Clean Catch Method Research Articles

PREVALENCE OF ASYMPTOMATIC BACTERIURIA AND ITS MICROBIOLOGICAL PROFILE IN PREGNANCY AT TERTIARY CARE HOSPITAL, JABALPUR

Objective: To determine the prevalence of asymptomatic bacteriuria (ASB), microbiological profile, and pregnancy outcome in asymptomatic pregnant women. Methods: Pregnant women attending outpatient clinic were selected randomly. Urine sample by clean catch method collected and battery of tests were performed. Prevalence of ASB and pregnancy outcome studied. Results: Total 114 pregnant women were studied, out of which 6 cases were positive for urine culture. Prevalence rate in our study found to be 5.3%. Study depicted that 33.4% women with asymptomatic bacteriuria had premature rupture of membranes, 16.7 % women had pre-eclampsia and 16.7% had severe anemia. 50 % babies were premature, 33.4% had fetal growth restriction and 16.7% developed acute respiratory distress syndrome. Conclusion: Urinary tract infections are common during pregnancy. Asymptomatic bacteriuria can progress to pyelonephritis and may result in adverse pregnancy outcome. Prevalence rate found to be 5.3%. Premature rupture of membranes and premature births were major adverse pregnancy outcome. E. coli was most common bacterial isolate found in the study and was highly sensitive to cefuroxime sodium. Pregnancy complications may be avoided by using regular screening with urine cultures.

Pediatric Uropathogens and their Antimicrobial Susceptibility Pattern: Experience from an Impoverished District of Karachi, Pakistan.

Urinary tract infection (UTI) is the most common infection of the pediatric age group. Several factors linked to higher prevalence include poor personal hygiene, improper sanitation, lower socioeconomic status, and malnourishment. In addition to having a worse quality of life, the 1.8 million children who live in Karachi's Korangi district are routinely exposed to such factors. The study aims to evaluate the frequency of UTI and distribution of uropathogens along with their antimicrobial susceptibility pattern in patients presenting to a pediatric tertiary care center in the Korangi district of Karachi, Pakistan. The study employed an observational cross-sectional design. The study was conducted at the Microbiology laboratory of Sindh Institute of Child Health and Neonatology, Karachi, Pakistan from 1st January to 15th August 2023. Urine samples of patients 1 to 16 years of age were collected via midstream clean catch method and of patients from birth up to 1 year were collected in urine collection bags. The samples were cultured on Cystine Lactose Electrolyte Deficient (CLED) agar and antibiotic susceptibility testing was performed using the Kirby-Bauer Disc Diffusion method. A total of 457 urine samples were collected, of which 90 (19.7%) were positive for significant uropathogens. With a mean age of 4.6 years, majority of the culture-positive patients were female (n = 72; 80%). Enterobacterales were the most frequently isolated (n = 88; 95.6%), of which Escherichia coli was the most common (73.9%; n = 68). Citrobacter (n = 7; 7.6%), Klebsiella (n = 6; 6.5%), Serratia (n = 4; 4.3%), Proteus (n = 2; 2.2%), Salmonella (n = 2; 2.2%), and Enterobacter (n = 1; 1.1%) were among the other Enterobacterales isolated. Meropenem and imipenem were the most effective in isolates from Enterobacterales (n = 88) followed by amikacin (n = 84), ciprofloxacin (n = 75), and piperacillin-tazobactam (n = 70). Ceftriaxone and cefixime exhibited moderate susceptibility (n = 69 and 52) whereas, amoxicillin-clavulanate was the least susceptible (n = 3). We report high frequency of UTI in our pediatric population with uropathogens and associated antimicrobial susceptibility pattern confirming to the existing trends of pediatric UTIs in Pakistan. In addition to valuable insights for treating patients under similar conditions, our study serves as a catalyst for further multi-center research in this area.

Isolation and Susceptibility of Microorganisms Responsible for Asymptomatic Antenatal Bacteriuria

Aim & Objective: Determination of prevalence, bacterial profile and antibiotic sensitivity of microorganisms responsible for asymptomatic UTI during pregnancy.
 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.
 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%).
 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.
 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.

An observational study on emerging antimicrobial resistance pattern in urinary tract Infection in Nepalese children

AIMS Evidence-based management and local antibiotic susceptibility pattern provides evidence to guide the development of urinary tract infection (UTI) treatments protocols decreasing the economic burden significantly. We aimed to investigate the aetiology and resistance pattern of bacterial uropathogens to commonly prescribed oral antibiotics (beta lactamase and fluoroquinolones) causing UTI and to recommend the most appropriate antibiotics.
 MATERIALS AND METHODS This study is cross sectional, retrospective study. We evaluated causative agents and antimicrobial resistance in urine, culture positive samples collected from July 2019 to June 2021 in a single hospital in Kathmandu, Nepal. To obtain urine samples, a midstream clean-catch method used in children who were toilet trained and transurethral catheterization performed in non-toilet-trained children. Urine samples were sent to the laboratory where they were inoculated using a 4 mm calibre loop on CLED (Cysteine Lactose Electrolyte Deficient) agar plate, and incubated at 37 °C for 18–24 h. Conventional methods (colony morphology, Gram stain) were opted. Different biochemical tests – catalase test, coagulase test and inoculation in Bile Esculin Agar was done for Gram-positive organisms, while Triple Sugar Indole (TSI) agar, Sulphide indole motility (SIM) agar, Simon's citrate agar and Christensen's urea agar were used for identification of Gram-negative bacilli. Significant growth was evaluated as ≥105 colony forming units (CFU)/ml of urine. Kirby-Bauer disc diffusion method was used to perform in vitro antimicrobial susceptibility tests in Mueller-Hinton agar plates. Total 13 drugs were tested for sensitivity pattern. To analyse resistance to antibiotics for different ages, subjects were divided into four age groups: Group I, 2 months - 1 year; Group II, 1 year - 5 year; Group III, 5 year - 10 year; Group IV, 10 year - 15 year.
 RESULTS Among 970 samples sent, a total of 230 positive urine cultures were identified, of which 116 (50.4%) were from girls and 114 (49.6%) were from boys. The most common age group was 2 months to 1 year (49.1%). The most common causative agent was Escherichia coli (49.1%) followed by Enterococcus faecalis (14.3%) and Klebsiella pneumoniae (11.3%). The overall resistance to Nalidixic acid (66%), Ceftriaxone (54.8%) Cefotaxime (48.3%) Ciprofloxacin (47.9%) and Co-trimoxazole (46.9%) was significant. The least resistance was for Chloramphenicol, Nitrofurantoin, and Norfloxacin was 9.5 %, 31.5 %, and 38.3 % respectively. Chloramphenicol (90.5%) was the most active agent against E. coli and Klebsiella, whereas Linezolid (92.7%) and cloxacillin (64.9%) was most active against Enterococcus and Staphylococcus species.
 CONCLUSION Escherichia coli was the most common causative agent of urinary tract infection in children. Nalidixic acid, Ceftriaxone, Cefotaxime, Ciprofloxacin and Co-trimoxazole had the highest resistance rates against urinary tract pathogens in our centre. For oral empirical antibiotic therapy, Chloramphenicol is the most appropriate choice for Escherichia coli and Klebsiella strains and Linezolid for Enterococcus species.

STUDY OF ANTIBIOTIC SENSITIVITY PATTERN IN CHILDREN WITH NEPHROTIC SYNDROME PRESENTING WITH UTI

BACKGROUND:Nephrotic syndrome (NS) results in proteinuria of more than 3.5 g protein per day and is characterized by edema,hyperlipidemia,hypoproteinemia and other metabolic disorders.Prevalence of UTI in nephrotic syndrome is high.It precipitates relapse and delays remission. AIMS AND OBJECTIVES:The aim of this retrospective study is to analyze the incidence of UTI,its Predisposing factors along with its bacterial and fungal etiologies in patients with NS and antibiotic sensitivity pattern in nephrotic children with UTI. METHODS: This retrospective study was carried out in a tertiary care, CIVIL HOSPITAL,AHMEDABAD between July 2018 and July 2019 among the admitted cases of nephrotic children under 12 years of age. Examinations for microscopy and cultures of urine, sputum, throat swab, blood and fluid were also carried out in the children,along with routine examination,if found necessary. Urinary specimens were collected by clean catch method following careful preparation of urethral orifices. The specimens were immediately inoculated on culture media. Identification of organisms and antibiotic sensitivity 1 susceptibility testing was performed according to CLSI guidelines 2010 by Kirby –Bauer disc diffusion method. RESULTS: Total 41 nephrotic children were enrolled.Incidence of UTI was fairly high in nephrotic syndrome,especially in frequent relapse (48.48%). Kleibsella pneumonia (45.5%) was the most common organism, followed by E.coli (24.24%),responsible for UTI in both first episode and frequent relapse of nephrotic syndrome in the following study. CONCLUSION: As per the study, common isolates of UTI in nephrotic syndrome have developed resistance to commonly used oral or parenteral drugs.In my study,it is observed that colistin was the most sensitive parenteral drug for all isolates followed by Meropenem and aminoglycoside.

Is There a Difference in the Contamination Rates of Urine Samples Obtained by Bladder Catheterization and Clean-Catch Collection in Preschool Children?

The objective of this study was to compare contamination rates in urine samples obtained by transurethral catheterization and clean-catch methods in preschool children aged 2 to 5 years. A retrospective, chart review was performed on patients evaluated in our emergency department over a 6-month period who had a urine culture obtained by either transurethral catheterization or clean-catch methods. The charts were reviewed for urine bacterial colony counts and divided into positive, negative, or contaminated cohorts. Demographic data were collected as well. Four hundred sixty patients met inclusion for this study. Of these patients, there were 120 samples collected by catheter (26.1%) and 340 samples collected by clean-catch method (73.9%).Female patients comprised 73% of the eligible samples (n = 336), and 27% were male (n = 124). Contamination rates significantly varied by collection method (P < 0.0001), with only 9 contaminated catheter samples (7.5%) and 125 contaminated clean-catch samples (36.76%). Contaminated samples were found in 122 of 336 female urine samples (36.3%), and 12 of 124 male urine samples (9.7%). There were no associations found between contamination rates and age within either sex. Our study demonstrated a higher urine culture contamination rate in preschool age children in the clean-catch method group compared with the transurethral catheterization group. This finding was particularly strong within the female subset, which could partially be accounted for by the small male sample size.

Bacterial Pattern of Community acquired Urinary Tract Infections: A Challenge for Antimicrobial Resistance

Background: Urinary tract infection (UTI) is considered one of the most common bacterial infections seen in health care. To our knowledge, there is no available antimicrobial resistance surveillance system for monitoring of community-acquired UTIs (CA- UTIs) in our country. Objectives: we aimed to discuss the bacterial pattern and resistance profile of CA-UTIs in Ismailia, Egypt. Methods: This cross-sectional study included 400 patients suffering from symptoms of acute UTIs. Urine specimens were collected by clean-catch mid-stream method, examined microscopically and inoculated immediately on blood agar and MacConkey's agar plates. Colony counting, isolation and identification of the urinary pathogens were performed by the conventional biochemical tests according to the isolated organism. Antibiotic susceptibility testing was performed by Kirby Bauer disk diffusion method. Interpretation was performed according to Clinical Laboratory Standard Institute (CLSI) guidelines. Results: out of 400 specimens, 136 of them revealed no bacterial growth or insignificant bacteriuria. Most of participants with UTI were females (81.8%) (p=0.008) and 54.5% of them were married (P=0.1). Gram negative bacteria were more common than Gram positive representing 66 % and 34% respectively. E. coli was the most common isolated organism (39%) followed by S. aureus (32%), K. Pneumoniae and Pseudomonas (10.5% for each), Proteus (6%) and Enterococci (2%). E. coli isolates showed the highest susceptibility to imipenem, meropenem, amikacin, nitrofurantoin, levofloxacin and ciprofloxacin. Most of our patients were diabetics (64.8%) (p=0.004). The mean ± SD of HbA1c was 6.4±2.0 with 4 to 12.6 range, S.E was 0.1 and 95% C.I was 6.2- 6.7. The highest mean ± SD of HbA1c was in S. aureus infections. Conclusion: Gram negative bacteria were most common than Gram positive with predominance of E. coli with significant relation to the presence of diabetes.

Comparison of two human infant urine collection methods for measuring estrone‐3‐glucuronide

Current human infant urine collection methods for the field are problematic for the researcher and potentially uncomfortable for the infant. In this study, we compared two minimally invasive methods for collecting infant urine: organic cotton balls and filter paper. We first collected urine from infants using the clean catch method. We then used those samples to compare the performance of filter paper and cotton ball collection protocols. We analyzed the clean catch and cotton samples using commercial estrone-3-glucuronide (E1G) kits and tried two different extraction methods for the filter paper. Using a paired t-test (n=10), we compared clean catch and cotton samples. We also compared effect sizes within and between methods. We were unable to extract enough urine from the filter paper to successfully assay the samples for E1G. The paired t-test revealed a statistically significant difference between the clean catch and cotton methods (t=2.63, p-value=0.03). However, the effect size was small (5.91 μg/ml, n=10, 95% CI=3.80, 8.02) and similar to or larger than the difference seen between duplicate wells for clean catch and cotton values. While this study is limited by sample size, our results indicate that filter paper is not a field-friendly method for collecting infant urine. However, we found that organic cotton balls showed similar values to the clean catch method, and we propose this method as an alternative, minimally invasive method for study of E1G in human infant urine.

Asymptomatic bacteriuria among pregnant women attending tertiary care teaching hospital

Introduction: One of the causes for adverse perinatal outcome is asymptomatic bacteriuria (ASB). The aim of this study is to determine the prevalence of asymptomatic bacteriuria among pregnant women. Materials and Methods: A total of 205 urine specimens were collected by clean catch method from pregnant women attending Vinayaka Missions Medical College and Hospital, to screen asymptomatic bacteriuria. Collected urine samples were sent to microbiology laboratory and subjected to standard microbiological procedures to identify the pathogen. Results: Out of 205 midstream urine specimens, 21 samples yielded significant bacterial growth and accounted for 10% asymptomatic bacteriuria. Asymptomatic bacteriuria was predominantly found between the age group of 18-25 years (52.38%). Significant bacterial growth was found in the specimens collected during three trimesters. Predominantly growth was seen from the urine specimens collected during second 8 (38.10%) and third trimester 8 (38.10%). Escherichia coli was the predominant bacteria isolated and accounted for 33.33%. Nitrofurantoin was found to be the most effective towards Gram positive and Gram negative bacteria. Conclusion: In our study, prevalence of asymptomatic bacteriura among pregnant women was 10%. Predominantly isolated bacteria was Escherichia coli. Among commonly used antibiotics to treat urinary tract infections, Nitrofurantoin was found to be the most effective drug. Keywords: Asymptomatic bacteriuria, Escherichia coli, Nitrofurantoin.

Utility of Urine KOH in Detecting Candiduria in Infants

Background: Candida species are common cause of urinary tract infection in infants requiring medical care. Candida fungal elements may be demonstrated in urine using microscopic examination with potassium hydroxide (KOH). However, detection of these elements does not always correlate with candiduria. Objectives: To establish the utility of urine KOH in identifying candiduria and to determine the risk factors, as well as urinalysis and CBC parameters associated with candiduria. Methods: This prospective cross-sectional study included admitted infants 1 year and below with urine culture and with any risk factor/s for candiduria. Additional urine KOH testing was done using clean catch or catheter method. Urine culture was used as the gold standard. Results: Among the 90 study participants with both urine culture and urine KOH, 13 (14%) had candiduria. The use of indwelling catheter, presence of urinary tract anomalies, positive leukocyte esterase in urinalysis, and increased monocyte counts in CBC are all associated with candiduria. Urine KOH has sensitivity of 100%, (CI 75.2-100%), specificity 59.7%, (CI 47.9-70.7%), PPV 29.5%, (CI 17.7-45.2%), and NPV 100%, (CI 92.2-100%) in detecting candiduria. Conclusions: Negative urine KOH has excellent negative predictive value, while positive urine KOH result may warrant further investigation. Urine KOH results should be interpreted with caution depending on patient’s risk factors, clinical status, and other laboratory results prior to initiation of empiric antifungal therapy. Positive urine KOH may not always require treatment.

Prevalence of urinary tract infection in febrile infants

Background: Urinary tract infection (UTI) is one of the most common bacterial infections in infancy, with a high risk of recurrence, and maybe an indicator of underlying urinary tract abnormality. It is often misdiagnosed due to irregular and unrelated symptomatology in the absence of directed screening. Objectives: The objectives of the study were to assess the feasibility of mid-stream clean catch method in infants for collecting a urine sample, compare the reliability of urinalysis in comparison with urine culture and to determine the prevalence of UTI among febrile infants in a rural setting. Materials and Methods: The study was conducted in a level-2 pediatric hospital involving 320 febrile infants attending the out-patient department from January 1, 2018, to June 30, 2018. Urine specimens were collected using midstream clean-catch urine (CCU) method and tested by urinalysis and culture. Results: Urine sample was successfully obtained by the CCU method in 320 (88.9%) out of 360 infants, of which only 8 (2.5%) showed contamination in culture. A total of 20 (6.25%) infants were culture positive for UTI. Only 14 (70%) of these showed positive urinalysis, while 17 (85%) of the culture-positive cases had a provisional diagnosis other than UTI. Further radiological examination revealed renal abnormalities in two out of six culture-positive infants who underwent subsequent studies. Conclusion: CCU method is reliable method for successful collection of urine and low contamination and can be used reliably in the absence of supra pubic aspiration/catheterization. Urinalysis lacks sensitivity in comparison with urine culture, necessitating the use of urine culture to diagnose/rule out UTI in infants. Culture-positive infants need to undergo a radiological examination to screen for abnormalities of the renal tract.

Urine sample collection from young pre-continent children: common methods and the new Quick-Wee technique.

Urinary tract infections (UTIs) are one of the most common bacterial infections of early childhood. However, as signs and symptoms are frequently non-specific in young children, a urine sample is required to diagnose or exclude UTI. National Institute for Health and Care Excellence (NICE) guidelines recommend that children with unexplained fever or signs suggestive of UTI should have a urine sample collected.1 Collecting urine from pre-continent children is challenging. Collection methods all have limitations. The choice of sample collection method must balance time, resources, contamination, invasiveness, and clinician and carer preferences. Despite being so commonly required for young children, there is significant variation in international guideline recommendations for the optimal method. NICE recommends the clean catch method, other non-invasive methods such as pads if clean catch is not possible, and catheter or suprapubic aspirate (SPA) if non-invasive methods are not possible.1 Sample contamination occurs when urine flushing over the perigenital skin collects incidental skin flora, or from inadvertent contact between skin and specimen jar. Contamination corrupts the test result. Precise contamination rates for each method of urine collection may be difficult to compare as definitions of contamination vary between centres and studies. However, perigenital skin cleaning before collection and care with collection technique may help to minimise …

Clinical Features of Febrile Urinary Tract Infection Caused by Extended-spectrum Beta-lactamase-producing Escherichia Coli in Children.

The global prevalence of infections caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli has been increasing. In children, ESBL-producing E. coli manifest mostly as febrile urinary tract infections (fUTIs). This study aimed to elucidate the clinical features of fUTI resulting from ESBL-producing E. coli in Japanese patients. The clinical features of children with E. coli-related fUTI were retrospectively examined. These children underwent treatment at the National Hospital Organization Saitama Hospital, Japan, between May 2010 and April 2018. Urine specimens were obtained by either bladder catheterization or the clean-catch method. All children having positive urine cultures (≥104 colony-forming unit/mL for catheter specimens and ≥105 colony forming unit/mL for clean-catch specimens) and a fever of ≥38°C were considered to have fUTI. During the study period, 171 patients were diagnosed with E. coli-related fUTI. Among these, 17 (9.9%) fUTI cases were caused by ESBL-producing E. coli. A significant difference was noted in the median age of the populations having ESBL-producing E. coli and non-ESBL-producing E. coli infections (2 and 5 months, respectively); other characteristics were not significantly different between the two patient groups. ESBL-producing E. coli infections markedly increased in our hospital between 2013 and 2018. In the present study, young age was the only risk factor for fUTI caused by ESBL-producing E. coli identified in Japanese children.

Diversity of the midstream urine microbiome in adults with chronic kidney disease

PurposeTo examine the characteristics of the midstream urine microbiome in adults with stage 3–5 non-dialysis-dependent chronic kidney disease (CKD).MethodsPatients with non-dialysis-dependent CKD (estimated glomerular filtration rate [eGFR] < 60 ml/min/1.73 m2) and diuretic use were recruited from outpatient nephrology clinics. Midstream voided urine specimens were collected using the clean-catch method. The bacterial composition was determined by sequencing the hypervariable (V4) region of the bacterial 16S ribosomal RNA gene. Extraction negative controls (no urine) were included to assess the contribution of extraneous DNA from possible sources of contamination. Midstream urine microbiome diversity was assessed with the inverse Simpson, Chao and Shannon indices. The diversity measures were further examined by demographic characteristics and by comorbidities.ResultsThe cohort of 41 women and 36 men with detectable bacterial DNA in their urine samples had a mean age of 71.5 years (standard deviation [SD] 7.9) years (range 60–91 years). The majority were white (68.0%) and a substantial minority were African-American (29.3%) The mean eGFR was 27.2 (SD 13.6) ml/min/1.73 m2. Most men (72.2%) were circumcised and 16.6% reported a remote history of prostate cancer. Many midstream voided urine specimens were dominated (> 50% reads) by the genera Corynebacterium (n = 11), Staphylococcus (n = 9), Streptococcus (n = 7), Lactobacillus (n = 7), Gardnerella (n = 7), Prevotella (n = 4), Escherichia_Shigella (n = 3), and Enterobacteriaceae (n = 2); the rest lacked a dominant genus. The samples had high levels of diversity, as measured by the inverse Simpson [7.24 (95% CI 6.76, 7.81)], Chao [558.24 (95% CI 381.70, 879.35)], and Shannon indices [2.60 (95% CI 2.51, 2.69)]. Diversity measures were generally higher in participants with urgency urinary incontinence and higher estimated glomerular filtration rate (eGFR). After controlling for demographics and diabetes status, microbiome diversity was significantly associated with estimated eGFR (P < 0.05).ConclusionsThe midstream voided urine microbiome of older adults with stage 3–5 non-dialysis-dependent CKD is diverse. Greater microbiome diversity is associated with higher eGFR.

Clinical Utility of Antibiotic against Uropathogen Isolated at a Tertiary Care Hospital of Dhaka City

Background: The antibiotic sensitivity pattern of uropathogenic bacteria is varied with different frequency. Objective: The purpose of the study was to determine the pattern of antibiotic sensitivity against uropathogens isolated from a tertiary care hospital of Dhaka City. Methodology: A cross-sectional study was conducted in the Department of Microbiology at Shaheed Suhrawardy Medical College, Dhaka, Bangladesh during period of January 2016 to December 2016. Among 307 consecutive urine samples were collected from patients of UTI in the microbiology laboratory. Samples were mid-stream urine specimens obtained by clean catch method received from various outpatient departments and inpatient wards were transported to the microbiology laboratory in sterile leak proof container were processed immediately. Bacteria were isolated and identified by standard laboratory procedure. Results: Of the 307 urine samples processed 170(55.4%) gave significant growth of pathogens. The prevalence of UTI is high among females (58.2%) than males (41.8%). The commonest isolates were Escherichia coli (71.2%), Pseudomonas (12.4%), Staphylococcus aureus (10.6%), Acinotobactor (4.1%) and Klebsiella (1.8%). Majority (92.4%) of (uropathogens) isolates were found to be MDR. Conclusion: The study revealed that E. coli is the predominant uropathogens of UTIs.

Management of Urinary Tract Infections in Children

Urinary Tract Infections (UTIs) are a common occurrence in paediatrics. UTIs present in children as fever, anorexia, vomiting, lethargy and dysuria. Approximately 80% of the time, Escherichia coli is the causative bacteria in paediatrics, however, fungal UTI caused by Candida species can occur in premature infants. With an estimated 150 million UTIs occurring worldwide annually, this paper aims to establish the ideal management of urinary tract infections in paediatrics. Clinical signs and symptoms of UTI in paediatrics are dependent on age of the child. Neonates (0–27 days old) present with sepsis, vomiting, fever, and prolonged jaundice, while school aged children present with symptoms similar to adults such as dysuria and urgency. Diagnosis of a UTI can be done by using a urine dipstick or using the midstream clean catch method in toilet trained children, and using the transurethral catheterisation or suprapubic aspiration method for infants and young children. In the wake of antibiotic resistance, choosing the best anti-microbial agent for treatment is imperative. Whilst asymptomatic bacteriuria does not require antibiotic treatment, amoxicillin and clavulanic acid combination, cephalexin, cefixime and cefpodoxime are the preferred oral antibiotics, provided there are no known allergies. Ceftriaxone, ampicillin, cefotaxime and gentamycin are the recommended parenteral antibiotics, provided age, allergic status and renal function are considered prior to use. Careful consideration needs to be given before using prophylaxis in UTIs and should be reserved for extreme cases.

Urinary Tract Infection, Incidence, Uropathogens and Antibiotic Sensitivity in Females

Introduction: Urinary tract infection in female population is one of the most common clinical infectious pathologies found worldwide due to anatomical location of urethral opening in relation to males. Continuous assessment of uropathogens and their sensitiveness to chemotherapeutic agent help us to manage these. The aim of this study to determine the presence of uropathpgens and their sensitkng from UTI.&#x0D; Method: It is a hospital based cross sectional study conducted at NGMC Teaching Hospital Kohalpur from July 2016 to June 2017. The urine samples were collected using the mid-stream clean catch method from 948 clinically suspected UTI female patients and the irantibiotic sensitiveness was determined using the standard procedures.&#x0D; Result: Overall culture positive was found in 262 patients (27.6%) among 948 urine samples. Among them e. coli contributed to cases 179(68.3%) followed by klebsiella 38(14.5%), enterobacter 21(8%), fungal 10(3.9%).Maximum no. of uropathogens were sensitive to chloramphenicol 224(93.4%) followed by nitrofurantin 232(88.7%), amikacin 246(94%), tobramycin 241(92.8%) and gentamycin 229(85.5%). Most of the organism were found to be resistant with ampicillin 255(97.5%) followed by cefpodoxime 242(92.4%),&#x0D; vancomycin 235(90%) and amoxicillin 234(89.6).&#x0D; Conclusion: and recommendation – Chloramphenicol, Nitrofurantin, Amikacin, Gentamicin and Tobramycinare the drugs of choice for the empirical therapytill the culture and sensitivity report is available. Continuous assessment is required for the early diagnosis and management of UTI.The culture and the sensitiveness of uropathogen are to be done and the treatment should be modified accordingly.

Rapid Detection of Urinary Tract Infections via Bacterial Nuclease Activity

Rapid and accurate bacterial detection methods are needed for clinical diagnostic, water, and food testing applications. The wide diversity of bacterial nucleases provides a rich source of enzymes that could be exploited as signal amplifying biomarkers to enable rapid, selective detection of bacterial species. With the exception of the use of micrococcal nuclease activity to detect Staphylococcus aureus, rapid methods that detect bacterial pathogens via their nuclease activities have not beendeveloped. Here, we identify endonuclease I as a robust biomarker for E.coli and develop a rapid ultrasensitive assay that detects its activity. Comparison of nuclease activities of wild-type and nuclease-knockout E.coli clones revealed that endonuclease I is the predominant DNase in E.coli lysates. Endonuclease I is detectable by immunoblot and activity assays in uropathogenic E.coli strains. A rapid assay that detects endonuclease I activity in patient urine with an oligonucleotide probe exhibited substantially higher sensitivity for urinary tract infections than that reported for rapid urinalysis methods. The 3hr turnaround time is much shorter than that of culture-based methods, thereby providing a means for expedited administration of appropriate antimicrobial therapy. We suggest this approach could address various unmet needs for rapid detection of E.coli.

Improving clean-catch contamination rates: A prospective interventional cohort study.

The clean-catch method of urine collection carries a high contamination rate. This study aims to evaluate the effects on contamination rate of providing a parent handout and pre-made urine collection pack for clean-catch urine collection. We conducted a single-centre prospective cohort interventional study in a tertiary paediatric ED. All children younger than 24 months who presented from April 2013 to June 2014 requiring a urine sample to be obtained were included. The intervention was provision of a pre-made urine collection pack including a standardised information handout. The primary outcome measure was the difference in proportion of urine contamination in samples obtained via a clean-catch pre- and post-intervention. The total number of urine specimens included was 288 in the pre-intervention group and 333 in the post-intervention group. Contamination rates were 14.9% in the pre-intervention group and 11.4% in the post-intervention group. There was no statistically significant reduction in contamination (P = 0.19). The contamination rates appeared to be associated with gender, with (pooled) female contamination rates being 16.4% (44/269) and male contamination rates being 10.5% (37/352). Most specimens of urine were collected via the clean-catch method (81.2%), followed by catheter urine specimen (13.7%) and suprapubic aspirate (5.1%). The contamination rate in our study for clean-catch urine collectively was 13%, catheter urine specimen 3.8% and suprapubic aspirate 0%. The contamination rate of clean-catch urine did not improve with the implementation of a pre-made urine collection pack including standardised written instructions.

Effect of urethral meatus cleansing on midstream urine contamination rate in boys

Background Clean-catch midstream urine (MSU) remains thestandard procedure for urine collection even if it's role to reducebacterial contamination rate is unclear.Objective To compare bacterial contamination rate betweenclean-catch (cleaning urethral meatus with medicated soap) andnon clean-catch MSU among boys.Methods An experimental study with parallel groups and blockrandomization was conducted. Toilet-trained boys aged 3 to 18years, without symptoms or signs of urinary tract infection wererecruited from the Pediatric Outpatient Clinic at Sardjito Hospitaland from a local elementary school. Subjects with history of renaldisease, those who were on under antibiotic treatment in thepreceding week, or with meatal abnormality or non-cooperativewere excluded. Urine specimen was collected by a trained nurse,and was cultured within one hour by personnel blinded to theassignment. Significant bacteriuria was defined as growth of asingle pathogenic organism (degree of pathogenicity group I-III)with colony count 2: 105 colony forming unit/mi. Contaminationwas defined as any growth not fulfilling criteria for significantbacteriuria or growth of multiple organisms.Results A total of 80 boys were enrolled. The contamination ratein the clean-catch group was 13% (5 out of 40) compared with10% (4 out of 40) in the non clean-catch group (P=l.O). Theadjusted risk ratio for contamination in the clean-catch MSUgroup, adjusted to age and circumcision status, was 1.37 (95%CI 0.42; 4.51).Conclusion Clean-catch method does not reduce bacterial con-tamination rate of midstream urine cultures in boys