Episodes Of UTI Research Articles

Prophylaxis Options in Children With a History of Recurrent Urinary Tract Infections: A Systematic Review.

The prevention of urinary tract infection recurrence (UTI) in children has been a challenge yet to be solved. Current practice in children with recurrent UTI (RUTI) suggests that antibiotic prophylaxis may prevent further episodes of UTI and future complications. To conduct a systematic review and meta-analysis of randomized controlled trials comparing prophylaxis options for the prevention of UTI and kidney scarring in children with a history of RUTI. We conducted a systematic literature search through major electronic databases (PubMed/Medline, Scopus and Cochrane Library) up to November 26th, 2023. Mean difference and SD were used for continuous outcomes and odds ratio for dichotomous outcomes. Our meta-analysis included 3335 participants from 23 studies. The primary outcome was the effect of the different prophylaxis options on the incidence of symptomatic UTI in children with RUTI during prophylactic treatment. Cranberry products and nitrofurantoin lead to lower odds of symptomatic UTI episodes during prophylaxis compared with the control group and control, trimethoprim-sulfamethoxazole, or trimethoprim groups accordingly. Nitrofurantoin may be the best option for UTI incidence reduction compared with all available documented interventions. No prophylaxis option has been shown to reduce kidney scarring. Nitrofurantoin and cranberry products may decrease the incidence of symptomatic UTI episodes in pediatric patients with a history of RUTI. Future randomized control trials studying nonantibiotic prophylaxis options focusing on children with UTI recurrence and the risk for kidney scarring are needed to draw further conclusions.

Infant urinary tract infection in Sweden — A national study of current diagnostic procedures, imaging and treatment

BackgroundUrinary tract infection (UTI) in infants is a common, potentially life-threatening bacterial infection, and must be managed carefully through the entire chain of care from diagnosis, choice of treatment, follow-up and risk stratification of future complications. This Swedish nationwide study of infant UTI was conducted to evaluate the current management of infant UTI, yield of investigations and the Swedish UTI guidelines’ ability to detect abnormalities of importance in the urinary tract.MethodsInfants < 1 year with a first episode of UTI were included in a prospective multicenter study. Treatment and follow-up were provided by local pediatricians. Clinical and laboratory findings and imaging results were reported to the coordinating center. The current management and results were compared with a previous Swedish study.ResultsOne thousand three hundred six infants were included. Urine sampling was performed with clean catch technique in 93% of patients. Initial oral antibiotic treatment was used in 63%, predominantly third generation cephalosporines. Permanent kidney abnormalities were found in 10% and dilating vesicoureteral reflux (VUR) in 8%. Higher rates of male gender, non-E. coli infection and ultrasound dilatation were seen in infants < 1 month. UTI recurrences were reported in 18%.ConclusionsInfant UTI is still generating a considerable amount of follow-up examinations. There is a significant shift towards clean catch as the main urine sampling method. Voiding cystourethrography is performed less frequently reducing the findings of low grade VUR. The incidence of renal scarring is comparable with earlier studies which suggests that the Swedish guidelines are able to identify individuals with risk for long-term complications.Graphical abstractA higher resolution version of the Graphical abstract is available as Supplementary information

Secondary Analysis of Interstitial Cystitis/Bladder Pain Syndrome Patients Enrolled in a Recurrent Urinary Tract Infection Prevention Study Provides a Novel Paradigm for Etio-Pathogenesis and Practical Management of This Infection Phenotype.

A subset of interstitial cystitis/bladder pain syndrome (IC/BPS) patients experience recurrent urinary tract infection (rUTI) associated with symptom flares. Recurrent UTI subjects with associated IC/BPS were enrolled in the first North American early clinical experience trial evaluating a new sublingual UTI preventative vaccine, MV140. It has been shown that women with rUTI develop an imbalance in the T helper 1 and 2 (Th2 over-expression) in the bladder mucosa. Our hypothesis-generating secondary analysis will suggest that this infection subcategory of IC/BPS patients develop a similar imbalance of Th1-Th2 response type to bacteria present in their urinary microbiome, leading to a bladder hypersensitivity that responds to mucosal immune modulation. Female participants with ≥3 documented UTI/year underwent a 3-month vaccination treatment period with a 9-month efficacy period after completion of vaccine treatment (total 12 months). There were no exclusion criteria for subjects in relation to baseline urinary symptoms and/or discomfort/pain. Primary outcome was no UTI following vaccination. Secondary outcomes included change in UTI incidence, overall patient-reported subjective global assessment (SGA responder defined as moderately or markedly improved on 7-point scale), and safety. Sixteen subjects with IC/BPS-related symptoms and rUTI (mean age 47; range 23-74 years; mean number of UTI episodes in previous year 6.1 +/- 4.2) were eligible to be included in the Health Canada-approved MV140 vaccine study for prevention of rUTI. All subjects completed the 3-month vaccination period. One subject was lost to follow-up after their 6-month visit. Six subjects were UTI-free, while all 16 subjects had a reduction in UTI episodes compared to the year pre-vaccination. The total post-vaccination reduction in UTI episodes compared to pre-vaccination was 80% (0.1 UTI/subject/month from 0.5 UTI/subject/month, respectively). At 12 months, 13 subjects (81%) were SGA responders (moderately or markedly improved), and the responders reported a reduction in IC/BPS symptoms, with 8 subjects reporting significant or almost complete resolution of their specific long-term bladder discomfort/pain and bothersome urinary frequency or urgency. Four subjects reported mild and self-limited adverse events during vaccination period, but none were related to MV140 vaccine. Sublingual MV140 vaccine in IC/BPS patients with rUTI not only achieved UTI-free or reduced UTI incidence status but also, after approximately 9 months post vaccination, resolution of patients' long-term treatment-refractory IC/BPS symptoms. This suggests some cases of IC/BPS may be etiologically based on Th2-driven hypersensitivity to bacteria within or entering the urinary microbiome that responds to a vaccine whose mechanism of action is to normalize or balance the bladder Th1/Th2 mucosal immune system.

Development of Predictive Models to Inform a Novel Risk Categorization Framework for Antibiotic Resistance in Escherichia coli-Caused Uncomplicated Urinary Tract Infection.

In clinical practice, challenges in identifying patients with uncomplicated urinary tract infections (uUTIs) at risk of antibiotic nonsusceptibility may lead to inappropriate prescribing and contribute to antibiotic resistance. We developed predictive models to quantify risk of nonsusceptibility to 4 commonly prescribed antibiotic classes for uUTI, identify predictors of nonsusceptibility to each class, and construct a corresponding risk categorization framework for nonsusceptibility. Eligible females aged ≥12 years with Escherichia coli-caused uUTI were identified from Optum's de-identified Electronic Health Record dataset (1 October 2015-29 February 2020). Four predictive models were developed to predict nonsusceptibility to each antibiotic class and a risk categorization framework was developed to classify patients' isolates as low, moderate, and high risk of nonsusceptibility to each antibiotic class. Predictive models were developed among 87 487 patients. Key predictors of having a nonsusceptible isolate to ≥3 antibiotic classes included number of previous UTI episodes, prior β-lactam nonsusceptibility, prior fluoroquinolone treatment, Census Bureau region, and race. The risk categorization framework classified 8.1%, 14.4%, 17.4%, and 6.3% of patients as having isolates at high risk of nonsusceptibility to nitrofurantoin, trimethoprim-sulfamethoxazole, β-lactams, and fluoroquinolones, respectively. Across classes, the proportion of patients categorized as having high-risk isolates was 3- to 12-fold higher among patients with nonsusceptible isolates versus susceptible isolates. Our predictive models highlight factors that increase risk of nonsusceptibility to antibiotics for uUTIs, while the risk categorization framework contextualizes risk of nonsusceptibility to these treatments. Our findings provide valuable insight to clinicians treating uUTIs and may help inform empiric prescribing in this population.

2838. Clinical Application and Validation of a Predictive Antimicrobial Resistance Risk Categorization Framework for Patients with Uncomplicated Urinary Tract Infection

Abstract Background Empiric antibiotic (ABX) treatment for uncomplicated urinary tract infections (uUTIs) can be ineffective due to antimicrobial resistance (AMR). Understanding the risk of AMR using data-driven approaches can inform appropriate ABX selection. We developed an AMR pathogen risk categorization framework in E. coli caused uUTI using predictive modeling and evaluated its clinical validity. Methods Eligible females with uUTI confirmed by positive E. coli urine culture treated with nitrofurantoin (NTF), trimethoprim/sulfamethoxazole (SXT), fluoroquinolones (FQs), or beta-lactams (BLs) were identified from the Optum de-identified electronic health record data set (Oct 2015–Feb 2020). We developed predictive models using machine learning to quantify AMR probability for each ABX class. A framework with 3 risk categories (low, moderate, high) was constructed using the predicted probability (PP) of non-susceptibility (NS) (Table 1). Six patient profiles from differing risk categorizations were reviewed for clinical validity by 5 clinicians (4 medical doctors, 1 pharmacist). Results Of 87,487 eligible patients, approximately half were classified as low or high risk (44.0–49.1% across ABX classes). The proportion of patients with infections due to NS organisms was 5–12-fold higher among patients classified as high or moderate vs low risk (Figure 1). After review of the patient profiles (Table 2), clinical experts confirmed the consistency of modeled risk classification for all 6 patients with their own assessment of AMR risk across all drug classes. Patient 1 was aged 20 yrs, White, West residence, no UTI or ABX history 1 year prior to her uUTI; PP of NS was low (NTF 1.5%, SXT 16.6%, FQs 4.8%, BLs 8.4%) and was classified as low risk for all ABX classes. In contrast, patient 6 was post-menopausal, Black, Midwest residence, and had UTI episodes, prior AMR, and multiple healthcare visits 1 year prior to uUTI. She had high PP of NS (NTF 10.3%, SXT 97.2%, FQs 96.4%, BLs 48.0%) and was categorized as high risk for all ABX classes. Conclusion AMR risk varied greatly between patients. Our prediction model contextualizes patients’ AMR PP to 4 commonly prescribed ABX classes in the setting of uUTIs. Clinical application of this framework could inform appropriate empiric ABX selection for patients with uUTI. Disclosures Ryan K. Shields, PharmD, MS, Allergan: Advisor/Consultant|Cidara: Advisor/Consultant|Entasis: Advisor/Consultant|GSK: Advisor/Consultant|Melinta: Advisor/Consultant|Melinta: Grant/Research Support|Menarini: Advisor/Consultant|Merck: Advisor/Consultant|Merck: Grant/Research Support|Pfizer: Advisor/Consultant|Roche: Grant/Research Support|Shionogi: Advisor/Consultant|Shionogi: Grant/Research Support|Utility: Advisor/Consultant|Venatorx: Advisor/Consultant|Venatorx: Grant/Research Support Wendy Y. Cheng, MPH, PhD, ORCID: 0000-0002-8281-2496, Analysis Group, Inc.: Wendy Y. Cheng is an employee of Analysis Group, Inc., a consulting company that received funding from GSK to conduct this study Kalé Kponee-Shovein, ScD, Analysis Group, Inc: Employee of Analysis Group, Inc., which received funding from GSK to conduct the study Fernando Kuwer, MSc, Analysis Group, Inc.: Employee of Analysis Group, Inc., which received funding from GSK to conduct the study Chi Gao, ScD, Analysis Group, Inc.: Employee of Analysis Group, Inc., which received funding from GSK to conduct the study Ashish V. Joshi, PhD, GSK: Employee|GSK: Stocks/Bonds Fanny S. Mitrani-Gold, MPH, GSK: Employee|GSK: Stocks/Bonds Patrick Schwab, PhD, GSK: Employment|GSK: Stocks/Bonds Diogo Ferrinho, PharmD, GSK: Employee|GSK: Stocks/Bonds Malena Mahendran, MS, Analysis Group, Inc.: Malena Mahendran is an employee of Analysis Group, Inc., a consulting company that received funding from GSK to conduct this study Daniel Indacochea, PhD, Analysis Group, Inc.: Employee of Analysis Group, Inc., which received funding from GSK to conduct the study Lisa Pinheiro, MFin, Analysis Group, Inc.: Employee of Analysis Group, Inc., which received funding from GSK to conduct the study Jimmy Royer, PhD, Analysis Group, Inc.: Employee of Analysis Group, Inc., which received funding from GSK to conduct the study Madison T. Preib, MPH, GSK: Employee|GSK: Stocks/Bonds Jennifer Han, MD, GSK: Employment|GSK: Stocks/Bonds Richard Colgan, MD, GSK: Advisor/Consultant

Randomized clinical trial of non-antibiotic prophylaxis with d-Mannose plus Proanthocyanidins vs. Proanthocyanidins alone for urinary tract infections and asymptomatic bacteriuria in de novo kidney transplant recipients: The Manotras study

BackgroundStudies analyzing non-antibiotic alternatives in kidney transplant UTI's are lacking. d-Mannose, a simple sugar, inhibits bacterial attachment to the urothelium, as does Proanthocyanidins; both could act as a synergic strategy preventing UTI; nonetheless their efficacy and safety have not been evaluated in kidney transplant population yet. MethodsThis is a pilot prospective, double-blind randomized trial. Sixty de novo kidney transplant recipients were randomized (1:1) to receive a prophylactic strategy based on a 24-h prolonged release formulation of d-Mannose plus Proanthocyanidins vs. Proanthocyanidins (PAC) alone. The supplements were taken for the first 3 months after kidney transplant and then followed up for 3 months as well. The main objective of the study was to search if the addition of Mannose to PAC alone reduced the incidence of UTI and/or asymptomatic bacteriuria in the first 6 months post-transplantation. Results27% of patients experienced one UTI episode (cystitis or pyelonephritis) while asymptomatic bacteriuria was very common (57%). Incidences according UTI type or AB were: 7% vs. 4% for cystitis episode (p 0.3), 4% vs. 5% for pyelonephritis (p 0.5) and 17% vs. 14% for asymptomatic bacteriuria (p 0.4) for patients in the Mannose+PAC group vs. PAC group respectively. The most frequent bacteria isolated in both groups was Escherichia coli (28% of all episodes), UTI or AB due to E. coli was not different according to study group (30% vs. 23% for Mannose+PAC vs. PAC alone p 0.37). ConclusionsNon-antibiotic therapy is an unmet need to prevent UTI after kidney transplantation; however, the use of d-Mannose plus PAC does not seem capable to prevent it.

#5808 EFFECTIVENESS OF ORAL FOSFOMYCIN PROPHYLAXIS IN KIDNEY TRANSPLANT RECIPIENTS

Abstract Background and Aims Urinary tract infections (UTIs) are one of the most common infectious complications in kidney transplant recipients (KTR), which are of great importance due to their high morbidity and recurrent nature. Our main objective was to evaluate the effectiveness of oral fosfomycin prophylaxis in a group of high-risk patients with recurrent/relapsing urinary tract infections. Method Retrospective study of a cohort of 60 KTR with frequent UTIs who had been prescribed daily fosfomycin calcium or fosfomycin trometamol every 7-10 days for prophylactic purposes. Demographic, clinical, analytical and microbiological data were collected during a year before and after prophylaxis. Results The median age was 61.8 (55.6-71.2) years, 68.3% were men, with 7.4 (2.8-13.6) years since the transplant. The main etiologies of the underlying renal disease were: autosomal dominant polycystic kidney disease 20%, chronic glomerulonephritis 18.3%, chronic tubulointerstitial nephropathy 10%, and diabetic kidney disease 10%, In 51.7% there was chronic pathology of the urinary tract (mainly vesico-prostatic disease, 24.8% and vesico-ureteral reflux, 15%), with a history of urological surgery in 23.3%. Up to 20% of the KTR had some type of endourological device (permanent/intermittent bladder catheter, percutaneous nephrostomy, Bricker, etc). The most frequently isolated germs were: E. coli and K. pneumoniae, 35.2 and 13.6% pre-prophylaxis and 28.3 and 22.6%, post-prophylaxis, respectively. The median number of UTI pre vs post-prophylaxis was 2 (1-4.75) vs. 1 (0.5-1.6) episode/patient/year (p&amp;lt;0.001), with a reduction in UTI episodes in 69% of patients. Admissions were also reduced, going from 35% in the pre-prophylaxis year to 10% post (p = 0.001). After prophylaxis, the percentage of resistance to fosfomycin increased from 26 to 54%. and a greater number of multi-resistant germs were isolated, 17.7 pre- vs 35% post-. The renal function remained stable during follow-up [CKD-EPI pre- 47.2(20.8) vs 47.2(21.2) ml/min post-]. Conclusion Oral fosfomycin prophylaxis may be useful in KTR despite the underlying urological pathology, managing to reduce UTI episodes and the need for admission for this reason.

#3722 CARBAPENEM-RESISTANT ENTEROBACTERIACEAE URINARY TRACT INFECTION IN RENAL TRANSPLANT RECIPIENTS: ROLE OF A NOVEL ANTIBIOTIC REGIMEN

Abstract Background and Aims Urinary tract infection (UTI), the most common bacterial infection among renal transplant recipients (RTRs), remains a challenge, particularly given the increased incidence of MDR organisms, including Carbapenem-resistant Enterobacteriaceae (CRE). CRE infections were associated with inferior patient and graft outcomes compared to other bacterial infections. Paradoxically, there have been no guidelines on managing CRE in RTRs besides multiple challenges, including the bacteriostatic nature, poor urinary concentration, and dose-limiting adverse effects of various antibiotics. The current study designed and assessed the outcomes of protocol-based therapy consisting of high-dose Meropenem in combination with other antibiotics followed by prolonged oral administration. Method This is a single-centre retrospective study conducted in the department of Nephrology and Renal transplantation, Sanjay Gandhi Post Graduate Institute of Medical Sciences, India, between 1st August 2016 till 31st July 2022. All the RTRs aged $ \ge $ 18 years admitted between 1st August 2016 and 31st July 2018 with symptomatic UTI and a urine culture positive for CRE were included in the study. Patients who received various antibiotics conventionally based on the treating physician's decision from August 2016 to July 2017 were considered under the Best available treatment (BAT) group, while the Standardized Therapeutic Antibiotic Regimen (STAR) group included patients treated from August 2017 to July 2018. The treatment of the STAR group consists of a therapeutic phase for at least six weeks (IV therapeutic phase for two weeks total or one week after the clinical recovery, whichever is later + Oral Therapeutic phase for four weeks) followed by an oral chemoprophylaxis phase for three months. Following the treatment of index UTI episodes due to CRE, follow-up both groups’ follow-up data until a minimum of four years were collected. Appropriate statistical tools were applied, and analyses were performed by SPSS software, version 25. Results A total of 37 patients fulfilling the inclusion criteria were included in the study, of which 13 patients were under the BAT group, and 24 were treated by the STAR-based protocol. The mean age of the study population was 37.6 $ \pm \ $12.3 years, and all were males. Most patients (70.2%) had the UTI due to CRE within one-month post-transplant, and the median duration of UTI post-transplant was 6.1 days (IQR: 4.5 – 33). The primary outcome, recurrence rates of UTI at 48-month follow-up among the patients in the STAR group, was significantly lower than those in the BAT group (30.4% vs 77.8%, p = 0.01). The death-censored graft survival was also significantly better among the STAR group than the BAT group (100% vs 75%, p = 0.03) after 48 months. Graft function at 48 months was also better in the STAR group (Serum creatinine- 1.4 ± 0.8 mg/dl vs 2.9 ± 2.2 mg/dl, p = 0.007). The patient survival, however, was similar among the two groups (95.8% vs 88.9%, p = 0.47). Conclusion Prolonged and combination antibiotic therapy followed by long-term antibiotic prophylaxis significantly reduced the recurrence of UTI due to CRE among the RTRs. Graft function and death-censored graft survival were also considerably better. Hence, the current study may pave the path for future RCTs based on combination antibiotic therapy as a solution to combat the challenge of CRE in RTRs.

Health Care Utilization and Cost Associated With Urinary Tract Infections in a Privately Insured Spinal Cord Injury Population.

Urinary tract infections (UTIs) are the most common secondary medical complication following spinal cord injury (SCI), significantly impacting health care resource utilization and costs. To characterize risk factors and health care utilization costs associated with UTIs in the setting of SCI. IBM's Marketscan Database from 2000-2019 was utilized to identify individuals with traumatic SCI. Relevant ICD-9 and ICD-10 codes classified individuals into two analysis groups: having ≥ 1 UTI episode or no UTI episodes within 2 years following injury. Demographics (age, sex), insurance type, comorbidities, level of injury (cervical, thoracic, lumbar/sacral), and health care utilization/payments were evaluated. Of the 6762 individuals retained, 1860 had ≥ 1 UTI with an average of three episodes (SD 2). Younger age, female sex, thoracic level of injury, noncommercial insurance, and having at least one comorbidity were associated with increased odds of UTI. Individuals with a UTI in year 1 were 11 times more likely to experience a UTI in year 2. As expected, those with a UTI had a higher rate and associated cost of hospital admission, use of outpatient services, and prescription refills. UTIs were associated with 2.48 times higher cumulated health care resource use payments over 2 years after injury. In addition to bladder management-related causes, several factors are associated with an increased risk of UTIs following SCI. UTI incidence substantially increases health care utilization costs. An increased understanding of UTI-associated risk factors may improve the ability to identify and manage higher risk individuals with SCI and ultimately optimize their health care utilization.

Infecciones del tracto urinario en personas mayores: etiología y susceptibilidades antimicrobianas en un área del sur de España

IntroductionUrinary tract infection (UTI) is one of the most prevalent diseases in clinical practice and increases in patients older than 65years compared to middle-aged patients. In order to improve empirical treatment, the etiology and antibiotic sensitivity profile of the most frequent bacteria that produce UTIs in older people have been studied. Material and methodsCross-sectional, descriptive and retrospective study in which isolated micro-organisms with significant counts in urine samples from patients with UTI were included. The global etiology and according to sex were analyzed. Only one urine sample per patient and UTI episode was considered. ResultsRegarding the origin of the sample, the highest proportion was in primary care with 4853 urine cultures (51.6% of positive urine cultures), followed by hospital care with 3565 urine cultures (46.4% of positive urine cultures) and 94 urine cultures in nursing homes elderly (2% positive urine cultures). Escherichia coli was the most isolated micro-organism both in the population as a whole (54%) and in each of the analyzed groups. It was observed that E.coli isolated in women was significantly higher than in men (χ2, P=.044). Their sensitivity was: 80% fosfomycin and 75% amoxicillin-clavulanic acid. ConclusionsE.coli continues to be the most frequently isolated micro-organism in UTI. Empirical treatment of UTI in our environment should include fosfomycin or amoxicillin-clavulanic acid, regardless of the health care unit and gender.

Incidence rates and trends of childhood urinary tract infections and antibiotic prescribing: registry-based study in general practices (2000 to 2020)

BackgroundTo improve the management of childhood urinary tract infections, it is essential to understand the incidence rates, testing and treatment strategy.MethodsA retrospective study using data from 45 to 104 general practices (2000 to 2020) in Flanders (Belgium). We calculated the incidence rates (per 1000 person-years) of cystitis, pyelonephritis, and lab-based urine tests per age (< 2, 2-4, 5-9 and 10-18 years)) and gender in children and performed an autoregressive time-series analysis and seasonality analysis. In children with UTI, we calculated the number of lab-based urine tests and antibiotic prescriptions per person-year and performed an autoregressive time-series analysis.ResultsThere was a statistically significant increase in the number of UTI episodes from 2000 to 2020 in each age group (p < 0.05), except in boys 2-4 years. Overall, the change in incidence rate was low. In 2020, the incidence rates of cystitis were highest in girls 2-4 years old (40.3 /1000 person-years 95%CI 34.5-46.7) and lowest in boys 10-18 (2.6 /1000 person-years 95%CI 1.8-3.6) The incidence rates of pyelonephritis were highest in girls 2-4 years (5.5, 95%CI 3.5-8.1 /1000 person-years) and children < 2 years of age (boys: 5.4, 95%CI 3.1-8.8 and girls: 4.9, 95%CI 2.7-8.8 /1000 person-years). In children 2-10 years, there was an increase in number of lab-based urine tests per cystitis episode per year and a decrease in total number of electronic antibiotic prescriptions per cystitis episode per year, from 2000 to 2020. In children with cystitis < 10 years in 2020, 51% (95%CI 47-56%) received an electronic antibiotic prescription, of which the majority were broad-spectrum agents.ConclusionsOver the last 21 years, there was a slight increase in the number of UTI episodes diagnosed in children in Flemish general practices, although the overall change was low. More targeted antibiotic therapy for cystitis in accordance with clinical guidelines is necessary to reduce the use of broad-spectrum agents in children below 10 years.

Ionizing Radiation Exposure in Children with Vesicoureteral Reflux: Should We Be Alarmed?

Abstract Objectives Ionizing radiation imaging is commonly used for diagnosis and follow up in children with vesicoureteral reflux (VUR). We aim to measure the effective dose (mSv) in patients with VUR. Methods We reviewed our electronic database of patients under 8-years-old with VUR. Primary endpoint was to calculate the effective radiation dose (ED). Absolute frequencies and percentages were reported for global qualitative variables. This study conducted a logistic regression model to calculate the odds ratio for radiation exposure. Analysis was performed using STATA version 14.0 (StataCorp LLC, College Station, TX, EEUU). Results A total of 140 patients were found, 97 were assessed for eligibility. We included 59 patients in the final analysis. Mean age was 20 ± 17.9 months, 66% were females. Most cases of VUR were bilateral (44%) and high grade (93.4%). The lowest number of studies per patient was two, with a minimum radiation of 5.7 mSv. The highest radiation was estimated at 20.7 mSv corresponding to a total of five studies. Logistic regression showed that highest grades of VUR and age of first UTI episode were associated with higher ED (OR, 1.7; 95% CI, 0.87-3.31), (OR 1.02; 95% CI 0.97-1.07) respectively. A mean ED for children with VUR was estimated of 5.5 ± 3 mSv/year. Conclusion In our study, the children with VUR were exposed to 5.5 mSv/year without counting the natural background radiation, which is alarming, and we believe should raise awareness worldwide in how we are unnecessarily diagnosing indolent VUR cases and following patients.

The role of uropathogenic Escherichia coli adhesive molecules in inflammatory response- comparative study on immunocompetent hosts and kidney recipients.

BackgroundUrinary tract infections (UTI) represent one of the most common contagious diseases in humans. Uropathogenic Escherichia coli (UPEC) strains are recognized as the most frequent causative agent, and these express a range of virulence factors including the adhesins. Immune response to UPEC under immunosuppression has not been fully understood yet. Interleukin 1β (IL1β), 6 (IL6) and 17 (IL17) represent clinically relevant markers of inflammation.AimThe study aimed to investigate the interplay between UPEC genotype and hosts’ immune status in shaping local inflammatory response in the course of an UTI episode. The respective numbers of: 18 kidney recipients with UPEC UTI, 28 immunocompetent hosts with UPEC UTI and 29 healthy controls were involved. Urine IL1β, IL6, and IL17/creatinine ratios in relation to fimH, csgA, papC, tosA, and flu genes presence in UPEC isolated from the urine samples were analyzed. Apart from traditional statistics, also machine learning algorithms were applied.ResultsThe urine levels of IL1β and IL 6 were similar in kidney recipients and the immunocompetent hosts. IL1β levels were higher in both kidney recipients and immunocompetent hosts than in controls, while IL6 levels were higher only in immunocompetent hosts than in controls. In the machine learning classification model, high urine IL17 levels were significantly more prevalent in controls, while low IL17 levels in urines infected with Ag43-positive UPEC strains, regardless of the host’s immune status. In the traditional statistical analysis, IL17 levels appeared significantly higher in urine samples from kidney recipients infected with Ag43–negative UPEC strains.ConclusionsIn the UTI- affected patients, the combination of the immune status of an individual and Ag43 status of the UPEC strain determined urine IL17 level in the analyzed group. However, IL17 levels above median were overall more prevalent in controls.

MO1004: Non-Antibiotic Prophylaxis with D-MANOSE for Uti in DE-NOVO Kidney Transplant Recipients: The Manotras Study

Abstract BACKGROUND AND AIMS Urinary tract infections (UTIs) are one of the most frequent complications in the first 6 months after kidney transplantation. (1) D-Mannose, a simple sugar, could play a very important role in the prevention of urinary infections, inhibiting the attachment of bacterial type one fimbriae to the urothelium, reducing their ability to infect de host. Proanthocyanides (PAC) have also been shown in vitro activity to inhibit the adherence of Escherichia coli by a similar mechanism. Both have shown promising results in reducing the risk of UTI in healthy women, but its efficacy has not been evaluated in kidney transplant population yet. (2) In this single-cantre, double-blind, prospective, randomized clinical trial, we aimed to evaluate the impact and security of a 24-h prolonged release formulation of D-Mannose in de-novo kidney transplantation UTI's. METHOD Between April 2019 and September 2020, 60 patients were recruited and randomized in 1:1 ratio according to treatment arm. Control group was treated with PAC, while the study group received PAC plus Mannose. Treatments were given as a prophylaxis strategy immediate after renal transplantation and during the first 3 months. All patients were followed for 6 months. RESULTS No statistically differences were observed in the baseline characteristics among study groups (Table 1). During the follow up; 61% of patients had at least one UTI episode (asymptomatic bacteriuria 56%, cystitis 6% and acute graft pyelonephritis 17%). Escherichia coli accounted for 28% of all UTI episodes, followed by Enterococcus faecalis (15%), Enterobacter cloacae (13%) and Klebsiella pneumoniae (13%). The main renal outcomes (eGFR at 6 months, acute rejection and DGF) did not differ among study groups. We found no statistically differences recording in the incidence of UTI between groups (Fig. 1). At univariate analysis the surgical complications, and female gender were independently associated with UTI. {OR 5.92, [95% confidence interval (95% CI) 1.021–34.36]; P = .041 and OR 3.59 95% CI 1.051–12.27; P = .047} with no effect of treatment with D-mannose. CONCLUSION In this study, a prophylaxis strategy based on Mannose + PAC did not show a significant impact compared with PAC alone on UTI in the de-novo kidney transplant population.

MP33-17 TRANSPERINEAL FUSION BIOPSIES WITH SOFTWARE REGISTRATION: CANCER DETECTION BY PIRADS V2

You have accessJournal of UrologyCME1 May 2022MP33-17 TRANSPERINEAL FUSION BIOPSIES WITH SOFTWARE REGISTRATION: CANCER DETECTION BY PIRADS V2 Eusebio Luna, Gloria Egui-Benatuil, Alberto Lopez-Prieto, Edward Gheiler, Kaufman Ariel, Farshad Shafizadeh, Luis Avila, Barrios Dailianys, Juan Martinez-Salamanca, and Fernando Bianco Eusebio LunaEusebio Luna More articles by this author , Gloria Egui-BenatuilGloria Egui-Benatuil More articles by this author , Alberto Lopez-PrietoAlberto Lopez-Prieto More articles by this author , Edward GheilerEdward Gheiler More articles by this author , Kaufman ArielKaufman Ariel More articles by this author , Farshad ShafizadehFarshad Shafizadeh More articles by this author , Luis AvilaLuis Avila More articles by this author , Barrios DailianysBarrios Dailianys More articles by this author , Juan Martinez-SalamancaJuan Martinez-Salamanca More articles by this author , and Fernando BiancoFernando Bianco More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002587.17AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recently, the European Urological Association guidelines on prostate biopsies made Transperineal Biopsies (TPBx) their standard of care and advised against transrectal biopsies due to harms such as UTI and urosepsis. We stopped performing TRBx in 2017. Herein we present our experience with TPBx, using fusion registration (MR/US) with a medical device. We aimed to determine the accuracy of piRADS V2 system in this setting. METHODS: For this study, we evaluated Fusion TPBx conducted from October 2017 and May 2021 conducted across 4 centers. Antibiotic prophylaxis was dependent on the surgeon. Indications for TPBx: elevated PSA, abnormal DRE, Prostate Cancer history. Patients had a multiparametric MRI within 3 months of their TPBx. The MRI was classified using piRADS system and lesions were contoured. Post biopsies follow up consisted of a results visitation and a 30-day phone call that inquired for averse events (AE). The path from the procedure and 30-day outcomes was prospectively collected into the FocalyxApp (IOS & Android). Correlations between TPBx results, piRADS, presence of prostatitis and prophylactic antibiotics were performed using chi-squares and Bayesan statistics. RESULTS: 1,317 Fusion TPBx were performed, 1,189 (90%), were conducted under local anesthesia in the office. Prophylactic antibiotics were NOT used in 579 (44%). No episodes of UTI or sepsis were detected. Median Age, BMI, PSA, MR volume, total cores, target cores, pain reported and Fusion TPBx time was 68.6 years, 27.6 kg/m2, 5.7 ng/ml, 53cc, 16, 7, 3/10 and 19min, respectively. Cancer was found in 617 (47%). The piRADS V2 detection rate for scores 2,3,4 and 5 were 11/35 (15%), 201/661(30%), 241/382(63%) and 162/199 (81%), respectively. Overall, 572 patients had histological evidence of prostatitis, 276/579 (44%) of the NO prophylaxis group and 316/738 (43%) of the prophylaxis group, p=0.6. There was no statistical association between histological prostatitis and piRADS, p=0.4. At 30 days, 48 patients experienced an AE, none experience any bacterial proven infection. The most common being urinary retention which occurred in 31 patients and correlated with MR Prostate Volume (Spearman, p=0.001). There were no correlations between AE and antibiotic use or piRADS in MRI. CONCLUSIONS: Our study performed using software fusion registration illustrates the value of the piRADS system. Furthermore, it questions the necessity of antibiotic prophylaxis for TPBx and shows the high prevalence of histological prostatitis neither correlated to piRADS or prophylaxis. Source of Funding: Urological Research Network Foundation © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e576 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Eusebio Luna More articles by this author Gloria Egui-Benatuil More articles by this author Alberto Lopez-Prieto More articles by this author Edward Gheiler More articles by this author Kaufman Ariel More articles by this author Farshad Shafizadeh More articles by this author Luis Avila More articles by this author Barrios Dailianys More articles by this author Juan Martinez-Salamanca More articles by this author Fernando Bianco More articles by this author Expand All Advertisement PDF DownloadLoading ...

MP02-15 IMPACT OF MV140 ON PATIENT RELATED BURDEN OF DISEASE ASSOCIATED WITH THE MANAGEMENT OF RECURRENT URINARY TRACT INFECTIONS (RUTI)

You have accessJournal of UrologyCME1 May 2022MP02-15 IMPACT OF MV140 ON PATIENT RELATED BURDEN OF DISEASE ASSOCIATED WITH THE MANAGEMENT OF RECURRENT URINARY TRACT INFECTIONS (RUTI) J. Curtis Nickel, Stephen Foley, Miguel Casanovas, Raquel Caballero, and María Fernanda Lorenzo-Gómez J. Curtis NickelJ. Curtis Nickel More articles by this author , Stephen FoleyStephen Foley More articles by this author , Miguel CasanovasMiguel Casanovas More articles by this author , Raquel CaballeroRaquel Caballero More articles by this author , and María Fernanda Lorenzo-GómezMaría Fernanda Lorenzo-Gómez More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002514.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Women with rUTI suffer from episodic pain and urinary symptoms, disability, costs, poor quality of life, as well as short- and long-term complications of antibiotic therapy. A randomized placebo-controlled trial evaluating a polybacterial sublingual vaccine, MV140, presented as a late breaking AUA abstract in September 2021 showed efficacy and safety in reducing the risk of developing UTI in women with rUTI (ITT n= 215). The personal impact of this vaccine on burden of disease in the women enrolled in this study was evaluated. METHODS: Female subjects with rUTI were randomized to placebo for 6 months or vaccine for 3 or 6 months (1:1:1 ratio) and followed for 12 months from initiation of therapy. The primary endpoint and major secondary endpoint were the mean number of UTI and UTI free rate in the 9-month efficacy period following 3 months of intervention. Secondary analyses relevant to this analysis included impact on patient safety, symptom severity, antibiotic use, healthcare utilization, costs and quality of life. RESULTS: As previously reported, there was a significant reduction in UTI episodes (3.0 in placebo group [IQR, 0.5-6.0] compared to 0.0 [IQR, 0.0-1.0] in both groups receiving MV140 [P<0.001]) and UTI-free rate (25.0% in placebo, 55.7% in MV140 3M and 58.0% in MV140 6M groups; P<0.001) with few treatment-related adverse events in all groups (study total n=9). The median number of antibiotic prescriptions was 4.5 [IQR, 1.0-8.5] for placebo group compared to 1.0 [IQR, 0.0-3.0] in both groups receiving MV140 (P<0.001). A significant reduction (75.0-100.0% decrease) in the need for healthcare resources with similar reduction in healthcare costs were observed in the vaccinated subjects. UTI symptom severity was significantly reduced in the vaccinated groups with a concomitant improvement in quality of life experienced by the vaccinated subjects compared to those receiving placebo (Figure 1). CONCLUSIONS: MV140 significantly reduces the personal burden of UTI disease by safely decreasing risk of subsequent UTI, reducing severity of breakthrough UTI, reducing antibiotic use, healthcare resources, costs and ultimately improving the quality of life in women suffering from rUTI. Source of Funding: Inmunotek © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e16 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information J. Curtis Nickel More articles by this author Stephen Foley More articles by this author Miguel Casanovas More articles by this author Raquel Caballero More articles by this author María Fernanda Lorenzo-Gómez More articles by this author Expand All Advertisement PDF DownloadLoading ...

Etiological Agents of Urinary Tract Infection (UTI)

Urinary tract infection is one of the most common infectious diseases and has a high financial burden on society. The occurrence of urinary tract infection acquired by the population is higher in young women, almost half of all women will have at least one UTI episode during their lifetime, and about 1 in 3 women will have at least one UTI episode at the age of 24 years. Urinary tract infection increases with age for both sexes. It is estimated that 10 percent of men and 20 percent of women over 65 years of age have bacterial symptoms. Worldwide, Community-associated UTI (CAUTI) prevalence is 0.7% and the main risk factors are age, sexual activity, history of urinary tract infection, and diabetes. UTI is caused by Gram-negative and Gram-positive bacteria, where more than 95 % of UTI cases are caused by bacteria. Gram-negative organisms, primarily from the Enterobacteriaceae family, are responsible for UTI. It includes Escherichia coli (74.20 %), Enterococcus spp (5.30 %), Staphylococcus saprophyticus (1.40 %) Pseudomonas spp. (3.20 %), Klebsiella pneumoniae (6.20 %), and Proteus mirabilis (2.00 %) are among the bacteria that cause UTIs, with other bacteria accounting for 8.70 % .The aim of this review is to provide a summary and critical evaluation of the published evidence about the etiological agents of urinary tract infection.

Recurrent Urinary Tract Infection Incidence Rates Decrease in Women With Cystitis Cystica After Treatment With d-Mannose: A Cohort Study.

d-Mannose is a promising nonantibiotic prophylaxis for recurrent urinary tract infection (rUTI). Recurrent UTI is common in postmenopausal women and may be especially prevalent in those with cystitis cystica (CC) lesions found on cystoscopy. Our objectives were to determine whether CC lesions are associated with a higher UTI incidence rate and whether d-mannose reduces this rate in women with CC. This is a retrospective cohort study of patients with rUTI who underwent cystoscopy at our institution (from which CC status was identified) and who were treated with d-mannose as a single agent for UTI prophylaxis. Participants were required to have at least 1 year of follow-up for UTIs both before and after d-mannose initiation to allow for a pre-post comparison. Twenty-seven patients were included in the analysis (13 with CC, 14 without CC). Most patients (88.9%) were postmenopausal. Patients with CC had a higher UTI incidence rate than patients without CC (4.69 vs 2.93 UTIs/year before starting d-mannose prophylaxis, P = 0.021). After initiating d-mannose prophylaxis, the UTI incidence rate decreased significantly in patients with CC (rate decrease = 2.23 UTIs/year, P = 0.0028). This decrease was similar in magnitude to that observed in patients without CC (rate decrease = 1.64 UTIs/year, P = 0.0007; P interaction = 0.58). Patients with rUTI with CC had more frequent UTI episodes than patients without CC. Patients in both groups had fewer UTI episodes after beginning d-mannose prophylaxis. These findings add to the body of literature supporting d-mannose for the prevention of rUTI in women, including those with CC.

Temporary vesicostomy in pediatrics: What are the potential predictors of functional and morphological improvement of the upper urinary tract?

Vesicostomy is a simple, well-tolerated, and reversible procedure with few complications that safeguards upper urinary tract (UUT), decreases VUR grade, decreases UTI, and preserves renal function and should be considered in patients with PUV who have undergone prior valve ablation and bladder function not improved, and in myelodysplastic children that do not respond to catheter drainage [1-4]. We evaluated the temporary vesicostomy as a safeguard of the UUT in children with bladder outlet obstruction, bladder dysfunction, and high-grade VUR with sepsis and assessed the possible predictors of the UUT's morphological and functional improvement since these have been rarely explored in previous reviews. We evaluated the outcome and complications of temporary vesicostomy who were operated on 69 children at our center from 2014 to 2019. There were 63 (91.3%) boys and 6 (8.7%) girls who underwent vesicostomy at a mean age of 15.38±2.74 months old. Twenty-nine cases (42%) were diagnosed as primary VUR, 23 (33.3%) had posterior urethral valve (PUV), and 5 (7.2%) had voiding dysfunction, while 12 (17.4%) were neurogenic bladder. Twenty-five (36.2%) patients were diagnosed prenatally and the remainder (44, 63.8%) postnatally. All patients were evaluated at least one year postoperatively. UTI was diagnosed in all cases before vesicostomy; 47 (68.1%) had a single episode of UTI and 22 (31.9%) had recurrent episodes of UTI. Mean serum creatinine was 1.75±0.13 (0.7-4.8) mg/dl. Serum creatinine and the rate of UTI significantly improved (p-value <0.01). Seven (10.1%) cases were complicated with prolapse, 8 (11.6%) with stenosis, and 10 (14.5%) with peristomal dermatitis, all of them were males. About 75.4% of cases developed morphological improvement, while 24.6% of cases not improved (p-value=0.0001). Improvement or stability of glomerular filtration rate (GFR) was seen in 84.1%, while 15.9% deteriorated GFR (p-value=0.0001). This deterioration is associated with prenatal renal dysplasia. Age less than one year, abdominal swelling, severe HUN, grade V VUR and recurrent UTI before vesicostomy all independently affect functional improvement after vesicostomy. Vesicostomy is a simple, reversible, and well-tolerated surgery with few complications that is indicated in children with bladder outlet obstruction, bladder dysfunction, and high-grade VUR to protect UUT, improve renal function, decrease VUR, hydronephrosis, and febrile UTI. Age less than one year, abdominal swelling, severe HUN, grade V VUR and recurrent UTI before vesicostomy all were predictors that independently affect morphological and functional outcomes after vesicostomy.

MP25-13 EXPERIENCE WITH COMPLETE TRIGONAL ELECTROFULGURATION FOR WOMEN WITH RECURRENT URINARY TRACT INFECTIONS: TWO YEARS FOLLOW-UP

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Kidney & Bladder I (MP25)1 Sep 2021MP25-13 EXPERIENCE WITH COMPLETE TRIGONAL ELECTROFULGURATION FOR WOMEN WITH RECURRENT URINARY TRACT INFECTIONS: TWO YEARS FOLLOW-UP Leopoldo Ribeiro-Filho, Felipe Hirasaki, Eduardo Miranda, Matheus Siqueira, Cristiano Gomes, Miguel Srougi, and William Nahas Leopoldo Ribeiro-FilhoLeopoldo Ribeiro-Filho More articles by this author , Felipe HirasakiFelipe Hirasaki More articles by this author , Eduardo MirandaEduardo Miranda More articles by this author , Matheus SiqueiraMatheus Siqueira More articles by this author , Cristiano GomesCristiano Gomes More articles by this author , Miguel SrougiMiguel Srougi More articles by this author , and William NahasWilliam Nahas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002022.13AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Recurrent urinary tract infections (RUTI) have a negative impact on quality of life, contribute to antimicrobial resistance and have a significant economic burden. Long-term antibiotic therapy is the main treatment alternative but is often ineffective or poorly tolerated. In selected women, electrofulguration (EF) of trigonal lesions has been shown to reduce UTI episodes. In this study we evaluated the efficacy of complete trigonal EF for women with RUTI. METHODS: Between August 2006 and December 2017, 73 women with RUTI defined as three or more episodes of UTI per year were included in the study and completed at least two years of follow-up. All had undergone proper evaluation to exclude common causes of RUTI and all had squamous metaplasia and/or inflammatory lesions of the trigone or bladder neck. All had failed multiple antibiotic courses and were offered trigonal electrofulguration. Under anesthesia, endoscopic electrofulguration of the entire trigonal and bladder neck mucosa was performed using a roller ball. Biopsies were obtained prior to fulguration for histopathology analysis and in situ hybridization for Human Papiloma Virus (HPV). Patients were maintained on continuous bladder irrigation for a few hours and discharged home with no indwelling catheter. We evaluated the rate of UTIs during the initial two years of followup after fulguration based on symptoms and a positive urine culture. RESULTS: The median age was 64 years (range 17–76) and the median follow-up time after EF was 4.2 years (range 2.5 to 14 years). The procedure was well tolerated by all patients. Adverse events, most frequently disuria were mild and transient. In 24/76 (33%) patients bladder lesions in areas other than the trigone and bladder neck were also fulgurated. Histologically, squamous metaplasia (SM) was found in 31 (42%) patients and chronic erosive trigonitis (ET) in 42 (58%). HPV in situ hybridization was positive in 4/31 (13%) patients in the SM group and none in the ET group. Overall, 70/76 (96%) patients remained free of UTI episodes during the first year of follow-up, including 29/31 (94%) in the SM group and 41/42 (98%) in the ET group. At 2 years of follow-up, 15/31 (48%) in the SM group remained infection-free vs 27/42 (64%) in the ET group .UTIs were typically sparse, mild and caused by multisensitive bacteria. CONCLUSIONS: Complete trigonal and bladder neck mucosal fulguration promoted a significant reduction of UTI episodes during the first two years of follow-up. Prospective controlled studies are needed to determine the role of EF in women with RUTI. Source of Funding: none © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e458-e458 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leopoldo Ribeiro-Filho More articles by this author Felipe Hirasaki More articles by this author Eduardo Miranda More articles by this author Matheus Siqueira More articles by this author Cristiano Gomes More articles by this author Miguel Srougi More articles by this author William Nahas More articles by this author Expand All Advertisement Loading ...