Course Of Urinary Tract Infection Research Articles

The molecular-genetic characteristics of uropathogenic Escherichia coli isolated from pregnant women with asymptomatic bacteriuria

Introduction. Uropathogenic Escherichia coli (UPEC) are the dominant bacterial pathogens of urinary tract infections (UTIs). UPEC belong to different phylogenetic groups and have many virulence factors, the study of which, in conjuction with the assessment of their relationship with clinical forms of UTI, is necessary for a better understanding of the pathogenesis of UTI and the development of new diagnostic algorithms. Aim: determination of the molecular genetic characteristics of uropathogenic Escherichia coli isolated from pregnant women with asymptomatic bacteriuria. Materials and methods. Clinical isolates of uropathogenic E. coli (n = 70) from pregnant women with asymptomatic bacteriuria were included in the study. The PCR method was used to determine the belonging to phylogenetic groups and detect 15 virulence markers — genes associated with adhesion (fimH, papC, sfa, afa, focG); toxin synthesis (cnf 1, hlyA, sat, vat, usp); siderophores (fyuA, iroN, iuc); capsular antigen (kpsMII). To assess the statistical significance of differences, Fisher's exact test was used. Differences were considered statistically significant at a confidence interval of 95% (p 0.05). Results. Most of the UPEC isolates belonged to phylogroup B2 (51,4%) and were characterized by the detection of all UPEC-associated virulence factors included in this study; genes associated with adhesion (sfa, focG), invasins (ibeA), synthesis of toxins (hlyA, cnf1, vat, usp) and capsule (kpsMII), siderophores (fyuA, iroN, hlyA) were detected significantly more frequently (p 0.05). Two or more virulence determinants were detected in 93% of isolates. Conclusion. The identification of key determinants of virulence and/or a combination of virulence genes can be a prognostic marker for predicting the course of UTI, especially in pregnant women, and will expand diagnostic capabilities taking into account the virulent properties of the uropathogen.

1696. Urinary tract infection due to Aerococcus urinae in children

Abstract Background Aerococcus urinae is a rare Gram-positive and catalase-negative coccus. A. urinae is primarily associated with urinary tract infection (UTI). It is responsible for urosepsis and occasionally complicated diseases, including endocarditis and osteomyelitis. The clinical presentations of adult patients with A. urinae have been described. However, there are very few reports in children. The clinical course of UTI due to A. urinae and the associated risk factors remain unclear. The aim of this study was to describe the clinical characteristics of UTI due to A. urinae in children. Methods We conducted a retrospective observational study at a tertiary children’s hospital in Tokyo, Japan. We included pediatric patients (< 18 years old) who had positive urine cultures for A. urinae (≥ 104 CFU/HPF) between June 1, 2006, and May 31, 2022. Information regarding clinical characteristics, including age, sex, underlying disease, laboratory test results, antibiotic susceptibility of A. urinae, treatment, and outcomes were collected from the electronic medical records. Results A total of 22,769 urine cultures were submitted during the study period, of which A. urinae was isolated in 35 (0.15%). We found 17 patients who were positive for A. urinae with greater than 104 CFU/HPF. Among them, 13 patients (76.5%) were male and 16 (94.1%) had underlying bladder dysfunction. The main clinical symptoms were fever (n=6, 35.3%), urine odor (n=4, 23.5%), and nausea (n=2, 11.8%). Five patients had diagnosed pyelonephritis due to A. urinae. All five patients were male, and the median age at presentation was 4.6 years (range 2.1-11.0 years). Four of them had underlying bladder dysfunction. All bacterial isolates were susceptible to the majority of antibiotics, including penicillin G, sulfamethoxazole, or ciprofloxacin. All patients had favorable outcomes following 10-14 days of ampicillin/amoxicillin-based antimicrobial therapy. Conclusion A. urinae was isolated in urine cultures primarily in male patients with underlying bladder dysfunction. All of the outcomes of antibiotic treatment were favorable. Disclosures Kensuke Shoji, MD, PhD, AstraZeneca K.K.: Honoraria|Gilead Sciences, Inc.: Honoraria|KYORIN Pharmaceutical Co.,Ltd.: Honoraria|Meiji Seika Pharma Co., Ltd.: Honoraria|Nippon Becton Dickinson Company, Ltd.: Honoraria|Novartis Pharma Co., Ltd.: Honoraria|Viatrs, Inc: Honoraria chikara Ogimi, MD, bioMerieux Japan Ltd.: Honoraria|Horiba: Honoraria|Pfizer: Honoraria

Urinary tract infection in children and adults: modern approaches to prevention and treatment (literature review)

Urinary tract infection occupies a leading place in the structure of uronof our own research, alternative approaches to complex therapy and prevention of various variants of the course of urinary tract infection are presented. At the stages of patient rehabilitation, special attention is paid to diet therapy, the use of modern phytopreparations, the preservation of the mucous microbiota, and immunomodulatory therapy.ephrological pathology in children and adults. Based on the analysis of literature data and the results.

Genome-wide analysis of fitness factors in uropathogenic Escherichia coli in a pig urinary tract infection model

Uropathogenic Escherichia coli (UPEC) is the primary cause of urinary tract infections (UTIs) in animals and humans. We applied Transposon-Directed Insertion Site sequencing (TraDIS) to determine the fitness genes in two well-characterized UPEC strains, UTI89 and CFT073, in order to identify fitness factors during UTI in a pig model. This novel animal model better reflects the course of UTI in humans than the commonly used mouse model, and facilitates the differentiation between sessile and planktonic UPEC populations. A total of 854 and 483 genes in UTI89 and CFT073, respectively, were predicted to contribute to growth in pig urine, and 1257 and 764, were scored as required for colonization of the bladder. The combined list of fitness genes for growth in urine and cystitis contained 741 (UTI89) and 439 (CFT073) genes. The essential genes for growth on LB agar media supplemented with kanamycin and the fitness factors during growth in human urine were also analyzed in CFT073. A total of 457 essential genes were identified and the pool of fitness genes for growth in human urine included 215 genes. The gene rfaG, which is involved in lipopolysaccharide biosynthesis, was included in all the fitness-gene-lists and was further confirmed to be relevant for all the conditions tested regardless of the host and the strain. Thus, this gene may represent a promising target for the development of new therapeutic strategies against UTI UPEC-associated. Besides this important observation, the study revealed strain-specific differences in gene-essentiality as well as in the fitness-gene-repertoire for growth in human urine and UTI of the pig model, and it identified novel factors required for UPEC-induced UTIs.

Urinary tract infections in patients with multiple sclerosis and different methods of bladder evacuation

Introduction and objectivesTo evaluate the incidence and course of urinary tract infections (UTI) in patients with multiple sclerosis (MS) and their relationship to the method of bladder evacuation. Materials and MethodsPatients with neurogenic bladder dysfunction due to MS (n=111) were enrolled in the study. During one-year follow-up, clinical examination with urine culture was performed every 4 months or whenever symptoms occurred. The control group included patients with symptomatic UTI, without neurological or autoimmune disease. Incidence of symptomatic and asymptomatic bacteriuria, the effect of urine drainage on UTI incidence, and the effect of antibiotics were statistically evaluated. Results54 MS patients completed the protocol. The mean incidence of symptomatic and asymptomatic bacteriuria in the MS group was 12.5% and 29.6%, respectively. A decreasing trend in the incidence of symptomatic, and an increasing trend in the incidence of asymptomatic bacteriuria was observed. Eradication of UTI in symptomatic MS patients was significantly lower than in controls (37.75% vs. 92.93%, P<0.05). Causative agents significantly differed in both groups (P=0.0005). The hypothesis that the incidence of UTIs in MS patients is independent of the method of bladder evacuation was not rejected (P>0.99 at visit 0, 1 and 3, P=0.078 at visit 2). ConclusionsThere is a significant difference between the causative agents of UTI in both groups. Eradication of bacteriuria in symptomatic MS patients is difficult when compared to the normal population. We have insufficient evidence to confirm the relationship between the incidence of UTI and the method of bladder evacuation.

A clinical case of surgical treatment of a 10-year-old girl with megaureter of the single kidney

Editrial comment. The described long-term multi-stage surgical treatment – performed at the child's place of residence was not adequate and was the threat of losing the only kidney. Management of patients with a non-reflexing form of megaureter, especially in the neonatal period, requires the assessment of not only the state of the kidney and ureter, but also the state of the bladder, in order to exclude the bladder-dependent form of megaureter. Proximal ureterocuteniostomy, especially of a single kidney, should not be used without a preliminary, full-fledged urological examination. Children with complex malformations of the urinary system should be promptly consulted in specialized medical institutions. Introduction. Among congenital malformations of the urinary system, one of the most common is megaureter. The recently developed surgical techniques and, namely, minimally invasive ones for megaureter treatment, in some cases prevent or delay surgical intervention. However, if deterioration of the renal function is seen, especially in patients with the only functioning kidney, radical surgery has to be performed in a timely manner, before the formation of irreversible changes in the renal parenchyma leading to nephrosclerosis. Purpose. To illustrate a successful surgical outcome in a patient with megaureter in the only functioning kidney when surgeons had to consider all anatomical features after ineffective previous surgical corrections. Material and methods. The authors present a clinical observation and management of a 10-year-old patient with megaureter in the only kidney after previous ineffective surgical corrections when both open traditional methods and long-term endovesical stentings were performed but without taking into account the anatomical localization of the ureteral junction. The patient also developed a latent course of urinary tract infection and chronic kidney disease stage 3 by classification of the National Kidney Foundation (NKF), and the working group on improving outcomes of kidney diseases, Kidney Disease Outcomes Quality Initiative (KDOQI). Results. Despite the existing problems – deficit in the ureter length caused by previous surgeries, impossible endovideosurgical laparoscopy because of metabolic disorders – the performed treatment was successful. The surgeons formed ureterocystoanastomosis by Cohen technique with extra-bladder mobilization of the ureter. Dynamic follow-up after surgical treatment lasted for 2 years. During the observation period, urodynamics of the upper urinary tract was restored and, one could see the elimination of leukocyturia, improvement of blood flow in the parenchyma of the only functioning kidney as well as stabilization of nitrogen metabolic parameters and glomerular filtration rate. Conclusion. While choosing surgical management, surgeons should consider anatomical features of the ureterovesical junction. Such an approach has promoted good results in the discussed case.

Infecciones del tracto urinario en pacientes con esclerosis múltiple y los diferentes sistemas de vaciado vesical

Introduction and objectivesTo evaluate the incidence and course of urinary tract infections (UTI) in patients with multiple sclerosis (MS) and their relationship to the method of bladder evacuation. Materials and methodsPatients with neurogenic bladder dysfunction due to MS (n=111) were enrolled in the study. During one-year follow-up, clinical examination with urine culture was performed every 4 months or whenever symptoms occurred. The control group included patients with symptomatic UTI, without neurological or autoimmune disease. Incidence of symptomatic and asymptomatic bacteriuria, the effect of urine drainage on UTI incidence, and the effect of antibiotics were statistically evaluated. ResultsFifty-four MS patients completed the protocol. The mean incidence of symptomatic and asymptomatic bacteriuria in the MS group was 12.5% and 29.6%, respectively. A decreasing trend in the incidence of symptomatic, and an increasing trend in the incidence of asymptomatic bacteriuria was observed. Eradication of UTI in symptomatic MS patients was significantly lower than in controls (37.75% vs. 92.93%, P<.05). Causative agents significantly differed in both groups (P=.0005). The hypothesis that the incidence of UTIs in MS patients is independent of the method of bladder evacuation was not rejected (P>.99 at visit 0, 1 and 3, P=.078 at visit 2). ConclusionsThere is a significant difference between the causative agents of UTI in both groups. Eradication of bacteriuria in symptomatic MS patients is difficult when compared to the normal population. We have insufficient evidence to confirm the relationship between the incidence of UTI and the method of bladder evacuation.

Toll-like receptor (TLR2, TLR4) polymorphisms and their influence on the incidence of urinary tract infections in children with and without urinary tract malformation

Toll-like receptors (TLRs) contribute to the innate immune system. They are an element of non-specific immunity, which enables organisms to react quickly to foreign antigens, without being previously exposed to them. TLRs are pattern recognition receptors. TLR gene polymorphisms are widely investigated in connection with various infections. The aims of the study were: to investigate the role of TLR2 and TLR4 polymorphisms in the course of urinary tract infections (UTIs); to test for differences in distribution of these polymorphisms between children with urinary tract malformations suffering from recurrent UTI (rUTI), children with malformations but without rUTI and healthy controls; to determine whether these polymorphisms predispose to rUTI; and to analyse how polymorphisms and urine neutrophil gelatinase-associated lipocalin (NGAL) and interleukin 8 (IL-8) concentrations affect one another. The group consisted of 133 children (1-18 years old), 68 female and 65 male. The group was divided into 4 subgroups: A (rUTI with urinary tract malformations), B (urinary tract malformations without rUTI), C (rUTI) and D (healthy controls). Polymorphisms were analysed using PCR-RFLP. IL-8 and NGAL urine concentrations were established using immunoenzymatic methods. TLR2 Arg753Gln and TLR4 Arg299Gly appeared significantly more often among children with rUTI. No correlation between urine IL-8 and urine NGAL and polymorphisms was found. Urine NGAL concentration was significantly higher among children with urinary tract malformations. TLR2 Arg753Gln and TLR4 Asp299Gly may predispose to rUTI. Urine NGAL concentration suggests the presence of kidney tissue injury, of varying degrees, among children with urinary tract malformations.

КЛИНИЧЕСКАЯ ЭПИДЕМИОЛОГИЯ ИНФЕКЦИЙ МОЧЕВОЙ СИСТЕМЫ В ПОПУЛЯЦИИ ЖЕНЩИН УКРАИНЫ. ЧАСТЬ 1: ДЕМОГРАФИЧЕСКАЯ ОЦЕНКА РАСПРОСТРАНЕННОСТИ И ФАКТОРЫ РИСКА

The purpose of the study: To identify the prevalence of various forms of urinary tract infection (UTI) in the population of Ukrainian women according to age. To determine the frequency of recurrent urinary tract infection in the female population, to determine the correlation of the form, duration and course of the disease, the frequency of relapses with the treatment and the nature of the medical care received. Material and methods. We designed, validated and implemented the web-based online questionnaire on prevalence, medical history and medical care of the urinary tract infections among 539 women (18-80 years old) in Ukraine. Results. A total of 339 (62.9%) women had symptoms of UTI. The prevalence of UTI in the 18-35 age group was 48.6%, that in the 36-55 age group 76.1 %, and that among women over 55 years old 75.5%. The growth trend in the number of UTI episodes, reported by the patients, was related to their age: older women generally suffered more UTI episodes during life compared to younger respondents. It was demonstrated that the main risk factors for the debut of UTI episode were the UTI history in the mother (40.2% of all patients), sexual activity (36.1%), childhood history of UTIs (23.9%), hypothermia (22.1%), bathing in the pool or pond (20.1%) and changing a sexual partner (18.9%). All other risk factors, including dietary disorders, overheating, gynecological visits, manipulations, abortions, childbirth and the puerperium, catheterization and the use of spermicides, did not play a significant role in the debut of a UTI episode among the interviewed patient population. We found a correlation between the main UTI risk factors and the type of disease course: sexual life played the main role in recurrent forms of disease (40.3% of patients with frequently recurrent UTIs) against 14.5% of patients with a single UTI episode where more significant factors included dietary disturbance (19.2%), hypothermia (29.5%) and bathing in ponds (20.9%). Conclusions. Frequently recurring course of UTI is inherent in 14.6% of the interviewed women and defines a 12% higher symptom score, reduction of quality of life by 26.8%, decrease of social activity by 19.4%, decline of physical activity by 20.4%, and an increase in deviations in family life and sexual activity by 25.4% and 7.9% respectively as compared to patients with sporadic UTIs. Patients with a recurrent UTI report, in general, 31.6% greater restrictions on visiting public places, 31% greater manifestations of social isolation and 42.2% worse relationships with a partner or spouse.

Maternal antibiotic exposure during pregnancy is a risk factor for community-acquired urinary tract infection caused by extended-spectrum beta-lactamase-producing bacteria in infants.

This study aimed to investigate the risk factors for community-acquired urinary tract infection (UTI) caused by extended-spectrum beta-lactamase (ESBL)-positive bacteria in infants. We retrospectively reviewed the medical records of infants aged < 1 year with first UTI from 2018 to 2019 at two tertiary centers in Korea. Data analyzed included clinical findings, birth history, delivery mode, milk type, use of postpartum care center, and previous use of antibiotics both in the patient and mother. Of 265 patients, 62 (23.4%) were diagnosed with first UTI caused by ESBL-positive bacteria at the median age of 3.6 (interquartile range (IQR) 2.3-5.4) months. Maternal use of antibiotics during pregnancy (29.0 vs. 10.3%, p < 0.001) and Klebsiella species (19.4% vs. 4.9%, p < 0.001) were significantly associated with ESBL-positive UTIs and remained valid in the multivariate analysis (odds ratio [OR], 3.40; 95% confidence interval [CI] 1.61-7.19, p =0.001, and OR 5.26; 95% CI 2.03-13.13, p = 0.001, respectively). Previous antibiotic exposure of patients, previous hospitalization, prematurity, delivery mode, milk type, and use of postpartum care center were not significantly different between ESBL-positive and ESBL-negative groups. With respect to the clinical course of UTI, the ESBL-positive group presented a higher number of blood leukocytes (p = 0.041) and longer hospital stay (p < 0.001) than the ESBL-negative group. About one-fourth of infantile UTI cases were ESBL-positive. Prenatal antibiotic exposure of mothers and Klebsiella species were associated with community-acquired UTI caused by ESBL-positive bacteria.

Longitudinal Follow-Up of Urinary Tract Infections and Their Treatment in Mice using Bioluminescence Imaging.

Urinary tract infections (UTI) rank among the most common bacterial infections in humans and are routinely treated with empirical antibiotics. However, due to increasing microbial resistance, the efficacy of the most used antibiotics has declined. To find alternative treatment options, there is a great need for a better understanding of the UTI pathogenesis and the mechanisms that determine UTI susceptibility. In order to investigate this in an animal model, a reproducible, non-invasive assay to study the course of UTI is indispensable. For years, the gold standard for the enumeration of bacterial load has been the determination of Colony Forming Units (CFU) for a particular sample volume. This technique requires post-mortem organ homogenates and serial dilutions, limiting data output and reproducibility. As an alternative, bioluminescence imaging (BLI) is gaining popularity to determine the bacterial load. Labeling pathogens with a lux operon allow for the sensitive detection and quantification in a non-invasive manner, thereby enabling longitudinal follow-up. So far, the adoption of BLI in UTI research remains limited. This manuscript describes the practical implementation of BLI in a mouse urinary tract infection model. Here, a step-by-step guide for culturing bacteria, intravesical instillation and imaging is provided. The in vivo correlation with CFU is examined and a proof-of-concept is provided by comparing the bacterial load of untreated infected animals with antibiotic-treated animals. Furthermore, the advantages, limitations, and considerations specific to the implementation of BLI in an in vivo UTI model are discussed. The implementation of BLI in the UTI research field will greatly facilitate research on the pathogenesis of UTI and the discovery of new ways to prevent and treat UTI.

Delayed diagnosis of pediatric bladder and prostate rhabdomyosarcoma – causes and consequences

Introduction: Pediatric rhabdomyosarcoma (RMS) is a rare disease, affecting 4.5-6.0 per 1 000 000 children a year. Bladder and/or prostate (B&amp;P) is the primary tumor site in approximately 10% of patients. Initial symptoms of B&amp;P RMS in children may mimic more common, benign conditions such as urinary tract infections (UTIs), functional disorders, and congenital anomalies of the urinary tract. Aim: The study aims to emphasize the role of careful clinical examination and strict following the diagnostic guidelines in early detection of pediatric B&amp;P RMS in primary care and emergency department settings. Case study: We present two male patients aged 2.5 and 3 years with embryonal B&amp;P RMS initially manifesting as atypical and/or recurrent UTI. In both children, proper diagnoses were delayed due to careless physical examination and failure to adhere to the current guidelines for UTI management. Despite symptoms of an atypical and severe course of UTI, no imaging examinations had been performed for several weeks until dramatic deteriorations of patients’ general conditions occurred. Results and discussion: The prolonged diagnostic processes caused unnecessary suffering of both children and significant delay of oncological treatment in one. In the latter patient, bladder preservation was not possible, resulting in decreased quality of life. Conclusions: Due to its rarity, B&amp;P RMS is infrequently included in the differential diagnosis in children with recurrent or atypical UTI. However, thorough physical examination and adherence to the guidelines of UTI management enable timely diagnosis of underlying malignancy. Early diagnosis of B&amp;P RMS leads to a better prognosis, less intensive treatment, and improved quality of life of B&amp;P RMS survivors.

Cranberries (Vacciniummacrocarpon aiton) in dog nutrition: influence on diet digestibility and palatability and in the course of urinary tract infections

ABSTRACT The objective was to evaluate the effects of cranberry on blood and urinary parameters of dogs (experiment I), digestibility of nutrients (experiment II), palatability of diet (experiment III) and the influence of cranberry on E. coli UPEC-MRHA fimbriae in vitro (experiment IV). For experiment I and II, ten dogs were fed with diets containing 0% or 0.4% cranberry for 30 days. Experiment III compared the diets containing 0% and 0.4% cranberry using 16 adult dogs. There were no statistical differences (P&gt;0.05) in the blood parameters evaluated. Dogs consuming cranberry presented lighter color and appearance of urine, compared to the control group (P&lt;0.05). The diet containing cranberry showed higher digestibility of dry matter, organic matter, ether extract, higher metabolizable energy (P&lt;0.05) and reduced fecal sialic acid concentration (P&lt;0.05) compared to the control diet. There was no influence of cranberry on the formation of fimbriae of E. coli UPEC-MRHA. There was a lower intake ratio of the diet containing cranberry (P&lt;0.05). The inclusion of 0.4% cranberry increases the digestibility of nutrients and influences the color and appearance of urine of dogs. However, it reduces diet palatability and does not alter the adhesion of E. coli UPEC-MRHA in vitro.

Comprehensive analysis of some risk factors in the formation of a recurrent course of urinary tract infection in children

The aim – to study the risk factors for the formation of recurrent urinary tract infection (UTI) in children with the determination of their prognostic value, both in single-factor and multifactorial impact.Materials and methods. A total of 2 235 children aged between 1 month to 18 years with nephrological diseases were examined. To assess the risk factors for recurrent UTI in the study population, the patients were divided into groups: with recurrent UTI – 1 (n = 447), without UTI– 0 (n = 1788). 14 traits were taken from the list of studied factors: age <1 year; female gender; ARVI ≥3 episodes over 6 months; undifferentiated connective tissue disease; kidney cystic formations; hydronephrosis and other abnormalities; vesico-ureteric reflux; neurogenic bladder, enuresis; synechia, phimosis; no deworming in the last 6 months; constipation or irritable bowel syndrome; crystalluria, accumulation of salts according to ultrasound; antibacterial therapy in the next 3 months; the presence of resistant urological strains.Results. The one-factor analysis allowed to remove statistically insignificant risk factors. As a result of multivariate analysis, a multiple logistic model was developed for the personalized prediction of a recurrent UTI in a child: odds = exp (0.712 × X1+ 3.808 × X2+ 6.982 × Х6 + 2.248×X7+ 0.165 × Х8+ 0.300 × X9+ 0.200 × X10+ 0.306 × X11+ 0.196 × X12+ 0.217 × X13+ 0.440 × X14 + (-3.489)), where Xn is a variable (or factor) which equals 1 in the case of a factor, and 0 – in the absence of a factor. The mathematical model of regression showed high statistical significance and informativeness based on the results of its testing, χ2 = 161.9; P < 0.001.Conclusions. Factors such as frequent ARVI, undifferentiated connective tissue disease, kidney cystic formations did not present a risk of recurrent UTI episodes. The dominating factors in UTI recurrences were the following: female sex increased the chance of UTI in a child almost 12 times (RR = 11.898 ± 0.252 [7.255; 19.514], P < 0.001); hydronephrosis – 11 times (RR = 10.968 ± 0.419 [4.825; 24.933], P < 0.001); vesico-ureteric reflux – 8 times (8.308 ± 0.221 [5.380; 12.804], P < 0.05); age <1 year – 4 times (RR = 3.73 ± 0.165 [2.702; 5.158], P < 0.05). Other factors influenced the development of UTI only in their combined effects and increased the probability of UTI by 1.2–1.6 times (P < 0.05).

P0962CHRONIC KIDNEY DESEASE AND URINARY TRACT INFECTION IN PREGNANTS

Abstract Background and Aims Pregnant women with chronic kidney disease (CKD) are at risk of developing/exacerbating urinary tract infection (UTI) due to the presence of additional (“specific”) risk factors. The aim of our study was estimation the features of UTI in women with CKD during pregnancy. Method The study included 139 women with CKD G1-G3 who had UTI during pregnancy. Most women (63) had chronic glomerulonephritis, 47 had with chronic pyelonephritis, and the rest had diabetic nephropathy (11), chronic tubulointerstitial nephritis (9), renal transplant (7) and lupus nephritis (2). An analysis of the bacteriological examination of urine, the sensitivity of pathogens to antibiotics, clinical manifestations and perinatal complications was performed. Results The following forms UTI are diagnosed: asymptomatic bacteriuria (50.4%), exacerbation of chronic pyelonephritis, including renal transplant (33.1%), acute pyelonephritis (16.5%). The true bacteriuria is determined identically at all stages of CKD, in those with chronic pyelonephritis in 70%, chronic glomerulonephritis in 45% of cases (p = 0.02). Gram-negative microorganisms become apparent in 73.6% of pregnant women with CKD, less often in patients with glomerular pathology than with chronic pyelonephritis (66% versus 81%). Escherichia coli among gram-negative microorganisms was 74.4%, a high frequency of detection of strains with the production of extended-spectrum β-lactamases was established. The course of asymptomatic bacteriuria in pregnant women with non-diabetic glomerulopathy was characterized by a moderate tendency to relapse and moderate release of resistant pathogens. The course of asymptomatic bacteriuria in patients with diabetic nephropathy and after kidney transplantation, on the contrary, had a pronounced tendency to relapse and the frequent release of resistant pathogens. Exacerbation of chronic pyelonephritis proceeded with minimal clinical manifestations, a vivid clinical picture of exacerbation of the disease was determined in one third of pregnant women. It was characterized by a high tendency to relapse and the development of systemic infection, a high frequency of release of resistant pathogens. Pregnant women with CKD who underwent UTI had a high risk of giving birth to premature babies (23% versus 11% p=0.01) who were required to carry out artificial lung ventilation and transfer to stage nursing (34% versus 16%, p=0.01). Conclusion The course of UTI in pregnant women with CKD is characterized by a high prevalence, dependence on primary renal disease, the release of resistant pathogens, and a high probability of an atypical clinical picture.

Group B Streptococcal Renal Abscess in a 17-Year-Old Girl with Type 1 Diabetes Mellitus

Streptococcus agalactiae or group B streptococcus (GBS) is associated with infections in neonates and pregnant women. Herein, we describe a rare case of GBS renal abscess with peritonitis and pleural effusion in a 17-year-old girl with type 1 diabetes mellitus. The girl was admitted due to fever and right flank pain. Laboratory findings included leukocytosis and increased C-reactive protein level and erythrocyte sedimentation rate. Her serum glucose level was 484 mg/dL. Urinalysis showed no pyuria. Renal sonography revealed parenchymal swelling in the right kidney. The patient was administered intravenous cefotaxime. Urine and blood cultures were negative. Fever seemed to improve, but the following day, she complained of abdominal pain and fever. Antibiotic was switched to imipenem, and abdominal and pelvic CT revealed a ruptured right renal abscess, peritonitis, and bilateral pleural effusion with atelectasis. Pigtail catheter drainage of the abscess was performed. Culture from the abscess was positive for GBS, and fever subsided 2 days after the drainage. She was discharged with oral cefixime. The clinical course of urinary tract infections (UTIs) can be atypical in patients with diabetes, and GBS can be a cause of UTIs. Prompt diagnosis and management are necessary to prevent complications in patients showing atypical courses. Key words: Streptococcus agalactiae; diabetes mellitus; urinary tract infection; pleural effusion

Mothers' knowledge about urinary tract infections in children and their prevention

Urinary tract infections (UTIs) are a serious medical problem. The disease affects a significant percentage of children, including newborns, infants, older children and adolescents. Numerous factors influence the course of UTI and the manifestation of clinical symptoms. UTIs that are diagnosed too late, untreated or poorly treated are the cause of many complications that can pose a serious threat to the health and even life of a child. In the prevention of UTI, in their diagnosis and therapy, an important role is played by nursing staff, who have an obligation to educate child carers on the subject of risk factors, the importance of check-ups in early diagnosis of infections, and rules in force during therapy. It is not without significance to learn skills related to the care of the child's intimate areas, as well as the principles relevant for the prevention of relapses.

Urinary tract infections.

Urinary tract infections (UTI) are amongst the most frequent bacterial infections and therefore are responsible for a significant fraction of antibiotic use, thus carrying a relevant social and economic burden. UTI may present as benign, uncomplicated cystitis or severe, life-threatening urosepsis. Due to the heterogeneity of UTI the European Section of Infections in Urology (ESIU) has introduced a phenotypical classification, based upon the clinical presentation, the risk factors and the antibiotic susceptibility of the causative pathogens. Presence of risk factors is a key point and could change dramatically the course of UTI. In scenario of uroseptic patients, early diagnosis and therapy are mandatory and a successful decompression of the obstructed urinary tract is predictor of survival. The multidisciplinary approach and a timely microbiological characterization are critical in this context.

Urinary tract infection during pregnancy affects the level of leptin, ghrelin and insulin in maternal and placental blood

Aim. We examined ghrelin, leptin and insulin in maternal blood during normal pregnancy and pregnancy complicated by urinary tract infection (UTI), as well as in cord blood at labor. Methods. A total of 36 delivering women with history of UTI during the third trimester of pregnancy were enrolled in the study; 12 healthy pregnant women served as a control. Infection markers (CRP and procalcitonin) were determined in maternal blood during the course of UTI and at labor. Ghrelin, leptin and insulin were determined during labor in venous maternal and in umbilical cord blood. Results. We found negative correlation between infection markers in maternal blood during UTI, and level of tested hormones in cord blood, indicating potential risk of placental impairment due to energetic imbalance. We noted lower level of leptin in mothers with UTI and no change in leptin from umbilical blood comparing subjects with and without UTI. Low level of ghrelin was observed in maternal and cord blood when pregnancy was complicated by UTI. Insulin concentrations were high in mothers with UTI and low in their newborn's cord blood. Increased maternal insulin level could indicate peripheral insulin resistance caused by the infection. Conclusion. UTI during pregnancy affects the concentration of hormones responsible for regulating energetic homeostasis within the placenta.

EFFICACY OF IMMUNOCORRECTIVE TREATMENT WITH SYNTHETIC DIPEPTIDE IN CHILDREN WITH PYELONEPHRITIS

The results of the open controlled prospective clinical and immunological trial indicate that including of pidotimod into the complex therapy of pyelonephritis in children (n=30) lead to reliable decrease of recurrence risk and frequency during 6 months after treatment withdrawal in comparison with children receiving antibacterial monotherapy (n=20). The duration of etiotropic treatment for arresting of the active manifestations of urinary tract infection was lower in patients who were administered the afore-mentioned drug. Immunological monitoring of the urine cytokine status during pidotimod treatment showed that there were signs of T helper 1 cells activation predominance (increase in interferon/interleukin 10 ratio), as well as decrease in granulocyte macrophage colony-stimulating factor concentration, which seems to cause the delayed influence of the drug on the course of urinary tract infection.