Cystitis Patients Research Articles

Antibiotic prescribing for acute uncomplicated cystitis among community pharmacists in Thailand.

This study aimed to evaluate the knowledge of community pharmacists toward acute uncomplicated cystitis regarding diagnosis, referral, and conformity to guidelines of the chosen antibiotic and to identify the associated factors with the pharmacist's knowledge. This was a descriptive cross-sectional survey using a questionnaire. Data was collected from 349 community pharmacies in upper southern Thailand between December 2021 and February 2022. Univariate logistic regression analysis was used to assess factors associated with an inappropriate diagnosis of acute uncomplicated cystitis. The variables with P-value < 0.2 were included in the multivariate model. The statistically significant level was set as P-value < 0.05. Three hundred and forty-nine pharmacists from 349 community pharmacies were included. Approximately 65% and 69% of the participants had the knowledge to identify which patients should be considered for cystitis and which patients should be considered for acute uncomplicated cystitis. Ninety eight percentage of pharmacists could select the appropriate antibiotic for uncomplicated cystitis patients. The most prescribed antibiotics were ciprofloxacin (44.7%), norfloxacin (40.7%), and ofloxacin (10.3%). Inappropriate diagnosis was significantly related to age (P = 0.016) and role in the community pharmacy (P = 0.033). The majority of participants had misconceptions about the differential diagnosis between complicated and uncomplicated cystitis. These were related to the community pharmacists' advanced age. Continuous pharmacy education should be established to advocate rational antibiotic use, especially in a country where community pharmacists are legally allowed to dispense antimicrobials without a prescription.

CN95 A novel nomogram based on inflammation biomarkers for predicting radiation cystitis in patients with local advanced cervical cancer

CN95 A novel nomogram based on inflammation biomarkers for predicting radiation cystitis in patients with local advanced cervical cancer

Choline Phosphate-Grafted Nanozymes as Universal Extracellular Vesicle Probes for Bladder Cancer Detection.

Urinary extracellular vesicles (uEVs) are regarded as highly promising liquid-biopsy biomarkers for the early diagnosis and prognosis of bladder cancer (BC). However, detection of uEVs remains technically challenging owing to their huge heterogeneity and ultralow abundance in real samples. We herein present a choline phosphate-grafted platinum nanozyme (Pt@CP) that acts as a universal EV probe for the construction of a high-throughput and high-sensitivity immunoassay, which allowed multiplex profiling of uEV protein markers for BC detection. With the Pt@CP-based immunoassays, three uEV protein markers (MUC-1, CCDC25, and GLUT1) were identified for BC, by which the BC cases (n = 48), cystitis patients (n = 27), and healthy donors (n = 24) were discriminated with high clinical sensitivity and specificity (area under curve = 98.3%). For the BC cases (n = 9) after surgery, the Pt@CP-based immunoassay could report the postoperative residual tumor that cannot be observed by cystoscopy, which is clinically significant for assessing BC recurrence. This work provides generally high sensitivity for EV detection, facilitating the discovery and clinical use of EV-based biomarkers.

A novel nomogram based on inflammation biomarkers for predicting radiation cystitis in patients with local advanced cervical cancer.

Platelet-to-albumin ratio (PAR) is a new systemic inflammatory prognostic indicator associated with many inflammatory diseases. However, its role in radiation cystitis (RC) is obscure. This study aimed to explore whether PAR could be used as an effective parameter for predicting the RC risk in local advanced cervical cancer (CC) treated with radiotherapy. A total of 319 local advanced CC patients who received radical radiotherapy at Fujian Cancer Hospital were enrolled between December 2018 and January 2021. Demographics and clinical parameters were retrospectively analyzed. Univariate and multivariate analyses were used to identify the risk factors for RC. Backward and stepwise regression was applied to construct two monograms-one with primary significant factors and the other with extra inflammatory biomarkers. A DeLong test was applied to compare the prediction abilities of two nomograms. Calibration curves and decision curve analysis (DCA) evaluated its prediction consistency, discrimination ability, and clinical net benefit. Univariate analysis showed that age, tumor size, stage, total radiation dose, pelvic radiation dose, Systemic Immune-Inflammation Index (SII), platelet-to-lymphocyte ratio (PLR), and PAR were significantly associated with RC occurrence (all p < 0.05). Multivariate analyses indicated that age, tumor size, stage, total radiation dose, and PAR were independent factors (all p < 0.05). Then, the area under curve (AUC) value of the nomogramSII+PAR was higher (AUC = 0.774) compared to that of the baseline nomogram (AUC = 0.726) (pDelong = 0.02). Also, the five-cross validation confirmed the stability of the nomogramSII+PAR. Moreover, the calibration curve and DCA exhibited the nomograms' good prediction consistency and clinical practicability. PAR and SII could be valued for CC patients who are treated with radiation therapy. The nomogram based on PAR and SII could stratify patients who need extra intervention and nursing care to prevent bladder radiation damage and improve patients' quality of life.

Qualitative study on shared decision making in cystitis management in general practice.

Cystitis is commonly treated with antibiotics, although non-antibiotic options could be considered for healthy non-pregnant women. Shared decision making (SDM) can be used in cystitis management to discuss the various treatment options but is not frequently applied in general practice. To identify barriers and facilitators for applying SDM in cystitis management in general practice. Qualitative explorative research in general practice with healthcare professionals (HCPs; GPs and GP assistants) and healthy non-pregnant women with a recent history of cystitis (patients). Individual semi-structured interviews were conducted between May and October 2022. We applied a combination of thematic and framework analysis. Ten GPs, seven GP assistants, and 15 patients were interviewed. We identified the following three main barriers and one key facilitator: (1) applying SDM is deemed inefficient; (2) HCPs assume that patients expect antibiotic treatment and some HCPs consider non-antibiotic treatment inferior; (3) patients are largely unaware of the various non-antibiotic treatment options for cystitis; and (4) HCPs recognise some benefits of applying SDM in cystitis management, including reduced antibiotic use and improved patient empowerment, and patients appreciate involvement in treatment decisions, but preferences for SDM vary. SDM is infrequently applied in cystitis treatment in general practice owing to the current focus on efficient cystitis management that omits patient contact, HCPs' perceptions, and patient unawareness. Nevertheless, both HCPs and patients recognise the long-term benefits of applying SDM in cystitis management. Our findings facilitate the development of tailored interventions to increase the application of SDM, which should be co-created with HCPs and patients, and fit into the current efficient cystitis management.

Radiation cystitis in acute admissions for haematuria.

To assess the outcomes of patients with haematuria from radiation cystitis admitted to Christchurch Hospital's Urology Service and identify treatment differences and hospitalisation trends. From November 2021 to January 2023, a retrospective analysis of 144 acute haematuria admissions was conducted. Data covered demographics, diagnosis, surgeries, complications and hospital stay length. Predictive factors for admissions and surgical interventions were explored. Of the 144 admissions, 22 (15.3%) were diagnosed with radiation cystitis. The management strategies for radiation cystitis and non-radiation cystitis patients showed no significant differences in transfusion requirements, anti-bleeding medication usage (finasteride and/or tranexamic acid), or the need for acute or elective surgery. The average length of stay for admission was similar between the groups (radiation cystitis: 3.7 days, non-radiation cystitis: 3.5 days, p<0.05), but the readmission rate was significantly higher for radiation cystitis patients (59.1% vs 25.4%, p<0.01). The management and hospital stay duration were similar for both cohorts; radiation cystitis patients faced increased readmissions, underscoring the necessity for rigorous monitoring and subsequent care. Upcoming research should target refining early interventions and management methods.

Investigation of Genes Encoding Siderophores in Escherichia coli Isolated from Cystitis Patients

Pathogenic bacteria represented a challenge in acquiring iron as it is typically bound to heme or by proteins like transferrin or lactoferrin in the body, to overcome this challenge, uropathogenic Escherichia.coli uses various strategies to capture iron, with siderophores being one of these strategies. Therefore, in this study aimed to identify the specific gene types (iucA, iroN and irp2) responsible for siderophore production in uropathogenic E.coli in the presence of FeSO4. And potential implications for understanding the role of siderophores in cystitis. A total of 300 urine samples were collected from patients with signs and symptoms of UTIs. The boiling method was used for DNA extraction, followed by the analysis of the presence of 3 siderophore genes using PCR. FeSO4 preparation performed using serial dilution method to prepare solution known concentration (10-1, 10-2, 10-3, 10-4, and 10-5), Iron sulfate was prepared and tested on EMB medium, the bacteria were cultured by spreading method and impregnated fitter paper, and bacterial growth was measured using a colony counter instrument. A total of 45 isolates of E.coli are recovered from (300) patients suffering from UTIs. Based on the results, it was found that 26 out of the 45 bacterial isolates contained the irp2 gene, while 5 isolates contained the iroN gene. While the third gene, iucA, was not present in any of the bacterial isolates. Additionally, the data showed in the presence of FeSO4 at concentrations of 10-4 showed a more prominent effect in increasing bacterial growth rate, however, cultures supplemented with iron at concentrations of 10-3 and 10-5 showed moderate growth and low growth at concentration 10-2, while a concentration of 10-1 had an inhibitory effect on growth of the E.coli. A set of 45 urine sample of E.coli isolated from outpatient in Al- Najaf center, it was found that the irp2 gene is one of the most prevalent genes in bacterial isolates, indicating its importance as a virulence factor in UTIs caused by E.coli. I found this study as well, the concentration of FeSo4 plays a significant role in its impact on the growth rate and gene expression of E.coli.

Gut microbiota and interstitial cystitis: exploring the gut-bladder axis through mendelian randomization, biological annotation and bulk RNA sequencing.

Several observational studies have indicated an association between interstitial cystitis and the composition of the gut microbiota; however, the causality and underlying mechanisms remain unclear. Understanding the link between gut microbiota and interstitial cystitis could inform strategies for prevention and treatment. A two-sample Mendelian randomization analysis was conducted using published genome-wide association study summary statistics. We employed inverse variance weighted, weighted mode, MR-Egger, weighted median, simple mode, and cML-MA methods to investigate the causal relationship between gut microbiota and interstitial cystitis. Sensitivity analysis was performed to validate the results. Relevant gut microbiota was examined through reverse MR. Single nucleotide polymorphisms were annotated using FUMA to identify genes associated with these genetic variants, thereby revealing potential host gene-microbiota associations in interstitial cystitis patients. Eight bacterial taxa were identified in our analysis as associated with interstitial cystitis. Among these, Butyricimonas, Coprococcus, Lactobacillales, Lentisphaerae, and Bilophila wadsworthia were positively correlated with interstitial cystitis risk, while taxa such as Desulfovibrio piger, Oscillibacter unclassified and Ruminococcus lactaris exhibited protective effects against interstitial cystitis. The robustness of these associations was confirmed through sensitivity analyses. Reverse MR analysis did not reveal evidence of reverse causality. Single nucleotide polymorphisms were annotated using FUMA and subjected to biological analysis. Seven hub genes (SPTBN1, PSME4, CHAC2, ERLEC1, ASB3, STAT5A, and STAT3) were identified as differentially expressed between interstitial cystitis patients and healthy individuals, representing potential therapeutic targets. Our two-sample Mendelian randomization study established a causal relationship between gut microbiota and interstitial cystitis. Furthermore, our identification of a host gene-microbiota association offers a new avenue for investigating the potential pathogenesis of interstitial cystitis and suggests avenues for the development of personalized treatment strategies.

2820. Clinical Outcomes in Patients Who Receive a One-Time Aminoglycoside Dose for ESBL Enterobacterales or Pseudomonas aeruginosa cystitis

Abstract Background Extended spectrum beta lactamase (ESBL) Enterobacterales and Pseudomonas aeruginosa can be highly resistant organisms resulting in prolonged hospitalizations or the requirement of outpatient parenteral antibiotics. The Infectious Disease Society of America recommends a single dose of an aminoglycoside for uncomplicated cystitis caused by ESBL Enterobacterales and difficult to treat Pseudomonas aeruginosa. However, there is very little recent clinical evidence to support this recommendation. At our institution, we extrapolate this data to complicated cystitis and recommend a one-time aminoglycoside dose following about 3 days of effective therapy to help facilitate completion of antibiotic therapy and/or discharge. The objective of this study was to evaluate the safety and efficacy of a single-dose aminoglycoside for cystitis caused by ESBL Enterobacterales or Pseudomonas aeruginosa. Methods This was a multicenter, retrospective, cohort study. Adult patients treated for cystitis with ESBL Enterobacterales or Pseudomonas aeruginosa from January 2020 to December 2022 were identified for analysis, and data was obtained from electronic health records. Patients who received ≥ 3 days of standard of care were compared to patients who received a one-time dose of an aminoglycoside with or without a short course of effective therapy before. The primary outcome of this study was rate of relapse, and secondary outcomes included readmission rates, length of stay, and safety. Results A total of 66 patients were included in the study, with 33 patients in each study arm. The study populations were comparable except there were more males and complicated cystitis patients in the standard of care group. There was no difference found in the rate of relapse. The length of stay was significantly different between the two groups (4.5 ± 4.4 days in the aminoglycoside group vs 14.1 ± 10.1 days in the standard of care group, p &amp;lt; 0.0001). No difference was found between the groups for readmission or safety. Conclusion A one-time dose of an aminoglycoside did not increase risk of relapse and was associated with shorter length of stay when used to treat cystitis caused by ESBL Enterobacterales or Pseudomonas aeruginosa. Disclosures All Authors: No reported disclosures

Evaluating the Effectiveness of Combination Antibiotic Therapy for Recurrent Cystitis in Women

Background: Investigating the Effectiveness of Combined Antibiotic Therapy for Recurrent Cystitis in Females. A study was conducted on twenty women with recurrent cystitis who received combination antibiotic therapy. The primary outcome measure for cystitis was the absence of all clinical and laboratory indicators of infection. The secondary objective was to assess symptom improvement related to cystitis. The findings revealed that, after using the combination antibiotic medication, cystitis symptoms disappeared completely in 18 out of the 20 women (90%), while 2 women (10%) experienced symptom improvement. According to these results, combination antibiotic therapy seems safe and effective for women with recurrent cystitis. Objective: The primary aim of this study was to evaluate the curative effects of combination antibiotic therapy in female repetitive cystitis (RC) patients who presented at the Main Gul Jehanzeb Hospital, Swat, during January 2018 and January 2019. Secondarily, we wanted to find out how well combination antibiotic therapy worked for female RC patients. Study Design: A retrospective study Duration and place of study: Main Gul Jehanzeb Hospital, Swat, from January 2018 to January 2019. Methods: A retrospective study of combination antibiotic therapy for curing recurrent cystitis in female patients was carried out at the Main Gul Jehanzeb Hospital, Swat, Pakistan. All women aged between 18 and 50 years who had a history of repeated cystitis, if they received medical treatment in the hospital's outpatient department during research periods and are outpatients now for one research visit, were included on this study. The drug cooperation mode of general practice co-operation network was used, while the principle of vaccination prevention was implemented to everyone for education against sexually transmitted diseases. In the clinic, clinical and laboratory diagnostics were utilized to make a comprehensive diagnosis and all cases were gave a standard questionnaire designed by research personnel. Phase 1 and Phase 2 of treatment: After a comprehensive medical history appraisal and physical examination, each patient received specific combination antibiotic therapy according to her diagnosis. The main purpose of our study was to obtain complete symptomatic remission of cystitis, as gauged by the absence of any clinical or laboratory evidence of infection. Additionally, a secondary object was to alleviate cystitis symptoms, or allay them to some extent. Results: In this study, 20 females who had RC were included. After receiving a combination of antibiotics, 18 of them (90%) had their cystitis symptoms completely eliminated, and the other 2 (10%) only had milder symptoms. Conclusion: This study has demonstrated that combined antibiotic therapy is safe and effective as a treatment for female recurrent cystitis. In recurrent cystitis, most women obtain relief from their symptoms using mixed antibiotics. Keywords:Recurrent Cystitis, Combination Antibiotic Therapy, Women

Distinguishing Bladder Cancer from Cystitis Patients Using Deep Learning

Urinary tract cancers are considered life-threatening conditions worldwide, and Bladder Cancer is one of the most malignant urinary tract tumors, with an estimated number of more than 1.3 million cases worldwide each year. Bladder Cancer is a heterogeneous disease; the main symptom is painless hematuria. However, patients with Bladder Cancer may initially be misdiagnosed as Cystitis or infection, and cystoscopy alone may sometimes be misdiagnosed as urolithiasis or Cystitis, thereby delaying medical attention. Early diagnosis of Bladder Cancer is the key to successful treatment. This study uses six deep learning methods through different oversampling techniques and feature selection, and then through dimensionality reduction techniques, to establish a set that can effectively distinguish between Bladder Cancer and Cystitis patient’s deep learning model. The research results show that based on the laboratory clinical dataset, the deep learning model proposed in this study has an accuracy rate of 89.03% in distinguishing between Bladder Cancer and Cystitis, surpassing the results of previous studies. The research model developed in this study can be provided to clinicians as a reference to differentiate between Bladder Cancer and Cystitis.

Efficacy and safety analysis of umbilical cord blood combined with haploid hematopoietic stem cell transplantation in the treatment of malignant hematological malignancies

Objective: To investigate the efficacy and safety of umbilical cord blood combined with haploid HSCT (haplo-cord HSCT) in the treatment of hematological malignancies. Methods: The data of 82 patients with hematologic malignancies who received haplo-cord HSCT from January 2017 to June 2021 in the Affiliated Cancer Hospital of Zhengzhou University were retrospectively analyzed. There were 52 male and 30 female patients, aged [M(Q1, Q3)] 29 (20, 41) years. All patients received myeloablative preconditioning regimen. The day of the donor stem cell infusion was recorded as day 0 (0 d), the day before the infusion was recorded as day-1 (-1 d), and the day after the infusion was recorded as day+1 (+1 d), and so on. Eighty-two patients received transfusion of peripheral blood and/or bone marrow stem cells from unrelated cord blood and haplotype donors after the myeloablative preconditioning regimen. The graft-versus-host disease (GVHD) prophylaxis regimen was 8 mg/kg ATG combined with cyclosporine, morte-macrolide, and methotrexate. Patients were evaluated for implantation and the occurrence of transplant-related complications such as GVHD, infection, hemorrhagic cystitis, and long-term patient survival. Results: The time of neutrophil engraftment [M(Q1, Q3)] was 13 (11, 15) days and 15 (13, 21) days for platelet. The 30-day cumulative incidence of neutrophil engraftment was 98.8% (81/82) and 100-day cumulative incidence of platelet engraftment was 92.7% (76/82). The cumulative incidence of acute graft-versus-host disease (aGVHD) in degree Ⅱ-Ⅳ and Ⅲ-Ⅳ was 24.4% (20/82) and 6.1% (5/82), respectively. The cumulative incidence of chronic GVHD in+18 months was 13.5% (11/82). The follow-up time [M(Q1, Q3)] was 26 (13, 41) months, and the overall survival (OS) rate, event-free survival (EFS) rate, cumulative recurrence rate (CIR) and non-recurrence mortality (NRM) rate at 3 years after transplantation were 70.5% (95%CI: 59.7%-81.3%), 66.1% (95%CI: 56.1%-76.1%), 6.3% (95%CI: 5.7%-26.9%) and 20.8% (95%CI: 12.0%-29.6%), respectively. The cumulative incidence of cytomegalovirus and EBV reactivation was 37.8% (31/82) and 14.6% (12/82), respectively. The cumulative incidence of hemorrhagic cystitis was 32.9% (27/82). Conclusion: The efficacy of haplo-cord HSCT in the treatment of hematologic malignancies is reliable, with rapid hematopoietic reconstitution, low incidence of GVHD and virus reactivation.

Chapter 3: Management of kidney injury caused by cancer drug therapy, from clinical practice guidelines for the management of kidney injury during anticancer drug therapy 2022.

Cisplatin should be administered with diuretics and Magnesium supplementation under adequate hydration to avoid renal impairment. Patients should be evaluated for eGFR (estimated glomerular filtration rate) during the treatment with pemetrexed, as kidney injury has been reported. Pemetrexed should be administered with caution in patients with a CCr (creatinine clearance) < 45mL/min. Mesna is used to prevent hemorrhagic cystitis in patients receiving ifosfamide. Febuxostat is effective in avoiding hyperuricemia induced by TLS (tumor lysis syndrome). Preventative rasburicase is recommended in high-risk cases of TLS. Thrombotic microangiopathy could be triggered by anticancer drugs and there is no evidence of efficacy of plasma exchange therapy. When proteinuria occurs during treatment with anti-angiogenic agents or multi-kinase inhibitors, dose reductions or interruptions based on grading should be considered. Grade 3 proteinuria and renal dysfunction require urgent intervention, including drug interruption or withdrawal, and referral to a nephrologist should be considered. The first-line drugs used for blood pressure elevation due to anti-angiogenic agents are ACE (angiotensin-converting enzyme) inhibitors and ARBs (angiotensin receptor blockers). The protein binding of drugs and their pharmacokinetics are considerably altered in patients with hypoalbuminemia. The clearance of rituximab is increased in patients with proteinuria, and the correlation with urinary IgG suggests similar pharmacokinetic changes when using other antibody drugs. AIN (acute interstitial nephritis) is the most common cause of ICI (immune checkpoint inhibitor)-related kidney injury that is often treated with steroids. The need for renal biopsy in patients with kidney injury that occurs during treatment with ICI remains controversial.

Does renal failure worsen radiation cystitis following radical prostatectomy?

To investigate the impact of renal function on the risk, severity, and management of radiation cystitis in patients who underwent postoperative radiation therapy for prostate cancer. Retrospective data was assessed from patients treated with adjuvant/salvage radiation therapy at a single academic institution between 2006 and 2020. The incidence, severity, and management of radiation cystitis were compared between three groups: CKD 0-2, CKD 3-4, and CKD 5. Associations of clinicopathologic factors with radiation cystitis were assessed in univariate and multivariate Cox regression models. A total of 110 patients who underwent radiation therapy following robot-assisted laparoscopic radical prostatectomy were included. The incidence of radiation cystitis following postoperative radiation therapy was 17% with a median presentation time of 34months (interquartile range 16-65months). The incidence of radiation cystitis was 100% in CKD 5 patients compared to 15% in CKD 0-2 and 17% in CKD 3-4 patients (p < 0.001). CKD 5 patients required more treatments, emergency department visits, and longer hospitalization times than CKD 0-4 patients (all p < 0.001). Multivariate analyses identified CKD 5 as the only significant factor associated with radiation cystitis (HR = 10.39, p = 0.026). End-stage renal failure is associated with the risk and severity of radiation cystitis in patients receiving postoperative radiation therapy. Knowledge of the potential morbidity of this complication in this population could guide physicians and patients as they evaluate risks and benefits prior to selecting adjuvant or salvage radiation therapy.

Prevalence of AcrAB-TolC efflux pump among Proteus mirabilis isolated from cystitis patients in Hilla City, Iraq

Abstract Background: Proteus mirabilis is a prevalent profiteer pathogen that causes the Spartan human ailment. It has been identified as a urinary tract infection (UTI) etiological agent that adheres to uroepithelial cells and the catheter surface. The most important efflux system in P. mirabilis, acrAB-to1C, is elaborated not merely in antimicrobial conflict but also in ferocity. Objectives: The current research conducted to look into the antibiotic sensitivity profile and acrAB-to1C efflux pump genes occurrence among P. mirabilis isolated from UTI patients. Materials and Methods: 515 urine cases were gathered from UTI patients, who visited urology consultancy clinics of three main hospitals and private clinic labs in Hilla City, Iraq. All mid-stream urine samples were cultured on diagnostic agars for P. mirabilis primary recognition and finally confirmed by16S rRNA gene PCR-sequencing. Antibiotic sensitivity was performed according to CLSI (2021), and then PCR detection of acrAB-to1C efflux pumps genes was observed. Results: The occurrence of P. mirabilis in the studied cases was 10.5% with 100% swarming isolates. The recovered isolates were extremely resistant to cefotaxime (100%), doxycycline (88.6%), minocycline (75.7%), and amoxicillin-clavulanic acid (67.1%). In contrast, the isolates showed nonresistance to pipracillin-tazabactam (0%), meropeneme (0%) and tinier resistance to amikacine (1.4%), imipeneme (2.9%), levofloxacine (4.2), and ofloxacin (5.7%), MDR rate was 96%. Molecular investigation using PCR, revealed acrA, acrB, and tolC genes with a prevalence of 51.4%, 61.4%, and 51.4%, respectively. Conclusion: These findings emphasize the significant title role of acrAB-to1C efflux impel in increasing antibiotic tolerance in P. mirabilis with a high incidence of MDR, so the future insights may need to focus on efflux pumps inhibitor-antibiotic combination treatment as a preventive device.

Case of a Hemorrhagic Cystitis Patient Taking Antiplatelets Treated with &lt;italic&gt;Jeoryeong-tang-hap-Samul-tang&lt;/italic&gt;

Hemorrhagic cystitis refers to massive inflammation and the diffuse vesical bleeding of the bladder. In patients with hematuria complaining of dysuria and pain, it is necessary to differentiate various causes, including cystitis, nephritis, and prostatitis. After the diagnosis of hemorrhagic cystitis, antibiotics usually treat and prevent further urinary tract infections. In the present case, a 78-year-old female patient with hemorrhagic cystitis presenting with hematuria underwent Korean medical treatment with &lt;i&gt;Jeoryeong-tang-hap-Samul-tang&lt;/i&gt; for 29 days. The effect of the treatment was assessed with the hematuria grading scale (HGS) per week, urinalysis per two weeks, and the NRS (numeric rating scale) of dysuria per day. After treatment, both HGS and NRS scores decreased, and protein, blood, and red blood cells (RBCs) in urinalysis improved. This case report suggests that &lt;i&gt;Jeoryeong-tang-hap-Samul-tang&lt;/i&gt; might be an effective option for hemorrhagic cystitis patients who continuously take antiplatelets.

Interstitial cystitis caused by immune dysregulation in LRBA deficiency: one among the rare urological manifestations in inborn errors of immunity

Inborn errors of immunity (IEI) rarely present with associated urological manifestations. Chronic cystitis and urethritis caused by ureaplasma and mycoplasma infection in hypogammaglobulinemia may result in bladder fibrosis. Papovaviridae such as BK or JC, can cause hemorrhagic cystitis in patients with T cell defects. Bladder granulomtata and urethral strictures can occur in chronic granulomatous disease. This is the first reported case of severe lymphocytic interstitial cystitis in a patient with lipopolysaccharide-responsive beige-like anchor protein (LRBA) deficiency. LRBA deficiency is known to impair CTLA-4 recycling, leading to decreased Treg cell function. A 13 year old male refugee presented with chronic recurrent debilitating suprapubic pain and dysuria, which progressed to extreme urinary frequency. He had a prior history of recurrent aseptic urinary tract infections, and one episode of gross hematuria. Extensive infectious investigations of urine (bacterial, mycobacterial cultures; viral PCRs), blood, and stool (Schistosoma) failed to isolate a pathogen. Bladder biopsy was positive for EBV by PCR but blood remained EBV-negative. Urinalysis showed microscopic hematuria while urodynamic studies were normal, and cystoscopy showed bladder and urethral irritation. Pathology confirmed lymphocytic interstitial cystitis, with primarily T cell infiltration. Immunological investigations revealed low IgG, IgA and IgM levels, B lymphopenia (1%), with low class-switched memory B cell development (3%) and absent response to protein and polysaccharide vaccine antigens. There were no signs of autoimmunity. Parents are consanguineous, and a sibling was likewise diagnosed with LRBA deficiency. Sanger sequencing of DNA confirmed the same homozygous family mutation in the LRBA gene, a likely pathogenic splice donor variant, c.2258+2T>G. The patient was started on immunoglobulin replacement. Trials of analgesics including NSAIDs, gabapentin, and morphine, and immunosuppression with corticosteroids and sirolimus, were unsuccessful in reducing urinary symptoms. Physiotherapy and antispasmodics were introduced when pelvic-floor dyssynergia with rectal pain developed. Subsequently-presenting enteropathy was managed with Abatacept (CTLA-4 IgG1 fusion protein), ultimately improving bladder symptoms after several months of therapy. Patient has since undergone HSCT and is now free of urinary tract symptoms. LRBA deficiency presents with hypogammaglobulinemia, infections, and immune dysregulation presenting with lymphocytic infiltration of non-lymphoid organs. This report highlights the phenotypic diversity of this disease.

Evasion of toll-like receptor recognition by Escherichia coli is mediated via population level regulation of flagellin production.

Uropathogenic Escherichia coli is a major cause of urinary tract infections. Analysis of the innate immune response in immortalized urothelial cells suggests that the bacterial flagellar subunit, flagellin, is key in inducing host defenses. A panel of 48 clinical uro-associated E. coli isolates recovered from either cystitis, pyelonephritis asymptomatic bacteriuria (ABU) or UTI-associated bacteraemia infections were characterized for motility and their ability to induce an innate response in urothelial cells stably transfected with a NF-κB luciferase reporter. Thirty-two isolates (67%) were identified as motile with strains recovered from cystitis patients exhibiting an uneven motility distribution pattern; seven of the cystitis isolates were associated with a > 5-fold increase in NF-κB signaling. To explore whether the NF-κB signaling response reflected antigenic variation, flagellin was purified from 14 different isolates. Purified flagellin filaments generated comparable NF-κB signaling responses, irrespective of either the source of the isolate or H-serotype. These data argued against any variability between isolates being related to flagellin itself. Investigations also argued that neither TLR4 dependent recognition of bacterial lipopolysaccharide nor growth fitness of the isolates played key roles in leading to the variable host response. To determine the roles, if any, of flagellar abundance in inducing these variable responses, flagellar hook numbers of a range of cystitis and ABU isolates were quantified. Images suggested that up to 60% of the isolate population exhibited flagella with the numbers averaging between 1 and 2 flagella per bacterial cell. These data suggest that selective pressures exist in the urinary tract that allow uro-associated E. coli strains to maintain motility, but exploit population heterogeneity, which together function to prevent host TLR5 recognition and bacterial killing.

Impact of a Multifaceted Intervention on Antibiotic Prescribing for Cystitis and Asymptomatic Bacteriuria in 23 Community Hospital Emergency Departments.

Background: Urinary tract infections (UTIs) are over-diagnosed and over-treated in the emergency department (ED) leading to unnecessary antibiotic exposure and avoidable side effects. However, data describing effective large-scale antimicrobial stewardship program (ASP) interventions to improve UTI and asymptomatic bacteriuria (ASB) management in the ED are lacking. Methods: We implemented a multifaceted intervention across 23 community hospital EDs in Utah and Idaho consisting of in-person education for ED prescribers, updated electronic order sets, and implementation/dissemination of UTI guidelines for our healthcare system. We compared ED UTI antibiotic prescribing in 2021 (post-intervention) to baseline data from 2017 (pre-intervention). The primary outcomes were the percent of cystitis patients prescribed fluoroquinolones or prolonged antibiotic durations (>7 days). Secondary outcomes included the percent of patients treated for UTI who met ASB criteria, and 14-day UTI-related readmissions. Results: There was a significant decrease in prolonged treatment duration for cystitis (29% vs 12%, P < .01) and treatment of cystitis with a fluoroquinolone (32% vs 7%, P < .01). The percent of patients treated for UTI who met ASB criteria did not change following the intervention (28% pre-intervention versus 29% post-intervention, P = .97). A subgroup analysis indicated that ASB prescriptions were highly variable by facility (range 11%-53%) and provider (range 0%-71%) and were driven by a few high prescribers. Conclusions: The intervention was associated with improved antibiotic selection and duration for cystitis, but future interventions to improve urine testing and provide individualized prescriber feedback are likely needed to improve ASB prescribing practice.

Clinical Profile of Children with Pyelonephritis and Cystitis in Dr. Soetomo General Academic Hospital, Surabaya

Highlights:1. In patients younger than one year old, cystitis was more frequent in boys. Meanwhile, in patients aged 1-5, girls were more frequent in pyelonephritis and cystitis.2. In pyelonephritis, all patients had fever, followed by diarrhea and lethargy.3. Urinary symptoms, such as dysuria and hematuria, were more frequent in cystitis than in pyelonephritis. AbstractIntroduction: Urinary tract infection (UTI) is a common infection in children. Prompt diagnosis and treatment of this infection are important to prevent further damage to the kidney. This study aimed to examine the clinical profile of children with pyelonephritis and cystitis in Dr. Soetomo General Academic Hospital, Surabaya.Methods: This was a descriptive study conducted in Dr. Soetomo General Academic Hospital, Surabaya, from June 2013 until December 2015, using secondary data and presented by percentage. Samples included in this study were children aged two months to five years old with UTI as a primary or secondary diagnosis of diarrhea and had urine culture results ≥ 105 CFU/ml.Results: There were 30 patients with pyelonephritis and 27 patients with cystitis. The prevalence of pyelonephritis was 0.285% and of cystitis was 0.247%. In pyelonephritis patients younger than one-year-old, boys and girls were equal. However, boys (60%) were more frequent in cystitis patients. In both pyelonephritis and cystitis patients aged 1-5, girls were more frequent (56.3%; 64.7%). In pyelonephritis patients, all patients were found with fever, followed by diarrhea (60%) and lethargy (56.7%) as the two most common symptoms. The two most common symptoms in cystitis patients were lethargy (44.4%) and irritability (33.3%). Urinary symptoms, such as dysuria and hematuria, were more frequent in cystitis (11.1%; 7.4%) patients than in pyelonephritis patients.Conclusion: Boys were more frequent to suffer urinary tract infections. Systemic symptoms were frequently found in pyelonephritis patients, while urinary symptoms were more frequent in cystitis patients.