Clean-catch Urine Research Articles

Molecular detection of Staphylococcus aureus in urine in patients with S. aureus bacteremia: an exploratory study.

Staphylococcus aureus bacteremia (SAB) is associated with a 90-day mortality of 28-34%. Many SAB-patients (7.8-39%) have a secondary S. aureus bacteriuria (SABU) mainly without symptoms of a urinary tract infection. Due to high morbidity and mortality, there is an interest in rapid detection of S. aureus bacteremia. Here, we compared a rapid nucleic acid amplification test (NAAT) with conventional culture to detect S. aureus in urine and to identify cases with increased risk for SAB. In a cross-sectional study, we assessed urine samples (mid-stream, clean catch and catheter urine) of patients with SAB and bacteremia other than SAB (non-SAB). Urine samples were collected ± 3 days to the collection of the positive blood culture and were cultured on a set of selective and non-selective agar plates. NAAT was performed using a commercial test (Xpert® SA Nasal Complete G3, Cepheid) from a sterile swab soaked in urine. We included samples from 100 patients (68% male, median age: 67.4 years) with SAB and 20 patients (75% male, median age: 65.84 years) with non-SAB. The sensitivity of detecting SAB from urine samples was 47% (specificity: 90%) for NAAT, when applying a Ct-value of ≤ 37.4 for positive results. Urine culture had a sensitivity of 25% and a specificity of 95%. Molecular and culture methods showed a moderate agreement (80%, Cohens kappa: 0.55). NAAT from urine has a higher sensitivity than culture in patients with SAB and could potentially identify cases with increased risk for SAB. Future studies should investigate whether this characteristic could translate into a clinical benefit through rapid detection of SAB.

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.

Prevalence of Uropathogens and Associated Risk Factors in Urinary Tract Infection in Pregnant Women Attending Antenatal Clinic in a Teaching Hospital in Awka, Nigeria

Urinary tract infection (UTI) is one of the very serious common problems encountered in pregnancy, and it is associated with severe maternal and fetal risks which include maternal chorioamnionitis, pyelonephritis, cystitis, preterm birth, low birth weight, and increased perinatal mortality if untreated. The prevalence of UTI varies worldwide. This study was undertaken to determine the prevalence of uropathogens and associated risk factors in UTI in pregnant women in Awka, Nigeria. This was a cross sectional study that involved 269 pregnant women. Clean-catch mid-stream morning urine specimens were collected and examined macroscopically, microscopically and bacteriologically. Information on Socio-demographic characteristics and some clinical factors were collected using pre-designed questionnaires. Statistical analysis was done using SPSS version 22 and the p-value was set at P=0.05. A total of 118 isolates were obtained and the prevalence of UTI in the study population was 39.8%. The most predominant bacterium was Enterococcus faecalis 34(29%), followed by Escherichia coli 21(17.8%), Klebsiella pneumoniae 15(12.7%), Staphylococcus aureus 10(8.4%), Staphyloccocus saprophyticus 7(6.0%), Enterobacter cloacae 6(5.1%), and Staphyloccocus epidermidis 4(3.4%). Citrobacter freundii, Pseudomonas aeruginosa and Proteus mirabilis occurred at frequency of 3(2.5%) each while Pseudomonas oryzihabitans and Morganella morganii occurred at 2(1.7%) each. Candida species were also isolated, including Candida albicans 4(3.4%), Candida krusei 3(2.5%) and Candida guilliermondii 1(0.8%). None of the socio-demographic variables were statistically associated with UTI. Teachings on personal hygiene during every antenatal visit can help prevent UTI in pregnant women.

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.

Protocol for surveillance of antimicrobial-resistant bacteria causing community-acquired urinary tract infections in low-income countries.

The spread of drug-resistant bacteria into the community is an urgent threat. In most low-middle-income countries (LMICs) settings, community-acquired infection (CAI) is empirically treated with no data to support the choice of antibiotics, hence contributing to resistance development. Continuous antimicrobial resistance (AMR) data on community-acquired pathogens are needed to draft empirical treatment guidelines, especially for areas with limited culture and susceptibility testing. Despite the importance of addressing antibiotic-resistant pathogens in the community setting, protocols for the surveillance of AMR bacterial infections are lacking in most (LMICs). We present a protocol for surveillance of AMR in LMICs using urinary tract infection (UTI) as a proxy for CAI to enable users to quantify and establish the drivers of AMR bacteria causing UTI. The protocol intends to assist users in designing a sustainable surveillance program for AMR in the community involving children above two years of age and adults presenting to a primary health facility for healthcare. Implementation of the protocol requires initial preparation of the laboratories to be involved, surveillance areas, selection of priority bacteria and antimicrobials to be used, and the design of a coordinated sampling plan. Recruitment should occur continuously in selected health facilities for at least 12 months to observe seasonal trends of AMR. At least 10 mL of clean-catch mid-stream urine must be collected into 20 mL calibrated sterile screw-capped universal bottles lined with 0.2 mg boric acid and transported to the testing laboratory. Utilise the data system that generates standard reports for patient care to be shared internally and externally in the regions and the world through global platforms such as the Global Antimicrobial Resistance Surveillance System.

Uro-pathogens: Multidrug resistance and associated factors of community-acquired UTI among HIV patients attending antiretroviral therapy in Dessie Comprehensive Specialized Hospital, Northeast Ethiopia.

Urinary tract infections are common bacterial and fungal infections in humans, occurring both in the community and in immunocompromised patients in healthcare settings. Urinary tract infections have a significant health impact on HIV-infected patients. Nowadays, drug-resistant pathogens are widespread poses a serious clinical risk, and causes urinary tract infection. The common agents of bacteria and fungi that cause urinary tract infection are Escherichia coli followed by Klebsiella pneumonia, Staphylococcus saprophyticus, Enterococcus faecalis, group B streptococcus, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus and Candida. albicans. This study aimed to investigate uro-pathogen, multidrug resistance pattern of bacteria, and associated factors of community-acquired urinary tract infection among HIV-positive patients attending antiretroviral therapy in Dessie comprehensive specialized hospital, Northeast Ethiopia from February 1, 2021, to March 30, 2021. An institutional-based cross-sectional study was conducted at Dessie Comprehensive Specialized Hospital. Socio-demographic and clinical data were collected by using structured questionnaires from HIV patients suspected of community-acquired urinary tract infections. About 10 ml of clean-catch midstream urine was collected and inoculated into Blood agar, MacConkey, and Cysteine lactose electrolyte deficient media. Yeasts were identified by using Gram stain, germ tube test, carbohydrate fermentation, assimilation tests, and chromogenic medium. Gram stain and biochemical tests were performed to identify isolates and an antimicrobial susceptibility pattern was performed on disc diffusion techniques. Data were entered and analyzed using SPSS version 25. Both bivariate and multivariable logistic regression analysis was performed and a P value of < 0.05 with an adjusted odds ratio with their 95% confidence interval (CI) was used as statistically significant associations. From the total 346 study participants, 92 (26.6%) were culture positive 75 (81.52%) were bacterial and 17 (18.48%) were fungal pathogens. From a total of 75 bacteria isolates 51(68%) were Gram-negative bacteria and the most commonly isolated bacteria were E. coli 16 (21.33%) followed by K. pneumoniae 11(14.67%) and enterococcus species 10(10.87. Of the 17 fungal isolates of fungi, 8(47.1%) were represented by C. tropicalis. Of the isolated bacteria, 61(81.3%) were resistant to three and above classes of antibiotics (drug classes). About 13 (81.3%) of E. coli, 9(81.8%) of K. pneumoniae, 8(80%) of Enterococcus species, 7 (77.8%) of P. aeruginosa, and CoNs 7(87.5%) were the most frequently exhibited three and above classes of antibiotics (multi-drug resistance). Amikacin and gentamicin were effective against Gram-negative Uro-pathogens. Participants aged>44year, female, being daily labor, being farmer, unable to read and write, patients with CD4 count of ≤ 200 cells/mm3 and CD4 count of 201-350 cells/mm3, who had chronic diabetics, patients having a history of hospitalization and who had urgency of urinations were statistically significant association with significant urinary tract infections. The burden of community-acquired urinary tract infections among HIV patients is alarmingly increased. Therefore, behavior change communications might be considered for promoting the health status of HIV patients. Moreover, CD4 level monitoring and therapeutics selection based on microbiological culture are quite advisable for the management of urinary tract infections of HIV patients.

Bacterial Uropathogens causing Urinary Tract Infection at Hetauda Hospital

Introduction: Urinary tract infection is the infection of the uroepithelium that mainly affects kidney, ureter, urinary bladder and urethra. The causative agents of urinary tract infections are bacteria and fungi. Among these, bacteria are the most causative uropathogens of urinary tract infections. Objectives: The objective of this study is to isolate, identify, characterized and perform antibiotic sensitivity test from the bacterial isolates. Methods: A descriptive cross-sectional study was conducted from March 2023 to May 2023. Ethical approval was obtained from Institutional Review Committee (IRC), Madan Bhandari Academy of Health Sciences, IRC-32-079. Total of 1120 urine samples were collected during this study. Convenient sampling technique was used for this study. Clean catch or mid-stream urine was collected in a sterile container. All urine samples were submitted to Department of Microbiology for culture. A set of biochemical tests were done for bacterial identification. Antibiotic sensitivity test was performed by Kirby-Bauer disk diffusion method. Results: Total of 1120 urine samples were collected from patients suspected to Urinary Tract Infections. Total urine culture positive was 340 (30.36%). Of these bacterial isolates, Escherichia coli (248, 73%) was the most common species, followed by Klebsiella species (26, 7.6%), Staphylococcus saprophyticus (23, 6.76%) and Enterococcus fecalis (18, 5.3%). Conclusion: As prevalence of bacteria causing urinary tract infections is increasing day by day; so its proper isolation, identification, characterization with their antibiotic profile is necessary as it forms the base line for the clinicians to choose appropriate antimicrobial agents for empirical as well as rational treatment for UTIs.

Bacterial abundance and antimicrobial resistance patterns of uropathogens among pregnant women with asymptomatic bacteriuria: Association with glycemic status

ObjectivesAntimicrobial resistance (AMR), a growing global menace, poses a significant threat to maternal and fetal health. Gestational diabetes mellitus (GDM) causes double trouble in pregnancy, increasing the risk of a variety of infectious morbidities while also raising the possible association with AMR. Asymptomatic bacteriuria (ASB) is a common problem in pregnancy, but little research has been done to date explicitly examining the relationship between GDM and ASB and yielded conflicting results. Even fewer studies have specifically examined the relationship between GDM and AMR in women with ASB. Retrieving the most recent information on the disease burden, the range of causative pathogens, their patterns of AMR, and associated risk factors in pregnant women is crucial to stop the exponential rise in AMR in pregnancy and improve maternal and neonatal outcomes of infectious morbidities. Hence, this study was planned to investigate the association between glycemic status and the contemporary bacterial profile, antimicrobial resistance(AMR), and associated variables among pregnant women with ASB Study designThis prospective, hospital-based, cross-sectional study was conducted among 320 pregnant women; divided into two groups, GDM and non-GDM. Data regarding sociodemographic and clinical characteristics were collected using a structured questionnaire. Clean-catch midstream urine samples were investigated for the presence of significant bacterial uropathogens and their AMR pattern was determined using recommended culture methods. ResultsWe found ASB in 46.25% of study participants with significantly higher occurrence in the GDM group. Dominant isolates were Escherichia coli followed by Klebsiella pneumoniae. AMR was noted in 51.35% and multidrug resistance(MDR) in 23.65% of isolates. Overall AMR, MDR and higher degrees of AMR were higher among uropathogens isolated from the GDM group as compared to the non GDM group, although the difference was not statistically significant. ConclusionThe high occurrence of ASB in pregnancy along with substantially high AMR in this study suggests the need for effective infection control and stewardship programmes. By defining the association of ASB and AMR with hyperglycemia, our study calls for the exploitation of this potential association in halting the pandemic of AMR and in improving the management of infectious morbidities, thus in-turn alleviating their undesired maternal and infant outcomes.

Asymptomatic Bacteriuria among Pregnant Women Attending Antenatal Care in Sudan

Background: Asymptomatic bacteriuria is common during pregnancy due to the apparent reduction in immunity of pregnant women, which appears to encourage the growth of both commensal and non-commensal microorganisms. The objective of this study was to determine the frequency of asymptomatic bacteriuria and identify the causative organisms among pregnant women. Methods and Results: This cross-sectional study was carried out at Ibrahim Malik Teaching Hospital and Bashaier University Hospital from April to July 2019 to assess the prevalence of asymptomatic bacteriuria among pregnant women. Fifty urine specimens were collected from pregnant women who didn’t show any signs or symptoms of UTI. Clean-catch mid-stream urine was collected into a sterile, universal container. Bacteriological culture and bacterial identification were carried out. The prevalence of asymptomatic bacteriuria in pregnant women in this study was 12%. Escherichia coli and Staphylococcus aureus were the most frequently isolated organisms: 2/6(33.3%) and 2/6(33.3%), respectively, followed by Proteus species 1/6(16.7%) and Klebsiella pneumonia 1/6(16.7%). Asymptomatic bacteriuria tended to increase from the first to the third trimester (1/8.3%, 2/11.1%, and 3/15%, respectively), but without statistical significance (P=0.845). We also found a trend to increase in the prevalence of asymptomatic bacteriuria with decreasing age: 2(15.4%) in the age group of 18-25 years, 3(11.5%) in the age group of 26-33 years, and only 1(9.1%) in the age group of 34-41 years (P=0.890). Conclusion: Periodic urine cultures should be performed routinely throughout pregnancy, especially during the first and third trimesters, to identify any unsuspecting unsuspected infection. Bacterial counts are of the most importance and should be done routinely. This measure will significantly reduce maternal and obstetric complications associated with pregnancy.

Survey of urinary tract infection among male students residing in the federal polytechnic, Ado-Ekiti

Urinary tract infections are among the most common bacterial infections in humans both in the community and hospital settings, and they occur in all age groups, and usually required urgent treatment. This study aimed at determining the prevalence of urinary tract infection among male students residing in the Federal Polytechnic, Ado-Ekiti, Ekiti State, Nigeria. Clean-catch midstream urine was collected from fifty (50) male students in the study area into clean sterile specimen bottles. The urine samples were processed and microbial isolates identified. The prevalence of urinary tract infection was significantly high (50%). Five bacterial strains were identified which are; Staphylococcus saphrophyticus, Staphylococcus aureus, Escherichia coli, Enterococcus faecalis and Pseudomonas aeruginosa. S. aureus was found to be the most prevalent and predominant bacterial causing urinary tract infection in males in the study area. The best choice of active antibacterial agents would be trimethoprim, cephalosporin and Fluoroquinolones in the treatment of urinary tract infections in male.

Bacterial Etiology of Urinary Tract Infection and Antibiogram Profile in Children Attending Debre Tabor Comprehensive Specialized Hospital, Northwest Ethiopia.

Bacterial urinary tract infections are important public health problems in children. This study was conducted to identify the bacterial agents of urinary tract infections and antibiogram patterns in children. A hospital-based cross-sectional study including 220 children was carried out between November 15, 2021, and March 10, 2022. Simple random sampling was used to enroll participants. The sociodemographic and clinically pertinent information was gathered using a semi-structured questionnaire. Every participant in the study who was ≤15 years old gave clean-catch midstream urine. Urine samples were inoculated onto a cystine lactose electrolyte-deficient agar using a calibrated inoculating loop with a 0.001 ml capacity and then incubated aerobically for 24 hours at 37°C. Subculturing for significant bacteriuria was done on MacConkey and blood agar. Gram staining, biochemical assays, and colony characteristics were used for bacterial identification. The disc diffusion method developed by Kirby and Bauer was used for antimicrobial susceptibility testing. SPSS software version 25 was used for data entry and analysis. To find the risk factors, bivariate and multivariate logistic regression analyses were performed. An association was deemed statistically significant if the p value at the 95 percent confidence interval was less than 0.05. In this study, the majority (50.5%) of the study participants were males. The mean age of the study participants was 6 ± 0.91 years. It was found that 31.8% of children had urinary tract infections. The most prevalent urinary pathogens among the isolates were E. coli (27.1%) and S. aureus (18.6%). Approximately 56% of the participants were infected with multidrug-resistant pathogens. Additionally, compared to children who have never had a urinary tract infection, children with a history of infection had 1.04 (95 percent confidence interval (CI): 0.39, 2.75) times higher risk of infection. This study has shown an alarming increase in the prevalence of pediatric urinary tract infections which warrants further investigation into multidrug-resistant bacterial infection.

Comparison of clean catch and bag urine using LC–MS/MS proteomics in infants

BackgroundUrinary proteomics identifies the totality of urinary proteins and can therefore help in getting an early and precise diagnosis of various pathological processes in the kidneys. In infants, non-invasive urine collection is most commonly accomplished with a urine bag or clean catch. The influence of those two collection methods on urinary proteomics was assessed in this study.MethodsThirty-two urine samples were collected in infants using urine bag and clean catch within 24 h. Nine boys and seven girls with a mean age of 4.3 ± 2.9 months were included (5 × post-pyelonephritis, 10 × non-kidney disease, 1 × chronic kidney disease (CKD)). Liquid chromatography-mass spectrometry (LC–MS/MS) was performed in data-independent acquisition (DIA) mode. Protein identification and quantification were achieved using Spectronaut.ResultsA total of 1454 urinary proteins were detected. Albumin and α-1-microglobulin were detected the most. The 18 top-abundant proteins accounted for 50% of total abundance. The number of proteins was slightly, but insignificantly higher in clean catch (957 ± 245) than in bag urine (876 ± 255). The median intensity was 1.2 × higher in the clean catch. Overall, differential detection of proteins was 29% between the collection methods; however, it diminished to 3% in the 96 top-abundant proteins. Pearson’s correlation coefficient was 0.81 ± 0.11, demonstrating a high intraindividual correlation. A principal component analysis and a heat map showed clustering according to diagnoses and patients rather than to the collection method.ConclusionUrinary proteomics shows a high correlation with minor variation in low-abundant proteins between the two urine collection methods. The biological characteristics overrule this variation.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information.

Antimicrobial Resistance and Biofilm Production in Uropathogens from Renal Disease Patients Admitted to Tribhuvan University Teaching Hospital, Nepal

Background. Various antibiotics are prescribed empirically by physicians to cope with infections in renal disease patients. A urinary tract infection (UTI) is often caused by biofilm-forming multidrug-resistant (MDR) uropathogens. This study aimed to analyze the antibiogram of UTI strains from renal disease patients and the biofilm-forming ability of those strains. Methods. 102 patients clinically diagnosed with a UTI and renal disease were recruited into the study from August 2017 to January 2018. Clean-catch midstream urine samples were processed for the isolation and identification of the bacteria following standard methodologies. The antibiogram of the isolates (n = 106) was produced by the Kirby–Bauer disc diffusion method. Detection of biofilm formation was performed in tissue culture plates. Results. The incidence of a UTI in renal disease was 19.1%. Most patients were diagnosed with chronic kidney disease (18.63%), nephrotic syndrome (16.67%), and nephrolithiasis (14.71%). The commonest uropathogens were Escherichia coli (52.8%), Klebsiella pneumoniae (16%), and Enterococcus spp. (15.0%). Ceftriaxone was the most common antibiotic prescribed empirically (37%), whereas nitrofurantoin was the most prescribed antibiotic as adjusted therapy (36.1%). Among the first- and second-line antibiotics, most Gram-negative bacteria were sensitive to amikacin (70.7%), meropenem (70.7%), cefoperazone-sulbactam (70.0%), piperacillin-tazobactam (67.2%), gentamicin (66.7%), and nitrofurantoin (66.7%). Most Gram-positive bacteria were sensitive to doxycycline (90.0%), nitrofurantoin (72.2%), gentamicin (66.7%), and tetracycline (62.5%). All MDR Gram-negative uropathogens were susceptible to colistin sulfate and polymyxin B. Among the 106 isolates, 74.5% produced biofilms and 70.8% were MDR. In 67.0% of cases, including both MDR and biofilm-producing bacteria, the empirical therapy needed adjustment. Conclusions. Aminoglycoside, carbapenem, beta-lactam inhibitor, and nitrofuran group of antibiotics may be the optimal first-line empirical therapies for uropathogens in hospitalized renal disease patients. Regular surveillance of resistance patterns and the study of biofilm formation in uropathogens must be performed to ensure effective management of the patients.

Clean-Catch Urine Specimen More Likely to Be Contaminated After Vaginal Surgery for Pelvic Organ Prolapse.

Accurate diagnosis of urinary tract infection after pelvic organ prolapse (POP) surgery is essential to postoperative care. Our aim was to determine the agreement between the urinalysis of a clean-catch versus a straight catheter urine specimen in women who underwent vaginal surgery for POP. This was a cross-sectional study evaluating patients after vaginal surgery for POP. A clean-catch and straight catheter urine specimen were collected at routine postoperative appointments. Routine urinalyses and urine cultures were performed for all patients. A urine culture yielding mixed urogenital flora (which includes Lactobacillus species), coagulase-negative staphylococci, and Streptococcus species was considered a contaminated result. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter at 3 weeks postoperatively was evaluated using weighted κ statistic. Fifty-nine participants enrolled. The agreement between the characteristics of urinalysis obtained via the clean catch versus the straight catheter was poor (κ = 0.018). The urine culture was more likely to be contaminated from the clean-catch urine specimen than from the straight catheter urine specimen (53.7% vs 23.1%).The positive and negative predictive values of leukocyte esterase on clean catch were 22.6% and 100%, respectively. Diagnosing urinary tract infection based on contaminated urinalyses may lead to antibiotic overuse and misdiagnosis of postoperative complications. Our results can help educate health care partners and discourage the use of clean-catch urine specimens when assessing women who have recently undergone vaginal surgery.

Frequency of urinary tract infection in children with nephrotic syndrome.

Objective: To Determine the Frequency of Urinary Tract Infection in Children Presenting With Nephrotic Syndrome. Study Design: Descriptive Cross Sectional Study. Setting: Department of Pediatrics, Lady Reading Hospital (LRH), Peshawar. Period: 16th July 2019 to 15th July 2020. Material &amp; Methods: All children presenting with nephrotic syndrome were evaluated, detailed history was obtained and complete detailed examination were performed to exclude the confounders and possible bias in the results of this study. From all these children, mid-stream clean urine catch urine was obtained with strict sterile technique and the sample was to hospital laboratory to diagnose UTI. Data was analyzed by SPSS. Results: Of these 106 study cases, 69 (65.1%) were male patients while 37 (34.9%) were female patients. The mean age of this study population was 7.71±3.11 years. Mean Duration of Illness was 5.25±4.38 months and 52.8% had duration of illness up to 6 months. Of these 106 study cases, 70 (66.00%) mothers were illiterate and 36(34.00%) mothers were literate. Urinary Tract Infection (UTI) was diagnosed in 27 (25.5%). Conclusion: Our Study results concludes that the frequency of urinary tract infection is very high (25.5%) in children with Nephrotic syndrome.

ANTIMICROBIAL SUSCEPTIBILITY PATTERN OF UROPATHOGENS AT A TERTIARY CARE HOSPITAL IN CENTRAL INDIA DURING COVID ERA.

Objective: The purpose of this study was to study the bacteriological profile of UTI in patients attending the tertiary care hospital and to study the antimicrobial sensitivity pattern of uropathogens. Methods: This cross-sectional study was conducted after obtaining clearance from the institutional ethics committee. Clean-catch mid-stream urine samples were collected from patients symptomatic of UTIs. Samples were cultured aerobically on CLED agar. Isolates having significant growth (&gt;105CFU/ml) were further processed for identification using standard microbiological techniques and their antimicrobial susceptibility pattern was evaluated by the Standard Kirby Bauer disk diffusion method as per CLSI 2020 guidelines. Results: A total of 480 urine samples were processed, yielding 174 isolates. Escherichia coli (42.50%) was predominant, followed by Klebsiella pneumonia, Pseudomonas aeruginosa, Staphylococcus aureus, Acinetobacter spp., Proteus spp., Providencia spp., Enterococcus spp., Citrobacter spp. and Morganella morganii. Gram-positive isolates exhibited high sensitivity towards vancomycin, linezolid, meropenem, and piperacillin tazobactum. Enteric coliforms exhibited high sensitivity towards colistin, meropenem, aminoglycosides, and piperacillin tazobactum. Non-fermenters exhibited high sensitivity towards colistin, meropenem, cefepime, and amoxycillin clavulanate. Conclusion: The rampant injudicious irrational overuse of antibiotics has led to the emergence of multi-drug resistant bugs, which is posing a serious challenge to clinicians in the management of infections. Developing therapeutic protocols guided by susceptibility profiles for tuning antibiotic therapy regimens is an important strategy in tackling this menace.

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.