History Of Recurrent Urinary Tract Infections Research Articles

Voiding cystourethrogram: How much should we be selective?

In this study, we examined the patients' characteristics, who underwent voiding cystourethrography (VCUG), in order to determine any selectivity for indication of this invasive method. After exclusion of indications of neurogenic bladder or antenatal hydronephrosis and control VCUGs, 159 VCUGs performed in our clinic within one year were evaluated. Patients are divided into three groups accoding to age. Clinical characteristic and findings of renal ultrasonography (US) and renal scintigraphy were examined. Vesicoureteral reflux (VUR) was detected in 61 (38.3%) of 159 patients who underwent cystourethrographic examinations, in 45.8% of the patients with a history of recurrent urinary tract infection (UTI), in 22.0% of the patients with pathological urinary system US without history of recurrent UTI. High-grade reflux rate was significantly more frequent in renal units with pathological US findings. Severe scar was significantly more frequent in renal units with high-grade reflux when compared to renal units without reflux and those with low-grade reflux. Predictive values of recurrent UTI, scarring status and pathological US for VUR were separately analyzed and seen that likelihood of indicating VUR was increased when all 3 risk factors were assessed together. Vesicoureteral reflux is a problem in which diagnostic process and management strategy should have to be considered in individualized manner for each patient. Before prescribing invasive VCUG, imaging urinary system by US and scintigraphy and determining whether there is recurrent UTI will improve selectivity and success of VCUG.

PP100 Economic Evaluation Of A New Non-Antibiotic First-line Treatment Of Recurrent Urinary Tract Infections

INTRODUCTION:Urinary tract infections (UTIs) are common in female patients in general practice. These bacterial infections affect half of all women at least once in their life. Antibiotics are usually prescribed for UTIs, and continuous low antimicrobial prophylaxis is administered to patients at high risk of recurrent UTI (rUTIs) (1). However, a major concern arises due to the increased rates of severe treatment-related side effects and emergence of antimicrobial resistance, which makes rUTIs management more challenging while seeking the use of more expensive alternatives. On this basis, clinical evaluations of rUTI interventions should be accompanied by economic evaluations in order to guide healthcare policy and decision processes about healthcare resources allocation. The aim of this work was to perform a cost-effectiveness analysis of a novel effective non-antibiotic treatment option for prophylaxis of female patients with a history of rUTIs, based on intravesical administration of hyaluronic acid (HA) plus chondroitin sulfate (CS), as compared to recommended 1st-line antibiotic therapy (2).METHODS:A cost-utility analysis was performed in order to estimate the effectiveness of each treatment, according to the number of UTIs annual episodes, and the incremental cost-effectiveness (ICER) for patients with UTI, starting from data collected during a multicentric observational case-cross-over clinical trial involving seven European centers (2). The economic model includes the costs of HA treatment and the costs associated with each UTI, such as costs of UTI diagnostics and antibiotic treatment, additional care by the elderly-care physician, additional nursing care, and hospitalizations, as well as the expected QALY, measured through the Short Form Health Survey (SF-36) questionnaires administered to patients, for both groups (3).RESULTS:At this stage, preliminary findings suggest that HA plus CS is a cost-effective alternative to antibiotics for the treatment of recurrent UTIs, that could reduce UTIs events in female patients with a history of recurrent UTI at an acceptable cost.CONCLUSIONS:The results of this study support the use of HA plus CS against antimicrobials as 1st-line therapy in the management of rUTIs.

Successful ureteroscopy for kidney stone disease leads to resolution of urinary tract infections: Prospective outcomes with a 12-month follow-up.

IntroductionTo investigate the resolution of urinary tract infection (UTI) with the successful treatment of kidney stone disease (KSD).We reviewed the outcomes of ureteroscopy (URS) and stone treatment for patients with positive urine culture or recurrent UTIs and evaluated whether the infection resolved with the clearance of their urinary stones.Material and methodsBetween March 2012 and July 2016, consecutive patients who underwent URS for stone disease with a history of recurrent UTIs or culture proven UTIs were identified from a prospective database. Data was recorded on stone free rate (SFR) and infection free rate (IFR) during the follow-up period at 3, 6 and 12-months.ResultsDuring the study period, 103 consecutive patients with stone disease and associated UTI underwent URS over a 52-month period (mean age: 60 years, Female: Male ratio of 2:1). The mean cumulative stone size was 16 mm (range: 3–107 mm) and a positive pre-operative urine culture was found in 81 (79%) patients. While the overall SFR was 96%, the total complication rate was 12.6% (n = 13) and these were all Clavien I/II complications.At follow-up, the SFR and IFR was 96% and 88% at 3-months, and 82% and 71% at 12-months, respectively (p <0.001). While almost three-quarters of patients were stone and infection free at 12-months, the majority of those with stones recurrence also had recurrence of their UTI.ConclusionsThe majority of patients will remain infection free at the 12-month follow-up if they are stone free after their initial treatment. Stone recurrence, which is more likely in high-risk patients, is also linked to the recurrence of their UTI.

Recurrent Urinary Tract Infection After Midurethral Sling: A Retrospective Study.

Our primary objective was to estimate the proportion of patients with culture-proven urinary tract infection (UTI) and recurrent UTI after midurethral sling (MUS), as well as to evaluate their risk factors. Our secondary objective was to characterize the difference in the proportion of patients with recurrent UTI before and after MUS. We conducted a retrospective study of patients who underwent MUS from 2009 to 2012 within a large health maintenance organization and subsequently had documentation of at least 1 positive urine culture (>100 K CFU/mL) within 1 year. Validated procedural and diagnostic codes were used to identify patients undergoing MUS and the diagnosis of UTI, respectively. Of the 7461 MUS performed, 883 (12%) patients had at least 1 culture-proven UTI and 258 (3.5%) patients met the definition of recurrent UTI postoperatively. Of those 883 patients, 89 (10%) patients met the definition of recurrent UTI before, and 258 (29%) patients after, MUS. McNemar χ test revealed that patients were more likely to have recurrent UTI after MUS compared with before (P < 0.0001). In multivariate logistic regression, Caucasian (odds ratio [OR], 1.60, 95% confidence interval [95% CI], 1.12-2.29; P = 0.01) and African-American (OR, 3.42; 95% CI, 1.42-8.29; P = 0.01) ethnicity, older age (OR, 1.02; 95% CI, 1.00-1.04; P = 0.03), and a history of recurrent UTI (OR 3.79, 95% CI 1.88-7.93, P = 0.0003) were risk factors for postoperative recurrent UTI. In this population, preoperative recurrent UTI was the only modifiable risk factor associated with an increased risk of postoperative recurrent UTI.

Antibiotic resistance properties of uropathogenic &lt;i&gt;Escherichia coli&lt;/i&gt; isolated from pregnant women with history of recurrent urinary tract infections

Purpose: To investigate the antibiotic resistance pattern of uropathogenic Escherichia coli (UPEC) strains isolated from pregnant women with history of recurrent urinary tract infections (RUTIs) and healthy pregnant women. Methods: A total of 485 high vaginal swab specimens were collected from pregnant women with history of RUTIs and healthy ones. Samples were cultured and those that were E. coli positive were analyzed by polymerase chain reaction (PCR) and disk diffusion tests. Results: Twenty eight out of 445 (6.29 %) samples were positive for E. coli . Prevalence of E. coli in pregnant women with history of RUTIs and healthy ones were 9 and 4.08 %, respectively. Women older than 40 years were the most commonly infected. UPEC strains showed the highest levels of resistance against ampicillin (96.42 %), tetracycline (85.71 %), amikacin (71.42 %), ciprofloxacin (67.85 %) and gentamycin (58.71 %). Conclusion: RUTIs and pregnancy in old age are two important risk factors for transmission of UPEC strains from the urinary tract into the vagina. Primary treatment of infected pregnant women with imipenem, mezlocillin and nitrofurantoin would be effective for the prevention and management of vaginal infections in pregnant women. Keywords: Uropathogenic Escherichia coli , Recurrent urinary tract infections, Antibiotic resistance, Pregnant women

Assessing ureteral patency using 10% dextrose cystoscopy fluid: evaluation of urinary tract infection rates

Intravenous indigo carmine has routinely been used to confirm ureteral patency after urogynecologic surgery. Recent discontinuation of the dye has altered clinical practice. In the absence of indigo carmine, we have used 10% dextrose in sterile water (D10) as cystoscopic fluid to evaluate ureteral patency. Glucosuria has been associated with urinary tract infection (UTI) invivo and significantly enhanced bacterial growth invitro. The concern is that the use of D10 would mimic a state of glucosuria albeit transient and increase the risk of postoperative UTI. The objectives of this study were to compare the rates of postoperative UTI and lower urinary tract (LUT) injuries between patients who underwent instillation of D10 vs normal saline at the time of intraoperative cystoscopy after urogynecological surgery. This was a retrospective cohort study of all women who underwent cystoscopic evaluation of ureteral patency at the time of urogynecological surgery from May through December 2014 at a tertiary care referral center. We compared patients who received D10 cystoscopy fluid vs those who used normal saline. Outcomes included UTI and diagnosis of ureteral or LUT injuries. UTI was diagnosed according to Centers for Disease Control and Prevention guidelines by symptoms alone, urine dipstick, urinalysis, or urine culture. Descriptive statistics compared the rates of UTI between the 2 groups, and a multivariable model was fit to the data to control for potential confounders and significant baseline differences between the groups. A total of 303 women were included. D10 was used in 113 cases and normal saline (NS) was used in 190. The rate of UTI was higher in the D10 group than the NS group: 47.8% (95% confidence interval [CI], 38.3-57.4) vs 25.9% (95% CI, 19.8-32.8, P < .001). After adjusting for age, pelvic organ prolapse stage, use of perioperative estrogen, days of postoperative catheterization, menopausal status, diabetes mellitus, and history of recurrent UTI, the UTI rate remained significantly higher with the use of D10 (adjusted odds ratio, 3.4 [95% CI, 1.6-7.5], P= .002) compared with NS. Overall, 3 cases of transient ureteral kinking (1.0%) and one cystotomy (0.3%) were identified intraoperatively. However, ureteral and LUT injuries were not different between groups. No unidentified injuries presented postoperatively. Although the use of D10 cystoscopy fluid has been successful in identifying ureteral patency in the absence of indigo carmine, it is associated with an increased rate of postoperative UTI compared with NS.

Causative pathogens and antibiotic resistance in children hospitalized for urinary tract infection.

Urinary tract infections (UTI) are one of the most common bacterial infections in children and a major cause of hospitalization. In this study we investigated the clinical characteristics, causative uropathogens; their antibiotic susceptibility and resistance patterns, treatment modalities and efficacy in children hospitalized for UTI in a tertiary care setting. Patients hospitalized for an upper UTI between March 2009 and July 2014 were enrolled. The urine culture-antibiogram results and accompanying urinary tract abnormalities were recorded retrospectively. A total of 142 patients (104 girls, 73.2%; 38 boys, 26.8%) were enrolled. Mean patient age was 32.6 ± 4.1 months. History of recurrent UTI was present in 45.8% (n = 65), with prior hospitalization in 12.0% (n = 17). Frequency of vesicoureteral reflux was 18.3% (n = 26). Gram-negative enteric microorganisms yielded growth in all culture-positive UTI and the most common microorganism was Escherichia coli (n = 114, 80.3%). Extended spectrum beta-lactamase-producing (ESBL (+)) bacterial strains were detected in 49.3% (n = 70), with third-generation cephalosporin resistance in all and increased duration of hospitalization. The prevalence of UTI with ESBL (+) bacterial strains with multi-drug resistance is increasing in the hospitalized pediatric population, therefore rational use of antibiotics is essential.

Obesity and recurrent urinary tract infections in premenopausal women: a retrospective study.

Studies on the association between obesity and the risk of urinary tract infection (UTI) show inconsistent results. The aim of this study was to determine whether there is any association between obesity and recurrent UTIs (RUTIs) among premenopausal women. A retrospective case-control study was conducted in the outpatient clinics of the internal medicine departments of three hospitals. All consecutive non-pregnant premenopausal women aged 20-55 years, who presented with RUTIs over a 2-year period, were included; these women were compared to randomly selected women from the same outpatient clinics who had no history of RUTI and were age-matched ±5 years. RUTI was defined as a symptomatic UTI that followed the resolution of a previous UTI, or three or more symptomatic episodes over a 12-month period. Six hundred and ninety-one premenopausal women with UTI were evaluated during the study period. A total 122 of 162 subjects with RUTIs were included in this study and compared to 122 control cases without a history of RUTI. The overall prevalence of RUTIs among the premenopausal women with UTI was 23.4% (162/691). Approximately half of those with RUTIs were obese. The mean age of women with RUTIs was 43.8±9 vs. 40±10 years among the controls (p=0.839). The mean body mass index of women with RUTIs was significantly higher than that of controls: 35±4 vs. 26±3kg/m(2) (p<0.001). Multivariate regression analysis showed that obesity was associated with RUTIs in premenopausal women (odds ratio 4.00, 95% confidence interval 3.2-4.61; p=0.001). Obesity was found to be associated with RUTIs in premenopausal women.

Labial adhesion and urinary tract problems: The importance of genital examination

Urinary tract infection (UTI) is a common bacterial illness in children. Delay in the treatment of UTI may lead to acute renal parenchymal damage and subsequent renal scarring. It is well established that several risk factors increase the tendency for UTI - one being labial adhesion (LA). The purpose of this study was to emphasize the importance of genital examination in girls with nephrourologic symptoms, particularly UTIs, in order to detect LA. Data were collected from the files of 46 girls with LA, including: the girl's age, thickness of LA, any recurrence and treatment options of LA, and the reason for admission to hospital. The LAs were grouped in terms of thickness as thin, moderate and dense, and also partial or complete. The average age of the girls at the first visit was 51.9 ± 37.57 months (min-max: 3.5-157 months). Twenty-seven (58.7%) of the girls had history of recurrent UTI. There was a marked association between the presence of UTI and the type of adhesions. The percentages of UTIs in girls with complete and partial LA were 84.0% and 28.6%, respectively (P < 0.05). The percentages of UTIs in girls with thick and thin LA were 100% and 44.1%, respectively (P < 0.05). None of the girls' primary care physicians or pediatricians recognized LA at the time of a periodic health examination. In the present study, girls with complete and thick LA had a greater tendency towards having UTIs than those with partial and thin LA, respectively. After treatment of LA, the UTIs did not recur in any girls. None of the girls in this study had undergone a previous genital examination. Therefore, this study suggests that physicians do not often perform genital examinations. Limitations of this study were the small sample size and the short follow-up period. In addition, although all of the girls were examined by the same physician, the thickness of the membrane is subjective and solely depends on the physician's experience. This study showed that although genital examination is a routine part of a physical examination, it is not always performed. Therefore, it is recommend that genital examination should be performed in girls with nephrourologic complaints, particularly for UTI. By timeously determining the presence of LA, many unnecessary and invasive investigations could be avoided in these children.

Are High Proanthocyanidins Key to Cranberry Efficacy in the Prevention of Recurrent Urinary Tract Infection?

Most research on American cranberry in the prevention of urinary tract infection (UTI) has used juices. The spectrum of components in juice is limited. This study tested whether whole cranberry fruit powder (proanthocyanidin content 0.56%) could prevent recurrent UTI in 182 women with two or more UTI episodes in the last year. Participants were randomized to a cranberry (n = 89) or a placebo group (n = 93) and received daily 500 mg of cranberry for 6 months. The number of UTI diagnoses was counted. The intent-to-treat analyses showed that in the cranberry group, the UTIs were significantly fewer [10.8% vs. 25.8%, p = 0.04, with an age-standardized 12-month UTI history (p = 0.01)]. The Kaplan-Meier survival curves showed that the cranberry group experienced a longer time to first UTI than the placebo group (p = 0.04). Biochemical parameters were normal, and there was no significant difference in urinary phenolics between the groups at baseline or on day180. The results show that cranberry fruit powder (peel, seeds, pulp) may reduce the risk of symptomatic UTI in women with a history of recurrent UTIs.

Factors associated with ciprofloxacin-resistant Escherichia coli urinary tract infections in discharged ED patients

BackgroundWe sought to identify factors associated with Escherichia coli resistance to ciprofloxacin among discharged emergency department (ED) patient visits treated for a urinary tract infection (UTI). We hypothesized that specific historical factors available upon ED presentation would be associated with increased odds of ciprofloxacin resistance in this population. MethodsWe conducted a retrospective, observational cohort study of consecutive discharged adult ED patient visits with a primary diagnosis of UTI caused by E coli to a single center from 2011 to 2014. Two investigators separately abstracted to a preconstructed data collection form the following independent variables on each included visit: patient age, sex, residence, active immunosuppressive condition or medication, chronic indwelling Foley catheter, hospitalization or antibiotic use within 90 days prior to presentation, and history of recurrent UTIs. We used multivariable logistic regression after taking into account colinearity to identify those independent variables associated with increased odds of ciprofloxacin resistance and report descriptive characteristics of the study cohort, odds ratios (ORs) with 95% confidence interval (CI) and model strength. ResultsAge at least 65 years (OR, 3.15; 95% CI, 1.44-6.87; P = .004), recurrent UTI (OR, 6.23; 95% CI, 2.38-16.30; P < .001), and recent hospitalization (OR, 3.99; 95% CI, 1.56-10.23; P = .004) were significantly associated with ciprofloxacin-resistant E coli UTIs in relevant visits. ConclusionIn this single-center study, age at least 65 years, recurrent UTI, and recent hospitalization were most clearly associated with increased odds of ciprofloxacin-resistant UTIs in discharged adult ED patient visits. If validated, these factors should suggest that alternative antimicrobial agents should be considered in the treatment of this condition among discharged adult ED patients.

Pielonefrite Cronica: una Causa Misconosciuta di Perdita del Trapianto di Rene

Chronic pyelonephritis : a misunderstood cause of renal allograft loss Although urinary tract infections (UTI) are the most frequent infections in kidney transplant patients, there are no sufficient data about the prevalence of acute and chronic pyelonephritis and organ or patient survival. We present the clinical case of a young woman with a kidney transplant admitted to our Nephrology Clinic because of an acute worsening of renal function and a history of recurrent UTI. The renal biopsy showed medul lary tissue with a severe tubule-interstitial damage, suggestive for acute rejection, insomuch that steroids were prescribed. Due to the lack of any clinical improvement, a second biopsy was performed, showing a histological picture of chronic pyelonephritis with a severe and advanced damage. Subsequently, because of the severe renal failure the patient underwent peritoneal dialysis and transplant nephrectomy. This clinical case is exemplificative of the possible adverse outcomes of recurrent UTI that might lead in a short time to organ failure, highlighting the importance of a definitive histologic diagnosis.

MP44-08 IMAGING AFTER UTI IN OLDER CHILDREN AND ADOLESCENTS

You have accessJournal of UrologyPediatrics: Urinary Tract Infection & Vesicoureteral Relux1 Apr 2014MP44-08 IMAGING AFTER UTI IN OLDER CHILDREN AND ADOLESCENTS Michael P. Kurtz, Jeanne S. Chow, Emilie K. Johnson, William Tan, Tanya Logvinenko, and Caleb P. Nelson Michael P. KurtzMichael P. Kurtz More articles by this author , Jeanne S. ChowJeanne S. Chow More articles by this author , Emilie K. JohnsonEmilie K. Johnson More articles by this author , William TanWilliam Tan More articles by this author , Tanya LogvinenkoTanya Logvinenko More articles by this author , and Caleb P. NelsonCaleb P. Nelson More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.1383AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail Introduction and Objectives While the 2011 AAP guidelines for evaluation after urinary tract infection (UTI) focused on infants age 2-24 months, there are few guidelines or data regarding workup in older children. Both voiding cystourethrogram (VCUG) and renal and bladder ultrasound (RBUS) have been used in such patients, but the value of such tests is uncertain. We sought to determine the clinical yield of RBUS and VCUG among older children and adolescents after UTI. Methods We analyzed VCUG and RBUS findings and clinical history of 3995 patients who underwent both studies on the same date between 1/06-12/10, and selected patients age 5-18 years who underwent imaging for indication of UTI. Patients with prior postnatal GU imaging or history of prenatal hydronephrosis (PNH) were excluded. RBUS was defined as positive for any degree of hydronephrosis or hydroureter, renal parenchymal or bladder abnormalities. A positive VCUG was defined as VUR>GII and/or bladder or urethral anomalies (e.g. diverticulum). Results We identified a cohort of 141 patients, 77% were of age 5-8 years, 29% age 8-12, and 2.8% age 12-18. 76.6% were female. 78.7% patients had a history of febrile UTI; 53.9% had a history of recurrent UTI. RBUS findings among girls included 9.2% hydronephrosis, 2.8% with ureteral dilation, 13% with renal parenchymal findings, and 9.2% with bladder findings. Among boys, 6.1% had hydronephrosis, 9.1% had ureteral dilation, 12% had renal parenchymal findings, and 18% had bladder findings. No subjects had moderate or greater hydronephrosis. On VCUG, VUR was observed in 49/141 subjects (34%); 41/108 (38%) girls and 8/33 (24%) boys. Other bladder or urethral anomalies were seen in 12%. 6.4% of all subjects had grade I, 26.2% had grade II-III, and1.4% had grade >III VUR. One boy had concurrent upper tract obstruction (precluding VUR grading); no boys had VUR > grade II. One boy had a urethral anomaly. Among girls, 1.9% had VUR > grade III. The test characteristics (with 95% CI) of any RBUS abnormality for VUR > grade II (or bladder or urethral anomalies) were: sensitivity 0.53 (0.36-0.70), specificity 0.71 (0.62-0.79), PPV 0.33 (0.22-0.48), NPV 0.85 (0.76-0.91). For any VUR grade (or bladder or urethral anomalies), these were: sensitivity 0.49 (0.37-0.62), specificity 0.76 (0.66-0.84), PPV 0.58 (0.44-0.71), NPV 0.69 (0.59-0.77). Conclusions Among older children with a history of UTI, mild genitourinary anomalies are common, but the yield of diagnostic imaging high grade hydronephrosis or high-grade VUR is very low. Renal ultrasound is not reliable as a screening test for predicting VCUG findings such as VUR, regardless of grade. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e445-e446 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Michael P. Kurtz More articles by this author Jeanne S. Chow More articles by this author Emilie K. Johnson More articles by this author William Tan More articles by this author Tanya Logvinenko More articles by this author Caleb P. Nelson More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Impact of extended‐spectrum β‐lactamase–producing organisms on clinical and economic outcomes in patients with urinary tract infection

To compare clinical and economic outcomes between patients with urinary tract infection (UTI) due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species (ESBL-EK) versus patients with non-ESBL-EK UTI. Eighty-four (3.6%) of 2345 patients admitted between September 1, 2011 and August 31, 2012 with UTI were positive for ESBL-EK. Fifty-five ESBL-EK UTI (cases) and matched controls (non-ESBL-EK UTI) were included in the analysis. Clinical and economic outcomes were compared between cases and controls for statistical significance. Cases were more likely to have diabetes mellitus, a history of recurrent UTIs, recently received antibiotics, recently been hospitalized, and had previous isolation of an ESBL-producing organism compared with controls. Failure of initial antibiotic regimen (62% vs 6%; P < 0.001) and time to appropriate antibiotic therapy (51 vs 2.5 hours; P < 0.001) were greater in cases. The median cost of care was greater (additional $3658; P = 0.02) and the median length of stay (LOS) prolonged for cases (6 vs 4 days; P = 0.02) despite similar hospital reimbursement (additional $469; P = 0.56). Although not significant, infection-related mortality (7.2% vs 1.8%) and 30-day UTI readmission (7.2% vs 3.6%) were higher in ESBL-EK cases. UTI caused by ESBL-EK is associated with significant clinical and economic burden. The cost of care and LOS of patients with ESBL-EK UTI were 1.5 times those caused by non-ESBL-EK. Importantly, the additional cost of care is a liability to the hospital, as this is not offset by reimbursement. Appropriate and timely initial antibiotics may minimize the ESBL-EK impact on outcomes of patients with UTI.

The Effect of an Oral Probiotic Containing Lactobacillus, Bifidobacterium, and Bacillus Species on the Vaginal Microbiota of Spayed Female Dogs

Recurrent urinary tract infections (UTIs) are often difficult to treat. Vaginal colonization with lactic acid-producing bacteria (LAB) is associated with reduced frequency of recurrent UTIs in women. Oral probiotics might help increase the prevalence of vaginal LAB and decrease the frequency of recurrent UTIs in dogs. Administration of an oral probiotic supplement containing Lactobacillus, Bifidobacterium, and Bacillus species will increase the prevalence of LAB in the vagina of dogs. Thirty-five healthy, spayed female dogs without history of recurrent UTIs. Prospective, controlled study. Enrolled dogs received an oral probiotic supplement for 14 or 28 days. A vaginal tract culture was obtained from each dog before and after oral probiotic administration. Twenty-three dogs received the oral probiotic supplement daily for a period of 14 days and 12 dogs received the oral probiotic supplement daily for a period of 28 days. Lactic acid-producing bacteria were isolated from 7 of 35 dogs prior to probiotic administration. After the treatment course, 6 of 35 dogs had LAB isolated. Only one of these dogs had LAB (Enterococcus canintestini) isolated for the first time. Enterococcus canintestini was the most common LAB isolated from all dogs in this study, although it was not included in the probiotic supplement. Lactic acid-producing bacteria are not a common isolate from the vaginal vault of dogs. Administration of this oral probiotic supplement for a 2- or 4-week period did not increase the prevalence of vaginal LAB in dogs.

D-mannose powder for prophylaxis of recurrent urinary tract infections in women: a randomized clinical trial

To test whether D-mannose powder is effective for recurrent urinary tract infection (UTI) prevention. After initial antibiotic treatment of acute cystitis, 308 women with history of recurrent UTI and no other significant comorbidities were randomly allocated to three groups. The first group (n = 103) received prophylaxis with 2 g of D-mannose powder in 200 ml of water daily for 6 months, the second (n = 103) received 50 mg Nitrofurantoin daily, and the third (n = 102) did not receive prophylaxis. Overall 98 patients (31.8%) had recurrent UTI: 15 (14.6) in the D-mannose group, 21 (20.4) in Nitrofurantoin group, and 62 (60.8) in no prophylaxis group, with the rate significantly higher in no prophylaxis group compared to active groups (P < 0.001). Patients in D-mannose group and Nitrofurantoin group had a significantly lower risk of recurrent UTI episode during prophylactic therapy compared to patients in no prophylaxis group (RR 0.239 and 0.335, P < 0.0001). In active groups, 17.9% of patients reported side effects but they were mild and did not require stopping the prophylaxis. Patients in D-mannose group had a significantly lower risk of side effects compared to patients in Nitrofurantoin group (RR 0.276, P < 0.0001), but the clinical importance of this finding is low because Nitrofurantoin was well tolerated. In our study, D-mannose powder had significantly reduced the risk of recurrent UTI which was no different than in Nitrofurantoin group. More studies will be needed to validate the results of this study, but initial findings show that D-mannose may be useful for UTI prevention.

Predicting Refractory Detrusor Overactivity: Are There any Clues at Diagnosis

Approximately one-third of patients diagnosed with detrusor overactivity (DO) will be refractory to treatment with antimuscarinic drugs. In this study, we examined baseline clinical details and history of urinary tract infection (UTI), urodynamics parameters, urinary pH and ATP in voided urodynamic fluid for any prognostic factors that would allow prediction of the refractory state at the time of diagnosis. At follow-up (2 to 5 years), patients were characterised as responders or non-responders based on a &gt;50% decrease in urge leaks and voids per 24 hours. Of the 61 patients who met the inclusion criteria, follow-up revealed that 25% of these did not respond to antimuscarinic therapy. There were no significant differences in urodynamic parameters in responders compared to non-responders. Patients with a greater number of leaks/week at baseline and a history of UTI were more likely to be non-responsive to antimuscarinic therapy. There was no difference in urinary pH or ATP concentration in voided urodynamic fluid in the two groups. The results indicate that severity of leakage at baseline history and a history of recurrent UTI appears to be poor prognostic features in patients with DO. These may be associated with the development of the ‘refractory’ state.

Asymptomatic Bacteriuria During First Year after Renal Transplantation

Introduction and aims: Urinary tract infections (UTIs) are the most common infections in renal transplant recipients and are considered a potential risk factor for poorer graft outcomes. Asymptomatic bacteriuria (AB) is the most prevalent form of UTIs, however its clinical impact has not been thoroughly evaluated and so far there are no established guidelines for screening and treatment of AB in renal transplant population. Therefore the aim of the study was to evaluate incidence, microbiology, risk factors for AB and the influence of AB episodes on renal graft function. Methods: We performed a retrospective cohort study reviewing medical records of patients who received a renal transplant at Gdañsk Transplantation Centre between January 2007 and December 2009. We analyzed urine cultures performed within first 12 months after RTx with reference to clinical data. Renal function assessed by creatinine concentration and eGFR was recorded 24 months after RTx. Results: We studied urine cultures and clinical data from 214 renal transplant recipients, including 59,8% of male gender, with mean age of 46 ± 14 years. We observed 176 AB episodes in 85 patients and this accounted for 53,6% of all diagnosed UTIs. Over 50% of AB episodes were diagnosed during the first month post-transplant and the most frequently isolated uropathogen was Enterococcus faecium (37%, n =33). Beginning from the second month the bacterium most frequently found in urine cultures was Escherichia coli (54%, n=47). In recurrent UTIs reinfections outnumbered relapses. Only female gender and comorbidity measured by Charlson Comorbidity Index emerged as independent predictors of AB in multivariate analysis. 46 out of 85 patients with AB developed also symptomatic UTIs. AB in multivariate analysis was an independent risk factor for symptomatic UTIs (both lower and upper UTIs) and in univariate analysis it was a risk factor for acute graft pyelonephritis and urosepsis. However, 39 out of 85 patients with AB episodes never developed symptomatic infections. Over 60% of the latter had AB uncovered only during first month post transplantation. Patients with a post-transplant history of only AB were unlikely to have a history of recurrent UTIs before RTx. The evolution of renal graft function estimated by creatinine concentration and eGFR MDRD did not differ significantly between patients with and without AB. Conclusions: Asymptomatic bacteriuria is the most common form of UTIs. Escherichia coli and Enterococcus faecium are predominant pathogens. Recurrent AB episodes, especially after the first month post-transplantation, may be considered either a risk factor or a marker of increased susceptibility to symptomatic infections. AB does not impair graft function in 24month observation. Even so, we recommend systematic screening for AB to identify those at risk of developing serious symptomatic infections to allow early detection and to introduce proper prophylaxis.

612 HISTORY OF RECURRENT URINARY TRACT INFECTION AND OTHER FACTORS ARE NOT PREDICTIVE OF ABNORMALITY ON VOIDING CYSTOURETHROGRAM

You have accessJournal of UrologyPediatrics: Imaging (Genital & Urinary Tract)/Infections and Vesicoureteral Reflux1 Apr 2012612 HISTORY OF RECURRENT URINARY TRACT INFECTION AND OTHER FACTORS ARE NOT PREDICTIVE OF ABNORMALITY ON VOIDING CYSTOURETHROGRAM Ariella Friedman, Cortney Wolfe-Christensen, Amanda Toffoli, Teresa Jones, Thomas Slovis, Jack Elder, and Yegappan Lakshmanan Ariella FriedmanAriella Friedman Detroit, MI More articles by this author , Cortney Wolfe-ChristensenCortney Wolfe-Christensen Detroit, MI More articles by this author , Amanda ToffoliAmanda Toffoli Detroit, MI More articles by this author , Teresa JonesTeresa Jones Detroit, MI More articles by this author , Thomas SlovisThomas Slovis Detroit, MI More articles by this author , Jack ElderJack Elder Detroit, MI More articles by this author , and Yegappan LakshmananYegappan Lakshmanan Detroit, MI More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2012.02.690AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Recent American Academy of Pediatrics guidelines against the use of a voiding cystourethrogram (VCUG) after most cases of initial pediatric febrile urinary tract infection (UTI) were made in order to spare patients the discomfort, expense, and radiation exposure associated with the study. It was simultaneously hoped that this would limit the study population to a group with higher theoretical risk for abnormality, increasing the pre-test probability of abnormal findings. Our study aimed to assess factors that may be associated with higher likelihood of abnormal VCUG, which would allow for more judicious recommendation of the test. METHODS A retrospective review was undertaken of all initial VCUGs performed at Children's Hospital of Michigan between January and June, 2010. Patients with prior VCUGs or history of VUR were excluded. Factors that were assessed for increased likelihood of VUR or other Urologic abnormality included degree of bladder distension with contrast medium, department of referring physician, listed indication for VCUG (i.e. UTI, hydronephrosis), mention of recurrent or multiple UTIs on the requisition, and mention of UTI and abnormality on imaging or history that might indicate the need for VCUG (i.e. hydronephrosis, family history of VUR). ANOVA and Chi-Square tests were performed where appropriate with SPSS. RESULTS Two hundred and sixty four patients underwent initial VCUG during this period. VUR was detected in 57 (21.5%), and Urologic abnormality including VUR was detected in 73 (27.7%). Degree of bladder distension (p=0.266), department of referring physician (p=0.755), indication for study (p=0.580), and history of recurrent UTI or UTI and other abnormality (p=0.742) were all not associated with increased likelihood of VUR. Similarly, degree of bladder distension (p=0.709), department of referring physician (p=0.472), indication for study (p=0.648), and history of recurrent UTI or UTI and other abnormality (p=0.949) were all not associated with increased likelihood of any Urologic abnormality on VCUG. CONCLUSIONS The likelihood of an abnormal VCUG is not increased when performed after recurrent UTI, nor when performed in the setting of UTI and other abnormality on history or radiologic exam. This reasons against postponing a VCUG until after a second UTI, as the probability of a positive finding is no greater in this setting. Degree of bladder distension during the study and department of referring physician further do not contribute to the likelihood of a positive study. © 2012 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 187Issue 4SApril 2012Page: e249 Advertisement Copyright & Permissions© 2012 by American Urological Association Education and Research, Inc.MetricsAuthor Information Ariella Friedman Detroit, MI More articles by this author Cortney Wolfe-Christensen Detroit, MI More articles by this author Amanda Toffoli Detroit, MI More articles by this author Teresa Jones Detroit, MI More articles by this author Thomas Slovis Detroit, MI More articles by this author Jack Elder Detroit, MI More articles by this author Yegappan Lakshmanan Detroit, MI More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Evidence of bladder oversensitivity in the absence of an infection in premenopausal women with a history of recurrent urinary tract infections

Study Type - Prevalence (case control) Level of Evidence 4. What's known on the subject? and What does the study add? Urinary tract infections (UTIs) have been implicated in the aetiology of interstitial cystitis/painful bladder syndrome (IC/PBS). Prior studies have described symptoms and laboratory tests suggestive of UTI at the onset of IC/PBS as well as a significant history of childhood recurrent UTIs. However, the mechanism by which recurrent UTIs contribute to the development of IC/PBS is not clear. Our study shows that women with recurrent UTI suffer from bladder oversensitivity. Our findings have useful clinical implications. Women with bladder oversensitivity complain of urinary frequency which is often misdiagnosed as an infection and treated with unnecessary antibiotics. Additionally, there are no effective therapies for bladder oversensitivity. Therefore, women with recurrent UTI should undergo prompt evaluation and treatment of episodes of infection to prevent the development of bladder oversensitivity. Our findings also provide a possible mechanism for the development of IC/PBS. Whether women with recurrent UTI are at increased risk for developing IC/PBS in the future will need to be confirmed in future studies. • To compare the mean voided volume and bladder sensation during filling cystometry in women with a history of recurrent urinary tract infection (UTI) and controls. • This was a case-control study including adult women seen in the urogynaecology clinic. • The cases were 49 women with at least three documented positive urine cultures >105 colonies/mL in the previous 12 months and no active infection at the time of data collection. • Controls were 53 women with stress urinary incontinence and no history of recurrent UTI or coexistent urge urinary incontinence. • We compared bladder diary variables and filling cystometry data in the absence of an active infection. • There was no significant difference in the median age, parity and body mass index of women with a history of recurrent UTI and controls. • The median number of voids per day and median number of voids per litre of fluid intake was significantly greater in women with recurrent UTI than controls (12 vs 7 voids/day and 6 vs 4 voids/L, P= 0.005 and P= 0.004 respectively). • The median average voided volume was significantly lower in women with recurrent UTI than controls (155 vs 195 mL, P= 0.008). • On filling cystometry, median volumes of strong desire to void and maximum cystometric capacity were significantly lower in women with recurrent UTI than controls (all P < 0.05). • In the absence of an infection, premenopausal women with a history of recurrent UTI have significantly greater urinary frequency, lower average voided volume and a lower threshold of bladder sensitivity than controls.