Urinary Infection Research Articles

Level of Anxiety Shows a Positive Correlation With the Frequency of Acute Cystitis Recurrence in Women.

Previous studies have simply confirmed recurrence of acute cystitis negatively affects a patient's psychological state. This study was performed to assess the impact of the recurrence of urinary tract infections on anxiety and depression and further assess whether there is a correlation between the number of recurrences and the degree of anxiety and depression. This cross-sectional study enrolled patients with recurrent cystitis who visited a tertiary care center between April 2018 and June 2022. For eligible patients, depression and anxiety were assessed by the Patient Health Questionnaire-9 and State-Trait Anxiety Inventory. Among the clinical characteristics, factors that independently affected the degree of depression and anxiety were analyzed. Additionally, the relationship between the level of anxiety, depression, and the number of recurrent cystitis was assessed. A total of 112 female patients with recurrent cystitis were enrolled in this study. The proportion of patients with depression (moderate, 8%; severe, 0%) was relatively low compared with that of patients with anxiety (moderate, 22.3%; severe, 68.8%). Multivariate regression analysis showed that more recurrent episodes were significantly associated with higher anxiety scores (P<0.001). It was confirmed that longer disease duration is associated with higher depression scores (P=0.031). Additionally, there was a positive correlation between the number of recurrences and State-Trait Anxiety Inventory and Patient Health Questionnaire-9 scores (r=0.362, P<0.001 and r=0.248, P=0.009, respectively). Our study reveals that recurrent cystitis notably increases patients' anxiety, correlating with the frequency of recurrences. Disease duration is also linked to depression. These findings emphasize the importance of preventing urinary tract infection recurrences to reduce psychological complications. To reinforce these results, larger cohort studies are necessary.

Anti-inflammatory and Antioxidant Effects of Plant Components in Complex Therapy for Acute Female Cystitis

It is well known that phytotherapy as a method of treatment and prevention of diseases with the use of medicinal plants and their extracts has a positive effect not only on the organ, but also on the whole body as a whole. The objective: to analyze the anti-inflammatory and antioxidant effects of a combined herbal remedy, which includes such active ingredients as castor oil (Castor oil), α-pinene, peppermint oil (Mentha piperita oil), extract of common nettle grass (Leonuri cardiacae), juniper berry oil (Juniperus oil), Ammi dental extract (Ammi visnaga), chamomile flower extract (Matricaria chamomilla), in young women with acute cystitis (AC). Materials and methods. 50 outpatient women with AC aged 18 to 35 years (average age – 25.9±6.1 years) took part in the study. The diagnosis was established on the basis of complaints, the results of the acute cystitis symptom score (ACSS), anamnesis data, physical examination and was confirmed by laboratory tests, clinical and biochemical blood tests were performed, and indicators of immune status were determined. The patients were divided into two groups of 25 people each. The groups were comparable in terms of age, severity of clinical symptoms, and laboratory parameters. Patients of the control group received a standard course of antibacterial therapy for 7 days. Women in the main group additionally took the combined herbal preparation at a dose of 1 capsule twice a day for 30 days and then for another 60 days at a dose of 1 capsule once a day. Follow-up visits were in 7 days after the first and 1 and 3 months after the start of therapy. During the study, the dynamics of complaints, the results of the ACSS questionnaire and laboratory analyzes of urine and blood were evaluated, and indicators of immune status and parameters of the oxidative stress-antioxidant status system were determined. Results. After a course of etiotropic treatment it was determined that the average duration of AC symptoms in patients of the control group was 1.67 times longer than in women of the main group (p&lt;0.05). After a month of using the combined herbal preparation, stabilization of the antioxidant protection system was observed, namely: indicators of oxidative stress in the main group were significantly more positive than in the control group (p&lt;0.01); indicators of the antioxidant system reached the norm and had significant differences compared to the control group (p&lt;0.05). In the main group, an increase in the functional reserve of phagocytic cells was observed, a pronounced increase in the number of cells capable of phagocytosis was determined, and the absorptive activity of neutrophils was also significantly greater than in the control group (p&lt;0.05). During the 3-month prophylactic course of treatment with the herbal preparation, the absence of recurrent disease was found in 96% of patients in the main group, in contrast to women in the control group, where the absence of reinfection was determined in only 72% of patients (p&lt;0.05). Conclusions. The use of a combined herbal preparation in a dose of 1 capsule 2 times a day in addition to the standard therapy of acute cystitis (AC) in women reliably shortens the duration of clinical symptoms and promotes faster clinical and laboratory recovery. After 30 days of use there is a normalization of indicators of oxidative stress, antioxidant protection and phagocytic activity of neutrophils. Complex therapy of AC with the inclusion of herbal medicine for 3 months is associated with significantly fewer cases of reinfection of the urinary tract compared to treatment without herbal therapy.

Urinary Track Infections

Urinary Track Infections

#1654 Infectious complications after kidney transplantation: a retrospective study

Abstract Background and Aims Infection is a major cause of morbidity among kidney transplant recipients. Allograft rejection is a frequent cause of dysfunction and its treatment increases the risk for both common and opportunistic infections. Nevertheless, its exact impact on infection incidence and further worsening of allograft dysfunction is not fully known. We aimed to characterize the incidence, nature, and severity of infectious complications following kidney transplantation, their association with previous rejection and its impact on allograft function. Method This was a single center retrospective study covering all patients transplanted between July 2021 and June 2023 in a tertiary referral center. Demographic and clinical data were collected from patient records, including donor and patient features, graft function over time and occurrence of either infection or rejection. Logistic regressions were adjusted considering sex, age, blood type and presence of diabetes as independent variables. Results A total of 139 patients were considered, 49 (35.3%) were women and 90 (64.7%) were men. Mean age was 49.6 ± 13.0 years. Median follow-up time was 375 [194-596] days. The main cause of renal disease was diabetes (37 patients, 26.8%) and most patients (113; 81.9%) were on hemodialysis for a median vintage of 3 [2.3] years. Considering the 139 transplants performed, 113 (81.2%) were isolated kidney, 24 (17.4%) were simultaneous kidney-pancreas and 2 (1.4%) were simultaneous kidney-liver transplantation. Eleven (7.9%) were living donor. During follow-up time, in-hospital infection occurred in 34 (24.4%) patients, mostly urinary (13, 38%) and blood stream (11, 32%) infections. These events significantly delayed hospital discharge (15.88 ± 8.52 vs 26.05 ± 14.3 days, p-value=0.001). During the follow up, a total of 107 (77%) patients developed 220 infection episodes leading to 47 hospital admissions. Urinary infections (64, 28.8%) and cytomegalovirus (CMV) viremia (64, 28.8%) were the most common at median follow-up time of 85.5 [40.25-183.75] and 159 [43.25-258.5] days, respectively. Median timing of diagnosis was 400.8 [203-614] days after transplant. They were much more common during the first three months (0.014 vs 0.002 per follow-up day). There were no differences in infection incidence between type of donor (p=0.76), type of allograft (p=0.361), immunosuppression protocol (thymoglobulin or basiliximab, p=0.45), renal replacement therapy or presence of diabetes. Regarding urinary infections, days of urinary catheterization (p=0.905), need for catheter replacement (p=0.092) or presence of residual diuresis (p=0.375) had no impact on infection rates. A positive correlation was found, between the number of infection episodes and creatinine increase over the first year (r=0.386; p&amp;lt;0.000). Allograft rejection was diagnosed and treated through protocol biopsy in 25 (18%) cases. These patients presented 17 confirmed episodes of infection over the three following months. Nine of them (36%) were CMV detectable viremias. Patients with a history of rejection had significantly more infections (1.49 ± 1.22 vs 2.20 ± 1.26, p=0.01), even after adjustment (p=0.006). Conclusion Early infections after kidney transplantation negatively impact hospital length of stay and allograft function. Furthermore, immunosuppressive treatment of allograft rejection carries a higher risk of infection. Further research is needed to clarify the impact of specific subsets of allograft rejection and immunosuppression protocols on the incidence of various types of infectious complications which could impair short-term renal function.

Effects of different sodium–glucose cotransporter 2 inhibitors in heart failure with reduced or preserved ejection fraction: a network meta-analysis

BackgroundThis systematic review and meta-analysis aimed to explore the effects of different sodium–glucose cotransporter-2 inhibitors (SGLT2i) on prognosis and cardiac structural remodeling in patients with heart failure (HF).MethodsRelevant studies published up to 20 March 2024 were retrieved from PubMed, EMBASE, Web of Science, and Cochrane Library CNKI, China Biomedical Literature Service, VIP, and WanFang databases. We included randomized controlled trials of different SGLT2i and pooled the prognosis data of patients with HF. We compared the efficacy of different SGLT2i in patients with HF and conducted a sub-analysis based on left ventricular ejection fraction (LVEF).ResultsWe identified 77 randomized controlled trials involving 43,561 patients. The results showed that SGLT2i significantly enhanced outcomes in HF, including a composite of hospitalizations for HF and cardiovascular death, individual hospitalizations for HF, Kansas City Cardiomyopathy Questionnaire (KCCQ) scores, left atrial volume index (LAVi), and LVEF among all HF patients (P &amp;lt; 0.05) compared to a placebo. Sotagliflozin was superior to empagliflozin [RR = 0.88, CI (0.79–0.97)] and dapagliflozin [RR = 0.86, CI (0.77–0.96)] in reducing hospitalizations for HF and CV death. Dapagliflozin significantly reduced hospitalizations [RR = 0.51, CI (0.33–0.80)], CV death [RR = 0.73, CI (0.54–0.97)], and all-cause mortality [RR = 0.69, CI (0.48–0.99)] in patients with HF with reduced ejection fraction (HFrEF). SGLT2i also plays a significant role in improving cardiac remodeling and quality of life (LVMi, LVEDV, KCQQ) (P &amp;lt; 0.05). Among patients with HF with preserved ejection fraction (HFpEF), SGLT2i significantly improved cardiac function in HFpEF patients (P &amp;lt; 0.05). In addition, canagliflozin [RR = 0.09, CI (0.01–0.86)] demonstrated greater safety compared to sotagliflozin in a composite of urinary and reproductive infections of HFpEF patients.ConclusionOur systematic review showed that SGLT2i generally enhances the prognosis of patients with HF. Sotagliflozin demonstrated superiority over empagliflozin and dapagliflozin in a composite of hospitalization for HF and CV death in the overall HF patients. Canagliflozin exhibited greater safety compared to sotagliflozin in a composite of urinary and reproductive infections of HFpEF. Overall, the efficacy of SGLT2i was greater in HFrEF patients than in HFpEF patients.

#2817 Preliminary results of dapagliflozin in inactive lupus nephritis cross-over randomized trial

Abstract Background and Aims Sodium-glucose co-transporter 2 (SGLT2) inhibitors slow the progression of chronic kidney disease (CKD). Lupus nephritis (LN) patients in remission may continue with residual proteinuria due to scars and hyperfiltration. However, LN patients were excluded from the main trials with SGLT2 inhibitors. This trial aims to assess the effect and safety of dapagliflozin in inactive LN patients with residual proteinuria. Method For this cross-over randomized trial, we include adult patients with LN class III, IV (±V) without active nephritis but with proteinuria &amp;gt;500 mg/24 h or UPC &amp;gt; 200 mg/g and eGFR ≥ 20 ml/min, in the maintenance treatment with a RAAS and mycophenolate mofetil (&amp;lt;2g/day) in stable a dose for at least four weeks before the randomization. We excluded patients with other etiologies of CKD, those with active LN lesions on the recent biopsy (AI&amp;gt;2), use of induction therapy in the last 12 months (cyclophosphamide, mycophenolate mofetil &amp;gt;2g/day and calcineurin inhibitors) and prednisone dose ≥ 20 mg/day. Due to safety issues, we excluded patients with recurrent urinary infections (&amp;gt;3 times/year). Those included were randomized to receive dapagliflozin 10 mg on top of standard of care therapy (SoC) or not. After 24 weeks the groups were switched and those without dapagliflozin received it for the next 24 weeks. Primary endpoint is reduction of proteinuria compared to baseline at 6 and 12 months. Secondary endpoints are sustained reduction of eGFR&amp;gt;30%; occurrence of hypotension symptoms; and number of infections on dapagliflozin treatment versus exclusive SoC therapy. The sample size was calculated for 28 patients enrolled providing 80% power to detect a 25% relative risk reduction in proteinuria (α level of 0.05). Results From 97 screened class III, IV (± V) LN patients under maintenance therapy, we excluded 67 due to active nephritis, low proteinuria or low eGFR. We included 30 patients that were randomized 14 to start the treatment with dapagliflozin on top of SoC and 16 to remain with the usual therapy for 24 weeks. Six patients were excluded from the analysis due to new LN flare or lost to follow-up. We analyzed the data of 12 patients in the initial Dapa + SoC and 12 patients in the initial SoC group after 3 (n = 21), 6 (n = 18), 9 (n = 14) and 12 (n = 12) months. Patients in initial Dapa group had a significant decrease in proteinuria after 6 months (1159 to 882 mg/day; p = 0.017) but increased to 1105 mg/day 6 months after the drug withdrawal (Fig. 1A). This preliminary analysis shows a significant reduction in the proteinuria of –35.8% in patients after 6 mo of dapagliflozin as opposed to an increase in 7.2% for those in the SoC therapy at the end of a 6 mo period, p = 0.02 (Fig. 1C). The drug was well tolerated, but 4 (33.3%) of the patients reported hypotension symptoms during the first days of dapagliflozin. There was one case of urinary infection in each group, but in the same patient. Conclusion Preliminary results show a significant reduction in residual proteinuria in patients with inactive LN with dapagliflozin without an increase in infections.

#2549 Real world data of dapagliflozin effect on proteinuria in primary glomerulopathies in Croatia

Abstract Background and Aims SGLT2 inhibitors, namely dapagliflozin, proved to slow progression of kidney disease in randomized clinical trials. Our aim was to assess real world efficacy of dapagliflozin on proteinuria level in primary glomerulopathies (GN). Method adult patients with biopsy proven glomerulonephritis from all university hospitals in Croatia who started dapagliflozin as a standard of care were enrolled. Data were analyzed if patients had at least six months of follow up. None of the patients were on immunosuppression. Data are shown as N (%) or median with interquartile range (IQR) and accompanied p levels. Results Overall 118 patients, predominantly male 84 (71.8%) of average age of 52 years (min–max 20–76), were enrolled. Most of the patients had IgA nephropathy (IgAN) (N = 55;46.6%), followed by membranous nephropathy (N = 27;22.9%), FSGS (N = 19;16.1%), membranoproliferative GN (N = 8;6.8%), Alport syndrome (N = 8;6.8%). 95.8% of patients were on ACE inhibitors or angiotensin receptor blockers and 10.7% were on mineralocorticoid receptor inhibitors and RAAS blockage was not significantly upscaled during follow up. During the median follow up of 12.2 (7.5-18.6) months, proteinuria was significantly reduced from 1139 (534–2265) to 701 (305-1543) mg/dU; p &amp;lt; 0.001. When divided by glomerulonephritis type, statistically significant reduction of proteinuria was observed in patients with IgAN and Alport syndrome, while trend of reduction of proteinuria was observed in all types of GN. There was a slight reduction in eGFR levels (54 (43-78) vs. 52 (39–73) ml/min/1,73 m²; p &amp;lt; 0.001) and rise in creatinine values (122 (89–149) vs. 128 (91–159) μmol/l; p &amp;lt; 0.001). There was a significant reduction in systolic (130 (120-140) vs.125 (115-134) mmHg; p &amp;lt; 0.001) and diastolic blood pressure (80 (75-90) vs. 80 (70-85) mmHg; p &amp;lt; 0.001). Reduction of uric acid level was noticed (377 (313–460) vs.343 (294–422); p &amp;lt; 0.001), while there was no effect on LDL levels (2.6 (2.12–3.53) vs.2.3 (1.9–3.30); p = 0.073). Dapagliflozin was well tolerated, one patient discontinued the therapy due to intolerance, one due to urinary infection and two due to relapse of GN which needed immunosuppressive therapy. One patient was excluded from analysis due to non-adherence. Conclusion SGLT2 inhibitor dapagliflozin has significant effect on reduction of proteinuria in patients with primary glomerulonephritis. Our data support a growing body of evidence that SGLT2 inhibitors should be used as a standard of care in patients with glomerular kidney diseases, especially IgAN. Future research should address earlier use of SGLT2 inhibitors during the treatment of glomerulonephritis alongside immunosuppressive therapy as well as look into the effect of SGLT2 inhibitors on mesangial cells.

#2917 Desensitization techniques in ABO-incompatible renal transplantation: efficacy and analysis of complications

Abstract Background and Aims Living donor transplantation is the best optimal choice for the vast majority of patients with terminal renal insufficiency. However, it is limited by the AB0/ HLA incompatibility between donor and receptor. The resolution of this inconvenient relies on desensitization of isoagglutinins (anti-AB0 immunoglobulins depletion); thus transplantation could be performed safely. For desensitization there are two techniques: specific adsorption (S) and non-specific (NS) techniques, including centrifugal therapeutic plasma exchange (cTPE) and membrane-based therapeutic plasma exchange (mTPE). The aims are to evaluate the efficacy of apheresis techniques: specific versus non-specific, and identify their complications. Secondary objectives include analyzing the acute rejection rate (RR), graft survival, and complications of each technique. Method A retrospective cohort study was conducted on AB0-incompatible living donor transplantation patients at our center (Bellvitge's Hospital) from 2014 to 2022. All patients (except 1) received rituximab and induction treatment by Thymoglobulin or Basiliximab, followed by maintenance treatment (Steroids, Mycophenolate, and calcineurin inhibitors). During follow-up, protocol renal biopsies (RB) were taken at one month and between 3-6 months post-transplantation. Complications were defined as significant haematological alterations, bleeding, or major infections requiring hospitalization. According to the technique used, two cohorts were identified: specific (Glycosorb®/Vitrosorb® columns) and non-specific: mTPE (prismaflex TPE2000) and cTPE (Spectra/Optia®). Both were anticoagulated with heparin or citrate randomly. An expert nurse supervised the technique. To calculate the efficacy we considered the percentual reduction of isoagglutinins in the first session. T-student test was used to calculate the percentage of complication and compare the results. Results A total of 50 patients were selected with a mean age (MA) of 49.5 ± 11.8. Four of these did not require apheresis due to lower title isoagglutinins (&amp;lt;1/8). Each cohort included 23 patients: specific with MA 49.5 vs non-specific 48.4, with a mean isoagglutinin titles in specific of 61.65 vs non-specific 11.8 (p = 0.05). Isoagglutinin clearance were higher in specific techniques with 73% vs 59% non-specific (p &amp;lt; 0.03). Due to the dispersion in the number of sessions, results are expressed with the median (4 sessions in specific vs 3 non-specific). Total renal graft survival rate is 93.4%. At one month, it was diagnosed by biopsy an acute renal rejection rate of 16.7% in non-specific vs 18.2% specific (p &amp;gt; 0.05). Considering complications, they are higher with non-specific 41.7% vs specific 18% (p &amp;lt; 0.05). Regarding infectious issues, there are no differences in cytomegalovirus or polyomavirus infections, but there are differences in urinary infections observing in non-specific 79.2% vs specific 63% (p &amp;lt; 0.05). Conclusion Specific techniques are more effective in reducing isoagglutinins, show a lower rate of complications and post-transplant infections, providing greater benefit to the patient.

COMPLICAÇÕES NEONATAIS CONCERNENTE A MORBIDADE MATERNA: DIABETES GESTACIONAL

The monitoring of this morbidity brings with it the need at public health level to emphasize regular monitoring through prenatal care, aiming at early diagnosis and treatment for Obstetric Diabetes (OD) or gestational diabetes mellitus (GDM), thus being able to reduce complications for the mother and fetus binomial. The aim of this study is to analyze these results among fetal or neonatal complications in women with GDM, bringing in the outcomes of premature birth, birth weight, neonatal morbidity and mortality, and the synergistic effect of concomitant risk factors and poor obstetric outcomes. A literature review was carried out using the following databases: Online Medical Literature Search and Analysis System (MEDLINE/PUBMED), Nursing Database - Brazilian Bibliography (BDENF), Web of Science and Cochrane Library (SCOPUS), CAPES Journals and Latin American and Caribbean Health Sciences Literature (LILACS). The search was carried out using descriptors combined with the Boolean operator “and”. From the searches, it was possible to see that the authors corroborate each other in relation to the main neonatal outcomes: Complications include fetal macrosomia, birth injuries, increased caesarean section rates, neonatal hospitalizations, neonatal hypoglycemia, neonatal respiratory distress syndrome (RDS), prematurity and fetal death. It can be concluded that for the mother the impacts, such as the risk of urinary system infections, are high, as well as bleeding in the postpartum period and tearing of the vaginal canal. For the child, hypoglycemia, prematurity and fetal macrosomia are some of the complications resulting from diabetes.

The effect of Marrubium vulgare L extracts against urinary tract bacteria pathogens infection in Alassaba'a hospital, of west Tripoli

Urinary tract infections (UTIs) are common infections that happen by many types of bacteria. Some of bacteria have resistance against several types of antibiotics. Many medicinal plants used as an alternative treatment around the world. Marrubium vulgare L has been reported to exhibit several biological properties. Thus, the aim of current study is estimating antimicrobial activities of M. vulgare against Escherichia coli, Klebsiella pneumoniae and Staphylococcus aureus, which caused urinary tract infections, isolated from infected patients. In the results, the growth of all tested bacteria was inhibited strongly by methanol extract at 1.0% (w/v) with inhibition zones 11.00, 11.00 and 15.50 mm against E. coli, k. pneumoniae and S. aureus respectively. Besides, Minimum Inhibitory Concentration (MIC) values were ranged between 0.625 to 1.25 mg/mL. While, Minimum Bactericidal Concentration (MBC) values were ranging between 1.25 to 2.5 mg/mL. On the other hand, hexane extract also was inhibited the growth of E. coli, k. pneumoniae and S. aureus with inhibition zones 10.00, 11.00 and 12.50 mm respectively. In addition, MIC values ranging 2.5 mg/mL, while MBC values of 5 mg/mL against all bacteria. In conclusion, the methanol extract of M. vulgare had a strongly effects on all bacteria compared to hexane extract, thus it can be developed as anti-bacterial agent.

Renal Hydatid Cyst in Children: A Case Report

The hydatid cyst, or hydatidosis, is a zoonotic infectious disease caused by the development of the larval form of the Echinococcus granulosus tapeworm in humans after accidental ingestion of embryonated eggs, which hatch into oncospheres and transform into hydatid cysts. Renal hydatid cyst is extremely rare in children. The positive diagnosis relies on epidemiological, clinical, radiological, and biological arguments. The standard treatment remains surgery. We report the case of a 5-year-old male child hospitalized for an isolated renal hydatid cyst fistulized into the urinary tract, revealed by lumbalgia and hydatiduria with a proteus mirabilis urinary infection on the cytobacteriological examination of urine. Paraclinical examinations, including ultrasound and uro-CT -scan, aided in diagnosis. Histopathological analysis confirmed the diagnosis of renal hydatidosis. Management was conservative surgical, with partial pericystectomy performed in our patient, resulting in a favorable outcome.

USE OF SGLT2-i IN ELDERLY PATIENTS WITH HFrEF- REAL WORD DATA

Abstract Introduction SGLT2-i have been shown to improve prognosis in patients with reduced ejection fraction heart failure (HFrEF) in randomized clinical trials (RCTs). However, we have little data on the use of these drugs in clinical practice, both in terms of safety and efficacy profile, especially in elderly patients. Objectives To describe the characteristics of HFrEF outpatients who started SGLT2-I and evaluate tolerability and effect of therapy. Results We evaluated 42 patients, 32 M and 10 F, with a mean age of 78±8.2 years (62.1% over 75). At baseline, the mean EF was 34.5%± 6.0 and the patients' renal function calculated with CKD-EPI was 56.3±18.6 ml/min/m2. We followed at 6 months 36 patients. After 6 months of SGLT2i therapy, there was a significant reduction in NYHA class (NYHA I 30.6% vs 9.8%, NYHA III 13.9% vs 31.7%), a slight recovery in EF (38% vs 33% p-value = 0.039) and a decrease in diuretic dose (34 mg/day vs 64 mg/day, p-value 0.033). Despite a slight initial reduction in eGFR, like RCTs, there was recovery of renal function at 6 months. At 6 months, only 2 patients discontinued SGLT2i therapy due to urinary infection. Conclusions In our analysis after 6 months of SGLT2-i therapy in elderly patients, there was clinical improvement as evidenced by improvement in NYHA class and reduction in diuretic therapy. SGLT2-i have been shown to be relatively safe, with no adverse effects occurring and no significant worsening of renal function.

Investigation on the treatment of empagliflozin in glycogen storage disease type Ib

Objective: To investigate the safety, efficacy and effective dose of empagliflozin in the treatment of glycogen storage disease type Ⅰb (GSD Ⅰb). Method: This was a cross sectional study. A total of 28 children with GSDⅠb who started oral empagliflozin treatment from January 2021 to June 2023 in the WeChat group of patients with glycogen storage disease were selected as the study objects. Clinical data such as general situation, current situation of medication and adverse reactions of the children were collected through questionnaires from June 18 to 30, 2023. The differences of symptoms and laboratory tests before and after empagliflozin treatment were compared by using paired chi-square test and Wilcoxon signed rank sum test. Results: Totally 28 children with GSD Ⅰb were from 12 different provinces, autonomous regions and municipalities in China. There were 14 males and 14 females, Empagliflozin treatment was started at the age of 4.8(2.4, 10.8) years, the time of treatment was 14.5(11.3, 21.5) months, the initial dosage was (0.23±0.11) mg/(kg·d), and the maintenance dosage was (0.28±0.12) mg/(kg·d). Empagliflozin showed positive effects on neutropenia, severity of inflammatory bowel disease like symptoms(Z=-3.70, -2.65, both P<0.05), The proportion of recurrent oral ulcers, recurrent bacterial infections and anemia was significantly lower than that before medication 18% (5/28) vs. (46% (13/28), 14% (4/28) vs. 46% (13/28), 21% (6/28) vs. 46% (13/28), χ²=4.05, 5.26, 3.05, all P<0.05). GCSF was once used in 5 children with GSD Ⅰb, all of them had completely stopped GCSF after empagliflozin treatment. The most common adverse events during empagliflozin treatment were hypoglycemia (5 children) and urinary infection (3 children). All 28 patients had no serious adverse reactions. Conclusions: Empagliflozin can increase the neutrophil count of children with GSD Ⅰb, and had a favorable effect on symptoms such as recurrent oral ulcers, and recurrent infection. The common adverse events during empagliflozin treatment were hypoglycemia and urinary infection.

MV140 Mucosal Vaccine Induces Targeted Immune Response for Enhanced Clearance of Uropathogenic E. coli in Experimental Urinary Tract Infection.

MV140 is an inactivated whole-cell bacterial mucosal vaccine with proven clinical efficacy against recurrent urinary tract infections (UTIs). These infections are primarily caused by uropathogenic E. coli (UPEC) strains, which are unique in their virulence factors and remarkably diverse. MV140 contains a non-UPEC strain, suggesting that it may induce an immune response against different UPEC-induced UTIs in patients. To verify this, we experimentally evaluated the cellular and humoral responses to UTI89, a prototypical UPEC strain, in mice vaccinated with MV140, as well as the degree of protection achieved in a UPEC UTI89 model of acute cystitis. The results show that both cellular (Th1/Th17) and antibody (IgG/IgA) responses to UTI89 were induced in MV140-immunized mice. MV140 vaccination resulted in an early increased clearance of UTI89 viable bacteria in the bladder and urine following transurethral infection. This was accompanied by a highly significant increase in CD4+ T cells in the bladder and an increase in urinary neutrophils. Collectively, our results support that MV140 induces cross-reactive humoral and cellular immune responses and cross-protection against UPEC strains.

Detection and diagnosis of bacterial pathogens in urine using laser-induced breakdown spectroscopy

The presence of bacterial cells from three species has been detected in clinical specimens of human urine using laser-induced breakdown spectroscopy (LIBS) by using a partial least squares discriminant analysis (PLS-DA) of 360 spectra obtained from 12 specimens of infected urine and 239 spectra obtained from eight specimens of sterile urine. Nominally sterile urine specimens obtained from four patients at a local hospital after being screened negative for the presence of bacterial pathogens were spiked with known aliquots of Escherichia coli, Staphylococcus aureus, and Enterobacter cloacae to simulate clinical urinary tract infections. Fifteen emission line intensities measured from the LIBS spectra and 92 ratios of those line intensities were used as 107 independent variables in the PLS-DA for discrimination between bacteria-containing specimens and sterile specimens. The PLS-DA models possessed a 98.3% sensitivity and a 97.9% specificity for the detection of pathogenic cells in urine when single-shot LIBS spectra were tested. To increase the signal to noise ratio, thirty spectra acquired from a single specimen were also averaged together and the averaged spectra were used to construct a model. When each averaged spectrum was withheld from the model individually for testing, the diagnostic test possessed a 100% sensitivity and a 100% specificity for the detection of bacterial cells in urine, although the number of test spectra was necessarily reduced.The entire LIBS spectrum from 200 nm – 590 nm was input into an artificial neural network analysis with principal component analysis pre-processing (PCA-ANN) to diagnose the bacterial species once detected. This PCA-ANN test possessed an overall sensitivity of 97.2%, an overall specificity of 98.6%, and an overall classification accuracy of 97.9% when using 80% of the data to build a model and withholding 20% for cross-validation testing. The PCA-ANN was also performed on each of the 12 bacteria-containing filters individually, using the other 11 filters to build the model. The average sensitivity of this test, calculated by averaging the sensitivities measured for each of the three bacterial species, was 70.9% and the average specificity was 85.5%. Based on these results, the average classification accuracy for the test when used to discriminate between the three microorganisms was 80.6%. These results indicate the potential usefulness of LIBS for rapidly detecting and possibly diagnosing urinary tract infections in a clinical setting.

Predictive Factors for Major Complications and Urological Cancer Diagnosis in Older Adults (≥80 Years) Admitted to the Emergency Department for Hematuria.

Background: Gross Hematuria is a relevant cause of admission to the emergency department in the general population and particularly in older adults (≥80 years). This specific urological symptom is often underestimated and usually associated with benign conditions such as urinary infections or poor hydration. Nevertheless, hematuria could lead to severe acute complications or be the first symptom of urological cancers. Methods: We retrospectively analyzed clinical data from 1169 patients aged ≥80 years consecutively admitted to the emergency department for hematuria. The primary endpoint of the study was to identify risk factors for major complications, and the secondary endpoint was to analyze risk factors for urological cancer diagnosis. The median age was 85 years (IQR 82-88 years), and 908 (77%) were males. Among them, 449 (38.4%) had a past medical history of urological neoplasm (kidney, ureter, bladder, prostate, or urethral cancer). Results: Overall, 87 patients (7.4%) had major complications (patient death, septic shock, and admission to the intensive care unit). Worse vital signs at admission, fever, and confusion (p < 0.001, OR 18.0 IC 95% [5.5-58.7]; p = 0.015, OR 2.0 IC 95% [1.1-3.5]; p = <0.001, OR 4.2 IC 95% [1.9-3.5], respectively), as well as lower hemoglobin values and higher Charlson comorbidity index (p < 0.001, OR 0.8 IC 95% [0.7-0.9]), p = 0.002, OR = 1.2 [1.1-1.3]) were independent predictive factors for major complications. The multivariate analysis identified as risk factors for diagnosis of urological cancer older age, male sex and higher comorbidity (OR 1.05 IC95% [1-1.09]; OR 2.19 IC95% [1.42-3.39] and OR 1.11 IC95% [1.2-1.2], respectively); interestingly the presence of indwelling vesical catheter (IVC) (OR 0.44 IC95% [0.24-0.82]) resulted as an independent factor for absence of urological cancers. Conclusions: Hematuria is a frequent symptom in older adults admitted to the emergency department. While this is often associated with benign conditions, there are some risk factors for major complications and for urological cancer that must be taken into account to identify the patients who need further evaluation or prompt hospital admission.

Association of common maternal infections with birth outcomes: a multinational cohort study.

It is unclear whether common maternal infections during pregnancy are risk factors for adverse birth outcomes. We assessed the association between self-reported infections during pregnancy with preterm birth and small-for-gestational-age (SGA) in an international cohort consortium. Data on 120,507 pregnant women were obtained from six population-based birth cohorts in Australia, Denmark, Israel, Norway, the UK and the USA. Self-reported common infections during pregnancy included influenza-like illness, common cold, any respiratory tract infection, vaginal thrush, vaginal infections, cystitis, urinary tract infection, and the symptoms fever and diarrhoea. Birth outcomes included preterm birth, low birth weight and SGA. Associations between maternal infections and birth outcomes were first assessed using Poisson regression in each cohort and then pooled using random-effect meta-analysis. Risk ratios (RR) and 95% confidence intervals (CI) were calculated, adjusted for potential confounders. Vaginal infections (pooled RR, 1.10; 95% CI, 1.02-1.20) and urinary tract infections (pooled RR, 1.17; 95% CI, 1.09-1.26) during pregnancy were associated with higher risk of preterm birth. Similar associations with low birth weight were also observed for these two infections. Fever during pregnancy was associated with higher risk of SGA (pooled RR, 1.07; 95% CI, 1.02-1.12). No other significant associations were observed between maternal infections/symptoms and birth outcomes. Vaginal infections and urinary infections during pregnancy were associated with a small increased risk of preterm birth and low birth weight, whereas fever was associated with SGA. These findings require confirmation in future studies with laboratory-confirmed infection diagnosis.

Female genital schistosomiasis burden and risk factors in two endemic areas in Malawi nested in the Morbidity Operational Research for Bilharziasis Implementation Decisions (MORBID) cross-sectional study.

Female genital schistosomiasis (FGS), caused by the parasite Schistosoma haematobium (Sh), is prevalent in Sub-Saharan Africa. FGS is associated with sexual dysfunction and reproductive morbidity, and increased prevalence of HIV and cervical precancerous lesions. Lack of approved guidelines for FGS screening and diagnosis hinder accurate disease burden estimation. This study evaluated FGS burden in two Sh-endemic areas in Southern Malawi by visual and molecular diagnostic methods. Women aged 15-65, sexually active, not menstruating, or pregnant, were enrolled from the MORBID study. A midwife completed a questionnaire, obtained cervicovaginal swab and lavage, and assessed FGS-associated genital lesions using hand-held colposcopy. 'Visual-FGS' was defined as specific genital lesions. 'Molecular-FGS' was defined as Sh DNA detected by real-time PCR from swabs. Microscopy detected urinary Sh egg-patent infection. In total, 950 women completed the questionnaire (median age 27, [IQR] 20-38). Visual-and molecular-FGS prevalence were 26·9% (260/967) and 8·2% (78/942), respectively. 6·5% of women with available genital and urinary samples (38/584) had egg-patent Sh infection. There was a positive significant association between molecular- and visual-FGS (AOR = 2·9, 95%CI 1·7-5·0). 'Molecular-FGS' was associated with egg-patent Sh infection (AOR = 7·5, 95% CI 3·27-17·2). Some villages had high 'molecular-FGS' prevalence, despite <10% prevalence of urinary Sh among school-age children. Southern Malawi carries an under-recognized FGS burden. FGS was detectable in villages not eligible for schistosomiasis control strategies, potentially leaving girls and women untreated under current WHO guidelines. Validated field-deployable methods could be considered for new control strategies.

Megacystis-microcolon-intestinal hypoperistalsis syndrome: don't forget the bladder.

Megacystis-microcolon-intestinal hypoperistalsis syndrome (MMIHS) is a well described clinical condition, but reports are focused on microcolon and intestinal hypoperistalsis, while data on bladder management are scant. Aim of the study is to present urological concerns in MMIHS. Retrospective evaluation of clinical data on urological management of MMIHS patients treated in the last 10years. Six patients were enrolled (3 male, 3 female). Three girls had prenatal diagnosis of megacystis (1 vesicoamniotic shunt was placed). All patients had genetic diagnosis: 5 had ACTG2 gene mutations and 1 MYH11 mutation. All patients were addressed to our attention for urinary symptoms, such as urinary retention, urinary tract infections, acute renal injury. Two patients presented frequent stoma prolapses. All children underwent a complete urological evaluation, and then started a bladder management protocol (clean intermittent catheterization, via urethra or cystostomy-tube placement), with improvement of urinary infections, upper urinary tract dilation and stoma prolapses, if present. All patients had good renal function at last follow-up. We believe that MMIHS patients must be addressed soon and before onset of symptoms for a multidisciplinary evaluation, including an early assessment by a pediatric urologist expert in functional disorder, to preserve renal function at its best.

Activity of cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations on Enterobacter cloacae complex and Klebsiella aerogenes in Spain (SMART 2016–2022)

Abstract Objectives To analyse the susceptibility profile to cefepime, carbapenems and new β-lactam/β-lactamase inhibitor combinations in Enterobacter cloacae complex and Klebsiella aerogenes isolated from intra-abdominal, urinary, respiratory and bloodstream infections in the SMART (Study for Monitoring Antimicrobial Resistance Trends) surveillance study in Spain. Methods The susceptibilities of 759 isolates (473 E. cloacae complex and 286 K. aerogenes) collected in 11 Spanish hospitals from 2016 to 2022 were analysed following the EUCAST 2023 criteria. Molecular characterization looking for β-lactamase genes was performed through PCR and DNA sequencing analysis. Results E. cloacae complex showed resistance to third-generation cephalosporins in 25% of the cases, whereas K. aerogenes was resistant in 35%. Regarding cefepime, resistance in E. cloacae was higher (10%) than in K. aerogenes (2%). Carbapenems showed &amp;gt;85% activity in both microorganisms. Ceftazidime/avibactam, imipenem/relebactam and meropenem/vaborbactam had good activity against these microorganisms (&amp;gt;95%). In contrast, the activity of ceftolozane/tazobactam was lower (80%). A high proportion of the isolates resistant to new β-lactam/β-lactamase inhibitor combinations carried a carbapenemase, mainly OXA-48-like and VIM-1. Conclusions Ceftazidime/avibactam, imipenem/relebactam and meropenem/vaborbactam show high activity against both E. cloacae complex and K. aerogenes isolates recovered in the SMART-Spain study. In contrast, differences have been found in the case of cefepime, showing more activity against K. aerogenes than E. cloacae complex. These results are useful for antimicrobial stewardship programmes and for the implementation of local and national guidelines.