Episodes Of Symptomatic Urinary Tract Infection Research Articles

Acidic Urine pH and Clinical Outcome of Lower Urinary Tract Infection in Kidney Transplant Recipients Treated with Ciprofloxacin and Fosfomycin.

Different factors, including antimicrobial resistance, may diminish the effectiveness of antibiotic therapy, challenging the management of post-transplant urinary tract infection (UTI). The association of acidic urine pH with microbiological and clinical outcomes was evaluated after fosfomycin or ciprofloxacin therapy in 184 kidney transplant recipients (KTRs) with UTI episodes by Escherichia coli (N = 115) and Klebsiella pneumoniae (N = 69). Initial urine pH, antimicrobial therapy, and clinical and microbiological outcomes, and one- and six-month follow-up were assessed. Fosfomycin was prescribed in 88 (76.5%) E. coli and 46 (66.7%) K. pneumoniae UTI episodes in the total cohort. When the urine pH ≤ 6, fosfomycin was prescribed in 60 (52.2%) E. coli and 29 (42.0%) K. pneumoniae. Initial urine pH ≤ 6 in E. coli UTI was associated with symptomatic episodes (8/60 vs. 0/55, p = 0.04) at one-month follow-up, with a similar trend in those patients receiving fosfomycin (7/47 vs. 0/41, p = 0.09). Acidic urine pH was not associated with microbiological or clinical cure in K. pneumoniae UTI. At pH 5, the ciprofloxacin MIC90 increased from 8 to >8 mg/L in E. coli and from 4 to >8 mg/L in K. pneumoniae. At pH 5, the fosfomycin MIC90 decreased from 8 to 4 mg/L in E. coli and from 512 to 128 mg/L in K. pneumoniae. Acidic urine is not associated with the microbiological efficacy of fosfomycin and ciprofloxacin in KTRs with UTI, but it is associated with symptomatic UTI episodes at one-month follow-up in E. coli episodes.

Effectiveness of Platelet-Rich Plasma Injections as Prophylaxis for Recurrent Urinary Tract Infection in Women.

To investigate the therapeutic efficacy of intravesical platelet-rich plasma (PRP) injections as prophylaxis for adult women with recurrent urinary tract infection (rUTI). This proof-of-concept study enrolled 63 women with rUTI in PRP treatment and control groups after achieving control of the most recent urinary tract infection (UTI) episode. The treatment group included 34 women who received 4 monthly intravesical PRP injections. The control group was made up of 30 women who received continuous antibiotic treatment for 3 months. After the completion of PRP or antibiotic treatment, outpatient follow-up was continued for up to 12 months. Treatment was considered successful if ≤2 UTI episodes occurred during a period of 12 months or ≤1 UTI episode within 6 months; otherwise, the outcome was considered a treatment failure. The frequency of symptomatic UTI episodes before and after PRP treatment was compared with that of the controls. Regression analysis was used to determine the association between potential predictors for a failed treatment outcome. At the study endpoint, 33 PRP and 25 control group patients were available for analysis. After four PRP injections, the frequency of rUTI episodes per month was significantly decreased compared with baseline (0.46 ± 0.27 vs. 0.28 ± 0.30, p = 0.047). The PRP treatment success rate was 51.5% (17 of 33) for the PRP group versus 48% (12 of 25) for the control group. The PRP treatment success group had significantly higher voided volume, lower post-void residual volume, and higher voiding efficiency than the PRP treatment failure group. A higher baseline voiding efficacy ≥0.71 was significantly associated with a successful outcome (OR 16.56; p = 0.049). The study results revealed that repeat intravesical PRP injections decreased the recurrence rate of UTI within 1 year in women with rUTI. The treatment success rate with intravesical PRP injections for rUTI was about 51.5%, whereas for women with prolonged antibiotic treatment, it was 48.0%. A baseline VE ≥ 0.71 was associated with a better treatment outcome with PRP injections.

MP65-13 DOES EARLY INTRODUCTION OF SELF INTERMITTENT CATHETERIZATION IMPROVE FUNCTIONAL OUTCOMES AND URINARY INFECTION IN ORTHOTOPIC ILEAL NEOBLADDER? RESULTS FROM A PROSPECTIVE MULTICENTRE STUDY

You have accessJournal of UrologyCME1 Apr 2023MP65-13 DOES EARLY INTRODUCTION OF SELF INTERMITTENT CATHETERIZATION IMPROVE FUNCTIONAL OUTCOMES AND URINARY INFECTION IN ORTHOTOPIC ILEAL NEOBLADDER? RESULTS FROM A PROSPECTIVE MULTICENTRE STUDY Antonio Luigi Pastore, Yazan AL Salhi, Andrea Fuschi, Alessia Martoccia, Fabio Maria Valenzi, Alessandro Sciarra, Stefano Salciccia, De Nunzio Cosimo, Andrea Tubaro, Costantino Leonardo, Giorgio Franco, Manfredi Bruno Sequi, and Antonio Carbone Antonio Luigi PastoreAntonio Luigi Pastore More articles by this author , Yazan AL SalhiYazan AL Salhi More articles by this author , Andrea FuschiAndrea Fuschi More articles by this author , Alessia MartocciaAlessia Martoccia More articles by this author , Fabio Maria ValenziFabio Maria Valenzi More articles by this author , Alessandro SciarraAlessandro Sciarra More articles by this author , Stefano SalcicciaStefano Salciccia More articles by this author , De Nunzio CosimoDe Nunzio Cosimo More articles by this author , Andrea TubaroAndrea Tubaro More articles by this author , Costantino LeonardoCostantino Leonardo More articles by this author , Giorgio FrancoGiorgio Franco More articles by this author , Manfredi Bruno SequiManfredi Bruno Sequi More articles by this author , and Antonio CarboneAntonio Carbone More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003323.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (ONB) is the preferred urinary diversion after radical cystectomy (RC), although its relate quality-of-life improvements are still under discussion. The principal factors associated with decrease in quality of life are continence status (both incontinence as well as urinary retention) and urinary tract infections (UTIs). The aim of this study is to investigate whether early clean intermittent catheterization (CIC) might improve functional outcomes, continence status, and reduce the incidence of UTIs. METHODS: In this study, patients were prospectively randomized in two groups. Patients that were on a standard postoperative care(Group A)or subjects that started CIC within the first post-operative month(Group B).All patients were evaluated postoperatively at 1, 3, 6, and 9 months after ONB. The CIC was executed 4 times/daily after each voluntary micturition. The postoperative evaluation included: postvoid residual volume(PVR), urine analysis and culture, number of pads/day and the selfadministrated questionnaire International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form(ICIQ-UI SF). RESULTS: From September 2017 to March 2021, 39 male and 8 female patients underwent laparoscopic or robot assisted RC with totally intracorporeal ONB (37 U shaped and 10 Padua reconstructions). All patients completed the nine months follow-up(mean 9.2 months; range 6-13 months). At the first follow up all patients were able to do self CIC. At this time mean PVR was 116.5 mL, ICIQ-UI SF mean score was 16, mean no. of pads/day was 3, 14 patients reported 3 episodes of symptomatic UTIs (Escherichia coli was the most common pathogen). At 3, 6 and 9 months follow up after surgery the PVR and the ICIQ-UI SF scores were significantly improved. The number of pads decreased to 2 pads/day at 3 months, and only one safety pad at 6 and 9 months. The episodes of UTIs significantly decreased over the time with only 8 patients at 3 months (reporting 4 symptomatic episodes), and 4 and two patients at 6 and 9 months, respectively. CONCLUSIONS: Our data strongly support the early introduction of self CIC in patients with ONB after RC. The CIC was significantly associated a reduced risk of incontinence, urinary retention, and UTI with significant improvement in QoL. These encouraging data need to be confirmed by further investigations with a larger number of patients. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e896 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Antonio Luigi Pastore More articles by this author Yazan AL Salhi More articles by this author Andrea Fuschi More articles by this author Alessia Martoccia More articles by this author Fabio Maria Valenzi More articles by this author Alessandro Sciarra More articles by this author Stefano Salciccia More articles by this author De Nunzio Cosimo More articles by this author Andrea Tubaro More articles by this author Costantino Leonardo More articles by this author Giorgio Franco More articles by this author Manfredi Bruno Sequi More articles by this author Antonio Carbone More articles by this author Expand All Advertisement PDF downloadLoading ...

Can Inflammatory Indices be Used to Predict Adverse Pregnancy Outcomes in Pregnant Women with Recurrent Urinary Tract Infection?

Aim: This study aimed to investigate the utility of inflammatory indices in predicting adverse maternal and neonatal outcomes in pregnant women with recurrent urinary tract infections. Material and Methods: This retrospective study was conducted on pregnant women treated for symptomatic urinary tract infection (UTI) between 2017 and 2021. Pregnant women with two or more episodes of symptomatic UTI were included in the study group. Pregnant women with one UTI were included in the control group. The study group consisted of 91 (46.9%) patients and the control group consisted of 103 (53.1%) patients. The groups were compared in terms of clinical characteristics, adverse outcomes, and inflammatory indices. Results: It was found that more adverse maternal and neonatal outcomes occurred in the study group compared to the control group (p=0.021, and p<0.001, respectively). The cut-off values for platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR), and systemic immune-inflammation index (SII) to predict adverse maternal outcomes were found 185.00 (p=0.015, area under the curve (AUC)=0.604, 95% confidence interval (CI)=0.558-0.782,), 4.34 (p=0.051, AUC=0.584, 95% CI=0.514-0.746), and 1210.48 (p=0.008, AUC=0.614, 95% CI=0.547-0.771), respectively. The cut-off values for PLR, NLR, and SII for predicting negative neonatal outcomes were found 192.98 (p=0.001, AUC=0.692, 95% CI=0.572-0.812), 4.67 (p=0.166, AUC=0.583, 95% CI=0.475-0.740), and 1339.47 (p=0.006, AUC=0.666, 95% CI=0.526-0.777), respectively. Conclusion: Although the success of discrimination is weak, PLR and SII may be useful to predict adverse maternal and neonatal outcomes in pregnant women with recurrent UTI.

Perioperative fosfomycin disodium prophylaxis against urinary tract infection in renal transplant recipients: a randomized clinical trial.

BackgroundSymptomatic urinary tract infection (UTI) is the most common infectious complication in renal transplant recipients (RTRs). Fosfomycin (FOS) is an attractive alternative for prophylaxis because it does not interact with immunosuppressants; although 90% is excreted unchanged in the urine, it does not require adjustment for renal function for single dose prophylaxis.MethodsRTRs were recruited into this randomized, double-blind, placebo-controlled trial. Participants were randomized (1:1) to receive one 4 g dose of FOS disodium intravenously 3 h (FOS group) or placebo (placebo group) before placement and removal of a urinary catheter and before removal of a double-J ureteral stent. All participants received prophylaxis with trimethoprim/sulfamethoxazole. The main outcome was a comparison of the mean number of symptomatic UTI and asymptomatic bacteriuria (AB) episodes per patient during a 7-week follow-up period. The study was registered at ClinicalTrials.gov, NTC03235947.ResultsEighty-two participants were included (41 in the FOS group and 41 in placebo group). The mean number of AB or symptomatic UTI episodes per patient was lower in the FOS group [intention-to-treat (ITT) 0.29 versus 0.60, P = 0.04]. The incidence of symptomatic UTI was lower in the FOS group (ITT, 7.3% versus 36.6%, P = 0.001), and there was no difference in the incidence of AB between both groups. The incidence of adverse events was similar in both groups.ConclusionsFOS addition is an effective and safe strategy to reduce the number of symptomatic UTIs during the first 7 weeks after renal transplant.

Access to sanitation and risk of developing urinary tract infections among women from low socio-economic settings

Background: Poor sanitation facilities are root cause of many health problems of people residing in slums. The present study estimates the prevalence of urinary tract infections (UTI) and identifies factors associated with an increased risk of UTI among women.Methods: A cross-sectional study was conducted among 616 women aged between 18 to 60 years residing in 33 slums across four cities in Maharashtra, India. Data related to individual characteristics of women, housing condition, access to sanitation facilities, behaviors adopted by the women that could lead to UTI and an episode of symptomatic UTI in the previous one month were recorded through structured questionnaire. Logistic regression analysis was performed to find out risk factors for UTI among women.Results: The prevalence of UTI was found to be 19.6%. The prevalence was higher among young women aged upto 30 years (23.2%). In absence of individual toilet, women had adopted certain behaviors such as urine holding (21.3%), modify dinner to avoid toilet use at night (26.6%) and avoid intake of liquids (10.7%) to reduce frequency of visits to toilet. All these behaviors were significantly associated with UTI. Multiple logistic regression indicated that UTI was strongly and independently associated with age (OR=1.64, 95%CI: 1.08, 2.47), no access to bathroom (OR=2.21, 95%CI: 1.08, 4.49) and avoid intake of liquids (OR=2.70, 95%CI: 1.53, 4.75) (p<0.05).Conclusions:Behavior modifications by women to adjust with restricted use of place of urination may affect their health and increase the likelihood of developing UTI. Younger women are more at risk of developing UTI.

Uro-Vaxom\xae versus placebo for the prevention of recurrent symptomatic urinary tract infections in participants with chronic neurogenic bladder dysfunction: a randomised controlled feasibility study

BackgroundPatients with lower neurogenic bladder dysfunction are at an increased risk of suffering from recurrent urinary tract infections. Recurrent symptomatic urinary tract infection is occasionally treated with antibiotics as a prophylactic prevention strategy. This risks increasing the frequency of antibiotic resistance. National healthcare policymakers have requested further research into alternative preventive measures for pathologies that require antibiotic treatment.MethodsThis study protocol describes a two-centre, randomised, double-blinded, placebo-controlled study to evaluate the prevention of recurrent urinary tract infections with the commercial immunotherapy agent Uro-Vaxom®, based on Escherichia coli pathogen-associated molecular patterns. Eligible participants are recruited by the direct healthcare team and randomised to receive Uro-Vaxom® in the form of an oral capsule, or a matching placebo. Participants will receive the study treatment daily for 3 months and followed up for an additional 3 months so that the number of symptomatic urinary tract infection episodes and individual signs and symptoms per episode can be recorded using participant study diaries. Primary outcome measures are: number of symptomatic urinary tract infections experienced over 3 months, number of symptomatic urinary tract infections experienced over 6 months, time from the start of treatment to the first urinary tract infection, and the presence of asymptomatic bacteriuria at 3 and 6 months. Secondary outcome measures are: individually recorded symptoms normally associated with recurrent urinary tract infection and consistency of reported symptoms during the symptomatic urinary tract infection experienced during the study, compliance with study protocol and study medication, and adverse events.DiscussionHealthcare policymakers recommend that alternative preventative strategies are identified for symptomatic urinary tract infections that require antibiotic treatment. If Uro-Vaxom® is shown to be effective, this feasibility study would warrant a larger, statistically powered, multicentre study to investigate whether this immunotherapy strategy is an effective preventative measure for recurrent symptomatic urinary tract infection for people with spinal cord injuries and neurological pathologies.Trial registrationISRTCN. Registered on 30 October 2015.ClinicalTrials.gov, ID: NCT0251901. Registered on 30 October 2015.URL of trial registry record: Ethics Ref: 15-LO-2069. IRAS Number: 185760. Sponsor Number: RXQ/648.NIHR Funding Reference: PB-PG-1013-32017.

Asymptomatic Bacteriuria is Harmless and Even Protective: Don’t Treat if You Don’t Have a Very Specific Reason

Symptom-free bacterial colonization of the lower urinary tract in an otherwise healthy individual was long misunderstood. Our current understanding is based on solid research proving that asymptomatic bacteriuria (ABU) is harmless and even protective against symptomatic urinary tract infection episodes. Thus, ABU should not be treated in patients with the exception of before endosurgery and, until we have accumulated more knowledge, in pregnant women.

Gentamicin bladder instillations decrease symptomatic urinary tract infections in neurogenic bladder patients on intermittent catheterization.

This study aimed to determine if gentamicin bladder instillations reduce the rate of symptomatic urinary tract infection (UTI) in neurogenic bladder (NGB) patients on intermittent self-catheterization (ISC) who have recurrent UTIs. Secondary aims were to examine the effects of intravesical gentamicin on the organism resistance patterns. We retrospectively reviewed our prospective NGB database. Inclusion criteria were NGB patients performing ISC exclusively for bladder drainage with clinical data available for six months before and six months after initiating prophylactic intravesical gentamicin instillations. Symptomatic UTIs were defined as symptoms consistent with UTI plus the need for antibiotic treatment. Twenty-two patients met inclusion criteria; etiology of NGB was 63.6% spinal cord injury, 13.6% multiple sclerosis. Median time since injury/diagnosis was 14 years and 6/22 (27.3%) had undergone urological reconstruction. Patients had fewer symptomatic UTI's (median 4 vs. 1 episodes; p<0.004) and underwent fewer courses of oral antibiotics after initiating gentamicin (median 3.5 vs. 1; p<0.01). Days of oral antibiotic therapy decreased from 15 before to five after gentamicin, but this did not reach significance. There were fewer telephone encounters for UTI concerns per patient (median 3 vs. 0; p=0.03). The proportion of multi-drug-resistant organisms in urine cultures decreased from 58.3% to 47.1% (p=0.04) and the rate of gentamicin resistance did not increase. Adverse events were mild and rare. Gentamicin bladder instillations decrease symptomatic UTI episodes and reduce oral antibiotics in patients with NGB on ISC who were suffering from recurrent UTIs. Antibiotic resistance decreased while on gentamicin instillations.

Should Asymptomatic Bacteriuria Be Systematically Treated in Kidney Transplant Recipients? Results From a Randomized Controlled Trial.

The indication for antimicrobial treatment of asymptomatic bacteriuria (AB) after kidney transplantation (KT) remains controversial. Between January 2011 and December 2013, 112 KT recipients that developed one episode or more of AB beyond the second month after transplantation were included in this open-label trial. Participants were randomized (1:1 ratio) to the treatment group (systematic antimicrobial therapy for all episodes of AB occurring ≤24 mo after transplantation [53 patients]) or control group (no antimicrobial therapy [59 patients]). Systematic screening for AB was performed similarly in both groups. The primary outcome was the occurrence of acute pyelonephritis at 24-mo follow-up. Secondary outcomes included lower urinary tract infection, acute rejection, Clostridium difficile infection, colonization or infection by multidrug-resistant bacteria, graft function and all-cause mortality. There were no differences in the primary outcome in the intention-to-treat population (7.5% [4 of 53] in the treatment group vs. 8.4% [5 of 59] in the control group; odds ratio [OR] 0.88, 95% confidence interval [CI] 0.22-3.47) or the per-protocol population (3.8% [1 of 26] in the treatment group vs. 8.0% [4 of 50] in the control group; OR 0.46, 95% CI 0.05-4.34). Moreover, we found no differences in any of the secondary outcomes. In conclusion, systematic screening and treatment of AB beyond the second month after transplantation provided no apparent benefit among KT recipients (NCT02373085).

Treated asymptomatic bacteriuria during first year after renal transplantation.

Urinary tract infections (UTIs) are widespread in renal transplant (RTx) recipients with asymptomatic bacteriuria (AB) as the predominant form. It is necessary to determine if AB is a risk factor for symptomatic UTIs. We analyzed clinical data and urine cultures performed within the first 12 months after RTx in 209 consecutive patients undergoing RTx at Gdańsk Transplantation Center between January 2007 and December 2009. We observed 170 AB episodes in 83 patients. This accounted for 53% of all diagnosed UTIs in 111 patients, with more than half of AB episodes occurring during the first month post transplant. The most prevalent uropathogen was Enterococcus faecium (36.8%, n = 32) and, from the second month after RTx, Escherichia coli (54.2%, n = 45). Female gender, use of induction with anti-thymocyte globulin, comorbidity measured by Charlson Comorbidity Index, history of acute rejection, and cytomegalovirus infection were risk factors for developing AB, and no differences in risk factors were seen for developing a symptomatic UTI vs. an AB after RTx. All patients with AB received antibiotic therapy. AB was an independent risk factor for symptomatic UTIs, but only 21 of 152 episodes of symptomatic UTIs were preceded by AB with the same causative agent. AB is a common finding in the RTx population and AB episodes may be considered a risk factor for symptomatic infections. It remains to be determined if the treatment of AB in RTx patients is in fact helpful or harmful in preventing symptomatic infections.

FRI0084 Urine Testing in Rheumatology – Myth or Evidence Based?

BackgroundUrine testing (dipstick and culture) is used in the rheumatology outpatient setting as a screening tool for proteinuria or hematuria (connective tissues diseases) or for assessment of those with symptoms...

Rare Emergence of Symptoms during Long-Term Asymptomatic Escherichia coli 83972 Carriage without an Altered Virulence Factor Repertoire

Asymptomatic bacteriuria established by intravesical inoculation of Escherichia coli 83972 is protective in patients with recurrent urinary tract infections. In this randomized, controlled crossover study a total of 3 symptomatic urinary tract infection episodes developed in 2 patients while they carried E. coli 83972. We examined whether virulence reacquisition by symptom isolates may account for the switch from asymptomatic bacteriuria to symptomatic urinary tract infection. We used E. coli 83972 re-isolates from 2 patients in a prospective study and from another 2 in whom symptoms developed after study completion. We phylogenetically classified the re-isolates, and identified the genomic restriction patterns and gene expression profiles as well as virulence gene structure and phenotypes. In vivo virulence was examined in the murine urinary tract infection model. The fim, pap, foc, hlyA, fyuA, iuc, iroN, kpsMT K5 and malX genotypes of the symptomatic re-isolates remained unchanged. Bacterial gene expression profiles of flagellated symptomatic re-isolates were unique to each host, providing no evidence of common deregulation. Symptomatic isolates did not differ in virulence from the wild-type strain, as defined in the murine urinary tract infection model by persistence, symptoms or innate immune activation. The switch from asymptomatic E. coli 83972 carriage to symptomatic urinary tract infection was not explained by reversion to a functional virulence gene repertoire.

Urinary catheter policies for long-term bladder drainage

People requiring long-term bladder draining commonly experience catheter-associated urinary tract infection and other problems. To determine if certain catheter policies are better than others in terms of effectiveness, complications, quality of life and cost-effectiveness in long-term catheterised adults and children. We searched the Cochrane Incontinence Group Specialised Trials Register (searched 28 September 2011). Additionally, we examined all reference lists of identified trials. All randomised and quasi-randomised trials comparing catheter policies (route of insertion and use of antibiotics) for long-term (more than 14 days) catheterisation in adults and children. Data were extracted by two reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the data in trials had not been fully reported, clarification was sought from the authors. When necessary, the incidence-density rates (IDR) and/or the incidence-density differences (IDD) within a certain time period were calculated. Eight trials met the inclusion criteria involving 504 patients in four cross-over and four parallel-group randomised controlled trials. Only two of the pre-stated six comparisons were addressed in these trials. Four trials compared antibiotic prophylaxis with antibiotics when clinically indicated. For patients using intermittent catheterisation, there were inconsistent findings about the effect of antibiotic prophylaxis on symptomatic urinary tract infection (UTI). Only one study found a significant difference in the frequency of UTI favouring prophylaxis. For patients using indwelling urethral catheterisation, one small trial reported fewer episodes of symptomatic UTI in the prophylaxis group.Four trials compared antibiotic prophylaxis with giving antibiotics when microbiologically indicated. For patients using intermittent catheterisation, there was limited evidence that receiving antibiotics reduced the rate of bacteriuria (asymptomatic and symptomatic). There was weak evidence that prophylactic antibiotics were better in terms of fewer symptomatic bacteriuria. No eligible trials were identified that compared alternative routes of catheter insertion. The data from eight trials comparing different antibiotic policies were sparse, particularly when intermittent catheterisation was considered separately from indwelling catheterisation. Possible benefits of antibiotic prophylaxis must be balanced against possible adverse effects, such as development of antibiotic resistant bacteria. These cannot be reliably estimated from currently available trials.

Probiotic lactobacillus reuteri RC-14 and lactobacillus rhamnosus GR-1 for prevention of urinary tract infections in catheterization-dependent girls with spina bifida

Purpose Urinary tract infections (UTI) represent a significant source of morbidity for boys and girls with spina bifida. In girls, uropathogens originating from the gut migrate through the vagina in order to ascend the urinary tract. The rate of bacteriuria among catheterization-dependent children with spina bifida is at least 40-80%, with many patients experiencing multiple episodes of UTI in association with bacteriuria. Clinical trials have suggested that oral ingestion of probiotic strains, such as L. reuteri RC-14 and L. rhamnosus GR-1, results in normalization of the vaginal microbiota and reduced risk of UTI in women. However, no studies have been carried out on catheterized girls. Material and Methods We conducted an open label, pilot clinical trial of orally administered RC-14 and GR-1 (2x109 cfu of each daily) in catheterization-dependent girls with spina bifida. Results Nine subjects were recruited for the study, with a mean age of 5.3 years. 2 of 9 subjects had pre-existing, asymptomatic bacteriuria. After 3 months of taking the probiotics, one subject demonstrated clearance of bacteriuria, whereas the other continued to have bacteriuria. Of the other seven subjects, all developed bacteriuria at least once. Only one subject had a symptomatic, febrile UTI during a total of 109 patient-weeks of follow-up, which was less than expected based upon previous records of the patients. No adverse effects associated with probiotic use were observed. Conclusions In conclusion, orally ingested L. reuteri RC-14 and L. rhamnosus GR-1 were well-tolerated by the children. The three month use of prophylactic probiotic lactobacilli did not appear to reduce acquisition of bacteriuria in girls, but may have prevented episodes of symptomatic UTI. We are currently planning a randomized clinical trial to further test this hypothesis.

Prophylaxis in Female Urinary Infections in Women

Recurrent urinary tract infections (UTI) in women cost billions of euro annually. E. Coli causes 70–95% of these infections and it has been observed, in vitro and in vivo, to have the capability to develop bacterial biofilms in the bladder: polysaccharide-rich matrix. At the present, the only way to overcome this mucopolysaccaride barrier is to administer long repeated cycles of chemotherapy. We submit prophylaxis to patients with recurrent UTI to sterilize urine for at least 6 consecutive months. Materials and Methods 42 women with recurrent UTI have been selected according to: urine culture, vaginal swabs, and DNA-probe for Chlamydia, Gonococcus, Mycoplasma. After giving informed consent patients were assigned to treatment group A and B. For the first 10 days both groups received ciprofloxacin 500 mg bid, and then group A received ciprofloxacin 250 mg on alternate days and 1 cpr before every sexual intercourse. The group B received placebo in the same modality. Every sexual intercourse had to be safe. All the patients, after the initial screening, repeated an urine culture every 10 days for the first 6 months and every 20 days for the next 6 months. The statistical analysis was performed by chi-square test. Results 44 patients finished the study. 23 pt of group A had sterile urine for the first 6 months of the study and 81% for the next 6 months; 1/23 had 2 episodes of symptomatic UTI. 71% of the 21 patients of group B had symptomatic bacteriuria 20 days after the first treatment (p&lt;0.001). 16/21 patients had symptomatic UTI in the first 6 months of the study and the 90% in the 12 months of the study (p&lt;0.001), in spite of every poussèe was treated with the same antibiotic scheme. Conclusions This kind of prophylaxis has few collateral effects, and it appears to be effective in the treatment of recurrent UTI in women.

Risk factors in the development of early technetium-99m dimercaptosuccinic acid renal scintigraphy lesions during first urinary tract infection in children.

To establish the variables that correlate with uptake defects in dimercaptosuccinic acid (DMSA) scintigraphy performed in the acute phase of a first episode of urinary tract infection (UTI). A prospective observational study was conducted in a cohort of 158 consecutive children with a first episode of symptomatic UTI. The therapeutic delay time (TDT) was recorded. DMSA scintigraphy was performed in all children and voiding cystourethrography in 150 of them. 85% of the patients were younger than 2 y. Mean TDT was 33.5 h. The aetiological agent was Escherichia coli in 140 children. DMSA scintigraphy was normal in 81. Vesicoureteric reflux was detected in 33. After a multivariate logistic regression analysis the following variables were retained in the final model: TDT > or = 48 h, growth of bacteria other than E. coli, percentage of polymorphonuclear cells > or = 60% and C-reactive protein > or = 30 mg l(-1). TDT > or = 48 h, bacteria other than E. coli, percentage of polymorphonuclear cells > or = 60% and CRP > or = 30 mg l(-1) influence the findings detected in the DMSA scintigraphy performed in the acute phase of a first episode of UTI.

Pilot trial of bacterial interference for preventing urinary tract infection

Objectives. To examine the safety and efficacy of bacterial interference in preventing symptomatic urinary tract infection (UTI). Methods. A prospective, nonrandomized, pilot clinical trial was conducted in patients with spinal cord injury who had neurogenic bladder and had frequent episodes of symptomatic UTI. The bladder of patients was inoculated with a nonpathogenic prototype of Escherichia coli 83972. The rate of symptomatic UTI in successfully colonized patients while colonized with E. coli 83972 was compared with (a) their own baseline prestudy rate and (b) the rate of symptomatic UTI in patients who were not successfully colonized. Results. Of 44 inoculated patients, 30 (68%) became colonized with E. coli 83972 for 1 month or longer. Only two episodes of symptomatic UTI occurred in the group of 30 patients while colonized with E. coli 83972 (a total of 34 patient-years), and none was attributed to E. coli 83972. The group of 30 patients experienced a 63-fold reduction in the rate of symptomatic UTI while colonized with E. coli 83972 versus their baseline prestudy period (mean 0.06 versus 3.77 episodes of symptomatic UTI/patient-year, P <0.001). The rate of symptomatic UTI was also 33-fold lower in this group of 30 patients while colonized with E. coli 83972 than in the well-matched group of 14 patients who were not successfully colonized (mean 0.06 versus 1.80 episodes of symptomatic UTI/patient-year, P <0.001). Conclusions. The results of this pilot study indicate that bacterial interference using E. coli 83972 may be safe and effective in preventing UTI.

A Five-Year Prospective Follow-Up of Women with Non-Obstructive Pyelonephritic Renal Scarring

Fifty women with pyelonephritic renal scarring were prospectively followed for five years and the changes in renal function were related to blood pressure control, plasma renin activity, urinary albumin excretion and the incidence of urinary tract infections (UTI). Five patients (10%) developed end stage renal disease. All these patients had bilateral disease, proteinuria and anti-hypertensive treatment at presentation. The mean +/- SD glomerular filtration rate (GFR) of all patients with renal scarring was 74 +/- 27 ml/min x 1.73 m2 at presentation which was significantly lower than the GFR in 55 patients with a recent episode of acute pyelonephritis (p less than 0.001) and 10 healthy controls (p less than 0.001). GFR and age corrected GFR decreased significantly during follow-up (p less than 0.001) and p less than 0.02 respectively). The decrease in GFR was significantly higher in patients with bilateral scarring, in patients on blood pressure treatment and in patients with an episode of symptomatic UTI during follow-up. Eight patients (16%) had antihypertensive treatment at presentation and another 11 patients (26%), of whom 10 had bilateral scarring, developed hypertension (greater than 140/90 mmHg) during follow-up. Seventy-five per cent of all patients had symptomatic UTI and 40% had an episode of acute pyelonephritis during follow-up. In conclusion, patients with pyelonephritic scarring have a high incidence of UTI and are at high risk of developing renal failure and hypertension. It is essential that recurrent episodes of symptomatic UTI are treated promptly and that blood pressure is monitored carefully in these patients.

A five-year prospective follow-up of women with non-obstructive pyelonephritic renal scarring

Fifity women with pyelonephritic renal scarring were prospectively followed for five years and the changes in renal function were related to blood pressure control, plasma renin activity, urinary albumin excretion and the incidence of urinary tract infections (UTI). Five patients (10%) developed end stage renal disease. All these patients had bilateral disease, proteinuria and anti-hypertensive treatment at presentation. The mean ± SD glomerular filtration rate (GFR) of all patients with renal scarring was 74 ± 27 ml/min × 1.73 m2 at presentation which was significantly lower than the GFR in 55 patients with a recent episode of acute pyelonephritis (p < 0.001) and 10 healthy controls (p < 0.001). GFR and age corrected GFR decreased significantly during follow-up (p < 0.001 and p < 0.02 respectively). The decrease in GFR was significantly higher in patients with bilateral scarring, in patients on blood pressure treatment and in patients with an episode of symptomatic UTI during follow-up. Eight patients (1...