Diagnosis Of Urinary Tract Infection Research Articles

Urinalysis Exhibits Excellent Predictive Capacity for the Absence of Urinary Tract Infection

ObjectiveTo assess predictive value of urinalysis for negative urine culture and absence of urinary tract infection, re-evaluate the microbial growth threshold for positive urine culture result, and describe antimicrobial resistance features. Urine culture is associated with 27% of U.S. hospitalizations, and unnecessary antibiotic prescription is a main antibiotic resistance contributor. MethodsUrinalyses with urine culture from women ages 18-49 from 2013 to 2020 were studied. Clinically diagnosed urinary tract infection (CUTI) was defined as (1) uropathogen growth, (2) documented diagnosis of urinary tract infection, and (3) antibiotic prescription. Sensitivity, specificity, and diagnostic predictive values were used to assess urinalysis performance in predicting isolation of a uropathogen by culture and in detection of CUTI. ResultsTotal 12,252 urinalyses were included. Forty-one percent of urinalyses were associated with positive urine culture and 1287 (10.5%) with CUTI. Negative urinalysis exhibited high predictive accuracy for negative urine culture (specificity 90.3%, PPV 87.3%) and absence of CUTI (specificity 92.2%, PPV 97.4%). Twenty-four percent of patients not meeting the CUTI definition were still prescribed antibiotics. Twenty-two percent of cultures associated with CUTI exhibited growth less than 100,000 CFU/mL. Escherichia coli was implemented as causing 70% of CUTIs, and 4.2% of these produced an extended spectrum beta-lactamase. ConclusionNegative urinalysis exhibits high predictive accuracy for absence of CUTI. A reporting threshold of 10,000 CFU/mL is more clinically appropriate than a 100,000 CFU/mL cutpoint. Reflex culture based on urinalysis results could complement clinical judgement and improve laboratory and antibiotic stewardship in premenopausal women.

Virtual Care and Urinary Tract Infection Management: Comparing Ancillary Service Orders and Patient Order Fulfillments Between Virtual and In-person Encounters During the COVID-19 Pandemic in the United States.

During the COVID-19 pandemic, more health care issues were being managed remotely. Urinary tract infections (UTIs) are being managed more often using telehealth although few reports compare the rate of UTI ancillary service orders placed and fulfilled during these visits. We aimed to evaluate and compare the rate of ancillary service orders and order fulfillments in incident UTI diagnoses between virtual and in-person encounters. The retrospective cohort study involved 3 integrated health care systems: Kaiser Permanente (KP) Colorado, KP Georgia, and KP Mid-Atlantic States. We included incident UTI encounters from adult primary care data from January 2019 to June 2021. Data were categorized as: prepandemic (January 2019-March 2020), COVID-19 Era 1 (April 2020-June 2020), and COVID-19 Era 2 (July 2020-June 2021). UTI-specific ancillary services included medication, laboratory, and imaging. Orders and order fulfillments were dichotomized for analyses. Weighted percentages for orders and fulfillments were calculated using inverse probability treatment weighting from logistic regression and compared between virtual and in-person encounters using χ2 tests. We identified 123,907 incident encounters. Virtual encounters increased from 13.4% prepandemic to 39.1% in COVID-19 Era 2. Ancillary service orders from virtual encounters were not placed as often as in-person encounters. However, the weighted percentage for ancillary service order fulfillment across all services remained above 65.3% across sites and eras, with many fulfillment percentages above 90%. Our study reported a high rate of order fulfillment for both virtual and in-person encounters. Health care systems should encourage providers to place ancillary service orders for uncomplicated diagnoses, such as UTI, to provide enhanced access to patient-centered care.

Enhancing urinary tract infection diagnosis for negative culture patients with metagenomic next-generation sequencing (mNGS).

Metagenomic next-generation sequencing (mNGS) is a promising technology that allows unbiased pathogen detection and is increasingly being used for clinical diagnoses. However, its application in urinary tract infection (UTI) is still scarce. The medical records of 33 patients with suspected UTI who were admitted to the Second Hospital of Tianjin Medical University from March 2021 to July 2022 and received urine mNGS were retrospectively analyzed. The performance of mNGS and conventional urine culture in diagnosing infection and identifying causative organisms was compared, and the treatment effects were evaluated in terms of changes in urinalyses and urinary symptoms. In the detection of bacteria and fungi, mNGS detected at least one pathogen in 29 (87.9%) cases, including 19 (57.6%) with positive mNGS but negative culture results and 10 (30.3%) with both mNGS and culture positive results. The remaining 4 (12.1%) patients were negative by both tests. Overall, mNGS performed better than culture (87.9% vs. 30.3%, P < 0.001). Within the 10 double-positive patients, mNGS matched culture results exactly in 5 cases, partially in 4 cases, and not at all in 1 case. In addition, mNGS detected a broader pathogen spectrum, detecting 26 species compared to only 5 species found in culture. The most abundant bacteria detected by mNGS was Escherichia coli, detected in 9 (27.2%) patients. All anaerobic bacteria, Mycobacterium Tuberculosis and all mixed pathogens were detected by mNGS. The final clinical diagnosis of UTI was made in 25 cases, and the sensitivity of mNGS was significantly higher than culture (100.0% vs 40.0%; P < 0.001) when using the diagnosis as a reference standard; the positive predictive value, negative predictive value and specificity were 86.2%, 100% and 50.0%, respectively. Importantly, targeted antibiotic therapy based on mNGS resulted in significant improvement in urinalyses and urinary symptoms in patients. mNGS is a technology that has shown clear advantages over culture, particularly in the context of mixed infections and UTIs that are difficult to diagnose and treat. It helps to improve the detection of pathogens, guide changes in treatment strategies, and is an effective complement to urine culture.

Lens Free Holographic Imaging for Urinary Tract Infection Screening.

The diagnosis of urinary tract infection (UTI) currently requires precise specimen collection, handling infectious human waste, controlled urine storage, and timely transportation to modern laboratory equipment for analysis. Here we investigate holographic lens free imaging (LFI) to show its promise for enabling automatic urine analysis at the patient bedside. We introduce an LFI system capable of resolving important urine clinical biomarkers such as red blood cells, white blood cells, crystals, and casts in 2 mm thick urine phantoms. This approach is sensitive to the particulate concentrations relevant for detecting several clinical urine abnormalities such as hematuria and pyuria, linearly correlating to ground truth hemacytometer measurements with R 2 = 0.9941 and R 2 = 0.9973, respectively. We show that LFI can estimate E. coli concentrations of 10 3 to 10 5 cells/mL by counting individual cells, and is sensitive to concentrations of 10 5 cells/mL to 10 8 cells/mL by analyzing hologram texture. Further, LFI measurements of blood cell concentrations are relatively insensitive to changes in bacteria concentrations of over seven orders of magnitude. Lastly, LFI reveals clear differences between UTI-positive and UTI-negative urine from human patients. LFI is sensitive to clinically-relevant concentrations of bacteria, blood cells, and other sediment in large urine volumes. Together, these results show promise for LFI as a tool for urine screening, potentially offering early, point-of-care detection of UTI and other pathological processes.

Risk of death in women hospitalized with a primary diagnosis of urinary tract infection

Risk of death in women hospitalized with a primary diagnosis of urinary tract infection

Diagnostic and Therapeutic Management of Urinary Tract Infections in Catalonia, Spain: Protocol for an Observational Cohort Study.

Antibiotic resistance is an individual and public health problem; multidrug-resistant infections could cause an estimated 10 million deaths worldwide by 2050. Unnecessary use of antimicrobials is the most important cause of resistance generation in the community, and an estimated 80% of antimicrobials are prescribed in primary health care, frequently for urinary tract infections (UTIs). This paper presents the protocol for the first phase of the Urinary Tract Infections in Catalonia (Infeccions del tracte urinari a Catalunya) project. We aim to examine the epidemiology of the different types of UTIs in Catalonia (an autonomous community in Spain) and their diagnostic and therapeutic management by health professionals. Furthermore, we aim to evaluate the correlation between types and total consumption of antibiotics for recurrent UTIs in 2 cohorts of women with the presence and severity of infectious complications of urological origin, especially pyelonephritis and sepsis, and 2 potentially serious infections: pneumonia and COVID-19. The study is a population-based observational cohort study including adults with a diagnosis of UTI registered in the Information System for the Development of Research in Primary Care (in Catalan: Sistema d'informació per al desenvolupament de la investigació en atenció primària), the Minimum Basic Data Sets of Hospital Discharges and Emergency Departments (in Catalan: Conjunt mínim bàsic de dades a l'hospitalització d'aguts i d'atenció urgent), and data from the Hospital Dispensing Medicines Register (in Catalan: Medicació hospitalària de dispensació ambulatòria) of Catalonia from the period between 2012 and 2021. We will evaluate the variables obtained from the databases to analyze the proportion of different types of UTIs, the percentage of adequate antibiotic treatments prescribed or received for recurrent UTIs according to the national guidelines, and the proportion of UTIs with complications. We expect to describe the epidemiology of UTIs in Catalonia from 2012 to 2021, as well as describe the diagnostic and therapeutic management of UTIs by health professionals. We expect to find a high percentage of UTI cases with inadequate management according to the national guidelines, considering that on many occasions UTIs are treated with second- or third-line antibiotic therapies with a preference for the longest regimens. Furthermore, the use of antibiotic suppressive therapies, or prophylaxis, in recurrent UTIs will likely be highly variable. Moreover, we aim to determine whether women with recurrent UTIs treated with antibiotic suppressive therapies have a higher incidence and severity of potentially serious future infections, with special attention to acute pyelonephritis, urosepsis, COVID-19, and pneumonia, compared to women who receive antibiotic treatment after they present with a UTI. This is an observational study of data from administrative databases that will not allow causality analysis. The limitations of the study will be handled according to the appropriate statistical methods. European Union Electronic Register of Post-Authorisation Studies EUPAS49724; https://www.encepp.eu/encepp/viewResource.htm?id=49725. DERR1-10.2196/44244.

A Comparison of Short Versus Long Course Intravenous Antibiotics When Treating Urinary Tract Infection in Infants

Urinary tract infections (UTIs) are a common reason for hospitalization in infants younger than 60 days, and the optimal approach to intravenous (IV) antibiotic therapy upon UTI diagnosis in this cohort is unknown. We determined whether there was an association between IV antibiotic therapy duration (long [>3 days] vs short [≤3 days]) and treatment failure via a retrospective review of infants with confirmed UTIs receiving IV antibiotics at a tertiary referral center. A total of 403 infants were included; 39% were treated with ampicillin and cefotaxime, and 34% with ampicillin and gentamycin or tobramycin. The median IV antibiotic duration was 5 (interquartile range: 3-10) days, and 5% of patients experienced treatment failure. The treatment failure rate was similar in both short- and long-course IV antibiotic groups (P > .05), and there was no significant association between treatment duration and failure. We conclude that treatment failure for infants hospitalized with UTI is uncommon and not associated with IV antibiotic duration.

Current Pyuria Cutoffs Promote Inappropriate Urinary Tract Infection Diagnosis in Older Women.

Pre-existing lower urinary tract symptoms (LUTS), cognitive impairment, and the high prevalence of asymptomatic bacteriuria (ASB) complicate the diagnosis of urinary tract infection (UTI) in older women. The presence of pyuria remains the cornerstone of UTI diagnosis. However, >90% of ASB patients have pyuria, prompting unnecessary treatment. We quantified pyuria by automated microscopy and flowcytometry to determine the diagnostic accuracy for UTI and to derive pyuria thresholds for UTI in older women. Women ≥65 years with ≥2 new-onset LUTS and 1 uropathogen ≥104 colony-forming units (CFU)/mL were included in the UTI group. Controls were asymptomatic and classified as ASB (1 uropathogen ≥105 CFU/mL), negative culture, or mixed flora. Patients with an indwelling catheter or antimicrobial pretreatment were excluded. Leukocyte medians were compared and sensitivity-specificity pairs were derived from a receiver operating characteristic curve. We included 164 participants. UTI patients had higher median urinary leukocytes compared with control patients (microscopy: 900 vs 26 leukocytes/µL; flowcytometry: 1575 vs 23 leukocytes/µL; P < .001). Area under the curve was 0.93 for both methods. At a cutoff of 264 leukocytes/µL, sensitivity and specificity of microscopy were 88% (positive and negative likelihood ratio: 7.2 and 0.1, respectively). The commonly used cutoff of 10 leukocytes/µL had a poor specificity (36%) and a sensitivity of 100%. The degree of pyuria can help to distinguish UTI in older women from ASB and asymptomatic controls with pyuria. Current pyuria cutoffs are too low and promote inappropriate UTI diagnosis in older women. Clinical Trials Registration. International Clinical Trials Registry Platform: NL9477 (https://trialsearch.who.int/Trial2.aspx?TrialID=NL9477).

EVALUATION OF MODIFIED NITRITE TEST AS A DIAGNOSTIC TEST IN URINARY TRACT INFECTION OF CHILDREN

Objective: Urinary tract infection (UTI) is common infection in children. Urine culture is the gold standard method for diagnosing urine infection but it takes more than 48 h to give results. The objective is to evaluate the diagnostic ability of modified nitrite test as a rapid diagnostic screening test for diagnosis of UTI in children. Methods: An observational and cross-sectional study was conducted in a tertiary care hospital in Udaipur over a period of 1 year. Children aged up to 60 months with suspected UTI were enrolled in the study. Children with congenital urogenital anomalies and prior antibiotic treatment were excluded from the study. Urine culture and modified nitrite test was done for every children. Results: Ninety children with suspected UTI were enrolled in the study. Urine culture was positive in 14 (15.55%) out of 90 urine samples. When modified nitrite test was compared to positive urine culture, true positives were 9 and 1 was false positive. Sensitivity, Specificity, PPV, NPV, and Accuracy was 64.29%, 98.68%, 90%, 93.75%, and 93.33%, respectively. Conclusion: Sensitivity and specificity of modified nitrite test are good enough as a diagnostic test for detection of UTI. It can be used as a point of care test for rapid screening and identifying the cases.

An electrochemical conducting polymer-based biosensor for Leukocyte esterase and nitrite detection for diagnosing urinary tract infections: A pilot study

Leukocyte esterase (LE) and nitrite (NIT) are biomarkers for the diagnosis of urinary tract infections (UITs). Fast and versatile multi-analyte biosensors are of increasing interest in disease detection. To our knowledge, research on the detection of these two markers in clinical samples by using disease-related electrochemical biosensors is rare. In this pilot study, we prepared an electrochemical sensor for detection of LE and NIT, based on LE antibody conjugated to a carboxylic acid-functionalized poly(3,4-ethylenedioxythiophene) (PEDOT-COOH) modified glassy carbon electrode (GCE), namely, LE antibody/Avidin/EDC-NHS/PEDOT-COOH/GCE, in which PEDOT-COOH as the substrate allows integration with biomolecules (LE antibody and avidin) for selectively recognizing LE and extends the sensing range due to the good electroactivity. The characterization of the electrode was demonstrated by scanning electron microscopy, Fourier-transform infrared spectroscopy, differential pulse voltammetry, and electrochemical impedance spectroscopy. Under the optimized conditions, the fabricated electrode showed good performance with a linear range of 9.1–131 µM and 0.2–590 μg L−1, and the limits of detection were 6.24 µM and 0.2 μg L−1 for NIT and LE, respectively. Finally, urine specimens were obtained from 13 patients enrolled at Taipei Veterans General Hospital. All urine samples with NIT and LE positive in urine strips were tested positive by our work for NIT and LE detection, and samples with negative findings tested negative. Using the device to detect NIT and LE for identifying patients with UTIs, the diagnostic sensitivity and specificity were 100 % and 87.5 %, respectively. Thus, this biosensor may be a potential alternative to the urine strip test because of its simplicity, rapidity, multi-analyte detection, and high sensitivity. A large-scale study using more diverse samples is warranted to validate its clinical value in assisting UTI diagnosis.

Megrment the Level of SDF1-Α in the Serum of Patients with Urinary Tract Infection and Patients with Vaginal Infection

Urinary tract infection, Bacterial vaginosis as one of the global threats affecting millions of women and causing some time deaths around the world. Objective: This study aims to assess levels of SDF1 and IgA in patients with Urinary tract infection, Bacterial vaginosis, and people enjoying good health as a control group. Methods: Collecting medical information from (180) participants in the Imam Al-Sadiq General Teaching Hospital in Iraq-Babylon, the Gynecology Consultant, according to specific criteria, the subjects were divided into three groups: the control group, the patients (UTI, BV), while the demographic study included age, education, Jobs, and living Laboratory results, signs and symptoms, SDF1-α and IgA levels were assessed by the enzyme-linked immunosorbent assay (ELISA) technique. Results: The results revealed that there were significant variations in SDF1 and IgA between the UTI group, BV group, and control groups. SDF1 level with the UTI group was (1.206522 ±.0927277 pg/ml) and for patients with BV was(1.213735 ±.0661389 pg/ml) whereas the control group appear was (1.130013±.0496400 pg/ml), IgA level in the UTI patients was (64.252983 ± 7.5946759pg/ml) and patients with BV was (60.441928±6.1457661pg/ml) whereas the control group appears was (48.011745 ±4.7938613 pg/ml) Conclusion: They can be considered good indicators to give knowledge about the diagnosis of urinary tract infection and bacterial vaginosis, and help doctors to give appropriate medications. Keywords: Urinary tract infection, bacterial vaginosis, stromal cell-derived factor 1-alpha, Immunoglobulin A.

Application of metagenomic next-generation sequencing in the diagnosis of urinary tract infection in patients undergoing cutaneous ureterostomy.

Urinary tract infection (UTI) is an inflammatory response of the urothelium to bacterial invasion and is a common complication in patients with cutaneous ureterostomy (CU). For such patients, accurate and efficient identification of pathogens remains a challenge. The aim of this study included exploring utility of metagenomic next-generation sequencing (mNGS) in assisting microbiological diagnosis of UTI among patients undergoing CU, identifying promising cytokine or microorganism biomarkers, revealing microbiome diversity change and compare virulence factors (VFs) and antibiotic resistance genes (ARGs) after infection. We performed a case-control study of 50 consecutive CU patients from December 2020 to January 2021. According to the clinical diagnostic criteria, samples were divided into infected group and uninfected group and difference of urine culture, cytokines, microorganism, ARGs and VFs were compared between the two groups. Inflammatory responses were more serious in infected group, as evidenced by a significant increase in IFN-α (p=0.031), IL-1β (0.023) and IL-6 (p=0.018). Clinical culture shows that there is higher positive rate in infected group for most clinical pathogens like Escherichia coli, Klebsiella pneumoniae, Staphylococcus aureus, Candida auris etc. and the top three pathogens with positive frequencies were E. coli, K. pneumoniae, and Enterococcus faecalis. Benchmarking clinical culture, the total sensitivity is 91.4% and specificity is 76.3% for mNGS. As for mNGS, there was no significant difference in microbiome α- diversity between infected and uninfected group. Three species biomarkers including Citrobacter freundii, Klebsiella oxytoca, and Enterobacter cloacae are enriched in infected group based on Lefse. E. cloacae were significantly correlated with IL-6 and IL-10. K. oxytoca were significantly correlated with IL-1β. Besides, the unweighted gene number and weighted gene abundance of VFs or ARGs are significantly higher in infected group. Notablely, ARGs belonging to fluoroquinolones, betalatmas, fosfomycin, phenicol, phenolic compound abundance is significantly higher in infected group which may have bad effect on clinical treatment for patients. mNGS, along with urine culture, will provide comprehensive and efficient reference for the diagnosis of UTI in patients with CU and allow us to monitor microbial changes in urine of these patients. Moreover, cytokines (IL-6, IL-1β, and IFN-a) or microorganisms like C. freundii, K. oxytoca or E. cloacae are promising biomarkers for building effective UTI diagnostic model of patients with CU and seriously the VFs and ARGs abundance increase in infected group may play bad effect on clinical treatment.

Enterococcus Species Isolated from Urine Cultures and Antibiotic Resistance Rates

While enterococci are found as flora elements in many parts of the body, they have recently emerged as different infectious agents such as urinary tract infections, bacteremia, and meningitis. Increasing antibiotic resistance also poses additional challenges in treatment. In this study, it was aimed to determine the species identification and antibiotic resistance rates of enterococci isolated from the urinary tract. Enterococcus strains isolated from urine culture samples sent to the routine microbiology laboratory from various clinics of our hospital between 01.01.2020 and 31.12.2021 with the preliminary diagnosis of urinary tract infection were included in this study. Samples were cultivated on sheep blood agar and eosin methylene blue agar, and species determination and antibiogram evaluation were carried out in accordance with the recommendations of EUCAST (European Committee on Antimicrobial Susceptibility Testing-2020-2021) using conventional methods and automated identification device (VITEK 2 Compact-BioMerieux-France). All enterococci isolates (n=349) were susceptible to vancomycin, teicoplanin, tigecycline and linezolid. Of Enterococcus faecalis isolates (n=238), 32.8% were resistant to ciprofloxacin, 23.7% to high-level gentamicin, 33.2% to imipenem, 2.5% to nitrofurantoin, and 26.9% to streptomycin. Of the Enterococcus faecium isolates (n=111), 84.7% were resistant to ciprofloxacin, 58.6% to high-level gentamicin, 91% to imipenem, 31.5% to nitrofurantoin, and 83.8% to streptomycin. In conclusion, it is important to determine the resistance patterns of enterococcus strains, which are most frequently isolated as the causative agent of urinary tract infection, and also cause other clinical presentations such as wound infection or bacteremia, and to establish appropriate treatment protocols and to determine new antibiotic resistances.

Patients’ Experiences, Expectations, Motivations, and Perspectives around Urinary Tract Infection Care in General Practice: A Qualitative Interview Study

While there are many alternatives to antibiotics for the symptomatic treatment of urinary tract infections (UTIs), their application in practice is limited. Among other things, general practitioners (GPs) often feel pressure from patients to prescribe antibiotics. To gain a better understanding of why this happens and where this pressure originates from, we investigated experiences, expectations, motivations, and perspectives of patients with UTIs in general practice. During this qualitative study we performed 14 semi-structured online interviews among female UTI patients in general practice. Interviews were based on a topic list derived from sensitising concepts. All the interviews were recorded, transcribed, and analysed using a constant comparative technique. Three main categories emerged from the data; (1) experienced versus unexperienced patients with UTI, (2) patient's lack of knowledge, and (3) patients feeling understood. Inexperienced patients consult a general practitioner for both diagnosis and symptom relief, while experienced patients seem to consult specifically to obtain antibiotics. In addition, patients have a lack of knowledge with regard to the diagnosis, treatment, self-care, and cause of UTIs. Finally, patients' satisfaction is increased by involving them more in the process of decision making, so they feel understood and taken seriously. Patients' expectations in UTI management in general practice often arise during their first experience(s) and play a major role in subsequent episodes. In conclusion, preventing misconceptions is especially important in the inexperienced patient group, as this may prevent future overtreatment of UTIs. In addition, involving patients in the decision making process will lead to greater understanding of the GP's treatment choices.

Opportunities for Antibiotic Reduction in Pediatric Patients With Urinary Tract Infection After Discharge From the Emergency Department.

The aim of this study was to evaluate how often antibiotics are adjusted by providers, specifically discontinued or de-escalated to a more narrow-spectrum agent, based on final culture and susceptibility results, when treating patients diagnosed with a urinary tract infection (UTI) in the pediatric emergency department (ED). This was a retrospective study of pediatric patients younger than 18 years who were discharged home from the ED with a diagnosis of UTI between January 1, 2018, and December 31, 2019. Patients were included if a urine culture was sent as part of their UTI workup and were excluded if they had been pretreated with antibiotics before the diagnosis. Discontinuation was considered possible if the urine culture had no or insignificant bacterial growth. De-escalation was defined as changing to a more narrow-spectrum antibiotic based on susceptibility testing. Empiric antibiotics were prescribed in 131 of 136 UTI episodes. Cefdinir (39%) and cephalexin (36%) were most commonly prescribed, but agents and durations were inconsistent. Discontinuation occurred in only 4 of 52 possible episodes (8%), resulting in a median of 6 extra days of unnecessary antibiotics per episode. For 62 of the 78 cases (79%) with culture confirmation, the prescribed empiric antibiotic was active against the isolated pathogen. A narrower agent could have been used in 29 of 62 (47%) of these cases. However, de-escalation was never attempted. Lack of de-escalation in these episodes resulted in a median of 7 extra days of unnecessary broad-spectrum antibiotic exposure. Inconsistent empiric antibiotics and inaccurate diagnosis result in excess antibiotic exposures for pediatric patients diagnosed with UTI. Postdischarge antimicrobial stewardship interventions are needed to reduce unnecessary antibiotic exposure in children.

Disparities in Access to Virtual Care for Urinary Tract Infections During the COVID-19 Era

Objective To characterize the difference in uptake of virtual care for urinary tract infections (UTIs) by demographic variables in the COVID-19 era. Methods We conducted a retrospective review of outpatient encounters for UTIs across a large health care system. The cohort was defined as patients with an encounter diagnosis of UTI via in-person or virtual care (telephone or technology-supported care), between March 1, 2020, and February 28, 2021. Analysis was limited to the first UTI encounter of the year for each patient. We compared the use of in-person and virtual visits by demographic variables using chi-square tests and multivariate logistic regression. Results A total of 6744 patients, with a mean age of 61 years, were seen for UTI during the study period. The majority of patients were White (85.5%) and female (83.7%), and were seen in person (55.9%). Of those seen virtually, 52.0% participated in telephone-only visits, and 47.9% were seen via technology-supported care, using video or chatbased platforms. On multivariate logistic regression, age under 30, lowest-quartile income, male sex, and a primary language other than English increased the odds that patients had been seen in person. Among those seen virtually, age over 50 significantly increased the odds of a telephone visit, as did being Black or Native American, having a lower-quartile income, and speaking a non-English primary language. Conclusions Although the expansion in virtual care has given some patients easier access to necessary care, the “digital divide” has worsened existing disparities for certain vulnerable populations. We demonstrate a difference in uptake of virtual health care by age, race, primary language, and income.

The Diagnosis of Urinary Tract Infections Using a Novel At-home Testing Protocol to Enhance Telemedicine: A Retrospective Analysis

ObjectiveTo retrospectively analyze a novel courier-based home urine collection strategy for patients with symptoms of urinary tract infections (UTIs). This model was developed to provide patient care using telehealth during the coronavirus 2019 pandemic. MethodsWe analyzed data from 2206 patients with symptomatic UTIs to investigate the efficacy of a home urine collection protocol. The primary outcome was the impact of home versus office collection. ResultsWe analyzed the results of 1112 patient samples collected in-office and 1084 patient samples collected at home. There was no difference in the rate of bacterial identification between females in the office and home collection groups. However, males in the office collection group had a higher rate of bacterial identification (p = .002). The turnaround time was significantly faster in the home collection group than the office collection group (4.08 hours shorter, p < 0.0014). Antibiotic use prior to sample collection was significantly higher in the home collection group for both males (p = .0004) and females (p = .004). Changes in antibiotics were significantly higher in the home collection group than in the office collection group for both males (p = .0009) and females (p = .0006). ConclusionOur home collection protocol is a viable method to provide prompt and reliable outpatient care to urology patients suffering from UTIs. Furthermore, this approach resulted in adequate management and quicker turnaround times. Our findings demonstrate the clinical viability of a decentralized healthcare model to treat UTIs.

Epidemiology, pathophysiology, diagnosis and treatment of urinary tract infections caused by bacteria

Urinary tract infections (UTIs) are among the most frequent diseases in hospital and outpatient clinical practice and can affect patients of all ages. UTIs can be of bacterial, fungal or parasitic origin, with bacteria being responsible for around 90% of cases. UTIs are caused in most cases by E. coli, a microorganism naturally present at the large intestine and perianal region. The diagnosis of UTIs is based on the patient&#39;s clinical picture, symptoms and laboratory diagnosis with urine samples. This paper briefly reviews the pathophysiology, diagnosis and treatment of UTIs, considering the most recent literature.

The evaluation of children hospitalized with the diagnosis of urinary tract infection

Aim: The aim of this study was to investigate the factors that cause urinary tract infections (UTI) and antibiotic susceptibility profiles with epidemiological and clinical features among children hospitalized with the diagnosis of UTI. Materials and Methods: This study was retrospective and evaluated the clinical and laboratory features of 216 patients aged 0-15 years old evaluated, who were hospitalized with a diagnosis of UTI in a single center. Results: The mean age of patients with confirmed UTI was 3.75±3.73, with a male-to-female ratio of 2:1. Fever was the most common symptom observed. In patients with confirmed UTI, urine nitrite positivity and high leukocyte positivity were significantly elevated (p=0.0001). Urine culture yielded positive results in 43% of the patients, with Escherichia coli (E. coli) being the most frequently detected pathogen. High rates of resistance were observed for the antibiotics ampicillin, cefuroxime, ceftriaxone, and trimethoprim-sulfamethoxazole (TMP-SMX), while resistance to aminoglycosides, nitrofurantoin, and carbapenems was less frequently encountered. Conclusion: Urine nitrite and high leukocyte positivity may be suggestive of a diagnosis of UTI in patients without positive urine culture results.

ARE C-REACTIVE PROTEIN AND PROCALCITONIN EFFECTIVE BIOMARKERS FOR URINARY TRACT INFECTION IN ELDERLY PATIENTS? WHAT SHOULD BE ADMINISTERED FOR EMPIRICIAL TREATMENT?

Introduction: In the absence of typical overt symptoms, diagnosis of urinary tract infection is more difficult in elderly individuals. This study investigated the benefits of C-reactive protein, procalcitonin, and leukocyte levels in supporting the diagnosis of urinary tract infection in the elderly and causative factors. Materials and Method: A retrospective examination of information from a hospital data system of patients &gt; 65 years of age, who were diagnosed with urinary tract infection in a 4-year period, was performed. Bacterial identification and antibiotic susceptibility tests were performed. Results: In the case group, procalcitonin and C-reactive protein levels were higher than those in the control group, and a moderately positive correlation with urinary tract infection was found (p&lt;0.001, r=0.454). Although procalcitonin was a better predictor than C-reactive protein , the risk criteria for C-reactive protein were also very close to those of procalcitonin. The cut-off values for C-reactive protein and procalcitonin were 6.93 mg/L and 0.075 ng/ml, respectively, and C-reactive protein levels were normal in 20% of cases. The most frequently isolated microorganisms were Escherichia coli (56%) and Klebsiella pneumoniae (16%). The extended-spectrum beta-lactamase rate was 35% for E. coli and 43% for K. pneumoniae isolates. Fosfomycin and ertapenem were the most effective antibiotics. Conclusion: Procalcitonin levels were high; however, the fact that C-reactive protein was found to be normal in one-fifth of cases should serve as a warning that urinary system infection can be missed in elderly patients in cases in which only C-reactive protein level is evaluated. Keywords: Aged; Drug Resistance; Urinary Tract Infections; C-Reactive Protein; Procalcitonin; Leukocytes.