Clean-catch Urine Samples Research Articles

Diversity and antibiotic sensitivity of uropathogens from a regional hospital in Rwanda

Background: Urinary tract infections are a common cause for antibiotic consumption. Empirical treatment is common for community-acquired infections owing to predictability of pathogens. Objectives: Describe sensitivity profiles of uropathogens at a regional hospital in Rwanda. Methods: Hospital-based cross-sectional study in which clean-catch urine samples were analyzed. A two-stage process involving dipstick urinalysis and urine culture was used to identify true infections. The Kirby-Bauer disc diffusion method was used for antibiotic sensitivity analysis as per EUCAST guidelines. Results: Of 198 samples studied, 107 met criterion for UTI with 94 yielding significant growth. Klebsiella pneumoniae (35%), and Escherichia coli (32%) were the most common organisms isolated. Others included Staphylococcal species, Proteus spp, Enterobacter spp and Salmonella. Very high resistance frequencies (above 70%) were observed against amoxycillin, cotrimoxazole, trimethoprim, aztreonam and fosfomycin. Resistance to fluoroquinolones, aminoglycosides and cephalosporins varied between 40-60%. High levels of cross resistance were observed for drugs of the same class. Resistance to the potentiated penicillins, meropenem, cefoxitin and nitrofurantoin were less than 30%. Piperacillintazo bactum performed best with 91% sensitivity against all organisms tested. Conclusion: High levels of resistance were observed for most antibiotics studied. For empirical treatment of community-acquired UTI in our setting, nitrofurantoin remains effective while ciprofloxacin is not. Keywords: Diversity and antibiotic sensitivity; uropathogens; Rwanda.

Concentration of kidney markers and detection of exosomes in urine samples collected in cotton wool balls in preterm and term neonates

Collecting urine samples in neonates by catheterisation or suprapubic puncture causes trauma, whereas self-adhesive collection bags can damage fragile skin. An alternative method is the collection of samples from urine-soaked cotton wool balls placed in diapers. The aim of this study was to compare the concentration of albumin, creatinine, neutrophil gelatinase-associated lipocalin (NGAL), and uromodulin between clean-catch urine and samples collected in cotton balls in neonates and assess the efficiency of exosome extraction. Standard clean-catch urine samples (SSs) were assayed for albumin, creatinine, NGAL, and uromodulin using commercial ELISA kits. Concentrations were compared to the same urine samples extracted immediately from soaked cotton wool balls (sample 2, S2) or the urine extracted from cotton wool balls placed in diaper in a warm incubator for 2 h before extraction (sample 3, S3). Exosomes were extracted from all three samples of one patient for visualisation by electron microscopy. Twenty-six infants (17 males) of median gestational age at birth of 32+1 weeks had urine collected at a median age of 29 days at 37+6 weeks corrected age. Concentrations in S2 and S3 were within 10% of the concentration of SS in 46% and 35% of specimens for albumin, 69% and 58% for creatinine, 12% and 12% for NGAL, and 27% and 15% for uromodulin, respectively, without consistent positive or negative bias. Urine albumin/creatinine ratios (UACRs) were 4.3% less in S2 and 4.5% less in S3 than in SS. Exosomes were extracted and visualised from all three sample types. Neonatal urine samples extracted from cotton wool balls can be used to screen for relevant albuminuria ​but provide imprecise estimates of NGAL and uromodulin. The proof of exosome extraction from urine collection in cotton wool balls opens the potential to examine exosomal cargo.

Asymptomatic Bacteriuria among Pregnant Women Attending Antenatal Care

The complication associated with bacteriuria during pregnancy not only result increase morbidity of the mother but also have detrimental effects on the fetus which may result in preterm labor, fetal growth retardation, hypertension and anemia. Studies have shown that the fetal mortality rate was 2.4 times higher than in pregnancy associated with urinary tract infection.This study conducted to determine the prevalence of asymptomatic bacteriuria in pregnant women. A cross-sectional study carried out during the year 2017 at a tertiary care hospital Alkhadra in Tripoli/Libya. 200 pregnant women aged between 19-43 years attending the obstetrics and gynecology clinics were included in this study. From these patient’s mid- stream clean catch urine samples were collected and processed. The following information were obtained from the patients; demographic data, parity, abortion history, history of UTI, history of DM, Urine culture result, type of organism. The minimum age was 19 years and the oldest was 43 years old. The mean maternal age of the cases was 29.2 ± 3.1 years. The multiparous cases were 61% and 48% of women had positive history to UTI before the study, also only 4% of cases were diabetic, regarding the time of diagnosis 18% were diagnosed at first trimester and 46% at the 2nd trimester while 36% diagnosed at the 3rd trimester. Regarding the urine culture results only 23% of cases had significant bateriuria and 8% had insignificant bateriuria, 14% the result was contaminated and 55% of cases their results were sterile, E. coli was the most predominant organism in the current study. The prevalence of asymptomatic bacteriuria in pregnant women (23%) was comparable with similar studies in other countries. The most common uropathogens isolated in this study were E.coli followed by K. pnuemoniae.

Nitrofurantoin susceptibility profile versus other antibiotics tested in uropathogens- a retrospective study from India

Introduction. Urinary Tract Infection (UTI) is one of the most common bacterial infections encountered by clinicians worldwide. The emergence of multidrug-resistant uropathogens necessitates a review of their susceptibility profiles. This study aims to assess the susceptibility trends of uropathogens to a panel of drugs, with special emphasis on Nitrofurantoin (NFT). Methods. A retrospective analysis was conducted on 2,099 mid-stream clean catch urine samples processed by standard microbiological methods. Clinical and Laboratory Standards Institute (CLSI) guidelines (2019) were followed. Statistical analysis was performed. Results. Out of all samples, 212 were culture positive. Escherichia coli (34.9%) and Enterococcus spp. (15.1%) were the most common Gram-negative and Gram-positive organisms, respectively. Gram-negative isolates were most susceptible to Colistin (97.38%), followed by NFT (69.35%). Gram-positive uropathogens were most sensitive to Linezolid (100%), followed by Vancomycin and NFT, each with 92.45% susceptibility. Conclusion. The increase in antibiotic resistance among various uropathogens underscores the need for surveillance data to inform the appropriate selection of antibiotics. Our study highlights that, among the panel of antibiotics tested, NFT appears to be a viable alternative for treating multidrug-resistant uropathogens.

Phenotypic characterization of ESBL-producing urinary isolates of E. coli and Klebsiella spp. in a tertiary care children's hospital in Nepal

BackgroundThe production of extended-spectrum beta-lactamases (ESBLs) among uropathogens, particularly E. coli and Klebsiella spp., poses a severe public health concern. This study explored the epidemiology of ESBL-producing E. coli and Klebsiella spp. isolated from urine samples obtained at a tertiary care children's hospital in Nepal.MethodsA cross-sectional study was conducted from August 2016 to February 2017. A total of 745 clean catch urine samples were obtained from pediatric patients under the age of 13 and subjected to semiquantitative culture. E. coli and Klebsiella spp. were identified using standard laboratory protocols. Antibiotic susceptibility testing was performed using the Kirby-Bauer disc diffusion method, and ESBL producers were phenotypically identified using the combined disk method.ResultsAmong the bacterial isolates, E. coli predominated, accounting for 139 (81.8%) positive cases. Notably, E. coli showed high susceptibility to nitrofurantoin, with 117 (84.2%) isolates being susceptible. Meanwhile, K. pneumoniae showed high susceptibility to gentamicin, with 21 (91.3%) isolates being susceptible. Of the 163 isolates of E. coli and Klebsiella spp., 62 (38.0%) were identified as multidrug-resistant (MDR), with 42 (25.8%) confirmed as phenotypic ESBL producers. Remarkably, all 41 (100%) ESBL-producing E. coli isolates were susceptible to imipenem.ConclusionsThe prevalence of ESBL producers among E. coli and K. pneumoniae isolates from pediatric patients underscores the importance of antimicrobial stewardship. Nitrofurantoin and gentamicin emerge as effective empirical treatment choices against these pathogens in children. However, the high rates of multidrug resistance and ESBL production highlight the necessity for routine surveillance, and early detection strategies to manage such infections effectively.

Vaginal and urinary evaluation of lactobacilli quantification by qPCR: Identifying factors that influence urinary detection and the quantity of Lactobacillus.

Vaginal colonization with lactobacilli has been linked to the health of the lower urinary tract in women. There is growing evidence that the bladder has its microbiome related closely to the vagina. In this study, we compared the three common vaginal Lactobacillus species (L. jensenii, L. iners and L. crispatus) in vaginal and urine samples to identify factors that influence urinary detection and the quantity of Lactobacillus. We used quantitative real-time PCR (qPCR) assays to measure the concentration of Lactobacillus jensenii, L. iners and L. crispatus in paired vaginal swabs and clean-catch urine samples from pre-and post-menopausal women. We compared demographic variables and vaginal Lactobacillus quantity between women with vaginal detection of at least one of the three species, detection in both vagina and urine, or urine only. We performed Spearman correlation between vaginal and urinary quantities of each species. We used multivariable logistic regression models to determine predictors of detectable Lactobacillus species in both samples (vs. vagina only or urine only). Models were adjusted for variables selected a priori: age, BMI, condom use, and recent sexual activity. Ninety-three paired vaginal fluid, and urine samples were included in the final analysis. 44 (47%) had no detectable Lactobacillus species in their urine samples, and 49 (53%) had at least one of the three Lactobacillus species (L. jensenii, L. iners and L. crispatus) detected in urine. Most women were white (91.4%), with a mean age of 39.8 ±13.8 years. The two groups were similar in demographics, gynecologic history, sexual history, recent use of antibiotics or probiotics within 7 days of sample collection, Nugent scores, and urine-specific gravity. Among the three Lactobacillus species, L. jensenii was more commonly detected in urine than the other two. For all three species, detection in the urine sample alone was infrequent. The concentrations of all three species were higher in vaginal samples than in urine samples. For all three Lactobacillus spp., vaginal abundance was associated with the urinary abundance of the same species even after adjusting for the Nugent score. In Spearman correlation analysis, urinary and vaginal Lactobacillus concentrations were positively correlated within the same species, with the most significant correlation coefficient for L. jensenii (R = 0.43, p<0.0001). Vaginal quantities were positively correlated between the three species, as were urinary quantities to a lesser extent. There was no meaningful correlation between the urinary quantity of one Lactobacillus sp. and the vaginal quantity of another species. In summary, the vaginal quantity of Lactobacillus was the most significant predictor of concurrent detection of the same species in the bladder, confirming the close relationship between these environments. Strategies to promote vaginal Lactobacillus colonization may also bring urinary colonization and the health of the lower urinary tract.

Urogenital urobiome of healthy children does not differ from that of children with bladder and bowel dysfunction

The pediatric urinary microbiome (urobiome) has been studied in the context of healthy children and children with genitourinary pathologies including neuropathic bladder, urinary tract infection (UTI) and nephrolithiasis. Little is known about the urobiome of children with bladder and bowel dysfunction (BBD), a condition that is an established risk factor of UTI. We hypothesized that the symptoms of a child with BBD may be related to urobiome composition. To evaluate the urogenital urobiome's role in BBD, we compared the urogenital urobiomes of children with and without BBD. We performed a prospective case-control pilot study at a single large, academic children's hospital. Cases included toilet trained prepubertal females over 2 years of age with BBD established through a validated scoring system and controls included asymptomatic, presumably healthy, children. Children were excluded if they had symptoms or lab work consistent with a concurrent UTI or antibiotic course for any reason within the prior 14 days. We performed 16S ribosomal RNA gene sequencing and expanded quantitative urine culture on clean catch urine samples. To compare within sample (alpha) diversity, we used the Kruskal-Wallis test. To compare between sample (beta) diversity, we calculated the Bray-Curtis distance and performed the PERMANOVA test. Data from 25 children with BBD and 8 asymptomatic controls were analyzed. The demographic and clinical characteristics of the two comparison groups were similar, though a higher proportion of Black children were included in the asymptomatic control group. Neither alpha diversity nor beta diversity was significantly different between the two groups. The core microbiome of the BBD group included all the genera in the core urogenital urobiome of the controls, plus additional genera associated with opportunistic infection and/or UTI, including Escherichia, Campylobacter and Streptococcus. The results of both the 16S sequencing and expanded quantitative urine culture in this small study suggest that the urogenital urobiomes of children with BBD do not differ significantly from those of asymptomatic children. However, the core urogenital urobiome of children with BBD included genera associated with opportunistic infection and/or UTI. This study was limited by the sample collection method ("clean catch" midstream voided urine samples, which introduce the possibility of vulvovaginal contamination), small sample size, and unequal balance of patient characteristics between the two study groups. The urogenital urobiomes of children with and without BBD do not appear to significantly differ. Larger studies are needed to confirm these findings.

Evaluation of Sorghum bicolor (L.) Moench on the Reduction of Creatinine Levels and Its Antioxidant Properties In vitro

The study investigated the effect of Sorghum bicolor (L.) Moench extract on the renal activity of both normal and ailing patients. Phytochemical analysis, antioxidant activity, vacuum liquid chromatography and TLC were carried out. The creatinine reduction ability was analyzed using Jaffe’s method for clean-catch spot urine samples of normal, diabetic and hypertensive patients. S. bicolor showed strong antioxidant activity with an IC50 value of 52.17 μg/ml, compared to the standard vitamin C with an IC50 value of 40.59 μg/ml. Statistical analysis (ANOVA) result showed a significant difference between the patients’ urine (rows) (p-value = 2.77×10–08) and a significant difference between the dose treatments (columns) (p-value = 8.38×10–14). Whilst different fractions of S. bicolor at different concentrations showed varying effects on the creatinine concentration, it reduced creatinine level in low doses and has antioxidant properties. Dhaka Univ. J. Pharm. Sci. 21(2): 165-172, 2022 (December)

Abstract 13157: Workplace Culture and Biomarkers of Sympathetic Activation

Workplace environment can impact health, but most research has focused on toxic chemicals. Recently, workplace culture—experiences, values, and behaviors unique to a workplace—is studied for its impact on overall health risk; however, connections with robust biologic markers of health remain to be established. Therefore, we examine associations between work environment and urinary levels of catecholamines and their metabolites as biomarkers of sympathetic activation. In 2018-19, we recruited participants (n=219) from an ongoing CV risk cohort to investigate workplace culture, overall well-being, and stress. Participants completed 7 questionnaires. Clean catch urine samples were used to measure catecholamines and their metabolites. To estimate associations between work and health scales and log or logit-transformed outcomes we used Pearson correlation and linear regression models adjusting for demographics and creatinine. Participants reporting higher well-being had lower levels of dopamine (DA) ( r = -0.28), serotonin (5HT) ( r = -0.17), and 3-methoxytyramine (3MT) ( r = -0.31), a product of dopamine breakdown. Participants reporting a more engaged workplace had lower levels of DA ( r = -0.20) and 3MT ( r = -0.22). Those reporting more positive workplace culture had lower levels of DA ( r = -0.17) and 3MT ( r = -0.26) and higher levels of norepinephrine ( r = 0.19) and 5-hydroxyindole-3-acetic acid (HIAA) ( r = 0.22). When participants identified more workplace isolation, they had higher levels of DA ( r = 0.19) and 3MT ( r = 0.19). Positive workplace culture was correlated with lower levels of DA ( r = -0.22) and 3MT ( r = -0.28) and higher levels of HIAA ( r = 0.22) and homovanillic acid ( r = 0.20). Given high correlations between catecholamines, we used 3MT for linear regression. In fully adjusted models we found in more positive work cultures, levels of 3MT remained significantly lower (β = -0.065 ±0.025, p = 0.01), accounting for 23% of the variance, and a significant positive association between workplace isolation and 3MT (β= 0.064 ±0.030, p = 0.04), accounting for 22% of the variance with 3MT, which may reflect greater dopamine degradation. These findings suggest an important relationship between how we work and sympathetic nervous system activity.

Prevalence and antimicrobial sensitivity of asymptomatic bacteriuria among sickle cell anaemia patients in Aminu Kano Teaching Hospital, Nigeria

Introduction: Urinary tract infection (UTI) is a common cause of morbidity in children with sickle cell anaemia (SCA) and may present as asymptomatic bacteriuria. Asymptomatic bacteriuria is often under-diagnosed and may lead to long term renal complications.&#x0D; Aim: This study compared the prevalence of asymptomatic bacteriuria, bacterial isolates and their antimicrobial sensitivity in children with and without SCA seen at Aminu Kano Teaching Hospital.&#x0D; Subjects and Methods: This cross-sectional study recruited 139 children with SCA in stable state and 139 children without SCA aged 1- 15 years. All children were tested for asymptomatic bacteriuria using clean catch or mid-stream urine samples. Children whose samples yielded significant bacteriuria (≥105cfu/ml) had a repeat urine culture within a week to confirm asymptomatic bacteriuria.&#x0D; Results: Both study groups had a mean age of 4.25 years ± 3.04, and a male: female ratio of 1.4:1. The prevalence of asymptomatic bacteriuria was higher in children with SCA(5.8%) compared to children without SCA (1.4%). Asymptomatic bacteriuria was more common among females in both study groups. The most common isolate in both groups was E. coli. Majority of the isolates were sensitive to quinolones, gentamycin and nitrofurantoin but resistant to commonly used antibiotics like amoxicillin and cotrimoxazole.&#x0D; Conclusion: Asymptomatic bacteriuria is more common in children with SCA than those without SCA. Majority of isolated pathogens showed low susceptibility to ampicillin, amoxicillin, cotrimoxazole and nalidixic acid, this implies that the use of these drugs for empirical or first line treatment for UTI in children with SCA should be avoided.

Diagnostic test accuracy of dipstick urinalysis for diagnosing urinary tract infection in febrile infants attending the emergency department

ObjectiveTo report the diagnostic test accuracy of dipstick urinalysis for the detection of urinary tract infections (UTIs) in febrile infants aged 90 days or less attending the emergency department (ED).DesignRetrospective...

Current Antibiotic Resistance Pattern of Prevalent Uropathogens in Urinary Tract Infection of Diabetic Patients in Comparison with non-Diabetics

Introduction: Urinary tract infections (UTIs) are a common infectious disease worldwide. Bacterial resistance to antibiotics is one of the most challenging global health problems. Regional surveillance programs are necessary to update knowledge on antimicrobial resistance patterns for empirical antibiotic treatment of the patients. This study aimed to explore the bacteriology and antibiotic resistance pattern of urological pathogens in diabetic patients compared to that in non-diabetics. Materials and Methods: A prospective study during the period from June 2021 to November 2021 in Khulna City Medical College Hospital was carried out including 347 diabetic and non-diabetic patients. Midstream clean-catch urine samples were collected from suspected UTI patients of age more than 14 years and inoculated in Mac Conkey &amp; Blood agar media for semi-quantitative urine culture and sensitivity test. Antibiotic susceptibility test was done by Kirby-Bauer disc diffusion method following clinical laboratory science (CLS) program. Results: Among the 347 inoculated samples, Culture positive were in 286 cases. Gram-negative E. coli was isolated from 119 (overall 41.6%, 51% in diabetics and 36.5% in non-diabetic patients) samples which were the most predominant bacteria, followed by Enterococcus, Pseudomonas and Klebsiella. UTI with E. coli was significantly at a higher rate in diabetic patients and Exhibits 100% resistance to Ceftriaxone, Nalidixic acid, Cefuroxime and Cefixime. Bacteria offered a high degree of resistance against commonly used antibiotics-Amoxycillin, Ciprofloxacin, Amikacin, Gentamycin, Levofloxacin, Nalidixic acid and Nitrofurantoin ranging from 7% to 93%. Conclusion: E. coli infection is significantly predominant in UTI cases in this study and exhibits a higher rate of resistance to all antibiotics in diabetic patients than that in non-diabetics. None of the antibiotics is 100% sensitive in diabetic patients. Imipenem, meropenem and Piperacillin remain .......

MP49-20 UROTYPES IN YOUNG WOMEN WITH PELVIC PAIN: A PILOT ANALYSIS OF CLINICAL URINARY MICROBIOME CLASSIFICATION

You have accessJournal of UrologyCME1 May 2022MP49-20 UROTYPES IN YOUNG WOMEN WITH PELVIC PAIN: A PILOT ANALYSIS OF CLINICAL URINARY MICROBIOME CLASSIFICATION James M. Weinberger, L. Marcella Henao, Crystal Cisneros, James E. Ackerman, and A. Lenore Ackerman James M. WeinbergerJames M. Weinberger More articles by this author , L. Marcella HenaoL. Marcella Henao More articles by this author , Crystal CisnerosCrystal Cisneros More articles by this author , James E. AckermanJames E. Ackerman More articles by this author , and A. Lenore AckermanA. Lenore Ackerman More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002624.20AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: There are substantial differences in the urobiomes of women depending on age and menopausal status. Our previous work demonstrated that younger women (age <45) tended to have a more limited set of dominant microbes and could be classified by Next Generation Sequencing into one of 3 “urotypes” based on the composition of Lactobacilli and E. coli. We sought to determine if we could confirm that pattern in an unselected sampling of women seeking urogynecologic care and if these patterns correlated with presenting complaints. METHODS: Women (age 18-45) presenting with LUTS were prospectively enrolled if their clean-catch urine sample was deemed unnecessary for analysis by the provider. Samples were assessed via quantitative PCR (qPCR) for E. coli and Lactobacillus crispatus, gasseri, iners and jensenii and classified into urotypes using unsupervised clustering. The subset of women complaining of painful urogenital conditions were classified into the following categories using ICD-10 codes and primary provider-given diagnosis: bladder-specific pain syndrome (BPS), myofascial pelvic pain (MPP), and unspecified pelvic pain (PP). We performed correlations between bacterial types and pain diagnoses. RESULTS: Using Lactobacillus spp. and E. coli, premenopausal women could be classified into 3 dominant urotypes; the majority of asymptomatic subjects fell into Urotype 1(low Lactobacilli, low E. coli). Of the 186 premenopausal women enrolled, 56 were diagnosed with BPS, MPP, or PP. Examining across urotype, the MPP and BPS groups segregate; patients with MPP were Urotype 1, while BPS exhibited elevated L. iners (Urotype 2) (Figure 1). The majority of PP patients were Lactobacillus-poor, falling into the E.coli-positive urotype (Urotype 3). CONCLUSIONS: Pelvic pain is a common complaint in this age group. While previous studies of pelvic pain have noted differences in diversity and Lactobacilli abundance between controls and pain groups, our qPCR-based urotyping was able to classify young women into three subgroups, demonstrating differential associations with asymptomatic controls and pelvic pain phenotypes. These data suggest that urotype data may be a meaningful mechanism to subclassify pelvic pain patients. Future studies are needed to determine if these groups correlate to treatment responses. Source of Funding: N/a © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e862 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information James M. Weinberger More articles by this author L. Marcella Henao More articles by this author Crystal Cisneros More articles by this author James E. Ackerman More articles by this author A. Lenore Ackerman More articles by this author Expand All Advertisement PDF DownloadLoading ...

Chlorhexidine skin cleaning to reduce clean-catch urine contamination in infants: A pilot study.

Clean-catch urine (CCU) samples are frequently contaminated. Our aim was to determine if cleaning with 0.1% chlorhexidine before CCU is a safe and feasible method to reduce contamination. Prospective interventional pilot study. Children 1-24 months underwent perigenital skin cleaning with 0.1% chlorhexidine. Primary outcome was contamination rate, and secondary outcomes were parent and clinician satisfaction with the procedure. Twelve of 54 urine samples were contaminated (22%, 95% CI 13-35). Over 90% of parents and clinicians were either 'satisfied' or 'very satisfied'. No adverse events were recorded. Cleaning with chlorhexidine solution before CCU is safe and feasible.

Risk Factors Associated with Urinary Tract Infection in Children

Introduction: Urinary tract infection is infection leading to an inflammatory response in the epithelium of the urinary tract. Urinary tract infection is defined as the growth of significant number of organisms of a single species in the urine, in the presence of symptoms. Significant bacteriuria is a growth with colony count of &gt;105 / ml of a single species in a mid-stream clean catch urine sample. Aims: To find the prevalence of urinary tract infection in children with fever and its risk factor. Methods: A hospital based cross sectional observational study was performed in Nepalgunj Medical College, Kohalpur from October 2019 to October 2020.Children of age two months to 14 years admitted in Department of Pediatrics and visiting in outdoor fulfilling inclusion criteria were taken for the study. Detailed history and examination was performed. Data related to age, sex, predisposing risk factors of Urinary tract infection, symptoms and relevant investigations was carried out in all patients. Results: Among 135 children, maximum 62(45.92%) children were in the age group 1-5 years. There were 70(51.85) male and 65(48.14) female children. The prevalence of culture positive of urinary tract infection was 19.20%. Pyuria was more significant in females in comparison to male, more common in age group less than 5 years. 26 children were culture positive among which males to female ratio in urine culture positive cases were 1: 2.3 and majority had E.coli positive in urine culture sample. Apart from the female children urinary tract infection was commonly seen in uncircumcised male comprising of 8(11.42%) of total male children. Conclusion: In children presenting with fever, urinary tract infection was one of the common causes. It was most common in children less than 5 years, female gender and uncircumcised male children were two commonly associated risk factors

Association between biofilm-production and antibiotic resistance in Escherichia coli isolates: A laboratory-based case study and a literature review.

Bacteria can enhance their survival by attaching to inanimate surfaces or tissues, and presenting as multicellular communities encased in a protective extracellular matrix called biofilm. There has been pronounced interest in assessing the relationship between the antibiotic resistant phenotype and biofilm-production in clinically-relevant pathogens. The aim of the present paper was to provide additional experimental results on the topic, testing the biofilm-forming capacity of Escherichia coli isolates using in vitro methods in the context of their antibiotic resistance in the form of a laboratory case study, in addition to provide a comprehensive review of the subject. In our case study, a total of two hundred and fifty (n = 250) E. coli isolates, originating from either clean-catch urine samples (n = 125) or invasive samples (n = 125) were included. The colony morphology of isolates were recorded after 24h, while antimicrobial susceptibility testing was performed using the Kirby-Bauer disk diffusion method. Biofilm-formation of the isolates was assessed with the crystal violet tube-adherence method. Altogether 57 isolates (22.8%) isolates were multidrug resistant (MDR), 89 isolates (35.6%) produced large colonies (>3 mm), mucoid variant colonies were produced in 131 cases (52.4%), and 108 (43.2%) were positive for biofilm formation. Biofilm-producers were less common among isolates resistant to third-generation cephalosporins and trimethoprim-sulfamethoxazole (P = 0.043 and P = 0.023, respectively). Biofilms facilitate a protective growth strategy in bacteria, ensuring safety against environmental stressors, components of the immune system and noxious chemical agents. Being an integral part of bacterial physiology, biofilm-formation is interdependent with the expression of other virulence factors (especially adhesins) and quorum sensing signal molecules. More research is required to allow for the full understanding of the interplay between the MDR phenotype and biofilm-production, which will facilitate the development of novel therapeutic strategies.

Assessing the Concordance Between Urogenital and Vaginal Microbiota: Can Urine Specimens Be Used as a Proxy for Vaginal Samples?

BackgroundThe vaginal microbiota play a key role in defense against reproductive tract infections; however, many population-based women’s health studies do not collect vaginal samples. Molecular examinations of urine samples have revealed common vaginal bacteria. We sought to assess the extent that community state type assignments of archived random-catch and clean-catch urine samples agreed with the paired vaginal samples in both reproductive-age and peri/post-menopausal women.ResultsUsing archived samples, we evaluated the microbiota concordance among women in three studies: two with paired mid-vaginal/random-catch urine (N=91 reproductive-age participants and N=13 peri/post-menopausal participants), and one with paired mid-vaginal/clean-catch urine (N=99 reproductive-age participants). Microbiota composition was characterized by sequencing amplicons of the 16S rRNA gene V3-V4 regions and assigned to community state types. Similarity of paired samples was gauged using agreement of community state types and Yue-Clayton θ indices. Analysis of Composition of Microbiomes II indicated which taxa were differently relatively abundant in paired vaginal and urine samples. In reproductive-age women, random-catch and clean-catch urines were 89.0% and 86.9% concordant on five community state types with paired mid-vaginal swabs, and Kappa statistics indicated almost perfect agreement (κrandom-catch=.85, κclean-catch=.81, p<0.0001). A small number of pairs of samples were discordant (23/190, 12%), and discordant pairs tended to be between samples classified to L. iners-dominated and/or low-Lactobacillus states. Concordance and agreement remained similar when dichotomizing the microbiota to Lactobacillus-dominated versus low-Lactobacillus microbiota, as well as when evaluating separately the three subtypes of the low-Lactobacillus community state type IV. Median similarity of paired urine/vaginal samples was high (θrandom-catch=.85, θclean-catch=.88), and a comparison of the random-catch and clean-catch similarity scores showed no significant difference (p=.80). Concordance and similarity were lower for peri/post-menopausal women, but agreement remained substantial (76.9% concordant, κrandom-catch= 0.64, θrandom-catch=.62). Taxonomic-level analysis confirmed these findings.ConclusionsRandom-catch and clean-catch urine samples showed substantial agreement on bacterial composition to paired mid-vaginal samples, indicating that the genitourinary microbiota may be a reliable proxy for assessing the overall composition of the vaginal microbiota via community state types. This data suggests that urine samples can, with proper interpretation, be utilized as a surrogate for developing preliminary data and hypothesis-generating studies.

Impact of Vaginal Estrogen on the Urobiome in Postmenopausal Women With Recurrent Urinary Tract Infection.

The aim of this study was to describe effects of vaginal estrogen (VE) on the urogenital microbiome in postmenopausal women with recurrent urinary tract infections (rUTIs). This is a secondary analysis of 17 participants enrolled in a randomized controlled trial of VE versus placebo on urinary tract infection recurrence in postmenopausal women with rUTIs. Paired clean-catch urine samples were collected at baseline and after 6 months of VE and sequenced using 16S rRNA gene sequencing. Sequence reads were analyzed using Quantitative Insights Into Microbial Ecology 2. Changes in α diversity, β diversity, and differentially abundant genera were measured between paired baseline and 6-month samples and between those with a urinary tract infection at 6 months (failures) and those without (successes). Of the 17 women, 11 were successes and 6 were failures after 6 months of VE treatment. There was a significant change in α diversity from baseline to month 6 in samples overall (Kruskal-Wallis χ2 = 3.47, P = 0.037) and in the treatment success group (Yuen T = -2.53, P = 0.035). The increase in relative abundance of Lactobacillus crispatus, Lactobacillus gasseri, and Lactobacillus iners AB-1 was correlated with month 6. A relative bloom of L. crispatus compared with L. gasseri was associated with treatment success (Kruskal-Wallis χ2 = 4.9, P = 0.0014). Lactobacillus increases in the urogenital microbiome of postmenopausal women with rUTI after 6 months of VE. However, only the relative increase in L. crispatus specifically may be associated with treatment success.

Asymptomatic Bacteriuria among Antenatal Clients in a Secondary Facility in Southwestern Nigeria

Context: Asymptomatic bacteriuria (ASB) is the presence of bacteria in the properly collected urine of a patient that has no signs or symptoms of a urinary tract infection (UTI). If diagnosed early, UTI and its grave consequences can be prevented in pregnant women. Aims: The goal was to ascertain the prevalence of ASB in pregnant women attending antenatal clinic. Subjects and Methods: The study was a cross-sectional descriptive study. Data were collected using the proforma. Clean catch urine samples were taken and sent for microscopy, culture, and sensitivity. The data were analyzed by statistical package for social sciences (SPSS) version 23. Results: A total of 42 women had ASB on urine culture, giving a prevalence of 30.4%. The most common organism cultured was Escherichia coli (21[50%]) and most of the organisms isolated were sensitive to nitrofurantoin (88.3%). Conclusions: This study found that the prevalence of ASB among antenatal clients was 30.4%. The dominant organism was found to be E. coli. Majority of the organisms were sensitive to nitrofurantoin (88.3%), cefuroxime (78.6%), ceftazidime (78.6%), and ceftriaxone (71.4%). We found a positive association between the density/number of urinary pus cells of the participants and the occurrence of ASB.

Can a Clean Catch Urine Sample Be Used to Diagnose Chlamydia and Gonorrhea in Adolescent Females?

PurposeClean catch urine samples may be an alternative specimen to test for chlamydia and gonorrhea infections. The aim of this study was to determine the sensitivity and specificity of clean urine for chlamydia and gonorrhea in women. MethodsThis was a noninferiority prospective cohort study of women aged 14–22 years requiring chlamydia and gonorrhea testing. Patients provided a vaginal swab (gold standard), clean urine (test sample), and dirty urine (usual care). All samples were analyzed using Hologic's Aptima Combo2 Assay, a second-generation nucleic acid amplification test. The sensitivity and specificity of the clean and dirty urine were calculated and compared. ResultsThree hundred and twenty-three females were included, mean age 17.0 ± 1.6 years. For chlamydia, 59 participants were positive by vaginal swab. The sensitivity of clean urine to diagnose chlamydia was 86.2% (95% CI: 74.8%–93.1%) and specificity was 98.8% (95% CI: 96.5%–99.8%). The sensitivity of dirty urine to diagnose chlamydia was 89.8% (95% CI: 79.2%–95.6%), and the specificity was 99.6% (95% CI 97.6%–100%). For gonorrhea, 18 participants were positive by vaginal swab. The sensitivity of clean urine to diagnose gonorrhea was 94.4% (95% CI: 72.4%–100%) and specificity was 99.7% (95% CI: 98.0%–100.0%). The sensitivity of dirty urine to diagnose gonorrhea was 100% (95% CI: 79.3%–100%) and specificity was 99.7% (95% CI: 98.0%–100%). Specificity of clean urine was noninferior compared with dirty urine for diagnosing chlamydia (p = .0004) and gonorrhea (p < .0001). ConclusionsClean urine samples may be an alternative option to diagnose chlamydia and gonorrhea in women.