Factors Of Urinary Tract Infection Research Articles

Asymptomatic pyuria and bacteriuria are not risk factors for urinary tract infection in women with type 2 diabetes mellitus initiated SGLT2 inhibitors.

Asymptomatic pyuria and bacteriuria are more prevalent in diabetic patients and may be associated with urinary tract infection (UTI). The aim of this study is to investigate the association between asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitor and UTI risk in female patients with type 2 diabetes. The study was designed as a practical, single-center, prospective, cohort study. The female outpatients with type 2 diabetes initiated SGLT2 inhibitor were included. Patients who were symptomatic or treated in the past 3months for urinary or genital tract infection, had a high risk for UTI were excluded. Hospitalization/antibiotic use for indications other than UTI were exclusion criteria during follow-up. All patients were followed up for 3months. Pyuria and bacteriuria were exposure and, UTI was the outcome. Cumulative incidence and relative risk of UTI were analyzed for pyuria and bacteriuria. 143 female patients were included among 1132 female type 2 diabetic patients. 13 patients were excluded during follow-up. 41.5% of the patients (n = 54) had pyuria and 28.5% (n = 37) had bacteriuria. The cumulative incidence of UTI was 20% in the whole cohort, 25,9% (n = 14/54) in the pyuria group and 18.9% (n = 7/37) in the bacteriuria group. The relative risk of UTI was 1.64 (95% CI: 0.82-3.26, p = 0.15) for pyuria, 0.92 (95% CI: 0.42-2.01, p = 0.84) for bacteriuria, and 1.2 (95% CI: 0.47-3.08, p = 0.69) for pyuria plus bacteriuria. Adjusted odd ratios revealed similar results. Asymptomatic pyuria/bacteriuria at the initiation of SGLT2 inhibitors are not risk factors for UTI in women with type 2 diabetes.

Prevalence and risk factors of urinary tract infection in pregnant women

Urinary tract infections (UTIs) are the most prevalent in pregnant women. There are associated risk factors that predispose the acquisition of a UTI in pregnancy, which can cause serious complications for mother and child. To determine the prevalence of UTI and associated risk factors in pregnant women at the Hospital Básico de Sangolquí. Observational, cross-sectional, analytical study conducted in 570 pregnant women from January 1 2021 to August 30 2022. The prevalence and risk factors associated with UTI were analyzed through 95% confidence intervals (95% CI) and odds ratio (OR) calculation. The global prevalence of UTI in pregnant women was 37.7% (IC 95% 33.7-41.7). The most frequent etiology was Escherichia coli (65.4%), followed by Staphylococcus spp. (21.8%). The age of pregnant women ranged from 12 to 45 years, with an average of 27.55 ± 7 years, out of which those with a previous history of UTI were at greater risk of presenting UTI (OR 4.05; 95% CI 2.65-6.18), followed by diabetes mellitus (OR 2.25; 95% CI 2.48-3.44), and overweight (OR 1.48; 95% CI 1.05-2.10). Regarding gestational age, the third trimester was a protective factor for UTI (OR 0.65; 95% CI 0.46-0.92]). The prevalence of UTI for pregnant women was 37.7%. The most frequent etiology was Escherichia coli. A history of UTI prior to pregnancy was the main risk factor.

Prevalence and Associated Factors of Urinary Tract Infection in Patients with Diabetic Neuropathy [Letter

Prevalence and Associated Factors of Urinary Tract Infection in Patients with Diabetic Neuropathy [Letter

Risk factor analysis for urinary tract infection in outpatients at a hospital in Subang, Indonesia

Background: Urinary Tract Infection (UTI) is considered an infectious disease with a high incidence rate; this is due to the individual’s lifestyle, which is a factor in the occurrence of UTI. To reduce the incidence of UTI, it can be done by knowing the risk factors that can influence the occurrence of UTI with individual awareness and practicing good habits. Purpose: to analyze the risk factors for urinary tract infection in outpatients. Methods: This research used quantitative research with a cross-sectional design that has been carried out on 89 patients who came for treatment at the Urology Polyclinic at RSUD Subang, using purposive sampling through a questionnaire on risk factors and symptoms of UTI, and then the data was analyzed using multiple linear regression tests. Results: The results of the study found that there is a relationship between age, gender, urinary retention habits, genital hygiene, and drinking habits and the incidence of UTI, with a P-value of 0.000 (P < 0.05). Conclusion: Age, gender, urinary retention habits, genital hygiene, and water drinking habits are risk factors for urinary tract infections both independently and simultaneously. Screening for UTI in outpatients, Geriatric age, female gender, urinary retention habits, bad genitourinary tract hygiene, and less water intake should be adopted.

Study of bacterial and hospital acquired factors of urinary tract infections in patients in district Chakwal

Study of bacterial and hospital acquired factors of urinary tract infections in patients in district Chakwal

Enhanced Risk Stratification for Short-Term Complications Following Vertebral Augmentation for Osteoporotic Vertebral Compression Fractures.

For patients with back pain from osteoporotic vertebral compression fractures (VCFs), vertebral augmentation remains the most utilized surgical intervention. Previous studies report 30-day readmission and mortality rates of up to 10% and 2%, respectively. These studies, however, have included patients with pathologic fractures and combined patients in different admission settings. We undertook the current study to address such shortcomings, which make risk stratification and appropriate counseling difficult. Four consecutive years of the National Surgical Quality Improvement Program database were queried. Patients who underwent vertebral augmentation for osteoporotic VCFs were divided into 3 groups: (1) outpatient group (defined as patients with same-day discharge), (2) inpatient group (defined as those who were admitted postoperatively), and (3) preprocedure hospitalized group (defined as those who were already inpatient or were at acute/intermediate care facilities and transferred). Postoperative 30-day complications and readmission rates were compared between different groups and examined using multivariate analyses. A total of 1023 patients underwent outpatient surgery; 503 were admitted on the day of surgery; and 149 patients were already in-hospital or were transferred from other facility. Mortality rates were 0.68%, 0.60%, and 2.68%, and readmission rates were 6.26%, 6.76%, and 12.8%, for outpatient, inpatient, and preprocedure hospitalization cohorts, respectively. Multivariate analyses identified preprocedure hospitalization as an independent risk factor for urinary tract infection (UTI; OR = 3.98, 95% CI = 1.41-11.20, P = 0.028), pneumonia (OR = 19.69, 95% CI = 3.81-101.65, P < 0.001), readmission (OR = 1.86, 95% CI = 1.06-3.26, P = 0.032), and mortality (OR = 4.49, 95% CI = 1.22-16.53, P = 0.024). Our findings suggest that published rates of complications and mortality are substantially impacted by the cohort of patients who are already hospitalized or transferred from other facilities. Such patients are at a higher risk of UTI, pneumonia, readmission, and mortality. Conversely, we show that a relatively healthy patient being offered outpatient same-day augmentation has a readmission risk 40% lower and a mortality risk 3 times lower than previously reported.

202-LB: Association between Diabetes and the Vaginal Microbiota

Type 2 diabetes is a known risk factor for urinary tract infection and vulvovaginal candidiasis, and this risk is modulated in part by vaginal microbiota. We sought to assess the associations between diabetes and the vaginal microbiota, specifically whether diabetes may reduce vaginal Lactobacillus spp., which produce lactic acid and protect the urogenital tract. This study included 811 participants (2,301 person-visits) aged 35-60 recruited to a 2-year observational cohort with mid-vaginal sampling every 6 months. Diabetes was defined as self-reported diabetes medications, history, or serum glycated albumin (GA) levels &amp;gt;16.5% (HbA1c not available). Vaginal microbiota was characterized by 16S rRNA gene sequencing and clustered into community state types (CSTs) by VALENCIA, a nearest centroid algorithm based on a reference dataset. Mixed-effects multinomial logistic regression with bootstrapping was used to assess the association between case status and CSTs. Among diabetes cases (n=45, 130 person-visits), 45% had L. crispatus, L. jensenii, L. gasseri-dominated (CST I/II/V), 12% had L. iners-dominated (CST III) and 43% had low-Lactobacillus (CST IV) microbiota. Diabetes cases had reduced odds of L. iners-dominated CST III (aOR: 0.54, 95% CI: 0.31-0.81) than controls (12% vs 24%) and no association with low-Lactobacillus CST IV (aOR=01.05, 95% CI: 0.76-1.44) compared to Lactobacillus-dominated CST I/II/V in a model adjusted for menopause status and race. Estimates were similar when only GA was used for a diabetes case definition on a subset (1,001 person-visits). The results suggest diabetes is associated with reduced L. iners dominance. Diabetes cases had even frequencies of low-Lactobacillus or the optimal Lactobacillus-dominated CSTs. L. iners is metabolically distinct from other lactobacilli, producing only L-lactic acid (not the more protective D-lactic acid), and is associated with increased reproductive tract infection risk. This data informs how diabetes may affect the vaginal microenvironment. Disclosure S. J. Robbins: None. R. M. Brotman: None. R. S. Miller: None. A. L. Beitelshees: None. M. Shardell: None. J. Ravel: None. S. I. Taylor: Consultant; Ionis Pharmaceuticals. Funding National Institute of Allergy and Infectious Diseases (F31-AI164859)

#5095 THE CURIOUS CASE OF GAS IN THE GRAFT KIDNEY

Abstract Background and Aims Emphysematous pyelonephritis (EPN) denotes a severe infection of renal parenchyma resulting in necrosis and gas accumulation in the renal and perirenal tissue. Risk factors for urinary tract infections in renal transplant recipients include advanced age, female gender, reflux nephropathy prior to transplantation, diabetes mellitus, deceased donor kidney, kidney–pancreas transplant, retransplantation, antibody induction for immunosuppression, urinary bladder catheterisation, history of allograft rejection with subsequent escalation of immunosuppressive therapy and use of ureteral stents. There are no definite guidelines for management of EPN in renal allografts. If unstable and deteriorating, graft nephrectomy should be undertaken as soon as possible. Any delay in surgical intervention, be it percutaneous drainage or nephrectomy may result in death. Method A 25-year old male, diagnosed with IgA Nephropathy (IgAN) received a living donor renal transplant from his mother in 2013 after a dialysis vintage of 3 years. He received Basiliximab induction followed by maintenance immunosuppression with Tacrolimus, Mycophenolate mofetil and Prednisolone. He had no history of UTI in the immediate post-transplant period. His blood glucose levels were within normal limits and he had not had any urological intervention. In 2019, patient was diagnosed with IgAN recurrence as a cause of chronic renal allograft injury. His Creatinine at last follow up in July 2022 was 4.1 mg/dL. He presented in September 2022 with fever, chills, vomiting, pain in the right iliac fossa and inability to extend his right leg. At presentation, his BP was 86/60mmHg, with pyrexia and tachycardia. Ultrasonography revealed an ill-defined collection superomedial to the graft kidney with doubtful posterior extension and air foci. Non-contrast CT study revealed a large subcapsular collection, extending posteriorly into the right iliac fossa involving the right psoas major and inferiorly into the pelvis, with air foci and no evidence of any urinary tract obstruction suggestive of Acute Emphysematous pyelonephritis with ruptured abscess. He was started on broad-spectrum iv antibiotics- Meropenem and Levofloxacin. Immunosuppression was reduced. Laboratory investigations revealed total leucocyte count of 37,000 cells/mm3, Creatinine of 11 mg/dL, urine routine microscopy revealed field full of pus cells. Blood and urine cultures grew ESBL Escherichia coli. He was taken up for urgent urological intervention in the form of percutaneous drain insertion. Frank pus was aspirated and 200mL drained instantaneously, cultures of which demonstrated the same organism. Within 24 hours of pus drainage, patient became afebrile and had pain relief. He was given 3 weeks of culture-appropriate iv antibiotics, to continue another 3 weeks of oral Carbapenem. However, his graft dysfunction persisted, with no recovery and he became dialysis-dependent. Discussion EPN of the renal allograft is a rare occurrence. A study of EPN in renal transplant recipients by Alexander et al from 2012 revealed 18 out of 22 patients were diabetics, 9 necessitated graft nephrectomy and 7 required percutaneous drainage in addition to antibiotics4. Till date, up to 30 cases of graft EPN have been reported in English literature. The striking feature is that more than 90% of these cases were diabetic. Conclusion The complete pathogenesis of renal allograft EPN, especially in patients with no apparent traditionally described risk factors remains yet to be understood. A high degree of suspicion and early intervention may help to save the allograft.

The Association between Serum Vitamin D Levels and Urinary Tract Infection Risk in Children: A Systematic Review and Meta-Analysis.

The association between serum vitamin D levels and urinary tract infection (UTI) in children is unclear. We undertook a systematic review and meta-analysis to evaluate the relationships between different vitamin D levels and the likelihood of UTI in children. Online databases, including Web of Science, PubMed, Embase, and Cochrane Library, were searched up to 6 February 2023 for studies based on the inclusion criteria. Weighted mean difference (WMD) and Odds Ratios (ORs), along with their 95% confidence intervals (CI), were calculated, and the random-effects model was used for analysis. Twelve case-control studies and one cross-sectional study (839 children with UTI and 929 controls) were included. We found that children with UTI had lower levels of serum vitamin D than healthy controls (WMD: -7.730, 95% CI: -11.57, -3.89; p < 0.001). Low vitamin D levels were significantly associated with UTI in children (OR: 2.80; 95% CI: 1.55, 5.05; p = 0.001). The likelihood of children having a UTI significantly increased when their serum vitamin D level was less than 20 ng/mL (OR: 5.49, 95% CI: 1.12, 27.04; p = 0.036). Therefore, vitamin D level, especially when less than 20 ng/mL, is a risk factor in UTI.

Profiling the Urobiota in a Pediatric Population with Neurogenic Bladder Secondary to Spinal Dysraphism.

The human bladder has been long thought to be sterile until that, only in the last decade, advances in molecular biology have shown that the human urinary tract is populated with microorganisms. The relationship between the urobiota and the development of urinary tract disorders is now of great interest. Patients with spina bifida (SB) can be born with (or develop over time) neurological deficits due to damaged nerves that originate in the lower part of the spinal cord, including the neurogenic bladder. This condition represents a predisposing factor for urinary tract infections so that the most frequently used approach to treat patients with neurogenic bladder is based on clean intermittent catheterization (CIC). In this study, we analyzed the urobiota composition in a pediatric cohort of patients with SB compared to healthy controls, as well as the urobiota characteristics based on whether patients received CIC or not.

Prevalence and Associated Factors of Urinary Tract Infection in Patients with Diabetic Neuropathy: A Hospital-Based Cross-Sectional Study.

Diabetic neurogenic bladder is one of the common complications in patients with diabetic neuropathy. However, studies reporting the prevalence and associated factors of urinary tract infections (UTIs) in patients with diabetic neuropathy are rare. Therefore, the present study aimed to explore the prevalence and influencing factors of UTI in patients with diabetic neuropathy. A hospital-based cross-sectional study that recruited patients with diabetic neuropathy was conducted from January 2019 to December 2021. Collected data included patient demographic information (age, sex, education level, body mass index), clinical data (duration of diabetes, method of administration), and laboratory tests. Multivariable logistic regression models were used to identify the factors associated with UTI risk. The strength of association was expressed as the odds ratio (OR) and 95% confidence interval (95% CI). A total of 579 patients were recruited (male, 68.2%; overall average age, 57.89 years). Using multivariate analysis with adjustment for confounding factors, female sex (odds ratio [OR]: 4.12; 95% CI: 2.24-7.60; P < 0.001), hypodermic insulin injection (OR: 2.10; 95% CI: 1.02-4.35; P = 0.045), chronic kidney disease (OR: 3.12; 95% CI: 1.11-8.80; P = 0.032), history of UTI (OR = 45.92; 95% CI: 8.62-244.76; P < 0.001), positive urinary nitrite (OR: 32.87; 95% CI: 7.37-146.70; P < 0.001), and high residual urine volume (OR: 2.19, 95% CI: 1.17-4.10; P = 0.014) were independent risk factors for UTI in patients with diabetic neuropathy. Compared with the patients aged <45 years, UTI prevalence increased 2.91-fold in patients aged 45-54 years (OR: 3.91; 95% CI: 1.02-15.03; P = 0.047) and 3.87-fold in those aged ≥65 years (OR: 4.87; 95% CI: 1.23-19.25; P = 0.024). The main findings of this study showed that older age, female sex, hypodermic insulin injection, CKD, history of UTI, and positive urinary nitrite were independent risk factors for UTI in patients with diabetic neuropathy. To minimize the occurrence and resulting disease burden of UTI, knowledge regarding UTI risk factors in patients with diabetic neuropathy is critical to designate interventions.

The Role of Urinary NGAL in the Management of Primary Vesicoureteral Reflux in Children.

Vesicoureteral reflux (VUR) is the most frequent congenital urinary tract malformation and an important risk factor for urinary tract infections (UTIs). Up to 50% of children with VUR may develop reflux nephropathy (RN), and the diagnosis and monitoring of renal scars are invasive and costly procedures, so it is paramount to find a non-invasive and accurate method to predict the risk of renal damage. Neutrophil gelatinase-associated lipocalin (NGAL) has already proven to be a good predictive biomarker in acute kidney injuries, but there are few studies that have investigated the role of NGAL in primary VUR in children. Our aim is to review the predictive value of urine NGAL (uNGAL) as a non-invasive biomarker of RN in children with primary VUR, as well as its ability to predict the evolution of chronic kidney disease (CKD). Based on our analysis of the available original studies, uNGAL can be an accurate and reliable biomarker of RN and its progression to CKD. Some studies suggested a good correlation between VUR severity and uNGAL levels, but other studies found no significant correlation. The relationship between VUR severity and uNGAL levels is likely complex and influenced by factors such as UTIs, the timing of the urine sample collection, and the age and overall health of the patient.

Bacterial profile, their antibiotic susceptibility pattern, and associated factors of urinary tract infections in children at Hiwot Fana Specialized University Hospital, Eastern Ethiopia.

Urinary tract infections (UTIs) are common pediatric infections and contribute to high morbidity and mortality. At present, the antimicrobial resistance emergency has quadrupled worldwide and poses a serious threat to the treatment of patients. However, there have been few studies on UTIs in children in Ethiopia, particularly in the east. This study aimed to assess the bacterial profile of urinary tract infections, their susceptibility to antimicrobial agents, and associated factors in under-five children at Hiwot Fana Specialized University Hospital, eastern Ethiopia. We conducted hospital-based quantitative study on 332 consecutively selected under-five children from March 20 to June 10, 2021. Parents and guardians were interviewed to collect data using a structured questionnaire. Random urine samples were collected aseptically, and standard microbiological techniques were used to identify the bacteria and test for susceptibility to various antibiotics. Data were entered into Epi Info version 7 and exported to Statistical Package for the Social Sciences (SPSS) version 25 for analysis. Data were analyzed using descriptive analysis, bivariate, and multivariable logistic regression analysis. The crude odds ratio (COR) and adjusted odds ratio (AOR) with their respective 95% confidence intervals (CI) were used to determine the significance of the predictors. A p-value at a 95% confidence interval of less than 0.05 was considered statistically significant. The overall prevalence of bacterial urinary tract infections was 80 (24.1%) 95% CI:19.40-29.00%). Most of the bacterial isolates 55 (68.75%) were gram-negative bacteria, predominantly E. coli 23 (28.75%) and K. pneumoniae 10 (12.50%). Being a rural resident (AOR: 4.10, 95%CI: 1.45 11.54), uncircumcised male (AOR: 3.52, 95%CI: 1.33, 9.39), previous history of antibiotic usage (AOR: 7.32, 95%CI: 2.11, 25.37), indwelling catheterization (AOR: 10.35, 95%CI: 3.74, 28.63), previous history of urinary tract infections (AOR: 5.64, 95% CI: 1.36, 23.38), and urinary frequency (AOR: 5.56, 95%CI: 2.03, 15.25) had higher odds of culture positive result. The majority of the isolates have shown high levels of antibiotic resistance. Meropenem, ciprofloxacin, and amoxicillin-clavulanic acid were effective against gram-negative uropathogens, whereas rifampin and ciprofloxacin were the most sensitive drugs for gram-positive isolates. From the tested bacterial isolates, 53/86 (61.6%), 11/86 (11.6%), and 2/86 (2.3%) were found to have multidrug resistance (MDR), extreme drug resistance (XDR), and pan drug resistance (PDR), respectively. About one-fourth of the children were culture-positive for many types of bacterial uropathogens; this is higher compared with most of the previous studies in Africa. Rural dwellers, uncircumcised males, indwelling catheterization, a history of antibiotic use and urinary tract infection, and frequent urination all had a higher risk of bacterial infections. Many isolates were resistant to multiple drugs, primarily beta-lactams. Urinary tract infections as well as the growth and spread of resistant bacterial pathogens should be monitor regularly.

MP70-15 PRIMARY VESICOURETERAL REFLUX IN A MODERN COHORT: WHAT ARE THE RISK FACTORS FOR URINARY TRACT INFECTIONS?

You have accessJournal of UrologyCME1 Apr 2023MP70-15 PRIMARY VESICOURETERAL REFLUX IN A MODERN COHORT: WHAT ARE THE RISK FACTORS FOR URINARY TRACT INFECTIONS? Daniel Wilkinson, Matthew Buell, Kai Wen Cheng, Cayde Ritchie, Levi Miles, Jocelyn Huang, Ala’a Farkouh, David Chamberlin, and Joshua Chamberlin Daniel WilkinsonDaniel Wilkinson More articles by this author , Matthew BuellMatthew Buell More articles by this author , Kai Wen ChengKai Wen Cheng More articles by this author , Cayde RitchieCayde Ritchie More articles by this author , Levi MilesLevi Miles More articles by this author , Jocelyn HuangJocelyn Huang More articles by this author , Ala’a FarkouhAla’a Farkouh More articles by this author , David ChamberlinDavid Chamberlin More articles by this author , and Joshua ChamberlinJoshua Chamberlin More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003338.15AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Children with vesicoureteral reflux (VUR) are known to be at increased risk of urinary tract infection (UTI). With a trend towards observational management of children with VUR, untreated VUR and subsequent UTI can lead to significant morbidity. The purpose of this study was to identify risk factors for development of UTI in a modern cohort of children with primary VUR. METHODS: We performed a review of a prospectively maintained clinical database of children with primary VUR at a single children’s hospital from July 2013 to June 2022. Children were included if they were diagnosed with primary VUR by voiding cystourethrography between the ages of 1 day to 18 years. Patients with secondary VUR were excluded. Demographic and clinical data were collected. The primary endpoint was development of a UTI defined by pyuria (>6 WBC/hpf or positive leukocyte esterase) on urinalysis and single-organism urine culture greater than 50,000 CFU/mL. Low-grade (LG) VUR was defined as International VUR grades 1-3 and high-grade (HG) VUR was defined as International VUR grades 4 and 5. Dilated ureter was defined as any ureteral dilation greater than 2 mm. Data were analyzed by performing univariate and multivariate Cox proportional hazards regressions as well as Chi Square tests. RESULTS: A total of 242 children had primary VUR, 116 (47.9%) male and 126 (52.1%) female. UTI occurred in 42 (17.3%) children with primary VUR, with an average follow-up time of 20.1 months [IQR of 6.2 - 45.0]. Female sex (HR: 2.39, 95% CI 1.22 - 4.67, p=0.011) and younger age at presentation of VUR (HR-1: 1.01, 95% CI 1.00 - 1.02, p=0.015) were found to be independent risk factors on multivariate analysis. Univariate analysis showed increased UTI rates in dilated ureter (14.6% non-dilated vs 30.5% dilated, p=0.024), HG VUR grade (13.2% in LG vs 23.7% in HG, p=0.038), and renal pelvis anterior-posterior diameter (APD) (16.9% ≤ 15 mm, 31.9% >15 mm p=0.032). Circumcision, degree of phimosis, constipation, voiding dysfunction, SFU grade of hydronephrosis, and prior febrile UTI were not found to be independent risk factors. CONCLUSIONS: Risk factors for UTI in children with primary VUR include female sex, age younger than 50 days old, dilated ureter, HG VUR, and hydronephrosis with APD greater than 15 mm. Treatment may be individualized to treat these higher risk patients. Further multi-institutional study of patients with primary VUR may help to further elucidate risk factors for UTI and improve the management of these patients. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1009 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Wilkinson More articles by this author Matthew Buell More articles by this author Kai Wen Cheng More articles by this author Cayde Ritchie More articles by this author Levi Miles More articles by this author Jocelyn Huang More articles by this author Ala’a Farkouh More articles by this author David Chamberlin More articles by this author Joshua Chamberlin More articles by this author Expand All Advertisement PDF downloadLoading ...

Age- and gender-specific normal post void residual urine volume in healthy adolescents

Elevated post void residual (PVR) is a significant risk factor for urinary tract infections (UTI). It is also a significant predictor of treatment outcomes in cases of vesicoureteral reflux, pediatric enuresis, and non-neurogenic LUT dysfunction. However, the absence of age-specific nomograms for adolescents may limit PVR's use in clinical practice. To establish age- and gender-specific normal PVR urine volume in adolescents. Healthy adolescents aged 12-18 years were recruited to undergo two uroflowmetry and PVR studies whenever they felt the urge to urinate. Adolescents with neurological disorders, known LUT dysfunction or UTI were excluded. A total of 1050 adolescents were invited, but only 651 consented. Fourteen participants were excluded due to low bladder volume (BV<100ml) in both assessments (n=12), BV<100ml in one assessment (n=1), or failure to provide relevant history (n=1). From the 1084 uroflowmetry and PVR obtained from 637 adolescents, 190 results were further excluded due to artefacts (n=152), BV<100ml (n=27), PVR >100ml (n=5) and missing information (n=6). Ultimately, 894 uroflowmetry and PVR from 605 adolescents (mean age 14.6±1.5 years) were analyzed. PVRs were higher in adolescents aged 15-18 years than in those aged 12-14 years (P<0.001). Moreover, they were higher in females than in males (P<0.001). Multivariate analysis revealed that PVR was positively influenced by age (P=0.001) and BV (P<0.001). The age- and gender-specific percentiles of PVR in ml and percentage of BV were calculated. We recommend a repeat PVR and close monitoring if PVR is above the 90th percentile, i.e., PVR >20ml (7% BV) for males of both the age groups, and PVR >25ml (9% BV) and PVR >35ml (>10% BV) for females aged 12-14 and 15-18 years, respectively. Further investigation may be warranted if the repeat PVR is above the 95th percentile, i.e., PVR >30ml (8% BV) and >30ml (11% BV) for males aged 12-14 and 15-18 years, respectively, and PVR >35ml (11% BV) and >45ml (13% BV) for females aged 12-14 and 15-18 years, respectively. PVR increases with age and varies by gender; thus, age-and gender-specific reference values should be used. Further data from other countries is required to determine whether the study's recommendations can be applied globally.

Prevalence and Associated Risk Factors of Urinary Tract Infection among Diabetic Patients: A Cross-Sectional Study

Urinary tract infections (UTIs) are one of the most common long-term complications of diabetes mellitus (DM). Additionally, various factors, such as socio-demographics, type of DM, fasting blood glucose, regular diabetes monitoring, comorbid chronic diseases, HbA1c, body mass index (BMI), and duration of DM, are also thought to predispose individuals to developing UTIs more frequently when they have DM. This research aims to evaluate the risk factors for UTIs and their prevalence among people with DM in Saudi Arabia (KSA). This cross-sectional study was conducted among 440 adults with type 1, type 2, and gestational DM. The participants had to be at least 18 years old, of both genders, and had been suffering from DM for any period of time. A self-administered questionnaire was utilized to collect data on demographic characteristics, such as sex, age, height, weight, material state, education level, income, and clinical profiles of DM and UTI. The crude (COR) and adjusted odds ratios (AOR) were calculated using logistic regression in the IBM SPSS software. The incidence of types 1 and 2 DM and gestational diabetes reached 34.1, 60.9, and 5%, respectively. Most of the participants had first-degree relatives with DM (65.9%). UTI was common in 39.3% of participants. A chi-squared statistical analysis revealed that the frequency of UTI varied depending (χ2 = 5.176, P = 0.023) on the type of DM. Burning urination and abdominal pain were the most common symptoms. The CORs for sex, marital status, hypertension, and BMI were significant (P < 0.05) and had values of 2.68 (95% CI = 1.78-4.02), 0.57 (95% CI = 0.36-0.92), 1.97 (95% CI = 1.14-3.43), and 2.83 (95% CI = 1.19-2.99), respectively. According to the adjusted model, only sex influenced the occurrence of UTIs. The AOR for sex was 3.45 (95% CI = 2.08-5.69). Based on this study, the authorities related to the health of DM patients can use its findings to guide awareness programs and clinical preparedness.

Antimicrobial susceptibility pattern of uropathogens in urinary tract infections (UTI) patients of Punjab, Pakistan

The prevalence, antimicrobial susceptibility pattern, and associated factors of urinary tract infections among Punjabi patients attending Tertiary Care Hospitals of Punjab were the objectives of this study. Participants were selected by systematic random sampling in a cross-sectional study at Tertiary Care Hospitals of Punjab. 988 participants provided clean catch midstream urine samples, which were then cultured and tested for antimicrobial susceptibility. We inoculated n=988 urine samples in which 255 samples were found positive for bacterial growth. Among them 126 were E. coli, 66 Klebsiella pneumoniae, 4 Enterobacter cloacae, and 21 were Pseudomonas spp. The frequency of Uropathogens was observed for Gram negative E. coli 49.02% and Gram positive bacteria were 7.78%. The prevalence of urinary tract infections was 16.4%. Pseudomonas aeruginosa (19, 7.3%), Pseudomonas spp. (2, 0.7%), Enterobacter cloacae (4, 1.5%), and Gram positive bacteria such as Methicillin resistant staphylococcus aureus (3, 1.1%), Methicillin sensitive staphylococcus aureus (15, 5.8%), and Enterococcus faecalis (20, 7.7%) were the most common bacteria. Ampicillin and tetracycline were both resistant to Gram-negative bacilli (96%) and Gram-positive cocci (72%), respectively. In the study area, a culture and susceptibility test is essential for effective urinary tract infection management.

Incidence and risk factors for urinary tract infection in the first year after kidney transplantation at 108 Military Central Hospital, Vietnam

Objective: To determine the incidence of urinary tract infections in kidney transplant patients in our hospital, to identify the microbial pathogens, risk factors for urinary tract infection. Subject and method: Primary kidney transplant patients at 108 Military Central Hospital with full follow-up records in the first year were included in the study. Age, sex, cause of kidney failure, pre-transplantation treatment measures, post-transplantation immunosuppressive regimen were collected. Patient was followed and midstream urine was cultured monthly. Result: There were 94 kidney transplant patients included in our study. Seventy patients (74.5%) were male and 24 (25.5%) were female. One hundred and two episodes of urinary tract infections in 37 patients (39.4%) were reported. Sex (female) (p=0.003; 95% CI: 1.716-14.021), urologic complications (p=0.006, 95% CI: 0.001-0.320) were found as risk factors for UTI in the first year of transplantation. Escherichia coli and Klebsiella pneumoniae were the most frequently isolated pathogens. UTI had no negative impact on short-term graft survival. Conclusion: The results of our study showed a high incidence of UTI in kidney transplant recipients. Infection control methods should be used regularly during post-transplant therapy.

Reducing urinary catheter use in geriatric patients - results of a single-center champion-led intervention

BackgroundIndwelling urinary tract catheters (UTC) are a well-known risk factor for urinary tract infections (UTI). Because geriatric patients are at high risk of infection, an intervention with a focus on appropriate and minimal UTC use was introduced in 4 acute care geriatric wards.MethodsBetween 11/2018 and 1/2020, unit-based data on UTC use and nosocomial UTI was collected in accordance with the methods of the German national surveillance system KISS. From 6/2019 to 1/2020, a champion-led intervention was implemented which focused on: (i) feedback of surveillance data, (ii) education and training in aseptic UTC insertion and maintenance, (iii) HCW’s daily assessment of UTC necessity based on a checklist and (iv) timely removal of unnecessary UTCs. UTC use, incidence, and incidence densities for catheter-associated UTI (CAUTI) were calculated before and during the intervention. In addition, we analyzed adherence to a scheduled daily assessment of UTC necessity. Rate ratios (RR) with 95% confidence intervals (95%CI) were calculated. Differences based on the quality of checklist completion were evaluated using the Kruskal Wallis test.ResultsWe analyzed the data of 3,564 patients with a total 53,954 patient days, 9,208 UTC days, and 61 CAUTI. Surveillance data showed a significant decrease in the pooled UTC utilization rate from 19.1/100 patient days to 15.2/100 patient days (RR = 0.80, 95%CI 0.77–0.83, p < 0.001). CAUTI per 100 patients dropped from 2.07 to 1.40 (RR = 0.68, 95%CI 0.41–1.12, p = 0.1279). Overall, 373 patients received a UTC during the intervention. Of those patients 351 patients had an UTC ≥ 2 days. The analysis of these patients showed that 186 patients (53%) received a checklist as part of their chart for daily evaluation of UTC necessity. 43 (23.1%) of the completed checklists were of good quality; 143 (76.9%) were of poor quality. Patients in the group whose checklists were of good quality had fewer UTC days (median 7 UTC days IQR (3–11)) than patients whose checklists were of poor quality (11 UTC days IQR (6–16), p = 0.001).ConclusionWe conclude that a champion-led, surveillance-based intervention reduces the use of UTC among geriatric patients. Further research is needed to determine to what extent the use of checklists in daily medical UTC assessment affects the prevention of CAUTI. The fact that patients whose checklists were completed well had fewer UTC days should encourage a conscientious and thorough daily review of the need for UTC.

Analysis of Risk Factors for Urinary Tract Infection in Children and Construction and Validation of a Prediction Model.

To analyse the risk factors for urinary tract infection (UTI) in children and construct and validate a risk prediction model. The study selected 258 children with suspected UTI in the paediatric department of our hospital from August 2019 to August 2021. Identified as the subjects in this research, paediatric patients' clinical data were used for retrospective analysis. Based on the counting results of urinary leucocytes and bacteria, children were divided into the UTI group (n = 67) and non-UTI group (n = 191). Univariate analysis and multivariate logistic regression analysis were used to screen the independent risk factors for UTI in children, and a prediction model was constructed according to the results. The Hosmer-Lemeshow goodness-of-fit (GOF) test and receiver operator characteristic (ROC) curve analysis were used to validate the calibration and application value of prediction model. Logistic regression analysis identified length of hospitalisation ≥10 days (OR = 3.611, 95% CI: 1.781-7.325), indwelling ureter (odds ratio (OR) = 3.203, 95% CI: 1.615-6.349), history of infection (OR = 4.827, 95% CI: 2.424-9.612), congenital malformation/dysplasia (OR = 4.212, 95% CI: 2.079-8.531), constipation (OR = 4.021, 95% CI: 1.315-12.299) and anaemia (OR = 2.275, 95% CI: 1.236-4.186) as risk factors for UTI in children (p < 0.05). The formulation method was adopted to construct the following prediction model of UTI in children: Z = 2.066 × (length of hospitalisation ≥10 days) + 1.164 × (indwelling ureter) + 1.574 × (history of infection) + 1.438 × (congenital malformation/dysplasia) + 1.392 × (constipation) + 0.882 × (anaemia). The test results revealed the good GOF and high calibration (χ2 = 9.077, p = 0.336) of prediction model. Furthermore, the area under the ROC curve was 0.825 (95% CI: 0.766-0.884, p < 0.001), indicating the good discrimination and prediction efficiency of model. Based on clinical results, further attention should be given to high-risk children with UTI, and intervention measures should be taken immediately. The application and popularisation of prediction model will allow us to provide strategic guidance for preventing and treating UTIs in clinics.