Frequency Of Urinary Tract Infections Research Articles

Parenteral Diarrhea and Pediatric Urinary Tract Infections: A Systematic Review

Background Parenteral diarrhea is non-infectious diarrhea associated with extraintestinal infections such as urinary tract infection (UTI), but evidence supporting this association is limited. We performed a systematic literature review to determine the reported frequency of UTI in pediatric patients who had diarrhea. Methods We searched electronic databases (PubMed, Scopus, Google Scholar, and CINAHL) to identify articles about diarrhea and UTI. We included English-language articles about studies of children (age, ≤5-years) who presented with diarrhea in which the frequency of culture-positive UTI was reported. We excluded studies that examined particular diets or specific pediatric patient populations presenting with diarrhea. Patient and study characteristics were extracted manually. Results The database search identified 32 articles. After excluding 25 articles and adding 3 articles identified during manual review of article references, there were 10 articles in the final review including 8 cohort and 2 case control studies. In all 10 studies combined, UTIs were observed in 172 of 1086 children who presented with diarrhea (15.8%), but the frequency of UTI varied between studies (range, 5 to 32%). Escherichia coli was the most common bacterial isolate from urine in all 9 studies that reported microbiology results. The stool and urine culture results (E. coli) were similar in 4 of the 6 studies that reported stool culture results. Conclusion In infants and children up to age 5-years, diarrhea may be associated with an UTI. In patients who have diarrhea of unknown cause, it may be prudent to consider an evaluation for a coexisting UTI.

Genitourinary tract symptoms in patients admitted with COVID-19: Exploring changes in frequency by determinants and pandemic waves

Background:Urothelial cells exhibit increased expression of angiotensin-converting enzyme-2 receptor, which is the binding site of severe acute respiratory syndrome coronavirus 2 to cells. The frequency and distribution of genitourinary tract symptoms in patients diagnosed with coronavirus disease 2019 (COVID-19) is unknown. Objective:We explored trends in genitourinary tract symptoms by gender and each of six pandemic waves in patients admitted for COVID-19, and related them with severity, death and length of hospitalization. Design, Setting, and Participants:A retrospective study took place in our institution of COVID-19 admitted patients. Only patients with RT-PCR or antigen test confirmed SARS-CoV-2 infection were included. Demographic, clinical, and genitourinary symptoms were explored. Outcome Measurements and Statistical Analysis:COVID-19 patients with genitourinary tract symptoms were compared with those without. Statistical comparisons were conducted by parametric and nonparametric tests for quantitative variables, and χ2 test for qualitative variables. Results and limitations:Out of a total of 4,661 COVID-19 patients, genitourinary symptoms were found in 21,1%. These symptoms were more frequent in patients admitted for longer than 30 days, except for urinary incontinence (UI) and erectile dysfunction (ED). Acute kidney injury (AKI) and urinary tract infections (UTI) had a higher presence in the 5th (16.7%; 12.8% respectively) and 3rd wave (13.3%; 12.6% respectively). Genitourinary symptoms were higher for those patients admitted in critical care units. Frequency of AKI, UI, UTI and acute urinary retention (AUR) were higher for patients who were finally deceased (26.2%; 3.5%; 13.6% and 3.6% respectively). Conclusions:A high frequency of genitourinary symptoms in patients admitted for COVID-19 was observed, whose frequency and distribution varied according to pandemic waves. Specific genitourinary conditions were associated with worse outcomes and poorer prognosis.

Urinary Tract Infections Among Gender Diverse People Assigned Female at Birth on Testosterone.

The current literature lacks evidence to support the relationship between gender-affirming testosterone use and urinary tract infections (UTIs). The aims of the study are to compare UTI rates among gender diverse people assigned female at birth on testosterone (GDT) to cisgender women (CW) and to identify factors associated with UTI. This is a retrospective cohort study of GDT and age-matched CW over a 5-year period. The primary outcome was based on the International Classification of Diseases, Ninth/Tenth Revisions, Clinical Modification, UTI diagnosis codes with a filled pharmacy order for antibiotics within 7 days of the diagnosis. The study included 2,401 GDT who were then age matched to 2,401 CW. The mean rates of UTI among GDT and CW were not significantly different at 0.09 and 0.10 UTIs per year, respectively. During the study period, 6.9% of GDT and 7.5% of CW had at least 1 UTI. Diabetes mellitus type 1 or 2 was significantly associated with UTI frequency among CW (P = 0.04) but not GDT (P = 0.96). The rate of UTIs among our young cohort of GDT and CW was similarly low. Diabetes mellitus type 1 or 2 was significantly associated with UTIs among CW but not GDT. These findings suggest that testosterone-induced vaginal atrophy may not be associated with a higher a UTI risk. A deeper understanding of the pathogenesis of UTI in people assigned female at birth and more data on the relationship between testosterone and UTIs are needed before recommending vaginal estrogen to all GDT with recurrent UTI.

Reasons for Altering Bladder Management and Satisfaction with Current Bladder Management in Chronic Spinal Cord Injury Patients

Patients with spinal cord injury (SCI) often require bladder management. However, patients routinely change their bladder management for better satisfaction. The reasons for altering a bladder management method in SCI patients remain insufficiently understood. The purposes of this study are to assess current satisfaction with bladder management and the reasons for changing bladder management in SCI patients. A prospective cross-sectional survey with a convenience sampling method was used. The study was conducted from January 2018 to December 2019. The inclusion criteria included an age ≥18 years and a diagnosis of SCI more than one year previously. The questionnaires were self-administered and collected from eligible patients during a free clinic service. A total of 515 SCI participants were enrolled. Two hundred and eighty-three (55.0%) participants had experienced changing their bladder management. The most used method of current bladder management was self-voiding. About 84.7% of participants reported being satisfied with their current bladder management. Bladder management changes were most often made due to frequent urinary tract infections. Furthermore, the participants dissatisfied with their management had more urological complications. This study indicates that appropriate bladder management can improve the subjective satisfaction of patients. For long-term care, preventing urinary tract infections is a helpful strategy for patients' satisfaction with bladder management.

Evaluation of urinary tract infections in neonatal indirect hyperbilirubinemia.

We have evaluated urinary tract infections (UTI) in neonatal indirect hyperbilirubinemia. Urine culture is not routinely requested in patients with indirect hyperbilirubinemia. However, debates continue about the frequency and investigation of UTI in neonatal indirect hyperbilirubinemia patients. The aim of this study was to determine the prevalence of UTI in neonates admitted to the hospital due to pathological indirect hyperbilirubinemia and whether a routine urine culture test is necessary in patients. In this retrospective study, we analyzed data from 1390 patients hospitalized to the Neonatal Unit due to pathological indirect hyperbilirubinemia. One hundred and eleven of these patients with detected bacterial agents in the urine cultures were evaluated. The type of the pathogens grown in urine culture, the number of colonies, and the antibiotic resistance status were evaluated. Among 1390 patients screened, 111 (8%) were found to have UTI, 68 of whom (61.3%) were male. Out of the microorganisms that grew, Escherichia coli was the dominant microorganism with 36.1%, which was followed by Klebsiella species (23.4%), and Enterococcus species (18%), respectively. The prevalence of UTI is high in the neonatal period as in all childhood and especially in patients admitted to the Neonatal Unit due to indirect hyperbilirubinemia. Escherichia coli and Klebsiella species are the most common bacterial agents that grow. Missing the diagnosis of urinary tract infection in neonates may cause renal problems. Therefore, we recommend requesting a urine culture in routine examinations of neonates who are diagnosed with pathological indirect hyperbilirubinemia and admitted to the hospital due to the need for phototherapy.

Antimicrobial Resistance Pattern of Bacterial Isolates in Urine of the Children Suffering from UTI

Background : Use of antibiotics are important in the treatment of Urinary Tract Infections (UTIs). However, the inappropriate use of antibiotics contributing to the development of antimicrobial resistance. Urine culture is the most common and important laboratory test to isolate the microbial agents, their susceptibility pattern and subsequently helps in the selection of appropriate antimicrobial to treat the infection. To isolate and identify the bacterial agents in urine of children suffering from suspected urinary tract infection and determine their antimicrobial resistance pattern this research was performed.
 Materials and methods: This retrospective study was conducted in the Department of Microbiology, IAHS, Chattogram, Bangladesh from March 2019 and April 2020. Total 2100 urine specimens were collected from the children attended in IAHS Inpatients and Outpatients Department of pediatrics at BBMH with suspected urinary symptoms. Bacterial culture and antimicrobial susceptibility testing were done in all urine specimens in BBMH Microbiology laboratory. The isolated samples were classified according to their age, sex, microorganisms and antibiotic susceptibility. Patients were divided into different age groups which are 0-2, 2-6, 6-12 and 12-17 years.
 Results: Out of total 2100 urine samples, 720 samples showed bacterial growth on culture. That revealed the prevalence of UTI among child about 34%. The most common isolated bacterial agents was Escherichia coli (68.01%), Klebsiellapneumoniae (19.86%), Klebsiellaoxytoca (3.34%), Enterobacter cloacae (2.23%), and Pseudomonas aeruginosa (1.95%). In the 0-2 years age group was significantly high in this group (p<0.05) in terms of infectious agents diversity and antibiotic resistance. Isolated bacterial agents shows resistance to ampicillin (70.2%), amoxicillin- clavulanate (49.0%), cefixime (38.2%), and trimethoprim/sulfamethoxazole (37.1%). The frequency of UTIs were found more in girls (56.6%) than that of boys among 0-2 year age group.
 Conclusion: In conclusion, ampicillin, cephalosporins, amoxicillin-clavulanate, and TMP/SMX should not be empirically commenced. In order to avert a rapid resistance development that is closely associated with widespread and inappropriate antibiotic use, the use of random antibiotics should be avoided and particularly the 3rd generation cephalosporins should be used more selectively. Although our data reflect only the results of patients admitted to a single hospital, classification of pathogens and determination of resistance rates against oral and parenteral antibiotics make this study valuable as it assesses the resistance patterns in the patients.
 IAHS Medical Journal Vol 4(2), December 2021; 17-23

The frequency of UTIs in people who undertake intermittent catheterization: A systematic review

Abstract Background Intermittent Catheterization (IC) is a common procedure used for the management of incomplete bladder emptying in various diseases such as spinal cord injury, multiple sclerosis and benign prostatic hypertrophy. Catheterization is associated with several complications and particularly with an increased risk of developing urinary tract infections (UTIs) responsible for high morbidity worldwide and significant costs to health systems and society.Today, this health problem is still underestimated. Therefore, the aim of this study was to summarize the available evidence on the clinical and epidemiological burden of UTIs among patients performing IC. Methods A systematic literature review was performed querying two online database (PubMed,Web of Science) from January 2012 to January 2022. All studies in English language and focused on the clinical-epidemiological burden of UTIs related to IC in the adult population were included. Results Overall, 43 studies were considered. It was described a range of UTIs from 26% to 63%, with an increased number of hospital admissions and length of stay. UTIs were more common in patients with spinal cord injuries (about 40%) and with multiple sclerosis (24-34%).The main risk factors associated with UTIs were catheter reuse, type of catheter and catheterization procedure adopted. Conclusions Data on IC-associated UTIs are still limited. Estimating the UTIs load in patients with IC could support healthcare professionals to identify the most appropriate type of catheter to reduce the risk of this important complication. Proper management of catheterization could improve patients’ quality of life and also reduce the impact of diseases associated with this procedure on health systems and society. Key messages

What are the risk factors for recurrent UTI with repeated ESBL-producing Enterobacteriaceae? A retrospective cohort study

IntroductionA previous study has shown that two-thirds of patients with urinary tract infections (UTIs) caused by extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae experience recurrence with the same bacteria on subsequent UTI episodes. However, little is known about which patients suffer from UTI due to ESBL-producing Enterobacteriaceae repeatedly. This study aimed to investigate the risk factors for recurrent UTI due to repeated ESBL-producing organism infections. MethodsThis retrospective, single-center, observational cohort study screened all patients with UTI caused by ESBL-producing strains between January 2012 and April 2019. Among the patients who were followed up, patients who experienced UTI recurrence were enrolled and divided into two groups: ESBL recurrence group and non-ESBL recurrence group. Multivariable Cox proportional hazards regression analyses were performed to evaluate the association between patient characteristics and the development of recurrent UTI caused by ESBL-producing Enterobacteriaceae. ResultsA total of 330 patients were followed up after the diagnosis of UTI caused by ESBL-producing organisms. Among the patients, 115 (34.8%) experienced UTI recurrence, and 71 (61.7%) of them experienced subsequent recurrent UTI due to ESBL-producing organisms. Patient's age (hazard ratio [HR], 1.02; 95% confidence interval [CI], 1.00–1.04; P = 0.046) and recurrent UTI history (HR, 1.69; 95% CI, 1.05–2.72; P = 0.031) were significantly associated with an increased risk of recurrence with ESBL-producing Enterobacteriaceae. ConclusionThese findings showed that a history of previous frequent UTI recurrence is the risk factor for recurrence of UTI due to repeated ESBL producing Enterobacteriaceae infections.

Frequency of Urinary Tract Infection (UTI) in Neonates Admitted with Indirect Hyperbilirubinemia

Objective: To determine the frequency of urinary tract infection (UTI) in neonates admitted with indirect hyperbilirubinemia. Study Design: A cross-sectional study. Place and Duration of the Study: Inpatient department of Pediatric Medicine, Bolan Medical College/Hospital Quetta from Jan 2019 to Dec 2020. Methodology: A total of 130 neonates of either gender (delivered at ≥ 32 weeks) admitted with primarily complaints of jaundice (with evidence of indirect hyperbilirubinemia) were included. Sex, age, weight and height of all neonates were noted. Serum bilirubin levels were asses and urine samples were also evaluated for the existence of urinary tract infection (UTI). Results: In a total of 130 neonates, 58 (44.6%) were males and 72 (55.4%) females. The UTI was found to be present in 41 (31.5%) neonates admitted with indirect hyperbilirubinemia. Among these 41 culture proven UTI cases, most common organism was E. coli found in 15 (36.6%) cases while Klebsiella was the 2nd most commonly found microorganism noted in 11 (26.8%) cases. Conclusion: Frequency of UTI was high (31.5%) among asymptomatic jaundiced newborns. Children presenting with jaundice needs to be evaluated for UTI. Keywords: E.Coli, indirect hyperbilirubinemia, Klebsiella , Urinary tract infection (UTI).

Medullary sponge kidney: unusual finding in kidney transplant recipient

BackgroundMedullary sponge kidney is generally considered a benign condition, gold standard for the diagnosis is urography but it has almost been replaced by UroCT that did not present the same sensibility. Although it is really rare, our sonography’s findings were consistent with medullary sponge kidney in the transplanted kidneys.Case presentationA 45-year-old woman with a long history of double-kidney transplantation complained of frequent urinary tract infections, a history of vague loin pain and came to our attention for sonography follow-up. Her kidney function was normal, we did not find signs of infections in the transplanted kidneys and urinary findings were normal. Curiously, the transplanted kidneys came from a newborn and the patient received a double-kidney transplantation in order to guarantee a satisfactory renal function.ConclusionsDespite a long history of kidney transplantation, genetic disease should not be forgotten when symptoms and images recall to specific inherited alterations. Sonography has to be considered in diagnostic path of kidney cystic disease.

Deprescribing: What About Vitamins, Minerals, and Other Nutritional Supplements?

Deprescribing: What About Vitamins, Minerals, and Other Nutritional Supplements?

Assessment of Bacterial Isolates from the Urine Specimens of Urinary Tract Infected Patient.

Urinary tract infections (UTIs) maintained a serious public health concern, as did the growth in antibiotic resistance both between uropathogenic microorganisms. A regular assessment of the microbiological agents that cause UTIs, as well as their antimicrobial resistance, is essential for a tailored empirical antibiotic response. Knowing the variables that cause UTIs can help you intervene quickly and simply to get the condition under control. The most common infecting species in acute infection is Escherichia coli (E. coli). To strengthen infection control strategies, it is necessary to know the prevalence and location of UTI. The goal of this research is to measure the frequency of microorganisms isolated from patients with UTIs as well as the antimicrobial sensitivity characteristics of Gram-negative bacteria. The purpose of this research has been to evaluate the frequency of UTIs by extracting and characterizing the various bacterial etiological organisms, as well as to assess the factors linked to UTIs. The goal of this research is to identify, characterize, and establish the antibiotic susceptibility patterns of bacteria linked to urinary tract infections. Fresh collected urine specimen was taken from inpatients or outpatients in UTI cases and bacteriologically tested using conventional microbiological methods. The Kirby-Bauer disc diffusion method was used to create the antibiogram. Staphylococcus saprophyticus, Staphylococcus aureus (28%), and Escherichia coli (24.6%) were the most common isolates (20%). The evaluated agents' antibacterial activity was all in the following order: cefixime, ciprofloxacin, augmentin, gentamicin, ceftazidime, nitrofurantoin, ofloxacin, and cefuroxime. It was discovered that each and every one of the microbes exhibited varied degrees of resistance to the antibiotics nitrofurantoin, ciprofloxacin, and ofloxacin. Every type of bacteria, with the exception of those belonging to the genus Streptococcus, has a Multiple Antibiotic Resistance Index (MARI) that is more than 0.2. The first-line therapies for urinary tract infections (UTIs) in the region would consist of ciprofloxacin, ofloxacin, and nitrofurantoin. Lower urinary tract infections almost never result in problems if they are diagnosed and treated as soon as possible and in the correct manner. However, if treatment is not sought, a urinary tract infection can lead to serious complications.

TETHERED CORD SYNDROME-CASE PRESENTATION

Introduction Tethered cord is a term for several different conditions. Common to all conditions of the tethered cord is that the movement of the spinal cord is limited at its base. During daily activities, the spinal cord can not move up and down inside the spinal canal, retreating against the restriction. Withdrawal of the spinal cord if minimal is unlikely to cause damage. In severe cases, the pressure can permanently injure the spinal cord. This functional disorder can be congenital (present at birth, the result of developmental malformations) or it can be acquired (arise later in life). Congenital attachment is usually detected in childhood, but not always. In some cases, congenital malformation is not detected, or properly diagnosed, until adulthood. Tethered Cord Syndrome is relatively rare in adults. Methods and materials We present a 2-year-old child, who has frequent urinary tract infections since infancy. Examined by a neurologist from our Clinic at 2 years of age with the presence of spasticity of the lower extremities and pes eqvinovarus on the right leg. Results Contrast-enhanced magnetic resonance imaging (MRI) diagnosis and consultation with a neurosurgeon are recommended. Conclusion The most common symptoms of this disease in children are lesions of the lower back, fatty tumors of the lower back, skin discoloration of the lower back, back pain, worsened by activity and relieved with rest, leg pain, especially in the back of legs , leg numbness, difficulty walking, deformities of the legs, scoliosis of the spine. If tethered cord sy is later diagnosed it can lead to loss of bladder and colon control. MRI is used for diagnosis. Early surgery is recommended in children to prevent further neurological deterioration. Keywords: Thetered cord, spinal cord, medulla spinalis

Intravesical hyaluronic acid with chondroitin sulphate to prevent urinary tract infection after spinal cord injury

Context/Objective Prevention of urinary tract infection (UTI) after spinal cord injury is an important goal. Intravesical hyaluronic acid with chondroitin sulphate (HA+CS) has been effective in preventing UTI in other settings. We aimed to demonstrate safety and feasibility of a standard treatment course of 7 intravesical HA+CS instillations over 12 weeks, in patients with acute (Arm A) and chronic (Arm B) spinal cord injury (SCI). Design Follow-up of adverse events, quality of life bladder management difficulty (BMD) and bladder complication (BC) T-scores at baseline (Arm B only), 12 and 24 weeks, and symptomatic urinary tract infection (UTI). Results Of 33 and 14 individuals screened, 2 and 8 participants were recruited to the study for Arm A and Arm B respectively. Of the 10 participants, 8 completed all 7 instillations. HA+CS commonly caused cloudy urine with urinary sediment which was mild and short-lived. In Arm B, a mean reduction in BMD and BC T-scores was observed from baseline (57.3 and 54.4 respectively), of 6.8 and 4.3 at 12 weeks and 1.6 and 2.8 at 24 weeks, respectively. Four participants with a history of frequent UTI in the prior 12 months did not have UTI in the 24 weeks of the study. Conclusions HA+CS was well tolerated. Recruitment was more difficult in early acute SCI; participants with chronic SCI were highly motivated to reduce UTI and manage self-administration without difficulty. Larger case–control or randomized controlled trials in patients with neurogenic bladder from SCI are warranted. Trial registration ClinicalTrials.gov identifier: NCT03945110.

Clinico-pathological study of urinary tract infection during pregnancy

Urinary tract infections (UTI) are the most common bacterial infections during pregnancy. Untreated UTI can be associated with serious obstetric complications. A cross-sectional study was conducted in Gynaecology and Obstetrics Department in our hospital between January 2019 to January 2021. A consecutive 125 pregnant women with or without symptoms of UTI were included in this study. Socio-demographic data including age, parity and duration of gestation were collected. Midstream urine was collected from each women into a container, culturing done and examined microscopically. The highest incidence of UTI is below forty years. The younger age groups having the highest rates was also observed in previous studies. Well socioeconomic (OR= 4.757) versus poor (OR= 9.123) have high statistically significant differences (P= 0.001). Furthermore, educated women (OR= 10.448, 9.988) versus not educated (OR= 11.252) with a high significant difference (P= 0.01). In this study, the frequency of UTI was higher in the second trimester compared to the first and third trimester. In this study, previous UTI was the significant risk factor. Women had past history of UTI have highest rate of re-infected (OR= 7.331, P= 0.05). Sexual activity was also risk factor for development of UTI (OR= 8.541).

Comprehensive assessment of holding urine as a behavioral risk factor for UTI in women and reasons for delayed voiding

BackgroundWomen of reproductive age group have greater predilection to urinary tract infections (UTI). Various risk factors increase the prevalence in women. Emergence of multidrug resistant uropathogens make clinical management of UTI challenging. Here we assess holding of urine as risk factor of UTI in women and reasons for delayed voiding. We also investigate the relationship between frequency of UTIs and overall behavioural features, menstrual hygiene and attitude of women towards their own health issues.MethodsA questionnaire based cross-sectional study was performed with 816 hostel residents with written consent. Self-reported data was statistically analysed using SPSS software. Urinalysis and urine culture were done for 50 women by random sampling to obtain the information on leading causative agents of UTI in the study population and their antimicrobial resistance profile.ResultsThe prevalence of UTI among the participants without risk factors was found to be 27.5 (95% CI: 24.4–30.7). Attitude of women towards their own personal health issues and use of public toilets showed a correlation with prevalence of infection. Delay in urination on habitual basis was found to be associated with UTI. Uropathogens isolated by random sampling were resistant to multiple drugs that are generally used to treat UTI.ConclusionsHolding urine for long time had proven to be an important risk factor and amongst different reasons of holding urine, holding due to poor sanitary condition of public toilets was the most common. Higher frequency of self-reported UTIs is related to holding of urine, behavioural features and attitude of women.

Ease of restroom access influences fluid consumption habits and health in classroom teachers

Objectives. There are rising concerns about the health of classroom teachers in the USA, including stress, hypertension and frequent urinary tract infections. Teacher working conditions are likely a contributor to their health concerns. Many teachers report that they cannot easily take a restroom break at work, and therefore they consume minimal water or other fluids. This study investigated the relationship between restroom access and fluid consumption and the prevalence of renal and cardiovascular health complications in classroom teachers. Methods. The responses of 844 teachers (92% women, 8% men; 65.1% between age 26 and 45 years) to an online survey about restroom accessibility, fluid consumption and health were analyzed using descriptive statistics, χ2 analyses and logistic regression. Results. Fifty-nine percent of teachers could not easily take a restroom break, and 54.7% consumed fewer than 2 cups of water per workday. Furthermore, 44.8% reported being pre-hypertensive and 4.9% reported being hypertensive. Teachers with insufficient restroom access were significantly more likely to report frequent urinary tract infections. Conclusions. This study demonstrates a relationship between restroom access, fluid consumption and renal/cardiovascular health in classroom teachers. Future research should directly investigate how teacher work environment impacts renal and cardiovascular health.

Urinary Tract Infections in Hospitalized COVID-19 Patients, What's Up, Doc?

The SARS-CoV-2 pandemic might have increased the risks of healthcare-associated infections (HAIs); however, several studies of HAI such as urinary tract infections (UTIs) and catheter-associated urinary tract infections (CAUTIs) have shown contradictory results. The aim of this study is to assess the clinical features of UTIs and bacterial isolates from urine samples of hospitalized COVID-19 patients. We conducted a retrospective observational study including 87 COVID-19 patients with UTIs admitted to our centre. Bacterial UTIs presented were 87: 9 (10.3%) community-acquired UTIs (coinfection group) and 78 (89.6%) hospital-acquired UTIs (superinfection group). In the coinfection group, the most frequent type was non-CAUTI with 5 (55.5%) patients; however, the most frequent UTI in the superinfection group was CAUTI, with 53 (67.9%) patients. The median number of days of hospitalization in coinfected patients was lower than superinfection patients: 13 (IQR 11, 23) vs. 34 days (IQR 23, 47) p < 0.006. All UTI patients admitted to ICU, 38 (43.7%), belonged to the superinfection group. The mortality rate was 26.4% (23/87), 22/23 in the superinfection group. The most common microorganisms were E. coli 27 (28.4%), E. faecalis 25 (26.3%) and E. faecium 20 (21.1%). There was an increased incidence of E. faecalis and E. faecium in UTIs as well as hospital-acquired UTIs. This can be related to urethral catheterization during hospitalization, UCI admissions and the number of days of hospitalization.

Changes over 6 years in secondary health conditions and activity limitations in older adults aging with long-term spinal cord injury.

The number of individuals aging with long-term spinal cord injury (SCI) is increasing. Still, there is limited knowledge about changes in secondary health conditions (SHCs) and activity limitations over time. To determine changes in SHCs and activity limitations in older adults aging with long-term SCI over 6 years, and to investigate how changes in SHCs and activity limitations are associated with gender, age, and injury characteristics. Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS). Community settings, Sweden. From the initial 123 participants in the SASCIS: 78 individuals (32% women); mean age 68 years; mean time since injury 31 years; injury levels C1-L3, AIS A-D. Not applicable MAIN OUTCOME MEASURE: Bowel and bladder function and problems, pain, spasticity, and the Spinal Cord Independence Measure (SCIM III). Over 6 years, bowel-related problems increased (31% to 47%, p= .015) and the occurrence of constipation doubled to 24% (p= .013). There were increases in frequent urinary tract infections (10% to 26%, p= .004), use of indwelling urinary catheters (15% to 23%, p= .031), and other bladder-related problems (4% to 22%, p< .001). The occurrence of pain was high (85%), with no significant change. Spasticity increased from 41% to 62% (p< .001). Activity limitations increased (SCIM III total score mean 67 to 61, p< .001, with significant decreases in all subscales). The increase in bowel-related problems was greater in males, and the deterioration in self-care was greater in participants with longer time since injury and with traumatic injuries. These findings support the notion that SHCs and activity limitations increase over time in older adults aging with long-term SCI. The results can inform clinicians and call for a proactive, holistic approach in the long-term follow-up to support healthy and active aging.

An Epidemiological and Multidrug Resistance Study for E. coli Isolated from Urinary Tract Infection (Three Years of Study)

Uropathogenic E. coli (UPEC) is problematic and still the leading cause of urinary tract infections worldwide. It is developed resistance against most antibiotics. The investigation, surveillance system, and efficient strategy will facilitate selecting an appropriate treatment that could control the bacterial distribution. The present study aims to investigate the epidemiology and associated risk factors of uropathogenic E. coli and to study their antibiotic resistance patterns. 1585 midstream urine specimens were collected from symptomatic urinary tract infections (UTI) patients (225 males and 1360 females) admitted to Zakho emergency hospital, Zakho, Kurdistan Region, Iraq from January 2016 until the end of December 2018. Specimens were inoculated on blood and MacConkey plates and incubated at 37оC for 24 hours. Uropathogenic E. coli was diagnosed based on gram staining, colony characteristics, and standard biochemical tests in accordance with local standards and guidelines. All isolates were screened for their antibiogram pattern using the disk diffusion method based on the Clinical and Laboratory Standards Institute guidelines. The results showed that out of 1585 urine specimens, 1026 (64.7%) were UTIs positive with a statistically higher rate in 2016 (83.6%) (P&lt; 0.0001). The UTIs frequency in females was significantly higher than males (P&lt; 0.0001). Generally, the uropathogenic E. coli represented 21.1% with the highest level in 2016 (22.9%). The uropathogenic E. coli rate was higher, statistically not significant, in females (21.4%) than males (18.5%) (P=0.4946). Additionally, through the three years of study, uropathogenic E. coli (UPEC) was in high frequency in February and May 2016. The female’s age group from 20 to 39 years was the most vulnerable (46%) form total infected females, while those from 70-74 years (1%) were the least susceptible in males and females. A high percentage (80.56 %) of multidrug resistance E. coli isolates was observed with high resistance against -lactamase and macrolides antibiotics. However, higher sensitivity was towards imipenem and meropenem. In conclusion, the wrong and overuse of antibiotics will increase the resistance rate of E. coli. For this reason, proper use of available antibiotics is necessary. Also, the educational programs and periodic monitoring of antimicrobial suscep­tibility are essential for reducing the antibiotic resistance rate.