Initial Urinary Tract Infection Research Articles

Antimicrobial Resistance Patterns in Pediatric Urinary Tract Infections: Insights from Hospitalized Children in Sudan

Introduction: Urinary tract infections (UTIs) are among the most common bacterial diseases in children, affecting 3–5% of girls and 1% of boys, and leading to significant antibiotic exposure in this population. Initial UTI treatment is often empirical, based on symptomatology without microbiological confirmation. Objective: This study aimed to identify the causative agents of UTIs in children, evaluate antimicrobial resistance rates, and recommend appropriate antibiotics. Materials and Methods: A cross-sectional study was conducted on 67 urine samples collected from hospitalized children at Gaafar Bin Ouf Children's Hospital in Khartoum, Sudan. Samples were processed for bacterial isolation, identification, and antimicrobial susceptibility testing using the Kirby-Bauer method. Results: Among the isolates, 24 (35.8%) were Staphylococcus aureus, 20 (29.9%) Klebsiella spp., 14 (20.9%) Escherichia coli, 8 (11.9%) Pseudomonas spp., and 1 (1.5%) Proteus spp. The highest resistance rates were observed for Amoxyclav (68.7%) and Erythromycin (61.2%), while Gentamicin (40.3%), Ciprofloxacin (43.3%), and Penicillin (46.3%) showed lower resistance rates. Conclusion: Staphylococcus aureus was the most common UTI pathogen in hospitalized children, with high resistance rates to Amoxyclav and Erythromycin. These findings highlight the need for regular resistance monitoring and revising empirical antibiotic protocols to improve treatment outcomes.

The Importance of Diagnostics in the Treatment of Urinary Tract Infections in the United Kingdom.

Current diagnosis of urinary tract infections (UTIs) in the UK initially relies on self-reported patient symptoms with no point-of-care test robust enough to accurately identify the causative pathogen and inform on antibiotic susceptibility. In serious UTI cases, standard urine culture is regarded as the gold standard for diagnosis and involves direct isolation, culture and antibiotic susceptibility testing of pathogens. These methods are not suitable in initial UTI diagnosis and treatment because of the time taken to conduct these analyses (≥3 days). Inaccurate and slow diagnostics can lead to unnecessary or incorrect antibiotic prescribing, which can lead to increased antimicrobial resistance and poorer patient outcomes. Novel point-of-care testing devices are urgently needed to improve the diagnostics of UTIs. In this article, we highlight novel point-of-care tests which are in development that can detect UTI-causing pathogens rapidly and accurately. These devices require additional studies to prove their clinical utilities. Adoption of these technologies can empower general practitioners (GPs) and pharmacists in prescribing decisions and improve antimicrobial stewardship.

Trends in urine sampling rates of general practice patients with suspected lower urinary tract infections in England, 2015–2022: a population-based study

ObjectivesInappropriate prescribing of antibiotics is a key driver of antimicrobial resistance. This study aimed to describe urine sampling rates and antibiotic prescribing for patients with lower urinary tract infections (UTIs)...

Evaluating the requirement of ultrasonography for children with their first urinary tract infection

Management of urinary tract infection (UTI) in children remains important. It may be the first sign for a possible underlying congenital abnormalities for the kidney and urinary tract (CAKUT). This study examined whether performing renal and bladder ultrasonography (RBUS) only for children who have a pathogen other than E. coli during their first urinary tract infection (UTI), or who experience UTI recurrence, would result in more missed diagnoses of kidney anomalies. Patients aged between 2 months and 2 years who were seen in a tertiary pediatric hospital during a 2-year period and diagnosed with UTI were included. RBUS and voiding cystourethrography (VCUG) were performed according to American Academy of Pediatrics (AAP) guidelines. Afterwards, we looked back and evaluated how often we found kidney problems when we only did a RBUS on patients who had an atypical cause of their first UTI or who had multiple UTIs. One hundred and seventy-eight patients who were followed up with UTI were included in this study. The isolated pathogen was E. coli in 104 cases (58.4%) and atypical in 74 cases (41.6%). VCUG was conducted on 40 patients, and vesicoureteral reflux (VUR) was discovered in 16 cases and ureteropelvic junction obstruction (UPJO) was discovered in 1 case. A different diagnostic approach that required the presence of an atypical pathogen at the first UTI or a fUTI recurrence to perform the RBUS would have missed just two severe kidney anomalies. It was observed that there could be a decrease of 40.4% in RBUS and at least 20% in VCUG. A diagnostic approach that necessitates the presence of an abnormal pathogen during the initial UTI or a second UTI episode for the RBUS to be carried out would lead to fewer negative ultrasounds with minimal risk of overlooking kidney anomalies.

The First ABO Incompatible Kidney Transplantation without Splenectomy in India - A Review at 12 Years.

The First ABO Incompatible Kidney Transplantation without Splenectomy in India - A Review at 12 Years.

Urologic practice patterns of pediatricians: a survey from a large multisite pediatric care center.

To evaluate the practice patterns of pediatricians as they relate to common urologic concerns. An anonymous 15-question survey was created and distributed to all pediatricians at our institution, a large multisite care center. This study was deemed exempt by the institutional review board. 55 of the 122 (45%) providers queried responded. 93% of the participants were female, and 7.3% were male. 55% recommended testicular self-examination at adolescence, while 39% did not recommend at any age. 78% stated that they were "Fairly confident" in the exam for undescended testicle (UTD). One-third referred patients with UDT to a subspecialist upon recognition at birth, 13% at 3 months of age, and 28% at 6 months of age. 10% reported obtaining a VCUG after the first febrile urinary tract infection (UTI), 26% after the second, and 36% only if there were abnormal findings on renal ultrasound. 28% of providers reported that they refer to pediatric urology after the initial febrile UTI. 19% provided antibiotics for UTI symptoms alone with negative urinalysis and urine culture. Despite established guidelines, practice patterns varied among pediatricians. Pediatricians typically followed the AAP's guidelines regarding VCUGs (62%), with only a few adhering to urologic recommendations (9%). Despite the consistency between AAP and AUA guidelines regarding the age at which to refer a patient for cryptorchidism, about 70% of practitioners referred patients too early or too late. Harmonized, consolidated guidelines between pediatricians and pediatric urologists would improve patient care and efficiency of the healthcare system.

Predicting factors of clinically significant urological anomalies after initial urinary tract infection among 2- to 24-month-old children.

To find more effective criteria to identify clinically significant urological anomalies after initial urinary tract infection among children. Children aged 2-24months with an initial urinary tract infection were consecutively recruited in a Japanese hospital from 2013 to 2019. Voiding cystourethrography, 99mTc dimercaptosuccinic acid scan and ultrasound were intended to perform for all cases. Clinically significant urological anomalies were defined as high-grade vesicoureteral reflux, obstructive and abnormal urinary tract lesions, need for surgical intervention, renal hypoplasia and scarring. Using classification and regression tree analysis, we sought the associated factors. We developed new criteria with these factors, retrospectively applied them to the original data, and calculated the sensitivity and specificity. One hundred sixty-seven patients were eligible, and 39 had clinically significant urological anomalies. Classification and regression tree analysis showed that the associated factors were non-E. coli infections, serum creatinine levels and ultrasound abnormalities. When the gold standards were performed on children with non-E. coli infections or serum creatinine levels ≥0.21mg/dl, sensitivity and specificity were 0.82 and 0.68, respectively. The criteria including non-E. coli infections and high-normal or higher serum creatinine levels may efficiently predict clinically significant urological anomalies after initial urinary tract infections.

Fecal impaction detected by imaging predicts recurrent urinary tract infection.

Few studies have evaluated the efficacy of ultrasonography (US) and abdominal radiography in assessing bladder and bowel dysfunction in children aged <24 months. We aimed to investigate the association between the risk of urinary tract infection (UTI) recurrence and fecal impaction using imaging findings. The medical records of 121 children (aged <24 months) with initial febrile UTI (fUTI) who were admitted to the authors' institution from January 2004 to September 2019 were reviewed retrospectively. We evaluated the rectal diameters of children with suspected fecal impaction that were measured using transabdominal US, or the rectal diameters divided by the distance between the ischial spines that were measured using abdominal radiography. Based on previous reports, we defined fecal impaction as a transabdominal US score of >30 mm or an abdominal radiography score of >0.5. The definition of functional constipation was based on the child/adolescent Rome IV criteria - i.e., a maximum stool frequency of twice per week. The median age at initial fUTI diagnosis was 4 months. The occurrence of fecal impaction identified via imaging was significantly greater in patients with UTI recurrence than in those without recurrence: yes/no: 17/9 (65.4%) versus 35/60 (36.8%); P = 0.013. On the other hand, the occurrence rates of constipation based on stool frequency did not differ between the two groups. In multiple logistic analyses, fecal impaction detected via imaging was identified as an independent risk factor for fUTI recurrence. Fecal impaction observed via US and abdominal radiography may be useful in predicting the recurrence of fUTI in children.

A Study on Antibiotic Sensitivity Pattern in Children Hospitalized for Urinary Tract Infection in a Tertiary Care Hospital in South India

Abstract: Background: The etiology of urinary tract infection (UTI) and their antibiotic sensitivity pattern vary from time to time and across different areas in India. This study is designed to analyse the resistance of uropathogens to commonly used antibiotics. Aim: To study antibiotic resistance trends of uropathogens and assess the antimicrobial utilization pattern according to the antimicrobial susceptibility test in the paediatric department of a tertiary care hospital. Materials and Methods: It was an ambispective observational cohort study conducted in 144 patients admitted with UTI for a period of one year and observed for recurrent UTI for the next one year. Results: E. coli (50%) was found to be the most common cause of UTI followed by Klebsiella (22.22%). E. coli and other isolates were more sensitive to Meropenem and Amikacin compared to other antibiotics tested. These isolates show increasing resistance to commonly used antibiotics. Most (74.31%) children were given single antimicrobial agent. Majority of the children were prescribed with Cephalosporins (60.41%), followed by Penicillin derivatives (29.17%) and Carbapenems (11.11%). Out of 144 children, antibiotics were prescribed according to culture sensitivity report in only 31.94%. Among children whose antibiotics were not selected based on the culture report, 40 had recurrent UTI in the following year. Conclusion: Recurrent UTI can occur if adequate antimicrobial therapy based on antimicrobial susceptibility test is not administered during the initial UTI episode. Close cooperation between physicians, microbiologists and pharmacists is essential to ensure that UTI patients receive antimicrobial therapy, if required based on local susceptibility data. Key words: UTI, Uropathogens, Antimicrobials, Pediatrics, Antibiotic resistance.

Oral steroids for reducing kidney scarring in young children with febrile urinary tract infections: the contribution of Bayesian analysis to a randomized trial not reaching its intended sample size

BackgroundThis study aimed to evaluate the effect of oral dexamethasone in reducing kidney scars in infants with a first febrile urinary tract infection (UTI).MethodsChildren aged between 2 and 24 months with their first presumed UTI, at high risk for kidney scarring based on procalcitonin levels (≥1 ng/mL), were randomly assigned to receive dexamethasone in addition to routine care or routine care only. Kidney scars were identified by kidney scan at 6 months after initial UTI. Projections of enrollment and follow-up completion showed that the intended sample size could not be reached before funding and time to complete the study ran out. An amendment to the protocol was approved to conduct a Bayesian analysis.ResultsWe randomized 48 children, of whom 42 had a UTI and 18 had outcome kidney scans (instead of 128 planned). Kidney scars were found in 0/7 and 2/11 patients in the treatment and control groups respectively. The probability that dexamethasone could prevent kidney scarring was 99% in the setting of an informative prior probability distribution (which fully incorporated in the final inference the information on treatment effect provided by previous studies) and 98% in the low-informative scenario (which discounted the prior literature information by 50%). The probabilities that dexamethasone could reduce kidney scar formation by up to 20% were 61% and 53% in the informative and low-informative scenario, respectively.ConclusionsDexamethasone is highly likely to reduce kidney scarring, with a more than 50% probability to reduce kidney scars by up to 20%.Trial registration numberEudraCT number: 2013-000388-10; registered in 2013 (prospectively registered)Graphical A higher resolution version of the Graphical abstract is available as Supplementary information

Metal-Organic Framework Enhanced Cellular and Humoral Immune Response Against Sepsis Causing Infection

Urinary tract infection (UTI) is the most common adult bacterial infections worldwide, with ~80% of all uncomplicated UTI caused by uropathogenic E. coli (UPEC). While anyone can develop a UTI, women in their 20’s and postmenopausal women are at particularly high risk—indeed, half of all women will develop a UTI in their lifetime. Even with antibiotic therapy, 25-50% of patients will experience recurrence within a year.1 Initial and subsequent UTIs can alter bladder epithelial cell barrier function, which in turn creates an environment more favorable to subsequent infection.2 This results in recurrent UTI, which requires long-term antimicrobial therapy and can reoccur in a patient indefinitely, causing a lifetime of pain, discomfort, and an elevated risk of septicemic death.3 Unfortunately, antibiotic resistance makes treating UTIs less effective. Indeed, 10–25% of uncomplicated UTI patient isolates are resistant to trimethoprim/sulfamethoxazole (TMP/SMX)—the standard-of-care antibiotic regime for UTI.4 , 5 Alarmingly, >70% of postmenopausal recurrent UTI patients are either allergic or resistant to TMP-SMX.5 Given the ubiquity of these infections and the high likelihood of recurrence, the societal cost is estimated to be over $5 billion each year in the US alone.6 A prophylactic or therapeutic vaccine would be an ideal first line of defense against UTIs for high risk groups, but no FDA-approved vaccines against UTI—or indeed any pathogenic E. coli infection—exist.7

Prevalence And Antimicrobial Susceptibility Patterns Of Bacteria Isolated From Urinary Tract Infections (UTIs) In Children At Children Hospital In Baghdad

Background: First six to twelve months after initial urinary tract infection, most infections are caused by Escherichiacoli, although in the first year of life Klebsiella pneumoniae, Pseudomonas, Enterobacter spp andEnterococcus spp, are more frequent than later in life, and there is a higher risk of urosepsis compared with adulthood&#x0D; Objectives: To determine the prevalence of bacterial isolates from Urinary Tract Infections of children at a children hospital in Baghdad and their antimicrobial susceptibility patterns.&#x0D; Type of the study: Cross-sectional study.&#x0D; Methods: During six months of study (1 June to 31 December, 2016), 117urine specimens were collected from a children hospital in Baghdad.&#x0D; Results: Out 38 isolates of Gram positive and Gram negative bacteria were obtained from urine specimens in a percentage of 5(13.2%) and 33(86.8%),respectively. The lowest incidence was among the 11-15 years old age group (11.9%) whereas the highest incidence was among the 1-5 years old age group (43.6%)(P≤0.05).Also out of 38positive cultures, the incidence was higher in females 31(81.6%)than that of males 7(18.4%).&#x0D; Out of 38 positive cultures, the isolation rate was 5(13.2%) for Gram positive isolates and 33(86.8%)for Gram negative isolates. The most frequently isolated bacteria was Escherichia coli19(50%)(P-value ≤ 0.05), while the only isolated Gram positive was Staphylococcus aureus5(42.86%) isolates.The most effective antibiotics for Staphylococcus aureus isolates were Vancomycin and Amikacinfor (100%) and for Gram negative isolates wasimipenem (100%). Ampicillin showed the highest resistance rate for both Gram positive and Gram negative isolates(100%) and Pesudomonas aeruginsa isolates showed the highest resistant rates to most antibiotics under study.&#x0D; Conclusions: The most frequently isolated bacteria was E. coli from all urine cultures and the most effective antibiotics for Staphylococcus aureus isolates were Vancomycin and Amikacinfor

RETRACTED ARTICLE: Childhood iron deficiency anemia leads to recurrent respiratory tract infections and gastroenteritis

Anemia affects approximately 30% of children all over the world. Acute respiratory tract infections (ARTI), urinary tract infections (UTI) and gastroenteritis (GE) are common infectious entities in children. Here, we assessed the association between anemia and development of recurrent ARTI, UTI, and GE in children. This was a case-control study in hospitalized 2–5 years old children in Professorial Pediatric Unit at Teaching Hospital Anuradhapura, Sri Lanka. An 18-month follow up was done to assess the risk factors for the development of recurrent ARTI, GE, UTI, and control presented without infections. Further, 6-month follow up done after 3-month iron supplementation to assess the occurrence of recurrences. Blood Hb concentration was measured using Drabking’s reagent. Logistic regression was used to find the risk factors for the development of recurrences. In ARTI, 121/165 (73.3%), GE, 88/124 (71%), UTI 46/96 (47.9%) and control 40/100 (40%) were having anemia. Initial ARTI group, recurrent ARTI was 24 (14.5%, p = 0.03); initial GE group: recurrent GE was 14 (11.3%, p = 0.03), recurrent ARTI was 11 (8.9%, p = 0.04); initial UTI group, development of; recurrent UTI was 8 (8.3%, p = 0.04); control, recurrent ARTI was 11 (11%, p = 0.03). Following 3-month iron supplementation reduction of recurrences was significant: initial ARTI recurrent ARTI in 90%, recurrent GE in 77.7%; initial GE recurrent GE in 83.3%, recurrent ARTI in 80%; initial UTI recurrent ARTI in 71.4% and control recurrent ARTI in 88.8%. Iron deficiency is a major type of anemia and anemic children are more prone to develop recurrent ARTI and GE. Once iron deficiency being corrected the rate of recurrent ARTI and GE was reduced. This would be a boost for policy developers to implement strategies at the community level to prevent iron deficiency in children to reduce ARTI and GE recurrences.

50 Years Ago in The Journal ofPediatrics: Initial Urinary Tract Infections, Observations in Children without Major Radiologic Abnormalities

50 Years Ago in The Journal ofPediatrics: Initial Urinary Tract Infections, Observations in Children without Major Radiologic Abnormalities

Targeted Workup after Initial Febrile Urinary Tract Infection: Using a Novel Machine Learning Model to Identify Children Most Likely to Benefit from Voiding Cystourethrogram.

Significant debate persists regarding the appropriate workup in children with an initial urinary tract infection. Greatly preferable to all or none approaches in the current guideline would be a model to identify children at highest risk for a recurrent urinary tract infection plus vesicoureteral reflux to allow for targeted voiding cystourethrogram while children at low risk could be observed. We sought to develop a model to predict the probability of recurrent urinary tract infection associated vesicoureteral reflux in children after an initial urinary tract infection. We included subjects from the RIVUR (Randomized Intervention for Children with Vesico-Ureteral Reflux) and CUTIE (Careful Urinary Tract Infection Evaluation) trials in our study, excluding the prophylaxis treatment arm of the RIVUR. The main outcome was defined as recurrent urinary tract infection associated vesicoureteral reflux. Missing data were imputed using optimal tree imputation. Data were split into training, validation and testing sets. Machine learning algorithm hyperparameters were tuned by the validation set with fivefold cross-validation. A total of 500 subjects, including 305 from the RIVUR and 195 from the CUTIE trials, were included in study. Of the subjects 90% were female and mean ± SD age was 21 ± 19 months. A recurrent urinary tract infection developed in 72 patients, of whom 53 also had vesicoureteral reflux (10.6% of the total). The final model included age, sex, race, weight, the systolic blood pressure percentile, dysuria, the urine albumin-to-creatinine ratio, prior antibiotic exposure and current medication. The model predicted recurrent urinary tract infection associated vesicoureteral reflux with an AUC of 0.761 (95% CI 0.714-0.808) in the testing set. Our predictive model using a novel machine learning algorithm provided promising performance to facilitate individualized treatment of children with an initial urinary tract infection and identify those most likely to benefit from voiding cystourethrogram after the initial urinary tract infection. This would allow for more selective application of this test, increasing the yield while also minimizing overuse.

The use of steroid cream for physiologic phimosis in male infants with a history of UTI and normal renal ultrasound is associated with decreased risk of recurrent UTI

An uncircumcised male infant with a history of urinary tract infection (UTI), physiologic phimosis, and a normal renal ultrasound is a common patient referred to pediatric urology clinics. Topical steroid creams have been shown to effectively release physiologic phimosis. The objective of this study was to test the hypothesis that use of steroid cream for physiologic phimosis is associated with a lower UTI recurrence in uncircumcised male infants with normal renal ultrasounds. Uncircumcised males younger than 12 months referred for a UTI with a normal renal ultrasound were included. A longitudinal data set was created, and recurrent UTIs were identified. The proportion with a recurrent UTI was compared between those who received a prescription for a steroid cream for phimosis and those who did not. The morbidity of the initial and recurrent UTIs was also described. The association of recurrent UTI with vesicoureteral reflux (VUR) was also evaluated. A total of 192 uncircumcised males with a median age of 5.8 months (interquartile range [IQR]: 3.5-7.9 months) were included. Twenty-seven patients were treated with a course of betamethasone valerate 0.1% cream, and 165 were not (Summary Table). There were no significant differences between groups in the frequency of voiding cystourethrogram (VCUG), diagnosis of VUR, or use of continuous prophylactic antibiotics (CAP). During a median follow-up of 8.7 months (IQR: 3.1-17.5 months), none of the patients treated with steroid cream had a recurrent UTI compared with 27 of 165 (16%) patients not treated (P=0.02). Among the 173 patients whose initial UTI was febrile, recurrent febrile UTIs occurred in no treated patients and 23 of 150 (15%) untreated patients (P=0.047). The results of this study are consistent with those of a previous randomized trial of steroid cream for physiologic phimosis which found lower recurrent UTI in those whose foreskins became retractable. In addition, the results are consistent with the declining incidence of UTIs in uncircumcised males mirroring the natural history of physiologic phimosis resolving. This study is limited by its retrospective nature and non-standardized follow-up. The use of steroid cream for physiologic phimosis is associated with a decreased risk of recurrent UTIs in uncircumcised male infants with a normal renal ultrasound. In this group, steroid cream for physiologic phimosis is a well-tolerated and simple alternative to circumcision to potentially decrease risk of recurrent UTI.

Therapy of urinary tract infections in gynecological practice

The urinary tract infection continue to exert significant impact on millions of patients worldwide, most of whom are otherwise healthy reproductive women. Antibiotic therapy for acute cystitis does not prevent recurrences, which plague up to one fourth of women after an initial urinary tract infection. Rising antimicrobial resistance among uropathogenic bacteria further complicates therapeutic decisions, necessitating new approaches based on fundamental investigation.

Antibiotic management of urinary tract infection in elderly patients in primary care and its association with bloodstream infections and all cause mortality: population based cohort study

ObjectiveTo evaluate the association between antibiotic treatment for urinary tract infection (UTI) and severe adverse outcomes in elderly patients in primary care.DesignRetrospective population based cohort study.SettingClinical Practice Research Datalink (2007-15)...

Urinary Tract Infection in Children

Urinary tract infections (UTI) are common among children. In the past 20 years, a number of key trials have substantially changed practice, in addition to clarifying the natural history of children managed expectantly. It is now clear that among children with normal kidneys at presentation, chronic kidney disease and hypertension are rare. Improved antenatal ultrasound now detects most significant abnormalities of the kidney and urinary tract, particularly severe hypodysplasia, which is often associated with high-grade vesico-ureteric reflux (VUR). This review aims to summarize the evidence-based treatment of UTI in children. There is no difference in symptomatic, microbiologic, or renal outcomes between intravenous and oral antibiotics in treating acute, febrile infection. Long-term antibiotic prophylaxis results in a statistically but not clinically significant reduction in recurrence among young children, with or without VUR. Trials to-date have failed to demonstrate that the surgical correction of VUR confers any additional benefit, which may be because the natural history of VUR is to resolution with time and/or that other factors are more important determinants of outcome. A more conservative approach to the management of UTI is warranted for most children. Antibiotic prophylaxis, voiding cystourethrography, and surgery for VUR are not indicated following an initial or infrequent UTI. These measures may have a role in selected subgroups of children at high risk of kidney disease, but this remains a hypothesis pending the results of ongoing trials.

ProteoStorm: An Ultrafast Metaproteomics Database Search Framework.

Shotgun metaproteomics has the potential to reveal the functional landscape of microbial communities but lacks appropriate methods for complex samples with unknown compositions. In the absence of prior taxonomic information, tandem mass spectra would be searched against large pan-microbial databases, which requires heavy computational workload and reduces sensitivity. We present ProteoStorm, an efficient database search framework for large-scale metaproteomics studies, which identifies high-confidence peptide-spectrum matches (PSMs) whileachieving a two-to-three orders-of-magnitude speedup over popular tools. A reanalysis of a urinary tract infection (UTI) dataset of 110 individuals revealed a complex pattern of polymicrobial expression, including sub-types of UTIs, cases of bacterial vaginosis, and evidence of no underlying disease. Importantly, compared to the initial UTI study thatrestricted the search database to a manually curated list of 20 genera, ProteoStorm identified additional genera that were previously unreported, including a case of infection with the rare pathogen Propionimicrobium.