Absence Of Urinary Tract Infection Research Articles

Portrait of a patient with systemic lupus erythematosus for the prescription of the type I interferon inhibitor anifrolumab

In recent years the use of monoclonal antibodies that block activity of type I interferon (IFN) or its receptors has become the new approach in the pharmacotherapy of systemic lupus erythematosus (SLE).Objective: to characterize patients with SLE treated with the type I IFN receptor inhibitor anifrolumab (AFM, Saphnelo®).Material and methods. The prospective 12-month study included 21 patients with SLE who met the 2012 SLICC criteria. Standard laboratory and immunological markers for SLE were examined in all patients. The SLEDAI-2K index was used to determine the activity of SLE and the CLASI index was used to determine the severity of the mucocutaneous syndrome. Organ damage was assessed using the SLICC/ACR Damage Index (DI). The LupusQol and FACIT-Fatigue questionnaires were used to analyze health-related quality of life (HRQoL).Results and discussion. Female patients prevailed in the study, female/male ratio – 17 (81%)/4 (19%), median age – 31 [27; 46] years, disease duration – 9 [6.0; 11.0] years. The majority of patients (86%) had moderate or high disease activity according to the SLEDAI-2K index. Among the clinical manifestations of SLE, skin and mucous membranes lesions predominated (81%). Non-erosive polyarthritis of varying severity was observed in 66% of cases. Serositis showed 24% of patients (pleurisy, pericarditis), 43% had hematological abnormalities (hemolytic anemia, leukopenia, lymphopenia) and 14% - urinary syndrome (daily proteinuria up to 0.5 g/l and/or urinary sediment – leukocytes/erythrocytes/cylinders up to 5 in the field of view in the absence of urinary tract infection). All patients had immunological disorders. 14% of them were diagnosed with antiphospholipid syndrome (APS) and 43% with Sjögren's syndrome.All patients received hydroxychloroquine, 95% received glucocorticoids (GC) from 5 to 60 mg/day, 66% received immunosuppressants (cyclophosphamide, mycophenolate mofetil, azathioprine, methotrexate). 33% of patients had anamnesis of treatment with biologic disease modifying antirheumatic drugs (rituximab, belimumab, dual anti-B-cell therapy) and Janus kinase inhibitor baricitinib. All patients experienced a significant deterioration in HRQoL.Conclusion. The indications for prescribing AFM to 21 patients with SLE were: active SLE according to SLEDAI-2K and/or CLASI with predominant involvement of skin, its appendages and development of polyarthritis with immunological disorders, intolerance/ineffectiveness of previous standard therapy and inability to achieve low average daily doses of oral GCs. Other clinical manifestations in some patients were: serositis, mild hematological disorders (Coombs-positive anemia, leukopenia), urinary syndrome. AFM could be prescribed for a combination of SLE with secondary APS and Sjögren's syndrome as well as for a high DI SLICC.

Percutaneous Tibial Nerve Stimulation in the Treatment of Refractory Idiopathic Overactive Bladder Syndrome: A Retrospective Cohort Study.

Overactive bladder (OAB) is a syndrome defined as urinary urgency, accompanied by increased frequency and nocturia with or without urge incontinence, in the absence of urinary tract infection or other obvious pathology. The standard therapies are anticholinergic agents, selective beta-3 adrenoreceptor agonists, or intradetrusor injections of botulinum toxin (BTX-A). For patients with contraindications for BTX-A or drug therapies, percutaneous tibial nerve stimulation (PTNS) may be used. PTNS shows fewer side effects than anticholinergic drugs and costs less than BTX-A. The primary outcome of this study was to assess the efficacy of PTNS in women with refractory OAB. Women with refractory OAB undergoing PTNS at our tertiary referral center from 2017 to 2019 were included. The validated German Female Pelvic Floor Questionnaire and a micturition protocol were filled out before and after PTNS. PTNS was applied weekly for 12 weeks. Improvements in OAB symptoms were seen in daily micturition frequency, urgency, and urgency incontinence from pre- to post-PTNS (p < 0.006). Impairments to quality of daily life were significantly (p < 0.0002) less severe after PTNS. There was a significant reduction in daytime voiding frequency from a median of nine to five (p < 0.0001). Substantial reductions in OAB symptoms, daily micturition frequency, urgency, and urgency incontinence were found in patients with refractory OAB after PTNS.

URINALYSIS AS A PREDICTOR FOR URINARY TRACT INFECTION: AN OBSERVATIONAL STUDY

Aims and Objectives: The aims and objectives of the study are to find the usefulness of urine dipstick and urinalysis in children with an intention to identify the parameters which most likely point toward the presence of urinary tract infection (UTI), whether a combination of the parameters analyzed rather than single parameter is useful in suggesting the presence or absence of UTI. Methods: The study was a prospective observational study done in 401 children below 16 years of age with clinically suspected UTI. Results: The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of dipstick leukocyte esterase (LE) and nitrite were 85%, 93.1%, 75.6%, 96.1% and 51.2%, 99.1%, 93.2%, 89.1%, respectively. In urine microscopic analysis, the sensitivity, specificity, PPV, NPV of bacteria were 68.5%, 96.9%, 84.6%, and 92.6% and those of pus cells were 80%, 93.1%, 74.4%, and 94.9%. Conclusion: Combination of parameters, i.e., LE, nitrite, and bacteria or LE, nitrite, and pus cells are good screening tools to predict and rule out UTI. Of the individual parameters analyzed, negative nitrites in dipstick and absence of bacteria in urine microscopy almost rule out UTI caused by most uropathogens.

Urinalysis Exhibits Excellent Predictive Capacity for the Absence of Urinary Tract Infection

ObjectiveTo assess predictive value of urinalysis for negative urine culture and absence of urinary tract infection, re-evaluate the microbial growth threshold for positive urine culture result, and describe antimicrobial resistance features. Urine culture is associated with 27% of U.S. hospitalizations, and unnecessary antibiotic prescription is a main antibiotic resistance contributor. MethodsUrinalyses with urine culture from women ages 18-49 from 2013 to 2020 were studied. Clinically diagnosed urinary tract infection (CUTI) was defined as (1) uropathogen growth, (2) documented diagnosis of urinary tract infection, and (3) antibiotic prescription. Sensitivity, specificity, and diagnostic predictive values were used to assess urinalysis performance in predicting isolation of a uropathogen by culture and in detection of CUTI. ResultsTotal 12,252 urinalyses were included. Forty-one percent of urinalyses were associated with positive urine culture and 1287 (10.5%) with CUTI. Negative urinalysis exhibited high predictive accuracy for negative urine culture (specificity 90.3%, PPV 87.3%) and absence of CUTI (specificity 92.2%, PPV 97.4%). Twenty-four percent of patients not meeting the CUTI definition were still prescribed antibiotics. Twenty-two percent of cultures associated with CUTI exhibited growth less than 100,000 CFU/mL. Escherichia coli was implemented as causing 70% of CUTIs, and 4.2% of these produced an extended spectrum beta-lactamase. ConclusionNegative urinalysis exhibits high predictive accuracy for absence of CUTI. A reporting threshold of 10,000 CFU/mL is more clinically appropriate than a 100,000 CFU/mL cutpoint. Reflex culture based on urinalysis results could complement clinical judgement and improve laboratory and antibiotic stewardship in premenopausal women.

Effect of Pharmacotherapy for Overactive Bladder on the Incidence of and Factors Related to Urinary Tract Infection: A Systematic Review and Meta-analysis.

The aim of this meta-analysis was to investigate the effect of pharmacotherapy for overactive bladder on the pathogenesis of urinary tract infection. A comprehensive search was performed in MEDLINE and the Cochrane Library using terms for overactive bladder, antimuscarinic agents, and beta 3-adrenoceptor agonists. The primary end point was the emergence of urinary tract infection after pharmacotherapy for overactive bladder. The secondary end point was the emergence of urinary retention, dysuria, and/or increased residual urine volume after overactive bladder treatment. Meta-analyses were conducted using random-effects models. A total of 35,939 patients in 33 trials (29 trials of antimuscarinic agents vs placebo, and 9 trials of beta 3-adrenoceptor agonists vs placebo) that included patients with overactive bladder were identified. At 1-3 months after treatment, the incidence of urinary tract infections was statistically significantly higher in the patients treated with antimuscarinic agents (RR: 1.23, 95% CI: 1.04, 1.45; P = .013) than in the placebo control group. The incidence of urinary tract infections was not increased in the patients treated with beta 3-adrenoceptor agonists (RR: 1.04, 95% CI: 0.76, 1.42; P = .796). Antimuscarinic agents also statistically significantly increased the risks of urinary retention, dysuria, and/or increased residual urine volume (RR: 2.88, 95% CI: 1.79, 4.63; P < .001), whereas beta 3-adrenoceptor agonists did not (RR: 1.26, 95% CI: 0.38, 4.14; P = .708). This meta-analysis showed that antimuscarinic agents statistically significantly increased the incidences of urinary tract infection and lower urinary tract symptoms and dysfunction, but beta 3-adrenoceptor agonists did not. To prevent urinary tract infection emergence, beta 3-adrenoceptor agonists might be safer than antimuscarinic agents.

The Epidemiology, Associated Factors and Bacterial Profile of Asymptomatic Bacteriuria in Pregnant Women: A Retrospective Chart Review Study in Saudi Arabia.

Asymptomatic bacteriuria (ASB) is the presence of significant amounts of bacteria within the urinary tract in the absence of urinary tract infection (UTI) symptoms, resulting in negative neonatal and pregnancy consequences. This study determined the prevalence, bacteriology patterns, and associated factors with ASB among pregnant women in both primary and hospital levels of care in the Eastern Province of Saudi Arabia. This retrospective chart review study included pregnant women between 18 and 50 years who performed the screening urine culture test during their first antenatal visit between 2017 and 2021, without UTI symptoms. The collected data involved the demographic, medical, and obstetric characteristics, and urine culture results. T-tests and chi-squared tests were used for bivariate associations followed by binary logistic regression models. ASB was positive among 03.42% of the 6471 pregnant women included in the study. Logistic regression revealed that the risk of positive ASB increased in pregnant women in the first and second trimesters (OR = 2.04, 95% CI = 1.41-2.93 and OR= 1.50, 95% CI = 1.03-2.19, respectively), as well as pregnant women with a history of previous UTI (OR = 2.98, 95% CI = 2.14-4.15). The predominant organism isolates were E. coli, followed by GBS, Klebsiella pneumoniae, and Enterococcus faecalis. With limited data on ASB among pregnant women in Saudi Arabia, findings from the current study could help decision-makers in the country assess the epidemiological characteristics of the condition. Further study is recommended to investigate the susceptibility patterns of commonly prescribed antibiotics with different uropathogens to guide the clinicians who deal with these cases. Additionally, a large national study across the other regions in the kingdom is suggested to calculate the prevalence of ASB in Saudi Arabia.

Splenic abscess presenting as diabetic ketoacidosis: A rare cause of DKA in Type 2 DM patient

Diabetic ketoacidosis is a relatively common and potentially life-threatening complication of insulin deficiency. The prevalence of DKA is relatively common in patients with Type 1 diabetes mellitus in comparison with Type 2 diabetes mellitus. The prevalence of DKA is seen in 0–128 cases per thousand population in Type 1 diabetes mellitus while Type 2 DM has a prevalence of 18% of the total population. Abdominal pain is the most common and specific symptom of DKA which is reported at around 46%. The two most common infections precipitating DKA are community-acquired pneumonia and UTI which correspond to around 30–50% of the total burden. Meanwhile, any infection or sepsis can precipitate DKA, the splenic abscess is rare, and there have been reported only a few cases. In patients with poor glycemic control, absence of urinary tract infection, and community-acquired pneumonia, deep organ abscesses should be screened for. Here, we present a case report of patient with non-resolving DKA who presented with splenic abscess.

Immunological imbalance in microcephalic children with congenital Zika virus syndrome.

Microcephalic children due congenital Zika virus syndrome (CZS) present neurological symptoms already well described. However, several other alterations can also be observed. Here, we aimed to evaluate the immune system of microcephaly CZS children. We showed that these patients have enlarged thymus, spleen and cervical lymph nodes, analysed by ultrasound and compared to the reference values for healthy children. In the periphery, they have an increase in eosinophil count and morphological alterations as hypersegmented neutrophils and atypical lymphocytes, even in the absence of urinary tract infections, parasitological infections or other current symptomatic infections. Microcephalic children due CZS also have high levels of IFN-γ, IL-2, IL-4, IL-5 and type I IFNs, compared to healthy controls. In addition, this population showed a deficient cellular immune memory as demonstrated by the low reactivity to the tuberculin skin test even though they had been vaccinated with BCG less than 2years before the challenge with the PPD. Together, our data demonstrate for the first time that CZS can cause alterations in primary and secondary lymphoid organs and also alters the morphology and functionality of the immune system cells, which broadens the spectrum of CZS symptoms. This knowledge may assist the development of specific therapeutic and more efficient vaccination schemes for this population of patients.

Use of Pseudoephedrine in the Management of Severe Clozapine Induced Urinary Urgency and Frequency

AimsClozapine has several effects on the genitourinary system including enuresis and an overactive bladder (OAB). However, little if any has been written about its effect in causing OAB and its prevalence. Typical feature of OAB is urinary urgency associated with urinary frequency in the absence of urinary tract infection or other obvious pathology. Having 8 voids or more in 24 hours in addition to urinary urgency is strongly suggestive of OAB. AB developed AOB while being treated with clozapine.MethodsAB is 33 years old white lady with a well-established diagnosis of emotionally unstable personality disorder. She has been in mental health services from her late teens. She has had a trial of several antipsychotics, both oral and depot and has had a number of DBT sessions and one EMDR with limited effect. Prior to this episode, AB has had two successful trials of clozapine, one resulting in her longest period (9 months) of living in the community in 1998.AB was started on clozapine again in 2021, she developed urinary frequency. She requested it to be stopped. Her condition deteriorated such that she needed intensive care unit. AB was again started on clozapine. She developed urinary frequency once more when the dose reached 250 mg. She did not have infection. For one week, her urinary frequency ranged from 36–66 in 24 hours. It was more evident in the day time. There was no incontinence. AB remained in her room close to her toilet. She stopped engaging in her therapy, she did not mix with others and did go out. She tried a number of medications-aripiprazole, oxybutynin and desmopressin with no benefit. Pseudoephedrine was started at 15 mg twice a day, eventually reaching 30 mg three times a day. Within two weeks, the urge disappeared and the frequency normalised. Six months on, AB remains well and has not reported any side effects.ResultsPseudoephedrine, an indirect alpha-adrenergic agonist successfully normalised AB's urinary frequency. It was evident so within few days though the maximum benefit was noted within two weeks. This is in agreement with what is reported in cases with enuresisConclusionVery little is known about clozapine induced OAB. It had a severe negative impact on AB, who failed to engage in her therapy and her social life. Pseudoephedrine brought relief within a short period of time. In case of OAB and when stopping clozapine is not an option because of underlying severe mental disorder; think of pseudoephedrine.

Correlation of Bacteriuria, Pyuria with Urine Culture in Symptomatic UTI Patients; a Study from a Tertiary Care Center in North India

Although culture is the gold standard for diagnosis of urinary tract infections (UTI), microscopy of well mixed drop of urine and several different dipstick rapid tests have become popular over the years, as culture is expensive, time consuming and requires a well-established microbiological laboratory and technical expertise. Rapid screening is also required in special circumstances, not only where it is difficult to identify urinary tract infection (UTI) on basis of clinical criteria alone but also where early diagnosis and prevention of complications affords significant benefit. This prospective cross sectional study was carried out in the Department of Microbiology of Government Medical College, Srinagar. A total of 800 patients were taken up for the study. Samples following the inclusion criteria were included in the study. Gram staining, wet mount for detection of pus cells and urine culture was performed. Data was compiled and compared with culture as gold standard for diagnosis of UTI. Results: wet mount examination for detection of pyuria was done on all 800 samples taken up for study which gave sensitivity, specificity, positive predictive value, negative predictive value of 75%, 55%, 37.14%, 86.32% respectively when compared to conventional culture. Gram staining for detection of bacteriuria was also done on all 800 samples and showed sensitivity, specificity, positive predictive value, negative predictive value of 90%, 89%, 74.51%, and 96.17% in comparison to culture. Conclusion: Although urine culture is used as the reference standard to determine the presence or absence of urinary tract infection (UTI), but it is an expensive and time consuming method. Substituting rapid diagnostic tests for a hospital laboratory urine analysis may be less time consuming and less expensive. Keywords: Bacteriuria, Pyuria, PPV of bacteriuria and pyuria, UTI, Rapid screening of UTI.

Clinical profile of children with primary vesicoureteric reflux and its association with renal parenchymal scarring

Context: Vesicoureteric reflux (VUR) has been implicated in renal injury before birth as well as in postnatal occurrence of urinary tract infection (UTI) and further renal damage. About 30–49% of children with primary VUR may develop renal scarring called reflux nephropathy. About 5–10% of children with reflux nephropathy may progress to chronic kidney disease in late childhood. Objectives: The objectives of the study were to study the clinical profile of children with primary VUR and to assess the relationship with grades of primary VUR and renal parenchymal scarring. Materials and Methods: Fifty children of age 1 month–5 years, diagnosed to have Primary VUR, were included in this prospective observational study. Detailed history was taken; examination was carried out as per the study protocol. Investigations included urine analysis, renal function tests, urine culture, renal ultrasonography, micturating cystourethrogram, and 99mTc dimercaptosuccinic acid (DMSA) scintigraphy. For those who had UTI, DMSA was carried out after a minimum period of 6 months after UTI episode. Results: Among the 50 children, 21 (42%) were male and 29 (58%) were female with male-to-female ratio of 0.72:1. Mean age at diagnosis was 9 months, ranging from 1 to 40 months. The number of children presented with UTI was 43 (86%), and 7 children (14%) were asymptomatic and were evaluated in view of abnormality in prenatal ultrasound scan. Unilateral VUR was found in 21 patients (42%), and 29 patients (58%) had bilateral VUR. Of all 79 refluxing units (21 unilateral plus 58 bilateral), 4% had VUR of Grade I severity, 30% of Grade II, 34% of Grade III, 28% of Grade IV, and 4% of Grade V severity. Renal parenchymal scarring on DMSA scan was detected in 42 (54%) of 79 refluxing units including 33% of Grade II, 55% of Grade III, 71% of Grade IV, and 100% of Grade V refluxing units. Prevalence of scarring in complicated, recurrent, and simple UTI was 100%, 93%, and 22%, respectively. Conclusion: Risk of renal scarring increased progressively with increasing severity of primary VUR. Complicated and recurrent UTI were found to be statistically significant risk factors for renal scarring. Renal scarring was also seen in absence of UTI in a small percentage of children with primary VUR.

Treatment Response of Botulinum-A Toxin Intradetusor Injections for Overactive Bladder (OAB) and Neurological Detrusor Overactivity (NDO) Refractory to Anticholinergics and Beta3-Adrenoceptor Agonists

Introduction: Overactive bladder (OAB), defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology.&#x0D; Methods: A retrospective review of patients getting intradetrusor onabotulinumA injections for OAB and NDO over a 6-year time frame was conducted. The principal outcome measures involved patient’s subjective improvements in OAB and NDO symptoms and the duration of symptomatic relief following every treatment. The secondary results measured relation of patient’s age and duration of each effective treatment cycle.&#x0D; Results: One hundred and thirty-Eight (138) consecutive patients who met the inclusion criteria were included in the study. The average age of women was 59.43 years. Eighty four (61%) of participants were still receiving botox injections while 54 women stopped treatment. The average time period between botulinum A injection and its efficacy in controlling OAB symptoms varied from 3 -8.5 months. There was no decrease in efficacy of the treatment with more cycles of treatment. The average age of women who received one, two, three and four or more cycles were 61.7, 53.87, 63.03, and 56.75 years respectively, which showed with advanced age efficacy of botulinum toxin does not decrease.&#x0D; Conclusions: Our results suggest that in patients who respond to intradetrusor botulinumA treatment, the duration of response does not decline with more treatment cycles, suggesting it as a safe long term treatment option for controlling OAB symptoms. Also there is no relation between advanced age and subsequent efficacy of botulinum A intradetrusor injections.

Prostate-specific antigen increase after urethral catheterisation: fact or myth

BackgroundTo find out any association of urethral catheterisation with rise in serum PSA.MethodsThis study was conducted in 80 patients of BPH who had to undergo catheterisation because of acute urinary retention. Patients were divided into two groups: Group A (n = 43 patients), age group 40–60 years, and Group B (n = 47 patients), age group 60–75 years. Values of PSA, free/total PSA and PSA density were recorded in both age groups before catheterisation and one and three days after catheterisation.ResultsPSA, PSA density and free/total PSA were not statistically different before and after urethral catheterisation.ConclusionsIn the absence of urinary tract infection, urethral catheterisation does not elevate serum PSA. PSA, PSA density and free/total PSA were not statistically different before and after urethral catheterisation.

Définition, épidémiologie et retentissement du syndrome clinique d’hyperactivité vésicale non neurologique

Overactive bladder (OAB) is a common condition with a significant functional impact in patients. To synthesize current knowledge on the definition, epidemiology and impact of OAB. A systematic literature review based on Pubmed, Embase, Google Scholar was conducted in June 2020. OAB is defined by urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology. In France, OAB affects 14% of the general population and this prevalence increases with age. This condition is a source of major deterioration in patients' quality of life with a physical (falls, fractures, sleep disorders, fatigue), psychic (anxiety, depression) social (limitation of leisure, isolation) and economic impact. The definition of OAB is standardized. OAB is a frequent condition and has significant functional consequences with a notable deterioration in quality of life.

Recent advances in managing overactive bladder

Overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology. In this review, we focus on recent advances in the management of OAB. We examine the evidence on the effect of anticholinergic load on OAB patients. Advances in medical treatment include a new beta-3 agonist, vibegron, which is thought to have fewer drug interactions than mirabegron. Treatment of genitourinary syndrome of the menopause with oestrogens and ospemifene have also shown promise for OAB. Botulinum toxin has been shown to be an effective treatment option. We discuss the new implantable neuromodulators that are on the market as well as selective bladder denervation and laser technology.

Cognitive Effects of Anticholinergic Load in Women with Overactive Bladder.

Overactive bladder syndrome (OAB) is defined as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency incontinence, in the absence of urinary tract infection or other obvious pathology. The mainstay of treatment of OAB is anticholinergic/antimuscarinic medication. These drugs block muscarinic receptors throughout the body, not only the bladder, including in the brain, which may lead to cognitive side effects. Anticholinergic load or burden is the cumulative effect of taking drugs that are capable of producing anticholinergic adverse effects. The elderly are more susceptible to these effects, especially as there is increased permeability of the blood brain barrier. The anticholinergic drugs for OAB are able to enter the central nervous system and lead to central side effects. There is increasing evidence that a high anticholinergic load is linked to the development of cognitive impairment and even dementia. Some studies have found an increased risk of mortality. In view of this, care is needed when treating OAB in the elderly. Trospium chloride is a quaternary amine anticholinergic, which has a molecular structure, which theoretically means it is less likely to cross the blood brain barrier and exert central side effects. Alternatively, mirabegron can be used, which is a beta-3 adrenoceptor agonist, which does not add to the anticholinergic load or exert central nervous system side effects. Conservative therapy can be used as an alternative to pharmacological treatment in the form of behavioral modification, fluid management and bladder retraining. Neuromodulation or the use of botox can also be alternatives, but success may be less in the older adult and will require increased hospital attendances.

Urine Proteomic Study in OAB Patients-Preliminary Report.

Overactive bladder (OAB) is defined by International Urogynecological Association (IUGA)/ International Continence Society (ICS) as urinary urgency, usually accompanied by frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection (UTI) or other obvious pathology. The pathophysiology of OAB is not well understood, however a number of different proteins and cytokines including vascular cell adhesion molecule-1 (VCAM-1) were found to be important in regulating structural integrity of the bladder wall. Proteome analysis may thus provide significant information with regard to OAB and may help in discovering novel diagnostic disease biomarkers. Sixteen Caucasian women aged 32–78 were included in the study. Patients were placed within 2 groups: OAB group (n = 8) and control group (n = 8). Urine samples were collected, immediately preserved in a protease inhibitor mixture, and frozen at −80 ℃. All samples were then further processed according to the isobaric tags for relative and absolute quantification (iTRAQ) manual. Proteins were labeled and analyzed in the mass spectrometer conjugated with liquid chromatograph (data are available via ProteomeXchange with the identifier PXD017799). There were no statistically significant differences in demographic data between control and OAB groups. VCAM-1 was the only protein that reached statistical significance as a differentiating protein in both of our experiments assessing the proteomic constitution in OAB patients. Studies involving a larger group of patients may provide further information on urinary bladder proteomics.

Promoting and maintaining urinary continence: Follow-up from a cluster-randomized trial of elderly village women in Bangladesh.

Pelvic floor and mobility exercises were shown to be effective in managing incontinence in a cluster-randomized trial (CRT) of village women aged 60 to 75 years in Bangladesh. The present analysis examines continence 12 months after the CRT and exercise program implementation with village paramedics as preceptors. Women from nine villages in the exercise arm of the CRT were followed-up 12 months after the 6-month intervention. They provided information about exercise since the CRT and a 3-day continence record (3DCR). Posttrial, a further 6-month exercise intervention led by village paramedics was initiated in 20 villages. Women completed the two-item Sandvik severity questionnaire before and after the intervention. Paramedics kept a record of each woman's attendance at the 48 exercise sessions RESULTS: A total of 130 of 150 women from the CRT completed the 12-month follow-up; 61.5% were dry on the 3DCR at follow-up. Total continence was related to the continuation of exercises carried out in the home and absence of urinary tract infection at follow-up. Those exercising at follow-up had an odds ratio (OR) of 3.49 (95% confidence interval [CI], 1.86-6.58) of being continent at follow-up. Higher end-of-CRT body mass index was associated with greater follow-up leakage. In the 20-village roll-out, with 316 incontinent women, improvement in both severity and total continence on the Sandvik questionnaire were related to a total number of sessions attended (OR = 1.09; 95% CI, 1.05-1.13). At roll-out, 38.6% achieved continence, comparable to 43.0% in the CRT using physiotherapy preceptors CONCLUSIONS: Group exercise classes led by paramedics resulted in a marked improvement in continence but maintenance requires exercise postintervention.

Overactive Bladder: Clinical Updates in Women's Health Care Primary and Preventive Care Review.

Overactive bladder (OAB) syndrome is a condition that involves urinary urgency, usually accompanied by increased daytime frequency and nocturia, with or without urgency urinary incontinence, in the absence of urinary tract infection or other obvious pathology. This condition is multifactorial, and several theories exist that explain the pathophysiologic process underlying the condition. Because the prevalence of the condition is high among women across all age groups, obstetrician-gynecologists will encounter women with OAB syndrome and should be able to evaluate and treat this condition. The appropriate management often is based on the degree of bother and severity of symptoms in an individual patient. This monograph will delineate the general characteristics of OAB syndrome from its epidemiology to potential causes and provide a detailed discussion of the evaluation of the patient with various diagnostic modalities and the range of available treatment options.

1442. Effect of Reflex Urine Culturing on Rates of Cultures and Infections in an Acute Care Hospital, Emergency Department, and Two Long-Term Care Facilities

BackgroundUrine cultures are often positive in the absence of urinary tract infection (UTI) leading to unnecessary antibiotics. Reflex culturing decreases unnecessary urine culturing in acute care settings but the benefit in other settings is unknown.MethodsThis was a quasi-experimental study performed at a health system consisting of an acute care hospital, an emergency department (ED), and two long-term care (LTC) facilities. Reflex urine criterion was a urine analysis with > 10 white blood cells/high-power field. Urine cultures performed per 100 bed days of care (BDOC) were compared pre- (August 2016 to July 2017) vs. post-intervention (August 2017 to August 2018) using interrupted time series regression. Catheter-associated UTI (CAUTI) rates were reviewed to determine potential CAUTIs that would have been prevented.ResultsIn acute care, pre-intervention, 894 cultures were performed (3.6 cultures/100 BDOC). Post-intervention, 965 urine cultures were ordered and 507 cultures were performed (1.8 cultures/100 BDOC). Reflex culturing resulted in an immediate 49% decrease in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.8/1000 catheter days and 1.6/1000 catheter days post-intervention. Reflex culturing would have prevented 4/14 CAUTIs. In ED, pre-intervention, 1393 cultures were performed (5.4 cultures/100 visits). Post-intervention, 1959 urine cultures were ordered and 917 were performed (3.3 cultures/100 visits). Reflex culturing resulted in an immediate 47% decrease in cultures performed (P = 0.0015). In LTC, pre-intervention, 257 cultures were performed (0.4 cultures/100 BDOC). Post-intervention, 432 urine cultures were ordered and 354 were performed (0.5 cultures/100 BDOC). Reflex culturing resulted in an immediate 75% increase in cultures performed (P < 0.001). The CAUTI rate 2 years pre-intervention was 1.0/1000 catheter days vs. 1.6/1,000 catheter days post-intervention. Reflex culturing would have prevented 1/13 CAUTIs.ConclusionReflex culturing canceled 16%-51% of cultures ordered with greatest impact in acute care and the ED and a small absolute increase in LTC. CAUTI rates did not change although reflex culturing would have prevented 29% of CAUTIs in acute care and 8% in LTC. Disclosures All authors: No reported disclosures.