Marker Of Urinary Tract Infection Research Articles

Accuracy of NGAL as a Biomarker for Urinary Tract Infection in Young Febrile Children: An Individual Patient Data Meta-Analysis

To compare the accuracy of urine neutrophil gelatinase-associated lipocalin (NGAL) and leukocyte esterase (LE) for the diagnosis of urinary tract infection (UTI) in children. We performed a systematic review and individual patient data meta-analysis of studies that examined urine NGAL as a marker of UTI in children <18years of age. We created a standardized definition of UTI and applied it to all included children. We compared sensitivity, specificity, and the area under the receiver operating characteristic curve (AUC) of NGAL with LE. We included individual patient data from 3 studies for a total of 845 children. Included children had a mean age of 0.9years (SD, 0.6years). Using a cutoff of 32.7ng/mL, NGAL had a sensitivity of 90.3% (95% CI: 83.2%-95.0%) and specificity of 93.7% (95% CI: 91.7%-95.4%) for the diagnosis of UTI. LE, using a cutoff of ≧ trace had a sensitivity of 81.1% (95% CI: 72.5%-87.9%) and specificity of 97.0% (95% CI: 95.4%-98.1%). The AUC for NGAL was 0.95 (95% CI: 0.92-0.98). The AUC for LE was 0.90 (95% CI: 0.86-0.93). In young, febrile children, urinary NGAL is more sensitive for the diagnosis of UTI than LE but is slightly less specific.

Laboratory markers of urinary tract infection in children: current state and prospects

Urinary tract infection (UTI) is a common and important clinical problem in all age groups. Diagnosis of UTI without localization is not difficult, while the differential diagnosis of UTI is complicated by the lack of specific criteria for pyelonephritis and cystitis. The presence of certain clinical symptoms in combination with a positive bacteriological examination of urine does not allow us to reliably determine the localization of the inflammatory process in the urinary system, which is important due to the different approaches to the treatment of pyelonephritis and cystitis. The review considers in detail the data of studies demonstrating insufficient sensitivity and specificity of the accepted markers of urinary tract infection. Studies have found that ESR and CRP cannot act as specific markers for UTI, especially in children with fever. It has been shown that the procalcitonin test can be considered as such a marker, however, a limited number of studies and a noticeable heterogeneity between studies do not allow us to state this fact definitely. In this regard, it is necessary to search for modern, more accurate biomarkers, that allow differentiating pyelonephritis and cystitis at the earliest stages. The article presents data of modern studies, demonstrating the role of cytokines as biomarkers of UTI, showing their role in differentiating UTI of the lower and upper parts. In addition, the potential role of antimicrobial peptides as diagnostic markers of UTI is considered.

Urinary HSP70 improves diagnostic accuracy for urinary tract infection in children: UTILISE study.

The accuracy of conventional urinalysis in diagnosing urinary tract infection (UTI) in children is limited, leading to unnecessary antibiotic exposure in a large fraction of patients. Urinary heat shock protein 70 (uHSP70) is a novel marker of acute urinary tract inflammation. We explored the added value of uHSP70 in discriminating UTI from other infections and conditions confused with UTI. A total of 802 children from 37 pediatric centers in seven countries participated in the study. Patients diagnosed with UTI (n = 191), non-UTI infections (n = 178), contaminated urine samples (n = 50), asymptomatic bacteriuria (n = 26), and healthy controls (n = 75) were enrolled. Urine and serum levels of HSP70 were measured at presentation in all patients and after resolution of the infection in patients with confirmed UTI. Urinary (u)HSP70 was selectively elevated in children with UTI as compared to all other conditions (p < 0.0001). uHSP70 predicted UTI with 89% sensitivity and 82% specificity (AUC = 0.934). Among the 265 patients with suspected UTI, the uHSP70 > 48ng/mL criterion identified the 172 children with subsequently confirmed UTI with 90% sensitivity and 82% specificity (AUC = 0.862), exceeding the individual diagnostic accuracy of leukocyturia, nitrite, and leukocyte esterase positivity. uHSP70 had completely normalized by the end of antibiotic therapy in the UTI patients. Serum HSP70 was not predictive. Urine HSP70 is a novel non-invasive marker of UTI that improves the diagnostic accuracy of conventional urinalysis. We estimate that rapid urine HSP70 screening could spare empiric antibiotic administration in up to 80% of children with suspected UTI. A higher resolution version of the Graphical abstract is available as Supplementary information.

Puberty health intervention to improve menstrual health and school attendance among adolescent girls in The Gambia: study methodology of a cluster-randomised controlled trial in rural Gambia (MEGAMBO TRIAL)

BackgroundMenstrual health (MH) is a recognised global public health challenge. Poor MH may lead to absence from school and work, and adverse health outcomes. However, reviews suggest a lack of rigorous evidence for the effectiveness of MH interventions on health and education outcomes. The objective of this paper is to describe the methods used in a cluster-randomised controlled trial to estimate the effect of a multi-component intervention to improve MH and school attendance in The Gambia.MethodsThe design ensured half the schools (25) were randomised to receive the intervention which comprised of the following components: (i) Peer education camps and menstrual hygiene laboratories in schools, (ii) Mother’s outreach sessions, (iii) Community meetings, and (iv) minor improvements of school Water Sanitation and Hygiene (WASH) facilities and maintenance. The intervention was run over a three-month period, and the evaluation was conducted at least three months after the last intervention activity was completed in the school or community. The other 25 schools acted as controls. Of these 25 control schools one Arabic school dropped out due to COVID-19. The primary outcome was the prevalence of girls missing at least one day of school during their last period. Secondary outcomes included: Urinary Tract Infection (UTI) symptoms, biochemical markers of UTI in urine, Reproductive Tract Infection symptoms, self-reported menstruation related wellbeing, social support and knowledge, perceptions and practices towards menstruation and MH in target school girls. In addition, a process evaluation using observations, routine monitoring data, survey data and interviews was undertaken to assess dose and reach (quantitative data) and assess acceptability, fidelity, context and possible mechanisms of impact (qualitative data). Cost and cost-effectiveness of the intervention package will also be assessed.ConclusionResults will add to scarce resources available on effectiveness of MH interventions on school attendance. A positive result may encourage policy makers to increase their commitment to improve operation and maintenance of school WASH facilities and include more information on menstruation into the curriculum and help in the reporting and management of infections related to adolescent menstruation.Trial Registration PACTR, PACTR201809769868245, Registered 14th August 2018, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=3539

Plasma D-Dimer as a Marker of Urinary Tract Infection in Children

Background: Urinary tract infections (UTIs) are very common in children. Several biomarkers have been used for the diagnosis of UTI and prediction of renal parenchymal involvement. Objectives: This study aimed to evaluate plasma D-dimer as a diagnostic marker of UTI in children. Methods: This cross-sectional study included 41 children aged 1 month to 14 years with their first febrile UTI confirmed by positive urine culture referred to Bandar Abbas Children’s Hospital, Iran, from October 1, 2017, to April 1, 2018. Participants’ demographic features, including age and gender were recorded. White blood cell (WBC) count, percentage of neutrophils, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and serum D-dimer were measured in random blood samples for all the patients. Results: Out of 41 children (mean age: 5.50 ± 4.01 years) evaluated in this study, 6 (14.6%) were male, and 35 (85.4%) were female. The mean plasma D-dimer level was 1496.49 ± 2787.55 µg/L. A significant positive correlation was found between D-dimer with ESR (r = 0.647, P = 0.026) and CRP (r = 0.525, P = 0.001). Plasma D-dimer was not associated with age; however, age was inversely correlated with WBC count (r = -0.327, P = 0.037). No significant relationship was found between plasma D-dimer, ESR, CRP, WBC count, and neutrophil percentage with gender (P &gt; 0.05). Conclusions: According to our results, in children aged 1 month to 14 years with culture-confirmed UTI, plasma D-dimer is positively correlated with ESR and CRP. Nevertheless, D-dimer appears not to be influenced by age or gender. Further studies are required to confirm the utility of D-dimer as a diagnostic marker of UTI in children.

\u201cA false sense of confidence\u201d The perceived role of inflammatory point-of-care testing in managing urinary tract infections in Dutch nursing homes: a qualitative study

BackgroundDiagnosing urinary tract infections (UTI) in nursing home residents is complex, due to frequent non-specific symptomatology and asymptomatic bacteriuria. The objective of this study was to explore health care professionals’ perceptions of the proposed use of inflammatory marker Point-Of-Care Testing (POCT) in this respect.MethodsWe conducted a qualitative inquiry (2018–2019) alongside the multicenter PROGRESS study (NL6293), which assessed the sensitivity of C-reactive protein and procalcitonin POCT in UTI. We used semi-structured face-to-face interviews. The participants were physicians (n = 12) and nurses (n = 6) from 13 nursing homes in the Netherlands. Most respondents were not familiar with inflammatory marker POCT, while some used POCT for respiratory tract infections. Both the interview guide and the analysis of the interview transcripts were based on the Consolidated Framework for Implementation Research.ResultsAll respondents acknowledged that sufficiently sensitive POCT could decrease diagnostic uncertainty to some extent in residents presenting with non-specific symptoms. They primarily thought that negative test results would rule out UTI and justify withholding antibiotic treatment. Secondly, they described how positive test results could rule in UTI and justify antimicrobial treatment. However, most respondents also expected new diagnostic uncertainties to arise. Firstly, in case of negative test results, they were not sure how to deal with residents’ persisting non-specific symptoms. Secondly, in case of positive test results, they feared overlooking infections other than UTI. These new uncertainties could lead to inappropriate antibiotics use. Therefore, POCT was thought to create a false sense of confidence.ConclusionsOur study suggests that inflammatory marker POCT will only improve UTI management in nursing homes to some extent. To realize the expected added value, any implementation of POCT requires thorough guidance to ensure appropriate use. Developing UTI markers with high negative and positive predictive values may offer greater potential to improve UTI management in nursing homes.

Urinary neutrophil gelatinase-associated lipocalin: a marker of urinary tract infection among febrile children.

BackgroundNeutrophil gelatinase-associated lipocalin (NGAL) has emerged as a valuable biomarker of urinary tract infection (UTI) in children.PurposeThis study aimed to compare the diagnostic accuracy of urinary NGAL (uNGAL) with those of serum C-reactive protein (CRP) and white blood cell (WBC) count for predicting UTI and acute pyelonephritis (APN) in febrile children.MethodsThe medical charts of children undergoing uNGAL measurements between November 2017 and August 2019 were retrospectively reviewed. Patients with a suspected or diagnosed UTIs were included. The diagnostic accuracies of uNGAL, serum CRP, and WBC count for detecting UTI and APN were investigated. Independent predictors of UTI and APN were investigated using multivariable logistic regression analyses.ResultsA total of 321 children were enrolled in this study. The uNGAL levels were higher in the UTI group (n=157) than in the non-UTI group (n=164) (P<0.05). Among children with a UTI, uNGAL levels were higher in the APN group (n=70) than, the non-APN group (n=87) (P<0.05). In the multivariate analysis, uNGAL was independently associated with UTI and APN (both P<0.05). Serum CRP and WBC count were not correlated with the presence of UTI and APN. Receiver operating curve analyses showed that the uNGAL level had the highest area under the curve (AUC) for predicting UTI and APN, respectively (AUC, uNGAL vs. CRP vs. WBC count, 0.860 vs. 0.608 vs. 0.669 for UTI; 0.780 vs. 0.680 vs. 0.639 for APN, all P<0.05, respectively). The predictive values and likelihood ratios of uNGAL were superior to those of serum CRP and WBC count for detecting UTI and APN at each cutoff level.ConclusionUNGAL may be more useful than serum CRP and WBC count for identifying and assessing UTI in febrile children.

Analysis of urine as an indicator of specific body conditions in pregnant women in rural mountainous region

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Urinalysis is a procedure for examining physical properties, particulate matter, cells, casts, crystals, organisms and solutes. Urinalysis is a routine screening and diagnostic tool used to identify infections including renal, urological, liver disease, diabetes mellitus and urinary tract infection (UTI). Urinalysis can be used to screen, glucose, leucocytes, nitrite and blood. Although urinalysis is an effective screening tool it should not be used in isolation to guide treatment because false positives, for example, nitrites, and false negatives, for example, glucose, can occur if the sample is contaminated or left to stand for too long. UTI is among the leading reasons for treatment in adult primary care medicine, accounting for a considerable percentage of antibiotic prescriptions. Aim of this study is to identify the markers of urinary tract infection by urine routine microscopic analysis in pregnant women.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This was a two months prospective study from June 1st 2019 to July 31st 2019. Urine samples of 72 pregnant women coming routinely to OPD of GMC, Doda were examined by physical and biochemical analysis by microscopy methods. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Majority of samples were pale yellow with turbid appearance. Protein was present in most of the samples whereas glucose was present in a minor number of samples. Microscopy revealed increase in pus and epithelial cells count in most of the samples while bacteria were present in almost half of the samples.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; To conclude from the present study that appearance, presence of protein, pus cells, epithelial cell and bacteria, all taken together can serve as a strong indicator of UTI.&lt;/p&gt;

Differentiated approaches to the treatment of urinary tract infection in children taking into account the etiological factor Enterococcus faecalis

Objective:The objective is to develop an algorithm of initial antimicrobial treatment of urinary tract infection (UTI) concidering the etiological factorEnterococcus faecalis, having spontaneous resistance to cephalosporins.Methods:The analysis of 6438 results of urine bacteriological examination of children with UTI, having received the treatment in multi-field children’s hospital for 9 years, and clinical manifestations of UTI associated withE. faecalisin 181 patients was carried out. Addirionally, antimicrobial susceptibility testing was carried out in 60 cultures ofE. faecalis.Results:E. faecalisis occurred to be the second etiological factor of UTI in order of importance in children and had high priority in its development in newborns. The detected diagnostic markers of UTI associated withE. faecalis, and its antimicrobial susceptibility are represented in the author-developed algorithm of the initial antimicrobial treatment.Conclusions:The algorithm of the initial antimicrobial treatment of UTI caused byE. faecaliswill help to prescribe a sustainable, early antimicrobial treatment at the stage of microbe identification.

Pyuria as a Marker of Urinary Tract Infection in Neurogenic Bladder: Is It Reliable?

The utility of the urinalysis as a potential marker to diagnose urinary tract infection (UTI) in patients with neurogenic bladder is controversial. We assessed the baseline urine characteristics and intraindividual variance of pyuria in a cohort of asymptomatic children with neurogenic bladder followed longitudinally. A cohort of 54 children with neurogenic bladder was followed from 2004 to 2015 at a single institution's multidisciplinary clinic. Urine data obtained from 529 routine urology visits were reviewed. Urine obtained within 2 weeks before or after treatment for UTI were excluded. Bladder surgery was defined as any operation that altered the bladder as a closed or sterile system. The effects of age, gender, catheterization, and bladder surgery on pyuria were evaluated using mixed-model regression analysis. Fifty patients with 305 urine samples had a mean length of follow-up of 3.2 years. Only 16/50 patients (32%) never had pyuria, and these patients had shorter follow-up compared with the group who ever had pyuria (≥5 white blood cells per high powered field) (1.7 vs. 3.8 years; P = 0.008). Catheterization was associated with a 15% increase in pyuria (P = 0.21). Surgery was associated with a 120% increase in pyuria (P < 0.001). The test-to-test variance of pyuria within an individual was consistently greater than between individuals (P < 0.001). Bladder surgery is associated with significant increases in pyuria among children with neurogenic bladder. The substantial test-to-test variation in pyuria in asymptomatic individuals indicates the low reliability of pyuria, when positive, as a marker for UTI in neurogenic bladder and the need to search for either methods to reduce this variability or alternative biomarkers of UTI in this population.

Urinary neutrophil gelatinase associated lipocalin – A sensitive marker for urinary tract infection in children

Early antibiotic treatment for urinary tract infection (UTI) in young children can prevent renal scarring. Sensitivity of pyuria and positive urine nitrite test as indicators of UTI are low, whereas results of urine culture, the gold standard for diagnosing UTI, may not be available for 48--72 h. Novel markers for rapid and accurate diagnosis of UTI would help in the early initiation of treatment in children with suspected UTI. We studied the utility of urinary neutrophil gelatinase-associated lipocalin (NGAL) as an early marker of UTI. This study included 100 children between 3 months and 5 years with suspected UTI. After parental consent, a midstream clean catch or suprapubic aspirate urine specimen was sent for culture and NGAL analysis. Sensitivity and specificity of urine NGAL as a marker of UTI were estimated. Of the 100 children evaluated, urine culture was positive in 34%. Median urine NGAL values were higher in culture-positive children than in culture-negative children (223.20 vs 13.65, P = 0.0001). Receiver operating curve analysis showed an optimal cutoff level of 27 ng/ml for urine NGAL (odds ratio, 8.2, 95% confidence interval, 3.1--22.1) correlating best with culture positivity. Sensitivity and specificity of urine NGAL estimation were significantly better (79.4% and 68.2%) when compared with urine white blood cell estimation (70.6% and 53%). Urine NGAL is a sensitive and specific marker to predict UTI in children with a cutoff level of 27 ng/ml. It may serve as a screening test for detecting simple, uncomplicated UTI in young children.

Identification of Urinary CD44 and Prosaposin as Specific Biomarkers of Urinary Tract Infections in Children With Neurogenic Bladders.

Purpose:Distinguishing urinary tract infection (UTI) from urinary tract colonization (UTC) in children with neurogenic bladders who require clean intermittent catheterization (CIC) is challenging. Our objective was to identify urinary proteins to distinguish UTI from UTC in CIC-dependent children that have potential to serve as objective markers of UTI.Experimental design:A total of 10 CIC-dependent children were included in the mass spectrometry analysis (UTI = 5, UTC = 5). Quantitative profiling of urine proteins with isobaric protein labeling was performed using tandem mass spectrometry. Candidate markers were normalized using a collective mixture of proteins from all samples. Relative quantitative abundance of proteins across all samples were compared. Proteins with >50% change in the average abundance were identified as proteins of interest, which were then measured using enzyme-linked immunosorbent assay (ELISA) in an additional 40 samples (no growth = 10, UTC = 15, UTI = 15).Results:Mass spectrometry revealed 8 differentially expressed proteins. Of these, apolipoprotein D, alpha-amylase 2B, non-secretory ribonuclease, CD44 antigen, and prosaposin were measurable by ELISA. Concentrations of both CD44 and prosaposin were significantly higher in UTI, with area under the curves (AUCs) of 0.72 and 0.78, respectively.Conclusion:Urinary CD44 and prosaposin are candidate markers that may assist with the diagnosis of UTI in CIC-dependent children.

Neutrophil Gelatinase Associated Lipocalin (NGAL), an Early Marker for Urinary Tract Infection and Acute Kidney Injury

Neutrophil Gelatinase Associated Lipocalin (NGAL), an Early Marker for Urinary Tract Infection and Acute Kidney Injury

Lower urinary tract symptoms that predict microscopic pyuria

Introduction and hypothesisUrinary dipsticks and culture analyses of a mid-stream urine specimen (MSU) at 105 cfu ml−1 of a known urinary pathogen are considered the gold standard investigations for diagnosing urinary tract infection (UTI). However, the reliability of these tests has been much criticised and they may mislead. It is now widely accepted that pyuria (≥1 WBC μl−1) detected by microscopy of a fresh unspun, unstained specimen of urine is the best biological indicator of UTI available. We aimed to scrutinise the greater potential of symptoms analysis in detecting pyuria and UTI.MethodsLower urinary tract symptom (LUTS) descriptions were collected from patients with chronic lower urinary tract symptoms referred to a tertiary referral unit. The symptoms informed a 39-question inventory, grouped into storage, voiding, stress incontinence and pain symptoms. All questions sought a binary yes or no response. A bespoke software package was developed to collect the data. The study was powered to a sample of at least 1,990 patients, with sufficient power to analyse 39 symptoms in a linear model with an effect size of Cohen’s f2 = 0.02, type 1 error probability = 0.05; and power (1-β); 95% where β is the probability of type 2 error). The inventory was administered to 2,050 female patients between August 2004 and November 2011. The data were collated and the following properties assessed: internal consistency, test–retest reliability, inter-observer reliability, internal responsiveness, external responsiveness, construct validity analysis and a comparison with the International Consultation on Incontinence Modular Questionnaire for female lower urinary tract symptoms (ICIQ-FLUTS). The dependent variable used as a surrogate marker of UTI was microscopic pyuria. An MSU sample was sent for routine culture.ResultsThe symptoms proved reliable predictors of microscopic pyuria. In particular, voiding symptoms correlated well with microscopic pyuria (χ2 = 88, df = 1, p < 0.001). The symptom inventory has significant psychometric characteristics as below: test–retest reliability: Cronbach’s alpha was 0.981; inter-observer reliability, Cronbach’s alpha was 0.995, internal responsiveness F = 221, p < 0.001, external responsiveness F = 359, df = 5, p < 0.001. The correlation coefficients for the domains of the ICIQ-FLUTS were around R = 0.5, p < 0.001.ConclusionThis symptoms score performed well on the standard, psychometric validation. The score changed in response to treatment and in a direction appropriate to the changes in microscopic pyuria. It correlated with measures of quality of life. It would seem to make a good candidate for monitoring treatment progress in ordinary clinical practice.

Urine TREM-1 as a marker of urinary tract infection in children.

ObjectiveTriggering receptor expressed on myeloid cells (TREM)-1 is a receptor that is thought to improve recognition of patients with true infection. In this study, we investigated whether Triggering receptor expressed on myeloid cells (TREM-1) is present in urine samples from children with urinary tract infection (UTI) and in samples from healthy children.MethodsA total of 128 samples met the inclusion criteria for the study. Urine samples were processed for culture and urinalysis as a regular protocol for patients with UTI. Samples were classified according to culture and urinalysis results. TREM-1 protein expression was detected with flow cytometry and sTREM-1 was assessed by ELISA.ResultsFlow cytometry showed detectable expression of TREM-1 in 100% of samples, UTI and non-UTI groups (p < 0.001). Mean fluorescence intensity of TREM-1 was different between the groups (p < 0.001). Levels of sTREM-1 were detected in patients with UTI, but not in non-UTI patients.ConclusionsAll of our patients (healthy and diseased) showed TREM-1 expression. However, TREM-1 levels in patients with UTI tend to be higher and are associated with increased neutrophils and cytokine activity induced by bacteria.

MP55-18 CAN WE RELY ON PYURIA AS A MARKER FOR UTI IN THE NEUROGENIC BLADDER?: AN 11 YEAR LONGITUDINAL ANALYSIS

You have accessJournal of UrologyPediatrics: Urinary Tract Infection and Vesicoureteral Reflux1 Apr 2016MP55-18 CAN WE RELY ON PYURIA AS A MARKER FOR UTI IN THE NEUROGENIC BLADDER?: AN 11 YEAR LONGITUDINAL ANALYSIS Ruthie Su, Mari Palta, Amy Lim, Christina Sauder, and Ellen Wald Ruthie SuRuthie Su More articles by this author , Mari PaltaMari Palta More articles by this author , Amy LimAmy Lim More articles by this author , Christina SauderChristina Sauder More articles by this author , and Ellen WaldEllen Wald More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.609AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES In this era of increasing antibiotic resistance, accurate diagnosis of infection before treatment is imperative. Urinary tract infection (UTI) is a leading cause of morbidity and healthcare utilization for patients with neurogenic bladder and also poses a major diagnostic dilemma. The interpretation of pyuria as a marker for UTI in these patients may be confounded by repeated catheterizations, asymptomatic bacteriuria, or reconstructive surgery. To determine the stability of pyuria in asymptomatic patients with neurogenic bladder we studied the effect of time, catheterization, and bladder surgery on the presence of urinary leukocytes. METHODS All patients evaluated at our institution’s Spina Bifida Clinic since 2004 were eligible. Electronic records were reviewed and only results of microscopic urine analyses obtained the same day as routine, well clinic visits were included. Clean intermittent catheterization (CIC) status at the time of urine collection and bladder surgical history (ie: reimplant, augment, Mitrofanoff, vesicostomy) were recorded. Analysis of repeated measurements was done with SAS, using multi-level modeling with random effects. RESULTS 53 patients (32 female, 21 male) were evaluated during well visits between March 2004 to March 2015. There were on average 10 visits (range 2-41) per person. 319 urine samples were included for analysis. 51% (27/53) of patients transitioned during the study period from spontaneously voiding to CIC. 28% (15/53) of patients underwent some form of bladder surgery. Pyuria increased on average with time, CIC, and bladder surgery but not significantly. Within individual variance was significant (p<0.001) and 6 times greater than between individual variance, accounting for 58%-86% of the total variation as age increased. Adjusting for age, CIC, or bladder surgery did not reduce intra-individual variance. CONCLUSIONS Pyuria varies unpredictably in asymptomatic children with neurogenic bladder. Accordingly, pyuria does not appear to be useful as a point of care marker for UTI, underscoring the importance of the need to search for other inflammatory biomarkers in these complex patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e743 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Ruthie Su More articles by this author Mari Palta More articles by this author Amy Lim More articles by this author Christina Sauder More articles by this author Ellen Wald More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Urine heat shock protein 70 levels as a marker of urinary tract infection in children.

Heat shock proteins (HSPs) are a multi-family group of proteins which are upregulated by the cell in response to exposure to hazardous (stress) factors, including infectious agents, to prevent changes in protein structure. The aim of our study was to assess whether urine levels of the 70-kDa family of HSPs (HSP70s) increase in children with urinary tract infection (UTI) and to determine the optimal urine (u) HSP70 cut-off level to predict UTI in children. Forty patients with symptomatic UTI (UTI group), 30 healthy children (control group), 21 asymptomatic patients with proven bacterial contamination in their urine culture (contamination group) and 30 patients with fever caused by other infections (non-UTI infection group) were enrolled in the study. Random urine samples were obtained for measurement of HSP70 and creatinine (Cr) from all groups. Urine was collected prior to the treatment of UTI at the time of presentation and after treatment. Urine HSP70 levels were measured by enzyme-linked immunosorbent analysis. A dimercaptosuccinic acid (DMSA) scan was performed at 5-7days after presentation in UTI group to distinguish patients with acute pyelonephritis from those with cystitis; based on this scan, no patients had acute pyelonephritis. Patients were classified with pyelonephritis in the presence of all of the following signs: axillary fever of ≥39°C, leukocytosis and positivity for C-reactive protein. The mean urine HSP70:Cr ratio (uHSP70/Cr) prior to treatment was significantly higher in the UTI group (449.86 ± 194.33pg/mg) than in the control, contamination and non-UTI infection groups (39.93 ± 47.61, 32.43 ± 9.09 and 45.14 ± 19.76, respectively; p = 0.0001). Using a cut-off of 158pg/mg uHSP70/Cr for the prediction of UTI, the sensitivity and specificity of the assay were 100 and 100%, respectively (area under the time-concentration curve = 1). The uHSP70/Cr was highest in the patients with clinical pyelonephritis (p = 0.001). Mean uHSP70/Cr after treatment decreased to 60.68 ± 51.11pg/mg in UTI group (p = 0 .0001). Our findings suggest that elevated uHSP70/Cr may be a useful biomarker for the prediction of UTI in children, with a high sensitivity and specificity, and that they may help to distinguish UTI from other infections as well as bacterial contamination of the urine.

Microfluidic paper-based analytical devices for colorimetric detection of urinary tract infection biomarkers on adult diapers.

Urinary tract infections (UTI) are common infection diseases in elderly patients. The conventional method of detecting UTI involves the collection of significant urine samples from the elderly patients. However, this is a very difficult and time-consuming procedure. This paper addresses the development of a microfluidic paper-based analytical device (μPAD) to detect UTI from urine collected from adult diapers. The design and fabrication for the μPAD is shown. The fabrication process involves melting solid wax on top of filter paper using a hot plate, followed by pattern transfer using a mold with rubbed wax. To demonstrate the feasibility of the proposed method, the μPAD with deposited nitrite reagent had detected different concentrations of nitrite solutions from 0.5 ppm to 100 ppm spiked in urine samples. A calibration curve was obtained by plotting the gray scale intensity values against the various nitrite concentrations. The results showed that the proposed paper-based device holds great potential as low-cost, disposable solution to sensitively detect UTI markers in urine sampled from diapers.

Urinary ATP and bacteria in shed urothelial cells as a superior diagnostic marker for urinary tract infection in renal transplant recipients

Urinary tract infections (UTIs) cause complications for renal transplant recipients (RTRs) and may result in graft loss. Routine urinalysis to detect UTIs is insensitive/inaccurate in RTRs. UTI detection methods with greater accuracy are needed. A ≥50 nmol/l urinary ATP concentration indicates UTI and ATP measurement may be a superior diagnostic test (1). We investigated various urinalysis tests in 53 RTRs. ATP concentrations and intracellular bacteria (IB) in shed urothelial cells were compared to bacterial culture results. 22% of RTRs tested UTI positive by bacterial culture. IB were identified in 44% or RTRs, but only 2% IB positive were also UTI positive by bacterial culture. There was a significant association of the conventional bacterial culture with both urinary ATP concentration and evidence of IB (Fisher's exact test, p&lt;0.05). 6% of RTRs had ATP concentrations ≥50 nmol/l. Those positive were also bacteria positive. 77% patients with ATP concentrations &lt;50 nmol/l were negative by bacteria culture. Diagnostic odds ratios (DORs) indicated that ATP was a much stronger UTI indicator (DOR = 30.580) compared to IB (0.079). However combined urinary ATP concentration and evidence of IB was an even stronger diagnostic indicator of UTI (DOR = 105). Low urinary ATP concentration combined with absence of IB in shed urothelial may provide as superior diagnostic test for absence of UTI in RTRs.Funding: St Peter's Trust (UK).

Procalcitonin as an indicator of urosepsis

BackgroundProcalcitonin has been advocated as a marker of bacterial infection, so this study was carried out to determine the usefulness of serum procalcitonin in the early diagnosis of urosepsis.MethodsThe subjects were 37 febrile patients with urinary tract infection in whom we examined the serum procalcitonin concentration at the start of treatment.ResultsThirty patients had acute pyelonephritis (16 simple, 14 complex), one had emphysematous pyelonephritis, five had acute prostatitis, and one had acute epididymitis. The procalcitonin level was <0.5 ng/mL in 18 patients, ≥0.5 ng/mL in one patient, ≥2 ng/mL in seven patients, and ≥10 ng/mL in 11 patients. Five of the 11 patients with procalcitonin levels ≥ 10 ng/mL had disseminated intravascular coagulation. All patients with urinary tract obstruction and disseminated intravascular coagulation had procalcitonin levels ≥ 10 ng/mL.ConclusionAlthough this retrospective study comprised a small number of patients, we found that procalcitonin was a useful marker for urinary tract infection.