Bladder Infection Research Articles

Retrieval of Gallbladder Through Epigastric Vs Umbilical Port After Laparoscopic Cholecystectomy

Objective: To compare the effectiveness of epigastrics vs. umbilical port after laparoscopic cholecystectomy by measuring the time taken to retrieve the gall bladder, post-operative pain, and infection.
 Study Design: Comparative prospective study.
 Place and Duration of Study: Department of Surgery Combined Military Hospital Abbottabad, from Jan to Jun 2019.
 Methodology: A total of 106 patients underwent laparoscopic cholecystectomy. Patients were randomly divided into two groups. Inclusion criteria were patients with symptomatic gallstones. Exclusion criteria were patients with comorbid medical conditions, acute cholecystitis, Empyema gall bladder, bile or stone spillage, and BMI >40. Time taken to retrieve the gall bladder, pain, and wound infection were used to compare the effectiveness of port sites. The results were collected on proforma and analyzed by using SPSS version 23.
 Results: Total 106 patients, having mean age of 45.90 ± 14.49 years. Gender distribution was similar (p=0.314). Retrieval time of gall bladder in epigastric group was 9.2 ± 2.98 and in umbilical group 9.73 ± 3.57 this difference was insignificant (p=0.516). In epigastric group pain was perceived in 3.69 ± 1.77 and in umbilical group 3.28 ± 1.39 with p-value of 0.062 which was nonsignificant. Wound infection in epigastric group was 1.07 ± 0.266 and in umbilical group 1.05 ± 0.233 with p-value of 0.439 which was in significant.
 Conclusion: Both port sites are equally effective and depend on Surgeon’s preference.

Synergism between the Synthetic Antibacterial and Antibiofilm Peptide (SAAP)-148 and Halicin.

Recently, using a deep learning approach, the novel antibiotic halicin was discovered. We compared the antibacterial activities of two novel bactericidal antimicrobial agents, i.e., the synthetic antibacterial and antibiofilm peptide (SAAP)-148 with this antibiotic halicin. Results revealed that SAAP-148 was more effective than halicin in killing planktonic bacteria of antimicrobial-resistant (AMR) Escherichia coli, Acinetobacter baumannii and Staphylococcus aureus, especially in biologically relevant media, such as plasma and urine, and in 3D human infection models. Surprisingly, SAAP-148 and halicin were equally effective against these bacteria residing in immature and mature biofilms. As their modes of action differ, potential favorable interactions between SAAP-148 and halicin were investigated. For some specific strains of AMR E. coli and S. aureus synergism between these agents was observed, whereas for other strains, additive interactions were noted. These favorable interactions were confirmed for AMR E. coli in a 3D human bladder infection model and AMR S. aureus in a 3D human epidermal infection model. Together, combinations of these two novel antimicrobial agents hold promise as an innovative treatment for infections not effectively treatable with current antibiotics.

PREVALENCE OF THE Anguillicola crassus PARASITE IN THE INTERNATIONAL MINHO RIVER

The European eel, Anguilla anguilla (Linnaeus, 1758), is vulnerable to infections by the parasitic nematode Anguillicola crassus Kuwahara, Niimi & Itagaki, 1974, mainly in freshwater ecosystems. The eel is a bioindicator species due to its benthic behaviour, predator, and life cycle. The parasite feeds on blood from the eel's swim bladder, causing damage to the walls and deterioration of this organ, reducing energy reserves, and affecting its migratory capacity for reproduction. Eels were captured at different sampling points divided into 4 areas of the international section of the Minho River in the following time periods: 1995-96, 2008-2011 and 2017-2021, through fyke nets and electric fishing sampling techniques. The objectives of this work were to analyze the dispersion and prevalence of A. crassus in the Minho River basin over time, infection rates and the eels condition. The prevalence levels found reach values ​​close to 75% in some sampled locations and 99% of eels shown pathological signs of swim bladder infection. The nematode dispersal area increased since the early 1990s when its presence in the Minho River was first recorded.

The C5a/C5aR1 Axis Contributes to the Pathogenesis of Acute Cystitis Through Enhancement of Adhesion and Colonization of Uropathogenic E. coli.

Our previous work using a murine model of pyelonephritis demonstrated that the C5a/C5aR1 axis plays a pathogenic role in acute kidney infection. In this study, we report that the C5a/C5aR1 axis also plays a pathogenic role in acute bladder infection. C5aR1-deficient mice had reduced bladder bacterial load and attenuated bladder tissue injury, which is associated with reduced expression of terminal α-mannosyl residues (Man) (a potential ligand for type 1 fimbriae of E. coli) at the luminal surface of the bladder epithelium and reduced early bacterial colonization of the bladder. In vitro, C5a stimulation enhanced mannose expression in and facilitated bacterial adhesion/colonization to human bladder epithelial cells. C5a stimulation also upregulated the activation of ERK1/2 and NF-κB signaling and gene expression of proinflammatory cytokines (i.e., Il6, Il1b, Cxcl1, Ccl2) in the epithelial cells, which could drive pro-inflammatory responses leading to tissue injury. Administration of the C5aR1 antagonist effectively reduced bladder bacterial load and tissue injury. Thus, our findings demonstrate a previously unknown pathogenic role for the C5a/C5aR1 axis in bladder infection and suggest that the C5a/C5aR1 axis-mediated upregulation of Man expression, enhancement of bacterial adhesion/colonization, and excessive inflammatory responses contribute to acute bladder infection. These findings improve our understanding of the pathogenesis of bladder infection with therapeutic implications for UTI.

Oral fosfomycin activity against Klebsiella pneumoniae in a dynamic bladder infection in vitro model.

IntroductionThe use of oral fosfomycin for urinary tract infections (UTIs) caused by non-Escherichia coli uropathogens is uncertain, including Klebsiella pneumoniae, the second most common uropathogen.MethodsA multicompartment bladder infection in vitro model was used with standard media and synthetic human urine (SHU) to simulate urinary fosfomycin exposure after a single 3 g oral dose (fAUC0–72 16884 mg·h/L, t½ 5.5 h) against 15 K. pneumoniae isolates including ATCC 13883 (MIC 2 to >1024 mg/L) with a constant media inflow (20 mL/h) and 4-hourly voiding of each bladder. The impact of the media (CAMHB + G6P versus SHU) on fosfomycin MIC measurements, drug-free growth kinetics and regrowth after fosfomycin administration was assessed. A low and high starting inoculum (5.5 versus 7.5 log10 cfu/mL) was assessed in the bladder infection model.ResultsCompared with CAMHB, isolates in SHU had a slower growth rate doubling time (37.7 versus 24.1 min) and reduced growth capacity (9.0 ± 0.3 versus 9.4 ± 0.3 log10 cfu/mL), which was further restricted with increased inflow rate (40 mL/h) and more frequent voids (2-hourly). Regrowth was commonly observed in both media with emergence of fosfomycin resistance promoted by a high starting inoculum in CAMHB (MIC rise to ≥1024 mg/L in 13/14 isolates). Resistance was rarely detected in SHU, even with a high starting inoculum (MIC rise to ≥1024 mg/L in 2/14 isolates).ConclusionsSimulated in an in vitro UTI model, the regrowth of K. pneumoniae urinary isolates was inadequately suppressed following oral fosfomycin therapy. Efficacy was further reduced by a high starting inoculum.

Canine Cystitis - Biofilm Formation by Bacterial Isolates

Background: Biofilms have been reported as important virulent markers associated with drug resistance in urinary tract infections (UTIs) in humans and dogs. However, in veterinary medicine, researches involving biofilm formation, treatments and preventions have been limited; yet, it is still possible to find few studies demonstrating biofilm-forming bacteria associated with different comorbidities such as otitis, wound infections, UTIs, and endometritis. These studies generally select dogs with chronic and recurrent infections, which could be an important factor in antibiotic resistance. We aimed to evaluate biofilms in sporadic cystitis regarding prevalence and drug resistance.Materials, Methods & Results: Urine samples were collected by cystocentesis from 36 client-owned dogs under clinical and laboratory suspicion of non-recurrent urinary bladder infection (cystitis). Urine was aseptically plated onto blood agar, MacConkey, and CLED, followed by incubation for 24 to 48 h. Definitive identification of a potential pathogen was made by subculture collected from an isolated colony to obtain a pure culture. The gram staining method and specific biochemical tests (phenol red fermentation, lysine, phenylalanine, citrate, sulfide-indole-motility, and urease) were used to distinguish and classify the bacteria. After identification, the bacteria were tested for antimicrobial susceptibility by a standard disk diffusion method, using the following antimicrobials: amoxicillin with clavulanic acid, ampicillin, ceftriaxone, ciprofloxacin, clindamycin, cefazolin, cephalothin, erythromycin, gentamicin, norfloxacin, and sulfamethoxazole-trimethoprim. The biofilm-forming ability was determined based on a culture in Congo red agar (CRA), where biofilm producer strains formed black colonies with a dry crystalline surface, while non-biofilm producer strains formed red colonies with a smooth surface. A crystal violet dye assay was used to confirm the CRA results. Of the 36 urine samples collected from dogs with suspected cystitis, a total of 37 isolates were obtained, from mixed or pure cultures. The most prevalent bacteria were Escherichia coli (11/37), followed by Staphylococcus spp. (8/37), Proteus spp. (7/37), and Enterococcus spp. (5/37). Other less prevalent bacteria were Klebsiella spp., Streptococcus spp., and Enterobacter spp. As for biofilm-forming ability, 67.6% (25/37) of the 37 bacterial isolates had biofilm formation in CRA and 54.05% (20/37) on the microplates containing crystal violet dye. There was no statistical difference in antimicrobial susceptibility between biofilm producer and non-biofilm producer bacteria.Discussion: We found a high proportion (> 54%) of in vitro biofilm-forming ability by different bacteria, which may indicate that biofilms may also be formed in vivo, in simple cystitis. Antimicrobial resistance was not noticed in bacteria capable of forming a biofilm; however, in a future study it is important to evaluate bacterial resistance in vivo, considering the possibility of having a different response than in vitro. In addition, the problem of the presence of a biofilm in vivo is that it can nullify the antimicrobial efficacy of therapeutic agents even with in vitro susceptibility. Besides the possibility of slow or incomplete diffusion of antibiotics through the extracellular matrix of the biofilm, aspects like hydration level, pCO2, pO2, pH, pyrimidine, and divalent cation concentration that negatively influence antimicrobial activity in vitro can also cause undesirable effects at the profound layers of the biofilm. In conclusion, all of the genera of bacteria isolated from dog’s sporadic cystitis in this study were able to form a biofilm in vitro. The pathogenicity and antibiotic resistance of bacteria appears unrelated to biofilm formation in vitro.Keywords: sessile bacteria, urine, simple cystitis, antibiotic resistance.

Loss of NLRP3 increases bacterial cystitis via IRAKM.

BackgroundWe attempted to characterize the molecular mechanisms that underpin urinary tract infections using a mouse model of cystitis induced by bacterial infection in a background of NOD-, LRR- and PYD domains-containing protein (NLRP3) deficiency.MethodsMale NLRP3 knockout (NLRP3−/−) and control mice (12 weeks old) were intraurethrally inoculated with 2×108 Escherichia coli (E. coli) and euthanized 1, 3, and 7 days later to assess the degree of bladder infection. Immunohistochemical detection of NLRP3 and interleukin-1 receptor-associated kinase M (IRAKM) was performed. Quantitative PCR analysis was performed to analyze the expression of interleukin (IL)-1β and tumor necrosis factor (TNF)-α.ResultsBladder infection was observed in control mice 1 day after inoculation with E. coli. The infection had disappeared by day 7. IL-1β and TNF-α levels were lower 1 day after injection but higher on days 3 and 7 in the NLRP3−/− group compared with the control mice (P<0.05). Expression of NLRP3 and IRAKM in wild-type (WT) group were significantly decreased 1 day post infection, and by day 7 were increased back to similar level on day 0. On the contrary, in the NLRP3−/− group, IRAKM was significantly lower than WT mice on day 0 and were significantly decreased by day 7.ConclusionsDeficiency of NLRP3 expression in NLRP3−/− mice contributes to the pathogenesis of chronic inflammation associated with cystitis through IRAKM.

Bladder carcinomas in patients with neurogenic bladder and urinary schistosomiasis: are they the same tumors?

The aim of our study was to evaluate and compare the expression of different immunohistochemical markers in Bladder Carcinomas (BC) in patients with Neurogenic Bladder (NB) and Urinary Schistosomiasis (US) infection. We collected tissue samples from patients with Neurogenic Bladder and Bladder Carcinoma (NBC Group) and from patients with Urinary Schistosomiasis infection and Bladder Carcinoma (SBC Group). We compared to these two groups to control samples from resection from patients with Urinary Schistosomiasis without Bladder Carcinoma (US Group); we also investigate patients' characteristics according to urothelial transitional cell carcinoma (TCC), and squamous cell carcinoma (SCC) histopathological differentiation. The expression of markers in all groups (CK7, CK14, CK20, FoxP3, GATA3, STAG2, CD3, CD8, Ki67, and P53) was analyzed using immunohistochemistry of tissue micro-array sections (TMA). Overall, 136 patients were included in the study (n = 72 in the NBC group, n = 33 in the SBC group, and n = 31 in the US group). In the TCC subgroup, the expression of CK7, CK14, CK20, and Ki67 was significantly higher compared to US controls (p 0.002; p < 0.001; p 0.036; p < 0.001). In the SCC subgroup, the expression of CK7, CK14, and CK20 was significantly higher compared to US controls (p 0.007; p < 0.001; p 0.005). Both in TCC and SCC subgroups, no difference in the expression of any tested markers was found comparing NBC and SBC groups. In US group, a significant higher expression of STAG2 was found compared to SCC subgroup (p 0.005). Based on our results, the profile of immunohistochemical biomarkers' expression in both NBC and SBC groups is similar.

Transurethral resection of bladder tumors (TURBT)

Die transurethrale Resektion von Blasengewebe (TUR-B) ist für die Diagnostik und Therapie bei Blasentumoren indiziert. Diese werden fragmentiert mittels diathermaler Schlinge abgetragen. Der Wundgrund wird zur Blutstillung koaguliert. Zu achten ist auf eine ausreichende Schnitttiefe, sodass die Detrusormuskulatur erfasst ist. Postoperativ kann zur Rezidivprophylaxe eine intravesikale Single-shot-Chemotherapie verabreicht werden. Methoden zur verbesserten Tumorvisualisation (insbesondere photodynamische Diagnostik) helfen, besonders bei multilokulärem Befund oder Carcinoma in situ (CIS) bessere Detektionsraten zu erreichen sowie das Rezidiv- und Progressionsrisiko zu senken. In Abhängigkeit von der Histologie ergibt sich das weitere Vorgehen: bei nicht muskelinvasivem Blasenkarzinom Nachsorge, adjuvante Instillationstherapie mittels Chemotherapie oder Bacillus Calmette-Guérin (BCG), die Nachresektion („second look TUR-B“), die Frühzystektomie oder bei muskelinvasivem Blasenkarzinom die Zystektomie oder (onkologisch nachrangig) die trimodale Therapie mit erneuter TUR‑B, Radiotherapie und Chemotherapie. Mögliche Komplikationen im Rahmen der TUR‑B sind v. a. Nachblutung mit Blasentamponade, extra- oder intraperitoneale Blasenperforation oder Infektionen des Urogenitaltrakts.

''A STUDY OF INDICATIONS OF PRIMARY CESAREAN SECTION AND FETOMATERNAL OUTCOME IN MULTIPAROUS WOMEN ON A TERTIARY CARE CENTRE''

Laparotomy and hysterotomy incision through surgery to deliver the fetus is called Cesarean section. In modern days, higher complications in normal vaginal delivery is the major reason for choice of c section in India whereas this was already followed by US since decades. Healthy survival was possible for women in ancient days post normal delivery as they performed heavy physical work. However, modern women have less physical ability for normal vaginal delivery because of the low strength and fear of issues after a normal vaginal delivery. Today's women being literate and aware of the difculties like Postpartum infections which includes uterine, bladder, or kidney infections, excessive bleeding after delivery, pain in the perineal area (between the vagina and the rectum), Vaginal discharge, swollen breasts, clogged ducts, Stretch marks and also the vital reasons are Hemorrhoids and constipation along with Urinary or fecal (stool) incontinence, Hair loss, Postpartum depression, Discomfort during sex and difculty regaining the pre-pregnancy shape becomes crucial factor to decide for C section over normal vaginal delivery.

Evaluation the Efficiency of Electrical Stimulation Advanced Methods on Management of Bowel and Bladder Functions in Spinal Cord Injury Subject; A Systematic Review of Literature.

Objective:To evaluate the efficiency of various methods used for SCI subjects in this regard based on the available literature.Methods:A search was done in some data bases such as Google scholar, ISI web of knowledge, PubMed, and Scopus. Some keywords such as bowel, bladder control and management were used in combination with SCI. The studies’ quality was evaluated with Pedro scale.Results:From 100 articles found, 21 papers were selected based on abstracts and titles. The quality of the studies varied between 5 and 7 based on Pedro scale. There were 3 studies on abdominal muscles stimulation, 1 on stimulation of tibial nerve, 8 on stimulation of sacral nerve root, 2 on combination of stimulation and exercise, 4 on Brindley bladder control and 3 on sacralizotomy.Conclusion:The bowel and bladder management functions is not the main problem of SCI subjects anymore. Some advantages of the mentioned procedures used for SCI subjects are including improved quality of life, socialization, and decreased bladder infection.

Pseudo Tumor of the Bladder Simulating Cancer: Pseudotumoral Glandular Cystitis

Intestinal metaplasia of the bladder is a rare pathology, estimated at less than 1% of bladder pathologies. Some forms, including pseudo tumor glandular cystitis, can mimic cancer. We report a rare case of this pathology, little studied in our context, treated in Senegal and we underline the epidemiologicalclinical and anatomopathological particularities. Observation: Mr. MN, 26 years old, non-smoking, known epileptic, with psychomotor delay since birth (under Tegretil and Gardenal), presented with a hip’s trauma, not operated on in 2012, then a left leg fracture following a traffic accident in August 2019. He consulted for recurrent terminal hematuria without urination burn, dysuria and pelvic pain. The clinical examination revealed a motor deficit, a normal prostate on rectal examination. Cystoscopy showed a solid, vegetative, ulcerated tumor lesion of the bladder, of trigonal location and of the right lateral wall without invasion sign, with ureteral meatus and permeable ureters. The rest of the devices and biological assessments examination are unremarkable. Abdomino-pelvic ultrasound revealed a semi-replete bladder with a non-significant post-void residue and 39.78 cc prostatic hypertrophy without repercussions on the upper urinary system. The patient underwent a complete and deep bladder’s transurethral resection which, after histological examination, showed a pseudotumoral glandular cystitis of the bladder. Conclusion: The bladder should be taken into account in adult patients, often males, with irritative and obstructive urinary signs. It can occur without previous bladder infection. This pathology can simulate bladder cancer from which the interest of the pathological examination which makes it possible to make the formal diagnosis.

Bladder infection with uropathogenic Escherichia coli increases the excitability of afferent neurons.

Urinary tract infections (UTIs) cause bladder hyperactivity and pelvic pain, but the underlying causes of these symptoms remain unknown. We investigated whether afferent sensitization contributes to the bladder overactivity and pain observed in mice suffering from experimentally induced bacterial cystitis. Inoculation of mouse bladders with the uropathogenic Escherichia coli strain UTI89 caused pelvic allodynia, increased voiding frequency, and prompted an acute inflammatory process marked by leukocytic infiltration and edema of the mucosa. Compared with controls, isolated bladder sensory neurons from UTI-treated mice exhibited a depolarized resting membrane potential, lower action potential threshold and rheobase, and increased firing in response to suprathreshold stimulation. To determine whether bacterial virulence factors can contribute to the sensitization of bladder afferents, neurons isolated from naïve mice were incubated with supernatants collected from bacterial cultures with or depleted of lipopolysaccharide (LPS). Supernatants containing LPS prompted the sensitization of bladder sensory neurons with both tetrodotoxin (TTX)-resistant and TTX-sensitive action potentials. However, bladder sensory neurons with TTX-sensitive action potentials were not affected by bacterial supernatants depleted of LPS. Unexpectedly, ultrapure LPS increased the excitability only of bladder sensory neurons with TTX-resistant action potentials, but the supplementation of supernatants depleted of LPS with ultrapure LPS resulted in the sensitization of both population of bladder sensory neurons. In summary, the results of our study indicate that multiple virulence factors released from UTI89 act on bladder sensory neurons to prompt their sensitization. These sensitized bladder sensory neurons mediate, at least in part, the bladder hyperactivity and pelvic pain seen in mice inoculated with UTI89.NEW & NOTEWORTHY Urinary tract infection (UTI) produced by uropathogenic Escherichia coli (UPEC) promotes sensitization of bladder afferent sensory neurons with tetrodotoxin-resistant and tetrodotoxin-sensitive action potentials. Lipopolysaccharide and other virulence factors produced by UPEC contribute to the sensitization of bladder afferents in UTI. In conclusion, sensitized afferents contribute to the voiding symptoms and pelvic pain present in mice bladder inoculated with UPEC.

A multicenter study of antimicrobial prescriptions for cats diagnosed with bacterial urinary tract disease.

ObjectivesThe aim of this study was to evaluate initial antimicrobial therapy in cats diagnosed with upper or lower bacterial urinary tract infections at veterinary practices in the USA and Canada.MethodsElectronic medical records from a veterinary practice corporation with clinics in the USA and Canada were queried between 2 January 2016 and 3 December 2018. Feline patient visits with a diagnosis field entry of urinary tract infection, cystitis and pyelonephritis, as well as variation of those names and more colloquial diagnoses such as kidney and bladder infection, and where an antimicrobial was prescribed, were retrieved.ResultsPrescription data for 5724 visits were identified. Sporadic cystitis was the most common diagnosis (n = 5051 [88%]), with 491 (8.6%) cats diagnosed with pyelonephritis and 182 (3.2%) with chronic or recurrent cystitis. Cefovecin was the most commonly prescribed antimicrobial for all conditions, followed by amoxicillin–clavulanic acid. Significant differences in antimicrobial drug class prescribing were noted between practice types and countries, and over the 3-year study period. For sporadic cystitis, prescription of amoxicillin–clavulanic acid increased significantly and cefovecin decreased between 2016 and 2018, and 2017 and 2018, while fluoroquinolone use increased between 2017 and 2018.Conclusions and relevanceThe results indicate targets for intervention and some encouraging trends. Understanding how antimicrobials are used is a key component of antimicrobial stewardship and is required to establish benchmarks, identify areas for improvement, aid in the development of interventions and evaluate the impact of interventions or other changes.

Urinary Infections in Pregnancy Conditions

The urinary tract infections (UTI’s) are common infections that can affect kidneys, ureters, and urethra. About 40% of urinary tract infections are caused during hospitalization and globally an estimated 600,000 patients are affected per year. Urinary tract infections are more prevalent in women due to their short urethra and its anatomical proximity to the anal orifice. A bladder infection may cause pelvic pain, increased urge to urinate, pain with urination and blood in the urine. A kidney infection may cause back pain, nausea, vomiting and fever. Bacteriuria is a major risk factor for the development of urinary tract infections during pregnancy and with further risk of preterm birth &amp; pyelonephritis if untreated. This study was carried out to isolate and identify bacteria involved in the first trimester of pregnancy. A cross sectional study was conducted from February, 2019 to June 2019. Structured questionnaires were used to collect data from pregnant women. UTI was diagnosed by urine culture on standard culture media. Out of 25 pregnant women included in this study, 15 (60.0%) were symptomatic and 10 (40.0%) asymptomatic. Escherichia coli(64%) was the most commonly found bacterial isolate followed by Psedomonas aeruginosa (20%), Klebsiella sp. (12%) and Proteus sp. (0.4%). Antibiotic susceptibility test by Kirby-Bayer Disc diffusion method revealed that all the bacterial isolates subjected to antibiogram test were sensitive or susceptible to Gentamycin, Nalidixic acid, Nitrofurantoin, Amikacin and Co-trimoxazole, and resistant to Amoxicillin, Norfloxacin and erythromycin were resistant to all bacterial isolates.

Interpersonal violence and painful bladder symptoms in community-dwelling midlife to older women

Women are more likely to present with genitourinary complaints immediately after exposure to interpersonal violence, but little is known about the long-term effects of violence on women's urologic health, including their susceptibility to bladder pain and infections. To determine whether lifetime interpersonal violence exposure and current posttraumatic stress disorder (PTSD) symptoms are associated with the prevalence or severity of painful bladder symptoms and a greater lifetime history of antibiotic-treated urinary tract infections in community-dwelling midlife and older women. We examined the cross-sectional data from a multiethnic cohort of community-dwelling women aged 40 to 80 years enrolled in a northern California integrated healthcare system. Women completed structured self-report questionnaires about their past exposure to physical and verbal/emotional intimate partner violence and sexual assault. The symptoms of PTSD were assessed using the PTSD checklist for the Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition, Civilian version. Additional structured self-report measures assessed the current bladder pain, other lower urinary tract symptoms, and the history of antibiotic-treated urinary tract infections. Multivariable logistic regression models examined self-reported interpersonal violence exposure history and current PTSD symptoms in relation to current bladder pain and antibiotic-treated urinary tract infection history. Among 1974 women (39% non-Latina White, 21% Black, 20% Latina, and 19% Asian), 22% reported lifetime interpersonal violence exposure, 22% reported bladder pain, and 60% reported a history of ever having an antibiotic-treated urinary tract infection. Lifetime experiences of sexual assault (odds ratio, 1.39; [95% confidence interval, 1.02-1.88]) and current PTSD symptoms (odds ratio, 1.96; [95% confidence interval, 1.45-2.65]) were associated with current bladder pain. A lifetime experience of physical intimate partner violence was associated with having a urinary tract infection at any time in life previously (odds ratio, 1.38; [95% confidence interval, 1.00-1.86]), as was emotional intimate partner violence (odds ratio, 1.88; [95% confidence interval, 1.43-2.48]), sexual assault (odds ratio, 1.44; [95% confidence interval, 1.09-1.91]), and current PTSD symptoms (odds ratio, 1.54; [95% confidence interval, 1.16-2.03]). In this ethnically diverse, community-based cohort, lifetime interpersonal violence exposures and current PTSD symptoms were independently associated with current bladder pain and the lifetime history of antibiotic-treated urinary tract infections in midlife to older women. The findings suggest that interpersonal violence and PTSD symptoms may be underrecognized markers of risk for urologic pain and infections in women, highlighting a need for trauma-informed care of these issues.

A case of concurrent gastrointestinal, peritoneal and urinary bladder tuberculosis

Tuberculosis is a top 10 leading cause of death worldwide. Lungs are primarily involved organs in tuberculosis. The rest of cases are extrapulmonary tuberculosis (14% reported in 2017). Extrapulmonary tuberculosis always presents with non-specific symptoms, thus at risk of delay diagnosis and management. In genitourinary tuberculosis, kidney alone and kidney with urinary bladder or ureter is affected in more than 70% of cases. The ureter and urinary bladder infections are almost always secondary to tuberculous involvement of the kidney. Bacilli haematogenic spreading is a known transmission pathway to the kidney. In this case, we diagnosed isolated urinary bladder tuberculosis caused by direct gastrointestinal tuberculosis infiltration, a rare occurrence of extrapulmonary tuberculosis. We illustrate the multiorgan involvement in tuberculosis infection including pulmonary, gastrointestinal, peritoneal and urinary bladder.

Pharmacokinetic/pharmacodynamic analysis of oral fosfomycin against Enterobacterales, Pseudomonas aeruginosa and Enterococcus spp. in an in vitro bladder infection model: impact on clinical breakpoints.

Fosfomycin is an established treatment for uncomplicated urinary tract infections (UTIs), yet evidence supporting susceptibility breakpoints is limited. We examine the UTI susceptibility criteria. Fosfomycin susceptibility, heteroresistance and in vitro growth in a bladder infection model, after a single 3 g dose of oral fosfomycin, were bridged to human pharmacokinetics with pharmacokinetic/pharmacodynamic and Monte Carlo analyses. Data from common uropathogens (24 Escherichia coli, 20 Klebsiella pneumoniae, 4 Enterobacter cloacae, 14 Pseudomonas aeruginosa, 8 Enterococcus faecalis and 8 Enterococcus faecium) were compared and analysed to ascertain species-specific PTA. Glucose-6-phosphate (G6P) increased MICs of E. coli, K. pneumoniae and E. cloacae (median 2-fold dilutions 3-5), but not of P. aeruginosa and Enterococcus. Atypical E. coli lacking G6P potentiation were killed in the bladder infection model despite high MICs (32-128 mg/L). Fosfomycin heteroresistance was uncommon in E. coli (MIC > 2 mg/L) but was detected in the majority of K. pneumoniae (MIC > 1 mg/L) and P. aeruginosa (MIC >8 mg/L). For these species, baseline heteroresistance was a strong predictor for treatment failure in the model. No heteroresistance was found in Enterococcus. The fAUC/MIC targets for stasis were 1935, 3393, 9968, 2738 and 283 for typical E. coli, K. pneumoniae, E. cloacae, P. aeruginosa and E. faecalis, respectively (synthetic human urine medium alone promoted a 1 log10 kill in E. faecium). A >95% PTA for stasis was only found at MIC ≤ epidemiological cut-off (ECOFF) for E. coli (4 mg/L). For other species, PTAs were low for WT populations. With the exception of E. coli, fosfomycin is a poor target for other uropathogen species. A reduction in oral fosfomycin UTI breakpoints is supported.

Brucella prostatic abscess: a retrospective study of eight cases and a literature review.

ObjectiveTo present the clinical characteristics, diagnostics, and treatments for Brucella prostatic abscess (BPA).MethodsWe retrospectively analyzed eight BPA patients according to their vocations, age, clinical manifestations, laboratory test results, magnetic resonance imaging (MRI) findings, and treatments.ResultsThe median age was 59 years. The most common clinical symptom was fever, followed by dysuria, erectile dysfunction, frequent urination, and urodynia. C-reactive protein (CRP) concentrations were significantly elevated in all patients, and in all by one patient, the erythrocyte sedimentation rate (ESR) was high. Prostate enlargement occurred in 87.5% of the patients. Lesions were located in the prostate peripheral (87.5%) and central zones (100%), with homogenous signals on T1-weighted imaging (T1WI) and a hyperintense signal on short tau inversion recovery (STIR). Patients had a small nodule or multiple nodules, with slight hyperintense to hyperintense signals on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI). Three patients had pelvic effusion, and seminal vesicle (37.5%), epididymis (12.5%), and bladder (12.5%) infections occurred. All patients received rifampicin and doxycycline with levofloxacin; all lesions had resolved at follow-up ultrasonography.ConclusionEven in epidemic areas, the incidence of BPA is relatively rare. Our findings may increase the understanding of BPA and reduce misdiagnosis and mistreatment.

MP25-09 MICROBIAL EXPOSURE REDUCES SUSCEPTIBILITY TO LOCALIZED UROPATHOGENIC E. COLI INFECTION IN THE BLADDER AND UROSEPSIS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP25)1 Sep 2021MP25-09 MICROBIAL EXPOSURE REDUCES SUSCEPTIBILITY TO LOCALIZED UROPATHOGENIC E. COLI INFECTION IN THE BLADDER AND UROSEPSIS Matthew Martin, Whitney Swanson, Tamara Kucaba, Molly Ingersoll, and Tom Griffith Matthew MartinMatthew Martin More articles by this author , Whitney SwansonWhitney Swanson More articles by this author , Tamara KucabaTamara Kucaba More articles by this author , Molly IngersollMolly Ingersoll More articles by this author , and Tom GriffithTom Griffith More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002022.09AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Urinary tract infections (UTI) are the most prevalent infectious disease of the bladder-affecting >130 million people worldwide annually. Uropathogenic E. coli (UPEC) causes most UTI, starting with bladder colonization and then ascension to the kidneys. In severe cases of pyelonephritis, bacteria can enter the bloodstream, causing urosepsis. The immune system is involved in the development of these pathologies and response to treatment, but relatively little is known about how the basal state of the immune system influences the ability to respond to local or systemic UPEC infection. The difficulty in performing hypothesis-driven research in humans justifies the need for a clinically relevant experimental UTI/urosepsis model. Most preclinical studies are conducted with specific pathogen-free (SPF) mice, which possess a largely naïve immune system equivalent to neonatal humans. Cohousing (CoH) SPF mice with microbially diverse pet store mice matures the immune system to resemble that of adult humans. Therefore, the objective of these studies is to determine how prior microbial exposure affects the immune response to local and systemic UPEC infections. METHODS: For these studies, we infected SPF and CoH mice with UPEC strain UTI89 locally via bladder instillation or systemically via intravenous injection. Immune cell composition in the bladder was determined before and after infection, and bacterial clearance and survival following infection was monitored. RESULTS: Microbial exposure altered the baseline immune cell composition in the bladder, with CoH mice showing increased numbers of CD4 T cells and neutrophils. Interestingly, CoH mice were better able to clear UPEC infection following local infection of the bladder. Following systemic infection to model urosepsis, greater numbers of immune cells (especially neutrophils) were found in the circulation of CoH mice, and CoH mice showed faster clearance of infection in the blood, spleen, and kidney. Importantly, all SPF mice succumbed to infection within 48 hours, while all CoH mice survived beyond 72 hours. CONCLUSIONS: Our results have important implications for models of UTI/urosepsis. They suggest a general history of microbial exposure reduces susceptibility to localized bladder infection and urosepsis. While these studies importantly further our understanding of the immune response initiated after local or systemic UPEC infection, they also suggest mouse studies incorporating exposure to diverse infections may provide a more clinically relevant experimental UTI/urosepsis model. Source of Funding: American Urological Association Research Scholar AwardUniversity of Minnesota Department of Urology General Research Funds © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e456-e456 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Matthew Martin More articles by this author Whitney Swanson More articles by this author Tamara Kucaba More articles by this author Molly Ingersoll More articles by this author Tom Griffith More articles by this author Expand All Advertisement Loading ...