non-UTI Group Research Articles

Risk Factors for Urinary Tract Infection in Children

Background & objective: Urinary tract infections (UTIs) are a common cause of febrile illness in young children. Due to the absence of overt clinical features in young children, appropriate collection of urine samples, and basic diagnostic tests at first-level health facilities in our country, UTIs are not generally reported as a cause of childhood morbidity. Due to a lack of studies on the epidemiology, risk factors, diagnosis, treatment, prognosis, and prevention of UTI in children in our country, the exact picture of this disease is yet unknown. This study is intended to identify the risk factors of UTI in children in our country. Methods: The present cross-sectional study was carried out in the Department of Pediatrics (both indoor and outdoor) of Bangabandhu Sheikh Mujib Medical University, BIRDEM, and Dhaka Medical College Hospital over a period of 1½ years from January 2015 to June 2016. A total of 201 children with signs and symptoms suspected of having urinary tract infections were subjected to urine culture; of them, 98 had definitive UTI and the rest 103 had no UTI or possible UTI. Several factors such as circumcisional status, constipation, encopresis, previous hospital admission, and premature birth were investigated whether they had any role in contributing to the development of UTI. Result: The children with UTIs were relatively young compared to those without UTIs. However, the age incidence of UTI was found to differ by sex. About one-third of UTI cases in boys were found in the first year of life, one-third between 2nd to 3rd year of life, and the rest one-third in 3rd year onwards. However, the peak age incidence in girls was observed to be 3rd year and onwards. In terms of clinical presentation, fever, and anorexia were more or less common (52% and 43.7% respectively), abdominal pain was less common (18%), and irritability and vomiting were seldom observed. The presence of constipation was significantly associated with UTI in children (p = 0.001). Encopresis was considerably higher in the UTI group than in the non-UTI group (p = 0.169). Conclusion: Children with UTI usually present with fever with or without dysuria, frequency, anorexia, and abdominal or loin pain. While boys more often acquire the disease in their infancy, girls usually present with the problem from 3 years during their toilet training. Thus, the children presented with unexplained febrile illness or any other signs and symptoms should be suggested for a urine culture to find the clue of febrile illness. Identification of risk factors of UTI will go a long way in preventing the same illness in the future. Ibrahim Card Med J 2023; 13 (1&2): 60-65

Analysis of Risk Factors for Urinary Tract Infections in Pregnant Women: A Retrospective Study.

Urinary tract infections (UTIs) are the most common bacterial infection during pregnancy. This study aimed to investigate the risk factors of UTI during pregnancy. In this study, pregnant women who underwent prenatal examination in our hospital from October 2019 to October 2023 were divided into UTI group and non-UTI group in accordance with whether or not they had a UTI. The general data, clinical data and laboratory indicators of the participants were collected. Multivariate logistic regression was used to analyse the influencing factors of UTI in pregnant women, and the results were shown with odds ratio (OR) and 95% confidence interval (95% CI). A total of 600 pregnant women were included in the study. The results found that 56 women (9.33%) had a combined UTI. The results of midstream urinary bacterial culture in the UTI group showed that Gram-negative bacteria accounted for 60.71% of all detected pathogenic bacteria, and Escherichia coli and Staphylococcus aureus were common strains, accounting for 46.43% and 23.21%, respectively. The proportions of patients in the UTI group who were ≥35 years old, had a high school education or below, had a history of abortion, had gestational diabetes, had ≥three vaginal and anal examinations, had a history of UTI and had urinary tract stones were significantly higher than the non-UTI group (p < 0.05). Multivariate logistic regression analysis showed that age ≥35 years (OR = 9.127; 95% CI: 4.668-17.810; p < 0.001), educational level of high school or lower (OR = 4.184; 95% CI: 2.448-7.160; p < 0.001), gestational diabetes (OR = 3.494; 95% CI: 1.789-6.803; p < 0.001), UTI history (OR = 2.074; 95% CI: 1.114-3.834; p < 0.001) and haemoglobin (Hb) <100 g/L (OR = 8.022; 95% CI: 4.532-14.325; p < 0.001) are risk factors for UTI in pregnant women. The common pathogenic bacteria of pregnant women with UTI are mainly Gram-negative bacteria. Older pregnant women, low educational level, gestational diabetes mellitus, history of UTI and anaemia may be risk factors for UTI in pregnant women.

Evaluation of diagnostic accuracy of urine neutrophil gelatinase-associated lipocalin in patients with symptoms of urinary tract infections: a meta-analysis.

Early and accurate diagnosis of urinary tract infection (UTI) can prevent serious sequelae including chronic kidney disease. Multiple individual studies have identified urine neutrophil gelatinase-associated lipocalin (uNGAL) as a promising biomarker for early diagnosis of UTI. We sought to understand the distribution and diagnostic accuracy of uNGAL values in patients presenting with UTI symptoms. Our systematic literature reviews in PubMed, Embase, and Cochrane Reviews up to March 2024, identified 25 studies reporting mean/median, standard deviation/quartiles, and detection limits of uNGAL in symptomatic patients with and without culture-confirmed UTI. Seventeen studies were in children. Meta-analyses were performed using the quantile estimation (QE) method estimating the distributions of uNGAL, which were then compared between the UTI and non-UTI groups for identifying the best cut-off points maximizing the Youden index. Sensitivity analyses were performed on all 25 studies including adult patients. We found that uNGAL levels were significantly higher in samples with confirmed UTI compared to those without. In pediatric studies, median and 95% confidence interval (CI) of uNGAL values were 22.41 (95% CI of 9.94, 50.54) ng/mL in non-UTI group vs. 118.85 (95% CI of 43.07, 327.97) ng/mL in UTI group. We estimated the cut-off point of 48.43 ng/mL with highest sensitivity (96%) and specificity (97%) in children. Sensitivity analysis including both pediatric and adult studies yielded similar results. The level of uNGAL in symptomatic patients with confirmed UTI is much higher than that reported in patients without UTI. It may be used as a diagnostic tool to identify UTI early among symptomatic patients. The range of uNGAL concentrations and cut-off points reported in subjects with UTI is much lower than that reported in patients with acute intrinsic kidney injury. https://www.crd.york.ac.uk/, PROSPERO (CRD42023370451).

Exploring the nexus: prevalence, risk factors, and clinical correlations of urinary tract infections in diabetes mellitus patients - a comprehensive retrospective analysis

Aims: This study investigates the frequency and associated factors of urinary tract infections (UTIs) in patients with diabetes mellitus (DM). Methods: This retrospective chart review focused on patients with diabetes mellitus. Data collection involved demographic details, DM diagnosis, comorbidities such as hypertension, hyperlipidemia, and coronary artery disease, along with medication usage. Laboratory values including blood glucose and HbA1c levels were also analyzed. The primary outcome of interest was the diagnosis of UTI, identified from clinical records. Results: 173 DM patients were included in the study. These patients were divided into two groups according to the presence of UTI: 52 patients in the UTI group and 121 patients in the non-UTI group. The incidence of UTI was significantly higher in women (37.9%) compared to men (10.2%). No significant differences were observed between the groups in terms of age, presence of hypertension, hyperlipidemia, or coronary artery disease. Interestingly, the usage of SGLT-2 inhibitors was significantly higher in the UTI group compared to the non-UTI group (26.8% vs. 14%, p=0.043). No significant differences were found in other medication usage or in the levels of glucose and HbA1c between the groups. Conclusion: The study highlights the increased risk of UTIs in DM patients, particularly among women and those using SGLT-2 inhibitors. These findings suggest the need for careful monitoring and tailored approaches in managing UTIs in DM patients, considering gender and specific DM treatments.

Prediction of upcoming urinary tract infection after intracerebral hemorrhage: a machine learning approach based on statistics collected at multiple time points.

Accurate prediction of urinary tract infection (UTI) following intracerebral hemorrhage (ICH) can significantly facilitate both timely medical interventions and therapeutic decisions in neurocritical care. Our study aimed to propose a machine learning method to predict an upcoming UTI by using multi-time-point statistics. A total of 110 patients were identified from a neuro-intensive care unit in this research. Laboratory test results at two time points were chosen: Lab 1 collected at the time of admission and Lab 2 collected at the time of 48 h after admission. Univariate analysis was performed to investigate if there were statistical differences between the UTI group and the non-UTI group. Machine learning models were built with various combinations of selected features and evaluated with accuracy (ACC), sensitivity, specificity, and area under the curve (AUC) values. Corticosteroid usage (p < 0.001) and daily urinary volume (p < 0.001) were statistically significant risk factors for UTI. Moreover, there were statistical differences in laboratory test results between the UTI group and the non-UTI group at the two time points, as suggested by the univariate analysis. Among the machine learning models, the one incorporating clinical information and the rate of change in laboratory parameters outperformed the others. This model achieved ACC = 0.773, sensitivity = 0.785, specificity = 0.762, and AUC = 0.868 during training and 0.682, 0.685, 0.673, and 0.751 in the model test, respectively. The combination of clinical information and multi-time-point laboratory data can effectively predict upcoming UTIs after ICH in neurocritical care.

Determinants of urinary tract infection in hospitalized patients with acute ischemic stroke

BackgroundStroke is a major cause of morbidity and mortality worldwide. Urinary tract infection (UTI) is a common post-acute ischemic stroke (AIS) complication. We assessed the incidence, determinant factors, infection characteristics, post-stroke complications, and outcomes of hospitalized AIS patients with UTI.MethodsThis retrospective cohort study included AIS patients admitted within 7 days of stroke onset. The patients were divided into the UTI group and the non-UTI (control) group. Clinical data were collected and compared between the groups.ResultsThere were 342 AIS patients (31 with UTIs and 311 controls). The multivariate analysis showed that an initial National Institutes of Health Stroke Scale (NIHSS) score of ≥ 15 (odds ratio [OR] 5.00, 95% confidence interval [CI] 1.33–18.72) and Foley catheter retention (OR 14.10, 95% CI 3.25–61.28) were risk factors for UTI, whereas smoking (OR 0.08, 95% CI 0.01–0.50), an initial systolic blood pressure (SBP) of > 120 mmHg (OR 0.06, 95% CI 0.01–0.31), and statin use (OR 0.02, 95% CI 0.0006–0.42) were protective factors. Twenty cases (64.5%) were community-acquired and 11 cases (35.3%) were hospital-acquired. Ten patients (32.3%) had catheter-associated UTIs. The most common pathogen was Escherichia coli (13 patients, 41.9%). Post-stroke complications were significantly more common in the UTI group, including pneumonia, respiratory failure, sepsis, brain edema, seizure, symptomatic hemorrhagic transformation, congestive heart failure, atrial fibrillation with a rapid ventricular response, acute kidney injury, and hyponatremia. The median length of stay (LOS) in the UTI group was 12 days versus 3 days in the control group (p < 0.001). The median 3-month modified Rankin Scale score was higher (5 in UTI and 2 in control; p < 0.001) and the median 3-month Barthel Index was lower (0 in UTI and 100 in control; p < 0.001) in the UTI group than in the control group.ConclusionsThe risk factors for post-AIS UTI included severe stroke (NIHSS score ≥ 15) and urethral catheter indwelling. An initial SBP of > 120 mmHg and statin use were protective factors. The UTI group had significantly worse post-stroke complications, a longer LOS, and worse 3-month outcomes. Smoking was protective, which requires further investigation.

Occurrence and Risk Factors for Acute Urinary Retention and Urinary Tract Infection in Patients Undergoing Urinary Drainage after Colorectal Resection.

This study aimed to explore the occurrence of acute urinary retention (AUR) and urinary tract infection (UTI) in patients undergoing urinary drainage after colorectal resection and analyse the risk factors. Clinical data of 167 patients with urinary drainage after colorectal resection in Affiliated Qingdao Central Hospital of Qingdao University, Qingdao Cancer Hospital from November 2020 to November 2022 were retrospectively analysed. Clinical data included age, gender, diabetes, hypertension, lesion location, surgical method, previous history of abdominal surgery, urinary system diseases (urinary calculi, benign prostatic hyperplasia and urethral stricture), use of antibiotics before surgery, use of analgesic and sedative drugs after surgery, postoperative extubation time and postoperative adhesive intestinal obstruction. The postoperative AUR and UTI in patients were statistically analysed. Univariate and multivariate logistic regression analyses were used to explore the risk factors and odds ratio (OR) for AUR and UTI. The incidences of AUR and UTI were 23.95% (40/167) and 16.77% (28/167). Patients were divided into AUR group (n = 40), non-AUR group (n = 127), UTI group (n = 28) and non-UTI group (n = 139). Logistic regression analysis showed that previous history of abdominal surgery (OR = 3.517, 95% CI: 1.005-12.313), urinary system diseases (OR = 8.253, 95% CI: 2.692-25.303), postoperative extubation time (OR = 0.536, 95% CI: 0.393-0.732) and postoperative adhesive intestinal obstruction (OR = 25.293, 95% CI: 6.747-94.827) were risk factors for AUR in patients with urinary drainage after colorectal resection (p < 0.05). Female (OR = 21.569, 95% CI: 1.094-425.138), long postoperative extubation time (OR = 26.218, 95% CI: 3.318-207.151) and urinary system diseases (OR = 8.647, 95% CI: 3.425-21.831) were risk factors for UTI in patients undergoing urinary drainage after colorectal resection (p < 0.05). Age and preoperative use of antibiotics were not key influencing factors for UTI (p > 0.05). Clinical attention is paid to high-risk factors and groups. Corresponding interventions are taken as soon as possible to reduce the occurrence of AUR and UTI and further improve the prognosis of patients with urinary drainage after colorectal resection.

Analysis of Risk Factors for Urinary Tract Infection in Children and Construction and Validation of a Prediction Model.

To analyse the risk factors for urinary tract infection (UTI) in children and construct and validate a risk prediction model. The study selected 258 children with suspected UTI in the paediatric department of our hospital from August 2019 to August 2021. Identified as the subjects in this research, paediatric patients' clinical data were used for retrospective analysis. Based on the counting results of urinary leucocytes and bacteria, children were divided into the UTI group (n = 67) and non-UTI group (n = 191). Univariate analysis and multivariate logistic regression analysis were used to screen the independent risk factors for UTI in children, and a prediction model was constructed according to the results. The Hosmer-Lemeshow goodness-of-fit (GOF) test and receiver operator characteristic (ROC) curve analysis were used to validate the calibration and application value of prediction model. Logistic regression analysis identified length of hospitalisation ≥10 days (OR = 3.611, 95% CI: 1.781-7.325), indwelling ureter (odds ratio (OR) = 3.203, 95% CI: 1.615-6.349), history of infection (OR = 4.827, 95% CI: 2.424-9.612), congenital malformation/dysplasia (OR = 4.212, 95% CI: 2.079-8.531), constipation (OR = 4.021, 95% CI: 1.315-12.299) and anaemia (OR = 2.275, 95% CI: 1.236-4.186) as risk factors for UTI in children (p < 0.05). The formulation method was adopted to construct the following prediction model of UTI in children: Z = 2.066 × (length of hospitalisation ≥10 days) + 1.164 × (indwelling ureter) + 1.574 × (history of infection) + 1.438 × (congenital malformation/dysplasia) + 1.392 × (constipation) + 0.882 × (anaemia). The test results revealed the good GOF and high calibration (χ2 = 9.077, p = 0.336) of prediction model. Furthermore, the area under the ROC curve was 0.825 (95% CI: 0.766-0.884, p < 0.001), indicating the good discrimination and prediction efficiency of model. Based on clinical results, further attention should be given to high-risk children with UTI, and intervention measures should be taken immediately. The application and popularisation of prediction model will allow us to provide strategic guidance for preventing and treating UTIs in clinics.

Bacterial Urinary Tract Infection and Early Asymptomatic Bacteriuria in Kidney Transplantation Still Negatively Affect Kidney Transplant Outcomes in the Era of Modern Immunosuppression and Cotrimoxazole Prophylaxis.

Risk factors and consequences of urinary tract infection (UTI) post-kidney transplant have been variously reported by studies that were heterogenous in immunosuppressants and prophylactic protocols. We aimed to clarify the risks and consequences of UTI in kidney transplant recipients with post-transplantation cotrimoxazole prophylaxis in the context of modern immunosuppression. This retrospective cohort included kidney transplant recipients receiving tacrolimus, mycophenolate, prednisolone, and cotrimoxazole for bacterial UTI prophylaxis. Recipients were categorized into non-UTI and UTI groups. Asymptomatic bacteriuria (ASB) was screened in the first 3 months and was evaluated for association with UTI. Of 348 kidney transplant recipients, 129 were in the UTI group and 219 in the non-UTI group. UTI risk factors were female sex, body mass index ≥ 25 kg/m2, human leukocyte antigen mismatch, and panel reactive antibody ≥ 50%. Recipients with recurrent UTI had inferior allograft function compared with non-UTI recipients. Patient survival was significantly lower in recipients with UTI in the first post-transplant month. Higher degree of immunosuppressions was associated with recurrent UTI and drug-resistant organisms. In conclusion, UTI continues to negatively affect graft function and survival of kidney transplant recipients. Treating ASB in the first 3 months did not reduce the UTI incidence in the first transplantation year.

Prevalence of USP and hlyA Genes and Association with Drug Resistance in Uropathogenic Escherichia coli Isolated from Patients in a Tertiary Hospital from Southeast China.

E. coli was cultured from the urine of patients from the tertiary hospital located in Southeast China from 2017 to 2019. The species were identified, drug sensitivity test was performed, and the presence of the virulence genes USP and hlyA was determined. A total of 483 strains of E. coli were isolated, including 132 from patients with urinary tract infection (UTI). The resistance to ciprofloxacin was more common in non-UTI patients, while resistance to gentamycin was significantly higher in the UTI group. In the UTI group, the proportions of isolated bacteria with the virulence USP (40.15%) and hlyA (8.33%) genes were significantly higher than in the non-UTI group (19.60 and 2.56%, respectively). The rate of resistance of E. coli toward levofloxacin in the USP+ group was significantly (p<0.05) higher than in the USP- group. Thus, we revealed the differences in the rate of drug resistance and prevalence of USP and hlyA between the UTI and non-UTI groups. Furthermore, the presence of the USP gene was found to be associated with greater resistance to levofloxacin.

Diabetes Mellitus as a Predictive Factor for Urinary Tract Infection for Patients Treated with Kidney Transplantation.

Background and Objectives: We aimed to investigate the rate of incidence and risk factors of post-transplant urinary tract infection (UTI) in patients receiving kidney transplantation (KT) at our institution. Materials and Methods: A retrospective cohort study was carried out on patients who underwent KT for end-stage kidney disease (ESKD) from January 2008 to December 2021 at Gifu University Hospital. UTI was defined as the existence of bacterial and/or fungal infection in urine with ≥105 colony-forming units/mL, with or without urinary and/or systemic symptoms of UTI. Patients were divided into two groups: those with UTI after KT (UTI group) and those without UTI (non-UTI group). The primary endpoint of this study was the relationship between covariates and UTI after KT. Results: Two hundred and forty patients with ESKD received KT at Gifu University Hospital. Thirty-four participants developed UTI after surgery, and the most common pathogen was Escherichia coli. At the end of the follow-up, graft loss was observed in six patients (2.5%), independent of UTI episodes. In the multivariate analysis, diabetes mellitus (DM) was statistically associated with post-transplant UTI in kidney transplant recipients. Conclusions: Preoperative serum glucose control in patients with DM may have a crucial role in preventing UTI and preserving renal function after KT.

Characteristics and risk factors of urinary tract infection in patients with HBV-related acute-on-chronic liver failure: A retrospective study.

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute decompensation, organ failures, and high short-term mortality. Hepatitis B virus (HBV) is the main cause of liver failure in China. Urinary tract infection (UTI) is one of the common bacterial infections in patients with HBV-ACLF. However, few studies concerning the risk factors and epidemiology have been published. A retrospective analysis of 539 patients with HBV-ACLF was performed. The prevalence, bacterial profile, and antibiotic susceptibility pattern were investigated and associated risk factors of UTI in patients with HBV-ACLF were evaluated with a logistic regression model. The overall prevalence of UTI among the study participants was 26.53% (143/539), and 64.34% (92/143) of them were asymptomatic. One hundred thirty-five strains of bacteria, including 74.07% (100/135) gram-negative bacteria and 53.33% (72/135) multidrug-resistant organisms, were cultivated from 143 patients with HBV-ACLF. Escherichia coli 46.67% (63/135) and Klebsiella pneumoniae 13.33% (18/135) were the most common bacteria. The antibiotic susceptibility test pattern showed that 92.93%, 81.63%, and 81.63% of the gram-negative isolates were sensitive to imipenem, tigecycline, and piperacillin/tazobactam, respectively. Meanwhile, all the gram-positive isolates were sensitive to linezolid, teicoplanin, and vancomycin. Compared with non-UTI group, the patients with UTI had higher serum creatinine, lower educational status, total bilirubin, direct bilirubin, and albumin. Finally, educational status and albumin were independent risk factors in the prevalence of UTI in patients with HBV-ACLF. UTI is one of the common bacterial infections seen in patients with HBV-ACLF. Gram-negative bacteria account for the majority of cultured bacteria, and multidrug-resistant bacteria are common. UTI is determined by a diverse set of complex factors, which lower educational status and hypoalbuminemia predict the more prevalence of UTI.

Risk Factors of Urinary Tract Infection in Pediatric Patients with Ureteropelvic Junction Obstruction after Primary Unilateral Pyeloplasty.

Objective Ureteropelvic junction obstruction (UPJO) represents to a leading cause of fetal hydronephrosis, which is associated with urinary tract infection (UTI) and urinary stone disease. This study is aimed at investigating risk factors of UTI in pediatric patients with UPJO after primary unilateral pyeloplasty. Methods The records of a consecutive series of patients undergoing primary pyeloplasty at a single institution between June 2015 and November 2021 were retrospectively reviewed. Demographic and clinical characteristics, including age, gender, weight, height, body mass index (BMI), creatinine (Cr), blood urea nitrogen (BUN), estimated glomerular filtration rate (eGFR), neutrophil ratio, lymphocyte ratio, neutrophil/lymphocyte ratio, renal pelvis anteroposterior diameter (APD), renal cortex thickness, caliectasis, open or laparoscopic pyeloplasty, and internal drainage or external drainage, were collected and analyzed. The incidence of postoperative UTI and its risk factors was analyzed. Results A total of 504 patients were enrolled in the study, and they were classified into the UTI group (n = 188) and non-UTI group (n = 361). Univariate analysis of the incidence of UTI revealed that age, gender, weight, height, BMI, surgical modality, Cr level, BUN level, neutrophil ratio, lymphocyte ratio and neutrophil/lymphocyte ratio, renal cortex thickness, and postoperative drainage modality were associated with UTI incidence after pyeloplasty in pediatric patients with UPJO. Multivariate analysis revealed that male gender, <19 months, weight < 11.5 (kg), height < 83 (cm), BMI < 17.09, BUN > 4.08 (mmol/L), and internal drainage were risk factors of postoperative UTI in pediatric patients with UPJO. Conclusion Our study demonstrated that male gender, <19 months, weight < 11.5 (kg), height < 83 (cm), BMI < 17.09, BUN > 4.08 (mmol/L), and internal drainage were risk factors of UTI in pediatric patients with UPJO after primary unilateral pyeloplasty, which may provide reference for prophylactic antibiotics for those patients with risk factors.

Risk factors for urinary tract infection in kidney transplantation from brain death donor and its role in graft function.

Urinary tract infection (UTI) is the most common infection complication after kidney transplantation, and the reports of the incidence vary greatly among different centers. This study aims to explore the risk factors for UTI after kidney transplantation with the donation from brain death (DBD) and the impact on graft function, thus to provide theoretical basis for comprehensive prevention and treatment of UTI after kidney transplantation. The clinical and laboratory data of DBD kidney transplantation from January 2017 to December 2018 in Xiangya Hospital, Central South University were collected and retrospectively analyzed. Patients were assigned into an UTI group and a non-UTI group. The base line characteristics, post-transplant complications, and graft function were compared between the 2 groups. Multivariate logistic regression was used to analyze the risk factors for UTI. A total of 212 DBD kidney transplant recipients were enrolled in this study. UTI occurred in 44 (20.75%) patients after transplantation. The female, the time of indwelling catheter, and postoperative urinary fistula were independent risk factors for UTI after DBD kidney transplantation. A total of 19 strains of gram-positive bacteria, 12 strains of gram-negative bacteria , and 10 strains of fungi were isolated from the urine of 44 UTI patients. The UTI after kidney transplantation significantly increased time of hospital stay (P<0.001) and raised the cost for antibiotics (P=0.004). The graft function was much worse in the UTI group compared with the non-UTI group (P<0.001) at 3 months after transplantation. Twenty (45.45%) patients recurred UTI within one year after transplantation. Non-hemodialysis before transplantation and perioperative combination of antibacterial and antifungal drugs were independent risk factors for recurrence of UTI. UTI after DBD kidney transplantation transplantation affects the renal function at 3 months and increases the patient's economic burden.

Risk of Mortality and Readmission among Patients with Pelvic Fracture and Urinary Tract Infection: A Population-Based Cohort Study.

Patients with pelvic fractures could encounter various complications during or after treatments. This cohort study investigated the risk of mortality and readmissions in patients with pelvic fractures, with or without urinary tract infections (UTIs), within 30 days following the pelvic fractures. This retrospective cohort study examined claim records from the Longitudinal Health Insurance Database 2000 (LHID2000). We selected patients hospitalized with pelvic fractures between 1997 and 2013 for study. Patients who had index data before 2000 or after 2010 (n = 963), who died before the index date (n = 64), who were aged <18 years (n = 94), or who had a pelvic injury (n = 31) were excluded. In total, the study cohort comprised 1623 adult patients; 115 had UTIs, and 1508 patients without UTIs were used as a comparison cohort. Multivariate analysis with a multiple Cox regression model and Kaplan–Meier survival analysis were performed to analyze the data. Our results showed that the 1-year mortality rate (adjusted hazard ratio [HR]: 2.32; 95% CI: 1.25–4.29) and readmission rate (adjusted HR: 1.72; 95% CI: 1.26–3.34) of the UTI group were significantly higher than those of the non-UTI group. Moreover, the Kaplan–Meier curve for the 1-year follow-up indicated that the UTI group had a higher cumulative risk of both mortality and hospital readmission compared with the non-UTI group. In conclusion, among patients with pelvic fracture, patients with UTI were associated with increased risks of mortality and readmission. Physicians must pay more attention to such patients to prevent UTIs among patients with pelvic fractures during hospitalization and conduct a follow-up after discharge within at least 1 year.

Association of Neutrophil Gelatinase associated Lipocalin and Leukocyte Differential Count in Children with Febrile Urinary Tract Infections

Purpose To investigate the association between urinary neutrophil gelatinase-associated lipocalin (uNGAL) and leukocyte differential count in children with urinary tract infections (UTIs). Methods A retrospective chart review was performed in children undergoing uNGAL measurements between June 2018 and September 2019. Patients with suspected or diagnosed UTIs were included. The relationship between uNGAL and blood leukocyte differential count was investigated in children. Results A total of 197 children were included in this study, 119 of whom (60%) had UTIs. The non-UTI patients (n=78) were diagnosed with pneumonia, acute gastroenteritis, viral upper respiratory infection, and others. After adjusting for age, gender, and fever duration, the leukocyte count, monocyte count, and uNGAL levels were higher in the UTI group than in the non-UTI group (P<0.05). uNGAL showed positive correlations with neutrophil counts, monocyte counts, the neutrophil-to-lymphocyte ratio, and the monocyte-to-lymphocyte ratio in the UTI group (P<0.05). uNGAL levels were only associated with the neutrophil-tolymphocyte ratio in the non-UTI group (P<0.05). In a multivariable logistic regression analysis, only uNGAL was associated with the presence of UTI (P<0.05). The area under the receiver operating characteristic curves for uNGAL and monocyte counts to identify UTI were 0.89 (95% confidence interval (CI): 0.824–0.939; P=0.025) and 0.7 (95% CI: 0.627–0.774; P=0.038), respectively. Conclusions In children with UTIs, uNGAL levels may be associated with blood leukocyte differential counts. uNGAL measurements and monocyte counts can be helpful in children with suspected UTIs. Key words: Biomarkers; Monocytes; Urinary tract infections

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.

Is it necessary to evaluate urinary tract infection in children with lower respiratory tract infection?

Although the incidence of urinary tract infection (UTI) in children with lower respiratory tract infection (LRTI) has been reported as 3.1-10.0%, the exact concomitant prevalence is questionable. Here, we evaluated the prevalence and related risk factors of UTI associated with LRTI in children under 36 months of age. We retrospectively reviewed the medical charts of 1574 patients under 36 months of age who were hospitalised with LRTI from January 2017 to December 2019 in a single centre, Seoul, South Korea. Among them, we analysed 278 patients who showed fever and performed urine evaluation. Urine was collected by catheterisation in children under 24 months of age and by voided urine between 24 and 36 months of age. The prevalence of concomitant UTI and LRTI was 13.6% in children under 24 months of age. Mean age was significantly younger in the UTI versus non-UTI group (6.93 ± 7.26 months vs. 12.61 ± 11.70 months; P < 0.001). When the participants were stratified by age, the prevalence of UTI was significantly higher in children younger than 24 months of age compared to older ones (P = 0.006). UTIs were more prevalent in boys than in girls (14.6% vs. 5.8%, P = 0.018). Peak body temperature, fever duration, premature birth and detected respiratory virus type did not differ between groups. It is not uncommon for children with LRTI with fever to be accompanied by UTI. When evaluating for UTI in children with febrile LRTI, age and sex must be considered.

A Retrospective Study on Risk Factors for Urinary Tract Infection in Patients with Intracranial Cerebral Hemorrhage.

Objective This study aimed to explore the risk factors of urinary tract infection (UTI) in patients with intracranial cerebral hemorrhage (ICH). Design This is a retrospective study, and a total of 77 patients with ICH consecutively admitted to the First Affiliated Hospital of USTC (Anhui Provincial Hospital, Hefei, China) during the period of August 2015 to August 2017 were included. The patients were divided into an UTI group (24 cases) and a non-UTI group (53 cases); patients with UTI were diagnosed according to clinical manifestations, recent urinary routines, and urine culture results. The following information in these two groups was recorded: age, sex, course of disease, side of paralysis, location and type of cerebral hemorrhage, disturbance of consciousness or not, the Brunnstrom stage of paralysed lower limbs, number of basic diseases, whether there were complications (tracheotomy, retention catheterization, pulmonary infection, pressure sore, deep venous thrombosis, etc.), whether rehabilitation interventions were conducted, blood routine, biochemistry index, DIC complete set, urine routine, and urine culture data. Univariate analysis and multivariate logistic regression analysis were used to examine the risk factors of UTI in patients with ICH. Results Univariate analysis showed that age, side of paralysis, disturbance of consciousness, the Brunnstrom stage of lower limbs, tracheotomies, retention catheterization, pulmonary infection, leukocyte count, neutrophil proportion, sodium, uric acid, D-dimer, and fibrinogen may be related to UTI in patients with ICH (P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), P < 0.05). Regression analysis showed that age (OR (95% CI) = 1.207 (1.022–1.424), Conclusions Increased age and high D-dimer are independent risk factors for UTI in patients with ICH, while right-sided paralysis is a protective factor for UTI in patients with ICH.

Diagnositic value of urine heparin-binding protein, interleukin-6 and white blood cell in bacterial urinary tract infection

Objective To evaluate the diagnostic values of urinary heparin-binding protein (HBP), interleukin-6 (IL-6) and white blood cell (WBC) levels in bacterial urinary tract infection (UTI). Methods A case-control method was used. Urine of 157 cases of bacterial UTI, 61 cases of non-infection, and 40 cases of normal controls were collected in the Third Xiangya Hospital of Central South University from September 2017 to March 2018. U-HBP levels were measured in duplicate using a commercial HBP ELISA, U-IL-6 concentrations were analyzed with an up-conversion luminescence. The method of quantitative culture of bacteria was used to identify pathogenic species. Rapid dipstick tests and urinary sediment analyses were detected by FUS-2000 Urinalysis Hybrid. For continuous variables with skewed distributions, comparisons among the three groups were performed using the nonparametric Kruskal-Wallis test, and Mann-Whitney U test was used to further evaluate the difference between two groups. The Chi-square test was applied to analyze dichotomous. Receiver operating characteristic curve (ROC curve) was constructed to analyze the clinical diagnostic values of U-HBP, U-IL-6 and U-WBC for bacterial UTI. Results The levels of U-HBP in UTI group, non-UTI group and control group were 513.43 (50.45-644.40) ng/ml, 55.65 (20.43-314.55) ng/ml and 4.83 (3.28-12.63) ng/ml. The scores of U-IL-6 were 5.72 (3.84-9.02) pg/ml, 5.31 (4.31-6.39) pg/ml and 5.06 (4.56-6.18) pg/ml. The scores of U-WBC were 205 (24-754) cells/μl, 34 (13-117) cells/μl and 0 (0-0) cell/μl. There were statistically significant differences of U-HBP and U-WBC among the three groups (HU-HBP=83.192, HU-WBC=100.416, P 0.05). The best Youden indexes of U-HBP and U-WBC diagnosing bacterial UTI were 0.475 and 0.441, respectively. The best cut-off level of U-HBP and U-WBC was 64.35 ng/ml and 119.25 cells/μl, respectively. Conclusions Testing the level of U-HBP was important for auxiliary diagnosing bacterial UTI, but testing U-IL-6 wasn′t. Key words: Urinary tract infections; Blood proteins; Carrier proteins; Antimicrobial cationic peptides; Interleukin-6; Leukocyte count