Episodes Of Urinary Tract Infection Research Articles

Urinary Tract Infections in Men in Primary Care in Catalonia, Spain.

Antimicrobial resistance is a major global problem that is primarily driven by the excessive and inappropriate utilization of antibiotics. Urinary tract infections (UTIs) are frequent in primary health care (PHC) and are typically treated with antibiotics. There is ample evidence on the management of this condition in women but not in men. The aim of this study was to describe the epidemiology of UTIs in men in Catalonia, Spain. We conducted a population-based observational cohort study that included male patients diagnosed with UTI within our SIDIAP and CMBD database during the period from 2012 to 2021. UTI diagnoses were grouped into five main groups (cystitis, prostatitis, orchitis and epididymitis, urethritis, and pyelonephritis). Of the 316,762 men with at least one recorded UTI episode, the majority were registered with a diagnosis of cystitis in PHC (212,958 patients). Quinolones were the most commonly recorded treatment for UTIs (between 18.3% and 38.6%, depending on the group), except for urethritis in which a combination of antibiotics (36.7%) was most frequently used. The treatment duration period was between 9 days and 18 days, except for the prostatitis group, in which treatment was extended to 21 days. Urine cultures were documented in up to 30% in the cystitis group. Pyelonephritis was the category linked to most septicemia cases (3.0%). Conclusions: This is the first study to assess UTIs in men using a large PHC database in Spain. The sociodemographic characteristics of our sample are similar to other studies in the literature. In our setting, the use of quinolones for the treatment of UTIs is the most registered, and its duration was between 9 days and 18 days, despite the fact that resistance to quinolones exceeds 20% of the strains in our area.

Water intake and recurrent urinary tract infections prevention: economic impact analysis in seven countries

BackgroundTo estimate the economic impact of preventing urinary tract infections (UTI) by increasing water intake among women with recurrent UTI and low fluid intake across seven countries: France, United Kingdom, Spain, United States of America, Mexico, China and Australia.MethodsA Markov model was developed to compare costs and outcomes of UTIs associated with low fluid intake in women versus a strategy of primary prevention by increasing water intake. Model inputs were based on randomized controlled trial data which found that increasing water intake by 1.5 L/day decreased the risk of developing cystitis by 48% in women with low fluid intake and recurrent UTI. A time horizon of 10 years was used; outcomes were from the payer perspective and included both direct and indirect costs, reported in 2019 United States dollars ($). Discounting rates varied by country. Scenarios of increasing levels of compliance to the increased water intake strategy were evaluated.ResultsThe total cost of one UTI episode, including diagnostics, treatment and complications, ranged from $2164 (Mexico) to $7671 (Australia). Assuming 80% compliance with the increased water intake strategy over a 10-year time horizon, the number of UTIs prevented ranged from 435,845 (Australia) to 24150,272 (China), resulting in total savings of 286 million (Australia) to $4.4 billion (China). Across all countries, increased water intake resulted in lower cost and fewer UTIs compared with low water intake.ConclusionPreventing recurrent UTIs by increasing water intake would reduce both the clinical and economic burden associated with UTI. Public, healthcare professionals and patients should be made aware about the preventive positive impact of appropriate water intake on UTIs.

Kidney transplant to vesicostomy: A safe strategy for children with end stage renal disease and lower urinary tract anomalies

Resolution of underlying urinary tract anomalies prior to kidney transplantation in patients with end stage renal disease (ESRD) secondary to uropathy, has been historically supported under the argument that this would help prevent infectious complications and graft loss. We propose to perform earlier kidney transplantation with a transient vesicostomy, deferring resolution of the uropathy to the post-transplantation period. The aim of this study was to evaluate the outcomes of kidney transplantation in children with a vesicostomy. A retrospective, multicenter study was performed including all patients under 18 years of age who underwent kidney transplantation with a vesicostomy, between January 2005 and December 2020 and had at least one year of follow up. Data related with the indication and timing of vesicostomy, time until transplantation, post-transplantation complications, urinary tract infections (UTI) and graft survival rate were collected. Of the 758 transplantations performed in the study period, 16 patients met the inclusion criteria. Mean age at transplantation was 58 months (range 20-151), and mean weight was 13.5Kg (range 8.4-20). Mean time from vesicostomy to kidney transplantation was 30 months (range 0-70). There were 2 (12.5%) ureteral complications that required reoperation. Eighteen episodes of UTI were identified in 8 patients (50%), accounting for 0.4 UTIs per patient-year of follow-up. UTIs did not lead to graft loss in any of the cases. Urinary tract reconstruction was performed in 5 patients (31.3%) at an interval of 1-91 months post-transplantation. After a mean follow-up of 44.8 months (range 13-200) from transplantation, patients with vesicostomy had a mean creatinine clearance of 86.6ml/min/1.73m2, with a mean serum creatinine level of 0.6mg/dl. Graft survival rate was 100%. Early kidney transplantation into a vesicostomy permits a resolution of the ESRD, avoiding deleterious effects related to dialysis. With a low rate of UTIs, we found no graft loss due to infectious complications. This strategy permits careful planning and better timing for the urinary tract reconstruction without delaying kidney transplantation. Kidney transplantation in pediatric patients with vesicostomy seems to be a safe and effective strategy. UTI rate was similar to that reported in the literature of patients with corrected urinary anomalies undergoing kidney transplantation without urinary diversion.

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

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

Evaluating the requirement of ultrasonography for children with their first urinary tract infection

Management of urinary tract infection (UTI) in children remains important. It may be the first sign for a possible underlying congenital abnormalities for the kidney and urinary tract (CAKUT). This study examined whether performing renal and bladder ultrasonography (RBUS) only for children who have a pathogen other than E. coli during their first urinary tract infection (UTI), or who experience UTI recurrence, would result in more missed diagnoses of kidney anomalies. Patients aged between 2 months and 2 years who were seen in a tertiary pediatric hospital during a 2-year period and diagnosed with UTI were included. RBUS and voiding cystourethrography (VCUG) were performed according to American Academy of Pediatrics (AAP) guidelines. Afterwards, we looked back and evaluated how often we found kidney problems when we only did a RBUS on patients who had an atypical cause of their first UTI or who had multiple UTIs. One hundred and seventy-eight patients who were followed up with UTI were included in this study. The isolated pathogen was E. coli in 104 cases (58.4%) and atypical in 74 cases (41.6%). VCUG was conducted on 40 patients, and vesicoureteral reflux (VUR) was discovered in 16 cases and ureteropelvic junction obstruction (UPJO) was discovered in 1 case. A different diagnostic approach that required the presence of an atypical pathogen at the first UTI or a fUTI recurrence to perform the RBUS would have missed just two severe kidney anomalies. It was observed that there could be a decrease of 40.4% in RBUS and at least 20% in VCUG. A diagnostic approach that necessitates the presence of an abnormal pathogen during the initial UTI or a second UTI episode for the RBUS to be carried out would lead to fewer negative ultrasounds with minimal risk of overlooking kidney anomalies.

Outcomes of Total Joint Arthroplasty Subsequent to Ostomy: A Case Series

BackgroundOstomy surgery is associated with a high rate of postoperative complications and poses several theoretical concerns for subsequent total joint arthroplasty (TJA). There is concern that ostomy may negatively impact nutrition or increase risk of known gastrointestinal (GI) complications such as obstruction, constipation, or diarrhea, particularly with the use of postoperative opioids. There is also concern that the open nature of the ostomy may increase the risk of infection. This case series reports outcomes and assesses the risk associated with TJA in patients with previous surgical history of intestinal ostomy. MethodsThis is an institutional review board-approved retrospective case series of patients with surgical history of ostomy who underwent total hip or total knee arthroplasty. Cohort consisted of 14 cases in 10 patients and was examined to report individual TJA and ostomy procedural details and outcomes. ResultsOf the 14 cases, none required GI clearance or prophylaxis outside of standard perioperative antibiotics prior to TJA surgeries, and all TJAs resulted in good outcomes. Four cases (29%) had a complication, although only 2 of these were GI complications and none were life-threatening or required further surgery. The first of the 2 experienced increased ostomy output, and symptoms were resolved promptly with rehydration. The second experienced decreased ostomy output, and symptoms were resolved promptly with changes in prn pain medications. Other complications were postoperative urinary tract infection and syncopal episode. ConclusionsTJA can be performed safely in the setting of ostomy with major consideration being risk of diarrhea or constipation during postoperative period.

The effect of a medicinal plant preparation on the frequency of episodes of exacerbation of recurrent cystitis and metabolic parameters in patients with type 2 diabetes mellitus taking glyphlosins

The problem of recurrent urinary tract infections (UTI) in patients with type 2 diabetes mellitus (DM 2) is relevant, especially when there is a combination of predisposing factors, such as female gender, history of UTI episodes, and therapy with sodium glucose cotransporter type 2 (SGLT-2) inhibitors, and the choice of effective and safe means could cause some difficulties, including ina terms of the burden of antibiotic resistance. To evaluate the effectiveness and safety of the phytoproduct Canephron® N for the prevention of exacerbations of recurrent cystitis and the effect on metabolic parameters in patients with type 2 diabetes taking SGLT-2 inhibitors. Prospective, randomized, open, parallel group study in 60 women. The main group took the drug Canephron® N for 3 months. The main parameters for evaluating were the frequency of recurrence of cystitis, level of albuminuria and LDL-cholesterol peroxidation product - malondialdehyde. Within 3 months of taking Canephron® N, exacerbations of chronic cystitis were diagnosed 2 times less often, a decrease in albuminuria was found in the form of an increase in the proportion of patients with an optimal level of albuminuria by 20%, a 50% reduction in the frequency of the initial increase in albuminuria, and the absence of moderate albuminuria in all patients at the end of course of therapy. A decrease in the level of MDA by 1.4 times was noted (p=0.019). Thus, the herbal drug Canephron® N can be used for accompanying therapy and prophylactic treatment in patients with recurrent cystitis on the background of DM 2, taking SGLT-2 inhibitors. The course of therapy should last at least 3 months.

Clinical Spectrum of Recurrent Urinary Tract Infections: A Single-Center Study

A retrospective observational study was undertaken to evaluate the clinical profile of recurrent urinary tract infections (UTIs) in a tertiary care hospital. Patients <18 years, kidney-transplant recipients, those on immunosuppressive agents and pregnant patients were excluded. Patients with ≥2 episodes of culture positive UTIs were included. Demographic details, investigations and treatment were recorded. Out of total 48 patients, 18 were female and 30 male. The common manifestations were acute pyelonephritis (52%), emphysematous pyelonephritis (20%) and cystitis (25%). Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (48%) was the most frequent organism isolated followed by Klebsiella spp. (29%) and Pseudomonas spp. (23%). Recurrent episodes of UTI with same organisms were noted in 62% patients. Death occurred in 12.5% patients due to septic shock. Renal calculi (24%) and double J (DJ) stent placement (30%) were associated with recurrent UTIs, though this was not statistically significant. Resistance to higher antibiotics (colistin, carbapenems, piperacillin-tazobactam, cefoperazone-sulbactam, third-generation cephalosporins) (65.4%, r = 0.81), diabetes (62.5%, r = 0.79), urological procedure (39.5%, r = 0.68), prior hospitalization (75%, r = 0.84), history of UTI prior to the study period (44%, r = 0.72) and need for per urethral catheter (PUC) beyond 7 days (35%, r = 0.74) had significant correlation with recurrent UTIs.

Возможности неантибактериальной терапии и профилактики инфекций мочевыводящих путей.

Introduction. Recurrent urinary tract infections (RUTI) are one of the most common nosologies in the practice of a urologist. About half of all women will have at least one episode of urinary tract infection (UTI) during their lifetime. Antibiotic therapy remains the mainstay of treatment for UTI. The need to search for alternative options for the treatment and prevention of UTIs is dictated by the frequent use of antibacterial drugs. Most often they talk about the use of D-mannose and herbal remedies. The purpose of this literature review is to critically analyze clinical studies conducted to date that have examined the effectiveness and safety of D-mannose and herbal medicines for the prevention and treatment of RUTI. Materials and methods. 13 studies were analyzed that assessed the effectiveness of D-mannose and a combined herbal medicine with antibacterial therapy. Results. Herbal preparations from centaury herb, lovage roots, rosemary herb and lingonberry leaves in combination with D-mannose and antibacterial therapy had a number of advantages in clinical practice in the form of a decrease in the titer of pathogenic microflora. Conclusions. The NephroBest phytocomplex together with the polysaccharide D-mannose is well tolerated, has no side effects and demonstrates excellent clinical results in the form of reducing the risk of relapse, eliminating the pathogen, quickly reducing symptoms and improving laboratory parameters.

The impact of childhood febrile urinary tract infection on urinary tract dilation in ultrasonography

Introduction and objective: Febrile urinary tract infection in a child may be the first manifestation of congenital anomalies of the kidneys and the urinary tract. Renal and bladder ultrasonography remains the first-line imaging modality in children with urinary tract infections. Urinary tract dilation found on ultrasonography prompts further invasive diagnosis; however, when performed in the acute phase of infection, it may potentially reveal misleading findings. Our study investigated whether acute urinary tract infection is associated with urinary tract dilatation and kidney oedema on ultrasonography. Materials and methods: We included 62 children up to 3 years of age with the first episode of febrile urinary tract infection in this prospective cohort study. We performed three ultrasonography examinations in each child: on the first day of the treatment, as well as two and four weeks after treatment onset. We scanned 124 kidneys. Results: The number of kidneys with urinary tract dilation has not significantly changed in consecutive ultrasound examinations. However, both renal length and width increased in the acute phase of urinary tract infection, correlating with symptom duration and C-reactive protein levels, and then subsided within 2–4 weeks. Conclusions: Febrile urinary tract infection does not significantly affect the results of renal and bladder ultrasonography for congenital anomalies of the kidneys and the urinary tract in children up to 3 years old. Kidneys are often involved in children with febrile urinary tract infections. Repeated ultrasound scans before further, more invasive diagnosis are recommended.

Hyponatremia and other potential markers of ultrasound abnormalities after a first febrile urinary tract infection in children

Urinary tract infections are the initial manifestation in 30% of urinary tract malformations. Identifying these patients, who could benefit from a specific treatment, is still challenging. Hyponatremia during urinary tract infection has been proposed as a urinary tract malformation marker. We evaluate the prevalence of hyponatremia during febrile urinary tract infections and its association with subjacent urinary tract malformations. We performed a retrospective study of healthy patients under 16 years, diagnosed with a first episode of febrile urinary tract infection, who had undergone blood testing in the acute episode and at least one renal ultrasound during follow-up (January 2014-November 2020). Hyponatremia was defined as (serum sodium ≤ 130 mEq/L). According to imaging findings, we classified patients into three groups: normal kidney ultrasound, mild pelviectasis, and significant urinary tract malformation. We performed logistic regression models to identify independent risk factors for urinary tract malformation and mild pelviectasis. We included 492 patients and 2.8% presented hyponatremia. We identified normal ultrasound in 77%, mild pelviectasis in 10.8%, and urinary tract malformation in 12% of patients. We found an association between mild pelviectasis and hyponatremia [OR 6.6 (CI95% 1.6–26.6)]. However, we found no association between hyponatremia and urinary tract malformation. The parameters that were associated with malformations were presenting a non-E. coli infection, C-reactive-protein levels over 80 mg/L, and bacteremia.Conclusion: Hyponatremia during the first episode of febrile urinary tract infection is present in 2.8% of patients and is associated with mild pelviectasis in imaging. However, hyponatremia does not indicate a greater need for complementary tests to screen for urinary tract malformations.What is Known:• Urinary tract infection is the first manifestation in 30% of children with urinary tract malformation.• Hyponatremia could be a marker to identify these children and guide the imaging approach.What is New:• Around 12% of children with a first episode of febrile urinary tract infection have a urinary tract malformation.• Non-E. coli infection, C-reactive protein levels over 80 mg/L, and bacteremia are markers for malformations to guide diagnostic imaging tests, but hyponatremia (Na ≤ 130 mEq/l) is not a reliable marker.

CpxA/R-Controlled Nitroreductase Expression as Target for Combinatorial Therapy against Uropathogens by Promoting Reactive Oxygen Species Generation.

The antibiotic resistances emerged in uropathogens lead to accumulative treatment failure and recurrent episodes of urinary tract infection (UTI), necessitating more innovative therapeutics to curb UTI before systematic infection. In the current study, the combination of amikacin and nitrofurantoin is found to synergistically eradicate Gram-negative uropathogens in vitro and in vivo. The mechanistic analysis demonstrates that the amikacin, as an aminoglycoside, induced bacterial envelope stress by introducing mistranslated proteins, thereby constitutively activating the cpxA/R two-component system (Cpx signaling). The activation of Cpx signaling stimulates the expression of bacterial major nitroreductases (nfsA/nfsB) through soxS/marA regulons. As a result, the CpxA/R-dependent nitroreductases overexpression generates considerable quantity of lethal reactive intermediates via nitroreduction and promotes the prodrug activation of nitrofurantoin. As such, these actions together disrupt the bacterial cellular redox balance with excessively-produced reactive oxygen species (ROS) as "Domino effect", accelerating the clearance of uropathogens. Although aminoglycosides are used as proof-of-principle to elucidate the mechanism, the synergy between nitrofurantoin is generally applicable to other Cpx stimuli. To summarize, this study highlights the potential of aminoglycoside-nitrofurantoin combination to replenish the arsenal against recurrent Gram-negative uropathogens and shed light on the Cpx signaling-controlled nitroreductase as a potential target to manipulate the antibiotic susceptibility.

Management of urinary tract infections in the community: a clinical audit and patient survey.

Urinary tract infection (UTI) is a common ailment but can develop into sepsis. The outcomes related to UTI may potentially be affected by both patient and clinician management of UTI. To explore the circumstances around a single UTI episode to determine whether there are patient and clinician-related variables that may contribute to differences in management. Survey and clinical audit in 12 general practices in England. Patients (n = 504) completed a bespoke survey and their corresponding index UTI consultation was audited. The TARGET (Treat Antibiotics Responsibly, Guidance, Education and Tools) UTI audit toolkit was utilised. A significantly higher proportion of females compared with males used self-management measures. Increase in fluid intake was 78% for females aged <65 years and 71% for females aged >65 years compared with 53% for males (P<0.001, Χ2 test). Analgesic use was 50% for females aged <65 years and 41% for females aged >65 years compared with 36% for males (P = 0.036, Χ2 test). Males also indicated they lacked UTI knowledge when compared with females (P = 0.002, Kruskal-Wallis test). Males also claimed to have waited significantly longer for a consultation appointment (P = 0.027, Χ2 test). Antibiotics were prescribed in 98% of all cases, with adherence to clinical diagnostic guidelines lowest in females aged <65 years. Only 40% (89/221 of cases in this guideline sub-cohort [females aged >65 years]) would have been a UTI, according to TARGET criteria, following a medical record audit. UTI symptom management by clinicians is suboptimal; the presence or absence of symptoms is often insufficiently recorded in medical records. Additionally, suboptimal adherence to guidelines concerning urinalysis and microbiological investigation is common. Known increased clinical risks for males may be compounded by their more limited knowledge of (self)-managing UTI and their comparatively late presentation.

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.

Prevalence of Enterococcal Urinary Tract Infections With Positive Nitrites in Urinalysis in Pediatric Patients With High-Risk for Enterococcal Infections.

Enterococcus is a relatively uncommon pathogen that causes urinary tract infections (UTIs) in healthy children. Most enterococcal infections occur in patients with risk factors such as anatomical or functional urinary tract anomalies, also known as CAKUT (congenital anomalies of kidney and urinary tract). Children who are suspected of having UTIs and who have certain risk factors are often treated specifically for enterococcal infection as part of their empiric regimen. Our primary objective was to determine the prevalence of enterococcal UTIs among high-risk children, and specifically among those with positive nitrite tests, with the goal of avoiding treatment with specific anti-enterococcal agents. This retrospective study included all the episodes of UTI treated at a tertiary pediatric center during 2010 to 2018. The data collected from medical records included nephrological and urological risk factors, nitrite status, and isolated pathogens. Of 931 episodes of UTI, 467 (50%) were considered high-risk. In all, 24 of the latter had Enterococcus as a single pathogen; 23 (96%) of these occurred in patients with negative nitrites in the first urine dipstick taken. The sole patient with high-risk factors, a positive nitrite test and coexisting enterococcal UTI had a history of previous enterococcal UTIs. In pediatric patients with nephrological and urological risk factors, who have positive nitrites in urinalysis, the risk for enterococcal UTI appears substantially low. Therefore, in this context, specific anti-enterococcal empirical antibiotic therapy may be unnecessary.

#5814 SGLT2 INHIBITORS IN IGA NEPHROPATHY: REAL-WORLD CLINICAL PRACTICE

Abstract Background and Aims Immunoglobulin A nephropathy (IgAn) is a common type glomerulonephritis that often progresses to advanced CKD despite the use of ACEi/ARBs and immunosuppression. DAPA CKD has demonstrated that dapagliflozin reduced the risk of CKD progression in patients with IgAn at high risk of progression (mean eGFR, 43.8 mL/min/1.73 m2, and median urinary albumin-to-creatinine ratio, 900 mg/g) for a median follow up of 2.1 years. EMPA KIDNEY demonstrated that empagliflozin was associated to a lower risk of progression of CKD than placebo in a pool of 853 patients with glomerular diseases also at higher risk of progression at 2 years of follow up. Based on both RCT, SGLT2i have been proposed as new therapeutic tools for management of IgAn. However, there is a lack of studies in real-world clinical practice. Thus, we aimed to evaluate the renal effect of SGTL2i at 12 months in a cohort of patients with biopsy proven IgAn. Method Multicenter retrospective observational study including all patients with biopsy proven IgAn who received SGLT2i in 2 hospitals in Spain. Results 19 patients were included, followed up for 12 months. 73,7% were men with a mean age of 48,37±16,74 and a mean evolution of IgAn of 3,5 years before SGLT2i initiation. 21% presented type 2 DM. Oxford scores were: M0 68,42%, M1 26,31%; E0 78,95%, E1 5,79%; S0 68,42%, S1 26,31%; T0 84,21%, T15,26%, T2 5,26%. No patient presented with crescents, and 63-42% presented IF and TA. Before SGLT2i, 21% have received immunosuppression, and 2 were on steroids at the time of SGLT2i initiation (one budesonide). 94,7% were on ACEi/ARBs. 57,9% received dapagliflozin, 15,8% empagliflozin and 26,3% canagliflozin. At baseline, patients showed creatinine 1,10 (0,91-1,49) mg/dL, eGFR 69,84±28,446 ml/min/1.73 m2, and UACR 315,00 (210,75-590,75) mg/g. As showed in Table 1, there is a transient decline in eGFR at month 1 after SLGT2i but then, there was a tendency to an improvement in eGFR (from 69,84±28,446 at baseline to 87,83±31,33), and a tendency to a decrease in UACR from 315,00 (210,75-590,75) at baseline to 152,00 (86,75-423,75) at month 12. From month 3 after SGLT2i, a significant decrease in uric acid was observed, and, at month 6, better systolic and diastolic BP control was achieved. A tendency to higher Hb levels was also observed, as well as a decrease in weight at the end of follow up. Interestingly, SGLT2i withdrawal was only necessary in 1 patient who presented acute pyelonephritis and AKI, requiring dialysis (baseline eGFR 20 ml7min.1.73 m2 and previously known episodes of urinary tract infection). No other adverse events were found. Conclusion In a cohort of patients with IgAn at high risk of progression, a stabilization of renal function was found at 12 months after SGLT2i initiation, with no decrease in eGFR and no increase in UACR. Treatment with SGLTi was associated to a decrease in uric acid levels, a better blood pressure control, and to an increase in Hb levels. Thus, in real-world clinical practice, SGLT2i seem to be a promising therapy for modifying the clinical course of IgAn with a favorable safety profile.

#6056 NEPHROLOGIC INVOLVEMENT IN A SURGICAL COMPLICATION: WHEN TO SUSPECT A PYELO-DUODENAL FISTULA

Abstract Background and Aims Spontaneous pyeloduodenal fistula is a rare condition occurring primarily after urologic events, in most cases infected kidney stones, pyonephrosis, xanthogranulomatous pyelonephritis, renal tumors, and infected renal cysts, with nowadays 80 cases described. The close relationship between the kidney and the duodenum is a facilitating condition. Method We describe the case of a 78 yo woman admitted in April 2022 for Acute Kidney Injury associated with fever, vomiting, oliguria and metabolic alkalosis. Over the last two years the patient reported recurrent febrile episodes associated with abdominal tenderness and weight loss. Urine cultures showed recurrent bacterial growth and she received antibiotics for recurrent episodes of pyelonephritis and lower urinary tract infections (K. Pneumonie ESBL +, E. Faecalis, P. Mirabilis). She was under nephrologic follow-up with a renal function demonstrating eGFR CKD-EPI of 35-30 ml/min/1.73 m2. In past medical history she reported atrial fibrillation in DOAC, heart failure with preserved ejection fraction, hypertension, previous left occipito-parietal ischemic stroke and right parotid adenoma. On physical examination of the abdomen there was no tenderness, mild pain in the right hypochondrium, Giordano's maneuver mild positive on the right side. Because of the evidence of lithiasis in the right kidney on ultrasound with grade III hydroureteronephrosis, we performed a CT scan with contrast, finding imaging compatible with right pyelonephritis with associated grade IV hydronephrosis, in particular lithiasic formation localized at the level of the right pyelo-ureteral junction (2 × 1cm), with partial involvement of the proximal portion of the ureter, severe calico-pyelic dilatation with overall reduction of the cortico-medullary thickness; diffuse inhomogeneity of the middle and lower thirds of the renal parenchyma, with evidence of some bubbles in contextual areas and inhomogeneity of the perirenal adipose tissue. Reduced nephrographic effect in the post-contrastographic phases and lack of elimination of the contrast in the urographic phase (12 min) were reported. She was started on antibiotics piperacillin-tazobactam and underwent right percutaneous nephrostomy placement. During the procedure we evidenced a communication between the calyx of the right upper calyceal group and an intestinal loop, probably the duodenum (Fig. 1). Results The patient underwent elective laparotomic surgery for right nephrectomy (Fig. 2) and closure of the intestinal fistula with duodenoraffia and omental patch. She was admitted to a post-operative intensive care unit, given comorbidities and the complexity of the operation. She was discharged in 9 days without post-operative complications, with stable renal function. One month after discharge the patient died of pneumonia. Conclusion Pyeloduodenal fistula is an infrequent condition causing occasional or continuous passing of materials between the alimentary canal and urinary tract. The presence of gastrointestinal symptoms and urinary tract alterations may be misinterpreted when occurring. Management of this case required collaboration between several specialists, with particular skills on AKI and CKD, infective complications, interventional radiology and surgical procedures. The outcome was strongly affected by the patient's general condition and comorbidities, with a good short-term outcome but complications on the long-term follow-up. The occurrence of air in the urinary tract is strongly suggestive of communications across the renal pelvis and the gastrointestinal tract. In particular if occurring in the setting of recurrent infections and nephrolithiasis, the diagnosis of pyelo-intestinal fistula should be considered.

Clinical Risk Scores to Predict Nonsusceptibility to Trimethoprim-Sulfamethoxazole, Fluoroquinolone, Nitrofurantoin, and Third-Generation Cephalosporin Among Adult Outpatient Episodes of Complicated Urinary Tract Infection.

Clinical risk scores were developed to estimate the risk of adult outpatients having a complicated urinary tract infection (cUTI) that was nonsusceptible to trimethoprim-sulfamethoxazole (TMP-SMX), fluoroquinolone, nitrofurantoin, or third-generation cephalosporin (3-GC) based on variables available on clinical presentation. A retrospective cohort study (1 December 2017-31 December 2020) was performed among adult members of Kaiser Permanente Southern California with an outpatient cUTI. Separate risk scores were developed for TMP-SMX, fluoroquinolone, nitrofurantoin, and 3-GC. The models were translated into risk scores to quantify the likelihood of nonsusceptibility based on the presence of final model covariates in a given cUTI outpatient. A total of 30 450 cUTIs (26 326 patients) met the study criteria. Rates of nonsusceptibility to TMP-SMX, fluoroquinolone, nitrofurantoin, and 3-GC were 37%, 20%, 27%, and 24%, respectively. Receipt of prior antibiotics was the most important predictor across all models. The risk of nonsusceptibility in the TMP-SMX model exceeded 20% in the absence of any risk factors, suggesting that empiric use of TMP-SMX may not be advisable. For fluoroquinolone, nitrofurantoin, and 3-GC, clinical risk scores of 10, 7, and 11 predicted a ≥20% estimated probability of nonsusceptibility in the models that included cumulative number of prior antibiotics at model entry. This finding suggests that caution should be used when considering these agents empirically in patients who have several risk factors present in a given model at presentation. We developed high-performing parsimonious risk scores to facilitate empiric treatment selection for adult outpatients with cUTIs in the critical period between infection presentation and availability of susceptibility results.

Antibiotic Prophylaxis for the Prevention of Urinary Tract Infections in Children: Guideline and Recommendations from the Emilia-Romagna Pediatric Urinary Tract Infections (UTI-Ped-ER) Study Group.

Background: Urinary tract infection (UTI) represents one of the most common infectious diseases and a major cause of antibiotic prescription in children. To prevent recurrent infections and long-term complications, low-dose continuous antibiotic prophylaxis (CAP) has been used. However, the efficacy of CAP is controversial. The aim of this document was to develop updated guidelines on the efficacy and safety of CAP to prevent pediatric UTIs. Methods: A panel of experts on pediatric infectious diseases, pediatric nephrology, pediatric urology, and primary care was asked clinical questions concerning the role of CAP in preventing UTIs in children. Overall, 15 clinical questions were addressed, and the search strategy included accessing electronic databases and a manual search of gray literature published in the last 25 years. After data extraction and narrative synthesis of results, recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) methodology. Results: The use of CAP is not recommended in children with a previous UTI, with recurrent UTIs, with vesicoureteral reflux (VUR) of any grade, with isolated hydronephrosis, and with neurogenic bladder. CAP is suggested in children with significant obstructive uropathies until surgical correction. Close surveillance based on early diagnosis of UTI episodes and prompt antibiotic therapy is proposed for conditions in which CAP is not recommended. Conclusions: Our systematic review shows that CAP plays a limited role in preventing recurrences of UTI in children and has no effect on its complications. On the other hand, the emergence of new antimicrobial resistances is a proven risk.

Primary clear-cell adenocarcinoma in women

Objectives: A literature review of clear cell adenocarcinoma (CCA) of the female urethra, which is a urinary tract neoplasm of low prevalence that can affect the urethra in rare occasions. Material and methods: A case report of CCA in a 59-year-old female with low urinary tract symptoms associated with two episodes of acute urinary retention and recurrent urinary tract infection (UTI) with the finding of a periurethral tumor in magnetic resonance image (MRI). Results: After cystectomy, double adnexectomy, urethrectomy, bilateral iliac-obturator lymphadenectomy, and ureteroileal deviation, the diagnosis of urethral CCA spread to lymph nodes was made. The case was discussed in the Urologic Oncology committee, indicating external radiotherapy and cisplatin as adjuvant treatment. Conclusions: Because of its aggressiveness, CCA is a rare tumor that requires radical surgery.