Positive Nitrite Research Articles

P-1576. An Exploration of the Utility of Urinalysis Criteria in Predicting Urine Culture Positivity

Abstract Background Urinalysis (UA) testing with reflex to culture is commonly ordered and is considered a tool for both diagnostic and antibiotic stewardship. Criteria for culture delineate normal from abnormal values leading to use for diagnosis of urinary tract infections (UTI). However, urinalysis criteria which predict urine culture growth that correlate with UTI are not well elucidated. The objective of this study is to evaluate the utility of several different indicators in urinalysis as reflex criteria to urine culture. The area under the curves are: 0.618 for WBCs, 0.607 for nitrites, 0.570 for LE by semi-quantitative testing, and 0.479 for LE by numeric testing. Methods Retrospective review of 14,212 unique de-identified samples of paired urinalysis and urine culture collected in the Froedtert Health System in Milwaukee, Wisconsin from 9/22/22 to 8/23/23. All urine specimens were included regardless of collection method. Cultures were deemed to be positive if growing at least 100,000 colony-forming units (CFU) of a likely urinary pathogen and were evaluated for white blood cells (WBC), leukocyte esterase (LE), and nitrite positivity in the corresponding urinalysis. Results For each criterion, sensitivity and negative predictive values (NPV) were calculated at varying thresholds. A threshold of 5 WBCs provided the greatest NPV at 88.60%, and the greatest sensitivity at 89.76%. Next, receiver operating characteristic (ROC) curves were generated and the area under the curves were: 0.618 for WBCs, 0.607 for nitrites, 0.570 for LE by semi-quantitative testing, and 0.479 for LE by numeric testing. Conclusion Of the three urinalysis criteria, WBC had the best sensitivity and NPV but the ROC curves suggest that none of the tests predict significant urine culture growth well, emphasizing the importance of clinical context in both determining when to test and how to interpret. As diagnosis of a UTI does not simply rest on certain CFU growth or uropathogen on urine culture, but requires incorporation of history and physical findings, the next stage will be to correlate urine testing results with symptoms. Disclosures All Authors: No reported disclosures

Prevalence of bacteriuria and bacterial resistance in adolescents from the center of the state of Tlaxcala, Mexico.

Urinary tract infections and bacteriuria are common in the pediatric population, and antibiotic resistance is increasing significantly. Recurrent urinary infections, symptomatic or asymptomatic, are a risk factor for developing chronic kidney disease in adolescents and young adults. This study aimed to assess the prevalence of bacteriuria diagnosed by culture to identify the main causal agents and sensitivity to antibiotics in adolescents from the central region of the state of Tlaxcala. A cross-sectional study was carried out among 905 adolescents from 11 to 18 years old who lived in the central region of the state of Tlaxcala, Mexico. Bacteriuria was evaluated by positive nitrites and leukocyte esterase, and urine culture with antibiogram. Multivariate logistic regression models were executed to evaluate the risk of presenting bacteriuria, with a confidence level of 95%. A total of 31 participants had a positive urine culture, with a bacteriuria prevalence of 3.4%, of which 29 cases were asymptomatic. The most frequent agent was Escherichia coli) in both sexes (28.6% in men and 29.7% in women) and regarding bacterial resistance: E. coli presented greater resistance to ampicillin, trimethoprim/sulfametoxazol and ceftriaxone. The risk factors associated with bacteriuria were female sex, sexual activity, use of contraceptives, and greater consumption of sweetened beverages. Bacteriuria is common in this adolescent population, so its early identification is necessary to treat it, and to prevent its complications.

69 Urinary tract infections in preterm infants: Review in two Canadian tertiary centers

Abstract Background Urinary tract infections (UTI) in premature infants are commonly seen in the neonatal intensive care unit (NICU). The reported prevalence of UTI in this population ranges from 1.9-12.2% due to the lack of standardized criteria for UTI among infants less than two months of age. Enterococcus and Enterobacteriaceae are well known to cause UTI and their resistance pattern has been reported to be rising in the neonatal nosocomial infections worldwide. Objectives To describe the epidemiology, microbiology, and antimicrobial treatment for UTI in premature infants based on different diagnostic criteria. Design/Methods This retrospective study (2019-2022) included infants born at <33 weeks of gestational age (GA) with positive urine cultures and ≥5 days of antimicrobials treatment. We collected data from two tertiary level NICUs in Canada, including demographics, microbial susceptibility patterns, urinalysis and imaging results, and antibiotic treatment. Results We identified 43 infants managed as UTI based on physicians’ discretions. The median GA at birth was 26-27 weeks, while the median onset of first UTI ranged 39-80 days, with male predominance [Table 2]. Mixed growth of organisms constituted 21-42% of cases of UTI [Table 1]. Among UTI cases with only single growth organism, we found 53.5% and 18.6% cases fulfilled UTI diagnostic criteria based on the concentration of colony forming units (CFU) of >104/mL or >107/L and >105/mL or >108/L, respectively [Table 1]. Of these cases, 67.4% of infants had urinalysis sent with the culture, and the higher the concentration of CFU, the more likely the samples showed positive nitrites on urinalysis, with 100% correlation among those with CFU >105/mL or >108/L. [Table 1] The most common pathogens were Enterococcus species, E.Coli, Klebsiella species, Citrobacter species and Enterobacter cloacae complex [Table 2]. Among gram negative bacilli (E. Coli and Klebsiella species), greater than 42-80% were resistant to 3rd generation cephalosporins (3GC). We did not identify any vancomycin-resistant Enterococcus strains. Median duration of antimicrobial treatment ranged from 8-13 days, depending on the diagnostic criteria applied. At least 10% of infants with UTI showed abnormalities on kidney ultrasound [Table 2]. Conclusion There exists a large variation in UTI prevalence according to different diagnostic criteria. Abnormal urinalysis with presence of nitrites were frequently associated with UTI of high CFU count. High resistance to 3GC among gram negative bacilli was concerning and carried an impact on the appropriate empirical treatment choice.

Antibiotic Appropriateness for Urinary Tract Infections in Children.

We examined local prescribing patterns across the entire treatment course for children treated for uncomplicated urinary tract infection (UTI) to determine opportunities for antibiotic stewardship initiatives. We conducted a retrospective review of emergency department and inpatient encounters for febrile and afebrile UTI in a children's hospital from 2021 to 2022. An antibiotic spectrum ranking was established, and providers' choices were assessed for appropriateness on the basis of the individuals' urine culture (UCx). Groups were stratified by fever presence and compared using χ2, Fisher's exact, and Mann-Whitney U tests. Of 172 encounters (83% emergency department), 99 (58%) had a positive UCx. Eighty (80%) grew Escherichia coli, with 67 (84%) being susceptible to cefazolin (minimum inhibitory concentration ≤16 mg/L). There were 229 antibiotic regimens and 39 (17%) were appropriate. Inappropriate antibiotic choices included unnecessary use of broad-spectrum antibiotics and misdiagnosed UTI. Grouping by encounter, at least 1 dose of a third cephalosporin was given in 51% of encounters, and 80% of these received it unnecessarily because of UTI misdiagnosis or suitability of a narrower-spectrum antibiotic. The median prescribed antibiotic duration was 7 days (interquartile range 7-10). Of 73 encounters with UCx growing mixed flora or a nonuropathogen, only 29 (40%) had antibiotics discontinued. Confirmed UTI was associated with fever and nitrite positivity. Our study revealed high prevalence of inappropriate antibiotics, particularly unnecessary prescribing of third cephalosporin, prescriptions not supported by laboratory data, and prolonged treatment courses. Our results identify factors that can be used to support UTI treatment pathways and ensure antibiotic stewardship.

Risk factors for bacteremia in infants with urinary tract infection

BackgroundSome infants with urinary tract infection (UTI) may exhibit concurrent bacteremia, potentially leading to septic shock or bacterial meningitis. Identifying risk factors for bacteremia in infants with UTI is crucial for prompt intervention to prevent subsequent adverse outcomes. MethodsBetween 2015 and 2021, a total of 632 infants with UTI aged ≤12 months were enrolled at Kaohsiung Veterans General Hospital (KSVGH), among whom 20 had concurrent bacteremia. We analyzed their differences in outcomes and demographic, clinical, and laboratory characteristics. Independent risk factors for bacteremic UTI were identified using binary logistic regression analysis. ResultsA positive underlying disease (including congenital anomalies of kidney and urinary tract [CAKUT] and prematurity), C-reactive protein (CRP) > 8 mg/dL, lower body weight, and positive urinary nitrite were independent risk factors for infants with UTI and bacteremia. ConclusionsPhysicians should be mindful of the potential for bacteremia to develop in infants with UTI, particularly those with concurrent positive underlying diseases or CRP >8 mg/dL.

Risk factors and nomogram for predicting urinary tract infection in patients with ureterolithiasis complicated with hydronephrosis.

Urinary tract infection (UTI) is a common disease in urology and often occurs in patients with urolithiasis. This study aimed to identify the risk factors for UTI in patients with ureterolithiasis complicated with hydronephrosis, and to construct a simple and practical nomogram to predict the incidence of UTI for patients. A total of 383 patients were enrolled from September 2019 to June 2022. The results from univariate and multivariate logistic regression showed the risk factors for predicting UTI and a prediction model was constructed. Subsequently, the differentiation, calibration, and clinical applicability of the model were estimated by receiver operating characteristic (ROC) curve analysis, calibration curve, and decision curve analysis (DCA), respectively. The study included 72 (18.80%) patients with UTI. Multivariate logistic regression showed that tissue rim sign (P=0.04), positive urinary nitrite (P<0.001), and positive urinary leukocyte esterase (P=0.005) were independent predictive indexes of UTI for patients with ureterolithiasis complicated with hydronephrosis, and a nomogram was constructed in accordance with these indicators. The area under the ROC curve was 0.773, which indicated good prediction ability. The Hosmer-Lemeshow test (P=0.97) indicated that the model fitted well. The calibration curve and DCA showed good consistency and clinical applicability, respectively. The prediction model constructed with the risk factors including tissue rim sign, positive urinary nitrite, and positive urinary leukocyte esterase can better detect patients with UTI early and take timely intervention measures.

Risk factors for treatment of asymptomatic bacteriuria in a rural health system.

Asymptomatic bacteriuria is often inappropriately treated, leading to antimicrobial-related adverse events and contributing to antimicrobial resistance. This study examined the asymptomatic bacteriuria treatment rate at a rural Wisconsin health system and the patient-specific factors that may be influencing clinicians' decisions to treat. This is a retrospective descriptive report of patients admitted from January to May 2022 at 7 rural Wisconsin hospitals. Patients were included if they were a hospitalized adult with asymptomatic bacteriuria. Patients were excluded if they had a urinary tract abnormality, active infection, symptoms of a urinary tract infection, a planned urological surgery, or treatment or prophylaxis for a urinary tract infection within 72 hours of admission, were immunocompromised, or were transferred from an outside facility. Electronic and manual chart abstraction were used for data collection. Of 429 patients with a positive urine culture, 137 patients with asymptomatic bacteriuria were included in the study. The median age was 75 years, and most patients were female (80.3%). The treatment rate of asymptomatic bacteriuria was 78.1%, amounting to 393 days of unnecessary antimicrobial therapy. Symptoms of fatigue (P = 0.014) and altered mentation (P < 0.006) and urinalysis results of nitrite positivity (P = 0.026) and pyuria (P < 0.001) were each independently associated with antimicrobial treatment. Despite guideline recommendations to avoid treatment of asymptomatic bacteriuria, treatment rates in rural hospitalized patients remain high. Nonspecific signs and symptoms of altered mentation and fatigue as well as laboratory findings of nitrite positivity and pyuria were factors associated with a decision to treat. Future stewardship efforts should speak to the poor specificity of these factors.

Beyond urinalysis: evaluation of various clinical and laboratory reflex criteria to warrant urine culture collection in the emergency department

BackgroundClinical criteria are essential for diagnosing urinary tract infections (UTIs) followed by urine testing, including urinalysis (UA). No study has evaluated the potential related factors that may guide the appropriate collection of urine cultures. Therefore, we aimed to assess the factors that may guide the appropriate collection of urine cultures.MethodsThis was a case-control study of patients for whom a urine culture and a UA were ordered in the emergency department (ED) between February 2018 and December 2022. The cases included patients with positive cultures, whereas the controls included patients without growth. Patients were excluded if they were pregnant, underwent any urological procedure, received antibiotics within 3 days before ED presentation, or before culture collection.ResultsOf the 263 patients, 123 had growth and 140 did not have growth in urine cultures. In the univariate analysis, female gender, urinary symptoms, urinary white blood cell (WBC) count > 5 cells/hpf, and nitrite in urine were significantly associated with growth (P < 0.05). However, only female gender (aOR, 1.86; 95% CI, 1.06–3.24), urinary WBC count > 5 cells/hpf (aOR, 4.60; 95% CI, 2.21–9.59), and positive nitrite in urine (aOR, 21.90; 95% CI, 2.80–171.00) remained significant in the multivariable analysis. These factors also remained significant in the subgroup of patients with urinary symptoms, except for the female gender.ConclusionA high urinary WBC count and positive nitrite in UA should be utilized as a guide to collect urine culture, particularly in female patients, to limit the unnecessary ordering of urine culture in the ED. These factors can be used as evidence-based UA reflex criteria as an antimicrobial stewardship intervention.

THE EXAMINATION OF URINALYSIS PROFILES OF PREGNANT WOMEN AND TODDLER AS AN EFFORTS OF SCREENING THE POTENTIAL OCCURRENCE OF STUNTING INCIDENTS AND LOW BIRTH WEIGHT BABIES IN PENJARINGAN FLATS, RUNGKUT DISTRICT, SURABAYA

Penjaringan Sari Flats is a solution implemented by the Surabaya City Government to overcome the limited housing in Surabaya. Due to the high number of residents , Penjaringan Sari Flats have a rapid and spread infectious rate. One of the impacts of infectious diseases that may be experienced by pregnant women and also children under five aged is low birth weight (LBW) babies and stunting. One solution to reduce the number of stunting and LBW that can be done is screening at early conditions of infection in pregnant women and toddler using the urine examination method (urinalysis). In examining a urine sample which is examined using the dipstick method (urinalysis using strips), 11 parameters can be read. Three of the eleven dipstick parameters (nitrite, leukocytes, and protein) were stated to be sufficient to screen a patient's initial infection profile. Participants in this community service activity are residents of Penjaringan Sari flats who are female, pregnant, and/or small children aged up to 5 years. The first stage carried out was the introduction of this program and activity plan to the Head of Penjaringan Sari Subdistrict. Data collection on the number of pregnant women and toddlers in Penjaringan Sari Village using observational methods. Data collection was carried out personally by the Head of Community Service accompanied by local women community. The number of pregnant women is 40 and toddlers are 60 as of August 2023. The results of urine sample examinations from 74 patients from residents of Penjaringan Sari Subdistrict are divided into two different categories: pregnant women and toddlers. In the category of pregnant women, around 90% of patients had positive leukocyte results, 60% had proteinuria, and 10% showed positive urine nitrite. In the second group, namely toddlers, the results showed that around 58.13% showed positive leukocytes, around 16.27% experienced proteinuria, and 4.65% of toddler patients had positive nitrite values.

The value of IL-6, PCT, qSOFA, NEWS, and SIRS to predict septic shock after Percutaneous nephrolithotomy

BackgroundThere are numerous methods available for predicting sepsis following Percutaneous Nephrolithotomy. This study aims to compare the predictive value of Quick Sequential Organ Failure Assessment (qSOFA), Systemic Inflammatory Response Syndrome (SISR), National Early Warning Score (NEWS), interleukin-6 (IL-6), and procalcitonin (PCT) for septicemia.MethodsPatients who underwent percutaneous nephrolithotomy were included in the study and divided into a control group and a septic shock group. The effectiveness of qSOFA, SIRS, NEWS, Interleukin-6, and Procalcitonin was assessed, with Receiver Operating Characteristic curves and Area Under the Curve used to compare the predictive accuracy of these four indicators.ResultsAmong the 401 patients, 16 cases (3.99%) developed septic shock. Females, elderly individuals, and patients with positive urine culture and positive nitrite in urine were found to be more susceptible to septic shock. PCT, IL-6, SIRS, NEWS, qSOFA, and surgical time were identified as independent risk factors for septic shock. The cutoff values are as follows: qSOFA score > 0.50, SIRS score > 2.50, NEWS score > 2.50, and IL-6 > 264.00 pg/ml. Among the 29 patients identified by IL-6 as having sepsis, 16 were confirmed to have developed sepsis. The qSOFA identified 63 septicemia cases, with 16 confirmed to have developed septicemia; NEWS identified 122 septicemia cases, of which 14 cases actually developed septicemia; SIRS identified 128 septicemia patients, with 16 confirmed to have developed septicemia. In terms of predictive ability, IL-6 (AUC 0.993, 95% CI 0.985 ~ 1) demonstrated a higher predictive accuracy compared to qSOFA (AUC 0.952, 95% CI 0.928 ~ 0.977), NEWS (AUC 0.824, 95% CI 0.720 ~ 0.929) and SIRS (AUC 0.928, 95% CI 0.888 ~ 0.969).ConclusionsIL-6 has higher accuracy in predicting septic shock after PCNL compared to qSOFA, SIRS, and NEWS.

Accuracy of Urinalysis for UTI in Spina Bifida.

Urinary tract infections (UTIs) are common, but overdiagnosed, in children with spina bifida. We sought to evaluate the diagnostic test characteristics of urinalysis (UA) findings for symptomatic UTI in children with spina bifida. Retrospective cross-sectional study using data from 2 centers from January 1, 2016, to December 31, 2021. Children with myelomeningocele aged <19 years who had paired UA (and microscopy, when available) and urine culture were included. The primary outcome was symptomatic UTI. We used generalized estimating equations to control for multiple encounters per child and calculated area under the receiver operating characteristics curve, sensitivity, and specificity for positive nitrites, pyuria (≥10 white blood cells/high-powered field), and leukocyte esterase (more than trace) for a symptomatic UTI. We included 974 encounters from 319 unique children, of which 120 (12.3%) met our criteria for UTI. Pyuria had the highest sensitivity while nitrites were the most specific. Comparatively, nitrites were the least sensitive and pyuria was the least specific. When the cohort was limited to children with symptoms of a UTI, pyuria remained the most sensitive parameter, whereas nitrites remained the least sensitive. Nitrites continued to be the most specific, whereas pyuria was the least specific. Among all encounters, the overall area under the receiver operating characteristics curve for all components of the UA was lower in children who use clean intermittent catheterizations compared with all others. Individual UA findings have moderate sensitivity (leukocyte esterase or pyuria) or specificity (nitrites) but overall poor diagnostic accuracy for symptomatic UTIs in children with spina bifida.

Influence of preoperative urine culture and bacterial species on urogenital sepsis after ureteral flexible lithotripsy in patients with upper urinary tract stones.

This retrospective study aims to identify risk factors for urogenic sepsis in patients with upper urinary tract stones following ureteral flexible lithotripsy (FURL). Additionally, we analyze the clinical characteristics of bacterial infections post-surgery. A total of 759 patients who underwent FURL at the Urology Department of Zunyi Medical University were included. Univariate and multivariate Logistic regression analyses were conducted to identify independent risk factors for urogenic sepsis post-FURL. The distribution of bacteria based on preoperative urine cultures was also analyzed. Statistical analysis was performed using R4.2.2 software. Of the 759 patients, positive preoperative urine culture, urine nitrite positivity, urine white blood cell count (WBC) ≥ 200 cells/μL, residual stones, and neutrophil-to-lymphocyte ratio (NLR) were found to be independent risk factors for urogenic sepsis after FURL. Among the 164 patients with positive preoperative urine cultures, 32 developed urogenic sepsis post-surgery, with 68.75% having positive preoperative cultures. The leading pathogens causing postoperative urogenic sepsis were Escherichia coli (E. coli), Enterococcus faecium, Proteus mirabilis, and Klebsiella pneumoniae. The probabilities of progression to urogenic sepsis were as follows: E. coli 19% (n = 12), Enterococcus faecium 43% (n = 3), Proteus mirabilis 33.3% (n = 1), and Klebsiella pneumoniae 33.3% (n = 1). The ages of affected patients were 47.17 ± 13.2, 53.7, 41, and 79 years, respectively. Rates of comorbid diabetes were 36.4, 66.7, 50, 100%, with nitrite positivity rates at 72.7, 33.3, 50, 0%. Ten female patients were infected with E. coli, while patients infected with Klebsiella pneumoniae had an NLR of 7.62. Positive preoperative urine culture, urine nitrite positivity, urine WBC ≥ 200 cells/μL, residual stones, and NLR are independent risk factors for urogenic sepsis after FURL. Escherichia coli is the predominant pathogen post-FURL, with notable female prevalence and nitrite-positive urine in infections. Enterococcus faecium infections are associated with diabetes.

Construction and validation of the nomogram predictive model for post-percutaneous nephrolithotomy urinary sepsis.

This study aimed to construct and validate a simple and accurate clinical nomogram for predicting the occurrence of post-percutaneous nephrolithotomy sepsis, aiming to assist urologists in the early identification, warning, and early intervention of urosepsis, and to provide certain evidence-based medicine basis. This study included patients who underwent PCNL surgery due to kidney or upper ureteral stones at the Department of Urology, Affiliated Hospital of Zunyi Medical University, from January 2019 to September 2022. This study utilized univariate and multivariate logistic regression analysis to screen and evaluate the risk factors for sepsis and construct a predictive model. An evaluation was performed using the receiver operating characteristic curve, calibration curve, and decision curve analysis curve. All statistical analyses were conducted using R version 4.2. A total of 946 patients who underwent post-PCNL were included in this study, among whom 69 patients (7.29%) developed post-PCNL urinary sepsis. Multiple-factor logistic regression analysis identified four independent risk factors associated with post-PCNL urinary sepsis, including positive urinary nitrite (OR = 5.9, P < 0.001), positive urine culture (OR = 7.54, P < 0.001), operative time ≥ 120min (OR = 20.93, P = 0.0052), and stone size ≥ 30mm (OR = 13.81, P = 0.0015). The nomogram model demonstrated good accuracy with an AUC value of 0.909, and in the validation cohort, the AUC value was 0.922. The calibration curve indicated a better consistency between the predictive line chart and the actual occurrence of post-PCNL urinary sepsis. The decision curve analysis curve showed favorable clinical utility. Preoperative positive urine culture, positive urinary nitrite, operative time ≥ 120min, and stone size ≥ 30mm are independent risk factors for developing post-PCNL urinary sepsis. The constructed line chart based on these factors effectively assesses the risk of urinary sepsis in patients after PCNL.

Pengaruh Positifitas Leukosit Esterase dan Nitrit Urine Terhadap Nilai Neutrophil Lymphocyte Ratio (NLR) pada Pasien Infeksi Saluran Kemih

Urinary tract infection (UTI) characterized by positivity of leukocyte esterase and nitrite can affect the Neutrophil Lymphocyte Ratio (NLR) value as a reflection of the degree of infection and inflammation by pathogenic microorganisms. Objective: To analyzed the effect of positivity leukocyte esterase and nitrite urine on NLR values in UTI patients. Methods: This study used an observational analytic method with a cross-sectional approach. UTI patients will be subjected to urinalysis and complete blood cell examination. The data obtained will be subjected to the Pearson correlation and linear regression tests. Results: This study used 36 samples of UTI patients with an abnormal number of positive leukocyte esterase samples in 36 samples (100%), positive urine nitrite in 20 samples (55,6%), and abnormal NLR values &gt;3,5 are 27 samples (75%) with a mean of 10,21. Conclusion: There is a significant influence and relationship between the positivity of leukocyte esterase and urine nitrite on NLR value in UTI patients with a simultaneous value of 45,1% and p 0,000.Keywords: UTI, leukocyte esterase, urine nitric, NLR

Impact of restrictive urinalysis reflex to culture criteria at a large community hospital

Treatment of asymptomatic bacteriuria (ASB) is a common, but often unnecessary, practice. Our objective was to determine the impact of restrictive urinalysis reflex to culture (UARC) criteria on rate of urine cultures (UC) ordered and ASB treatment. Criteria were modified from positive leukocyte esterase, positive nitrites, or white blood cells (WBC) >10 cells to only WBC >10 cells.This pre-post study evaluated UARCs ordered in the emergency department or inpatient units. The primary outcome was the proportion of reflex UCs prevented. Secondary outcomes included the frequency of repeat UARCs and stand-alone UCs, gram-negative rod (GNR) bacteremia, and ASB treatment.In the pre-intervention, there were 4761 UARCs compared to 5420 in the post-intervention; 37.9 % and 21.4 % reflexed to UCs, a 43.5 % reduction in UCs. The rate of repeat UARCs, stand-alone UCs, and GNR bacteremia in the pre- and post-interventions were similar. ASB treatment rate was numerically lower in the post-intervention.

A Prospective Study to Identify Asymptomatic Bacteriuria: The Causative Organisms, Antibiotic Sensitivity and its Safety in Pregnant Females

Introduction: The common procedure of urinary catheterization during childbirth may introduce bacteria that can cause urinary tract infections. Immune function is relatively compromised during pregnancy. The current study was aimed to identify antenatal patients with bacteriuria, the causative organism and its antibiotic sensitivity in patients with bacteriuria. Materials and Methods: The current prospective crosssectional study involved antenatal patients who were being admitted to the delivery room. A clean catch midstream urine sample was collected in a sterile container of which 5 to 10 mL of the sample was obtained in a separate sterile vial (container 1) for screening tests for leucocyte esterase and nitrite, and the remaining sample (container 2) was taken for routine microscopy, culture, and sensitivity. The reports were collected and tabulated, and bacteriuria was confirmed and statistically analyzed. Results: A total of 200 patients were evaluated, and 40 of them had asymptomatic bacteriuria. In this study positive leukocyte esterase test and nitrite test results were considerably higher in the cases than the controls (p &lt; 0.05) at 10.0 and 47.5%, respectively. Escherichia coli was found to be the most prevalent bacteria in this study, followed by, Pseudomonas, Enterococcus faecalis, Candida albicans, and coagulasenegative Streptococcus and Klebsiella. Most of the E. coli isolates (100.0%) were sensitive to amikacin, a category D drug. The majority of Pseudomonas isolates (100.0%) were sensitive to colistin, a category C drug. Amongst category A drugs, Pseudomonas was sensitive to – cefoperazone-sulbactam, meropenem and piperacillin-tazobactam. Conclusion: It is a standard practice to send urine routine and microscopy test in antenatal patients. As most patients are asymptomatic, investigations are required for early diagnosis of significant bacteria like leucocyte esterase, nitrite and culture and sensitivity. This will help us to institute appropriate treatment and improve maternal and fetal outcomes.

Intraepithelial Inclusions on Urinalysis Screening among COVID-19 Cases: Are they Covicytes?-A Hospital-Based Cohort Study with Narrative Review.

"Intraepithelial inclusions on urinalysis screening among COVID-19 cases: Are they Covicytes?-A hospital-based cohort study with narrative review." Coronavirus disease 2019 (COVID-19)-associated delayed acute kidney injury (AKI) is often reported in subsequent waves of the pandemic. Early intervention and regular follow-up influence the outcome and inhibit progression into chronic kidney disease (CKD). This is the first study to identify urinary cytomorphological abnormalities (Covicytes) and predict COVID-19-associated delayed AKI with a narrative review of the possible etiologies for intraepithelial inclusions. A hospital-based cohort study with a narrative review. Screening urinalysis to assess the cytomorphology of epithelial cells (ECs) and inclusions in Leishman and periodic acid-Schiff (PAS)-stained smears by two independent pathologists was performed in reverse transcriptase polymerase chain reaction (RT-PCR)-confirmed COVID-19 cases at a tertiary care center. Basic statistical tools were used for descriptive statistical analysis, and data were expressed in mean, proportion, and frequency. Cytomorphological abnormalities (48/188) were predominant among adult males. Leukocyturia (39/48) with positive nitrite test (28/39), high ECs (27/48) and squamous cell-to-tubular EC (SC:TEC) ratio, intraepithelial intracytoplasmic inclusions predominantly in TECs (Covicytes), and multiple well-visualized, perinuclear PAS-negative neutrophilic vacuoles (17/39) were found. The association with preexisting diabetes (31/48), hypertension (10/48), and disease severity was noted. This study reported COVID-19-associated urinary cytomorphological abnormalities and interesting unique inclusions (Covicytes) that may be a result of underlying inflammatory changes, reactive hyperplasia, degenerative changes, or defective endocytosed vacuoles. The possible etiologies for renal inclusions were reviewed. We recommend compulsory baseline and follow-up urinary cytology screening for all COVID-19-suspected patients to detect and predict delayed AKI before clinical and biochemical manifestation during disease endemicity.

7295 elderly hospitalized patients with catheter-associated urinary tract infection: a case-control study

BackgroundCatheter-associated urinary tract infection (CAUTI) ranks second among nosocomial infections in elderly patients after lung infections. Improper treatment can lead to death. This study analysed the risk factors, pathogen distribution, clinical characteristics and outcomes of CAUTI in elderly inpatients with a large sample size to provide evidence for clinical prevention and control.MethodsBased on the HIS and LIS, a case‒control study was conducted on all hospitalized patients with indwelling urinary catheters ≥ 60 years old from January 1, 2019, to December 31, 2022, and the patients were divided into the CAUTI group and the non-CAUTI group.ResultsCAUTI occurred in 182 of 7295 patients, and the infection rate was 3.4/per 1000 catheter days. Urine pH ≥ 6.5, moderate dependence or severe dependence in the classification of self-care ability, age ≥ 74 years, male sex, hospitalization ≥ 14 days, indwelling urinary catheter ≥ 10 days, diabetes and malnutrition were independent risk factors for CAUTI (P < 0.05). A total of 276 strains of pathogenic bacteria were detected in urine samples of 182 CAUTI patients at different times during hospitalization. The main pathogens were gram-negative bacteria (n = 132, 47.83%), followed by gram-positive bacteria (n = 91, 32.97%) and fungi (n = 53, 19.20%). Fever, abnormal procalcitonin, positive urinary nitrite and abnormal urination function were the clinical characteristics of elderly CAUTI patients (P < 0.001). Once CAUTI occurred in elderly patients, the hospitalization days were increased by 18 days, the total hospitalization cost increased by ¥18,000, and discharge all-cause mortality increased by 2.314 times (P<0.001).ConclusionThe situation of CAUTI in the elderly is not optimistic, it is easy to have a one-person multi-pathogen infection, and the proportion of fungi infection is not low. Urine pH ≥ 6.5, moderate or severe dependence on others and malnutrition were rare risk factors for elderly CAUTI in previous studies. Our study analysed the clinical characteristics of CAUTI in the elderly through a large sample size, which provided a reliable basis for its diagnosis and identified the adverse outcome of CAUTI.

Clinical and laboratory features of urinary tract infection in hospitalized children

Background: Urinary tract infections (UTIs) is a common infection in children and a significant problem in Indonesia. Epidemiological data in developing countries are not widely available. This study aimed to determine the clinical and laboratory features of UTIs in hospitalized children. Methods: A retrospective study at a tertiary hospital in Denpasar–Bali. Children diagnosed with UTIs from January 1st, 2021–December 31st, 2022 were enrolled. Subjects are characterized based on age, nutritional status, and comorbidity. Clinical and laboratory features were described. Results: There were 84 children diagnosed with UTIs. A total of 30 subjects (35.7%) were &lt;1–year-old and mostly female (52.4%). Most subjects (47.6%) were well–nourished and had comorbidities (92.9%) from a non-kidney disease (65.5%). Eight (9.5%) of the 52 subjects had hypertension. The most common symptom in the &lt; 1–year–old group was jaundice (50%). The predominant symptom in the 1–5–year–old group was also fever (71.4%). Localized symptoms in the &gt; 5–year–old groups showed dysuria (38.5%), urinary retention (30.8%), and frequency (26.9%). Urinalysis showed 30 subjects (35.7%) with positive nitrites and pyuria (66.7%). Leukocytosis was found in 24 subjects (72%) with a median NLR of 1.8. Abnormalities found in imaging examinations were cystitis (19.2%), hydronephrosis (42.1%), and hydroureter (11.5%). Conclusion: Age &lt; 1–year–old, female, had comorbidities with predominant symptom was fever found in hospitalized UTIs. Half of the subjects had leukocytosis, abnormalities in urinalysis, and urology imaging. However, further research is needed to know the association and risk factors for UTIs in hospitalized children.

Development and validation of a predictive model for post-percutaneous nephrolithotomy urinary sepsis: a multicenter retrospective study.

The objective of this retrospective, multicenter study was to analyze the factors associated with the development of urogenital sepsis after percutaneous nephrolithotomy (PCNL) and to establish a nomogram prediction model of urogenital sepsis after PCNL. A total of 2066 postoperative PCNL patients were included from three medical institutions: Zunyi Medical University Hospital, Beijing Jishuitan Hospital Guizhou Hospital, and Fenggang County People's Hospital. Clinical data of 1623 patients from the Department of Urology of Zunyi Medical University Hospital were randomized into a training cohort (Zunyi training cohort, N.=1139) and an internal validation cohort (Zunyi internal validation cohort, N.=484) using computer generated random numbers in a 7:3 ratio. Univariate and multivariate logistic regression analyses were performed on the compliance training cohort to identify risk factors for urogenital sepsis after PCNL and to develop a column line graph prediction model based on these risk factors. Finally, Zunyi internal validation cohort and two external validation cohorts (Guiyang external cohort, N.=306; Fenggang external cohort, N.=137) were used to validate the prognostic accuracy of the nomogram prediction model. R4.2.2 statistical software was used for all statistical data analyses. Multifactorial logistic regression analysis of the Zuiyi training cohort (N.=1139) identified five independent risk factors associated with urogenital sepsis after PCNL, including urine culture positivity (odds ratio [OR]=5.29, P<0.001), urine nitrite positivity (OR=5.97, P<0.001), operation time ≥60 min (OR=4.4, P=0.0037), residual stone (OR=5.18, P<0.001), and size ≥30 mm (OR=3.22, P=0.0086). Nomogram were constructed based on these independent risk factors. The area under the curve (AUC) of the nomogram model was 0.907 in the in-progress sample and 0.948 after internal validation. The AUC of the model was 0.855 and 0.804 after external validation of the Guiyang external validation cohort and the Fenggang validation cohort, respectively, indicating good discrimination ability. The calibration curves of the nomogram showed good agreement, and the decision curve analysis demonstrated high clinical utility. Based on the clinical independent risk factors such as positive urine culture, positive urine nitrite, operation time ≥60min, stone residue, stone size ≥30mm, nomogram prediction model of urogenital sepsis after PCNL was established, which can provide reference for urologists to develop preoperative evaluation and treatment strategies for patients with percutaneous nephrolithotomy.