Onset Of Urinary Tract Infection Research Articles

Sticker-Type Remote Monitoring System for Early Risk Detection of Catheter Associated Urinary Tract Infections.

A substantial number of critically ill patients in intensive care units (ICUs) rely on indwelling urinary catheters (IDCs), demanding regular monitoring of urine bags. This process increases the workload for healthcare providers and elevates the risk of exposure to contagious diseases. Moreover, IDCs are a primary cause of catheter-associated urinary tract infections (UTIs) in ICU patients whose delayed detection can have life-threatening complications. To address this, we have developed a Sticker Type Antenna for Remote Sensing (STARS) system capable of measuring urine flow rate and conductivity as early-risk markers for UTIs, alongside tracking patients' urine bag status to facilitate medical automation for healthcare providers. STARS comprises a simple, low-cost, disposable antenna module for contactless measurements of urine volume and conductivity, and a reusable wireless module for real-time data transmission. Systematic studies on STARS revealed its stable performance within physiologically relevant ranges of urine volume (0 to 2000 ml) and conductivity (5 to 40 mS/cm) in urine bags. As a proof-of-concept, STARS was tested in artificially created healthy and infected urine specimens to validate its non-contact sensing performance in detecting the onset of UTIs in catheterized patients within a hospital-like environment. STARS represents the first application of a real-time, contactless, wireless monitoring platform for simultaneous urine bag management and early risk detection of UTIs.

A lightweight unsupervised approach for adverse health detection and digital biomarker discovery in people living with dementia

AbstractBackgroundSensor‐based remote health monitoring of persons living with dementia (PLwD) can be used to gain insights into their health and monitor the progression of their condition, with minimal intrusion. This helps minimize preventable hospital admissions, while allowing researchers to improve their understanding of dementia. Existing approaches for detecting activity and behavioural anomalies in PLwD are challenged by noise in data, lack of annotated datasets, multivariate data, scalability, data drift and explainability.MethodWe propose and evaluate a solution based on the Matrix Profile, an exact, ultra‐fast distance‐based anomaly detection algorithm, specifically the Contextual Matrix Profile (CMP), to detect anomalies that may indicate unusual activity and onset of UTI. Daily household movement data collected via passive infrared (PIR) sensors are used to generate CMPs from location‐wise sensor counts, duration and change in hourly movement patterns. We create CMP‐based multivariate anomaly detection models to generate a single daily normalized anomaly score for each patient. We discover digital biomarkers of anomalies and evaluate our method vs. three state‐of‐the‐art algorithms.ResultCMP‐based models yield up to 85% recall with only a 5% alert rate, when evaluated on a subset of 9363 days from 15 participant households with 41 clinically validated incidences of urinary tract infections (UTI) and hospitalization, collected by the UK Dementia Research Institute between August 2019 and July 2021. Our multidimensional CMP model offers the best balance of recall vs. anomalies raised, with excellent generalisation. We discover that bathroom early AM activity (midnight to 6 am) is the prime cross‐patient digital biomarker of anomalies. This validates findings in literature that unusual bathroom activity is a clinically significant feature in UTI for dementia. We also demonstrate a cross‐patient view of anomaly patterns.ConclusionWe address the need for anomaly detection and scoring using multivariate time series sensor data in remote health monitoring. The CMP allows configurability, ability to denoise and detect patterns, and explainability to clinical practitioners. With higher sensitivity, fewer alerts and better overall performance than state‐of‐the‐art methods, and the ability to discover digital biomarkers of anomalies, the CMP is a clinically meaningful unsupervised anomaly detection technique for dementia and beyond.

H-type Rectourethral Fistula with Anal Stenosis in a Male Patient: A Case Report with Literature Review

Background: H-type rectourethral fistula is a rare variant of anorectal malformation that affects male neonates. It is usually associated with anal stenosis but with a normal anal position and shape, so it is difficult to be diagnosed early after birth. We present this case to evaluate the functional outcome of this rare anomaly in a male patient and compare it with other reported cases with different ages at diagnosis. Case Presentation: A nine-month-old infant presented with recurrent attacks of urinary tract infection and failure to thrive. After proper evaluation, the diagnosis of an H-type rectourethral fistula with anal stenosis was confirmed, and a diverting double-barreled colostomy was performed as an initial procedure. Posterior sagittal anorectoplasty with ligation and division of fistula was successfully done, followed by colostomy closure. Now the patient is five years old and is continent for urine and stool. Conclusions: The diagnosis of H-type rectourethral fistula with anal stenosis is challenging to physicians, and a high index of suspicion is required to reach the diagnosis as the anal opening had a normal shape and location. If this condition is diagnosed and treated early, these patients will have an excellent functional prognosis, as the muscle complex and anal sphincter are well developed.

Onset of urinary tract infections in ICU patients

Background: Urinary tract infections are widespread among intensive care unit patients than in the general population. But what makes the occurrence of UTIs more common in ICU patients? Although studies about the prevalence of urinary tract infections are available, significantly less data is available on the onset of UTIs in intensive care units. Therefore, we aimed this study to evaluate the prevalence of urinary tract infections in ICU patients. We also tried to find out different risk factors and their possible solutions. Aims and ObjectivesRisk factors involved in the onset of urinary tract infections in ICU patientsTo make recommendations based on the studyMaterials and MethodsThe primary target audience in our research work is particularly, i.e. intensive care unit patients. Therefore, we decided to collect data from 3 intensive care units from three hospitals. We also included a questionnaire for physicians to know their points of view about the issue. Finally, we collected data and compiled it in MS Excel for further processing.Results: The prevalence of the population was found to be very high. Almost forty per cent was recorded. Conclusion: Cleanliness, hygiene and proper sterilization is needed and is the need of the hour.

Clinical and Therapeutic Treatment Approach Between Diabetes Mellitus and Urinary Tract Infection

Diabetes Mellitus is a metabolic syndrome of multiple origins, caused by the insulin absence in the bloodstream and/or by the inability of insulin to adequately exert its effects, causing hyperglycemia and subsequent complications in the body's organic systems. Urinary tract infection (UTI) is one of the most frequent due to the glucose increase in blood circulation and the impairment of cellular immunity, creating a favorable environment for the bacteria proliferation at the inflammation spots. This review describes the clinical and therapeutic aspects of diabetes mellitus and urinary tract infection, with guidelines on glucose management in these events. A non-systematic review was carried out in the Virtual Health Library, PubMed, Scielo, and Google Academic databases with the descriptors Diabetes mellitus, Urinary Tract Infection, Hyperglycemia, Bacteriuria, and Urinary Incontinence. The most relevant articles were selected. Pertinent clinical and therapeutic issues were discussed, covering the diabetes factors that contribute to the onset of UTI; urinary tract infection complications in patients with diabetes mellitus; asymptomatic bacteriuria, recurrent urinary tract infections, and urinary incontinence in people with diabetes; treatments for diabetes and urinary tract infection; and the relationship between glucose-lowering medications and UTI. Given the greater susceptibility of people with diabetes to acquire UTI, the combined insight into these diseases is crucial, both for better UTI prevention in diabetics and for the treatment of both.

Urinary Tract Infection in Omani Children: Etiology and Antimicrobial Resistance. A Comparison between First Episode and Recurrent Infection

Aims: The aims of this study were identification of the causative organisms, uropathogens’ resistance, and extended-spectrum β-lactamase producing bacteria in primary and recurrent urinary tract infection.
 Study Design: A retrospective study included Omani children, less than 14 years, with any documented urinary tract infection.
 Place and Duration of Study: Sultan Qaboos University Hospital between September 2008 and August 2012.
 Methodology: Comparison was made between both groups using Chi-squared (χ2) test as appropriate.
 Results: The first group included 175 children with first attack of urinary tract infection. Escherichia coli was the leading pathogen (69%), Klebsiella pneumonia (17%; P<0.001), and extended-spectrum β-lactamase producing bacteria (3%). 230 isolated uropathogens from 74 patients with recurrent urinary tract infection. The most common isolated pathogen was Escherichia coli 187 (81.3%; P<0.001), followed by Klebsiella pneumonia 12 (5.1%), and extended-spectrum β-lactamase producing bacteria (7%; P=0.042). Overall resistance to parenteral antibiotics was less evident than oral antibiotics, with least resistance to Meropenem and Imipenem (1% each). Higher resistance was found in recurrent urinary tract infection to Augmentin, Cefuroxime, Ceftriaxone, and Cefotaxime. Oral Nitrofurantoin showed least resistance in first and recurrent urinary tract infection, but increased in non- Escherichia coli uropathogens.
 Conclusion: Escherichia coli and ESBL were more common in recurrent urinary tract infection, while Klebsiella pneumonia were found more in first urinary tract infection. Meropenem, Imipenem, Amikacin, and Piperacillin/Tazobactam can be used cautiously and selectively, while Cefotaxime and Ceftriaxone cannot be used in both groups. Our report shows high resistance rates to Ampicillin, Cefuroxime, and Amoxicillin/Clavulanate. First-generation cephalosporin is not recommended for use as empiric therapy. We recommend the use of Ciprofloxacin and Nitrofurantoin as empiric treatment in both groups, with close monitoring of clinical response. Indeed, a larger scale multicenter national and regional studies are recommended in Oman and gulf region.

Serum neutrophil gelatinase-associated lipocalin for predicting anemia of inflammation in children with urinary tract infection.

Anemia of inflammation (IA), the second most common cause of childhood anemia, results from macrophage iron sequestration and impaired erythropoiesis. Neutrophil gelatinase-associated lipocalin (NGAL) plays an important role in innate microbial immunity through its influence on intracellular iron homeostasis and inhibition of erythropoiesis. The predictive value of NGAL in IA was assessed in 74 children (age 6.30 ±3.64 months) with the first episode of urinary tract infection (UTI). Anemia of inflammation was found in 50% of children, including those with non-febrile UTI, and delayed onset of anemia was observed in 20% of children. There were no differences in NGAL levels between the anemic and non-anemic children, and no correlations between NGAL and hemoglobin (HGB) levels and red blood cell (RBC) count. In multivariate logistic regression analysis elevated C-reactive protein (CRP) was only independently associated with the presence of anemia in children with UTI [OR (95% CI): 1.128 (1.005-1.265), p = 0.040]. In stepwise multiple analysis age independently correlated with RBC (β = 0.051, p = 0.001), while CRP independently correlated with HGB (β = –0.037, p = 0.027) and RBC (β = –0.022, p = 0.014). ROC analysis demonstrated better diagnostic profiles for CRP, procalcitonin (PCT) and fever duration for predicting the risk of IA than NGAL (AUC: 0.690, 0.669, 0.678 vs. 0.638, respectively). Despite the increase in HGB levels after 4-5 weeks from the onset of UTI, HGB values were still significantly lower in the anemic than in non-anemic children. NGAL was not useful for predicting IA in UTI, since its diagnostic value was inferior to conventional inflammatory markers.

Endocrinopathy Causing Skeletal Decalcification and Ectopic Calcification Highlighted by Imaging Tour

Primary Hyperparathyroidism (PHPT) is an endocrine disorder which is caused by increased production of Parathyroid Hormone (PTH). Hypercalcemia leads to a number of symptoms and may cause patient's morbidity and even mortality if left untreated. In the present case, a 21-year-old female presenting with frequent attacks of urinary tract infection, diffuse bone pain and episodic pain abdomen since 15 months. On clinical, biochemical and radiological evaluation, the case was diagnosed as PHPT due to left superior parathyroid adenoma. Patient underwent uneventful surgical parathyroidectomy following preoperative optimisation. She achieved normocalcaemia without any surgical complications. This case is presented to highlight the impact of hyperparathyroidism on calcium metabolism leading to extensive skeletal decalcification and ectopic deposition of calcium leading to end organ damage. Various images are used to highlight this phenomenon of decalcification and calcification.

Predictive factors and management of urinary tract infections after kidney transplantation: a retrospective cohort study.

Urinary tract infection (UTI) is one of the most common infectious complications in kidney transplant recipients. The aims of our study were to identify possible predictive factors for UTI and advocate for the management of UTI after kidney transplantation (KT). Between January 2013 and December 2018, 182 adult patients with end-stage kidney disease who underwent KT were retrospectively analyzed. Patients who had urinary symptoms and positive urine culture were diagnosed with UTI. The types of urinary bacteria causing UTIs were also examined. UTIs occurred in forty-one patients (25.1%), and the median time to UTI onset (UTI-free survival) after KT was 189days. The Cox hazard regression analysis showed that the predictive factors for UTI onset were as follows: posttransplant urinary catheterization, including indwelling urinary catheterization and clean intermittent catheterization; a maximum bladder capacity before KT of less than 150ml; and a low serum albumin level at 1month after KT. The most common causative agent was Escherichia coli (56.6%), followed by Enterococcus spp. (15.6%) and Klebsiella spp. Kidney transplant recipients with prolonged postoperative malnutrition, posttransplant voiding dysfunction and/or urinary storage disorder had an increased risk of UTI. Bladder function tests, such as uroflowmetry, postvoid residual urine tests, and urodynamic tests, were needed to predict UTI. For patients with malnutrition, care should be taken to ensure sufficient calorie intake. Kidney transplant recipients who develop UTI should be treated as complicated UTI patients.

TRATAMIENTO NO FARMACOLÓGICO DE LA INFECCIÓN URINARIA

En varios estudios in vitro se observó que el jugo y cóctel de cranberries tenían efectos inhibitorios sobre la adherencia bacteriana pero sin poder bactericida, por lo tanto se propuso su uso para prevención de la infección urinaria (IU). Estudios clínicos sobre la eficacia del jugo de cranberries han sido limitados y no han demostrado disminución en la aparición de la infección del tracto urinario (ITU), desaconsejando su uso prolongado y aparición de efectos adversos gastrointestinales. Los probióticos reducirían el riesgo de ITU recurrente porque mantiene un pH bajo, producen citoquinas antiinflamatorias y peróxido de hidrógeno como microbicida.

Controversies Regarding Management of Vesico-ureteric Reflux.

The primary goal in the management of a child with urinary tract infection (UTI) is to prevent recurrence of UTI and acquired renal damage. Approximately 15% of children develop renal scarring after a first episode of febrile UTI. Vesico-ureteric reflux (VUR) is diagnosed in 30-40% of children imaged after first febrile UTI. The 'top-down' approach involving ultrasound and dimercaptosuccinic acid scan (DMSA) first after an appropriate interval following UTI, can help in avoiding voiding cystourethrogram (VCUG), an invasive test with higher radiation exposure. The majority view remains that VCUG should be done after the second attack of UTI in girls and first attack of UTI in boys. Although the evidence in favour of antibiotic prophylaxis remains doubtful in preventing renal scars associated with VUR, it remains the first line treatment for high-grade reflux (grade 3-5) with an aim to prevent UTI and allow spontaneous resolution of VUR. Early identification and appropriate treatment of associated bowel bladder dysfunction is an essential part of successful medical management of VUR. Endoscopic treatment of VUR, using a bulking agent, is useful in grade 3 VUR. The main controversy regarding intervention (endoscopic/open surgical intervention) involves absence of strong evidence for these interventions in reducing renal scarring on randomized controlled trials. However, several recent trials have found the surgical interventions to be effective in reducing recurrent pyelonephritis and repeated hospital admissions.

Risk factors for surgical site infection and urinary tract infection after spine surgery.

This study aimed to identify and compare risk factors for surgical site infection (SSI) and non-surgical site infections (non-SSIs), particularly urinary tract infection (UTI), after spine surgery. We retrospectively reviewed 825 patients (median age 59.0years (range 33-70years); 442 males) who underwent spine surgery at Kagoshima University Hospital from January 2009 to December 2014. Patient parameters were compared using the Mann-Whitney U and Fisher's exact tests. Risk factors associated with SSI and UTI were analyzed via the multiple logistic regression analysis. P<0.05 was considered statistically significant. SSI occurred in 14 of 825 cases (1.7%), and non-SSI occurred in 23 of 825 cases (2.8%). Most non-SSIs were UTIs (20 of 23 cases, 87.0%). In the 14 patients with SSI, UTI occurred before SSI onset in one patient, and after SSI onset in two patients. UTI onset before SSI was not a risk factor for SSI. Multiple logistic regression analysis indicated that common risk factors for SSI and UTI were operation time (P=0.0019 and 0.0162, respectively) and ASA classification 3 (P=0.0132 and 0.0356, respectively). The 1week post-operative C-reactive protein (CRP) level was a risk factor for UTI (P=0.0299), but not for SSI (P=0.4996). There was no relationship between SSI and symptomatic UTI after spine surgery. Risk factors for post-operative SSI and UTI were operative time and ASA classification 3; 1week post-operative CRP was a risk factor for UTI only.

A 9 Month-old male with First Attack of Urinary Tract Infection

A 9 Month-old male with First Attack of Urinary Tract Infection A 9 month-old male with history of first time urinary tract infection, normal physical examination and renal function tests underwent kidney ultrasonography. The ultrasound report showed kidney anomalies. He underwent abdominopelvic computed tomography (CT) (Figure 1A and B) and Voiding cystourethrography (VCUG) (Figure 2 A and B) due to abnormal findings in sonography. What is your diagnosis?

Value of Ultrasound in Detecting Urinary Tract Anomalies After First Febrile Urinary Tract Infection in Children.

Background Urinary tract infection (UTI) is an infection that affects part of the urinary tract. Ultrasound is a noninvasive test that can demonstrate the size and shape of kidneys, presence of dilatation of the ureters, and the existence of anatomic abnormalities. The aim of the study is to estimate the value of ultrasound in detecting urinary tract anomalies after first attack of UTI. Methods This study was conducted at the Nephrology Clinic, New Children's Hospital, Faculty of Medicine, Cairo University, from August 2012 to March 2013, and included 30 children who presented with first attack of acute febrile UTI. All patients were subjected to urine analysis, urine culture and sensitivity, serum creatinine, complete blood count, and imaging in the form of renal ultrasound, voiding cysto-urethrography, and renal scan. Results All the patients had fever with a mean of 38.96°C ± 0.44°C and the mean duration of illness was 6.23 ± 5.64 days. Nineteen patients (63.3%) had an ultrasound abnormality. The commonest abnormalities were kidney stones (15.8%). Only 2 patients who had abnormal ultrasound had also vesicoureteric reflux on cystourethrography. Sensitivity of ultrasound was 66.7%, specificity was 37.5%, positive predictive value was 21.1%, negative predictive value was 81.8%, and total accuracy was 43.33%. Conclusion We concluded that ultrasound alone was not of much value in diagnosing and putting a plan of first attack of febrile UTI. It is recommended that combined investigations are the best way to confirm diagnosis of urinary tract anomalies.

Neonatal urinary tract infection may increase the risk of childhood asthma.

The aim of this population-based retrospective cohort study was to investigate the onset of urinary tract infection in newborns and the associated risks of childhood asthma. Children with neonatal UTI (n = 3,312) and randomly selected controls (n = 13,243) were enrolled for our analysis. We calculated the follow-up person-years for each participant from the index date until the diagnosis of asthma, the end of 2008, or withdrawal from the insurance system (because of death or loss to follow-up). Furthermore, we compared the risk of asthma between non-UTI and UTI cohorts by using Cox proportional hazards model analysis, the adjusted hazard ratio (aHR), and a 95 % confidence interval (95 % CI). The overall asthma incidence rate was found to be 1.53-fold significantly higher in the UTI cohort than in the non-UTI cohort (70.3 vs 45.8 per 1000 person-years). After we adjusted for potential risk factors, the overall risk of asthma remained higher in the UTI cohort (aHR = 1.47, 95 % CI = 1.35-1.59). The incidence rate was higher in boys than in girls. Overall, patients suffering from UTI may have a greater risk of developing asthma than patients without UTI. This nationwide retrospective cohort study demonstrates that neonatal UTI may increase the risk of childhood asthma.

Recurrent urinary tract infection and risk of bladder cancer in the Nijmegen bladder cancer study.

Background:Controversy exists on whether urinary tract infection (UTI) is a risk factor for urinary bladder cancer (UBC). Here, the association is investigated using data from one of the largest bladder cancer case–control studies worldwide.Methods:Information on (i) history and age at onset of regular cystitis (‘regular low-UTI') and (ii) number and age at onset of UTI treated with antibiotics (‘UTI-ab') from 1809 UBC patients and 4370 controls was analysed. Odds ratios (ORs) and 95% confidence intervals (CI) adjusted for age, education, smoking, and use of aspirin/ibuprofen were generated, for men and women separately.Results:Regular low-UTI was associated with an increased UBC risk (men: OR (95% CI) 6.6 (4.2–11); women: 2.7 (2.0–3.5)), with stronger effects in muscle-invasive UBC. Statistically significant decreased risks (ORs ∼0.65) were observed for up to five UTI-ab, specifically in those who (had) smoked and experienced UTI-ab at a younger age. In women, UTI experienced after menopause was associated with a higher UBC risk, irrespective of the number of episodes.Conclusions:Regular cystitis is positively associated with UBC risk. In contrast, a limited number of episodes of UTI treated with antibiotics is associated with decreased UBC risk, but not in never-smokers and postmenopausal women.

Do patients who complain of lower urinary tract symptoms frequently have clinically significant pyuria?

There is still controversy about whether post-void residual (PVR) urine volume affects the onset of urinary tract infection (UTI). In addition, although male patients with lower urinary tract symptoms (LUTS) might potentially have PVR, the association between LUTS and UTI or asymptomatic pyuria with or without bacteriuria remains unclear. We studied the frequency of asymptomatic pyuria, with and without bacteriuria, in patients with LUTS without a previous history of urinary tract manipulation at the first visit and their sequential courses. This retrospective study was done by reviewing medical charts. A total of 453 male patients who complained of LUTS and visited our outpatient clinic in 2008 were included in this study. The frequency of pyuria, with or without bacteriuria, in this study at the first visit was 4.9%. The median PVR volumes at the initial examination were 79 ml in the 22 patients with pyuria and 22 ml in the 431 patients without pyuria. The difference of the PVR volume between the patients with pyuria and those without pyuria was statistically significant (p = 0.0095). Twelve patients were treated with alpha-blockers without antimicrobial chemotherapy and pyuria disappeared in 5 (41.7%) of them. However, the decrease in the rate of PVR was not significantly different between the patients with persisting pyuria and those without pyuria. A not negligible number of patients with LUTS had pyuria at the first visit; however, there was no febrile UTI in their clinical course even if they received no urological manipulation.

Initial Presentation in Psychiatry Emergency Room Led to Diagnosis of Many Urinary Bladder Stones in a Male Patient

The first case of man who presented to psychiatry emergency room for evaluation of abnormal behavior because of urinary stones was reported. Careful evaluation of patient led to a diagnosis of 37 urinary bladder stones in an Egyptian man with obstructive uropathy and metabolic defects in the form of hyperoxaluria and hypocitraturia. Knowledge of the differential diagnosis of metabolic defects can lead to successful outcome in preventing reformation of urinary tract stones after surgery. A 61-year-old Egyptian man presented to psychiatry emergency room because he was found lying on floor in bathroom to urinate by his wife who thought her husband needed psychiatric evaluation. Patient gave history of frequent urination and dysuria on and off for 3 years. In the last 3 months before his presentation to emergency room, he got into a habit of lying down on his left side when he went to bathroom to urinate because it was easier for him to pass urine. Renal consultation requested because of presence of red blood cells in urinalysis. Computed tomography of the abdomen and pelvis showed bilateral hydronephrosis and multiple bladder stones. Twenty-four-hour urine collection showed low urinary citrate and high oxalate. Patient underwent open vesicolithotomy and removal of 36 stones. Stone analysis showed 75% uric acid and 25% calcium oxalate. Patient did very well after surgery, and 1 month later, he underwent transuretheral resection of prostate without any complications. Now patient has no difficulty passing urine and he has no recent attack of urinary tract infection. Knowledge of the differential diagnosis of metabolic defects in men with urinary bladder stones would hopefully provide clinicians with the proper diagnostic tools to more specifically treat such patients with improved success in preventing reformation of urinary tract stones after surgery.

Pathogen colonization in patients with acute cerebral stroke

Purpose: To identify the pathogens that frequently cause infection and to explore their clinical features in acute stroke patients. Methods: From June 1, 1999 to December 31, 2008, we reviewed medical records of 263 patients with acute stroke and 351 controls. Within 30 days from admission, 109 and 107 patients had one or more bacterial cultures, respectively. The cumulative bacteria-free probability of all patients and the incidence of each isolated pathogen were assessed. We searched for the factors associated with isolation of different Gram-negative bacilli (GNB). Results: Patients with recent stroke were prone to healthcare-associated colonization within 2 weeks from admission. One-fourth of stroke patients had positive bacterial culture. Stroke patients had a high incidence of Staphylococcus aureus and various GNB in their sputum. When urinary tract infections (UTIs) began 9 days or more after admission, the contributory pathogens were most often glucose-nonfermenting bacilli. However, if UTIs occurred within 9 days after admission, the pathogens were likely to be Enterobacteriaceae bacilli. Conclusions: Stroke patients had high incidence of pathogenic bacteria in their sputum which might be prone to pneumonia. The time after admission of the onset of UTI is useful information for predicting contributory pathogens and planning for appropriate treatment.Implications for RehabilitationSpecial care should be taken for reducing healthcare-associated pathogenic colonization within the first 2 weeks of hospitalization after stroke.Good oral hygiene to decrease the colonization of Staphylococcus aureus and various Gram-negative bacilli in sputum is important for pneumonia prevention in stroke patients.Stroke patients suspected of having urinary tract infections 9 days or more after admission are likely infected with glucose-nonfermenting bacilli, whereas many isolates from the earlier cultures are Enterobacteriaceae bacilli. Accordingly, physicians can start empirical treatment early.

Male genitoplasty for 46 XX congenital adrenal hyperplasia patients presenting late and reared as males

Aim:To evaluate the clinical profile and management of 46 XX Congenital Adrenal Hyperplasia (CAH) patients presenting with severe virilization and assigned a male gender.Materials and Methods:Of 173 children diagnosed with CAH at the Pediatric Intersex Clinic since 1980, seven children with CAH presented late with severe virilization and were reared as males. All of them were assigned the male sex with removal of the female adnexa. Six were treated with male genitoplasty. Appropriate hormonal supplementation was offered after puberty.Results:The mean age at presentation was 14.2 years (7 – 21). Six patients had presented after puberty, only one at seven years of age. Staged male genitoplasty comprising of chordee correction, male urethroplasty, and bilateral testicular prosthesis was performed. The female adnexa (uterus, ovaries, most of the upper vagina, and the fallopian tubes) were removed. The mental makeup was masculine in six and bigender in one. Bilateral mastectomy was performed at puberty in all. Hormonal treatment comprised of glucocorticoids and testosterone. Six patients were comfortable with the outcome of the masculinizing genitoplasty. One had a short-sized phallus. One had repeated attacks of urinary tract infection arising from the retained lower vaginal pouch. Social adjustments were good in all, except in one who had a bigender mental makeup.Conclusion:CAH patients with severe virilization presenting late and reared as males are extremely rare. However, the assigned gender can be retained adequately as males, meeting the socioeconomic compulsions of the society. The results are satisfactory following appropriate surgical procedures and hormonal supplementation.