Complicated UTI Research Articles

Efficacy of blood urea nitrogen and the neutrophil-to-lymphocyte ratio as predictors of mortality among elderly patients with genitourinary tract infections: A retrospective multicentre study

ObjectivesTo investigate whether initial blood urea nitrogen (BUN) and the neutrophil-to-lymphocyte ratio (NLR) in the emergency department (ED) are associated with mortality in elderly patients with genitourinary tract infections. MethodsA total of 541 patients with genitourinary tract infections in 5 EDs between November 2016 and February 2017 were included and retrospectively reviewed. We assessed age, sex, comorbidities, vital signs, and initial laboratory results, including BUN, NLR and the SOFA criteria. The primary outcome was all-cause in-hospital mortality. ResultsThe nonsurvivor group included 32 (5.9%) elderly patients, and the mean arterial pressure (MAP), NLR and BUN were significantly higher in this group than in the survivor group (p < 0.001, p = 0.003, p < 0.001). In multivariate analysis, MAP <70 mmHg, NLR ≥23.8 and BUN >28 mg/dl were shown to be independent risk factors for in-hospital mortality (OR 3.62, OR 2.51, OR 2.76: p = 0.002, p = 0.033, p = 0.038, respectively). Additionally, NLR ≥23.8 and BUN >28 were shown to be independent risk factors for mortality in admitted elderly with complicated UTI (p = 0.030, p = 0.035). When BUN and NLR were combined with MAP, the area under the ROC curve (AUROC) value was 0.807 (0.771–0.839) for the prediction of mortality, the sensitivity was 87.5% (95% CI 71.0–96.5), and the specificity was 61.3% (95% CI 56.9–65.5%). ConclusionThe initial BUN and NLR values with the MAP were good predictors associated with all-cause in-hospital mortality among elderly genitourinary tract infections visiting the ED.

Association of Virulence Genes with Antibiotic Resistance in Pakistani Uropathogenic E. coli Isolates.

Escherichia coli various strains can cause alarmingly serious infections. Countries like Pakistan harbour the class of bacteria with one of the highest rates of resistance, but very little has been done to explore their genetic pool. This study was designed to find out the frequency of virulence genes of Uropathogenic E. coli and their association with antibiotic resistance along with the evolutionary adaptation of the selected gene through the phylogenetic tree. Isolates from 120 urinary tract infected patients were collected. Antibiotic sensitivity was detected by the disk diffusion method and DNA extraction was done by the boiling lysis method followed by PCR-based detection of virulence genes. The final results were analysed using the chi-square test. The isolates were found to be least susceptible to nalidixic acid, followed by ampicillin, cotrimoxazole, cefotaxime, ciprofloxacin, aztreonam, amoxicillin, gentamycin, nitrofurantoin and imipenem. The iucC was the most common virulence gene among the resistant isolates. About 86% of the collected samples were found to be multi-drug resistant. Statistical analysis revealed a significant association between the iucC gene and resistance to ampicillin (P=0.03) and amoxicillin (P=0.04), and also between fimH and resistance to aztreonam (P=0.03). This study unravels the uncharted virulence genes of UPEC in our community for the very first time. We report a high frequency of the iucC and fimH virulence genes. This, along with their positive association with resistance to beta-lactam antibiotics in the studied community, indicates their important role in the development of complicated UTIs.

Epidemiology, definition and treatment of complicated urinary tract infections.

UTIs are amongst the most frequent bacterial infections. However, the clinical phenotypes of UTI are heterogeneous and range from rather benign, uncomplicated infections to complicated UTIs (cUTIs), pyelonephritis and severe urosepsis. Stratification of patients with UTIs is, therefore, important. Several classification systems exist for the description and classification of UTIs, with the common rationale that cUTIs have a higher risk of recurrence or chronification, progression or severe outcome than uncomplicated UTIs. The pathophysiology and treatment of cUTIs and pyelonephritis are driven more by host factors than by pathogen attributes. cUTIs and pyelonephritis are associated with high antimicrobial resistance rates among causative pathogens. However, antimicrobial resistance rates can differ substantially, depending on the population being studied and whether the data being analysed are from surveillance studies, registry data or interventional studies, in which specific inclusion and exclusion criteria are used for patient selection. For example, antibiotic resistance rates are higher in patients with urosepsis than in those with less severe infections. Thus, treatment outcomes differ substantially among studies, ranging from 50% to almost 100% clearance of infection, depending on the patient population analysed, the UTI entities included and the primary outcome of the study. Pyelonephritis and cUTIs have emerged as infection models for the study of novel antibiotics, including extensive investigation of novel substances active against Gram-negative bacteria.

Prevalence of virulent Candida spp. in complicated urinary tract infection of nephrolithiatic patients from surgical units of tertiary care hospitals Islamabad

Candida species are the commensal organisms of human mucosa and opportunistically cause the diseases in susceptible persons. This study aimed to determine the prevalence and virulence of different Candida spp. among nephrolithiatic patients and their association with complicated UTI (cUTI). A total of 164 urine samples were collected from surgical units of two tertiary care hospitals (Poly Clinic and Pakistan Institute of Medical Sciences Hospital, Islamabad). From 74 kidney stone patients, 77 isolates of Candida spp. were confirmed through standard microbiological and molecular characterization. C. albicans was the predominant species with 51 isolates (66.2%) followed by 26 (33.8%) of C. non-albicans. The nephrolithiatic patients suffering from cUTI were more prone to be infected with Candida (P=0.047). Among all isolates, 83% (64) of the Candida isolates were biofilm formers, 80% (60) showed the esterase production and 64.9% (50) showed phospholipase production. Candida isolates positive for various virulence factors were more prevalently isolated from both catheterized and recurrent UTI patients. Among Candida spp., 16.9% (13) isolates showed resistance to fluconazole and 19.5% (15) against voriconazole and 11 isolates were resistant for both tested antifungals. Candida isolated from cUTI cases showed comparatively enhanced virulence attributes and antifungal resistance, suggesting that these factors might have role in development of cUTI in nephrolithiatic patients. Hence, this work highlights the high prevalence of both C. albicans and non albicans spp. in nephrolithiatic patients. So, there is need to administer evidence based antifungal therapy rather than empirical therapy to reduce the cUTI in nephrolithiatic patients.

P0333ACQUIRED HEMOPHAGOCYTIC LYMPHOHISTIOCYTOSIS IN A PATIENT WITH EMPHYSEMATOUS PYELONEPHRITIS AND SEVERE SEPSIS: A CASE REPORT

Abstract Introduction Hemophagocytic lymphohistiocytosis (HLH) is a rare disorder of uncontrolled immune activation.Incidence in the adult population remains unclear. Primary HLH is caused by genetic mutations affecting the cytotoxic function of T lymphocytes and natural killer (NK) cells and typically presents in young children. Secondary HLH occurs in the setting of infectious, malignant, rheumatologic, or metabolic conditions. Various infections have been described as triggers. The diagnosis of HLH is particularly challenging, as many features overlap with other causes of severe illness including sepsis and hematologic malignancy. Background 53-years-old male patient presented to a hospital elsewhere with complaints of fever, dysuria and malaise for 1 week. On evaluation, he was diagnosed as bilateral pyelonephritis with right sided emphysematous pyelonephritis,with urosepsis, acute kidney injury (AKI) on chronic kidney disease (CKD). Due to severe azotaemia and acidosis, patient required dialytic support (SLED) on 2 occasions. Subsequently, patient underwent bilateral DJ stenting, right renal papilla extraction and optical urethrotomy.Due to persistent fever and not improving general wellbeing patient was shifted to Star hospital for further management. Course in hospital Patient presented with severe sepsis and empiric antibiotic therapy started after sending appropriate cultures (date of admission 18.7.19). As cultures were suggestive of CRBSI, dialysis catheter removed and antibiotics continued. He improved initially, however he again had high-grade intermittent fever,then right sided PCNL and drainage of perinephric collection was done. Post procedure patient developed septic shock, hyperkalemia and acidemia. Left IJV dialysis catheter was placed and initiated on SLED. He underwent right nephrectomy and left DJ stent exchange in view of persistent fever despite using broad spectrum antibiotics and antifungals. X-ray chest showed pulmonary edema and 2D echo revealed global hypokinesia. Patient further deteriorated, vasopressor requirement increased and required intubation and mechanical ventilation on 1.8.19. Patient received GM-CSF in view of leukopenia. To look for other causes of non-responding sepsis, serum ferritin and interleukin 6 (IL-6) were tested. Ferritin was 4532 ng/ml&amp; IL-6 was 531 pg/ml as on 1.8.19. Bone marrow aspiration and biopsy (3.8.19) revealed acquired hemophagocytosis,hence he was started on corticosteroids (1 mg/kg/day prednisolone equivalent) and other appropriate antibiotics continued. Gradually fever subsided and hemodynamic improved. As patient showed adequate respiratory attempts and acceptable oxygenation, he was extubated on 9.8.19. Patient remained on alternate day haemodialysis. Patent was discharged from hospital on 19.8.19 with tunnelled right IJV catheter for haemodialysis. Corticosteroids (prednisolone) tapered off gradually over a period of 8 weeks. After 8 weeks; patient remains dialysis dependant but back to work and routine life. Conclusion In events of non-responding sepsis, immunological disorders could be screened for and treated accordingly. Seemingly, treating immunological disorders and sepsis is seen antagonistic but might be mutually complementary as is seen in this particular case with acquired HLH where patient responded to immune suppression with corticosteroid. In literature search, we could not find association of HLH with emphysematous pyelonephritis. Hence, this could be a unique case of immune activation in a patient with complicated UTI, AKI and resulting in dialysis dependency. Moreover, antibiotic resistance and scarcity of new antibiotics are two more reasons to search for immune dysregulation in sepsis. As many of these cases could be immune dysregulation and not infection per se.

140-LB: Effect of Vaginal Estrogen as Hormone Replacement Therapy for Menopause on SGLT2 Inhibitor–Associated Urinary Tract Infection: A Prospective Cohort Study

Introduction: Estrogen deficiency after menopause is an important predisposing factor for recurrent UTI (r UTI). Vaginal application of estrogen as “hormone replacement therapy (eHRT)” for prevention of menopause associated r UTI has moderate recommendation and evidence level grade B by AUA/CUA/SUFU guidelines 2019. Glycosuria with use of SGLT 2I among T2DM, increase risk of r UTI by 4-9%. SGLT2 I use among T2DM, post-menopausal females may further increase risk of r UTI. Aim and Objective: This study was designed to observe (1) the Risk and frequency of UTI due to SGLT2 I among post-menopausal females with T2DM and (2) Preventive effect of vaginal e HRT for r UTI among them. Methods: Forty-two, post-menopausal females having T2DM, using vaginal e HRT were selected as cases whereas controls were 38 matched females not using e HRT. Subjects in both groups were prescribed SGLT2 I considering eligibility and simultaneously adjusted the doses of other OHA’s or insulin to maintain the glycemic targets. They were targeted to follow for 12 months and evaluated periodically for symptomatic UTI and maintenance of glycemic targets. Diagnosis of symptomatic UTI was made using standard definition and guidelines. Result: The 42 cases who were using vaginal e HRT (M = 2.5, SD = 1.5) compared to the 38 controls who were not using e HRT (M = 3.5, SD = 1.6) demonstrated significantly lesser frequency of UTI, t (78) = -2.56, p = .012. All the episodes of symptomatic UTI among cases were uncomplicated whereas 1 episode of UTI among 4 comparators forced for withdrawal of SGLT2 I and exclusion from observation period. The Fisher exact test statistic value is 0.0467. The result is significant at p &amp;lt; .05. Conclusion: Estrogen HRT after menopause significantly reduces the frequency of UTI among T2DM females using SGLT2 I. Not using eHRT in these group of subjects may significantly increase risk of complicated UTI. Disclosure A. Gautam: None. P.K. Agrawal: None. N. Pursnani: None. R. Rani: None.

Impact of antibiotic de-escalation on hospitalized patients with urinary tract infections: A retrospective cohort single center study

BackgroundUrinary tract infections (UTIs) can be caused by multiple drug-resistant bacteria. Empirical broad-spectrum antibiotics help minimize the risk of disease progression. Although antibiotic de-escalation is important to reduce resistance, adverse drug effects, and costs, few studies have evaluated the impact of antibiotic de-escalation on complicated UTIs in hospitalized patients. MethodsIn this retrospective cohort single center observational study conducted over a period of 1 year at Prince Sultan Military Medical City (PSMMC), the rate of antibiotic de-escalation following reporting culture and sensitivity results, hospital length of stay (LOS), and factors associated with antibiotic de-escalation failure were determined. ResultsNinety-one patients were enrolled in this study. Baseline characteristics were comparable between groups. The rate of successful de-escalation was 29.7% (27 patients) while 70.3% (64 patients) failed to experience de-escalation. The median hospital LOS was significantly lower in successfully de-escalated patients, at 3 days interquartile range (IQR) (2–6), while in the failed group it was 10 days IQR (6–21) (p<0.001). However, the identified factor associated with failure was a multidrug-resistant (MDR) pathogen that was significantly higher in the failed group than in the successful group: 38 patients (59.4%) versus 6 patients (22.2%; p<0.001), respectively. ConclusionAntibiotic de-escalation is an essential antimicrobial stewardship strategy. The findings of this study showed that de-escalation was associated with better patient outcomes (i.e., reduced hospital LOS) in patients admitted due to UTIs. In this study's site hospital, there is a potential for improving the current de-escalation rate. MDR pathogens were the only significant reason identified for de-escalation failure. Further data are needed on the large scale to evaluate reasons for de-escalation failure.

Impact of Complicated Urinary Tract Infection on Renal Graft Function

BackgroundUrinary tract infection (UTI) is the most common infectious complication after renal transplantation. It is uncertain whether the development of UTI has an impact on renal graft function. The objective of this study was to evaluate the effects of complicated and recurrent UTI on 2-year renal graft function. MethodsThis was a historical cohort study in renal transplantation patients in a kidney transplant center. All renal transplant recipients from June 2004 to September 2016 were included. A linear regression analysis was performed to study the association between the outcome (variation in estimated glomerular filtration rate [eGFR] by the Chronic Kidney Disease Epidemiology Collaboration [CKD-EPI] equation between month 1 and month 24 post-transplant) and the UTI. The approval of the Ethics and Research Committee to carry out this study was obtained. ResultsIn total, 276 kidney transplants were performed during the observation period. Of the transplant patients, 193 (69.9%) did not develop a UTI and 83 (30.1%) presented at least 1 complicated UTI. Patients who presented at least 1 UTI had a variation in eGFR during the observation period of –12.6 mL/min/1.73 m2 (95% confidence interval [CI] –4.5 to –20.7 mL/min/1.73 m2; P = .02), compared with those without a UTI. Said difference persisted in the adjusted model controlling for variables that have an impact on the eGFR. This difference was –10.7 mL/min/1.73 m2 (95% CI –3.1 to –18.2 mL/min/1.73 m2; P = .006). ConclusionThe findings suggest that the occurrence of complicated UTI has a negative impact on graft function and that prevention and monitoring of UTIs should be stepped up to avoid their deleterious effects on graft function.

New Antibiotic for Complicated UTIs.

Cefiderocol (Fetroja) is a newly approved cephalosporin antibiotic for adults with complicated urinary tract infections, including pyelonephritis, caused by susceptible gram-negative microorganisms when there are limited or no alternative treatments.A higher rate of all-cause mortality was seen in cefiderocol-treated patients compared with patients given other antibiotics in a clinical trial of critically ill patients with carbapenem-resistant gram-negative infections.

Assessment of Pathogenic Potential, Virulent Genes Profile, and Antibiotic Susceptibility of Proteus mirabilis from Urinary Tract Infection.

Proteus mirabilis is the third most common bacterium that can cause complicated UTI, especially in catheterized patients. Urovirulence genes of P. mirabilis strains are poorly identified among UTI patients. The aims of the present study were to determine the prevalence of the uropathogenic P. mirabilis strains isolated from UTI patients by the detection of several P. mirabilis virulence genes and to characterize the antibiotic susceptibility profile of P. mirabilis isolates. P. mirabilis isolates were collected from urine specimens of patients suffering from UTI. Virulence genes in P. mirabilis, namely, hpmA, hpmB, rsbA, luxS, ureC1, hlyA, rpoA, atfA, atfC, mrpA, and pm1 were detected in the isolates via PCR detection method. All P. mirabilis virulence genes were detected in more than 90% of the isolates except hlyA gene, which was detected in only 23.8% of the isolates. The rate of susceptibility for ceftriaxone was 96.8%, followed by norfloxacin (82.5%), gentamicin (71.4%), ciprofloxacin (69.8%), cephalexin (52.4%), nalidixic acid (42.9%), sulfamethoxazole (39.7%), ampicillin (36.5%), and nitrofurantoin (3.2%). Significant associations (P < 0.05) were detected between antimicrobial susceptibility of each of the following antibiotics and the presence virulence genes. Cephalexin antimicrobial susceptibility was significantly associated with the presence each of ureC1 and atfC. Sulfamethoxazole antimicrobial susceptibility was significantly associated with the presence atfA. Ceftriaxone antimicrobial susceptibility was significantly associated with the presence each of hpmA, ureC1, rpoA, atfC, mrpA, and pm1. Nitrofurantoin antimicrobial susceptibility was significantly associated with the presence each of hpmA, ureC1, rpoA, atfA, atfC, mrpA, and pm1. In conclusion, an association between the presence of urovirulence genes of P. mirabilis and increasing P. mirabilis resistance to antimicrobials has been demonstrated.

First Study of Antimicrobial Activity of Ceftazidime-Avibactam and Ceftolozane-Tazobactam Against Pseudomonas aeruginosa Isolated from Patients with Urinary Tract Infection in Tehran, Iran.

PurposePseudomonas aeruginosa causes complicated and/or nosocomial UTI. These infections are usually associated with severe and multi-drug resistant P. aeruginosa isolates. As there is no study about the activity of novel antibiotics ceftazidime-avibactam (CZA) and ceftolozane-tazobactam (C/T) against P. aeruginosa isolates in Iran, we aimed to evaluate for the first time the efficacy of these agents against P. aeruginosa isolated from patients with UTI in Iran. Then, the genetic diversity of the resistant isolates was assayed.MethodsIn this study, a total of 200 P. aeruginosa isolates were collected from patients with UTI in Tehran, Iran. Disk diffusion and Minimum Inhibitory Concentration (MIC) methods were applied to determine the resistance of the isolates to CZA, C/T, and the other antibiotics. Extended-spectrum β-lactamases (ESBLs) and Metallo Beta Lactamase (MBL) production were assayed by Combination disk diffusion test (CDDT). Polymerase chain reaction (PCR) was carried out to detect the resistance genes, including beta-lactamases and carbapenemases genes. Finally, genomic analysis of the isolates was performed using the Pulse field gel electrophoresis (PFGE).ResultsAmong the isolates, 16 (8%) were resistant to CZA and C/T that MIC confirmed it. The resistant isolates showed high resistance to the other classes of antibiotics. Among the resistant isolates, 31.2% and 75% were ESBL and MBL producers, respectively. The prevalence of blaOXA10, blaVIM, blaOXA48, blaOXA2, and blaCTX-M was 100%, 50%, 31.2%, 25%, and 12.5%. Furthermore, two isolates (12.5%) harbored blaPER and blaNDM genes. The resistant isolates were grouped into 14 distinct pulsotypes and two shared pulsotypes were found.ConclusionCeftazidime-avibactam and ceftolozane-tazobactam showed high activity against the P. aeruginosa isolated from patients with UTI in Iran. The low rate of resistance to the antibiotics is also alarming and should be considered to avoid further spreading of the antibiotic resistance among the P. aeruginosa and the other bacteria.

Cefiderocol Is Approved for Complicated UTI and Pyelonephritis

In November 2019, the U.S. Food and Drug Administration (FDA) approved cefiderocol for the treatment of complicated urinary tract infections (cUTI) and

Urinary tract infection in females, a clinicopathological corelation and appraisal

Background: Urinary tract infection is defined as infection of the urinary tract mainly Urethra, bladder and upper tract including Ureter and Kidney leading to significant bactiriuria. Objectives: The aim of this study was to evaluate and a critical appraisal of the problem of UTI in females with special emphasis on Clinico pathological correlation as prevalent in our society especially problem of recurrent UTI in females under setting of uncomplicated, complicated, recurrent UTI in females. Material and Methods: This is a retrospective uncontrolled study undertaken in Balrampur Hospital, Lucknow between January to December 2018. Patient population included were females aged 8yrs to 80yrs, who visited OPD and the patients admitted in our hospital indoor during this period, who had nosocomial infection especially with lower Urinary tract symptoms. All the patients were subjected to thorough history taking, clinical, physical examination and urine samples were sent for routine and microscopic examination and for culture where needed. Patients with lower urinary tract symptoms giving history of bladder outlet obstruction or any anatomical or functional disorder of the Urinary Tract were subjected to investigations like ultrasonography, X-Ray KUB, CT and cystoscopy and uroflowmetry studies specially in cases were BOO was suspected. Results & Conclusions: UTI in females is very prevalent, our study showed on incidence of 18.4% (of all LUTS patients referred for UTI). Nosocomial infections contributed to 38% of UTI cases in our study. Screening for diabetes in UTI patients showed an incidence of 10.3% 30% of HAUTI cases had Indwelling Urinary Urinary Catheter. UTI was most prevalent in 18 to 30 years age group i.e. 41% of all UTI cases in all age groups under considerations. The incidence of RUTI cases was 21%, maximum coming from post menopausal age group. Incidence of ASB was found to be 7%, amongst all 930 patients. In diabetics the incidence of ASB was 11.4%. UPEC was found to be the leading causative agent in both uncomplicated and complicated UTI cases.

Antibiotic Resistance Among Uropathogenic Escherichia coli.

Urinary tract infections (UTIs) belong to the most common community-acquired and nosocomial infections. A main etiological factor of UTIs is uropathogenic Escherichia coli (UPEC). This review describes the current state of knowledge on the resistance of UPEC to antibiotics recommended for the treatment of UTIs based on the available literature data. Nitrofurantoin and fosfomycin are recommended as first-line therapy in the treatment of uncomplicated cystitis, and the resistance to these antimicrobial agents remains low between UPEC. Recently, in many countries, the increasing resistance is observed to trimethoprim-sulfamethoxazole, which is widely used as the first-line antimicrobial in the treatment of uncomplicated UTIs. In European countries, the resistance of UPEC to this antimicrobial agent ranges from 14.6% to 60%. The widespread use of fluoroquinolones (FQs), especially ciprofloxacin, in the outpatients is the cause of a continuous increase in resistance to these drugs. The resistance of UPEC to FQs is significantly higher in developing countries (55.5–85.5%) than in developed countries (5.1–32.0%). Amoxicillin-clavulanic acid is recommended as first line-therapy for pyelonephritis or complicated UTI. Resistance rates of UPEC to amoxicillin-clavulanic acid are regionally variable. In European countries the level of resistance to this antimicrobial ranges from 5.3% (Germany) to 37.6% (France). Increasing rates of UPEC resistance to antimicrobials indicate that careful monitoring of their use for UTI treatment is necessary.

1460. The Effectiveness of Short vs. Long Antibiotic Therapy in Hospitalized Adult Patients with Urinary Tract Infections: A Systematic Review and Meta-Analysis

BackgroundUrinary tract infections (UTIs) are a frequent cause of morbidity and mortality in hospitalized patients, if not adequately and promptly treated. The optimal treatment duration is controversial and most recommendations are based on clinical experience. Current guidelines recommend 5–14 days of treatment depending on the type and severity of infection and the antibiotic used. With the emergence of multi-drug resistance, shorter durations are increasingly favored. This systematic review of randomized controlled trials (RCTs) aims at providing updated evidence on the effectiveness of short (≤7 days) vs. long (>7 days) antibiotic regimens in hospitalized adult patients.MethodsMEDLINE, EMBASE, and CENTRAL were searched to identify relevant RCTs. Trial quality was evaluated using Cochrane’s Risk of Bias Tool. The primary outcome was clinical success. Secondary outcomes included microbiological success, withdrawal due to adverse events (AE), relapse, and reinfection rates. A random-effect meta-analysis was performed using R.Results8 RCTs conducted between 1995 and 2018 were identified. Trial quality was considered poor in 5, fair in 1 and good in 2 RCTs. Clinical and microbiological success was reported in all studies. Withdrawal due to AE was reported in 5, relapse and reinfection in 3 studies. Overall, there was no difference in clinical success between short and long courses (OR = 0.92, 95% CI 0.66–1.29; 2111 patients) (figure). Similarly, microbiological success was comparable in the two arms (OR = 1.0, 95% CI 0.70–1.43; 2111 patients). There was a higher, but nonsignificant, number of withdrawals due to AE in the long duration arm (OR = 0.78, 95% CI 0.29–2.11; 1890 patients). Patients receiving short courses had a nonsignificant higher rate of relapse (OR = 2.65, 95% CI 0.31–22.39, 175 patients). However, there was no difference in reinfection rates (OR = 1.12, 95% CI 0.26–4.90; 175 patients). A subgroup analysis limited to complicated UTIs showed similar results.ConclusionBased on the limited available evidence, short antibiotic courses appear to be equally effective as longer courses in the management of inpatient UTIs. Further research is needed to determine appropriate antibiotic treatment durations and assess treatment-related development of drug resistance. Disclosures All authors: No reported disclosures.

3206 Intestinal Motility: Not Part of Trihexyphenidyl's Job Description

INTRODUCTION: Paralytic ileus presents similarly to mechanical obstruction; however, there is absence of a culprit anatomic lesion. It is commonly due to surgical intervention, peritonitis, trauma, medications, electrolyte disturbances, or intestinal ischemia. CASE DESCRIPTION/METHODS: This is the case of an 86-year- old male with past medical history of Parkinson's Disease and hypertension who was admitted at IM ward due to complicated UTI and bacteremia. During hospitalization, the patient developed abdominal distention and referred not having a bowel movement in 5 days. Physical exam was remarkable for a distended, tympanic, and non-tender abdomen. Labs displayed improving leukocytosis, normocytic-normochromic anemia, and absence of electrolyte disturbances. KUB was ordered, which revealed a very dilated stomach with gaseous distention in the stomach and small intestine as well as moderate amount of stool in the colon. As a result, Miralax, a sodium phosphate enema, and a nasogastric tube with intermittent suction were recommended. However, no bowel movements were reported as a result. Therefore, mineral oil was recommended the following day. Given lack of significant improvement, half a gallon of polyethylene glycol (golytely) was added to therapy. Two large bowel movements were achieved as a result. However, the patient's abdomen continued distended and tympanic for which CT abdomen with contrast was done. CT results showed no evidence of mechanical obstruction. Given lack of improvement despite interventions, trihexyphenidyl, which patient had recently started for Parkinson's Disease, was discontinued. Patient was not on opioid or other constipation inducing medications. Five bowel movements were reported in the 24-hours that followed removal of medication. The following day KUB displayed improvement and physical exam was remarkable for positive bowel sounds in all 4 quadrants and a non- tender, non-distended abdomen. DISCUSSION: Rapid resolution of symptoms suggests trihexyphenidyl as culprit. It is important to note that although anti-cholinergics are known to cause or precipitate paralytic ileus, few cases have been reported as a result of trihexyphenidyl use. Trihexyphenidyl is prescribed with frequency for the treatment of Parkinson's Disease, being aware of its side effects may lead to prompt diagnosis and better outcomes.

Resistance Pattern of Nitrofurantoin of Uropathogens in Different Age Groups at Dr. Lal Path Labs, National Reference Laboratory, Rohini, Delhi

Aims and Objectives: This study was undertaken to highlight the resistance pattern of Nitrofurantoin among 5162 UTIs causing isolates at Microbiology Department of Dr. Lal Path Labs between April to June 2019.&#x0D; Materials and Methods: This retrospective study was performed in Department of Microbiology at Dr. Lal Path Labs, Delhi during period April to June 2019. Standard loopful midstream urine samples collected in a sterile container were inoculated on UTI Chromagar and incubated overnight at 37ºC and demonstrating significance colony count of ≥105 CFU/ml. Common Enterobacteriaceae group of isolates and Gram positive isolates identified by MALDI TOF-MS (Bruker, Daltonics) were included in this study. To determine Nitrofurantoin resistance by VITEK-AST (Biomerieux) system on 280/P628 antibiotic susceptibility testing cards respectively as per as CLSI M100-S-29. Proteus spp, Pseudomonas spp., Acinetobacter spp, of complicated UTI isolates were excluded from this study. &#x0D; Results: Of the 29485 urine samples tested during April to June 2019, 5162 (17.5%) were culture positive. Out of the 5162 positive isolates 2856 (55.3%) were isolated from female patients and 2306 (44.7%) from male patients. The most common bacterial isolates were members of Enterobacteriaceae 4728 (91.5%) and Gram positive were 434 (8.5%). The most predominant age group infected with uropathogens were elderly adults ≥ 50 years of age constituted 58.1% of the UTIs culture positive cases. Klebsiella pneumoniae demonstrated highest resistance of 92.3% whereas Staphylococcus aureus demonstrated the least resistance of 8.3%.&#x0D; Discussion and Conclusion: The alarming substantial resistance to Nitrofurantoin in decreasing order has been noticed in Enterobacteriaceae i.e., Klebsiella pneumonia (92.3%), Enterobacter spp.(58.2%), Citrobacter spp (42.6%) and Gram positive Enterococcus spp. (45.6%) which is across all age groups. Most susceptible to Nitrofurantoin were Escherichia coli (69.9%) in Gram negative and Staphylococcus aureus (91.7%) in Gram positive. This finding emphasis the need of robust restriction of Nitrofurantoin antibiotic policy and usage to uncomplicated UTIs caused by Escherichia coli and Staphylococcus aureus.

Emergence of hypervirulent K. pneumoniae causing complicated UTI in kidney stone patients

K. pneumoniae termed as classical K. pneumoniae (cKP) and hypervirulent K. pneumoniae (hvKP) have significant role in pathogenicity of complicated UTI (cUTI). hvKP has not been ever reported from Pakistan. This study aimed to determine the prevalence of hvKP among kidney stone patients and their association with cUTI. Total 121 urine samples were collected from two tertiary care hospitals (Poly Clinic and Pakistan Institute of Medical Sciences hospital, Islamabad). From 43.5% (53) kidney stone patients, 61 isolates of K. pneumoniae (cKP 43, hvKP 18) were confirmed through standard microbiological and biochemical characterization methods. K. pneumoniae prevalence in kidney stone patients with cUTI was 67.6% (48) (hvKP 25%, cKP 75%). All K. pneumoniae isolates were strong biofilm formers. Age was important in development of cUTI in patients of age group 31–50 years in which biofilm formation and bactericidal activity of K. pneumoniae was significant with P = 0.017 and P = 0.05 respectively. Antibiotic susceptibility was tested and 20 (33%) isolates showed Multi-drug resistance (MDR). hvKP isolated from cUTI, showed comparatively enhanced virulence attributes with multidrug resistance, suggesting their role in development of cUTI in kidney stone patients, hence there is need for whenever prescribing antimicrobial therapy in these patients, hvKP should also be focused.

Serogroup distribution, diversity of exotoxin gene profiles, and phylogenetic grouping of CTX-M-1- producing uropathogenic Escherichia coli

The emergence of CTX-M-1 producing Uropathogenic Escherichia coli (UPEC) has become a serious challenge. In addition to antimicrobial resistance, a number of virulence factors have been shown. Therefore, this study was designed to determine the prevalence of O- serogroups, phylogenetic groups, exotoxin genes, and antimicrobial resistance properties of CTX-M-1- producing UPEC. A total of 248 UPEC isolates were collected. The antibiotic resistance was performed, and PCR was used to detect the blaCTX-M1, exotoxins, serogroups and phylogroups of UPEC. Of 248 isolates, 95 (38.3%) harbored blaCTX-M-1. Of them, serogroups O1 and O25 were predominant, accounting for 20% and 13.7%, respectively. The hlyA was the dominant exotoxin gene (32.6%), followed by sat (28.4%), vat (22.1%), cnf (13.7%), picU (8.4%), and cdt (2.1%). The hlyA gene was significantly associated with pyelonephritis (P = 0.003). Moreover, almost half of the isolates (45.4%) belonged to phylogenetic group B2. Most of exotoxin genes were present in significantly higher proportions in group B2 isolates except cdt gene (P < 0.05). All of the isolates were susceptible to imipenem, nitrofurantoin, and fosfomycin. The CTX-M-1-producing UPEC strains causing nosocomial infections are more likely to harbor certain exotoxin genes, raising the possibility that this increase in virulence genes may result in an increased risk of complicated UTI.

Plazomicin once daily effective for complicated UTI.

Plazomicin once daily effective for complicated UTI.