Common Urinary Tract Infection Research Articles

FREQUENCY OF UTI IN PREGNANCY ASSOCIATED WITH PRETERM LABOUR: A CROSS-SECTIONAL STUDY

This Cross-Sectional Study aimed to determine how common urinary tract infections (UTIs) are in pregnant women experiencing preterm labour. In addition, the study assessed the standard procedure of routinely doing a urine culture and urinalysis simultaneously in these instances. The study was conducted between September 2022 and August 2023 at the Gynae & Obs Department of GKMC Swabi. The medical records of pregnant patients who were hospitalised at the Gynae & Obs department of GKMC Swabi due to preterm labour were analysed. The study determined the incidence of UTIs in these women. The women were divided into two groups based on their diagnoses upon admission: group 1 had preterm labour/preterm prelabour rupture of membranes (PTL/PPROM), and Group 2 had threatened preterm labour (TPL). Urinalysis and urine culture assessments were performed in these two groups to develop a plan to minimise unnecessary urine cultures. Out of 200 women who had preterm uterine contractions, 4.9% had a UTI. There was no difference in the prevalence of UTI between the two groups of women. 3.5% of the urine samples had a positive culture. Escherichia coli was the most commonly found bacterium in both groups of women. A urine culture with a positive screening rate of 7.2% and 91.2% sensitivity can be used to identify women in the TPL group who should have their urine cultured if an abnormal cell counts or a large presence of bacteria exists in the urine. This method can reduce unnecessary urine cultures. The study found that among pregnant women with preterm labour, the incidence of UTIs was 4.9%, with no statistically significant variation between subgroups. Using certain criteria allows unnecessary urine cultures to be reduced while UTIs in this group are promptly detected.

The management and treatment of cystitis: same challenges, new strategies

Cystitis is an inflammation of the bladder that is most often caused by bacterial infection and is the most common urinary tract infection. This lower urinary tract infection (UTI) is one of the most frequently encountered infections in women in outpatient practice. The concept of the urobiome, the microbiome of the urinary tract, has recently emerged and has improved our comprehension of the physiopathology of UTI. Recent studies have highlighted the potential limits of additional examinations used in our clinical practice. The emergence of delayed therapy is a novelty in the treatment of lower UTI; it likely allows for an overall reduction in antibiotic consumption while remaining an effective treatment. Alternatives to antibiotic treatment exist but most have yet to be tested in sufficiently powered randomized trials.

Low Phase Angle and Skeletal Muscle Index Increase Hospital-Acquired Infections During Stroke Rehabilitation

ObjectivesSarcopenia is common in patients with stroke and may increase the risk of medical complications such as infection. However, assessing sarcopenia in stroke patients with consciousness disturbance, aphasia or severe paralysis is challenging. This study aimed to investigate whether a combined assessment of phase angle (PhA) and skeletal muscle index (SMI), estimated using bioelectrical impedance analysis, was associated with 2 common nosocomial infections, hospital-acquired pneumonia (HAP) and urinary tract infection (UTI), during inpatient stroke rehabilitation. DesignSingle-center retrospective observational study. Settings and ParticipantsA total of 1068 patients with stroke admitted to a rehabilitation hospital between January 2016 and September 2019 were analyzed. MethodsThe study variables included demographic characteristics, comorbidities, stroke severity, blood chemistry and urine analysis, SMI, and PhA obtained using bioelectrical impedance analysis. Patients were classified as normal, low PhA only, low SMI only, and low PhA + SMI. Multivariate Cox proportional analysis was used to determine the variables associated with HAP and UTI. ResultsA combination of low PhA + SMI was observed in 429 (40.2%) patients. Over a median follow-up duration of 46 days, HAP occurred in 187 patients (17.5%) and UTI occurred in 155 patients (14.5%). The low PhA + SMI group showed a significantly higher incidence of HAP and UTI than the normal group (32.6% vs 4.6%, P < .001, for HAP; 20.7% vs 6.2%, P < .001, for UTI). In multivariate Cox analyses, low PhA and SMI were associated with significantly higher rates of HAP [hazard ratio (HR) 3.36, 95% CI 1.796-6.304, P < .001] and UTI (HR 1.71, 95% CI 1.002-2.947, P < .05) after adjusting for confounding variables. Conclusions and ImplicationsCombination of low PhA + SMI was independently associated with a higher risk of HAP and UTI in stroke patients who underwent inpatient rehabilitation. Measuring PhA and SMI using bioelectrical impedance analysis might be helpful in establishing care plans in these population.

Poor performance status is a risk factor for higher detection of Gram positive coccus in stone-related pyelonephritis

IntroductionWe aimed to investigate the detection rate of causative organisms in stone-related pyelonephritis and to compare their distribution according to patient backgrounds. MethodsWe retrospectively identified patients with stone-related pyelonephritis. Clinical data were collected between November 2012 and August 2020 at Wakayama Medical University Hospital, including on patient backgrounds and causative organisms. Patients were categorized by Eastern Cooperative Oncology Group performance status (PS) as the good PS group (0, 1) and the poor PS group (2–4). Bacteria were divided into Gram-positive cocci (GPC) or non-GPC groups and logistic regression analysis was used to examine factors that predict detection of GPC. ResultsSeventy-nine patients had stone-related pyelonephritis, 54 (68.4 %) in the good PS group and 25 (31.6 %) in the poor PS group. In the good PS group, Escherichia coli (67 %) was followed by Klebsiella species (9 %), while in the poor PS group, Escherichia coli (20 %) was followed by Enterococci and Staphylococci (12 %). GPC detection rate was significantly higher in the poor PS group than in the good PS group (40.0 % vs 14.8 %, p = 0.016), and multivariate logistic regression analysis showed that poor PS was an independent factor predicting detection of GPC (OR = 6.54, p = 0.02). ConclusionsThe distribution of the causative organisms in stone pyelonephritis was similar to that in common complicated urinary tract infections. Poor PS may be an independent predictor of GPC detection in patients with stone pyelonephritis.

A Study on The Antibiotic Use Pattern Among Patients with Urinary Tract Infections at a County Referral Hospital in Kenya

Urinary tract infections are a prevalent cause of hospital visits, particularly among females and the elderly. Timely diagnosis and adherence to clinical guidelines are crucial for effective management. This study aimed to evaluate antibiotic usage patterns in urinary tract infection patients at Thika Level 5 Hospital, providing insights into prescribing practices and guideline adherence. A cross-sectional study enrolled 308 participants using purposive sampling. Data were extracted from patient files and supplemented with information on clinical guideline availability and supplies for UTI diagnosis and treatment. Descriptive analysis was conducted using Microsoft Excel, with strict adherence to ethical data protection protocols. The study found that a significant proportion of participants (n=78, 25.4%) fell within the 39-49 years age group. Patients under 49 years old constituted the majority (n=200, 65.1%). Cystitis (41.4%) was the most common specific urinary tract infection diagnosis, followed by pyelonephritis (23.5%) and urethritis (18.9%). Common comorbidities included diabetes mellitus (n=31, 27.0%), benign prostatic hyperplasia (BPH) (n=16, 13.9%), and hydrocele (n=11, 9.6%). Ceftriaxone was the predominant antibiotic prescribed in both outpatient (single STAT doses) and inpatient settings, followed by cefixime (n=105, 34.2%) and azithromycin (n=70, 22.8%). Notably, most prescribed antibiotics belonged to the World Health Organization Watch list. Among the 307 prescriptions reviewed, only 112 (36.7%) adhered to Kenyan Clinical Management and Referral Guidelines Volume III. Non-compliant prescriptions involved incorrect antibiotic choice, inappropriate duration and lack of indication. However, prescription frequency, route of drug administration and total dose generally aligned with recommendations.

Study Gene Expression of OXA-48and CTX-M-1 Genes Cephalosporin resistance in Escherichia coli isolated from urinary tract infections in Baghdad hospitals

Escherichia coli are a normal flora in the human. It is pathogenic in patients with immune system disorders and is the leading cause of enteritis, urinary tract infection, septicemia and other medical infections. E. coli is the most common cause of community and hospital-acquired urinary tract infections (UTIs). It is responsible for &gt;80% of all cases of UTI. These study samples were taken from Al-Karama Teaching Hospital and Al-Yarmouk Teaching Hospital in Baghdad. This study aimed to determine the Minimum Inhibition concentration (MIC) of Ceftazidim. As well as comparing the effect of antibiotics and without antibiotics on beta-lactam genes (OXA-48 –CTXM-1) resistance to Cephalosporin where there is an overexpression of gene expression in the antibiotic between (125-64) µg/ml. Bacteria produce beta-lactam enzymes that break down the beta-lactam ring in the antibiotic, which reduces the effectiveness of antibiotics. This mechanism is one of the mechanisms of resistance in bacteria. The presence of both genes increases the resistance of this species to Cephalosporin. The results of gene expression when treated with antibiotics for the OXA-48 gene in his sample were 1.4, and the highest value was 14.5, as well as for the CTX-M-1 gene, where the results ranged between the lowest value of 1.3 and the highest value of 7.3 when compared to the control samples, we notice an overexpression of gene. It was concluded that the resistance of E. coli to Ceftazidim was related to the genes blaOXA45 and CTXM-1, but the primary role may be due to blaOXA45. Keywords: Gene Expression, OXA-48 Gene, CTX-M-1 Gene, Cephalosporin, Escherichia coli.

Antibiotic-Dispensing Patterns and Awareness of Anti-microbial Resistance Among the Community Pharmacists in South-Central India.

Background Anti-microbial resistance (AMR) is an ongoing epidemic contributing to extremely high healthcare costs and hospital admissions. Inappropriate dispensing of antibiotics is one of the root causes of AMR. Hence, our study aimed to assess antibiotic-dispensing patterns and AMR awareness among pharmacists from South-Central India. Methodology This cross-sectional observational study was conducted over a period of two months from June to July 2023. The pharmacies in urban and semi-urban areas of coastal and central districts of the Indian state of Andhra Pradesh were surveyed. Data were collected using a predesigned questionnaire for antibiotic-dispensing patterns and awareness of AMR, as approved by the Institutional Ethics Committee of Aster Ramesh Hospital, Vijayawada, India. The data were collected and analyzed descriptively by cross-tabulation. Results Among the 389 pharmacies that responded, 78% (n = 303) were dispensing antibiotics over the counter (OTC) and 22% (n = 86) were dispensing antibiotics only for valid prescriptions. It was found that antibiotics were dispensed OTC for common ailments such as the common cold, cough, sore throat, nasal congestion, fever, diarrhea, and urinary tract infections. As per the World Health Organization-recommended Access, Watch, and Reserve (AWaRe) criterion, antibiotics under the Watch group such as macrolides (azithromycin), fluoroquinolones (ciprofloxacin, norfloxacin, levofloxacin, and ofloxacin) and third-generation cephalosporins (cefixime and cefpodoxime) were found to be widely dispensed OTC. The most common antibiotics dispensed OTC were azithromycin (54.1%), amoxicillin (47.5%), cefixime (40%), amoxicillin + clavulanic acid (15.2%), ofloxacin (13.5%), ciprofloxacin (10%), and doxycycline (6.6%). Among the OTC dispensers, 82.5% (n = 250) were unaware of AMR and 17.5% were partially aware. However, 57% (n = 49) were unaware of AMR and its effects, in pharmacies dispensing antibiotics for valid prescriptions. Conclusion Our findings aggregateevidence on the alarming trend of inappropriate antibiotic-dispensing patterns that may further exacerbate AMR. Strict regulatory enforcement and periodical monitoring to regulate antibiotic dispensing to control unethical dispensing are inevitably necessary.

B-236 Portable 2 Hour Sample-to-Answer Multi-pathogen Phenotypic Antibiotic Susceptibility Test (AST)

Abstract Background Antimicrobial Resistance is a rapidly growing issue worldwide, arising from the overuse and misuse of antibiotics. The strongest tool the medical community has available to combat AMR is rapid, correct application of antibiotics to identified bacterial infections. Clinics and physician offices seek on-site rapid solutions to speed the pathway to timely and appropriate antibiotic therapies. GeneCapture is prototyping a rapid, sample-to-answer product to provide antibiotic susceptibility results directly from infected urine or wound samples. The test provides a susceptible vs non-susceptible call in under two hours and can be applied to samples with single or mixed pathogens. With support from the Defense Health Agency, a portable table-top instrument and disposable cartridge are being engineered to run this test at the point of care, allowing same-day prescriptions. The process is currently operational on the lab bench. Methods Fluorescent labeling of bacterial species, followed by optical counting, determines population growth with/without a suite of antibiotics. An on-board algorithm instantly converts raw cell numbers into a differential call of Susceptible or Non-susceptible for each bug/drug pair. A disposable cartridge with on-board antibiotics has been designed and is being finalized for fabrication. The optical counting is operating in a desktop device. Results Testing to date includes 124 strains from 7 of the most common Urinary Tract Infection and wound pathogens against a panel of six antibiotics. A total of 541 antibiotic/bacterial strain pairs in single or multiple pathogen antibiotic susceptibility testing (AST), are producing an initial 88.7% agreement to gold standard culture results. These results are all generated in two hours or less of assay time and represent a strong preliminary data set. Conclusion This 2-hour portable, novel, phenotypic AST profiling will produce informed and effective treatment options for medics, clinics and physician offices long before existing AST methods could return results.

Prevalence, drivers and surveillance of antibiotic resistance and antibiotic use in rural China: Interdisciplinary study.

This study aimed to characterise antibiotic prescribing and dispensing patterns in rural health facilities in China and determine the community prevalence of antibiotic resistance. We investigated patterns and drivers of antibiotic use for common respiratory and urinary tract infections (RTI/UTI) in community settings, examined relationships between presenting symptoms, clinical diagnosis and microbiological results in rural outpatient clinics, and assessed potential for using patient records to monitor antibiotic use. This interdisciplinary mixed methods study included: (i) Observations and exit interviews in eight village clinics and township health centres and 15 retail pharmacies; (ii) Urine, throat swab and sputum samples from patients to identify potential pathogens and test susceptibility; (iii) 103 semi-structured interviews with doctors, patients, pharmacy workers and antibiotic-purchasing customers; (iv) Assessment of completeness and accuracy of electronic patient records through comparison with observational data. 87.9% of 1123 recruited clinic patients were prescribed antibiotics (of which 35.5% contained antibiotic combinations and >40% were for intravenous administration), most of whom had RTIs. Antibiotic prescribing for RTIs was not associated with presence of bacterial pathogens but was correlated with longer duration of infection (OR = 3.33) and presence of sore throat (OR = 1.64). Fever strongly predicted prescription of intravenous antibiotics (OR = 2.87). Resistance rates in bacterial pathogens isolated were low compared with national data. 25.8% of patients reported antibiotics use prior to their clinic visit, but only 56.2% of clinic patients and 53% of pharmacy customers could confirm their prescription or purchase included antibiotics. Diagnostic uncertainty, financial incentives, understanding of antibiotics as anti-inflammatory and limited doctor-patient communication were identified as key drivers of antibiotic use. Completion and accuracy of electronic patient records were highly variable. Prevalence of antibiotic resistance in this rural population is relatively low despite high levels of antibiotic prescribing and self-medication. More systematic use of e-records and in-service training could improve antibiotic surveillance and stewardship in rural facilities. Combining qualitative and observational anthropological methods and concepts with microbiological and epidemiological investigation of antibiotic resistance at both research design and analytic synthesis stages substantially increases the validity of research findings and their utility in informing future intervention development.

Nitrofurantoin: properties and potential in treatment of urinary tract infection: a narrative review.

Nitrofurantoin (NF), a wide-spectrum antibiotic accessible since 1953, is utilized widely to treat urinary tract infections as it usually stays active against drug-resistant uropathogen. The use of Nitrofurantoin has increased exponentially since new guidelines have repositioned it as first-line therapy for uncomplicated lower urinary tract infection (UTI). To, although fluoroquinolones are usually used to re-evaluate the first- and second-line therapies for treating uncomplicated UTI, their level of utilization is thought to be inappropriately excessive and will eventually have a detrimental impact; thus, we hypothesize that NF might be the best choice for this condition, because of its low frequency of utilization and its high susceptibility in common UTI pathogens. It can be concluded from this review that NF can be considered as the most effective drug in the treatment of acute urinary infection, but due to the long-term side effects of this drug, especially in elderly patients, it is essential to introduce some criteria for prescribing NF in cases of chronic UTI.

Assessing the urinary concentration of nitrofurantoin and its antibacterial activity against Escherichia coli, Staphylococcus pseudintermedius, and Enterococcus faecium isolated from dogs with urinary tract infections.

Nitrofurantoin, a broad-spectrum nitrofuran class antibiotic, is applied as a first-line antibiotic in treating human urinary tract infections (UTIs) due to its great efficacy and high achievable concentration. The interest in using this antibiotic in companion animals has increased due to the growing demand for effective antibiotics to treat UTIs caused by multidrug-resistant bacteria. Currently, the susceptibility interpretations for nitrofurantoin are based on the breakpoints set for humans, while the canine-specific breakpoints are still unavailable. In this study, we assessed the concentration of nitrofurantoin reaching the dog's urine using the recommended oral dosing regimen. In addition, we examined the efficacy of this breakpoint concentration against the common canine UTI pathogens, Escherichia coli, Staphylococcus pseudintermedius, and Enterococcus faecium. Eight experimental beagle dogs were treated with ~5 mg/kg of nitrofurantoin macrocrystal PO 8qh for 7 days. The urine samples were collected via cystocentesis at 2, 4, and 6 h after administration on day 2 and day 7 and used to quantify nitrofurantoin concentrations by ultra-high performance liquid chromatography. The results showed that 26.13-315.87 μg/mL nitrofurantoin was detected in the dogs' urine with a mean and median concentration of 104.82 and 92.75 μg/mL, respectively. Additionally, individual dogs presented with urinary nitrofurantoin concentrations greater than 64 μg/mL for at least 50% of the dosing intervals. This concentration efficiently killed E. coli, and S. pseudintermedius, but not E. faecium strains carrying an MIC90 value equal to 16, 16, and 128 μg/mL, respectively. Taken together, these results suggest that the value of 64 μg/mL may be set as a breakpoint against UTI pathogens, and nitrofurantoin could be an effective therapeutic drug against E. coli and S. pseudintermedius for canine UTIs.

Food Safety during Pregnancy: Current Consideration

Food safety is critical during pregnancy. Pregnancy hormone changes reduce immune function, making pregnant women more vulnerable to food-borne illnesses. The unborn fetus is particularly sensitive to food-borne diseases since its immune system has not yet matured. Pregnant women must be extremely cautious about what they eat since they are eating not just for their health but also for the health of their unborn babies. When a pregnant woman eats well, she reduces her chances of anemia, low birth weight, and birth defects. Herbal medication use during pregnancy is associated with a woman's age, family financial level, and educational standing. Preeclampsia risk was reduced, labor was extended, and the common cold and urinary tract infection were all treated with herbal treatments during pregnancy. Some herbal products may include ingredients that should not be eaten while pregnant. Herbs may include elements that cause fetal damage, uterine contractions, premature delivery, or miscarriage. The effects of various herbs on pregnant women or fetuses have not been well researched. Herbal drugs are subjected to quality control to ensure consistency, safety, and efficacy. According to this approach, the purpose of this review was to give succinct information on comprehensive food intake, dietary supplements, and the use of herbal items during pregnancy.

Epidemiology and Risk Factors of UTIs in Children-A Single-Center Observation.

Patients with positive urine cultures diagnosed with acute pyelonephritis (APN) or cystitis (CYS) were analyzed for clinical symptoms, laboratory tests, risk factors, and etiology, depending on their age and sex. We studied 948 children with UTIs (531 girls and 417 boys), with a median age of 12 (IQR 5-48 months). A total of 789 children had clinical symptoms; the main symptom was fever (63.4% of patients). Specific symptoms of UTIs were presented only in 16.3% of patients. Children with APN had shown significantly more frequent loss of appetite, vomiting, lethargy, seizures, and less frequent dysuria and haematuria than children with CYS. We found significantly higher median WBC, CRP, and leukocyturia in children with APN than with CYS. The risk factors of UTIs were presented in 46.6% of patients, of which 35.6% were children with APN and 61.7% with CYS. The main risk factor was CAKUT, more frequently diagnosed in children with CYS than APN, mainly in children &lt;2 years. The most commonly isolated bacteria were Escherichia coli (74%). There was a higher percentage of urine samples with E. coli in girls than in boys. Other bacteria found were Klebsiella species, Pseudomonas aeruginosa, Proteus mirabilis, and Enterococcus species. Patients with APN were younger and had higher inflammatory markers. Often, fever is the only symptom of UTI in children, and other clinical signs are usually non-specific. The most common UTI etiology is E. coli, regardless of the clinical presentation and risk factors.

890. Bundled Antimicrobial Stewardship Intervention Reduces Inpatient Third Generation Cephalosporin Use without Restriction

Abstract Background The use of third generation cephalosporins (3GC) has been linked to collateral damage such as increased risk of infection with C. difficile, ESBL-producing organisms, VRE, and MRSA. Reduction in use of 3GC has been shown to reduce prevalence of these infections, particularly with C. difficile and ESBLs. An increase in 3GC use was observed at our facility in 2019 and 2020, likely due to targeted fluoroquinolone reduction initiatives in 2019 and COVID-19 surges in 2020. A multifaceted intervention targeting 3GC reduction without restriction was implemented starting in December 2020. Figure 1Monthly third generation cephalosporin use (Days of Therapy per 1000 patient days) from January 2019 to December 2021. Methods We conducted a retrospective quasi-experimental study evaluating the impact of a combination of interventions intended to reduce 3GC use. The intervention included modification of local clinical guidelines for urinary tract infection (UTI) and community acquired pneumonia (CAP), provider education, and daily review of active 3GC orders in 2021. Local guideline changes include preferred use of ampicillin/sulbactam and amoxicillin/clavulanate for CAP and cefazolin and cephalexin for UTI over 3GCs. Use of first generation cephalosporins for UTI was supported by local antibiogram susceptibilities for common UTI pathogens. Days of therapy (DOT) per 1000 patient days were collected monthly and yearly for ceftriaxone, ceftazidime, cefpodoxime, and cefdinir for pre-intervention (January 2019 to December 2019 and January to December 2020) and post-intervention (January 2021 to December 2021) periods. Results 3GC use significantly decreased from 89.52 DOT per 1000 patient days in 2020 to 53.06 in 2021, a 40.73% reduction. To account for increases in antibiotic use during COVID-19 surges in 2020 as a potential confounding variable, 2019 3GC use was also compared to 2021 use. A 31.40% decrease was seen, with 77.35 DOT per 1000 patient days in 2019. This effect was sustained through COVID-19 surges in January and August 2021 (Figure 1). Conclusion A combination of interventions without restriction of 3GC was successful in reducing inpatient use of this class of antibiotics, including through two COVID-19 surges in 2021. Further study is required to determine impact on clinical outcomes, such as C. difficile and antimicrobial resistance rates. Disclosures All Authors: No reported disclosures.

Sitafloxacin pharmacokinetics/pharmacodynamics against multidrug-resistant bacteria in a dynamic urinary tract infection in vitro model.

Sitafloxacin is one of the newer generation fluoroquinolones with highly active against multidrug-resistant (MDR) bacteria. Our objectives were to identify the sitafloxacin pharmacokinetic/pharmacodynamic (PK/PD) index and breakpoints against MDR isolate in the urinary tract infection model. Forty-eight MDR isolates underwent sitafloxacin and levofloxacin microdilution susceptibility testing. A 24 h in vitro model was established that simulated the healthy subjects urodynamics of sitafloxacin fumarate injection. Ten MDR isolates (four carbapenem-resistant Escherichia coli, three carbapenem-resistant P. aeruginosa and three vancomycin-resistant E. faecium) were selected. The drug efficacy was quantified by the change in log colony counts within 24 h. A sigmoid Emax model was fitted to the killing effect data. Monte Carlo simulations were performed to assess target attainment for the sitafloxacin fumarate doses of 100 and 200 mg q24h. Analysis indicated that the MICs of sitafloxacin were all significantly lower than that of levofloxacin (P < 0.01). The UAUC0-24h/MIC targets required to achieve stasis, 1-log10 killing and 2-log10 killing were 63.60, 79.49 and 99.45 (carbapenem-resistant E. coli), 60.85, 90.31 and 128.95 (carbapenem-resistant P. aeruginosa), 65.91, 77.81 and 103.11 (vancomycin-resistant E. faecium). Monte Carlo simulation showed the infusion of sitafloxacin fumarate 100 mg q24h was able to achieve 90% probability of target attainment against bacteria with MIC of 8 mg/L for the common complicated urinary tract infections. Sitafloxacin fumarate injection is an alternative therapeutic agent for the treatment of UTIs caused by MDR isolates.

Is Urine Egress into the Female Urethra a Risk Factor for UTI?

In 50% of typical (nonneurogenic) women, at least one urinary tract infection (UTI) will occur, with cystitis being the most common UTI, with about 25% of patients experiencing recurrence. A factor not currently included in UTI risk models is egress of urine from the bladder into the urethra during bladder filling and activities of daily living. Urinary egress, if it occurs, would shorten the distance that bacteria need to travel to gain access to the bladder. Video urodynamics with contrast medium can demonstrate urinary egress; however, the observations can be difficult to conduct. Egress can be expected to be more likely in women with lower urinary tract conditions such as urge and stress incontinence. Treatment of the incontinence also reduces UTI rates and the reduction could, in part, be due to reduced urine egress. If UTI risk remains after incontinence management, then further treatment with pelvic floor exercises and pessaries could be considered to reduce the risk from potential residual urine egress. In summary, urine egress as a risk factor for UTI needs further research and clinical consideration.

P8.016: Gram Negative Blood Stream Infection in Renal Transplant Recipients: Risk Factors and Outcome From a Transplant Center in Pakistan

Background: Gram-negative bacteremia (GNB) is a common cause of bloodstream infection in renal transplant recipients (RTR). The risk factors are cytomegalovirus infection (CMV), pre-transplant dialysis, acute rejection, urological abnormalities, and ureteral stent. The mortality rate is 2.5 to 11%. Considering the huge impact on morbidity and mortality, our aim is to analyze the characteristics and outcomes of GNB in RTRs. Methods: A case-control study at Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan. The files of all renal transplant recipients who had documented GNB from January 2015 to December 2017 were reviewed till December 2020. The controls were matched with age, sex, and date of transplant. The first episode of GNB was taken. Clinical features, received anti-thymocyte globulin (ATG) or solumederol and cytomegalovirus infection (CMV) 90 days pre or post bacteremia, recurrent urinary tract infections (UTI), source of bacteremia and microbiology, all-cause mortality at day 28 and graft function at the last follow up were noted. Results: Out of 1009 RTR, 33 (3.3%) episodes of GNB occurred. The mean age was 30±11.85years, 61% males. Around 48% developed bacteremia within 6 months post-transplant. The most common source was UTI (75.8%). Fever in 48% and only 39% had leukocytosis. Around 9% were admitted in the intensive care unit. E-coli was the most common organism (70%) (Table 1). Stone disease at the time of transplant was significantly associated with bacteremia (p=0.029). There was no difference in receiving ATG or solumeredol and CMV before bacteremia. A significant number of patients received solumeredol for rejection (p=0.035) and had CMV (p=0.044) within 90 days after bacteremia. Recurrent UTI is significantly associated with bacteremia (p<0.001). The graft function at the last follow-up (2 years) was significantly deranged in patients with bacteremia (p=0.0001). Conclusion: Gram-negative bacteremia was found in 3% of RTR and half of them developed within 6 months post-transplant. UTI was the most common source and recurrent UTI was significantly associated with bacteremia. The stone disease was the most significant risk factor. Patients develop rejection and CMV infection within 3 months post bacteremia. There was a significant graft dysfunction among patients with bacteremia at a mean follow-up of 2 years. We need to focus on the management of recurrent UTIs to prevent bacteremia and graft dysfunction in renal transplant recipients.

One Size Does Not Fit All: Variability in Urinary Symptoms and Microbial Communities

The discovery of the urinary microbiome prompted researchers to begin characterizing microbiota associated with various health and disease states; however, the etiology of bladder infections, the most common urinary tract infection (UTI), is still simplistically attributed to the invasion of a uropathogen, mainly Escherichia coli, without regard for the resident microbial community. In addition, the clinical variability of UTI symptoms remains poorly understood. Very little research has been done to investigate the role of baseline microbial communities in development and resolution of UTI symptoms. The goal of this study was to identify associations between urinary microbiota and lower urinary tract symptoms profiles in adult women with UTI symptoms. This is a secondary analysis of a previously published IRB-approved study that included 225 women who reported having acute UTI symptoms, submitted catheterized urine specimens for analysis by an enhanced urine culture method and were assessed for symptom resolution 7-10 days after receiving culture-directed antibiotic treatment. In this UTI population, we identified six distinct symptom profiles, termed symptotypes, that were characterized by varying severity and degree of bother of certain lower urinary tract symptoms. These symptotypes were not associated with urotype or the presence of specific microbes. In participants with pain on presentation, the presence of non-E. coli and non-uropathogens was associated with persistence of symptoms at follow up; however, this was not true for those with E. coli urotype. These data suggest that the presence of E. coli may not account for the underlying cause of typical UTI symptoms; instead, co-existence of a uropathogen in the context of the existing urinary microbiota and the host may be responsible for these symptom profiles.

The prevalence and combination of gonorrhea and chlamydia in patients with urethritis and treatment outcome

ABSTRACT Introduction Urethritis is a common urinary tract infection, in which urethritis due to sexually transmitted infection accounts for a large proportion, especially among sexually active men. The most common causes include gonorrhea and chlamydia. Aim To evaluate the prevalence and combination of gonorrhea and chlamydia in patients with urethritis and treatment outcome. Material and Methods A retrospective study was caried out on all patients with urethritis due to gonorrhea and/or chlamydia at the Center for Andrology and Sexual Medicine (Vietnam-Germany University Hanoi, Vietnam) from January 2021 to March 2021. The patient's urethritis was confirmed by culture and Polymerase Chain Reaction (PCR) testing of fluid from the patient's penis. Patient data were collected and analyzed. Main Outcome Measure The number of urethritis patients were caused by gonorrhea and/or chlamydia were collected during 3 months is 54, the combination of two bacteria was 15% and overall treatment results were good. Results The mean age of patients was 29.56 ± 6.7 (18-54) years old. There were 17/54 (31%) patients with simple gonococcal infection, 29/54 (54%) patients were diagnosed with urethritis solely due to chlamydia, 8/54 (15%) patients had urethritis due to both gonorrhea and chlamydia. Of the 25 patients with gonococcal urethritis (mono and chlamydia co-infection): 18/25 patients (72%) were culture positive, while 7 patients (28%) were positive with gonorrhea by PCR. Antibiogram results of 18 patients diagnosed with gonorrhea showed that 18/18 patients were sensitive to spectinomycin, followed by cefoxitin (15/18 patients - accounting for 83.3%), cefotaxime (12/18 patients - accounting for 66.7%) and ceftriaxone (11 out of 18 patients -61.1%). All patients diagnosed with gonococcal urethritis alone or co-infection with chlamydia recovered after the treatment. One of 29 patients with chlamydial urethritis remained symptomatic after completion of the treatment and was tested positive for chlamydia by PCR; while 28 of 29 patients showed good results. Conclusion The physician should note the presence of gonorrhea and/or chlamydia and their combination in the diagnosis of urethritis. People who are diagnosed with this disease need to be treated early with the right antibiotics for a good outcome. Disclosure Work supported by industry: no.

Urinary Tract Infection in Parkinson's Disease.

Urinary tract infection (UTI) is a common precipitant of acute neurological deterioration in patients with Parkinson’s disease (PD) and a leading cause of delirium, functional decline, falls, and hospitalization. Various clinical features of PD including autonomic dysfunction and altered urodynamics, frailty and cognitive impairment, and the need for bladder catheterization contribute to an increased risk of UTI. Sepsis due to UTI is a feared consequence of untreated or undertreated UTI and a leading cause of morbidity in PD. Emerging research suggests that immune-mediated brain injury may underlie the pathogenesis of UTI-induced deterioration of PD symptoms. Existing strategies to prevent UTI in patients with PD include use of topical estrogen, prophylactic supplements, antibiotic bladder irrigation, clean catheterization techniques, and prophylactic oral antibiotics, while bacterial interference and vaccines/immunostimulants directed against common UTI pathogens are potentially emerging strategies that are currently under investigation. Future research is needed to mitigate the deleterious effects of UTI in PD.