Clean-catch Urine Samples Research Articles

Antibiotic resistance: a comparison between inpatient and outpatient uropathogens

Urinary tract infection is one of the most common infections and its treatment is complicated by the emergence of antibiotic resistance. Resistance patterns of organisms differ between community-acquired and hospital-associated urinary tract infections. The aim of this study was to determine the most effective antibiotics against uropathogens and if antibiotic resistance differed by setting (inpatient versus outpatient). This 2016-2017 cross-sectional study examined 300 midstream clean-catch urine samples with positive culture (150 outpatient and 150 inpatient samples) for the uropathogens isolated and the resistance of these pathogens to different antibiotics. Samples were obtained from the laboratory of Baharloo hospital, Tehran. The differences in antibiotic resistance between inpatient and outpatient uropathogens were analysed using the chi-squared test. Escherichia coli (72.0% of the 300 samples) and Klebsiella spp (13.0%) were the most common uropathogens isolated. A greater proportion of inpatient samples showed resistance to ceftriaxone, cefixime, sulfamethoxazole-trimethoprim, ciprofloxacin and nalidixic acid than the outpatient samples (P < 0.05). The most effective antibiotics for Gram-negative uropathogens were imipenem (only 6.0% of these uropathogens overall were antibiotic-resistant), amikacin (6.3%) and nitrofurantoin (10.3%). Uropathogen resistant rates in inpatients were higher than outpatient rates. The use of imipenem and amikacin instead of traditional first-line empirical therapy (fluoroquinolone and sulfamethoxazole-trimethoprim) is advised for hospitalized patients with urinary tract infections.

Clinico-epidemiological profile of children with of asymptomatic phase of renal disease

Pyuria is defined as more than 5WBCs/mm3 of urine and if this definition is taken into consideration it correlates in 90% cases of UTI. However, pyuria may be masked in significant infections due to Proteus, Klebsiella and Pseudomonas due to disintegration of White Blood Cells caused by alkaline condition produced by these urease positive organisms. Children were subjected to physical examination, blood pressure recording and urine was collected and further analyzed. All children were advised to collect mid stream clean catch urine sample under strict aseptic precautions. The collected urine samples were tested for protein, blood and bacteria by dipstick method and microscopy rapid screening test like griess nitrate test was done. 95% of the children had no RBCs in urine. 2.8% showed 1-5 RBCs/ HPF. Significant hematuria (> 5 RBCs/ HPF) was seen in 2.2% of children.

Pattern of uropathogens and antibiotic sensitivity in diabetes patients attending to out - Patient department and diabetes clinic of a teaching hospital: A cross-sectional study.

Introduction:Diabetes mellitus is the most common endocrinological disease associated with different life-threatening infections. Urinary Tract Infection is one of them which may lead to Intensive care Unit admission and even death. In this study, we would like to find out the spectrum of uropathogen and its antibiotic sensitivity, so that we can choose empirical antibiotics early to save lives.Aim and Objectives:To find out spectrum of uropathogens in Diabetic patients attending to Diabetes Clinic of a tertiary hospital and to find out the Antibiotic sensitivity pattern in isolated bacteria.Material and Methods:In this cross-sectional observational hospital-based study, consecutive patients of any age and gender having Diabetes mellitus and symptoms of Urinary Tract Infection, who attended Out-patient Department and Diabetes Clinic of General Medicine Department from August 2020 to October 2020, were included. After taking consent and brief history, mid-stream clean catch urine sample was collected in sterile container and sent to a Microbiology laboratory for culture of micro-organism and sensitivity to antibiotics.Results:Among 202 diabetic patients recruited in our study, 138 (68.31%) were female and 64 (31.69%) were male. The mean age of all participants was 50.23 ± 11.45 years. Culture confirmed UTI was 24.3% and patients showing classic UTI symptoms were 32.7%. Compared to male, most of the culture-positive and symptomatic patients were female (26.0% and 37% respectively). Culture-positive patients who showed classic UTI symptoms were 42.42%; however, we found 15.44% asymptomatic patients who showed culture positivity. The mean HbA1c level was 7.5 ± 1.6%. Subgroup analysis revealed that patients with HbA1c >7.5% were at a significantly higher risk of developing culture-positive UTI (P < 0.00001, Odds ratio 21.71). Prevalence of gram-negative and gram-positive bacteria were 65.3% (32 out of 49) and 28.57% (14 out of 49), respectively. The major organism isolated were Escherichia coli (39%), Klebsiella spp. (19%), Enterococcus spp. (12%), Staphylococcus aureus (12%), and Candida spp. (6%). The sensitivity pattern of the gram-negative bacilli showed the presence of Extended-spectrum betalactamases (ESBLs) in 36.84% (11 out of 32 isolates). The bacteria grown were most sensitive to Piperacillin-tazobactam (100%), Cefoperazone-sulbactam (100%) and Meropenem (100%) whereas Fluoroquinolone and Co-Amoxyclav showed least sensitivity (43.8% and 37.5% respectively). The Staphylococcus spp. showed 100% sensitivity to Vancomycin, Teicoplanin, Linezolid whereas Penicillin-G and Ampicillin showed 12.5% sensitivity. The Enterococcus spp. revealed 100% sensitivity to Vancomycin, Teicoplanin, Linezolid, and Fosfomycin. Drug resistance is emerging in clinical isolates. Prevalence of ESBL in Enterobacteriacea was found to be 34%.Conclusion:All patients with diabetes must be searched for urinary tract bacterial colonization by simple routine urinary culture even though they are asymptomatic. Resistance to common antibiotics, particularly to oral formulations (especially Fluoroquinolones and Ampicillin) is increasing day by day due to indiscriminate use of antibiotics. This study highlighted that the policy makers should formulate antibiotic policy for rational use of antibiotics, which could help clinicians to prescribe proper antibiotics. However, regular monitoring of susceptibility pattern of urinary pathogens is essential.

Asymptomatic bacteriuria

Introduction: Asymptomatic bacteriuria (ASB) is a condition characterised by significant infection in urine. Its association with diabetes mellitus is strongly suggested. However, the exact prevalence has been controversial. Objectives: The study was undertaken with the aim of evaluating the prevalence and aetiology of asymptomatic bacteriuria in diabetics as well as non-diabetics. Materials and Methods: A total of 460 patients were included in the study with 230 diabetics and 230 non-diabetics. Midstream clean catch urine samples were collected alongwith parallel blood samples for estimating the glycosylated haemoglobin levels. Results: Of the total 460 subjects, 78 (17.0%) had ASB with 56 in diabetics and 22 in non-diabetics, depicting a higher rate of ASB in diabetes mellitus. Majority of the patients who had ASB were aged more than 60 years, irrespective of whether in the diabetic or non-diabetic category. Also, there was a significant difference in the type of infective organism in urine from diabetic patients as compared to the non-diabetic patients. Conclusion: A higher prevalence rate of ASB was observed in diabetic patients as compared to non-diabetics. Furthermore, the newer infecting organisms that are more common in patients with diabetes mellitus was highlighted in the study. Keywords: Asymptomatic bacteriuria, Urine, Diabetes, Glycosylated haemoglobin

Prevalence Of Urinary Tract Infections (Utis) Among Pregnant Women Attending Antenatal Clinic At Ile –Ife, Southwestern Nigeria

Abstract Introduction/Objective This is a prospective study that reports the prevalence of Urinary Tract Infections (UTIs) and the bacteriological causative agents among pregnant women attending antenatal clinics at a Secondary Care Hospital in Ile Ife, South western Nigeria. 335 mid-stream clean catch urine samples were collected from pregnant women between April -July 2017. Methods These were cultured for the presence of bacterial pathogens. All the isolates were subjected to antibiotic sensitivity testing on Mueller Hinton agar by modified Kirby-Bauer disk diffusion technique using CLSI, guidelines. Data were analysed using SPSS for Windows version 16 and WHONET 5. Results A total of 190 showed significant bacterial growth while 145 showed no significant bacterial growth. Bacterial agents isolated included Klebsiella spp. showing the highest occurrence of [60(31.5%) followed by Escherichia coli and Staphylococcus aureus with prevalences of [49(25.7%) and [32(16.8%) respectively. Other organisms implicated are Proteus mirabilis [20(10.5%), Coagulase Negative Staphylococci [24(12.3%) and Pseudomonas aeruginosa with the least prevalence of [5(2.6%). Resistant to antibiotics such as amoxycilin 64%, gentamicin 52.6%, erythromycin 62.5%, ceftazidime 69%, cefotaxime 74%, ceftriaxone 79.6% while a high sensitivity to tetracycline (88.5%), nitrofurantoin (96.3%), imipenem (100%) respectively. Conclusion This study indicated a high prevalence of UTIs (56.7%) in pregnant women though most of them showed no clinical manifestation.

Are polymerase chain reaction tests for chlamydia and gonorrhea performed on clean catch urine samples comparable with polymerase chain reaction tests performed on nonclean catch samples?

Are polymerase chain reaction tests for chlamydia and gonorrhea performed on clean catch urine samples comparable with polymerase chain reaction tests performed on nonclean catch samples?

Association between Biofilm-Production and Antibiotic Resistance in Uropathogenic Escherichia coli (UPEC): An In Vitro Study.

Urinary tract infections (UTIs) are among the most common infections requiring medical attention worldwide. The production of biofilms is an important step in UTIs, not only from a mechanistic point of view, but this may also confer additional resistance, distinct from other aspects of multidrug resistance (MDR). A total of two hundred and fifty (n = 250) Escherichia coli isolates, originating from clean-catch urine samples, were included in this study. The isolates were classified into five groups: wild-type, ciprofloxacin-resistant, fosfomycin-resistant, trimethoprim-sulfamethoxazole-resistant and extended spectrum β-lactamase (ESBL)-producing strains. The bacterial specimens were cultured using eosine methylene blue agar and the colony morphology of isolates were recorded. Antimicrobial susceptibility testing was performed using the Kirby–Bauer disk diffusion method and E-tests. Biofilm-formation of the isolates was carried out with the crystal violet tube-adherence method. n = 76 isolates (30.4%) produced large colonies (>3 mm), mucoid variant colonies were produced in n = 135 cases (54.0%), and n = 119 (47.6%) were positive for biofilm formation. The agreement (i.e., predictive value) of mucoid variant colonies in regard to biofilm production in the tube-adherence assay was 0.881 overall. Significant variation was seen in the case of the group of ESBL-producers in the ratio of biofilm-producing isolates. The relationship between biofilm-production and other resistance determinants has been extensively studied. However, no definite conclusion can be reached from the currently available data.

Self assessment

You see Luke, a 10-week old boy in the emergency department. He has been unsettled for the past 24 h in that has been vomiting and is not able to tolerate feeds. Today his temperature was 38 C at home and is 38.6 C in the department. You obtain intravenous access and send blood tests, including blood cultures. A clean catch urine sample is also collected and cerebrospinal fluid (CSF) sent to the laboratory for analysis. The baby recovers well after 48 h IV antibiotics and completes a further 5 days treatment.

MP10-18 FUNCTIONAL ANALYSIS OF THE URINARY TRACT MICROBIOME OF CALCIUM OXALATE STONE FORMERS

You have accessJournal of UrologyStone Disease: Basic Research & Pathophysiology II (MP10)1 Apr 2020MP10-18 FUNCTIONAL ANALYSIS OF THE URINARY TRACT MICROBIOME OF CALCIUM OXALATE STONE FORMERS Naveen Kachroo, Caitlin Gold, Manoj Monga, and Aaron Miller* Naveen KachrooNaveen Kachroo More articles by this author , Caitlin GoldCaitlin Gold More articles by this author , Manoj MongaManoj Monga More articles by this author , and Aaron Miller*Aaron Miller* More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000830.018AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Individuals with urinary stone disease (USD) are more likely to take antibiotics in the past and harbor a functionally less diverse microbiome than those with no history of the disease. The urinary tract microbiome of USD patients exhibits greater levels of dysbiosis than the gut microbiome. Therefore, the objective of the current study was to determine what microbial functions of the urinary tract are associated with calcium oxalate (CaOx) formers to understand how the microbiome may contribute to the onset of CaOx stones. METHODS: Two groups of patients, either with no history of USD or an active episode of CaOx stones, were recruited with five patients in each group. The metabolic potential of the urinary tract microbiome was quantified through comparative shotgun metagenomics from clean catch urine samples. Functional differences between groups were assessed through non-parametric t-tests of the normalized abundances of full-length genes, which were annotated through Prodigal and KEGG pathways. Additionally, draft genomes were extracted from the data to aid in future mechanistic studies. RESULTS: Shotgun metagenomics revealed that individuals with CaOx stones had a urinary tract microbiome distinct from those with no history of USD. CaOx stone formers were functionally less diverse than controls, corroborating previous metabolomic studies. Reduced functions of stone formers included oxalate metabolism, previously thought to be relegated to the gut microbiome, as well as transmembrane transport, proteolysis, and oxidation-reduction processes. A total of 17 draft genomes were extracted from the data, primarily from the Lactobacillus genus, which are thought protect against USD and urinary tract infections. CONCLUSIONS: Our prospective clinical study shows that individuals with USD harbor a distinct urinary tract microbiome. Surprisingly, USD patients harbored lower levels of oxalate-degrading genes, which suggests oxalate metabolism may continue in the urinary tract and play a role in inhibiting CaOx stone formation. Additional functions reduced in CaOx stone formers, such as proteolysis and oxidation-reduction processes overlap with known mechanisms of stone formation and thus may also play important roles for the onset of USD. Source of Funding: Lerner Research Institute © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e132-e133 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Naveen Kachroo More articles by this author Caitlin Gold More articles by this author Manoj Monga More articles by this author Aaron Miller* More articles by this author Expand All Advertisement PDF downloadLoading ...

Asymptomatic bacteriuria among pregnant women attending antenatal care at Mbale Hospital, Eastern Uganda.

Asymptomatic bacteriuria in pregnancy (ASBP) is associated with adverse pregnancy outcomes such as pyelonephritis, preterm or low birth weight delivery if untreated. The aim of this study was to determine the prevalence of asymptomatic bacteriuria, the isolated bacterial agents, and their antibiotic sensitivity patterns in pregnant women attending antenatal care at Mbale Hospital. This was a cross sectional study in which 587 pregnant women with no symptoms and signs of urinary tract infection were recruited from January to March 2019. Mid-stream clean catch urine samples were collected from the women using sterile containers. The urine samples were cultured using standard laboratory methods. The bacterial colonies were identified and antibiotic sensitivity was done using disc diffusion method. Chi squared tests and logistic regression were done to identify factors associated with asymptomatic bacteriuria. A p value < 0.05 was considered statistically significant. Out of the 587 pregnant women, 22 (3.75%) tested positive for asymptomatic bacteriuria. Women aged 20-24 years were less likely to have ASBP when compared to women aged less than 20 years (AOR = 0.14, 95%CI 0.02-0.95, P = 0.004). The most common isolates in descending order were E. coli (n = 13, 46.4%) and S.aureus (n = 9, 32.1%). Among the gram negative isolates, the highest sensitivity was to gentamycin (82.4%) and imipenem (82.4%). The gram positive isolates were sensitive to gentamycin (90.9%) followed by imipenem (81.8%). All the isolates were resistant to sulphamethoxazole with trimethoprim (100%). Multidrug resistance was 82.4% among gram negative isolates and 72.4% among the gram positive isolates. There was high resistance to the most commonly used antibiotics. There is need to do urine culture and sensitivity from women with ASBP so as to reduce the associated complications.

606: Stability of the maternal urinary microbiome across pregnancy

To assess for longitudinal variation in the maternal urinary microbiome from the 1st trimester (1T) to the 2nd trimester (2T) of pregnancy. This is a prospective IRB-approved cohort study of 29 pregnant women with a singleton pregnancy < 14 weeks. Consented subjects provided a clean catch urine sample during their 1T and again in the 2T. Exclusion criteria included recurrent UTI, antibiotic use since conception, and urinary tract anomalies. Both samples were assessed by 16S rRNA gene sequencing. Using genus-level classification, from a single replica, alpha-diversity was measured, the Bray–Curtis distance calculated, and the complete method used for hierarchical clustering in RStudio. The clusters, termed urotypes, were named for the predominant microbe. Species-level identification was used to calculate the Bray-Curtis dissimilarity index (BC). A BC value of 0.5 was used to sort paired 1T and 2T urine samples as similar (< 0.5) or different (≥0.5). For descriptive purposes, samples were hierarchically clustered with complete-linkage agglomeration by the 1T urine results. A total of 29 patients were assessed in the first trimester. Thirteen patients provided a 2T urine, including 1 patient who was diagnosed with asymptomatic bacteriuria and was subsequently treated with antibiotics. The majority were multiparous (n=9) with a mean age of 29.5 years. 16S rRNA gene sequencing detected live microbes in 1T and 2T urine samples for all subjects. (Figure 1). 1T and 2T urine samples clustered into 3 and 4 urotypes, respectively, with the Lactobacillus urotype most common. Based on BC indices (Figure 2), paired 1T and 2T samples were similar (BC< 0.5) for 92% (n=12) of subjects Of the 11 subjects with a 1T Lactobacillus urotype, 8 had a 2T Lactobacillus urotype, including the patient who was diagnosed with asymptomatic bacteriuria and treated with antibiotics. The clean catch urine microbiome of pregnant women in their 1st trimester is similar to the 2nd trimester. Lactobacillus was the dominant organism at both time points for the vast majority of women.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Prevalence of Urinary Tract Infections (UTIs) Among Pregnant Women Attending Antenatal Clinic at Ile-Ife, Southwestern Nigeria

Abstract Objectives This is a prospective study that reports the prevalence of urinary tract infections (UTIs) and the bacteriological causative agents among pregnant women attending antenatal clinics at a secondary care hospital in Ile-Ife, southwestern Nigeria. In total, 335 midstream clean-catch urine samples were collected from pregnant women between April and July 2017. Methods These were cultured for the presence of bacterial pathogens. All the isolates were subjected to antibiotic sensitivity testing on Mueller Hinton agar by a modified Kirby-Bauer disk diffusion technique using CLSI guidelines. Data were analyzed using SPSS for Windows version 16 and WHONET 5. Results A total of 190 showed significant bacterial growth while 145 showed no significant bacterial growth. Bacterial agents isolated included Klebsiella spp. showing the highest occurrence of 60 (31.5%), followed by Escherichia coli and Staphylococcus aureus with prevalences of 49 (25.7%) and 32 (16.8%), respectively. Other organisms implicated are Proteus mirabilis (20 [10.5%]), coagulase-negative staphylococci (24 [12.3%]), and Pseudomonas aeruginosa with the least prevalence (5 [2.6%]). They have a resistance to antibiotics such as amoxycillin (64%), gentamicin (52.6%), erythromycin (62.5%), ceftazidime (69%), cefotaxime (74%), and ceftriaxone (79.6%) but a high sensitivity to tetracycline (88.5%), nitrofurantoin (96.3%), and imipenem (100%), respectively. Conclusion This study indicated a high prevalence of UTIs (56.7%) in pregnant women, though most of them showed no clinical manifestation.

Contamination in Adult Midstream Clean-Catch Urine Cultures in the Emergency Department: A Randomized Controlled Trial

IntroductionA midstream clean-catch urine sample is recommended to obtain a urine culture in symptomatic adults with suspected urinary tract infection. The aim of this randomized controlled trial was to determine whether a novel funnel urine-collection system combined with a silver-colloidal cleaning wipe would decrease mixed flora contamination in midstream clean-catch urine cultures from ambulatory adults in the emergency department. MethodsIn a 2x2 factorial trial, adult participants were randomized to 4 groups: (A) sterile screw-top urine collection container/cup paired with a castile-soap wipe (control group); (B) sterile screw-top urine collection container/cup paired with a colloidal silver-impregnated wipe; (C) sterile urine-collection funnel paired with a castile-soap wipe; (D) sterile urine-collection funnel paired with a colloidal silver-impregnated wipe. ResultsThe trial was stopped after interim analysis, as the contamination rate in the control group (30%) was markedly lower than the historical ED contamination rate (40%) at the study site. From 1,112 urinalysis results, 223 urine culture results were analyzed (190 female patients and 33 male patients). Urine contamination rates were as follows: Group A, n = 67 (29.9% contaminated); Group B, n = 69 (34.8% contaminated); Group C, n = 51 (23.5% contaminated); Group D, n = 36 (22.2% contaminated). The differences in contamination rates were not statistically different among any of the groups. DiscussionThe use of a funnel urine-collection system and silver-impregnated wipe did not reduce urine-culture contamination in adult midstream clean-catch urine cultures in the emergency department.

A Randomized, Double-Blind, Placebo-Controlled Pilot Study to Assess the Urinary Anti-Adhesion Activity Following Consumption of Cranberry + health™ Cranberry Supplement (P06-114-19)

ObjectivesUrinary tract infections (UTIs) are the second most common bacterial infections and are often treated with antibiotics. The North American cranberry is recommended for UTI prophylaxis in women with recurrent UTI as a nutritional alternative approach. The ability of cranberry components or their metabolites to inhibit the adhesion of uropathogenic E.coli to the bladder is considered as an important mechanism by which cranberry mitigates UTIs. The objective of this study was to evaluate the anti-adhesion activity of urine from healthy individuals against both type I pili and P-fimbriae uropathogenic E.coli, after the consumption of Cranberry + health™ Cranberry Supplement. MethodsIn this randomized, double-blind, placebo-controlled pilot trial (n = 20), subjects consumed two cranberry chews, one in the morning and one in the evening. Clean-catch urine samples collected at baseline and post-intervention (0–3 h, 3–6 h, 6–9 h, 9–12 h, 12–24 h, 24–30 h, 30–36 h) were tested for anti-adhesion activity utilizing both a mannose-resistant human red blood cell hemagglutination assay specific for P-fimbriae E. coli and a T24 cell line model for type I pili E.coli (UTI89). ResultsUrinary ex vivo anti-adhesion activity against P-fimbriae E. coli after consuming cranberry chew was significantly greater (p < 0.05) than placebo chew at 0–3 h, 3–6 h, 6–9 h, 9–12, and 12–24 time point. Urinary anti-adhesion activity against type I pili E.coli (UTI89) following cranberry chew was significantly greater (p < 0.1) than placebo chew at 3–6 h, 6–9 h, and 12–24 h time point. ConclusionsAcute consumption of Cranberry + health™ Cranberry Supplement provides ex vivo anti-adhesion activity, which may help to improve urinary tract health. Funding SourcesOcean Spray Cranberries, Inc.

Antibiotic Resistance in Urinary Tract Infection in a Tertiary Care Hospital in Bangladesh-A Follow-up Study

Introduction: Bacterial resistance to antibiotics is one of the most challenging global health threats. Urinary tract infections (UTIs) are a common infection. Regional surveillance programs are necessary to update knowledge on antimicrobial resistance pattern where empirical antibiotic treatment is the mainstay. The aim of this follow up study is to see the changing trends in bacteriology and antibiotic resistance pattern among urological pathogens in comparison to similar study 5 years back.&#x0D; Materials and Methods: We performed a prospective study in Comilla Medical College Hospital, Bangladesh during the period of July 2015- June 2016. Midstream clean-catch urine samples were collected from 658 suspected UTI patients with age more than 12 years and inoculated in MacConkey&amp; Blood agar media for semi quantitative urine culture and sensitivity test. Antibiotic susceptibility pattern was done by Kirby-Bauer disc diffusion method following clinical laboratory science (CLS) program.&#x0D; Results: Culture positive were in 198 samples among 658 inoculated samples. E. coli was isolated from 171(86%) samples which was the most predominant bacteria followed by Klebsiella and Enterococcus. UTI with E. coli was significantly increased in the year 2016 in comparison to 2011. Meropenem, imipenem, amikacin, tazobactum, gentamycin nitrofurantoin, and mecillinum found resistance against 0% to 12% of the urological pathogens. Bacteria offered high degree of resistance against commonly used antibiotics - amoxycillin, amoxiclav, cephradine and cefixime ranging 60% to 86%. Comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, amoxiclav and reduced resistance for nalidexic acid, mecillinum and cefuroxime.&#x0D; Conclusion: E. coli infection is significantly increaseing in follow up study from 2011 to 2016 with no steady increase in resistance to all antibiotics. Imipenem, meropenem, tazobactum, amikacin and nitrofurantoin still remain more sensitive while comparative study of 2016 vs 2011 shows significant increased resistance for ceftriaxone, and amoxiclave and reduced resistance for nalidexic acid, mecillinum, cefixime and cefuroxime.&#x0D; Medicine Today 2019 Vol.31(1): 9-14

Uncomplicated Urinary Tract Infection in Ambulatory Primary Care Pediatrics: Are We Using Antibiotics Appropriately?

Antimicrobial stewardship programs target antimicrobial use within the inpatient care setting. However, most antimicrobials are prescribed at ambulatory sites. We aim to determine the appropriateness of the diagnosis and treatment of uncomplicated urinary tract infection (UTI) in children within the outpatient setting at our institution, and to evaluate the cost of antibiotic treatment in our patient cohort. This retrospective study was conducted by reviewing electronic records of patients aged 2 to 18 years diagnosed with uncomplicated UTI and treated with antibiotics in the outpatient setting from January 1, 2016, to April 30, 2016. Appropriate diagnosis was defined as confirmed UTI that included: pyuria (>5 white blood cells per high-power field or positive for leukocyte esterase), a positive urine culture (≥50,000 colony units/mL of a single uropathogen for a catheterized sample or ≥100,000 colony units/mL for a clean catch urine sample), and lower urinary tract symptoms. Treatment was considered appropriate if the patient was prescribed first-line antibiotic for the susceptible isolate (trimethoprim sulfamethoxazole, amoxicillinclavulanate, nitrofurantoin, and cephalexin), and if the appropriate dose was used. We included 178 patients receiving a diagnosis of uncomplicated UTI and treated with antibiotics. Of these, 70% received an inappropriate diagnosis (n = 125). 58% (n= 72) of improperly diagnosed patients had polymicrobial growth in their urine cultures. Antibiotics prescribed mostly in this group were trimethoprim-sulfamethoxazole (53%, n = 66) and cephalexin (22%, n = 27). Only 30% of all included patients received an appropriate diagnosis (n = 53). Of all appropriate diagnosis patients (n = 53), 26% were treated inappropriately (n = 14) with either wide-spectrum antibiotics (n = 8) or with low calculated dose (n = 6). The estimated cost of antibiotic treatment for the inappropriate diagnosis group (n = 125) was $10,755.87. Antimicrobial stewardship programs should target the pediatric outpatient setting and antibiograms should be developed. Education of providers about the appropriate diagnosis and treatment of uncomplicated UTI in children is essential for reducing the cost of inappropriate therapy.

The Effect of Bladder and Lumbar Stimulation Technique for Collection of Urine in Newborns

Background: Sign and symptoms of urinary tract infections (UTI) are not specific in infants and young children, fever being the commonest sign. Therefore, collecting urine samples for culture is required to diagnose or exclude UTI. Obtaining a clean catch urine sample in neonates and infants is a great challenge as it is unpredictable, time consuming and requires lot of patience. Objectives: The objectives of the study were to determine the effect of bladder and lumbar stimulation technique (BLST) for collection of midstream urine in newborns and to evaluate contamination rates of urine samples collected. Methods: An experimental research was conducted in BPKIHS, Dharan, Nepal including total of 54 term newborns. Urine culture was indicated for different reasons to the admitted newborns. They were randomly assigned either to the experimental group or the control group. Twenty-five minutes after feeding, the genitals and perineal area of the babies were cleaned. The newborns were held under the armpits with legs dangling. Bladder and Lumbar stimulation technique was only applied to the newborns in the experimental group. Success was defined as collection of urine sample within 5 minutes (<300s) of starting the stimulation maneuver in the experimental group and of holding under the armpits in the control group. Results: The success rate of urine collection was significantly higher in the experimental group (88.88%) than in the control group (25.92%) p<0.001. The median time for sample collection was 1.07 minutes (64.2s) [IQR=1.52minutes (91.2s)] in experimental group and 1.52minutes (91.2s) [IQR= 2.78 minutes (166.8s) for control group (p=0.069). Contamination was not found in urine samples collected by BLST in experimental group. Conclusion: The study suggests that bladder and lumbar stimulation technique is safe, quick and effective way of collecting midstream clean catch urine in newborns.

A randomized, double-blind, placebo-controlled pilot study to assess bacterial anti-adhesive activity in human urine following consumption of a cranberry supplement.

Urinary tract infections (UTIs) are one of the common bacterial infections treated with antibiotics. The North American cranberry is recommended for prophylaxis in women with recurrent UTIs as a nutritional alternative. The ability of cranberry components and their metabolites to inhibit adhesion of uropathogenic Escherichia coli (E. coli) is an important mechanism by which cranberry mitigates UTIs. The objective of this study was to evaluate urinary anti-adhesion activity against type 1 and P-type uropathogenic E. coli after consumption of cranberry +health™ cranberry supplement (cranberry chew). In this randomized, double-blind, placebo-controlled, crossover design pilot trial (n = 20), subjects consumed two cranberry or placebo chews, one in the morning and one in the evening. Clean-catch urine samples collected at the baseline and post-intervention (0-3, 3-6, 6-9, 9-12, 12-24, 24-30, 30-36 h) were tested for anti-adhesion effects with a mannose-resistant human red blood cell hemagglutination assay specific for P-type E. coli, or a T24 cell line model for type 1 E. coli. Urinary anti-adhesion activity against P-type E. coli after consumption of the cranberry chew was significantly greater (p < 0.05) than that observed with placebo chew at all time points except 24-36 h. Ex vivo anti-adhesion effects on type 1 E. coli were greater (p < 0.05) after cranberry chew consumption than placebo chew at 3-6 and 6-9 h urine collections. In conclusion, consumption of cranberry +health™ cranberry supplement exhibited greater ex vivo urinary anti-adhesion activity compared to placebo, suggesting that it may have the potential to help promote urinary tract health.

640: Does first-trimester clean catch urine reflect the microbiome of the vagina or lower urinary tract?

Assess if microbes in clean catch urine of pregnant women resemble those of the vagina or the lower urinary tract. This is a prospective IRB-approved cohort study of 29 pregnant women with a singleton pregnancy <14 weeks. Exclusion criteria included recurrent UTI, antibiotic use since conception, and urinary tract anomalies. During their 1st trimester visit, consented subjects provided paired clean catch urine and vaginal swab samples. Samples were assessed by an Expanded Quantitative Culture (EQC) method that - compared to the standard urine culture method - uses more types of media and atmospheric conditions with a longer incubation period. Colony forming units (CFU) were counted for each morphologically distinct colony type; representative colonies were purified for identification using MALDI-TOF Mass Spectroscopy. Species identification and CFU counts were combined for analysis using the Bray-Curtis dissimilarity index (BC). A BC value of 0.5 was used to sort paired vaginal and urine samples as similar (<0.5) or different (≥0.5). For descriptive purposes, samples were hierarchically clustered with complete-linkage agglomeration by their vaginal culture results. The majority of the subjects were multiparous (n=20) with a mean age of 29.6 years. EQC detected live microbes in both urine and vaginal samples of all subjects. The vaginal samples clustered into 4 distinct community state structures (Figure). Based on BC indices, paired urine and vaginal samples were dissimilar (BC≥0.5) for 72% (n=21) of subjects. Of the 8 subjects with similar urine and vaginal microbiomes (BC<0.5), Lactobacillus was dominant in 88% of vaginal samples (n=7) and 100% of urine samples (n=8). In contrast, of the 21 subjects with dissimilar microbiomes (BC>0.5), a minority (24%, n=5) had a Lactobacillus-dominant urine sample (p<0.01). The clean catch urine microbiome of pregnant women in their 1st trimester is most often distinct from their vaginal microbiome, evidence that their lower urinary tract contains a unique microbiome. Women with dissimilar urine and vaginal microbiomes were less likely to have Lactobacillus-dominant urine. Given these findings, the vaginal microbiome should not be assumed to represent the lower urinary tract microbiome.

Biofilm Production and Antimicrobial Resistance among Uropathogens in Pediatric Cases: a Hospital Based Study

The study was designed to provide account of etiological agents of urinary tract infection in pediatric patients and the antimicrobial resistance pattern plus biofilm producing profile of the isolates. The prospective study was conducted in Alka Hospital, Nepal with 353 clean catch urine samples from children. It was obtained during July 2014 to January 2015 which were first cultured by semi-quantitative method, followed by antimicrobial susceptibility testing and biofilm production assay on Congo red agar. Multidrug- resistance, extensively drug- resistance and pandrug- resistance among isolates were considered as per international consensus. Out of 353 samples, 64 (18.13%) showed positive growth in culture, confirming urinary tract infection. E. coli, 44 (68.8%) was the predominant organism followed by Klebsiella spp. 6 (14.1%). Most E. coli were sensitive to amikacin (93.2%) followed by nitrofurantoin (86.4%), and highly resistant to ampicillin (95.5%). Of 64 isolates, 23 (35.93%) were found to be multidrug- resistant strains. Biofilm was produced by 36 (56.25%) isolates. This study showed higher biofilm production and resistance to in-use antibiotics rendering ineffective for empirical use. Regular surveillance of resistance patterns should be done to regulate multidrug- resistant bugs and to ensure effective management of urinary tract infection in children in a tertiary care setups.