History Of Urinary Tract Infection Research Articles

Clinical Outcomes and Risk Factor Analysis of Patients Presenting with Emphysematous Cystitis: A 15-Year Retrospective Multicenter Study.

Background and objectives: To investigate the risk factors for emphysematous cystitis (EC) compared to those of acute cystitis (AC) to increase clinicians awareness of the possibility for the aggravation of patient status. Materials and methods: We retrospectively reviewed a total of 54 patients who were hospitalized with a diagnosis of EC by abdominal computed tomography (CT) scan from 2006 to 2020. The control group included 92 patients who were hospitalized for the treatment of AC in the same period. We sought to identify the clinical features and predisposing diseases, such as age, sex, diabetes mellitus (DM), hypertension (HTN), cerebrovascular accident (CVA), chronic kidney disease (CKD), neurogenic bladder (NB), history of urinary tract infection (UTI), and emphysematous pyelonephritis (EPN), that were associated with the development of EC. Results: The median (interquartile range (IQR)) age of the patients with EC was older than that of the patients with AC (78.5 (15.3) years (range: 52–100) vs. 70.0 (26.5) years (range: 28–97 years)). Sepsis and mortality occurred only in the EC group (48.1% and 11.1%, respectively). The univariate analysis of predisposing factors revealed that age, DM, HTN, CVA, CKD, and NB were significantly associated with EC. In the multivariate analysis, DM (OR, 6.251; 95% CI, 2.254–17.250; p < 0.001), CKD (OR, 18.439; 95% CI, 3.421–99.404; p = 0.001), NB (OR, 7.374; 95% CI, 1.993–27.285; p = 0.003) were associated with EC. Conclusions: The results of this study revealed that DM, CKD, and NB were significant risk factors for EC. The tendency toward sepsis and high mortality underscore the need for careful observation while treating patients with EC with the risk noted above.

E.coli versus Non-E.coli Urinary Tract Infections in Children: A Study from a Large Tertiary Care Center in Saudi Arabia.

BackgroundWhile Escherichia coli (E. coli) is the most common uropathogen implicated in urinary tract infections (UTIs) in children, some studies have found that there are different characteristics between different uropathogens in children. The aim of this study was to compare E. coli and non-E. coli UTIs in children with respect to their demographic data, predisposing factors, and imaging results.MethodologyA retrospective chart review was done in children during their first admission with urine culture confirmed UTI in a tertiary care center. We divided patients into E. coli and non-E. coli groups according to urine culture results.ResultsOut of 202 children with their first admission for a culture-proven UTI, pathogens other than E. coli accounted for 24.3% of UTIs. Klebsiella pneumoniae was the most common non-E. coli pathogen, followed by Pseudomonas aeruginosa and Enterococcus species. Non-E. coli UTIs were significantly more common in male subjects, younger children, and children with a past history of UTI or who had received antibiotics prior to admission. In addition, higher rates of abnormalities on renal ultrasound and VCUG were found with non-E. coli organisms.ConclusionThere is a significant difference in demographic and imaging findings in children with non-E. coli UTIs. These findings may impact the work-up and treatment of UTIs in the pediatric population.

POS1159 THE ROLE OF URINARY TRACT INFECTIONS AS A SOURCE OF OSTEOARTICULAR INFECTIONS IN A RHEUMATOLOGY DEPARTMENT DURING THE 2010-2020 PERIOD: A RETROSPECTIVE STUDY

Background:There are several sources of infection in the pathogenesis of osteoarticular infections (OAI). Urinary tract infections (UTI) have rarely been involved whereas skin infection and Staphylococcus aureus represent the classic pair.Objectives:To describe the role of UTI as the source of infection in OAI including septic arthritis (SA) on native joints and infectious spondylodiscitis (SPDI). To compare characteristics of these cases with those of others source and those without any known source.Methods:Medical records of patients aged 18 years old or above who were diagnosed with a non-tuberculous OAI in the department of rheumatology of our hospital during the 2010-2020 period were selected and retrospectively reviewed. The following cases were excluded: SA on prosthetic joint, OIA on surgical material, osteomyelitis, post-operative OAI, SA after joint injection, brucellosis, Lyme disease. Only proven cases where included on the basis of an isolated pathologic organism at the site of OAI infection and/or in the blood (with typical clinical, biological and imaging features). Usually the OAI was considered of urinary source if the same microorganism grew in urine and the OA/blood sample. Cases with probable urinary source were also included on the basis of the type of microorganism and a history of UTI and/or urologic surgery and/or recent antibiotic therapy.Results:95 consecutive cases of proven OAI were included. There were 17 cases (18%) of urinary origin. In 12 cases the same micro-organism grew in urine and OA/blood culture: 5 methicillin sensitive Staphylococcus aureus, 2 Streptococcus Gallolyticus (associated with E. Coli in one case), 1 Escherichia Coli, 1 Klebsiella pneumoniae, 1 Enterococcus faecalis, 1 aerococcus urinae, 1 candida glabrata. Five patients had a probable urine source. In one patient with SPDI and an history of recurrent UTI, blood culture grew E. Coli whereas urine culture grew Enterococcus faecalis. In 4 cases, urine was sterile but a sample (OA in 3, blood in 1) was positive for E. Coli (n=2) or Pseudomonas aeruginosa (n=2).The type of OAI was: SPDI in 10 cases, peripheral SA in 4 cases, both of them in one case and pubic symphysitis in 2 cases. Blood culture was positive in 10 cases and OA sample in 9 cases. Demographics characteristics were: male 59%; age 68.7±11 years. Risk factors were: diabetes 29%; cancer treated with cytotoxic chemotherapy 2 cases; inflammatory disease 2 cases; urological disease and/or recurrent UTI in 59%; immunodeficiency 1 case. Duration of symptoms was 47.1 +/- 50.7 days. Urinary symptoms where present in 29% of patients and fever in 47%. There was no case of infectious endocarditis. Surgical intervention was realized in only one patient. No patient has been admitted in intensive care unit and no patient died. Length of hospitalization was 28±8.5 days. Duration of antibiotic therapy was 13.6±9 weeks. One patient with pubic symphysitis was not cured.The comparison between the group of OAI with urinary source (n=17) and the groups with another primary source of infection (n=52) or no known source of infection (n=26) shows in the first one: a higher prevalence of SPDI (59% vs 34% and 19% respectively), an older age (68.7 years vs 61.9 and 59.7 respectively), a higher prevalence of diabetes or cancer, a longer duration of symptoms (47.1+/-50.7 days vs 21.9+/-29.6 and 22.5+/-25.4 respectively) and a lower mean value of CRP (156+/-135 mg/l vs 182+/-124 and 180+/-140 respectively). A UTI was detected in 76% of OAI of urinary source but also in 13% of other cases (including E. Coli 5 cases).Conclusion:In the years 2010-2020, UTI was responsible for 18% of non-tuberculous OAI as we defined them in this study. A UTI does not demonstrate the responsibility of the microorganism isolated. Thoracolumbar SPDI is the main type. This relatively high frequency has not been reported before and is probably the consequence of the increasing population of aged patients with risk factors and urologic diseases. Clinicians have to be aware of it and prevention is required.Disclosure of Interests:None declared.

The voiding pattern of aterm neonates

Introduction: The concept of voiding patterns in neonates had not been completely understood. The voiding pattern in neonates was physiologically different from that in older children. The brain's development affects voiding patterns in frequency, bladder volume, and post-void residual bladder volume, as the child keeps growing. This study aims to understand the physiological neonates' voiding system in Indonesian newborns.Materials and methods: We evaluate ten normal-born and 12 perinatology-hospitalized aterm neonates without anatomical or physiological urologic abnormalities at RSUP Haji Adam Malik from October to November 2019. We used an observational study, assessing the voiding physiology in newborns, including voiding frequency and urine volume. Infants with a history of urinary tract infection or present bacteriuria confirmed by urine culture were excluded. Voiding volume, frequency, bladder capacity, and residual volume were measured. Results: We collected a total of 22 patients, with 12 patients were perinatology-hospitalized and ten patients were healthy neonates with ten subjects were male, and 12 subjects were female. There was no correlation between voiding frequency and total voiding volume with perinatology-hospitalized, healthy neonates, and sex. (p&gt;0.05). Independent T-test was performed with a p-value for volume, frequency, bladder capacity, and residual volume of 0.225, 0.112, 0.031, and 0.663. We got a significant difference in bladder capacity between healthy neonates and perinatology-hospitalized. No significant differences were noted in other variables. Pearson correlation analysis was performed to determine the correlation between total voiding volume and age of gestation, body weight, length, head circumference, abdominal circumference, and chest circumference. The correlation coefficients were 0.772, 0.869, 0.623, 0.698, 0.079, 0.523 in order, with significant p-value in the age of gestation, body weight, length, head circumference, and chest circumference. There were correlations between total voiding volume and age of gestation, body weight, length, head circumference, and chest circumference. Conclusion: In conclusion, we found there was a significant difference in bladder capacity between healthy neonates and perinatology-hospitalized.

The Effect of the Duration between Preoperative Bladder Urine Culture and Semirigid Ureteroscopic Lithotripsy on the Rate of Systemic Inflammatory Response Syndrome Postoperatively

Purpose The aim of this study is to analyze the preoperative and intraoperative factors that might induce systemic inflammatory response syndrome (SIRS) after semirigid ureteroscopic lithotripsy (SUL), and to evaluate the impact of duration between preoperative bladder urine culture (PBUC) and surgery on postoperative systemic inflammatory response syndrome (SIRS). Methods A retrospective review was conducted including patients who underwent SUL in our center between June 2015 and June 2020. Prior to surgery, PBUC were obtained from all patients and postoperatively patients were observed for signs of SIRS. Univariable and multivariable binary logistic regression analysis were implemented to demonstrate the factors that predict SIRS postoperatively. Results The entire study included a cohort of 572 patients. The rate of SIRS following SUL was 1.7%. Predictive factors for SIRS were listed as stone volume, surgical time, and history of recurrent urinary tract infection. No significant difference was detected in terms of the duration between PBUC and SUL when comparing the SIRS group with the other group. Conclusion The duration between PBUC and SUL is not efficacious factor for SIRS. It may be useful to conduct prospective studies to enlighten this issue as endourologists deal with this duration dilemma often in daily practice. Keywords: Semirigid ureteroscopic lithotripsy, Systemic inflammatory response syndrome, Preoperative bladder urine culture.

Expression and function of human ribonuclease 4 in the kidney and urinary tract.

Antimicrobial peptides are essential host defense mechanisms that prevent urinary tract infections. Recent studies have demonstrated that peptides in the ribonuclease A superfamily have antimicrobial activity against uropathogens and protect the urinary tract from uropathogenic Escherichia coli (UPEC). Little is known about the antibacterial function or expression of ribonuclease 4 (RNase 4) in the human urinary tract. Here, we show that full-length recombinant RNase 4 peptide and synthetic amino-terminal RNase 4 peptide fragment have antibacterial activity against UPEC and multidrug-resistant (MDR)-UPEC. RNASE4 transcript expression was detected in human kidney and bladder tissue using quantitative real-time PCR. Immunostaining or in situ hybridization localized RNase 4 expression to proximal tubules, principal and intercalated cells in the kidney's collecting duct, and the bladder urothelium. Urinary RNase 4 concentrations were quantified in healthy controls and females with a history of urinary tract infection. Compared with controls, urinary RNase 4 concentrations were significantly lower in females with a history of urinary tract infection. When RNase 4 was neutralized in human urine or silenced in vitro using siRNA, urinary UPEC replication or attachment to and invasion of urothelial and kidney medullary cells increased. These data show that RNase 4 has antibacterial activity against UPEC, is expressed in the human urinary tract, and can contribute to host defense against urinary tract infections.NEW & NOTEWORTHY Ribonuclease 4 (RNase 4) is a newly identified host defense peptide in the human kidney and bladder. RNase 4 kills uropathogenic Escherichia coli (UPEC) and multidrug-resistant UPEC. RNase 4 prevents invasive UPEC infection and suppressed RNase 4 expression may be a risk factor for more severe or recurrent urinary tract infection.

Continuous medical education activities; Answers to Case No. 4

A 19-years-old female patient was admitted to the outpatient clinic. She gave a history of urinary tract infection (UTI) 4 months preceding admission for which she was treated with oral ampicillin without complications. Five days prior to this admission, she began to complain nausea without vomiting. One day later, she developed left flank pain, fever, and chills, and increased micturition frequency. She was admitted to a general hospital. She noted foul-smelling urine on the day before admission. She was presented with a temperature of 38.8°C.

Antimicrobial resistance and ESBL profile of Uropathogens among pregnant women at Edna Adan Hospital, Hargeisa, Somaliland.

The emergence and spread of antimicrobial resistance (AMR) among uropathogens is increasing, especially in resource limited settings due to a number of reasons. The production of Extended Spectrum β-Lactamase (ESBL) by some strains of E. coli and methicillin resistant Staphylococcus species, limits the choice of antimicrobials in the treatment of urinary tract infection (UTI) globally. However, little is known about the type of uropathogenes and their current AMR profile among pregnant women in Hargeisa, Somaliland. Clean-catch mid-stream urine samples were collected and processed for bacteriological culture and antimicrobial sensitivity testing (AST). Ceftazidime (30µg) and Cefotaxime (30µg) disks were used for ESBL screening as per CLSI guideline and each ESBL screening positive isolate were phenotypically confirmed by a combination disk test. Among 376 study participants, 79 (21.0%) had significant bacteriuria (SBU). Majority at 58(73.4%) of the isolates were Gram-negative. The most predominant isolate was E.coli, 36(45.6%) followed by K. pneumonea 16(20.3%) and S. aureus at 9(11.4 %). The proportion of ESBL producing isolates was 25(32.9%). Gram-negatives showed high level resistance to ampicillin, amoxicillin, cefotaxime, and cephalexin at 87%, 85%, 57%, and 52%, respectively. Previous history of UTI, monthly income, educational status and having dysuria were significantly associated with SBU (p<0.05). Relatively high prevalence of uropathogens and an increased level of drug resistance were documented. Therefore, continued surveillance on the type of uropathogens and their AMR pattern is needed to ensure appropriate recommendations for the rational empirical treatment of UTI and for policy input.

Urınary tract ınfectıons in obese children and adolescents with their outcomes and clinical aspects

Aim: The relationship between obesity and urinary tract infections (UTI) was reported in adult studies, but pediatric data is lacking. Methods: This prospective study included children, who were admitted to the outpatient clinic only with the complaint of obesity. UTI screening with symptomatic questioning and clinical feature was performed. Symptomatic participants were examined(urinalysis, culture, or/and blood work, imaging tests). Characteristics of those with UTI, and we determined an obese/overweight, but non-UTI control group matched with age and gender and conducted a case-control study. Results: In this study, 1001 participants were screened, UTI frequency was 3,39%, with 91,2% female predominance. The mean age of all participants was 11.44±3.21 years. All of the UTIs were lower tract infections. Escherichia coli(82,4%) was the most frequently isolated microorganism. History of UTI and hypertension was more frequent in the UTI group(n=34) compared with non UTI group (n=136)(p=0,001; p=0,001). Conclusion: In the UTI group, hypertension and previous UTI history were shown to be more common, so it may be important to question obese/overweight children for UTI at their clinical application.

Does the duration between urine culture and percutaneous nephrolithotomy affect the rate of systemic inflammatory response syndrome postoperatively?

This study aimed to evaluate the preoperative and intraoperative factors that may cause systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL) and to investigate the effect of the duration between urine culture (UC) and operation on postoperative SIRS. Three hundred and fifty-six patients who had PCNL between January 2015 and June 2019 were retrospectively included in the study. UC was obtained from all patients before the operation and during the puncture at the beginning of the operation. Postoperatively, patients were closely monitored for fever and other signs of SIRS. The post-PCNL SIRS incidence was 7%. In univariable and multivariable analyses, the rate of ipsilateral PCNL history, recurrent urinary tract infection (UTI) history, operation time and the length of hospital stay were significant predictive factors for SIRS. The duration between UC and PCNL was not a statistically significant variable in both univariable and multivariable analysis. Our study concluded that the duration between UC and PCNL is not an influential factor for post-PCNL SIRS. Clarifying this issue may be possible with prospective studies in which the effects of factors such as ipsilateral PCNL history and recurrent urinary tract infection history which has been proven to be risk factors for post-PCNL SIRS are restricted.

Association between severity of prenatally diagnosed hydronephrosis and receipt of surgical intervention postnatally among patients seen at a fetal-maternal center

BackgroundHydronephrosis (HN) is the most common abnormality detected on prenatal ultrasound. This study sought to stratify outcomes of patients by severity of prenatal HN with postnatal outcomes.MethodsThis was a retrospective review of patients referred to a tertiary care fetal-maternal clinic with diagnosis of prenatal HN from 2004 to 2019. HN severity was categorized as mild, moderate, or severe. Data were analyzed to determine the association between HN severity and surgical intervention. Decision for surgery was based on factors including history of multiple urinary tract infections, evidence of renal scarring, and/or reduced renal function. Surgery-free survival time was represented by the Kaplan–Meier method, and hazard ratios were calculated using the log-rank test.Results131 kidneys among 101 infants were prenatally diagnosed with hydronephrosis; 35.9% had mild HN, 29.0% had moderate HN, and 35.1% had severe HN. 8.5% of patients with mild HN, 26.3% of patients with moderate HN, and 65.2% of patients with severe HN required surgery. Patients with severe HN were 12.2 (95% CI 6.1–24.4; p < 0.001) times more likely to undergo surgery for HN than patients with mild HN and 2.9 (95% CI 1.5–5.3; p = 0.003) times more likely to undergo surgery than patients with moderate HN. Patients with moderate HN were 4.3 times more likely to require surgery than patients with mild HN (95% CI 1.5–12.9; p = 0.01). Median age at surgery was 11.8 months among patients with mild HN (IQR 11.7–14.1 months), 6.6 months among patients with moderate HN (IQR 4.2–16.4 months), and 5.4 months among patients with severe HN (3.7–12.4 months).ConclusionAmong this cohort of referrals from a fetal-maternal clinic, severity of HN correlated with increased likelihood of surgical intervention. Continued assessment of patients with prenatal HN should be evaluated to best determine the role of the pediatric urologist in cases of prenatal HN.

Bilateral pelvic kidneys with upper pole fusion and malrotation: a\xa0 case report and \xa0review of the\xa0literature

BackgroundThe incidence of ectopic kidneys is 1:12,000 clinically and 1:900 postmortem. Patients with pelvic mal-rotated kidneys are more susceptible to recurrent urinary tract infections, recurrent renal stones, and renal injury. Fusion of the kidney lower poles is relatively common compared to other types of renal anomalies.Case presentationWe present the case of a 36-year-old Sudanese female patient who presented with a long history of recurrent urinary tract infections unresponsive to antibiotics. Ultrasound scan revealed bilateral pelvic kidneys. Computed tomography (CT) urography confirmed bilateral ectopic fused kidneys, with the left kidney mal-rotated (renal pelvis facing upwards and laterally). Kidney infection secondary to vesicoureteral reflux was diagnosed. Antibiotics were prescribed according to culture and sensitivity. The patient responded well to ciprofloxacin.ConclusionA history of recurrent urinary tract infections without an apparent cause is highly suggestive of renal anomaly and should be investigated expediently. Ultrasonography or CT imaging may be utilized to aid in diagnosis. Early recognition may help prevent the high risk of end-stage renal failure associated with anomalies.

Miniaturized percutaneous Nephrolithotomy without antibiotic prophylaxis: a single institution experience.

To assess the feasibility of sparing routine antibiotic prophylaxis in patients without preoperative urinary tract infection (UTI) undergoing a miniaturized percutaneous nephrolithotomy (mPCNL). A retrospective, monocentric study was conducted to evaluate the outcome of a modified perioperative antibiotic management strategy according to the principles of antibiotic stewardship (ABS). From December 2015 patients undergoing mPCNL for kidney stone with preoperative unremarkable urine culture no longer received an antibiotic prophylaxis (NoPAP). The NoPAP group was compared to mPCNL patients who received standard antibiotic prophylaxis (PAP) in the two years before. Analysis focused on postoperative complications. Logistic regression analysis was performed to identify potential risk factors. Postoperative fever occurred in 8% of the NoPAP and 9% of the PAP patients (p = 0.764). Clavien 1-3 complications did not differ between groups with 33% in the NoPAP and 41% in the PAP (p = 0.511). No Clavien 4-5 complications were seen. A (partial) staghorn stone (HR 5.587; p = 0.019) and an infectious stone component (HR 6.313; p = 0.003) were identified as significant risk factors for postoperative fever. By sparing routine antibiotic prophylaxis the overall antibiotic usage was reduced from 100% (PAP) to 9% (NoPAP). Patients with negative preoperative UC, a none-staghorn stone and no history of recurrent UTI or infectious stones may not need routine antibiotic prophylaxis prior to mPCNL. A prospective validation is warranted.

POS-188 UNUSUAL PRESENTATION OF PRIMARY HYPEROXALURIA TYPE 1 AS POSTPARTUM ACUTE KIDNEY INJURY

Primary hyperoxaluria type 1 (PH1) is a rare autosomal recessive disease caused by a mutation in the AGXT gene, resulting in deficiency of the alanineglyoxylate:aminotransferase enzyme. Often, the first sign is multiple recurrent nephrolithiasis, usually developped in second or third decade of life. This leads to renal interstitial and tubular damage, fibrosis, and end-stage renal disease (ESRD). We report an original case of PH type 1 without nephrolithiasis with unusual presentation as postpartum acute renal injury. A 34-year-old Tunisian woman was admitted to our center at 8 weeks postpartum with renal failure. She had no history of kidney stones or urinary tract infections. She had a family history of renal failure in her cousin. Her family history was also notable for consanguinity, her parents were first cousins. It was her first pregnancy, renal function was normal and she was delivered at 38 weeks, by elective cesarean section for persistent bleeding from low-lying placenta. The patient was seen by Nephrologist 8 week postpartum. She reported persistent bilateral flank pain, epigastralgia, nausea and vomiting, without fever. Blood pressure was 170/100 mm Hg and she appeared euvolemic. She reported maintaining fluid intake of approximately 2 L/day. Urinalysis shows no proteinuria, no hematuria and urine culture was negative. Her serum creatinine was 13,28 mg/dL, renal clearance (MDRD)= 3.4 ml/min, urea was 34.6 mmol/l, blood count revealed an hypochromic microcytic anemia (hemoglobin:6,3 g/dl; VGM=76.3; TCMH=26.7). Kidney ultrasounds show increased parenchymal echogenicity with altered corticomedullary differentiation without renal calculi (Fig.1). Kidney biopsy revealed abundant (> 90/hpf) optically clear intratubular crystalline inclusions which were accompanied by diffuse acute tubular injury, moderately severe tubulointerstitial scarring, and patchy moderate chronic interstitial inflammation, consistent with a crystalline nephropathy (Fig.2). On genetic testing, she was found to be homozygous for I244T mutation in the P11L-containing alanine:glyoxylate aminotransferase missense mutation in the AGXT gene, consistent with PH1. The patient began intensive hemodialysis (4 h, three times a week) and she was referred for combined liver and kidney transplantation. We report an unusual presentation of PH type 1 as acute kidney injury in the postpartum period without nephrolithiasis. Nephrologist should be aware of such situation.

Prevalence of Bacterial Urinary Tract Infection and Antimicrobial Susceptibility Patterns Among Diabetes Mellitus Patients Attending Zewditu Memorial Hospital, Addis Ababa, Ethiopia.

BackgroundUrinary tract infection (UTI) is caused by colonization and growth of microorganisms within the urinary system. Diabetic patients are more prone to bacterial UTI due to impaired host defense and high glucose concentration in urine. Surveillance of uropathogens and their antibiogram is a key to patient management.MethodsA hospital-based cross-sectional study was conducted from May to July, 2018. Urine samples were collected for culture and identification based on the standard protocol. An antimicrobial susceptibility test (AST) was done for all isolates using the Kirby–Bauer disk diffusion method. Data were entered into Epi-data version 3.2.1 and exported to the Statistical Package for the Social Science (SPSS) version 20.ResultsOut of 225 participants, significant bacteriuria was reported in 9.8% of the cultures. Five species of bacteria were isolated and E. coli (63.6%) was the leading uropathogen, followed by K. pneumoniae (13.6%). Duration of diabetes, previous history of UTIs and symptomatic UTI were found to be strongly associated with significant bacteriuria. Gram-negative bacterial isolates showed high sensitivity to nitrofurantoin and meropenem (100%). In contrast, a high level of resistance to ampicillin, doxycycline and cefuroxime (100%) and to amoxicillin-clavulanate (94.4%) was observed. Gram-positive bacteria showed high level of resistance to penicillin (100%). Multiple-drug resistance (MDR) was high for Gram-negative bacteria (100%).ConclusionPrevious history of UTIs and duration of diabetes were found to be important factors that increase the prevalence of UTI among diabetes patients. This study also showed a high prevalence of drug resistance to doxycycline, amoxicillin-clavulanate, cefuroxime and penicillin for both Gram-negative and Gram-positive bacteria. Since therapeutic selection for empirical treatment and management should be based on knowledge of the local bacterial profile and antimicrobial response, we suggest physicians take this high resistance profile in to consideration when prescribing antimicrobials against the pathogens in question.

Risk factors for prostate cancer in Kohgiluyeh and BoyerAhmad provinces, Iran

Background: Prostate cancer is the most common malignant cancer and the second most common cancerin men worldwide. It is the second leading cause of death after lung cancer in men. This study performed todetermine the risk factors for prostate cancer in Kohgiluyeh and Boyer-Ahmad provinces.Method: The present study was a retrospective and case-control study in which 80 prostate cancer patientsand 140 controls matched in Kohgiluyeh and Boyer-Ahmad provinces. Data collected using a questionnaireand interviewed by the researcher. To analyze the data, Chi-square and logistic regression tests with oddsratio with 95% confidence conducted using SPSS v.22 software.Results: The results showed that in the univariate conditional logistics analysis, The highest odds ratiofor prostate cancer related to red meat consumption 2-4 times a week (95% CI: 2.60 – 26.40) was 20.74and The smallest odds ratio was related to continuous physical activity 0.34 ( 95% CI: 0.19 – 0.61). Inthe multivariate conditional logistic regression model, after removing the confounding variables, it wasobserved that the history of pelvic imaging, red meat consumption 2-4 times a week, fast food consumptionand processed meat consumption 2-4 times a week, Family history of prostate cancer, history of urogenitalinfections were identified as the most effective factors in prostate cancer.Conclusion: Family history of prostate cancer, history of urinary tract infection, history of smoking, historyof pelvic imaging, consumption of red meat, consumption of fast food and processed meats were the mostimportant predictors of prostate cancer in this study. It can be considered by educational and health plannersto prevent this cancer and take appropriate intervention measures.

High dose versus low dose standardized cranberry proanthocyanidin extract for the prevention of recurrent urinary tract infection in healthy women: a double-blind randomized controlled trial

PurposeOur objective was to assess the efficacy of a high dose cranberry proanthocyanidin extract for the prevention of recurrent urinary tract infection.Material and methodsWe recruited 145 healthy, adult women with a history of recurrent urinary tract infection, defined as ≥ 2 in the past 6 months or ≥ 3 in the past 12 months in this randomized, controlled, double-blind clinical trial. Participants were randomized to receive a high dose of standardized, commercially available cranberry proanthocyanidins (2 × 18.5 mg daily, n = 72) or a control low dose (2 × 1 mg daily, n = 73) for a 24-week period. During follow-up, symptomatic women provided urine samples for detection of pyuria and/or bacteriuria and received an appropriate antibiotic prescription. The primary outcome for the trial was the mean number of new symptomatic urinary tract infections during a 24-week intervention period. Secondary outcomes included symptomatic urinary tract infection with pyuria or bacteriuria.ResultsIn response to the intervention, a non-significant 24% decrease in the number of symptomatic urinary tract infections was observed between groups (Incidence rate ratio 0.76, 95%CI 0.51–1.11). Post-hoc analyses indicated that among 97 women who experienced less than 5 infections in the year preceding enrolment, the high dose was associated with a significant decrease in the number of symptomatic urinary tract infections reported compared to the low dose (age-adjusted incidence rate ratio 0.57, 95%CI 0.33–0.99). No major side effects were reported.ConclusionHigh dose twice daily proanthocyanidin extract was not associated with a reduction in the number of symptomatic urinary tract infections when compared to a low dose proanthocyanidin extract. Our post-hoc results reveal that this high dose of proanthocyanidins may have a preventive impact on symptomatic urinary tract infection recurrence in women who experienced less than 5 infections per year.Trial registration: Clinicaltrials.gov, identifier NCT02572895

A Rare, Unusual Presentation of Newberyite Urolithiasis in Adolescent Female -A Case Report and Review of Literature

We report a rare case of newberyite (magnesium monohydrate phosphate trihydrate) urolithiasis in a young female with a past medical history significant for longstanding autoimmune hepatitis. She presented to the emergency department with newly diagnosed nephrolithiasis. Over the next 2 years, she had recurrent renal calculi and 3 urologic procedures. Notably, she did not have any history of urinary tract infections or genitourinary abnormalities. Her last stone analysis revealed the unusual combination of newberyite and ammonium acid urate. The pathophysiology of ammonium acid urate and newberyite stone formation as well as risk factors of development are discussed in this report.

Recurrent Nephrolithiasis Causing Kidney Failure

A 56-year-old woman with diabetes mellitus and kidney failure treated by kidney transplantation 3 months prior is referred to your clinic for elevated serum creatinine. She gives a personal history of recurrent urinary tract infections in the setting of obstructive uropathy and recurrent nephrolithiasis. Two years ago, she developed kidney failure. Imaging at the time revealed staghorn calculi with left hydroureter (Fig 1). She underwent bilateral ureteral stent placement with some improvement in glomerular filtration rate (GFR); however, she continued to experience progressive GFR decline and required hemodialysis.

Investigating Pelvic Floor Muscle Strength in Women of Reproductive Age and Factors Affecting It.

This descriptive study was designed to investigate the pelvic floor muscle strength (PFMS) of women aged 18 to 49 years and to examine the factors that may have an effect on PFMS. The study was conducted on 258 women who visited a gynecology outpatient clinic between January 2019 and January 2020, who met the research criteria, and who agreed to participate in the study. The data were collected using the Sociodemographic Characteristics Information Form. The Modified Oxford Scale (MOS) and a perineometer were used to evaluate the PFMS of the women. The mean PFMS value measured using the perineometer was 31.56 ± 12.17 cmH2O (moderate pressure). The PFMS values were 20.00 to 29.9 cmH2O (weak pressure) and 30.00 to 39.9 cmH2O (moderate pressure) in 23.6% of the women, respectively. The PFMS values measured with MOS were of grade 3 strength (moderate pressure) in 23.6% of the women and grade 2 strength (weak pressure) in 23.3%. A statistically significant strong correlation was found between the perineometer measurement and the women's MOS values. Moreover, a statistically significant difference was found between the PFMS values measured with the perineometer, MOS scores, and women's age groups, educational status, marital status, employment status, income status, persistent cough, use of nicotine, alcohol and coffee consumptions, chronic constipation, history of frequent urinary tract infections, regular exercise, body mass index, history of pregnancy, mode of delivery, use of episiotomy at birth, perineal rupture at birth, use of forceps vacuum at birth, multiple pregnancies, delivery of a baby weighing ≥4,000 g, treatment during pregnancy, hysterectomy, menopause, frequency of sexual intercourse, and pain during sexual intercourse (p < .05). We conclude that most of the women in the study had weak to moderate PFMS, that the evaluation of PFMS with the MOS positively overlapped with the perineometric measurements, and that a number of sociodemographic and obstetric variables act as risk factors that affect PFMS. The PFMS of all women should be assessed as part of their routine gynecological examinations.