Culture-proven Urinary Tract Infection Research Articles

Antibiotic resistance patterns of pediatric community-acquired urinary tract infections in a tertiary care center in Jeddah, Saudi Arabia.

Urinary tract infections (UTIs) are common in children. UTIs can lead to serious and permanent damage to the urinary tract if treatment is delayed or insufficient, particularly in repeated infections. Knowledge of antibiotic resistance trends aids in the selection of appropriate empiric antibiotics. There is limited data regarding this in Saudi Arabia. This study aimed to investigate uropathogens and their antibiotic resistance patterns in the pediatric community in a tertiary care center. The study population included children aged 0 to 14 years old who had culture-proven UTIs evaluated in the Department of Pediatrics, King Abdulaziz University Hospital in Jeddah, Saudi Arabia from February 2019 to September 2021. Out of 510 UTI episodes, Escherichia coli (54.5%) was the predominant causative pathogen. Of the total episodes, 137 (26.8%) were caused by extended spectrum beta-lactamase (ESBL) producers. In general, the highest resistance was observed against ampicillin (73.2%), cefazolin (54.6%), co-trimoxazole (46%), and cefuroxime (40.6%), whereas amikacin (0.4%), imipenem (0.8%), and meropenem (0.8%) showed the lowest rates of resistance. Antibiotic resistance is a major concern worldwide due to misuse of antibiotics and subsequent rise of multidrug resistant organisms. Our findings highlight the rise in antibiotic resistance, particularly in E. coli strains. Furthermore, ESBL-producing bacteria were responsible for approximately one-third of UTIs. Our study emphasizes the importance of local antibiograms for pediatric community-acquired infections, as it guides clinicians in every center in the choice of appropriate empiric antibiotic treatment.

Does prophylactic antibiotics post pediatric pyeloplasty reduce the incidence of febrile UTIs?

PurposeThe use of postoperative prophylactic antibiotics in pediatric upper urinary tract reconstruction remains controversial. In this study, we examined whether low dose antibiotics administered following pediatric pyeloplasty reduce the incidence of febrile urinary tract infections at our institution. As a secondary outcome, in those patients with infection, additional analysis was performed to better quantify which patient population benefits the most from low dose prophylactic antibiotics.MethodsInstitutional review board approval (IRB) was obtained. All methods were carried out in accordance with relevant guidelines and regulations. A retrospective study was performed in patients who underwent pyeloplasty (2011–2017) at our institution. Surgical approach (laparoscopic versus robotic assisted versus open, with or without internal JJ ureteral stent) were based on surgeon preference. Patients of 8 fellowship trained pediatric urologists were included in the study period. Patients with prior history of urologic interventions or other congenital genitourinary tract abnormalities were excluded. Demographics (age, gender, ethnicity, insurance status), prior history of culture proven urinary tract infection, surgical details (administration of perioperative antibiotics), and postoperative outcomes including; 1) re-admission 30 days post-surgery, 2) any urine cultures collected due to suspected urinary tract infection.ResultsA total of 209 patients (149 boys, 60 girls) met our inclusion criteria with 55/209 (26%) receiving postoperative prophylactic antibiotics. The average age was 6 years (range: 2 months-18 years). Indwelling ureteral stent was used in 176 (84%) patients. Eleven patients (5%) had a culture-proven urinary tract infection within 30-days postoperatively. No significant differences were seen in postoperative complications or incidence of urinary tract infection when comparing surgical approaches, +/- ureteral stent, or the use of antibiotics. Secondary analysis noted statistically significant increase in post-operative urinary tract infection in younger children (2.8 v. 6.2 years, p = 0.02), those patients who had a positive preoperative urine culture (8/11, p = 0.01) and those with public health insurance (p = 0.038).ConclusionThe incidence of postoperative urinary tract infection following pyeloplasty in our cohort was relatively low. There was a higher incidence of urinary tract infection in patients less than 3 years old. The use of antibiotics in patients post pyeloplasty did not appear to affect the incidence of post-operative urinary tract infection, however, they may have a role in children who have not yet potty trained and in patients with positive preoperative urine culture.

Conversion to Disposable Cystoscopes Decreased Post-procedure Encounters and Infections Compared to Reusable Cystoscopes.

We evaluated for differences in post-procedure 30-day encounters or infections following office cystoscopy using disposable vs reusable cystoscopes. Cystoscopies performed from June to September 2020 and from February to May 2021 in our outpatient practice were retrospectively reviewed. The 2020 cystoscopies were performed with reusable cystoscopes, and the 2021 cystoscopies were performed with disposable cystoscopes. The primary outcome was the number of post-procedural 30-day encounters defined as phone calls, patient portal messages, emergency department visits, hospitalizations, or clinic appointments related to post-procedural complications such as dysuria, hematuria, or fever. Culture-proven urinary tract infection within 30 days of cystoscopy was evaluated as a secondary outcome. We identified 1,000 cystoscopies, including 494 with disposable cystoscopes and 506 with reusable cystoscopes. Demographics were similar between groups. The most common indication for cystoscopy in both groups was suspicion of bladder cancer (disposable: 153 [30.2%] and reusable: 143 [28.9%]). Reusable cystoscopes were associated with a higher number of 30-day encounters (35 [7.1%] vs 11 [2.2%], P < .001), urine cultures (73 [14.8%] vs 3 [0.6%], P = .005), and hospitalizations attributable to cystoscopy (1 [0.2%] vs 0 [0%], P < .001) than the disposable scope group. Positive urine cultures were also significantly more likely after cystoscopy with a reusable cystoscope (17 [3.4%] vs 1 [0.2%], P < .001). Disposable cystoscopes were associated with a lower number of post-procedure encounters and positive urine cultures compared to reusable cystoscopes.

MP52-04 PATIENT'S EXPERIENCE AND SATISFACTION WITH INTRAVESICAL GENTAMICIN IRRIGATIONS

You have accessJournal of UrologyCME1 Apr 2023MP52-04 PATIENT'S EXPERIENCE AND SATISFACTION WITH INTRAVESICAL GENTAMICIN IRRIGATIONS Patricia Maymi-Castrodad, Connie Pines, Martin Forchhmeimer, Denise Tate, and Anne Cameron Patricia Maymi-CastrodadPatricia Maymi-Castrodad More articles by this author , Connie PinesConnie Pines More articles by this author , Martin ForchhmeimerMartin Forchhmeimer More articles by this author , Denise TateDenise Tate More articles by this author , and Anne CameronAnne Cameron More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.04AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Gentamicin bladder instillations have been shown to decrease urinary tract infections (UTI) in patients with neurogenic lower urinary tract dysfunction (NLUTD) on intermittent self-catheterization (ISC). Even with proven clinical efficacy of gentamicin irrigation, patient’s experience has not been studied. We aim to assess patient’s experience and satisfaction with intravesical gentamicin irrigations in patient with NGLUTD with refractory recurrent urinary tract infections. METHODS: An interview study of patients who tried gentamicin bladder instillations either presently or in the past. Eligibility was patients with NGLUTD performing CIC and recurrent UTIs (3 culture proven UTI in a year requiring antibiotics). We conducted interviews focusing on patient’s UTI history, bladder health, use of gentamycin, and validated questionnaire Neurogenic Bladder Symptom Scale (NBSS), Spinal Cord Injury Quality of Life (SCI-QOL) Bladder complications, management difficulties, and Patient- Reported Outcome Measurement (PROMIS) Global Health Scale. RESULTS: 36 patients met the inclusion criteria; 56.4% were male and 92.3% White, median age of 61 years (range 33-77). Etiology of NGLUTD were Spinal Cord Injury (71.8%), Spina Bifida (5.1%), Multiple Sclerosis (10.3%), and Transverse Myelitis (2.6%). Only 5.6% had undergone bladder surgery. 77.8% reported still doing gentamicin flushes, with 78.6% very satisfied with the experience. The median number of documented UTI prior to starting irrigations was 3 (range 2-6.5) and the number of documented UTI during the 12 months after was 0 (range 0-1). Reasons for stopping irrigations included difficulty conducting the flushes (12.5%), insurance or other financial reasons (25.0%) or recurrent UTIs (62.5%). The NBSS showed 63.9% of participants when experiencing UTIs can be treated at home with antibiotics and 22.2% required hospital admission. The SCI-QOL showed 83.3% of patient are not limited in their daily activities as a result of their UTIs. The PROMIS showed 44.4 % would rate their QOL as good, 25.0% as very good, and 11.1% as Excellent. CONCLUSIONS: Gentamycin instillations reduce the incidence of UTI in NGLUTD patients performing CIC. Participants reported satisfaction and good QoL when not having UTIs with the use of intravesical gentamicin instillations. Education on technique for the installations and insurance or financial coverage in this population may improve patient’s compliance to maintain reduce risk of UTI. Source of Funding: National Institute of Independent Living and Disability Research © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e703 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Patricia Maymi-Castrodad More articles by this author Connie Pines More articles by this author Martin Forchhmeimer More articles by this author Denise Tate More articles by this author Anne Cameron More articles by this author Expand All Advertisement PDF downloadLoading ...

Community-Acquired Urinary Tract Infection Among Sexually Active Women: Risk Factors, Bacterial Profile and Their Antimicrobial Susceptibility Patterns, Arba Minch, Southern Ethiopia

Globally, urinary tract infections (UTIs) are a common health issue among women. Investigating risk factors associated with culture-proven UTIs and the antimicrobial resistance profile of uropathogens would provide insight into planning prevention and control measures. To identify the risk factors associated with UTIs among sexually active women and determine antimicrobial susceptibility patterns of uropathogenic bacterial isolates. A case-control study was conducted from February to June 2021, involving 296 women (62 case group and 234 control group in a ratio of 4:1). Cases were defined as culture-confirmed UTIs, and controls were non-UTIs. A semi-structured questionnaire was used to collect demographic, clinical, and behavioral data. The antimicrobial susceptibility test was done by the Kirby-Bauer disc diffusion method. The data were analyzed using SPSS version 25. Bivariable and multivariable logistic regressions were used to identify risk factors, and the strength of association was measured by adjusted odds ratios and a 95% confidence interval used at P-values < 0.05. The results revealed that recent coitus and frequency of coitus more than three times per week (P=0.001) were independent predictors of UTIs. Swabbing from back to front, a history of UTI and a delay in voiding were also independent predictors (P < 0.05). On the other hand, a daily water intake of 1 to 2 litres reduced the risk of UTI (P= 0.001). The predominant uropathogenic isolate was Escherichia coli (35.48%). Over 60% of isolates were resistant to cotrimoxazole, penicillin, cephalosporin, and fluoroquinolones. The most effective antibiotics included piperacillin-tazobactam, aminoglycosides, carbapenem, and nitrofurantoin. 85% and 50% of isolates were MDR and ESBL producers, respectively. The finding indicates the importance of public intervention targeting the identified risk factors and the resistance phenotype to reduce the burden of UTIs with antimicrobial resistance in the study area.

Operative vaginal delivery as an independent risk factor for maternal postpartum infectious morbidity

A recent study from the United Kingdom suggested that a single dosage of adjunctive amoxicillin/clavulanic acid with operative vaginal delivery reduces maternal infectious morbidity by 40% (from 19% to 11%). However, 89% of their study population received an episiotomy. This study aimed to evaluate whether operative vaginal delivery is an independent risk factor for composite maternal postpartum infectious morbidity in a population with a low episiotomy rate. This was a retrospective cohort study of patients with viable singleton vaginal deliveries after ≥34 weeks gestation at a single perinatal center (2013-2018). The patients were categorized by the mode of delivery: spontaneous vaginal delivery or operative vaginal delivery (forceps or vacuum-assisted). The primary outcome was a composite of maternal infectious morbidity up to 6 weeks after delivery, defined as (1) endometritis, (2) perineal wound morbidity (infection, breakdown, or dehiscence), or (3) culture-proven urinary tract infection. The patient characteristics and outcomes were compared between the groups using appropriate tests. Multivariable models were used to estimate the association between operative vaginal delivery and study outcomes compared with spontaneous vaginal delivery, with adjustment for selected confounders. Of 14,647 deliveries meeting the inclusion criteria, 732 (5.0%) were operative vaginal deliveries: 354 (48%) forceps and 378 (52%) vacuums. Overall, 210 (1.4%) patients developed the morbidity composite. Patients having an operative vaginal delivery were more likely to be nulliparous, have labor inductions, develop intrapartum chorioamnionitis, receive an episiotomy, and sustain a third- or fourth-degree laceration. After adjusting for confounding factors, no significant association was observed between operative vaginal delivery and composite morbidity (adjusted odds ratio, 1.4 [0.8-2.4]) or any of its individual components. Administration of postpartum antibiotics and documented fever were also similar between groups. There was also no significant association between instrument (forceps vs vacuum) and the maternal infection composite. In this single-center US cohort, operative vaginal delivery was not an independent risk factor for maternal composite postpartum infectious morbidity.

Commensal Urinary Lactobacilli Inhibit Major Uropathogens In Vitro With Heterogeneity at Species and Strain Level.

The human urinary microbiome is thought to affect the development and progression of urinary tract infections (UTI), particularly recurrent UTIs in aging populations of women. To understand the possible interactions of urinary pathogens with commensal bacteria inhabiting the aging bladder, we conducted an initial functional assessment of a representative set of urinary lactobacilli that dominate this niche in postmenopausal women. We created a repository of urinary bladder bacteria isolated via Enhanced Quantitative Urinary Culture (EQUC) from healthy postmenopausal women, as well as those with a culture-proven recurrent UTI (rUTI) diagnosis. This repository contains lactobacilli strains from eight different species. As many other lactobacilli are known to inhibit human pathogens, we hypothesized that some urinary lactobacilli will have similar abilities to inhibit the growth of typical uropathogens and thus, provide a link between the urinary microbiome and the predisposition to the rUTI. Therefore, we screened the urinary lactobacilli in our repository for their ability to inhibit model uropathogens in vitro. We observed that many urinary isolates strongly inhibit model strains of gram-negative Escherichia coli and Klebsiella pneumoniae but demonstrate less inhibition of gram-positive Enterococcus faecalis. The observed inhibition affected model strains of uropathogens as well as clinical and multidrug-resistant isolates of those species. Our preliminary analysis of inhibition modes suggests a combination of pH-dependent and cell-dependent inhibition. Overall, inhibition strongly varies among species and strains of urinary lactobacilli. While the strength of the inhibition is not predictive of health outcomes in this limited repository, there is a high level of species and strain diversity that warrants future detailed investigations.

The Association Between Vitamin D and Urinary Tract Infection in Children: A Case-Control Study.

Background and objectiveUrinary tract infection (UTI) is one of the common causes of febrile illness in young children. Vitamin D influences the levels of endogenous cathelicidin, an antimicrobial peptide, which improves bladder wall immunity and prevents UTIs. In light of this, we conducted this study to determine the association between vitamin D deficiency and UTIs in children and to identify whether vitamin D deficiency is one of the risk factors for UTIs.Materials and methodsThis was a case-control study of children aged between one to five years. Eighty-two children with the first episode of febrile culture-proven UTI as cases and 82 healthy children as a control group were included in this study. The sera were analyzed for 25-hydroxy vitamin D levels and classified as vitamin-D deficient if their level was below 30 ng/mL. Descriptive statistics were presented as numbers and percentages. Continuous data were expressed as means and standard deviations (SD). Pearson's chi-square test was used to test the significance of the differences in variables between the two groups. Multiple logistic regression equation methods were used to predict the relationship between the dependent and independent variables.ResultsThe mean age of the study and the control group was 2.36 ±1.42 years and 2.57 ±1.26 years, respectively. The mean serum 25-hydroxy vitamin D levels in the patients and controls were 24.27 ±9.70 ng/mL and 31.97 ±10.7 ng/mL (p<0.001), respectively. Vitamin D deficiency was present in 34 (41.5%) patients and 10 (2.2%) in the control group (p<0.001).ConclusionBased on our findings, vitamin D deficiency might be one of the risk factors for UTIs in children. Vitamin D deficiency is significantly associated with febrile UTIs in children between one to five years of age.

"Parenteral" Diarrhea Associated With Pediatric Urinary Tract Infections: A Retrospective Chart Review.

The association of noninfectious diarrhea with extraintestinal infections such as otitis media, pneumonia, or febrile urinary tract infections (UTIs) is commonly known as parenteral diarrhea. Although this association has been described for over a century and parenteral diarrhea is mentioned in current reference literature, available evidence for this association seems to be limited. The primary research question was to determine if there is an association between UTIs and reports of diarrhea. A retrospective chart review was performed using the medical records from October 1, 2017, to March 29, 2019 at our tertiary pediatric medical center. We searched for all cases of afebrile and febrile UTIs evaluated in the pediatric emergency department or admitted directly to the hospital for treatment. All children younger than 5 years were eligible for inclusion. Exclusion criteria included children with recent urological procedures, known urinary tract disease, immune suppression, sepsis, or known gastrointestinal diseases. The medical records of each of the pediatric patients with culture-positive UTIs were reviewed for reports of concurrent diarrhea or diarrhea-like illness. In addition, using a comparative quantitative design, we performed a retrospective chart review of all children younger than 5 years with 1 of 2 noninfectious chief complaints, head trauma, and extremity fractures, presenting during the same period to assess the background rate of reported diarrhea.This research project received the approval of the University of South Alabama's Institutional Review Board. A total of 236 children with a culture-positive UTI presented to our pediatric medical center from October 1, 2017 to March 29, 2019. Reports of diarrhea were documented in the medical record for 44 of the 236 UTIs (18.6%). Escherichia coli was the predominant infectious agent in 32 of the 44 children (72.7%) with culture-positive UTIs and diarrhea. Of the 368 comparison group patients who visited the pediatric emergency department for a noninfectious complaint, diarrhea was reported in 2 patients (0.01%). Our retrospective review of pediatric patients younger than 5 years with culture-proven UTIs found an association of reported diarrhea. It is our opinion based on our single-center retrospective chart review that the current available evidence suggests an association between UTIs and extraintestinal diarrhea. Future prospective studies are recommended to confirm this association.

“i’m not going home with a catheter”: patient-centered outcomes associated with peri-operative intermittent catheterization

Impaired bladder emptying after surgery is often managed with an indwelling catheter, which can be a source of dissatisfaction, infection, and burden. Intermittent straight catheterization (ISC) is an alternative, though it is less well studied. This study describes patient satisfaction and outcomes associated with planned ISC after outpatient pelvic reconstructive surgery. This was an ancillary analysis of a prospective cohort study at an academic tertiary referral center from September 2018-June 2021. Participants completed pre-operative ISC teaching that included an instructional video (SGS; A Guide to Female Clean Intermittent Catheterization, 6:20 minutes), 1:1 teaching with an RN or MD, and provision of ISC supplies. After surgery, participants were instructed to ISC until they had 2 consecutive outpatient PVRs < ½ voided volume. Demographic information was self-reported, clinical information was abstracted from the medical record, and patient satisfaction was assessed 2 weeks post-procedure. For the 158 participants, mean age was 51.9 ±11.3 years, mean BMI was 28.9 ±5.8 kg/m2, with 140/155 (90.3%) identifying as white and 18/155 (11.6%) as Hispanic. Average provider time-investment in ISC teaching was 9.8 ±5.6 minutes. Providers performing ISC teaching subjectively noted “some” difficulty with ISC for 21/158 (13.3%) participants, “minimal” difficulty for 15/158 (9.5%), and “no” difficulty for 122/158 (77.2%). Mean time from ISC teaching to surgery was 16.3 ±15.6 days. Mean duration of surgery was 43.4 ±28.3 minutes. The average number of outpatient ISCs was 4.9 ±5.7. Median time to achievement of 2 PVRs < ½ voided volume was 6.3 hours (95% CI 5.8–8.6). One-hundred forty-one participants (141/158, 89.2%) performed ≥1 ISC post-operatively, with difficulties noted in Table 1. Most participants reported satisfaction on 2-week follow-up (Figures 1 and 2). Difficulty performing ISC was not associated with time since ISC teaching (p=0.29) or difficulty noted at ISC teaching by the provider (p=0.25). On multiple logistic regression, age, BMI, and prolapse beyond the hymen did not predict difficulty learning or performing ISC. Between ISC teaching and 6 weeks post-procedure, 23/158 (14.6%) participants endorsed symptoms of a urinary tract infection (UTI), 16/158 (10.1%) had a culture-proven UTI, 2/16 (12.5%) of which were diagnosed pre-operatively. Some women undergoing pelvic reconstructive surgery report ease and satisfaction with ISC. This was not limited by age, BMI, prolapse stage, or provider-perceived difficulty learning ISC.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Factors Associated with Ureteral Stent Failure in Patients with Malignant Ureteral Obstruction.

Introduction: Management of malignant ureteral obstruction (MUO) with ureteral stents remains a clinical challenge, often involving frequent stent exchanges attributable to stent failure or other urological complications. We report our institutional experience with ureteral stents for management of MUO, including analysis of clinical factors associated with stent failure. Methods: We performed a retrospective review of patients treated with indwelling ureteral stents for MUO in nonurothelial malignancies at our tertiary-care institution between 2008 and 2019. Univariate Cox proportional hazards analysis was performed to identify clinical variables associated with stent failure and stent-related complications. Stent failure was defined as need for unplanned stent exchange, placement of percutaneous nephrostomy (PCN), or tandem stents. Results: In our cohort of 78 patients, the median (range) number of stent exchanges was 2 (0-17) during a total stent dwell time of 4.3 (0.1-40.3) months. Thirty-four patients (43.6%) developed a culture-proven urinary tract infection (UTI) during stent dwell time. Thirty-five patients (44.8%) had stent failure. Twenty-two patients (28.2%) underwent unplanned stent exchanges, 23 (29.5%) required PCN after initial stent placement, and 6 (7.7%) required tandem stents. Ten (28.6%) patients with stent failure were treated with upsized stents, which led to resolution in seven patients. Stent failure occurred with 20/44 (45.4%) Percuflex™, 15/27 (55.6%) polyurethane, and 2/3 (66.7%) metal stents. In patients with ≥2 exchanges (N = 45), median time between exchanges was 4.1 (2.0-14.8) months. Bilateral stenting and history of radiation predicted UTI development. Median overall patient survival after initial stent placement was 19.9 months (95% CI 16.5-37.9 months). Conclusions: Ureteral stent failure poses a significant medical burden to patients with MUO. Better methods to minimize stent-related issues and improve patient quality of life are needed. Using a shared decision-making approach, clinicians and patients should consider PCN or tandem stents early in the management of MUO.

Chlorhexidine gluconate vs povidone-iodine vaginal antisepsis for urogynecologic surgery: a randomized controlled noninferiority trial

Although povidone-iodine (iodine) is the only Food and Drug Administration-approved vaginal antiseptic solution, there is a lack of comparative data evaluating alternatives. Chlorhexidine gluconate is readily accessible, recommended by multiple societies as an alternative for patients with iodine allergy, and preliminary data indicate that it may provide superior antisepsis. This study aimed to compare the effectiveness of chlorhexidine and iodine as presurgical vaginal antiseptic solutions in preventing the most common surgery-associated infection after gynecologic surgery, urinary tract infections. We conducted a randomized controlled noninferiority trial among women undergoing urogynecologic surgery. The primary outcome measure was symptomatic urinary tract infection within 2 weeks after surgery. The secondary outcomes included culture-proven urinary tract infection at 2 and 6 weeks after surgery, symptomatic urinary tract infections at 6 weeks after surgery, any surgical site infection at 2 weeks after surgery, and patient-reported vaginal irritation after surgery. We required 58 participants per arm to demonstrate noninferiority of chlorhexidine vs iodine (margin of relative risk of <1.5 for the upper limit of 95% confidence interval) between groups for the primary outcome. A total of 119 participants (61 in the chlorhexidine group and 58 in the iodine group) completed the primary outcome and were included in the analyses. There was no difference in the groups' demographic characteristics, medical history, operations performed, or perioperative factors. Chlorhexidine was not inferior to iodine concerning the primary outcome, symptomatic urinary tract infection at 2 weeks after surgery (10% vs 17%; relative risk, 0.6; 95% confidence interval [-∞, 1.3]). Furthermore, chlorhexidine was not inferior to iodine for the secondary urinary tract infection outcomes (culture-proven urinary tract infection at 2 and 6 weeks after surgery and symptomatic urinary tract infection at 6 weeks after surgery). Groups were similar in terms of surgical site infection (overall 3/119 [2.5%]) and presence of any vaginal irritation (4/54 [7.4%], for both groups). Chlorhexidine was not inferior to iodine for vaginal antisepsis before urogynecologic surgery concerning urinary tract infection. Given the similar postoperative urinary tract infection rates demonstrated in this study and the lack of difference in vaginal irritation, chlorhexidine seemed to be a safe and reasonable option for vaginal antisepsis before surgical procedures. Additional studies are needed to further examine surgical site infection.

PD01-01 PREVALENCE OF URINARY TRACT INFECTIONS IN WOMEN WITH INTERSTITIAL CYSTITIS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Interstitial Cystitis (PD01)1 Sep 2021PD01-01 PREVALENCE OF URINARY TRACT INFECTIONS IN WOMEN WITH INTERSTITIAL CYSTITIS Kyle Smith-Honore, Alexandra Dubinskaya, Catherine Bresee, Kai Dallas, Kamil Barbour, Jayoung Kim, Stephen Freedland, and Jennifer Anger Kyle Smith-HonoreKyle Smith-Honore More articles by this author , Alexandra DubinskayaAlexandra Dubinskaya More articles by this author , Catherine BreseeCatherine Bresee More articles by this author , Kai DallasKai Dallas More articles by this author , Kamil BarbourKamil Barbour More articles by this author , Jayoung KimJayoung Kim More articles by this author , Stephen FreedlandStephen Freedland More articles by this author , and Jennifer AngerJennifer Anger More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000001965.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Flares, or the sudden increase in symptoms, are common in patient with interstitial cystitis/bladder pain syndrome (IC/BSP). Symptoms flares often have a clinical presentation similar to urinary tract infections (UTI), with pain, frequency and urgency. However, the prevalence of culture-proven UTIs that occur in women with an IC/BPS diagnosis is not well established. METHODS: This is a retrospective study of all women carrying an ICD-9/10 code for IC/BPS (595.1/N30.10) in the VA system between October 2004–July 2016 who presented to the clinic at least once with concern for IC/BPS symptom exacerbation. Female patients older than 18 years of age were identified as having IC/BPS if they had a diagnosis code for IC/BPS. Patient demographics, visit chief complaint, urine culture collection and urine culture positivity were assessed. Associations between the patients presenting symptom, and urine culture testing and results were compared with the chi-square test. RESULTS: Overall, 469 women (1,444 total visits) were identified with 0.8 average visits per year. The most common visit chief complaint was pelvic pain (n=734, 50.8%) (Table 1). A urine culture was more likely to be collected (122 of 200, 61.0%) if dysuria was present as compared to visits were only pelvic pain was present (213 of 734, 29.0%, p<0.001 ) or neither pelvic pain nor dysuria were present (51 of 262, 19.5%, p<0.001). If a culture was sent, a complaint of dysuria only was associated with the highest rate of culture positivity (23 of 122, 18.9%, p=0.001) as compared to all other groups. CONCLUSIONS: Overall, positive cultures in women with IC/BPS flares were relatively low. A positive urine culture was most common in visits where only dysuria was present. This data thus supports carrying a higher index of suspicion of UTI if patients present in this fashion. Source of Funding: CDC © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e30-e30 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Kyle Smith-Honore More articles by this author Alexandra Dubinskaya More articles by this author Catherine Bresee More articles by this author Kai Dallas More articles by this author Kamil Barbour More articles by this author Jayoung Kim More articles by this author Stephen Freedland More articles by this author Jennifer Anger More articles by this author Expand All Advertisement Loading ...

A study to determine risk factors for renal scarring as detected by dimercaptosuccinic acid scan in children with urinary tract infection

Background: The aim of the study was to determine the risk factors for renal scarring detected by DMSA (dimercaptosuccinic acid) scan in children with culture-proven urinary tract infection (UTI).Methods: A hospital based observational case-control study was conducted from 2018 June to 2020 June in children aged between 1 month to 5 years who underwent a DMSA scan following culture-proven UTI (N=72). Of the children fulfilling the criteria, 43 had renal scarring in the DMSA scan as a case group and the remaining 29 children who had no renal scarring were taken as a control group.Results: Of the total 72 cases with culture-positive UTI, 59% of patients had renal scarring and the rest and 40% were scar negative. There was no significant difference in the renal scarring observed with respect to age in the two groups. There was significant (p&lt;0.05) the association noted between renal scarring and VUR (vesicoureteric reflux). A significant difference was observed in the renal scarring between the two groups regarding the presence of recurrent UTI (p=0.000). Although most cases (97.7%) had a fever in the DMSA positive group, this was not a significant risk factor for scarring (p&gt;0.05). In DMSA positive group, circumcision was not a significant risk factor for scarring.Conclusions: VUR and recurrent UTI were significant risk factors for renal scarring in children with culture-proven UTI as detected by DMSA scan. The other risk factors like age, sex, fever, leucocytosis and circumcision were not found to be significant.

Methenamine hippurate compared with trimethoprim for the prevention of recurrent urinary tract infections: a randomized clinical trial.

The objective was to find an alternative treatment to a low-dose antibiotic for the prevention of recurrent urinary tract infections (UTI) and to evaluate the difference in rates of reinfection within 1year when treated with methenamine hippurate for prophylaxis compared with trimethoprim. We present a non-blinded randomized trial comparing methenamine hippurate with trimethoprim for the prevention of recurrent UTI at 12months after starting treatment. Women over 18 who had at least two culture-positive UTI in the prior 6months or three in the prior year were included. Ninety-two patients met enrollment criteria and were randomized to receive daily prophylaxis with methenamine hippurate or trimethoprim for a minimum of 6months. Both intent-to-treat and per-protocol analyses if patients received the alternative drug after randomization were analyzed using Student's t test, Mann-Whitney U test, Kaplan-Meier curves, log-rank test, and a logistic and multivariate regression model. The primary outcome of this study was culture-proven UTI recurrence by 12months after initiating prophylaxis. In the intent-to-treat analysis, we found no difference between groups in recurrent UTI, with a 65% (28 out of 43) recurrence in the trimethoprim group versus 65% (28 out of 43) in the methenamine hippurate group (p= 1.00). In the per-protocol analysis, 65% (26 out of 40) versus 65% (30 out of 46) of patients had UTI recurrences in the trimethoprim group versus the methenamine hippurate group (p= 0.98). Methenamine hippurate may be an alternative for the prevention of recurrent UTI, with similar rates of recurrence and adverse effects to trimethoprim.

E.coli versus Non-E.coli Urinary Tract Infections in Children: A Study from a Large Tertiary Care Center in Saudi Arabia.

BackgroundWhile Escherichia coli (E. coli) is the most common uropathogen implicated in urinary tract infections (UTIs) in children, some studies have found that there are different characteristics between different uropathogens in children. The aim of this study was to compare E. coli and non-E. coli UTIs in children with respect to their demographic data, predisposing factors, and imaging results.MethodologyA retrospective chart review was done in children during their first admission with urine culture confirmed UTI in a tertiary care center. We divided patients into E. coli and non-E. coli groups according to urine culture results.ResultsOut of 202 children with their first admission for a culture-proven UTI, pathogens other than E. coli accounted for 24.3% of UTIs. Klebsiella pneumoniae was the most common non-E. coli pathogen, followed by Pseudomonas aeruginosa and Enterococcus species. Non-E. coli UTIs were significantly more common in male subjects, younger children, and children with a past history of UTI or who had received antibiotics prior to admission. In addition, higher rates of abnormalities on renal ultrasound and VCUG were found with non-E. coli organisms.ConclusionThere is a significant difference in demographic and imaging findings in children with non-E. coli UTIs. These findings may impact the work-up and treatment of UTIs in the pediatric population.

Baseline Characteristics, Evaluation, and Management of Women With Complaints of Recurrent Urinary Tract Infections.

The aims of this study were to determine the proportion of women presenting for recurrent urinary tract infections (UTIs) who met the diagnostic criteria (culture-proven UTI ≥3 in 1 year or ≥2 in 6 months) and to assess advanced testing utilization, preventive therapy use, and risk factors. This is a retrospective chart review of women seen as new urogynecology consults for recurrent UTI (rUTI) between April 1, 2017, and April 1, 2018, followed through April 1, 2019. Exclusion criteria included catheter use, cancer treatment within 2 years, and prior organ transplant, urinary diversion, conduit, or bladder augmentation. Of 600 women, 71% had follow-up with a median of 179 days. Urinary tract infection symptoms included frequency (50%), dysuria (46%), urgency (43%), and malodorous urine (7%). One third met the rUTI diagnostic criteria. Two hundred thirty-four (39%) underwent advanced testing, and 9% (21/234) of women who underwent advanced testing had a change in clinical care. Preventive therapy use increased after consultation (P < 0.001), with vaginal estrogen (47%) being most common. Compared with women not meeting the rUTI criteria, women meeting the rUTI criteria were more likely to be older (adjusted odds ratio [aOR], 1.03/year; 95% confidence interval [CI], 1.02-1.04), have a prior history of gynecologic cancer (aOR, 4.07; 95% CI, 1.02-16.25), or report UTI symptoms of dysuria (aOR, 2.27; 95% CI, 1.57-3.27), or malodorous urine (aOR, 2.96; 95% CI, 1.47-5.94) and, while equally likely to be receiving preventive treatment prior to consultation, were more likely after consultation (OR, 3.06; 95% CI, 2.05-4.55). Thirty-seven percent of women seen for rUTI met the diagnostic criteria. Advanced imaging rarely changed care. Education about diagnostic criteria and preventive therapy is warranted.

Twice-Daily Nitrofurantoin Administration Following Short-term Transurethral Catheterization After Pelvic Reconstructive Surgery: A Randomized Clinical Trial.

The objective of this study was to evaluate if twice-daily nitrofurantoin for 5 days after discontinuation of transurethral catheterization decreases the rate of urinary tract infection (UTI) in women with postoperative urinary retention (POUR) after pelvic reconstructive surgery. This was a double-blind, placebo-controlled, randomized trial conducted across 2 clinical sites between October 2017 and April 2019. Women with acute POUR after pelvic reconstructive surgery were included and randomized to nitrofurantoin (100 mg) or placebo twice-daily for 5 days. The primary outcome was clinically suspected UTI (defined as dysuria, frequency, and irritation in the absence of vaginal discharge) and/or culture-proven UTI (defined as greater than 105 colony forming units of a single organism) within 30 days of surgery. Secondary outcomes included evaluation of adverse events related to study medication and medication adherence. Data from 164 participants were eligible for intention-to-treat analysis (nitrofurantoin, n = 82; placebo, n = 82). There were no significant demographic or intraoperative differences except for body mass index and race. Median duration of catheterization was 3 days (interquartile range, 2-5 days, P = 0.12). Fifteen women in the nitrofurantoin group and 14 women in the placebo group experienced UTI within 30 days (18.3% vs 17.1%; P = 0.84; odds ratio, 1.09; 95% confidence interval, 0.49-2.43). There were no study medication allergies; however, nausea was the most common intolerance. Most women in each group completed the study drug treatment (91.5% vs 86.4%, P = 0.30). Nitrofurantoin prophylaxis after transurethral catheter removal did not reduce the risk of UTI in women with acute POUR after pelvic reconstructive surgery.

The incidence of transient infantile pseudohypoaldosteronism in Ireland: A prospective study.

To review the clinical course, outcome and incidence of infantile salt wasting associated with urinary tract infection (UTI) and/or urinary tract malformation (UTM) over a two-year surveillance period on the island of Ireland. A two-year (2013-14) prospective surveillance undertaken via the Irish and Ulster Paediatric Surveillance Units. Monthly prepaid postcards were circulated to consultant paediatricians (n=260) at all paediatric units on the island of Ireland. Infants under one year of age presenting for the first time with hyponatraemia (Na<130mmol/L) and/or hyperkalaemia (K>5.0mmol/L) associated with urosepsis/UTM were reported. All 7 reported patients (6 male) had culture-proven UTI, and 5 (71%) also had an underlying UTM (one diagnosed antenatally). Four (57%) patients had a documented elevated serum aldosterone supporting secondary pseudohypoaldosteronism (PHA) as the underlying diagnosis. Data on aldosterone were not reported in the other 3 patients, but clinical features were suggestive of secondary PHA. The estimated incidence for the Irish population of transient PHA is 1 per 13,200 total live births per year. Salt wasting is a rare complication of UTI, especially if associated with underlying UTM. Boys appear to be at particular risk.

764 Operative vaginal delivery as an independent risk factor for maternal postpartum infection

Recent studies suggest prophylactic antibiotics are effective in reducing maternal postpartum (PP) infection following operative vaginal delivery (OVD). There is limited data in the US, where episiotomy and laceration repair practices may differ, affecting the risk of PP infection after OVD. We sought to evaluate whether OVD is an independent risk factor for maternal PP infection. Retrospective cohort study of all singleton vaginal deliveries >34 weeks’ gestation at a single perinatal center (2013-2018). Women were categorized by mode of delivery: spontaneous vaginal delivery (SVD) or OVD (forceps/vacuum assisted). The primary outcome was a composite of confirmed or suspected maternal infection up to 6 weeks after delivery defined as: (1) endometritis (CDC definition), (2) perineal wound morbidity (infection or breakdown) or (3) culture proven urinary tract infection. Outcomes were compared between groups; multivariable generalized estimating equations were used to estimate the adjusted odds ratios (95% CI) with SVD as the reference group. Of 14,646 deliveries meeting inclusion criteria, 732 (5%) were OVDs. The overall composite rate was 1.4%. Women undergoing an OVD were more likely to be nulliparous, undergo labor induction, develop chorioamnionitis, have an episiotomy, and sustain a 3rd/4th degree laceration (Table 1). After controlling for these known confounders, there was no difference in composite infection following OVD compared to SVD (aOR 1.28 [0.73-2.23]) or any of its individual components (Table 2). There were no differences in receipt of PP antibiotics or PP fever. We considered the individual contribution of forceps (p=0.20) vs vacuum (p=0.95) on the adjusted odds of the composite outcome, which indicated no differences by instrument. Accounting for risk factors associated with PP infection and the need for OVD, OVD itself does not appear to be an independent risk factor for maternal PP infection in our population. Routine use of prophylactic antibiotics with OVD may not be warranted based on contemporary 2nd stage labor management patterns in the US.View Large Image Figure ViewerDownload Hi-res image Download (PPT)