Features Of Urinary Tract Infection Research Articles

Clinical features of urinary tract infection in infants born preterm

Urinary tract infection (UTI) is common among young infants. The diagnosis of UTI requires a better understanding of the clinical and laboratory presentations in this age group. This study describes the clinical and laboratory aspects of UTI in young infants who were born preterm compared with infants who were born full term. All infants aged less than 3 months who had their first episode of UTI (excluding infants with UTI that occurred during neonatal intensive care unit stay) between July 2003 and June 2006 were retrospectively analyzed. A total of 73 infants (32 preterm and 41 term) were included. Clinical and laboratory presentations were compared between the two groups. Overall, 49.3% of patients had fever, 52% had poor feeding, 47.9% had vomiting, and 39.7% had apnea. There were no significant differences in clinical features of UTI between the two groups. Term infants had an elevated C-reactive protein in 45% of cases, leukocytosis in 30.8% and thrombocytosis in 61.5%, while preterm infants had elevated C-reactive protein in 21.9% of cases, leukocytosis in 3.6%, and thrombocytosis in 35.7%, (P = 0.041, P = 0.037, and P = 0.008, respectively). Urinary leukocytes were present in 40% of term and in 26% of preterm infants (P = 0.360). There was no difference in vesicoureteral reflux between the two groups. Clinical features of UTI of early infancy were similar in preterm and term infants. Both groups had similar vesicoureteral reflux. Symptomatic preterm infants with UTI were less likely to have abnormal laboratory findings.

Epidemiology and characteristics of urinary tract infections in children and adolescents.

Background: Urinary tract infections (UTIs) are among the most common infections in the pediatric population. Over the last two decades, antibiotic resistance is increasing significantly as extended spectrum beta lactamase (ESBL) producing organisms are emerging. The aim of this study is to provide a comprehensive view of the epidemiologic characteristics of UTIs in hospitalized children, examine the risk factors of UTIs caused by ESBL-producing organisms, and determine the resistance patterns in the isolated organisms over the last 10 years.Methods: Retrospective chart review was conducted at two Lebanese medical centers. Subjects were identified by looking at the following ICD-9 discharge codes: “Urinary tract infection,” “UTI,” “Cystitis,” and/or “Pyelonephritis.” Children less than 18 years of age admitted for UTI between January 1st, 2001 and December 31st, 2011 were included. Cases whose urine culture result did not meet our definition for UTI were excluded. Chi-square, Fisher's exact test, and multivariate logistic regression were used to determine risk factors for ESBL. Linear regression analysis was used to determine resistance patterns.Results: The study included 675 cases with a median age of 16 months and female predominance of 77.7% (525 cases). Of the 584 cases caused by Escherichia coli or Klebsiella spp, 91 cases (15.5%) were found to be ESBL-producing organisms. Vesico-ureteral reflux and previous antibiotics use were found to be independent risk factors for ESBL-producing E. coli and Klebsiella spp. (p < 0.05). A significant linear increase in resistance to all generations of Cephalosporins (r2 = 0.442) and Fluoroquinolones (r2 = 0.698) was found.Conclusion: The recognition of risk factors for infection with ESBL-producing organisms and the observation of increasing overall resistance to antibiotics warrant further studies that might probably lead to new recommendations to guide management of UTIs and antibiotic use in children and adolescents.

Clino-Pathological Features of Urinary Tract Infection in Rural India

The study was aimed to understand the clino-pathological characteristics of urinary tract infection along with the techniques used in diagnosis and treatment of the presenting infection. The study takes into consideration the various risk factors such as age, sex, and diabetes mellitus which can precipitate a urinary tract infection. The study was conducted at the Global Baroda Hospital, Vadodara and Narhari Hospital, Vadodara in the duration from January to March 2012, under the supervision of Dr. Hiten Kareliya. A questionnaire was prepared in accordance to evaluate risk factors of urinary tract infection. The patients under study were chosen according to specific inclusion criteria. The uropathogens were isolated with the help of biochemical testing. E. coli (38%) was found to be the most prevalent organism followed by Klebsiella and Candida albicans (both 10%), Pseudomonas aeruginosa (9%), Staphylococcus (7%).

International Conference “Urogenital Infections and Tuberculosis” in Novosibirsk, Russia, Has Opened New Perspectives in the Fight against Tuberculosis

The first International Conference “Urogenital Infections and Tuberculosis” was held in Novosibirsk 24–26 October 2013. Three hundred and twelve delegates from 73 cities in 16 countries took part in the conference. Actual problems of urogenital tract infection (UTI) including tuberculosis (TB) as a specific infection were discussed, including: nosocomial infections in urology, various aspects of prostate biopsy, epidemiology and diagnosis of urogenital tuberculosis, gender and age related characteristics of urinary tract infections, and male infertility, etc.

Clinical profile of urinary tract infections in diabetics and non-diabetics

The risk of urinary tract infection (UTI) is higher in diabetics compared to non-diabetics. The aetiology and the antibiotic resistance of uropathogens have been changing over the past years. Hence the study was undertaken to determine if there are differences in clinical and microbiological features of UTI between diabetic and non-diabetic subjects, to study the influence of diabetes mellitus on the uropathogens and antibiotic sensitivity pattern in patients with UTI. A total of 181 diabetics (83 males and 98 females) and 124 non-diabetic subjects (52 males and 72 females) with culture positive UTI were studied. Patients with negative urine culture (n= 64), those diagnosed and treated outside (n= 83) and not willing to participate in the study (n= 24) were excluded. Almost 30 per cent of the patients (both diabetics and nondiabetics) presented with asymptomatic bacteriuria and the prevalence of pyelonephritis was significantly higher (p= 0.04) in diabetics compared to non-diabetic patients. The majority of the diabetics with UTI (87.14 per cent) had glycosylated haemoglobin (HbA1c) > 6.5 per cent with p < 0.001. The isolation rate of Escherichia coli (E. coli) from urine culture was higher (64.6 per cent) among diabetic patients followed by Klebsiella (12.1 per cent) and Enterococcus (9.9 per cent). The prevalence of extendedspectrum beta-lactamase (ESBL) producing E.coli was significantly higher in diabetics (p= 0.001) compared to nondiabetics. E.coli showed maximum sensitivity to carbapenems in both diabetic and non-diabetic subjects and least susceptibility to ampicillin. The prevalence of pyelonephritis is significantly higher in diabetics than in non-diabetic subjects, with E. coli being the most common isolate. Elevated glycosylated hemoglobin (HbA1c) predisposes diabetics to UTI. Investigation of bacteriuria in diabetic patients for urinary tract infection is important for treatment and prevention of renal complications.

Renal outcome in biopsy proven cases of graft pyelonephritis.

The incidence, risk factors and outcome of graft pyelonephritis are variably described in literature. All patients who had been transplanted at our center between January 2002 and November 2006 and had presented with acute graft dysfunction were subjected to biopsy. Those patients who had neutrophilic casts and interstitial inflammation with predominant neutrophils were included in the study. Out of the 265 patients, 110 were transplanted in the period and underwent biopsy for graft dysfunction. Out of the 110 patients, 26 had biopsy proven acute graft pyelonephritis (AGPN). Nine patients had early AGPN (within 6 months) and the other 17 had late AGPN. Nearly 19% of patients were culture negative and five patients had no clinical features of urinary tract infection; AGPN being a surprise finding on biopsy. Among the risk factors, only hepatitis C virus infection was significantly associated with AGPN. All patients received 4-6 weeks of antibiotics with at least 3 weeks of parenteral antibiotics. Majority (75%) of our patients experienced relapse of AGPN. Graft function was significantly lower 6 months after onset when compared to baseline, portending a poor outcome for these patients. Out of 26, 7 (27%) of our patients had biopsy features of concomitant acute cellular rejection. The treatment of acute rejection, however, did not improve the outcome.

English

Virilizing or masculinizing features in a female can be an alarm for the doctor and a source of embarrassment for the patient. These features appear as a result of hyperandrogenism, the source being ovary or adrenal gland. Here is a case of Virilizing ovarian tumour in a 51 year old diabetic female. This patient presented with a 14 year history of appearance of hair all over the body with loss of scalp hair. She also had complaints of pain in lower abdomen with excessive micturition for 3 months. Examination showed hirsutism and features of virilisation. Suprapubic mass was present on abdominal examination. Per vaginal exam revealed a soft mass? Ovarian. Radiological tests showed features suggestive of ovarian malignancy with possible uterine involvement and mild ascites. Most routine hematological investigations were normal. Total testosterone was grossly elevated (>1500 ng/dl); CA-125 was also raised (103.7 U/ml). FSH & LH values were low, TSH was normal while estradiol& progesterone were raised. Urine microscopy had features of urinary tract infection; hence treatment was started for the same. Patient underwent panhysterectomy. Histopathological studies confirmed steroid cell left ovarian tumour (T1aN0Mx), which was the source of virility in the patient. Patient improved dramatically

Association of Pyuria and Clinical Characteristics With the Presence of Urinary Tract Infection Among Patients With Acute Nephrolithiasis

Pyuria is a useful indicator of urinary tract infection among patients with compatible symptoms; however, its utility has not been adequately investigated among patients with acute nephrolithiasis. Therefore, we examine performance characteristics of pyuria and other clinical and laboratory correlates for urinary tract infection among patients with acute nephrolithiasis. A single-center prospective observational study examining the performance characteristics of pyuria and other clinical correlates for urinary tract infection was conducted among patients older than 17 years and presenting with acute nephrolithiasis confirmed by computed tomography and for whom urine culture was obtained. Of 360 patients with acute nephrolithiasis, 28 (7.8%) had urinary tract infection, defined as growth of a single uropathogen at greater than or equal to 10(3) colony-forming units/mL. For the presence of urinary tract infection, pyurialevel greater than 5 WBCs/high-power field (hpf) had a sensitivity of 86% and specificity of 79%; greater than 20WBCs/hpf had a sensitivity of 68% and specificity of 93%. In 307 patients who lacked history of fever or measured temperature greater than 37.9°C (100.2°F), pyuria level greater than 5 WBCs/hpf had a sensitivity of 79% and specificity of 81% for urinary tract infection; greater than 20 WBCs/hpf had a sensitivity of 57% and specificity of 94%. Patients with urinary tract infection more often were female; had a history of dysuria, frequent urination, chills, urinary tract infection, or subjective fever; or had measured temperature of greater than 37.9°C (100.2°F). About 8% of patients presenting with acute nephrolithiasis have urinary tract infection, in many without clinical findings of infection, and pyuria has only a moderate accuracy in identifying urinary tract infection in this setting. Clinical features of urinary tract infection, a greater degree of pyuria, and female sex increases the likelihood of infection.

Characteristics of urinary tract infections in different patient subpopulations and depending on the bladder emptying system

IntroductionTo analyze the prevalence and etiology of urinary tract infection in patients with neurogenic bladder depending on the bladder emptying system used as compared to a population with no neurological impairment. To assess perception of urinary tract infection by patients with neurogenic bladder. Materials and methodsAn epidemiological and prospective study was conducted on 283 patients, in whom a total of 283 urethral cultures were performed. Of these, 106 came from patients with neurological damage, 28 from a control group with no neurological impairment, 74 from patients admitted to the intensive care unit (ICU) of our hospital, and 75 from patients who attended the emergency room for symptoms of acute urinary tract infection. The sensitivity and specificity of patient perception as indicative of urinary tract infection was analyzed using ROC curves. ResultsPositive urethral cultures were found in 66% of patients with neurological damage and 25% of control patients. Within the neurological group, patients with the highest rates of positive urethral cultures were those with myelomeningocele (MMC) (81.5%) and spinal cord injuries (71.7%), with a statistically significant difference (p=0.01). The microorganism most commonly found in all subgroups was Escherichia coli, followed by Enterococcus faecalis and Pseudomonas aeruginosa in the neurological subgroup, Enterococcus faecalis and Proteus mirabilis in the control subgroup, and Klebsiella pneumoniae and Staphylococcus agalactiae in the emergency room subgroup. In the ICU subgroup, the most commonly found microorganism was Enterococcus faecalis, followed by Escherichia coli and Pseudomonas aeruginosa.Sensitivity for perception by neurological patients as an indication of the presence of urinary tract infection was 97.2%, as compared to 80% in the control group. Specificity was low in both groups. ConclusionsE. coli was the microorganism found in positive urethral cultures from all subgroups, except in the ICU group. The groups with the highest urinary tract infection rates were patients with MMC and spinal cord injuries. Sensitivity and specificity (as measured using ROC curves) for perception by neurological patients as an indication of the presence of urinary tract infection was higher in neurological patients than in the nonneurological control group (p=0.0004, area: 0.643).

Adecuación del tratamiento empírico de la infección urinaria en urgencias

Introduction To describe characteristics of urinary tract infections attended in an Emergency Department. To assess antibiotic prescription and inappropriate treatment implications. Methods Adults patients attended in an Emergency Department during 2 months with UTI confirmed with urocultive were included. Appropriate antibiotic treatment was considered if the first antibiotic used was sensitive. We compared patients with appropriate and inappropriate antibiotic treatment. A logistic regression was performed to evaluate variables associated to inappropriate antibiotic treatment. Results A total of 151 patients were included (61% women, 67.1[22.3] years). Comorbidity was present in 63% of patients. Urinary sepsis was the most frequent diagnosis (32.5%). E coli was isolated in 65.6% of cases, and 10% presented bacteremia. Percentage of inappropriate antibiotic treatment was 20.5. It was associated (uncontrolled analysis) with male gender, elder patients, recent urinary simptoms, urologic manipulation more than 1 month ago, previous antibiotic use (especially ciprofloxacin or amoxicillin-clavulanate) and presentation with urinary sepsis. Logistic regression analysis showed association only with age (HR 0.978 per year, CI95% 0.957–1, p=0.029) and previous antibiotic use (HR 0.298, CI95% 0.098–0.901, p=0.05). Patients with inappropriate antibiotic treatment did not have higher mortality. Conclusions Inappropriate antibiotic treatment for UTI in Emergency Department is relatively frequent and it is associated to older age and previous antibiotic use.

Clinical Analysis on 104 Cases of Urinary Tract Infection in Infants

Objective To investigate the onset,clinical features of urinary tract infection in infants.Methods Retrospective analysis was performed on clinical data of 104 cases of urinary tract infection in infants from September 2004 to May 2008.Results Among those with confirmed urinary tract infection,61% were found with age less than one year old.Fever was the most common form of onset.accounting for 75%.42 cases (49%)of the 86 cases of selectively performed DMSA imaging were diagnosed as acute pyelonephritis(APN),3cases had scars formation.The proportion of young infants under one year of age,the number of high fever,and the proportion of increased peripheral white blood cells count and C-reactive protein(CRP)level were significantly higher than those without APN.Conclusion Fever is the most prominent clinical feature of urinary tract infection in infants and young children;the incidence of APN in urinary tract infection in infants and young children cannot be neglected;young infants,high fever,increased peripheral white blood cells count and level of CRP may be the risk factors of APN. Key words: Urinary tract infection; Infants and young children; Fever; Acute pyelonephritis

Infección de vías urinarias por especies de Candida

To determine the frequency and characteristics of urinary tract infection (UTI) by Candida in diabetic patients (with and without symptoms) and to compare them with non-diabetic patients (with and without symptoms). Longitudinal, descriptive, and observational study. Study conducted at the "Dr Ignacio Chavez" Clinic of family medicine, ISSSTE: Mexico. There were 2 kinds of patients; 1 with diabetes mellitus diagnosis (DM) with and without clinical picture of probable urinary tract infection (UTI), and 1 without DM and with and without clinical picture of probable UTI. A urine culture and a confidential questionnaire were administered to find the presence of urinary symptoms and likely risk factors associated with the infection. To associate these risks, the chi2 statistical method was used, with significance at 95% and Fisher's Exact Test for small frequencies, using the EpiInfo V.6.0 program. Two hundred thirty seven patients between 28 and 82 years old were included. The prevalence of urinary infection by Candida was 5.1%, but only 33% of these had C albicans. There was no association between candidiasis and factors like age, sex, or presence of DM, but it was related to previous treatments, previous UTI and the evolution time of DM. The conscious search by both doctor and laboratory for Candida micro-organisms as factors causing UTI is important. This is especially so in those patients with factors of risk that may condition Candida's presence.

Who Are You--Staphylococcus saprophyticus?

Staphylococcus saprophyticus is a leading cause of cystitis in young women. S. saprophyticus shares many clinical features of urinary tract infection caused by Escherichia coli, but differs in pathogenesis, seasonal variation, and geographic distribution. This review summarizes what is known and what still needs to be learned about this microorganism.

Antibiotic Sensitivity Patterns of Microbial Isolates from the Urine of Pregnant Women with Urinary Tract Infections

Context: Urinary tract infections are the most common bacterial infections during pregnancy. Though the causative organisms have remained essentially the same over time, they have become increasingly resistant to the usual antibiotics. Objective: To determine the current microbial isolates and their pattern of antibiotic sensitivity in pregnant women with urinary tract infection. Patients and Methods:This was a descriptive study done in the Obstetric Unit of the Obafemi Awolowo Unversity Teaching Hospitals Complex, Ile-Ife, Osun State, Nigeria. Midstream urine specimens of all pregnant women with features of urinary tract infection were collected and subjected to microscopy, culture and sensitivity before commencement of antibiotic therapy. Results: The incidence of urinary tract infection in pregnancy was 6.2%. The commonest organisms isolated were Escherichia coli (42.2%), Staphylococcus aureus (21.9%), Klebsiella spp (12.8%), unspecified coliform organisms (11.7%) and Streptococcus faecalis (4.2%). Nitrofurantoin (83.7%), gentamicin (61.2%) and pefloxacin (54.2%) were the only antibiotics to which at least 50% of the organisms isolated were sensitive. Conclusion: Gram-negative organisms remain the leading group of organisms infecting the urinary tract of pregnant women at Ile-Ife, Nigeria and they are generally sensitive to nitrofurantoin, gentamicin and pefloxacin. Key Words: Urinary Tract Infection, Pregnancy, Antibiotic Sensitivity [Trop J Obstet Gynaecol, 2003, 20: 113-115]

Pharmacologic Basis for the Treatment of Pyelonephritis.

Urinary tract infections (UTIs) are among the most common bacterial infections in humans. Even though physicians have been treating UTIs for 60 years, there has been no standardized approach regarding the rational choice of antimicrobial agents and optimal treatment duration for these infections. This review discusses the pharmacologic basis for the treatment of UTIs. Although most antibiotics concentrate well in the urine and can eradicate most of the sensitive uropathogens that cause lower UTI, antibiotics given for the treatment of pyelonephritis must concentrate and kill bacteria embedded within the renal parenchyma. Investigators once believed that antibiotics must concentrate in sufficient amounts in the urine of infected patients to be effective in treating pyelonephritis. In fact, the efficacy of an antibiotic in the treatment of pyelonephritis is proportional to its capacity to converge in high concentration not only in urine but also in the renal parenchyma because serum and urine levels of antibiotics are poor predictors of the intrarenal levels. Other factors should also be taken into consideration in the management of UTIs, such as the time of day antibiotics are given because significant time-dependent differences have been observed in the pharmacokinetics and rate of excretion in urine of several antibiotics. Finally, the authors review the recent development in the inflammatory response in the urinary tract that may explain the clinical features of UTI and may be useful in the diagnosis as well as better management of UTI.

Urinalysis in urinary tract infection.

In 376 children, between 6 months and 5 years of age, with suspected urinary tract infection, 4 parameters of a routine urine examination were correlated with culture reports. In diagnosing urinary infection, the sensitivity and specificity of proteinuria was 79 and 80% respectively, that of bacteriuria 78 and 96% and that of pyuria > 10 wbc/hpf 80 and 82% respectively. 61% among the culture positive groups had all these three parameter present, as against only 0.5% in the culture negative group (P < 0.001). All these 3 parameters were absent in 70% in the culture negative group, as against 8% in the culture positive group (P < 0.001). Bacteriuria in association with either proteinuria or Pyuria > 10 Wbc/hpf had 98% specialty is diagnosis. In diagnosis UTI, Pyuria > 10 wbc/hpf was significantly more specific (82:66.6) than the conventional > 5 wbc/hpf. Isolated proteinuria, isolated pyuria, isolated bacteriuria and microscopic haematuria were not features of urinary tract infection in children. Urine culture can be more selectively done if the routine urinalysis is well interpreted. In the absence of dependable culture facilities, a routine urine examination can be reliably used in the diagnosis of UTI in children.

Incidence and characteristics of urinary tract infections caused by Corynebacterium urealyticum (Corynebacterium group D2).

The incidence and characteristics of urinary tract infections caused by Corynebacterium urealyticum were studied prospectively in 20,766 urine samples. Corynebacterium urealyticum was isolated from 67 samples (0.32%). Twenty-four percent of the patients from whom Corynebacterium urealyticum was isolated showed mild symptoms and had no risk factors other than prolonged hospitalization and previous antibiotic treatment. Sixty percent of the patients had urinary tract-related symptoms. The main risk factors were underlying urinary tract disease, antibiotic treatment, prolonged hospitalization and urological manipulation. Patients with antimicrobial treatment had a favourable clinical course, with the exception of two patients with encrusted cystitis.

Asymptomatic vesicoureteral reflux in children.

Between 1973 and 1992, a routine voiding cystourethrography screening was performed in all children attending our urological clinic. A total of 1023 children were diagnosed as cases of primary vesicoureteral reflux; 166 (210 renal units) of them were asymptomatic and were studied retrospectively. Ninety-one patients presented with enuresis, 39 with hypospadias, 14 with undescended testis, 8 with asymptomatic proteinuria and 14 had other manifestations such as intersexuality, inguinoscrotal swelling, abnormal external genitalia, etc. We documented high-grade reflux (IV-V) in 16.2% and renal scarring in 16.7% of the 210 renal units. None of the children showed features of urinary tract infection (UTI) or had a definite history in the past, but 23.5% of the 166 cases developed UTI during their follow-up period. Spontaneous resolution of reflux was observed in 52.7% of the 150 renal units and progression of renal scarring in 20% during follow-up. Antireflux operation was performed in 15 cases (26 renal units). In 9 children (5.4%) we found gross renal damage which progressed in two cases to end-stage renal disease followed by renal transplantation. A small kidney was noted in 5 patients and hypertension in two. It is concluded that the natural history of asymptomatic reflux is almost the same as in symptomatic reflux. Thus, routine voiding cystourethrography is suggested in all children attending a urological clinic in order to detect reflux as early as possible.

Elevated interleukin-8 levels in the urine of patients with urinary tract infections.

Pyuria is one of the main features of urinary tract infections (UTI). Nevertheless, the mechanism of polymorphonuclear leukocyte (PMN) recruitment into the urine remains to be investigated. We examined whether interleukin-8 (IL-8), a potent neutrophil chemoattractant and activator, was involved in pyuria seen in UTI. Of 113 patients, 112 had elevated levels of IL-8 in their urine (1,078.0 +/- 181.5 pg/ml), regardless of whether they had an upper or lower UTI; this was in contrast to undetectable levels (less than 16 pg/ml) in the urine of all of the 20 normal individuals and 74 control patients without UTI. A concomitant study revealed increases in urine IL-6, but not IL-1 beta, and tumor necrosis factor alpha levels in patients with UTI. In addition to gram-negative bacteria, a wide spectrum of microorganisms was capable of inducing IL-8 production in urine. Local production of IL-8 in the urinary tract was suggested by a urine IL-8 level that was higher than the paired serum IL-8 level. The urine IL-8 level correlated with the number of PMN in the urine, and an average of half of the chemotactic activity in urine from patients with UTI could be abrogated by anti-IL-8 antibody treatment in vitro. Furthermore, urine IL-8 purified from patients was bioactive and showed multiple forms on immunoblotting analysis. This is the first documentation of IL-8 in the urine of patients with UTI, and these results imply that IL-8 is involved in inducing PMN migration into the urinary tract.

Urinary Tract Infections

To the Editor.— The recent article by Crain et al1 on urinary tract infections (UTIs) in febrile infants younger than 8 weeks of age covers many important features of urinary tract infections in young infants. It confirms data suggesting that uncircumcised males have an increased incidence of positive urine cultures. It confirms that infants may have positive urine cultures in the absence of a positive urinalysis. The study also demonstrates, again, that some infants with positive urine cultures can have positive blood cultures.