Evidence Of Urinary Tract Infection Research Articles

Natural Products in the Treatment of Lower Urinary Tract Dysfunction and Infection.

The popularity of natural products for the treatment of lower urinary tract symptoms (LUTS) differs considerably between countries. Here we discuss the clinical evidence for efficacy in two indications, male LUTS suggestive of benign prostatic hyperplasia and urinary tract infections, and the mechanistic evidence from experimental studies. Most evidence for male LUTS is based on extracts from saw palmetto berries, stinging nettle roots, and pumpkin seeds, whereas most evidence for urinary tract infection is available for European golden rod and combined preparations although this field appears more fragmented with regard to extract sources. Based on differences in sample collection and extraction, extracts from the same plants are likely to exhibit at least quantitative differences in potential active ingredients, which makes extrapolation of findings with one extract to those of others potentially difficult. While only limited information is available for most individual extracts, some extracts have been compared to placebo and/or active controls in adequately powered trials.

Clinical characteristics and outcomes in febrile infants aged 29-90 days with urinary tract infections and cerebrospinal fluid pleocytosis.

Fever without a focus is a common reason for medical evaluations, hospitalizations, and the antimicrobial treatment of infants younger than 90 days. The presence of cerebrospinal fluid (CSF) pleocytosis could be challenge for clinicians who treat febrile young infants with urinary tract infection (UTI). We evaluated the factors associated with sterile CSF pleocytosis and the clinical outcomes of the patients. A retrospective review of patients aged 29-90 days with febrile UTIs who underwent a non-traumatic lumbar puncture (LP) at Pusan National University Hospital from January 2010 to December 2020 was conducted. CSF pleocytosis was defined as white blood cell (WBC) counts ≥9/mm3. A total of 156 patients with UTI were eligible for this study. Four (2.6%) had concomitant bacteremia. However, no patients had culture-proven bacterial meningitis. In correlation analysis, although weak strength, CSF WBC counts were positively correlated with C-reactive protein (CRP) level (Spearman r = 0.234; P = 0.003). Thirty-three patients had CSF pleocytosis [21.2%; 95% confidential interval (CI), 15.5-28.2]. The time from fever onset to the hospital visit, peripheral blood platelet counts, and CRP level at admission were statistically significant in patients with sterile CSF pleocytosis compared to those without CSF pleocytosis. In the multiple logistic regression, only CRP was independently associated with sterile CSF pleocytosis (cutoff, 3.425 mg/dl; adjusted odds ratio, 2.77; 95% CI, 1.19-6.88). The proportion of fever defervescence by hospital day 2 was 87.9% in patients with CSF pleocytosis and 89.4% in those without CSF pleocytosis (P = 0.759). There was no statistical difference in the fever defervescence curves between the two patient groups (P = 0.567). No patients had neurological manifestations or complications. Coexisting sterile CSF pleocytosis among febrile infants with UTIs suggest a systemic inflammatory response. However, the clinical outcomes between the two groups were similar. A selective LP should be considered in young infants with evidence of UTI, and inappropriate antibiotic therapy for sterile CSF pleocytosis should be avoided.

Acute Kidney Injury in a COVID-19 Lung Transplant Recipient

Dear Editor, A 63-year-old man was referred to our hospital for extracorporeal membrane oxygenation (ECMO) following a severe COVID-19 infection 4 months back. He was put on V-V ECMO and continued on the same for a month. He was evaluated and found to have extensive pulmonary fibrosis. He was considered for a lung transplantation and after appropriate medical evaluation and repeated negative severe acute respiratory syndrome coronavirus 2 (SARS-COV 2) reverse real-time polymerase chain reaction tests, he underwent a deceased donor transplantation 2 months back. He had no comorbidities, and pretransplant evaluation did not reveal any significant cardiac, liver or renal abnormalities. His creatine phosphokinase (CPK) at the time of transplantation was checked and was found to be normal. The posttransplant course was uneventful and he was off ventilatory support from the 14th posttransplant day. Posttransplant serum creatinine was 0.8 mg/dl, and his urinalysis did not reveal any abnormality. His initial tacrolimus levels were on the lower side (8.7 ng/ml), and accordingly, his tacrolimus dose was increased. The repeat level was 11.9 ng/ml (target 12–15 ng/ml in first 6 months) 6 weeks’ posttransplantation, his urine output started to decrease and his creatinine started to rise. A nephrology consultation was sought and evaluation revealed the presence of new-onset proteinuria. There was no evidence of urinary tract infection. Because of worsening renal functions (serum creatinine – 2.1 mg/dl and blood urea – 210 mg/dl) and reducing urine output, he was advised dialysis. He did not appear to be dehydrated, and his inferior vena cava diameter was 1.8 cm and not collapsible. The high urea was considered because of his steroids (20 mg/day and protein-rich parenteral nutrition. A provisional diagnosis of acute tubular necrosis (ATN) with the underlying glomerular disease was considered. As there was no improvement in his renal functions, he underwent a renal biopsy. His histopathological examination of the biopsy showed normal viable glomeruli with scattered tubules with denuded lining. There was no interstitial inflammation and tubular atrophy [Figure 1a]. Some tubules showed casts which stained positive for myoglobin [Figure 1b]. The electron microscopy showed podocyte loss (>30%) and significant subendothelial basement membrane rarefaction [Figure 1c]. No new therapy was advised as he was on triple immunosuppression, which was felt to be appropriate for the glomerular pathology. After another 2 weeks of dialysis, he made slow renal recovery. He was discharged off dialysis after another week. His predischarge creatinine was 0.8 mg/dl.Figure 1: Histopathological examination of the biopsy show features of acute tubular necrosis (a). Myoglobin tubular casts were noted in immunohistochemistry (b). Electron microscopy revealed podocyte injury with significant basement rarefaction (c)Acute kidney injury (AKI) is common post lung transplantation.[1] It is anticipated that the incidence of AKI will be a major concern in severe COVID-19-infected patients who undergo lung transplantation as SARS-COV-2 infection has a propensity to involve kidneys.[2] AKI, in our case, appears to be multifactorial. Our patient had underlying ATN, which we believe was because of the hemodynamic instability secondary to an emergency transplant in a critically sick individual. What was unusual in our case was the co-existence of myoglobin casts and the electron microscopic evidence of basement membrane pathology. Rhabdomyolysis is known to happen in patients with COVID-19 infection[3] and occasionally in patients on ECMO. As the CPK in the patient was consistently normal from the time of transplantation, it is speculated that the myoglobin casts depict past injury secondary to COVID-19 infection. The third component was the evidence of glomerular injury, which cannot be explained by ATN. Recent evidence also suggests that glomerular disease develops 4–6 weeks following COVID-19 infection.[4,5] The glomerular involvement in our patient is also a sequelae of COVID-19 infection pretransplant. The most common finding in COVID-19-induced glomerular disease is focal segmental glomerulosclerosis (FSGS).[6] Our patient had podocytopathy, but the pathology was not consistent with FSGS. We believe the biopsy manifestations of underlying glomerular involvement seem to have been modified by posttransplant immunosuppression. Our case highlights unique pathomechanisms of AKI in a COVID-19 lung transplant recipient. Declaration of patient consent The authors certify that patient consent has been taken for participation in the study and for publication of clinical details and images. Patients understand that the names, initials would not be published, and all standard protocols will be followed to conceal their identity. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Antibiotic Sensitivity in Complicated and Uncomplicated UTI in Potuakhali Medical College Hospital

Introduction: Urinary tract infection (UTI) is a common reason for attending hospital emergency departments (ED). A complicated urinary tract infection (UTI) is associated with structural or functional abnormalities of the genitourinary tract or presence of any underlying disease. Objective: To assess the antibiotic sensitivity in complicated and uncomplicated UTI. Materials and Methods: The study was carried out in the Department of Medicine and Department of Microbiology. The urine samples were collected from the OPDs (outpatients departments). These sample collection sites were chosen as they mostly covered the urban area of the city. The duration of the study was one and a half year from July 2018 to January 2020. The urine samples of 200 patients, comprised of 60 males and 140 females, who attended the outpatient departments (OPDs) of three hospitals and had clinical evidence of urinary tract infection, determined by treating physicians, were included in this study. Results: Most common isolated pathogen was Eschericia coli 170(85.0%) followed by staphylococcus aureus 40(20.0%) and Klebsiella (10%). Multiple organisms were found few cases. Regarding drug sensitivity it was observed that maximum sensitivity was to Amikacin 94.0% followed by Nitrofurantoin 92.0%, Levofloxacin 90.0%, Meropenam 88.0%, Amoxicillin+Clavulanate 70.0% and Cefixim 70.0%. Conclusion: Female patients were predominant most common isolated pathogen were Eschericia coli, staphylococcus aureus and Klebsiella. Amikacin, Nitrofurantoin, Levofloxacin, Meropenam and Amoxicillin+Clavulanate were more sensitive antibiotic. Medicine Today 2022 Vol.34(1): 70-74

Emphysematous cystitis as a potential marker of severe Crohn's disease

BackgroundEmphysematous cystitis (EC) is characterized by the presence of air within the bladder wall, often a complication of urinary tract infection (UTI) by gas-producing organisms. However, EC has also been reported in the setting of infectious colitis suggesting an alternate etiology. We report a rare case of EC in the setting of severe Crohn’s colitis with no clinical evidence of UTI.Case presentationA 43-year old female presented with a 2-month history of bloody diarrhea consisting of 8–12 bowel movements a day, weight loss of 10 kg and peripheral edema. She also had multiple ulcerated lesions on her abdominal wall and in the perianal region. Initial CT scan was significant for pancolitis, anasarca and EC. The follow-up CT cystogram, flexible cystoscopy and pelvic MRI confirmed the diagnosis of EC and ruled out any fistulous tracts in the pelvis including enterovesical/colovesical fistula. The patient did not report any urinary symptoms and the urinalysis was within normal limits. An extensive infectious workup was negative. Despite the paucity of infectious findings, the EC was empirically treated with an intravenous third-generation cephalosporin. Colonoscopy was significant for multiple ulcerated and hyperemic areas with pseudopolyps all throughout the right, transverse and left colon. Biopsies confirmed Crohn’s colitis with no evidence of granulomata or dysplasia. Immunohistochemistry was negative for CMV. The perianal and abdominal wall lesions were suspected to be pyoderma gangrenosum although biopsies were equivocal. The colitis was initially treated with intravenous steroids followed by biologic therapy with Infliximab. Despite appropriate escalation of therapies, the patient developed colonic perforation requiring subtotal colectomy.ConclusionThis is a rare case of EC in a patient with severe Crohn’s colitis. There was no evidence of urinary tract infection or fistulising disease. According to our review, this is the first reported incident of EC in a patient with inflammatory bowel disease without any prior intra-abdominal surgeries. While active Crohn’s disease alone is a critical illness, we conclude that concomitant EC may be a poor prognostic factor.

Urine Bacteriology in Post-Kidney Transplant Patients with Double-J Stents

Background: Kidney transplantation is the gold standard treatment modality for patients with end-stage renal disease. Ureteric stenting is commonly used during kidney transplantation to reduce the incidence of ureteric complications post-transplantation. The presence of ureteric stents could be complicated by bacterial colonisation and urinary tract infections.
 Objective: To identify the urinary flora in patients with double-J stents following kidney transplantation and establish bacteria colonisation and their antimicrobial susceptibility.
 Methods: Over one-year, single urine samples of consecutive 100 post-renal transplant patients were subjected to bacteriologic analysis. Early morning midstream urine was obtained into a sterile bottle from all the participants for laboratory analysis.
 Results: The mean age of post kidney transplantation patients was 47.6 ±12.3 years. Hypertension and diabetes were the commonest co-morbidities associated with End-Stage-Renal-Disease (ESRD), accounting for 61% and 28%, respectively. E. coli was the commonest isolate (70.4%). Microbiological evidence of Urinary Tract Infection (UTI) revealed by pyuria (pus cells >4/HPF) was found in 40.9%. Tigecycline, nitrofurantoin and tetracycline showed the highest sensitivity pattern in 9%, 8% and 8%, respectively, with significant resistance against cephalosporins and fluoroquinolones.
 Conclusion: The fourth week of double-J ureteric stent insertion in kidney transplant recipients showed a high incidence of urinary bacterial colonisation.

Quinolone-resistant uropathogenic E. coli: is there a relation between qnr genes, gyrA gene target site mutation and biofilm formation?

Introduction. The resistance to quinolone reported in uropathogenic Escherichia coli (UPEC) is commonly caused by mutations in the target site encoding genes such as the gyrA gene. Bacterial plasmids carrying resistance genes such as qnr genes can also transfer resistance. Biofilms produced by UPEC can further aid the development of resistant urinary tract infections (UTIs).Hypothesis. Biofilm production is associated with higher prevalence of quinolones resistance genetic determinants.Aim. To detect the prevalence of qnr genes and gyrA gene mutation among quinolone-resistant UPEC and to investigate the relation between these genetic resistance determinants and biofilm production.Methodology. Catheterized urine samples were collected from 420 patients with evidence of UTIs and processed using standard techniques. Isolated UPEC were screened for quinolone resistance using an antimicrobial susceptibility test. Biofilm production among quinolone-resistant isolates was detected using the tissue culture plate method. All quinolone-resistant isolates were screened for qnr genes (qnrA, qnrB and qnrS) by multiplex PCR and for gyrA gene mutation by PCR-RFLP.Results. Two hundred and sixty-four UPEC isolates were detected from 420 processed urine samples. Out of the identified 264 UPEC, 123 (46.6 %) isolates were found to be quinolone-resistant, showing resistance to 1 or more of the tested quinolones. Of the 123 quinolone-resistant UPEC detected, 71(57.7 %) were biofilm producers. The qnr genes were detected among 62.6 % of the quinolone-resistant UPEC, with an estimated prevalence of 22.8, 32.5 and 37.4 % for qnrA, qnrB and qnrS genes, respectively. Additionally, the gyrA gene mutation was identified among 53.7 % of the quinolone-resistant isolates. We reported a significant association between biofilm production and the presence of qnrA, qnrB and qnrS genes. Furthermore, the gyrA gene mutation was significantly associated with biofilm-producing isolates. The coexistence of qnr genes, gyrA gene mutation and biofilm production was demonstrated in almost 40 % of the quinolone-resistant isolates.Conclusions. A significantly higher prevalence of qnr genes (qnrA, qnrB and qnrS) as well as the gyrA gene mutation was found among biofilm-forming UPEC. The reported coexistence of these different resistance mechanisms could aggravate quinolone resistance. Therefore, monitoring of resistance mechanisms and a proper stewardship programme are necessary.

Prevalence and associated risk factors of urinary tract infection in pregnancy at the Douala General Hospital, Cameroon: a case–control study

Introduction. The burden of urinary tract infection (UTI) in pregnancy has been understudied in Cameroon.Aim: to determine the prevalence and risk factors of UTI in pregnancy in a tertiary hospital in Cameroon.Materials and methods. A hospital-based matched case-control study of pregnant women with evidence of UTI and those without who underwent antenatal care and gave birth at the Douala General Hospital from January 2014 to December 2018. Demographic, reproductive health/clinical data were collected using a pre-tested questionnaire and analyzed with SPSS.Results. The prevalence of UTI in pregnancy was 4.41 %. Poor antenatal care uptake (AOR = 5.64; 95 % CI = 2.21–14.33), multiple weekly sexual intercourses (AOR = 4.64; 95 % CI = 0.22–96.94), a history of UTI (AOR = 3.01; 95 % CI = 1.12–8.04) and drying the genitals from back to front (AOR = 5.50; 95 % CI = 1.95–15.44) were associated factors.Conclusion. The prevalence of UTI in pregnancy is low amid multiple associated factors. Screening for UTI in pregnancy should be made the standard of obstetric care in Cameroon.

Hyperthyroidism is not a risk factor for subclinical bacteriuria in cats: A prospective cohort study.

BackgroundSubclinical bacteriuria is defined as a positive bacterial urine culture in the absence of clinical evidence of urinary tract infection (UTI). Studies have reported that hyperthyroid cats have UTIs (mostly subclinical) with prevalence rates of 12%‐22%. Consequently, clinicians consider hyperthyroidism a risk factor for development of subclinical bacteriuria, and many recommend urine culture when evaluating hyperthyroid cats.ObjectivesTo compare the prevalence of subclinical bacteriuria (based on positive urine culture) in untreated hyperthyroid cats to that in euthyroid cats of similar age and sex.AnimalsThree hundred and ninety‐three hyperthyroid cats presented for radioiodine treatment and 131 euthyroid cats (≥7 years of age) presented for routine examination. Cats with signs of lower urinary tract disease were excluded.MethodsProspective cohort study. Both hyperthyroid and euthyroid cats had urine collected by cystocentesis for complete urinalysis and culture. Data pertaining to age, sex, body condition, and serum thyroxine and creatinine concentrations also were acquired. Logistic regression was performed to evaluate for potential risk factors for subclinical bacteriuria.ResultsHyperthyroid cats showed a low prevalence of subclinical bacteriuria (4.3%), which did not differ from that found in euthyroid cats (4.6%). Of the signalment factors evaluated, only female sex was a significant risk factor (odds ratio [OR], 6.9; P = .002). Furthermore, positive urine cultures were more likely in specimens with dilute urine concentration (<1.035), pyuria, or microscopic bacteriuria.Conclusions and Clinical ImportanceHyperthyroid cats are not at risk for subclinical bacteriuria. In the absence of lower urinary tract signs, no clinical benefit exists in routinely performing urine cultures when evaluating hyperthyroid cats.

A255 EMPHYSEMATOUS CYSTITIS: A MARKER OF SEVERE CROHN’S DISEASE?

Abstract Background Emphysematous cystitis (EC) is characterized by the presence of air within the bladder walls, a complication of infection by gas producing organisms within the urinary system. However, rare cases of EC in the setting of infectious gastroenteritis have been reported suggesting an alternate etiology. We report a case of EC in the setting of severe Crohn’s colitis with no clinical evidence of urinary tract infection. Aims This report outlines the rare case of a patient with active Crohn’s disease who presented with bloody diarrhea, anemia, hypoalbuminemia and initial radiological evidence of EC. We expand on the subsequent clinical investigations, diagnosis, treatment plan and hospital course of the patient. Methods Case report, review of literature. Results A 43-year old female presented with a 2-month history of bloody diarrhea consisting of 8–12 bowel movements a day, 10 kg of weight loss and peripheral edema. She also had multiple ulcerated lesions on her abdominal wall and in the perianal region. Initial CT scan was significant for pancolitis, anasarca and EC. The follow-up CT cystogram, flexible cystoscopy and pelvic MRI confirmed the diagnosis of EC and ruled out any fistulous tracts in the pelvis including enterovesical/colovesical fistula. The patient did not report any urinary symptoms and the urinalysis was within normal limits. Infectious workup including urine and blood cultures, stool ova and parasite, stool C. difficile PCR, TB IGRA, Hep A, Hep B, Hep C and HIV serologies were all negative. Despite the paucity of infectious findings, the EC was empirically treated with an intravenous third-generation cephalosporin. Colonoscopy was significant for multiple ulcerated and hyperemic areas with pseudopolyps all throughout the right, transverse and left colon. Biopsies confirmed Crohn’s colitis with no evidence of granulomata or dysplasia, and were also negative for CMV immunohistochemistry. The perianal and abdominal wall lesions were suspected to be pyoderma gangrenosum although biopsies were equivocal. The colitis was initially treated with intravenous steroids followed by biologic therapy with Infliximab. While there was some interval improvement of symptoms, the in-hospital course was further complicated by a rectal bleed requiring surgical obliteration of the rectal artery, then a colonic perforation requiring total colectomy. Conclusions This is a rare case of EC in a patient with severe Crohn’s colitis. There was no clinical evidence of urinary tract infection or fistulising disease. According to our review, this is the first reported incident of EC in a patient with inflammatory bowel disease without any prior intra-abdominal surgeries. While active Crohn’s disease alone is a critical illness, we conclude that concomitant EC is a poor prognostic factor. Funding Agencies None

Uropathogens of Urinary Tract Infection in Pregnancy and Maternal-Fetal Outcomes at the Douala Referral Hospital, Cameroon: A Case-Control Study

Background: Urinary tract infection (UTI) is common in pregnancy and accounts for a high burden of maternal and perinatal morbidity/mortality and health expenditure. The burden of this condition has been understudied in Cameroon. We aimed to determine the uropathogens of urinary tract infection in pregnancy, and the maternal-fetal outcomes of UTI at the Douala Referral Hospital. Methods: We conducted an analytic matched case-control study of 206 pregnant women with evidence of urinary tract infection (103 cases) and those without (103 controls) who underwent antenatal care and gave birth at the DRH from January 2019 to April 2019. Socio-demographic, laboratory and maternal-fetal outcome data were collected using a pre-tested structured questionnaire and analyzed with SPSS version 23. Statistical significance was set at p Results: Escherichia coli (51.5%), Proteus mirabilis (15.5%), Staphylococcus aureus (11.7%) and Klebsiella sp. (6.8%) were the predominant uropathogens of UTI. Maternal outcomes of UTI were puerperal pyelonephritis (AOR 3.1; 95% CI: 1.11 - 3.55, p = 0.0023), preterm labor (AOR 4.4; 95% CI: 1.0 - 2.7, p = 0.008) and preterm birth (AOR 4.6; 95% CI 1.9 - 22.9, p = 0.05). Furthermore, low birth weight (AOR 2.1; 95% CI: 0.8 - 5.6, p = 0.05), neonatal infection (AOR 13; 95% CI: 0.9 - 191.6, p = 0.04) and neonatal intensive care unit admission (AOR 2.5; 95% CI: 1.7 - 3.6, p = 0.003) were fetal outcomes of UTI. Conclusion: Escherichia coli was the main uropathogenic agent of UTI during pregnancy. Maternal outcomes of UTI were puerperal pyelonephritis, preterm labor and delivery while fetal outcomes include: low-birth weight, neonatal infection and neonatal intensive care admission. Prompt diagnosis of this condition is the cornerstone to avoid adverse outcomes.

Relevance of Screening for Urinary Tract Infection in Well Infants with Prolonged Jaundice: A Prospective Cohort Study

&#x0D; &#x0D; &#x0D; &#x0D; Background: Recent retrospective studies suggest irrelevance of urine screening for neonate with prolonged jaundice. We re-evaluated the incidence of urinary tract infection (UTI) among these infants, their renal outcome and evaluated the cost incurred. Methods: This is a prospective cohort study. Asymptomatic, prolonged jaundiced infants with unconjugated hyperbilirubinemia were screened for evidence of UTI as per local guidelines. Infants with pyuria would have urine sent for culture and sensitivity. Unit cost was referenced from hospital purchase. Statistical analysis was performed using SPSS 24.0. Results: A total of 291 cases were analyzed. Majority were term infants (93.8%). The commonest cause of prolonged jaundice was breast milk jaundice, hence an incidence rate of 0.34%. Only one infant persistently showed single uropathogen on urinary culture with concurrent pyuria. Urinary structures were normal on ultrasonography and there was no evidence of renal cortical scarring. No recurrence of UTI documented in the first year of life. Each “clean-catch” urinalysis costed RM7. This unit cost escalated to RM37 for catheterized sample. A negative urine culture costed RM28 while a positive culture twice this price. The average cost effectiveness ratio (ACER) in this study was RM5856.56 per detection of case. Conclusion: Incidence of UTI is low. In our study, an undesirable outcome is negligible. Unnecessary parental anxiety from the potentially laborious procedure could be avoided. This study refutes previous literature to include such screening in prolonged jaundice as this may well be irrelevant.&#x0D; &#x0D; &#x0D; &#x0D;

Prostatic malakoplakia associated with severe chronic active prostatitis

A 70-year-old black male presented with a 2-month history of obstructive lower urinary tract symptoms. He had no current or previous proven history of urinary tract infections and was not on any antibiotics, steroids or immunosuppressive drugs. A tender, firm and non-nodular prostate was noted on digital rectal examination and his prostate-specific antigen level was 32.4 ug/L. Histopathological analysis following transrectal ultrasound-guided prostate biopsy showed an unusual finding, malakoplakia associated with severe chronic active prostatitis. Only a limited number of cases of prostatic malakoplakia have ever been reported in the literature. We present the first ever case of malakoplakia without any evidence of urinary tract infection associated with severe chronic active prostatitis in a black African male. Level of evidence: Level 5.

Prevalence and antibiotic resistance profiles of extended spectrum β-lactamase-producing &lt;i&gt;Escherichia coli&lt;/i&gt; among paediatric patients with urinary tract infection in St. Patricks’ Hospital, Mile Four, Abakaliki, Ebonyi State, Nigeria

Background: The extended spectrum beta-lactamase (ESBL)-producing Escherichia coli strains which have been implicated in septicaemia among hospitalized children is a serious concern due to their high resistance rates to commonly used antimicrobial agents. The objective of this study was to determine the prevalence and antibiotic susceptibility of urinary ESBL-producing E. coli in paediatric patients who had clinical evidence of urinary tract infections (UTI). Methodology: Clean catch specimens of urine collected from 100 eligible paediatric patients with clinical evidence of UTI in St. Patricks’ Hospital, Mile Four, Abakaliki, Ebonyi State, were cultured for isolation of E. coli using standard bacteriological techniques. Isolates were confirmed for ESBL production by double disk synergy test (DDST), and antibiotic susceptibility of the ESBL-producing ones was determined by the modified Kirby Bauer disk diffusion method. Results: Twenty one (21%) E. coli were isolated out of which 11 (52 %) were ESBL producers, all of which were totally resistant (100%) to cefotaxime, ticarcillin and sulfamethoxazole-trimethoprim, 85% to aztreonam and 83% to ceftazidime. The multiple antibiotic resistance index (MARI) values ranged from 0.4 to 0.9, which implies high usage of antimicrobials Conclusion: The high prevalence of multi-drug resistant ESBL-producing E. coli obtained in this study shows that there has been overuse (abuse or misuse) of antibiotics in the study area. There is need for antimicrobial stewardship programme that will ensure prudent use of antimicrobial agents to forestall the emergence and spread of multi-drug resistant bacteria. Keywords: Paediatrics, Escherichia coli , ESBL, urine, multi-drug resistance

Risk of Meningitis in Infants Aged 29 to 90 Days with Urinary Tract Infection: A Systematic Review and Meta-Analysis

To determine the risk of bacterial meningitis in infants aged 29-90days with evidence of urinary tract infection (UTI). PubMed (MEDLINE), Embase, and the Cochrane Library were systematically searched for studies reporting rates of meningitis in infants aged 29-90days with abnormal urinalysis or urine culture. Observational studies in infants with evidence of UTI who underwent lumbar puncture (LP) reporting age-specific event rates of bacterial meningitis and sterile cerebrospinal fluid pleocytosis were included. Prevalence estimates for bacterial meningitis in infants with UTI were pooled in a random effects meta-analysis. Three prospective and 17 retrospective cohort studies were included in the meta-analysis. The pooled prevalence of concomitant bacterial meningitis in infants with UTI was 0.25% (95% CI, 0.09%-0.70%). Rates of sterile pleocytosis ranged from 0% to 29%. Variation in study methods precluded calculation of a pooled estimate for sterile pleocytosis. In most studies, the decision to perform a LP was up to the provider, introducing selection bias into the prevalence estimate. The risk of bacterial meningitis in infants aged 29-90days with evidence of UTI is low. A selective approach to LP in infants identified as low risk for meningitis by other clinical criteria may be indicated.

Myelolipoma: a rare incidentally detected adrenal lesion

Adrenal myelolipomas are benign, uncommon neoplams that are being increasingly detected due to frequent use of imaging studies. They are lipomatous tumours They are usually asymptomatic and sometimes associated with endocrinological dysfunction.We report a case of middle aged gentleman, with accidentally detected adrenal mass and no hormonal disturbances. The patient was evaluated initially for fever. Laboratory investigations revealed evidence of urinary tract infection. Ultrasound abdomen showed a hyperechoeic mass in suprarenal region with a hypoechoeic component. The patient was managed conservatively and discharged after a few days. On further work up, MRI showed a well defined suprarenal mass with hyperintensity, possibly adrenal myelolipoma. The tumour was removed laparoscopically and histopathology revealed features of myelolipoma. The patient was discahrged after an uneventful postoperative period. Adrenal myelolipomas are rare, benign tumours of adrenal gland diagnosed incidentally. Careful evaluation is important including imaging studies and endocrinological testing. Larger or symptomatic tumours can be excised surgically. Laparoscopic resection is a safe procedure in tumours considered for surgery, with favourable patient outcome. DOI:10.21276/APALM.1447

Incidence of Urinary Tract Infections (UTI) amongst Patients Attending Primary Health Centres in Anambra State

Urinary tract infections (UTIs) are one of the most prevalent extra-intestinal bacterial infections. It is a common disease encountered in medical practice affecting people of all ages, from neonate to geriatric age group. These infections are on the increase for outpatients attending Primary Health Centres in Anambra State, Nigeria, therefore the need for this study. The prevalence rate of urinary tract infection, age distribution and influence of sex were determined. Susceptibility pattern of the infectious organisms to antimicrobial agent were examined. Clean-catch midstream urine samples were collected and examined. Out of 3000 urine samples examined, 528 bacterial isolates were recovered and characterized. These include: Escherichia coli (24.2%), Klebsiella spp. (18.2%), Staphylococcus aureus (18.2%), Proteus mirabilis (9.1%), Pseudomonas aeruginosa (9.1%), Enterococcus faecalis (9.1%), Citrobacter intermedius (6.1%) and Staphylococcus saprophyticus (6.1%). More females (52%) were infected than males (48%) and in both sexes, the highest incidence was found amongst the age group, 26 - 38 years. Gram negative rods had the highest incidence in both sexes. Among the towns in Anambra state, Umunya in southern province was observed to have the highest incidence rate of UTI. Susceptibility test of the bacterial isolates to antimicrobial agents showed that Staphylococcus aureus was sensitive to Cephalexin, Penicillin V, Erythromycin and Gentamycin while Pseudomonas aeruginosa was resistant to all the antibiotics. Escherichia coli and Klebsiella spp. were resistant to all the antibiotics except Gentamycin while Citrobacter intermedius was resistant only to Cephalexin and Erythromycin. This study provides the evidence of urinary tract infections amongst outpatients of primary health centres and the drugs for their control.

The female urinary microbiome in urgency urinary incontinence

The purpose of this study was to characterize the urinary microbiota in women who are planning treatment for urgency urinary incontinence and to describe clinical associations with urinary symptoms, urinary tract infection, and treatment outcomes. Catheterized urine samples were collected from multisite randomized trial participants who had no clinical evidence of urinary tract infection; 16S ribosomal RNA gene sequencing was used to dichotomize participants as either DNA sequence-positive or sequence-negative. Associations with demographics, urinary symptoms, urinary tract infection risk, and treatment outcomes were determined. In sequence-positive samples, microbiotas were characterized on the basis of their dominant microorganisms. More than one-half (51.1%; 93/182) of the participants' urine samples were sequence-positive. Sequence-positive participants were younger (55.8 vs 61.3 years old; P = .0007), had a higher body mass index (33.7 vs 30.1 kg/m(2); P = .0009), had a higher mean baseline daily urgency urinary incontinence episodes (5.7 vs 4.2 episodes; P < .0001), responded better to treatment (decrease in urgency urinary incontinence episodes, -4.4 vs -3.3; P = .0013), and were less likely to experience urinary tract infection (9% vs 27%; P = .0011). In sequence-positive samples, 8 major bacterial clusters were identified; 7 clusters were dominated not only by a single genus, most commonly Lactobacillus (45%) or Gardnerella (17%), but also by other taxa (25%). The remaining cluster had no dominant genus (13%). DNA sequencing confirmed urinary bacterial DNA in many women with urgency urinary incontinence who had no signs of infection. Sequence status was associated with baseline urgency urinary incontinence episodes, treatment response, and posttreatment urinary tract infection risk.

Antimicrobial prescribing for urinary tract infections in patients undergoing total hip or knee arthroplasty (THA/TKA)

Patients undergoing THA/TKA were screened pre- & postoperatively with urinalysis (UA) including urine dipstick & microscopy. We hypothesized that: 1) many patients without evidence of urinary tract infection (UTI) receive antibiotics if clinicians base treatment on UA results alone; 2) a protocol for screening patients for UTI would decrease treatment for UTI without increasing surgical site infection (SSI) rates.

THE ROLE OF A1166C ANGIOTENSIN II TYPE-1 RECEPTOR GENE POLYMORPHISM IN URINARY ALBUMIN EXCRETION RATE ON HYPERTENSIVE SUBJECTS

Background: Expression of angiotensin-II type 1 receptor (AT1R) play a role in angiotensin-II (Ang-II) mechanism of action. Angiotensin-II also have a role on urinary albumin excretion (UAE) incidence in hypertensive subjects. Objective: Understanding the role of A1166C AT1R gene polymorphism on UAE rate in hypertensive subjects. Method: This is an observational study with cross-sectional approach, conducted in 2014 at Dr. Wahidin Sudirohusodo Hospital Makassar. We included both hypertensive and controlled hypertensive subjects, eGFRMDRD ≥60 ml/menit/.73 m2, no evidence of urinary tract infection, no diabetes mellitus, not on period of menstruation or hematuria. Based on ACR, subjects were classified into A1 (ACR <30 mg/g), A2 (ACR 30–300 mg/g) and A3 (ACR >300 mg/g). A1 group was categorized as normal, while A2 and A3 group as abnormal. A1166C AT1R gene polymorphism detected by PCR examination if we found genotype: AT1R 1166AA, AT1R 1166AC and AT1R 1166CC. Non-AA genotype are AT1R 1166AC and AT1R 1166CC, and AA genotype is AT1R 1166AA. Result: From 71 subjects, 20 subjects (28.2%) are non-AA genotype and 51 subjects (71.8%) are AA genotype. From 20 non-AA genotype subjects, 4 subjects (20%) with abnormal UAE rate and 16 subjects (80%) with normal UAE rate. While from 51 subjects with AA genotype, 6 subjects (11,8%) with abnormal UAE rate and 45 subjects (88.2%) with normal UAE rate. The risk of non-AA genotype to have UAE rate increment is 1.9 times compared with AA genotype, but statistically not significant (CI: 0,47–7,51; p = 0.452). Conclusion: We found that C allele of the A1166C AT1R gene polymorphism is not a risk factor for UAE rate increment in hypertensive subjects.