Clean-catch Urine Samples Research Articles

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

Background: 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.Methods: 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.Results: 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.Conclusions: 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.Keywords: AMR; antimicrobial resistance; biofilm; urinary tract infection; UTI.

ANTIBIOTIC SUSCEPTIBILITY TESTING FOR ESCHERICHIA COLI CAUSING URINARY TRACT INFECTIONS IN SOKOTO METROPOLIS

Objective: The study was designed to diffuse awareness on the prevalence of Escherichia coli as a causative agent of urinary tract infection (UTI) in Sokoto metropolis as well as to determine the susceptibility to commonly used antibiotics in Specialist Hospital Sokoto (SHS). This is also to raise awareness of the risk of giving antibiotics and their direct impact on the outcome analysis of UTIs.Methods: This study was conducted at SHS, and ethical approval to carry out the study was obtained from the Ethical Committee of the hospital. Informed consent was obtained from each participant. Early morning, mid-stream clean catch urine samples were collected by patients in sterile disposable containers. The antibiotic susceptibility of the isolates was determined against 10 commonly prescribed antibiotics in SHS using the modified Kirby–Bauer disc agar diffusion.Results: A total of 86 urine samples were analyzed over 2 months, and 34 were culture positive giving an isolation rate of 39.5%, while 48 were culture negative giving a rate of 55.8%, and 4 (4.7%) were undecided. A total of 16 isolates were E. coli (47.1%), while 18 accounts for others (52.9%). The results of antimicrobial susceptibility profile to 10 antibiotics showed that E. coli displayed high susceptibility to vancomycin (91.6%), followed by amikacin (89.2%) and then meropenem (88.0%), while high rate of resistance was found in nalidixic acid (81.2%), followed by co-trimoxazole (73.3%) and then norfloxacin (76.2%).Conclusion: When there is an adequate detection of E. coli and other uropathogens, it will aid in selecting the appropriate antimicrobial therapy and this will also serve as a means of infection control. This will go a long way in reducing the cost of treatment and threat of resistance as witnessed in the management of some uropathogens.

Mass Spectrometric Identification of Urinary Biomarkers of Pulmonary Tuberculosis

BackgroundTuberculosis (TB) is the leading infectious cause of death worldwide. A major barrier to control of the pandemic is a lack of clinical biomarkers with the ability to distinguish active TB from healthy and sick controls and potential for development into point-of-care diagnostics. MethodsWe conducted a prospective case control study to identify candidate urine-based diagnostic biomarkers of active pulmonary TB (discovery cohort) and obtained a separate blinded “validation” cohort of confirmed cases of active pulmonary TB and controls with non-tuberculous pulmonary disease for validation. Clean-catch urine samples were collected and analyzed using high performance liquid chromatography-coupled time-of-flight mass spectrometry. ResultsWe discovered ten molecules from the discovery cohort with receiver-operator characteristic (ROC) area-under-the-curve (AUC) values >85%. These 10 molecules also significantly decreased after 60 days of treatment in a subset of 20 participants followed over time. Of these, a specific combination of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine exhibited ROC AUCs >80% in a blinded validation cohort of participants with active TB and non-tuberculous pulmonary disease. ConclusionUrinary levels of diacetylspermine, neopterin, sialic acid, and N-acetylhexosamine distinguished patients with tuberculosis from healthy controls and patients with non-tuberculous pulmonary diseases, providing a potential noninvasive biosignature of active TB. FundingThis study was funded by Weill Cornell Medicine, the National Institute of Allergy and Infectious Diseases, the Clinical and Translational Science Center at Weill Cornell, the NIH Fogarty International Center grants, and the NIH Tuberculosis Research Unit (Tri-I TBRU).

Utility of catheterized specimens in reducing overdiagnosis of urinary tract infections in women.

To evaluate the utility of catheterized samples in reducing overdiagnosis of UTI based on voided specimens among patients presenting with a range of urinary symptoms. We also aimed to determine variables that may modify the predictive value of the voided midstream urine culture. Patient charts were reviewed to identify female patients referred to our voiding dysfunction clinic with a range of complaints warranting urine studies (5/2014-8/2016). Patients with a positive voided urine culture who also had a catheterized urine culture in our system were included. Multiple logistic regression analysis was performed to identify patient characteristics associated with a negative catheterized specimen despite a positive voided specimen. One hundred and seven women were included in the study. Eighty percent of the cohort was post-menopausal. Although all patients had positive voided specimens, only 53 (49.5%) had positive catheterized specimens. On multivariate analysis negative nitrites on clean catch UA was a significant predictor of a negative catheterized sample (adjusted OR 8.9, 95%CI 2.2-43.7, P = 0.003). WBC/HPF <10 on clean catch UA trended towards significance (adjusted OR 4.72, 95%CI 1.1-26.1, P = 0.05). Relying on clean catch urine samples may lead to significant over-diagnosis of UTIs. Our study suggests that in female patients who have vague symptoms of UTI, obtaining catheterized specimens may be beneficial in avoiding the overdiagnosis of UTIs and the overuse of antibiotics. Larger, prospective studies testing our hypothesis are necessary, and would greatly assist in establishing clinical practices that reduce the amount of antibiotics inappropriately prescribed.

Microbial metagenome of urinary tract infection

Urine culture and microscopy techniques are used to profile the bacterial species present in urinary tract infections. To gain insight into the urinary flora, we analyzed clinical laboratory features and the microbial metagenome of 121 clean-catch urine samples. 16S rDNA gene signatures were successfully obtained for 116 participants, while metagenome sequencing data was successfully generated for samples from 49 participants. Although 16S rDNA sequencing was more sensitive, metagenome sequencing allowed for a more comprehensive and unbiased representation of the microbial flora, including eukarya and viral pathogens, and of bacterial virulence factors. Urine samples positive by metagenome sequencing contained a plethora of bacterial (median 41 genera/sample), eukarya (median 2 species/sample) and viral sequences (median 3 viruses/sample). Genomic analyses suggested cases of infection with potential pathogens that are often missed during routine urine culture due to species specific growth requirements. While conventional microbiological methods are inadequate to identify a large diversity of microbial species that are present in urine, genomic approaches appear to more comprehensively and quantitatively describe the urinary microbiome.

Identification and Characterization of Candida on CHROMAgar™ in Pregnant Women of Multan, Pakistan

Introduction: Infections to vagina with fungi/yeast are ten times more common during pregnancy because of hormonal and biochemical fluctuations. Increased use of antibiotics and presence of high levels of reproductive hormones during pregnancy also stimulate yeast colonization with Candida species. These two contributes significantly to be an important risk factor in Vulvovaginal Candidiasis (VVC) and Urinary Tract Infections (UTI), a complication during pregnancies. Overall occurrence of UTI/vaginal yeast infections increases with progression of pregnancy and maximizes by third trimester worldwide. Study parameters: In the current study, pregnant women were look for presence of UTI by Candida species in different trimesters within the city of Multan. The total of 70 women with different gestational stages, attending gynecologists, aged 18-39 years were included in the investigation. A clean catch urine samples were cultured on CHROMAgar™ Candida, a selective medium, for the isolation and presumptive identification of yeast species. Of all samples, 25 women (36%) were positive for Candida yeast infection (symptomatically and asymptomatically). Colonies were identified as C. albicans (48%), C. krusei (16%), C. tropicalis (16%) along with some mixed infections with C. parapsilosis and C. krusei. Two of the mixed cultures (8%) were isolated with C. albicans and C. tropicalis, one (4%) with C. albicans and C. krusei, one (4%) with C. tropicalis and C. krusei. Results: The highest incidence, 36% (n=9/25), of candiduria was recorded in the age group of 30-35 years. The colony counts in urine were also studied in different gestational stages and age. Total of 23% isolations share high counts (>1000 CFU/mL). While other 33% have intermediate (<600 CFU/mL) and 30% isolates were with low colony counts (<150 CFU/mL). The species distribution in these positive specimens reveals increased percentages of nonalbicans species with increasing gestational stage. Conclusion: From these findings it is concluded that incidence of candiduria in pregnant women were higher in 2nd and 3rd trimester of pregnancy with an increase in mixed Candida infections in young women. It is recommended to educate the group so that less young individuals are affected.

Neutrophil Gelatinase-Associated Lipocalin Biomarker and Urinary Tract Infections: A Diagnostic Case-Control Study (NUTI Study).

Acute uncomplicated urinary tract infection (UTI) in women is often treated based on symptoms alone. Urinary tract infection symptoms are highly sensitive but lack specificity and result in overuse of antibiotics. We sought to determine if urine neutrophil gelatinase-associated lipocalin (uNGAL) levels in urine can accurately discriminate between UTI and healthy women. We recruited adult women aged 18 to 85 years presenting in the ambulatory setting from November 2014 to January 2016. Cases were defined as women with Centers for Disease Control and Prevention-defined UTI symptoms and a positive urine culture of more than 10 organisms/mL on a midstream clean-catch specimen. Women without UTI symptoms were matched by age and menopausal status as control subjects. Exclusion criteria were no UTIs within 8 weeks, urinary tract anomalies, renal disease, pregnancy, or diabetes. Clean-catch urine samples were obtained for measuring uNGAL, prior to antibiotic treatment of cases. We used Mann-Whitney U test to compare the 2 groups. Receiver operating characteristic curves were plotted to compare the performance of uNGAL to established urinary markers. We enrolled 50 UTI cases and 50 control subjects. Urine NGAL levels were higher in the UTI group than in the control subjects (P < 0.0001). Using a cutoff of 23.9 ng/mL, NGAL achieved 98% sensitivity and 100% specificity. The receiver operating characteristic curve had an area under the curve of 0.97 (95% confidence interval, 0.93-1.00), which was significantly high and showed that uNGAL can identify UTI. Urine NGAL has the potential as a biomarker for diagnosing UTIs in adult women.

Persistence of uropathogenic Escherichia Coli in the bladders of female patients with sterile urine after antibiotic therapies.

This study aimed to provide evidence of persistent uropathogenic Escherichia coli (UPEC) in female patients with recurrent urinary tract infection (UTI) after antibiotic therapy. We collected biopsies of the bladder, and clean-catch urine samples from 32 women who had episodes of recurrent UTI and were given antibiotic therapy. Urine samples and biopsies were analyzed by conventional bacteriological techniques. Phylogenetic group and 16 virulence factors (VFs) of UPEC were determined using polymerase chain reaction (PCR). The infection capability of UPEC was confirmed in a mouse model. Immunofluorescence and electron microscopy were used to detect intracellular bacterial communities (IBCs) in the mouse model. The results showed that all urine specimens were detected sterile. E. coli was found in 6 of 32 biopsies (18.75%), and was identified to be UPEC by PCR. Different VFs associated with the formation of IBCs were identified in all six UPEC isolates. Each UPEC isolate was capable of forming IBCs within the bladder epithelial cells of mice. In conclusion, UPEC with distinctive pathological traits and the capability of IBC formation was first found in the bladders of women after antibiotic therapy, suggesting that the IBC pathogenic pathway may occur in humans and it plays an important role in UTI recurrence.

Evaluation of a New Strategy for Clean-Catch Urine in Infants.

A new noninvasive bladder stimulation technique has been described to obtain clean-catch urine (CCU) in infants aged <30 days. Objectives were (1) to determine proportion and predictive factors for successful CCU collections using a stimulation maneuver technique among infants <6 months and (2) to determine the proportion of bacterial contamination with this method. A prospective cohort study was conducted in a tertiary pediatric emergency department among infants <6 months needing a urine sample. CCU samples were collected using a standardized stimulation technique. Invasive technique was performed after CCU for three specific conditions. Primary outcomes were proportions of successful CCU specimens and bacterial contamination. We determined associations between successful urine samples and 4 predictive factors (age, sex, low oral intake, and recent voiding). A total of 126 infants were included (64 boys, median age: 55 days). The CCU procedure was effective in 62 infants (49%; median time: 45 seconds). Infants 0 to 29 days; 30 to 59 days, and 60 to 89 days had more successful procedures, compared with infants >89 days (odds ratios [95% confidence interval (CI)]: 4.3 [1.4 to 13.4]; 3.2 [1.2 to 8.4]; and 4.44 [1.5 to 13.3], respectively). The contamination proportion was 16% (95% CI: 8% to 27%) in the CCU group. This proportion was not statistically different compared with the invasive method group (6%, 95% CI: 3% to 15%). The CCU procedure is a quick and effective noninvasive method in children aged <90 days. Contamination proportions were similar to those reported in the literature for urethral catheterization. Circumstances for which the CCU procedure could be performed are proposed.

Factors Influencing the Development of Urothelial Lesions and Breast Tuberculosis among Pulmonary TB Patients Undergoing Directly Observed Therapy in Abeokuta and Ilishan Metropolises, Ogun State, Nigeria

This questionnaire-laboratory based cohort study evaluated some socio-demographic characteristics and urothelial integrity among pulmonary tuberculosis (TB) patients. A total of 49 confirmed TB positive patients (males= 17 and females =32) within the age range of 10-79 years were recruited from Abeokuta and Ilishan metropolises, and divided into 2 groups: patients on anti-TB drugs and those not on anti-TB drugs. Smears made using cell deposits from fresh clean catch urine samples were stained by the Papanicolaou and Giemsa techniques. In this study, high frequency of TB infection was associated with gender, ethnicity, residency, marital status, occupation, and income status. The prevalence of urothelial lesion and breast tuberculosis was 24.5% and 8.2%, respectively with high frequency among patients within the age range of 30 to 39 years. A significant difference between patients on anti-TB drugs and those not on anti-TB drugs was observed in relation to low grade urothelial lesions (p<0.05). Subgroup comparison showed that approximately 47%, 45%, 34% and 17% of the urothelial lesions were associated with lack of TB therapy, HIV and TB co-infection, females and breast tuberculosis, respectively when compared with other subgroups. Interestingly, polyomavirus (45%), HIV (43%) fungal infections (39%), parasites (24%) and crystals (18%) were associated with the urothelial lesions (p<0.05). This study suggests that lack of TB therapy, age, female-sex and some co-infections may increase the risk of urothelial lesions and breast tuberculosis. Thus, female patients living in TB endemic areas and within the age range of 30 to 59 years should be screened pre- and post treatment.

Improving the Diagnosis and Treatment of Urinary Tract Infection in Young Children in Primary Care: Results from the DUTY Prospective Diagnostic Cohort Study.

Up to 50% of urinary tract infections (UTIs) in young children are missed in primary care. Urine culture is essential for diagnosis, but urine collection is often difficult. Our aim was to derive and internally validate a 2-step clinical rule using (1) symptoms and signs to select children for urine collection; and (2) symptoms, signs, and dipstick testing to guide antibiotic treatment. We recruited acutely unwell children aged under 5 years from 233 primary care sites across England and Wales. Index tests were parent-reported symptoms, clinician-reported signs, urine dipstick results, and clinician opinion of UTI likelihood (clinical diagnosis before dipstick and culture). The reference standard was microbiologically confirmed UTI cultured from a clean-catch urine sample. We calculated sensitivity, specificity, and area under the receiver operator characteristic (AUROC) curve of coefficient-based (graded severity) and points-based (dichotomized) symptom/sign logistic regression models, and we then internally validated the AUROC using bootstrapping. Three thousand thirty-six children provided urine samples, and culture results were available for 2,740 (90%). Of these results, 60 (2.2%) were positive: the clinical diagnosis was 46.6% sensitive, with an AUROC of 0.77. Previous UTI, increasing pain/crying on passing urine, increasingly smelly urine, absence of severe cough, increasing clinician impression of severe illness, abdominal tenderness on examination, and normal findings on ear examination were associated with UTI. The validated coefficient- and points-based model AUROCs were 0.87 and 0.86, respectively, increasing to 0.90 and 0.90, respectively, by adding dipstick nitrites, leukocytes, and blood. A clinical rule based on symptoms and signs is superior to clinician diagnosis and performs well for identifying young children for noninvasive urine sampling. Dipstick results add further diagnostic value for empiric antibiotic treatment.

Evaluation of the Bladder Stimulation Technique to Collect Midstream Urine in Infants in a Pediatric Emergency Department.

ObjectiveMidstream clean-catch urine is an accepted method to diagnose urinary tract infection but is impracticable in infants before potty training. We tested the bladder stimulation technique to obtain a clean-catch urine sample in infants.Materials and methodsWe included 142 infants under walking age who required a urine sample in a cross- sectional study carried out during a 3-months period, from September to November 2014, in the emergency department of the University Children’s Hospital of Nice (France). A technique based on bladder stimulation and lumbar stimulation maneuvers, with at least two attempts, was tested by four trained physicians. The success rate and time to obtain urine sample within 3 minutes were evaluated. Discomfort (EVENDOL score ≥4/15) was measured. We estimated the risk factors in the failure of the technique. Chi-square test or Fisher’s exact test were used to compare frequencies. T-test and Wilcoxon test were used to compare quantitative data according to the normality of the distribution. Risk factors for failure of the technique were evaluated using a multivariate logistic regression model.ResultsWe obtained midstream clean-catch urine in 55.6% of infants with a median time of 52.0 s (10.0; 110.0). The success rate decreased with age from 88.9% (newborn) to 28.6% (>1 y) (p = 0.0001) and with weight, from 85.7% (<4kg) to 28.6% (>10kg) (p = 0.0004). The success rate was 60.8% for infants without discomfort (p<0.0001). Heavy weight and discomfort were associated with failure, with adjusted ORs of 1.47 [1.04–2.31] and 6.65 [2.85–15.54], respectively.ConclusionBladder stimulation seems to be efficient in obtaining midstream urine with a moderate success rate in our study sample. This could be an alternative technique for infants before potty training but further randomized multicenter studies are needed to validate this procedure.

Maternal body burden of cadmium and offspring size at birth

Increasing evidence suggests an inverse association between cadmium (Cd) and size at birth, potentially greatest among female neonates. We evaluated whether greater maternal body burden of Cd is associated with reduced neonatal anthropometry (birthweight, birth length, head circumference, and ponderal index) and assessed whether these associations differ by infant sex. The analytic sample for the present study (n=396) was derived from a subcohort of 750 women randomly drawn from among all participants (N=4344) in the Omega Study, a prospective pregnancy cohort. Creatinine-corrected Cd in maternal clean-catch spot urine samples (U-Cd) was quantified by inductively coupled plasma mass spectrometry. Continuous log2-transformed Cd (log2-Cd) and U-Cd tertiles (low<0.29μg/g creatinine, middle 0.29–0.42μg/g creatinine, high≥0.43μg/g creatinine) were used in multivariable linear regression models. Females had reduced birth length with greater U-Cd tertile, whereas males birth length marginally increased [β(95% CI) females: low=reference, middle=−0.59cm (−1.37, 0.19), high=−0.83cm (−1.69, 0.02), p-trend=0.08; males: low=reference, middle=0.18cm (−0.59, 0.95), high=0.78cm (–0.04, 1.60), p-trend=0.07; p for interaction=0.03]. The log2-Cd by infant sex interaction was statistically significant for ponderal index [p=0.003; β(95% CI): female=0.25kg/m3 (−0.20, 0.70); male=−0.63kg/m3 (−1.01, −0.24)] and birth length [p<0.001; β(95% CI): female=−0.47cm (−0.74, −0.20), male=0.32cm (0.00, 0.65)]. Our findings suggest potential sex-specific reversal of Cd’s associations on birth length and contribute to the evidence suggesting Cd impairs fetal growth.

Prevalence and pattern of urinary abnormalities among apparently healthy adult Nigerians

Background: Urinalysis is a simple and cheap method of screening for systemic diseases including kidney disease and may open a window of opportunity for prevention/early treatments especially in resource-constrained settings like Nigeria. We therefore studied the pattern of urinary abnormalities among an apparently healthy urban population. Methods: Mid-stream clean catch urine samples were collected from 1048 apparently healthy subjects and tested for urinary abnormalities using the dipstick method following a health promotional talk in Idi-araba, a Lagos slum. Results: A total of 1048 randomly selected subjects with a mean age of 38.7 ΁ 14.5 years (age range 18-85 years) were screened. This consisted of 597 (57%) females and 451 (43%) males. Protenuria, hematuria, leucocyturia, nitrituria, and glucosuria were present in 18.9%, 1.7%, 9.2%, 1.8% and 2% of the subjects respectively. Proteinuria and haematuria was more prevalent in subjects aged ≥40 years (P < 0.05). The prevalence of leucocyturia, nitrituria, and glucosuria were independent of age (P < 0.05). There were no gender differences in the prevalence of urinary abnormalities (P < 0.05). Four hundred and forty-four (42.3%) of the cohort had hypertension (HTN). Proteinuria and leucocyturia were more prevalent in hypertensive subjects (P < 0.05) while hematuria, nitrituria, and glucosuria was independent of hypertensive status of subjects (P < 0.05). Conclusion: Urinary abnormalities are common among apparently healthy adults in Lagos. It is therefore recommended that it should be routinely done as a cheap screening tool and further evaluation conducted where necessary. This may result in cheaper treatment and better outcomes.

Antimicrobial Evaluation of Bacterial Isolates from Urine Specimen of Patients with Complaints of Urinary Tract Infections in Awka, Nigeria

Urinary tract infections (UTIs) account for one of the major reasons for most hospital visits and the determination of the antimicrobial susceptibility patterns of uropathogens will help to guide physicians on the best choice of antibiotics to recommend to affected patients. This study is designed to isolate, characterize, and determine the antimicrobial susceptibility patterns of the pathogens associated with UTI in Anambra State Teaching Hospital, Amaku, Anambra State, Nigeria. Clean catch urine samples of inpatient and outpatient cases of UTI were collected and bacteriologically analyzed using standard microbiological procedures. Antibiogram was done by the Kirby-Bauer disc diffusion method. The most prevalent isolates were S. aureus (28%), E. coli (24.6%), and S. saprophyticus (20%). The antibacterial activities of the tested agents were in the order of Augmentin < Ceftazidime < Cefuroxime < Cefixime < Gentamicin < Ofloxacin < Ciprofloxacin < Nitrofurantoin. It was found that all the organisms were susceptible in varying degrees to Nitrofurantoin, Ciprofloxacin, and Ofloxacin. It was also observed that all the bacterial species except Streptococcus spp. have a Multiple Antibiotic Resistance Index (MARI) greater than 0.2. For empiric treatment of UTIs in Awka locality, Nitrofurantoin, Ciprofloxacin, and Ofloxacin are the first line of choice.

Prevalence and susceptibility of uropathogens: a recent report from a teaching hospital in Bangladesh.

BackgroundThis investigation was aimed to determine the current status of prevalence and antimicrobial susceptibility of uropathogens isolated in a teaching hospital in Bangladesh. A retrospective analysis was done at the department of Microbiology of Islami Bank Medical College, Rajshahi (IBMCR), Bangladesh during January to December, 2012. Midstream clean-catch urine samples were collected from 443 suspected urinary tract infection patients of different age and sex groups. Uropathogens were identified by standard and specific microbiological techniques and antimicrobial susceptibility pattern was determined by Kirby Bauer Disc diffusion method following Clinical and Laboratory Standards Institute (CLSI) guidelines.FindingsCulture yielded a total of 189 (42.66 %) significant growths of uropathogens including 179 (94.71 %) unimicrobial (single bacterial species) and 10 (5.29 %) polymicrobial (pair of two different bacterial species) growths. Gender distribution showed 34.44 % male and 48.29 % female UTI patients with male to female ratio of 1:1.46, respectively. E. coli was the predominant isolate (59.30 %), followed by Staph saprophyticus (19.09 %), Enterococcus spp. (11.56 %), Klebsiella spp. (5.53 %), Pseudomonas spp. (2.01 %), Proteus spp. (1.51 %) and Enterobacter spp. (1.00 %). Very high frequency of resistance ranging from 72.03 to 91.53 % to cotrimoxazole, ciprofloxacin, cefuroxime, cephradin, amoxicillin and nalidixic acid, moderately high resistance to ceftriaxone (55.08 %) and gentamicin (40.68 %) and low resistance to nitrofurantoin (16.10 %) were shown by E. coli. Similarly, Staph. saprophyticus and Enterococcus spp. showed low resistance (18.42 and 21.74 %) to nitrofurantoin, but moderately high against cefaclor, gentamycin, cefuroxime and ceftriaxone. Klebsiella spp. and Proteus spp. were 72.73 and 66.67 % susceptible, respectively to gentamycin only but low frequency of susceptibility (<50 %) was found to all other antimicrobial agents. Peudomonas spp. was 75 % susceptible to nitrofurantoin only and showed 75–100 % resistance to all other agents. Enterobacter spp. were 50 % resistant to nitrofurantoin, gentamycin, cefuroxime, cefaclor and ceftriaxone but showed 100 % resistance to all remaining antimicrobials.ConclusionsCurrent uropathogens showed the highest rate of susceptibility to nitrofurantoin and gentamicin which can be adapted for empirical treatment of urinary tract infections.

Prevalence of Urinary Tract Infection among Children Attending Babban Mutum Science Primary School Shekal, Bauchi State, Nigeria

The study was conducted to determine the prevalence of Urinary Tract Infection among children attending Babban Mutum Science Primary School Shekal, Bauchi State, Nigeria. The study was carried out between May to July 2014. Among apparently healthy pupils, a questionnaire was administered to determine the risk factors from different age groups, sex, and bed wetting history. One hundred (100) clean-catch urine samples were obtained from the pupils using standard procedures. Microbial culture on Cystein Lactose Electrolyte Deficient (CLED) ager and subsequent Biochemical tests revealed that Eschericia coli (E. coli) with 11 (28.9%) was the most prevalent while Staphylococcus aureus with 2 (5.3%) was the least prevalent of the samples with significant bacterial growth (≥105 CFU/ml). 38 isolates were obtained out of which Gram negative bacteria were the most isolated. The in-vitro antibiotic resistance pattern of the isolates to common antimicrobial agents shows that the isolates are susceptible to all the antibiotics except Amoxycilline which is shown to be less effective in showing great sensitivity.

Screening of presumptive urinary tract infections by the automated urine sediment analyser sediMAX.

Urinary tract infections (UTI) are among the most common bacterial infections and urine samples represent a large proportion of the specimens processed in clinical microbiology laboratories, up to 80% of which, however, yield negative results. Automated microscopy is widely used for urine sediment analysis and has recently been evaluated in a few studies for bacteriological screening of urine samples, achieving high levels of performance. We present a study in which urine samples from both inpatients and outpatients, with either clean-catch or indwelling catheter urine samples, were screened for UTI by urine culture, as the reference method, and the automated urine analyser sediMAX, for the detection of bacteria, leukocytes and yeasts. In total, 3443 urine samples were evaluated. When a single algorithm was adopted for sediMAX to screen the total patient population, 96.4% sensitivity, 75.4% specificity, 57.8% positive predictive value, and 98.4% negative predictive value were found. However, for male outpatients and all patients with indwelling catheter other algorithms were necessary to improve performances. Altogether, with sediMAX false negative rate was 2.4% and false positive rate was 27.6%. In addition, 54% of the investigated samples could have avoided urine culture. After the identification of specific algorithms for different patient subgroups, the automated urine analyser sediMAX can be reliably employed in the screening of UTI.

Urinary tract infection, its causative microorganism and antibiotic susceptibility in Nagaland

Aim: We studied the causative microorganisms and antibiotic susceptibility of urinary tract infections (UTI) for both male and female in Nagaland, North-Eastern India. Materials and Methods: This is a retrospective study done at Christian Institute of Health Sciences and Research, Dimapur, where urinary samples received for culture and sensitivity in the laboratory from January 2012 to June 2013 were included. Organisms were identified by doing standard culture method, and antibiotic sensitivity was done by Kirby-Bauer Disc diffusion method from mid-stream clean catch urine sample. Results: A total of 1789 samples were analyzed in this study, where 502 (28.1%) showed significant growth, 330 (18.4%) showed insignificant growth, and the rest 957 (53.5%) showed no growth. The most commonly isolated bacterium was Escherichia coli both in an outpatient department (31%) and in-patient department (38%) patients followed by Klebsiella pneumonia, Pseudomonas sp., Enterococcus, Staphylococcus aureus, Candida, and Proteus. Analysis of the samples showed that UTI was more common in females (60%) as compared to males (40%). It was also observed that the samples responded effectively to chloramphenicol (29%), gentamicin (28%), imipenem (26%), and amikacin (21%). High degree of resistance was shown for nalidixic acid, ciprofloxacin, norfloxacin, amoxyclav, and ofloxacin. Conclusion: Antibiotics have been in use for a long period and more often the misuse of antimicrobial drugs has today led to a general rise in the emergence of resistant bacteria. This study may aid health professionals in choosing the appropriate treatment for patients in North-Eastern India.

Maternal Body Burden of Cadmium and Offspring Size at Birth

Increasing evidence suggests an inverse association between cadmium (Cd) and size at birth, potentially greatest among female neonates. We evaluated whether greater maternal body burden of Cd is associated with reduced neonatal anthropometry (birthweight, birth length, head circumference, and ponderal index) and assessed whether these associations differ by infant sex. The analytic sample for the present study (n=396) was derived from a subcohort of 750 women randomly drawn from among all participants (N=4344) in the Omega Study, a prospective pregnancy cohort. Creatinine-corrected Cd in maternal clean-catch spot urine samples (U-Cd) was quantified by inductively coupled plasma mass spectrometry. Continuous log2-transformed Cd (log2-Cd) and U-Cd tertiles (low<0.29μg/g creatinine, middle 0.29-0.42μg/g creatinine, high≥0.43μg/g creatinine) were used in multivariable linear regression models. Females had reduced birth length with greater U-Cd tertile, whereas males birth length marginally increased [β(95% CI) females: low=reference, middle=-0.59cm (-1.37, 0.19), high=-0.83cm (-1.69, 0.02), p-trend=0.08; males: low=reference, middle=0.18cm (-0.59, 0.95), high=0.78cm (-0.04, 1.60), p-trend=0.07; p for interaction=0.03]. The log2-Cd by infant sex interaction was statistically significant for ponderal index [p=0.003; β(95% CI): female=0.25kg/m(3) (-0.20, 0.70); male=-0.63kg/m(3) (-1.01, -0.24)] and birth length [p<0.001; β(95% CI): female=-0.47cm (-0.74, -0.20), male=0.32cm (0.00, 0.65)]. Our findings suggest potential sex-specific reversal of Cd's associations on birth length and contribute to the evidence suggesting Cd impairs fetal growth.