Asymptomatic Urinary Tract Infection Research Articles

A novel chaperone-effector-immunity system identified in uropathogenic Escherichia coli UMN026.

Urinary tract infections (UTIs) are very common worldwide. According to their symptomatology, these infections are classified as pyelonephritis, cystitis, or asymptomatic bacteriuria (AB). Approximately 75-95% of UTIs are caused by uropathogenic Escherichia coli (UPEC), which is an extraintestinal bacterium that possesses virulence factors for bacterial adherence and invasion in the urinary tract. In addition, UPEC possesses type 6 secretion systems (T6SS) as virulence mechanisms that can participate in bacterial competition and in bacterial pathogenicity. UPEC UMN026 carries three genes, namely, ECUMN_0231, ECUMN_0232, and ECUMN_0233, which encode three uncharacterized proteins related to the T6SS that are conserved in strains from phylogroups B2 and D and have been proposed as biomarkers of UTIs. To analyze the frequency of the ECUMN_0231, ECUMN_0232, ECUMN_0233, and vgrG genes in UTI isolates, as well as their expression in Luria Bertani (LB) medium and urine; to determine whether these genes are related to UTI symptoms or bacterial competence and to identify functional domains on the putative proteins. The frequency of the ECUMN and vgrG genes in 99 clinical isolates from UPEC was determined by endpoint PCR. The relationship between gene presence and UTI symptomatology was determined using the chi2 test, with p < 0.05 considered to indicate statistical significance. The expression of the three ECUMN genes and vgrG was analyzed by RT-PCR. The antibacterial activity of strain UMN026 was determined by bacterial competence assays. The identification of functional domains and the docking were performed using bioinformatic tools. The ECUMN genes are conserved in 33.3% of clinical isolates from patients with symptomatic and asymptomatic UTIs and have no relationship with UTI symptomatology. Of the ECUMN+ isolates, only five (15.15%, 5/33) had the three ECUMN and vgrG genes. These genes were expressed in LB broth and urine in UPEC UMN026 but not in all the clinical isolates. Strain UMN026 had antibacterial activity against UPEC clinical isolate 4014 (ECUMN-) and E. faecalis but not against isolate 4012 (ECUMN+). Bioinformatics analysis suggested that the ECUMN genes encode a chaperone/effector/immunity system. The ECUMN genes are conserved in clinical isolates from symptomatic and asymptomatic patients and are not related to UTI symptoms. However, these genes encode a putative chaperone/effector/immunity system that seems to be involved in the antibacterial activity of strain UMN026.

Prevalence of Klebsiella pneumoniae and Acinetobacter baumannii in Urine Samples of Pregnant Women in South-East, Nigeria

Background: Pregnancy induces so many changes in the woman’s body that likely predisposes them to Klebsiella pneumoniae and Acinetobacter baumannii which causes Urinary Tract Infections (UTIs). Aims: To determine the prevalence of Klebsiella pneumoniae and Acinetobacter baumannii in urine samples of pregnant women attending ante-natal clinics at three health institutions within the study area. Study Design: This study was a descriptive cross-sectional study. Place and Duration of Study: Department of Microbiology Federal University Teaching Hospital, Owerri, Teaching Hospital Orlu and General Hospital Okigwe, Imo State between October 2021 and February 2022. Methodology: Urine samples were collected aseptically from 408 pregnant women between 18-45 years and analyzed by culturing onto the surface of freshly prepared MacConkey and Chromogenic agar plates for the isolation of Klebsiella pneumoniae and Acinetobacter baumannii respectively and confirmed by appropriate biochemical tests. Results: From the results, there was a prevalence rate of 145/408 (35.54%) for both isolates with Klebsiella pneumoniae being more dominant with a prevalence rate of 96/408 (23.53%) as against Acinetobacter baumannii that was 49/408 (12.01%). The highest prevalence of the isolates was seen in the Owerri zone with a prevalence rate of 37 (9.07%) for Klebsiella pneumoniae and 23 (5.64%) for Acinetobacter baumannii, respectively. The highest age-specific prevalence of the isolates within the three zones was observed in the 24–29-year-olds with a prevalence rate of 42 (10.29%) in the Owerri zone. In contrast, the prevalence of both organisms was higher in pregnant women in their third trimester of pregnancy with a prevalence rate of 72 (17.65%) and in multigravida women with a prevalence rate of 217 (53.2%). Conclusion: The results from this study showed that these isolates are becoming more predominant in causing both symptomatic and asymptomatic urinary tract infections in pregnant women, hence regular check-ups and proper treatments of urinary tract infections in pregnant women should be encouraged.

Incidence of Asymptomatic Urinary Tract Infection in Pregnant Women in Obio Cottage Hospital, Port Harcourt, River State, Nigeria

Incidence of Asymptomatic Urinary Tract Infection in Pregnant Women in Obio Cottage Hospital, Port Harcourt, River State, Nigeria

Uropathogens and their antibiograms in asymptomatic bacteriuria among university students in Zaria, Nigeria

Invasion of urinary tract by pathogens can lead to urinary tract infections (UTIs). Asymptomatic UTI is characterized by bacteriuria that is not accompanied by typical urinary tract symptoms, which often goes unnoticed until it has become serious. Early detection, accurate diagnosis and appropriate selection of antibiotics can improve prognosis, prevent chonic progression of renal disease and increase treatment success. Students in tertiary institutions may become at risk of UTIs due to overcrowding, poor hygiene practices and sexual activities. This study was focused on assessing the prevalence and antibiograms of uropathogens causing asymptomatic bacteriuria among university students. Mid-stream urine samples of early morning were obtained from 201 students of Ahmadu Bello University, Zaria, Nigeria. Structured questionnaires were administered to the students to collect their socio-demographic information and exposure to certain risk factors. The samples were inoculated onto sterile Xylose Lysine Deoxycholate agar and Centrimide agar plates, incubated at 37°C for 24 h. The pure isolates were identified by cultural morphology, Gram staining and biochemical characterization, and were further challenged with selected antibiotics. Bacterial uropathogens identified were Citrobacter spp and Pseudomonas aeruginosa with prevalence of 10(5.0%) and 5(2.5%) respectively. The females were more infected than the males. The oldest students of 25-27 years and 28-30 years old had the highest occurrences of Citrobacter spp and Pseudomonas aeruginosa respectively. All the cases of Citrobacter spp were found among single students, but higher occurrence of Pseudomonas aeruginosa was found among the married subjects. Students who have spent the longest time (i.e. in their 6th year) in school had the highest infection with the uropathogens. Students that stayed off-campus, share public latrines, drink sachet water and claimed to have one sex partner each were found with higher occurrences of asymptomatic infections. The antibiotic susceptibility test showed that all the isolates were most susceptible to Ciprofloxacin, Ofloxacin, and Pefloxacin, and resistant to Septrin. However, isolates of Pseudomonas aeruginosa were resistant to Streptomycin. Students should be well-informed about the risks associated with poor hygiene, over-crowding and unhealthy sexual habits. Routine checkups will help to prevent asymptomatic UTIs from developing into severe infections or complications.

Screening of Asymptomatic Urinary Tract Infection among School Childrens through Dipstick and Microscopic Examination

Background: Urinary tract infections (UTI) are among the most prevalent pediatric infectious diseases, leading to substantial healthcare utilization including hospitalization and antibiotic therapy. Despite the asymptomatic nature of many pediatric UTIs, these infections can contribute to significant morbidity if left undiagnosed and untreated, including the development of chronic kidney disease. Objective: This study aimed to assess the prevalence of asymptomatic UTIs in school-going children and to evaluate the effectiveness of dipstick and microscopic urinalysis as diagnostic tools. Methods: A cross-sectional study was conducted with 67 asymptomatic school-aged children in the district of Nowshera, KP. Urine samples were analyzed using urine dipstick tests followed by microscopic examination to detect the presence of pyuria, hematuria, and proteinuria. The study excluded children previously diagnosed with UTI or any other infectious disease. SPSS version 25 was utilized for data analysis, with results presented in descriptive statistics. Results: Of the total children screened, 40 (59.7%) were male, and 27 (40.3%) were female. Age distribution was split between 3 to 7 years (25.4%) and 8 to 15 years (74.6%). The dipstick and microscopic examinations revealed UTI positivity in 46 children (68.7%). Specifically, pyuria was detected in 32.83%, hematuria in 32.83%, and proteinuria in 18% of the screened children. Conclusion: The study highlights the high prevalence of asymptomatic UTIs among school children and emphasizes the necessity for routine urine examinations as an integral component of pediatric healthcare to prevent future complications. Furthermore, dipstick and microscopic analyses were validated as efficient diagnostic tools for early detection of UTIs.

Evolution of Urinary Tract Infection Understanding: From Ancient Insights to Contemporary Perspectives

This research delves into the historical understanding and evolutionary trajectory of urinary tract infections (UTIs) from ancient descriptions to modern comprehension. The study explores the historical perspectives from ancient Egyptian insights to Hippocratic beliefs and traces the evolution of management approaches until the discovery of microorganisms as causative agents. Advancements in antimicrobial therapy and the changing landscape of UTI treatment strategies are also outlined, considering the emergence of antibiotic resistance. Defining UTI, the research emphasizes the differentiation between asymptomatic bacteriuria and UTI, highlighting crucial aspects and clinical implications. The prevalence of UTIs across different demographics and regions, especially in children, is examined. Variations in prevalence rates and contributing factors are explored in detail, considering regional disparities, age groups, and gender differences. Moreover, the research identifies several risk factors contributing to UTI occurrence, including gender, age, uncircumcision in males, improper toilet training, vesicoureteral reflux, and other anatomical and behavioral aspects. It also delves into the pathophysiology of UTIs, elucidating the multifaceted factors involved, such as aetiologic agents, anatomical variations, immunological factors, and genetic influences affecting the location, course, and prognosis of UTIs. The clinical forms of UTIs, namely acute pyelonephritis and cystitis, are outlined, delineating the symptoms, diagnostic approaches, and clinical implications associated with each form. The research emphasizes the importance of accurate differentiation between these clinical forms for appropriate treatment and long-term consequences, particularly renal scarring and other complications associated with pyelonephritis. In summary, this comprehensive review consolidates historical insights, epidemiological trends, risk factors, pathophysiological mechanisms, and clinical manifestations to offer a holistic understanding of UTIs, providing valuable insights for effective management and future research directions. Keywords: Urinary tract infection, historical perspective, prevalence, risk factors, pathophysiology, clinical forms, antimicrobial therapy.

Asymptomatic Urinary Tract Infection in School Going Female Children Attending to a Teritiary Care Hospital

Asymptomatic Urinary Tract Infection in School Going Female Children Attending to a Teritiary Care Hospital

Purulent pericarditis caused by methicillin-sensitive Staphylococcus aureus bacteriuria

BackgroundPurulent pericarditis (PP)— a purulent infection involving the pericardial space—requires a high index of suspicion for diagnosis as it often lacks characteristic signs of pericarditis and carries a mortality rate as high as 40% even with treatment. Common risk factors include immunosuppression, diabetes mellitus, thoracic surgery, malignancy, and uremia. Most reported cases of PP occur in individuals with predisposing risk factors, such as immunosuppression, and result from more commonly observed preceding infections, such as pneumonia, osteomyelitis, and meningitis. We report a case of PP due to asymptomatic bacteriuria in a previously immunocompetent individual on a short course of high-dose steroids.Case presentationAn 81-year-old male presented for severe epigastric pain that worsened with inspiration. He had been on high-dose prednisone for presumed inflammatory hip pain. History was notable for urinary retention requiring intermittent self-catheterization and asymptomatic bacteriuria and urinary tract infections due to methicillin-sensitive Staphylococcus aureus (MSSA). During the index admission he was found to have a moderate pericardial effusion. Pericardial fluid cultures grew MSSA that had an identical antibiogram to that of the urine cultures. A diagnosis of purulent pericarditis was made.ConclusionPP requires a high index of suspicion, especially in hosts with atypical risk factors. This is the second case of PP occurring as a result of asymptomatic MSSA bacteriuria. Through reporting this case we hope to highlight the importance of early recognition of PP and the clinical implications of asymptomatic MSSA bacteriuria in the setting of urinary instrumentation and steroid use.

"Electronic Phenotyping" Antimicrobials to Facilitate Outpatient Stewardship for Asymptomatic Bacteriuria and Urinary Tract Infection in Renal Transplant.

Asymptomatic bacteriuria and urinary tract infection in renal transplant are important antimicrobial stewardship targets but are difficult to identify within electronic medical records. We validated an "electronic phenotype" of antibacterials prescribed for these indications. This may be more useful than billing data in assessing antibiotic indication in this outpatient setting.

Unlocking the pathological pathway in urinary tract infection-induced brain fog: A literature review

Brain fog is a common and bothersome symptom caused by urinary tract infections. Along with other symptoms like delirium, memory issues, confusion, and disorientation, this cognitive impairment may include trouble thinking clearly. Sudden confusion or delirium can be brought on by urinary tract infections, especially in elderly or dementia patients. It is hypothesized that urinary tract infections affect hippocampal neurogenesis and other aspects of brain homeostasis, which may be linked to their effects on cognitive function. Moreover, mental anguish and confusion are linked to urinary tract infections, though not all symptoms that resemble urinary tract infections are caused by urinary tract infections. Our search turned up articles about delirium, brain fog, and urinary tract infections in PubMed, Google Scholar, Scopus, and other online databases. Urinary tract infections (UTIs) can cause a variety of symptoms, including brain fog, confusion, and delirium. These symptoms can impair cognitive function and require a thorough diagnosis. This review describes the various symptoms that are linked to urinary tract infections, ranging from traditional indications like fever and frequent urination to non-specific symptoms like delirium and confusion. It emphasizes how important it is to diagnose and comprehend non-specific symptoms by including assessment tools such as the Glasgow Coma Scale, DSM-V, and the Brief Confusion Assessment Method. In addition, it discusses the current controversy regarding the management of individuals with asymptomatic bacteriuria or urinary tract infections, emphasizing the difficulties in avoiding and treating urinary tract infections -related mental impairment. Confusion and delirium brought on by urinary tract infections are better understood when underlying causes, such as immunological, genetic, and microbiological factors, are investigated. Evaluating underlying factors such as immunological, genetic, microbiological aspects can lead to a better understanding of the confusion and uncertainty caused by UTI. This knowledge can help healthcare professionals in conditions, in order to improve diagnostic, therapeutic and management strategies for patients experiencing UTI and possibly cognitive impairment.

Antibiogram of uropathogens and associated risk factors among asymptomatic female college students in Dessie town, Northeast Ethiopia.

Asymptomatic urinary tract infection (asymptomatic bacteriuria and asymptomatic candiduria) may not be routinely detected in sexually active non-pregnant female population at the initial and reversible stages. This is mainly due to the fact that most women may not feel compelled to seek medical attention. The aim of this study was to determine the prevalence, and factors associated with urinary tract infection (UTI), and antibiogram of the uropathogen isolates among asymptomatic female college students. An institutional-based cross-sectional study was conducted at selected colleges in Dessie from January 2021-March 2021. A total of 422 reproductive age (15 to 49 years) non-pregnant female students were included. Socio-demographic and clinical characteristics data were collected using structured questionnaires. Ten mLs of freshly voided mid-stream urine specimen was collected, transported and processed according to the standard operating procedures. Data were coded and entered for statistical analysis using SPSS version 22.0. Descriptive statistics, bivariate and multivariate logistic regression analysis were performed and p-values <0.05 with the corresponding 95% confidence interval (CI) were considered statistically significant. The overall prevalence of UTI was 24.6%. The prevalence of asymptomatic UTI bacteriuria and candiduria was 57 (13.5%) and 47 (11.1%), respectively. The predominant uropathogens were Staphylococcus saprophyticus 24 (23.1%), followed by Candida tropicalis 23 (22.1%), Candida albican 10 (9.6%), Candida krusei 9 (8.7%) and Escherichia coli 8 (7.7%). Gram negative bacterial isolates showed a higher level of resistance to amoxicillin-clavulanic acid 24 (92.3%). Gram positive bacterial uropathogens showed high level of resistance to penicillin 28 (96.6%) and trimethoprim-sulfamethoxazole 23 (79.3%). Gram positive bacterial isolates were sensitive to norfloxacin, clindamycin, and ciprofloxacin, accounting for 24 (82.7%), 20 (69.0%), and 19 (65.5%), respectively. Multidrug resistance was seen in 50 (87.7%) of bacterial uropathogens. Factors identified for acquisition of UTI were frequency of sexual intercourse (≥3 per week) (AOR = 7.91, 95% CI: (2.92, 21.42), and genital area washing habit (during defecation (AOR = 5.91, 95%CI: (1.86, 18.81) and every morning (AOR = 6.13, 95%CI: (1.60, 23.45)). A significant prevalence of uropathogens, and high resistance of bacterial isolates to the commonly prescribed drugs were detected. Therefore, routine UTI screening, regular health education on the risk of asymptomatic infectious diseases for reproductive age group females, and antimicrobial susceptibility testing should be practiced to avoid the progression of an asymptomatic infection into a symptomatic UTI.

Isolation and Susceptibility of Microorganisms Responsible for Asymptomatic Antenatal Bacteriuria

Aim &amp; Objective: Determination of prevalence, bacterial profile and antibiotic sensitivity of microorganisms responsible for asymptomatic UTI during pregnancy.&#x0D; Methodology: The type of study is cross-sectional, Prospective type, was conducted at the PUMHS for Women Nawabshah (SBA) after approval from the Ethical Review Committee and the duration was 2 years from 1st Jan 2021-31st Dec 2022. Samples were collected by non-probability- convenient method from all pregnant women without any clinical complaints attending the Outpatient Department of Gynecology and Obstetrics PUMHS Hospital Nawabshah. The midstream urine collected by clean catch method in sterile containers was processed for DR of urine including physical, chemical, and microscopic examination. After the urine detailed report, the samples were sent for, culture by using the following media, blood, Macconkey’s, and CLED agar. Growth-positive samples were proceeding for gram staining, biochemical tests, and antibiotic sensitivity reports according to world standard methods for confirmation.&#x0D; Results: Out of 477 patients 96 (20%) were positive for ASB, with the mean age of the patient being 29.32±5.74 The most common microorganisms found in the study were E.coli 67 (69.7.%), followed by Klebisella in 4(4%), proteus 9(9%), pseudomonas 8(8.3%), staphylococcus aureus 2(2%), staphylococcus saprophyticus in 4(4%), streptococcus pyogen 2(2%).&#x0D; There was 100% sensitivity found for all isolated microorganisms following culture examination to following antibiotics: Ciprofloxacin, Cefuroxime, Imepenem, Ceftriaxone Amikacin, Meropenem, and Piperacillin-tazobactam; however, 52% and 45% sensitivity of E.coli and 100% sensitivity of streptococci were present for amoxicillin-clavulanic acid and ampicillin respectively.&#x0D; Conclusion: A rising number of silent antenatal bacteriuria was observed in younger age women with severe maternal and fetal complications in advanced stages of pregnancy and thereafter. It is therefore suggested to routinely perform urine cultures for every suspected pregnant lady during advanced antenatal visits to diagnose and properly treat the asymptomatic bacteriuria in terms of avoiding antibiotic resistance and materno-fetal complications in the near future.

Complete blood profile of children diagnosed with asymptomatic urinary tract infection: oral nutritional supplement (ONS) intervention

Background: Young children are at high risk of urinary tract infections (UTI) that present as asymptomatic non-specific signs without clinical presentation. UTIs put children at risk of malnutrition, and thus early diagnosis, nutritional management, and medication are important. The administration of oral nutritional supplements (ONS) with an energy intake of 400 kcal/day is thought to be an effective strategy to provide balanced nutritional needs. Objectives: This study aims to investigate the clinical symptoms and growth pattern of young children with UTIs and with clinical symptoms of poor feeding and growth faltering who received medical treatment and nutritional intervention for three months. Methods: A cross-sectional analytical study was conducted from January 2019 to December 2020 at the outpatient installation unit of Husada Utama Hospital. Subjects were children aged one to five years old, with the main complaint of poor feeding and constant weight gain. UTIs were identified according to the urine culture results. If the count exceeded 100.000 cfu/ml, it was determined as a urinary tract infection. Results: A total of 37 children were enrolled in this study and received diet advice, ONS, and medication. The proportion of boys was higher than girls in this study (21 to 16, respectively). Undernutrition was experienced by 14 subjects (37.84%) who were stunted or severely stunted (13 subjects or 35.14%), underweight or severely underweight (seven subjects or 18.92%), and wasted (four or 10.81%). It was shown that ONS improves mean corpuscular volume (MCV) and mean corpuscular haemoglobin (MCH) significantly, and slightly increased haemoglobin though there was no significant difference. White blood cell (WBC) and lymphocyte levels reduced after ONS intervention. Conclusion: Nutritional intervention with ONS improves erythropoiesis (MCV and MCH) but reduces WBC and lymphocytes in children with UTIs.

Asymptomatic Urinary Tract Infection Treatment in Adults Admitted to Inpatient Psychiatry: A Retrospective COHORT study.

Introduction: Treatment of asymptomatic bacteriuria remains prevalent despite recommendations against treatment in most patient populations. Rates of asymptomatic treatment of urinary tract infection (UTI) has not been thoroughly evaluated within the inpatient psychiatry population. The objective of this study is to describe the rate of antibiotic use for the treatment of asymptomatic UTI in psychiatric inpatients and investigate factors contributing to overuse. Methods: This IRB approved retrospective cohort study evaluated adults admitted to inpatient psychiatry from May 1, 2021 to May 1, 2022 that received an antibiotic for UTI. The primary outcome assessed the rate of asymptomatic treatment, defined as treatment without urinary symptoms. Secondary outcomes evaluated most frequently prescribed antibiotics, determined the impact of altered mental status (AMS) on treatment, and correlated the incidence of UTI treatment with primary psychiatric disorder. Results: One hundred nine patients were identified and 61 were included for analysis. The rate of asymptomatic treatment for UTI was 84%. The most prescribed antibiotic was nitrofurantoin (48%). All patients with AMS (23%) were asymptomatic. Altered mental status did not significantly impact the rate of empiric treatment (P = .098). Primary psychiatric disorder did not significantly impact rate of empiric treatment for UTI (P = .696). Common disorders in this population were depression, schizophrenia, and bipolar disorder with rates of asymptomatic treatment of 79% (n = 19), 87% (n = 13), and 78% (n = 7), respectively. Discussion: Frequent asymptomatic treatment of UTI was identified in this inpatient psychiatry population. These results emphasize the need for antibiotic monitoring and stewardship in this setting.

Management of Asymptomatic Bacteriuria and Urinary Tract Infections in Patients With Neurogenic Bladder and Factors Associated With Inappropriate Diagnosis and Treatment

ObjectiveInappropriate diagnosis and treatment of asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are leading causes of antibiotic overuse but have not been well-studied in patients with risks for complicated UTI such as neurogenic bladder (NB). Our aim was to describe ASB and UTI management in patients with NB and assess factors associated with inappropriate management. DesignRetrospective cohort study. SettingFour Department of Veteran's Affairs (VA) medical centers. ParticipantsAdults with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis (MS), or Parkinson disease (PD) and encounters with an ASB or UTI diagnosis between 2017 and 2018. Clinical and encounter data were extracted from the VA Corporate Data Warehouse and medical record reviews for a stratified sample of 300 encounters from N=291 patients. InterventionsNone. Main Outcome MeasuresPrevalence of appropriate and inappropriate ASB and UTI diagnosis and treatment was summarized. Multivariable logistic regression models assessed factors associated with inappropriate management. ResultsN=200 UTI and N=100 ASB encounters were included for the 291 unique patients (SCI/D, 39.9%; MS, 36.4%; PD, 23.7%). Most patients were men (83.3%), >65 years (62%), and used indwelling or intermittent catheterization (68.3%). Nearly all ASB encounters had appropriate diagnosis (98%). 70 (35%) UTI encounters had inappropriate diagnosis, including 55 (27.5%) with true ASB, all with inappropriate treatment. Among the remaining 145 UTI encounters, 54 (27%) had inappropriate treatment. Peripheral vascular disease, chronic kidney disease, and cerebrovascular disease were associated with increased odds of inappropriate management; indwelling catheter (aOR 0.35, P=.01) and Physical Medicine & Rehabilitation provider (aOR 0.29, P<.01) were associated with decreased odds. ConclusionUp to half of UTI encounters for patients with NB had inappropriate management, largely due to inappropriate UTI diagnosis in patients with true ASB. Interventions to improve ASB and UTI management in patients with NB should target complex patients with comorbidities being seen by non-rehabilitation providers.

PREVALENCE OF URINARY TRACT INFECTIONS AMONG FEMALES OF REPRODUCTIVE AGE GROUP IN TERTIARY CARE TEACHING HOSPITAL

Objective: The purpose of the current study is to isolate, characterize, and evaluate the antibiotic susceptibility profile of the pathogenic bacteria causing urinary tract infections (UTIs) in females of reproductive age. Methods: This is a cross-sectional descriptive study carried out in a Tertiary care teaching hospital for 1 year. A total of 100 urine samples from female patients in the reproductive age range of 15–44 years constitute the study’s sample size. Clean catch midstream urine samples were taken in sterile containers and inoculated on a different culture medium, such as cysteine, lactose, and electrolyte-deficient agar, to isolate the UTI pathogen. MacConkey agar was inoculated in parallel to target the growth of Gram-negative bacilli. Thereafter, using the common microbiological procedures, all positive cultures with significant bacteriuria were identified at the species level based on the colony features, Gram-staining reaction, and pattern of biochemical profiles. To investigate the pattern of antibiotic susceptibility, the disc diffusion method was used. Results: Among the 100 study cases, the prevalence of UTI was seen in 38% of individuals and UTI was absent in 62% of individuals. Among the females (38% cases) who had UTI, 81% had symptomatic UTI and 19% had asymptomatic UTI. Among the 81% symptomatic individuals of UTI, all they showed burning micturition followed by 74% of individuals showed dysuria Among the uropathogens isolated, majority were Escherichia coli (40.7%) followed by CONS (22.3%) Majority of the E. coli isolates showed sensitivity to piperacillin/tazobactam and nitrofurantoin. Conclusion: If left untreated, UTI is a significant public health issue. Early detection and timely treatment will lower the risk of developing further UTI complications, as well as the patient’s pain, length of stay in the hospital, and economic loss.

Antimicrobial Susceptibility Patterns of Klebsiella Species Causing Urinary Tract Infections in Pregnant Women

Background: Urinary tract infections (UTIs) are the most prevalent type of infection during pregnancy and are notoriously difficult to treat. Significant maternal and fetal risk is associated with UTI during pregnancy, with the most prevalent clinical manifestations being asymptomatic bacteriuria, acute cystitis, and acute pyelonephritis.&#x0D; Objectives: To identify Klebsiella species causing urinary tract infection among pregnant women and its antimicrobial susceptibility pattern by modified Kirby Bauer disc diffusion method in Rajshahi Medical College Hospital.&#x0D; Materials and Method: A descriptive cross-sectional study was conducted between July 2021 to June 2022 in the Microbiology Department of Rajshahi medical college and the Gynecology and Obstetrics Department of RMCH to determine the antimicrobial susceptibility pattern of Klebsiella species causing urinary tract infection in pregnant women. The urine samples were inoculated onto MacConkeys agar, blood agar, nutrient agar, and chromogenic UTI agar media and incubated aerobically at 370 C overnight (18-20 hrs).&#x0D; Results: In all trimesters, 294 urine samples were obtained from pregnant women with asymptomatic and symptomatic UTIs. Among the 114 (38.77%) culture-positive samples, 111 (97.36%) were single isolates, whereas 3 (2.63%) included multiple isolates. Klebsiella spp. comprised 21 out of 117 culture-positive bacterial isolates (17.94%). Regarding antimicrobial susceptibility testing, Klebsiella spp. demonstrated a significant degree of sensitivity to meropenem and nitrofurantoin. In this investigation, Klebsiella spp. was found to be the cause of bacteriuria among pregnant women.&#x0D; Conclusion: Doctors should adhere to the antimicrobial susceptibility test results when selecting the appropriate medications to treat pregnant women with UTIs.&#x0D; TAJ 2022; 36: No-1: 41-46

Incidence and risk factors of asymptomatic bacteriuria in patients with type 2 diabetes mellitus: a meta-analysis

BackgroundThe prevalence of type 2 diabetes mellitus (T2DM) is increasing each year and has become one of the most prominent health concerns worldwide. Patients with T2DM are prone to infectious diseases, and urinary tract infections are also widespread. Despite a comprehensive understanding of urinary tract infection (UTI), there is a lack of research regarding primary prevention strategies for asymptomatic bacteriuria (ASB).ObjectiveTo clarify the incidence and risk factors of asymptomatic urinary tract infection in patients with T2DM by meta-analysis to provide evidence for preventing UTI. Help patients, their families, and caregivers to identify the risk factors of patients in time and intervene to reduce the incidence of ASB in patients with T2DM. Fill in the gaps in existing research.Study designMeta-analyses were conducted in line with PRISMA guidelines.MethodsEleven databases were systematically searched for articles about ASB in T2DM, and the retrieval time was selected from the establishment of the database to February 5, 2023. Literature screening, quality evaluation, and meta-analysis were independently performed by two researchers according to the inclusion and exclusion criteria, and a meta-analysis was performed using Stata 17.0.ResultsFourteen articles were included, including cohort and case–control studies. A meta-analysis of 4044 patients with T2DM was included. The incidence of ASB in patients with T2DM was 23.7%(95% CI (0.183, 0.291); P < 0.001). After controlling for confounding variables, the following risk factors were associated with ASB in patients with T2DM: age (WMD = 3.18, 95% CI (1.91, 4.45), I2 = 75.5%, P < 0.001), female sex (OR = 1.07, 95% CI(1.02, 1.12), I2 = 79.3%, P = 0.002), duration of type 2 diabetes (WMD = 2.54, 95% CI (1.53, 5.43), I2 = 80.7%, P < 0.001), HbA1c (WMD = 0.63, 95% CI (0.43, 0.84), I2 = 62.6,%. P < 0.001), hypertension (OR = 1.59, 95% CI (1.24, 2.04), I2 = 0%, <0.001), hyperlipidemia (OR = 1.66, 95% CI (1.27, 2.18), I2 = 0%, P < 0.001), Neuropathy (OR = 1.81, 95% CI (1.38, 2.37), I2 = 0%, P < 0.001), proteinuria (OR = 3.00, 95% CI (1.82, 4.95), I2 = 62.7%, P < 0.001).ConclusionThe overall prevalence of ASB in T2DM is 23.7%. Age, female sex, course of T2DM, HbA1C, hypertension, hyperlipidemia, neuropathy, and proteinuria were identified as related risk factors for ASB in T2DM. These findings can provide a robust theoretical basis for preventing and managing ASB in T2DM.

Appropriateness of antibiotic use for patients with asymptomatic bacteriuria or urinary tract infection with positive urine culture: a retrospective observational multi-centre study in Korea

Antibiotic resistance threatens public health worldwide, and inappropriate use of antibiotics is one of the main causes. To evaluate qualitative use of antibiotics in asymptomatic bacteriuria (ABU) and urinary tract infection (UTI). Cases of positive urine culture (≥105 colony-forning units/mL) performed in inpatient, outpatient and emergency departments in April 2021 were screened in 26 hospitals in the Republic of Korea. The cases were classified as ABU, lower UTI and upper UTI. The appropriateness of antibiotic use was evaluated retrospectively by infectious disease specialists using quality indicators based on clinical guidelines for ABU and UTI. This study included a total of 2697 patients with ABU or UTI. The appropriateness of antibiotic use was assessed in 1157 patients with ABU, and in 677 and 863 patients with lower and upper UTI, respectively. Among the 1157 patients with ABU, 251 (22%) were prescribed antibiotics without appropriate indications. In 66 patients with ABU in which antibiotics were prescribed with appropriate indications, the duration was adequate in only 23 (34.8%) patients. The appropriateness of empirical and definite antibiotics was noted in 527 (77.8%) and 353 (68.0%) patients with lower UTI, and 745 (86.3%) and 583 (78.2%) patients with upper UTI, respectively. The duration of antibiotics was adequate in 321 (61.8%) patients with lower UTI and 576 (78.7%) patients with upper UTI. This nationwide qualitative assessment of antibiotic use in ABU and UTI revealed that antibiotics were often prescribed inappropriately, and the duration of antibiotics was unnecessarily prolonged.

“Acute urinary antibiotics”—A simple metric to identify outpatient antibiotic stewardship opportunities in renal transplant

Background:International Classification of Diseases, Tenth Edition (ICD-10) data help track outpatient antibiotic prescribing but lack validation in immunocompromised populations or subspecialty clinics for this purpose. Asymptomatic bacteriuria (ASB) and urinary tract infection (UTI) are important stewardship targets in renal transplant (RT) patients, but they may require alternative metrics to best monitor prescribing patterns. We describe ICD-10 utilization for RT clinic encounters in which antibiotics were prescribed. We developed a metric classifying “acute urinary antibiotics” (AUA) to track antibiotic use for ASB and UTI, and we validated systematic identification of AUA to enable practical implementation. Methods: We examined RT clinic visit and telemedicine encounters from 2018 to 2021 conducted 1 month after transplant. This project was deemed non–human-subjects research by the Stanford Panel on Human Subjects in Medical Research. Results: The analytic cohort included 420 antibacterial prescriptions from 408 encounters (Fig. 1). Of 238 patients, 136 (57%) were male and 112 (47%) were Hispanic or Latino. The most common primary ICD-10 code was Z94.0 (kidney transplant status) (N = 302 of 408 encounters, 75%); 26 encounters (6%) were coded for UTI (eg, N39.0, urinary tract infection, site not specified); and 214 encounters (53%) had multiple ICD-10 codes. The R82.71 code (bacteriuria) was never used. However, 215 prescriptions (51%) were classified as AUA (Fig. 2). The validation cohort included 130 prescriptions; 59 (45%) were classified as AUA and 51 (39%) had documented intent to treat ASB or UTI (positive percent agreement, 83%; negative percent agreement, 97%) (Table 1). For patients &gt;1 month after transplant, the positive percent agreement was 95% and the negative percent agreement was 98%. Of 51 patients receiving AUA, 32 (63%) were asymptomatic despite frequently having a code for UTI (Fig. 3). Conclusions: ICD-10 coding may not be helpful in monitoring antibiotic prescribing in RT patients. The AUA metric offers a practical alternative to track antibiotic prescribing for urinary syndromes and reliably correlates with physician intent. Monitoring AUA prescribing rates could help identify opportunities to optimize antibiotic use in this complex outpatient setting.Disclosures: None