63.6%, p=0.08) were similar between the ceftibuten and the cefixime group. Adverse effects caused by ceftibuten treatment included diarrhea and slight elevation of the serum level of liver transaminase in 2 (6.5%) patients. Those caused by cefixime treatment included slight elevation of serum level of liver transaminase in 2 (6.5%) patients and skin rash in 1 (3.2%) patient. All of these adverse effects resolved quickly after the regimen had been completed, and no patient discontinued the regimen because of the adverse effects. The results suggest that oral administration of ceftibuten 200 mg twice daily is as effective and safe as oral administration of cefixime 200 mg twice daily in the treatment of complicated urinary tract infections.

  17. Urinalysis and Urinary Tract Infection: Update for Clinicians

    PubMed Central

    Young, Jennifer L.

    2001-01-01

    Dysuria is a common presenting complaint of women and urinalysis is a valuable tool in the initial evaluation of this presentation. Clinicians need to be aware that pyuria is the best determinate of bacteriuria requiring therapy and that values significant for infection differ depending on the method of analysis. A hemocytometer yields a value of ≥ 10 WBC/ mm3 significant for bacteriuria, while manual microscopy studies show ≥ 8 WBC/high-power field reliably predicts a positive urine culture. In cases of uncomplicated symptomatic urinary tract infection, a positive value for nitrites and leukocyte esterase by urine dipstick can be treated without the need for a urine culture. Automated urinalysis used widely in large volume laboratories provides more sensitive detection of leukocytes and bacteria in the urine.With automated microscopy, a value of > 2 WBC/hpf is significant pyuria indicative of inflammation of the urinary tract. In complicated cases such as pregnancy, recurrent infection or renal involvement, further evaluation is necessary including manual microscopy and urine culture with sensitivities. PMID:11916184

  18. Detection of urinary tract infections by rapid methods.

    PubMed Central

    Pezzlo, M

    1988-01-01

    A review of rapid urine screens for detection of bacteriuria and pyuria demonstrates a number of available alternatives to the culture method. Selection of one or more of these systems for routine use is dependent upon the laboratory and the patient population being tested. The laboratory approach to the diagnosis of urinary tract infection should consider the clinical diagnosis of the patient whenever possible. Keeping in mind that quantitative urine cultures alone cannot be used to detect infection in some patient populations unless lower colony counts are considered, a rapid screen may be a more practical approach. It has become accepted that 10(5) CFU/ml can no longer be used as the standard for all patient groups, that pyuria often is important in making the diagnosis of a urinary tract infection, and that most of the rapid screens are more sensitive than the culture method at 10(5) CFU/ml. Presently, no one approach can be recommended for all laboratories and all patient groups. However, each diagnostic laboratory should select one approach which is best for its situation. It is not practical, efficient, or cost effective to define a protocol for each possible clinical condition; however, all should be considered when developing a protocol. This protocol should be compatible with the patient population and communicated to the physicians. Use of a rapid screen should be beneficial to the patient, the physician, and the laboratory. PMID:3058296

  19. Measuring Escherichia coli Gene Expression during Human Urinary Tract Infections

    PubMed Central

    Mobley, Harry L. T.

    2016-01-01

    Extraintestinal Escherichia coli (E. coli) evolved by acquisition of pathogenicity islands, phage, plasmids, and DNA segments by horizontal gene transfer. Strains are heterogeneous but virulent uropathogenic isolates more often have specific fimbriae, toxins, and iron receptors than commensal strains. One may ask whether it is the virulence factors alone that are required to establish infection. While these virulence factors clearly contribute strongly to pathogenesis, bacteria must survive by metabolizing nutrients available to them. By constructing mutants in all major metabolic pathways and co-challenging mice transurethrally with each mutant and the wild type strain, we identified which major metabolic pathways are required to infect the urinary tract. We must also ask what else is E. coli doing in vivo? To answer this question, we examined the transcriptome of E. coli CFT073 in the murine model of urinary tract infection (UTI) as well as for E. coli strains collected and analyzed directly from the urine of patients attending either a urology clinic or a university health clinic for symptoms of UTI. Using microarrays and RNA-seq, we measured in vivo gene expression for these uropathogenic E. coli strains, identifying genes upregulated during murine and human UTI. Our findings allow us to propose a new definition of bacterial virulence. PMID:26784237

  20. Genomic diversity and fitness of E. coli strains recovered from the intestinal and urinary tracts of women with recurrent urinary tract infection.

    PubMed

    Chen, Swaine L; Wu, Meng; Henderson, Jeffrey P; Hooton, Thomas M; Hibbing, Michael E; Hultgren, Scott J; Gordon, Jeffrey I

    2013-05-01

    Urinary tract infections (UTIs) are common in women, and recurrence is a major clinical problem. Most UTIs are caused by uropathogenic Escherichia coli (UPEC). UPEC are generally thought to migrate from the gut to the bladder to cause UTI. UPEC form specialized intracellular bacterial communities in the bladder urothelium as part of a pathogenic mechanism to establish a foothold during acute stages of infection. Evolutionarily, such a specific adaptation to the bladder environment would be predicted to result in decreased fitness in other habitats, such as the gut. To examine this prediction, we characterized 45 E. coli strains isolated from the feces and urine of four otherwise healthy women with recurrent UTI. Multilocus sequence typing and whole genome sequencing revealed that two patients maintained a clonal population in both these body habitats throughout their recurrent UTIs, whereas the other two exhibited a wholesale shift in the dominant UPEC strain colonizing both sites. In vivo competition studies in mouse models, using isolates taken from one of the patients with a wholesale population shift, revealed that the strain that dominated her last UTI episode had increased fitness in both the gut and the bladder relative to the strain that dominated in preceding episodes. Increased fitness correlated with differences in the strains' gene repertoires and carbohydrate and amino acid utilization profiles. Thus, UPEC appear capable of persisting in both the gut and urinary tract without a fitness trade-off, emphasizing the need to widen our consideration of potential reservoirs for strains causing recurrent UTI.

  1. Fosfomycin versus meropenem in bacteraemic urinary tract infections caused by extended-spectrum β-lactamase-producing Escherichia coli (FOREST): study protocol for an investigator-driven randomised controlled trial

    PubMed Central

    Rosso-Fernández, Clara; Sojo-Dorado, Jesús; Barriga, Angel; Lavín-Alconero, Lucía; Palacios, Zaira; López-Hernández, Inmaculada; Merino, Vicente; Camean, Manuel; Pascual, Alvaro; Rodríguez-Baño, Jesús; Kindelán, Natera

    2015-01-01

    Introduction Finding therapeutic alternatives to carbapenems in infections caused by extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC) is imperative. Although fosfomycin was discovered more than 40 years ago, it was not investigated in accordance with current standards and so is not used in clinical practice except in desperate situations. It is one of the so-called neglected antibiotics of high potential interest for the future. Methods and analysis The main objective of this project is to demonstrate the clinical non-inferiority of intravenous fosfomycin with regard to meropenem for treating bacteraemic urinary tract infections (UTI) caused by ESBL-EC. This is a ‘real practice’ multicentre, open-label, phase III randomised controlled trial, designed to compare the clinical and microbiological efficacy, and safety of intravenous fosfomycin (4 g/6 h) and meropenem (1 g/8 h) as targeted therapy for this infection; a change to oral therapy is permitted after 5 days in both arms, in accordance with predetermined options. The study design follows the latest recommendations for designing trials investigating new options for multidrug-resistant bacteria. Secondary objectives include the study of fosfomycin concentrations in plasma and the impact of both drugs on intestinal colonisation by multidrug-resistant Gram-negative bacilli. Ethics and dissemination Ethical approval was obtained from the Andalusian Coordinating Institutional Review Board (IRB) for Biomedical Research (Referral Ethics Committee), which obtained approval from the local ethics committees at all participating sites in Spain (22 sites). Data will be presented at international conferences and published in peer-reviewed journals. Discussion This project is proposed as an initial step in the investigation of an orphan antimicrobial of low cost with high potential as a therapeutic alternative in common infections such as UTI in selected patients. These results may have a

  2. ROPE Registry Project to Determine the Safety and Efficacy of Prostate Artery Embolisation (PAE) for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Enlargement (LUTS BPE).

    ClinicalTrials.gov

    2016-08-03

    Lower Urinary Tract Symptoms Caused by Benign Prostatic Enlargement (LUTS BPE); Prostate Artery Embolisation (PAE); Transurethral Resection of the Prostate (TURP); Open Prostatectomy; Laser Enucleation or Ablation of the Prostate

  3. [Tumor of the urinary tract and renal lithiasis. Apropos of 4 cases].

    PubMed

    Benjelloun, S; el Mrini, M; Aboutaied, R; el Moussaoui, A

    1992-01-01

    The authors present four observation of renal lithiasis associated with a tumor of the upper urinary tract. The rarity of this association and the facility to only consider lithiasis often conceal the tumor. They define the "high risk lithiasis" for which CT-scan is mandatory. Tumor of the urinary tract has to be treated and the prognosis becomes less favorable. PMID:1297670

  4. Does Urinary Bladder Shape Affect Urinary Flow Rate in Men with Lower Urinary Tract Symptoms?

    PubMed Central

    Ateşçi, Yusuf Ziya; Aydoğdu, Özgü; Karaköse, Ayhan; Karal, Ömer; Şentürk, Utku

    2014-01-01

    We aimed to investigate the role of urinary bladder shape which may potentially change with advancing age, increased waist circumference, pelvic ischemia, and loosening of the urachus on bladder emptying and UFR. We retrospectively investigated the medical records of 76 men. The patients were divided into two groups according to bladder shapes in MRI scan (cone and spheric shapes). There was a significant difference between the two groups in terms of IPSS, Qmax, Qave, and waist circumference. A positive correlation has been demonstrated between mean peak urinary flow rate measured with UFM and mean flow rate calculated using the CP. There was a significant difference between mean urinary flow rates calculated with CP of cone and sphere bladder shapes. The change in the bladder shape might be a possible factor for LUTS in men and LUTS may be improved if modifiable factors including increased waist circumference and loosening of the urachus are corrected. PMID:24511301

  5. [Ciprofloxacin and therapy of urinary tract infections, including those due to Staphylococcus saprophyticus].

    PubMed

    Ivanov, D V; Budanov, S V

    2006-01-01

    Staphylococcus saprophyticus is one of the main pathogens of cystitis in young women. The human biotopes are contaminated by the staphylococcus on direct contacts with domestic animals or after using not properly cooked food of animal origin. Young women are more susceptible to colonization of the urinary tract by S. saprophyticus vs. the other contingents. Sexual intercourse is conducive to the colonization and infection. Shifts in the urinary tract microflora due to the use of spermicide, as well as candidiasis promote colonization of the urinary tract by S. saprophyticus. At present fluoroquinolones are considered as a significant independent group of chemotherapeutics within the class of quinolones, inhibitors of DNA gyrase, characterized by high clinical efficacy in the treatment of urinary tract infections. Especially significant clinical experience with ciprofloxacin in the therapy of urinary tract infections is available.

  6. [Unambiguous practice guidelines on urinary tract infections in primary and secondary care].

    PubMed

    van Asselt, Kristel M; Prins, Jan M; van der Weele, Gerda M; Knottnerus, Bart J; van Pinxteren, Bart; Geerlings, Suzanne E

    2013-01-01

    The Dutch College of General Practitioners (NHG) practice guideline 'Urinary tract infections' intended for primary health care and the Dutch Working Party on Antibiotic Policy (SWAB) practice guideline 'Antimicrobial therapy in complicated urinary tract infections' intended for specialists in secondary care, were reviewed together. - In the NHG guideline the differentiation between 'complicated' and 'uncomplicated' urinary tract infections has been replaced by categorisation into age, sex, risk group and the presence of fever, or invasion of tissues.- If urinary tract infection has been diagnosed, a dip slide test can be used to determine resistance.- The guidelines recommend the most narrow-spectrum antibiotic to reduce further increase in antimicrobial resistance.- A chapter about women with recurrent urinary tract infections has been added to the SWAB guideline. Amongst other things, the chapter provides information on the prescription of prophylactic lactobacillus in secondary care. PMID:24004930

  7. Relationship between lower urinary tract abnormalities and disease-related parameters in multiple sclerosis.

    PubMed

    Koldewijn, E L; Hommes, O R; Lemmens, W A; Debruyne, F M; van Kerrebroeck, P E

    1995-07-01

    Multiple sclerosis affects the lower urinary tract in many patients. The relationship between lower urinary tract abnormalities and disease-related parameters of multiple sclerosis is not well described. We screened urologically and neurologically 212 patients according to a standard protocol. Micturition complaints were noted in 52% of the patients and urodynamic abnormalities were found in 64%. A statistical correlation was found between detrusor hyperactivity and detrusor hypoactivity with disease-related parameters, that is disease duration, disability status, myelin basic protein concentration in the cerebrospinal fluid and neurophysiological investigations. No relationship was found between detrusor hypersensibility or detrusor hyposensibility and the aforementioned disease-related parameters. In 1 patient upper urinary tract abnormalities were noted in combination with urodynamic abnormalities. We conclude that lower urinary tract abnormalities can be found in every patient with multiple sclerosis unrelated to the state of the disease. Severe upper urinary tract abnormalities are rare. PMID:7539859

  8. Novel Strategies in the Prevention and Treatment of Urinary Tract Infections

    PubMed Central

    Lüthje, Petra; Brauner, Annelie

    2016-01-01

    Urinary tract infections are one of the most common bacterial infections, especially in women and children, frequently treated with antibiotics. The alarming increase in antibiotic resistance is a global threat to future treatment of infections. Therefore, alternative strategies are urgently needed. The innate immune system plays a fundamental role in protecting the urinary tract from infections. Antimicrobial peptides form an important part of the innate immunity. They are produced by epithelial cells and neutrophils and defend the urinary tract against invading bacteria. Since efficient resistance mechanisms have not evolved among bacterial pathogens, much effort has been put into exploring the role of antimicrobial peptides and possibilities to utilize them in clinical practice. Here, we describe the impact of antimicrobial peptides in the urinary tract and ways to enhance the production by hormones like vitamin D and estrogen. We also discuss the potential of medicinal herbs to be used in the prophylaxis and the treatment of urinary tract infections. PMID:26828523

  9. Management of urinary tract calculi by extracorporeal shock wave lithotripsy.

    PubMed

    Wadhwa, S N; Seth, A; Sood, R; Gupta, N P; Dogra, P N; Hemal, A K

    1994-02-01

    From July 1989 to April 1993, Extracorporeal Shockwave Lithotripsy (ESWL) was performed on 642 patients, of which 21 were from the pediatric age group. All treatments were done on a second generation lithotriptor-Siemens Lithostar, which does not require any modification for positioning of children. Fragmentation was achieved in all the patients (100%). A complete stone free rate was achieved in 17/21 patients (80.9%). Three (14.3%) patients had insignificant residual fragments whereas 1 (4.8%) had a residual fragment approximately 4 mm in size. 5640 shocks were required on an average. We have used low energy shockwaves with good results. General anesthesia was required for lithotripsy in only one child. The average fluoro exposure time was 1.6 minutes. We conclude that ESWL is a safe and effective method for treating urinary tract calculi in children.

  10. Congenital Anomalies of the Kidney and the Urinary Tract (CAKUT)

    PubMed Central

    2014-01-01

    This article reviews the majority of Congenital Anomalies of the Kidney and Urinary Tract (CAKUT) with emphasis in Pediatric Pathology describing and illustrating lesions as varied as ureteral duplications, ureteropelvic junction obstruction, horseshoe kidney, posterior urethral valve and prune belly syndrome, obstructive renal dysplasia, nonmotile ciliopathies and several syndromes associated with renal malformations (Meckel–Joubert, short rib, Bardet–Biedl, asplenia/polysplenia, hereditary renal adysplasia, Zellweger, trisomies, VACTER-L, Potter, caudal dysplasia, and sirenomelia), as well as ADPK, and ARPK. The purpose of this review is not only to describe the congenital renal anomalies, but also to analyze the more recent therapeutic interventions that may modify the natural history of some of these severe conditions. PMID:25313840

  11. Treatment and Prophylaxis in Pediatric Urinary Tract Infection

    PubMed Central

    Nickavar, Azar; Sotoudeh, Kambiz

    2011-01-01

    Urinary tract infection (UTI) is the most common serious bacterial infection in early life. Appropriate diagnosis and treatment prevent complications such as hypertension, proteinuria and end stage renal disease. A computerized search of MEDLINE, Embase and other databases was done to find the latest results about the treatment and prevention in pediatric UTI. Randomized control trials, systematic reviews and original articles were assessed. Search terms were “UTI, treatment, prophylaxis, prevention, and children”. All children with complicated or simple UTI were included in our search study from neonatal period to late childhood and medical aspects of treatment were reviewed. Recently, treatment approaches have been changed by simplification of drug administration. Oral treatment is recommended especially in older infants and children instead of strict intravenous treatment and patient admission. In addition, prophylactic treatment becomes easier and limited to certain cases. In this article, we review the recent information and approaches in this setting. PMID:21448397

  12. [Urinary Tract Infections - Current Innovations in Urine Diagnostics].

    PubMed

    Bonkat, G; Seifert, H-H; Halla, A; Bachmann, A

    2016-05-01

    Urine culture (UC) confirms the diagnosis of urinary tract infection (UTI) and is still considered the diagnostic 'gold standard' for pathogen identification, quantification and resistance testing. However, up to 80% of samples will not yield bacterial growth. Different techniques are currently approved for resistance testing. However, all of them are culture based and have the disadvantage of being very slow. In the field of urology, the development of drug resistance of uropathogens complicates the optimal administration of antimicrobial agents not only in the treatment, but also in the prevention of UTI before endourological and open surgical procedures. In this context, rapid identification of microbiological agents, including timely antimicrobial resistance testing (ART) is desirable. This overview presents alternative techniques (flow cytometry, PCR-based techniques, MALDI-TOF MS and microcalorimetry) to urine culture and discusses their advantages and disadvantages. PMID:27096941

  13. [The current diagnosis of tumors of the upper urinary tract].

    PubMed

    Saltirov, I; Terziev, T; Genadiev, Ts

    1997-01-01

    The treatment results and survivorship of patients with upper urinary tract tumors (UUTT) are largely dependent on the early diagnosis of the lesions. Twenty-eight patients presenting UUTT are studied and treated in the Clinic of Urology over the period 1987 through 1995. The diagnostic protocol includes both standard radiographic and cytological techniques, and endoscopic methods allowing for visualization and histopathological characterization of the neoplasm. The diagnostic relevance of the various methods and their efficacy are assayed, with emphasis on the necessity of their use in the differential diagnosis. The diagnostic approach described contributes to mace precise early diagnosis with preoperative determination of the degree of tumor differentiation which has an essential practical bearing on the choice of operative procedure and prognosis of the disease.

  14. Autonomic receptors in urinary tract: Sex and age differences

    SciTech Connect

    Latifpour, J.; Kondo, S.; O'Hollaren, B.; Morita, T.; Weiss, R.M. )

    1990-05-01

    As age and sex affect the function of the lower urinary tract, we studied the characteristics of adrenergic and cholinergic receptors in various parts of lower urinary tract smooth muscle of young (6 months) and old (4 1/2-5 years) male and female rabbits. Saturation experiments performed with (3H)prazosin, (3H)yohimbine, (3H)dihydroalprenolol and (3H)quinuclidinyl benzylate in rabbit bladder base, bladder dome and urethra indicate the presence of regional, sex- and age-related differences in the density of alpha-1, alpha-2, and beta adrenergic and muscarinic cholinergic receptors. Alpha-2 adrenergic receptor density is considerably higher in the female than in the male urethra of both age groups, whereas the higher density of beta adrenergic receptors in the female than in the male bladder base is observed only in the younger animals. The density of muscarinic receptors is higher in bladder dome than in bladder base or urethra in young rabbits of both sexes. In the old animals, the density of muscarinic receptors in bladder base increases to the level observed in bladder dome. Inhibition experiments with selective adrenergic agonists and antagonists indicate that the pharmacological profiles of alpha-2 adrenergic receptors in the urethra and beta adrenergic receptors in the bladder dome and bladder base are similar in both sexes and at both ages. Beta-2 adrenergic receptors are shown to be predominant in bladder base and bladder dome of rabbits. Parallel studies in rabbit urethra, adult rat cortex and neonatal rat lung show that the urethral alpha-2 adrenergic receptors are of the alpha-2A subtype.

  15. Lasers in the management of calcified urinary tract stents

    NASA Astrophysics Data System (ADS)

    Nseyo, Unyime O.; Tunuguntla, Hari S. G. R.; Crone, Michael

    2003-06-01

    Indwelling double J ureteral stents are used for internal urinary diversion for ureteral obstruction and post-surgical drainage of the upper urinary tract. Stent calcification is a serious complication especially in those with forgotten stents. In a retrospective review of 16 patients (10 male and 6 female) we found holmium laser to be highly effective in the management of calcified stents. Encrustations/calcifications were noted on the distal end of the sent in 6 patiens (37.5%), middle and distal portions in 2 patients (12.5%), along the entire length of the stent in 3 patients (18.75%), lower portion of the stent in 4 patients (25%) and at the upper and lower ends of the stent in one patient (6.25%). Cystolitholapaxy, retrograde ureteroscopy (URS) with holmium: YAG (yttrium-aluminum-garnet) laser intracorporeal lithotripsy, percutaneous nephrostolithotomy (PNL) and antegrade URS with holmium: YAG laser intracorporeal lithotripsy were effectively performed without intraoperative complications. Lithotripsy became necessary before stent removal in 11 patients (68.75%). Holmium laser lithotripsy was useful in managing 7 patients (43.75%), and shockwave lithotripsy (SWL) in 6 patients (37.5%). In two patients (12.5%) both holmium and SWL were used before the stent can be removed.

  16. [Morphologic and functional heterogeneous changes of the urinary bladder different parts at rats with infravesical obstruction of the urinary tracts].

    PubMed

    Kudriavtsev, Iu V; Kirpatovskiĭ, V I; Mudraia, I S; Khromov, R A; Kudriavtseva, L V

    2012-01-01

    Infravesical obstruction of the lower urinary tracts of 30 rats was carried out by the measured constriction of the urethral prevesical parts. Morphologic and functional changes of the urinary bladder different parts were studied in 1 week and in 3 months. Compensatory hypertrophy of the detrusor was accompanied increasing of hypertrophied, atrophic and native forms of leiomyocytes, as so their transformation into myofibroblasts with connective tissue formation between the muscle fibers mainly in the neck of urinary bladder Contractility of the detrusor decreased with their tonus increasing mainly in the neck of urinary bladder too. Weakening effect of adrenalin in 3 month after obstruction significantly decreased, while in the body and neck of urinary bladder it virtually disappeared. Blockade of alpha-adrenoreceptors after noradrenalin stimulation resulted in enchancement of the hypertrophic detrusor contraction when tonus of the urinary neck decreased. On the contrary, in the intact urinary bladder the similarly influence resulted in weakening of contraction.

  17. The relative importance of Staphylococcus saprophyticus as a urinary tract pathogen: distribution of bacteria among urinary samples analysed during 1 year at a major Swedish laboratory.

    PubMed

    Eriksson, Andreas; Giske, Christian G; Ternhag, Anders

    2013-01-01

    To determine the distribution of urinary tract pathogens with focus on Staphylococcus saprophyticus and analyse the seasonality, antibiotic susceptibility, and gender and age distributions in a large Swedish cohort. S. saprophyticus is considered an important causative agent of urinary tract infection (UTI) in young women, and some earlier studies have reported up to approximately 40% of UTIs in this patient group being caused by S. saprophyticus. We hypothesized that this may be true only in very specific outpatient settings. During the year 2010, 113,720 urine samples were sent for culture to the Karolinska University Hospital, from both clinics in the hospital and from primary care units. Patient age, gender and month of sampling were analysed for S. saprophyticus, Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. Species data were obtained for 42,633 (37%) of the urine samples. The most common pathogens were E. coli (57.0%), Enterococcus faecalis (6.5%), K. pneumoniae (5.9%), group B streptococci (5.7%), P. mirabilis (3.0%) and S. saprophyticus (1.8%). The majority of subjects with S. saprophyticus were women 15-29 years of age (63.8%). In this age group, S. saprophyticus constituted 12.5% of all urinary tract pathogens. S. saprophyticus is a common urinary tract pathogen in young women, but its relative importance is low compared with E. coli even in this patient group. For women in other ages and for men, growth of S. saprophyticus is a quite uncommon finding.

  18. Chronic Infections of the Urinary Tract and Bladder Cancer Risk: a Systematic Review.

    PubMed

    Anderson-Otunu, Oghenetejiri; Akhtar, Saeed

    2016-01-01

    Literature on the relationship between recurrent urinary tract infections and urinary bladder carcinoma risk has been inconsistent. Therefore, we carried out this systematic review of observational studies to ascertain if there is any association between chronic urinary tract infection and urinary bladder carcinoma. A total of 10 databases were searched using Boolean: CINAHL, PUBMED, Google Scholar, Medline, Science Direct, SCIRUS, Cochrane, UK PubMed central, NHS evidence and WHO-website. The search yielded an initial hit of 3,518 articles and after screening and critical appraisal, seven studies were included for this review. Four articles reported an association between chronic urinary tract infections and bladder cancer while three concluded a weak or no association at least in one gender. Main findings in this review were that most of the studies reported an association between chronic urinary tract infections and bladder cancer risk. However, inferences about the causal association between chronic urinary tract infections and bladder cancer risk should be drawn cautiously considering the methodological limitations of case-control studies included in this review. Therefore, more empirical evidence is needed to determine the causal nature of relationships between chronic urinary tract infections and bladder cancer risk. PMID:27644620

  19. Urinary tract toxicity in rats following administration of beta 3-adrenoceptor agonists.

    PubMed

    Waghe, M; Westwood, R; Nunn, G; Kalinowski, A; Aldridge, A

    1999-01-01

    ZD7114, [(S)-4-[2-(2-hydroxy-3 phenoxypropylamine)ethoxy]-N-(2-methoxyethyl) phenoxyacetamide], and ZD2079, [(R)-N-(2-[4- (carboxymethyl)phenoxy]ethyl)-N-(beta-hydroxyphenethyl)ammonium chloride], are beta 3-adrenoceptor stimulants with selectivity for brown adipose tissue. ZD7144 is the hydrochloride salt of the S-enantiomer of the racemic amide ZD2079. They were developed as potential novel treatments for obesity and non-insulin-dependent diabetes mellitus. Male and female rats were dosed separately by gavage for a minimum of 28 days with 0, 10, 50, and 500 mg/kg/day of ZD7114 or with 0, 10, 30, and 150 mg/kg/day of ZD2079. Two further groups of male and female rats were dosed with 0 and 500 mg/kg/day of ZD7114 for 28 days and were then allowed a 6-wk, undosed withdrawal period. At high doses, both compounds caused urinary tract toxicity, which primarily affected the distal tubules and collecting ducts of the kidney via tubular necrosis. They also caused ureteric inflammation, cystitis, and accumulation of crystalline inclusions throughout the urinary tract. As a result of urinary tract toxicity, affected animals from one or both studies showed reduced red blood cell indices, lower platelet counts, and higher white cell counts. Blood chemistry revealed lower plasma concentrations of glucose (7.28 +/- 1.37 compared to 8.11 +/- 0.65 for the control) and total protein (63.42 +/- 3.65 compared to 69.17 +/- 3.24 for the control) and increased plasma urea (37.15 +/- 19.96 compared to 8.09 +/- 0.87 for the control). Urinalysis showed an increase in the number of crystals, blood, and protein. In the urinary tract, the severe crystalluria with accumulation of crystalline material indicated that this may have a role in the etiology of the target organ toxicity. Poor solubility of the compounds at normal urinary pH was considered a possible mechanism for the crystalluria. PMID:10207980

  20. Towards a vaccine against Escherichia coli-associated urinary tract infections.

    PubMed

    Serino, Laura; Moriel, Danilo Gomes; Rappuoli, Rino; Pizza, Mariagrazia

    2010-03-01

    Evaluation of: Alteri CJ, Hagan EC, Sivick KE, Smith SN, Mobley HLT: Mucosal immunization with iron receptor antigens protects against urinary tract infections. PLoS Pathog. 5(9), E1000586 (2009). Urinary tract infection is one of the most common infections in humans. The eradication of uropathogenic Escherichia coli-mediated urinary tract infections has still not been achieved and no effective licensed vaccines are currently available. To overcome the limitations of previous approaches in developing an efficacious vaccine, Alteri et al., through a functional genomic approach, identified six novel vaccine candidates shown to be protective against urinary tract infection in a mouse model. The six proteins all belong to the class of outer membrane iron receptors, are upregulated in iron-restricted conditions and were demonstrated to induce, upon mucosal vaccination, antigen-specific antibodies and cytokine responses, which correlated with protection in a mouse model of urinary tract infection. Therefore, for the first time, antigens that were previously recognized as necessary for bacterial pathogenesis, being involved in iron acquisition in an iron-limited environment such as the urinary tract, are now proposed as potential candidates for the development of a vaccine against uropathogenic strain-associated urinary tract infections.

  1. Molecular epidemiology of Proteus mirabilis infections of the catheterized urinary tract.

    PubMed

    Sabbuba, N A; Mahenthiralingam, E; Stickler, D J

    2003-11-01

    Proteus mirabilis compromises the care of many patients undergoing long-term indwelling bladder catheterization. It forms crystalline bacterial biofilms in catheters which block the flow of urine, causing either incontinence due to leakage or painful distention of the bladder due to urinary retention. If it is not dealt with, catheter blockage can lead to pyelonephritis and septicemia. We have examined the epidemiology of catheter-associated P. mirabilis infections by use of pulsed-field gel electrophoresis (PFGE) of NotI restriction enzyme digests of bacterial DNA. This technique was shown to be more discriminatory than the classical phenotypic Dienes typing technique. We demonstrated that each of 42 isolates from diverse environmental sources and 10 of 12 isolates from blood, wound swabs, and mid-stream urine samples of hospitalized patients had distinct genotypes. Examination of a set of 55 isolates of P. mirabilis, each from a different clinical or environmental source, identified 49 distinct genotypes and 43 Dienes types. The index of discrimination was 0.993 for the PFGE method and 0.988 for the Dienes method. Applying the PFGE method to isolates from catheter-associated urinary tract infections confirmed that the strains present in the crystalline catheter biofilms were identical to those isolated from the same patient's urine. An analysis of samples taken during a prospective study of infections in catheterized nursing home patients revealed that a single genotype of P. mirabilis can persist in the urinary tract despite many changes of catheter, periods of noncatheterization, and antibiotic therapy.

  2. Neonatal outcome of fetuses with urinary tract abnormalities diagnosed by prenatal ultrasonography.

    PubMed Central

    Steele, B T; De Maria, J; Toi, A; Stafford, A; Hunter, D; Caco, C

    1987-01-01

    Between 1979 and 1986 an abnormality of the urinary tract was diagnosed by prenatal ultrasound examination in 93 fetuses. Postnatal investigation at a large teaching hospital showed a definite abnormality in 85 infants, 66 of whom were boys. An obstructed urinary tract, usually requiring surgery, was present in 46 infants. Other abnormalities included a multicystic kidney (in 15 infants), vesicoureteric reflux (in 9), prune-belly syndrome (in 5) and polycystic kidneys (in 5). Early recognition and treatment of urinary tract disorders in infants should be accompanied by informed prenatal counselling to minimize parents' anxiety. PMID:3297273

  3. Biliary tract infections caused by Aeromonas species.

    PubMed

    Chao, C M; Lai, C C; Tang, H J; Ko, W C; Hsueh, P-R

    2013-02-01

    This study investigated the clinical and microbiological characteristics of patients with Aeromonas infections of the biliary tract. Patients with bile cultures positive for Aeromonas species during the period July 2004 to December 2011 were identified from a computerized database of a hospital in Taiwan. Patients with Aeromonas infections of the biliary tract were further identified. During the study period, a total of 1,142 isolates of Aeromonas species were obtained from 750 patients. Of those patients, 91 (12.1 %) had Aeromonas infections of the biliary tract. The annual incidence (episodes per 10,000 patient-days) of biliary tract infections caused by all Aeromonas species was 0.31 in 2007, 0.12 in 2010, and 0.27 in 2011. A. hydrophila was the most common species isolated (n = 41, 45.1 %), followed by A. caviae (n = 30, 33.0 %), A. veronii biovar sobria (n = 15, 16.5 %), and A. veronii biovar veronii (n = 5, 5.5 %). The majority of patients (n = 77, 84.6 %) had polymicrobial infections. Hepatobiliary stones (n = 50, 54.9 %) and hepatobiliary cancer (n = 38, 41.8 %) were the most common underlying diseases, followed by diabetes mellitus (n = 29, 31.9 %) and liver cirrhosis (n = 7, 7.7 %). The in-hospital mortality rate was 8.8 %. Infection-related mortality was associated with underlying immunocompromised condition (p = 0.044) and use of mechanical ventilation (p = 0.004), but was not associated with inappropriate antibiotic usage or concomitant bacteremia (n = 8, 8.8 %). In conclusion, biliary tract infections caused by Aeromonas species are not uncommon and can develop in both immunocompromised and immunocompetent patients; however, patients with underlying hepatobiliary diseases are particularly susceptible to these infections.

  4. Complicated Catheter-Associated Urinary Tract Infections Due to Escherichia coli and Proteus mirabilis

    PubMed Central

    Jacobsen, S. M.; Stickler, D. J.; Mobley, H. L. T.; Shirtliff, M. E.

    2008-01-01

    Catheter-associated urinary tract infections (CAUTIs) represent the most common type of nosocomial infection and are a major health concern due to the complications and frequent recurrence. These infections are often caused by Escherichia coli and Proteus mirabilis. Gram-negative bacterial species that cause CAUTIs express a number of virulence factors associated with adhesion, motility, biofilm formation, immunoavoidance, and nutrient acquisition as well as factors that cause damage to the host. These infections can be reduced by limiting catheter usage and ensuring that health care professionals correctly use closed-system Foley catheters. A number of novel approaches such as condom and suprapubic catheters, intermittent catheterization, new surfaces, catheters with antimicrobial agents, and probiotics have thus far met with limited success. While the diagnosis of symptomatic versus asymptomatic CAUTIs may be a contentious issue, it is generally agreed that once a catheterized patient is believed to have a symptomatic urinary tract infection, the catheter is removed if possible due to the high rate of relapse. Research focusing on the pathogenesis of CAUTIs will lead to a better understanding of the disease process and will subsequently lead to the development of new diagnosis, prevention, and treatment options. PMID:18202436

  5. Preventing urinary tract infection: progress toward an effective Escherichia coli vaccine

    PubMed Central

    Brumbaugh, Ariel R; Mobley, Harry LT

    2012-01-01

    Uncomplicated urinary tract infections (UTIs) are common, with nearly half of all women experiencing at least one UTI in their lifetime. This high frequency of infection results in huge annual economic costs, decreased workforce productivity and high patient morbidity. At least 80% of these infections are caused by uropathogenic Escherichia coli (UPEC). UPEC can reside side by side with commensal strains in the gastrointestinal tract and gain access to the bladder via colonization of the urethra. Antibiotics represent the current standard treatment for UTI; however, even after treatment, patients frequently suffer from recurrent infection with the same or different strains. In addition, successful long-term treatment has been complicated by a rise in both the number of antibiotic-resistant strains and the prevalence of antibiotic-resistance mechanisms. As a result, preventative approaches to UTI, such as vaccination, have been sought. This review summarizes recent advances in UPEC vaccine development and outlines future directions for the field. PMID:22873125

  6. Prophylactic antibiotics in children at risk for urinary tract infection.

    PubMed

    Hellerstein, Stanley; Nickell, Ellen

    2002-07-01

    The outcome of using prophylactic antibiotics in children considered at risk for a urinary tract infection (UTI) was documented in 66 children during the period of suppressive antibiotics and for a follow-up period of 3.7+/-2.2 years (range 0.92-9.83 years). A breakthrough UTI occurred in 13 girls but none of the boys during the initial course of prophylactic antibiotics. During the follow-up period, 33 girls and 5 boys had no recurrence of infection, while 25 girls and 3 boys had UTIs. Statistical analysis of the data using chi-square and risk estimate relating factors for infection to the occurrence of a UTI showed that during the period of initial prophylactic antibiotic there was significant risk of infection among children with voiding dysfunction and abnormal kidneys and during the follow-up there was increased risk of infection among those with voiding dysfunction and vesicoureteric reflux (VUR) of grade 3 or greater severity. Lesser grades of VUR and constipation did not significantly increase the risk of UTI. These observations should be useful in developing a study to define the risks and benefits of prophylactic antibiotic in "at-risk" children.

  7. Electrical management of neurogenic lower urinary tract disorders.

    PubMed

    Joussain, C; Denys, P

    2015-09-01

    Management of lower urinary tract dysfunction (LUTD) in neurological diseases remains a priority because it leads to many complications such as incontinence, renal failure and decreased quality of life. A pharmacological approach remains the first-line treatment for patients with neurogenic LUTD, but electrical stimulation is a well-validated and recommended second-line treatment. However, clinicians must be aware of the indications, advantages and side effects of the therapy. This report provides an update on the 2 main electrical stimulation therapies for neurogenic LUTD - inducing direct bladder contraction with the Brindley procedure and modulating LUT physiology (sacral neuromodulation, tibial posterior nerve stimulation or pudendal nerve stimulation). We also describe the indications of these therapies for neurogenic LUTD, following international guidelines, as illustrated by their efficacy in patients with neurologic disorders. Electrical stimulation could be proposed for neurogenic LUTD as second-line treatment after failure of oral pharmacologic approaches. Nevertheless, further investigations are needed for a better understanding of the mechanisms of action of these techniques and to confirm their efficacy. Other electrical investigations, such as deep-brain stimulation and repetitive transcranial magnetic stimulation, or improved sacral anterior root stimulation, which could be associated with non-invasive and highly specific deafferentation of posterior roots, may open new fields in the management of neurogenic LUTD. PMID:26321622

  8. Can circumcision prevent recurrent urinary tract infections in hospitalized infants?

    PubMed

    Cason, D L; Carter, B S; Bhatia, J

    2000-12-01

    Urinary tract infection (UTI) is an uncommon but concerning condition for hospitalized premature infants. A retrospective chart review of all male infants admitted to the neonatal intensive care unit (NICU) from June 1996 through March 1999 was conducted at the Medical College of Georgia--a large academic medical center with a tertiary Level III NICU--to investigate the frequency and potential prevention of recurrent UTI in hospitalized infants. The effect of circumcision on recurrence of UTI was also investigated. There were 38 infants with 53 UTIs among 744 male infants admitted during the study period (5.1%). Infants were divided into two groups: A1 <37 weeks with a single UTI and A2 <37 weeks with more than one UTI. In groups A1 and A2, 57% of the first UTIs were due to Candida or E. coli, the remaining were due to other gram-negative organisms and Staphylococcus species. Mean gestational age (GA) in groups A1 and A2 were similar (29 +/- 2 weeks, and 29 +/- 4 weeks); however, mean GA of infants with Candida UTI was 27 +/- 2 weeks, and for bacterial UTI, 30 +/- 3 weeks (p<0.01). None of the premature infants in the study had a recurrent UTI once a circumcision was performed. Premature uncircumcised males had an increased risk for UTI (Odds Ratio=11.1, 95% CI, 3.3-28.9, p<0.001). Circumcision appears beneficial in reducing the risk for recurrent UTI in these infants.

  9. Treatment of urinary tract infection. Clinical and economic considerations.

    PubMed

    Plumridge, R J; Golledge, C L

    1996-04-01

    The epidemiology, clinical manifestations, natural history and management of urinary tract infection (UTI) are briefly reviewed as background to the economic considerations of diagnosis and treatment. Specific pharmacoeconomic analyses, such as cost-effectiveness and cost-benefit analyses, of UTI are not available. Analysis of the direct costs of diagnosis and treatment reveal that laboratory costs comprise the largest proportion, followed by physician consultation and pharmaceutical costs, respectively. Antimicrobial treatment has focused on acquisition cost without due regard to costs associated with method of delivery (especially with parenteral therapy), drug monitoring, complications, suboptimal therapy, drug wastage and waste disposal. These factors indicate a preference for ambulatory therapy using oral antimicrobials rather than institutional care using parenteral agents. Indirect costs, such as lost work time and quality-of-life factors, are not readily available. Evidence suggests that nosocomial UTIs add significantly to hospital costs. Studies citing the cost effectiveness of infection control programmes have often lacked detail and may have accrued benefits to the service without apportioning full costs. Future research directions include analysis of laboratory economics in relation to the clinical encounter, improved analysis of the utility and total costs of newer antimicrobials, quantifying home versus hospital treatment and improved costing of infection control programmes.

  10. Kidney imaging in management of delayed febrile urinary tract infection.

    PubMed

    Sayedzadeh, Sayed Abolhassan; Malaki, Majid; Shoaran, Maryam; Nemati, Massood

    2011-11-01

    We report a cross-sectional study performed to evaluate the imaging findings of 40 children, aged one month to five years (16.65 ± 14.97 months), who presented with protracted fever of more than 48 hours due to urinary tract infection (UTI). About 85% of the patients had positive Tc99-Dimercaptosuccinic acid (DMSA) scan and 58% had vesicoureteral reflux (VUR). Kidney sonography aided in the diagnosis and treatment in 10% of the patients. Age, sex, presence or laterality of VUR did not contribute to defective DMSA scan (pyelonephritis) (P > 0.05). Delayed diagnosis and treatment of febrile UTI is associated with a high incidence of positive findings of DMSA scan irrespective of age, sex or presence/absence of VUR. In mild VUR, the DMSA scan may be normal while in patients with moderate and severe VUR the DMSA scan is almost always abnormal. Thus, our study shows that a normal DMSA scan can help in ruling out moderate to severe forms of VUR and that cystography remains an excellent and standard tool for the diagnosis of VUR.

  11. Evaluation of Novel Urinary Tract Infection Biomarkers in Children

    PubMed Central

    Watson, Joshua R.; Hains, David S.; Cohen, Daniel M.; Spencer, John David; Kline, Jennifer M.; Yin, Han; Schwaderer, Andrew L.

    2016-01-01

    Background Pediatricians frequently use urinalysis to diagnose urinary tract infection (UTI) while awaiting urine culture results, but sensitivity and specificity of urinalysis are limited. This study evaluated the diagnostic accuracy of the antimicrobial peptides human α-defensin 5 (HD5) and human neutrophil peptides (HNP) 1-3 as novel UTI biomarkers in children. Methods We prospectively enrolled 199 pediatric Emergency Department or Urgent Care patients evaluated for a UTI. Urine concentrations of HD5 and HNP1-3 were measured by enzyme-linked immunosorbent assay. Urine culture was the reference standard. Sensitivities and specificities of leukocyte esterase (LE), HD5, HNP1-3, and test combinations were compared. Results For predicting positive urine culture, the areas under the receiver operating characteristic curves for HD5 and HNP1-3 were 0.86 (95% CI, 0.81-0.92) and 0.88 (95% CI, 0.82-0.93), respectively. Compared to LE ≥ trace, the combination test “LE and HD5” increased specificity by 6% (95% CI, 3%-10%) without decreasing sensitivity. In the subgroup whose urine was collected by a clean-catch method, combination tests “LE and HD5” and “HD5 and HNP1-3” increased specificity by > 10% compared to LE alone. Conclusion Urine antimicrobial peptide profiles are a promising novel strategy as an adjunct to urinalysis to aid UTI diagnosis in children. PMID:26885759

  12. Ejaculatory dysfunction in the treatment of lower urinary tract symptoms.

    PubMed

    DeLay, Kenneth Jackson; Nutt, Max; McVary, Kevin T

    2016-08-01

    The link between lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and sexual dysfunction is well established. Sexual dysfunction can encompass both ejaculatory dysfunction (EjD) and erectile dysfunction (ED). Ejaculatory dysfunction can consist of premature ejaculation, delayed ejaculation, retrograde ejaculation, anejaculation, decreased force of ejaculation and pain upon ejaculation. The impact of different medical and surgical therapies on ejaculatory function will be reviewed. We reviewed the various categories of LUTS treatment including the canonical epidemiology and pathophysiology as well as the surgical and medical treatments for LUTS/BPH. We note that most surgeries and several medical treatments have a certain but ill-defined negative impact on ejaculatory function. Several MISTs and selected medical therapies appear to have little impact on EjD. Both EjD and BPH are very common disorders in men under the care of an urologist. It is well documented that there is a clinical association between these two entities. Unfortunately many of the medical treatments and almost all surgical treatment impact the ejaculatory function of the patient. The surgical treatment of BPH often leads to retrograde ejaculation while medical treatment leads to anejaculation. PMID:27652217

  13. Ejaculatory dysfunction in the treatment of lower urinary tract symptoms

    PubMed Central

    DeLay, Kenneth Jackson; Nutt, Max

    2016-01-01

    The link between lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and sexual dysfunction is well established. Sexual dysfunction can encompass both ejaculatory dysfunction (EjD) and erectile dysfunction (ED). Ejaculatory dysfunction can consist of premature ejaculation, delayed ejaculation, retrograde ejaculation, anejaculation, decreased force of ejaculation and pain upon ejaculation. The impact of different medical and surgical therapies on ejaculatory function will be reviewed. We reviewed the various categories of LUTS treatment including the canonical epidemiology and pathophysiology as well as the surgical and medical treatments for LUTS/BPH. We note that most surgeries and several medical treatments have a certain but ill-defined negative impact on ejaculatory function. Several MISTs and selected medical therapies appear to have little impact on EjD. Both EjD and BPH are very common disorders in men under the care of an urologist. It is well documented that there is a clinical association between these two entities. Unfortunately many of the medical treatments and almost all surgical treatment impact the ejaculatory function of the patient. The surgical treatment of BPH often leads to retrograde ejaculation while medical treatment leads to anejaculation. PMID:27652217

  14. Non-Antibiotic Prophylaxis for Urinary Tract Infections.

    PubMed

    Beerepoot, Mariëlle; Geerlings, Suzanne

    2016-01-01

    Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (UTIs). Well-known steps in the pathogenesis of UTIs are urogenital colonization and adherence of uropathogens to uroepithelial cell receptors. To prevent colonization in postmenopausal women, vaginal, but not oral, estrogens have been shown to restore the vagina lactobacilli flora, reduce vaginal colonization with Enterobacteriaceae, and reduce the number of UTIs compared to placebo. Different lactobacilli strains show different results in the prevention of recurrent UTIs. Intravaginal suppositories with Lactobacillus crispatus in premenopausal women and oral capsules with Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 in postmenopausal women are promising. Ascorbic acid (vitamin C) cannot be recommended for the prevention of UTIs. Cranberries are thought to contain proanthocyanidins that can inhibit adherence of P-fimbriated E. coli to the uroepithelial cell receptors. Cranberry products decreased UTI recurrences about 30%-40% in premenopausal women with recurrent UTIs, but are less effective than low-dose antimicrobial prophylaxis. However, the optimal dose of cranberry product has still to be determined. Initially OM-89, a vaccine with 18 heat-killed E. coli extracts, seemed promising, but this was not confirmed in a recently randomized trial. PMID:27092529

  15. Ejaculatory dysfunction in the treatment of lower urinary tract symptoms

    PubMed Central

    DeLay, Kenneth Jackson; Nutt, Max

    2016-01-01

    The link between lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) and sexual dysfunction is well established. Sexual dysfunction can encompass both ejaculatory dysfunction (EjD) and erectile dysfunction (ED). Ejaculatory dysfunction can consist of premature ejaculation, delayed ejaculation, retrograde ejaculation, anejaculation, decreased force of ejaculation and pain upon ejaculation. The impact of different medical and surgical therapies on ejaculatory function will be reviewed. We reviewed the various categories of LUTS treatment including the canonical epidemiology and pathophysiology as well as the surgical and medical treatments for LUTS/BPH. We note that most surgeries and several medical treatments have a certain but ill-defined negative impact on ejaculatory function. Several MISTs and selected medical therapies appear to have little impact on EjD. Both EjD and BPH are very common disorders in men under the care of an urologist. It is well documented that there is a clinical association between these two entities. Unfortunately many of the medical treatments and almost all surgical treatment impact the ejaculatory function of the patient. The surgical treatment of BPH often leads to retrograde ejaculation while medical treatment leads to anejaculation.

  16. Oxidative status parameters in children with urinary tract infection

    PubMed Central

    Petrovic, Stanislava; Bogavac-Stanojevic, Natasa; Kotur-Stevuljevic, Jelena; Peco-Antic, Amira; Ivanisevic, Ivana; Ivanisevic, Jasmina; Paripovic, Dusan; Jelic-Ivanovic, Zorana

    2014-01-01

    Introduction: Urinary tract infection (UTI) is one of the most common bacterial infectious diseases in children. The aim of this study was to determine the total prooxidant and antioxidant capacity of children with UTI, as well as changes of oxidative status parameters according to acute inflammation persistence and acute kidney injury (AKI) development. Materials and methods: The patients enrolled in the study comprised 50 Caucasian children (median age was 6 months) with UTI. Total oxidant status (TOS), total antioxidant status (TAS), oxidative stress index (OSI), inflammation marker C-reactive protein (CRP) and renal function parameters urea and creatinine were analyzed in patient’s serums. Results: According to duration of inflammation during UTI, TAS values were significantly higher (0.99 vs. 0.58 mmol/L, P = 0.017) and OSI values were significantly lower (0.032 vs. 0.041 AU, P = 0.037) in the subjects with longer duration of inflammation than in the subjects with shorter duration of inflammation. We did not find significant difference in basal values of oxidative status parameters according to AKI development. Conclusions: OSI values could detect the simultaneous change of TAS and TOS due to change in the oxidative-antioxidant balance during the recovery of children with UTI. TAS and OSI as markers of oxidative stress during UTI are sensitive to accompanying inflammatory condition. Further investigations are needed to evaluate whether TAS, TOS and OSI could be used to monitor disease severity in children with UTI. PMID:24969920

  17. Focal Hyperhidrosis Associated with Recurrent Urinary Tract Infections.

    PubMed

    Ismail, Dina; Madhwapathi, Vidya; Ladoyanni, Evmorfia

    2016-01-01

    Hyperhidrosis affects almost 3% of the population and is characterized by sweating that occurs in excess of that needed for normal thermoregulation. It can occur as a primary disease or secondary to underlying clinical conditions. Hyperhidrosis can stem from neurogenic sympathetic over activity involving normal eccrine glands. We report the interesting case of a 75-year-old male patient with a 6-month history of new onset secondary focal hyperhidrosis of buttocks, pelvis, and upper thighs. Each time his symptoms worsened he was found to have culture positive urine samples for Escherichia coli (E. coli). He underwent urological investigation and was found to have urethral strictures and cystitis. The hyperhidrosis improved each time his urinary tract infection (UTI) was treated with antibiotics and continued to remain stable with a course of prophylactic trimethoprim. We hypothesize that the patient's urethral strictures led to inhibition in voiding which in turn increased the susceptibility to UTIs. Accumulation of urine and increased bladder pressure in turn raised sympathetic nerve discharge leading to excessive sweating. We recommend that a urine dip form part of the routine assessment of patients presenting with new onset focal hyperhidrosis of pelvis, buttocks, and upper thighs. Timely urological referral should be made for all male patients with recurrent UTI. To the authors' knowledge, there have been no other reports of UTI-associated focal hyperhidrosis. PMID:27379188

  18. Non-Antibiotic Prophylaxis for Urinary Tract Infections

    PubMed Central

    Beerepoot, Mariëlle; Geerlings, Suzanne

    2016-01-01

    Increasing antimicrobial resistance has stimulated interest in non-antibiotic prophylaxis of recurrent urinary tract infections (UTIs). Well-known steps in the pathogenesis of UTIs are urogenital colonization and adherence of uropathogens to uroepithelial cell receptors. To prevent colonization in postmenopausal women, vaginal, but not oral, estrogens have been shown to restore the vagina lactobacilli flora, reduce vaginal colonization with Enterobacteriaceae, and reduce the number of UTIs compared to placebo. Different lactobacilli strains show different results in the prevention of recurrent UTIs. Intravaginal suppositories with Lactobacillus crispatus in premenopausal women and oral capsules with Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 in postmenopausal women are promising. Ascorbic acid (vitamin C) cannot be recommended for the prevention of UTIs. Cranberries are thought to contain proanthocyanidins that can inhibit adherence of P-fimbriated E. coli to the uroepithelial cell receptors. Cranberry products decreased UTI recurrences about 30%–40% in premenopausal women with recurrent UTIs, but are less effective than low-dose antimicrobial prophylaxis. However, the optimal dose of cranberry product has still to be determined. Initially OM-89, a vaccine with 18 heat-killed E. coli extracts, seemed promising, but this was not confirmed in a recently randomized trial. PMID:27092529

  19. Early prediction of urinary tract infection in neonates with hyperbilirubinemia

    PubMed Central

    Nickavar, Azar; Khosravi, Nastaran; Doaei, Mahdiye

    2015-01-01

    Introduction: Hyperbilirubinemia is a common manifestation of infectious disorders during the neonatal period. Urinary tract infection (UTI) is one of the serious bacterial infections with hyperbilirubinemia among newborn infants. Objectives: The aim of this study was to identify the early predictive risk factors of UTI in neonates with hyperbilirubinemia, to prevent its long-term complications. Patients and Methods: A total of 95 neonatal hyperbilirubinemia were evaluated in 2 groups with (n = 40) and without UTI (n = 55). Results: Mean age at diagnosis of UTI was 16.37 ± 8.86 days. Hyperbilirubinemia was detected in 70% of patients during the first week of life. There was a significant difference regarding the age at admission, duration of hyperbilirubinemia, serum bilirubin and creatinine, white blood cells (WBC) , and also Hgb levels between the 2 groups in univariate analysis. However, prolonged jaundice (OR = 10.3, P = 0.001) and serum bilirubin concentration (OR = 5.15, P = 0.001) were statistically associated with a positive urine culture in multivariate analysis. Conclusion: Screening of UTI is recommended in neonates with prolonged unexplained jaundice, leukocytosis, and increased serum creatinine. PMID:26468481

  20. Prevention of urinary tract infections with vaccinium products.

    PubMed

    Davidson, Elyad; Zimmermann, Benno F; Jungfer, Elvira; Chrubasik-Hausmann, Sigrun

    2014-03-01

    Cranberries exert a dose-dependent inhibition of the adherence of E. coli fimbriae to uroepithelial cells. This was demonstrated in vitro but also ex vivo in vitro with urine from cranberry consumers. The active principle has not been identified in detail but type-A proanthocyanidins (PAC) play an important role in the mechanism of action. Since the three species, American cranberry (Vaccinium macrocarpon), European cranberry (Vaccinium oxycoccus) and/or lingonberry (Vaccinium vitis-idaea), have different patterns of type-A PACs, results from one species cannot be transferred to the others. It seems likely that most of the studies with monopreparations from V. macrocarpon were underdosed. Whereas photometric PAC quantification may overestimate the true content on co-active compounds, reversed phase high-performance liquid chromatograpy may underestimate them. Recent studies with PAC doses in the upper range (DMAC method) or declared type-A PAC content in the daily dose reveal a dose-dependent trend of clinical effectiveness, however, with a possible ceiling effect. In order to clarify this, future three-arm studies should investigate Vaccinium preparations with higher type-A PAC doses than previously used. We analysed two popular European vitis-idaea products, a mother juice and a proprietary extract. Both preparations may be appropriate to confirm the Vaccinium urinary tract infection-preventive effect beyond doubt.

  1. Focal Hyperhidrosis Associated with Recurrent Urinary Tract Infections

    PubMed Central

    Madhwapathi, Vidya; Ladoyanni, Evmorfia

    2016-01-01

    Hyperhidrosis affects almost 3% of the population and is characterized by sweating that occurs in excess of that needed for normal thermoregulation. It can occur as a primary disease or secondary to underlying clinical conditions. Hyperhidrosis can stem from neurogenic sympathetic over activity involving normal eccrine glands. We report the interesting case of a 75-year-old male patient with a 6-month history of new onset secondary focal hyperhidrosis of buttocks, pelvis, and upper thighs. Each time his symptoms worsened he was found to have culture positive urine samples for Escherichia coli (E. coli). He underwent urological investigation and was found to have urethral strictures and cystitis. The hyperhidrosis improved each time his urinary tract infection (UTI) was treated with antibiotics and continued to remain stable with a course of prophylactic trimethoprim. We hypothesize that the patient's urethral strictures led to inhibition in voiding which in turn increased the susceptibility to UTIs. Accumulation of urine and increased bladder pressure in turn raised sympathetic nerve discharge leading to excessive sweating. We recommend that a urine dip form part of the routine assessment of patients presenting with new onset focal hyperhidrosis of pelvis, buttocks, and upper thighs. Timely urological referral should be made for all male patients with recurrent UTI. To the authors' knowledge, there have been no other reports of UTI-associated focal hyperhidrosis. PMID:27379188

  2. [Endoluminal ultrasonography in diagnosing and treating upper urinary tract diseases].

    PubMed

    Martov, A G; Saliukova, Iu R; Saliukov, R V

    2002-01-01

    Endoluminal ultrasound scanning (EUS) of the upper urinary tracts (UUT) with intracavitary catheter sensor was performed in 15 patients (7 men and 8 women) aged 21 to 61 years. In 8 patients EUS was diagnostic (in one patient it was made twice, in 2 cases--in combination with ureteroscopy and biopsy), in 7 patients it was a diagnostic stage of the following surgical intervention, in 6--in combination with roentgenoendoscopic correction of strictures of the ureteropelvic segment (UPS) and in 1--in combination with transurethral pyelolithotripsy. A total of 16 procedures were made: 15 transurethral and 1--percutaneous. Endoluminal ultrasonography was conducted not only of the whole ureter but also of renal calycopelvic system (RAPS) which presented endosonographic semiotics of UUT. EUS has diagnosed urate concrement in 4 cases, "cross" vessels which narrowed UPS in 3 cases with late hydronephrotic transformation. In one patient EUS was carried out in combination with ureteroscopy and biopsy as a control examination 6 and 18 months after transurethral endoresection of ureteral tumor. In 6 patients with UPS strictures EUS was made for diagnosis of suspected cross vessels before endopyelotomy. No complications during EUS were encountered. Pilot experience with intracavitary ultrasonography of the UUT shows its high diagnostic potential and clinical value. This technique details inner structures of the ureter and RAPS with adjacent tissues due to minimal distance between the sensor and studied object.

  3. [Localization and functions of c-kit positive cells in the urinary tract].

    PubMed

    Gil, Krzysztof; Urbanowicz, Wiesław; Thor, Piotr

    2009-01-01

    Interstitial cells of Cajal (ICCs) play an important role in the regulation of gut motility as they are responsible for the slow wave activity of smooth muscle. There is strong evidence that several subpopulations of ICC are present in the wall of the urinary tract. This review presents the currently available literature on the localization and proposed functions of interstitial cells of Cajal (ICC) in the urinary tract.

  4. Neural control of lower urinary tract and targets for pharmacological therapy.

    PubMed

    Bortolini, Maria Augusta T; Bilhar, Andreisa P M; Castro, Rodrigo A

    2014-11-01

    Studies on the physiology and pharmacology of the lower urinary tract have brought new information and concepts about the complex neural control of micturition. There are many mechanisms, some proven and others not yet completely understood, in which pharmacological agents may act facilitating the filling, storage, and emptying of the bladder. This review describes the peripheral innervation and the main pathways involved in lower urinary tract control. It also presents potential targets for the treatment of voiding dysfunctions. PMID:25001574

  5. Measurement of urinary lactoferrin as a marker of urinary tract infection.

    PubMed

    Arao, S; Matsuura, S; Nonomura, M; Miki, K; Kabasawa, K; Nakanishi, H

    1999-03-01

    The usefulness of the measurement of urinary lactoferrin (LF) released from polymorphonuclear leukocytes and of an immunochromatography test strip devised for measuring urinary LF for the simple and rapid diagnosis of urinary tract infections (UTI) was evaluated. Urine specimens were collected from apparently healthy persons and patients diagnosed as suffering from UTI. In the preliminary study, the LF concentrations in 121 normal specimens and 88 specimens from patients (60 with UTI) were quantified by an enzyme-linked immunosorbent assay. The LF concentration was 3,300.0 +/- 646.3 ng/ml (average +/- standard error of the mean) in the specimens from UTI patients, whereas it was 30.4 +/- 2.7 ng/ml and 60.3 +/- 14.9 ng/ml in the specimens from healthy persons and the patients without UTI, respectively. Based on these results, a 200-ng/ml LF concentration was chosen as the cutoff value for negativity. Each urine specimen was reexamined with the newly devised immunochromatography (IC) test strip to calculate the indices of efficacy. Based on the cutoff value, it was calculated that the sensitivity, specificity, and positive and negative predictive values of the IC test were 93.3, 89.3, 86.2, and 94.9%, respectively, compared with the results of the microscopic examination of the urine specimens for the presence of leukocytes. The respective indices for UTI were calculated as 95.0, 92.9, 89.7, and 96.6%. The tests were completed within 10 min. These results indicated that urine LF measurement with the IC test strip provides a useful tool for the simple and rapid diagnosis of UTI.

  6. Disseminated adenoviral infection masquerading as lower urinary tract voiding dysfunction in a kidney transplant recipient.

    PubMed

    Aboumohamed, Ahmed; Flechner, Stuart M; Chiesa-Vottero, Andres; Srinivas, Titte R; Mossad, Sherif B

    2014-11-01

    Viral infections continue to cause significant morbidity in immunosuppressed kidney transplant patients. Although cytomegalovirus, Epstein-Barr virus and polyoma "BK" virus are more frequently encountered, the Adenovirus can cause multi-organ system infections, and may be difficult to diagnose because it is not often considered in the initial work up in kidney transplant recipients. We present an unusual case of a kidney recipient 1 year post-transplant with disseminated adenoviral infection, who had an initial presentation of lower urinary tract voiding dysfunction with hematuria and sterile pyuria. This progressed to a severe tubulointerstitial nephritis and acute kidney injury that improved with reduction of immunosuppression. Serial blood viral loads are useful for monitoring the course of infection. Urinary adenoviral infection should be considered in the differential diagnosis whenever a kidney transplant recipient presents with unexplained lower tract voiding dysfunction, hematuria, and sterile pyuria. The allograft kidney and bladder can be targets of viral proliferation. Early diagnosis with reduction of immunosuppressive therapy is essential to clear the virus and maintain allograft function. PMID:23816478

  7. Patients with Urinary Incontinence Appear More Likely to Develop Upper Urinary Tract Stones: A Nationwide, Population-Based Study with 8-Year Follow-Up

    PubMed Central

    Chung, Hsiao-Jen; Lin, Alex Tong-Long; Lin, Chih-Chieh; Chen, Tzeng-Ji; Chen, Kuang-Kuo

    2016-01-01

    This study aimed to investigate associations between primary urinary incontinence and development of upper urinary tract stones in a nationwide population in Taiwan. Data of 1,777 adults with primary urinary incontinence and 26,655 controls (groups A, B, and C) without urinary incontinence at study inception were retrieved from the National Health Insurance System database in Taiwan and were analyzed retrospectively. No enrolled subjects had previous diagnosis of upper urinary tract stones or spinal cord injury. All subjects were followed through end of 2009, with a minimum follow-up of 8 years. A greater percentage of study subjects (334/1777, 18.8%) developed upper urinary tract stones than that of control groups A (865/8885, 9.7%) and B (888/8885, 10%), and C (930/8885, 10.5%) (all p-values < 0.0001). Urinary incontinence was associated with significantly increased risk of developing urinary tract stones (HR 1.99, 95% CI, 1.70–2.34, p < 0.001). Age and metabolic syndrome status were both associated with developing upper urinary tract stones (both p-values < 0.0001). After adjusting for metabolic syndrome, regression analysis showed that urinary incontinence was still associated with a significantly increased risk of developing upper urinary tract stones (HR 1.99, 95% CI = 1.76–2.26, p < 0.0001). Long-term follow-up of Taiwanese patients with primary urinary incontinence suggests that urinary incontinence is associated with a significantly increased risk of developing upper urinary tract stones. Study findings suggest that physicians treating patients with urinary incontinence should give attention to early detection of upper urinary tract stones. PMID:27536881

  8. Patients with Urinary Incontinence Appear More Likely to Develop Upper Urinary Tract Stones: A Nationwide, Population-Based Study with 8-Year Follow-Up.

    PubMed

    Chung, Hsiao-Jen; Lin, Alex Tong-Long; Lin, Chih-Chieh; Chen, Tzeng-Ji; Chen, Kuang-Kuo

    2016-01-01

    This study aimed to investigate associations between primary urinary incontinence and development of upper urinary tract stones in a nationwide population in Taiwan. Data of 1,777 adults with primary urinary incontinence and 26,655 controls (groups A, B, and C) without urinary incontinence at study inception were retrieved from the National Health Insurance System database in Taiwan and were analyzed retrospectively. No enrolled subjects had previous diagnosis of upper urinary tract stones or spinal cord injury. All subjects were followed through end of 2009, with a minimum follow-up of 8 years. A greater percentage of study subjects (334/1777, 18.8%) developed upper urinary tract stones than that of control groups A (865/8885, 9.7%) and B (888/8885, 10%), and C (930/8885, 10.5%) (all p-values < 0.0001). Urinary incontinence was associated with significantly increased risk of developing urinary tract stones (HR 1.99, 95% CI, 1.70-2.34, p < 0.001). Age and metabolic syndrome status were both associated with developing upper urinary tract stones (both p-values < 0.0001). After adjusting for metabolic syndrome, regression analysis showed that urinary incontinence was still associated with a significantly increased risk of developing upper urinary tract stones (HR 1.99, 95% CI = 1.76-2.26, p < 0.0001). Long-term follow-up of Taiwanese patients with primary urinary incontinence suggests that urinary incontinence is associated with a significantly increased risk of developing upper urinary tract stones. Study findings suggest that physicians treating patients with urinary incontinence should give attention to early detection of upper urinary tract stones. PMID:27536881

  9. Localization of urinary tract infection in elderly, institutionalized women with asymptomatic bacteriuria.

    PubMed

    Nicolle, L E; Muir, P; Harding, G K; Norris, M

    1988-01-01

    We determined the site of urinary tract infection in 51 elderly, institutionalized women (mean age, 80.5 years) with asymptomatic bacteriuria by using the Fairley bladder washout technique. Thirty-four (67%) infections were localized in the kidney and 17 (33%) in the bladder. Women with renal infection were older than those with bladder infection (81.9 vs. 77.6 years of age; P = .04). The antibody-coated bacteria test had a sensitivity of 58%, specificity of 71%, positive predictive value of 82%, and negative predictive value of 43% for upper-urinary-tract infection. A quantitative urinary leukocyte count of greater than or equal to 20 leukocytes/mm3 had a positive predictive value of 80% and a negative predictive value of 88% for upper-urinary-tract infection. This study suggests that the majority of elderly, institutionalized women with asymptomatic bacteriuria have upper-urinary-tract infection. Both the antibody-coated bacteria test and the quantitative urinary leukocyte count may be useful as noninvasive tests for localization of urinary tract infection in this population.

  10. Are we closer to seeing carcinoma in situ in the upper urinary tract?

    PubMed Central

    Aboumarzouk, Omar

    2016-01-01

    Introduction There is observed increase in detection rate of upper urinary tract urothelial cancer worldwide. This is a result of improved imaging as well as implementation of novel technologies of direct visualization of upper urinary tract. Standard techniques still remain insufficient to diagnose flat urothelial lesions. Carcinoma in situ is characterized by flat disordered proliferation of urothelial cells with marked cytologic abnormality, which occur within one cell layer as well as full thickness urothelium and therefore requires a better technology to pick up early and subtle mucosal changes. Material and methods The review presents available diagnostic tools in detection of upper urinary tract urothelial cancer and their ability to depict carcinoma in situ. Results Ureterorenoscopy is an investigation of choice as various promising techniques are under pilot investigations to enhance visualization of upper urinary tract carcinoma in situ. So far only photodynamic diagnosis has been reported to be as effective in detection of carcinoma in situ in the upper as within the lower urinary tract. Conclusions Although we are close to see upper urinary tract carcinoma in situ all new promising diagnostic techniques still require further validation in multicenter clinical trials to indicate any change to current recommendations. PMID:27551552

  11. Epidemiologic approach for early detection and control of renal and urinary tract diseases in rural populations.

    PubMed

    Sayed, Hanan A; Hammam, Olfat; Sabry, Hoda; Akl, Maha; Amin, Tarek; El Lithy, Tarek; Roshdy, Mamdouh; El Ganzoury, Hossam

    2007-04-01

    The dipstick testing, microscopic examination of urine and urine cytology were performed for inhabitants from two rural villages (El Shobak El Sharki, V.1 & El Katta, V.2) in Giza G. The proliferating cell nuclear antigen (PCNA) and Schistosoma haematobium antigen were done by immuno-histochemical stain to confirm diagnosis. Also, they were subjected to medical questionnaire, clinical examination, ultra-sonography of kidneys and urinary tract. The results showed that V.2 had higher percentage of haematuria, proteinuria, glucosuria and lower urinary tract infection than V.1. Crystaluria was higher in V.1. Sensitivity of dipstick testing compared to microscopic examination was 26.6%, & specificity was 78.7%. Lower urinary tract infection cytologically detected was 44.2% sensitivity & 62.5% specificity compared to pyuria detected by microscopic examination of urine. Among those suffering variable urinary abnormalities, schistosome antigen was not detected in any fixed urine samples in comparison to corresponding confirmed positive controls. Urine cytology detected urinary tract infection, crystaluria, dysplasia and atypia, squamous metaplasia and transitional cell carcinoma (TCC). PCNA positivity was found in TCC (100%), dysplasia (50%) and squamous metaplasia (28.6%). So, microscopic examination of urine proved valuable for tract abnormalities as pyuria, haematuria and crystaluria. Also, urine cytology is a must for malignancy of urinary tract especially in adult males. PMID:17580586

  12. Decreasing urinary tract infections through staff development, outcomes, and nursing process.

    PubMed

    Ribby, Kevin J

    2006-01-01

    For patients with indwelling catheters, even with current standards of care and evidence-based practice, urinary tract infections continue to be a problem. Data were gathered on urinary catheter usage in a large, rural acute care hospital, and outcomes profiles were developed (including mortality, morbidity, length of stay, and costs). An innovative poster and video approach focusing on alternatives to urinary catheterization, early discontinuance of catheters, and proper insertion and care techniques were used to educate nursing staff and improve outcomes.

  13. Novel antiseptic urinary catheters for prevention of urinary tract infections: correlation of in vivo and in vitro test results.

    PubMed

    Hachem, Ray; Reitzel, Ruth; Borne, Agatha; Jiang, Ying; Tinkey, Peggy; Uthamanthil, Rajesh; Chandra, Jyotsna; Ghannoum, Mahmoud; Raad, Issam

    2009-12-01

    Urinary catheters are widely used for hospitalized patients and are often associated with high rates of urinary tract infection. We evaluated in vitro the antiadherence activity of a novel antiseptic Gendine-coated urinary catheter against several multidrug-resistant bacteria. Gendine-coated urinary catheters were compared to silver hydrogel-coated Foley catheters and uncoated catheters. Bacterial biofilm formation was assessed by quantitative culture and scanning electron microscopy. These data were further correlated to an in vivo rabbit model. We challenged 31 rabbits daily for 4 days by inoculating the urethral meatus with 1.0 x 10(9) CFU streptomycin-resistant Escherichia coli per day. In vitro, Gendine-coated urinary catheters reduced the CFU of all organisms tested for biofilm adherence compared with uncoated and silver hydrogel-coated catheters (P < 0.004). Scanning electron microscopy analysis showed that a thick biofilm overlaid the control catheter and the silver hydrogel-coated catheters but not the Gendine-coated urinary catheter. Similar results were found with the rabbit model. Bacteriuria was present in 60% of rabbits with uncoated catheters and 71% of those with silver hydrogel-coated catheters (P < 0.01) but not in those with Gendine-coated urinary catheters. No rabbits with Gendine-coated urinary catheters had invasive bladder infections. Histopathologic assessment revealed no differences in toxicity or staining. Gendine-coated urinary catheters were more efficacious in preventing catheter-associated colonization and urinary tract infections than were silver hydrogel-coated Foley catheters and uncoated catheters.

  14. How botulinum toxin in neurogenic detrusor overactivity can reduce upper urinary tract damage?

    PubMed Central

    Baron, Maximilien; Grise, Philippe; Cornu, Jean-Nicolas

    2016-01-01

    Intradetrusor injections of botulinum toxin are the cornerstone of medical treatment of neurogenic detrusor overactivity. The primary aim of this treatment is to ensure a low pressure regimen in the urinary bladder, but the mechanisms leading to long-term protection of the urinary tract remain poorly understood. In this paper, we highlight the potential benefits of intradetrusor injections of botulinum toxin regarding local effects on the bladder structures, urinary tract infections, stone disease, vesico ureteral reflux, hydronephrosis, renal function based on a comprehensive literature review. PMID:26981445

  15. [Relationship between lower urinary tract symptoms in men and erectile dysfunction].

    PubMed

    Alcántara Montero, A; Brenes Bermúdez, F J; Pérez Feito, D

    2016-04-01

    The relationship between lower urinary tract symptoms (LUTS) and erectile dysfunction (ED) is the result of their greater association in advanced age. Nevertheless, several investigations show that urinary tract symptoms have an independent relationship with sexual dysfunction and lower satisfaction. Likewise, the severity of LUTS correlates with the magnitude of sexual dysfunction, which suggests a possible causal relationship. The combined therapeutic approach of these 2 entities (ED and LUTS) brings a benefit to the patient both in urinary symptoms and sexual sphere. This review focuses on the relationship between ED, LUTS due to benign prostatic hyperplasia, and related therapies. PMID:26452608

  16. Risk Factors for Urinary Tract Infections in Cardiac Surgical Patients

    PubMed Central

    Gillen, Jacob R.; Isbell, James M.; Michaels, Alex D.; Lau, Christine L.

    2015-01-01

    Abstract Background: Risk factors for catheter-associated urinary tract infections (CAUTIs) in patients undergoing non-cardiac surgical procedures have been well documented. However, the variables associated with CAUTIs in the cardiac surgical population have not been clearly defined. Therefore, the purpose of this study was to investigate risk factors associated with CAUTIs in patients undergoing cardiac procedures. Methods: All patients undergoing cardiac surgery at a single institution from 2006 through 2012 (4,883 patients) were reviewed. Patients with U.S. Centers for Disease Control (CDC) criteria for CAUTI were identified from the hospital's Quality Assessment database. Pre-operative, operative, and post-operative patient factors were evaluated. Univariate and multivariable analyses were used to identify significant correlations between perioperative characteristics and CAUTIs. Results: There were 55 (1.1%) documented CAUTIs in the study population. On univariate analysis, older age, female gender, diabetes mellitus, cardiogenic shock, urgent or emergent operation, packed red blood cell (PRBC) units transfused, and intensive care unit length of stay (ICU LOS) were all significantly associated with CAUTI [p<0.05]. On multivariable logistic regression, older age, female gender, diabetes mellitus, and ICU LOS remained significantly associated with CAUTI. Additionally, there was a significant association between CAUTI and 30-d mortality on univariate analysis. However, when controlling for common predictors of operative mortality on multivariable analysis, CAUTI was no longer associated with mortality. Conclusions: There are several identifiable risk factors for CAUTI in patients undergoing cardiac procedures. CAUTI is not independently associated with increased mortality, but it does serve as a marker of sicker patients more likely to die from other comorbidities or complications. Therefore, awareness of the high-risk nature of these patients should lead to

  17. Bacteriophages as Potential Treatment for Urinary Tract Infections

    PubMed Central

    Sybesma, Wilbert; Zbinden, Reinhard; Chanishvili, Nino; Kutateladze, Mzia; Chkhotua, Archil; Ujmajuridze, Aleksandre; Mehnert, Ulrich; Kessler, Thomas M.

    2016-01-01

    Background: Urinary tract infections (UTIs) are among the most prevalent microbial diseases and their financial burden on society is substantial. The continuing increase of antibiotic resistance worldwide is alarming so that well-tolerated, highly effective therapeutic alternatives are urgently needed. Objective: To investigate the effect of bacteriophages on Escherichia coli and Klebsiella pneumoniae strains isolated from the urine of patients suffering from UTIs. Material and methods: Forty-one E. coli and 9 K. pneumoniae strains, isolated from the urine of patients suffering from UTIs, were tested in vitro for their susceptibility toward bacteriophages. The bacteriophages originated from either commercially available bacteriophage cocktails registered in Georgia or from the bacteriophage collection of the George Eliava Institute of Bacteriophage, Microbiology and Virology. In vitro screening of bacterial strains was performed by use of the spot-test method. The experiments were implemented three times by different groups of scientists. Results: The lytic activity of the commercial bacteriophage cocktails on the 41 E. coli strains varied between 66% (Pyo bacteriophage) and 93% (Enko bacteriophage). After bacteriophage adaptation of the Pyo bacteriophage cocktail, its lytic activity was increased from 66 to 93% and only one E. coli strain remained resistant. One bacteriophage of the Eliava collection could lyse all 9 K. pneumoniae strains. Conclusions: Based on the high lytic activity and the potential of resistance optimization by direct adaption of bacteriophages as reported in this study, and in view of the continuing increase of antibiotic resistance worldwide, bacteriophage therapy is a promising treatment option for UTIs highly warranting randomized controlled trials. PMID:27148173

  18. Interactions between Cytokines, Congenital Anomalies of Kidney and Urinary Tract and Chronic Kidney Disease

    PubMed Central

    Simões e Silva, Ana Cristina; Valério, Flávia Cordeiro; Vasconcelos, Mariana Affonso; Miranda, Débora Marques; Oliveira, Eduardo Araújo

    2013-01-01

    Fetal hydronephrosis is the most common anomaly detected on antenatal ultrasound, affecting 1–5% of pregnancies. Postnatal investigation has the major aim in detecting infants with severe urinary tract obstruction and clinically significant urinary tract anomalies among the heterogeneous universe of patients. Congenital uropathies are frequent causes of pediatric chronic kidney disease (CKD). Imaging techniques clearly contribute to this purpose; however, sometimes, these exams are invasive, very expensive, and not sufficient to precisely define the best approach as well as the prognosis. Recently, biomarkers have become a focus of clinical research as potentially useful diagnostic tools in pediatric urological diseases. In this regard, recent studies suggest a role for cytokines and chemokines in the pathophysiology of CAKUT and for the progression to CKD. Some authors proposed that the evaluation of these inflammatory mediators might help the management of postnatal uropathies and the detection of patients with high risk to developed chronic kidney disease. Therefore, the aim of this paper is to revise general aspects of cytokines and the link between cytokines, CAKUT, and CKD by including experimental and clinical evidence. PMID:24066006

  19. Antibacterial potential of silver nanoparticles against isolated urinary tract infectious bacterial pathogens

    NASA Astrophysics Data System (ADS)

    Jacob Inbaneson, Samuel; Ravikumar, Sundaram; Manikandan, Nachiappan

    2011-12-01

    The silver nanoparticles were synthesized by chemical reduction method and the nanoparticles were characterized using ultraviolet-visible (UV-Vis) absorption spectroscopy and X-ray diffraction (XRD) studies. The synthesized silver nanoparticles were investigated to evaluate the antibacterial activity against urinary tract infectious (UTIs) bacterial pathogens. Thirty-two bacteria were isolated from mid urine samples of 25 male and 25 female patients from Thondi, Ramanathapuram District, Tamil Nadu, India and identified by conventional methods. Escherichia coli was predominant (47%) followed by Pseudomonas aeruginosa (22%), Klebsiella pneumoniae (19%), Enterobacter sp. (6%), Proteus morganii (3%) and Staphylococcus aureus (3%). The antibacterial activity of silver nanoparticles was evaluated by disc diffusion assay. P. aeruginosa showed maximum sensitivity (11 ± 0.58 mm) followed by Enterobacter sp. (8 ± 0.49 mm) at a concentration of 20 μg disc-1 and the sensitivity was highly comparable with the positive control kanamycin and tetracycline. K. pneumoniae, E. coli, P. morganii and S. aureus showed no sensitivity against all the tested concentrations of silver nanoparticles. The results provided evidence that, the silver nanoparticles might indeed be the potential sources to treat urinary tract infections caused by P. aeruginosa and Enterobacter sp.

  20. [Genetic Basis of Congenital Anomalies of the Kidney and Urinary Tract].

    PubMed

    Bodria, Monica; Sanna-Cherchi, Simone

    2015-01-01

    Congenital anomalies of the kidney and urinary tract (CAKUT) occur have an incidence of about 1% and they are one of the most common birth defects. CAKUT is the most common cause of end stage renal disease in children, leading to high morbidity and mortality in these patients. Recent studies indicate a strong genetic component in the determination of CAKUT. The genetic architecture of these malformations involves both point mutations and structural variants. The recent improvement in next-generation sequencing technologies resulted in a boost on discovery of new genes involved in CAKUT. Results from micro-array study have demonstrated that rare structural variants are an important source of genetic variation in patients with CAKUT. Moreover, these structural variants have been proven to be associated with developmental disorders that develop later in life, especially neurodevelopment diseases, such as autism, schizophrenia, epilepsy, intellectual disability, and others. The easy pre-natal diagnosis of CAKUT by ultrasound and the possibility of a rapid molecular diagnosis in a significant fraction of patients, implicate the kidney and urinary tract as new possible sentinels for other diseases that develop later in life, bearing strong implications for personalized medicine. PMID:26479062

  1. Yap and Taz are required for Ret-dependent urinary tract morphogenesis.

    PubMed

    Reginensi, Antoine; Hoshi, Masato; Boualia, Sami Kamel; Bouchard, Maxime; Jain, Sanjay; McNeill, Helen

    2015-08-01

    Despite the high occurrence of congenital abnormalities of the lower urinary tract in humans, the molecular, cellular and morphological aspects of their development are still poorly understood. Here, we use a conditional knockout approach to inactivate within the nephric duct (ND) lineage the two effectors of the Hippo pathway, Yap and Taz. Deletion of Yap leads to hydronephrotic kidneys with blind-ending megaureters at birth. In Yap mutants, the ND successfully migrates towards, and contacts, the cloaca. However, close analysis reveals that the tip of the Yap(-/-) ND forms an aberrant connection with the cloaca and does not properly insert into the cloaca, leading to later detachment of the ND from the cloaca. Taz deletion from the ND does not cause any defect, but analysis of Yap(-/-);Taz(-/-) NDs indicates that both genes play partially redundant roles in ureterovesical junction formation. Aspects of the Yap(-/-) phenotype resemble hypersensitivity to RET signaling, including excess budding of the ND, increased phospho-ERK and increased expression of Crlf1, Sprouty1, Etv4 and Etv5. Importantly, the Yap(ND) (-/-) ND phenotype can be largely rescued by reducing Ret gene dosage. Taken together, these results suggest that disrupting Yap/Taz activities enhances Ret pathway activity and contributes to pathogenesis of lower urinary tract defects in human infants. PMID:26243870

  2. Virulence factors in Proteus bacteria from biofilm communities of catheter-associated urinary tract infections.

    PubMed

    Hola, Veronika; Peroutkova, Tereza; Ruzicka, Filip

    2012-07-01

    More than 40% of nosocomial infections are those of the urinary tract, most of these occurring in catheterized patients. Bacterial colonization of the urinary tract and catheters results not only in infection, but also various complications, such as blockage of catheters with crystalline deposits of bacterial origin, generation of gravels and pyelonephritis. The diversity of the biofilm microbial community increases with duration of catheter emplacement. One of the most important pathogens in this regard is Proteus mirabilis. The aims of this study were to identify and assess particular virulence factors present in catheter-associated urinary tract infection (CAUTI) isolates, their correlation and linkages: three types of motility (swarming, swimming and twitching), the ability to swarm over urinary catheters, biofilm production in two types of media, urease production and adherence of bacterial cells to various types of urinary tract catheters. We examined 102 CAUTI isolates and 50 isolates taken from stool samples of healthy people. Among the microorganisms isolated from urinary catheters, significant differences were found in biofilm-forming ability and the swarming motility. In comparison with the control group, the microorganisms isolated from urinary catheters showed a wider spectrum of virulence factors. The virulence factors (twitching motility, swimming motility, swarming over various types of catheters and biofilm formation) were also more intensively expressed.

  3. Spread of Enterococcal Surface Protein in Antibiotic Resistant Entero-coccus faecium and Enterococcus faecalis isolates from Urinary Tract Infections

    PubMed Central

    Kafil, Hossein S; Mobarez, Ashraf M

    2015-01-01

    Enterococci rank among leading cause of nosocomial bacteremia and urinary tract infection in hospital and community acquired infections. Several traits that may contribute to enhanced virulence have been identified in Enterococci. Extracellular surface protein (Esp) is a virulence factor that contributes in biofilm formation and resistance to environmental stresses. In this study we aimed to determine occurrence of esp in E. faecium and E. faecalis isolates isolated from urinary tract infections and to investigate whether there is any correlation between presence of esp and antibiotic resistance. One hundred and sixty six isolates were collected from patients with UTI and after identification by biochemical and PCR, antibiotic resistances were examined. The presence of esp was investigated by primer-specific PCR. 43.3% of isolates identified as E. faecium and 56.7% as E. faecalis. The esp gene was found in 76.1% of E. faecium isolates and 77.9% of E. faecalis isolate. There were significant correlation between esp positive E. faecium and resistance to Vancomycin (p<0.01), also in E.faecalis we found correlation between esp positive and resistance to Ampicillin, Chloramphenicol and Tetracycline (p<0.01, p<0.01, p<0.01 respectively). Occurrence of esp in our isolates from urinary tract infection was high that indicates importance of this gene in urinary tract infections and shows importance of ability to forming biofilm and hydrophobicity of surface of Enterococci for causing urinary infection by Enterococci. Also, our finding showed significant correlation between resistance to antibiotics and presence of esp in Enterococci. PMID:26161154

  4. Host-specific induction of Escherichia coli fitness genes during human urinary tract infection.

    PubMed

    Subashchandrabose, Sargurunathan; Hazen, Tracy H; Brumbaugh, Ariel R; Himpsl, Stephanie D; Smith, Sara N; Ernst, Robert D; Rasko, David A; Mobley, Harry L T

    2014-12-23

    Uropathogenic Escherichia coli (UPEC) is the predominant etiological agent of uncomplicated urinary tract infection (UTI), manifested by inflammation of the urinary bladder, in humans and is a major global public health concern. Molecular pathogenesis of UPEC has been primarily examined using murine models of UTI. Translational research to develop novel therapeutics against this major pathogen, which is becoming increasingly antibiotic resistant, requires a thorough understanding of mechanisms involved in pathogenesis during human UTIs. Total RNA-sequencing (RNA-seq) and comparative transcriptional analysis of UTI samples to the UPEC isolates cultured in human urine and laboratory medium were used to identify novel fitness genes that were specifically expressed during human infection. Evidence for UPEC genes involved in ion transport, including copper efflux, nickel and potassium import systems, as key fitness factors in uropathogenesis were generated using an experimental model of UTI. Translational application of this study was investigated by targeting Cus, a bacterial copper efflux system. Copper supplementation in drinking water reduces E. coli colonization in the urinary bladder of mice. Additionally, our results suggest that anaerobic processes in UPEC are involved in promoting fitness during UTI in humans. In summary, RNA-seq was used to establish the transcriptional signature in UPEC during naturally occurring, community acquired UTI in women and multiple novel fitness genes used by UPEC during human infection were identified. The repertoire of UPEC genes involved in UTI presented here will facilitate further translational studies to develop innovative strategies against UTI caused by UPEC.

  5. Synchrotron X-ray fluorescence microscopy of gallium in bladder tissue following gallium maltolate administration during urinary tract infection.

    PubMed

    Ball, Katherine R; Sampieri, Francesca; Chirino, Manuel; Hamilton, Don L; Blyth, Robert I R; Sham, Tsun-Kong; Dowling, Patricia M; Thompson, Julie

    2013-11-01

    A mouse model of cystitis caused by uropathogenic Escherichia coli was used to study the distribution of gallium in bladder tissue following oral administration of gallium maltolate during urinary tract infection. The median concentration of gallium in homogenized bladder tissue from infected mice was 1.93 μg/g after daily administration of gallium maltolate for 5 days. Synchrotron X-ray fluorescence imaging and X-ray absorption spectroscopy of bladder sections confirmed that gallium arrived at the transitional epithelium, a potential site of uropathogenic E. coli infection. Gallium and iron were similarly but not identically distributed in the tissues, suggesting that at least some distribution mechanisms are not common between the two elements. The results of this study indicate that gallium maltolate may be a suitable candidate for further development as a novel antimicrobial therapy for urinary tract infections caused by uropathogenic E. coli.

  6. Synchrotron X-Ray Fluorescence Microscopy of Gallium in Bladder Tissue following Gallium Maltolate Administration during Urinary Tract Infection

    PubMed Central

    Sampieri, Francesca; Chirino, Manuel; Hamilton, Don L.; Blyth, Robert I. R.; Sham, Tsun-Kong; Dowling, Patricia M.; Thompson, Julie

    2013-01-01

    A mouse model of cystitis caused by uropathogenic Escherichia coli was used to study the distribution of gallium in bladder tissue following oral administration of gallium maltolate during urinary tract infection. The median concentration of gallium in homogenized bladder tissue from infected mice was 1.93 μg/g after daily administration of gallium maltolate for 5 days. Synchrotron X-ray fluorescence imaging and X-ray absorption spectroscopy of bladder sections confirmed that gallium arrived at the transitional epithelium, a potential site of uropathogenic E. coli infection. Gallium and iron were similarly but not identically distributed in the tissues, suggesting that at least some distribution mechanisms are not common between the two elements. The results of this study indicate that gallium maltolate may be a suitable candidate for further development as a novel antimicrobial therapy for urinary tract infections caused by uropathogenic E. coli. PMID:23877680

  7. Lower Levels of Urinary Nerve Growth Factor Might Predict Recurrent Urinary Tract Infections in Women

    PubMed Central

    2016-01-01

    Purpose: To investigate the changes in urinary nerve growth factor (uNGF) levels after acute urinary tract infection (UTI) and to assess the role of uNGF in predicting UTI recurrence in women. Methods: Women with uncomplicated, symptomatic UTIs were enrolled. Cephalexin 500 mg (every 6 hours) was administered for 7–14 days to treat acute UTIs. Subsequently, the patients were randomized to receive either sulfamethoxazole/trimethoprim 800 mg/160 mg daily at bedtime, or celecoxib 200 mg daily for 3 months and were monitored for up to 12 months. NGF levels in the urine were determined at baseline, 1, 4, and 12 weeks after the initiation of prophylactic therapy, and were compared between women with first-time UTIs and recurrent UTIs, sulfamethoxazole/trimethoprim and celecoxib-treated women, and no UTI recurrence and UTI recurrence that occurred during the follow-up period. Twenty women free of UTIs served as controls. Results: A total of 139 women with UTI and 20 controls were enrolled in the study, which included 50 women with a first-time UTI and 89 women with recurrent UTIs. Thirty-seven women completed the study. Women with recurrent UTIs (n=23) had a trend of lower uNGF levels than women with first-time UTIs (n=14). During follow-up, 9 women had UTI recurrence. The serial uNGF levels in women with UTI recurrence were significantly lower than those in women who did not have UTI recurrence during the follow-up period. Conclusions: The lower levels of uNGF in women with recurrent UTI and the incidence of UTI recurrence during follow-up suggest that lower uNGF might reflect the defective innate immunity in women with recurrent UTI. PMID:27032555

  8. Convective Water Vapor Energy for Lower Urinary Tract Symptoms/Benign Prostatic Hyperplasia.

    PubMed

    DeLay, Kenneth Jackson; McVary, Kevin T

    2016-08-01

    Benign prostatic hyperplasia (BPH) refers to proliferation of smooth muscle and epithelial cells within the transition zone of the prostate. Half of men over 40 develop histologic BPH. About half of men with BPH develop an enlarged prostate gland, called benign prostatic enlargement; among these, about half develop some degree of bladder outlet obstruction. Bladder outlet obstruction and changes in smooth muscle tone and resistance may result in lower urinary tract symptoms, including storage disturbances (such as daytime urinary urgency, frequency, and nocturia) and voiding disturbances (such as urinary hesitancy, weak urinary stream, straining to void, and prolonged voiding). PMID:27476129

  9. Effects of exercise training on urinary tract function after spinal cord injury.

    PubMed

    Hubscher, Charles H; Montgomery, Lynnette R; Fell, Jason D; Armstrong, James E; Poudyal, Pradeepa; Herrity, April N; Harkema, Susan J

    2016-06-01

    Spinal cord injury (SCI) causes dramatic changes in the quality of life, including coping with bladder dysfunction which requires repeated daily and nightly catheterizations. Our laboratory has recently demonstrated in a rat SCI model that repetitive sensory information generated through task-specific stepping and/or loading can improve nonlocomotor functions, including bladder function (Ward PJ, Herrity AN, Smith RR, Willhite A, Harrison BJ, Petruska JC, Harkema SJ, Hubscher CH. J Neurotrauma 31: 819-833, 2014). To target potential underlying mechanisms, the current study included a forelimb-only exercise group to ascertain whether improvements may be attributed to general activity effects that impact target organ-neural interactions or to plasticity of the lumbosacral circuitry that receives convergent somatovisceral inputs. Male Wistar rats received a T9 contusion injury and were randomly assigned to three groups 2 wk postinjury: quadrupedal locomotion, forelimb exercise, or a nontrained group. Throughout the study (including preinjury), all animals were placed in metabolic cages once a week for 24 h to monitor water intake and urine output. Following the 10-wk period of daily 1-h treadmill training, awake cystometry data were collected and bladder and kidney tissue harvested for analysis. Metabolic cage frequency-volume measurements of voiding and cystometry reveal an impact of exercise training on multiple SCI-induced impairments related to various aspects of urinary tract function. Improvements in both the quadrupedal and forelimb-trained groups implicate underlying mechanisms beyond repetitive sensory information from the hindlimbs driving spinal network excitability of the lumbosacral urogenital neural circuitry. Furthermore, the impact of exercise training on the upper urinary tract (kidney) underscores the health benefit of activity-based training on the entire urinary system within the SCI population. PMID:26984956

  10. Candiduria in Catheter Associated Urinary Tract Infection with Special Reference to Biofilm Production

    PubMed Central

    Rishpana, Mythreyi Shekar

    2015-01-01

    Introduction Urinary tract infections as a result of Candida species are becoming increasingly common in hospital settings. The association is higher in patients with prolonged urinary catheterization and also various pre-disposing factors. Aim This study was done to look into the significance of candiduria in the catheterized patients and to perform microbial catheterization of yeast and biofilm detection by tube method to guide treatment protocol. Materials and Methods This is a prospective study. One hundred urine samples were collected over a period of 3 months. Specimens included were those of patients presenting with nosocomial Urinary tract infection (UTI) after 72 hours of hospitalization. The urine samples obtained were immediately processed in microbiology laboratory by semi-quantitative method as per standard protocol. All yeast isolates were stored for further microbial characterization. Biofilm production was detected by tube method. Results In the present study we observed that out of 100 samples obtained from catheterized patients presenting with nosocomial UTI 26% were caused by Candida species. Among the 26 Candida isolates 16 (61.53%) were non albicans Candida and 10(38.47%) were Candida albicans. Out 26 Candida isolates, 14(53.84%) of the candida isolates were found to produce biofilm. Biofilm production was found to occur more frequently among non albicans Candida 10(62.5%) than Candida albicans 4(40.0%). Conclusion The present study reiterates the presence of candiduria in catheterized patients. Non-albicans candida speices are replacing candida albicans as the predominant pathogen for nosocomial UTI. It was also observed that Biofilm formation is seen more frequently with non albicans candida species than with Candida albicans. PMID:26557518

  11. Effects of exercise training on urinary tract function after spinal cord injury.

    PubMed

    Hubscher, Charles H; Montgomery, Lynnette R; Fell, Jason D; Armstrong, James E; Poudyal, Pradeepa; Herrity, April N; Harkema, Susan J

    2016-06-01

    Spinal cord injury (SCI) causes dramatic changes in the quality of life, including coping with bladder dysfunction which requires repeated daily and nightly catheterizations. Our laboratory has recently demonstrated in a rat SCI model that repetitive sensory information generated through task-specific stepping and/or loading can improve nonlocomotor functions, including bladder function (Ward PJ, Herrity AN, Smith RR, Willhite A, Harrison BJ, Petruska JC, Harkema SJ, Hubscher CH. J Neurotrauma 31: 819-833, 2014). To target potential underlying mechanisms, the current study included a forelimb-only exercise group to ascertain whether improvements may be attributed to general activity effects that impact target organ-neural interactions or to plasticity of the lumbosacral circuitry that receives convergent somatovisceral inputs. Male Wistar rats received a T9 contusion injury and were randomly assigned to three groups 2 wk postinjury: quadrupedal locomotion, forelimb exercise, or a nontrained group. Throughout the study (including preinjury), all animals were placed in metabolic cages once a week for 24 h to monitor water intake and urine output. Following the 10-wk period of daily 1-h treadmill training, awake cystometry data were collected and bladder and kidney tissue harvested for analysis. Metabolic cage frequency-volume measurements of voiding and cystometry reveal an impact of exercise training on multiple SCI-induced impairments related to various aspects of urinary tract function. Improvements in both the quadrupedal and forelimb-trained groups implicate underlying mechanisms beyond repetitive sensory information from the hindlimbs driving spinal network excitability of the lumbosacral urogenital neural circuitry. Furthermore, the impact of exercise training on the upper urinary tract (kidney) underscores the health benefit of activity-based training on the entire urinary system within the SCI population.

  12. Lower Urinary Tract Dysfunction in Elementary School Children: Results of a Cross-Sectional Teacher Survey

    PubMed Central

    Ko, Lauren N.; Chuang, Kai-wen; Champeau, Angelique; Allen, I. Elaine; Copp, Hillary L.

    2016-01-01

    Purpose Lower urinary tract dysfunction in school-aged children is common and yet data are lacking on current teacher practice regarding bathroom use and daytime incontinence during classroom hours. We determined the prevalence of elementary school teachers who promote lower urinary tract health and identified predictors for and against such behavioral promotion. Materials and Methods We performed an electronic cross-sectional survey among self-identified teachers using targeted social media advertisement during a 1-week period in July 2014. The empirical survey tool consisted of 27 questions and collected data on 5 principal domains, including 1) teacher demographics, 2) rules and regulations on water intake and bathroom use during classroom hours, 3) characteristics of school bathrooms in terms of safety, supervision and suitability for use, 4) experience with and management of students with daytime incontinence and 5) training on the topic of lower urinary tract health. Predictors for promoting lower urinary tract health were identified by multivariable logistic regression. Results Of the 4,166 teachers who completed the survey 88% indicated that they encourage students to hold urine. Despite strict bathroom protocols 81% of teachers allowed children unlimited access to water. Of the teachers 82% reported never having undergone any professional development on bathroom regulations for children. Overall only 24% of surveyed teachers met criteria for promoting lower urinary tract health. The odds of promoting lower urinary tract health decreased with ascending grade level (OR 0.80, 95% CI 0.76–0.84). Conversely it increased if teaching experience was greater than 5 years (OR 1.66, 95% CI 1.39–1.98) or professional development on the subject had been received (OR 1.42, 95% CI 1.18–1.70). Conclusions Of elementary school teachers 76% are not promoting lower urinary tract health in school-aged children. Professional development training on the topics of lower

  13. Australian Institute of Sport and the Australian Paralympic Committee position statement: urinary tract infection in spinal cord injured athletes.

    PubMed

    Compton, Stacey; Trease, Larissa; Cunningham, Corey; Hughes, David

    2015-10-01

    Patients with spinal cord injuries are at increased risk of developing symptomatic urinary tract infections. Current evidence-based knowledge regarding prevention and treatment of urinary tract infection in the spinal cord injured population is limited. There are currently no urinary tract infection prevention and management guidelines specifically targeted towards elite spinal cord injured athletes. This position statement represents a set of recommendations intended to provide clinical guidelines for sport and exercise medicine physicians and other healthcare providers for the prevention and treatment of urinary tract infection in spinal cord injured athletes. It has been endorsed by the Australian Institute of Sport (AIS) and the Australian Paralympic Committee (APC). PMID:25869093

  14. Australian Institute of Sport and the Australian Paralympic Committee position statement: urinary tract infection in spinal cord injured athletes.

    PubMed

    Compton, Stacey; Trease, Larissa; Cunningham, Corey; Hughes, David

    2015-10-01

    Patients with spinal cord injuries are at increased risk of developing symptomatic urinary tract infections. Current evidence-based knowledge regarding prevention and treatment of urinary tract infection in the spinal cord injured population is limited. There are currently no urinary tract infection prevention and management guidelines specifically targeted towards elite spinal cord injured athletes. This position statement represents a set of recommendations intended to provide clinical guidelines for sport and exercise medicine physicians and other healthcare providers for the prevention and treatment of urinary tract infection in spinal cord injured athletes. It has been endorsed by the Australian Institute of Sport (AIS) and the Australian Paralympic Committee (APC).

  15. [Urinary tract infections in pregnancy: when to treat, how to treat, and what to treat with].

    PubMed

    Kladenský, J

    2012-04-01

    Urinary tract infections (UTI) in pregnant women are a relatively frequent occurrence and the spectrum of these infections ranges from lower urinary tract disease (asymptomatic bacteriuria, acute cystitis) to upper urinary tract disease (acute pyelonephritis). Anatomical and functional changes in the urinary tract in pregnancy result in significantly higher susceptibility to progression of the infection from asymptomatic bacteriuria to the stage of acute pyelonephritis. Untreated asymptomatic bacteriuria in pregnancy leads, in as much as 40%, to the development of acute pyelonephritis with all the subsequent negative effects not only for the woman herself, but particularly for the fetus. Bacteriuria in pregnancy accounts for a significantly higher number of newborns with a low birth weight, low gestational age and higher neonatal mortality rate. Therefore, it is necessary to perform screening for bacteriuria in pregnant women and, when the finding is positive, to treat this bacteriuria. The selection of an appropriate antimicrobial agent to treat urinary tract infection in pregnancy is limited by the safety of a given drug not only for the woman, but particularly for the fetus. The article provides an overview of medications that can be safely used throughout the pregnancy or only in certain stages of pregnancy. The selection of an appropriate antibiotic should always be preceded by the result of urine culture. The article presents the principles and rules for treating asymptomatic bacteriuria, acute cystitis and acute pyelonephritis in pregnant women. PMID:22702077

  16. Fibroblast growth factor receptor signaling in kidney and lower urinary tract development.

    PubMed

    Walker, Kenneth A; Sims-Lucas, Sunder; Bates, Carlton M

    2016-06-01

    Fibroblast growth factor receptors (FGFRs) and FGF ligands are highly expressed in the developing kidney and lower urinary tract. Several classic studies showed many effects of exogenous FGF ligands on embryonic renal tissues in vitro and in vivo. Another older landmark publication showed that mice with a dominant negative Fgfr fragment had severe renal dysplasia. Together, these studies revealed the importance of FGFR signaling in kidney and lower urinary tract development. With the advent of modern gene targeting techniques, including conditional knockout approaches, several publications have revealed critical roles for FGFR signaling in many lineages of the kidney and lower urinary tract at different stages of development. FGFR signaling has been shown to be critical for early metanephric mesenchymal patterning, Wolffian duct patterning including induction of the ureteric bud, ureteric bud branching morphogenesis, nephron progenitor survival and nephrogenesis, and bladder mesenchyme patterning. FGFRs pattern these tissues by interacting with many other growth factor signaling pathways. Moreover, the many genetic Fgfr and Fgf animal models have structural defects mimicking numerous congenital anomalies of the kidney and urinary tract seen in humans. Finally, many studies have shown how FGFR signaling is critical for kidney and lower urinary tract patterning in humans. PMID:26293980

  17. Fluid manipulation among individuals with lower urinary tract symptoms: a mixed methods study

    PubMed Central

    Elstad, Emily A; Maserejian, Nancy N; McKinlay, John B; Tennstedt, Sharon L

    2011-01-01

    Aims and objective To determine, qualitatively and quantitatively, how individuals use fluid manipulation to self-manage the urinary symptoms of daytime frequency, urgency and urine leakage and the underlying rationale for this behaviour. Background Lower urinary tract symptoms are prevalent and burdensome, and little is known about how individuals with lower urinary tract symptoms manipulate their fluid intake. Design A mixed methods design included statistical analysis of data from a population-based survey of urologic symptoms and qualitative analysis of in-depth interviews. Method Quantitative data came from 5503 participants of the baseline Boston Area Community Health Survey, a population-based, random sample epidemiologic survey of urologic symptoms. Qualitative data came from in-depth interviews with a random subsample from Boston Area Community Health of 152 black, white and Hispanic men and women with LUTS. Results Qualitative data showed that some respondents restricted fluid intake while others increased it, in both cases with the expectation of improved symptoms. Quantitative data showed that fluid intake was greater in men and women reporting frequency (p < 0·001). Women with frequency drank significantly more water (p < 0·001), while women with urgency drank significantly less water (p = 0·047). Conclusions This study found divergent expectations of the role of fluids in alleviating symptoms, leading some individuals to restrict and others to increase fluid intake. Individuals with lower urinary tract symptoms may need guidance in fluid management. Relevance to clinical practice Nurses should be aware that patients may self-manage lower urinary tract symptoms by restricting fluid intake, putting them at risk for dehydration, constipation and urinary tract infection, but also that they may be increasing their fluid intake, which could worsen symptoms. This study pinpoints a specific area of need among patients with lower urinary tract symptoms and

  18. Heterogeneity of morphological and functional changes in various compartments of rat urinary bladder in infravesical obstruction of the urinary tract.

    PubMed

    Kirpatovskii, V I; Kudryavtsev, Yu V; Mudraya, I S; Belik, S M; Khromov, R A

    2009-01-01

    Infravesical obstruction of the lower urinary tract was simulated in rats by dosed constriction of the prevesical portion of the urethra. The functional and morphological changes in various urinary bladder compartments were evaluated after 1 week and 3 months. The development of compensatory hypertrophy of the detrusor was associated with an increase in the number of hypertrophic, atrophic, and young leiomyocyte forms and their transformation into myofibroblasts, with the formation of connective tissue laminae between myofibril bundles mainly in the zone of urinary urinary bladder neck. Specific contractility of the detrusor strips decreased with increasing their tone, which was most pronounced in the neck zone. The relaxing effect of norepinephrine was significantly lower after 3 months of obstruction and virtually disappeared in the zone of the urinary bladder body and neck. Blockade of a-adrenoceptors after adrenostimulation with norepinephrine stimulated contractions of the hypertrophic detrusor against the background of reduced tone of the urinary bladder neck, in contrast to intact urinary bladder where this treatment reduced contractions.

  19. Enterococcus faecalis overcomes foreign body-mediated inflammation to establish urinary tract infections.

    PubMed

    Guiton, Pascale S; Hannan, Thomas J; Ford, Bradley; Caparon, Michael G; Hultgren, Scott J

    2013-01-01

    Urinary catheterization elicits major histological and immunological changes that render the bladder susceptible to microbial invasion, colonization, and dissemination. However, it is not understood how catheters induce these changes, how these changes act to promote infection, or whether they may have any protective benefit. In the present study, we examined how catheter-associated inflammation impacts infection by Enterococcus faecalis, a leading cause of catheter-associated urinary tract infection (CAUTI), a source of significant societal and clinical challenges. Using a recently optimized murine model of foreign body-associated UTI, we found that the implanted catheter itself was the primary inducer of inflammation. In the absence of the silicone tubing implant, E. faecalis induced only minimal inflammation and was rapidly cleared from the bladder. The catheter-induced inflammation was only minimally altered by subsequent enterococcal infection and was not suppressed by inhibitors of the neurogenic pathway and only partially by dexamethasone. Despite the robust inflammatory response induced by urinary implantation, E. faecalis produced biofilm and high bladder titers in these animals. Induction of inflammation in the absence of an implanted catheter failed to promote infection, suggesting that the presence of the catheter itself is essential for E. faecalis persistence in the bladder. Immunosuppression prior to urinary catheterization enhanced E. faecalis colonization, suggesting that implant-mediated inflammation contributes to the control of enterococcal infection. Thus, this study underscores the need for novel strategies against CAUTIs that seek to reduce the deleterious effects of implant-mediated inflammation on bladder homeostasis while maintaining an active immune response that effectively limits bacterial invaders.

  20. Female stress and urge incontinence in family practice: insight into the lower urinary tract.

    PubMed

    Viktrup, L

    2002-11-01

    As many as 25% of all women are affected by urinary incontinence, but only a few are treated. This frequent, often medically unrecognised, condition occurs in women of all ages. The continence mechanism is based on bladder detrusor control, intact anatomical structures in and around the urethra, correct positioning of the bladder neck and a comprehensive innervation of the lower urinary tract. Age and childbearing are established risk factors for the development of urinary incontinence, but other factors are currently suggested. The evaluation of urinary incontinence should include history, gynaecological examination, urine test, frequency-volume diary and a pad-weighing test. Female urinary incontinence can be treated in general practice by simple means, e.g. pelvic floor muscle training, bladder training, electrostimulation, drug therapy, or a combination of these approaches. This review updates the knowledge of the continence mechanism and summarises the epidemiology, risk factors, assessment and treatment of urinary incontinence in general practice.

  1. Evaluation and management of recurrent urinary tract infections in children: state of the art.

    PubMed

    Awais, Muhammad; Rehman, Abdul; Baloch, Noor Ul-Ain; Khan, Farid; Khan, Naseer

    2015-02-01

    Urinary tract infections (UTIs) represent an important cause of febrile illness in young children and can lead to renal scarring and kidney failure. However, diagnosis and treatment of recurrent UTI in children is an area of some controversy. Guidelines from the American Academy of Pediatrics, National Institute for Health and Clinical Excellence and European Society of Paediatric Radiology differ from each other in terms of the diagnostic algorithm to be followed. Treatment of vesicoureteral reflux and antibiotic prophylaxis for prevention of recurrent UTI are also areas of considerable debate. In this review, we collate and appraise recently published literature in order to formulate evidence-based guidance for the diagnosis and treatment of recurrent UTI in children.

  2. False-positive Chlamydiazyme results during urine sediment analysis due to bacterial urinary tract infections.

    PubMed Central

    Demaio, J; Boyd, R S; Rensi, R; Clark, A

    1991-01-01

    Our study examined whether urinary tract infections (UTIs) would cause false-positive results when urine sediment was tested with the Chlamydiazyme (CZ) system. Thirty-six infected urine samples and fifteen controls were studied. All controls were negative. Forty-seven percent of Escherichia coli UTIs (n = 30) and 100% of Klebsiella pneumoniae UTIs (n = 4) were positive on CZ testing of urine sediment. Nine E. coli UTIs positive by CZ were negative by direct fluorescent-antibody staining. When suspensions of the pure cultures were analyzed, 47% of E. coli and 100% of K. pneumoniae samples were CZ positive. False-positive results were not related to organism biotype or urine characteristics, including pH, specific gravity, and leukocyte count. We conclude that the presence of a UTI and also bacterial contamination must be ruled out prior to urine sediment testing. PMID:1885739

  3. Isolation and characterization of atypical Listeria monocytogenes associated with a canine urinary tract infection.

    PubMed

    Palerme, Jean-Sébastien; Pan, Po Ching; Parsons, Cameron T; Kathariou, Sophia; Ward, Todd J; Jacob, Megan E

    2016-09-01

    Listeria monocytogenes, a well-described cause of encephalitis and abortion in ruminants and of food-borne illness in humans, is rarely associated with disease in companion animals. A case of urinary tract infection associated with an atypical, weakly hemolytic L. monocytogenes strain is described in a diabetic dog. The serotype of the L. monocytogenes isolate was determined to be 1/2a (3a), with the multilocus genotyping pattern 2.72_1/2a. A nucleotide substitution (Gly145Asp) was detected at residue 145 in the promoter prfA region. This residue is within the critical helix-turn-helix motif of PrfA. The source of the L. monocytogenes strain remains unknown, and the dog recovered after a 4-week course of cephalexin (30 mg/kg orally twice daily). PMID:27493137

  4. Vesico-amniotic shunting for lower urinary tract obstruction in a fetus with VACTERL association.

    PubMed

    Kanasugi, Tomonobu; Kikuchi, Akihiko; Haba, Gen; Sasaki, Yuri; Isurugi, Chizuko; Oyama, Rie; Sugiyama, Toru

    2016-09-01

    Newborn cases of VACTERL association with lower urinary tract obstruction (LUTO) are rare and there have been no reports on those patients undergoing fetal therapy in English literature. We successfully performed vesico-amniotic shunting in a fetus having LUTO caused by abnormality of the external genitalia at 16 weeks' gestation. Although fetal karyotype was normal 46XY, follow-up fetal ultrasound examinations revealed ventriculomegaly in the brain, a small stomach and a right multicystic dysplastic kidney. MRI at 31 weeks' gestation suggested lobar type holoprosencephaly. Diagnosis of VACTERL association was confirmed postnatally. We consider that vesico-amniotic shunting is indicated for a fetus of VACTERL association with LUTO if the parents wish the procedure after genetic counseling and explanations about the fetal conditions.

  5. Vesico-amniotic shunting for lower urinary tract obstruction in a fetus with VACTERL association.

    PubMed

    Kanasugi, Tomonobu; Kikuchi, Akihiko; Haba, Gen; Sasaki, Yuri; Isurugi, Chizuko; Oyama, Rie; Sugiyama, Toru

    2016-09-01

    Newborn cases of VACTERL association with lower urinary tract obstruction (LUTO) are rare and there have been no reports on those patients undergoing fetal therapy in English literature. We successfully performed vesico-amniotic shunting in a fetus having LUTO caused by abnormality of the external genitalia at 16 weeks' gestation. Although fetal karyotype was normal 46XY, follow-up fetal ultrasound examinations revealed ventriculomegaly in the brain, a small stomach and a right multicystic dysplastic kidney. MRI at 31 weeks' gestation suggested lobar type holoprosencephaly. Diagnosis of VACTERL association was confirmed postnatally. We consider that vesico-amniotic shunting is indicated for a fetus of VACTERL association with LUTO if the parents wish the procedure after genetic counseling and explanations about the fetal conditions. PMID:27061706

  6. Clinical Options for the Treatment of Urinary Tract Infections in Children

    PubMed Central

    Ramlakhan, Shammi; Singh, Virendra; Stone, Joanne; Ramtahal, Alicia

    2014-01-01

    Urinary Tract Infections (UTI) are a common cause of childhood febrile illness with 7% of girls and 2% of boys having a symptomatic culture positive UTI by the age of six years. Although there are conflicting views on the long term sequelae of UTI, as well as the place of prophylaxis, the universal aims of treatment of childhood UTI remain those of symptom alleviation, prevention of systemic infection and short and longer term complications. There is good evidence of historical and emerging resistance patterns, therefore rationalisation of prescription patterns by knowledge of sensitivities coupled with re-examination of empirical antibiotic choices is clearly important. Local formularies should reflect geographical resistance patterns along with best evidence on the duration and choice of antibiotic in order to maximize therapeutic effect, while minimizing the development of resistant strains. PMID:25210486

  7. Clinical options for the treatment of urinary tract infections in children.

    PubMed

    Ramlakhan, Shammi; Singh, Virendra; Stone, Joanne; Ramtahal, Alicia

    2014-01-01

    Urinary Tract Infections (UTI) are a common cause of childhood febrile illness with 7% of girls and 2% of boys having a symptomatic culture positive UTI by the age of six years. Although there are conflicting views on the long term sequelae of UTI, as well as the place of prophylaxis, the universal aims of treatment of childhood UTI remain those of symptom alleviation, prevention of systemic infection and short and longer term complications. There is good evidence of historical and emerging resistance patterns, therefore rationalisation of prescription patterns by knowledge of sensitivities coupled with re-examination of empirical antibiotic choices is clearly important. Local formularies should reflect geographical resistance patterns along with best evidence on the duration and choice of antibiotic in order to maximize therapeutic effect, while minimizing the development of resistant strains. PMID:25210486

  8. Metachronous urothelial carcinoma of whole urinary tract in a dialysis-dependent patient: A case report

    PubMed Central

    WANG, YIMIN; JIN, BAIYE; YAO, XIAOLIN

    2016-01-01

    Numerous studies have reported an association between end-stage renal disease (ESRD) and malignancy. The predominant malignant tumor that occurs in patients with ESRD in Asian countries is urothelial carcinoma (UC). According to recent research, cases of UC in dialysis-dependent patients are associated with higher recurrence rates and more aggressive biological behavior compared with patients without ESRD. The necessity of 1-step total urinary tract exenteration for dialysis-dependent patients with UC is advocated by certain studies. The current study reports a case of metachronous bladder cancer and bilateral upper urinary tract tumor in a dialysis-dependent patient. Three separate surgeries were performed to remove the bladder, and left and right urinary tract, respectively. The question of whether the stepwise strategy or the 1-step surgery should be selected for such special cases remains in debate. PMID:27313734

  9. Epidemiology and characteristics of urinary tract infections in children and adolescents

    PubMed Central

    Hanna-Wakim, Rima H.; Ghanem, Soha T.; El Helou, Mona W.; Khafaja, Sarah A.; Shaker, Rouba A.; Hassan, Sara A.; Saad, Randa K.; Hedari, Carine P.; Khinkarly, Rima W.; Hajar, Farah M.; Bakhash, Marwan; El Karah, Dima; Akel, Imad S.; Rajab, Mariam A.; Khoury, Mireille; Dbaibo, Ghassan S.

    2015-01-01

    Background: Urinary tract infections (UTIs) are among the most common infections in the pediatric population. Over the last two decades, antibiotic resistance is increasing significantly as extended spectrum beta lactamase (ESBL) producing organisms are emerging. The aim of this study is to provide a comprehensive view of the epidemiologic characteristics of UTIs in hospitalized children, examine the risk factors of UTIs caused by ESBL-producing organisms, and determine the resistance patterns in the isolated organisms over the last 10 years. Methods: Retrospective chart review was conducted at two Lebanese medical centers. Subjects were identified by looking at the following ICD-9 discharge codes: “Urinary tract infection,” “UTI,” “Cystitis,” and/or “Pyelonephritis.” Children less than 18 years of age admitted for UTI between January 1st, 2001 and December 31st, 2011 were included. Cases whose urine culture result did not meet our definition for UTI were excluded. Chi-square, Fisher's exact test, and multivariate logistic regression were used to determine risk factors for ESBL. Linear regression analysis was used to determine resistance patterns. Results: The study included 675 cases with a median age of 16 months and female predominance of 77.7% (525 cases). Of the 584 cases caused by Escherichia coli or Klebsiella spp, 91 cases (15.5%) were found to be ESBL-producing organisms. Vesico-ureteral reflux and previous antibiotics use were found to be independent risk factors for ESBL-producing E. coli and Klebsiella spp. (p < 0.05). A significant linear increase in resistance to all generations of Cephalosporins (r2 = 0.442) and Fluoroquinolones (r2 = 0.698) was found. Conclusion: The recognition of risk factors for infection with ESBL-producing organisms and the observation of increasing overall resistance to antibiotics warrant further studies that might probably lead to new recommendations to guide management of UTIs and antibiotic use in children

  10. Characterization of Escherichia coli isolates from hospital inpatients or outpatients with urinary tract infection.

    PubMed

    Toval, Francisco; Köhler, Christian-Daniel; Vogel, Ulrich; Wagenlehner, Florian; Mellmann, Alexander; Fruth, Angelika; Schmidt, M Alexander; Karch, Helge; Bielaszewska, Martina; Dobrindt, Ulrich

    2014-02-01

    Uropathogenic Escherichia coli (UPEC) is the most common cause of community- and hospital-acquired urinary tract infections (UTIs). Isolates from uncomplicated community-acquired UTIs express a variety of virulence traits that promote the efficient colonization of the urinary tract. In contrast, nosocomial UTIs can be caused by E. coli strains that differ in their virulence traits from the community-acquired UTI isolates. UPEC virulence markers are used to distinguish these facultative extraintestinal pathogens, which belong to the intestinal flora of many healthy individuals, from intestinal pathogenic E. coli (IPEC). IPEC is a diarrheagenic pathogen with a characteristic virulence gene set that is absent in UPEC. Here, we characterized 265 isolates from patients with UTIs during inpatient or outpatient treatment at a hospital regarding their phylogenies and IPEC or UPEC virulence traits. Interestingly, 28 of these isolates (10.6%) carried typical IPEC virulence genes that are characteristic of enteroaggregative E. coli (EAEC), Shiga toxin-producing E. coli (STEC), and atypical enteropathogenic E. coli (aEPEC), although IPEC is not considered a uropathogen. Twenty-three isolates harbored the astA gene coding for the EAEC heat-stable enterotoxin 1 (EAST1), and most of them carried virulence genes that are characteristic of UPEC and/or EAEC. Our results indicate that UPEC isolates from hospital patients differ from archetypal community-acquired isolates from uncomplicated UTIs by their spectrum of virulence traits. They represent a diverse group, including EAEC, as well as other IPEC pathotypes, which in addition contain typical UPEC virulence genes. The combination of typical extraintestinal pathogenic E. coli (ExPEC) and IPEC virulence determinants in some isolates demonstrates the marked genome plasticity of E. coli and calls for a reevaluation of the strict pathotype classification of EAEC.

  11. Long-Term Lithium Use and Risk of Renal and Upper Urinary Tract Cancers.

    PubMed

    Pottegård, Anton; Hallas, Jesper; Jensen, Boye L; Madsen, Kirsten; Friis, Søren

    2016-01-01

    Lithium induces proliferation in the epithelium of renal collecting ducts. A recent small-scale cohort study reported a strong association between use of lithium and increased risk of renal neoplasia. We therefore conducted a large-scale pharmacoepidemiologic study of the association between long-term use of lithium and risk of upper urinary tract cancer, including renal cell cancer and cancers of the renal pelvis or ureter. We identified all histologically verified upper urinary tract cancer cases in Denmark between 2000 and 2012 from the Danish Cancer Registry. A total of 6477 cases were matched by age and sex to 259,080 cancer-free controls. Data on lithium use from 1995 to 2012 were obtained from the Danish Prescription Registry. We estimated the association between long-term use of lithium (≥5 years) and risk of upper urinary tract cancer using conditional logistic regression with adjustment for potential confounders. Long-term use of lithium was observed among 0.22% of cases and 0.17% of controls. This yielded an overall nonsignificant adjusted odds ratio (OR) of 1.3 (95% confidence interval [95% CI], 0.8-2.2) for upper urinary tract cancer associated with long-term use of lithium. Analyses stratified by stage and subtype of upper urinary tract cancer revealed slight but nonsignificant increases in the ORs for localized disease (OR, 1.6; 95% CI, 0.8-3.0) and for renal pelvis/ureter cancers (OR, 1.7; 95% CI, 0.5-5.4). In conclusion, in our nationwide case-control study, use of lithium was not associated with an increased risk of upper urinary tract cancer.

  12. Mimickers and tumours in the lower urinary tract: Do we need more efficient vigilance?

    PubMed Central

    Metcalfe, Peter D.; Bascom, Alex; Sergi, Consolato

    2013-01-01

    Lower urinary tract symptoms are common in pediatric urology, but an atypical presentation may portend significant pathophysiology. We present 5 cases of young males with a sudden change in urinary symptoms, which resulted in the discovery of a variety of benign bladder tumours. We present the clinical, radiologic and histologic findings of these cases emphasizing on mimickers in clinics. Although rare tumours, these may be increasing in frequency and pediatric care may further be enhanced by the development of multinational registry. PMID:23826055

  13. Case study: Transitional care for a patient with benign prostatic hyperplasia and recurrent urinary tract infections.

    PubMed

    Bradway, Christine; Bixby, M Brian; Hirschman, Karen B; McCauley, Kathleen; Naylor, Mary D

    2013-01-01

    Chronic urologic conditions, including benign prostatic hyperplasia, recurrent urinary tract infections, and urinary incontinence, are common in older adults. This article highlights the urologic and transitional care needs of an elderly, cognitively impaired male during and after an acute hospitalization. Collaboration between the patient, his family, the advanced practice nurse, primary care providers, and outpatient urology office are described. The importance of mutual goal setting and a focused plan for transitional care are discussed.

  14. Concurrent upper and lower urinary tract robotic surgery: A case series

    PubMed Central

    Pisipati, Sailaja; Bach, Christian; Daneshwar, Datesh; Rowe, Edward W.; Koupparis, Anthony J.

    2014-01-01

    The da Vinci Surgical System (Intuitive Surgical Inc.) continues to develop as a platform in urological surgery. Synchronous upper and lower urinary tract tumours requiring extirpative surgery are not uncommon. We report the first case robotic series of combined complex upper and lower urinary tract surgery. Six high-risk anaesthetic patients with a median age of 71 years and apparent synchronous upper and lower urinary tract pathologies underwent concurrent robotic surgery. Five underwent robotic nephroureterectomy and robotic-assisted radical cystectomy (RARC); 1 had combined robotic nephroureterectomy and robotic-assisted radical prostatectomy (RALP). The mean length of stay was 10 days, with an average blood loss of 416.7 mL. The median console time for nephroureterectomy, RALP and RARC was 90, 90 and 210 minutes, respectively. Four patients had intra-corporeal ileal conduit urinary diversion. There were no Clavien grade 3, 4, or 5 complications. In all patients, 30- and 90-day mortality was nil. Margins were clear in the entire cohort. We concluded that combined upper and lower urinary tract robotic surgery is safe and technically feasible with acceptable complications and oncological outcomes. PMID:25485015

  15. Oral immunotherapy of recurrent urinary tract infections: a double-blind placebo-controlled multicenter study.

    PubMed

    Schulman, C C; Corbusier, A; Michiels, H; Taenzer, H J

    1993-09-01

    We treated 166 patients suffering from recurrent urinary tract infections under double-blind conditions for 3 months with 1 capsule daily of either the immunostimulating bacterial extract (85) or a placebo (81), followed by a 3-month observation period without the test drugs. The bacterial extract exerted a significant beneficial curative action and long-term consolidative effect on the frequency of recurrent urinary tract infections with marked improvements in the characteristic signs and symptoms. It was significantly superior to placebo for the majority of the assessed parameters: number of recurrent urinary tract infections, bacteriuria, leukocyturia, erythrocyturia, nitrituria, albuminuria and casts in urine. Consumption of antibiotics, chemotherapeutics, urinary antiseptics or disinfectants was significantly less under active drug therapy compared to placebo. Tolerance was good with only 2 side effects reported in 2 patients (2%) in the active group compared to 11 among 5 (6%) in the placebo group. Therefore, the bacterial extract can be considered an efficient and well tolerated drug for the treatment of urinary tract infections, and their accompanying signs and symptoms, as well as for decreasing the risk of recurrences and the need for antibiotics and other antibacterial drugs.

  16. Stones of the upper urinary tract. Update on minimal-invasive endourological treatment.

    PubMed

    Lahme, Sven; Zimmermanns, Volker; Hochmuth, Andreas; Liske, Peter

    2008-03-01

    So far extracorporal shockwave lithotripsy (SWL) is the treatment of choice for upper urinary tract stones. Since the introduction of new minimal-invasive endourological procedures, such as retrograde flexible uretero-renoscopy (fURS) and minimal-invasive percutaneous nephrolithotomy (Mini-Perc), alternative treatment modalities are available, which show enhanced stone-free rates and decreased treatment morbidity even in unfavorable stone localizations of the lower calix and calyceal diverticulum stones. In experienced hands modern endourological approaches are suitable as first-line treatment of upper urinary tract stones. Even in elderly patients and large stone burden the endourological techniques show acceptable results.

  17. Clear cell adenocarcinoma of the renal pelvis: an extremely rare neoplasm of the upper urinary tract.

    PubMed

    Liu, K-W; Lin, V C-H; Chang, I-W

    2013-12-01

    Clear cell adenocarcinoma (CCA) in the urinary tract is a rare neoplasm morphologically identical to the Müllerian counterpart. Clear cell adenocarcinoma is extremely rare in the upper urinary tract. We present a case with CCA of the renal pelvis. Microscopically, the tumor exhibited exophytic growth with predominantly tubulocystic structures, as well as solid and papillary patterns. The neoplastic cells were cuboidal with clear to pale eosinophilic cytoplasm and abundant intracellular and extracellular eosinophilic hyaline globules. By immunohistochemically, the tumor was labeled by cytokeratins and hepatocyte nuclear factor-1β. The patient was still alive without evidence of recurrence in the follow-up period of nineteen months after diagnosis. PMID:24375047

  18. Botulinum toxin: new option for refractory lower urinary tract symptoms in women.

    PubMed

    Rickey, Leslie M; Kenton, Kimberly

    2008-03-01

    Lower urinary tract symptoms refractory to standard therapies create significant distress and quality of life impact for women with these disorders. Likewise, they are challenging for clinicians caring for these women. Once conservative measures are exhausted, the few remaining treatment options are often invasive and associated with significant morbidity. Botulinum toxin is an emerging medical therapy with increasing applications in the lower urinary tract and pelvic floor, which has proven to be an effective and safe alternative for the treatment of some refractory pelvic floor disorders.

  19. Loracarbef versus cefaclor in the treatment of urinary tract infections in women.

    PubMed Central

    Iravani, A

    1991-01-01

    In a double-blind, prospective, randomized study, 108 college women with acute urinary tract infections were treated for 7 days with either loracarbef (LY163892) at 200 mg once daily (n = 53) or cefaclor at 250 mg three times daily (n = 55). The cure rates at 5 to 9 days after treatment in the loracarbef and cefaclor groups were 96 and 90%, respectively. Both loracarbef and cefaclor are safe, well tolerated, and effective in the treatment of urinary tract infections in women. PMID:2069382

  20. Reducing catheter-associated urinary tract infections in a neuro-spine intensive care unit.

    PubMed

    Schelling, Kimberly; Palamone, Janet; Thomas, Kathryn; Naidech, Andrew; Silkaitis, Christina; Henry, Jennifer; Bolon, Maureen; Zembower, Teresa R

    2015-08-01

    A collaborative effort reduced catheter-associated urinary tract infections in the neuro-spine intensive care unit where the majority of infections occurred at our institution. Our stepwise approach included retrospective data review, daily rounding with clinicians, developing and implementing an action plan, conducting practice audits, and sharing of real-time data outcomes. The catheter-associated urinary tract infection rate was reduced from 8.18 to 0.93 per 1,000 catheter-days and standardized infection ratio decreased from 2.16 to 0.37.

  1. Intracellular Bacterial Communities: A Potential Etiology for Chronic Lower Urinary Tract Symptoms

    PubMed Central

    Scott, Victoria C. S.; Haake, David A.; Churchill, Bernard M.; Justice, Sheryl S.; Kim, Ja-Hong

    2015-01-01

    Patients with persistent lower urinary tract symptoms and negative urine cultures are often difficult to treat. Infection may go undetected in these patients because the concentrations of bacteria in their urine are beneath the threshold of standard urine culture techniques. Empiric treatment may result in temporary relief, followed by recurrent symptoms. Occult and recurrent urinary tract infection may be due to both invasion of the bladder wall by uropathogenic Escherichia coli and the formation of biofilm-like intracellular bacterial communities. This review examines emerging evidence for a role of intracellular bacterial communities in human infection. PMID:26189137

  2. Immune modulation by group B Streptococcus influences host susceptibility to urinary tract infection by uropathogenic Escherichia coli.

    PubMed

    Kline, Kimberly A; Schwartz, Drew J; Gilbert, Nicole M; Hultgren, Scott J; Lewis, Amanda L

    2012-12-01

    Urinary tract infection (UTI) is most often caused by uropathogenic Escherichia coli (UPEC). UPEC inoculation into the female urinary tract (UT) can occur through physical activities that expose the UT to an inherently polymicrobial periurethral, vaginal, or gastrointestinal flora. We report that a common urogenital inhabitant and opportunistic pathogen, group B Streptococcus (GBS), when present at the time of UPEC exposure, undergoes rapid UPEC-dependent exclusion from the murine urinary tract, yet it influences acute UPEC-host interactions and alters host susceptibility to persistent outcomes of bladder and kidney infection. GBS presence results in increased UPEC titers in the bladder lumen during acute infection and reduced inflammatory responses of murine macrophages to live UPEC or purified lipopolysaccharide (LPS), phenotypes that require GBS mimicry of host sialic acid residues. Taken together, these studies suggest that despite low titers, the presence of GBS at the time of polymicrobial UT exposure may be an overlooked risk factor for chronic pyelonephritis and recurrent UTI in susceptible groups, even if it is outcompeted and thus absent by the time of diagnosis.

  3. Unilateral renal agenesis associated with additional congenital abnormalities of the urinary tract in a Pekingese bitch.

    PubMed

    Agut, A; Fernandez del Palacio, M J; Laredo, F G; Murciano, J; Bayon, A; Soler, M

    2002-01-01

    An eight-month-old Pekingese bitch with urinary incontinence was found to have three congenital anomalies of the urinary tract: left renal agenesis, bilateral ectopic ureters with a left cranial blind-ending ureter, and urinary bladder hypoplasia. The diagnoses were made by retrograde vaginourethrography, excretory urography, ultrasonography and duplex Doppler ultrasonography. Although urological anomalies associated with renal agenesis have been frequently observed, a cranial blind-end ectopic ureter has not, to the authors' knowledge, been described in the bitch. The dog was managed medically with a restricted protein diet because of a compromised unilateral kidney with hydronephrosis and hydroureter.

  4. Zinc uptake contributes to motility and provides a competitive advantage to Proteus mirabilis during experimental urinary tract infection.

    PubMed

    Nielubowicz, Greta R; Smith, Sara N; Mobley, Harry L T

    2010-06-01

    Proteus mirabilis, a Gram-negative bacterium, represents a common cause of complicated urinary tract infections in catheterized patients or those with functional or anatomical abnormalities of the urinary tract. ZnuB, the membrane component of the high-affinity zinc (Zn(2+)) transport system ZnuACB, was previously shown to be recognized by sera from infected mice. Since this system has been shown to contribute to virulence in other pathogens, its role in Proteus mirabilis was investigated by constructing a strain with an insertionally interrupted copy of znuC. The znuC::Kan mutant was more sensitive to zinc limitation than the wild type, was outcompeted by the wild type in minimal medium, displayed reduced swimming and swarming motility, and produced less flaA transcript and flagellin protein. The production of flagellin and swarming motility were restored by complementation with znuCB in trans. Swarming motility was also restored by the addition of Zn(2+) to the agar prior to inoculation; the addition of Fe(2+) to the agar also partially restored the swarming motility of the znuC::Kan strain, but the addition of Co(2+), Cu(2+), or Ni(2+) did not. ZnuC contributes to but is not required for virulence in the urinary tract; the znuC::Kan strain was outcompeted by the wild type during a cochallenge experiment but was able to colonize mice to levels similar to the wild-type level during independent challenge. Since we demonstrated a role for ZnuC in zinc transport, we hypothesize that there is limited zinc present in the urinary tract and P. mirabilis must scavenge this ion to colonize and persist in the host. PMID:20385754

  5. Urinary tract infections in patients admitted to rehabilitation from acute care settings: a descriptive research study.

    PubMed

    Romito, Diane; Beaudoin, JoAnn M; Stein, Patricia

    2011-01-01

    The use of an indwelling urinary catheter comes with associated risks. At a hospital in southern California, nurses on the acute rehabilitation unit suspected their patients were arriving from acute care with undiagnosed urinary tract infections (UTIs). This descriptive research study quantified the incidence of UTI on admission to a rehabilitation unit and correlations with catheter use. During the study period, 132 patients were admitted to acute rehabilitation from an acute care setting, and 123 met criteria to participate in the study. Among participants, 12% had a UTI upon admission. Questionnaires examined nursing attitudes toward appropriate urinary catheter use and proactive catheter removal. The data revealed that nurses want to be involved in decisions about urinary catheter use and that medical/surgical and rehabilitation nurses agree strongly about advocating for patients with indwelling urinary catheters.

  6. Fimbriation, capsulation, and iron-scavenging systems of Klebsiella strains associated with human urinary tract infection.

    PubMed

    Tarkkanen, A M; Allen, B L; Williams, P H; Kauppi, M; Haahtela, K; Siitonen, A; Orskov, I; Orskov, F; Clegg, S; Korhonen, T K

    1992-03-01

    Thirty-two strains of Klebsiella pneumoniae and seven strains of Klebsiella oxytoca isolated from urinary tract infections in elderly adults were analyzed for capsular antigens, iron-scavenging systems, and fimbriation. All strains were capsulated. Twenty-seven different K antigens were identified among the strains, with no particular antigen dominating. All strains produced the iron-scavenging system enterochelin as analyzed by bioassay and DNA hybridization. In contrast, the aerobactin iron-sequestering system was not detected in any of the strains. All strains caused hemagglutination of tannin-treated human erythrocytes and reacted with an anti-type 3 fimbriae antiserum as well as in DNA hybridization with a type 3 fimbria-specific probe, indicating that the Klebsiella strains possessed this fimbrial type. Possession of type 1 fimbriae was analyzed by agglutination tests and by hybridization with DNA probes from two distinct Klebsiella type 1 fimbria gene clusters. Phenotypic expression of the type 1 fimbriae was found in 29 of 32 K. pneumoniae strains, whereas 30 strains reacted with either of the two type 1 fimbrial cluster DNA probes. In K. oxytoca, however, only three of seven strains expressed type 1 fimbriae and reacted with the DNA probes. The type 3 fimbriae were found to bind to a fraction of epithelial cells exfoliated in normal human urine, whereas the type 1 fimbriae bound strongly to urinary slime. No inhibitors of type 3 fimbrial binding were detected in human urine.

  7. Etiologic profile and antimicrobial susceptibility of community-acquired urinary tract infection in two Cameroonian towns

    PubMed Central

    2012-01-01

    Background Urinary tract infection (UTI) represents one of the most common diseases encountered in community medical practice. In resource poor settings, treatment is usually empiric due to the high cost and long duration required for reporting diagnosis by culture and antibiotic susceptibility testing. With the growing problem of drug resistance knowledge of antibiotic susceptibility pattern is pertinent for successful eradication of invading pathogens. Our study, the first of its kind in Cameroon, analyzed the distribution and antibiotic susceptibility of bacteria causing community-acquired urinary tract infection (CAUTI) in two towns (Bamenda and Buea) with a large number of young and middle aged persons, to provide data that could guide empiric treatment. Findings We cultured 235 urine specimens and analyzed the antibiotic susceptibility of isolates by the disc diffusion technique. Uropathogens were recovered from 137 (58.3%), with prevalence rates in Buea and Bamenda being 65.9% and 54% respectively. Predominant pathogens were Escherichia coli (31.4%), Klebsiella oxytoca (25.5%) and Staphylococcus spp (24.1%). Geographic variation in uropathogen distribution and antibiotic susceptibility was observed, and a significant difference in pathogen distribution with respect to gender. The 20–39 years age group had the highest prevalence of infection. All pathogens isolated were detected in this group. Isolates exhibited low susceptibility to antibiotics tested. Bamenda isolates generally exhibited lower susceptibility compared to those from Buea. Conclusion Regional variation in etiology of CAUTI and antibiotic susceptibility observed in our study emphasizes the need to establish local and national antimicrobial resistance monitoring systems in Cameroon to provide information for the development of CAUTI treatment guidelines. PMID:22564344

  8. [Lower urinary tract obstruction (LUTO)--clinical picture, prenatal diagnostics and therapeutic options].

    PubMed

    Bildau, J; Enzensberger, C; Degenhardt, J; Kawecki, A; Tenzer, A; Kohl, T; Stressig, R; Ritgen, J; Utsch, B; Axt-Fliedner, R

    2014-02-01

    The aetiology of urinary tract obstructions (LUTO) is heterogeneous. The most common entities are isolated posterior urethral valves or urethral atresia in male foetuses. In female foetuses LUTO is frequently a part of complex malformations. The natural history of LUTO is characterised by high morbidity and mortality due to the development of severe pulmonary hypoplasia caused by oligo- or anhydramnios affecting the cannalicular phase (16-24 weeks of gestation) of pulmonary development. The degree of renal damage is variable and ranges from mild renal impairment in infancy to end-stage renal insufficiency, necessitating dialysis and transplantation. Foetal interventions in order to bypass the obstruction are biologically plausible and technically feasible. Vesico-amniotic shunting as well as (currently less frequent) foetoscopic cystoscopy and laser ablation of posterior urethral valves are minimally invasive treatment options. Previous reports indicate that prenatal therapy is suitable to reduce perinatal mortality but does not improve postnatal renal function. Selection of foetuses who may profit from prenatal intervention is aggravated by the lack of reliable prognostic criteria for the prediction of postnatal renal function in both ultrasound and foetal urine analysis. Furthermore, there is no randomised trial available at the time of writing. Because of a relevant complication rate and still no clear evidence for foetal benefit, interventions should be performed in specialised centres. Further studies are necessary to improve case selection of affected foetuses and to evaluate the impact of interventions in earlier gestational weeks. The data from the PLUTO trial (percutaneous shunting in lower urinary tract obstruction) conducted by the University of Birmingham may help to answer these questions. In the meantime selection of foetuses for prenatal intervention puts high requirements on interdisciplinary counselling in every case. A general treatment algorithm

  9. Mucosal Immunization with Iron Receptor Antigens Protects against Urinary Tract Infection

    PubMed Central

    Smith, Sara N.; Mobley, Harry L. T.

    2009-01-01

    Uncomplicated infections of the urinary tract, caused by uropathogenic Escherichia coli, are among the most common diseases requiring medical intervention. A preventive vaccine to reduce the morbidity and fiscal burden these infections have upon the healthcare system would be beneficial. Here, we describe the results of a large-scale selection process that incorporates bioinformatic, genomic, transcriptomic, and proteomic screens to identify six vaccine candidates from the 5379 predicted proteins encoded by uropathogenic E. coli strain CFT073. The vaccine candidates, ChuA, Hma, Iha, IreA, IroN, and IutA, all belong to a functional class of molecules that is involved in iron acquisition, a process critical for pathogenesis in all microbes. Intranasal immunization of CBA/J mice with these outer membrane iron receptors elicited a systemic and mucosal immune response that included the production of antigen-specific IgM, IgG, and IgA antibodies. The cellular response to vaccination was characterized by the induction and secretion of IFN-γ and IL-17. Of the six potential vaccine candidates, IreA, Hma, and IutA provided significant protection from experimental infection. In immunized animals, class-switching from IgM to IgG and production of antigen-specific IgA in the urine represent immunological correlates of protection from E. coli bladder colonization. These findings are an important first step toward the development of a subunit vaccine to prevent urinary tract infections and demonstrate how targeting an entire class of molecules that are collectively required for pathogenesis may represent a fundamental strategy to combat infections. PMID:19806177

  10. Strengths and Limitations of Model Systems for the Study of Urinary Tract Infections and Related Pathologies.

    PubMed

    Barber, Amelia E; Norton, J Paul; Wiles, Travis J; Mulvey, Matthew A

    2016-06-01

    Urinary tract infections (UTIs) are some of the most common bacterial infections worldwide and are a source of substantial morbidity among otherwise healthy women. UTIs can be caused by a variety of microbes, but the predominant etiologic agent of these infections is uropathogenic Escherichia coli (UPEC). An especially troubling feature of UPEC-associated UTIs is their high rate of recurrence. This problem is compounded by the drastic increase in the global incidence of antibiotic-resistant UPEC strains over the past 15 years. The need for more-effective treatments for UTIs is driving research aimed at bettering our understanding of the virulence mechanisms and host-pathogen interactions that occur during the course of these infections. Surrogate models of human infection, including cell culture systems and the use of murine, porcine, avian, teleost (zebrafish), and nematode hosts, are being employed to define host and bacterial factors that modulate the pathogenesis of UTIs. These model systems are revealing how UPEC strains can avoid or overcome host defenses and acquire scarce nutrients while also providing insight into the virulence mechanisms used by UPEC within compromised individuals, such as catheterized patients. Here, we summarize our current understanding of UTI pathogenesis while also giving an overview of the model systems used to study the initiation, persistence, and recurrence of UTIs and life-threatening sequelae like urosepsis. Although we focus on UPEC, the experimental systems described here can also provide valuable insight into the disease processes associated with other bacterial pathogens both within the urinary tract and elsewhere within the host.

  11. Urinary Incontinence: Causes and Methods of Evaluation

    ERIC Educational Resources Information Center

    Griebling, Tomas L.

    2008-01-01

    This article presents the third of a multi-part series offering the most timely educational information, innovative approaches, products and technology solutions as well as coping and stigma-fighting approaches available on the subject of incontinence. Here, the author introduces the types and physiology of urinary incontinence. The author also…

  12. [Multimodal surgical management of stones in the upper urinary tract].

    PubMed

    Fritschi Urs; Kabongo, Olivier M'Baya; Tawadros, Thomas; Jichlinski, Patrice; Valerio, Massimo

    2014-12-01

    Emergency and differed urinary stone treatment are basic challenges in daily urological practice. By proposing the complete range of treatment and by improving medical and paramedical skills, management of stone patients can be optimized. In this article, we present the latest developments in stone treatment as well as our experiences with new technologies. PMID:25626248

  13. Methods to determine effects of cranberry proanthocyanidins on extraintestinal infections: Relevance for urinary tract health.

    PubMed

    Feliciano, Rodrigo P; Krueger, Christian G; Reed, Jess D

    2015-07-01

    Urinary tract infections (UTI) are one of the most frequent extraintestinal infections caused by Escherichia coli (ExPEC). Cranberry juice has been used for decades to alleviate symptoms and prevent recurrent UTI. The putative compounds in cranberries are proanthocyanidins (PAC), specifically PAC with "A-type" bonds. Since PAC are not absorbed, their health benefits in UTI may occur through interactions at the mucosal surface in the gastrointestinal tract. Recent research showed that higher agglutination of ExPEC and reduced bacterial invasion are correlated with higher number of "A-type" bonds and higher degree of polymerization of PAC. An understanding of PAC structure-activity relationship is becoming feasible due to advancements, not only in obtaining purified PAC fractions that allow accurate estimation, but also in high-resolution MS methodologies, specifically, MALDI-TOF MS. A recent MALDI-TOF MS deconvolution method allows quantification of the ratios of "A-type" to "B-type" bonds enabling characteristic fingerprints. Moreover, the generation of fluorescently labeled PAC allows visualization of the interaction between ExPEC and PAC with microscopy. These tools can be used to establish structure-activity relationships between PAC and UTI and give insight on the mechanism of action of these compounds in the gut without being absorbed. PMID:25917127

  14. Methods to determine effects of cranberry proanthocyanidins on extraintestinal infections: Relevance for urinary tract health.

    PubMed

    Feliciano, Rodrigo P; Krueger, Christian G; Reed, Jess D

    2015-07-01

    Urinary tract infections (UTI) are one of the most frequent extraintestinal infections caused by Escherichia coli (ExPEC). Cranberry juice has been used for decades to alleviate symptoms and prevent recurrent UTI. The putative compounds in cranberries are proanthocyanidins (PAC), specifically PAC with "A-type" bonds. Since PAC are not absorbed, their health benefits in UTI may occur through interactions at the mucosal surface in the gastrointestinal tract. Recent research showed that higher agglutination of ExPEC and reduced bacterial invasion are correlated with higher number of "A-type" bonds and higher degree of polymerization of PAC. An understanding of PAC structure-activity relationship is becoming feasible due to advancements, not only in obtaining purified PAC fractions that allow accurate estimation, but also in high-resolution MS methodologies, specifically, MALDI-TOF MS. A recent MALDI-TOF MS deconvolution method allows quantification of the ratios of "A-type" to "B-type" bonds enabling characteristic fingerprints. Moreover, the generation of fluorescently labeled PAC allows visualization of the interaction between ExPEC and PAC with microscopy. These tools can be used to establish structure-activity relationships between PAC and UTI and give insight on the mechanism of action of these compounds in the gut without being absorbed.

  15. Probe-based confocal laser endomicroscopy of the urinary tract: the technique.

    PubMed

    Chang, Timothy C; Liu, Jen-Jane; Liao, Joseph C

    2013-01-01

    Probe-based confocal laser endomicroscopy (CLE) is an emerging optical imaging technology that enables real-time in vivo microscopy of mucosal surfaces during standard endoscopy. With applications currently in the respiratory and gastrointestinal tracts, CLE has also been explored in the urinary tract for bladder cancer diagnosis. Cellular morphology and tissue microarchitecture can be resolved with micron scale resolution in real time, in addition to dynamic imaging of the normal and pathological vasculature. The probe-based CLE system (Cellvizio, Mauna Kea Technologies, France) consists of a reusable fiberoptic imaging probe coupled to a 488 nm laser scanning unit. The imaging probe is inserted in the working channels of standard flexible and rigid endoscopes. An endoscope-based CLE system (Optiscan, Australia), in which the confocal endomicroscopy functionality is integrated onto the endoscope, is also used in the gastrointestinal tract. Given the larger scope diameter, however, application in the urinary tract is currently limited to ex vivo use. Confocal image acquisition is done through direct contact of the imaging probe with the target tissue and recorded as video sequences. As in the gastrointestinal tract, endomicroscopy of the urinary tract requires an exogenenous contrast agent-most commonly fluorescein, which can be administered intravenously or intravesically. Intravesical administration is a well-established method to introduce pharmacological agents locally with minimal systemic toxicity that is unique to the urinary tract. Fluorescein rapidly stains the extracellular matrix and has an established safety profile. Imaging probes of various diameters enable compatibility with different caliber endoscopes. To date, 1.4 and 2.6 mm probes have been evaluated with flexible and rigid cystoscopy. Recent availability of a < 1 mm imaging probe opens up the possibility of CLE in the upper urinary tract during ureteroscopy. Fluorescence cystoscopy (i

  16. Probe-based confocal laser endomicroscopy of the urinary tract: the technique.

    PubMed

    Chang, Timothy C; Liu, Jen-Jane; Liao, Joseph C

    2013-01-01

    Probe-based confocal laser endomicroscopy (CLE) is an emerging optical imaging technology that enables real-time in vivo microscopy of mucosal surfaces during standard endoscopy. With applications currently in the respiratory and gastrointestinal tracts, CLE has also been explored in the urinary tract for bladder cancer diagnosis. Cellular morphology and tissue microarchitecture can be resolved with micron scale resolution in real time, in addition to dynamic imaging of the normal and pathological vasculature. The probe-based CLE system (Cellvizio, Mauna Kea Technologies, France) consists of a reusable fiberoptic imaging probe coupled to a 488 nm laser scanning unit. The imaging probe is inserted in the working channels of standard flexible and rigid endoscopes. An endoscope-based CLE system (Optiscan, Australia), in which the confocal endomicroscopy functionality is integrated onto the endoscope, is also used in the gastrointestinal tract. Given the larger scope diameter, however, application in the urinary tract is currently limited to ex vivo use. Confocal image acquisition is done through direct contact of the imaging probe with the target tissue and recorded as video sequences. As in the gastrointestinal tract, endomicroscopy of the urinary tract requires an exogenenous contrast agent-most commonly fluorescein, which can be administered intravenously or intravesically. Intravesical administration is a well-established method to introduce pharmacological agents locally with minimal systemic toxicity that is unique to the urinary tract. Fluorescein rapidly stains the extracellular matrix and has an established safety profile. Imaging probes of various diameters enable compatibility with different caliber endoscopes. To date, 1.4 and 2.6 mm probes have been evaluated with flexible and rigid cystoscopy. Recent availability of a < 1 mm imaging probe opens up the possibility of CLE in the upper urinary tract during ureteroscopy. Fluorescence cystoscopy (i

  17. Chromobacterium violaceum Septicaemia and Urinary Tract Infection: Case Reports from a Tertiary Care Hospital in South India

    PubMed Central

    Orvankundil, Shabana; Lalitha, Saradadevi Karunakaran; Thazhethekandi, Raji; Thottathil, Jahana

    2016-01-01

    Chromobacterium violaceum is a gram negative oxidase positive bacillus that causes human infections infrequently. It is a normal inhabitant of soil and stagnant water of the tropical and subtropical areas. In humans, it can cause infections ranging from life threatening sepsis with metastatic abscesses to skin infections and urinary tract infections. The organism is notoriously resistant to most cephalosporins and Ampicillin. Fluoroquinolones and aminoglycosides show good in vitro susceptibility. High mortality rates associated with these infections necessitate prompt diagnosis and appropriate antimicrobial therapy. Here we present three cases of Chromobacterium violaceum infection from Government Medical College Kozhikode, Kerala. PMID:27747113

  18. Metabolic Syndrome, Inflammation and Lower Urinary Tract Symptoms – Possible Translational Links

    PubMed Central

    He, Qiqi; Wang, Zhiping; Liu, Guiming; Daneshgari, Firouz; MacLennan, Gregory T.; Gupta, Sanjay

    2015-01-01

    Background Epidemiological data suggest that lower urinary tract symptoms (LUTS) may be associated with metabolic syndrome (MetS). Inflammation has been proposed as a candidate mechanism at the crossroad between these two clinical entities. The aim of this review article is to evaluate the role of MetS-induced inflammation in the pathogenesis and progression of LUTS. Methods A systematic review was conducted using the keywords ‘metabolic syndrome AND lower urinary tract symptoms’ within the title search engines including PubMed, Web of Science, and the Cochrane Library for relevant research work published between 2000 and January 2015. The obtained literature was reviewed by the primary author (QH) and was assessed for eligibility and standard level of evidence. Results Total of 52 articles met the eligibility criteria. Based on database search during the past 15 years and our systematic review of prospective and retrospective cohorts, case-control trials, observational studies and animal data identified a possible link between MetS-induced inflammation and LUTS including benign prostatic hyperplasia, bladder outlet obstruction, overactive bladder, urinary incontinence and others possible urinary tract abnormalities. Conclusions There is convincing evidence to suggest that MetS and inflammation could be important contributors to LUTS in men, particularly in the development of benign prostatic hyperplasia. However, the role of MetS-induced inflammation remains unclear in overactive bladder, urinary incontinence and etiology of LUTS progression. PMID:26391088

  19. Bifidobacterium—friend or foe? A case of urinary tract infection with Bifidobacterium species

    PubMed Central

    Pathak, Poonam; Trilligan, Cheryl; Rapose, Alwyn

    2014-01-01

    Bifidobacterium—a commensal of the human intestine is considered non-pathogenic and has been advocated as a probiotic due to its potential beneficial effects. However, there have been case reports implicating bifidobacteria as pathogenic agents in a variety of different infectious conditions. We discuss here one such case of a complicated urinary tract infection associated with Bifidobacterium spp. PMID:25253483

  20. Fighting urinary tract infections with antibiotic and non-antibiotic therapies.

    PubMed

    Peri, Lluis

    2016-06-25

    Urinary tract infections (UTIs) place a considerable burden on the patient and are associated with substantial economic cost. Treatment of UTIs is mainly achieved using antibiotics, however, the rise in antibiotic resistance is concerning and the use of non-antimicrobial prophylaxis offers alternative treatment methods.

  1. Ribonucleases 6 and 7 have antimicrobial function in the human and murine urinary tract

    PubMed Central

    Becknell, Brian; Eichler, Tad; Beceiro, Susana; Li, Birong; Easterling, Robert; Carpenter, Ashley R.; James, Cindy; McHugh, Kirk M.; Hains, David S.; Partida-Sanchez, Santiago; Spencer, John David

    2014-01-01

    Recent evidence suggests antimicrobial peptides protect the urinary tract from infection. Ribonuclease 7 (RNase 7), a member of the RNase A superfamily, is a potent epithelial-derived protein that maintains human urinary tract sterility. RNase 7 expression is restricted to primates, limiting evaluation of its antimicrobial activity in vivo. Here we identified Ribonuclease 6 (RNase 6) as the RNase A Superfamily member present in humans and mice that is most conserved at the amino acid level relative to RNase 7. Like RNase 7, recombinant human and murine RNase 6 has potent antimicrobial activity against uropathogens. Quantitative real-time PCR and immunoblot analysis indicate that RNase 6 mRNA and protein are up-regulated in the human and murine urinary tract during infection. Immunostaining located RNase 6 to resident and infiltrating monocytes, macrophages, and neutrophils. Uropathogenic E. coli induces RNase 6 peptide expression in human CD14+ monocytes and murine bone marrow derived macrophages. Thus, RNase 6 is an inducible, myeloid-derived protein with markedly different expression from the epithelial-derived RNase 7 but with equally potent antimicrobial activity. Our studies suggest RNase 6 serves as an evolutionarily conserved antimicrobial peptide that participates in the maintenance of urinary tract sterility. PMID:25075772

  2. Role of uroflowmetry with electromyography in the evaluation of children with lower urinary tract dysfunction

    PubMed Central

    Babu, Ramesh; Gopinath, Vinu

    2015-01-01

    Introduction: A conventional urodynamic study (UDS) is considered invasive while uroflowmetry is considered inadequate in the evaluation of children with lower urinary tract dysfunction. The aims of this study were to identify the role of uroflowmetry with electromyography (UFEMG) in this group. Methods: A cohort of 121 children (age 5–12 years; M:F = 2:3) with symptoms of lower urinary tract dysfunction underwent a detailed voiding history and clinical assessment. Those with evidence of neurological abnormality, obstructive uropathy or active urinary tract infection were not included. They were prospectively studied using UFEMGfirst, followed by UDS on the same day. Results: A total of 76 (63%) children had abnormality on UFEMG while only 12 (10%) had abnormality on UDS. UFEMG was significantly superior in picking up abnormality (P = 0.03). Three types of UFEMG abnormalities were identified: (1) dysfunctional voiding (prolonged staccato trace with active pelvic floor and normal voided volume: n = 42), (2) idiopathic detrusor overactivity (shortened trace with quiet pelvic floor and reduced voided volume: n = 16) and (3) detrusor underutilization disorder (prolonged flat trace with quiet pelvic floor and large voided volume: n = 18). Conclusions: UFEMG is ideal non-invasive test in children with lower urinary tract dysfunction. It helps in identifying the different patterns and the appropriate treatment modality. PMID:26604449

  3. Role of Uropathogenic Escherichia coli Virulence Factors in Development of Urinary Tract Infection and Kidney Damage

    PubMed Central

    Bien, Justyna; Sokolova, Olga; Bozko, Przemyslaw

    2012-01-01

    Uropathogenic Escherichia coli (UPEC) is a causative agent in the vast majority of urinary tract infections (UTIs), including cystitis and pyelonephritis, and infectious complications, which may result in acute renal failure in healthy individuals as well as in renal transplant patients. UPEC expresses a multitude of virulence factors to break the inertia of the mucosal barrier. In response to the breach by UPEC into the normally sterile urinary tract, host inflammatory responses are triggered leading to cytokine production, neutrophil influx, and the exfoliation of infected bladder epithelial cells. Several signaling pathways activated during UPEC infection, including the pathways known to activate the innate immune response, interact with calcium-dependent signaling pathways. Some UPEC isolates, however, might possess strategies to delay or suppress the activation of components of the innate host response in the urinary tract. Studies published in the recent past provide new information regarding how virulence factors of uropathogenic E. coli are involved in activation of the innate host response. Despite numerous host defense mechanisms, UPEC can persist within the urinary tract and may serve as a reservoir for recurrent infections and serious complications. Presentation of the molecular details of these events is essential for development of successful strategies for prevention of human UTIs and urological complications associated with UTIs. PMID:22506110

  4. [Differential diagnosis of postoperative fistulas of the urinary tract (author's transl)].

    PubMed

    Zimmermann, A; Siewert, R; Stuhler, T

    1979-01-01

    A case is demonstrated in which an indwelling intravenous catheter was pushed by mistake via V. subclavia and the right heart into the V. cava inf. There the catheter perforated the wall of the V. cava. The continued infusion induced a cystic retroperitoneal tumor. The puncture of this tumor was followed by a fistula that was misinterpreted as a fistula of the urinary tract.

  5. Contribution of Siderophore Systems to Growth and Urinary Tract Colonization of Asymptomatic Bacteriuria Escherichia coli

    PubMed Central

    Watts, Rebecca E.; Totsika, Makrina; Challinor, Victoria L.; Mabbett, Amanda N.; Ulett, Glen C.; De Voss, James J.

    2012-01-01

    The molecular mechanisms that define asymptomatic bacteriuria (ABU) Escherichia coli colonization of the human urinary tract remain to be properly elucidated. Here, we utilize ABU E. coli strain 83972 as a model to dissect the contribution of siderophores to iron acquisition, growth, fitness, and colonization of the urinary tract. We show that E. coli 83972 produces enterobactin, salmochelin, aerobactin, and yersiniabactin and examine the role of these systems using mutants defective in siderophore biosynthesis and uptake. Enterobactin and aerobactin contributed most to total siderophore activity and growth in defined iron-deficient medium. No siderophores were detected in an 83972 quadruple mutant deficient in all four siderophore biosynthesis pathways; this mutant did not grow in defined iron-deficient medium but grew in iron-limited pooled human urine due to iron uptake via the FecA ferric citrate receptor. In a mixed 1:1 growth assay with strain 83972, there was no fitness disadvantage of the 83972 quadruple biosynthetic mutant, demonstrating its capacity to act as a “cheater” and utilize siderophores produced by the wild-type strain for iron uptake. An 83972 enterobactin/salmochelin double receptor mutant was outcompeted by 83972 in human urine and the mouse urinary tract, indicating a role for catecholate receptors in urinary tract colonization. PMID:21930757

  6. Uroplakin 1b is critical in urinary tract development and urothelial differentiation and homeostasis.

    PubMed

    Carpenter, Ashley R; Becknell, M Brian; Ching, Christina B; Cuaresma, Edward J; Chen, Xi; Hains, David S; McHugh, Kirk M

    2016-03-01

    Proper development and maintenance of urothelium is critical to its function. Uroplakins are expressed in developing and mature urothelium where they establish plaques associated with the permeability barrier. Their precise functional role in development and disease is unknown. Here, we disrupted Upk1b in vivo where its loss resulted in urothelial plaque disruption in the bladder and kidney. Upk1b(RFP/RFP) bladder urothelium appeared dysplastic with expansion of the progenitor cell markers, Krt14 and Krt5, increased Shh expression, and loss of terminal differentiation markers Krt20 and uroplakins. Upk1b(RFP/RFP) renal urothelium became stratified with altered cellular composition. Upk1b(RFP/RFP) mice developed age-dependent progressive hydronephrosis. Interestingly, 16% of Upk1b(RFP/RFP) mice possessed unilateral duplex kidneys. Our study expands the role of uroplakins, mechanistically links plaque formation to urinary tract development and function, and provides a tantalizing connection between congenital anomalies of the kidney and urinary tract along with functional deficits observed in a variety of urinary tract diseases. Thus, kidney and bladder urothelium are regionally distinct and remain highly plastic, capable of expansion through tissue-specific progenitor populations. Furthermore, Upk1b plays a previously unknown role in early kidney development representing a novel genetic target for congenital anomalies of the kidney and urinary tract. PMID:26880456

  7. Visibility of the urethral meatus and risk of urinary tract infections in uncircumcised boys

    PubMed Central

    Dubrovsky, Alexander Sasha; Foster, Bethany J.; Jednak, Roman; Mok, Elise; McGillivray, David

    2012-01-01

    Background: Uncircumcised boys are at higher risk for urinary tract infections than circumcised boys. Whether this risk varies with the visibility of the urethral meatus is not known. Our aim was to determine whether there is a hierarchy of risk among uncircumcised boys whose urethral meatuses are visible to differing degrees. Methods: We conducted a prospective cross-sectional study in one pediatric emergency department. We screened 440 circumcised and uncircumcised boys. Of these, 393 boys who were not toilet trained and for whom the treating physician had requested a catheter urine culture were included in our analysis. At the time of catheter insertion, a nurse characterized the visibility of the urethral meatus (phimosis) using a 3-point scale (completely visible, partially visible or nonvisible). Our primary outcome was urinary tract infection, and our primary exposure variable was the degree of phimosis: completely visible versus partially or nonvisible urethral meatus. Results: Cultures grew from urine samples from 30.0% of uncircumcised boys with a completely visible meatus, and from 23.8% of those with a partially or nonvisible meatus (p = 0.4). The unadjusted odds ratio (OR) for culture growth was 0.73 (95% confidence interval [CI] 0.35–1.52), and the adjusted OR was 0.41 (95% CI 0.17–0.95). Of the boys who were circumcised, 4.8% had urinary tract infections, which was significantly lower than the rate among uncircumcised boys with a completely visible urethral meatus (unadjusted OR 0.12 [95% CI 0.04–0.39], adjusted OR 0.07 [95% CI 0.02–0.26]). Interpretation: We did not see variation in the risk of urinary tract infection with the visibility of the urethral meatus among uncircumcised boys. Compared with circumcised boys, we saw a higher risk of urinary tract infection in uncircumcised boys, irrespective of urethral visibility. PMID:22777988

  8. Occult bacterial lower urinary tract infections in cats-urinalysis and culture findings.

    PubMed

    Litster, Annette; Moss, Susan; Platell, Joanne; Trott, Darren J

    2009-04-14

    Bacterial urinary tract infections (UTIs) can be detected in feline urine submitted for urinalysis and culture as part of the diagnostic workup for a variety of conditions. Our aim was to investigate urinalysis and culture findings in urine specimens from cats with no history of lower urinary tract signs. Study inclusion criteria required cystocentesis specimens from cats with no history of lower urinary tract signs, inappropriate urination, or previous UTI (including pyelonephritis). Of 132 specimens, 38 were culture positive and 94 were culture negative. Culture positive urine specimens were more likely to come from older female cats (p=0.03, p<0.001, respectively) and they had higher pH (p=0.001), erythrocyte (p=0.013) and leukocyte counts (p=0.003) than culture negative urine specimens. Gram-negative infected specimens (n=15) had lower urine specific gravity and higher leukocyte counts than Gram-positive infected specimens (n=21; p=0.0012, p=0.005, respectively) and culture negative specimens (p=0.003, p<0.0001, respectively). Urine protein:creatinine ratio was higher in Gram-negative infected urine than in culture negative urine (p=0.013). Enterococcus faecalis was the most commonly isolated bacteria (19 of a total of 44 isolates; 43.2%) and E. coli phylogenetic group B2 was the most common Gram-negative isolate (14 of a total of 44 isolates; 31.8%). We conclude that feline bacterial urinary tract infections can occur in cats without lower urinary tract signs, particularly older females and that they are associated with high urine erythrocyte and leukocyte counts. PMID:19056189

  9. Treating urinary tract stones: common questions about a common problem.

    PubMed

    Monga, Manoj

    2010-08-01

    Urinary stones are a common and costly problem. Although shockwave lithotripsy is the mainstay of treatment for stones, a number of other surgical tools and approaches may be beneficial to some patients. Newer diagnostic techniques and technologies are improving our ability to determine the size, location, and composition of stones and, thus, our approach to treatment. And an increased focus on diet and metabolism is helping patients prevent stone formation. This article reviews the current approaches to diagnosing and treating urologic stones and answers questions primary care physicians often ask about this topic.

  10. Urinary Tract Refunctionalization After Prior Diversion in Children

    PubMed Central

    Hendren, W. Hardy

    1974-01-01

    Thirty-two children who had undergone previous urinary diversion were operated upon to refunctionalize the bladder. In 24 the diversion had been considered permanent, and in eight, temporary. Success in these procedures suggests that many young patients deserve a second look for possible “undiversion.” ImagesFig. 6.Fig. 7.Fig. 8.Fig. 9.Fig. 10.Fig. 11.Fig. 12.Fig. 13.Fig. 14.Fig. 15.Fig. 16.Fig. 17a.Fig. 17b.Fig. 18. PMID:4416811

  11. Whole genome sequence of Staphylococcus saprophyticus reveals the pathogenesis of uncomplicated urinary tract infection.

    PubMed

    Kuroda, Makoto; Yamashita, Atsushi; Hirakawa, Hideki; Kumano, Miyuki; Morikawa, Kazuya; Higashide, Masato; Maruyama, Atsushi; Inose, Yumiko; Matoba, Kimio; Toh, Hidehiro; Kuhara, Satoru; Hattori, Masahira; Ohta, Toshiko

    2005-09-13

    Staphylococcus saprophyticus is a uropathogenic Staphylococcus frequently isolated from young female outpatients presenting with uncomplicated urinary tract infections. We sequenced the whole genome of S. saprophyticus type strain ATCC 15305, which harbors a circular chromosome of 2,516,575 bp with 2,446 ORFs and two plasmids. Comparative genomic analyses with the strains of two other species, Staphylococcus aureus and Staphylococcus epidermidis, as well as experimental data, revealed the following characteristics of the S. saprophyticus genome. S. saprophyticus does not possess any virulence factors found in S. aureus, such as coagulase, enterotoxins, exoenzymes, and extracellular matrix-binding proteins, although it does have a remarkable paralog expansion of transport systems related to highly variable ion contents in the urinary environment. A further unique feature is that only a single ORF is predictable as a cell wall-anchored protein, and it shows positive hemagglutination and adherence to human bladder cell associated with initial colonization in the urinary tract. It also shows significantly high urease activity in S. saprophyticus. The uropathogenicity of S. saprophyticus can be attributed to its genome that is needed for its survival in the human urinary tract by means of novel cell wall-anchored adhesin and redundant uro-adaptive transport systems, together with urease.

  12. Whole genome sequence of Staphylococcus saprophyticus reveals the pathogenesis of uncomplicated urinary tract infection

    PubMed Central

    Kuroda, Makoto; Yamashita, Atsushi; Hirakawa, Hideki; Kumano, Miyuki; Morikawa, Kazuya; Higashide, Masato; Maruyama, Atsushi; Inose, Yumiko; Matoba, Kimio; Toh, Hidehiro; Kuhara, Satoru; Hattori, Masahira; Ohta, Toshiko

    2005-01-01

    Staphylococcus saprophyticus is a uropathogenic Staphylococcus frequently isolated from young female outpatients presenting with uncomplicated urinary tract infections. We sequenced the whole genome of S. saprophyticus type strain ATCC 15305, which harbors a circular chromosome of 2,516,575 bp with 2,446 ORFs and two plasmids. Comparative genomic analyses with the strains of two other species, Staphylococcus aureus and Staphylococcus epidermidis, as well as experimental data, revealed the following characteristics of the S. saprophyticus genome. S. saprophyticus does not possess any virulence factors found in S. aureus, such as coagulase, enterotoxins, exoenzymes, and extracellular matrix-binding proteins, although it does have a remarkable paralog expansion of transport systems related to highly variable ion contents in the urinary environment. A further unique feature is that only a single ORF is predictable as a cell wall-anchored protein, and it shows positive hemagglutination and adherence to human bladder cell associated with initial colonization in the urinary tract. It also shows significantly high urease activity in S. saprophyticus. The uropathogenicity of S. saprophyticus can be attributed to its genome that is needed for its survival in the human urinary tract by means of novel cell wall-anchored adhesin and redundant uro-adaptive transport systems, together with urease. PMID:16135568

  13. Higher risk of urothelial carcinoma in the upper urinary tract than in the urinary bladder in hemodialysis patients.

    PubMed

    Hsiao, Po-Jen; Hsieh, Po-Fan; Chang, Chao-Hsiang; Wu, Hsi-Chin; Yang, Chi-Rei; Huang, Chi-Ping

    2016-06-01

    Purpose This study used the a nationwide population-based retrospective cohort study with the claims data from the Taiwan National Health Insurance Research Database to investigate the risk of urothelial carcinoma (UC) for hemodialysis (HD) patients. Methods The study population consisted of 2689 patients with end-stage renal disease (ESRD) newly diagnosed in 2000-2002 and underwent maintenance HD. Then, 21,449 reference patients were collected without HD randomly selected and matched with sex and age. The exclusion criteria were previous long-term analgesics and Chinese medication usage. Incidence density rates of UC in upper urinary tract (UTUC) and bladder (UBUC) were estimated for both cohorts by the end of 2012. Hazard ratios (HRs) of UC were measured in association with HD, covariates, and comorbidity. Results The incidence of UC was significantly higher in the HD cohort than in the reference cohort for both UT (21.8 vs. 0.65 per 10,000 person-years) and UB (17.7 vs. 3.55 per 10,000 person-years). The multivariate Cox proportional hazard regression analysis showed that the HRs of UTUC in HD cohort was 33.3 (95% CI = 15.9-69.5) and 5.14 for UBUC (95% CI = 3.24-8.15). The risk increased further for HD patients with comorbidity of hematuria, urinary tract infection (UTI) or hydronephrosis. Conclusion Patients with ESRD on HD are at a high risk of developing UC, especially UTUC in Taiwan. They will be paid more frequent to check urine analysis, urine cytology, and upper urinary tract survey. PMID:26956094

  14. Molecular epidemiology of Staphylococcus saprophyticus isolated from women with uncomplicated community-acquired urinary tract infection.

    PubMed

    Widerström, Micael; Wiström, Johan; Ferry, Sven; Karlsson, Carina; Monsen, Tor

    2007-05-01

    Staphylococcus saprophyticus is a common cause of urinary tract infections (UTIs) in women. Little is known about the molecular epidemiology of S. saprophyticus UTIs. In the current study, we compared 76 isolates of S. saprophyticus prospectively isolated from women with uncomplicated UTI participating in a randomized placebo-controlled treatment trial performed in northern Sweden from 1995 to 1997 with 50 strains obtained in 2006 from five different locations in northern Europe with pulsed-field gel electrophoresis (PFGE). The aim was to elucidate the molecular epidemiology of this uropathogenic species and to investigate whether specific clones are associated with UTI in women. A total of 47 different PFGE profiles were detected among the 126 analyzed isolates. Ten clusters consisting of 5 to 12 isolates each showing PFGE DNA similarity of >85% were identified. Several clusters of genetically highly related isolates were detected in the original trial as well as among isolates obtained during 2006 from different locations. In the original trial, clonal persistence was found among 16 of 21 (76%) patients examined in the placebo group at follow-up 8 to 10 days after inclusion, indicating a low spontaneous short-time bacteriological cure rate. We conclude that multiple clones of S. saprophyticus were causing lower UTIs in women. The result suggests that some human-pathogenic clones of S. saprophyticus are spread over large geographical distances and that such clones may persist over long periods of time.

  15. Developmental Genetics and Congenital Anomalies of the Kidney and Urinary Tract.

    PubMed

    Uy, Natalie; Reidy, Kimberly

    2016-03-01

    Congenital anomalies of the kidney and urinary tract (CAKUT) are common birth defects and the leading cause of end-stage renal disease in children. There is a wide spectrum of renal abnormalities, from mild hydronephrosis to more severe cases, such as bilateral renal dysplasia. The etiology of the majority of cases of CAKUT remains unknown, but there is increasing evidence that genomic imbalance contributes to the pathogenesis of CAKUT. Advances in human and mouse genetics have contributed to increased understanding of the pathophysiology of CAKUT. Mutations in genes involved in both transcription factors and signal transduction pathways involved in renal development are associated with CAKUT. Large cohort studies suggest that copy number variants, genomic, or de novo mutations may explain up to one-third of all cases of CAKUT. One of the major challenges to the use of genetic information in the clinical setting remains the lack of strict genotype-phenotype correlation. However, identifying genetic causes of CAKUT may lead to improved diagnosis of extrarenal complications. With the advent of decreasing costs for whole genome and exome sequencing, future studies focused on genotype-phenotype correlations, gene modifiers, and animal models of gene mutations will be needed to translate genetic advances into improved clinical care. PMID:27617142

  16. Prenatal diagnosis and postpartal therapy of fetal obstructions related to the urinary tract.

    PubMed

    Meyer-Schwickerath, M; Bedow, W; Rascher, W

    1990-01-01

    114 fetal malformations were diagnosed by ultrasound in the years 1983-1987 at our institute. 32 of these malformations involved the urinary tract. Fetuses with multicystic dysplasic kidneys and oligohydramnios have only a poor prognosis. In obstructive uropathy, however, exact antenatal diagnosis makes early leads to specific postpartal urological therapy. Modern ultrasound equipment makes it possible to localize the site of obstruction and/or dilatation in fetuses. The amount of amnion fluid indicates the degree of obstruction and is an important factor the postpartal prognosis of the children. Relieve of obstruction should be the first step of urological therapy directly after birth. We prefer to perform reconstructive surgery as soon as possible in the first 2 to 3 weeks of life. In children with subpelvic stenosis pyeloplasty is performed in the first weeks of life. Our results of 13 pyeloplasties in newborn are favourable. In children with megaureters dynamic scintigraphy or pressure flow studies (Whitaker test) are performed to diagnose or to exclude obstruction as a cause of dilatation (n = 14). In case of obstruction we perform an ureterocutaneostomy (Ring- or Sober procedure) immediately. Urethral valves causing subvesical obstruction could be treated by transvesical antegrade valve ablation, performed in 9 newborn with good success.

  17. Urinary tract obstruction in the mouse: the kinetics of distal nephron injury.

    PubMed

    Hiatt, Michael J; Ivanova, Larissa; Trnka, Peter; Solomon, Marc; Matsell, Douglas G

    2013-09-01

    Congenital urinary tract obstruction is the single most important cause of childhood chronic kidney disease. We have previously demonstrated that human and primate fetal obstruction impairs the development, differentiation, and maturation of the kidney. Research using postnatal rodent models has primarily focused upon the role of proximal tubular injury, with few reports of collecting duct system pathology or the suitability of the postnatal models for examining injury to the distal nephron. We have employed the mouse unilateral ureteric obstruction (UUO) model and examined time points ranging from 1 to 14 days of obstruction. Many of the key features of fetal collecting duct injury are replicated in the postnatal mouse model of obstruction. Obstruction causes a sixfold increase in myofibroblast accumulation, two- to threefold dilatation of tubules of the distal nephron, 65% reduction of principal cell aquaporin 2 expression, 75% reduction of collecting duct intercalated cell abundance, and disruption of E-cadherin- and βcatenin-mediated collecting duct epithelial adhesion. Notably, these features are shared by the distal and connecting tubules. This work confirms that distal nephron pathology is a significant component of postnatal mouse UUO. We have highlighted the utility of this model for investigating collecting duct and distal tubule injury and for identifying the underlying mechanisms of the distal nephron's contribution to the repair and fibrosis.

  18. Divalent flagellin immunotherapy provides homologous and heterologous protection in experimental urinary tract infections in mice.

    PubMed

    Sabharwal, Neha; Chhibber, Sanjay; Harjai, Kusum

    2016-01-01

    Immunotherapy employs selected prokaryotic elements which are specially targeted because of their designated important role in the pathogenicity of the microbes. Among these is the flagellin of P. aeruginosa, which plays a major role in establishment of urinary tract infections (UTIs). In this study we envisage divalent flagellin (a combination of flagellin subtypes, 'a' and 'b') as an immunotherapeutic candidate against UTIs caused by Pseudomonas aeruginosa. Flagellin proteins were isolated from P. aeruginosa strains and characterized by MALDI-TOF. Their efficacy was checked in an ascending model of UTI. Divalent flagellin ('a' and 'b') when given together (intraperitoneally, i.p.) to female LACA mice at a concentration of 5 μg each, protected mice against pyelonephritis due to P. aeruginosa strains with no bacterial load at peak day of infection. Tissue destruction was minimum, as assessed by MDA levels and renal histopathology. Divalent flagellin immunization also drastically reduced pro-inflammatory cytokine levels (TNF α and IL-1β) in renal homogenates as determined by ELISA. It also prevented UTI caused by heterologous strain Escherichia coli. Antibodies against both flagellin proteins were assessed by ELISA. Passive immunization protected mice against UTI induced by either of the strains, P. aeruginosa and E. coli. These results confirmed homologous and heterologous protection provided by divalent flagellin. PMID:26655680

  19. [Extracorporeal shockwave lithotripsy for upper urinary tract stone].

    PubMed

    Lechevallier, E; Traxer, O; Saussine, C

    2008-12-01

    Extracorporeal shockwave lithotripsy (ESWL) is the fragmentation of stone by means of acoustic shockwaves created by an extracorporeal source. ESWL brakes the stone by spallation and squeezing. The optimal frequency for fragmentation is 1Hz. The initial power must be low, then progressively increased during the session. The contra-indications for ESWL are pregnancy, major deformities, severe obesity, aortic aneurism, uncontrolled coagulation disorders, untreated urinary infection, cardiac pacemaker. A stone density of 1000UH is a risk factor for fragmentation failure. The success rate for the kidney and the ureter is 60-80% and 80%, respectively. Stone clearance may be facilitated by alpha blockers. Asymptomatic and non-infected residual fragments less than 4mm must be followed-up annually.

  20. Lower urinary tract dysfunction in pelvic gynecologic cancer: the role of urodynamics.

    PubMed

    Aoun, Fouad; Peltier, Alexandre; van Velthoven, Roland

    2014-01-01

    The exact incidence of lower urinary tract dysfunction is not known and its pathogenesis is not completely understood. Advances in urodynamic assessment and widespread availability of a standardized technique have facilitated its exploration prior to and subsequent to the surgical management of patients with gynecologic pelvic cancer. We performed a PubMed and Medline literature search using the following keywords: bladder dysfunction, urinary dysfunction, and urodynamics and all these terms in combination with radical hysterectomy in order to analyze the role of urodynamics in patients with pelvic gynecologic cancer in the preoperative as well as in the early and late postoperative settings. PMID:25506360

  1. Regulatory and metabolic networks for the adaptation of Pseudomonas aeruginosa biofilms to urinary tract-like conditions.

    PubMed

    Tielen, Petra; Rosin, Nathalie; Meyer, Ann-Kathrin; Dohnt, Katrin; Haddad, Isam; Jänsch, Lothar; Klein, Johannes; Narten, Maike; Pommerenke, Claudia; Scheer, Maurice; Schobert, Max; Schomburg, Dietmar; Thielen, Bernhard; Jahn, Dieter

    2013-01-01

    Biofilms of the Gram-negative bacterium Pseudomonas aeruginosa are one of the major causes of complicated urinary tract infections with detrimental outcome. To develop novel therapeutic strategies the molecular adaption strategies of P. aeruginosa biofilms to the conditions of the urinary tract were investigated thoroughly at the systems level using transcriptome, proteome, metabolome and enzyme activity analyses. For this purpose biofilms were grown anaerobically in artificial urine medium (AUM). Obtained data were integrated bioinformatically into gene regulatory and metabolic networks. The dominating response at the transcriptome and proteome level was the adaptation to iron limitation via the broad Fur regulon including 19 sigma factors and up to 80 regulated target genes or operons. In agreement, reduction of the iron cofactor-dependent nitrate respiratory metabolism was detected. An adaptation of the central metabolism to lactate, citrate and amino acid as carbon sources with the induction of the glyoxylate bypass was observed, while other components of AUM like urea and creatinine were not used. Amino acid utilization pathways were found induced, while fatty acid biosynthesis was reduced. The high amounts of phosphate found in AUM explain the reduction of phosphate assimilation systems. Increased quorum sensing activity with the parallel reduction of chemotaxis and flagellum assembly underscored the importance of the biofilm life style. However, reduced formation of the extracellular polysaccharide alginate, typical for P. aeruginosa biofilms in lungs, indicated a different biofilm type for urinary tract infections. Furthermore, the obtained quorum sensing response results in an increased production of virulence factors like the extracellular lipase LipA and protease LasB and AprA explaining the harmful cause of these infections.

  2. Regulatory and Metabolic Networks for the Adaptation of Pseudomonas aeruginosa Biofilms to Urinary Tract-Like Conditions

    PubMed Central

    Dohnt, Katrin; Haddad, Isam; Jänsch, Lothar; Klein, Johannes; Narten, Maike; Pommerenke, Claudia; Scheer, Maurice; Schobert, Max; Schomburg, Dietmar; Thielen, Bernhard; Jahn, Dieter

    2013-01-01

    Biofilms of the Gram-negative bacterium Pseudomonas aeruginosa are one of the major causes of complicated urinary tract infections with detrimental outcome. To develop novel therapeutic strategies the molecular adaption strategies of P. aeruginosa biofilms to the conditions of the urinary tract were investigated thoroughly at the systems level using transcriptome, proteome, metabolome and enzyme activity analyses. For this purpose biofilms were grown anaerobically in artificial urine medium (AUM). Obtained data were integrated bioinformatically into gene regulatory and metabolic networks. The dominating response at the transcriptome and proteome level was the adaptation to iron limitation via the broad Fur regulon including 19 sigma factors and up to 80 regulated target genes or operons. In agreement, reduction of the iron cofactor-dependent nitrate respiratory metabolism was detected. An adaptation of the central metabolism to lactate, citrate and amino acid as carbon sources with the induction of the glyoxylate bypass was observed, while other components of AUM like urea and creatinine were not used. Amino acid utilization pathways were found induced, while fatty acid biosynthesis was reduced. The high amounts of phosphate found in AUM explain the reduction of phosphate assimilation systems. Increased quorum sensing activity with the parallel reduction of chemotaxis and flagellum assembly underscored the importance of the biofilm life style. However, reduced formation of the extracellular polysaccharide alginate, typical for P. aeruginosa biofilms in lungs, indicated a different biofilm type for urinary tract infections. Furthermore, the obtained quorum sensing response results in an increased production of virulence factors like the extracellular lipase LipA and protease LasB and AprA explaining the harmful cause of these infections. PMID:23967252

  3. Fungal Urinary Tract Infection in Burn Patients with Long-Term Foley Catheterization

    PubMed Central

    Kim, Jinsup; Kim, Dae Sung; Lee, Yong Seong

    2011-01-01

    Purpose It is well known that fungi become predominant microorganisms in the urine of patients with long-term Foley catheters. This study was conducted to evaluate the lengths of time for fungi to cause urinary tract infection (UTI) and to identify predictors of fungal UTI in burn patients with long-term Foley catheters. Materials and Methods A total of 93 patients who did not have infection at the time of admission but later had fugal UTI were evaluated. Urinalysis, urine culture, and Foley catheter indwelling were done at admission. All patients were administered prophylactic antibiotics from admission. Urine cultures were run every week, and catheters were changed every 2 weeks for each patient. Results Three of the 93 patients (3.2%) displayed fungal UTI at the 1st week of catheter indwelling. However, most patients (78.5%) displayed fungal UTI from 2nd to 5th week after catheter indwelling. The most prevalent fungus identified was Candida tropicalis (60.2%). By univariate logistic regression analysis, only the total body surface area burned (TBSAB) was predictive of fungal UTI in burn patients (p=0.010). By multivariate logistic regression analysis, underlying disease (p=0.032) and TBSAB (p=0.036) were predictors of fungal UTI. Patients with higher TBSAB were more likely to display shorter intervals from Foley catheterization to fungal UTI. Conclusions Fungal UTI was initially found at the 1st week of urinary catheter indwelling, but the majority of cases occurred after the 1st week and appeared earlier in patients with underlying disease or higher TBSAB. Underlying disease and TBSAB were predictors of early fungal UTI. PMID:22025959

  4. [The diagnosis and therapy of first community acquired urinary tract infection in children].

    PubMed

    Miron, Dan; Grossman, Zachi

    2009-11-01

    A first urinary tract infection (UTI) in childhood is more prevalent in females < 5-years-old. Circumcision generally protects males from UTI, however, during the month following the procedure, the prevalence of infection increases up to 12 times in circumcised boys when compared with those not circumcised. Almost all the infections are caused by aerobic Gram-negative bacteria of which E. coli are responsible for 70-90% of the cases. Signs and symptoms of UTI vary in different age groups. Factors associated with the likelihood of UTI are: non-circumcised male, fever > 40 degrees C, and a fever > 39 degrees C for more than 48 hours with no other focus of infection on physical examination. Urinalysis and urine microscopy are screening tests for UTI. In children with clinical symptoms and signs suggesting UTI, the results of these tests have a positive predictive value (if both are positive), or negative predictive value (if both are negative) approximating 100%. The definitive diagnosis of UTI is based on the urine culture. Bag urine culture is associated with a very high rate of contamination. Therefore, in non-toilet trained children, urine culture should be obtained directly from the urinary bladder either by supra pubic aspiration or in and out transurethral catheterization. Mid stream clean voided urine specimens obtained from circumcised males in the first months of life are also acceptable. Depending on the clinical presentation, oral therapy can begin from as early as two months of age, and the recommended empiric drugs for first febrile UTI are cefuroxime axetil, or amoxicillin clavulanate. Cephlexin is recommended for cystitis.

  5. Catheter-associated urinary tract infections in intensive care units at a university hospital in Turkey.

    PubMed

    Keten, Derya; Aktas, Firdevs; Guzel Tunccan, Ozlem; Dizbay, Murat; Kalkanci, Ayse; Biter, Gülsah; Keten, Hamit Sirri

    2014-01-01

    In this study, urinary catheter utilization rates, the causative agents for catheter-associated urinary tract infection (CAUTI) and their antimicrobial susceptibilities in intensive care units (ICUs) in 2009 were investigated at Gazi university hospital. We aimed to determine the causative agents and risk factors for CAUTIs, and antimicrobial susceptibilities of the pathogens; and also sensitivities of Candida spp. to antifungal agents with Microdilution and E-test. The most common etiological agents of CAUTIs were Candida spp. (34.7%). The most frequently isolated Candida spp. was C.albicans (52.4%). All C. albicans spp. were sensitive to fluconazole. Microdilution, used as a reference method to determine the sensitivity to antifungal agents, was compared with E test. E test was found to be sufficient to analyze sensitivity to amphotericin B, caspofungin, fluconazole and voriconazole, but inappropriate for itraconazole. E.coli and Klebsiella spp. were found to be causative agents for CAUTI in 20.6% and 9.9% of cases respectively. Pseudomonas spp. and Acinetobacter spp. were isolated in 14% and 8.2% of the cases, respectively. All E.coli and Klebsiella strains were found sensitive to carbapenems. Carbapenem sensitivity was found in 47.1% and 30% of the cases infected with Pseudomonas and Acinetobacter strains, respectively. According to our results, fluconazole therapy seems to be an appropriate choice for the treatment of CAUTIs caused by C.albicans. Third and fourth generation cephalosporins should not be used for empirical treatment because of the high prevalence of extended spectrum beta-lactamase production among E.coli and Klebsiella isolates.

  6. Autosomal Dominant Pseudohypoaldosteronism Type 1 in an Infant with Salt Wasting Crisis Associated with Urinary Tract Infection and Obstructive Uropathy

    PubMed Central

    Bowden, Sasigarn A.; Cozzi, Corin; Hickey, Scott E.; Thrush, Devon Lamb; Astbury, Caroline; Nuthakki, Sushma

    2013-01-01

    Type 1 pseudohypoaldosteronism (PHA1) is a salt wasting syndrome caused by renal resistance to aldosterone. Primary renal PHA1 or autosomal dominant PHA1 is caused by mutations in mineralocorticoids receptor gene (NR3C2), while secondary PHA1 is frequently associated with urinary tract infection (UTI) and/or urinary tract malformations (UTM). We report a 14-day-old male infant presenting with severe hyperkalemia, hyponatremic dehydration, metabolic acidosis, and markedly elevated serum aldosterone level, initially thought to have secondary PHA1 due to the associated UTI and posterior urethral valves. His serum aldosterone remained elevated at 5 months of age, despite resolution of salt wasting symptoms. Chromosomal microarray analysis revealed a deletion of exons 3–5 in NR3C2 in the patient and his asymptomatic mother who also had elevated serum aldosterone level, confirming that he had primary or autosomal dominant PHA1. Our case raises the possibility that some patients with secondary PHA1 attributed to UTI and/or UTM may instead have primary autosomal dominant PHA1, for which genetic testing should be considered to identify the cause, determine future recurrence risk, and possibly prevent the life-threatening salt wasting in a subsequent family member. Future clinical research is needed to investigate the potential overlapping between secondary PHA1 and primary autosomal dominant PHA1. PMID:24455331

  7. Ultrasonography of the liver, spleen, and urinary tract of the cheetah (Acinonyx jubatus).

    PubMed

    Carstens, Ann; Kirberger, Robert M; Spotswood, Tim; Wagner, Wencke M; Grimbeek, Richard J

    2006-01-01

    Diseases of the abdomen of the cheetah (Acinonyx jubatus) include those affecting the liver, spleen, and urinary tract. The most common diseases of captive-bred cheetah are gastritis, gastric ulceration, glomerulosclerosis, and hepatic veno-occlusive disease, and are the most frequent causes of mortality in these animals. The purpose of this study was to describe the ultrasonographic anatomy of the normal liver, spleen, kidney, and urinary bladder of the anesthetized captive-bred cheetah. Twenty-one cheetahs were examined. Eight of the 21 animals had subclinical evidence of either gastritis or chronic renal disease. The ultrasonographic appearances of the liver, gall bladder, common bile duct, and spleen were evaluated and various measurements made. Statistical analyses of the measurements were performed on all the healthy and subclinically ill animals taking sex, age, mass, and anesthetic protocol into account. There were no significant differences in any parameters between the healthy and subclinically ill animals (P > 0.25) and data were combined for statistical analyses. The mean mass was 41.1kg ( +/- 8.8) and the mean age was 5.0 years (+/- 2.2). The mean thickness of the liver medial to the gall bladder was 67.0 mm (+/- 14.8) and the liver was within the left costal arch in 75% of animals, extended caudal to the right costal arch in 50% of animals for an average of 30 mm, and extended caudal to the sternum in 63% of animals for an average of 32.5 mm. The maximum mean hepatic vein diameter at the entrance to the caudal vena cava was 8.6 +/- 2.8 mm; the mean diameters of the portal vein at the hilus and that of the caudal vena cava as it entered the liver were 7.5 +/- 1.6 and 9.9 +/- 4.1 mm, respectively. The mean diameter of the caudal vena cava was significantly affected by the type of anesthetic used (P < 0.10). The mass of the animals was significant in explaining the variance in maximum portal vein diameters (P < 0.10). The mean maximum velocity of the

  8. Medical and alternative therapies in urinary tract stone disease

    PubMed Central

    Yuvanc, Ercan; Yilmaz, Erdal; Tuglu, Devrim; Batislam, Ertan

    2015-01-01

    Nephrolithiasis is a serious problem for both patients and the health system. Recurrence stands out as a significant problem in urinary system stone disease, the prevalence of which is increasing gradually. If recurrence is not prevented, patients may go through recurrent operations due to nephrolithiasis. While classical therapeutic options are available for all stone types, the number of randomized controlled studies and extensive meta-analyses focusing on their efficiency are inadequate. Various alternative therapeutic options to these medical therapies also stand out in recent years. The etiology of urolithiasis is multifactorial and not always related to nutritional factors. Nutrition therapy seems to be useful, either along with pharmacological therapy or as a monotherapy. General nutrition guidelines are useful in promoting public health and developing nutrition plans that reduce the risk or attenuate the effects of diseases affected by nutrition. Nutrition therapy involves the evaluation of a patient’s nutritional state and intake, the diagnosis of nutrition risk factors, and the organization and application of a nutrition program. The main target is the reduction or prevention of calculus formation and growth via decreasing lithogenic risk factors and increasing lithogenic inhibitors in urine. This review focuses briefly on classical medical therapy, along with alternative options, related diets, and medical expulsive therapy. PMID:26558186

  9. A practical guide to urinary tract ultrasound in a child: Pearls and pitfalls

    PubMed Central

    Park, K

    2014-01-01

    The aim of this review article is to equip the sonographer with the necessary knowledge to perform a detailed and clinically relevant assessment of the urinary tract in a child. Many of the techniques and principles used in the imaging of the urinary tract in adults can be applied to children. There are, however, notable differences with which the sonographer should be familiar. There is often a certain amount of trepidation when asked to image a child, but there are a number of simple steps that can make the process easier and more fulfilling. This article begins with advice on how to maintain cooperation in a child and the differences in the technical aspects of imaging of children. This is followed by a detailed review of the different pathologies that may be encountered, as well as highlighting information that is particularly relevant to the clinician looking after the child. PMID:27433222

  10. Diagnosis of upper urinary tract obstruction in children: comparison of diuresis renography and pressure flow studies

    SciTech Connect

    Gonzalez, R.; Chiou, R.

    1985-04-01

    A report is given of the use of diuresis renography and pressure flow studies to diagnose urinary tract obstruction in 41 collecting systems of 33 children. If differential pressures between the renal pelvis and the bladder in excess of 22 cm. water at a flow rate of 10 ml. per minute is accepted as evidence of obstruction and below 15 cm. water is accepted as normal the interpretation of the renogram showing O'Reilly's pattern IIIa as evidence of stasis without obstruction was correct in 74 per cent of the cases. Likewise, the interpretation of O'Reilly's renogram pattern IIIb as showing partial obstruction was correct in only 40 per cent of the cases. Thus, the authors urge caution in the use of the diuresis renogram to diagnose or to rule out upper urinary tract obstruction.

  11. Urinary tract disease in dogs: US findings. A mini-pictorial essay.

    PubMed

    Robotti, G; Lanfranchi, D

    2013-01-01

    Ultrasound (US) is the most commonly used imaging method for studying urinary tract disorders in dogs, as it is easy to perform, inexpensive and provides excellent contrast resolution in real-time. However, US examination of dogs presents a series of technical difficulties, and the US operator must therefore have a longstanding experience and access to high-quality equipment including a range of different probes to achieve a correct diagnosis. The aim of this mini-pictorial essay is to describe US findings and patterns which permit identification of the most common pathologies of the urinary tract in dogs. The technical difficulties that may be encountered are also evaluated as well as integration with other imaging modalities (traditional X-ray, computed tomography, magnetic resonance imaging).

  12. The problems of urinary tract infections with Candida spp. aetiology in women.

    PubMed

    Tomczak, Hanna; Szałek, Edyta; Grześkowiak, Edmund

    2014-01-01

    Urinary tract infections (UTIs) in women are a growing clinical concern. The most frequent risk factors of UTIs with fungal aetiology in women are: antibiotic therapy (especially broad-spectrum antibiotics), immunosuppressive therapy, diabetes, malnutrition, pregnancy, and frequent intercourse. The aim of the study was to analyse urinary tract infections with Candida spp. aetiology in women hospitalised at the Clinical Hospital in Poznań, Poland, between 2009 and 2011. The investigations revealed that as many as 71% of positive urine cultures with Candida fungi came from women. The following fungi were most frequently isolated from the patients under analysis: C. albicans (47%), C. glabrata (31%), C. tropicalis (6%), C. krusei (3%). In order to diagnose a UTI the diagnosis cannot be based on a single result of a urine culture. Due to the small number of antifungal drugs and high costs of treatment, antifungal drugs should be applied with due consideration and care.

  13. [Clinical and economic expedience of ertapenem therapy of complicated urinary tract infection].

    PubMed

    Kolbin, A S; Sidorenko, S V; Zagorodnikova, K A; Musatov, V B; Iakovlev, A A

    2011-01-01

    Clinical and economic investigation of various antibiotics use in the treatment of complicated urinary tract infection (CUTI) was performed under the Russian economic environment. The drugs of comparison were ertapenem, ceftriaxone and levofloxacin. Direct costs and their structure were shown, and the cost efficiency was calculated. Alternative analysis and one-side susceptibility analysis were performed. In complicated urinary tract infections when the major pathogens were Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis it was clinically and economically reasonable to start the treatment with ceftriaxone or ertapenem, while levofloxacin could be an alternative strategy. When the effects of the acquired resistance on the treatment effectiveness were evaluated (SIS model) it was shown that the pathogens susceptibility to ertapenem was preserved for a significantly longer time than that to ceftriaxone or levofloxacin (60 months). Such a parameter may serve as an additional evidence of the reasonable use of ertapenem as the starting treatment of CUTI.

  14. The role of micronutrients in the risk of urinary tract cancer

    PubMed Central

    Bukowczan, Jakub; Sobczynski, Robert; Leszczyszyn, Jaroslaw; Chlosta, Piotr L.

    2016-01-01

    Prostate, bladder and kidney cancers remain the most common urological malignancies worldwide, and the prevention and treatment of these diseases pose a challenge to clinicians. In recent decades, many studies have been conducted to assess the association between supplementation with selected vitamins and elements and urinary tract tumour initiation and development. Here, we review the relationship between vitamins A, B, D, and E, in addition to calcium, selenium, and zinc, and the risk of developing prostate, kidney and bladder cancer. A relatively consistent body of evidence suggests that large daily doses of calcium (> 2,000 mg/day) increase the risk of prostate cancer. Similarly, supplementation with 400 IU/day of vitamin E carries a significant risk of prostate cancer. However, there have been many conflicting results regarding the effect of these nutrients on kidney and bladder neoplasms. Moreover, the role of other compounds in urinary tract carcinogenesis needs further clarification. PMID:27186192

  15. Urinary tract infections in pregnancy: old and new unresolved diagnostic and therapeutic problems

    PubMed Central

    Małyszko, Jolanta; Wieliczko, Monika

    2015-01-01

    Urinary tract infections (UTIs) are common in pregnant women and pose a great therapeutic challenge, since the risk of serious complications in both the mother and her child is high. Pregnancy is a state associated with physiological, structural and functional urinary tract changes which promote ascending infections from the urethra. Unlike the general population, all pregnant women should be screened for bacteriuria with urine culture, and asymptomatic bacteriuria must be treated in every case that is diagnosed, as it is an important risk factor for pyelonephritis in this population. The antibiotic chosen should have a good maternal and fetal safety profile. In this paper, current principles of diagnosis and management of UTI in pregnancy are reviewed, and the main problems and controversies are identified and discussed. PMID:25861291

  16. [Homeopathic prophylaxis of urinary tract infections in patients with neurogenic bladder dysfunction].

    PubMed

    Pannek, J; Jus, M C; Jus, M S

    2012-04-01

    Recurrent urinary tract infections (UTI) in patients with spinal cord injury are a frequent clinical problem. Often, preventive measures are not successful. We present the case reports of five patients with recurrent UTI who received additional homeopathic treatment. Of these patients, three remained free of UTI, whereas UTI frequency was reduced in two patients. Our initial experience with homeopathic prevention of UTI is encouraging. For an evidence-based evaluation of this concept, prospective studies are required. PMID:22419012

  17. Type 1 fimbrial expression enhances Escherichia coli virulence for the urinary tract.

    PubMed Central

    Connell, I; Agace, W; Klemm, P; Schembri, M; Mărild, S; Svanborg, C

    1996-01-01

    Type 1 fimbriae are adhesion organelles expressed by many Gram-negative bacteria. They facilitate adherence to mucosal surfaces and inflammatory cells in vitro, but their contribution to virulence has not been defined. This study presents evidence that type 1 fimbriae increase the virulence of Escherichia coli for the urinary tract by promoting bacterial persistence and enhancing the inflammatory response to infection. In a clinical study, we observed that disease severity was greater in children infected with E. coli O1:K1:H7 isolates expressing type 1 fimbriae than in those infected with type 1 negative isolates of the same serotype. The E. coli O1:K1:H7 isolates had the same electrophoretic type, were hemolysin-negative, expressed P fimbriae, and carried the fim DNA sequences. When tested in a mouse urinary tract infection model, the type 1-positive E. coli O1:K1:H7 isolates survived in higher numbers, and induced a greater neutrophil influx into the urine, than O1:K1:H7 type 1-negative isolates. To confirm a role of type 1 fimbriae, a fimH null mutant (CN1016) was constructed from an O1:K1:H7 type 1-positive parent. E. coli CN1016 had reduced survival and inflammatogenicity in the mouse urinary tract infection model. E. coli CN1016 reconstituted with type 1 fimbriae (E. coli CN1018) had restored virulence similar to that of the wild-type parent strain. These results show that type 1 fimbriae in the genetic background of a uropathogenic strain contribute to the pathogenesis of E. coli in the urinary tract. Images Fig. 3 Fig. 4 PMID:8790416

  18. Influence of circumcision technique on frequency of urinary tract infections in neonates.

    PubMed

    Harel, Liora; Straussbergr, Rachel; Jackson, Shlomo; Amir, Jacob; Tiqwa, Petah

    2002-09-01

    An increase in urinary tract infection (UTI) during the first weeks after traditional Jewish circumcision has been reported. Circumcision can be performed by a nonmedical person (mohel) or by a physician, with the main difference being in hemostasis techniques. We assessed the effect of circumcision procedure on development of UTI in neonates. Circumcision performed by a mohel was associated with higher incidence of UTI compared with that by physicians. Hemostasis technique and shaft wrapping are postulated risk factors.

  19. Kidney function and the use of nitrofurantoin to treat urinary tract infections in older women

    PubMed Central

    Singh, Namisha; Gandhi, Sonja; McArthur, Eric; Moist, Louise; Jain, Arsh K.; Liu, Aiden R.; Sood, Manish M.; Garg, Amit X.

    2015-01-01

    Background: The antibiotic nitrofurantoin is commonly used to treat uncomplicated urinary tract infections. However, when this drug is used by patients with reduced kidney function, its urine concentration may be subtherapeutic. Methods: We conducted a population-based study of older women (mean age 79 years) in Ontario, Canada, whose estimated glomerular filtration rate was relatively low (median 38 mL/min per 1.73 m2) and for whom 1 of 4 antibiotics had been prescribed for urinary tract infection: nitrofurantoin, ciprofloxacin, norfloxacin or trimethoprim–sulfamethoxazole. We assessed 2 measures of treatment failure in the subsequent 14 days: receipt of a second antibiotic indicated for urinary tract infection and hospital encounter (emergency department visit or hospital admission) with a urinary tract infection. We repeated the analysis for older women with relatively high estimated glomerular filtration rate (median 69 mL/min per 1.73 m2). Results: The baseline characteristics of the 4 antibiotic groups were similar. Relative to nitrofurantoin, the other antibiotics (including ciprofloxacin) were associated with a lower rate of treatment failure among women with relatively low estimated glomerular filtration rate (for ciprofloxacin v. nitrofurantoin: second antibiotic prescription, 130/1989 [6.5%] v. 516/3739 [13.8%], odds ratio [OR] 0.44, 95% confidence interval [CI] 0.36–0.53; hospital encounter, 21/1989 [1.1%] v. 95/3739 [2.5%], OR 0.41, 95% CI 0.25–0.66). However, a similar risk of treatment failure with nitrofurantoin was also observed among women with relatively high estimated glomerular filtration rate. The results were consistent in multiple additional analyses. Interpretation: In this study, the presence of mild or moderate reductions in estimated glomerular filtration rate did not justify avoidance of nitrofurantoin. PMID:25918178

  20. High Frequency of Staphylococcus Saprophyticus Urinary Tract Infections Among Female Adolescents.

    PubMed

    Lo, Denise Swei; Shieh, Huei Hsin; Barreira, Eliane Roseli; Ragazzi, Selma Lopes Betta; Gilio, Alfredo Elias

    2015-09-01

    Staphylococcus saprophyticus is a rarely reported agent of urinary tract infection (UTI) in the pediatric population. In our retrospective 3-year study, S. saprophyticus comprised 24.5% of 106 isolates of UTIs in female adolescents 12-15 years of age who attended an emergency department. Clinicians should be aware of the high prevalence of this etiology when empirically treating UTIs in female adolescents.

  1. [Sudden drop out of school due to psychic stress after repeated urinary tract surgery].

    PubMed

    Haapasalo-Pesu, Kirsi-Maria

    2012-01-01

    A 15-year old boy dropped out of school, withdrew into his home and, on inquiry upon the matter, threatened with suicide. Upon disentangling the issue it turned out that the boy perceived his urinary tract disease and associated pediatric surgery procedures so shameful and distressing that they had eventually exceeded his psychic ability. The mental state of the boy improved with therapeutic discussions and adolescent psychiatric rehabilitation.

  2. Surface charge-conversion polymeric nanoparticles for photodynamic treatment of urinary tract bacterial infections.

    PubMed

    Liu, Shijie; Qiao, Shenglin; Li, Lili; Qi, Guobin; Lin, Yaoxin; Qiao, Zengying; Wang, Hao; Shao, Chen

    2015-12-11

    Urinary tract infections are typical bacterial infections which result in a number of economic burdens. With increasing antibiotic resistance, it is urgent that new approaches are explored that can eliminate pathogenic bacteria without inducing drug resistance. Antimicrobial photodynamic therapy (PDT) is a new promising tactic. It is a gentle in situ photochemical reaction in which a photosensitizer (PS) generates reactive oxygen species (ROS) under laser irradiation. In this work, we have demonstrated Chlorin e6 (Ce6) encapsulated charge-conversion polymeric nanoparticles (NPs) for efficiently targeting and killing pathogenic bacteria in a weakly acidic urinary tract infection environment. Owing to the surface charge conversion of NPs in an acidic environment, the NPs exhibited enhanced recognition for Gram-positive (ex. S. aureus) and Gram-negative (ex. E. coli) bacteria due to the charge interaction. Also, those NPs showed significant antibacterial efficacy in vitro with low cytotoxicity. The MIC value of NPs to E. coli is 17.91 μg ml(-1), compared with the free Ce6 value of 29.85 μg ml(-1). Finally, a mouse acute cystitis model was used to assess the photodynamic therapy effects in urinary tract infections. A significant decline (P < 0.05) in bacterial cells between NPs and free Ce6 occurred in urine after photodynamic therapy treatment. And the plated counting results revealed a remarkable bacterial cells drop (P < 0.05) in the sacrificed bladder tissue. Above all, this nanotechnology strategy opens a new door for the treatment of urinary tract infections with minimal side effects.

  3. Surface charge-conversion polymeric nanoparticles for photodynamic treatment of urinary tract bacterial infections

    NASA Astrophysics Data System (ADS)

    Liu, Shijie; Qiao, Shenglin; Li, Lili; Qi, Guobin; Lin, Yaoxin; Qiao, Zengying; Wang, Hao; Shao, Chen

    2015-12-01

    Urinary tract infections are typical bacterial infections which result in a number of economic burdens. With increasing antibiotic resistance, it is urgent that new approaches are explored that can eliminate pathogenic bacteria without inducing drug resistance. Antimicrobial photodynamic therapy (PDT) is a new promising tactic. It is a gentle in situ photochemical reaction in which a photosensitizer (PS) generates reactive oxygen species (ROS) under laser irradiation. In this work, we have demonstrated Chlorin e6 (Ce6) encapsulated charge-conversion polymeric nanoparticles (NPs) for efficiently targeting and killing pathogenic bacteria in a weakly acidic urinary tract infection environment. Owing to the surface charge conversion of NPs in an acidic environment, the NPs exhibited enhanced recognition for Gram-positive (ex. S. aureus) and Gram-negative (ex. E. coli) bacteria due to the charge interaction. Also, those NPs showed significant antibacterial efficacy in vitro with low cytotoxicity. The MIC value of NPs to E. coli is 17.91 μg ml-1, compared with the free Ce6 value of 29.85 μg ml-1. Finally, a mouse acute cystitis model was used to assess the photodynamic therapy effects in urinary tract infections. A significant decline (P < 0.05) in bacterial cells between NPs and free Ce6 occurred in urine after photodynamic therapy treatment. And the plated counting results revealed a remarkable bacterial cells drop (P < 0.05) in the sacrificed bladder tissue. Above all, this nanotechnology strategy opens a new door for the treatment of urinary tract infections with minimal side effects.

  4. Urinary tract infection: finding an answer when conventional testing is not helpful.

    PubMed

    Saldano, Dawn Diaz

    2008-08-01

    Children who present with urinary tract infections (UTIs) and a fever, and who had negative radioloogical tests for vesicoureteral reflux (VUR), are often tested further with a voiding cystourethrogram (VCUG). If the VCUG is negative, health care providers and parents become frustrated, as the search for a definitive diagnosis becomes more elusive. If conventional tests do not provide the expected diagnosis of VUR, it is essential for nurses and other health care providers to be aware of alternative methods for further evaluation.

  5. Alternative Approaches to Conventional Treatment of Acute Uncomplicated Urinary Tract Infection in Women

    PubMed Central

    Foxman, Betsy; Buxton, Miatta

    2013-01-01

    The increasing resistance of uropathogens to antibiotics, and recognition of generally self-limiting nature of uncomplicated urinary tract infection (UTI) suggests that it is time to reconsider empirical treatment of UTI using antibiotics. Identifying new and effective strategies to prevent recurrences and alterative treatment strategies are a high priority. We review the recent literature regarding the effects of functional food products, probiotics, vaccines, and alternative treatments on treating and preventing UTI. PMID:23378124

  6. [Cranberry (Vaccinium macrocarpon) and urinary tract infections: study model and review of literature].

    PubMed

    Lavigne, J-P; Bourg, G; Botto, H; Sotto, A

    2007-11-01

    Cranberries (Vaccinium macrocarpon) have long been the focus of interest for their beneficial effects in preventing urinary tract infections. Among cranberry compounds, a group of proanthocyanidins (PACs) with A-type linkages were isolated which exhibit bacterial anti-adhesion activity against uropathogenic Escherichia coli strains. These PAC inhibit P-fimbriae synthesis and induce a bacterial deformation. This activity was demonstrated on both antibiotic susceptible and resistant bacteria. This review focused on the last discoveries in the knowledge of cranberry effects.

  7. Evaluation of New bioMérieux Chromogenic CPS Media for Detection of Urinary Tract Pathogens

    PubMed Central

    Rigaill, Josselin; Verhoeven, Paul O.; Mahinc, Caroline; Jeraiby, Mohamed; Grattard, Florence; Fonsale, Nathalie; Carricajo, Anne

    2015-01-01

    Four chromogenic media were compared for their ability to detect urinary tract pathogens in 299 urine specimens, of which 175 were found positive, allowing the growth of 279 microorganisms. After 18 to 24 h of incubation, the CPS ID4, CPSE, CPSO (bioMérieux), and UriSelect4 (Bio-Rad) media showed sensitivities of 97.1%, 99.3%, 99.6%, and 99.6%, respectively. PMID:25994162

  8. [Urinary tract tumor in a horseshoe kidney diagnosed after renal trauma].

    PubMed

    el-Mrini, M; Aboutaieb, R; Benjelloun, S

    1993-01-01

    The discovery of a urinary tract tumor in a horseshoe kidney following renal trauma led the authors to report this case. They emphasise the fact that this association is very rare, the importance of follow-up urography in cases of renal trauma, and that the persistence of urographic abnormalities justifies the use of computed tomography. They also indicate the technical details of horseshoe kidney surgery. PMID:8503658

  9. High Frequency of Staphylococcus Saprophyticus Urinary Tract Infections Among Female Adolescents.

    PubMed

    Lo, Denise Swei; Shieh, Huei Hsin; Barreira, Eliane Roseli; Ragazzi, Selma Lopes Betta; Gilio, Alfredo Elias

    2015-09-01

    Staphylococcus saprophyticus is a rarely reported agent of urinary tract infection (UTI) in the pediatric population. In our retrospective 3-year study, S. saprophyticus comprised 24.5% of 106 isolates of UTIs in female adolescents 12-15 years of age who attended an emergency department. Clinicians should be aware of the high prevalence of this etiology when empirically treating UTIs in female adolescents. PMID:26075812

  10. Emergence of Raoultella ornithinolytica on O'ahu: a case of community-acquired R. ornithinolytica urinary tract infection.

    PubMed

    Nakasone, Elizabeth S; Kaneshiro, Ricky; Min, Kathleen; Tokeshi, Jinichi

    2015-05-01

    Human infection with Raoultella ornithinolytica is rare, with only ten cases having been reported previously. This case report describes a local patient diagnosed with community-acquired R. ornithinolytica urinary tract infection in 2014.

  11. Antibody-Based Therapy for Enterococcal Catheter-Associated Urinary Tract Infections

    PubMed Central

    Flores-Mireles, Ana L.; Walker, Jennifer N.; Potretzke, Aaron; Schreiber, Henry L.; Pinkner, Jerome S.; Bauman, Tyler M.; Park, Alyssa M.; Desai, Alana

    2016-01-01

    ABSTRACT Gram-positive bacteria in the genus Enterococcus are a frequent cause of catheter-associated urinary tract infection (CAUTI), a disease whose treatment is increasingly challenged by multiantibiotic-resistant strains. We have recently shown that E. faecalis uses the Ebp pilus, a heteropolymeric surface fiber, to bind the host protein fibrinogen as a critical step in CAUTI pathogenesis. Fibrinogen is deposited on catheters due to catheter-induced inflammation and is recognized by the N-terminal domain of EbpA (EbpANTD), the Ebp pilus’s adhesin. In a murine model, vaccination with EbpANTD confers significant protection against CAUTI. Here, we explored the mechanism of protection using passive transfer of immune sera to show that antisera blocking EbpANTD-fibrinogen interactions not only is prophylactic but also can act therapeutically to reduce bacterial titers of an existing infection. Analysis of 55 clinical CAUTI, bloodstream, and gastrointestinal isolates, including E. faecalis, E. faecium, and vancomycin-resistant enterococci (VRE), revealed a diversity of levels of EbpA expression and fibrinogen-binding efficiency in vitro. Strikingly, analysis of 10 strains representative of fibrinogen-binding diversity demonstrated that, irrespective of EbpA levels, EbpANTD antibodies were universally protective. The results indicate that, despite diversity in levels of fibrinogen binding, strategies that target the disruption of EbpANTD-fibrinogen interactions have considerable promise for treatment of CAUTI. PMID:27795399

  12. Epidemiology of urinary tract infection: II. Diet, clothing, and urination habits.

    PubMed

    Foxman, B; Frerichs, R R

    1985-11-01

    Although several health habits and behaviors are commonly cited in medical and nursing textbooks as potential causes of urinary tract infection (UTI) in women, few have been studied in a systematic fashion. In a case-control study, we evaluated the associations between UTI and the most commonly mentioned risk factors: urination habits, diet, clothing, and soaps. Because sexual intercourse and diaphragm use increase the risk of UTI, we assessed the effect of health habits and behaviors controlling for these two risk factors. Women with initial UTI were compared with controls with no UTI history; women with a second UTI were compared to those with initial UTI. For the 25 initial cases, 19 secondary cases, and 181 controls enrolled in the study from a university health service, we found using tampons and drinking soft drinks to be moderately associated (RR greater than or equal to 1.4) with both initial and recurrent UTI. Although several other individual habits had only small associations with UTI, several of these behaviors together might substantially increase risk of initial or recurring UTI.

  13. Validation of Cefazolin as Initial Antibiotic for First Upper Urinary Tract Infection in Children

    PubMed Central

    Abe, Yoshifusa; Wakabayashi, Hitomi; Ogawa, Yasuha; Machida, Ayano; Endo, Mio; Tamai, Tetsuro; Sakurai, Shunsuke; Hibino, Satoshi; Mikawa, Takeshi; Watanabe, Yoshitaka; Ugajin, Kazuhisa; Fukuchi, Kunihiko; Itabashi, Kazuo

    2016-01-01

    To validate the policy of administering cefazolin (CEZ) as a first-line antibiotic to children who are hospitalized with their first febrile urinary tract infection (UTI), we evaluated microbial susceptibility to CEZ and the efficacy of CEZ. The 75 enrolled children with febrile UTI were initially treated with CEZ. Switching CEZ was not required in 84% of the patients. The median fever duration, prevalence of bacteremia, prevalence of UTI caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli, and median duration of hospitalization were significantly higher in the CEZ-ineffective group. The risks of vesicoureteral reflux, indication of operation, and renal scarring are not increased, even when CEZ is ineffective as a first-line antibiotic. CEZ is effective in more than 80% of pediatric patients with their first febrile UTI, but it should be switched to appropriate antibiotics considering sepsis or the ESBL-producing Enterobacteriaceae pathogen, when fever does not improve within 72 hours. PMID:27335998

  14. The role of voiding cystourethrography in the investigation of children with urinary tract infections

    PubMed Central

    Lee, Linda C.; Lorenzo, Armando J.; Koyle, Martin A.

    2016-01-01

    Urinary tract infections (UTIs) represent a common bacterial cause of febrile illness in children. Of children presenting with a febrile UTI, 25–40% are found to have vesicoureteral reflux (VUR). Historically, the concern regarding VUR was that it could lead to recurrent pyelonephritis, renal scarring, hypertension, and chronic kidney disease. As a result, many children underwent invasive surgical procedures to correct VUR. We now know that many cases of VUR are low-grade and have a high rate of spontaneous resolution. The roles of surveillance, antibiotic prophylaxis, endoscopic injection, and ureteral reimplantation surgery also continue to evolve. In turn, these factors have influenced the investigation of febrile UTIs. Voiding cystourethrography (VCUG) is the radiographic test of choice to diagnose VUR. Due to its invasive nature and questionable benefit in many cases, the American Academy of Pediatrics (AAP) no longer recommends VCUG routinely after an initial febrile UTI. Nevertheless, these guidelines pre-date the landmark Randomized Intervention of Children with Vesicoureteral Reflux (RIVUR) trial and there continues to be controversy regarding the diagnosis and management of VUR. This paper discusses the current literature regarding radiographic testing in children with febrile UTIs and presents a practical risk-based approach for deciding when to obtain a VCUG. PMID:27713802

  15. Usefulness of neutrophil-lymphocyte ratio in young children with febrile urinary tract infection

    PubMed Central

    Han, Song Yi; Lee, I Re; Park, Se Jin; Kim, Ji Hong

    2016-01-01

    Purpose Acute pyelonephritis (APN) is a serious bacterial infection that can cause renal scarring in children. Early identification of APN is critical to improve treatment outcomes. The neutrophil-lymphocyte ratio (NLR) is a prognostic marker of many diseases, but it has not yet been established in urinary tract infection (UTI). The aim of this study was to determine whether NLR is a useful marker to predict APN or vesicoureteral reflux (VUR). Methods We retrospectively evaluated 298 pediatric patients (age≤36 months) with febrile UTI from January 2010 to December 2014. Conventional infection markers (white blood cell [WBC] count, erythrocyte sedimentation rate [ESR], C-reactive protein [CRP]), and NLR were measured. Results WBC, CRP, ESR, and NLR were higher in APN than in lower UTI (P<0.001). Multiple logistic regression analyses showed that NLR was a predictive factor for positive dimercaptosuccinic acid (DMSA) defects (P<0.001). The area under the receiver operating characteristic (ROC) curve was high for NLR (P<0.001) as well as CRP (P<0.001) for prediction of DMSA defects. NLR showed the highest area under the ROC curve for diagnosis of VUR (P<0.001). Conclusion NLR can be used as a diagnostic marker of APN with DMSA defect, showing better results than those of conventional markers for VUR prediction. PMID:27186221

  16. Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract

    PubMed Central

    Ramanathan, Subramaniyan; Kumar, Devendra; Khanna, Maneesh; Al Heidous, Mahmoud; Sheikh, Adnan; Virmani, Vivek; Palaniappan, Yegu

    2016-01-01

    Congenital abnormalities of the kidney and urinary tract (CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis (bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number (agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography (US) is typically the first imaging performed as it is easily available, non-invasive and radiation free used both antenatally and postnatally. Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management. PMID:26981222

  17. CIPROFLOXACIN RESISTANCE PATTERN AMONG BACTERIA ISOLATED FROM PATIENTS WITH COMMUNITY-ACQUIRED URINARY TRACT INFECTION

    PubMed Central

    REIS, Ana Carolina Costa; SANTOS, Susana Regia da Silva; de SOUZA, Siane Campos; SALDANHA, Milena Góes; PITANGA, Thassila Nogueira; OLIVEIRA, Ricardo Riccio

    2016-01-01

    SUMMARY Objective: To identify the main bacterial species associated with community-acquired urinary tract infection (UTI) and to assess the pattern of ciprofloxacin susceptibility among bacteria isolated from urine cultures. Methods: We conducted a retrospective study in all the patients with community-acquired UTI seen in Santa Helena Laboratory, Camaçari, Bahia, Brazil during five years (2010-2014). All individuals who had a positive urine culture result were included in this study. Results: A total of 1,641 individuals met the inclusion criteria. Despite the fact that participants were female, we observed a higher rate of resistance to ciprofloxacin in males. The most frequent pathogens identified in urine samples were Escherichia coli, Klebsiella pneumoniae and Staphylococcus saprophyticus. Antimicrobial resistance has been observed mainly for ampicillin, sulfamethoxazole + trimethoprim and ciprofloxacin. Moreover, E. coli has shown the highest rate of ciprofloxacin resistance, reaching 36% of ciprofloxacin resistant strains in 2014. Conclusion: The rate of bacterial resistance to ciprofloxacin observed in the studied population is much higher than expected, prompting the need for rational use of this antibiotic, especially in infections caused by E. coli. Prevention of bacterial resistance can be performed through control measures to limit the spread of resistant microorganisms and a rational use of antimicrobial policy. PMID:27410913

  18. The medical management of lower urinary tract symptoms and benign prostatic hyperplasia.

    PubMed

    Holtgrewe, H L

    1998-11-01

    Prostatism is a widely used term assigned to the symptom complex of older men with voiding dysfunction. The cause of the syndrome has routinely been ascribed to an enlarged prostate. More recent thinking recognizes that many men with such symptoms do not, in fact, have prostate enlargement or benign prostatic hyperplasia (BPH) and that such symptoms are not a surrogate for BPH. Such recognition is essential if cost effective medical management of lower urinary tract symptoms (LUTS) is to be achieved. Prostate volume has emerged as a key factor in the selection of medical therapy of LUTS and BPH not only regarding symptom relief but also to the newer concept of the prevention of disease progression and the avoidance of future adverse events in those men with true BPH. In the United States, medical management is now first line therapy for LUTS. The proper selection of therapy based on the patient's individual pathophysiologic characteristics is now made possible by many new recent studies within the medical literature.

  19. Development of a Phage Cocktail to Control Proteus mirabilis Catheter-associated Urinary Tract Infections.

    PubMed

    Melo, Luís D R; Veiga, Patrícia; Cerca, Nuno; Kropinski, Andrew M; Almeida, Carina; Azeredo, Joana; Sillankorva, Sanna

    2016-01-01

    Proteus mirabilis is an enterobacterium that causes catheter-associated urinary tract infections (CAUTIs) due to its ability to colonize and form crystalline biofilms on the catheters surface. CAUTIs are very difficult to treat, since biofilm structures are highly tolerant to antibiotics. Phages have been used widely to control a diversity of bacterial species, however, a limited number of phages for P. mirabilis have been isolated and studied. Here we report the isolation of two novel virulent phages, the podovirus vB_PmiP_5460 and the myovirus vB_PmiM_5461, which are able to target, respectively, 16 of the 26 and all the Proteus strains tested in this study. Both phages have been characterized thoroughly and sequencing data revealed no traces of genes associated with lysogeny. To further evaluate the phages' ability to prevent catheter's colonization by Proteus, the phages adherence to silicone surfaces was assessed. Further tests in phage-coated catheters using a dynamic biofilm model simulating CAUTIs, have shown a significant reduction of P. mirabilis biofilm formation up to 168 h of catheterization. These results highlight the potential usefulness of the two isolated phages for the prevention of surface colonization by this bacterium. PMID:27446059

  20. Idiopathic Cystitis in Domestic Cats—Beyond the Lower Urinary Tract

    PubMed Central

    Buffington, C.A.T.

    2013-01-01

    Signs of lower urinary tract (LUT) disease in domestic cats can be acute or chronic, and can result from variable combinations of abnormalities within the lumen of the LUT, the parenchyma of the LUT itself, or other organ system(s) that then lead to LUT dysfunction. In the majority of cats with chronic signs of LUT dysfunction, no specific underlying cause can be confirmed after standard clinical evaluation of the LUT, so these cats typically are classified as having idiopathic cystitis. A syndrome in human beings commonly known as interstitial cystitis (IC) shares many features in common with these cats, permitting comparisons between the two species. A wide range of similarities in abnormalities has been identified between these syndromes outside as well as inside the LUT. A variety of potential familial and developmental risk factors also have been identified. These results have permitted generation of the hypothesis that some of these people have a disorder affecting the LUT rather than a disorder of the LUT. This perspective has suggested alternative diagnostic strategies and novel approaches to treatment, at least in cats. The purpose of this review is to summarize research investigations into the various abnormalities present in cats, to compare some of these findings with those identified in human beings, and to discuss how they might modify perceptions about the etiopathogenesis, diagnosis, and treatment of cats with this disease. PMID:21564297

  1. Recurrent complicated urinary tract infection due to rare pathogen Sphingomonas paucimobilis: contamination or real deal?

    PubMed

    Demir, Tulin; Dadali, Mumtaz

    2016-09-01

    Sphingomonas paucimobilis is an aerobic, oxidase-positive, yellow-pigmented, non-fermentative, Gram-negative opportunistic pathogen that rarely causes infections in humans. It is commonly found in nosocomial environments and, despite its low clinical virulence, it can be responsible for several different infections especially among patients with underlying disease. Here we describe a clinical case of a 46-year-old male paraplegic patient with a history of neurogenic bladder due to insulin-dependent diabetes mellitus and renal failure who was admitted to the urology clinic of a university hospital in Kirsehir, Turkey, with the complaints of urinary tract infection (UTI) including fever, chills, dysuria, abdominal and back pain. The urine culture was positive for Sphingomonas paucimobilis identified by the Vitek-2 system and the patient was successfully treated with oral co-trimoxazole 800/160 mg twice a day for ten days associated to cefixime and fosfomycin. A literature review of UTIs associated to Sphingomonas paucimobilis is reported as well. PMID:27668907

  2. Interaction between atypical microorganisms and E. coli in catheter-associated urinary tract biofilms.

    PubMed

    Azevedo, Andreia S; Almeida, Carina; Melo, Luís F; Azevedo, Nuno F

    2014-09-01

    Most biofilms involved in catheter-associated urinary tract infections (CAUTIs) are polymicrobial, with disease causing (eg Escherichia coli) and atypical microorganisms (eg Delftia tsuruhatensis) frequently inhabiting the same catheter. Nevertheless, there is a lack of knowledge about the role of atypical microorganisms. Here, single and dual-species biofilms consisting of E. coli and atypical bacteria (D. tsuruhatensis and Achromobacter xylosoxidans), were evaluated. All species were good biofilm producers (Log 5.84-7.25 CFU cm(-2) at 192 h) in artificial urine. The ability of atypical species to form a biofilm appeared to be hampered by the presence of E. coli. Additionally, when E. coli was added to a pre-formed biofilm of the atypical species, it seemed to take advantage of the first colonizers to accelerate adhesion, even when added at lower concentrations. The results suggest a greater ability of E. coli to form biofilms in conditions mimicking the CAUTIs, whatever the pre-existing microbiota and the inoculum concentration. PMID:25184430

  3. Development of a Phage Cocktail to Control Proteus mirabilis Catheter-associated Urinary Tract Infections

    PubMed Central

    Melo, Luís D. R.; Veiga, Patrícia; Cerca, Nuno; Kropinski, Andrew M.; Almeida, Carina; Azeredo, Joana; Sillankorva, Sanna

    2016-01-01

    Proteus mirabilis is an enterobacterium that causes catheter-associated urinary tract infections (CAUTIs) due to its ability to colonize and form crystalline biofilms on the catheters surface. CAUTIs are very difficult to treat, since biofilm structures are highly tolerant to antibiotics. Phages have been used widely to control a diversity of bacterial species, however, a limited number of phages for P. mirabilis have been isolated and studied. Here we report the isolation of two novel virulent phages, the podovirus vB_PmiP_5460 and the myovirus vB_PmiM_5461, which are able to target, respectively, 16 of the 26 and all the Proteus strains tested in this study. Both phages have been characterized thoroughly and sequencing data revealed no traces of genes associated with lysogeny. To further evaluate the phages’ ability to prevent catheter’s colonization by Proteus, the phages adherence to silicone surfaces was assessed. Further tests in phage-coated catheters using a dynamic biofilm model simulating CAUTIs, have shown a significant reduction of P. mirabilis biofilm formation up to 168 h of catheterization. These results highlight the potential usefulness of the two isolated phages for the prevention of surface colonization by this bacterium. PMID:27446059

  4. Recurrent complicated urinary tract infection due to rare pathogen Sphingomonas paucimobilis: contamination or real deal?

    PubMed

    Demir, Tulin; Dadali, Mumtaz

    2016-09-01

    Sphingomonas paucimobilis is an aerobic, oxidase-positive, yellow-pigmented, non-fermentative, Gram-negative opportunistic pathogen that rarely causes infections in humans. It is commonly found in nosocomial environments and, despite its low clinical virulence, it can be responsible for several different infections especially among patients with underlying disease. Here we describe a clinical case of a 46-year-old male paraplegic patient with a history of neurogenic bladder due to insulin-dependent diabetes mellitus and renal failure who was admitted to the urology clinic of a university hospital in Kirsehir, Turkey, with the complaints of urinary tract infection (UTI) including fever, chills, dysuria, abdominal and back pain. The urine culture was positive for Sphingomonas paucimobilis identified by the Vitek-2 system and the patient was successfully treated with oral co-trimoxazole 800/160 mg twice a day for ten days associated to cefixime and fosfomycin. A literature review of UTIs associated to Sphingomonas paucimobilis is reported as well.

  5. An Overview of the Predictors of Symptomatic Urinary Tract Infection Among Nursing Students

    PubMed Central

    Vyas, S; Varshney, D; Sharma, P; Juyal, R; Nautiyal, V; Shrotriya, VP

    2015-01-01

    Background: Urinary tract infection (UTI) is the most common infection experienced by humans after respiratory and gastro-intestinal infections, and also the most common cause of nosocomial infections for patients admitted to hospitals indeed UTIs are the most frequent bacterial infection in women. Aim: The aim was to determine the prevalence of UTI and to identify factors associated with an increased risk of UTI among nursing students. Subjects and Methods: The cross-sectional study involved 177 unmarried nursing students aged 18–30 years studying in the SRMSIMS, Nursing College Bareilly. A structured questionnaire was used, and study subjects were asked regarding the symptoms of UTI in the previous 3 months. Chi-square test and Univariate Logistic Regression was used to analyze the data. Results: The overall prevalence of UTI was found to be 19.8% (35/177). Rural background, inadequate water intake, and unsatisfactory toilet habits were found to be strong predictors of UTI. Conclusions: There is an urgent need to sensitize the nursing students regarding the growing need of the issue so that they themselves become aware in addition to raising the awareness of other high-risk groups. PMID:25745578

  6. Mecillinam resistance and outcome of pivmecillinam treatment in uncomplicated lower urinary tract infection in women.

    PubMed

    Monsen, Tor J; Holm, Stig E; Ferry, Björn Magnus; Ferry, Sven A

    2014-04-01

    Pivmecillinam (PIV) is a first-line antimicrobial for treatment of lower urinary tract infection in women (LUTIW). Mecillinam, the active substance of PIV, is bactericidal mainly against gram-negative uropathogens, whereas gram-positive species are considered intrinsically resistant. However, successful treatment of LUTIW caused by Staphylococcus saprophyticus has been reported, but more rarely for other gram-positive species. The aim of this study was to compare clinical and bacteriological outcome of PIV vs placebo treatment among uropathogens with special focus on mecillinam-resistant isolates. We analysed data from a prospective, multicentre, placebo-controlled, primary health care, therapy study performed in Sweden in 1995–1998 that included 1143 women with symptoms suggestive of LUTIW. Urine cultures were collected and symptoms registered at inclusion and at follow-up visits. Overall, the efficacy of PIV was superior to that of placebo. Clinical and bacteriological outcomes of PIV treatment were similar for S. saprophyticus, Escherichia coli as for most other uropathogens irrespective of their susceptibility to mecillinam. However, the occurrence of enterococci increased nearly fivefold shortly post PIV treatment, although with mild symptoms and a high spontaneous eradication. As susceptibility to mecillinam in vitro did not predict bacteriological and clinical outcome of PIV treatment, we suggest that the present breakpoints for mecillinam should be revised. PMID:24738161

  7. Multi-modality imaging review of congenital abnormalities of kidney and upper urinary tract.

    PubMed

    Ramanathan, Subramaniyan; Kumar, Devendra; Khanna, Maneesh; Al Heidous, Mahmoud; Sheikh, Adnan; Virmani, Vivek; Palaniappan, Yegu

    2016-02-28

    Congenital abnormalities of the kidney and urinary tract (CAKUT) include a wide range of abnormalities ranging from asymptomatic ectopic kidneys to life threatening renal agenesis (bilateral). Many of them are detected in the antenatal or immediate postnatal with a significant proportion identified in the adult population with varying degree of severity. CAKUT can be classified on embryological basis in to abnormalities in the renal parenchymal development, aberrant embryonic migration and abnormalities of the collecting system. Renal parenchymal abnormalities include multi cystic dysplastic kidneys, renal hypoplasia, number (agenesis or supernumerary), shape and cystic renal diseases. Aberrant embryonic migration encompasses abnormal location and fusion anomalies. Collecting system abnormalities include duplex kidneys and Pelvi ureteric junction obstruction. Ultrasonography (US) is typically the first imaging performed as it is easily available, non-invasive and radiation free used both antenatally and postnatally. Computed tomography (CT) and magnetic resonance imaging (MRI) are useful to confirm the ultrasound detected abnormality, detection of complex malformations, demonstration of collecting system and vascular anatomy and more importantly for early detection of complications like renal calculi, infection and malignancies. As CAKUT are one of the leading causes of end stage renal disease, it is important for the radiologists to be familiar with the varying imaging appearances of CAKUT on US, CT and MRI, thereby helping in prompt diagnosis and optimal management. PMID:26981222

  8. Prevention of catheter-associated urinary tract infection: implementation strategies of international guidelines1

    PubMed Central

    Andrade, Vera Lúcia Fonseca; Fernandes, Filipa Alexandra Veludo

    2016-01-01

    Objective to describe strategies used by health professionals on the implementation of the Centers for Disease Control and Prevention guidelines for the prevention of urinary infection related to catheterism. Method systematic review on literature based on data from CINAHL(r), Nursing & Allied Health Collection, Cochrane Plus Collection, MedicLatina, MEDLINE(r), Academic Search Complete, ACS - American Chemical Society, Health Reference Center Academic, Nursing Reference Center, ScienceDirect Journals and Wiley Online Library. A sample of 13 articles was selected. Results studies have highlighted the decrease of urinary tract infection related to catheterism through reminder systems to decrease of people submitted to urinary catheterism, audits about nursing professionals practice and bundles expansion. Conclusion the present review systemizes the knowledge of used strategies by health professionals on introduction to international recommendations, describing a rate decrease of such infection in clinical practice. PMID:27027676

  9. A Metaproteomics Approach to Elucidate Host and Pathogen Protein Expression during Catheter-Associated Urinary Tract Infections (CAUTIs)

    PubMed Central

    Lassek, Christian; Burghartz, Melanie; Chaves-Moreno, Diego; Otto, Andreas; Hentschker, Christian; Fuchs, Stephan; Bernhardt, Jörg; Jauregui, Ruy; Neubauer, Rüdiger; Becher, Dörte; Pieper, Dietmar H.; Jahn, Martina; Jahn, Dieter; Riedel, Katharina

    2015-01-01

    Long-term catheterization inevitably leads to a catheter-associated bacteriuria caused by multispecies bacterial biofilms growing on and in the catheters. The overall goal of the presented study was (1) to unravel bacterial community structure and function of such a uropathogenic biofilm and (2) to elucidate the interplay between bacterial virulence and the human immune system within the urine. To this end, a metaproteomics approach combined with in vitro proteomics analyses was employed to investigate both, the pro- and eukaryotic protein inventory. Our proteome analyses demonstrated that the biofilm of the investigated catheter is dominated by three bacterial species, that is, Pseudomonas aeruginosa, Morganella morganii, and Bacteroides sp., and identified iron limitation as one of the major challenges in the bladder environment. In vitro proteome analysis of P. aeruginosa and M. morganii isolated from the biofilm revealed that these opportunistic pathogens are able to overcome iron restriction via the production of siderophores and high expression of corresponding receptors. Notably, a comparison of in vivo and in vitro protein profiles of P. aeruginosa and M. morganii also indicated that the bacteria employ different strategies to adapt to the urinary tract. Although P. aeruginosa seems to express secreted and surface-exposed proteases to escape the human innate immune system and metabolizes amino acids, M. morganii is able to take up sugars and to degrade urea. Most interestingly, a comparison of urine protein profiles of three long-term catheterized patients and three healthy control persons demonstrated the elevated level of proteins associated with neutrophils, macrophages, and the complement system in the patient's urine, which might point to a specific activation of the innate immune system in response to biofilm-associated urinary tract infections. We thus hypothesize that the often asymptomatic nature of catheter-associated urinary tract infections

  10. Pharmacological effects of epidermal growth factor (EGF) with focus on the urinary and gastrointestinal tracts.

    PubMed

    Vinter-Jensen, L

    1999-01-01

    Epidermal growth factor (EGF) belongs to a family of growth factor ligands and receptors. At present, five ligands have been recognized which as EGF exert their effects via binding to the same EGF receptor. The family has three other receptors erbB2, erbB3, and erbB4, which have their own ligands (the heregulins). The system is ubiquitously distributed in mammals, and has important roles in normal development, and in regenerative and neoplastic growth. Mouse and human EGF were discovered in 1962 and 1975 by Stanley Cohen and Harry Gregory, respectively, due to EGFs potent systemic effects. EGF accelerated eyelid opening in newborn mice and inhibited gastric acid secretion in humans. Already in the late thirties, a factor in human urine was recognized which prevented or accelerated healing of experimental damage in the gastrointestinal tract. This factor appeared to be EGF. Around 1980, an effect of commercial interest was described-EGF caused shedding of the fleece in sheep. In line with the original observations, several studies have examined effects of EGF on developmental processes. Amongst other effects, EGF accelerates lung and intestinal maturation before birth and in newborn mammals. Due to the possible use of EGF in the wool industry, it was mandatory to know more about EGF. Amongst other effects in mature sheep and other animals are haemodynamic changes, changes in electrolyte homeostasis, and endocrinological changes. In relation to experimental damage, the therapeutic potential of systemic EGF has been demonstrated in all parts of the gastrointestinal tract, in the kidneys, in the liver and in the trachea. EGF has even been tried in humans in gastric ulcer healing and in necrotising enterocolitis. Studies on prolonged treatment with EGF have first recently appeared. We described effects of 4-5 weeks of treatment in Goettingen minipigs and in rats, and two other groups described effects in monkeys and in rats. In summary, species differences were observed

  11. What is the efficacy of circumcision in boys with complex urinary tract abnormalities?

    PubMed

    Bader, Mohammed; McCarthy, Liam

    2013-12-01

    The risk of urinary tract infection (UTI) in normal boys is 1%. This risk is significantly increased in boys with congenital abnormalities of the urinary tract, which includes such abnormalities as vesico-ureteric reflux, obstructive megaureter (VUJO) and posterior urethral valves. UTI in these boys can lead to urosepsis, a potentially life-threatening complication, and in the longer term renal scarring complicating pyelonephritis can lead to chronic renal impairment or even end-stage renal disease. Circumcision has been shown in normal boys to reduce the risk of UTI by 90%, and potentially could be a simple intervention to reduce the risk of urosepsis and renal scarring. In order to make this decision a clinician really needs to have the answers to two questions: 1) What is the risk of UTI in this particular boy? 2) What is the evidence of efficacy of circumcision in this particular condition? This article reviews what evidence exists to make a calculation of the risk/benefit ratio for circumcision in boys with abnormalities of the urinary tract.

  12. Levofloxacin in the treatment of complicated urinary tract infections and acute pyelonephritis

    PubMed Central

    McGregor, Jessina C; Allen, George P; Bearden, David T

    2008-01-01

    Levofloxacin is a widely used fluoroquinolone approved for the treatment of complicated urinary tract infections and acute pyelonephritis. A comprehensive review of the medical literature identified five publications evaluating levofloxacin for the treatment of either complicated urinary tract infections or acute pyelonephritis. All trials, although variable in their inclusion criteria and levofloxacin dosing strategies, reported microbiologic, clinical, and safety-related outcomes. High microbiologic eradication rates, ranging from 79.8% to 95.3%, were observed in all studies. Escherichia coli was the most commonly isolated uropathogen. Data on levofloxacin resistance, both at baseline and after therapy, were limited. Clinical success was observed to range from 82.6% to 93% when measured after the completion of therapy. These clinical and microbiologic results were comparable to the fluoroquinolone comparators in all trials. Insufficient data are available to evaluate the outcomes in any meaningful patient subgroups, including catheterized patients, and those with other specific complicating factors. Levofloxacin was well tolerated in these studies, with headache, gastrointenstinal effects, and dizziness being the most commonly reported adverse events. The published data support the use of levofloxacin in complicated urinary tract infections and acute pyelonephritis. Further trials are necessary to evaluate levofloxacin within specific patient sub-populations. PMID:19209267

  13. ANTIBIOTIC RESISTANCE PATTERNS OF URINARY TRACT INFECTIONS IN A NORTHEASTERN BRAZILIAN CAPITAL.

    PubMed

    Cunha, Mirella Alves; Assunção, Gabriela Lins Medeiros; Medeiros, Iara Marques; Freitas, Marise Reis

    2016-01-01

    Urinary tract infection is a common problem worldwide. Its clinical characteristics and susceptibility rates of bacteria are important in determining the treatment of choice and its duration. This study assessed the frequency and susceptibility to antimicrobials of uropathogens isolated from community-acquired urinary tract infections in the city of Natal, Rio Grande do Norte State capital, northeastern Brazil, from 2007 to 2010. A total of 1,082 positive samples were evaluated; E. coli was the most prevalent pathogen (60.4%). With respect to the uropathogens susceptibility rates, the resistance of enterobacteria to ciprofloxacin and sulfamethoxazole-trimethoprim was 24.4% and 50.6%, respectively. Susceptibility was over 90% for nitrofurantoin, aminoglycosides and third-generation cephalosporins. High resistance rates of uropathogens to quinolones and sulfamethoxazole-trimethoprim draws attention to the choice of these drugs on empirical treatments, especially in patients with pyelonephritis. Given the increased resistance of community bacteria to antimicrobials, local knowledge of susceptibility rates of uropathogens is essential for therapeutic decision making regarding patients with urinary tract infections.

  14. ANTIBIOTIC RESISTANCE PATTERNS OF URINARY TRACT INFECTIONS IN A NORTHEASTERN BRAZILIAN CAPITAL

    PubMed Central

    CUNHA, Mirella Alves; ASSUNÇÃO, Gabriela Lins Medeiros; MEDEIROS, Iara Marques; FREITAS, Marise Reis

    2016-01-01

    Urinary tract infection is a common problem worldwide. Its clinical characteristics and susceptibility rates of bacteria are important in determining the treatment of choice and its duration. This study assessed the frequency and susceptibility to antimicrobials of uropathogens isolated from community-acquired urinary tract infections in the city of Natal, Rio Grande do Norte State capital, northeastern Brazil, from 2007 to 2010. A total of 1,082 positive samples were evaluated; E. coli was the most prevalent pathogen (60.4%). With respect to the uropathogens susceptibility rates, the resistance of enterobacteria to ciprofloxacin and sulfamethoxazole-trimethoprim was 24.4% and 50.6%, respectively. Susceptibility was over 90% for nitrofurantoin, aminoglycosides and third-generation cephalosporins. High resistance rates of uropathogens to quinolones and sulfamethoxazole-trimethoprim draws attention to the choice of these drugs on empirical treatments, especially in patients with pyelonephritis. Given the increased resistance of community bacteria to antimicrobials, local knowledge of susceptibility rates of uropathogens is essential for therapeutic decision making regarding patients with urinary tract infections. PMID:26910446

  15. Upper-urinary-tract urothelial tumors: conservative treatment by Nd:YAG laser

    NASA Astrophysics Data System (ADS)

    Gaboardi, Franco; Bozzola, Andrea; Melodia, Tommaso; Gulfi, Gildo M.; Galli, Stefano

    1993-05-01

    Upper urinary malignancies are rare tumors whose diagnosis sometimes represents a difficult dilemma. In selected cases, it is possible to treat the tumor with laser irradiation. This approach is reserved to low-stage low-grade tumors, a tumor in a solitary kidney, bilateral syncroneous disease or patients with deterioration of renal function. Thirty one patients suspected to have malignancies, as they presented upper tract filling defects at IVP, underwent uretero-pyeloscopy to confirm the diagnosis. Twenty patients with upper urinary tract urothelial tumors were treated with Nd:YAG laser irradiation. Before the procedure, the ureter and the pelvis were accessed by 0.038 inch guide-wire or 4 French ureteral catheter. A power of 25 - 30 watts/3 seconds was carried out for the laser irradiation of the tumor and of the base. Sometime after the procedure a ureter single J catheter was left indwelling for 48 hours. In the follow-up the patients had endoscopic surveillance every three months. Actually 12 patients are tumor-free after 3 - 36 months. Eight patients had a recurrence after the first treatment and they underwent new laser irradiation. All the recurrences were in other sites of the upper urinary tract and seemed to be related to tumor grade. In conclusion, conservative endourological ureteropyeloscopy coupled with Nd:YAG laser irradiation should be considered a useful treatment in selected patients.

  16. Effectiveness and Safety of Ureteroscopic Holmium Laser Lithotripsy for Upper Urinary Tract Calculi in Elderly Patients.

    PubMed

    Yoshioka, Takashi; Otsuki, Hideo; Uehara, Shinya; Shimizu, Toshihiro; Murao, Wataru; Fujio, Koji; Fujio, Kei; Wada, Koichiro; Araki, Motoo; Nasu, Yasutomo

    2016-06-01

    Upper urinary tract calculi are common; however, there is no recommended treatment selection for elderly patients. Ureteroscopic holmium laser lithotripsy (URS lithotripsy) is minimally invasive, and it provides a high stone-free rate (SFR) treatment for upper urinary tract calculi. Here, we retrospectively evaluated the surgical outcomes of URS lithotripsy after dividing the 189 cases into 3 groups by patient age: the '<65 group' (<65 years old, n=108), the '65-74 group' (65-74 years old, n=42), and the ' 75 group' ( 75 years old, n=39). The patients' characteristics, stone status, and perioperative outcomes were assessed. The 65-74 group and the 75 group had a significantly higher prevalence of hypertension compared to the<65 group. Compared to the<65 group, the 65-74 group had a significantly higher prevalence of hyperlipidemia, and the 75 group had significantly higher the American Society of Anesthesiologists (ASA) scores. Despite these preoperative risk factors, SFR and postoperative pyelonephritis in the 65-74 group and the 75 group were similar to those of the<65 group. In conclusion, URS lithotripsy is the preferred treatment for upper urinary tract calculi, even for elderly patients who have multiple preoperative risk factors. PMID:27339204

  17. Urinary Tract Physiological Conditions Promote Ciprofloxacin Resistance in Low-Level-Quinolone-Resistant Escherichia coli.

    PubMed

    Martín-Gutiérrez, Guillermo; Rodríguez-Beltrán, Jerónimo; Rodríguez-Martínez, José Manuel; Costas, Coloma; Aznar, Javier; Pascual, Álvaro; Blázquez, Jesús

    2016-07-01

    Escherichia coli isolates carrying chromosomally encoded low-level-quinolone-resistant (LLQR) determinants are frequently found in urinary tract infections (UTIs). LLQR mutations are considered the first step in the evolutionary pathway producing high-level fluoroquinolone resistance. Therefore, their evolution and dissemination might influence the outcome of fluoroquinolone treatments of UTI. Previous studies support the notion that low urine pH decreases susceptibility to ciprofloxacin (CIP) in E. coli However, the effect of the urinary tract physiological parameters on the activity of ciprofloxacin against LLQR E. coli strains has received little attention. We have studied the activity of ciprofloxacin under physiological urinary tract conditions against a set of well-characterized isogenic E. coli derivatives carrying the most prevalent chromosomal mutations (ΔmarR, gyrA-S83L, gyrA-D87N, and parC-S80R and some combinations). The results presented here demonstrate that all the LLQR strains studied became resistant to ciprofloxacin (according to CLSI guidelines) under physiological conditions whereas the control strain lacking LLQR mutations did not. Moreover, the survival of some LLQR E. coli variants increased up to 100-fold after challenge with a high concentration of ciprofloxacin under UTI conditions compared to the results seen with Mueller-Hinton broth. These selective conditions could explain the high prevalence of LLQR mutations in E. coli Furthermore, our data strongly suggest that recommended methods for MIC determination produce poor estimations of CIP activity against LLQR E. coli in UTIs. PMID:27139482

  18. Immunoanatomic distribution of cytostructural and tissue-associated antigens in the human urinary tract.

    PubMed Central

    Cordon-Cardo, C.; Finstad, C. L.; Bander, N. H.; Melamed, M. R.

    1987-01-01

    The main objective of the present study is to define the expression and/or modulation of antigenic phenotypes in cells of the normal human kidney and urothelium according to cell type. Fourteen antibodies detecting differentiation and structural antigens expressed in the human urinary tract have been used to define the immunoanatomic distribution of these antigenic systems. They include urinary tract antigens (Tamm-Horsfall glycoprotein and prostate-specific antigen), tissue-associated antigens (epithelial membrane antigen, Factor VIII antigen, and Protein S-100), and cytoskeletal antigens of the intermediate filament classes (cytokeratins, vimentin, desmin, glial fibrillary acidic protein, and neurofilaments. Immunofluorescence and immunoperoxidase analyses performed on normal human fetal and adult tissue sections have demonstrated that these antigens are expressed by different cell types and domains of the nephron. Studies correlating normal fetal and adult tissues reveal that some of the antigens appear at distinct stages of maturation, representing early and late antigenic expression events. These antibodies offer a wide range of potential applications that include studies of embryogenesis of the human urinary tract and immunopathologic analyses of neoplastic and nonneoplastic diseases of the human kidney and urothelium. Images Figure 1 Figure 2 Figure 3 Figure 4 PMID:3548401

  19. Urinary tract infections due to Trichosporon spp. in severely ill patients in an intensive care unit

    PubMed Central

    Mattede, Maria das Graças Silva; Piras, Cláudio; Mattede, Kelly Dematte Silva; Ferrari, Aline Trugilho; Baldotto, Lorena Simões; Assbu, Michel Silvestre Zouain

    2015-01-01

    Objective To evaluate the incidence of urinary tract infections due to Trichosporon spp. in an intensive care unit. Methods This descriptive observational study was conducted in an intensive care unit between 2007 and 2009. All consecutive patients admitted to the intensive care unit with a confirmed diagnosis were evaluated. Results Twenty patients presented with urinary tract infections due to Trichosporon spp. The prevalence was higher among men (65%) and among individuals > 70 years of age (55%). The mortality rate was 20%. The average intensive care unit stay was 19.8 days. The onset of infection was associated with prior use of antibiotics and was more frequent in the fall and winter. Conclusion Infection due to Trichosporon spp. was more common in men and among those > 70 years of age and was associated with the use of an indwelling urinary catheter for more than 20 days and with the use of broadspectrum antibiotics for more than 14 days. In addition, patients with urinary infection due to Trichosporon spp. were most often hospitalized in intensive care units in the fall and winter periods. PMID:26465246

  20. ABO and rhesus blood groups as prognostic factors in transitional cell carcinomas of the upper urinary tract.

    PubMed

    Krogh, J; Kvist, E

    1992-01-01

    In a study of 290 patients with transitional cell carcinoma of the upper urinary tract an excess of blood group A was found. Comparisons between blood group A versus O and rhesus-positive versus rhesus-negative in relation to tumor stages or grades of dysplasia showed no significant differences neither at presentation nor in actuarial survival rates. It is concluded that the blood group systems ABO and rhesus have no prognostic value in urothelial tumors of the upper urinary tract.

  1. Role of Old Antibiotics in the Era of Antibiotic Resistance. Highlighted Nitrofurantoin for the Treatment of Lower Urinary Tract Infections

    PubMed Central

    Munoz-Davila, Maria Jose

    2014-01-01

    Bacterial infections caused by antibiotic-resistant isolates have become a major health problem in recent years, since they are very difficult to treat, leading to an increase in morbidity and mortality. Nitrofurantoin is a broad-spectrum bactericidal antibiotic that, through a complex mode of action which is not completely understood, affects both Gram-negative and Gram-positive bacteria. Nitrofurantoin has been used successfully for a long time for the prophylaxis and treatment of acute lower urinary tract infections in adults, children and pregnant women, but the increased emergence of antibiotic resistance has made nitrofurantoin a suitable candidate for the treatment of infections caused by multidrug-resistant pathogens. Here, we review the mechanism of action, antimicrobial spectrum, pharmacology and safety profile of nitrofurantoin. We also investigate the therapeutic use of nitrofurantoin, including recent data which highlight its role in the management of community urinary tract infection, especially in cases of multidrug-resistant isolates, in which oral active antimicrobials are limited resources nowadays. PMID:27025732

  2. Recurrent Urinary Tract Infections and Related Conditions (For Parents)

    MedlinePlus

    ... A promising vaccine that would protect against E. coli (the most common bacterium that causes UTIs) is ... are often suggested because they may prevent E. coli from attaching to the walls of the bladder. ...

  3. Nutritional and gastrointestinal complications of the use of bowel segments in the lower urinary tract.

    PubMed

    Steiner, M S; Morton, R A

    1991-11-01

    Almost all segments of the gastrointestinal tract have been used as urinary tract substitutes. The specific nutritional and gastrointestinal complications depend on the particular portion of bowel that is removed from the alimentary tract. The use of stomach theoretically may predispose the patient to hypergastrinemia and peptic ulcer disease, hypocalcemia, and iron deficiency or megaloblastic anemia. Resection of a large amount of jejunum causes malabsorption. Limited use of colon segments usually is well tolerated, but loss of large parts of the colon directly decreases available absorptive area, resulting in diarrhea. Resection of the ileum and ileocecal valve can lead to several disease states. One is mixed secretory-osmotic diarrhea. Decreased ileal reabsorption of bile salts results in fat malabsorption and steatorrhea. The presentation of increased amounts of bile salts and fatty acids to the colon decreases water absorption and stimulates active chloride and water secretion, producing a cholera-like high-volume secretory diarrhea. The loss of the ileocecal valve and ileum segment accelerates intestinal transit time, which does not allow for complete digestion and absorption of food. Water and electrolytes remain associated with undigested food particles and may overwhelm the absorptive capacity of the colon, resulting in an osmotic diarrhea. A second problem is vitamin B12 deficiency. Surgical reduction of sites in the terminal ileum for active and exclusive uptake of vitamin B12 might lead to hypovitaminosis. If this is unrecognized, patients may develop irreversible neurologic injury. A third problem is cholelithiasis. Derangements in bile salt metabolism can occur when as little as 10 cm of ileum is resected, and the propensity to form gallstones is increased. Pigment gallstones appear to be the predominant stone associated with ileal resections. The fourth possible problem is urolithiasis, the etiology of which is multifactorial in patients with ileal

  4. A retrovesical echinococcal cyst: unusual cause of acute urinary retention.

    PubMed

    Selvaggi, F P; Fabiano, G; Santacroce, S; Traficante, A

    1978-01-01

    In a middle-aged man a rare case of echinococcal cyst of the retrovesical space is reported as a very unusual cause of acute urinary retention. The discussion points out the difference between primary and secondary hydatid cyst of the retroperitoneum, the diagnostic problems and a suggested treatment is given.

  5. Mutations in SOX17 are Associated with Congenital Anomalies of the Kidney and the Urinary Tract

    PubMed Central

    Gimelli, Stefania; Caridi, Gianluca; Beri, Silvana; McCracken, Kyle; Bocciardi, Renata; Zordan, Paola; Dagnino, Monica; Fiorio, Patrizia; Murer, Luisa; Benetti, Elisa; Zuffardi, Orsetta; Giorda, Roberto; Wells, James M; Gimelli, Giorgio; Ghiggeri, Gian Marco

    2010-01-01

    Congenital anomalies of the kidney and the urinary tract (CAKUT) represent a major source of morbidity and mortality in children. Several factors (PAX, SOX,WNT, RET, GDFN, and others) play critical roles during the differentiation process that leads to the formation of nephron epithelia. We have identified mutations in SOX17, an HMG-box transcription factor and Wnt signaling antagonist, in eight patients with CAKUT (seven vesico-ureteric reflux, one pelvic obstruction). One mutation, c.775T>A (p.Y259N), recurred in six patients. Four cases derived from two small families; renal scars with urinary infection represented the main symptom at presentation in all but two patients. Transfection studies indicated a 5–10-fold increase in the levels of the mutant protein relative to wild-type SOX17 in transfected kidney cells. Moreover we observed a corresponding increase in the ability of SOX17 p.Y259N to inhibit Wnt/β-catenin transcriptional activity, which is known to regulate multiple stages of kidney and urinary tract development. In conclusion, SOX17 p.Y259N mutation is recurrent in patients with CAKUT. Our data shows that this mutation correlates with an inappropriate accumulation of SOX17-p.Y259N protein and inhibition of the β-catenin/Wnt signaling pathway. These data indicate a role of SOX17 in human kidney and urinary tract development and implicate the SOX17–p.Y259N mutation as a causative factor in CAKUT. Hum Mutat 31:1352–1359, 2010. © 2010 Wiley-Liss, Inc. PMID:20960469

  6. Protective Temporary Vesicostomy for Upper Urinary Tract Problems in Children: A Five-Year Experience

    PubMed Central

    Rouzrokh, Mohsen; Mirshemirani, Alireza; Khaleghnejad-Tabari, Ahmad; Sadeghian, Naser; Mohajerzadeh, Leily; Mohkam, Maesomeh

    2013-01-01

    Objective Temporary vesicostomy is a urinary diversion procedure for patients with upper urinary tract (UUT) dilatation, secondary to bladder outlet obstruction or dysfunction. The aim of this study was to evaluate our experience in children undergoing such diversion, analyzing its efficacy to prevent urinary tract infection (UTI), improve or resolve hydronephrosis, stabilize or improve kidney function and restore the health of UUT. Methods In this retrospective study, patients who had vesicostomy by Blocksom technique due to bladder outlet obstruction or dysfunction were evaluated in Mofid Children’s Hospital (in Tehran) from March 2007 to March 2012. The reason for applying this procedure was failure in clinical treatment. Data regarding gender, age, diagnosis, time of any surgical intervention, associated anomalies, primary/secondary complications and mortality were collected using a questionnaire, and evaluated by giving a grade that ranged from 0 (worst) to 10 (best) based on Lickert’s scale. Findings From a total number of 53 patients, (88.7% male and 11.3% female) with a mean age of 225 days, 66% had posterior urethral valve and 16 (30%) neurogenic bladder. UTI was present in all cases, hydronephrosis in 52 (98.1%), and vesico-ureteral reflux only in 45 (84.9%) patients. Valve ablation was performed in 17 cases, and clean intermittent catheterization in14 patients which were unsuccessful. We performed vesicostomy in all patients. Mortality rate was 7.5%. Vesicostomy was closed in 35 patients. Cure rate was 85% in UTI, 82.7% in hydronephrosis, 80% in VUR, and 86.5% in kidney function. Conclusion Vesicostomy is a simple procedure that protects upper urinary tract, decreases hydronephrosis, and improves kidney function. The procedure is well tolerated and reversible, with less complication and should be considered in children in whom conservative and medical treatment has failed. PMID:24910742

  7. Radiology and treatment of urinary tract stone disease.

    PubMed

    Bush, W H

    1992-04-01

    Renal and ureteral calculi are treated primarily using extracorporeal lithotripsy, with percutaneous nephrostolithotomy retaining an important role for the treatment of large stones and complex situations. Aspects of pretherapy evaluation are reviewed. The vast majority of calculi 5 mm or less in diameter in the mid and lower ureter will pass spontaneously; in patients with acute ureteral obstruction, lower-osmolar nonionic contrast for urography caused as much discomfort as conventional high-osmolar contrast. Treatment planning for extracorporeal lithotripsy has changed in that internal stenting is no longer routinely recommended. Milk-of-calcium and calyceal diverticular stones respond poorly to extracorporeal lithotripsy. The access route used for percutaneous stone removal varies among investigators. Some advocate an intercostal approach for up to one third of patients; substantial complications occur with placement of a track above the 11th rib. Sepsis develops after percutaneous nephrostomy in up to 21% of patients, but the risk of sepsis can be decreased significantly by the administration of antibiotics during and after the procedure. Complications of extracorporeal lithotripsy include renal hematoma (especially if the patient is hypertensive or is taking aspirin), regional organ injury, and bacteremia. Although originally feared to occur frequently, hypertension occurring after or caused by extracorporeal lithotripsy was not confirmed to be a major problem. The incidence in a 2-year postlithotripsy follow-up was no greater than that for control subjects. PMID:1554585

  8. New therapeutic strategies for the treatment of male lower urinary tract symptoms.

    PubMed

    Dimitropoulos, Konstantinos; Gravas, Stavros

    2016-01-01

    Male lower urinary tract symptoms (LUTS) are prevalent in the general population, especially in those of advanced age, and are characterized by notable diversity in etiology and presentation, and have been proven to cause various degrees of impairment on quality of life. The prostate has traditionally been regarded as the core cause of male LUTS. As a result, medical treatment aims to provide symptomatic relief and effective management of progression of male LUTS due to benign prostatic enlargement. In this context, α1-blockers, phosphodiesterase-5 inhibitors, and 5α-reductase inhibitors have long been used as monotherapies or in combination treatment to control voiding LUTS. There is accumulating evidence, however, that highlights the role of the bladder in the pathogenesis of male LUTS. Current research interests have shifted to bladder disorders, and medical management is aimed at the bladder. Muscarinic receptor antagonists and the newly approved β3-adrenergic agonist mirabegron aim to alleviate the most bothersome storage LUTS and thus improve quality of life. As voiding and storage LUTS frequently coexist, combination therapeutic strategies with α1-blockers and antimuscarinics or β3-agonists have been introduced to manage symptoms effectively. Anti-inflammatory agents, vitamin D3-receptor analogs, and cannabinoids represent treatment modalities currently under investigation for use in LUTS patients. Furthermore, luteinizing hormone-releasing hormone antagonists, transient receptor-potential channel blockers, purinergic neurotransmission antagonists, Rho-kinase inhibitors, and inhibitors of endothelin-converting enzymes could have therapeutic potential in LUTS management, but still remain in the experimental setting. This article reviews new strategies for the medical treatment of male LUTS, which are dictated by the potential role of the bladder and the risk of benign prostatic hyperplasia progression. Moreover, combination treatments and therapies

  9. New therapeutic strategies for the treatment of male lower urinary tract symptoms

    PubMed Central

    Dimitropoulos, Konstantinos; Gravas, Stavros

    2016-01-01

    Male lower urinary tract symptoms (LUTS) are prevalent in the general population, especially in those of advanced age, and are characterized by notable diversity in etiology and presentation, and have been proven to cause various degrees of impairment on quality of life. The prostate has traditionally been regarded as the core cause of male LUTS. As a result, medical treatment aims to provide symptomatic relief and effective management of progression of male LUTS due to benign prostatic enlargement. In this context, α1-blockers, phosphodiesterase-5 inhibitors, and 5α-reductase inhibitors have long been used as monotherapies or in combination treatment to control voiding LUTS. There is accumulating evidence, however, that highlights the role of the bladder in the pathogenesis of male LUTS. Current research interests have shifted to bladder disorders, and medical management is aimed at the bladder. Muscarinic receptor antagonists and the newly approved β3-adrenergic agonist mirabegron aim to alleviate the most bothersome storage LUTS and thus improve quality of life. As voiding and storage LUTS frequently coexist, combination therapeutic strategies with α1-blockers and antimuscarinics or β3-agonists have been introduced to manage symptoms effectively. Anti-inflammatory agents, vitamin D3-receptor analogs, and cannabinoids represent treatment modalities currently under investigation for use in LUTS patients. Furthermore, luteinizing hormone-releasing hormone antagonists, transient receptor-potential channel blockers, purinergic neurotransmission antagonists, Rho-kinase inhibitors, and inhibitors of endothelin-converting enzymes could have therapeutic potential in LUTS management, but still remain in the experimental setting. This article reviews new strategies for the medical treatment of male LUTS, which are dictated by the potential role of the bladder and the risk of benign prostatic hyperplasia progression. Moreover, combination treatments and therapies

  10. The humoral pattern recognition molecule PTX3 is a key component of innate immunity against urinary tract infection.

    PubMed

    Jaillon, Sébastien; Moalli, Federica; Ragnarsdottir, Bryndis; Bonavita, Eduardo; Puthia, Manoj; Riva, Federica; Barbati, Elisa; Nebuloni, Manuela; Cvetko Krajinovic, Lidija; Markotic, Alemka; Valentino, Sonia; Doni, Andrea; Tartari, Silvia; Graziani, Giorgio; Montanelli, Alessandro; Delneste, Yves; Svanborg, Catharina; Garlanda, Cecilia; Mantovani, Alberto

    2014-04-17

    Immunity in the urinary tract has distinct and poorly understood pathophysiological characteristics and urinary tract infections (UTIs) are important causes of morbidity and mortality. We investigated the role of the soluble pattern recognition molecule pentraxin 3 (PTX3), a key component of the humoral arm of innate immunity, in UTIs. PTX3-deficient mice showed defective control of UTIs and exacerbated inflammation. Expression of PTX3 was induced in uroepithelial cells by uropathogenic Escherichia coli (UPEC) in a Toll-like receptor 4 (TLR4)- and MyD88-dependent manner. PTX3 enhanced UPEC phagocytosis and phagosome maturation by neutrophils. PTX3 was detected in urine of UTI patients and amounts correlated with disease severity. In cohorts of UTI-prone patients, PTX3 gene polymorphisms correlated with susceptibility to acute pyelonephritis and cystitis. These results suggest that PTX3 is an essential component of innate resistance against UTIs. Thus, the cellular and humoral arms of innate immunity exert complementary functions in mediating resistance against UTIs.

  11. Exposure to co-amoxiclav as a risk factor for co-amoxiclav-resistant Escherichia coli urinary tract infection.

    PubMed

    Leflon-Guibout, Véronique; Ternat, Géraldine; Heym, Beate; Nicolas-Chanoine, Marie-Hélène

    2002-02-01

    The objective of the study was to define whether individual exposure to co-amoxiclav is a risk factor for selecting co-amoxiclav-resistant Escherichia coli in vivo. One hundred and eight patients were included in our study as soon as they were found to have a urinary tract infection (UTI) due to E. coli. Stool probes were also undertaken for some of these patients. Co-amoxiclav administration in the month before diagnosing the UTI, and any treatment to cure the current UTI were recorded for all patients. When co-amoxiclav-resistant E. coli was detected in the stools after diagnosis of E. coli UTI, isolates were compared with urinary E. coli isolates in terms of clonal relatedness, beta-lactam susceptibility and mechanisms of beta-lactam resistance. The patients who had taken co-amoxiclav in the month before the reported E. coli UTI had a significantly higher risk of being infected with co-amoxiclav-resistant E. coli. Those patients treated with amoxicillin for a current infection were at greater risk of intestinal carriage of co-amoxiclav-resistant E. coli; those treated with co-amoxiclav had a greater risk of intestinal carriage of co-amoxiclav-resistant Gram-negative bacilli than patients treated with third-generation cephalosporins or fluoroquinolones. Hence, individual exposure to co-amoxiclav is a risk factor for UTIs caused by co-amoxiclav-resistant E. coli or for carrying co-amoxiclav-resistant Gram-negative bacilli in the digestive tract.

  12. The humoral pattern recognition molecule PTX3 is a key component of innate immunity against urinary tract infection.

    PubMed

    Jaillon, Sébastien; Moalli, Federica; Ragnarsdottir, Bryndis; Bonavita, Eduardo; Puthia, Manoj; Riva, Federica; Barbati, Elisa; Nebuloni, Manuela; Cvetko Krajinovic, Lidija; Markotic, Alemka; Valentino, Sonia; Doni, Andrea; Tartari, Silvia; Graziani, Giorgio; Montanelli, Alessandro; Delneste, Yves; Svanborg, Catharina; Garlanda, Cecilia; Mantovani, Alberto

    2014-04-17

    Immunity in the urinary tract has distinct and poorly understood pathophysiological characteristics and urinary tract infections (UTIs) are important causes of morbidity and mortality. We investigated the role of the soluble pattern recognition molecule pentraxin 3 (PTX3), a key component of the humoral arm of innate immunity, in UTIs. PTX3-deficient mice showed defective control of UTIs and exacerbated inflammation. Expression of PTX3 was induced in uroepithelial cells by uropathogenic Escherichia coli (UPEC) in a Toll-like receptor 4 (TLR4)- and MyD88-dependent manner. PTX3 enhanced UPEC phagocytosis and phagosome maturation by neutrophils. PTX3 was detected in urine of UTI patients and amounts correlated with disease severity. In cohorts of UTI-prone patients, PTX3 gene polymorphisms correlated with susceptibility to acute pyelonephritis and cystitis. These results suggest that PTX3 is an essential component of innate resistance against UTIs. Thus, the cellular and humoral arms of innate immunity exert complementary functions in mediating resistance against UTIs. PMID:24745336

  13. Discrimination of urinary tract infection pathogens by means of their growth profiles using surface enhanced Raman scattering.

    PubMed

    Avci, Ertug; Kaya, Nur Selin; Ucankus, Gizem; Culha, Mustafa

    2015-11-01

    Urinary tract infection (UTI) is a widespread infection and affects millions of people around the globe. The gold standard for identification of microorganisms causing infection is urine culture. However, current methods require at least 24 h for the results. In clinical settings, identification and discrimination of bacteria with less time-consuming and cheaper methods are highly desired. In recent years, the power of surface-enhanced Raman scattering (SERS) for fast identification of bacteria and biomolecules has been demonstrated. In this study, we show discrimination of urinary tract infection causative pathogens within 1 h of incubation using principal component analysis (PCA) of SERS spectra of seven different UTI causative bacterial species. In addition, we showed differentiation of them at their different growth phases. We also analyzed origins of bacterial SERS spectra and demonstrated the highly dynamic structure of the bacteria cell wall during their growth. Graphical Abstract Collection of bacteria from urine sample, and their discrimination using their SERS spectra and multivariate analysis.

  14. [Usage of the novel synthetic material carbilan for urinary tract reconstruction in experiment].

    PubMed

    Kirpatovskiĭ, V I; Mudraia, I S; Kudriavtsev, Iu V; Kudriavtsev, Iu P; Evsiukov, S E

    2001-01-01

    Carbilan was tried as a new synthetic suturing material and ureteral prosthesis in reconstruction surgery on the urinary tracts. In experiments on 24 dogs carbilan suturing threads were used for establishment of ureteral-ureteral and vesicoureteral anastomoses, suturing of the ureter, bladder or urethra. In a comparative group of 36 dogs such operations were made using chrome-plated catgut. Complications occurred in 3.8 and 17.6% of the dogs from the carbilan and catgut groups, respectively. Replacement of the part of the ureter in the middle or in the lower third 3-5 cm in length for a carbilan transplant was conducted in 8 dogs. In 6 cases of the suture leaking, the prosthesis underwent deformation and compression by commissures which formed around the flap within 3 months after the implantation. In 2 experiments the prosthesis was sealed with fibrin (a short-term implantation into the artery). This provided normal function of the prosthesis for 9-13 months. Later, the urinary tracts were also obstructed. No occlusions of the prosthesis with urinary salts or detritus were observed. Histologically, both suturing threads and ureteral prosthesis made of carbilan showed good biocompatibility. Massive commissures around the prosthesis arose because of its leaking and contact of the urine with the surrounding tissues.

  15. Urinary Tract Infection In Young Healthy Women Following Heterosexual Anal Intercourse: Case Reports.

    PubMed

    Lema, Valentino M

    2015-06-01

    Urinary tract infections (UTIs) are among the most common bacterial infections in outpatient clinical settings globally. Young healthy women are at highest risk of community-acquired UTI. While uncomplicated UTI is not life-threatening, it is associated with high morbidity and treatment costs. The pathogenesis of urinary tract infection in young healthy women is complex. It is influenced by a number of host biological and behavioural factors and virulence of the uropathogen. The infecting uropathogens in community-acquired UTI originate from the fecal flora, E. coli being the most predominant, accounting for 80-90% of these UTIs. Vaginal colonization with uropathogens, a pre-requisite for bladder infection may be facilitated by sexual intercourse, which has been shown to be a strong risk factor and predictor of UTI. While majority of studies have explored the association between heterosexual vaginal intercourse and UTI in healthy young women, the possible association with heterosexual receptive anal intercourse has not received adequate attention despite evidence of high prevalence globally. This paper presents two young healthy married women who had severe UTI following heterosexual anal intercourse and discusses possible association thereof. Understanding the risk factors for UTI and identification of possible predisposing conditions in a particular individual are important in guiding therapeutic approaches and preventive strategies. Cognisant of reportedly high prevalence of various sexual practices including receptive heterosexual anal intercourse and their impact on individuals' health, details on sexual history should always be enquired into in young women presenting with genito-urinary complaints. PMID:26506666

  16. Epidemiology and natural history of urinary tract infections in children.

    PubMed

    Stull, T L; LiPuma, J J

    1991-03-01

    Recent retrospective surveys have supported previous investigations in demonstrating the incidence of UTI during infancy; 0.3% to 1.2% of infants develop symptomatic UTI during the first year of life. Boys are more commonly infected during the first 3 months of life. After the first year, symptomatic UTI is much more frequent among girls. Similarly, asymptomatic bacteriuria is more frequently detected in boys than in girls during the first 12 months of life. Thereafter, the incidence decreases markedly in boys but increases in girls. Recent investigations indicate that lack of circumcision is a risk factor for UTI among male infants. Recurrent UTI is common and frequently asymptomatic. The most important microbiologic factor that is associated with E. coli causing acute pyelonephritis is adherence mediated by P fimbriae. Other factors, such as capsule, lipopolysaccharide, aerobactin production, and serum resistance, also determine the invasiveness of E. coli. Vesicoureteral reflux appears to be an important host factor predisposing to UTI. Microbiologic and host factors that are determinants of renal scarring are under investigation.

  17. Lymphoid neoplasms of the urinary tract and male genital organs: a clinicopathological study of 40 cases.

    PubMed

    Schniederjan, Stephanie D; Osunkoya, Adeboye O

    2009-08-01

    Lymphoid neoplasms of the urinary tract and male genital organs are relatively rare, comprising less than 5% of all primary extranodal lymphomas; only a handful of small case series and isolated case reports have been published describing their predominant sites and subtypes. We identified 40 patients with lymphoid neoplasms of the urinary tract and male genital organs. Hematoxylin and eosin slides and immunohistochemical stains were reviewed, and follow-up data were also obtained. Twenty-six of 40 cases (65%) were primary genitourinary lymphomas. Mean age at diagnosis was 56 years (range 4-86 years). Among renal, bladder, and ureter lymphomas, a male predominance was noted (1.6:1). The subtypes of the lymphoid neoplasms observed were diffuse large B-cell lymphoma (17 cases, 43%); Burkitt lymphoma, extranodal marginal zone lymphoma, SLL/CLL, and follicular lymphoma (4 cases, or 10% each); B-cell ALL (2 cases, 5%); B-cell lymphoma, unclassifiable, with features intermediate between diffuse large B-cell lymphoma and Burkitt lymphoma, mantle cell lymphoma, plasmacytoma, polymorphic post-transplant lymphoproliferative disorder, and peripheral T-cell lymphoma NOS (1 case, or 2.5% each). In most cases, the genitourinary tract was the site of initial presentation. Genitourinary tract lymphomas most commonly occurred in the kidney. B-cell non-Hodgkin's lymphomas predominated, with diffuse large B-cell lymphoma being the most common subtype in the entire group. Extranodal marginal zone lymphoma was seen only in the kidney, rather than the bladder, where it is typically thought to be more common. Although this study confirms the predominance of diffuse large B-cell lymphoma in extranodal sites, the findings also highlight the variety of lymphomas that may occur in the genitourinary tract. This diversity of subtypes affirms the importance of fully characterizing lymphomas by immunohistochemistry and other modalities, which are indispensable for accurate diagnosis.

  18. THE INFLUENCE OF URINARY TRACT INFECTIONS ON TREATMENT OF FRACTURE OF PROXIMAL FEMUR IN PATIENTS WITH SYSTEMIV OSTEOPOROSIS.

    PubMed

    Palshina, A M; Bannaev, I F; Palshin, G A; Shamaeva, S Kh; Yadrikhinskaya, V N; Komissarov, A N; Krivoshapkina, A G

    2015-01-01

    In the structure of intrahospital infections the infections of urinary tract make up from 20 to 40%. This problem represents special medical-social significance for trauma departments as patients with trauma are being in forced situation for along time. 380 patients older than 60 years (average age 73.6 ± 9.2 years) with a fracture of proximal femur against background of the systemic osteoporosis having in-patient treatment in the trauma department of the Republic Hospital No2 were being examined and treated from 2011 to 2013. Urinary tract infections were diagnosed in 130 (34.2%) patients (average age 77.3 ± 8.3 years). Women (80%-82%) with the average age 77.7 ± 8.2 years prevailed by gender signs. From them 40 (30.8%) patients admitted with prehospital urinary tract infections and intrahospital urinary tract infections were diagnosed in 90 (69.2%) patients. In etiological structure of urinary tract infections the part of gram-negative microorganisms made up 47.4%, the leading role belonged to the family of Enterobacteriaceae. Escherichia coli (23.3%) and Klibsiella pneumonia (12%) were the most significant from them. Gram-positive microorganisms 44% were sown in the second place. More frequently Enterococci (33.6%) were separated such as Enterococcus faecium (18.1%) and Enterococcus faecalis (15.5%). Intrahospital urinary tract infections resistant to antimicrobial therapy were observed in 6.7% patients with systemic osteoporosis and fracture of proximal femur. The average duration of preoperative preparation and in-patient treatment of patients with fracture of proximal femurand concomitant urinary tract infections is much more (3.9 days and 5.4 bed-days correspondingly) higher than the average indications of all operated patients in the department.

  19. THE INFLUENCE OF URINARY TRACT INFECTIONS ON TREATMENT OF FRACTURE OF PROXIMAL FEMUR IN PATIENTS WITH SYSTEMIV OSTEOPOROSIS.

    PubMed

    Palshina, A M; Bannaev, I F; Palshin, G A; Shamaeva, S Kh; Yadrikhinskaya, V N; Komissarov, A N; Krivoshapkina, A G

    2015-01-01

    In the structure of intrahospital infections the infections of urinary tract make up from 20 to 40%. This problem represents special medical-social significance for trauma departments as patients with trauma are being in forced situation for along time. 380 patients older than 60 years (average age 73.6 ± 9.2 years) with a fracture of proximal femur against background of the systemic osteoporosis having in-patient treatment in the trauma department of the Republic Hospital No2 were being examined and treated from 2011 to 2013. Urinary tract infections were diagnosed in 130 (34.2%) patients (average age 77.3 ± 8.3 years). Women (80%-82%) with the average age 77.7 ± 8.2 years prevailed by gender signs. From them 40 (30.8%) patients admitted with prehospital urinary tract infections and intrahospital urinary tract infections were diagnosed in 90 (69.2%) patients. In etiological structure of urinary tract infections the part of gram-negative microorganisms made up 47.4%, the leading role belonged to the family of Enterobacteriaceae. Escherichia coli (23.3%) and Klibsiella pneumonia (12%) were the most significant from them. Gram-positive microorganisms 44% were sown in the second place. More frequently Enterococci (33.6%) were separated such as Enterococcus faecium (18.1%) and Enterococcus faecalis (15.5%). Intrahospital urinary tract infections resistant to antimicrobial therapy were observed in 6.7% patients with systemic osteoporosis and fracture of proximal femur. The average duration of preoperative preparation and in-patient treatment of patients with fracture of proximal femurand concomitant urinary tract infections is much more (3.9 days and 5.4 bed-days correspondingly) higher than the average indications of all operated patients in the department. PMID:26887137

  20. Hypercalcemia in Upper Urinary Tract Urothelial Carcinoma: A Case Report and Literature Review

    PubMed Central

    McHugh, Jonathan B.; Miller, David C.; Esfandiari, Nazanene H.

    2013-01-01

    Objective. We here report a patient with upper urinary tract urothelial carcinoma with hypercalcemia likely due to elevated 1,25-dihydroxyvitamin D. Methods. We present a clinical case and a summary of literature search. Results. A 57-year-old man, recently diagnosed with a left renal mass, for which a core biopsy showed renal cell carcinoma, was admitted for hypercalcemia of 11.0 mg/mL He also had five small right lung nodules with a negative bone scan. Both intact parathyroid hormone and parathyroid hormone-related peptide were appropriately low, and 1,25-dihydroxyvitamin D was elevated at 118 pg/dL. The patient's calcium was normalized after hydration, and he underwent radical nephrectomy. On the postoperative day 6, a repeat 1,25-dihydroxyvitamin D was 24 pg/mL with a calcium of 8.1 mg/dL. Pathology showed a 6 cm high-grade urothelial carcinoma with divergent differentiation. We identified a total of 27 previously reported cases with hypercalcemia and upper tract urothelial carcinoma in English. No cases have a documented elevated 1,25-dihydroxyvitamin D level. Conclusion. This clinical course suggests that hypercalcemia in this case is from the patient's tumor, which was likely producing 1,25-dihydroxyvitamin D. Considering the therapeutic implications, hypercalcemia in patients with upper urinary tract urothelial carcinoma should be evaluated with 1,25-dihydroxyvitamin D. PMID:23476827

  1. Application of a nanotechnology antimicrobial spray to prevent lower urinary tract infection: a multicenter urology trial

    PubMed Central

    2012-01-01

    Background Catheter-associated urinary tract infection (CAUTI) is a common nosocomial device-associated infection. It is now recognized that the high infection rates were caused by the formation of biofilm on the surface of the catheters that decreases the susceptibility to antibiotics and results in anti-microbial resistance. In this study, we performed an in vitro test to explore the mechanism of biofilm formation and subsequently conducted a multi-center clinical trial to investigate the efficacy of CAUTI prevention with the application of JUC, a nanotechnology antimicrobial spray. Methods Siliconized latex urinary catheters were cut into fragments and sterilized by autoclaving. The sterilized sample fragments were randomly divided into the therapy and control group, whereby they were sprayed with JUC and distilled water respectively and dried before use. The experimental standard strains of Escherichia coli (E. coli) were isolated from the urine samples of patients. At 16 hours and 7 days of incubation, the samples were extracted for confocal laser scanning microscopy. A total of 1,150 patients were accrued in the clinical study. Patients were randomized according to the order of surgical treatment. The odd array of patients was assigned as the therapy group (JUC), and the even array of patients was assigned as the control group (normal saline). Results After 16 hours of culture, bacterial biofilm formed on the surface of sample fragments from the control group. In the therapy group, no bacterial biofilm formation was observed on the sample fragments. No significant increase in bacterial colony count was observed in the therapy group after 7 days of incubation. On the 7th day of catheterization, urine samples were collected for bacterial culture before extubation. Significant difference was observed in the incidence of bacteriuria between the therapy group and control group (4.52% vs. 13.04%, p < 0.001). Conclusions In this study, the effectiveness of JUC in

  2. Antimicrobial susceptibilities of Escherichia coli isolates as agents of community-acquired urinary tract infection (2008–2014)

    PubMed Central

    Yılmaz, Nisel; Ağuş, Neval; Bayram, Arzu; Şamlıoğlu, Pınar; Şirin, M. Cem; Derici, Yeşer Karaca; Hancı, Sevgi Yılmaz

    2016-01-01

    Objective Urinary tract infections (UTIs) are among the most frequently seen community-acquired infections worldwide. E. coli causes 90% of urinary system infections. To guide the empirical therapy, the resistance pattern of E. coli responsible for community-acquired UTI was evaluated throughout a seven-year period in this study. Material and methods The urine cultures of patients with urinary tract infections admitted to outpatient clinics between 1st January 2008 and 31st December 2014 were analyzed. Presence of ≥105 colony-forming units/mL in urine culture media was considered as significant for UTI. Isolated bacteria were identified by standard laboratory techniques or automated system VITEK2 (BioMerieux, France) and BD PhoenixTM 100 (BD, USA), as required. Antibiotic susceptibility testing was performed by Kirby-Bauer disk diffusion method using Clinical Laboratory Standard Institute (CLSI) criteria. Results A total of 13281 uropathogens were isolated. Overall E. coli accounted for 8975 (67%) of all isolates. Resistance rates of E. coli to antimicrobial agents was demonstrated to be as follows: ampicillin 66.9%, cefazolin 30.9%, cefuroxime 30.9%, ceftazidime 14.9%, cefotaxime 28%, cefepime 12%, amoxicillin-clavulanic acid 36.9%, trimethoprim-sulfamethoxazole (TMP-SXT) 20%, ciprofloxacin 49.9%, amikacin 0.3%, gentamycin 24%, nitrofurantoin 0.9%, and fosfomycin 4.3%. There was no resistance to imipenem nor meropenem. The frequency of ESBL-producing E. coli strains was 24%. Conclusion It is concluded that fosfomycin and nitrofurantoin are appropriate empirical therapy for community-acquired UTI empirical therapy, but the fluoroquinolones and the TMP-SXT shall not be used in the emprical treatment of UTI at this stage. In conclusion, as resistance rates show regional differences, it is necessary to regularly examine regional resistance rates to determine the appropriate empiric antibiotic treatment and national antibiotic usage policies must be reorganized

  3. Overview of the Epidemiology of Lower Urinary Tract Dysfunction in South Korea

    PubMed Central

    2016-01-01

    This review assessed the epidemiology of voiding dysfunctions in South Korea. Comprehensive understanding of this epidemiology is crucial because the senior population and the social burden are increasing because of voiding dysfunctions is growing. We searched the medical records using several terms related to voiding dysfunction: benign prostatic hyperplasia, urinary incontinence, lower urinary tract symptoms, overactive bladder, and nocturia. We then estimated the prevalence of voiding dysfunctions in South Korea; our data were comparable with those from other countries, with slight differences. The ranges of incidences varied widely between studies, mostly because investigators defined disorders differently. Voiding dysfunction greatly affects healthcare costs and individual quality of life; therefore, more proper and valuable epidemiologic data are needed. In addition, efforts to unify the definitions of various voiding dysfunctions and progress in investigational methodologies using multimedia are warranted. PMID:27377940

  4. Engaging health care workers to prevent catheter-associated urinary tract infection and avert patient harm.

    PubMed

    Fakih, Mohamad G; Krein, Sarah L; Edson, Barbara; Watson, Sam R; Battles, James B; Saint, Sanjay

    2014-10-01

    Preventing catheter-associated urinary tract infection (CAUTI) remains a significant challenge for US hospitals. The "On the CUSP: Stop CAUTI" initiative represents the single largest national effort (involving >950 hospitals) to mitigate urinary catheter risk. The program brings together key organizations to assist state hospital associations and hospitals by providing education and coaching support, addressing both the technical aspects of preventing CAUTI and CAUTI-specific socio-adaptive challenges. At the local level, engaging health care workers, from physicians and nurses to other ancillary services, is critical. This includes (1) making the importance of addressing CAUTI stakeholder specific, (2) ensuring support from leaders of essential disciplines, (3) underscoring the importance of the collaborative nature of CAUTI prevention, and (4) identifying champions within the organization to lead and be accountable for the work. Sustainability is ensured by integrating the process into the health care worker's daily routine activities.

  5. Capgras-like syndrome in a patient with an acute urinary tract infection

    PubMed Central

    Salviati, Massimo; Bersani, Francesco Saverio; Macrì, Francesco; Fojanesi, Marta; Minichino, Amedeo; Gallo, Mariana; De Michele, Francesco; Chiaie, Roberto Delle; Biondi, Massimo

    2013-01-01

    Delusional misidentification syndromes are a group of delusional phenomena in which patients misidentify familiar persons, objects, or themselves, believing that they have been replaced or transformed. In 25%–40% of cases, misidentification syndromes have been reported in association with organic illness. We report an acute episode of Capgras-like delusion lasting 8 days, focused on the idea that people were robots with human bodies, in association with an acute urinary infection. To our knowledge, this is the first case report associating urinary tract infection with Capgras-like syndrome. Awareness of the prevalence of delusional misidentification syndromes associated with acute medical illness should promote diligence on the part of clinicians in recognizing this disorder. PMID:23355784

  6. Molecular identification of multi drug resistant bacteria from urinary tract infected urine samples.

    PubMed

    Kumar, M S; Das, A P

    2016-09-01

    Urinary tract infections (UTIs) are of great concern in both developing and developed countries all over the world. Even though the infections are more common in women and children, they are at a considerable rate in men and of all ages. The uropathogens causing the infections are spread through various routes. The treatment generally recommended by the physicians is antibiotic usage. But, most of the uropathogens have evolved antibiotic resistance mechanisms. This makes the present situation hectic in control and prevention of UTIs. The present study aims to illustrate the multidrug resistance patterns among isolated bacterial strains from infected urine samples in Odisha state, India. Four bacterial strains were isolated and identified as Proteus sp. SK3, Pseudomonas sp. ADMK77, Proteus sp. BLKB2 and Enterobacter hormaechei strain CW-3 by 16S rRNA gene sequencing. Phylogenetc analysis indicated the strains belong to three various genera namely, Proteus, Pseudomonas and Enterobacter. The evolutionary timeline of the bacteria was studied by constructing phylogenetic trees by Neighborhood Joining method. The presence of ESBL gene and biofilm forming capability were studied for the four strains. Antibiotic susceptibility patterns of the isolates were studied toward the commonly recommended antibiotics. Both the Proteus strains were found commonly susceptible to aminoglycoside and sulphonamide groups. Pseudomonas strain was found to be susceptible to cephems, aminoglycosides and fluoroquinolones. Enterobacter sp was found to be resistant to almost all antibiotic groups and susceptible to only sulphonamides group. The antibiotic susceptibility patterns of the bacteria help in choosing the empirical antibiotic treatment for UTI. PMID:27354209

  7. Impact of urinary tract infections on short-term kidney graft outcome.

    PubMed

    Bodro, M; Sanclemente, G; Lipperheide, I; Allali, M; Marco, F; Bosch, J; Cofan, F; Ricart, M J; Esforzado, N; Oppenheimer, F; Moreno, A; Cervera, C

    2015-12-01

    Urinary tract infections (UTIs) are frequent after renal transplantation, but their impact on short-term graft outcome is not well established. All kidney transplants performed between July 2003 and December 2010 were investigated to evaluate the impact of UTI on graft function at 1 year after transplantation. Of 867 patients who received a kidney transplant, 184 (21%) developed at least one episode of UTI, at a median of 18 days after transplantation. The prevalence of acute graft pyelonephritis (AGP) was 15%. The most frequent pathogens identified were Escherichia coli, Klebsiella species, and Pseudomonas aeruginosa, 37% of which were considered to be multidrug-resistant strains. Thirty-eight patients (4%) lost their grafts, 225 patients (26%) had graft function impairment and the 1-year mortality rate was 3%; however, no patient died as a consequence of a UTI. Surgical re-intervention and the development of at least one episode of AGP were independently associated with 1-year graft function impairment. Moreover, the development of at least one episode of AGP was associated with graft loss at 1 year. Patients with AGP caused by a resistant strain had graft function impairment more frequently, although this difference did not reach statistical significance (53% vs. 36%, p 0.07). Neither asymptomatic bacteriuria nor acute uncomplicated UTI were associated with graft function impairment in multivariate analysis. To conclude, UTIs are frequent in kidney transplant recipients, especially in the early post-transplantation period. Although AGP was significantly associated with kidney graft function impairment and 1-year post-transplantation graft loss, lower UTIs did not affect graft function. PMID:26235196

  8. Multiplex Pathogen Identification for Polymicrobial Urinary Tract Infections Using Biosensor Technology: A Prospective Clinical Study

    PubMed Central

    Mach, Kathleen E.; Du, Christine B.; Phull, Hardeep; Haake, David A.; Shih, Mei-Chiung; Baron, Ellen Jo; Liao, Joseph C.

    2014-01-01

    Purpose Rapid diagnosis of urinary tract infection would have a significant beneficial impact on clinical management, particularly in patients with structural or functional urinary tract abnormalities who are highly susceptible to recurrent polymicrobial infections. We examined the analytical validity of an electrochemical biosensor array for rapid molecular diagnosis of urinary tract infection in a prospective clinical study in patients with neurogenic bladder. Materials and Methods The electrochemical biosensor array was functionalized with DNA probes against 16S rRNA of the most common uropathogens. Spinal cord injured patients at a Veterans Affairs hospital were recruited into the study. Urine samples were generally tested on the biosensor within 1 to 2 hours of collection. Biosensor results were compared with those obtained using standard clinical microbiology laboratory methods. Results We successfully developed a 1-hour biosensor assay for multiplex identification of pathogens. From July 2007 to December 2008 we recruited 116 patients, yielding a total of 109 urine samples suitable for analysis and comparison between biosensor assay and standard urine culture. Of the samples 74% were positive, of which 42% were polymicrobial. We identified 20 organisms, of which Escherichia coli, Pseudomonas aeruginosa and Enterococcus species were the most common. Biosensor assay specificity and positive predictive value were 100%. Pathogen detection sensitivity was 89%, yielding a 76% negative predictive value. Conclusions To our knowledge we report the first prospective clinical study to successfully identify pathogens within a point of care time frame using an electrochemical biosensor platform. Additional efforts to improve the limit of detection and probe design are needed to further enhance assay sensitivity. PMID:19837423

  9. Long-term results of retroperitoneoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma in China

    PubMed Central

    Wang, Xiao-Qing; Jiang, Feng-Ming; Chen, Qi-Hui; Hou, Yu-Chuan; Zhang, Hai-Feng; Hao, Yuan-Yuan; Zhang, Long; Wang, Chun-Xi

    2013-01-01

    Objective: We compared long-term clinical outcomes of upper urinary tract transitional cell carcinoma (TCC) patients treated by retroperitoneoscopic nephroureterectomy (RNU) or open radical nephroureterectomy (ONU). Methods: Upper urinary tract TCC patients were treated with RNU (n = 86) or ONU (n = 72) and followed-up for more than three years. Demographic and clinical data, including preoperative indexes, intraoperative indexes and long-term clinical outcomes, were retrospectively compared to determine long-term efficacy of the two procedures. Results: The RNU and ONU groups were statistically similar in age, gender, previous bladder cancer history, tumour location, pathologic tumour stage, pathologic node metastasis or tumour pathologic grade. The original surgery time required for both RNU and ONU was statistically similar, but RNU was associated with a significantly smaller volume of intraoperative estimated blood loss and shorter length of postoperative hospital stay. Follow-up (average: 42.4 months, range: 3–57) revealed that the RNU 3-year recurrence-free survival rate was 62.8% and the 3-year cancer specific survival rate was 80.7%. In the ONU group, the 3-year recurrence-free survival and the three-year cancer-specific survival rates were 59.2% and 80.3%, respectively. Neither of the survival rates were statistically different between the two groups. T stage, grade, lymph node metastasis and bladder tumour history were risk factors for tumour recurrence; the operation mode and the bladder cuff incision mode had no correlation with the recurrence-free survival. Conclusion: The open surgery strategy and the retroperitoneoscopic nephroureterectomy strategy are equally effective for treating upper urinary tract TCC. However, the RNU procedure is less invasive, and requires a shorter duration of postoperative hospitalized care; thus, RNU is recommended as the preferred strategy. PMID:22630340

  10. Treatment of erectile dysfunction and lower urinary tract symptoms by phosphodiesterase inhibitors.

    PubMed

    Uckert, Stefan; Stief, Christian G

    2011-01-01

    To date, it is widely accepted that several disorders of the male and female urogenital tract, such as erectile dysfunction, bladder overactivity, urinary stone disease, the benign prostatic syndrome, as well as symptoms of female sexual arousal and orgasmic dysfunctions, can be therapeutically approached by influencing the function of the smooth musculature of the respective organs. To achieve a pronounced drug effect without significant adverse events, a certain degree of tissue selectivity is mandatory. Selective intervention in intracellular pathways regulating smooth muscle tone has become the most promising strategy to modulate tissue and organ function. Since the concept of taking a pill to relieve symptoms of lower urinary tract dysfunction is now widely accepted following the successes of phosphodiesterase 5 (PDE5) inhibitor treatment of erectile dysfunction, the treatment of urological diseases has focused on orally available drugs acting via influencing intracellular signaling pathways, thereby combining a high response rate with the advantage of an on-demand intake. Specifically, the use of isoenzyme-selective PDE inhibitors offers great opportunities in the medical treatment of various genitourinary diseases. These agents are regarded to be safe and to be efficacious, i.e., having a fast onset of drug action and an improved effect-to-side-effect ratio. As experience with this class of compounds and their use in urology is rapidly growing, basic and clinical research in this field will most likely expand the pharmacological armamentarium of innovative treatment options in the next few years. The purpose of this review is to summarize current, as well as potential, upcoming indications for the use of PDE inhibitors in the pharmacotherapy of male erectile dysfunction and lower urinary tract symptoms. PMID:21695646

  11. Monitoring of the upper urinary tract in patients with bladder cancer

    PubMed Central

    Ayyathurai, Rajinikanth; Soloway, Mark S.

    2011-01-01

    Upper urinary tract (UUT) transitional cell carcinoma (TCC) is relatively rare tumor. Approximately 0.7-4% of patients with primary bladder cancer develops UUT-TCC. The symptoms related to an UUT-TCC often occur with an advanced stage which leads one to emphasize a surveillance strategy to monitor the UUT to allow for an earlier diagnosis. Although the risk of UUT-TCC after bladder cancer is well established, there is a paucity of recommendations suggesting the optimal method and frequency of monitoring the UUT and there is no consensus among them. This article reviews the recommendations on monitoring the UUT in patients with bladder cancer. PMID:21814316

  12. [Antibacterial activity of essential oils on microorganisms isolated from urinary tract infection].

    PubMed

    Pereira, Rogério Santos; Sumita, Tânia Cristina; Furlan, Marcos Roberto; Jorge, Antonio Olavo Cardoso; Ueno, Mariko

    2004-04-01

    The antibacterial activity of essential oils extracted from medicinal plants (Ocimum gratissimum, L., Cybopogum citratus (DC) Stapf., and Salvia officinalis, L.) was assessed on bacterial strains derived from 100 urine samples. Samples were taken from subjects diagnosed with urinary tract infection living in the community. Microorganisms were plated on Müller Hinton agar. Plant extracts were applied using a Steers replicator and petri dishes were incubated at 37 degrees C for 24 hours. Salvia officinalis, L. showed enhanced inhibitory activity compared to the other two herbs, with 100% efficiency against Klebsiella and Enterobacter species, 96% against Escherichia coli, 83% against Proteus mirabilis, and 75% against Morganella morganii. PMID:15122392

  13. Continuous sulfa prophylaxis for urinary tract infection in renal transplant recipients.

    PubMed

    Peters, C; Peterson, P; Marabella, P; Simmons, R L; Najarian, J S

    1983-11-01

    During a 12 to 25 month follow-up period, 252 renal transplant recipients maintained with continuous sulfa prophylaxis were observed for evidence of bacteriuria. Although symptoms were rare, positive cultures were obtained in 6 percent of the patients who responded to conventional antibiotic outpatient therapy. Compared with sulfisoxazole, trimethoprim-sulfamethoxazole led to slightly fewer infections, especially with gram-negative organisms. Toxicity from sulfa was minimal and occasional leukopenia reversed by temporarily withholding azathioprine. Continuous sulfa prophylaxis in renal transplant patients is therefore safe and effective in minimizing the incidence of urinary tract infection, as well as other opportunistic infections known to be treatable by sulfa agents.

  14. [Herbal medicines against urinary tract infections--traditional empiricism or pharmacological evidence?].

    PubMed

    Bastigkeit, Matthias

    2015-02-01

    Empirically, a variety of plants are used for uncomplicated urinary tract infections. The variety of phytopharmaceuticals with valid results is much smaller. There is a variety of observational studies about Cranberry, bearsgrape leaves, birch leaves and European goldenrod. This also justifies a recommendation in the pharmacy in a complementary medical treatment. Desireably, larger placebo-controlled studies, which proove the empirical healing, would provide more evidence. Children, pregnant women, men and patients with fever, severe cramps and blood in the urine should not medicate themselve. The patient should be referred to a doctor.

  15. An unusual retroperitoneal sero-negative hydatid cyst presenting with lower urinary tract symptoms.

    PubMed

    Erdem, Mehmet Remzi; Akbaş, Alpaslan; Onol, Fikret Fatih; Tanidir, Yilören; Onol, Sinasi Yavuz

    2009-01-01

    Hydatid cysts can be found in almost every structure in human body. Thus they can mimic numerous pathologies. Serological analyses are the best assistants in the diagnosis of hydatid cysts. But as serological investigations have limited sensitivity and specificity, they might misdirect our diagnosis. Lungs are the most common involved organ in this parasitic infection. But the brain, muscles, kidneys, bones, heart, pancreas, and rarely the retroperitoneum have also been reported to be involved. An unusual case of a sero-negative hydatid cyst located in the retroperitoneum presenting with lower urinary tract symptoms is reported in this paper.

  16. [Herbal medicines against urinary tract infections--traditional empiricism or pharmacological evidence?].

    PubMed

    Bastigkeit, Matthias

    2015-02-01

    Empirically, a variety of plants are used for uncomplicated urinary tract infections. The variety of phytopharmaceuticals with valid results is much smaller. There is a variety of observational studies about Cranberry, bearsgrape leaves, birch leaves and European goldenrod. This also justifies a recommendation in the pharmacy in a complementary medical treatment. Desireably, larger placebo-controlled studies, which proove the empirical healing, would provide more evidence. Children, pregnant women, men and patients with fever, severe cramps and blood in the urine should not medicate themselve. The patient should be referred to a doctor. PMID:26376538

  17. Population-Based Case–Control Study of Chinese Herbal Products Containing Aristolochic Acid and Urinary Tract Cancer Risk

    PubMed Central

    Lai, Ming-Nan; Chen, Pau-Chung; Chen, Ya-Yin

    2010-01-01

    Background Consumption of Chinese herbs that contain aristolochic acid (eg, Mu Tong) has been associated with an increased risk of urinary tract cancer. Methods We conducted a population-based case–control study in Taiwan to examine the association between prescribed Chinese herbal products that contain aristolochic acid and urinary tract cancer. All patients newly diagnosed with urinary tract cancer (case subjects) from January 1, 2001, to December 31, 2002, and a random sample of the entire insured population from January 1, 1997, to December 31, 2002 (control subjects), were selected from the National Health Insurance reimbursement database. Subjects who were ever prescribed more than 500 pills of nonsteroidal anti-inflammatory drugs and/or acetaminophen were excluded, leaving 4594 case patients and 174 701 control subjects in the final analysis. Adjusted odds ratios (ORs) and 95% confidence intervals (CIs) were estimated by using multivariable logistic regression models for the association between prescribed Chinese herbs containing aristolochic acid and the occurrence of urinary tract cancer. Models were adjusted for age, sex, residence in a township where black foot disease was endemic (an indicator of chronic arsenic exposure from drinking water [a risk factor for urinary tract cancer]), and history of chronic urinary tract infection. Statistical tests were two-sided. Results Having been prescribed more than 60 g of Mu Tong and an estimated consumption of more than 150 mg of aristolochic acid were independently associated with an increased risk for urinary tract cancer in multivariable analyses (Mu Tong: at 61–100 g, OR = 1.6, 95% CI = 1.3 to 2.1, and at >200 g, OR = 2.1, 95% CI = 1.3 to 3.4; aristolochic acid: at 151–250 mg, OR = 1.4, 95% CI = 1.1 to 1.8, and at >500 mg, OR = 2.0, 95% CI = 1.4 to 2.9). A statistically significant linear dose–response relationship was observed between the prescribed dose of Mu Tong or the estimated cumulative dose

  18. Rare variants in BRCA2 and CHEK2 are associated with the risk of urinary tract cancers

    PubMed Central

    Ge, Yuqiu; Wang, Yunyan; Shao, Wei; Jin, Jing; Du, Mulong; Ma, Gaoxiang; Chu, Haiyan; Wang, Meilin; Zhang, Zhengdong

    2016-01-01

    Previous studies have shown that two rare variants, rs11571833 in BRCA2 and rs17879961 in CHEK2 were associated with lung cancer. However, the associations between these two variants and urinary tract cancers risk remain largely unexplored. We applied imputation of three genome-wide association studies published in the database of Genotypes and Phenotypes (dbGaP). Unconditional logistic regression analysis and meta-analysis were performed to assess the association between these two variants and the risk of urinary tract cancers. Our results showed that rs11571833[T] had an effect on urinary tract cancers predisposition (ORmeta = 1.45, Pmeta = 0.013), especially associated with increased the risk of bladder cancer (ORmeta = 1.60, Pmeta = 0.010). Moreover, rs17879961[C] had a protective effect on the urinary tract cancers (ORmeta = 0.67, Pmeta = 1.0 × 10−3) and was mostly associated with a lower incidence of renal cell carcinoma (ORmeta = 0.51, Pmeta = 2.0 × 10−3). Together, our study indicates that BRCA2 and CHEK2 play an important role in the genetic susceptibility to urinary tract cancers. PMID:27632928

  19. Rare variants in BRCA2 and CHEK2 are associated with the risk of urinary tract cancers.

    PubMed

    Ge, Yuqiu; Wang, Yunyan; Shao, Wei; Jin, Jing; Du, Mulong; Ma, Gaoxiang; Chu, Haiyan; Wang, Meilin; Zhang, Zhengdong

    2016-01-01

    Previous studies have shown that two rare variants, rs11571833 in BRCA2 and rs17879961 in CHEK2 were associated with lung cancer. However, the associations between these two variants and urinary tract cancers risk remain largely unexplored. We applied imputation of three genome-wide association studies published in the database of Genotypes and Phenotypes (dbGaP). Unconditional logistic regression analysis and meta-analysis were performed to assess the association between these two variants and the risk of urinary tract cancers. Our results showed that rs11571833[T] had an effect on urinary tract cancers predisposition (ORmeta = 1.45, Pmeta = 0.013), especially associated with increased the risk of bladder cancer (ORmeta = 1.60, Pmeta = 0.010). Moreover, rs17879961[C] had a protective effect on the urinary tract cancers (ORmeta = 0.67, Pmeta = 1.0 × 10(-3)) and was mostly associated with a lower incidence of renal cell carcinoma (ORmeta = 0.51, Pmeta = 2.0 × 10(-3)). Together, our study indicates that BRCA2 and CHEK2 play an important role in the genetic susceptibility to urinary tract cancers. PMID:27632928

  20. [Infection and urinary lithiasis].

    PubMed

    Bruyere, F; Traxer, O; Saussine, C; Lechevallier, E

    2008-12-01

    Urinary infection is a risk factor for lithiasis. Urinary tract infection is a factor of gravity of urinary stone. The stone can exist before the infection which colonizes the stone, infected stone. The infection can be the cause of the stone, infectious stone (struvite stone). Infectious stones can be secondary to a non urinary infectious agent, oxalobacter formigenes (OF) and nanobacteria. The first-line treatment of struvite stone is percutaneous surgery. Perioperative antibiotics, renal urines and stone cultures are obligatory. PMID:19033073

  1. [Non-vascular interventional radiology nonvascular interventional radiology of the urinary tract].

    PubMed

    Miki, M

    1989-08-01

    Several kinds of nonvascular interventional radiology of the urinary tract are reviewed. Transurethral balloon dilation of the prostate (TU-DP) is a newly developed nonsurgical treatment for benign prostate hyperplasia, which is performed under local anesthesia with minimal morbidity and requires no hospitalization. The TUDP technique involves dilating the prostatic urethra and bladder neck to 75 F for 10 minutes under fluoroscopic control using a high-pressure dilating balloon. Long-term follow-up studies are required. Percutaneous nephrolithotomy (PNL) and transurethral ureterolithotomy (TUL) have signified a revolution in stone surgery of upper urinary tract. Indications for these treatments, endoscopic manipulation, complications and their clinical features are presented. The procedure of PNL consists of 3 steps, puncture for nephrostomy tract, tract dilation and stone removal. Among these steps the most important is the puncture and it should be effected through the calyx. During the operation, if there is too much bleeding, it can be discontinued at any time while keeping the track open. It is no longer necessary for the kidney to be free of stones at the end of the operation. TUL is performed with a rigid or flexible ureterorenoscope. Dilation of the ureteral orifice and the intramural ureter is necessary for passing the scopes. When they have been sufficiently dilated, the ureterorenoscope can be passed to the level of the renal pelvis through the urethra. Calculi have been removed successfully at a higher rate in lower ureter. Endopyelotomy may be performed safely as an initial procedure to correct congenital obstruction of the ureteropelvic junction. Recent advancements have permitted an approach to percutaneous resection for renal pelvic tumor in a solitary kidney or bilateral synchronous disease. There are great expectations for continuing important innovations in the field of interventional radiology. PMID:2476077

  2. Lower urinary tract obstruction in male children - a report of three cases.

    PubMed

    Lynser, Donboklang; Marbaniang, Evarisalin; Khongsni, Pynskhemboklang

    2016-09-01

    Urinary retention in young children and infancy is relatively rare. The commonest malignancy cause of bladder outlet obstruction in infancy is prostatic rhabdomyosarcoma; the commonest cause of congenital bladder outlet obstruction in a male infantis posterior urethral valve and the commonest cause of urethral obstruction in male children is urethral calculi. We present here a report on three cases of urethral obstruction in male children. PMID:27622420

  3. Back to the metal age: battle for metals at the host-pathogen interface during urinary tract infection.

    PubMed

    Subashchandrabose, Sargurunathan; Mobley, Harry L T

    2015-06-01

    Urinary tract infection (UTI) represents one of the most common bacterial infections in humans and uropathogenic E. coli (UPEC) is the major causative agent of UTI in people. Research on UPEC and other bacterial pathogens causing UTI has now identified the critical role of metal transport systems in the pathogenesis of UTI. Here we review the major effectors of metal transport in bacteria and host proteins that impair metal acquisition by bacterial pathogens. In particular, we describe the studies that identified iron, zinc and nickel import and copper export as key virulence and fitness determinants during UTI. Various metal transport systems and mechanisms that govern the expression of metal transport systems are also presented here. Specific examples from UPEC and other uropathogens, when available, are presented to depict the battle for metals at the host-pathogen interface during UTI.

  4. Prevalence of transposons encoding kanamycin, ampicillin and trimethoprim resistance in isolates from urinary tract infections detected using DNA probes.

    PubMed

    Chang, S F; Chang, L L; Chow, T Y; Wu, W J; Chang, J C

    1992-03-01

    Drug resistant Gram-negative bacteria causing urinary tract infections were collected. Kanamycin, ampicillin or trimethoprim-resistant strains were analyzed separately for the presence of Tn5, Tn3, or Tn7 by colony hybridization. Of these isolates, kanamycin-resistant transposons were present in 38.2% of 60 kanamycin-resistant isolates. A 3.3 kb fragment containing SacI-BamHI transposase of Tn3 and 42.6% showed a positive reaction in 129 ampicillin-resistant clinical isolates. Among the 75 trimethoprim-resistant isolates studied, 52% were shown to contain Tn7 when probed with a 1 kb BamHI fragment of Tn7. Results from Southern hybridizations demonstrated that these antibiotic resistant genes had been born on plasmids in some clinical isolates.

  5. Back to the metal age: battle for metals at the host–pathogen interface during urinary tract infection

    PubMed Central

    Subashchandrabose, Sargurunathan

    2015-01-01

    Urinary tract infection (UTI) represents one of the most common bacterial infections in humans and uropathogenic E. coli (UPEC) is the major causative agent of UTI in people. Research on UPEC and other bacterial pathogens causing UTI has now identified the critical role of metal transport systems in the pathogenesis of UTI. Here we review the major effectors of metal transport in bacteria and host proteins that impair metal acquisition by bacterial pathogens. In particular, we describe the studies that identified iron, zinc and nickel import and copper export as key virulence and fitness determinants during UTI. Various metal transport systems and mechanisms that govern the expression of metal transport systems are also presented here. Specific examples from UPEC and other uropathogens, when available, are presented to depict the battle for metals at the host–pathogen interface during UTI. PMID:25677827

  6. Reducing unnecessary urinary catheter use and other strategies to prevent catheter-associated urinary tract infection: an integrative review

    PubMed Central

    Meddings, Jennifer; Rogers, Mary A M; Krein, Sarah L; Fakih, Mohamad G; Olmsted, Russell N; Saint, Sanjay

    2014-01-01

    Background Catheter-associated urinary tract infections (CAUTI) are costly, common and often preventable by reducing unnecessary urinary catheter (UC) use. Methods To summarise interventions to reduce UC use and CAUTIs, we updated a prior systematic review (through October 2012), and a meta-analysis regarding interventions prompting UC removal by reminders or stop orders. A narrative review summarises other CAUTI prevention strategies including aseptic insertion, catheter maintenance, antimicrobial UCs, and bladder bundle implementation. Results 30 studies were identified and summarised with interventions to prompt removal of UCs, with potential for inclusion in the meta-analyses. By meta-analysis (11 studies), the rate of CAUTI (episodes per 1000 catheter-days) was reduced by 53% (rate ratio 0.47; 95% CI 0.30 to 0.64, p<0.001) using a reminder or stop order, with five studies also including interventions to decrease initial UC placement. The pooled (nine studies) standardised mean difference (SMD) in catheterisation duration (days) was −1.06 overall (p=0.065) including a statistically significant decrease in stop-order studies (SMD −0.37; p<0.001) but not in reminder studies (SMD, −1.54; p=0.071). No significant harm from catheter removal strategies is supported. Limited research is available regarding the impact of UC insertion and maintenance technique. A recent randomised controlled trial indicates antimicrobial catheters provide no significant benefit in preventing symptomatic CAUTIs. Conclusions UC reminders and stop orders appear to reduce CAUTI rates and should be used to improve patient safety. Several evidence-based guidelines have evaluated CAUTI preventive strategies as well as emerging evidence regarding intervention bundles. Implementation strategies are important because reducing UC use involves changing well-established habits. PMID:24077850

  7. Evaluation of cefazolin as a surrogate marker for cefpodoxime susceptibility for urinary tract isolates.

    PubMed

    Bookstaver, David A; Bland, Christopher M; Arroyo, Miguel A

    2015-10-01

    Of the cephalosporins, cefpodoxime has the most published clinical data for the treatment of urinary tract infections. In 2014, the Clinical and Laboratory Standards Institute (CLSI) guidelines recommended that cefazolin should be used as the surrogate marker for cefpodoxime among urinary tract isolates, replacing cephalothin. This study attempted to determine how well cefazolin serves as the surrogate marker. Additionally, it investigated how cefuroxime compared with cefazolin as a surrogate marker. The MicroScan Walkaway Plus system was used to determine susceptibility for cefazolin and cefuroxime on consecutive urine cultures with a colony count of ≥ 50 000 organisms. Only Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis isolates were included, following CLSI guidelines. Simultaneously, an Etest for cefpodoxime was conducted. The cefpodoxime interpretation was compared with that of the other two agents, and the categorical agreement was calculated, defined as the percentage of identical susceptibility interpretations. Cefazolin (92 %) had a significantly higher categorical agreement than cefuroxime (85 %) among 284 isolates (P = 0.011). The major error rate was 4.4 % for cefazolin and 1.1 % for cefuroxime. The very major error rate was 64 % for cefazolin and 18 % for cefuroxime among the 11 cefpodoxime-resistant isolates. Cefazolin was a better predictor of cefpodoxime susceptibility than the previously recommended agent, cephalothin. However, cefuroxime had better major and very major error rates than cefazolin.

  8. Incidence of urinary tract infection in patients without bacteriuria undergoing SWL: comparison of stone types.

    PubMed

    Dinçel, C; Ozdiler, E; Ozenci, H; Tazici, N; Koşar, A

    1998-02-01

    Extracorporeal shockwave lithotripsy (SWL) currently is accepted as the preferred treatment for most renal and upper ureteral calculi. However, little is known about the infection risks of SWL. In this study, the incidence and severity of urinary tract infection in 117 patients with renal calculi undergoing SWL were evaluated and the stone characteristics of those with and without infection were compared. The patients were followed clinically and bacteriologically 1 and 14 days after the procedure. Bacteriuria was noted in six patients within 24 hours after SWL. No bacteriuria was noted 2 weeks later. Of these patients, three were symptomatic (including dysuria, burning, and fever >38 degrees C). No patient was hospitalized. We found no significant correlation between the occurrence of bacteriuria and the number or size of the stones (P > 0.05), nor was there any correlation between bacteriuria and the stone-free rate or the location of the calculi (P > 0.05). However, there was a significantly higher risk of urinary tract infection in patients with struvite stones than in those with other types of stones (17.3% v 2.1%). In patients with infection stones, prophylactic antimicrobial chemotherapy is necessary even if bacteriuria is not present before SWL.

  9. Keratinized squamous metaplasia of the upper urinary tract resulting in recurrent renal colic.

    PubMed

    Ghali, Fady; Pattison, Erik; Pais, Vernon M

    2015-10-01

    A 60-year-old female with an extensive history of stone disease and shock wave lithotripsy presents with recurrent and increasingly severe renal colic. Work-up reveals obstruction with translucent debris that is found to be composed of keratin. Her history of chronic irritation of the collecting system has resulted in keratinizing squamous metaplasia (KSM) with hyperkeratosis that has sloughed from the upper urinary tract and has become lodged in the ureter. Because of the worsening of her symptoms on conservative management, the patient elected for a nephrectomy and her symptoms have since resolved. KSM of the renal pelvis is a relatively rare phenomenon and most often presents with irritative symptoms. It is thought to result from chronic irritation of the urothelium. KSM has been found to be coincident with squamous cell cancers of the urinary tract, though clear data implicating KSM as a premalignant lesion is lacking. We present a case of recurrent renal colic secondary to sloughing keratin debris from KSM. PMID:26249552

  10. Urinary tract infections, active component, U.S. Armed Forces, 2000-2013.

    PubMed

    2014-02-01

    Urinary tract infections (UTIs) are common among young adults, especially women. During the 14-year surveillance period, 30.4 percent of females and 3.5 percent of males who served in the active component had a least one UTI diagnosed during a medical encounter. The incidence rate of first-time UTIs was 70.4 per 1,000 person-years (p-yrs) among females and 7.2 per 1,000 p-yrs among males. Among those who received a diagnosis of UTI, 41.3 percent of females and 13.0 percent of males had recurrences. Rates of UTIs were highest among the youngest age group among females and the youngest and oldest age groups among males. Service members in armor/motor transport occupations in both genders had the greatest incidence rates of UTI compared to other occupations while pilots and air crew had the lowest incidence rates. The rates of UTIs overall were 130.9 per 1,000 p-yrs among females and 8.5 per 1,000 p-yrs among males. The occurrence of a first-ever urinary tract infection may be an opportunity for a healthcare provider to educate the patient about the risk factors for UTI, strategies to prevent recurrent infection, and the appropriate response to the new onset of typical symptoms of UTI.

  11. Clinical application of Patlak plot CT-GFR in animals with upper urinary tract disease.

    PubMed

    Alexander, Kate; Dunn, Marilyn; Carmel, Eric Norman; Lavoie, Jean-Pierre; Del Castillo, Jérôme R E

    2010-01-01

    Glomerular filtration rate (GFR), an important parameter of renal function, is difficult to assess clinically. Serum creatinine and blood urea nitrogen measurements lack sensitivity, whereas radionuclide determination of GFR is not always available and requires postinjection patient isolation. GFR can be determined using computed tomography (CT), most commonly via Patlak plot analysis. Four adult cats, two adult dogs, and a foal underwent abdominal CT under general anesthesia for various diseases of the upper urinary tract. CT-GFR was measured with a single-slice dynamic acquisition and Patlak plot analysis. In five animals, the total CT-GFR appeared to be below normal, corresponding with mild (two animals) and moderate (two animals) increases of serum creatinine in four. In the two animals with normal or increased CT-GFR, serum creatinine was within the reference values. A significant negative logarithmic relationship was found between CT-GFR and serum creatinine values (P = 0.008; r2 = 0.75). No complications occurred during or following CT-GFR. CT examination provided clinically relevant information in 3/5 patients with possible ureteral obstruction and in 3/3 patients with suspected ureteral calculi. Single-slice dynamic CT-GFR was practical and provided clinically useful information in this small series of patients undergoing CT of the upper urinary tract. There was a significant relationship between CT-GFR and serum creatinine values, which supports the clinical potential of CT-GFR and justifies further investigation of this technique. PMID:20806874

  12. The relationship between histological prostatitis and lower urinary tract symptoms and sexual function

    PubMed Central

    Kumsar, Sukru; Kose, Osman; Aydemir, Huseyin; Halis, Fikret; Gokce, Ahmet; Adsan, Oztug; Akkaya, Zeynep Kahyaoglu

    2016-01-01

    ABSTRACT This prospective analysis assessed the effect of histological prostatitis on lower urinary tract functions and sexual function. The patients were separated into two groups as histologically observed prostatitis (Group A) and no prostatitis (Group B) according to the biopsy outcomes. International prostate symptom score, international index of erectile function-5 scores, maximal and average flow rate, and residual urine volumes were compared statistically between groups. There was no significant difference (P>0.05) in baseline age (t=0.64), body mass index value (t=0.51), prostate volume (t=0.87), prostate-specific antigen levels (t=0.43), maximal (t=0.84) and average flow rate (t=0.59), and post-void residual urine volume (t=0.71). Mean international prostate symptom score in patients with prostatitis was numerically but not significantly higher than that in those without prostatitis (t=0.794, P=0.066). Mean international index of erectile function-5 score in the prostatitis group was significantly lower than that in those without prostatitis (t=1.854, P=0.013). Histological prostatitis notably affected sexual function of patients and may serve as a major risk factor for sexual dysfunction while having little effect on lower urinary tract symptoms. PMID:27286118

  13. Lower urinary tract dysfunction in the neurological patient: clinical assessment and management.

    PubMed

    Panicker, Jalesh N; Fowler, Clare J; Kessler, Thomas M

    2015-07-01

    Lower urinary tract (LUT) dysfunction is a common sequela of neurological disease, resulting in symptoms that have a pronounced effect on quality of life. The site and nature of the neurological lesion affect the pattern of dysfunction. The risk of developing upper urinary tract damage and renal failure is much lower in patients with slowly progressive non-traumatic neurological disorders than in those with spinal cord injury or spina bifida; this difference in morbidity is taken into account in the development of appropriate management algorithms. Clinical assessment might include tests such as uroflowmetry, post-void residual volume measurement, renal ultrasound, (video-)urodynamics, neurophysiology, and urethrocystoscopy, depending on the indication. Incomplete bladder emptying is most often managed by intermittent catheterisation, and storage dysfunction by antimuscarinic drugs. Intradetrusor injections of onabotulinumtoxinA have transformed the management of neurogenic detrusor overactivity. Neuromodulation offers promise for managing both storage and voiding dysfunction. An individualised, patient-tailored approach is required for the management of LUT dysfunction associated with neurological disorders.

  14. Variable selection in covariate dependent random partition models: an application to urinary tract infection.

    PubMed

    Barcella, William; Iorio, Maria De; Baio, Gianluca; Malone-Lee, James

    2016-04-15

    Lower urinary tract symptoms can indicate the presence of urinary tract infection (UTI), a condition that if it becomes chronic requires expensive and time consuming care as well as leading to reduced quality of life. Detecting the presence and gravity of an infection from the earliest symptoms is then highly valuable. Typically, white blood cell (WBC) count measured in a sample of urine is used to assess UTI. We consider clinical data from 1341 patients in their first visit in which UTI (i.e. WBC ≥ 1) is diagnosed. In addition, for each patient, a clinical profile of 34 symptoms was recorded. In this paper, we propose a Bayesian nonparametric regression model based on the Dirichlet process prior aimed at providing the clinicians with a meaningful clustering of the patients based on both the WBC (response variable) and possible patterns within the symptoms profiles (covariates). This is achieved by assuming a probability model for the symptoms as well as for the response variable. To identify the symptoms most associated to UTI, we specify a spike and slab base measure for the regression coefficients: this induces dependence of symptoms selection on cluster assignment. Posterior inference is performed through Markov Chain Monte Carlo methods. PMID:26536840

  15. [TITANIUM NICKELIDE TECHNOLOGIES IN MINIMALLY INVASIVE SURGERY OF KIDNEY AND UPPER URINARY TRACT].

    PubMed

    Feofilov, L V

    2015-01-01

    The most common pathology of the kidney and upper urinary tract includes nephrolithiasis, ureteral strictures and renal cysts. In the treatment of patients with these diseases, the majority of surgeons prefer minimally invasive techniques, including endoscopic surgery. The complication rate of percutaneous surgery is a major factor in encouraging the search for new treatments. We have analyzed the results of 402 x-ray-endoscopic operations performed with the use of technologies based on titanium nickelide materials in patients with nephrolithiasis, ureteral strictures and kidney cysts. The high effectiveness and reliability of porous titanium nickelide cryoapplicator was noted in control of percutaneous channel bleeding and prevention. The proposed suspension nephropexy with fine titanium granules in coexisting nephrolithiasis and nephroptosis demonstrated 1.5 times greater effectiveness compared to the traditional nephropexy, reducing duration of nephrostomy and rehabilitation by almost 3 times. The proposed methods of intubation by permanent and temporary stents with shape memory after percutaneous ureteropelvic junction stricture correction are promising in the treatment of patients with this pathology of the upper urinary tract. Application of titanium nickelide implants in simple renal cyst surgery has led to a significant increase in the effectiveness of these operations, improvement in long-term results and patients' quality of life. PMID:26665762

  16. Reconsultation and Antimicrobial Treatment of Urinary Tract Infection in Male and Female Patients in General Practice

    PubMed Central

    Tandan, Meera; Duane, Sinead; Cormican, Martin; Murphy, Andrew W.; Vellinga, Akke

    2016-01-01

    Current antimicrobial prescribing guidelines indicate that male and female patients with urinary tract infections (UTIs) should be treated with same antimicrobials but for different durations. The aim of this study was to explore the differences in reconsultations and antimicrobial prescribing for UTI for both males and females. A total of 2557 adult suspected UTI patients participating in the Supporting the Improvement and Management of Prescribing for urinary tract infection (SIMPle) study from 30 general practices were analyzed. An antimicrobial was prescribed significantly more often to females (77%) than males (63%). Nitrofurantoin was prescribed more often for females and less often for males (58% vs. 41%), while fluoroquinolones were more often prescribed for males (11% vs. 3%). Overall, reconsultation was 1.4 times higher in females, and if the antimicrobial prescribed was not the recommended first-line (nitrofurantoin), reconsultation after empirical prescribing was significantly higher. However, the reconsultation was similar for males and females if the antimicrobial prescribed was first-line. When a urine culture was obtained, a positive culture was the most important predictor of reconsultation (Odds ratio 1.8 (95% CI 1.3–2.5)). This suggests, when prescribing empirically, that male and female UTI patients should initially be treated with first-line antimicrobials (nitrofurantoin) with different durations (50–100 mg four times daily for three days in females and seven days for males). However, the consideration of a culture test before prescribing antimicrobials may improve outcomes. PMID:27649253

  17. Reconsultation and Antimicrobial Treatment of Urinary Tract Infection in Male and Female Patients in General Practice.

    PubMed

    Tandan, Meera; Duane, Sinead; Cormican, Martin; Murphy, Andrew W; Vellinga, Akke

    2016-01-01

    Current antimicrobial prescribing guidelines indicate that male and female patients with urinary tract infections (UTIs) should be treated with same antimicrobials but for different durations. The aim of this study was to explore the differences in reconsultations and antimicrobial prescribing for UTI for both males and females. A total of 2557 adult suspected UTI patients participating in the Supporting the Improvement and Management of Prescribing for urinary tract infection (SIMPle) study from 30 general practices were analyzed. An antimicrobial was prescribed significantly more often to females (77%) than males (63%). Nitrofurantoin was prescribed more often for females and less often for males (58% vs. 41%), while fluoroquinolones were more often prescribed for males (11% vs. 3%). Overall, reconsultation was 1.4 times higher in females, and if the antimicrobial prescribed was not the recommended first-line (nitrofurantoin), reconsultation after empirical prescribing was significantly higher. However, the reconsultation was similar for males and females if the antimicrobial prescribed was first-line. When a urine culture was obtained, a positive culture was the most important predictor of reconsultation (Odds ratio 1.8 (95% CI 1.3-2.5)). This suggests, when prescribing empirically, that male and female UTI patients should initially be treated with first-line antimicrobials (nitrofurantoin) with different durations (50-100 mg four times daily for three days in females and seven days for males). However, the consideration of a culture test before prescribing antimicrobials may improve outcomes. PMID:27649253

  18. [Evaluation of Clinitek in the screening and optimisation of the diagnosis of urinary tract infection].

    PubMed

    Laudat, P

    1991-01-01

    A study was conducted to compare the interest of using Clinitek and leucocytes esterase, blood, nitrites strip Multistix-8 SG (Ames-Bayer Diagnostics) with conventional method (dilution of urine in agar plate) and with automated system (Autobac) as a screening procedure to detect significant bacteriuria. The results are expressed in terms of sensitivity, specificity, predictive value of a negative and positive test. A total of 1303 urine samples were tested of which 730 (56%) were founded negative with Clinitek or conventional urine analysis (Se = 83.6%; VPN = 89.6%). Criteria for urinary tract infection were present for 193 samples (14.8%), the predictive value of a negative test for leucocytes, blood or nitrites (99.6%) justifies the use of Clinitek for economical screening of urine. Overall agreement is higher with the results or Clinitek (in few seconds) than with the Autobac (in 4-5 hours) when compared to the conventional method. The authors propose Clinitek as an effective method for screening and optimised urine analysis for urinary tract infection.

  19. Quantifying and characterizing proanthocyanidins in cranberries in relation to urinary tract health.

    PubMed

    Krueger, Christian G; Reed, Jess D; Feliciano, Rodrigo P; Howell, Amy B

    2013-05-01

    The "A-type" proanthocyanidins in cranberry fruit (Vaccinium macrocarpon Ait.) are bioactive components associated with prevention of urinary tract infections (UTI). Cranberry juice, fruit (fresh and dried), functional foods, and cranberry dietary supplements are promoted for prevention of UTI and for maintenance of urinary tract health (UTH), on the basis of their content of cranberry proanthocyanidins (c-PAC) with "A-type" interflavan bonds. With increasing consumer use of cranberries for maintenance of UTH and an expanding number of commercial cranberry products of different types, the availability of unified methods for measuring levels of c-PAC is important. This review discusses quantitative and qualitative analysis of c-PAC with "A-type" interflavan bonds in relation to their biological activity for UTI prevention. The integrity (including authenticity, standardization, efficacy, and safety) of cranberry fruit, juices, and dietary supplements may now be measured by using recent advances in mass spectrometry, liquid chromatography, production of c-PAC standards, and improved simple quantitative techniques.

  20. [Frequency of isolation and antibiotic sensitivity of strains of coli bacilli from urinary tract infections isolated in private laboratories].

    PubMed

    Bourlioux, P; Bourlioux, N; Bournaud, M

    1983-06-01

    Frequency of isolation and antibiotic susceptibility of E. coli strains isolated from urinary tract infections in private laboratory. The urinary tract infections are not the most frequent infections in man. However cytobacteriological analysis are often required for the diagnosis. The critical evaluation of 3000 analysis brings the followed conclusions: 1) 16% of the analysis correspond to a urinary tract infection; 2) the most frequently isolated germs are E. coli (65%) and Proteus mirabilis (11%); 3) E. coli is always very susceptible to antibiotics especially aminosides (100%) polymyxine E (92%), cotrimoxazole (91%) and quinolones (90%); 4) hospital bacteria can be found with a low frequency. However, in our study, Staphylococcus aureus has been isolated in 6% of the cases. This seems to be in relation with the passage of patients in an obstetric clinic.

  1. A non-surgical rat model of foreign body-associated urinary tract infection with Pseudomonas aeruginosa.

    PubMed

    Kurosaka, Y; Ishida, Y; Yamamura, E; Takase, H; Otani, T; Kumon, H

    2001-01-01

    This study established a rat model of foreign body-associated urinary tract infection. A spiral polyethylene tube (PT) was placed transurethrally into the bladder without surgical manipulation, followed by transurethral inoculation with Pseudomonas aeruginosa. The persistence of P. aeruginosa in the kidneys and bladder was significantly enhanced by placement of the PT, whereas the bacteria were eliminated rapidly from the urinary tract in the animals without the PT. Scanning electron microscopy revealed a thick biofilm on the surface of the PT from the early stage of infection. Histopathologically, acute pyelonephritis was followed by chronic renal inflammation as well as continuous and sporadic polymorphonuclear leukocyte accumulation and hemorrhage in the pelvis and adjacent tissues, suggesting continuous ascending introduction of the bacteria from the biofilm adhering to the PT. We believe our model simulates the pathophysiology of foreign body-associated urinary tract infection characterized by biofilm formation on the surface of a foreign body.

  2. Upper and Lower Urinary Tract Outcomes in Adult Myelomeningocele Patients: A Systematic Review

    PubMed Central

    Veenboer, Paul W.; Bosch, J. L. H. Ruud; van Asbeck, Floris W. A.; de Kort, Laetitia M. O.

    2012-01-01

    Background The introduction of sophisticated treatment of bladder dysfunction and hydrocephalus allows the majority of SB patients to survive into adulthood. However, no systematic review on urological outcome in adult SB patients is available and no follow-up schemes exist. Objectives To systematically summarize the evidence on outcome of urinary tract functioning in adult SB patients. Methods A literature search in PubMed and Embase databases was done. Only papers published in the last 25 years describing patients with open SB with a mean age >18 years were included. We focused on finding differences in the treatment strategies, e.g., clean intermittent catheterization and antimuscarinic drugs versus early urinary diversion, with regard to long-term renal and bladder outcomes. Results A total of 13 articles and 5 meeting abstracts on urinary tract status of adult SB patients were found describing a total of 1564 patients with a mean age of 26.1 years (range 3–74 years, with a few patients <18 years). All were retrospective cohort studies with relatively small and heterogeneous samples with inconsistent reporting of outcome; this precluded the pooling of data and meta-analysis. Total continence was achieved in 449/1192 (37.7%; range 8–85%) patients. Neurological level of the lesion and hydrocephalus were associated with incontinence. Renal function was studied in 1128 adult patients. In 290/1128 (25.7%; range 3–81.8%) patients some degree of renal damage was found and end-stage renal disease was seen in 12/958 (1.3%) patients. Detrusor-sphincter dyssynergy and detrusor-overactivity acted as adverse prognostic factors for the development of renal damage. Conclusions These findings should outline follow-up schedules for SB patients, which do not yet exist. Since renal and bladder deterioration continues beyond adolescence, follow-up of these individuals is needed. We recommend standardization in reporting the outcome of urinary tract function in adult SB

  3. Decreased microbiota diversity associated with urinary tract infection in a trial of bacterial interference

    PubMed Central

    Mapes, Abigail C; Ajami, Nadim J; Petrosino, Joseph F; Ramig, Robert F; Trautner, Barbara W

    2015-01-01

    Background Patients with long-term indwelling catheters are at high risk of catheter-associated urinary tract infection (CAUTI). We hypothesized that colonizing the bladder with a benign E. coli strain (E. coli HU2117, a derivative of E. coli 83972 would prevent CAUTI in older, catheterized adults. Materials and Methods Adults with chronic, indwelling urinary catheters received study catheters that had been pre-coated with E. coli HU2117. We monitored the cultivatable organisms in the bladder for 28 days or until loss of E. coli HU2117. Urine from 4 subjects was collected longitudinally for 16S rRNA gene profiling. Results Eight of the ten subjects (average age 70.9 years) became colonized with E. coli HU2117, with a mean duration of 57.7 days (median: 28.5, range 0-266). All subjects also remained colonized by uropathogens. Five subjects suffered invasive UTI, 3 febrile UTI and 2 urosepsis/bacteremia, all associated with overgrowth of a urinary pathogen. Colonization with E. coli HU2117 did not impact bacterial bladder diversity, but subjects who developed infections had less diverse bladder microbiota. Conclusions Colonization with E. coli HU2117 did not prevent bladder colonization or subsequent invasive disease by uropathogens. Microbial diversity may play a protective role against invasive infection of the catheterized bladder. PMID:26048203

  4. Congenital anomalies of kidney and upper urinary tract in children with congenital hypothyroidism; a case-control study

    PubMed Central

    Yousefichaijan, Parsa; Dorreh, Fatemeh; Rafeie, Mohammad; Sharafkhah, Mojtaba; Safi, Fatemeh; Amiri, Mohammad; Ebrahimimonfared, Mohsen

    2015-01-01

    Introduction: Congenital hypothyroidism (CH) may be significantly associated with congenital malformations. However, there is little evidence on the relationship between renal and urinary tract anomalies and CH. Objectives: The aim of this study was to compare the renal and upper urinary tract anomalies in children with and without primary CH (PCH). Patients and Methods: This case-control study was conducted on 200 children aged 3 months to 1 year, referring to Amir-Kabir hospital, Arak, Iran. One hundred children with PCH, as the case group, and 100 children without CH, as the control group, were selected. For all children, ultrasonography and other diagnostic measures (if necessary) were performed to evaluate renal and upper urinary tract anomalies (ureter and bladder). Results: The frequency of renal and upper urinary tract anomalies among 43 children with primary CH, with 83 cases (72.8%), was significantly higher than the frequency of anomalies among the 19 children in the control group, with 31 cases (27.1%) (OR = 3; CI 95%: 1.6-5.4; P = 0.001). Among the anomalies studied, only the differences in frequency of uretero-pelvic junction obstruction (UPJO) (OR = 6; CI 95%: 1.3-28; P = 0.018) and hydronephrosis (OR = 22; CI 95%: 5-95; P = 0.001) was significant between the two groups. Conclusion: Our study demonstrated that PCH is significantly associated with the frequency of congenital anomalies of the kidneys and upper urinary tracts. However, further studies are recommended to determine the necessity of conducting screening programs for anomalies of the kidneys and urinary tract in children with CH at birth. PMID:26693499

  5. Concised Form for Lower Urinary Tract Dysfunction Symptom Scale in Children

    PubMed Central

    Ebiloglu, Turgay; Kopru, Burak; Ergin, Giray; Sahin, Soykan; Irkilata, Hasan Cem; Kibar, Yusuf

    2016-01-01

    Introduction Symptom Scales (SS) are questionnaires for evaluating and following up of special illnesses. SS used for the diagnosis and follow-up of Lower Urinary Tract Dysfunction (LUTD) in children is called LUTD Symptom Scale (LUTDSS). Aim Aim of the present study was to identify the questions which are more important for the diagnosis of LUTD in children and create a simpler SS. Materials and Methods From January 2005 to March 2015, 631 children between the age 5 and 15 were enrolled in this study. Eleven children with active urinary tract infections were excluded from the study. Two hundred sixty three children from the nursery and secondary school saying that they have no urinary complaints and having LUTDSS <9 were designed as control group. Three hundred fifty seven children with LUTDSS score ≥9 were thought as having LUTD and diagnoses were verified with 3-day bladder diaries and 2-time Uroflow-EMG-PVR tests. The answered questions of LUTDSS in patient and control group were compared. Results Children with daytime incontinence (first question of questionnaire) were 47.7 (4.8-510) times (p=0.01), children with enuresis (third question) were 59.53 (6.2-961) times (p=0.001), children with pause while urinating (eighth question) were 28.7 (4.4-2090) times (p=0.001), children with urgency (tenth question) were 54.7 (29.3-604) times (p=0.039) more likely to have LUTD than the children not having these complaints. The area under ROC curve created by using 1,3,8, and 10 questions was calculated 86.4%. Conclusion The diagnosis and control of LUTD can be made by using only 1., 3., 8. and 10. questions, and these 4 questions could form simpler SS for LUTD in children. PMID:27630896

  6. Initial experience with sacral neuromodulation for the treatment of lower urinary tract dysfunction in Brazil

    PubMed Central

    Rios, Luis Augusto Seabra; Averbeck, Marcio Augusto; França, Wagner; Sacomani, Carlos Alberto Ricetto; Almeida, Fernando G.; Gomes, Cristiano Mendes

    2016-01-01

    ABSTRACT Objectives: We report on the short-term outcomes of sacral neuromodulation (SNM) for treatment of idiopathic lower urinary tract dysfunction in Brazil (procedures performed before 2014). Materials and Methods: Clinical data and surgical outcomes of patients who underwent SNM staged procedures were retrospective evaluated. Urological assessment included a focused medical history and physical examination, measurement of postvoid residual volumes, urodynamics, and bladder diaries. A successful test phase has been defined by improvement of at least 50% of the symptoms, based on bladder diaries. Results: From January 2011 to December 2013, eighteen consecutive patients underwent test phase for SNM due to refractory overactive bladder (15 patients), non-obstructive chronic urinary retention (2 patients), and bladder pain syndrome/interstitial cystitis (1 patient). All patients underwent staged procedures at four outpatient surgical centers. Mean age was 48.3±21.2 (range 10-84 years). There were 16 women and 2 men. Median follow-up was 3 months. Fifteen patients (83.3%) had a successful test phase and underwent implantation of the pulse generator (IPG). Median duration of the test phase was 7 days (range 5–24 days). Mean age was 45.6±18.19 years in responders versus 61.66±34.44 years in non-responders (p=0.242). Mean operative time (test phase) was 99±33.12 min in responders versus 95±35 min for non-responders (p=0.852). No severe complications were reported. Conclusion: SNM is a minimally invasive treatment option for patients with refractory idiopathic lower urinary tract dysfunction. Our initial experience with staged technique showed that tined-lead electrodes yielded a high rate of responders and favorable clinical results in the short-term follow-up. PMID:27176186

  7. Concised Form for Lower Urinary Tract Dysfunction Symptom Scale in Children

    PubMed Central

    Ebiloglu, Turgay; Kopru, Burak; Ergin, Giray; Sahin, Soykan; Irkilata, Hasan Cem; Kibar, Yusuf

    2016-01-01

    Introduction Symptom Scales (SS) are questionnaires for evaluating and following up of special illnesses. SS used for the diagnosis and follow-up of Lower Urinary Tract Dysfunction (LUTD) in children is called LUTD Symptom Scale (LUTDSS). Aim Aim of the present study was to identify the questions which are more important for the diagnosis of LUTD in children and create a simpler SS. Materials and Methods From January 2005 to March 2015, 631 children between the age 5 and 15 were enrolled in this study. Eleven children with active urinary tract infections were excluded from the study. Two hundred sixty three children from the nursery and secondary school saying that they have no urinary complaints and having LUTDSS <9 were designed as control group. Three hundred fifty seven children with LUTDSS score ≥9 were thought as having LUTD and diagnoses were verified with 3-day bladder diaries and 2-time Uroflow-EMG-PVR tests. The answered questions of LUTDSS in patient and control group were compared. Results Children with daytime incontinence (first question of questionnaire) were 47.7 (4.8-510) times (p=0.01), children with enuresis (third question) were 59.53 (6.2-961) times (p=0.001), children with pause while urinating (eighth question) were 28.7 (4.4-2090) times (p=0.001), children with urgency (tenth question) were 54.7 (29.3-604) times (p=0.039) more likely to have LUTD than the children not having these complaints. The area under ROC curve created by using 1,3,8, and 10 questions was calculated 86.4%. Conclusion The diagnosis and control of LUTD can be made by using only 1., 3., 8. and 10. questions, and these 4 questions could form simpler SS for LUTD in children.

  8. Antibiotic sensitivity pattern of uropathogens from pregnant women with urinary tract infection in Abakaliki, Nigeria

    PubMed Central

    Onoh, RC; Umeora, OUJ; Egwuatu, VE; Ezeonu, PO; Onoh, TJP

    2013-01-01

    Background Urinary tract infection (UTI) is a common bacterial infection during pregnancy and a significant cause of perinatal and maternal morbidity and mortality. The causative bacteria have remained virtually the same although with variations in individual prevalence. There has been an increasing resistance by these bacteria to the commonly available antibiotics. Objectives To determine the prevalence of UTI, the common causative bacteria, and their antibiotic sensitivity pattern among pregnant women with UTI. Methodology This is a descriptive study that was carried out at the Obstetrics Department of two tertiary institutions in Abakaliki, Ebonyi State, Nigeria (Federal Medical Center and Ebonyi State University Teaching Hospital) over a period of 12 months. Midstream urine specimens from selected pregnant women with clinical features of UTI were collected for microscopy, culture, and sensitivity. The results were analyzed with the 2008 Epi Info™ software. Results A total of 542 pregnant women presented with symptoms of UTI and were recruited for the study over the study period. Of the 542 pregnant women, 252 (46.5%) had significant bacteriuria with positive urine culture and varying antibiotic sensitivity pattern. The prevalence of symptomatic UTI was 3%. Escherichia coli was the most common bacteria isolated with a percentage of 50.8%. Other isolated micro organisms included Stapylococcus aereus (52 cultures, 20.6%), Proteus mirabilis (24 cultures, 9.5%), S. saprophyticus (18 cultures, 7.1%), Streptococcus spp. (14 cultures, 5.6%), Citrobacter spp. (5 cultures, 2.0%), Klebsiella spp. (4 cultures, 1.6%), Enterobacter spp. (4 cultures, 1.6%), and Pseudomonas spp. (3 cultures, 1.2%). Levofloxacin had the highest overall antibiotic sensitivity of 92.5%. Others with overall antibiotic sensitivity pattern greater than 50% included cefpodoxime (87.3%), ofloxacin (77.4%), ciprofloxacin (66.7%), ceftriaxone (66.7%), and gentamicin (50.8%). Conclusion E. coli was the

  9. Urine Stasis Predisposes to Urinary Tract Infection by an Opportunistic Uropathogen in the Megabladder (Mgb) Mouse

    PubMed Central

    Becknell, Brian; Mohamed, Ahmad Z.; Li, Birong; Wilhide, Michael E.; Ingraham, Susan E.

    2015-01-01

    Purpose Urinary stasis is a risk factor for recurrent urinary tract infection (UTI). Homozygous mutant Megabladder (Mgb-/-) mice exhibit incomplete bladder emptying as a consequence of congenital detrusor aplasia. We hypothesize that this predisposes Mgb-/- mice to spontaneous and experimental UTI. Methods Mgb-/-, Mgb+/-, and wild-type female mice underwent serial ultrasound and urine cultures at 4, 6, and 8 weeks to detect spontaneous UTI. Urine bacterial isolates were analyzed by Gram stain and speciated. Bladder stones were analyzed by x-ray diffractometry. Bladders and kidneys were subject to histologic analysis. The pathogenicity of coagulase-negative Staphylococcus (CONS) isolated from Mgb-/- urine was tested by transurethral administration to culture-negative Mgb-/- or wild-type animals. The contribution of urinary stasis to CONS susceptibility was evaluated by cutaneous vesicostomy in Mgb-/- mice. Results Mgb-/- mice develop spontaneous bacteriuria (42%) and struvite bladder stones (31%) by 8 weeks, findings absent in Mgb+/- and wild-type controls. CONS was cultured as a solitary isolate from Mgb-/- bladder stones. Bladders and kidneys from mice with struvite stones exhibit mucosal injury, inflammation, and fibrosis. These pathologic features of cystitis and pyelonephritis are replicated by transurethral inoculation of CONS in culture-negative Mgb-/- females, whereas wild-type animals are less susceptible to CONS colonization and organ injury. Cutaneous vesicostomy prior to CONS inoculation significantly reduces the quantity of CONS recovered from Mgb-/- urine, bladders, and kidneys. Conclusions CONS is an opportunistic uropathogen in the setting of urinary stasis, leading to enhanced UTI incidence and severity in Mgb-/- mice. PMID:26401845

  10. Squamous cell carcinoma of the suprapubic tract: A rare presentation in patients with chronic indwelling urinary catheters.

    PubMed

    Massaro, Peter Alexander; Moore, Jonathan; Rahmeh, Tarek; Morse, Michael J

    2014-07-01

    Squamous cell carcinoma (SCC) of the bladder is uncommon, but can arise in the setting of long-term bladder catheterization and chronic inflammation. SCC can arise primarily from the suprapubic catheter tract, but fewer than 10 such cases have been reported. We document 2 cases of SCC arising from the suprapubic tract associated with chronic indwelling urinary catheters. SCC must be differentiated from granulomatous conditions, which are quite common in patients with suprapubic catheters.

  11. Squamous cell carcinoma of the suprapubic tract: A rare presentation in patients with chronic indwelling urinary catheters.

    PubMed

    Massaro, Peter Alexander; Moore, Jonathan; Rahmeh, Tarek; Morse, Michael J

    2014-07-01

    Squamous cell carcinoma (SCC) of the bladder is uncommon, but can arise in the setting of long-term bladder catheterization and chronic inflammation. SCC can arise primarily from the suprapubic catheter tract, but fewer than 10 such cases have been reported. We document 2 cases of SCC arising from the suprapubic tract associated with chronic indwelling urinary catheters. SCC must be differentiated from granulomatous conditions, which are quite common in patients with suprapubic catheters. PMID:25132900

  12. Squamous cell carcinoma of the suprapubic tract: A rare presentation in patients with chronic indwelling urinary catheters

    PubMed Central

    Massaro, Peter Alexander; Moore, Jonathan; Rahmeh, Tarek; Morse, Michael J.

    2014-01-01

    Squamous cell carcinoma (SCC) of the bladder is uncommon, but can arise in the setting of long-term bladder catheterization and chronic inflammation. SCC can arise primarily from the suprapubic catheter tract, but fewer than 10 such cases have been reported. We document 2 cases of SCC arising from the suprapubic tract associated with chronic indwelling urinary catheters. SCC must be differentiated from granulomatous conditions, which are quite common in patients with suprapubic catheters. PMID:25132900

  13. Antibiotic Resistance, RAPD- PCR Typing of Multiple Drug Resistant Strains of Escherichia Coli From Urinary Tract Infection (UTI)

    PubMed Central

    Marialouis, Xavier Alexander

    2016-01-01

    Introduction Global spreading of multidrug resistant strains of Escherichia coli is responsible for Urinary Tract Infection (UTI) which is a major health problem in of concern. Among the gram negative bacteria, the major contributors for UTI belongs to the family Enterobacteriaceae, which includes E. coli, Klebsiella, Citrobacter and Proteus. However, E. coli accounts for the major cause of Urinary tract infections (UTIs) and accounts for 75% to 90% of UTI isolates. Aim The main aim of this study is to analyse the phylogenetic grouping of clinical isolates of UTI E. coli. Materials and Methods In this study nearly 58 E. coli strains were isolated and confirmed through microbiological, biochemical characterization. The urine samples were collected from outpatients having symptoms of UTI, irrespective of age and sex in Tamil Nadu, India. The isolates were subjected to analyse for ESBL and AmpC β-lactamase production. To understand its genetic correlation, molecular typing was carried out using RAPD-PCR method. Results Here we noted phenotypically twenty seven isolates were positive for ESBL and seven for AmpC β-lactamase production. However, among the ESBL isolates higher sensitivity was noted for Nitrofurantoin and Cefoxitin. It is worth to note that the prevalence of UTIs was more common among female and elderly male. Phylogenetic grouping revealed the presence of 24 isolates belonged to B2 group followed by 19 isolates to group A, eight isolates to group B1 and Seven isolates to group D. Conclusion Phenotypically most of the strains were positive for ESBL and showed high sensitivity for Nitrofurantoin and cefoxitin. PMID:27134870

  14. Timing and Outcome of Renal Replacement Therapy in Patients with Congenital Malformations of the Kidney and Urinary Tract

    PubMed Central

    van Stralen, Karlijn J.; Verrina, Enrico; Bjerre, Anna; Wanner, Christoph; Heaf, James Goya; Zurriaga, Oscar; Hoitsma, Andries; Niaudet, Patrick; Palsson, Runolfur; Ravani, Pietro; Jager, Kitty J.; Schaefer, Franz

    2013-01-01

    Summary Background and objectives Congenital anomalies of the kidney and urinary tract (CAKUT) are the leading cause of ESRD in children, but the proportion of patients with individual CAKUT entities progressing to ESRD during adulthood and their long-term clinical outcomes are unknown. This study assessed the age at onset of renal replacement therapy (RRT) and patient and renal graft survival in patients with CAKUT across the entire age range. Design, setting, participants, & measurements Patients with CAKUT were compared with age-matched patients who were undergoing RRT for other renal disorders on the basis of data from the European Renal Association-European Dialysis and Transplant Association Registry. Competing risk and Cox regression analyses were conducted. Results Of 212,930 patients commencing RRT from 1990 to 2009, 4765 (2.2%) had renal diagnoses consistent with CAKUT. The proportion of incident RRT patients with CAKUT decreased from infancy to childhood and then increased until age 15–19 years, followed by a gradual decline throughout adulthood. Median age at RRT start was 31 years in the CAKUT cohort and 61 years in the non-CAKUT cohort (P<0.001). RRT was started earlier (median, 16 years) in patients with isolated renal dysplasia than in those with renal hypoplasia and associated urinary tract disorders (median, 29.5–39.5 years). Patients with CAKUT survived longer than age- and sex-matched non-CAKUT controls because of lower cardiovascular mortality (10-year survival rate, 76.4% versus 70.7%; P<0.001). Conclusions CAKUT leads to ESRD more often at adult than pediatric age. Treatment outcomes differ from those of acquired kidney diseases and vary within CAKUT subcategories. PMID:23085722

  15. Burdock root extracts limit quorum-sensing-controlled phenotypes and biofilm architecture in major urinary tract pathogens.

    PubMed

    Rajasekharan, Satish Kumar; Ramesh, Samiraj; Bakkiyaraj, Dhamodharan; Elangomathavan, Ramaraj; Kamalanathan, Chakkaravarthi

    2015-02-01

    Bacterial biofilms are serious concern in patients infected with urinary tract infections, complicated urinary tract infections and other device-associated infections. Microbes within the biofilms are effectively shielded from antibiotics and host immune cells, hence can be treated only with agents which has the potential to disassemble the biofilms. The study is focused on the root extracts of Arctium lappa Linn. as a source for complementary medicine against three major biofilm forming clinical isolates of Escherichia coli, Proteus mirabilis, and Serratia marcescens. Methanol extracts of burdock roots (BR) showed no bactericidal activity (p > 0.05) against the uropathogens, whereas restrained the biofilms (p < 0.05) on polystyrene and glass surfaces at a biofilm inhibitory concentration of 100 µg/mL. The 3D confocal laser scanning microscopy was used to analyze the biofilm architecture which showed significant reduction in the surface area. Z-stack analysis has also revealed substantial reduction in the biofilm thickness (E. coli-50.79%, P. mirabilis-69.49%, and S. marcescens-75.84%). Further, BR extracts also inhibited quorum-sensing (QS)-controlled cellular phenotypes such as violacein, prodigiosin, swarming motility, and cell surface hydrophobicity. LC-MS/MS analysis of BR extracts identified the presence of two major quercetin derivatives (miquelianin and peltatoside) along with few other constituent components. Exploring such phytocompounds will provide potential agents to treat infections caused by biofilm forming uropathogens. The antibiofilm and anti-QS agents will ultimately serve as armor, facilitating the host immune system to fight infections.

  16. Burdock root extracts limit quorum-sensing-controlled phenotypes and biofilm architecture in major urinary tract pathogens.

    PubMed

    Rajasekharan, Satish Kumar; Ramesh, Samiraj; Bakkiyaraj, Dhamodharan; Elangomathavan, Ramaraj; Kamalanathan, Chakkaravarthi

    2015-02-01

    Bacterial biofilms are serious concern in patients infected with urinary tract infections, complicated urinary tract infections and other device-associated infections. Microbes within the biofilms are effectively shielded from antibiotics and host immune cells, hence can be treated only with agents which has the potential to disassemble the biofilms. The study is focused on the root extracts of Arctium lappa Linn. as a source for complementary medicine against three major biofilm forming clinical isolates of Escherichia coli, Proteus mirabilis, and Serratia marcescens. Methanol extracts of burdock roots (BR) showed no bactericidal activity (p > 0.05) against the uropathogens, whereas restrained the biofilms (p < 0.05) on polystyrene and glass surfaces at a biofilm inhibitory concentration of 100 µg/mL. The 3D confocal laser scanning microscopy was used to analyze the biofilm architecture which showed significant reduction in the surface area. Z-stack analysis has also revealed substantial reduction in the biofilm thickness (E. coli-50.79%, P. mirabilis-69.49%, and S. marcescens-75.84%). Further, BR extracts also inhibited quorum-sensing (QS)-controlled cellular phenotypes such as violacein, prodigiosin, swarming motility, and cell surface hydrophobicity. LC-MS/MS analysis of BR extracts identified the presence of two major quercetin derivatives (miquelianin and peltatoside) along with few other constituent components. Exploring such phytocompounds will provide potential agents to treat infections caused by biofilm forming uropathogens. The antibiofilm and anti-QS agents will ultimately serve as armor, facilitating the host immune system to fight infections. PMID:25226848

  17. Immunization with the yersiniabactin receptor, FyuA, protects against pyelonephritis in a murine model of urinary tract infection.

    PubMed

    Brumbaugh, Ariel R; Smith, Sara N; Mobley, Harry L T

    2013-09-01

    Urinary tract infections (UTI) are common and represent a substantial economic and public health burden. Roughly 80% of these infections are caused by a heterogeneous group of uropathogenic Escherichia coli (UPEC) strains. Antibiotics are standard therapy for UTI, but a rise in antibiotic resistance has complicated treatment, making the development of a UTI vaccine more urgent. Iron receptors are a promising new class of vaccine targets for UTI, as UPEC require iron to colonize the iron-limited host urinary tract and genes encoding iron acquisition systems are highly expressed during infection. Previously, three of six UPEC siderophore and heme receptors were identified as vaccine candidates by intranasal immunization in a murine model of ascending UTI. To complete the assessment of iron receptors as vaccine candidates, an additional six UPEC iron receptors were evaluated. Of the six vaccine candidates tested in this study (FyuA, FitA, IroN, the gene product of the CFT073 locus c0294, and two truncated derivatives of ChuA), only FyuA provided significant protection (P = 0.0018) against UPEC colonization. Intranasal immunization induced a robust and long-lived humoral immune response. In addition, the levels of FyuA-specific serum IgG correlated with bacterial loads in the kidneys [Spearman's rank correlation coefficient ρ(14) = -0.72, P = 0.0018], providing a surrogate of protection. FyuA is the fourth UPEC iron receptor to be identified from our screens, in addition to IutA, Hma, and IreA, which were previously demonstrated to elicit protection against UPEC challenge. Together, these iron receptor antigens will facilitate the development of a broadly protective, multivalent UTI vaccine to effectively target diverse strains of UPEC.

  18. Critical evaluation of ceftolozane–tazobactam for complicated urinary tract and intra-abdominal infecti