Urinary Tract Infection Complications Research Articles

Impact of untreated preoperative asymptomatic bacteriuria in patients undergoing holmium laser enucleation of prostate.

Treatment of preoperative asymptomatic bacteriuria (ASB) before endoscopic surgery is recommended by European Association of Urology (EAU) guidelines. United Kingdom (UK) practice varies, however, owing to the historical nature of the evidence behind the guidelines, risk of increased antimicrobial resistance, the paradoxical view that treatment of ASB leads to increased infection and inefficiencies in rescheduling. We do not routinely treat ASB in our practice before holmium enucleation of the prostate (HoLEP). To determine the safety of this, we examined our experience focusing on the infective complications. Retrospective data collection was performed on consecutive patients undergoing HoLEP between 2015 and 2020. Indication, preoperative urine cultures and infective complications were recorded. No patients were pretreated with oral antibiotics. All patients received intravenous antibiotics on induction and routine postoperative oral antibiotics at the surgeon's discretion. Some 443 patients were studied. No urosepsis occurred in the 125 patients with ASB compared with 2 of 318 patients (0.6%) with no growth on preoperative urine culture. Twenty-nine (7%) patients were treated with oral antibiotics for symptomatic postoperative complications (urinary tract infection without fever, epididymitis and haematuria). ASB did not predict for infective complications (urosepsis odds ratio [OR]: 0.50 p=0.66; oral antibiotics OR: 0.97 p=0.93). Not treating ASB before a HoLEP procedure is safe. This supports the judicious use of antimicrobials preoperatively. Other modalities of endoscopic surgery should be similarly assessed.

Asymptomatic Bacteriuria and Urological Surgery: Risk Factor or Not? Results from the National and Multicenter TOCUS Database.

Current guidelines recommend screening and treatment of asymptomatic bacteriuria prior to all urological surgeries breaching the mucosa. But few evidence is supporting this recommendation. At least, risk stratification for postoperative urinary tract infection to support this strategy is lacking. The aim of this study was to define the associated factors for postoperative febrile infectious complications (urinary tract infection or surgical site infection) in urological surgery. We conducted a retrospective, multicentric study including all consecutive patients undergoing any urological surgery with preoperative urine culture. The primary outcome was the occurrence of a urinary tract infection or surgical site infection occurring within 30 days after surgery. rom 2016 to 2023, in 10 centers, 2389 patients were included with 838 (35%) positive urine cultures (mono/bi/polymicrobial). Postoperative infections occurred in 106 cases (4.4%), of which 44 had negative urine cultures (41%), 42 had a positive mono/bi-microbial urine cultures (40%) and 20 had a polymicrobial urine cultures (19%). In multivariable analysis, urinary tract infections during the previous 12 months of surgery (OR 3.43; CI 95 2.07-5.66; P < .001), monomicrobial/bimicrobial preoperative urine culture (OR 3.68; CI 95 1.57-8.42; P 0.02), polymicrobial preoperative urine culture (OR 2.85; CI 95 1.52-5.14; P < .001), operative time (OR 1.09; CI 95 1.04-1.15; P < .001) were independent associated factors for postoperative febrile infections. Positive urine culture, including preoperative polymicrobial urine culture, prior to urological surgery was associated with postoperative infection. Additionally, patients experiencing infectious complications also had a higher incidence of other complications. The effectiveness of systematic preventive antibiotic therapy for a positive urine culture has not been conclusively established.

Anaesthetic Management for Rt Emphysematous Pyelonephritis with Grade I Hydroureteronephrosis with Perinephric Abscess with Left Lobar Pneumonia

ntroduction: A perinephric abscess is usually a complication of urologic infection which results from fat necrosis. Before the era of antibiotics, perinephric abscesses were due to prolonged bacteremia. More than 3/4 of perinephric abscesses are now due to complications of urinary tract infections. Case Report: We present a 71 year old female case with Right Emphysematous Pyelonephritis Grade I Hydroureteronephrosis with left perinephric abscess, left lobar pneumonia posted for bilateral DJ stenting with perinephric drain placement under continuous spinal anesthesia. Presented with H/o lower back pain, associated with fever since 3 days and H/o burning micturition, since 6 months. She is known case of Type 2 DM since 23 years and on Inj. Biphasic Insulin, Tablet vildagliptin, Tablet Dapaglifazone, known case of hypothyroidism and on tablet Thyroxin 50 mg OD in morning. H/o stroke 20 years back right side Upper &amp; lower limb affected. H/o previous appendectomy 20 years back, CT–KKUB suggestive of Emphysematous Pyelonephritis, right side with grade I HUN, left perinephric fat with ill diffused hypodense area in upper lobe of left kidney. Non obstructive left renal calculus 4.0mm. ECG shows RBBB, Saturation was 92% on Roomair, On ABG analysis severe metabolic acidosis found. We planned to administer continuous spinal anesthesia. Patient was explained about the continuous spinal anesthesia &amp; written informed consent was taken. Tablet Alprazolam 0.25 mg, and tablet Rantac, 15 was given previous night and in morning on the day of surgery. Nil per oral is maintained 8 hours before surgery. A 18 Gauge IV cannula was secured, a 5 lead Electrocardiogram, Pulse Oximeter, NIBP and ETCo2 monitoring was done. Under strict aseptic precautions, L3 L4 space was identified and using 18G tuhoy needle, Lumbar puncture is done. Injection Bupivacaine 0.8cc given, block is achieved till T8 level. Surgery was lasted for one and half hour. Vitals were stable. Patient shifted to recovery room and was under observation for an hour, patient was shifted to post operative ward. Conclusion: This is an Original case report, which provide a successful management of anesthesia, of bilateral DJ stenting with perinephric drain placement under continuous spinal anesthesia. Anesthesia Management for Right Emphysematous Pylonephritis with grade I HUN. With perinephric abscess with left lobar Pneumonia.

Biomarkers for urinary tract infection: present and future perspectives.

A prompt diagnosis of urinary tract infection (UTI) is necessary to minimize its symptoms and limit sequelae. The current UTI screening by urine test strip analysis and microscopic examination has suboptimal diagnostic accuracy. A definitive diagnosis of UTI by urine culture takes two to three days for the results. These limitations necessitate a need for better biomarkers for the diagnosis and subsequent management of UTI in children. Here, we review the value of currently available UTI biomarkers and highlight the potential of emerging biomarkers that can facilitate a more rapid and accurate UTI diagnosis. Of the newer UTI biomarkers, the most promising are blood procalcitonin (PCT) and urinary neutrophil gelatinase-associated lipocalin (NGAL). PCT can provide diagnostic benefits and should be considered in patients who have a blood test for other reasons. NGAL, which is on the threshold of clinical care, needs more research to address its scope and utilization, including point-of-care application. Employment of these and other biomarkers may ultimately improve UTI diagnosis, guide UTI therapy, reduce antibiotic use, and mitigate UTI complications.

An integrative approach to assessing the pathogenic potential of &lt;i&gt;Escherichia coli&lt;/i&gt; strains isolated from urine

Introduction. Uropathogenic Escherichia coli (UPEC) are characterized by the ability to survive and reproduce in the urinary tract due to the presence of specific virulence factors. In routine laboratory practice, the detection of diagnostically significant bacteriuria does not provide an idea of the level of infection of the urinary system (renal parenchyma, bladder), the pathogenic potential of the strain in the progression and chronicity of the infectious process, and the occurrence of life-threatening conditions (urosepsis, meningitis).&#x0D; Objective. To characterize the population structure, genetic diversity and pathogenic potential of E. coli strains isolated from urine.&#x0D; Materials and methods. 194 strains of E. coli isolated from urine were studied. Detection of 17 genes encoding the synthesis of: adhesins (pap, fimH, sfa, focG, afa), toxins (hlyA, cvaC, cnf, cdtB), capsular antigens (kpsMTII, kpsMTIII, kpsMT K1), siderophores (fyuA, iutA), invasins (ibeA), genetic markers of the pathogenicity island (PAI) of UPEC CFT073, the gene (traT) encoding serum resistance capacity and phylogenetic groups were performed by PCR (CXT-1000, BioRad, USA) with published primers (Synthol, Sibenzyme, Evrogen, Russia). To assess the statistical significance of differences, Fisher's exact test was used. Differences were considered significant at a confidence interval of 95% (p 0.05).&#x0D; Results. E. coli strains more often (p 0.05) belonged to the phylogenetic group B2 (57.7%). Pathogenetically significant virulence determinants were identified in 97.9% of strains. Based on the combination of 17 genes, 134 individual virulence genotypes were identified. In 93.3% of strains, a genetic predisposition to the occurrence of recurrent urinary tract infections (UTIs) was revealed, in 6.9% there was a potential for the development of pyelonephritis and recurrent cystitis. Markers of life-threatening complications of UTI were identified in 12% of strains, of which 10.7% were the development of urosepsis and 1.3% were meningitis.&#x0D; Conclusion. Detection of a complex of genes in E. coli strains isolated from urine confirms the etiological significance of the isolate and allows one to assess the pathogenic potential for the development of chronic and severe life-threatening complications.

Diabetes, SGLT-2 Inhibitors, and Urinary Tract Infection: a Review.

The aim of this review is to focus on epidemiology, pathogenesis, risk factors, management, and complications of UTI in people with diabetes as well as reviewing the association of SGLT-2 inhibitors with genitourinary infections. Individuals diagnosed with T2DM are more prone to experiencing UTIs and recurrent UTIs compared to individuals without T2DM. T2DM is associated with an increased risk of any genitourinary infections (GUI), urinary tract infections (UTIs), and genital infections (GIs) across all age categories. SGLT2 inhibitors are a relatively new class of anti-hyperglycemic agents, and studies suggest that they are associated with an increased risk of genitourinary infections. The management of diabetes and lifestyle modifications with a patient-centric approach are the most recognized methods for preventing critical long-term complications including genitourinary manifestations of diabetes. The available data regarding the association of SGLT-2 inhibitors with genitourinary infections is more comprehensive compared to that with UTIs. Further research is needed to better understand the mechanisms underlining the association between SGLT-2 inhibitors and genital infections and UTIs.

Comprehensive Review of Urinary Tract Infections in Renal Transplant Recipients: Clinical Insights and Management Strategies.

Urinary tract infections (UTIs) pose a significant challenge in the care of renal transplant recipients. This comprehensive review explores this population's multifaceted landscape of UTIs, emphasizing the importance of early diagnosis and tailored management strategies. Renal transplant recipients face an elevated risk of UTIs due to immunosuppression, altered urinary tract anatomy, and complex comorbidities. Complications of UTIs can lead to graft dysfunction and systemic illness, underscoring the need for effective management. The emergence of multidrug-resistant uropathogens adds complexity to treatment, highlighting the importance of targeted antibiotic therapy. Antibiotics are the most commonly prescribed drugs for UTIs, with nitrofurantoin, fosfomycin, amoxicillin, and amoxicillin-clavulanate potassium being some of the commonly used antibiotics. However, the emergence of multidrug-resistant uropathogens has led to the exploration of alternative treatments, such as bacteriophage therapy, as a potential alternative against multidrug-resistant uropathogenic bacteria. Analgesics such as phenazopyridine can be prescribed to relieve discomfort associated with UTIs. Estrogen therapy has also been suggested as a potential treatment option for UTIs, particularly in postmenopausal women. Trimethoprim-sulfamethoxazole or trimethoprim is recommended as first-line therapy for uncomplicated UTIs. The choice of drug and therapy for UTIs depends on the severity of the infection, the causative organism, and the presence of antibiotic resistance.Preventive measures encompass pre-transplant evaluation, perioperative strategies, post-transplant follow-up, and vaccination. A multidisciplinary approach involving transplant specialists, infectious disease experts, pharmacists, and patient engagement is vital for successful care. The future of UTI management lies in ongoing research, exploring personalized medicine, novel therapies, and innovative prevention strategies. By implementing these strategies and advancing research, healthcare providers can improve graft and patient survival, enhancing the quality of care for renal transplant recipients.

Liver, renal, genitourinary and diabetic ketoacidosis risks among new users of empagliflozin versus dipeptidyl peptidase-4 inhibitors in patients with type 2 diabetes: Post-authorization safety study based on multinational cohorts.

To estimate risks of diabetic ketoacidosis (DKA), acute liver injury (ALI), acute kidney injury (AKI), chronic kidney disease (CKD), severe complications of urinary tract infection (UTI) and genital infection (GI) among patients with type 2 diabetes initiating empagliflozin versus those initiating a dipeptidyl peptidase-4 (DPP-4) inhibitor. In this large multinational, observational, new-user cohort study in UK, Danish and US healthcare data sources, patients initiated empagliflozin or a DPP-4 inhibitor between August 2014 and August 2019, were aged ≥18 years, and had ≥12 months' continuous health plan enrolment. Incidence rates by exposure and incidence rate ratios, adjusted for propensity-score deciles, were calculated. In total, 64 599 empagliflozin initiators and 203 315 DPP-4 inhibitor initiators were included. There was an increased risk [pooled adjusted incidence rate ratios (95% confidence interval)] of DKA [2.19 (1.74-2.76)] and decreased risks of ALI [0.77 (0.50-1.19) in patients without predisposing conditions of liver disease; 0.70 (0.56-0.88) in all patients] and AKI [0.54 (0.41-0.73)]. In the UK data, there was an increased risk of GI [males: 4.04 (3.46-4.71); females: 3.24 (2.81-3.74)] and decreased risks of CKD [0.53 (0.43-0.65)] and severe complications of UTI [0.51 (0.37-0.72)]. The results were generally consistent in subgroup and sensitivity analyses. Compared with DDP-4 inhibitor use, empagliflozin use was associated with increased risks of DKA and GI and decreased risks of ALI, AKI, CKD and severe complications of UTI. These associations are consistent with previous studies and known class effects of sodium-glucose cotransporter 2 inhibitors, including renoprotective effects and beneficial effects on alanine aminotransferase levels.

Role of routine urine culture in diagnoses of asymptomatic bacteriurea&amp; hence decreasing UTI complication during pregnancy

In order to decrease the complications of urinary tract infection during pregnancy as abortion, preterm labor ,IUGR, stillbirth, and pregnancy induced hypertension and cost effective to decrease hospital admission . prospective controlled study of 300 pregnant patients, were divided to groups according to presence of bacteriurea, and then to presence of symptoms. The age of patients were between 19 &amp;42 years (average=30yr.).and the parity ranged from primigravida up to Para seven .urine examination and culture sensitivity done for all ,the patients who diagnosed and treated according to the results of investigations and before they developed symptoms ,they had less complications during their pregnancies and better outcome after delivery. Conclusion: Our study prove that routine urine examination ,and urine culture &amp;sensitivity at every trimester in pregnant lady will gives cheap ,easy, and non invasive method for diagnosis and subsequent treatment of urinary tract infection.

Air in the Water: A Case of Emphysematous Cystitis and Point-of-Care Ultrasound in the Emergency Department

Emphysematous cystitis is a rare and potentially fatal complication of urinary tract infections. We present a case of bacterial emphysematous cystitis in a 59-year-old woman who presented with behavioral changes, aggression, visual hallucinations, unintentional weight loss, fecal incontinence, and occasional diarrhea for 2 months. The diagnosis was suspected by abdominal ultrasound and confirmed by abdominal computed tomography. This highlights the importance of imaging as a diagnostic tool for emphysematous cystitis, particularly point-of-care ultrasound in the emergency department, due to its sensitivity and freedom from radiation.

Renal Pelvic Haemorrhage Complicating Emphysematous Pyelonephritis.

Renal pelvic haemorrhage is an uncommon cause of haematuria. It can mimic renal neoplasms, which sometimes results in unnecessary nephrectomy.Although the prognosis of renal pelvic haemorrhage is generally benign, careful observation for complications of urinary tract infection is important.

The prevalence of urinary tract disease in the elderly,Bani waleed, Libya

Urinary tract infection (UTI) is common infections occurred in elderly. The study aimed to evaluate the prevalence of the UTI in elderly people and to determine the most risk factors for serious clinical complications of UTI.&#x0D; Methodology: Data of a descriptive cross sectional study were collected from Central Bani Waleed Hospital, 106 UTI patients over 60 year old were involved in this study.&#x0D; Results: The most age group effected with UTI was 70-79 y (35.8%), followed by age group 60-69 y (31.1%). The men old people were more susceptible to UTI than women one (51.8% and 48.1% respectively), as well as elderly diabetic patients were susceptible to UTI more than non-diabetic (58.4% and 41.5% respectively). E.coli represented the most causative agent of UTI (71.7%). Cystitis (65.09 %) was the most prevalent UTI among elderly than pyelonephritis (34.91%).&#x0D; Conclusion: As the human age progress , the resistance of immune system deficiencies gradually become more susceptible to infectious diseases. The UTI one of these infections that can lead to serious complications in elderly immunocompromised. In addition, the comorbidities factors increase the directly affected of old people to UTI.

Invasive Fungus Balls Diagnosed by Point-of-Care Ultrasound in the Emergency Department

BackgroundGenitourinary tract fungus balls are a rare complication of urinary tract infections (UTI). They arise from dense aggregations of hyphae that combine with surrounding urothelial cells and debris. Symptoms can progress to urosepsis and systemic dissemination. Unfortunately, fungus balls may remain unrecognized. Even with computed tomography (CT) and magnetic resonance imaging, fungus balls can be mistaken for malignancies, urinary calculi, or blood clots. Case ReportA 54-year-old man with past medical history of type 2 diabetes mellitus presented to the Emergency Department (ED) reporting urinary retention for one week. He had undergone Foley catheter insertion three separate times for this symptom over the past five weeks. The emergency physicians expected that point-of-care ultrasound (POCUS) would show a distended, anechoic bladder. Instead, there were multiple discrete, gravitationally-dependent, circular echogenic masses without posterior acoustic shadowing, floating freely within a mosaic-like background of mixed echogenicity urine. These findings, together with the CT scan subsequently ordered, raised concern for fungus balls. Instead of being discharged with antibiotics for UTI, the patient was admitted for antifungal coverage, with contingency plans for bladder irrigation and antifungal instillation as needed. Why Should an Emergency Physician be Aware of This?This is the first known case report in which emergency physicians used POCUS to diagnose invasive fungus balls in the ED. POCUS findings led to further CT imaging and specialist consultation that otherwise would not have occurred. Rather than discharge with antibiotics, goal-directed management and appropriate disposition mitigated the risk of systemic decompensation in an immunocompromised patient.

Can we define the optimal postvoid residual volume at which intermittent catheterization should be recommended, and are there other measures that could guide an intermittent catheterization protocol: ICI-RS 2023.

The postvoid residual (PVR) volume of urine in the bladder is widely used in clinical practice as a guide to initiate treatment, including clean-intermittent self-catheterization (CISC). It is often believed that an elevated PVR causes complications such as recurrent urinary tract infections (UTI) and renal failure. However, evidence for this is limited and identifying alternative measures to guide treatment decisions may optimize patient care. At the International Consultation on Incontinence Research Society (ICI-RS) meeting in 2023 a Think Tank addressed the question of whether we can define the optimal PVR at which CISC should be recommended, and whether there are other measures that could guide a CISC protocol. The Think Tank conducted a literature review and expert consensus meeting focusing on current limitations in defining and measuring PVR, and highlighting other measures that may optimize selection for, and persistence with, CISC. There is no consensus on the threshold value of PVR that is considered "elevated"or "significant." There is a lack of standardization on terminology, and the normal range of PVR in different populations of different ages remains to be well-studied. The measurement of PVR is influenced by several factors, including intraindividual variation, timing and method of measurement. Furthermore, the evidence linking an elevated PVR with complications such as UTI and renal failure is mixed. Other measures, such as bladder voiding efficiency or urodynamic parameters, may be better at predicting such complications, and therefore may be more relevant at guiding a CISC protocol. There is a lack of high quality evidence to support PVR as a predictor for complications of UTI or renal failure. Threshold values for normal PVR in different populations are unknow, and so threshold values for "elevated"or "significant"PVR cannot be determined. Other factors, such as urodynamic findings, may be better at predicting complications and therefore guiding management decisions, and this remains to be studied. Areas for further research are proposed.

PREVALENCE OF URINARY TRACT INFECTIONS AMONG FEMALES OF REPRODUCTIVE AGE GROUP IN TERTIARY CARE TEACHING HOSPITAL

Objective: The purpose of the current study is to isolate, characterize, and evaluate the antibiotic susceptibility profile of the pathogenic bacteria causing urinary tract infections (UTIs) in females of reproductive age. Methods: This is a cross-sectional descriptive study carried out in a Tertiary care teaching hospital for 1 year. A total of 100 urine samples from female patients in the reproductive age range of 15–44 years constitute the study’s sample size. Clean catch midstream urine samples were taken in sterile containers and inoculated on a different culture medium, such as cysteine, lactose, and electrolyte-deficient agar, to isolate the UTI pathogen. MacConkey agar was inoculated in parallel to target the growth of Gram-negative bacilli. Thereafter, using the common microbiological procedures, all positive cultures with significant bacteriuria were identified at the species level based on the colony features, Gram-staining reaction, and pattern of biochemical profiles. To investigate the pattern of antibiotic susceptibility, the disc diffusion method was used. Results: Among the 100 study cases, the prevalence of UTI was seen in 38% of individuals and UTI was absent in 62% of individuals. Among the females (38% cases) who had UTI, 81% had symptomatic UTI and 19% had asymptomatic UTI. Among the 81% symptomatic individuals of UTI, all they showed burning micturition followed by 74% of individuals showed dysuria Among the uropathogens isolated, majority were Escherichia coli (40.7%) followed by CONS (22.3%) Majority of the E. coli isolates showed sensitivity to piperacillin/tazobactam and nitrofurantoin. Conclusion: If left untreated, UTI is a significant public health issue. Early detection and timely treatment will lower the risk of developing further UTI complications, as well as the patient’s pain, length of stay in the hospital, and economic loss.

Kidney abscess as a rare complication of the urinary tract infections in children - 20 years of single-center observations

Introduction and objectiveKidney abscess is one of the complications of the urinary tract infection. Gram (-) intestinal flora is considered the most common etiological factor in development of kidney abscess. The spreading of bacteria usually occurs via an ascending route. Currently, in the era of antibiotic therapies, the kidney abscess is a relatively rare complication.Material and methodsThe study aimed to analyse the prevalence, risk factors, clinical course of the disease, results of treatment, and the long-term consequences in pediatric patients with kidney abscess diagnosis.ResultsThe renal abscess was diagnosed in 8 out of 32,000 hospitalized children (0.00025%) (5 girls, 3 boys, average age 6 years). In 7 cases, the association with urinary tract infection was confirmed (87.5%). In all patients, the abscess was limited to the renal parenchyma and its diameter was below 50 mm; two patients had multiple abscesses. Three children (37.5%) had a history of urinary tract disease. All patients had increased levels of the inflammation markers but the renal function parameters were within the reference values. Five children (62.5%) presented clinical symptoms (fever, pain, dysuria); in 2 children (25%) the clinical course was chronic and oligosymptomatic. The sensitivity and specificity of ultrasound examinations (US) were 100% accurate in the diagnosis and monitoring of treatment. In all cases, antibiotic therapy was effective. Post-antibiotic treatment renoscintigraphy showed persistent post-inflammatory scars in 62.5% of cases.ConclusionsDuring 20 years of observations, kidney abscess was a rare complication of urinary tract infection. Most patients did not have any underlying risk factors. Ultrasound examination had high sensitivity and specificity in the diagnosis and monitoring of the treatment. Broad-spectrum, prolonged antibiotic therapy proved to be an effective treatment in all patients. However, after the abscess has been successfully healed, most patients required permanent nephrology care due to the presence of the post-inflammatory scars.

A case of abdominal distress and kidney dysfunction in a patient with diabetes.

A 65-year-old male with diabetes mellitus and dyslipidemia presented with a fever and dysuria for the past week. He developed hematuria, lower abdominal discomfort, and constipation. During examination, tachycardia (120 beats per min) and relative hypotension (96/57 mmHg) were observed. Laboratory tests revealed acute kidney injury with metabolic acidosis (serum creatinine of 5.47 mg/dL, pH value 7.29 BE: −7.7). Kidney, ureter, and bladder imaging showed bladder distension with gas formation (Figure 1). An abdominal computed tomography scan revealed emphysematous cystitis (Figure 2). The patient was initially treated with foley irrigation and antibiotics, but he developed respiratory distress on the same day and was intubated for urosepsis. Blood and urine cultures showed Klebsiella pneumoniae. He received temporary hemodialysis due to refractory fluid overload and Kidney Disease Improving Global Outcomes (KDIGO) stage III acute kidney injury by serum creatinine criteria during hospitalization. Emphysematous urinary tract infections (UTIs) involve gas formation in the urinary tract and are commonly caused by Escherichia coli or Klebsiella pneumoniae, particularly in individuals with diabetes.1 Emphysematous cystitis is a rare type of UTI characterized by gas formation in the bladder wall. The symptoms include abdominal pain, dysuria, and pneumaturia. The diagnosis is made through imaging, and treatment involves antibiotics.2 In severe cases, hospitalization may be required. Emphysematous cystitis is a rare but serious complication of UTIs, particularly in individuals with diabetes. Early diagnosis and appropriate management, including antibiotics and surgical therapy, if necessary, are essential for improving outcomes.3 Patients or the public were not involved in the design, conduct, reporting, or dissemination plans of our research.

Emphysematous cystitis, iliopsoas abscess, and pneumorrhachis in an elderly woman: a case report

BackgroundEmphysematous cystitis is a well-described life threatening complication of urinary tract infection, most commonly seen in patients with diabetes and typically caused by gas forming bacterial or fungal pathogens. Pneumorrhachis is the rare finding of gas within the spinal canal, most commonly reported in the context of cerebrospinal fluid leakage secondary to trauma or spinal instrumentation. To our knowledge there is only one other reported case of pneumorrhachis in the setting of emphysematous cystitis.Case presentationThis is a single case report of pneumorrhachis in the setting of emphysematous cystitis. An 82-year-old Asian female patient originally from East Asia, with no prior medical history besides hypertension, presented to hospital with a chief complaint of acute on chronic neck pain and functional decline. Examination revealed nonspecific neurosensory deficits and suprapubic tenderness. Laboratory investigations demonstrated leukocytosis and extended-spectrum beta-lactamase containing Escherichia coli bacteremia and bacteriuria. Computed tomography showed emphysematous cystitis with widespread gas within the cervical and lumbar spinal canal, as well as multiple gas-containing soft tissue collections in the bilateral psoas muscles and paraspinal soft tissues. Despite prompt antimicrobial therapy the patient passed away within 48 hours from septic shock.ConclusionsOur case adds to a growing body of literature showing that the spread of air to distant sites, including the spine, may be a poor prognostic indicator in patients with gangrenous intraabdominal infections. This report highlights the importance of recognizing the causes and presentation of pneumorrhachis to facilitate early diagnosis and treatment of potentially life threatening and treatable causes.

Effect of pelvic peritoneum reconstruction on the prognosis of patients underwent laparoscopic low anterior resection of rectal adenocarcinoma

Objective: To investigate the effect of pelvic peritoneum reconstruction on the prognosis of patients underwent laparoscopic low anterior resection of rectal adenocarcinoma. Methods: This retrospective cohort study included 97 patients who underwent laparoscopic low anterior resection of rectal adenocarcinoma in General Surgery Department, the First Affiliated Hospital of Soochow University from January 2017 to June 2021. According to the implementation of pelvic peritoneum reconstruction, the subjects were divided into study group (48 patients underwent pelvic peritoneum reconstruction after laparoscopic resection) and control group (49 patients not underwent pelvic peritoneum reconstruction). The two groups were compared in terms of Wexner score of anal function, anorectal manometry results, normal rate of defecation sensation, pelvic floor anatomical structure and postoperative complications. Five-year survival analysis was performed. Results: Patients in the study group and the control group were (61.25±10.38) years old and (59.47±11.40) years old (P>0.05). The proportions of male patients were 60.4% (29 cases) and 55.1% (27 cases) (P>0.05) in the study group and control group, respectively. At 3, 6 and 12 months after surgery, Wexner scores of anal function in the study group were lower than those in the control group [(14.29±2.07) vs (16.33±2.18), P<0.001; (9.57±2.34) vs (11.26±2.85), P=0.002; (5.41±1.36) vs (7.86±1.95), P<0.001, respectively]. The anal resting pressure and anal systolic pressure of the study group were higher than those of the control group [(56.29±7.31) mmHg vs (52.88±6.65) mmHg, P=0.018; (129.33±17.36) mmHg vs (110.45±15.22) mmHg, P<0.001, respectively] (1 mmHg=0.133 kPa). The rectal sensory volume, rectal maximum tolerance volume, and the length of anal high-pressure area in the study group were greater than those in the control group [(32.15±4.38) vs (29.76±4.29), P=0.008; (209.57±40.27) vs (184.39±37.56), P=0.002; (3.07±0.52) vs (2.80±0.49), P=0.010, respectively]. At 3 and 6 months after surgery, the normal rates of defecation sensation in the study group were 47.9% (23 cases) and 70.8% (34 cases), respectively, higher than those in the control group [26.5% (13 cases) and 51.0% (25 cases)] (P=0.029 and 0.046, respectively). The detection rate of intestinal tube accumulation in the study group was lower than that in the control group [12.5% (6 cases) vs 38.9% (19 cases)] (P=0.003). There was no significant difference in the total incidence of complications (anastomotic leakage, abdominal infection, intestinal obstruction, pendant pneumonia and urinary tract infection) between the two groups [18.8% (9 cases) vs 24.5% (12 cases)] (P=0.493). There was no significant difference in 5-year cumulative survival rate between the study group and the control group (71.6% vs 68.2%, P=0.309). Conclusion: Pelvic peritoneum reconstruction can improve postoperative anal function and reduce intestinal tube accumulation in patients underwent laparoscopic low anterior resection of rectal adenocarcinoma with high safety and feasibility.

O04 A novel, fast, accurate, cost-effective antimicrobial susceptibility test for urine samples

Abstract Objectives To show that iFAST (impedance-based fast antimicrobial susceptibility test) can give accurate susceptibility results for urinary tract infection (UTI) samples in less than 5 h. Background UTIs are one of the most common forms of infection and reasons for antibiotic prescribing. Empirical prescribing without reference to antimicrobial susceptibility tests (ASTs) is common due to the high incidence, burden of symptoms and the length of time needed for an AST (24–48 h). However, untreated UTIs can lead to complications and in severe cases to bacteraemia and death. In addition, resistance to frontline antibiotics is increasing, leading to increased treatment failure. There is, therefore, a need for a fast, accurate and cost-effective AST for urine samples. Bacterial impedance cytometry can measure the opacity and electrical size of individual cells by measuring the change in the electrical current as single cells flow between micro-electrodes. Bacteria treated with antibiotics change their electrical size and opacity compared with untreated cells. This change is visible on the iFAST within 2 h of exposure to above MIC of antibiotics, thereby enabling detection of cells susceptible to breakpoint concentrations of antibiotics. The iFAST technology and workflow can fit into current diagnostic laboratory practice. Methods Fifty-eight Escherichia coli and Klebsiella pneumoniae strains were streaked onto standard agar plates and incubated at 37°C. After 2 h a streak of cells was inoculated into 0.9% saline. Cell count was measured using the iFAST and adjusted to 5 × 105 cfu/mL. 100 μL samples were exposed to EUCAST susceptibility breakpoint concentrations of frontline UTI antibiotics in MH2: co-amoxiclav (2/8 mg/L), amoxicillin (8 mg/L), ceftazidime (1mg/L), cefalexin (16mg/L), ciprofloxacin (0.25mg/L), gentamicin (2 mg/L), nitrofurantoin (64mg/L), trimethoprim (4mg/L) or a no antibiotic control and incubated at 37°C. After 2 h, 60 μL of each culture were measured in the iFAST for 2 min and compared with the no antibiotic control, using percentage cell count and a 50% population contour. In parallel, a gold standard microbroth dilution MIC was carried out, according to EUCAST guidelines, on the cultures. Results For the 441 tests conducted (58 strains in 8 antibiotics, nitrofurantoin is only recommended for E. coli treatment and was therefore disregarded for K. pneumoniae), overall concordance with the gold standard microbroth dilution MIC method was 95.2% for total cell count metric and 94.9% for cells in the population contour. The highest concordance was seen for ceftazidime (100% for both metrics) and amoxicillin (100 and 99% respectively), the lowest for trimethoprim (92% and 89% respectively). All non-concordances, except one strain with trimethoprim, showed an MIC of ±1 log2 (doubling dilution) different to the breakpoint concentration, which was used for iFAST. This is the normal technical variability of the gold standard method. Conclusions iFAST has up to 100% concordance with current gold standard MIC methods and delivers the results in less than 5 h compared with 24–48 h for current ASTs. This novel, fast, accurate and cost-effective AST could increase evidence-based antibiotic prescribing, thereby improving patient treatment, decreasing risk of UTI complications and overall decreasing antimicrobial resistance development.