Follow-up Urine Cultures Research Articles

Evaluation of the effectiveness of an antimicrobial peptide-cytokine product in the complex treatment of pregnant women with asymptomatic bacteriuria

Background. Asymptomatic bacteriuria in pregnant women can contribute to urological and gestational complications. Antibiotic therapy is recommended in patients with 105 CFU/mL and above in the urine. However, choosing antimicrobial therapy is challenging for those with 103104 CFU/mL.
 Aim. To assess the effectiveness of Superlymph combined with phytotherapy in pregnant women with asymptomatic bacteriuria.
 Materials and methods. Pregnant women aged 21 to 38 with asymptomatic bacteriuria (bacterial count of 103104 CFU/mL), comparable in age, reproductive history, and extragenital comorbidities, were divided into three groups. In group 1 (32 subjects), Superlymph and a herbal medicine containing centaury, lovage root, and rosemary leaves were used. In group 2 (33 subjects), only the herbal medicinal product was used. In group 3 (35 subjects), the above drug products were not used. The patients received the herbal medicinal product containing centaury, lovage root, and rosemary leaves 2 tablets TID for 14 days. Superlymph was administered intravaginally (1 suppository [10 units] BID for 10 days). A follow-up urine culture for groups 1 and 2 was taken 23 weeks after the completion of therapy, and for patients of group 3, 23 weeks after the previous culture. A routine general clinical assessment of pregnant women was performed. Statistical analysis was carried out using the Statistica 12.0 software.
 Results. Patients of the main group that received the peptide-cytokine and herbal medicinal products had the most significant improvement compared with pregnant women of other groups, as shown by complete eradication from the urinary tract of Escherichia coli, improved urinary laboratory tests, cytology, and fewer gestational complications. Premature onset of labor was significantly less common (6-fold) in patients of the main group versus controls, who refused the proposed therapy for asymptomatic (moderate) bacteriuria.
 Conclusion. The addition of peptide-cytokine agent Superlymph increases the treatment effectiveness in pregnant women with asymptomatic bacteriuria.

Prevalence of positive urine culture in the presence of inactive urine sediment in 1049 urine samples from dogs.

BackgroundUrinalysis (UA) is often used to screen for bacterial cystitis, regardless of sediment results, and followed up by quantitative urine culture (UC) for definitive diagnosis.ObjectivesDetermine prevalence of positive UCs in dogs with inactive urine sediments on routine UA.AnimalsA total of 1049 urine samples with inactive urine sediments and UCs collected from dogs presented to a veterinary specialty hospital between January 2018 and February 2020.MethodsRetrospective study of dogs with an inactive urine sediment on routine UA and follow‐up UCs. Signalment, UA findings, proteinuria, and UC results were recorded. Associations among these findings were assessed using multivariate logistic regression carried out using a backward stepwise method.ResultsOverall prevalence of positive UC was 3.4% (95% confidence interval [CI], 2.4‐4.8). Escherichia coli was the most commonly isolated bacteria. Only naturally voided samples were associated with increased prevalence of positive culture when compared to collection by cystocentesis or a non‐specified method. No statistically significant association with culture positivity was found for urine protein‐to‐creatinine ratio, urine specific gravity, urine pH, breed, age, or sex.Conclusions and Clinical ImportanceBased on the low prevalence (3.4%) of positive culture in urine samples from dogs with inactive sediment on routine UA and the relatively high cost of UC and sensitivity, cost‐benefit analysis including clinical suspicion of lower urinary tract disease should inform testing decisions, rather than routinely performing cultures on urine samples without active sediments.

Oral fosfomycin use for pyelonephritis and complicated urinary tract infections: a 1 year review of outcomes and prescribing habits in a large municipal healthcare system.

The rising incidence of MDR uropathogens has driven increased use of oral fosfomycin for treatment of complicated urinary tract infections (cUTIs). However, there are limited data to support its use for cUTI, especially pyelonephritis. We performed a retrospective review of all oral fosfomycin prescriptions between 1 January and 31 December 2017 in the Los Angeles County Department of Health Service system, the second largest US municipal health system. We examined demographics, clinical characteristics, adverse events and 30 day treatment success for patients with cUTI. Follow-up urine cultures till 31 December 2018 were examined for emergence of fosfomycin resistance. Of 154 patients prescribed fosfomycin, 99 (64%) had cUTI. Of these, 39 (39%) had lower tract, 37 (37%) pyelonephritis and 23 (23%) non-pyelonephritis upper tract cUTI. Escherichia coli ESBL producers were the predominant pathogens (73%). Of the 63 patients with 30 day follow-up, 49 (78%) had clinical success, including 16/20 (80%) treated for pyelonephritis. Treatment failure was associated with male sex (P < 0.01), urological abnormalities (P = 0.05), non-E. coli cUTI (P = 0.03) and receipt of <25% IV therapy prior to fosfomycin switch (P = 0.03). Of patients prescribed fosfomycin (n = 154), fosfomycin-resistant E. coli were found in 9/64 (14%) of the patients with follow-up urine cultures >30 days after initial treatment. Despite the lack of data supporting its use, we found that most patients receiving oral fosfomycin off-label for cUTI, including pyelonephritis, had clinical success. However, emergence of subsequent resistance warrants caution. Prospective comparative studies should be done to better evaluate oral fosfomycin use for cUTI.

Oral fosfomycin for the treatment of lower urinary tract infections among kidney transplant recipients-Results of a Spanish multicenter cohort.

Oral fosfomycin may constitute an alternative for the treatment of lower urinary tract infections (UTIs) in kidney transplant recipients (KTRs), particularly in view of recent safety concerns with fluroquinolones. Specific data on the efficacy and safety of fosfomycin in KTR are scarce. We performed a retrospective study in 14 Spanish hospitals including KTRs treated with oral fosfomycin (calcium and trometamol salts) for posttransplant cystitis between January 2005 and December 2017. A total of 133 KTRs developed 143 episodes of cystitis. Most episodes (131 [91.6%]) were produced by gram-negative bacilli (GNB), and 78 (54.5%) were categorized as multidrug resistant (including extended-spectrum β-lactamase-producing Enterobacteriaceae [14%] or carbapenem-resistant GNB [3.5%]). A median daily dose of 1.5g of fosfomycin (interquartile range [IQR]: 1.5-2) was administered for a median of 7days (IQR: 3-10). Clinical cure (remission of UTI-attributable symptoms at the end of therapy) was achieved in 83.9% (120/143) episodes. Among those episodes with follow-up urine culture, microbiological cure at month 1 was achieved in 70.2% (59/84) episodes. Percutaneous nephrostomy was associated with a lower probability of clinical cure (adjusted odds ratio: 10.50; 95% confidence interval: 0.98-112.29; P = 0.052). In conclusion, fosfomycin is an effective orally available alternative for treating cystitis among KTRs.

2263. Fosfomycin Trometerol Use for Complicated UTIs Including Pyelonephritis, a 1-year Review of Outcomes and Prescribing Habits

BackgroundTreatment of complicated urinary tract infections (UTI) caused by multidrug-resistant organisms (MDROs) is increasingly problematic given limited oral antibiotic options. In these situations, fosfomycin is increasingly used. However, there are limited outcome and pharmacokinetic data to support fosfomycin use for complicated UTIs (cUTI), especially in the upper tract. We describe fosfomycin use for complicated cUTI in our healthcare system.MethodsWe performed a retrospective review of all fosfomycin prescriptions between 1/1-December 31/17 in the Los Angeles Department of Health Service system, which consists of 4 medical centers and 19 clinics that provide care to >600,000 patients annually. In our system, fosfomycin use requires ID approval. We collected demographics, clinical characteristics, adverse effects, and 30-day success rates. Subsequent urine cultures up to December 31/18 were examined for fosfomycin susceptibility.ResultsA total of 156 patients received fosfomycin; 21 (13%) had lower UTI, 39 (25%) had lower tract cUTI, 24 (15%) had upper tract not pyelonephritis, and 37 (24%) had pyelonephritis. The majority (n = 98, 63%) were female, 82 (53%) had urological or functional abnormalities, 67 (43%) had diabetes, 26 (17%) were immunocompromised and most (n = 135, 87%) presented from the community. E.coli was the predominant pathogen (n = 123, 79%), 112 (91%) of these produced ESBL. For cUTI (n = 100), dosing interval was q24h (3%), q48h (51%) and q72h (46%). Among patients with 30-day outcomes (n = 100, 64%), success was seen in 84 (84%), and was 79% (14/64) among those with cUTI. Failure was associated with male gender (p = 0.005), urological abnormalities (p = 0.047), and non-E. coli UTIs (p = 0.03). Only 1 adverse effect at 30 days was described. Fosfomycin-resistant E. coli were found in 9/64 (14%) of patients with follow-up urine cultures > 30 days after initial treatment (mean 5.7 ± 4.03 mo.).ConclusionDespite the lack of data supporting its use, we found that most patients receiving fosfomycin for complicated upper UTIs had clinical success. However, emergence of subsequent resistance warrants caution. Further studies should be done to better understand optimal use of fosfomycin for complicated UTIs.Disclosures All authors: No reported disclosures.

The frequency of urinary tract infection and subclinical bacteriuria in dogs with allergic dermatitis treated with oclacitinib: a prospective study.

Oclacitinib is a selective Janus kinase inhibitor for the treatment of canine allergic pruritus and atopic dermatitis in dogs. Glucocorticoids and ciclosporin increase urinary tract infection (UTI) frequency in dogs with inflammatory skin disease. Prospective study to evaluate the frequency of UTI and subclinical bacteriuria in dogs with allergic dermatitis receiving oclacitinib. Client-owned dogs ≥2 years of age with a history of allergic dermatitis without apparent history of urinary tract disease or predisposition to UTI were included. Prior to enrolment, urinalysis and quantitative urine culture were performed after a washout period of at least 14 days from systemic antimicrobial drugs and 28 days for ciclosporin and systemic glucocorticoids. Dogs received oclacitinib at labelled dosing for an intended period of 180-230 days with a follow-up urinalysis and urine culture performed regardless of urinary tract signs. Systemic antimicrobial and immune-modulating drugs were not administered during the study. None of the 55 dogs in this study developed UTI while receiving oclacitinib based on follow-up urinalysis and urine culture performed during a range of 58-280 days (mean 195 days). Two dogs developed self-limiting abnormal urinary tract signs without urine culture or urinalysis findings consistent with UTI. These findings indicate that bacteriuria is not an expected adverse effect in dogs treated with oclacitinib without a prior history of UTI or predisposing condition during this treatment period. Therefore, routine urine culture is not indicated for such dogs in the absence of abnormal urinalysis or clinical signs of urinary tract disease.

Micafungin Therapy for Symptomatic Candiduria in Hospitalized Patients

Background Fluconazole is the drug of choice for candiduria requiring treatment; however, it may not be optimal in some cases because of resistance, drug interactions, or adverse effects. Case reports and retrospective analyses suggest that echinocandins may be effective in treating candiduria and Candida urinary tract infections, despite low urinary concentrations. The purpose of this investigation was to evaluate the effectiveness of echinocandins for the treatment of Candida urinary tract infections in hospitalized patients. Methods This was a 5-year, retrospective evaluation of patients treated with micafungin for Candida urinary tract infections (symptomatic) or asymptomatic candiduria with qualifying conditions (pregnancy, neutropenia, recent urologic procedure). The primary outcome was clinical success, defined as symptom resolution (symptomatic patients) or urine sterilization (asymptomatic patients) by the end of treatment. Secondary outcomes included urine sterilization in all patients and time to symptom resolution. Results A total of 302 patients with candiduria received micafungin during the study period. Of these, 97 met the inclusion criteria; however, 83 were excluded. Fourteen patients were included in the case series. Twelve patients (85.7%) were symptomatic, and 2 (14.3%) were asymptomatic with neutropenia. Ten patients (71.4%) achieved the primary outcome of symptom resolution or urine sterilization by the end of treatment. Six patients (42.9%) had urine sterilization by the end of therapy; however, a follow-up urine culture was not performed in the remaining 8 patients. Median time to symptom resolution was 4 days. Conclusions In some clinical settings, micafungin may be an effective therapy for Candida urinary tract infections in hospitalized patients.

Should Asymptomatic Bacteriuria Be Systematically Treated in Kidney Transplant Recipients? Results From a Randomized Controlled Trial.

The indication for antimicrobial treatment of asymptomatic bacteriuria (AB) after kidney transplantation (KT) remains controversial. Between January 2011 and December 2013, 112 KT recipients that developed one episode or more of AB beyond the second month after transplantation were included in this open-label trial. Participants were randomized (1:1 ratio) to the treatment group (systematic antimicrobial therapy for all episodes of AB occurring ≤24 mo after transplantation [53 patients]) or control group (no antimicrobial therapy [59 patients]). Systematic screening for AB was performed similarly in both groups. The primary outcome was the occurrence of acute pyelonephritis at 24-mo follow-up. Secondary outcomes included lower urinary tract infection, acute rejection, Clostridium difficile infection, colonization or infection by multidrug-resistant bacteria, graft function and all-cause mortality. There were no differences in the primary outcome in the intention-to-treat population (7.5% [4 of 53] in the treatment group vs. 8.4% [5 of 59] in the control group; odds ratio [OR] 0.88, 95% confidence interval [CI] 0.22-3.47) or the per-protocol population (3.8% [1 of 26] in the treatment group vs. 8.0% [4 of 50] in the control group; OR 0.46, 95% CI 0.05-4.34). Moreover, we found no differences in any of the secondary outcomes. In conclusion, systematic screening and treatment of AB beyond the second month after transplantation provided no apparent benefit among KT recipients (NCT02373085).

The Effectiveness of Prophylactic Antibiotics with Oral Levofloxacin against Post-Shock Wave Lithotripsy Infectious Complications: A Randomized Controlled Trial.

To evaluate the efficacy of prophylactic antibiotics in reduction of infections after shock wave lithotripsy (SWL) in patients undergoing shock wave lithotripsy (SWL). The study was a randomized control trial. Between 2012 and 2014, patients with pre-operative sterile urine undergoing SWL were randomly assigned by the randomization ratio of 1:1 to receive prophylactic antibiotics with single-dose oral levofloxacin (500 mg) or no treatment (control group), respectively. Urinalysis and urine cultures were obtained between post-operative day five and seven, respectively. Pyuria was defined as ≥10 white blood cells per high power field (WBC/hpf). Significant bacteriuria was defined as ≥10(5) colony forming units per milliliter (CFU/mL) uropathogens. Febrile urinary tract infection (fUTI) was defined as body temperature higher than 38.0°C with pyuria or significant bacteriuria within seven days after SWL treatment. Initially, 274 patents underwent randomization with 135 and 139 patients in the levofloxacin and control group, respectively. A total of 206 patients (106 with placebo and 100 with levofloxacin) with complete follow-up of urinalysis were eligible for analysis. The rates of post-operative pyuria were not significantly different in patients with and without prophylaxis (8% versus 4.7%, p = 0.33). Moreover, there was also no significant difference in rates of bacteriuria in patients with and without prophylaxis (1% versus 0%, p = 0.49). Patients without follow-up urinalysis and urine culture received telephone survey. Among them, there was only one patient reporting post-SWL fever in the levofloxacin group (0.7%) compared with none (0%) in the control group (p = 0.49). As the results of the interim analysis revealed no benefit of levofloxacin in preventing post-SWL pyuria, bacteriuria, and fUTI, we terminated the study early before the pre-planned sample size was achieved. The incidence of asymptomatic and fUTI is low in patients with pre-SWL sterile urine undergoing SWL. Therefore, prophylactic antibiotics may be unnecessary in this cohort of patients.

Implementation of a Quality Improvement Project to Document & Decrease the Rate of Contaminated Urine Cultures in our Neonatal Population

ISSUE: Lo et al. (2008) found that urinary tract infections (UTI) are the most common hospital acquired infection. They identified that 80% of UTI’s are attributable to an indwelling urinary catheter. The two guiding documents infection preventionist reference when seeking guidance on Catheter Associated Urinary Tract Infection (CAUTI) prevention are the Healthcare Infection Control Practices Advisory Committee (2010) and the SHEA/IDSA Practice Recommendations (2008). Neither document addresses the neonatal population, nor does the National Healthcare Safety Network (NHSN) (2010) have a CAUTI benchmark for NICU’s. Furthermore, we were unable to identify expected rates of urine contamination specific for the neonatal population. The following abstract outlines our response to this literature gap. Project aim: To decrease the rate of contaminated urine cultures by 20% by the end of 2013. PROJECT: Our NICU is a Level III, 54 bed unit in an urban teaching facility. Using the Plan-Do-Study-Act methodology we analyzed all urine cultures collected from January through mid October, 2012. We conducted a literature review, created and delivered education on appropriate urine specimen collection using LippincottWilliams &Wilkins (2012) and implemented an audit process on every urine culture ordered. RESULTS: January through October, 2012 we had 26 incidences of symptomatic UTI, Criterion 3 & 4, using the NHSN (2012) surveillance definitions. In two incidences the patients involved had a foley in place. Over the same time period we collected an average of 24 urine specimens a month, 17 of which, on average, were negative. Ninety percent were collected by straight catheterization and 78% of the positive cultures were collected from male patients. Approximately 9% of positive cultures yielded mixed flora with no predominant organism, while 41.3% had colony counts 10,000 or less. Specimen collection education occurred in November, 2012. Preliminary results indicate a reduction in the number of contaminated urine cultures in NICU. Process measure results are pending. LESSON LEARNED: The Division of Health Care Quality Promotion (2009) estimated that CAUTI cost w$1000 per incidence. Costs associated with UTI treatment include antimicrobial therapy, central access required to deliver therapy, follow-up urine cultures and renal ultrasounds. Non-fiscal costs include adverse effects of antimicrobial therapy on bowel flora, increased risk of necrotizing enterocolitis, multidrug-resistant-organism development, pain and discomfort to the neonate, and emotional toll on the family members and care providers. The bottom line is, just because these infections are not benchmarked, doesn’t mean they shouldn’t be measured.

Foul Smelling Urine in a 7-year-old Boy Caused by Aerococcus urinae

To the Editors: Aerococcus urinae is an infrequently reported Gram-positive coccus mostly associated with urinary tract infection in elderly females. Sporadically, the organism has been described as the cause of severe infections.1 We report a young boy who had malodorous urine as the only sign of colonization with A. urinae. This 7-year-old boy was seen at the outpatient clinic because he exuded a bad odor. He was in good health and his medical history was unremarkable. Urinating was not painful and he had no fever. His mother described that after the boy urinated the whole house smelled bad. The general practitioner had found no leucocyturia or nitrite in the urine. Because it was believed that the smell occurred from smegma from under the preputium, a circumcision had been performed but this had no effect on the odor. At physical examination, he was a healthy boy with normal weight and height. The examination, including the genitals, was normal. A metabolic screen was reported normal. Repeated urine cultures consistently revealed significant growth (105 colony forming units/mL) of alpha hemolytic colonies identified as A. urinae. A course of 7 days treatment with co-trimoxazole was given and the smell disappeared. A follow-up urine culture was negative. Echography of the urinary tract revealed no abnormalities. This boy had repeatedly A. urinae in his urine with a foul smell as the only sign. A single course of antibiotics totally resolved the problem of the malodor. A. urinae is reported in about 0.2–0.3% of urine specimens sent in for culture. More than 90% of the patients are females >65 years of age. Most patients have a local or systemic underlying condition, predisposing to urinary tract infection.1 There is no relation between odor and urinary tract infections in the elderly.2 In young patients, A. urinae is reported rarely; we found only 1 article reporting pyelonephritis in a 12-year-old boy who had a history of pyeloplasty for vesicoureteral reflux.3 Our patient had no signs of an underlying disease. Although co-trimoxazole resistance has been described as a key feature in the identification of A. urinae, it was found recently that this is an in vitro effect. Most strains are susceptible to co-trimoxazole.4 A foul smell in children can be a result of bad hygiene, certain food stuffs, undesired loss of urine or feces or even of a metabolic disease. Although some do believe that the malodor of urine is a sign of an urinary tract infection, it has been demonstrated that this is not always true.5 Tjalling W. de Vries, MD, PhD Department of Pediatrics Medical Centre Leeuwarden Leeuwarden, The Netherlands Afke H. Brandenburg, MD, PhD Izore, Centre for Infectious Diseases Leeuwarden, The Netherlands

Comparative Effectiveness of Aminoglycosides, Polymyxin B, and Tigecycline for Clearance of Carbapenem-Resistant Klebsiella pneumoniae from Urine

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an increasingly common cause of health care-associated urinary tract infections. Antimicrobials with in vitro activity against CRKP are typically limited to polymyxins, tigecycline, and often, aminoglycosides. We conducted a retrospective cohort study of cases of CRKP bacteriuria at New York-Presbyterian Hospital from January 2005 through June 2010 to compare microbiologic clearance rates based on the use of polymyxin B, tigecycline, or an aminoglycoside. We constructed three active antimicrobial cohorts based on the active agent used and an untreated cohort of cases that did not receive antimicrobial therapy with Gram-negative activity. Microbiologic clearance was defined as having a follow-up urine culture that did not yield CRKP. Cases without an appropriate follow-up culture or that received multiple active agents or less than 3 days of the active agent were excluded. Eighty-seven cases were included in the active antimicrobial cohorts, and 69 were included in the untreated cohort. The microbiologic clearance rate was 88% in the aminoglycoside cohort (n = 41), compared to 64% in the polymyxin B (P = 0.02; n = 25), 43% in the tigecycline (P < 0.001; n = 21), and 36% in the untreated (P < 0.001; n = 69) cohorts. Using multivariate analysis, the odds of clearance were lower for the polymyxin B (odds ratio [OR], 0.10; P = 0.003), tigecycline (OR, 0.08; P = 0.001), and untreated (OR, 0.14; P = 0.003) cohorts than for the aminoglycoside cohort. Treatment with an aminoglycoside, when active in vitro, was associated with a significantly higher rate of microbiologic clearance of CRKP bacteriuria than treatment with either polymyxin B or tigecycline.

Adherence to evidence-based guidelines for the management of pyelonephritis in pregnancy

Pyelonephritis occurs in approximately two per cent of pregnancies and can cause significant maternal and fetal morbidity and mortality. Evidence-based guidelines recommend appropriate antibiotic therapy, urine culture for test of cure after treatment and monthly follow-up cultures until delivery. To evaluate adherence to guidelines for the management of antepartum pyelonephritis within an Australian obstetric population and to assess associations with noncompliance. A retrospective study was performed for the 103 pregnant women admitted with pyelonephritis between January 2001 and December 2009 at the Royal Brisbane and Women's Hospital, a tertiary referral obstetric hospital. We assessed baseline characteristics, the frequency of appropriate treatment and follow-up, and any associations among these. The guideline recommended antibiotic treatment was prescribed in 90.3% of women. Of the women with antibiotic-resistant organisms, 31.6% had their antibiotics changed appropriately. The test of cure urine culture was performed in only 35.0% of women after treatment completion. Inadequate long-term follow-up occurred in 60.2% of the cohort studied. Inappropriate follow-up was associated with low socioeconomic status (P=0.04), unemployment (P=0.04) and the absence of a test of cure urine culture (P=0.001). The empiric treatment of antepartum pyelonephritis is generally appropriate; however, antibiotic changes for bacterial resistance are inadequate. Test of cure and monthly follow-up urine cultures are infrequently performed despite their recommendation in published treatment guidelines.

A guideline for the inpatient care of children with pyelonephritis

BACKGROUND AND OBJECTIVES:Febrile urinary tract infections and pyelonephritis are common in children and frequently lead to hospitalization for management, especially in the child who appears toxic. The American Academy of Pediatrics (AAP) practice parameter on the diagnosis, treatment and evaluation of the initial urinary tract infection in febrile infants and young children provides experience and evidence-based guidelines for the practitioner caring for children between the ages of 2 months to 2 years. No established guideline exists for older children and the AAP guideline does not specifically focus on inpatient care.METHODS:We conducted a comprehensive review of recently published literature and practice guidelines to develop a consensus on the inpatient diagnosis and management of children with pyelonephritis.RESULTS:Eight recommendations are proposed for the diagnosis and management, including revised guidelines for the imaging studies postpyelonephritis on the basis of current best evidence.CONCLUSION:Proper diagnosis of pyelonephritis, timely initiation of appropriate therapy and identification of children at risk for renal injury will help to reduce immediate as well as long-term complications due to chronic kidney disease.

Escherichia coliandKlebsiella pneumoniaeCarbapenemase in Long-term Care Facility, Illinois, USA

To the Editor: Escherichia coli harboring Klebsiella pneumoniae carbapenemases (KPCs) are now rarely being reported. Worldwide, KPC-2 has been detected in Israel and the People’s Republic of China (1,2). Within the United States, carbapenem-resistant E. coli carrying blaKPC has been isolated in New Jersey (3) and Cleveland, Ohio (4), and 7 carbapenem-resistant E. coli isolates were obtained from 3 different hospitals in Brooklyn, New York (5). Urban et al. (6) recently reported 9 KPC-2 and KPC-3 carbapenemases in urinary E. coli isolates from 7 long-term care facilities. We report such an isolate from a resident of a long-term care facility. This case involved a 68-year-old female resident of a long-term care facility in Centralia, Illinois, who had multiple chronic medical problems, including cerebral palsy, a seizure disorder, and recurrent urinary tract infections. A urine culture grew >105 CFU/mL of E. coli susceptible to amikacin, gentamicin, tobramycin, piperacillin/tazobactam, trimethoprim/sulfamethoxazole, imipenem, and nitrofurantoin. Tigecycline susceptibility was not determined. Trimethoprim/sulfamethoxazole therapy was initiated. Follow-up urine culture almost 3 weeks later again grew >105 CFU/mL of E. coli, now susceptible to amikacin, gentamicin, tobramycin, nitrofurantoin, and tigecycline. The isolate was resistant to imipenem and meropenem. A modified Hodge test demonstrated production of a carbapenemase (7), and the blaKPC gene was detected by PCR at the Centers for Disease Control and Prevention (CDC). The patient was treated with a 10-day course of nitrofurantoin, 100 mg by gastrostomy tube 2× per day. Chart review indicated that contact precautions were instituted only after discovery of the second E. coli isolate. Seventeen days later, a repeat urine culture grew >105 CFU/mL of K. pneumoniae susceptible only to amikacin, gentamicin, tobramycin, and tigecycline. No treatment was given. Follow-up urine culture grew >105 CFU/mL of K. pneumoniae again with a similar resistance pattern. The modified Hodge test result was positive (7) and was confirmed as blaKPC positive by PCR at CDC. The resident was transferred to an acute care facility for further evaluation and was treated with amikacin. At completion of therapy, a repeat urine culture was negative for organisms. Our case, like that of Urban et al. (6), involved a urinary isolate from a resident of a long-term care facility. As increasing numbers of resistant gram-negative rods colonize such patients, the patients may acquire a bacterium carrying a KPC plasmid conferring broad-spectrum resistance as described in our patient. These plasmids may then be laterally transferred to other gram-negatives, which may have occurred in this case. Our case underscores the gravity of the evolutionary process of emergent, multidrug–resistant enterobacteriaceae. Even though E. coli strains that harbor carbapenemase genes are not ubiquitous, additional therapeutic interventions are needed to prevent the spread of these bacteria, which are likely to infect increasing numbers of patients.

Sensibilidad antimicrobiana de los uropatógenos y resultados del tratamiento antibiótico de las infecciones urinarias en atención primaria

An increase in the resistance to antimicrobial agents among bacteria causing urinary tract infections (UTI) has been reported. The aim of this study was to relate uropathogen susceptibility to prescribed antibiotics for UTI to the clinical outcome after therapy in primary health care patients. A prospective longitudinal study, including 118 women diagnosed with UTI was carried out in primary health care centers. The results of urine culture, antimicrobial susceptibility testing and the prescribed antibiotic treatment were recorded. The patients' clinical outcome and the results of follow-up urine cultures after therapy were also recorded. The uropathogens isolated were susceptible to the prescribed antibiotic in 86% of patients. Clinical improvement at two weeks was observed in 91% of patients with bacteria sensitive to the prescribed antibiotics and 7% of patients with resistant bacteria (P = 0.06). At 4-6 weeks, there were no clinical symptoms in 88% of patients with sensitive bacteria and 71% of patients with resistant bacteria (p = 0.23). In follow-up urine cultures, bacteria had been eradicated in 74% of patients with sensitive bacteria and 50% with resistant bacteria (p = 0.34). The majority of women diagnosed with UTI in primary health care had uropathogens sensitive to the prescribed antibiotic and treatment was effective at short term in this study. The results of antimicrobial susceptibility testing were not always related to the clinical outcome; bacterial resistance may overestimate the risk of therapeutic failure in UTI.

Adequacy of Urinary Tract Infection Management Among Minority Underserved Children

Urinary tract infection (UTI) is one of the common bacterial infections in children and may lead to substantial morbidity. This study examines (1) the frequency of the performance of follow-up urine cultures and imaging studies for children diagnosed with UTI and (2) the relationship of the demographic and insurance status of patients with the management and follow-up of UTI. We conducted a retrospective chart review of children with first-time documented UTI at six different county medical center satellite outpatient clinics and hospital-based pediatric outpatient walk-in clinics, serving an indigent minority community, from January 1998 to December 2000. We identified 144 children with confirmed UTI. Of 144 subjects in our study, 44% had follow-up urine cultures and 43% of these children showed continued infection after a full course of antibiotics. Renal ultrasonography and voiding cystourethrogram were performed in 53% and 39% of children, respectively. Of those patients who did not receive follow-up imaging, 67% had no documentation for follow-up appointments. However, in 29% of cases attempts had been made to contact patients who were scheduled for follow-up, but they did not return for the studies. These data suggest there is a significant failure rate for the follow-up of pediatric UTI. There is need for educational intervention among pediatricians who provide medical care to ethnically diverse underserved, often uninsured, minority children. This intervention should reinforce compliance with the standard recommendations for appropriate UTI follow-up studies and imaging and provide realistic strategies for achieving recommended outcomes in these high-risk populations.

Adequacy of urinary tract infection management among minority underserved children

Urinary tract infection (UTI) is one of the common bacterial infections in children and may lead to substantial morbidity. This study examines (1) the frequency of the performance of follow-up urine cultures and imaging studies for children diagnosed with UTI and (2) the relationship of the demographic and insurance status of patients with the management and follow-up of UTI. We conducted a retrospective chart review of children with first-time documented UTI at six different county medical center satellite outpatient clinics and hospital-based pediatric outpatient walk-in clinics, serving an indigent minority community, from January 1998 to December 2000. We identified 144 children with confirmed UTI. Of 144 subjects in our study, 44% had follow-up urine cultures and 43% of these children showed continued infection after a full course of antibiotics. Renal ultrasonography and voiding cystourethrogram were performed in 53% and 39% of children, respectively. Of those patients who did not receive follow-up imaging, 67% had no documentation for follow-up appointments. However, in 29% of cases attempts had been made to contact patients who were scheduled for follow-up, but they did not return for the studies. These data suggest there is a significant failure rate for the follow-up of pediatric UTI. There is need for educational intervention among pediatricians who provide medical care to ethnically diverse underserved, often uninsured, minority children. This intervention should reinforce compliance with the standard recommendations for appropriate UTI follow-up studies and imaging and provide realistic strategies for achieving recommended outcomes in these high-risk populations.

Follow-Up Urine Cultures and Fever in Children With Urinary Tract Infection

No AccessJournal of UrologyUrological Survey: ABSTRACTS: SOCIOECONOMIC FACTORS, UROLOGICAL EPIDEMIOLOGY AND PRACTICE PATTERNS1 Aug 2004Follow-Up Urine Cultures and Fever in Children With Urinary Tract Infection Peter C. AlbertsenM.D. Peter C. AlbertsenPeter C. Albertsen More articles by this author View All Author Informationhttps://doi.org/10.1016/S0022-5347(05)61788-0AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail "Follow-Up Urine Cultures and Fever in Children With Urinary Tract Infection." The Journal of Urology, 172(2), p. 805 © 2004 by American Urological Association, Inc.FiguresReferencesRelatedDetails Volume 172Issue 2August 2004Page: 805 Advertisement Copyright & Permissions© 2004 by American Urological Association, Inc.MetricsAuthor Information Peter C. Albertsen More articles by this author Expand All Advertisement PDF DownloadLoading ...

Follow-up Urine Cultures and Fever in Children With Urinary Tract Infection

Urology| March 01 2004 Follow-up Urine Cultures and Fever in Children With Urinary Tract Infection AAP Grand Rounds (2004) 11 (3): 26–27. https://doi.org/10.1542/gr.11-3-26 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Follow-up Urine Cultures and Fever in Children With Urinary Tract Infection. AAP Grand Rounds March 2004; 11 (3): 26–27. https://doi.org/10.1542/gr.11-3-26 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: fever, urinary tract infections, urine culture You do not currently have access to this content.