Antibiotics For 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.

Safety, pharmacokinetics, and food-effect of pivmecillinam after single- and multiple-dose in healthy Chinese subjects: a phase I study.

Urinary tract infection (UTI) is one of the most prevalent bacterial infectious diseases worldwide. However, the resistance of urinary pathogens to other UTI antibiotics such as trimethoprim and trimethoprim/sulphamethoxazole increased. Pivmecillinam is a prodrug of mecillinam, which is effective for the treatment of urinary tract infections. The purpose of this study was to assess the safety, and pharmacokinetics of pivmecillinam and mecillinam after single- and multiple-dose oral administration of pivmecillinam tablets in healthy Chinese subjects. The study also investigated the profile of urinary excretion of mecillinam, as well as the effect of food and gender on the pharmacokinetics of pivmecillinam and mecillinam. This study was a single-center, open-label phase I study carried out in three groups. In total, 34 subjects were included in the study: group 1-food effect study with pivmecillinam 200mg (n = 12); group 2-single- and multiple-dose study with pivmecillinam 400mg (n = 12); group 3-single dose study with pivmecillinam 600mg (n = 10). The plasma and urine concentrations of pivmecillinam and mecillinam were measured, and their pharmacokinetics were calculated. Treatment-emergent adverse events were evaluated and recorded in safety assessments for three groups. No severe adverse events were found in this study. After a single dose of pivmecillinam was taken orally, the maximum plasma concentration (Cmax) and the area under the concentration-time curve (AUC) of pivmecillinam increased in a dose-proportional manner, nor did mecillinam. Food had significant effects on Cmax and AUC0-t of pivmecillinam and Cmax of mecillinam. The mean cumulative percentage of urine excretion of mecillinam at 0 to 24h ranged from 35.5 to 44.0%. Urinary cumulative excretion is relative to the drug dose, but the diet and multiple-dose administration did not affect the urinary cumulative excretion rate. The safety and pharmacokinetics of pivmecillinam and mecillinam after single- (200/400/600mg) or multiple-dose (400mg) administration were demonstrated in healthy Chinese subjects. Food affected the pharmacokinetics of pivmecillinam and mecillinam.

Antibiotic Overtreatment of Presumed Urinary Tract Infection among Children with Spina Bifida

To identify factors associated with overtreatment of presumed urinary tract infection (UTI) among children with spina bifida using such criteria. A retrospective review of children with spina bifida (age < 21 years) evaluated in the Emergency Department (ED) at a single institution was performed. Patients with a urinalysis (UA) performed who were reliant on assisted bladder emptying were included. The primary outcome was overtreatment, defined as receiving antibiotics for presumed UTI but ultimately not meeting spina bifida UTI criteria (≥ 2 urologic symptoms plus pyuria and urine culture growing >100k CFU/mL). The primary exposure was whether the components of the criteria available at the time of the ED visit (≥ 2 urologic symptoms plus pyuria) were met when antibiotics were initiated. Among 236 ED encounters, overtreatment occurred in 80% of cases in which antibiotics were initiated (47% of the entire cohort). Pyuria with <2 urologic symptoms was the most important factor associated with overtreatment (OR 9.6). Non-Hispanic White race was associated with decreased odds of overtreatment (OR 0.3). Overtreatment of presumed UTI among patients with spina bifida was common. Pyuria, which is not specific to UTI in this population, was the main driver of overtreatment. Symptoms are a cornerstone of UTI diagnosis among children with spina bifida, should be collected in a standardized manner, and considered in a decision to treat.

Intravenous antibiotics for urinary tract infections in children with neurologic impairment.

Children with high-intensity neurologic impairment (HINI) have an increased risk of urinary tract infection (UTI) and prolonged intravenous (IV) antibiotic exposure. To determine the association between short (≤3 days) and long (>3 days) IV antibiotic courses and UTI treatment failure in hospitalized children with HINI. We performed a retrospective cohort study examining UTI hospitalizations at 49 hospitals in the Pediatric Health Information System from 2016 to 2021 for children (1-18 years) with HINI. The primary outcome was UTI readmission within 30 days. Our secondary outcome was the association of hospital-level variation in short IV antibiotic course use with readmission. Readmission rates were compared between short and long courses using multivariable regression. Of 5612 hospitalizations, 3840 (68.4%) had short IV antibiotic courses. In our adjusted model, children with short IV courses were less likely than with long courses to have a 30-day UTI readmission (4.0%, 95% CI [3.6%, 4.5%] vs. 6.3%, 95% CI [5.1%, 7.8%]). Despite marked hospital-level variation in short IV course use (50.0%-87.5% of hospitalizations), there was no correlation with readmissions. Children with HINI hospitalized with UTI had low UTI readmission rates, but those who received long IV antibiotic courses were more likely to experience UTI readmission versus those receiving short courses. While residual confounding may influence our results, we did not find that short IV courses impacted readmission at the hospital level despite variation in use across institutions. Long IV antibiotic courses are associated with risks and may not confer benefit in this population.

Effect of methenamine hippurate shortage on antibiotic prescribing for urinary tract infections in Norway-an interrupted time series analysis.

Despite a lack of conclusive evidence of effect, methenamine hippurate is widely prescribed as preventive treatment for recurrent urinary tract infections (UTIs) in Norway. A national discontinuation of methenamine hippurate treatment due to a 4-month drug shortage in 2019 presented an opportunity to evaluate its preventive effect on UTIs among regular users. To estimate the impact of the methenamine hippurate drug shortage on prescription frequency of UTI antibiotics. Data from The Norwegian Prescription Database was analysed using an interrupted time series design. The time series consisted of 56 time periods of 14 days. The model included two naturally occurring interruptions: (i) the methenamine hippurate drug shortage, and (ii) reintroduction of the drug. The study population were 18 345 women ≥50 years receiving ≥2 prescriptions of methenamine hippurate in the study period before the shortage. Main outcome measure was number of prescriptions of UTI antibiotics per 1000 methenamine hippurate users. Prescription rates of antibiotics for respiratory tract infections were analysed to assess external events affecting antibiotic prescribing patterns. We found a significant increase of 2.41 prescriptions per 1000 methenamine hippurate users per 14-day period during the drug shortage (95%CI 1.39, 3.43, P < 0.001), followed by a significant reduction of -2.64 prescriptions after reintroduction (95%CI -3.66, -1.63, P < 0.001). During the methenamine hippurate drug shortage, we found a significant increase in prescribing trend for UTI antibiotics followed by a significant decrease in prescribing trend after reintroduction. This change in trend seems to reflect a preventive effect of the drug on recurrent UTIs.

Genotypic Detection of Carbapenems Resistance Genes in Acinetobacter baumannii Isolated from Urinary Tract Infection Patients

Acinetobacter baumannii is a Gram-negative bacterium characterized by its short, round, rod-shaped morphology. It is an opportunistic pathogen that poses a significant threat, particularly to immunocompromised patients, often those with hospital stays lasting less than 90 days. Between June 2022 and July 2023, 214 urine samples were collected from individuals suspected of having urinary tract infections (UTIs). These samples were subjected to antibiotic resistance testing, focusing on detecting specific genes related to carbapenem resistance, namely blaNDM, blaKPC, and blaVIM.The study's results revealed a notable trend in antibiotic resistance among the bacterial isolates. Ceftazidime, cefotaxime, and ceftriaxone, commonly used antibiotics for UTIs, showed a high resistance rate among the tested isolates. This resistance highlights the challenges healthcare professionals face when treating UTIs caused by Acinetobacter baumannii. On the other hand, the isolates displayed a comparatively lower resistance rate to imipenem and meropenem, two necessary carbapenem antibiotics. This lower resistance to carbapenems is encouraging as these drugs are often considered the last line of defense against multidrug-resistant bacterial infections. The presence of carbapenem resistance genes, such as blaNDM, blaKPC, and blaVIM, in the Acinetobacter baumannii isolates is of particular concern. These genes confer resistance to carbapenem antibiotics, crucial for treating severe infections caused by multidrug-resistant bacteria. In conclusion, the study aims to study the growth of antibiotic resistance in Acinetobacter baumannii, especially in urinary tract infections in immunocompromised patients with more extended hospital stays. It also highlights the need for Surveys and periodic examinations to detect the spread of bacteria and their resistance. Keywords: Carbapenems, UTI, genes, blaNDM, blaKPC, and blaVIM.

Genotypic Detection of Carbapenems Resistance Genes in Acinetobacter baumannii Isolated from Urinary Tract Infection Patients

Acinetobacter baumannii is a Gram-negative bacterium characterized by its short, round, rod-shaped morphology. It is an opportunistic pathogen that poses a significant threat, particularly to immunocompromised patients, often those with hospital stays lasting less than 90 days. Between June 2022 and July 2023, 214 urine samples were collected from individuals suspected of having urinary tract infections (UTIs). These samples were subjected to antibiotic resistance testing, focusing on detecting specific genes related to carbapenem resistance, namely blaNDM, blaKPC, and blaVIM.The study's results revealed a notable trend in antibiotic resistance among the bacterial isolates. Ceftazidime, cefotaxime, and ceftriaxone, commonly used antibiotics for UTIs, showed a high resistance rate among the tested isolates. This resistance highlights the challenges healthcare professionals face when treating UTIs caused by Acinetobacter baumannii. On the other hand, the isolates displayed a comparatively lower resistance rate to imipenem and meropenem, two necessary carbapenem antibiotics. This lower resistance to carbapenems is encouraging as these drugs are often considered the last line of defense against multidrug-resistant bacterial infections. The presence of carbapenem resistance genes, such as blaNDM, blaKPC, and blaVIM, in the Acinetobacter baumannii isolates is of particular concern. These genes confer resistance to carbapenem antibiotics, crucial for treating severe infections caused by multidrug-resistant bacteria. In conclusion, the study aims to study the growth of antibiotic resistance in Acinetobacter baumannii, especially in urinary tract infections in immunocompromised patients with more extended hospital stays. It also highlights the need for Surveys and periodic examinations to detect the spread of bacteria and their resistance. Keywords: Carbapenems, UTI, genes, blaNDM, blaKPC, and blaVIM.

Pathogens Causing Pediatric Community Acquired Urinary Tract Infections and Their Increasing Antimicrobial Resistance: A Nationwide Study.

Urinary tract infections (UTIs) in childhood are common and are associated with considerable acute morbidity and long-term complications. The need for updated data to optimize empiric antibiotic therapy is crucial. We aimed to investigate the pathogens causing pediatric community acquired UTIs, their correlation with demographic characteristics, and trends in their antimicrobial resistance. This nationwide cross-sectional study included all 53,203 children (<18 years) diagnosed with UTI in community outpatient clinics in the following selected years: 2007, 2011, 2015, 2019 and 2021. Escherichia coli (E. coli) (82.1%) was the most common uropathogen, followed by Enterobacter, Klebsiella, Proteus, Pseudomonas, and Enterococcus species. The bacterial distribution displayed statistically significant (p < 0.0001) gender- and sector-specific patterns with a higher relative prevalence of non-E. coli UTI in Jewish and males. The rate of extended-spectrum beta-lactamase-positive E. coli increased substantially and significantly (p < 0.001) from only 6.1% in 2007 to 25.4% in 2021. Most non-E. coli uropathogens exhibited resistance to commonly used empiric antibiotics for UTIs in children. These findings are significant in guiding optimal empiric antibiotic treatment for pediatric community acquired UTIs. The resistance of uropathogens to antimicrobials is region- and time-dependent. Therefore, the periodic and local assessment of antibiotic resistance trends is essential to update guidelines and provide the most appropriate antibacterial therapy for children with UTIs.

High Fosfomycin Susceptibility in Escherichia Coli Recovered from Urine in Brazil

Urinary Tract Infections (UTIs) are widespread globally, with a notably higher incidence in women. In 2018, the European Medicines Agency (EMA) endorsed the use of fluoroquinolones for uncomplicated UTI treatment. Following this recommendation, several international agencies adopted similar guidelines. Consequently, older antimicrobial agents like fosfomycin emerged as primary treatment options for UTIs. In this context, our study aimed to evaluate the susceptibility of Escherichia coli strains from urine samples to various recommended UTI antibiotics. These strains were collected between January 2017 and July 2020 in São Paulo, Brazil. We utilized the disk-diffusion method for antimicrobial susceptibility testing, interpreting the results according to BRCAST/EUCAST guidelines. Out of the 86,957 urine cultures undertaken during this timeframe, 10,041 yielded E. coli isolates. Of these, 8,655 were tested against fosfomycin, with 99.0% (8,572 strains) found to be susceptible. Additionally, susceptibility rates for other drugs were as follows: nitrofurantoin (95.8%), amoxicillin/clavulanic acid (83.9%), ciprofloxacin (65.1%), norfloxacin (65.6%), and levofloxacin (67.7%). Notably, of the 571 ESBL-positive strains, 94.0% were susceptible to fosfomycin. It’s important to mention a slight decline in fosfomycin susceptibility observed during this period. This finding underscores the importance of continuous monitoring for fosfomycin resistance and rational usage of the drug.

Uropathogenic distribution and antibiotic resistance patterns according to multidrug-resistant bacteria colonization status in patients with stroke.

Urinary tract infections (UTI) are common in patients with stroke. The colonization of multidrug-resistant organisms (MDR) has recently become a global issue, and infection with MDR is associated with a poorer prognosis. This study aimed to investigate the uropathogenic distribution in stroke patients according to MDR colonization and investigate the infection risk and antibiotic resistance of each uropathogen to help determine initial antibiotic treatment. This study is a retrospective study conducted on patients who underwent inpatient treatment for stroke at Kosin University Gospel Hospital in 2019 to 2021. The participants were classified into Group VRE if vancomycin-resistant Enterococcus (VRE) colonization was confirmed, Group CRE if carbapenem-resistant Enterobacteriaceae (CRE) colonization was confirmed, and Group Negative if no MDR colonization was confirmed. Urine culture was performed if symptomatic UTI was suspected. Uropathogenic distribution, antibiotic resistance patterns were assessed by one-way analysis of variance, independent t-test, and Pearson chi-square test. And the infection risk factors for each uropathogen were assessed by multinomial logistic regression analysis. Six hundred thirty-three participants were enrolled. The mean age of all participants was 69.77 ± 14.91, with 305 males and 328 females, including 344 hemorrhagic strokes and 289 ischemic strokes. No growth in urine culture was the most common finding (n = 281), followed by Escherichia coli (E.coli) (n = 141), and Enterococcus spp. (n = 80). Group Negative had significantly more cases of no growth in urine culture than Group VRE (Odds ratio [OR], 11.698; 95% confidence interval [CI], 3.566-38.375; P < .001) and than Group CRE (OR, 11.381; 95% CI, 2.665-48.611; P < .001). Group VRE had significantly more E.coli (OR, 2.905; 95% CI, 1.505-5.618; P = .001), and more Enterococcus (OR, 4.550; 95% CI, 2.253-9.187; P < .001) than Group Negative. There was no statistical difference in antibiotic resistance according to MDR colonization in E coli, but for Enterococcus spp., Group VRE and CRE showed significantly more resistance to numerous antibiotics than Group Negative. MDR colonization increases the risk of UTI and is associated with greater antibiotic resistance. For appropriate administration of antibiotics in UTI, continuous monitoring of the latest trends in uropathogenic distribution is required, and clinicians should pay more attention to the use of initial empirical antibiotics in patients with MDR colonization.

1853 Improving treatment for urinary tract infections for older adults in the Health and Ageing Unit

Abstract Introduction A suspected urinary tract infection (UTI) is the most common reason to prescribe antibiotics in a frail older patient. Therefore, correct recognition and documentation of UTIs, as well prescribing of antibiotics, is important for optimising patient care. Methods We reviewed UTI antibiotic prescribing practice across the Health and Ageing Unit (HAU) wards at Kings College Hospital over a two-month period. Weekly data we collected from all patients commenced on antibiotics for a suspected UTI highlighted key areas for improvement. We designed and delivered a multifaceted educational intervention to all healthcare professionals caring for older adults across the HAU. This consisted of teaching sessions, distribution of posters, and board round reminders. Results A further two months of data post-intervention showed improvements in several outcomes. Correct prescribing rose from 61% to 93%. The number of prescriptions with stop dates went up from 50% to 68%. The number of patients with urine samples processed in the laboratory rose from 64% to 93%. We also saw an improvement in the management of patients with catheter associated UTIs. Conclusions A multidisciplinary team intervention of teaching and visual cues improved the management of UTIs. This shows the power of multifaceted educational interventions for improving the care of older adults.

Diagnostic validation study of rapid urinary tract infection diagnosis kit at peripheral health facilities of West Bengal, India

Patients reporting to the outpatient departments of peripheral health care settings in India with symptoms of urinary tract infection (UTI) receive one or the other antibiotic before culture confirmation and out of the total culture confirmed UTI cases, in less than one third cases the prescribed antibiotics matches to the antibiotic sensitivity test result. Hence, in this study, an indigenous point-of-care (POCT) rapid diagnostic kit (Rapidogram) for UTI was validated against conventional urine culture and sensitivity to understand its possible applicability at peripheral health care settings. This cross-sectional study was conducted during November 2021 to June 2022 in OPDs of two peripheral hospitals. A sample size of 300 was calculated using prevalence of urinary tract infection (UTI) as 33% for sensitivity and specificity using Buderer’s formula. Urine specimens were collected following standard aseptic procedures from the recruited suspected UTI cases and transferred to laboratory maintaining the cold chain. The validation work up was done in two sections: lab validation and field validation. Out of 300 urine samples, 29 were found positive for the growth of UTI pathogen by both methods and 267 were found negative by both methods. Thus, the kit shows very high specificity (99.6%; 97.9–99.9%) and considerably high sensitivity (90.6%; 74.9–98.0%). We also observed higher PPV, NPV, test accuracy (> 96%). Diagnostic Odds Ratio and Youden index were respectively 2581 and 0.89. Clinical data showed that 44% of the suspected UTI cases were prescribed at least one antibiotic before urine test. Mostly they received Norfloxacin whereas the mostly identified organism E.coli was sensitive to Nitrofurantoin. In the context of absence of microbiology facility at peripheral setting and rampant empirical use of antibiotics in UTI, this highly specific and sensitive POCT for UTI may be used as it not only identifies the organism, also shows the antibiotic sensitivity pattern.

A comparative study of resistance to multiple antibiotics in urinary tract infection among diabetic versus non-diabetic patients in a tertiary care hospital

Background: Tract infection (UTI) is a prevalent disease encountered in clinical practice, with increased prevalence in diabetic patients across all age groups. Left untreated, UTIs can lead to significant morbidity. Antibiotic resistance poses a significant challenge to managing this infection. This study aims to determine and compare the resistance patterns to multiple antibiotics used in treating UTI between diabetic and non-diabetic patients, addressing the existing gap in available data. Aims and Objectives: The primary objective of the study was to compare the resistance patterns to multiple antibiotics used in UTIs among diabetic and non-diabetic patients. The secondary objective was to assess the most common organism causing UTI. Materials and Methods: An observational study at K R Hospital of Mysore Medical College included 120 UTI-diagnosed patients. Diabetes history was confirmed through blood reports, and urine cultures were analyzed to identify UTI-causing organisms and assess sensitivity patterns. Results: The most common organism causing UTIs was found to be Escherichia coli in both groups (50% in diabetics, 43.33% in non-diabetics). Following this, in diabetics, Acinetobacter accounted for 18.33% and Klebsiella for 15%, while in non-diabetics, Acinetobacter was present in 15% and Pseudomonas in 12%. Imipenem showed the highest sensitivity (46.66% in diabetics, 43.33% in non-diabetics). Subsequently, nitrofurantoin and cotrimoxazole each displayed a sensitivity of 20% in diabetics. In nondiabetics, norfloxacin (31.66%), amikacin (20%), and gentamicin (20%) exhibited sensitivity. There was notably high resistance to ciprofloxacin (98.33% in diabetics, 78.33% in non-diabetics), followed by resistance to norfloxacin (91.66%) and ampicillin (66.66%) in diabetics, and 55% resistance to both nitrofurantoin and norfloxacin in non-diabetics. Diabetic patients showed a statistically significant reduction in susceptibility, particularly to norfloxacin, ciprofloxacin, gentamicin, cefotaxime, and ampicillin. In the study group, 100% of diabetic patients and 81.66% of non-diabetic patients exhibited resistance to three or more antimicrobial agents. Conclusion: Diabetic patients showed a significant decrease in sensitivity to fluoroquinolones, aminoglycosides, and beta-lactam drugs, highlighting the need for cautious use of higher antibiotics. Both groups exhibited an increased frequency of multidrug-resistant strains, emphasizing the importance of obtaining culture sensitivity reports prior to treatment initiation.

Prescription pattern of antibiotics in urinary tract infection based on antimicrobial susceptibility test at a tertiary care hospital

Introduction: Urinary tract infection is a common bacterial infection associated with significant morbidity, mortality, and financial burden. This study aimed to identify the causative bacteria, assess their antimicrobial susceptibility patterns and evaluate empirical and definitive antibiotic therapy for urinary tract infection. Methods: A hospital-based crosssectional study was conducted at the outpatient medicine department at a teaching hospital in Nepal from February 15 to July 14, 2022. Two hundred participants with positive urine cultures and antimicrobial susceptibility testing were included. The microorganism causing urinary tract infection and prescription pattern of antibiotics pre-and post-AST report were analyzed. Results: The majority of isolated pathogens were gram-negative bacteria (73%), with Escherichia coli being the most common (53.5%), followed by Staphylococcus aureus among gram-positive bacteria (14.5%). Female patients had a higher incidence of urinary tract infection (59.5%) than males (40.5%). The age group above 60 years had the highest occurrence (34%). Antibiotic susceptibility testing revealed that Escherechia coli exhibited higher sensitivity to nitrofurantoin, amikacin, and meropenem, while resistance was observed against ampicillin, cefixime, and norfloxacin. Empirical antibiotics were commonly prescribed, with levofloxacin and ceftriaxone being the most frequent choices. After antibiotic susceptibility testing, nitrofurantoin and levofloxacin were frequently prescribed. Conclusions: This study provides valuable insights into the etiology of urinary tract infection and antibiotic susceptibility patterns, aiding in selecting appropriate antimicrobial therapy based on local resistance patterns.

The Most Prescribed Antibiotics for Urinary Tract Infections in Pregnant Women in Nasiriya City- South of Iraq

Antibiotics are chemicals or natural compounds that act by fighting various types of bacterial infections including urinary tract infection in pregnant women which is considered the most vulnerable patients to such infection due to several factors which may be hormonal , anatomical etc. The aim of this recent study is to confirm a pattern of antibiotic selection used for urinary tract infection in pregnant women in Nasiriya city- South of Iraq. Ninety pharmacies were asked about the antibiotics prescribed for their patients, the doses, dosage form, dose frequency, concomitant drugs (aim from administration of these drugs with antibiotics) and adverse effect. The study period was extended from January2022 till August 2022. From this study , the most dispensed antibiotics ware Cefexime 35.5% in a dose 400 mg capsule every twelve hours and the most frequently prescribed dosage form according to the physicians feedback and the analysis of the data was displayed the oral administration either (tablets or capsules) and it is less commonly prescribed are paraenteral antibiotics . In this work cefixime was the most dispended with a percent (35.5) cefixime may be due to it because there is more prescription due to safety during pregnancy , also it available in pharmacies

Exploring treatment burden of Oral Nutritional Supplements (ONS) and impact on antibiotics using a data linkage approach

Abstract Introduction Treatment burden associated with thickeners is significant1. Understanding of potential treatment burden associated with ONS is lacking, however wastage due to ONS partial or full nonconsumption, and stock piling are recognised2. Wastage is evidence of over prescribing. Improving fluid intake by increasing variety is evidence based3 - ONS reduces opportunity. Whether thickener or ONS is prescribed, patients can withdraw consent by not drinking (verbally/silently). We investigated a potential correlation between ONS and low intake dehydration, and if detectable using a proxy measure: antibiotic prescribing for urinary tract infection (UTI). We explored using ePACT2 data to investigate co-prescribing of interventions that inter-relate, a type of data linkage study. Improved fluid intake can decrease laxative use, but did not reduce antibiotic use3. We hypothesized that with a large data set, it may be possible to detect associations of treatment burden and antibiotic use. Aim To explore the relationship between prescribing of ONS with antibiotics for UTIs in older adults in Primary Care (England). Methods We investigated co-prescribing of antibiotics prescribed for UTI (nitrofurantoin, trimethoprim) and ONS in older adults (&amp;gt; 65 years) in Primary Care. Data was obtained from the NHS Business Services Authority Data Services Support as bespoke analysis of prescribing ePACT2 data linked by NHS number. Retrospective analysis was performed on anonymised data for 3 years (January 2019 to December 2022). Ethical approval was not required. Data unattributable to a specific region was excluded. Results Initial analysis suggested that prescribing of UTI antibiotics was 3 times more common in older adults prescribed ONS compared with controls (an average 2.86% of the patients on GP list were prescribed an antibiotic for a UTI, increasing to 8.59% for those co-prescribed ONS). This correlation appeared consistent, however, due to high volume and level of detail of UTI antibiotic prescribing, this interpretation is incorrect. On further analysis, the population rate of UTI antibiotic and ONS was plotted to show trend over time, demonstrating no correlation. Prescription of UTI antibiotic over time is consistent, reflecting that acute lower UTI is not very reducible, and antibiotic prophylaxis use is common and repeated monthly. Additionally, from this data set you cannot ascertain if frequency of antibiotic prescription(s) pre-dates initiation of ONS. We did not investigate confounding factors such as co-prescribing of catheter use, gender, frailty and advancing age. Our oldest patients with decreased thirst, reduced appetite cues and ability to eat and drink will also be those most likely to get an UTI. Discussion/Conclusion Future data linkage work in this area should include a wider range of data e.g. detailed demographics, medical and prescribing history over time and all adverse events from low intake dehydration. Exploration of the impact of ONS and thickener prescription on patient experience, perceived treatment burden and the impact on fluid intake would be useful. Audit of shared decision making at initiation and review would also be beneficial in obtaining baseline data on consent at start and throughout duration of prescription.

Genetic and functional enrichments associated with Enterococcus faecalis isolated from the urinary tract.

Urinary tract infection (UTI) is a global health issue that imposes a substantial burden on healthcare systems. Women are disproportionately affected by UTI, with >60% of women experiencing at least one UTI in their lifetime. UTIs can recur, particularly in postmenopausal women, leading to diminished quality of life and potentially life-threatening complications. Understanding how pathogens colonize and survive in the urinary tract is necessary to identify new therapeutic targets that are urgently needed due to rising rates of antimicrobial resistance. How Enterococcus faecalis, a bacterium commonly associated with UTI, adapts to the urinary tract remains understudied. Here, we generated a collection of high-quality closed genome assemblies of clinical urinary E. faecalis isolated from the urine of postmenopausal women that we used alongside detailed clinical metadata to perform a robust comparative genomic investigation of genetic factors that may be involved in E. faecalis survival in the urinary tract.

Invasive Fungus Balls Diagnosed by Point-of-Care Ultrasound in the Emergency Department

BackgroundGenitourinary tract fungus balls are a rare complication of urinary tract infections (UTI). They arise from dense aggregations of hyphae that combine with surrounding urothelial cells and debris. Symptoms can progress to urosepsis and systemic dissemination. Unfortunately, fungus balls may remain unrecognized. Even with computed tomography (CT) and magnetic resonance imaging, fungus balls can be mistaken for malignancies, urinary calculi, or blood clots. Case ReportA 54-year-old man with past medical history of type 2 diabetes mellitus presented to the Emergency Department (ED) reporting urinary retention for one week. He had undergone Foley catheter insertion three separate times for this symptom over the past five weeks. The emergency physicians expected that point-of-care ultrasound (POCUS) would show a distended, anechoic bladder. Instead, there were multiple discrete, gravitationally-dependent, circular echogenic masses without posterior acoustic shadowing, floating freely within a mosaic-like background of mixed echogenicity urine. These findings, together with the CT scan subsequently ordered, raised concern for fungus balls. Instead of being discharged with antibiotics for UTI, the patient was admitted for antifungal coverage, with contingency plans for bladder irrigation and antifungal instillation as needed. Why Should an Emergency Physician be Aware of This?This is the first known case report in which emergency physicians used POCUS to diagnose invasive fungus balls in the ED. POCUS findings led to further CT imaging and specialist consultation that otherwise would not have occurred. Rather than discharge with antibiotics, goal-directed management and appropriate disposition mitigated the risk of systemic decompensation in an immunocompromised patient.

Misconceptions and Knowledge Gaps on Antibiotic Use and Resistance in Four Healthcare Settings and Five European Countries-A Modified Delphi Study.

Misconceptions and knowledge gaps about antibiotics contribute to inappropriate antibiotic use and antimicrobial resistance. This study aimed to identify and prioritize misconceptions and knowledge gaps about antibiotic use from a healthcare professionals' perspective. A modified Delphi study with a predefined list of statements, two questionnaire rounds, and an expert meeting was conducted. The statements were rated by healthcare professionals from France, Greece, Lithuania, Poland, and Spain, and from general practice, out-of-hour services, nursing homes, and pharmacies. A total of 44 pre-defined statements covered the following themes: (1) antimicrobial resistance in general, (2) use of antibiotics in general, (3) use of antibiotics for respiratory tract infections, and (4) use of antibiotics for urinary tract infections. Consensus was defined as ≥80% agreement between the professionals during the second Delphi round. For 30% of the statements, professionals from the four settings together reached consensus. In each setting individually, at least 50% of the statements reached consensus, indicating that there are still many misconceptions and knowledge gaps that need to be addressed. Six educational tools (leaflets, posters, checklists) were developed to address the knowledge gaps and misconceptions. These can be used by patients and healthcare professionals to improve the use of antibiotics in practice.

P12 Assessing the clinical utility of antibiotics for urinary tract infections in India: findings from a questionnaire survey

Abstract Background We aimed to formulate a consensus for the therapeutic utilization of antibiotics based on contemporary evidence and the real-world experiences of the clinicians at the forefront of the care of patients with urinary tract infection (UTI). Methods We developed customized technological response system for mapping exercise and panel of eminent specialists was convened. Prior consent was obtained, and the weblink of the questionnaire was provided. Sub-expert nationwide panel (n=397), across India (PRISM Survey group), rated their level of agreement with 11 questions with each item on a five-point Likert scale and 5 objective response questions. The consensus was pre-defined if the weighted mean score for the Likert scale was &amp;gt;100. Data were statistically analysed by GraphPad software version 9.5.0. Results The mean years of experience were 9.2 years (SD ±10, 95% CI 8.2–10), and cumulative clinical experience was 3669 person-years. The predominant clinical practice setting of the respondents was a public hospital (58.6%). The highest agreement score in the decreasing rank order (of adjusted weighted mean score) for UTI were: antibiotic resistance is a major challenge (126.1), oral fosfomycin-based regimens are effective against MDR pathogens (123.4), is a good option for bacterial biofilm reduction (121.7), the potential to manage recurrent lower UTI (121.6), oral fosfomycin along with nitrofurantoin is been useful to manage MDR UTI (106.8), nitrofurantoin and fosfomycin are chosen as empirical treatment (103.7), fosfomycin has stood the test of time (120.2). Adjusted mean response scores (±SD, 95% CI) for consensus were: agree (73±9.4, 95% CI 66 to 79) followed by strongly agree (32±13, 95% CI 24 to 41), neither agree nor disagree (13±4.9, 95% CI 9.8 to 16), disagree (−6.5±4.7, 95% CI −9.7 to −3.4), strongly disagree (−0.86±0.9, 95% CI −1.5 to −0.26). Conclusions In the era of MDR UTI, time-tested oral fosfomycin and nitrofurantoin can improve management of UTI without increasing the complexity.