Etiology Of Urinary Tract Infections Research Articles

Evaluation of the utility of video-urodynamics in children with urinary tract infection and voiding dysfunction.

To assess the use of video-urodynamic studies (VUDS) in children with urinary tract infection (UTI) and symptoms of voiding dysfunction (frequency, urgency, incontinence), to ascertain whether VUDS significantly assists in diagnosis and deciding treatment. Over a 16-month period, all children seen at our centre with a UTI in conjunction with previous symptoms suggestive of voiding dysfunction underwent free and pressure-flow VUDS. Forty-two children underwent VUDS and 38 (mean age 9 years, range 4-16, 15 male, 23 female) had sufficient information to be included in the study. All children had a prior history of voiding dysfunction (mean 55 months). Only five patients were found to have reflux and three of these had associated detrusor instability. In addition, 24 of 33 patients who did not have reflux had abnormalities on urodynamic study, the most common problem being detrusor instability in 17 of 24 patients. Other abnormalities included sphincter dyssynergia (five patients), poor bladder compliance (two) and hypersensitivity on bladder filling (three). VUDS can provide information about the aetiology of UTI and voiding dysfunction in children that cannot be obtained from any other source. The results of VUDS can be used to select specific treatments, to avoid inappropriate therapy and to identify children who may benefit from follow-up studies despite normal findings on voiding cystourethrography. From these results, we believe that VUDS should be considered for children with UTI and voiding dysfunction.

Changing trends in frequency and antimicrobial resistance of urinary pathogens in outpatient clinics and a hospital in Southern Israel, 1991-1995.

In order to monitor changes in the frequency and antimicrobial resistance of urinary pathogens over several years, urinary cultures received from outpatient clinics and from a hospital during a period of one month each in 1991 and 1995 were analyzed at a clinical microbiology laboratory. In 1991 and 1995, 1366 and 1534 significant monomicrobic cultures respectively were reviewed. The frequency of Escherichia coli dropped significantly in the outpatient clinics from 70.5% to 61.2% (p < 0.0001). The frequency of Proteus mirabilis, Morganella morganii, Pseudomonas aeruginosa and other gram-negative bacteria also decreased, but the frequency of Klebsiella spp. and Enterobacter spp. increased from 2.6% to 5.8% (p < 0.0001). In the hospital, the frequency of Enterobacter spp. (p < 0.04), Escherichia coli and Morganella morganii declined from 1991 to 1995, whereas the frequency of Pseudomonas aeruginosa (p = 0.001), Acinetobacter spp. (p < 0.05), Klebsiella spp., Proteus mirabilis and other gram-negative rods increased considerably. The frequency of gram-positive aerobic bacteria rose markedly in outpatient specimens from 6.1% to 13.5% (p < 0.0001), while a decline from 14.4% to 9.3% was noted in hospital specimens (p < 0.02). A significant rise in the resistance of Escherichia coli to gentamicin and ciprofloxacin (p < 0.0001) was detected in outpatient isolates. In the hospital, gram-negative urinary pathogens demonstrated increased resistance to ampicillin (p = 0.042), cefuroxime (p = 0.005), gentamicin (p = 0.002) and ciprofloxacin (p < 0.0001) during the study period. The changing etiology of urinary tract infections and the increasing resistance of organisms indicate that periodic monitoring and possibly also modification of empirical therapy are required.

Virulence of enterococci in experimental pyelonephritis

Enterococci are well established in the aetiology of urinary tract infection and pyelonephritis. Little is known, however, of the relative virulence of the species of bacteria in this group. The virulence of group D streptococci was examined by determining the bacterial counts per gram of infected kidney after the intravenous injection of 1×109 bacteria. The descending order of virulence for the strains was S. faecalis var. zymogenes and S. faecalis var. liquefaciens, S. faecium, and S. durans.

Clinical observations relating to incidence and aetiology of urinary-tract infections in children.

Observations have been made on 350 children with urinary tract infections, all having significant pyuria and bacilluria and some also with radiological or histological evidence of pyelo nephritis. Of these, 193 were seen at a urological clinic for children held in the Royal Victoria Infirmary, a teaching hos pital in Newcastle upon Tyne, and 157 at Dryburn, a non teaching hospital in Durham. The experiences at the two hospitals differed. Cases were selected in both, but in different ways, those at the teaching hospital being mainly referred by paediatricians because of suspected or revealed abnormalities in the renal tract, while those at the peripheral hospital were referred by family doctors. Certainly the cases seen at the teaching hospital were more severe, with frequent abnormalities, and were both more difficult to control and more liable to relapse.

Bacteria Involved in Etiology of Urinary Tract Infections

Bacteria Involved in Etiology of Urinary Tract Infections