Chronic Recurrent Urinary Tract Infections Research Articles

Analysis of complications of neurogenic bladder dysfunction in children

Dysfunction of the lower urinary tract is a fairly common consequence of perinatal lesions of the nervous system. Dysfunction of the bladder and muscles of the urogenital diaphragm in this group of children can be accompanied by severe urodynamic disorders and, in some cases, can lead to complications such as chronic recurrent urinary tract infection, vesicoureteral reflux, nephrosclerosis, kidney atrophy, chronic renal failure. Purpose. To study uronephrological complications in children with various forms of neurogenic bladder dysfunction and suggest methods for their prevention and pathogenetic treatment. Material and methods. 67 children with neurogenic bladder dysfunction were examined. All children underwent comprehensive uronephrological and neurological diagnostics using objective neuroimaging, electrophysiological and functional research methods. Results. Complications leading to somatic health disorders in patients were diagnosed. These included chronic cystitis — in 13 (19.4%) patients, chronic pyelonephritis — in 57 (85.1%), vesicoureteral reflux — in 25 (37.3%), chronic renal failure — in 8 (11.9%) children. Therapy for neurogenic bladder dysfunction consisted of basic therapy of the central nervous system lesion, as well as symptomatic therapy aimed at normalizing the functional state of the bladder. In the vast majority of cases of neurogenic bladder dysfunction complications, their relief occurred within a year in the process of curing the underlying disease. In some cases, in children with severe neurological disorders (myelodysplasia, meningoradiculocele), along with medication and physiotherapy, surgical manipulations (periodic bladder catheterization) and surgical interventions (epicystostomy) were performed. Conclusion. In children with detrusor hyperreflexia and mild «high» lesions of the nervous system, clinical symptoms of neurogenic bladder dysfunction were usually noted, worsening only their quality of life. In children with a significant neurological deficit and a rather severe lesion of the lumbosacral spinal cord, complications developed that worsened the somatic health of this group of patients.

Escherichia coli-associated follicular cystitis in dogs: Clinical and pathologic characterization.

Follicular cystitis is an uncommon inflammatory change in the urinary bladder wall characterized by the formation of tertiary lymphoid structures (TLSs) in the submucosa. To characterize clinical and pathologic features of follicular cystitis in dogs and to explore in situ distribution and possible role of Escherichia coli as an associated cause. Eight dogs diagnosed with follicular cystitis and 2 control dogs. Retrospective descriptive study. Dogs diagnosed with follicular cystitis (macroscopic follicular lesions in the urinary bladder mucosa and histopathologic detection of TLSs in bladder wall biopsies) were identified from medical records. Paraffin embedded bladder wall biopsies were subject to in situ hybridization for E. coli 16SrRNA identification. Follicular cystitis was diagnosed in large breed (median weight 24.9 kg, interquartile range [IQR] 18.8-35.4 kg) female dogs with a history of chronic recurrent urinary tract infections (UTIs; median duration of clinical signs 7 months, IQR 3-17 months; median number of previous UTIs 5, IQR 4-6). Positive E. coli 16SrRNA signal was detected within developing, immature and mature TLSs in 7/8 dogs, through submucosal stroma in 8/8 dogs and within the urothelium in 3/8 dogs. Chronic inflammation associated with an intramural E. coli infection in the urinary bladder wall represents a possible triggering factor for the development of follicular cystitis.

Does Secondary Plant Metabolite Ursolic Acid Exhibit Antibacterial Activity against Uropathogenic Escherichia coli Living in Single- and Multispecies Biofilms?

Multispecies bacterial biofilms are the often cause of chronic recurrent urinary tract infections within the human population. Eradicating such a complex bacterial consortium with standard pharmacotherapy is often unsuccessful. Therefore, plant-derived compounds are currently being researched as an alternative strategy to antibiotic therapy for preventing bacterial biofilm formation and facilitating its eradication. Therefore, our research aimed to determine the effect of secondary plant metabolite ursolic acid (UA) on the growth and survival, the quantity of exopolysaccharides formed, metabolic activity, and morphology of uropathogenic Gram-negative rods living in single- and mixed-species biofilms at various stages of their development. Spectrophotometric methods were used for biofilm mass formation and metabolic activity determination. The survival of bacteria was established using the serial dilution assay. The decrease in survival and inhibition of biofilm creation, both single- and multispecies, as well as changes in the morphology of bacterial cells were noticed. As UA exhibited better activity against young biofilms, the use of UA-containing formulations, especially during the initial steps of urinary tract infection, seems to be reasonable. However, the future direction should be a thorough understanding of the mechanisms of UA activity as a bioactive substance.

Chronic Recurrent Urinary Tract Infection Presenting as Urgency Urinary Incontinence in a Postmenopausal Woman

Chronic Recurrent Urinary Tract Infection Presenting as Urgency Urinary Incontinence in a Postmenopausal Woman

Stigma and self-management: an Interpretative Phenomenological Analysis of the impact of chronic recurrent urinary tract infections after spinal cord injury

Study designQualitative, phenomenological design.ObjectivesNeurogenic bladder dysfunction and urinary tract infection (UTI) are common secondary consequences to neurological damage to the spinal cord. This study sought to establish the impact of chronic, recurrent UTIs on people with spinal cord injury (SCI).SettingCommunity sample, United Kingdom.MethodsTwelve participants with SCI, aged between 28 and 68 years, who had experienced at least three recurrent UTI events within the previous 12 months were recruited. Detailed qualitative information was obtained from semi-structured interviews, which lasted between 30 and 60 min. Interpretative Phenomenological Analysis was performed to explore the lived experience of UTIs.ResultsInterview findings identified a range of factors related to the experience of recurrent UTIs in people with SCI. These were classified into the following themes: (1) Symptom Management Precedence, (2) Stigma-Motivated Risk Management and (3) Exhaustive Exploration of Treatment Options. Participants discussed management of acute exacerbations. Distress arose from perceptions of UTIs as potentially stigmatizing and fear of relying on antibiotics. Arising from this fear, many participants sought alternative prevention and management strategies.ConclusionsThese results suggest that chronic recurrent UTIs act as major barriers to social participation, with adverse effects on quality of life of people with a neurogenic bladder after SCI. People with SCI would benefit from additional assessment of the impact of recurrent UTIs, so that healthcare professionals can address specific concerns, such as the psychosocial impact of urinary incontinence and stigmatizing views. Additional support to enhance self-management and facilitate social participation should be provided.

Recurrent Urinary Tract Infections in the Setting of Mesh Implants

Mid-urethral polypropylene mesh slings are widely accepted as a standard for surgical management of stress urinary incontinence due to a low complication rate and superior efficacy. Synthetic mesh implants used to augment female pelvic prolapse repairs gained popularity following introduction of these slings. Mesh implants for prolapse have been under increased scrutiny after the FDA safety notification was published in 2008 due to a higher than anticipated complication rate. While the complication rate of mesh slings used for incontinence is low, both incontinence mesh and prolapse mesh are associated with similar types of complications. These include mesh exposure, pain, voiding dysfunction, and infections. The majority of available literature describes the incidence of acute urinary tract infections in the immediate postoperative period, specifically after mid-urethral sling procedures for incontinence. The rates of de novo recurrent urinary tract infections and risk factors for these infections after polypropylene mesh placement are not well-characterized. The incidence of recurrent urinary tract infections after polypropylene mesh-augmented surgery for stress urinary incontinence and for pelvic organ prolapse is low. Risk factors for recurrent urinary tract infections after surgery include urinary retention, need for indwelling or intermittent catheterization, and preoperative history of recurrent urinary tract infections. While multiple theories exist, the current literature has not been able to determine risk factors for de novo recurrent urinary tract infections after mesh-augmented surgery in women without urinary retention or prior history of recurrent urinary tract infections. While some have suggested that the implant is coated with a bacterial biofilm resulting in chronic low levels of bacterial shedding, and thus predisposing certain individuals to chronic recurrent urinary tract infections, this theory remains unproven. It is also not known if revision of the mid-urethral slings or if removal of the mesh implant in women in this subgroup will result in the resolution of recurrent infections.

Low Dose Trimethoprim Prophylaxis in Long Term Control of Chronic Recurrent Urinary Tract Infection

26 patients with chronic urinary tract infections (UTI) were treated with 1 tablet of 100 mg trimethoprim (TMP) once daily for up to 6 months as long term prophylaxis. The recurrence rate before prophylaxis was 26/100 months, compared to a significantly lower frequency (3.3 recurrences/100 months, p less than 0.001) during prophylaxis. The post-prophylactic rate returned to the pre-prophylaxis rate: 23 recurrences/100 months. All Escherichia coli strains causing post-prophylactic UTI were TMP sensitive. The number of rectal enterobacteria were markedly reduced during prophylaxis (p less than 0.05). A 10% recovery of TMP resistant enterobacteria from rectal swabs was noted early (less than or equal to 1 month) during prophylaxis, but no significant further accumulation occurred.

Long-term treatment with pivmecillinam in patients with recurrent bacteriuria.

Thirty out-patients with chronic recurrent urinary tract infections, who had failed to respond to 10 days treatment with either pivmecillinam and/or amoxycillin, received a 3-month course of pivmecillinam at a dose of 200 mg, three times daily. Twenty-seven patients had bacteriuria due to Enterobacteriaceae, mainly Escherichia coli, sensitive to mecillinam in vitro. Pivmecillinam eradicated all the initial urinary pathogens. Reinfections occurred during treatment in three patients, who remained asymptomatic. Four subjects complained of gastro-intestinal side-effects, and therapy was withdrawn in three instances. Another three patients described unusual adverse events towards the end of the course of treatment, described as an odd sensation in the body and a desire for salt. The sensation disappeared a few days after the end of treatment. Treatment with pivmecillinam had no adverse effect on haematopoietic, hepatic or renal function.

Daily bacteriological examination of urine during antimicrobial treatment of urinary tract infections

Bacteriologic examinations of urine were performed daily in 85 patients admitted for chronic recurrent urinary tract infections and treated with antibacterial drugs. The results have shown that the effect of therapy can be evaluated fairly accurately on the basis of bacteriological findings in urine within the first four days of treatment. When sterility was achieved as early as after one or two days of therapy, the urine remained sterile in more than 90% of the patients throughout the first post-treatment week; in more than 80% therapy had a long-term effect. A slowly subsiding urinary tract infection or reduced urinary bacterial count indicates that therapy will be ineffective.

Evaluation of diagnostic parameters in chronic recurrent urinary tract infection in children. III. Pyuria, hematuria, and proteinuria (author's transl)

Pyuria, proteinuria and haematuria have been shown to be unreliable parameters for the diagnosis of bacteriuria in 171 children with 455 recurrences of chronic urinary tract infection. Bacteriuria caused haematuria in 5%, proteinuria in 18% and even pyuria in only 47% of all instances. Pyuria has been also found in 11% of sterile urines. The incidence of pyuria increases with the age of the children and depends on the type of the organisms, but the latter was true mainly in children with obstructive lesions of the urinary tract. Children with repeated proteinuria during follow-up tend to have a higher incidence of pathologic findings on the i.v.-pyelogram.

Evaluation of diagnostic factors in chronic recurrent urinary-tract infections in children. II. Clinical symptoms (author's transl)

2490 investigations in 171 children with chronic recurrent urinary-tract infections seen in a specialized out-patient unit for an average of 23 months demonstrated that clinical symptoms cannot be used as indicators of pyelitis or cystitis. 43% of recurrences (n=471) were completely asymptomatic. The symptomatology depends on the age of the patient and duration of the disease. Recurrences in the late course of the disease become frequently asymptomatic. Children with predominantly asymptomatic bacteriuria show pathological X-ray findings indicative of renal parenchymatous involvement as frequently as children with predominantly symptomatic recurrences.

HIGH RATE OF URINARY TRACT INFECTION FOLLOWING CLITORECTOMY IN GIRLS WITH CONGENITAL ADRENAL HYPERPLASIA (CAH)

Clitorectomized girls with CAH were noticed to develop more frequently urinary tract infections than normal female children. The bladder urine of 39 female patients with CAH was examined. 9 of these patients (23%) suffered from a chronic-recurrent infection of the urinary tract. In 19 cases a total amputation of the clitoris had been performed. The incidence of infections was high in this group: 3 developed an acute infection and 7 (37%) were found to have a chronic-recurrent urinary tract infection. In 3 of them the infection was discovered before the operation already and continued to exist afterwards. This high rate of urinary tract infection in CAH girls indicates an elevated disposition probably due to the CAH itself and to the steroid therapy, or to the changed anatomic situation by the amputation of the clitoris, An intensive examination of the urinary tract in patients with CAH seems to be necessary.

Indanyl carbenicillin in chronic recurrent urinary tract infections.

Indanyl carbenicillin in chronic recurrent urinary tract infections.

Cephaloridine: Clinical and laboratory studies in children

The results of treatment of gram-negative and gram-positive bacterial infections withcephaloridine, a semisynthetic derivative of cephalosporin C, in 22, infants and children are described. Clinical and bacteriological cure occurred in 19 patients; 2 patients died although their infecting organisms were sensitive to cephaloridine; it was believed that death was related in one case to the severity of the primary, illness and in the other to underlying malignancy. One patient with chronic recurrent urinary tract infection with Escherichia coli relapsed upon cessation of therapy. Blood levels were adequate to cover the minimal inhibitory concentration of susceptible microorganisms. Cephaloridine was well tolerated; side effects were limited to one instance of temporary skin rash.