Non-complicated Urinary Tract Infections Research Articles

Can Lactobacillus sp. Prevent Alone Recurrent Non-Complicated Urinary Tract Infection?

At least once in their lifetime, no matter what age, approximately 50% of women are confronting with non-complicated...

Characterization of Fosfomycin and Nitrofurantoin Resistance Mechanisms in Escherichia coli Isolated in Clinical Urine Samples.

Fosfomycin and nitrofurantoin are antibiotics of choice to orally treat non-complicated urinary tract infections (UTIs) of community origin because they remain active against bacteria resistant to other antibiotics. However, epidemiologic surveillance studies have detected a reduced susceptibility to these drugs. The objective of this study was to determine possible mechanisms of resistance to these antibiotics in clinical isolates of fosfomycin- and/or nitrofurantoin-resistant UTI-producing Escherichia coli. We amplified and sequenced murA, glpT, uhpT, uhpA, ptsI, cyaA, nfsA, nfsB, and ribE genes, and screened plasmid-borne fosfomycin-resistance genes fosA3, fosA4, fosA5, fosA6, and fosC2 and nitrofurantoin-resistance genes oqxA and oqxB by polymerase chain reaction. Among 29 isolates studied, 22 were resistant to fosfomycin due to deletion of uhpT and/or uhpA genes, and 2 also possessed the fosA3 gene. Some modifications detected in sequences of NfsA (His11Tyr, Ser33Arg, Gln67Leu, Cys80Arg, Gly126Arg, Gly154Glu, Arg203Cys), NfsB (Gln44His, Phe84Ser, Arg107Cys, Gly192Ser, Arg207His), and RibE (Pro55His), and the production of truncated NfsA (Gln67 and Gln147) and NfsB (Glu54), were associated with nitrofurantoin resistance in 15/29 isolates; however, the presence of oqxAB plasmid genes was not detected in any isolate. Resistance to fosfomycin was associated with the absence of transporter UhpT expression and/or the presence of antibiotic-modifying enzymes encoded by fosA3 plasmid-mediated gene. Resistance to nitrofurantoin was associated with modifications of NfsA, NfsB, and RibE proteins. The emergence and spread of these resistance mechanisms, including transferable resistance, could compromise the future usefulness of fosfomycin and nitrofurantoin against UTIs. Furthermore, knowledge of the genetic mechanisms underlying resistance may lead to rapid DNA-based testing for resistance.

Independent validation of a predictive nomogram for risk of reinfection in women with recurrent non-complicated urinary tract infections.

Aims:Independent external validation of a predictive nomogram for risk of reinfection in women with a history of non-complicated recurrent urinary tract infection (UTI).Methods:A retrospective longitudinal study was conducted to validate the LUTIRE nomogram in a Brazilian female cohort. The nomogram was applied to 81 women presenting non-complicated recurring UTI screened at a urological clinic. External validation was performed using the nomogram variables in patients followed up from January 2014 to December 2016 at a urological clinic. Accuracy of the nomogram was obtained by analyzing the predictive capacity observed in the area under the receiver operating characteristic (ROC) curve. A multivariate logistic regression model was used to assess the ability of the nomogram variables to predict the recurrence of UTI over 12 months. The time to recurrence of infection was calculated using a Kaplan–Meier curve and the log-rank test with calculation of the hazard ratio.Results:The mean age of the study population was 42.8 years; 57 women (70.37%) had recurrence. The independent variables with statistical significance in the multivariate analysis were gram-negative bacteria [odds ratio (OR) 18.38; p = 0.03897] and number of UTIs in the past 12 months (OR 25.11; p = 0.00006). The accuracy of the nomogram for discriminating patients who had UTI recurrence was 82.6% (95% CI = 72.5–90.1).Conclusion:The LUTIRE nomogram showed good accuracy among Brazilian women with recurrent UTI.

Severe sepsis and septic shock by Escherichia coli, clinical and microbiological analysis in Medellin, Colombia

Escherichia coli is a common cause of a broad spectrum of infections, from non-complicated urinary tract infection, to severe sepsis and septic shock, that are associated to high impact outcomes, such as ICU admission and mortality. To establish differences in mortality, ICU admission, ESBL positive strains and antibiotic treatment, between patients with E. coli related severe sepsis and septic shock, with or without bacteremia and its variability based on the source of infection. Secondary data analysis of a multicentric prospective cohort study. From 458 patients with E. coli isolation, 123 had E. coli exclusively in blood culture, 222 solely in urine culture, and 113 in both samples. Escherichia coli isolation exclusively in blood culture was associated with higher frequency of ICU admission (n = 63; 51.2%), higher rate of mechanical ventilation requirement (n = 19; 15.5%), higher mortality and longer hospital stay (n = 22; 18%; median of 12 days, IQR= 7 - 17, respectively); but with a lower occurrence of ESBL strains, compared to patients with positive urine culture and positive blood/urine cultures (n = 20; 17.7% and n = 46; 20.7%, respectively). 424 patients (92.6%) received antibiotic treatment in the first 24 hours. The most commonly prescribed was piperacilin/tazobactam (n = 256;60.3%). The proportion of patients empirically treated with carbapenems vs non-carbapenems was similar in the three groups. The source of infection, associated with ESBL strains risk factors, are useful tools to define prognosis and treatment in this population, because of their clinical and microbiological variability. Patients with E. coli isolation exclusively in the blood culture had higher frequency of non-favorable outcomes in comparison to patients with E. coli in urine culture with or without bacteremia. Additionally, in our population patients with E. coli solely in blood culture have lower prevalence of ESBL positive strains.

Antiadhesive Activity and Metabolomics Analysis of Rat Urine after Cranberry (Vaccinium macrocarpon Aiton) Administration.

Cranberry (Vaccinium macrocarpon Aiton) is used to treat noncomplicated urinary tract infections (UTIs). A-type procyanidins (PAC-A) are considered the active constituents able to inhibit bacterial adhesion to the urinary epithelium. However, the role of PAC-A in UTIs is debated, because of their poor bioavailability, extensive metabolism, limited knowledge about urinary excretion, and contradictory clinical trials. The effects of 35-day cranberry supplementation (11 mg/kg PAC-A, 4 mg/kg PAC-B) were studied in healthy rats using a ultra performance liquid chromatography-mass spectrometry (UPLC-MS)-based metabolomics approach. Microbial PAC metabolites, such as valeric acid and valerolactone derivatives, were related to cranberry consumption. An increased urinary excretion of glucuronidated metabolites was also observed. In a further experiment, urine samples were collected at 2, 4, 8, and 24 h after cranberry intake and their antiadhesive properties were tested against uropathogenic Escherichia coli. The 8 h samples showed the highest activity. Changes in urinary composition were studied by ultra performance liquid chromatography-time-of-flight (UPLC-QTOF), observing the presence of PAC metabolites. The PAC-A2 levels were measured in all collected samples, and the highest amounts, on the order of ng/mL, were found in the samples collected after 4 h. Results indicate that the antiadhesive activity against uropathogenic bacteria observed after cranberry consumption is ascribable to PAC-A metabolites rather than to a direct PAC-A effect, as the measured PAC-A levels in urine was lower than those reported as active in the literature.

Can Oral Antibiotics Be an Alternative to Carbapenems in The Treatment of Non-Complicated Urinary Tract Infections Caused by Extended Spectrum Beta-lactamase Positive Escherichia coli?

Can Oral Antibiotics Be an Alternative to Carbapenems in The Treatment of Non-Complicated Urinary Tract Infections Caused by Extended Spectrum Beta-lactamase Positive Escherichia coli?

Clinical features and pathogens analysis of complicated and non-complicated urinary tract infections in infants

Objective To summarize the clinical and pathogenic characteristics of urinary tract infection(UTI) in infants, and to provide reference for clinical diagnosis and treatment. Methods One hundred and eighty-eight cases of hospitalized infants with UTI diagnosis standard in Department of Pediatric Renal Rheumatism Immunology, Shengjing Hospital Affiliated to China Medical University from January 2012 to January 2015 were collected, and on the basis of the imaging they were divided into complex group(complicated UTIs) and non-complex group(non-complicated UTIs), the differences between 2 groups in the general condition, clinical manifestations, serological examination, urine culture and distribution of pathogenic bacteria and drug sensitivity results were analyzed. Results Among 188 UTI infants, 148 were male and 40 were female, 50 cases were in complex group(26.6%), and 138 cases were in non-complex group(73.4%). In complex group, the prevalence of prenatal ultrasound abnormalities(34.0%), the incidence of recurrent infections(24.0%), the number of fever incidence(78.0%), and peripheral WBC count[(16.4±4.3)×109/L] were higher than those in non-complex group[1.5%, 10.9%, 58.7%, (14.6±3.5)×109/L](all P<0.05), and the naked eye hematuria incidence was lower than that of the non-complex group(14.0% vs 34.8%, P=0.006). In complex group, pneumonia klebsiella bacteria positive rate was higher than that of non-complex group(22.0% vs 2.9%, P=0.000), and the positive rate of Escherichia coli was lower than that of non-complex group(26.0% vs 46.4%, P=0.000). There was no difference in the drug sensitivity and resistance of the pathogenic bacteria in the urine culture of 2 groups. Conclusions For fever, increased peripheral WBC, repeated infection and urine culture for Klebsiella pneumoniae UTI infants, in particular, should be alert to the prese-nce of urinary tract abnormalities, timely improve the urinary system ultrasound and urinary tract contrast is very necessary. Key words: Infant; Urinary tract infection; Clinical feature; Pathogenic bacteria

Persistent Therapeutic Effect of Repeated Injections of Onabotulinum Toxin A in Refractory Bladder Pain Syndrome/Interstitial Cystitis

We evaluate the efficacy and safety of repeated intratrigonal injections of onabotulinum toxin A in patients with bladder pain syndrome/interstitial cystitis. This is a single center, long-term, prospective study in which 16 women with bladder pain syndrome/interstitial cystitis refractory to standard treatment received 4 consecutive intratrigonal injections of onabotulinum toxin A. Onabotulinum toxin A (100 U) was injected under cystoscopic control in 10 trigonal sites, each receiving 10 U in 1 ml saline. General anesthesia was used in all treatments. Re-treatment was allowed 3 months after injection. Outcome measures included pain visual analog scale (0-10), O'Leary-Sant score, a 3-day voiding chart and a quality of life questionnaire at the first month and every 3 months after each injection. Voiding dysfunction and urinary tract infections were assessed at 2 weeks and every 3 months afterward. Treatment duration was determined when patients requested another injection. Mean ± SD patient age was 41.8 ± 12.5 years. At baseline pain score was 5.9 ± 1.8, O'Leary-Sant score 28.8 ± 6.3, urinary frequency 16.4 ± 5.3, mean voided volume 112 ± 42 ml and quality of life 5 ± 0.9. Mean decrease in pain score, O'Leary-Sant score, urinary frequency and mean increase in voided volume and quality of life were similar after each treatment. Individual symptom relief lasted 6 to 12 months with an average duration of 9.9 ± 2.4 months. There were no cases of voiding dysfunction. Five patients had noncomplicated urinary tract infections. Symptomatic improvement of bladder pain syndrome/interstitial cystitis persists in a repeated intratrigonal injection program of 100 U onabotulinum toxin A. Time to request re-treatment remained stable. Adverse events were mild, without voiding dysfunction requiring intermittent catheterization.

Antibiotic resistance and trend of urinary pathogens in general outpatients from a major urban city

We assessed the antimicrobial resistance patterns of pathogens responsible for urinary tract infections (UTI) in outpatients in São Paulo, Brazil, as well as the Escherichia coli antimicrobial resistance trend. Outpatients urine cultures were collected from January 2000 to December 2003. Statistical analysis considered positive results for one bacterial species with colony count >or= 100,000 CFU/mL. Stratification was done on age group and gender. Statistical tests used included chi-square and the chi-square test for trend to evaluate differences between susceptibility rates among age groups and ordering in the E. coli resistance rates per year, respectively. There were 37,261 positive results with Enterobacteriaceae isolated in 32,530 (87.3%) and Gram-positive cocci in 2,570 (6.9%) cultures. E. coli had the highest prevalence (71.6%). Susceptibility tests were performed in 31,716 cultures. E. coli had elevated resistance rates (> 30%) to ampicillin, trimethoprim-sulfamethoxazole, and tetracycline. Significant differences between age groups and ordering among years were observed. The use of trimethoprim-sulfamethoxazole is precluded in the population studied due to elevated resistance rates (> 30%) among most prevalent pathogens. Significant resistance rate differences among age groups and years were observed, particularly for fluoroquinolones. Fluoroquinolones should be used with caution. Nitrofurantoin should be used as empirical therapy for primary, non-complicated urinary tract infections.

Influence of Non-Complicated Urinary Tract Infection on Renal Relapses in Proliferative Lupus Nephritis

In patients with proliferative lupus nephritis treated with IV cyclophosphamide, analyze urinary tract infection (UTI) as a cause of treatment delay and renal relapses, compared with lupus nephritis patients without infection. We studied SLE patients (ACR criteria) with renal biopsy showing nephritis class IV. All patients received monthly intravenous cyclophosphamide (CYC) treatment during 6 months. Thereafter patients were assigned to 2 groups: patients who developed UTI, and those who did not; renal function tests, UTI and renal relapses were bimonthly evaluated during one year (follow-up period). To analyze data, Student t test, χ2, Fisher exact (when appropiate), and bivariate analysis, were performed. We studied 50 patients, 25 with UTI (Group I) and 25 without UTI (G-II).The mean age was 30.07 ± 8.15 years, 82% were female. Escherichia coli was the pathogen most frequently isolated (73%). UTI (G-I) was the cause for treatment delay in 19 cases (76%), compared with 3 patients (12%) in G-II whose treatment was delayed because of some other causes (severe leucopenya, hypersensibility, and gastrointestinal side effects) (OR, 23.22; 95% CI, 5.26- 105.1; P=.001). During the follow-up, 90.9% of patients in G-I reached partial or complete renal remission within 3 months, but only 35% mantained remission after the year of follow-up. Meanwhile, patients in G-II had complet and partial renal remission of 85% and 63%, respectively. In the first group we observed persistent albuminuria (P< .05), low complement levels and high ab-dsDNA titers. Renal flares were present in 18 patients in G-I and 9 in G-II. UTI in lupus nephritis patients has a negative impact. It leads to delayed CYC therapy and to a higher renal flare rate. Determinar si la infección de vías urinarias (IVU) es un indicador de retraso en el tratamiento inmunodepresor y de recaída renal en pacientes con nefritis lúpica. Se analizó a pacientes con nefritis lúpica proliferativa difusa que recibieron tratamiento con ciclofosfamida intravenosa durante, al menos, 6 meses. Al cabo de ese tiempo se realizó un seguimiento prospectivo asignando a los pacientes a uno de 2 grupos: grupo I (pacientes que durante el seguimiento desarrollaron IVU), y grupo II (grupo control, pacientes sin infección). Se evaluaron bimestralmente la función renal y el número de recaídas durante un año de seguimiento. Para el análisis estadístico, se emplearon la prueba de la t de Student, la prueba de la χ2, el test de Fisher (cuando se requiera) y el análisis bivariado. Resultados: Se incluyó a 50 pacientes, 25 en cada grupo. Los casos del grupo I correspondieron a IVU no complicada. La edad promedio fue de 30,07 ± 8,15, y el 82% eran mujeres. El uropatógeno descrito con más frecuencia fue Escherichia coli (73%). La presencia de IVU determinó la interrupción temporal del tratamiento en 19 casos (76%), mientras que en el grupo sin IVU esto ocurrió sólo en 3 pacientes (12%), por otras causas, como leucopenia grave, hipersensibilidad y síntomas gastrointestinales graves (odds ratio = 23,22; intervalo de confianza del 95%, 5,26-105,1; p = 0,001). Durante elaño de seguimiento, en el grupo I, el 90,9% alcanzó la remisión parcial en los primeros 3 meses de seguimiento y el 35% logró la remisión completa después de un año; en el grupo II, los porcentajes de remisión fueron del 85 y el 63%, respectivamente. En el grupo I se observó un incremento en la albuminuria (p < 0,05), persistencia de hipocomplementemia y títulos elevados de anticuerpos anti-ADN. En este grupo se encontraron 18 exacerbaciones y en el grupo control, 9. Conclusiones: En pacientes con nefritis lúpica proliferativa difusa, la presencia de IVU no complicada se asocia a un retraso en el tratamiento inmunodepresor y a un incremento en las recaídas renales.

Significado clínico del aislamiento de Streptococcus agalactiae de orina de pacientes de centros de salud

Streptococcus agalactiae is a well-recognized pathogen in the obstetric population and is a cause of invasive infection in adults with underlying diseases. Nevertheless, the role of S. agalactiae in urinary tract infections in the adult non-pregnant population treated in outpatient health care centers has been less extensively studied. The clinical significance of S. agalactiae isolation in urine samples from health care center patients was studied in five areas of Spain over a period of six months. The study protocol included the collection of personal, epidemiological and clinical data. A total of 85 patients were studied; 79 were women (17 pregnant) and 6 men. Pyuria was found in 72.9% of the cases. A total of 26.4% (n = 18) of non-pregnant women and all the men had some type of chronic underlying disease and 35.3% (n = 24) had urinary disease. Among the pregnant women, 53% had asymptomatic bacteriuria and 35.3% had vaginal and/or urethral colonization. Among the group of men and non-pregnant women, the most frequent entity was non-complicated cystitis, seen in 66.1% (45 of 68) of cases, followed by complicated infection in 19.1% and asymptomatic bacteriuria in 11.8%. Of the 45 patients with non-complicated cystitis, 35 (77.7%) were over 40 years old and 19 (42.2%) were over 60 years old. Among the population of non-pregnant adults treated in outpatient health care centers, S. agalactiae isolation from urine was found mainly in women over 40 years old and was the cause of non-complicated urinary tract infection in more than half of cases.

Cefixime in Urinary Tract Infections with Special Reference to Pediatrics: Overview

Cefixime is a third-generation oral cephalosporin that is highly active against a broad range of Gram-negative and some Gram-positive aerobic bacteria. In non-complicated urinary tract infections it is at least as effective as other usual treatments, and has a low rate of side effects. Several clinical studies have been performed on cefixime in urinary tract infections both in adults and children. On the basis of the literature data, cefixime could be indicated in the treatment of non-complicated urinary tract infections in children either as monotherapy or as switch therapy.

Bacteriological Comparison of Cefixime in Patients with Noncomplicated Urinary Tract Infection in Spain

Clinical failure rates and the overuse of oral antibiotics are particularly acute in the case of non-complicated urinary tract infections (UTIs). Recent preliminary results from a major microbiological study in Spain have indicated significantly increased levels of resistance and insensitivity of isolated pathogens to commonly used antibiotics. Escherichia coli was by far the commonest pathogen isolated. Susceptibility was lowest with amoxicillin plus clavulanic acid, at 65.9% (334 of 507 gram-negative strains isolated). On the other hand, excellent susceptibility was noted with cefixime, corresponding to an MIC of ≦4 µg/ml, at 99.2% (504 of 507). The results raise questions about the choice of antibiotics currently used in general practice, and suggest that cefixime may be a better first-line empiric treatment for noncomplicated UTIs.

Short-term treatment of urinary tract infections with trimethoprim/sulphamethoxazole: a clinical and bacteriological study.

Abstract The clinical effects of treatment with a trimethoprim (TMP)-sulphamethoxazole (SM) combination were studied in 40 patients with urinary tract infection. The indication for treatment was symptoms of urinary tract infection with > 10(5) colonies per ml of urine. The dosage was 160 mg of TMP and 800 mg of SM administered orally twice daily for 10 days. The bacteriological in vitro examination revealed synergic effect of the two agents on 30 out of 55 bacterial strains (55%). Out of 32 strains which were resistant or slightly sensitive to SM, synergy was revealed in 14 instances (44%). Development of resistance to TMP was seen in one case. In 20 patients with non-complicated urinary tract infections, sterile urine was found 3 and 14 days after termination of treatment in 100% and 89%, respectively. In one case there was recurrence, and in one case reinfection occurred. In 20 patients with complicated urinary tract infections, sterile urine was found 3 and 14 days after termination of treatment in 80% and 55%, respectively. In 4 cases infection recurred, and in 5 cases the treatment had no effect. Side effects were seen in 3 patients; one case of exanthem, one of nausea, and one of leucopenia. In one case treatment had to be withdrawn because of exanthem, in another because of nausea.