Form Of Urinary Tract Infection Research Articles

Transurethral Resection of Necrotic Tissue in the Bladder Caused by Emphysematous Cystitis

Emphysematous cystitis is a relatively rare form of urinary tract infection. A 72-year-old man with diabetes mellitus and long-term indwelling urethral catheterization was diagnosed with emphysematous cystitis. The clinical findings were resolved by conservatively managing the patient with antibiotics. However, cystoscopy subsequently revealed a yellowish-white soft tissue mass in the bladder, which was unlikely to be a bladder tumor. The mass could not be removed easily and frequently caused urinary catheter obstruction. We successfully removed this mass by performing transurethral resection twice. Through histopathological examination, the mass was identified as necrotic tissue comprising bacteria, fibrin, and suspected bladder mucosa.

Emphysematous cystitis: A rare form of urinary tract infection

Emphysematous cystitis: A rare form of urinary tract infection

Determining the effectiveness of the immature granulocyte percentage and systemic immune-inflammation index in predicting acute pyelonephritis

ABSTRACT Aim The most serious form of urinary tract infection (UTI) is acute pyelonephritis (APN), which can result in bacteremia and renal scarring. This study aims to show the roles that the systemic immune-inflammation index (SII) and the immature granulocyte (IG) percentage play in predicting APN in pediatric patients by comparing them with traditional infection markers. By illustrating a significant relationship between APN, the IG percentage, and the SII, the study’s contributions to the differential diagnosis of UTI can promote a rapid and appropriate treatment of APN. Material and Methods The present study included 522 pediatric patients. The patients were divided into two groups: (I) an APN group (n = 236) and (II) a lower UTI group (n = 286). Results The mean age of the sample was 5.05 ± 4.7 years. According to the most appropriate cutoff values, the findings showed that among all the parameters, C-reactive protein (CRP) and the IG percentage had the highest sensitivities, specificities, and predictive values for predicting APN. Conclusion This study emphasizes the support features of the IG percentage and the SII in the diagnosis of APN in pediatric patients, a topic that has recently attracted attention. The findings indicated that among all of the parameters behind CRP, the IG percentage and the SII had the highest sensitivities, specificities, and predictive values for forecasting APN. It is worth noting that these methods can be applied without additional costs or burdens to the patient.

Принципы подбора терапии энуреза у детей и подростков.

Introduction. The problem of enuresis to this day remains relevant primarily in connection with a decrease in the quality of life of both children, due to psychological discomfort, and their parents. The aim of the study was to select effective algorithms for the diagnosis and treatment of nocturnal enuresis in children and adolescents, taking into account the pathogenesis of the disease. Materials and methods. Children aged 5 to 15 years with a clinically confirmed diagnosis of enuresis were selected for the study. Depending on the clinical form of the disease, the children were divided into three groups. The first group included patients with the primary form of enuresis, the second-with secondary enuresis, and the third-with a mixed form of the disease. After an additional examination, all patients were assigned treatment based on their clinical group. Patients of the first clinical group were prescribed desmopressin as a treatment. In the second clinical group, treatment was carried out taking into account the level of damage to the nervous system. In the case of a suspected lesion of the cervical spine, electrophoresis was performed with a 1% solution of Euphyllini with an electrode applied to the cervical region. Nootropics and group B vitamins were prescribed for suspected cerebral lesions. In hyperexcitability syndrome, patients received Тenoten for children. In the third clinical group, treatment was carried out in two stages. The first stage corresponded to the protocol of treatment of the secondary form of enuresis, was carried out in a hospital setting. Further treatment was carried out on an outpatient basis in accordance with the recommendations for the treatment of the primary form of enuresis. Results. Positive dynamics was observed in all three clinical groups after the treatment. In 2.7% of children, a clinical cure was observed after the first course of therapy. 71.8% have a complete recovery after two courses of therapy. In 17.3% – after three courses of treatment. Conclusion. Principles of therapy selection for enuresis in children and adolescents require a comprehensive diagnosis and careful selection of therapy, depending on the pathogenetic form. The current control of therapy can be carried out by a pediatrician, and the intermediate results of treatment should be evaluated by a neurologist and a urologist. Hospitalization in a hospital is indicated in the case of the development of concomitant complications in the form of urinary tract infection, infectious and urodynamic disorders.

The pathogenetic role of some cytokines in the development and course of various clinical forms of urinary tract infections in children

Background. The purpose of the research: to study the content of interleukin-6 and interleukin-15 cytokines in the blood serum of children with urinary tract infection and to establish their pathogenetic role in the development of various clinical forms of the disease. Materials and methods. The study groups consisted of 84 children (mean age of 10.0 ± 1.3 years). The main group was divided into subgroups: the first one — 17 children with acute pyelonephritis, the second — 21 patients with chronic pyelonephritis, the third — 16 children with acute cystitis, the fourth subgroup — 10 patients with unspecified urinary tract infections. The control group included 20 relatively healthy children. The content of interleukin-6 and interleukin-15 was evaluated by enzyme-linked immunosorbent assay. Results. It was established that the development of acute urinary tract infections was accompanied by a high level of serum pro-inflammatory interleukin-6. We found the highest level in children with cystitis, which exceeded that of the control group by 2.8 times (р < 0.01). In children with acute pyelonephritis, this cytokine was 1.8 times higher (р < 0.05). However, patients with chronic pyelonephritis had only a tendency towards its increase (p > 0.05). Interleukin-15 in the main group was statistically higher than in controls (р < 0.05). In children of subgroups 3 and 4, its level did not differ from that of the control group (p > 0.05). However, in subgroups 1 (р < 0.05) and 2 (р < 0.01), we observed a statistically significant increase in interleukin-15 level. A direct correlation between interleukin-15 content and disease duration (r = 0.64, р < 0.05) was also found. Conclusions. The development of an acute inflammatory process in the urinary tract in children occurs against the background of a marked increase in the expression of interleukin-6, while a chronic inflammatory process develops with a statistically significant increase in the level of interleukin-15 in blood serum.

Targeted Immunomodulation Therapies as New Options to Cure Urinary Tract Infections

Abstract With their high prevalence and predisposition to recurrence, urinary tract infections are important contributors to antibiotic prescription worldwide. Studies involving alternative urinary tract infections treatments emerged as a priority in the last years, developing as a response to rapid global dissemination of multi-drug resistant uropathogens. One of these non-antibiotic strategies is based on the hypothesis that recurrent and severe forms of urinary tract infections have a genetic susceptibility pattern, involving the variability of the innate immune response to germs aggression. Yet insufficient studied, the immunology of urinary tract infections is still a subject for new bold researches. By focusing the precise defect that leads to predisposition towards severe or recurrent evolution of the disease and by targeting to correct them, these new therapies examples outlined in our review can bring a ray of hope in the treatment of UTI and the burden they represent.

The level of antimicrobial peptides in different clinical forms of urinary tract infections in children

The aim. To study the content of antimicrobial peptides in the serum of children with urinary tract infections depending on the clinical form of the disease and to establish their pathogenetic role in the development of various clinical forms of pathology. Materials and methods. The study groups consisted of 84 children (mean age – 10.0 ± 1.3 years). The main group was divided into subgroups: the first subgroup – 17 children with acute pyelonephritis, the second subgroup – 21 patients with chronic pyelonephritis, the third subgroup – 16 patients with acute cystitis, the fourth subgroup – 10 patients with unspecified urinary tract infections. The control group consisted of 20 relatively healthy children. The study of the content of cathelicidin, hepcidin and lactoferrin was performed by enzyme-linked immunosorbent assay. Results. The development of urinary tract infection was accompanied by a statistically significant increase in the content of cathelicidin (P < 0.05). The highest level of serum cathelicidin was registered in children of the first (P <0.05) and third subgroups (P < 0.05). In the other two subgroups, the level of LL-37 had only a trend towards increasing (P > 0.05). The level of hepcidin in the main study group was statistically lower than in the control group (P < 0.05). The development of chronic pyelonephritis and acute cystitis occurred amid a statistically significant decrease in hepcidin levels by 2.5 and 1.7 times (P < 0.01 and P < 0.05, respectively). The level of lactoferrin in the general group was within the control group figures (P > 0.05), however, there was a statistically significant decrease in serum lactoferrin in a subgroup of children with unspecified urinary tract infections (P < 0.05). We determined a relationship between hepcidin and lactoferrin levels in the investigated groups and found a clear direct relationship in a subgroup of children diagnosed with chronic pyelonephritis (r = 0.58, P < 0.01). Conclusions. Each nosological form of urinary tract infection has its own configuration of antimicrobial peptides. The analysis of the relationship between hepcidin and lactoferrin, the antimicrobial peptides that limit the access of the pathogens to serum iron, indicates the synchronization of the body’s defense mechanisms aimed at eliminating the pathogen.

A Rare form of Urinary tract Infection in a Transplanted patient

A Rare form of Urinary tract Infection in a Transplanted patient

Opportunities of drugs based on D-mannose and herbal components in the treatment and prevention of recurrent lower urinary tract infections in women

BACKGROUND: Recurrent cystitis is a common form of urinary tract infections. In the treatment of this disease antibacterial drugs are usually used. At the same time, there are plant components that can be a worthy substitute for antibiotic therapy.
 AIM: To evaluate the efficacy and safety of the biologically active complex Cystalis, containing D-mannose, grape seed extract and bearberry extract, in the treatment and prevention of recurrent cystitis in women.
 MATERIALS AND METHODS: The study included 60 women with recurrent cystitis. All patients answered the Acute Cystitis Symptom Scale (ACSS). The patients were divided into 2 groups of 30 people each. Patients of the 1st group received standard antibiotic therapy for recurrence of cystitis in accordance with the results of bacteriological examination of urine, followed by observation for 6 months. Patients of the second group instead of antibiotic therapy received the biologically active complex Cistalis one capsule (350 mg) 2 times a day for 3 months, followed by observation for 3 months.
 RESULTS: Before the start of treatment Escherichia coli was detected in 26 patients (86.7%) in the 1st group and in 28 (93.3%) patients in the 2nd group. At a follow-up visit 30 days after the initial examination the total score on the ACSS scale in patients of the 1st group decreased from 6.6 1.4 to 0.03 0.18 points (p 0.001), in patients of the 2nd group from 6.4 1.3 to 0 (p 0.001). The sum of scores in the Quality of Life (QoL) domain in the representatives of the 1st group decreased from 6.3 1.3 to 0 (p 0.001), and in the 2nd group decresead from 5.6 1.0 also to 0 (p 0.001). In patients of both groups, the level of leukocytes and erythrocytes in the urine significantly decreased. During the 6-month follow-up period 8 recurrences of UTIs were registered in patients of the 1st group, and only 2 recurrences in patients of the 2nd group. The probability of developing a recurrence of cystitis in patients of the 2nd group was significantly lower than in patients of the 1st group (2 = 4.603, p = 0.032).
 CONCLUSIONS: An analysis of the results of the study showed the high efficiency of using the Cystalis complex for the treatment of cystitis and the prevention of its recurrence.

ОСОБЕННОСТИ ТЕЧЕНИЯ ИНФЕКЦИИ МОЧЕВЫХ ПУТЕЙ У РЕБЕНКА С НЕЙРОГЕННЫМ МОЧЕВЫМ ПУЗЫРЕМ НА ФОНЕ COVID-19

Urinary tract infection (UTI) and chronic pyelonephritis, in particular, are a serious medical and social problem. Late diagnosis and improper treatment of this pathology lead to serious consequences for the health of children. Frequent relapses, a wide variety of pathogens, lack of verbal contact with young children, and much more make the diagnosis and treatment of UTIs a complex and multifaceted task. Due to frequent relapses, diagnostic defects and incorrect treatment tactics can lead to decreased kidney function and chronic kidney disease. In the context of the COVID-19 pandemic, the attention of doctors to chronic pathologies is reduced, which can undoubtedly lead to a deterioration in the quality of the diagnostic and treatment process. However, despite the importance of fighting the pandemic, the decline in the quality of medical care for other categories of patients is unacceptable. It is known that intercurrent diseases, including viral infections, often lead to exacerbations of chronic forms of UTI, and the role of COVID-19 in this is an important issue that requires careful study. In this regard, we decided to present a clinical case of an exacerbation of chronic pyelonephritis and difficulties in treating a child with a neurogenic bladder against the background of COVID-19.

Emphysematous pyelonephritis: Nephrectomy is still standard of treatment? 15 years ‘experience

Emphysematous pyelonephritis (EPN) is a severe form of urinary tract infection with a high mortality unless treated rapidly and effectively. Our objective is to review our experience over 15 years (from 2005 to 2020) on conservative treatment according to clinical, bacteriological, radiological, therapeutic and evolutionary aspects of EPN. We analyzed the medical record of patients treated for EPN at the Urology service of Mohammed the VIth University Hospital of Marrakesh. There were 18 patients with an average age of 54 years. They were all diabetics. Lithiasis obstruction of the upper excretory tract was found in 15 patients (83%). The germs involved were Gram-negative bacilli, especially E. coli (61% in our series) followed by Staphylococci (22.2%), Klepsiella (11.1%), and proteus mirabilis in 5.5% of cases. Resuscitation measures, including antibiotic and insulin therapy, were introduced as a matter of urgency for patients if needed. In 77.8% of cases, treatment was conservative: 11 patients (61.1%) underwent endoscopic drainage with a JJ stents and 3 patients (16.6%) underwent open drainage of peri-renal collections with a nephrostomy tube placement). Only 4 patients (22.2%) patients underwent nephrectomy. No deaths were observed during the course.

КЛИНИЧЕСКАЯ ЭПИДЕМИОЛОГИЯ ИНФЕКЦИЙ МОЧЕВОЙ СИСТЕМЫ В ПОПУЛЯЦИИ ЖЕНЩИН УКРАИНЫ. ЧАСТЬ 1: ДЕМОГРАФИЧЕСКАЯ ОЦЕНКА РАСПРОСТРАНЕННОСТИ И ФАКТОРЫ РИСКА

The purpose of the study: To identify the prevalence of various forms of urinary tract infection (UTI) in the population of Ukrainian women according to age. To determine the frequency of recurrent urinary tract infection in the female population, to determine the correlation of the form, duration and course of the disease, the frequency of relapses with the treatment and the nature of the medical care received. Material and methods. We designed, validated and implemented the web-based online questionnaire on prevalence, medical history and medical care of the urinary tract infections among 539 women (18-80 years old) in Ukraine. Results. A total of 339 (62.9%) women had symptoms of UTI. The prevalence of UTI in the 18-35 age group was 48.6%, that in the 36-55 age group 76.1 %, and that among women over 55 years old 75.5%. The growth trend in the number of UTI episodes, reported by the patients, was related to their age: older women generally suffered more UTI episodes during life compared to younger respondents. It was demonstrated that the main risk factors for the debut of UTI episode were the UTI history in the mother (40.2% of all patients), sexual activity (36.1%), childhood history of UTIs (23.9%), hypothermia (22.1%), bathing in the pool or pond (20.1%) and changing a sexual partner (18.9%). All other risk factors, including dietary disorders, overheating, gynecological visits, manipulations, abortions, childbirth and the puerperium, catheterization and the use of spermicides, did not play a significant role in the debut of a UTI episode among the interviewed patient population. We found a correlation between the main UTI risk factors and the type of disease course: sexual life played the main role in recurrent forms of disease (40.3% of patients with frequently recurrent UTIs) against 14.5% of patients with a single UTI episode where more significant factors included dietary disturbance (19.2%), hypothermia (29.5%) and bathing in ponds (20.9%). Conclusions. Frequently recurring course of UTI is inherent in 14.6% of the interviewed women and defines a 12% higher symptom score, reduction of quality of life by 26.8%, decrease of social activity by 19.4%, decline of physical activity by 20.4%, and an increase in deviations in family life and sexual activity by 25.4% and 7.9% respectively as compared to patients with sporadic UTIs. Patients with a recurrent UTI report, in general, 31.6% greater restrictions on visiting public places, 31% greater manifestations of social isolation and 42.2% worse relationships with a partner or spouse.

Prevalence and Antifungal Susceptibility Pattern of Candida species Isolated from Patients with Urinary Tract Infections

Background: The presence of Candida species in the urine is termed candiduria, and it is a common form of urinary tract infection (UTI). Many other species of Candida organism apart from Candida albicans are known with increasing the occurrence of resistance to available antifungal agents.
 Objectives: To determine the prevalence and sensitivity pattern of Candida isolates obtained from urine samples of diagnosed urinary tract infections.
 Methods: Midstream urine of patients attending the Lagos University Teaching Hospital, Ikeja Lagos, were collected and inoculated on Sabouraud Dextrose Agar (SDA). Microbiological processing was done with Gram reaction, germ tube test, CHROME agar TM and sugar fermentation test using API 32C system. Antifungal susceptibility tests were done using the agar disc diffusion method.
 Results: Candida species were obtained from 36 (12.9%) of 280 patients with UTI. Candida albicans (CA) had the highest frequency (12; 33.3%) compared to 24 (66.7%) for Non-albicans Candida (NAC). The speciation of Candida using Chrome Agar showed some misidentification from the API32C identification, but there was a significant correlation between API32C and Chrome Agar methods (r = 0. 9793). Half of the C. albicans species were sensitive to fluconazole while C. hellenica was only sensitive to Nystatin. The C. parapsilopsis had the highest susceptibility pattern, with 86% and 71% for fluconazole and ketoconazole, respectively. Generally, ketoconazole had the highest effectiveness on Candida species.
 Conclusion: This study demonstrated the role of Candida species in UTIs and their high susceptibility to ketoconazole.

Выбор антибактериального препарата при инфекциях мочевыделительной системы у детей

Инфекции мочевыделительной системы в детском возрасте занимают второе место по частоте обращений за первичной медицинской помощью. Escherichia coli — наибольший причинно-значимый возбудитель внебольничных форм инфекций мочевыделительной системы, которые, как правило, носят неосложненный характер и чаще диагностируются у девочек после трехмесячного возраста. Klebsiella pneumoniae превалирует при нозокомиальных формах инфекций мочевыводящих путей, характеризующихся осложненным течением и чаще диагностируемых у мальчиков до трехмесячного возраста. Одной из причин повторных эпизодов инфекций мочевыводящих путей является формирование антибиотикорезистентности за счет действия β-лактамаз микроорганизмов к наиболее часто используемым антибактериальным препаратам группы аминопенициллинов. В литературном обзоре обоснован выбор антибактериальной терапии инфекций мочевыделительной системы в детском возрасте с учетом клинической эффективности, безопасности и чувствительности основных уропатогенов. Обобщены результаты рандомизированных клинических исследований эффективности и безопасности использования цефалоспорина III поколения цефиксима у детей с инфекциями мочевыделительной системы. Особое внимание уделено сохранению бактериальной чувствительности на уровне свыше 90 % к действию цефиксима у Escherichia coli и Klebsiella pneumoniae и высокой комплаентности при возможности однократного ежедневного перорального применения в качестве самостоятельной терапии на амбулаторном этапе и потенциального перехода от парентерального использования цефалоспоринов III поколения к менее инвазивному — пероральному приему, особенно у детей.

Резистентність до протимікробних препаратів серед клінічних ізолятів, виділених при інфекції сечових шляхів у дітей

Актуальність. Інфекція сечових шляхів (ІСШ) — одна з основних причин госпіталізації дітей до стаціонару. Однією з основних причин неефективного лікування ІСШ у дітей є антибіотикорезистентність збудників ІСШ. Метою дослідження було визначення стану поширеності антибіотикорезистентності серед збудників інфекції сечових шляхів. Матеріали та методи. Дослідження антибіотикорезистентності проводилося на 61 клінічному ізоляті, що були виділені зі зразків сечі дітей, які були госпіталізовані з приводу захворювання на різні форми ІСШ. Визначення чутливості до 23 антимікробних препаратів здійснювалося за допомогою методу антимікробних дисків з подальшим визначенням зон затримок росту. Результати. Найбільшу ефективність щодо збудників інфекцій сечових шляхів мали представники групи аміноглікозидів (амікацин — до 91,9 % клінічних ізолятів, гентаміцин — до 82 %). Цефалоспорини ІІІ покоління мали різний рівень антибіотикорезистентності, що коливалася у межах від 11,8 % (цефтизоксим) до 42,5 % (цефподоксим). Зберігається високий рівень чутливості до синтетичних протимікробних препаратів: чутливість до фурагіну становила 89,8 %, до фосфоміцину — 86,5 %. Висновки. Рівень антибіотикорезистентності щодо збудників ІСШ значно варіює у різних антибактеріальних препаратів, а також залежно від форми ІСШ, тому проведення дослідження антибіотикорезистентності є важливим етапом в лікуванні хворих на ІСШ.

Hemolytic activity and biofilm-formation among clinical isolates of group B streptococcus causing acute urinary tract infection and asymptomatic bacteriuria

Streptococcus agalactiae, also known as group B Streptococcus, is an aetiological agent of urinary tract infection (UTI) in adults, including cystitis, pyelonephritis and asymptomatic bacteriuria (ABU). Whereas ABU-causing S. agalactiae (ABSA) have been shown to grow and achieve higher culture denstity in human urine compared to uropathogenic S. agalactiae (UPSA) other phenotypic distinctions between S. agalactiae isolated from different forms of UTI are not known. Here, we define the hemolytic activities and biofilm-formation of a collection of clinical isolates of UPSA, ABSA and recurrent S. agalactiae bacteriuria (rSAB) strains to explore these phenotypes in the context of clinical history of isolates. A total of 61 UPSA, 184 ABSA, and 47 rSAB isolates were analyzed for relative hemolytic activity by spot assay on blood agar, which was validated using a erythrocyte lysis suspension assay. Biofilm formation was determined by microtiter plate assay with Lysogeny and Todd-Hewitt broths supplemented with 1% glucose to induce biofilm formation. We also used multiplex PCR to analyze isolates for the presence of genes encoding adhesive pili, which contribute to biofilm formation. Comparing the hemolytic activities of 292 isolates showed, surprisingly, that ABSA strains were significantly more likely to be highly hemolytic compared to other strains. In contrast, there were no differences between the relative abilities of strains from the different clinical history groups to form biofilms. Taken together, these findings demonstrate a propensity of S. agalactiae causing ABU to be highly hemolytic but no link between clinical history of UTI strains and ability to form biofilm.

AAUS guideline for acute bacterial prostatitis 2021

This guideline is supported by the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection (AAUS). This is the second version of the AAUS guideline for acute bacterial prostatitis (ABP) (the first version has not been published). ABP constitutes a urologic emergency. It is uncommon and usually occurs in concert with a urinary tract infection (UTI) but can have a dramatic presentation. Many clinicians usually diagnose and empirically treat ABP. A correct diagnosis has therapeutic implications because ABP may require a longer treatment course than other forms of UTI and because the choice of antibiotic to complete treatment after fever subsides should be based on its ability to penetrate prostatic tissue.

A Study of Microbiological Profile in patients with Acute Pyelonephritis in a Tertiary Care Hospital, Nandyal

Background : Acute pyelonephritis is a bacterial infection that affects the renal parenchyma that can be life-threatening and often leads to renal scarring. It usually ascended from the lower urinary tract, and also reach the kidney via the bloodstream. Early diagnosis and management of acute pyelonephritis have a better impact on patient outcomes. Acute pyelonephritis is one of the severe conditions with high mortality and morbidity. It represents the most severe form of urinary tract infection. Acute pyelonephritis is the most common cause of communityonset bacteremia in elderly patients1. Aim: To study the microbiological profile in patients with acute pyelonephritis admitted in a tertiary care hospital. Materials and Methods: A Hospital-based Prospective study was conducted in the Department of Medicine, Santhiram medical college & general hospital for a 2 year period.Universal Sampling Technique was used for the selection of study subjects.The study population included patients admitted with fever, flank pain, and positive urine or blood cultures in the department of general medicine in Santhiram medical college and general hospital.The final sample size was 50 subjects. Results: In the present study, 50 participants were selected as the study population. The mean age of the study population was 57.48 ± 11.21. The majority of participants (70%) were distributed in a 50 to 69-year age group. Majority of participants were females (60%) and males (40%).In the current study among participants, in the current study, urine culture was positive in 29 patients (58%) of the study population. In 29(58%) of the subjects who had a culture-positive infection, the most predominant infectious agent in the present study group was Escherichia. coli and was reported in 22 (44%) of the study subjects. Other causative organisms include, Klebsiella pneumonia was reported in 2(4%) subjects. Candida albicans, Citrobacter, Enterococcus faecalis, and Pseudomonas were isolated in 1 (2%) subject each. One subject had a dual infection with Escherichia coli and Candida.In current study, among the 29 culture isolates, none of them were resistant to Cefperazone plus Sulbactum or Piperacillin plus tazobactam. The highest proportion of resistance was reported for Ampicillin as 82.1% of isolates were resistant. Levofloxacin resistance was found in 67.9% of isolates. Gentamicin and Amikacin resistance was found 17.86% and 3.6% of the isolates. Nitrofurantoin resistance was found in 2 (7.1%) of isolates. Conclusion: The mean age of the study population was 57.480 ± 11.2072 years in the study population, and there was a slight female preponderance in the occurrence of APN.The majority of participants (78%) were distributed ina 50 to 69-year age group.Diabetes, hypertension, ureteric calculus, and past history of UTI were the common risk factors identified in the study population.In.More than half (58%) of the study population had a culture-positiveinfection.TheThe most common organism isolated in the study population was E.Coli, responsible for 44% of the cases. None of them were resistant to Cefoperazone plus Sulbactum or Piperacillin plus tazobactam. The other antimicrobials, which have not shown any resistance, were Meropenem and Colistin.The highest proportion of resistance was reported for Ampicillin in 82.1%, followed by Levofloxacin in 67.9% of isolates. ICU admission rate was higher in culture-positive cases (63.6%), as compared to culture-negative cases (36.4%)None of the study subjects had hospital mortality

English

BACKGROUND Acute pyelonephritis (APN) is one of the most severe forms of urinary tract infections (UTI) with a higher incidence among females compared to males. Escherichia coli is the commonest causative organism isolated in 80 % of the cases in Kerala. Risk factors like structural or functional abnormalities of urogenital system, immunosuppression, comorbidities and virulence & resistance of microorganism play vital roles in predicting the prognosis. Our aim was to study the prevalence of various risk factors of acute pyelonephritis in adult patients, the clinical profile, aetiological agents and their sensitivity to antibiotics, and related complications on their usage. METHODS In a cross-sectional observational study, 100 adult patients with acute pyelonephritis admitted in a tertiary teaching hospital in Kerala were studied between January 2016 and January 2017. Detailed history and clinical examination were carried out. Complete haemogram, random blood sugar, renal function test, urine culture and sensitivity, and ultrasonogram of abdomen and pelvis were done. RESULTS The most common age group was 40 - 49 years with a male to female ratio of 2:3. Dysuria was observed in 82 % of patients followed by increased frequency of micturition in 65 % and vomiting in 42 %. Diabetes mellitus was observed in 55 % of patients and recurrent UTI in 44 %. Escherichia coli was found in 66 % of patients followed by Klebsiella in 23 %. Culture showed that 85 % of the bacteria were sensitive to piperacillin-tazobactam. 44 % of the patients did not respond to the empirical antibiotic, and the failure rate was higher among those empirically treated with ciprofloxacin. 41 % of the patients developed acute kidney injury, which necessitated haemodialysis in 23 %. 14 % of the patients developed septic shock and the mortality was 10 %. CONCLUSIONS Certain risk factors such as diabetes, hypertension, chronic kidney disease and indwelling catheters were associated with increased incidence of complications. Hence, in presence of such risk factors appropriate treatment and preventive measures should be initiated promptly. Among the pathogens, 85 % of the organisms were sensitive to piperacillin–tazobactam. Hence, piperacillintazobactam can be recommended as the first line empirical antibiotic. KEYWORDS Acute Pyelonephritis, Urinary Tract Infection, Acute Kidney Injury (AKI), and E. coli

Androgen-Influenced Polarization of Activin A-Producing Macrophages Accompanies Post-pyelonephritic Renal Scarring.

Ascending bacterial pyelonephritis, a form of urinary tract infection (UTI) that can result in hospitalization, sepsis, and other complications, occurs in ~250,000 US patients annually; uropathogenic Escherichia coli (UPEC) cause a large majority of these infections. Although UTIs are primarily a disease of women, acute pyelonephritis in males is associated with increased mortality and morbidity, including renal scarring, and end-stage renal disease. Preclinical models of UTI have only recently allowed investigation of sex and sex-hormone effects on pathogenesis. We previously demonstrated that renal scarring after experimental UPEC pyelonephritis is augmented by androgen exposure; testosterone exposure increases both the severity of pyelonephritis and the degree of renal scarring in both male and female mice. Activin A is an important driver of scarring in non-infectious renal injury, as well as a mediator of macrophage polarization. In this work, we investigated how androgen exposure influences immune cell recruitment to the UPEC-infected kidney and how cell-specific activin A production affects post-pyelonephritic scar formation. Compared with vehicle-treated females, androgenized mice exhibited reduced bacterial clearance from the kidney, despite robust myeloid cell recruitment that continued to increase as infection progressed. Infected kidneys from androgenized mice harbored more alternatively activated (M2) macrophages than vehicle-treated mice, reflecting an earlier shift from a pro-inflammatory (M1) phenotype. Androgen exposure also led to a sharp increase in activin A-producing myeloid cells in the infected kidney, as well as decreased levels of follistatin (which normally antagonizes activin action). As a result, infection in androgenized mice featured prolonged polarization of macrophages toward a pro-fibrotic M2a phenotype, accompanied by an increase in M2a-associated cytokines. These data indicate that androgen enhancement of UTI severity and resulting scar formation is related to augmented local activin A production and corresponding promotion of M2a macrophage polarization.