Urinary Tract Infection In Females Research Articles

The Role of Ureaplasma and Mycoplasma Species in Recurrent Lower Urinary Tract Infection in Females: A Scoping Review.

It is unknown if recurrent urinary tract infection in the gynecologic population is associated with Mycoplasma and Ureaplasma genitourinary infections. The purpose of this scoping review is to highlight the literature surrounding Mycoplasma and Ureaplasma infections in the setting of recurrent urinary tract infections in the gynecologic population. MEDLINE ALL and Embase were searched to retrieve articles published in or after 1950 through 2024. Studies included were those with adults over age 18, non-pregnant, diagnosed with recurrent urinary tract infection and concurrent genitourinary infection with Ureaplasma or Mycoplasma published in English. Study designs eligible were quantitative, qualitative, and mixed methods studies. Publication types were also extended to conference abstracts and unpublished data. 2 independent investigators systematically performed title/abstract screening and full-text review using standardized inclusion criteria. For disagreements in either title and abstracts or full-text articles, consensus was reached through discussion by the 2 screeners and/or a 3rd final adjudicator. Screening and data extraction were performed on Covidence, a web-based platform for systematic review management. There were 1170 studies identified before title and abstract screening. 26 full-text articles were reviewed for eligibility. Of these, 23 full-text studies were excluded. 3 studies met full inclusion criteria and data extraction was performed on these 3 studies. There were 2 additional studies included after identification via other methods. There is a need for more recent and robust studies examining the role of Ureaplasma and Mycoplasma genitourinary infections amongst gynecologic patients with recurrent urinary tract infections.

A multiple logistic model for prediction of urinary tract infections in an urban community: A public health perspective

Urinary tract infection (UTI) is one of the most common infectious diseases globally. A lot of clinical research has been done on UTI patients, but a questionnaire-based study on UTI is scarce. A cross-sectional study was conducted on outpatients with a high suspicion of uncomplicated UTI in Hayes Memorial Mission Hospital at Prayagraj (Eastern part of Northern India) to find out the frequency of symptoms and predisposing factors and their relationship towards the prediction of UTI. Logistic regression analysis showed a significant association between UTI and some of the variables. Also, the factors responsible for the occurrence of UTI are “gender”, “how many times you urinate from morning till night”, “a sudden desire to urinate, which is difficult to hold”, “weakness of urinary stream”, “splitting or spraying of the urinary stream” and “fever”. A statistical model (multiple logistic model) has been also established for the prediction of UTIs with an accuracy of 82.2%. It is also observed that the prevalence rate (odds ratio) of UTI in females is 2.38 times that of males. The study created a screening questionnaire for patients suspected of having UTI. A multiple logistic model has been established for the prediction of UTI which can be instrumental for clinicians from a public health perspective in the management of Urinary Tract Infections in this era of escalating AMR.

2845. Two Times versus Four Times Daily Cephalexin Dosing for the Treatment of Uncomplicated Urinary Tract Infection in Females

Abstract Background The current IDSA treatment guidelines recommend beta-lactam antibiotics as an alternative, rather than first-line agents, for the treatment of uncomplicated UTI (uUTI). Changing susceptibilities over the past decade, however, have resulted in the need to rely on oral cephalosporins for uUTI. Cephalexin is a commonly prescribed oral first-generation cephalosporin with excellent bioavailability and urinary penetration; however, little data exist to support optimal dosing for uUTI, with pharmacokinetic data supporting twice daily dosing, but common drug databases recommending four times daily dosing. Methods This retrospective, multicenter, cohort study included adult female patients treated at Trinity Health Michigan ambulatory sites who received cephalexin for symptomatic uUTI with cefazolin-susceptible urine cultures between February 1, 2020, and August 31, 2022. The primary objective was to compare uUTI treatment failure between patients treated with cephalexin 500 mg twice daily (BID Tx) versus 500 mg four times daily (QID Tx) in the outpatient setting. Treatment failure was defined as the combined endpoint of continued symptoms or necessitation of new therapy while on the initially prescribed 5-7 day course of treatment or recurrent UTI within 30 days of initial therapy. Secondary outcomes included reported adverse events within 7 days of treatment and occurrence of C. difficile within 30 days of treatment. Pregnancy, diagnosis of pyelonephritis or complicated UTI, presence of urinary catheter, history of recurrent UTI, receipt of IV antibiotics, or urine culture not susceptible to cefazolin resulted in exclusion. Results A total of 261 patients were included (BID Tx, n= 173; QID Tx, n= 88). There was no difference in treatment failure observed between groups (BID Tx 12.7% vs QID Tx 17%, p=0.343), including failure while on therapy (BID Tx 2.3% vs QID Tx 5.7%, p=0.438) or recurrence within 30 days (BID Tx 10.4% vs QID Tx 11.3%, p=0.438). No differences in reported adverse events (BID Tx 4.6% vs QID Tx 5.7%, p=0.103) or C. difficile within 30 days of treatment (BID Tx 0% vs QID Tx 0%, p=1.0) were observed between groups. Conclusion Reduced frequency, 500 mg twice daily, cephalexin is as effective as more frequent, four times daily, dosing for uUTI and may improve patient adherence. Disclosures All Authors: No reported disclosures

Albuminuria Is Affected by Urinary Tract Infection: A Comparison between Biochemical Quantitative Method and Automatic Urine Chemistry Analyzer UC-3500.

The automated urine reagent strip test is a cost-effective tool for detecting albuminuria in patients. However, prior research has not investigated how urinary tract infections (UTIs) affect the test's accuracy. Therefore, this study aims to assess the impact of UTIs on albuminuria diagnosis using both the biochemical quantitative method and the test strip method of the Fully Automatic Urine Chemistry Analyzer, UC-3500 (Sysmex, Kobe, Japan). From March to December 2019, we prospectively collected midstream urine from adult female UTI patients before and after one week of cephalexin treatment. The urine samples were subjected to culture, routine urinalysis, and albuminuria diagnosis using the biochemical quantitative method and UC-3500. Albuminuria was defined as a urine albumin to creatinine ratio (UACR) ≥ 30 mg/g in the biochemical quantitative method. The results were compared between the two methods. Among fifty-four female patients (average age: 50.5 ± 4.4 years) with UTIs, 24 (44.44%) had transient albuminuria. The quantitative UACR significantly decreased after one week of antibiotic treatment (median: 53 mg/g to 9 mg/g; median difference: -0.54, p < 0.0001). UC-3500 exhibited a higher false positive rate for diagnosing albuminuria during UTIs (42%) compared to after treatment (19%). Its agreement with the biochemical quantitative method was moderate during UTI (κ = 0.49, 95% confidence interval [CI]: 0.24-0.73) and good after treatment (κ = 0.65, 95% CI: 0.45-0.86). UC-3500's accuracy in diagnosing albuminuria is influenced by UTIs, leading to either transient albuminuria or a false positive reaction of the test strip. UTI should be excluded or treated before its application in albuminuria screening.

Two Times Versus Four Times Daily Cephalexin Dosing for the Treatment of Uncomplicated Urinary Tract Infections in Females.

The current treatment guidelines of the Infectious Diseases Society of America recommend β-lactam antibiotics as alternative rather than first-line agents for the treatment of uncomplicated urinary tract infection (uUTI). Cephalexin is a commonly prescribed first-generation cephalosporin with excellent bioavailability and urinary penetration; however, little data exist to support optimal dosing for uUTI. This retrospective multicenter cohort study included adult female patients who received 5 to 7 days of cephalexin for symptomatic uUTI with a cefazolin-susceptible urine culture. The primary objective was to compare uUTI treatment failure (eg, continued or recurrent symptoms within 30 days) between patients treated with cephalexin 500 mg twice daily (BID group) and 500 mg 4 times daily (QID group) in the outpatient setting. Secondary outcomes included time to treatment failure, reported adverse events within 7 days of treatment, and occurrence of Clostridioides difficile within 30 days of treatment. A total of 261 patients were included (BID, n = 173; QID, n = 88). Baseline characteristics were similar between the groups. Escherichia coli was the most commonly isolated pathogen (85.4%). There was no difference in treatment failure observed between the groups (BID 12.7% vs QID 17%, P = .343), including failure while undergoing therapy (BID 2.3% vs QID 5.7%, P = .438) or recurrence within 30 days (BID 10.4% vs QID 11.3%, P = .438). No differences in reported adverse events (BID 4.6% vs QID 5.6%, P = .103) were observed between groups. Twice-daily cephalexin is as effective as 4-times-daily dosing for uUTI. A twice-daily dosing strategy may improve patient adherence.

Clinico-Bacteriological study of Nosocomial Infections in the Paediatric Intensive Care Unit (PICU)

Background: In this study, we wanted to study the incidence, risk factors and clinical and bacteriological pattern of nosocomial infections in PICU. Methods: This study was conducted in the PICU of 900 bedded Tertiary hospital. 74 suspected cases of nosocomial infections were studied prospectively, identified as per the guidelines laid down by CDC. Results: The incidence of nosocomial infections was 29% (N=255). Bloodstream infections were the most commonly observed in the present study (43.24%, 32/74) followed by Urinary Tract Infection (UTI) (32.43%, 24/74), Nosocomial pneumonia (16.21%, 12/74), and SSI (8.1%, 6/74). There were two patients with more than one nosocomial infections. The average duration of stay in children with NI the overall length of stay was 589 days with an average of 7.95 days compared to 4.63 days in children without NI. Conclusions: The risk of nosocomial infection was directly related to the duration of stay in the PICU and the duration of placement of indwelling catheters /tubes. Age and sex were the important independent risk factors for causing nosocomial infections as the incidence was more in the 2 months age group. BSI occurred more commonly in males while UTI in females. Other risk factors like malnutrition, immuno-compromised status and underlying illness were also associated with nosocomial infections. The most common organism was E. coli (sensitive to amikacin) followed by klebsiella and maximum sensitivity to piperacillin-tazobactam. Length of stay in PICU more in children with NI. There was no significance in mortality between both groups. Abbreviations: NI- Nosocomial infections. PICU- Pediatric intensive care unit. UTI- Urinary tract infections.

Efficacy of Five Days Nitrofurantoin Therapy versus Fosfomycin Stat Dose in Clinical Resolution of Uncomplicated Urinary Tract Infections

Objective: To compare the efficacy of 5-days Nitrofurantoin therapy versus Fosfomycin stat dose in clinical resolution of uncomplicated urinary tract infections in females of reproductive age group.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Department of Medicine, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Apr 2019 to Mar 2020.&#x0D; Methodology: A total of 498 females of reproductive age (18 years to 40 years) with lower urinary tract infection symptoms(increased urinary hesitancy, frequent micturition, tenderness at suprapubic region) and positive urine dipstick test for nitrates/leukocyte esterase test were incorporated in the study. Patients were randomly assigned to Group-A and Group-B,comprising 249 patients. Group-A was given tablet Nitrofurantoin 100mg every six hourly. Group-B was given Fosfomycin 3gstat dose. Patients were advised to follow up on days 14 and 28 of treatment to observe the clinical resolution of urinary tractinfection symptoms and bacteriologic response.&#x0D; Results: Clinical resolution of urinary tract infection on the 28th day of treatment was attained in 172(69.1%) patients of the Nitrofurantoin-Group versus 140(56.2%) patients receiving Fosfomycin (p-value 0.003). Baseline urine cultures were positive in 286(57.4%) patients. Microbiologic resolution was achieved in 109 of 140(77.9%) and 100 of 146(68.4%) (p- value=0.026).&#x0D; Conclusion: Among the females of reproductive age, five days of Nitrofurantoin therapy is superior to stat dose Fosfomycin in the clinical and microbiologic resolution of uncomplicated urinary tract infections.

Patients’ Experiences, Expectations, Motivations, and Perspectives around Urinary Tract Infection Care in General Practice: A Qualitative Interview Study

While there are many alternatives to antibiotics for the symptomatic treatment of urinary tract infections (UTIs), their application in practice is limited. Among other things, general practitioners (GPs) often feel pressure from patients to prescribe antibiotics. To gain a better understanding of why this happens and where this pressure originates from, we investigated experiences, expectations, motivations, and perspectives of patients with UTIs in general practice. During this qualitative study we performed 14 semi-structured online interviews among female UTI patients in general practice. Interviews were based on a topic list derived from sensitising concepts. All the interviews were recorded, transcribed, and analysed using a constant comparative technique. Three main categories emerged from the data; (1) experienced versus unexperienced patients with UTI, (2) patient's lack of knowledge, and (3) patients feeling understood. Inexperienced patients consult a general practitioner for both diagnosis and symptom relief, while experienced patients seem to consult specifically to obtain antibiotics. In addition, patients have a lack of knowledge with regard to the diagnosis, treatment, self-care, and cause of UTIs. Finally, patients' satisfaction is increased by involving them more in the process of decision making, so they feel understood and taken seriously. Patients' expectations in UTI management in general practice often arise during their first experience(s) and play a major role in subsequent episodes. In conclusion, preventing misconceptions is especially important in the inexperienced patient group, as this may prevent future overtreatment of UTIs. In addition, involving patients in the decision making process will lead to greater understanding of the GP's treatment choices.

Antibiotic Sensitivity Pattern and Demographic Characteristics of Urinary Tract Infection among Hospitalized Children

Introduction: Urinary tract infection (UTI) is the third most common infection during childhood and considered as an important risk factor for the development long-term complications. It was aimed to look into the demographic characteristics, clinical presentations, and antimicrobial resistance among children hospitalized for UTI. Methods: This cross-sectional observational study was conducted at the Inpatients Department of Uttara Adhunik Medical College and Hospital, Dhaka, Bangladesh. The study duration was 2 years, from July 2017 to June 2019, during which period, a total of 90 children with urinary tract infection visiting the study place were included in the study, following the inclusion and exclusion criteria. Result: The age of the participants ranged from over 1 months to 5 years., with majority (55.56%) being between the age of 2-5 years. The male to female ratio was 1:1.73. Fever was the commonest presenting symptom in participants, with 87.78% prevalence, followed by vomiting in 80% of the participants. The commonest organism cultured in this study was E. coli (80%), followed by Klebsiella spp. (20%). Isolated pathogens were highly sensitive to Amikacin (100.0%), Meropenem (100.0%), Imipenem (97.0%) and Nitrofurantoin (90.9% - 100.0%), moderately sensitivity to third generation Cephalosporine and highly resistant to Ampicillin (75.0 - 78.8%), Amoxiclav (72.7% - 87.5%) and Cephalexin (81.1% - 87.5%). Conclusion: The proportion of urinary tract infection in females was higher than males. Most patients presented with more than one symptom but most commonly presented with fever. E. coli was the most common isolated bacteria in hospitalized children with a principal diagnosis of UTI. Most of the isolated pathogens were highly resistant to ampicillin, cotrimoxazole, and highly sensitivity to amikacin, nitrofurantoin and meropenem.

Patient-Friendly Summary of the ACR Appropriateness Criteria: Recurrent Lower Urinary Tract Infections in Females.

A urinary tract infection (UTI) is a bacterial infection of the urinary system. Uncomplicated UTIs, without physical or functional abnormalities of the urinary tract, usually respond to antibiotics and do not require further imaging tests. In contrast, complicated UTIs, in which individuals may suffer from an underlying condition, usually require imaging tests for diagnosis.

Evaluation of antibacterial activities for three commonly used antibiotics produced by different manufactures on female urinary tract infection Uropathogens in kalar city.

Health professional staff often claims information about trying to differentiate the used antibiotics based on the manufacturers that produce the drug, which may lead to a differentiation in the prescribing of the antibiotics by a physician. Numerous antibiotics produced by different manufactures, under different brands names are available in pharmacies for urinary tract infection (UTI) treatment; this study proceeds to find out and evaluates antibacterial activities of three most used antibiotics, produced by different antibiotic producers on uropathogens in Kalar city. Kirby–Bauer disk diffusion method is employed to assess antibacterial effectiveness of Amikacin (Ak), Levoflaxocilin (Lv) and Nitrofuratoin (Nr) against reference strains of Escherichia coli, Pseudomonas aeruginosa, Staphylococcus saprophyticus and clinically isolated uropathogens (Escherichia coli, Pseudomonas aeruginosa, Staphylococcus saprophyticus, Proteus vulgaris, and Klebsiella pneumoniae). Inhibition zones (IZ) were determined in millimeter unit to show the activity of the antibiotics. It has been found that the activity of all brands on sensitive bacterial strains were in the preferred range and surpassed the threshold of (IZ) determined by Clinical Laboratories Standards Institute (CLSI) guide. The lack of significant differences among most tested brands for each antibiotic, support this idea.

Cystoscopy Findings in Females with Recurrent Lower Urinary Tract Infections who were referred to Tishreen University Hospital between 2021 - 2022

The importance of our study comes from that recurrent lower urinary tract infection in females is one of the most common cases that referred to the urology clinic, and it is considered a challenge to treatment in the case of reliance on clinical, radiological and laboratory diagnosis only, while cystoscopy may provide information that may be useful in managing the reviewed cases.

Diagnoses after newly recorded abdominal pain in primary care: observational cohort study.

BackgroundNon-acute abdominal pain in primary care is diagnostically challenging.AimTo quantify the 1-year cumulative incidence of 35 non-malignant diagnoses and nine cancers in adults after newly recorded abdominal pain in primary care.Design and settingObservational cohort study of 125 793 Clinical Practice Research Datalink GOLD records.MethodParticipants, aged ≥40 years, had newly recorded abdominal pain between 1 January 2009 and 31 December 2013. Age- and sex-stratified 1-year cumulative incidence by diagnosis is reported.ResultsMost (>70%) participants had no pre-specified diagnoses after newly recorded abdominal pain. Non-malignant diagnoses were most common: upper gastrointestinal problems (gastro-oesophageal reflux disease, hiatus hernia, gastritis, oesophagitis, and gastric/duodenal ulcer) in males and urinary tract infection in females. The incidence of upper gastrointestinal problems plateaued at age ≥60 years (aged 40–59 years: males 4.9%, 95% confidence interval [CI] = 4.6 to 5.1, females 4.0%, 95% CI = 3.8 to 4.2; aged 60–69 years: males 5.8%, 95% CI = 5.4 to 6.2, females 5.4%, 95% CI = 5.1 to 5.8). Urinary tract infection incidence increased with age (aged 40–59 years: females 5.1%, 95% CI = 4.8 to 5.3, males 1.1%, 95% CI = 1.0 to 1.2; aged ≥70 years: females 8.0%, 95% CI = 7.6 to 8.4, males 3.3%, 95% CI = 3.0 to 3.6%). Diverticular disease incidence rose with age, plateauing at 4.2% (95% CI = 3.9 to 4.6) in males aged ≥60 years, increasing to 6.1% (95% CI = 5.8 to 6.4) in females aged ≥70 years. Irritable bowel syndrome incidence was higher in females (aged 40–59 years: 2.9%, 95% CI = 2.7 to 3.1) than males (aged 40–59 years: 2.1%, 95% CI = 1.9 to 2.3), decreasing with age to 1.3% (95% CI = 1.2 to 1.5) in females and 0.6% (95% CI = 0.5 to 0.8) in males aged ≥70 years.ConclusionAlthough abdominal pain commonly remains unexplained, non-malignant diagnosis are more likely than cancer.

Efficacy of Cranberry Juice in the Prevention of Recurrent Urinary Tract Infection

Background: One of the most common bacterial infections in primary care is urinary tract infections, which are second only to respiratory infections. Women are at higher risk of developing IBD. Cranberry has long been known for its beneficial effects on urinary tract health. Clinical trials have shown that regular consumption of cranberry juice can prevent UTI. Aim: To determine the efficacy of cranberry juice in prevention of recurrence of urinary tract infection in females with recurrent UTIs presenting in a tertiary care hospital. Study design&amp; duration: Descriptive Case Series from 01-04-2016 TO 30-09-2016. Setting: Department of Obstetrics and Gynaecology, Jinnah Hospital, Lahore. Methods: A total of 160 females were prescribed 300mg concentrated cranberry extract twice daily for 12 weeks. Females were followed up in OPD at 6 weeks and 12 weeks for evaluation of symptoms and sign determined on clinical examination and a urine culture for recurrence of UTI, if symptoms of UTI and a +ve culture noticed during follow-up period then recurrence was labeled. Results: Patients ranged between 18-40 year. Mean age of the patients was 30.78±6.55 years. Total no of caseswas 160, 49 patients (30.6%) were primigravida and 111 patients (69.4%) were multigravida. Efficacy of cranberry extract was observed in 130 cases (81.3%). Stratification with regard to age, and parity was carried out Conclusion: In conclusion, the results of the present study support that cranberry extract associated with protective effect against recurrent urinary tract infections in our population. Keywords: Recurrent urinary tract infection, Cranberry extract, Prevention

Antimicrobial resistance among bacteria isolated from urinary tract infections in females in Namibia, 2016\u20132017

BackgroundThe emergence of antimicrobial resistance (AMR) among bacterial pathogens demands a local understanding of the epidemiological situation. This information is needed both for clinical treatment decision-making purposes as well as for the revision of current care guidelines. Clinical AMR data from Namibia is sparse, whilst urinary tract infections remain not only widespread but they disproportionally affect females. This paper aims to describe the national antimicrobial resistance situation of major bacterial uropathogens in females within the 14 Namibian regions.MethodRetrospective countrywide information on clinical urine cultures performed in females in Namibia in 2016–2017 was obtained from the national public health laboratory, Namibia Institute of Pathology (NIP). The data set included both microbiological findings as well as antimicrobial susceptibility test (AST) results. The AST was done as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Resistance to 3rd generation cephalosporins was indicative of Extended Spectrum-ß-lactamase (ESBL) production. Data analysis was done with WHONET using expert interpretation rules.ResultsIn total, 22,259 urinary cultures were performed, of which 13,673 (61.4%) were culture positive. Gram-negative bacterial species accounted for 72.6% of the findings. The most common pathogens identified were Escherichia coli, Klebsiella pneumoniae and Proteus mirabilis. Most of these were from young females, with a median age ranging from 28 to 32 years for the various pathogens. Resistance to ampicillin was 77.7% in E. coli and 84.9% in K. pneumoniae. In E. coli, resistance to 1st line empiric therapy antibiotic, nitrofurantoin, was below 13%, except for one region that showed 59.2% resistance. Resistance to third generation cephalosporin (3GC) was used as a proxy for ESBL production. By year 2017, 3GC resistance was 22%, 31.4% and 8.3% for E. coli, K. pneumoniae and P. mirabilis, respectively.ConclusionWe report high resistance to ampicillin, quinolones and sulfamethoxazole-trimethoprim amongst E. coli. Resistance rates to third-generation cephalosporins was also concerningly high at 22%. Resistance to carbapenems was low. However, superiority of nitrofurantoin was found, which provides rational support for the usefulness of nitrofurantoin as an empiric therapy regimen for the treatment of urinary tract infections in this setting.

Risk Factors Associated with Urinary Tract Infection in Children

Introduction: Urinary tract infection is infection leading to an inflammatory response in the epithelium of the urinary tract. Urinary tract infection is defined as the growth of significant number of organisms of a single species in the urine, in the presence of symptoms. Significant bacteriuria is a growth with colony count of &gt;105 / ml of a single species in a mid-stream clean catch urine sample. Aims: To find the prevalence of urinary tract infection in children with fever and its risk factor. Methods: A hospital based cross sectional observational study was performed in Nepalgunj Medical College, Kohalpur from October 2019 to October 2020.Children of age two months to 14 years admitted in Department of Pediatrics and visiting in outdoor fulfilling inclusion criteria were taken for the study. Detailed history and examination was performed. Data related to age, sex, predisposing risk factors of Urinary tract infection, symptoms and relevant investigations was carried out in all patients. Results: Among 135 children, maximum 62(45.92%) children were in the age group 1-5 years. There were 70(51.85) male and 65(48.14) female children. The prevalence of culture positive of urinary tract infection was 19.20%. Pyuria was more significant in females in comparison to male, more common in age group less than 5 years. 26 children were culture positive among which males to female ratio in urine culture positive cases were 1: 2.3 and majority had E.coli positive in urine culture sample. Apart from the female children urinary tract infection was commonly seen in uncircumcised male comprising of 8(11.42%) of total male children. Conclusion: In children presenting with fever, urinary tract infection was one of the common causes. It was most common in children less than 5 years, female gender and uncircumcised male children were two commonly associated risk factors

Effect of patient’s sex on early perioperative outcomes following anterior cervical discectomy and fusion

ObjectiveDifferences in morbidity and mortality measures between males and females have been demonstrated for a variety of spinal surgeries, however, studies of anterior cervical discectomy and fusion (ACDF) are limited. To investigate the impact ofsexon 30-day perioperative outcomes of ACDF. MethodsRetrospective 1:1 propensity score-matched cohort study. Patients who underwent ACDF between 2016 and 2018 were reviewed from the ACS-NSQIP database.Propensity score matchingand subgroup analysis were used. Results21,180 patients met inclusion criteria. 11,194 patients underwent single-level ACDF and 9986 patients underwent multi-level ACDF. In the single-level group, there were 6168 (55.1%) males and 5026 (44.9%) females. In the multi-level group, there were 5033 (50.4%) males and 4953 (49.6%) females. In both single/multi-level groups, females were more likely to be of older age, be functionally dependent, and have higher BMI and lower preoperative hematocrit level. Males were more likely to be Caucasian, smokers, have myelopathy, diabetes mellitus, hypertension and bleeding disorders. In both single/multi-level groups, except for the higher incidence of urinary tract infection (UTI) in females and myocardial infarction (MI) in males, there were no significant differences in morbidity and mortality between males and females. ConclusionsSeveral differences in demographics and baseline health status exist between males and females undergoing ACDF. When attempting to control for comorbid conditions, we found that sex by itself is not an independent risk factor for higher perioperative morbidity or mortality in patients undergoing ACDF, except for the higher incidence of UTI in females and MI in males. These results are important findings for clinicians and spine surgeons while counseling patients undergoing this type of procedure.

Association between body mass index and urinary tract infection: a systematic review and meta-analysis of observational cohort studies.

Very few studies have investigated the relationship between body mass index (BMI) and risk of urinary tract infection (UTI), and conclusions from these available studies have been inconsistent. To resolve this inconsistency, we performed a systematic review and meta-analysis to precisely examine the association between BMI and UTI. This meta-analysis was performed based on the PRISMA recommendations. PubMed, Web of Science, Scopus, Embase, and Google Scholar databases were searched for all published observational studies that reported the risk of UTI based on BMI categories up to March 2020. Fourteen (n = 14) articles comprising 19 studies in different populations met our inclusion criteria. The overall analysis showed a significant increased risk of UTI in subjects affected by obesity vs. individuals without obesity (RR = 1.45; 95% CI: 1.28 - 1.63; I2 = 94%), and a non-significant increased risk of UTI in subjects who were overweight (RR = 1.03; 95% CI: 0.98 - 1.10; I2 = 49.6%) and underweight (RR = 0.99; 95% CI: 0.81 - 21; I2 = 0.0%) when compared to subjects who had normal weight. In the stratified analysis, we showed that obesity increased the risk of UTI in females (RR = 1.63; 95% CI: 1.38 - 1.93) and in subjects below 60years old (RR = 1.53; 95% CI: 1.33 - 1.75). This systematic review and meta-analysis recognized a significant relationship between BMI and incidence of UTI in obese vs. non-obese subjects, as well as in females and in individuals below 60years old.

Symptomatic Urinary tract infection in patients with type 2 diabetes: A prospective study

Background: Patients with type 2 diabetes (T2D) are at increased risk of urinary tract infection (UTI). Objective: The aim was to study clinical, etiological profile, complications, and follow-up of symptomatic UTI in T2D patients and the effect on glycemic control and renal parameters. Materials and Methods: This was a hospital-based prospective study done on admitted 200 T2D symptomatic UTI patients. Various clinical, biochemical parameters and urine examination and culture were monitored. All patients were followed for 6 months with respect to the number of UTIs, glycemic control, and renal parameters. Results: UTI was common in females (81%) compared to males (19%). Lower UTI (cystitis) was present in 55.5% and pyelonephritis 44.5%, emphysematous pyelonephritis in 9.5%, and bacteremia in 58.1% of UTI patients. Bacteriuria was present in 69%. Escherichia coli (55%) was the most common organism isolated from urine culture. Severe hyperglycemia was present in 83.5%, diabetic ketoacidosis in 8%, hyperglycemic hyperosmolar state in 13%, shock in 14.5%, and multiorgan dysfunction syndrome in 10.5% of UTI patients. UTI in females was significantly associated with postmenopausal state, longer duration of diabetes, retinopathy, nephropathy, poor glycemic control, acute kidney injury, cystopathy, and upper UTI. The prevalence of recurrent UTI was 39.6%. Recurrent UTI patients had significantly higher glycosylated hemoglobin at follow-up than at baseline, but renal parameters did not improve despite intensive treatment. Conclusion: Symptomatic UTI in T2D patients is common in postmenopausal females with longer duration of diabetes, poor glycemic control, cystopathy, and chronic diabetic complications. Recurrent UTI patients have poor glycemic control on follow-up while renal parameters do not improve.

Health vigilance concerning female urinary tract infections: Epidemiological profile and antibiotic resistance

The objectives of our work were to establish the epidemiological and bacteriological profile of female urinary tract infection at the Mohammed VI University Hospital of Oujda (Morocco), and then to study the drug resistance of the bacterial strains isolated. This is a retrospective study over 36 months including urine samples from patients hospitalized or consulting at the CHU Mohamed VI of Oujda (Morocco). Urines were processed according to the recommendations of the Medical Microbiology Reference (REMIC) and the EUCAST (European Committee on Antimicrobial Susceptibility Testing). We collected 12556 requests for CBEU from different departments. At the top of the list was the emergency department with a rate of 37% (n= 4666) followed by outpatient clinics (33.1%; n=4226). 5% (n=630) of the CBEU were positive. Escherichia coli (E. coli ) dominated the epidemiological profile with a rate of 72.50% (n=482). E. coli was resistant to penicillins in 69.50% (n=299) of cases, protected penicillins in 34.80% (n=149), third generation cephalosporins (C3G) in 9% (n=38), fluoroquinolones in 17.5% (n=73), Trimethoprim-Sulfamethoxazole in 46% (n=196) of cases and gentamicin in 12% (n=51) of cases. None of the strains were resistant to carbapenems. Awareness-raising on the proper use of antibiotics, issuing national recommendations for the treatment of urinary tract infections in order to standardize therapeutic regimens. Effective control of these infections requires a global prevention strategy that implies close collaboration between epidemiologists, clinicians, bacteriologists, hygienists and the health care team.