Acute Urinary Tract Infection Research Articles

Use of antibiotics for urinary tract infections up to and after care home admission in Denmark: a nationwide study.

Older people have the highest use of antibiotics for acute and chronic urinary tract infection (UTI), despite diagnostic uncertainty and the growing problem of antibiotic resistance. We aim to describe use-patterns of UTI antibiotics two years prior to and following care home admission in Denmark. This was a register-based nationwide drug-utilization study. In a cohort comprising all Danish residents admitted into a care home from 2015 to 2021, we described the use of UTI antibiotics, and examined differences between regions and individual care homes in rates of UTI antibiotic use. Further, we described trends in UTI-related contacts with hospitals in the two years prior to and following care home admission. The cohort comprised 101,297 residents (61% female; median age 84years). UTI antibiotic use doubled from 7 to 14 treatments/100 residents/month two months prior to care home admission and remained at 10 treatments/100 residents/month the following two years. Prescription of pivmecillinam (55%) was most common. Primary care practitioners prescribed the majority (92%) of UTI antibiotics. UTI-related hospital contacts peaked at two months prior to care home admission, with 6 admissions/100 residents/month, subsequently dropping to 2 admission/100 residents/month. We found considerable variation in UTI antibiotic use, with 10% of care homes responsible for 20% of treatments in 2021. Use of UTI antibiotics increased prior to and remained at a stable high level following care home admission in Denmark. Despite variation in use across regions and individual care homes, an overall decrease was seen throughout the years 2016-2021.

Urinary Tract Infections in Children.

Despite the American Academy of Pediatrics guidelines for the evaluation, treatment, and management of urinary tract infections (UTIs), UTI diagnosis and management remains challenging for clinicians. Challenges with acute UTI management stem from vague presenting signs and symptoms, diagnostic uncertainty, limitations in laboratory testing, and selecting appropriate antibiotic therapy in an era with increasing rates of antibiotic-resistant uropathogens. Recurrent UTI management remains difficult due to an incomplete understanding of the factors contributing to UTI, when to assess a child with repeated infections for kidney and urinary tract anomalies, and limited prevention strategies. To help reduce these uncertainties, this review provides a comprehensive overview of UTI epidemiology, risk factors, diagnosis, treatment, and prevention strategies that may help pediatricians overcome the challenges associated with acute and recurrent UTI management.

Spectroscopic Determination and In vitro Bioequivalence Studies of Different Amoxicillin Capsule Brands

Amoxicillin is an aminopenicillin antibiotic, used in the treatment of several infections resulting from susceptible Gram-positive and Gram-negative, such as pneumonia, acute otitis media, acne vulgaris, bacterial endocarditis, streptococcal pharyngitis, urinary tract, Lyme borreliosis, Salmonella, Helicobacter pylori, chlamydia, and odontogenic infections. The study aimed to determine the in-vitro bioequivalence of amoxicillin capsules from various brands using physicochemical and spectroscopic parameters. Weight uniformity, friability, disintegration, dissolving tests, and UV spectroscopy were used to determine the in-vitro bioequivalence of different brands of amoxicillin capsules. The weight variation for all the capsules showed compliance with the USP specifications (≤10% weight deviation). All brands complied with the USP/BP specification for the disintegration test, as disintegration time ranged from 7 to 12 minutes. The dissolution profile of the innovator and the generic brands showed a percentage release from 80.81 – 89.11% within 30 minutes. The first-order kinetics, t1/2 and k of amoxicillin released ranged from 16.01 – 27.11 min and 2.56 – 4.33 x 10-2 min-1 respectively. A straight-line graph was obtained as a calibration curve of amoxicillin. UV absorption spectrum showed four distinctive peaks at 240, 275, 320, and 360 nm, with the maximum at 240 nm, while the percentage content of amoxicillin ranged from 90.58 ± 1.38 to 98.74 ± 0.97%. This result complied with the BP and USP specifications. Hence, there was a strong correlation between the release rate constant, k, and time since values were ≥ 0.8087 compared with the innovator and other brands.

Nucleoside-diphosphate kinase of uropathogenic Escherichia coli inhibits caspase-1-dependent pyroptosis facilitating urinary tract infection

Uropathogenic Escherichia coli (UPEC) is the most common causative agent of urinary tract infection (UTI). UPEC invades bladder epithelial cells (BECs) via fusiform vesicles, escapes into the cytosol, and establishes biofilm-like intracellular bacterial communities (IBCs). Nucleoside-diphosphate kinase (NDK) is secreted by pathogenic bacteria to enhance virulence. However, whether NDK is involved in UPEC pathogenesis remains unclear. Here, we find that the lack of ndk impairs the colonization of UPEC CFT073 in mouse bladders and kidneys owing to the impaired ability of UPEC to form IBCs. Furthermore, we demonstrate that NDK inhibits caspase-1-dependent pyroptosis by consuming extracellular ATP, preventing superficial BEC exfoliation, and promoting IBC formation. UPEC utilizes the reactive oxygen species (ROS) sensor OxyR to indirectly activate the regulator integration host factor, which then directly activates ndk expression in response to intracellular ROS. Here, we reveal a signaling transduction pathway that UPEC employs to inhibit superficial BEC exfoliation, thus facilitating acute UTI.

Antibiotic Duration and UTI Outcomes in Recurrent UTI Patients.

Little evidence is available to inform management of acute urinary tract infections (UTIs) in women with recurrent urinary tract infection (rUTI). This study aimed to compare the proportion of acute UTIs with persistence/relapse or recurrence based on duration of treatment antibiotics (acute UTI guideline-consistent versus extended). A retrospective noninferiority study of women with rUTI was performed at an academic tertiary referral center from January 2016 to December 2020. Exposure was UTI treatment with acute UTI guideline-consistent versus extended antibiotics. Outcomes were persistent/relapsed UTI (subsequent culture with the same pathogen requiring additional antibiotics within 4 weeks), recurrent UTI (culture with different pathogen), or resolution. Sample size was calculated under the null hypothesis that the proportion of acute UTIs with persistence/relapse or recurrence after acute UTI guideline-consistent antibiotics would be within a 10% noninferiority margin of extended duration (α = 0.05, β = 0.20, 2-sided tests, P < 0.05 significant). We included 219 patients with 553 acute UTIs. The mean ± SD number of UTIs per patient was 2.53 ± 1.88, the mean ± SD age was 68.60 ± 16.29 years, and the mean ± SD body mass index was 29.73 ± 7 (calculated as weight in kilograms divided by height in meters squared). There were no differences in prior surgical procedures postvoid residual volume, pelvic floor disorders, or preventive treatments between groups. Two-hundred sixty UTIs (260 of 553 [47%]) were treated with acute UTI guideline-consistent antibiotics. Overall, 86 of 553 UTIs (15.6%) persisted/relapsed, and 29 of 553 (5.2%) recurred. The difference in the proportions of UTIs with persistence/relapse or recurrence excluded the noninferiority margin (4.4%; 95% confidence interval, -0.04 to 6.80%). In total, 115 of 553 UTIs (20.8%) had persistence/relapse or recurrence. In this cohort of patients with rUTI experiencing acute UTIs, acute UTI guideline-consistent duration of antibiotics was noninferior.

Bioinspired Nanozymes as Nanodecoys for Urinary Tract Infection Treatment.

Urinary tract infections (UTIs), common bacterial infections in communities and medical facilities, are mainly mediated by FimH. The glycan sites of the uromodulin protein play a crucial role in protecting against UTIs by interacting with FimH. A bioinspired approach using glycan-FimH interactions may effectively reduce bacteria through an antiadhesive mechanism, thereby curbing bacterial resistance. However, typical antiadhesive therapy alone fails to address the excessive reactive oxygen species and inflammatory response during UTIs. To bridge this gap, antioxidant nanozymes with antiadhesive ability were developed as nanodecoys to counter bacteria and inflammation. Specifically, ultrasmall dextran-coated ceria (DEC) was engineered to address UTIs, with dextran blocking FimH adhesion and ceria exhibiting anti-inflammatory properties. DECs, metabolizable by the kidneys, reduced bacterial content in the urinary tract, mitigating inflammation and tissue damage. In murine models, DECs successfully treated acute UTIs, repeated infections, and catheter-related UTIs. This dual approach not only highlights the potential of nanozymes for UTIs but also suggests applicability to other FimH-induced infections in the lungs and bowels, marking a significant advancement in nanozyme-based clinical approaches.

Herbal Solutions for Urinary Tract Infections: A Literature Review

If treatment is not received, Urinary Tract Infections (UTIs), which are frequent microbial illnesses affecting the urinary system, can lead to discomfort and problems. Because they have antibacterial qualities and can potentially reduce UTI symptoms, natural treatments have been used. Supplements or juice made from cranberries are one popular natural treatment. Proanthocyanidins, which are found in cranberries, have the potential to inhibit bacteria, especially E. coli, from adhering to the lining of the urinary tract, hence decreasing the risk of infection. Its efficacy is still up for discussion, though, and certain drinks’ high sugar content may make UTI symptoms worse. D-mannose, a kind of sugar included in fruits like peaches and cranberries, is another commonly utilised treatment. D-mannose inhibits germs from sticking to the walls of the urinary system, in a manner akin to that of cranberries. It’s believed to be effective against E. coli, a common UTI-causing bacterium, but it’s ideal dosage and long-term effects require further research. Probiotics are thought to be helpful for UTIs, particularly those that contain lactobacilli strains. They may lessen the chance of infection by assisting in the maintenance of a balanced population of bacteria in the urinary tract and gut. There is, however, little data to support their direct influence on UTI treatment. Herbal treatments with possible antibacterial effects, such as buchu, goldenseal, and bearberry (uva-ursi), have been used historically. These herbs have ingredients that may aid in the battle against germs in the urinary system, but further research is needed to determine how safe and effective they are. Increasing water consumption is a simple yet effective treatment. Drinking enough water dilutes urine, which lowers the quantity of bacteria that could lead to an illness, and aids in the removal of bacteria from the urinary system. Even while these natural treatments seem promising for treating UTIs, it is important to see a doctor before using them, particularly if you think the illness may be serious. Certain medical issues may prevent the use of natural therapies, or they may interact negatively with medicines. When used as the only treatment for acute UTIs, they are frequently less successful than when used as preventative measures or in conjunction with traditional medicines. The main line of treatment for severe or persistent UTIs is still medical intervention with antibiotics to avoid complications and recurrent infections.

Snížená hladina magnezia v moči po ileokolické resekci u pacientů s Crohnovou chorobou

Summary: Introduction: Urinary excretion of magnesium is an important preventive factor against nephrolithiasis by inhibiting several key processes in its pathogenesis. Patients with Crohn’s disease (CD) have an approximately 2-fold higher risk of lithiasis, especially those after ileocolic (IC) resection. The aim is to determine the magnesuria level in these patients and compare it with patients with CD and IC involvement without resection and then both groups with healthy controls. The secondary objective was to assess calciuria and other modifying factors. Methods: CD patients aged 18 years or older with IC resection (group 1) and terminal ileal involvement without resection (group 2) were enrolled in the study, with subjects without known bowel disease as controls (group 3). Exclusion criteria were citrate therapy, severe renal insufficiency (GFR &lt; 30 ml/ min/ 1.73 m2), more than two bowel resections, ileostomy, colectomy, short bowel syndrome, acute urinary tract infection and evidence of CD relapse. Anamnestic data were collected by questionnaire, blood and fresh urine samples were collected, renal and gallbladder ultrasound was performed for the presence of lithiasis, and patients underwent 24-hour urine collection to determine oxaluria, citraturia, magnesuria and calciuria. Results: 107 subjects were included in the study, including 34 patients with IC resection, 42 with CD without resection and 31 healthy controls. 43% were women, mean age was 38 ± 11.5 years. There was a significant difference in magnesuria values between the resection and non-resection group (median 2.28 vs. 3.97 mmol/ l; P = 0.047) and especially between the resection group and healthy controls (median 2.28 vs. 4.31 mmol/ l; P = 0.0003). The group without resection vs. healthy controls did not reach a significant difference (median 3.97 vs. 4.31 mmol/ l; P = 0.455). Calciuria values did not differ significantly between groups (median 3.75 vs. 4.6 vs. 4.3 mmol/ l; P = 0.293). Conclusion: Magnesuria values of CD patients after IC resection were significantly lower compared to the group of CD patients with IC involvement without resection and healthy controls. The group without resection achieved results comparable to controls. Calciuria values were not significantly different between groups in our study. We hypothesize that patients with CD after IC resection at higher risk of urolithiasis might benefit from Mg supplementation to prevent concretion formation. However, confirmation of this thesis will require verification by further research. Key words: inflammatory bowel disease – Crohn’s disease – urolithiasis – magnesium – calcium oxalate

The relationship between urine heat shock protein 70 and congenital anomalies of the kidney and urinary tract: UTILISE study

BackgroundCongenital anomalies of the kidney and urinary tract (CAKUT) are defined as structural malformations of the kidney and/or urinary tract. Heat shock proteins (HSPs) are expressed in the kidney in response to cellular changes, such as thermal, hemodynamic, osmotic, inflammatory, and mechanical stresses. This study aimed to assess uHSP70 levels during acute urinary tract infections (UTI) and non-infection periods in patients with CAKUT, and to evaluate whether uHSP70 is elevated in CAKUT subtypes.MethodsAmong patients with CAKUT, 89 patients with UTI (CAKUT-A), 111 without UTI (CAKUT-B), and 74 healthy children were included in the study. uHSP70 levels were measured using enzyme-linked immunosorbent assay (ELISA).ResultsuHSP70 level was significantly higher in the CAKUT-A group than in the CAKUT-B and healthy control groups (p &amp;lt; 0.0001). Moreover, the level of uHSP70 was significantly higher in the CAKUT-B group than in the control group (p &amp;lt; 0.0001), but was not different between the CAKUT subtypes (p &amp;gt; 0.05).ConclusionUrine HSP70 can also be used to predict UTI in patients with CAKUT. Moreover, uHSP70 levels were higher in children with CAKUT during the non-infectious period than in healthy controls. This suggests that children with CAKUT are at risk of chronic non-infectious damage.

Uropathogenic Escherichia coli Subverts Host Autophagic Defenses by Stalling Preautophagosomal Structures to Escape Lysosome Exocytosis

Abstract Urinary tract infections are primarily caused by uropathogenic Escherichia coli (UPEC). UPEC infects bladder epithelial cells (BECs) via fusiform vesicles and escapes into the cytosol by disrupting fusiform vesicle membrane using outer membrane phospholipase PldA, and establishes biofilm-like intracellular bacterial communities (IBCs) for protection from host immune clearance. Cytosolic UPEC is captured by autophagy to form autophagosomes, then transported to lysosomes, triggering the spontaneous exocytosis of lysosomes. The mechanism by which UPEC evades autophagy to recognize and form IBCs remains unclear. Here, we demonstrate that by inhibiting autophagic flux, UPEC PldA reduces the lysosome exocytosis of BECs. By reducing intracellular phosphatidylinositol 3-phosphate levels, UPEC PldA increases the accumulation of NDP52 granules and decreases the targeting of NDP52 to autophagy, hence stalling preautophagosome structures. Thus, our results uncover a critical role for PldA to inhibit autophagic flux, favoring UPEC escapes from lysosome exocytosis, thereby contributing to acute urinary tract infection.

Factors allowing the management of patients with acute urinary tract infection in the short stay unit: a single-center retrospective study

Factors allowing the management of patients with acute urinary tract infection in the short stay unit: a single-center retrospective study

A Bird's-Eye View of the Pathophysiologic Role of the Human Urobiota in Health and Disease: Can We Modulate It?

For a long time, urine has been considered sterile in physiological conditions, thanks to the particular structure of the urinary tract and the production of uromodulin or Tamm-Horsfall protein (THP) by it. More recently, thanks to the development and use of new technologies, i.e., next-generation sequencing and expanded urine culture, the identification of a microbial community in the urine, the so-called urobiota, became possible. Major phyla detected in the urine are represented by Firmicutes, Bacteroidetes, Proteobacteria, and Actinobacteria. Particularly, the female urobiota is largely represented by Lactobacillus spp., which are very active against urinary pathogenic Escherichia (E.) coli (UPEC) strains via the generation of lactic acid and hydrogen peroxide. Gut dysbiosis accounts for recurrent urinary tract infections (UTIs), so-called gut-bladder axis syndrome with the formation of intracellular bacterial communities in the course of acute cystitis. However, other chronic urinary tract infections are caused by bacterial strains of intestinal derivation. Monomicrobial and polymicrobial infections account for the outcome of acute and chronic UTIs, even including prostatitis and chronic pelvic pain. E. coli isolates have been shown to be more invasive and resistant to antibiotics. Probiotics, fecal microbial transplantation, phage therapy, antimicrobial peptides, and immune-mediated therapies, even including vaccines for the treatment of UTIs, will be described.

Pathogenic Escherichia coli (E. coli) food borne outbreak: Detection methods and controlling measures

Food-borne illnesses and diseases are major threats to human health. Common food borne pathogens include bacteria such as Escherichia coli Serogroup (O157), Bacillus cereus, Clostridium botulinum, Campylobacter sp., C. perfringens, some Listeria monocytogenes, Salmonella spp., Shigella spp., Staphylococcus aureus, and Vibrio spp. etc. Pathogenic E. coli infection usually causes severe diarrhea. Escherichia coli is the most common cause of acute urinary tract infections as well as urinary tract sepsis. Diarrheagenic E. coli pathotypes can be passed in the feces of humans and other animals. Safeguarding public health during mass gatherings is a big challenge. Despite the recent advances in food preservation techniques and food safety, significant disease outbreaks linked to food borne pathogens such as bacteria, fungi, and viruses still occur worldwide indicating that these pathogens still constitute significant risks to public health. However, at present the conventional method for E. coli detection requires several days, especially in cases where E. coli concentrations are low. Enrichment is a commonly used method for bacterial isolation to increase the cell counts of target bacteria. However, traditional culturing method is also a slow and laborious process requiring a series of steps and may require the use of adjunct methods (e.g. biochemical, serological, nucleic acid-based methods for conclusive identification) and can take up to a week for bacteria. The culture-based approaches coupled with other methods such as PCR, immunoassays, bacteriophages, NGS, Biosensors, and MALDI TOF MS are increasingly being used for the detection and identification of food borne pathogens. Nucleic acid-based methods such as Real-Time PCR and vPCR combined with sequencing approaches are more widely used than immunoassay and NGS-based approaches for pathogen detection. Nanobiotechnology is the latest approach for the detection of pathogens. Bacteriophages are one such unique biological entity that showed excellent host selectivity and have been actively used as recognition probes for pathogen detection. Antibiotics are efficient, powerful, and the most commonly used treatment against pathogenic E. coli. Other ways to treat or prevent E. coli contamination, such as probiotics, antimicrobial nanoparticles, and radiation treatment had been reported.

Urinary tract infection in pediatric patients – Recent updates

In children, urinary tract infection (UTI) is a common condition. Prompt identification and treatment are critical for reducing morbidity associated with this illness. Throughout infancy, the symptoms and indications remain nonspecific. During the first 2 years of life, the most prevalent sign of UTI is unexplained fever. Symptoms and indicators of pyelonephritis after the 2nd year of life include fever, chills, rigor, flank discomfort, and costovertebral angle tenderness. Suprapubic pain, dysuria, urinary frequency, urgency, murky urine, malodourous urine, and suprapubic tenderness are examples of the lower tract symptoms and indicators. When UTI is suspected, a urinalysis and urine culture should be conducted. In the treatment of acute uncomplicated UTI, second or third-generation cephalosporin and amoxicillin-clavulanate are currently the medications of choice. Parenteral antibiotic therapy is advised for infants under 2 months of age and any child who seems toxic is hemodynamically unstable, is immunocompromised, is unable to tolerate, or is not responding to oral medication. This study focuses on the most recent updates about UTIs in children and provides a comprehensive overview of the subject.

Retracted: Changes in Serum CRP and PCT Levels in Patients with Acute Simple Lower Urinary Tract Infection and Evaluation of the Efficacy of Treatment with Shuangdong Capsules.

[This retracts the article DOI: 10.1155/2022/9750237.].

Bacterial Persistence in Urinary Tract Infection Among Postmenopausal Population.

Urinary tract infections (UTIs) are common in older-aged women. Our study examined bacterial persistence with commonly prescribed antibiotics. Bacterial growth was demonstrated despite antibiotic treatment. The aims of this study were to quantify the bacterial persister phenotype in urine collected from postmenopausal women with acute and recurrent UTI and to determine the capabilities of first-line antibiotics to effectively treat persister cells. This was an institutional review board-approved cross-sectional analysis within a large academic referral center. Uropathogens were cultured from postmenopausal women with acute or recurrent UTI and screened for persister cells using persistence assays. Demographic and clinical variables were collected and analyzed. The entire experimental process was repeated in triplicate. Data were analyzed for significance (P < 0.05) between the persister culture and antibiotic treatments using a 1-way analysis of variance with multiple comparisons in Prism 9.3.0. Forty participants were included: 62.5% White, 22.5% Black, 3% Asian, and 2% Hispanic with a mean age of 72.3 ± 11.62 years. The persister phenotype was demonstrated in all of Escherichia coli isolates. Treatment with fosfomycin demonstrated reduced colony-forming units per milliliter compared with control (P < 0.01). Among recurrent isolates, there was a statistically significant decrease in colony-forming units per milliliter after antibiotic treatment with all 4 antibiotics (P < 0.05). This study demonstrated in vitro bacterial persistence in uropathogens from urogynecology patients despite treatment with commonly prescribed antibiotics. Fosfomycin generated the least amount of persister cells. Results suggest that persistence may be one bacterial defense mechanism involved in UTIs. Further research is needed to understand the clinical implications.

Kidney pathology in liver cirrhosis

Objective. To analyze the structure and frequency of kidney pathology in liver cirrhosis according to sectional analysis and to study the relationship between acute renal injury and urinary tract infection.Materials and methods. The design of the study is mixed: descriptive and analytical, which included conducting a retrospective case–control study of kidney pathology based on the results of the protocols of pathoanatomical autopsies on the basis of the state healthcare institution “Gomel Regional Clinical Pathoanatomical Bureau” for the period of January 2022 – July 2023 and clinical, laboratory, instrumental, cytological, microbiological data of patients with liver cirrhosis. The study included 98 deceased patients, including 70 (71.4%) men, 28 (28.6%) women. The average age was 53.9 years, the majority of patients were persons of working age — 72.9% of men and 60.7% of women, 21.4% were young people.Results. The most common kidney pathology in liver cirrhosis according to sectional analysis is acute renal injury (57.1%). Kidney abscesses (3%), tubulointerstitial nephritis (2%) and pyelonephritis (4%) were less frequently diagnosed. Despite the absence of a history of kidney diseases in most patients with cirrhosis, classical clinical, laboratory and instrumental signs of renal tissue damage, macroscopic and microscopic changes of the kidneys were revealed in 100% of cases at autopsy. In 84.7% of cases, acute tubular necrosis was morphologically diagnosed from focal (51%) to total (19.4%), which was not always accompanied by an increase in serum creatinine levels. A moderate relationship was established between acute kidney injury and urinary tract infection (OR = 14; 95 % CI 11.13–16.61).Conclusion. The most common complication of liver cirrhosis associated with an unfavorable prognosis is acute renal injury, which is associated with the presence of urinary tract infection.

Meta-analysis of perioperative outcomes and safety of percutaneous nephrostomy versus retrograde ureteral stenting in the treatment of acute obstructive upper urinary tract infection.

The debate regarding the optimal drainage method for acute obstructive upper urinary tract infection persists, focusing on the choice between percutaneous nephrostomy (PCN) and retrograde ureteral stenting (RUS). This study aims to systematically examine the perioperative outcomes and safety associated with PCN and RUS in treating acute obstructive upper urinary tract infections. A comprehensive investigation was conducted using the Medline, Embase, Web of Science, and Cochrane databases up to December 2022, following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The utilized keywords included 'PCN', 'RUS', 'acute upper obstructive uropathy', and 'RCT'. Inclusion criteria encompassed studies providing accurate and analyzable data, which incorporated the total subject count, perioperative outcomes, and complication rates. The assessed perioperative outcomes included fluoroscopy time, normalization of temperature, normalization of serum creatinine, normalization of white blood cell (WBC) count, and operative time. Safety outcomes encompassed failure rate, intraoperative and postoperative hematuria, postoperative fever, postoperative pain, and postoperative nephrostomy tube or stent slippage rate. The study protocol was prospectively registered at PROSPERO (CRD42022352474). The meta-analysis encompassed 7 trials involving 727 patients, with 412 assigned to the PCN group and 315 to the RUS group. The outcome of the meta-analysis unveiled a reduced occurrence of postoperative hematuria in the PCN group [odds ratio (OR) = 0.54, 95% confidence interval (CI) 0.30-0.99, p = 0.04], along with a decreased frequency of insertion failure (OR = 0.42, 95% CI 0.21-0.81, p = 0.01). In addition, the RUS group exhibited a shorter fluoroscopy time than the PCN group (mean difference = 0.31, 95% CI 0.14-0.48, p = 0.0004). Given the significant impact of hematuria and catheterization failure on postoperative quality of life, the preference for PCN appears more advantageous than RUS.

JUSTIFICATION OF NITROXOLINE APPLICATION IN CONDITIONS OF GROWTH OF RESISTANCE OF UROPATHOGENES TO NEW GENERATIONS OF ANTIMICROBATES

Nitroxoline is a synthetic uroantiseptic, effective against a wide range of gram-positive, gram-negative bacteria and fungi. For a long time it has been used for the treatment and prevention of acute, chronic and recurrent urinary tract infections, because to this day retains high activity against bacteria of the family Enterobacteriaceae. With increasing resistance of uropathogens to new antimicrobial drugs, Nitroxoline may be an alternative drug for the treatment of acute uncomplicated urinary tract infections. The results of scientific research on the importance of Nitroxoline as a first-line drug in the treatment of this nosological group of diseases are contradictory. This motivates the study and analysis of the professional literature in the direction of clinical efficacy and determining the place of Nitroxoline among other uroseptics in the treatment of urinary tract infections in today's conditions.

Urinary tract infection triggering hypercalcemic crisis in an asymptomatic patient with primary hyperparathyroidism

Hypercalcemic crisis (HC) is a rare and severe complication of primary hyperparathyroidism (PHPT), characterized by markedly elevated serum calcium levels and diverse clinical manifestations. PHPT is the primary cause of hypercalcemia and is often asymptomatic. The factors that trigger HC in PHPT are not fully understood. Here we report a patient who was diagnosed with HC resulting from previously undetected PHPT. Remarkably, the patient exhibited no symptoms of PHPT before the HC episode. The patient presented with neurological symptoms, including altered behavior and slurred speech, which were attributed to hypercalcemia. The probable trigger for HC in this case appears to be an acute febrile illness related to a urinary tract infection (UTI). The occurrence of an acute febrile illness or UTI as a precipitating factor for HC in PHPT is a rare and infrequently documented phenomenon in the existing medical literature.