Urinary Research Articles

Influence of the polysaccharide capsule on virulence and fitness of Klebsiella pneumoniae

IntroductionThe capsular polysaccharide (CPS) of pathogenic bacteria is a critical virulence factor, often evading phagocytosis by host immune cells, while also interfering with the contact of the pathogen with host cells and contributing to biofilm formation. Klebsiella pneumoniae, a Gram-negative human pathogen associated with high antimicrobial resistances, produces 77 CPS serotypes. The CPS masks proteinaceous factors but also protects K. pneumoniae from uptake by host phagocytic cells and activation of the complement system. In addition to nosocomial, urinary tract and bloodstream infections or pneumonia hypervirulent strains have a highly mucoid phenotype and can cause soft tissue infections, liver abscesses, and meningitis as well. The CPS is therefore crucial for both escaping detection by the immune system and enhancing the virulence potential.MethodsIn this study, we generated a non-encapsulated mutant (Kpn2146∆wza) to observe how the CPS interferes with K. pneumoniae adhesion, survival in blood, and invasiveness in an experimental infection model.ResultsInfection of A549 lung epithelial cells showed similar adherence levels for the wild-type and non-capsulated strain, while our data showed a moderately higher internalization of Kpn2146Δwza when compared to the wild-type. In whole blood killing assays, we demonstrate that the K. pneumoniae capsule is essential for survival in human blood, protecting K. pneumoniae against recognition and clearance by the human immune system, as well as complement-mediated opsonization and killing. The non-encapsulated mutant, in contrast, was unable to survive in either whole blood or human plasma. Infections of Galleria mellonella larvae showed a significantly decreased virulence potential of the CPS-deficient mutant.DiscussionIn conclusion, our data indicate a crucial role of CPS in vivo.

Early Sacral Neuromodulation: A Promising Opportunity or an Overload for Patients with a Recent Spinal Cord Injury? A Cross-Sectional Study

Background: A solid rationale exists for early sacral neuromodulation in the form of causal therapy that improves neurogenic lower urinary tract dysfunction after complete spinal cord injury. However, the short and early time frame for minimally invasive therapy poses a series of ethical and medical issues, which has impeded clinical realisation thus far. Objectives: We performed a cross-sectional study on patients with chronic spinal cord injury to learn about patients’ attitudes towards early treatment to prepare for large randomised controlled trials. Methods: A cohort of patients (n = 86, mixed genders) with spinal cord injury over two years was analysed. Their lower urinary tract-related quality of life was assessed using the Qualiveen-30 tool. The extent of neurogenic lower urinary tract dysfunction, patients’ awareness of it, and their attitude towards early sacral neuromodulation were explored with a specific questionnaire. Results: A total of 61.9% (n = 52) of patients declared that, in retrospect, they would have agreed to early treatment prior to the emergence of their autonomic dysfunction. Of these patients, 51.8% (n = 29) would have also consented to early sacral neuromodulation. Quality of life had no impact on their decision. More than half of the patients (n = 49, 57.0%) stated they had not grasped the momentous nature of neurogenic lower urinary tract dysfunction when being informed about it. This finding was subsequently correlated with a decreased lower urinary tract-related quality of life. Conclusion: Patients with neurogenic lower urinary tract dysfunction are likely to agree to an early therapeutic approach. Clinical implementation requires knowledge and acceptance of the procedure on the part of patients and their caregivers.

Prediction of higher ceftazidime-avibactam concentrations in the human renal interstitium compared with unbound plasma using a minimal physiologically based pharmacokinetic model developed in rats and pigs through microdialysis.

Last resort antibiotics, like ceftazidime-avibactam (CZA), were used to treat urinary tract infections caused by multidrug-resistant bacteria. However, no data on tissue distribution were available. Our aim was to describe the in vivo kidney distribution of CZA in healthy rats and pigs using a physiologically based pharmacokinetic model (PBPK). Microdialysis probes were inserted into the blood, muscle, and kidney of both species. The experiment started with a retrodialysis by drug period. An i.v. single dose of CZA was administered. Samples were collected for 3 h in rats and 7 h in pigs. A PBPK model was developed to describe tissue and blood CZA pharmacokinetics in animals and to predict human concentrations. The PBPK model adequately described CZA rat and pig data in each tissue and blood. In both species, the concentration profiles of CZA in muscle and blood were almost superimposed, with muscle-to-plasma area under the curve (AUC) ratios close to one. However, kidney CZA concentrations were higher than those in blood, as indicated by kidney-to-plasma AUC ratios exceeding one (respectively 2.27 in rats and 2.63 in pigs for ceftazidime [CAZ]; 2.7 in rats and 4.5 in pigs for avibacam [AVI]). Prediction of human concentrations led to same observations. This study demonstrated an excellent penetration of CZA into the renal parenchyma of rats and pigs. Our PBPK model adequately described the data, and AUCs were higher in the renal cortex interstitium compared with unbound plasma. Our data suggested that the joint PK/PD target for CZA in humans could be attained with reduced CZA doses.

Renal Abscess Associated with SGLT2 Inhibitors Administration in Heart Failure Without Other Previous Risk Factors: A Case Report

Background and Clinical Significance: Renal abscess represents one infectious urological complication with lethal potential. The treatment of this pathology may differ depending on the severity of the symptoms and the size of the infectious collection. Diabetes, immunosuppression, and associated urinary pathologies are most frequently responsible for the development of abscesses. This case report presents the first documented case of a renal abscess associated with Sodium-glucose cotransporter 2 (SGLT2) inhibitors in a person without previous predisposing pathologies. Case Presentation: A 62-year-old patient presented to the emergency department for pain in the right flank, vomiting, and dysuria. The patient’s medical history revealed Heart Failure New York Heart Association (NYHA) Class II, Coronary Artery Disease (CAD) with prior angioplasty, and permanent Atrial Fibrillation. No prior urological or immunosuppressive conditions were detected. The Computed Tomography (CT) evaluation confirmed the ultrasound suspicion of a right renal abscess performed in the emergency room. The only risk factor identified was the initiation of SGLT2 inhibitor therapy for cardiac pathology approximately 2 months before. According to the small dimensions and urine culture, the abscess was successfully treated with antibiotic administration in collaboration with the urology department. The infectious process was remitted within 2 weeks. Conclusions: To our knowledge this is the first documented case of a renal abscess associated with SGLT2 inhibitor administration in a person without previous predisposing risk factors. Despite the relatively low incidence of urinary tract infections (UTIs) associated with SGLT2 inhibitors, their widespread use in the treatment of various socially significant conditions highlights the need for both patients and medical specialists to be aware of all potential risks and pay increased attention to these cases.

Characterization of sulopenem antimicrobial activity using in vitro time-kill kinetics, synergy, post-antibiotic effect, and sub-inhibitory MIC effect methods against Escherichia coli and Klebsiella pneumoniae isolates.

Sulopenem is an oral and intravenous penem antibiotic in clinical development for treatment of urinary tract and intra-abdominal infections caused by multidrug-resistant pathogens. This study evaluated in vitro antimicrobial activity of sulopenem by post-antibiotic effect (PAE), sub-inhibitory minimal inhibitory concentration PAE effect (PAE-SME), checkerboard testing, and time-kill testing. Testing sulopenem at 1×, 5×, or 10× the baseline MIC resulted in a PAE interval of 0.0-0.7 hours. When exposed to 0.5× the sulopenem MIC following 5× MIC, all isolate/agent combinations had PAE-SME values of >4.8 hours. Checkerboard testing revealed no instances of antagonism between sulopenem and comparator agents-indifference was observed in most sulopenem checkerboard combinations. Sulopenem demonstrated bactericidal activity (≥3 log10 [99.9%] reduction in viable organism counts) in all time-kill assays following 24 hours of incubation at 8× the baseline MIC (6/6), 5/6 displaying this activity within 8 hours. The present antimicrobial parameters seen at concentrations surrounding the MIC support optimization of sulopenem dosing and further development. The oral dosing regimen of sulopenem etzadroxil/probenecid 500 mg/500 mg administered every 12 hours was recently evaluated in two phase 3 clinical trials where sulopenem demonstrated efficacy against amoxicillin-clavulanate in uncomplicated urinary tract infection (uUTI) and against ciprofloxacin in fluoroquinolone-resistant uUTI.IMPORTANCESulopenem is an oral and intravenous penem antibiotic in clinical development for treatment of urinary tract and intra-abdominal infections caused by multidrug-resistant pathogens. This study evaluated sulopenem via broth microdilution susceptibility testing, PAE, sub-inhibitory MIC PAE effect, checkerboard testing, and time-kill testing. The results of this study-interpreted along with recent pharmacodynamic in vitro one-compartment and hollow-fiber infection model work-provide insight into the in vitro activity of sulopenem.

Epidemiology of urinary tract infections in the Middle East and North Africa, 1990–2021

ObjectiveThis research reports the incidence, mortality, and disability-adjusted life years (DALYs) associated with urinary tract infections (UTIs) in the Middle East and North Africa (MENA) region, stratified by sex, age, and Socio-demographic Index (SDI) from 1990 to 2021.MethodsData were sourced from the Global Burden of Disease 2021 study, encompassing all 21 countries in the region. Metrics such as absolute counts, age-standardised rates, and percentage changes from 1990 to 2021 are presented with 95% uncertainty intervals (UIs).ResultsIn 2019, the MENA region recorded an incidence rate of 4,033.4 per 100,000 (95% UIs: 3,553.7–4,548.7) and 7,687 deaths (95% UIs: 6,663–8,969). The DALY rate was 41.3 per 100,000 (95% UIs: 36.1–47.2), which was highest among older adults, reaching a peak in the 80–89 age range, and increasing with age, particularly from the 50 + age groups. A non-linear relationship was identified between the burden of UTIs and the SDI, with higher-than-expected rates in lower SDI countries such as Syria and Lebanon.ConclusionDespite a substantial increase in the total number of UTI cases and DALYs in the region from 1990 to 2021, the age-standardised rates remained stable. The larger burden in lower SDI countries highlights the urgent need for targeted public health interventions. Improving healthcare access and antibiotic stewardship is crucial to mitigating the growing burden of UTIs, particularly among older populations in the region.

Vaginal colonization, vertical transmission rate, antimicrobial susceptibility profile, and associated factors of potential neonatal pathogens among pregnant women at public health facilities of Northeast Ethiopia

BackgroundVaginal colonization by pathogenic bacteria increases the risk of bacterial infections such as sepsis, which is associated with high neonatal mortality. More than half a million newborn deaths occur globally each year due to infections that lead to sepsis. However, the problem is worsening in Ethiopia the evidence of vaginal colonization and vertical transmission is scarce.MethodsA healthcare facility-based cross-sectional study was conducted in Dessie town from April 1 to June 30, 2023, among 348 pregnant women and their newborns. Socio-demographic, clinical, and related data were collected using a pre-tested semi-structured questionnaire. Vaginal swab samples from pregnant women and pooled external ear, nasal area, and umbilical swab samples from the newborns were collected and transported using Amies transport media. Samples were inoculated into blood agar, Todd Hewitt selective enrichment broth, and MacConkey agar for bacterial isolation, and Sabouraud Dextrose Agar and CHROM Agar for Candida species isolation. The antimicrobial susceptibility was performed on isolates using the Kirby-Bauer disc diffusion technique. Data was analyzed by SPSS version 25.0. Logistic regression model was used to identify the associated factors. Finally, variables with p < 0.05 and their 95% confidence interval were considered statistically significant.ResultsA total of 348 pregnant women attending vaginal delivery were included in the study. The maternal colonization and vertical transmission rates were 55.5% (193/348) and 53.9% (104/348), respectively. The most frequent potential pathogen among pregnant women was Escherichia coli (27.6%), followed by Candida spp. (14.1%), and Klebsiella spp. (6%). Similarly, the predominant isolates in the newborns were E. coli (16.4%), Candida spp. (6.3%), and Klebsiella spp. (3.6%). The overall multidrug resistance levels of potential pathogens were 37.3%. Living with domestic animals (p = 0.001), having premature rupture of membrane (p = 0.010) and history of urinary tract infection (p = 0.013) were significantly associated with maternal colonization. Potential pathogen colonization newborn was significantly associated with duration of labor (p = 0.024) and low birth weight (p < 0.001).ConclusionThe finding of the present study revealed that vaginal colonization and vertical transmissions of potential pathogens and their antimicrobial resistance is still a significant problem. This alarms the urgency of evidence based-intervention to improve maternal and neonatal health.

Photodynamic therapy for the precise treatment of localized prostate cancer

Over the past 20 years, early diagnosis of prostate cancer has become increasingly prevalent due to the promotion of prostate-specific antigens, and its treatment has become a focal point. However, there are some drawbacks associated with therapies for early prostate cancer, such as active surveillance and radical prostatectomy, which may include urinary incontinence, erectile dysfunction, and urinary tract infection. In contrast, photodynamic therapy (PDT) is introduced into the treatment of prostate cancer because of its advantages, such as high precision to tumor cells, low toxicity, and no radiation. Compared to radical prostatectomy, the PDT has low risk and minimal trauma. Although PDT is in the early stages of clinical development, it holds promise for the effective treatment of localized prostate cancer. Herein, we reviewed studies on the mechanisms of PDT and photosensitizers for prostate cancer. Given the rapid development of nanotechnology, photosensitizers wrapped by nanomaterials have emerged as new option with significant advantages, particularly of in achieving high tumor selectivity using functional nanomaterials. Numerous PDT clinical trials on prostate cancer have been conducted worldwide. We also reviewed the results of a few photosensitizers in these clinical trials. However, a few limitations and challenges regarding PDT for prostate cancer still exist. In addition, future development and potential clinical application strategies of future PDT are predicted.

Laparoscopic-assisted colostomy with anorectal malformation: friend or foe?

Abstract Purpose The standard management of anorectal malformations (ARM) without perineal fistula involves fecal diversion via a sigmoid colostomy. This report aims to describe our initial experience and evaluate the feasibility and benefits of laparoscopically-assisted loop colostomy in a neonate with ARM without perineal fistula, addressing the question of whether this minimally invasive approach offers advantages over traditional open techniques. Methods We report the case of a full-term male newborn with an imperforate anus. A laparoscopic-assisted loop colostomy was performed on the second day of life. Three trocars were used: a 5 mm umbilical port for the laparoscope and two 3 mm ports on the flanks. The surgical technique, including trocar placement, bowel mobilization, stoma creation, and closure, is described. The postoperative course and long-term outcomes were monitored over 17 months, including subsequent anorectoplasty and stoma closure. Results The laparoscopic approach provided superior visualization of pelvic anatomy, enabling accurate identification of the fistula and optimal stoma placement. Postoperatively, the patient exhibited early stoma function, rapid recovery, and no complications such as urinary tract infections or stomal issues. Follow-up procedures, including anorectoplasty and colostomy closure, were performed without incident. The patient remains healthy and complication-free at 17 months of age Conclusion Laparoscopic-assisted colostomy offers distinct advantages over the open technique, including reduced complications, improved recovery, and favorable cosmetic outcomes. This minimally invasive method represents a promising alternative for ARM management, aligning with modern pediatric surgical advancements.

Antimicrobial susceptibilities of clinical bacterial isolates from urinary tract infections to fosfomycin and comparator antibiotics determined by agar dilution method and automated micro broth dilution.

Uncomplicated bUTIs are often caused by Escherichia coli, Klebsiella pneumoniae, and Enterococcus faecalis. Fosfomycin is one of the recommended firstline antibiotics for the treatment of symptomatic, uncomplicated bUTIs. Fosfomycin susceptibility testing is complicated by the fact that although both CLSI and EUCAST recognize agar dilution (AD) as the reference method albeit being labor-intensive, breakpoints are different, and Etest is only approved by EUCAST. We investigated the susceptibility of bUTI clinical isolates to fosfomycin using AD and compared performance in a subset of isolates to Etest. Fosfomycin susceptibility profiles of bacterial isolates were compared to other firstline antibiotics. We found isolates were susceptible to fosfomycin at similar or higher rates compared to other firstline antibiotics. Importantly, fosfomycin was effective against isolates producing extended-spectrum beta-lactamases and those that were resistant to other firstline treatments. Furthermore, our data showed Etest was a viable option for susceptibility testing with 94% agreement to the AD.

Transurethral microwave thermotherapy with the CoreTherm®Concept in men with prostates larger than 100 grams - a consecutive case series.

Transurethral microwave thermotherapy (TUMT) is well described for lower urinary tract symptoms in men with prostates between 30 and 100 grams. We aimed to describe the results in men with prostates larger than 100 grams. We retrospectively recorded age, prostate size, occurrence of urinary retention, and Danish Prostate Symptom Score (DAN-PSS) prior to treatment in men with prostates exceeding 100 grams. Following treatment, we assessed satisfaction, DAN-PSS, and the results of uroflowmetry and postvoid residual urine. We included 50 consecutive patients with prostates over 100 g. The median age was 78 years, and the median prostate size was 126 g (range 101-230). Forty-four men were treated due to urinary retention and 6 due to lower urinary tract symptoms. Treatments were performed under local anesthesia. The median duration was 15 minutes (range 8-32 minutes) and the median destruction was 25% of the prostatic volume (range 11-26%). Eight patients had destruction of <20%. No side effects were noted. Forty-nine patients completed 6-month follow-up. The 41/49 (84%) men who had tissue destruction of ≥20% reported to be satisfied. The median DAN-PSS score was 3 (range 0-18), the median Qmax was 12 mL/s (range 5.1-23.1 mL/s) and the median postvoid residual volume was 89 mL (range 0-331 mL). Symptoms were unchanged in the 8/49 (16%) men who had <20% tissue destruction. TUMT represents a useful alternative to surgery in men with infravesical obstruction and a prostate of more than 100 grams.

Correction: Shkalim Zemer et al. Pathogens Causing Pediatric Community Acquired Urinary Tract Infections and Their Increasing Antimicrobial Resistance: A Nationwide Study. Pathogens 2024, 13, 201

In the original publication [...]

Emerging Role of Laser Lithotripsy for Bladder Stones: Real-World Outcomes from Two European Endourology Centers with a Systematic Review of Literature.

Introduction and Objective: We aimed to look at the evidence for laser lithotripsy for bladder stones (BSs) to provide results from two centers on bladder calculi treatment. In addition, the outcomes of prostatic and other surgical interventions performed in nearly half of all patients. Methods: A retrospective analysis of two large European endourology tertiary centers for patients who underwent laser lithotripsy for BS between 2016 and 2024 (7 years). All patients provided consent and were counseled for the study accordingly, and the studies were registered as an audit in the individual centers. Results: A total of 122 patients were analyzed (mean age of 68.17 ±16.38 years; male:female ratio of 97:25). Thirteen (10.7%) patients had a preoperative long-term catheter. Overall, 42 (34.43%) patients had multiple stones (n = 2.19, ±2.08), with a median stone burden of 32.36 ± 24.13 mm. The mean operative time was 61.6 ± 37.25 minutes, with an overall stone-free rate (SFR) of 95.1% (n = 116). Postoperative complications were noted in nine (7.38%) patients, which included urinary tract infection or sepsis (n = 4, 3%), pain (n = 2, 1.6%), and bleeding/acute urinary retention/urethral stone (n = 1 each, 0.82%). All the complications were Clavien-Dindo I/II and treated conservatively. Six patients (4.9%) with planned concomitant surgical intervention needed a completion (second) intervention at a later date. Sixty patients (49.2%) had concomitant procedure along with their BS treatment. Twenty-two patients (18%) with a mean prostate size of 60.71 cc (±30.50 cc) underwent a transurethral resection of prostate (n = 16, 13.1%) or bladder neck incision (n = 6, 4.9%). Others underwent ureteroscopy (n = 13, 10.7%), transurethral resection of bladder tumor (n = 5, 4.1%), suprapubic catheter repositioning (n = 10, 8.2%), or urethral dilation (n = 10, 8.2%). The mean hospital stay was 1.4 ± 1.33 days. Conclusion: Laser fragmentation of BSs stands out as a safe and efficient choice with a good SFR and low risk of major complications, and perhaps should be considered the new gold standard for BS management. It also allows for concomitant treatment of enlarged prostate and other endourologic procedures with good outcomes.

Epigenetic modifications in bladder cancer: crosstalk between DNA methylation and miRNAs

Bladder cancer (BC) is a malignant tumor characterized by a high incidence of urinary system diseases. The complex pathogenesis of BC has long been a focal point in medical research. With the robust development of epigenetics, the crucial role of epigenetic modifications in the occurrence and progression of BC has been elucidated. These modifications not only affect gene expression but also impact critical biological behaviors of tumor cells, including proliferation, differentiation, apoptosis, invasion, and metastasis. Notably, DNA methylation, an important epigenetic regulatory mechanism, often manifests as global hypomethylation or hypermethylation of specific gene promoter regions in BC. Alterations in this methylation pattern can lead to increased genomic instability, which profoundly influences the expression of proto-oncogenes and tumor suppressor genes. MiRNAs, as noncoding small RNAs, participate in various biological processes of BC by regulating target genes. Consequently, this work aims to explore the interaction mechanisms between DNA methylation and miRNAs in the occurrence and development of BC. Research has demonstrated that DNA methylation not only directly influences the expression of miRNA genes but also indirectly affects the maturation and functionality of miRNAs by modulating the methylation status of miRNA promoter regions. Simultaneously, miRNAs can regulate DNA methylation levels by targeting key enzymes such as DNA methyltransferases (DNMTs), thereby establishing a complex feedback regulatory network. A deeper understanding of the crosstalk mechanisms between DNA methylation and miRNAs in BC will contribute to elucidating the complexity and dynamics of epigenetic modifications in this disease, and may provide new molecular targets and strategies for the early diagnosis, treatment, and prognostic evaluation of BC.

Kidney Fibrosis In Vitro and In Vivo Models: Path Toward Physiologically Relevant Humanized Models.

Chronic kidney disease (CKD) affects over 10% of the global population and is a leading cause of mortality. Kidney fibrosis, a key endpoint of CKD, disrupts nephron tubule anatomy and filtration function, and disease pathomechanisms are not fully understood. Kidney fibrosis is currently investigated with in vivo models, that gradually support the identification of possible mechanisms of fibrosis, but with limited translational research, as they do not fully recapitulate human kidney physiology, metabolism, and molecular pathways. In vitro 2D cell culture models are currently used, as a starting point in disease modeling and pharmacology, however, they lack the 3D kidney architecture complexity and functions. The failure of several therapies and drugs in clinical trials highlights the urgent need for advanced 3D in vitro models. This review discusses the urinary system's anatomy, associated diseases, and diagnostic methods, including biomarker analysis and tissue biopsy. It evaluates 2D and in vivo models, highlighting their limitations. The review explores the state-of-the-art 3D-humanized in vitro models, such as 3D cell aggregates, on-chip models, biofabrication techniques, and hybrid models, which aim to mimic kidney morphogenesis and functions. These advanced models hold promise for translating new therapies and drugs for kidney fibrosis into clinics.

The Sex-Dependent Ameliorative Effect of Intermittent Fasting on Urinary System Functions in Genetic Absence Epileptic Rats

Epilepsy, a brain condition causing recurrent seizures, can disrupt various body functions, including urination. This study explored how alternate-day fasting (ADF), a type of intermittent fasting, a diet involving one day of eating and fasting, subsequently affects urinary system health in epileptic rats. Using a genetic rat model of epilepsy, we examined bladder and kidney function through tissue analysis, biochemical tests, and physiological assessments, focusing on differences between males and females. The results showed that epilepsy causes significant urinary system damage linked to inflammation and oxidative stress. However, ADF reduces this damage by lowering inflammation and restoring antioxidant balance. Male rats exhibited more oxidative damage, while female rats responded better to ADF, likely due to hormonal differences. These findings suggest ADF as a potential, cost-effective dietary approach to protect against urinary complications in epilepsy and similar conditions. Understanding these effects may lead to improved treatments for both genders and a better quality of life for people with chronic diseases.

Exploring Anatomical Variations and Potential Associations between the Upper Urinary Tract and Renal Vasculature: Findings from 160-Slice CT Imaging in Northern Nigeria

Abstract Introduction: As anatomical variations relate to the urinary system, knowledge on them is valuable, especially in the proper evaluation and conduction of surgical as well as interventional procedures of the urinary tract. The study aimed to determine the prevalence and possible association between anatomical variations of the upper urinary tract and renal vasculature. Materials and Methods: A total of 200 computed tomograms were generated with Toshiba Aquilion Prime 160-slice scanner and analysed for the presence of potential anatomical variations using a Vitrea multi-modality work station capable of image post-processing by two expert radiologists. Results: Anatomical variations of the upper urinary tract were commoner on the right with a prevalence of 33.5% and 29.0% on the right and left, respectively, while for the renal vasculature, the variations are commoner on the left at 27.0% and 28.5%, respectively. The most common anatomical variation of the upper urinary tract found on the right was extra-renal bifid pelvis at 25 (12.5%), while on the left, it was baggy extra-renal pelvis at 27 (13.5%). Early branching hilar renal artery and accessory superior polar renal artery, both at 19 (9.5%), were the most common renal vasculature variations on the right and left, respectively. There was a statistically significant association between anatomical variations of the upper urinary tract and renal vasculature with a P &lt; 0.001. Conclusion: This study proposed that anatomical variations of the upper urinary tract are commoner on the right side, while for the renal vasculature, they are commoner on the left. There was a statistically significant association between the anatomical variations of the upper urinary tract and that of the renal vasculature, indicating an increasing likelihood of one occurring if the other is present.

Urinary bacteriophage cooperation with bacterial pathogens during human urinary tract infections supports lysogenic phage therapy.

Despite much promise in overcoming drug-resistant infections, clinical studies of bacteriophage antibacterial therapy have failed to show durable effectiveness. Although lysogeny plays an important role in bacterial physiology, its significance in diverse microbiomes remains unclear. Here, we tested the following hypotheses: 1) urinary microbiome phage populations switch to a higher relative proportion of temperate phages, and 2) the activity of the phage recombination machinery (integration/excision/transposition) is higher during human urinary tract infections (UTIs) than in non-infected urinary tracts. Using human urine, model organisms, mass spectrometry, gene expression analysis, and the phage phenotype prediction model BACPHLIP, the results corroborated our hypotheses at the functional protein and gene levels. From a human health perspective, these data suggest that temperate phages may facilitate bacterial infections rather than function as protective agents. These findings support the use of lysogenic phages as therapeutic Trojan Horses.

Susceptibility profile and associated factors of urinary tract infections among women with established preterm labor delivering at a tertiary teaching hospital in Eastern Uganda: a cross-sectional study

BackgroundUrinary tract infections have been recognized as a significant health issue since ancient times, but they are particularly concerning during pregnancy due to their potential to cause severe complications like preterm labor and low birth weight leading to significant neonatal morbidity and mortality. This study aimed to determine the prevalence, antibiotic susceptibility and factors associated with urinary tract infections among women with established preterm labor at Jinja Regional Referral Hospital.MethodsThis was a hospital-based cross-sectional study carried out from 1st January 2024 to 30th April 2024. Using a consecutive sampling method, 385 pregnant women were enrolled until the desired sample size was reached. Data was collected via pretested questionnaires, and antibiotic susceptibility patterns were determined via urine culture and sensitivity. Data was analysed using STATA Version 14.2. Bivariate and multivariate analyses were used to determine association between the dependent and independent variables, with P < 0.05 as the level of significance at 95% confidence interval. The results were presented in pie charts, bar graphs and tables.ResultsThe prevalence of urinary tract infection was 114 (29.6%). The effectiveness of antibiotics against common Urinary tract Infection (UTI) pathogens varied significantly. E. coli was the most frequently isolated organism in UTIs, accounting for 42.98% of the cases followed by Enterococcus at 24.56%. Ceftriaxone was the most effective agent overall, with 81% of the pathogens showing susceptibility, followed by cefixime (78%) and co-amoxiclav (73%). Nitrofurantoin (64%) and cefuroxime (66%) had moderate effectiveness, whereas ampicillin (50%) was less effective. Azithromycin (34%) and erythromycin (28%) were the least effective. No formal education, being unemployed, monthly income less than 500,000 Ugandan Shillings, a history of urinary tract infection, Parity of one or more, a gestational age ≥ 26 weeks and diabetes (aOR = 8.00; 95% CI = [1.75–36.48]; P = 0.007), (aOR = 2.72; 95% CI = [1.38–5.23]; P = 0.003), (aOR = 2.55; 95% CI = [1.29–5.16]; P = 0.007), (aOR = 4.60; 95% CI = [2.64–8.25]; P < 0.001), (aOR = 1.90; 95% CI = [1.07–3.45]; P = 0.028), (aOR = 2.41; 95% CI = [1.17–4.92]; P = 0.017), (aOR = 3.11; 95% CI = [1.33–7.12]; P = 0.009), respectively, were significantly associated with urinary tract infection.ConclusionsIn this study, the prevalence of urinary tract infection was high compared with the worldwide prevalence. The majority of the isolates were susceptible to ceftriaxone, followed by co-amoxiclav, cefixime, nitrofurantoin, ampicillin, azithromycin and erythromycin. Primary or no formal education, monthly income ≤ 500,000Ugandan shillings, history of urinary tract infections, gestational age ≥ 26 weeks and diabetes were significantly associated with urinary tract infection.

Molecular analysis of AmpC-producing Escherichia coli isolated from pediatric patients.

AmpC-mediated cephalosporin resistance occurs in 1.0% to 3.3% of Escherichia coli isolates due to production of either plasmid-mediated AmpC (p-AmpC) or chromosomal AmpC (c-AmpC). Data on the prevalence and molecular characteristics of AmpC-producing E. coli in pediatric patients are limited. We analyzed E. coli clinical strains with resistance phenotype consistent with AmpC production isolated from patients at a pediatric hospital in Japan between 2015 and 2022. Sequence types, resistance genes, and relevant mutations were identified through whole genome sequencing. Promoter and attenuator regions of the chromosomal ampC gene were examined and the presence of plasmid-mediated ampC genes was determined. Among 2,081 E. coli strains, 80 (3.8%) from 27 patients demonstrated the AmpC phenotype. The median patient age was 55 months, with 92.6% having underlying diseases, mainly renal and urinary tract abnormalities. Of the 27 strains, p-AmpC was found in 9 strains including 6 strains belonging to ST131, while c-AmpC was identified in 18 strains including 9 ST73 strains and 4 ST12 strains. ST131 and ST73 were the major AmpC-E. coli lineages isolated from children with underlying diseases. Most ST131 strains harbored p-ampC, while all ST73 strains acquired cephalosporin resistance by c-AmpC production through promoter and attenuator mutations, suggesting the presence of both AmpC mechanisms in a lineage-specific manner in E. coli identified among hospitalized children.