Positive Urinary Tract Infection Research Articles

Levels of IL-6 and IL-8 in complicated versus uncomplicated urinary tract infection

Background: Urinary tract infections (UTIs) are one of the world's most frequent infectious diseases, affecting 150 million people each year and resulting in severe morbidity and high medical expenditures. UTIs can be clinically defined as uncomplicated UTIs (uUTIs) or complicated UTIs (cUTIs) to differentiate infections of benign origin from those with a higher risk of recurrence or progression to severe pathology. The aim of this study was to evaluate interleukin-6 (IL-6) and IL-8 as potential biomarkers in differentiating complicated and uncomplicated Methods: Ninety samples of urine were collected. There were 43 samples from healthy controls and 47 samples from UTI patients, those who have been clinically diagnosed with UTIs by the urologist. The serum IL-6 and IL-8 were measured using an enzyme-linked immunosorbent assay and commercially available kits. Results: The levels of both IL-6 and IL-8 were significantly higher in UTI patient then in control subjects (p=0.001, p=0.001). A significant difference was observed in the mean of level IL-6 between culture positive UTI patients and culture negative UTI patients (p=0.014). In addition, the type of bacterial growth, a significant difference was observed in the mean of serum IL-6 and IL-8 level in UTI caused by gram negative bacteria in comparison with UTI caused by gram positive bacteria. Conclusion: High levels of IL-6 are associated with the growth of gram-negative bacteria, and this indicates that gram-negative bacteria could induce stronger inflammatory responses than gram-positive bacteria. IL-8 levels are higher in UTIs caused by gram-negative bacteria. This result further supported the evidence that gram-negative bacteria are potent inducers of inflammatory responses.

Association Between Spontaneous Preterm Labor and Genitourinary Tract Infections Among Pregnant Women in a Tertiary Care Hospital in South India: A Cross-Sectional Study.

Introduction and objectives Preterm labor, defined by the WHO as the onset of labor between 20 and 37 weeks of gestation, is a major contributor to neonatal morbidity and mortality, with spontaneous preterm birth accounting for two-thirds of these cases. Genitourinary tract infections, particularly urinary tract infections (UTIs), are a significant risk factor for preterm labor, with studies suggesting that 40% of spontaneous preterm births are associated with genital tract infections. This study aims to determine the association between spontaneous preterm labor and genitourinary tract infections in a sample of antenatal women and evaluate its impact on maternal and neonatal outcomes. Methods This cross-sectional study included 144 antenatal women with spontaneous preterm labor, threatened preterm labor, or preterm premature rupture of membranes (PPROM), presenting between 28 and 37 weeks of gestation at Sri Ramachandra Medical College. Midstream urine samples and vaginal swabs were collected for culture and sensitivity testing. Additional parameters, such as maternal age, body mass index (BMI), parity, socioeconomic status (SES), and history of preterm births, were recorded. Blood tests were performed to measure total counts and C-reactive protein (CRP) levels. Maternal and neonatal outcomes, including birth weight and neonatal sepsis, were analyzed. Results Of the 144 women, 34 (24%) had a positive UTI culture, withEscherichia colibeing the most common organism isolated (35%). The majority of UTI-positive cases were observed in women aged 25-29 years (13, 38%) and those from lower socioeconomic classes (22, 65%). A significant association was found between positive UTI cases and elevated total white blood cell counts and CRP levels. Neonatal outcomes in UTI-positive cases included low birth weight (13, 38%) and neonatal sepsis (3, 9%), while maternal complications were mostly limited to asymptomatic bacteriuria and acute cystitis. Conclusion The study demonstrates a significant association between spontaneous preterm labor and UTIs. Regular screening for genitourinary infections in pregnancy, particularly in high-risk groups such as women from lower socioeconomic backgrounds, could help reduce the incidence of preterm labor and improve neonatal outcomes. Early diagnosis and treatment of UTIs are crucial for preventing complications in both mothers and neonates.

A-106 Determination of Urinary NGAL Reference Intervals from Specimens of Healthy Adult and Pediatric Individuals

Abstract Background Neutrophil gelatinase-associated lipocalin (NGAL) is a 25kDa protein implicated in multiple biological processes, including attenuation of apoptosis and differentiation of renal tubule epithelial cells and nephrons. NGAL is also produced and secreted by injured kidney tubule epithelial cells. As such, NGAL can serve as an early urinary biomarker for acute kidney injury (AKI). This multi-site, cross-sectional study aimed to establish reference intervals for urinary NGAL (uNGAL) in healthy pediatric and adult populations using a particle-enhanced turbidimetric assay. Methods Apparently healthy individuals, aged ≥ 3 months, were eligible for this study. Subjects with an active urinary tract infection (UTI) on the day of sample collection, acute kidney injury (AKI) or a history of AKI, stage 4 or 5 chronic kidney disease (CKD), known congenital anomalies of the kidney and urinary tract, known urothelial, urological, or kidney malignancies were excluded from the study. Subjects with uncorrected congenital heart disease, having undergone solid organ or bone marrow transplantation, receiving renal replacement therapy, and having undergone surgery (urologic, nephrectomy, or correction of congenital heart disease) were also excluded. A total of 688 subjects were screened, 677 were eligible, and 629 (91.4%) were considered evaluable per the protocol. The 59 excluded subjects were ineligible due to missing/incorrect information in the informed consent form, or not evaluable due to meeting exclusion criteria, mostly a positive UTI test. Urine samples were tested for NGAL on a Roche cobas® c501 analyzer in single determinations. Results Tables 1 and 2 describe the NGAL summary statistics and central 95% reference intervals by age and gender. Conclusions These data demonstrate the normal urine NGAL values in an apparently healthy pediatric and adult populations.

Clinical Adjudication of Outpatient Complications Reported in the U.S. News and World Report’s Urology Rankings

ObjectivesTo assess whether the US News and World Report (USNWR) Urology specialty ranking methodology accurately captures and classifies complications following elective outpatient urology procedures. MethodsWe conducted electronic health record chart review of n=80 elective, outpatient urology procedures with complications from 2019-2023 across four hospitals in our integrated US health system. We used the Solventum AM-PPC software and USNWR methodology to determine eligibility and measure complications. For each complication identified by the software, we assessed: 1.) Whether the procedure was performed by a urologist; 2.) Whether the adjudicator agreed with the complication type; and 3.) Whether the complication was a clinically-related sequelae of the index procedure. We reported Clavien-Dindo severity of each complication. Results: Our adjudication agreed on complication type in 62/80 (78%) complications, and 64/80 (80%) complications were clinically related to the index urology procedure. Combined, 57/80 (71%) complications were concordant on both complication type and clinical relatedness. However, 38/80 (48%) index procedures were conducted by interventional radiologists, not urologists. Furthermore, 11/80 (13.8%) complications were false positive urinary tract infections (UTIs). ConclusionsThe USNWR methodology for elective outpatient urology procedural complications showed reasonable clinical validity but detected several false positive UTIs. Further, USNWR should clarify the extent to which procedures performed by interventional radiologists belong in urology rankings.

Epidemiology and antimicrobial resistance trends of pathogens causing urinary tract infections in Mwanza, Tanzania: A comparative study during and after the implementation of the National Action Plan on Antimicrobial Resistance (2017-2022)

ObjectivesTo delineate the epidemiology and antimicrobial resistance (AMR) trends of pathogens causing urinary tract infections (UTIs) during (June 2019-June 2020) and after (March-July 2023) the implementation of the National Action Plan on AMR 2017-2022 in Mwanza, Tanzania. MethodsThis cross-sectional study was conducted among 2097 patients with clinical symptoms of UTIs during (n = 1144) and after (n = 953) the National Action Plan on AMR 2017-2022. Quantitative urine culture was done to isolate significant bacteria causing UTI, which were then identified to the species level and tested for antimicrobial susceptibility. Tabulations, descriptive, and logistic regression analyses were used to analyze categorical and continuous variables, as well as the association between outcome and independent variables. Statistical significance was defined as P ≤0.05 at a 95% confidence interval (CI). ResultsThe overall prevalence of culture-positive UTIs was 22.8% (479 of 2097; 95% CI: 21.1-24.7%), with no significant difference between the study periods (21.8% [249 of 1144; 95% CI: 19.5-24.3%]) vs 24.1% (230 of 953; 95% CI: 21.5-26.9%), P = 0.274). We observed a significant increase in resistance to ciprofloxacin (32.0% vs 45.8%, P = 0.0481) and third-generation cephalosporins (marked by extended-spectrum β-lactamase–producing Enterobacterales [ESBL-PE], 38.7% vs 56.9%, P = 0.0307). Additionally, UTIs caused by ESBL-PE is significantly common among patients in higher-tier hospitals (58.4% vs 34.0%; OR [95% CI]: 2.51 [1.41-4.48], P = 0.002). ConclusionsThere was a significant increase in bacterial resistance to ciprofloxacin and third-generation cephalosporins, as well as ESBL-PE. These results emphasize the critical need to enhance AMR surveillance, improve infection prevention and control measures, and strengthen antimicrobial stewardship programs.

Clinical Spectrum of Recurrent Urinary Tract Infections: A Single-Center Study

A retrospective observational study was undertaken to evaluate the clinical profile of recurrent urinary tract infections (UTIs)in a tertiary care hospital. Patients <18 years, kidney-transplant recipients, those on immunosuppressive agents and pregnantpatients were excluded. Patients with ≥2 episodes of culture positive UTIs were included. Demographic details, investigationsand treatment were recorded. Out of total 48 patients, 18 were female and 30 male. The common manifestations were acutepyelonephritis (52%), emphysematous pyelonephritis (20%) and cystitis (25%). Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (48%) was the most frequent organism isolated followed by Klebsiella spp. (29%) and Pseudomonasspp. (23%). Recurrent episodes of UTI with same organisms were noted in 62% patients. Death occurred in 12.5% patientsdue to septic shock. Renal calculi (24%) and double J (DJ) stent placement (30%) were associated with recurrent UTIs,though this was not statistically significant. Resistance to higher antibiotics (colistin, carbapenems, piperacillin-tazobactam,cefoperazone-sulbactam, third-generation cephalosporins) (65.4%, r = 0.81), diabetes (62.5%, r = 0.79), urological procedure(39.5%, r = 0.68), prior hospitalization (75%, r = 0.84), history of UTI prior to the study period (44%, r = 0.72) and need forper urethral catheter (PUC) beyond 7 days (35%, r = 0.74) had significant correlation with recurrent UTIs.

Levels of IL-6 and IL-8 in Complicated versus Uncomplicated Urinary Tract Infection

Urinary tract infections (UTIs) are one of the world's most frequent infectious diseases, affecting 150 million people each year and resulting in severe morbidity and high medical expenditures. UTIs can be clinically defined as uncomplicated UTIs (uUTIs) or complicated UTIs (cUTIs) to differentiate infections of benign origin from those with a higher risk of recurrence or progression to severe pathology. The aim of this study was to evaluate interleukin-6 (IL-6) and IL-8 as potential biomarkers in differentiating complicated and uncomplicated. Ninety samples of urine were collected. There were 43 samples from healthy controls and 47 samples from UTI patients—those who have been clinically diagnosed with UTIs by the urologist. The serum IL-6 and IL-8 were measured using an enzyme-linked immunosorbent assay and commercially available kits. The levels of both IL-6 and IL-8 were significantly higher in UTI patient then in control subjects (p=0.001, p=0.001). A significant difference was observed in the mean of level IL-6 between culture positive UTI patients and culture negative UTI patients (p=0.014). In addition, the type of bacterial growth, a significant difference was observed in the mean of serum IL-6 and IL-8 level in UTI caused by gram negative bacteria in comparison with UTI caused by gram positive bacteria. High levels of IL-6 are associated with the growth of gram-negative bacteria, and this indicates that gram-negative bacteria could induce stronger inflammatory responses than gram-positive bacteria. IL-8 levels are higher in UTIs caused by gram-negative bacteria. This result further supported the evidence that gram-negative bacteria are potent inducers of inflammatory responses.

The prevalence of multidrug resistance in uropathogens of patients admitted in the intensive care unit of a tertiary care hospital.

Urinary tract infections (UTIs) are among the most common bacterial infections, posing significant public health challenges due to increasing antimicrobial resistance (AMR). This study aims to assess the prevalence, demographic characteristics, microbial profile, and antimicrobial resistance patterns in Indian patients with UTIs admitted to intensive care unit. A total of 154 patients with positive UTIs were included in this cross-sectional study. The prevalence data including demographics, microbial isolates, and antimicrobial susceptibility patterns were collected. Additionally, risk factors for multidrug resistance uropathogens were assessed using multivariate analyses. The patient cohort had diverse demographic, with a slight male predominance of 52.6% (n = 81). The most common comorbidities were hypertension 59.1% (n = 91) and diabetes mellitus 54.5% (n = 84). The microbial profile was dominated by gram-negative bacteria, particularly Escherichia coli 26.62% (n = 41) and Klebsiella pneumoniae 17.53% (n = 27). The predominant gram-positive and fungal isolate was Enterococcus faecium 7.14% (n = 11) and Candida spp. 18.83% (n = 29), respectively. Substantial resistance was noted against common antimicrobials, with variations across different pathogens. Gram-negative bacteria, particularly Escherichia coli and Klebsiella pneumoniae, exhibited high MDR rates, emphasizing the challenge of antimicrobial resistance. Multivariate logistic regression identified age groups 50-65 and over 65, and prolonged catheterization as significant risk factors for MDR infections. A significantly high resistance rate among pathogens emphasizes the need for judicious antimicrobial use. Our findings emphasize the necessity of ongoing surveillance and tailored interventions based on local pathogen prevalence and antibiogram data to effectively address the threat of AMR threat for better management of UTI management in ICU settings.

Critically Evaluating the Role for Postoperative Antibiotics in Patients Undergoing Urethroplasty With Buccal Mucosa Graft: A Claims Database Analysis

ObjectivesTo compare outcomes among patients undergoing first-time urethroplasty with buccal mucosa graft (BMG) who receive post-operative antibiotics versus those who do not. MethodsA retrospective cohort study was conducted using the TriNetX claims database between 2008-2022. Using CPT, ICD10, and LOINC codes, patients >18 years old undergoing primary urethroplasty with BMG who received an outpatient prescription for antibiotics between post-operative day 0-30 or did not were queried. Patients with positive pre-operative urine culture or urinary tract infection (UTI) within 30 days pre-operatively were excluded. Surgical outcomes included 5-year revision rates and revision-free survival. Safety outcomes included new UTI within 30 days, surgical site infection (SSI) within 90 days, or Clostridium difficile infection within 30 days of urethroplasty. ResultsWe identified 884 patients (81% antibiotic cohort, 19% non-antibiotic cohort) that met inclusion criteria. Age at time of urethroplasty, suprapubic tube presence, and pre-existing medical comorbidities were comparable between cohorts (Table 1A). There was no difference in 5-year rates and revision-free survival for endoscopic revision (11.5% vs. 9.5%, RR 1.2, 95% CI [0.7, 2.0], RFS log-rank p=0.6), re-do urethroplasty (12.9% vs. 13.7%, RR 0.9, 95% CI [0.6, 1.5], RFS log-rank p=0.7), or all-cause revision (19.8% vs. 17.7%, RR 1.1, 95% CI [0.8, 1.6], p=0.5) between groups. Post-operative rates of UTI, SSI, and Clostridium difficile infection were similar between groups. ConclusionsIn this large retrospective cohort study of patients undergoing urethroplasty with BMG, we observed no significant benefit from use of post-operative antibiotics on long-term revision rates or perioperative infectious complications.

Comparison Shows that Multiplex Polymerase Chain Reaction Identifies Infection-associated Urinary Biomarker–positive Urinary Tract Infections That Are Missed by Standard Urine Culture

BackgroundMultiplex polymerase chain reaction (M-PCR) has increased sensitivity for microbial detection compared with standard urine culture (SUC) in cases diagnosed as urinary tract infections (UTIs), leading to questions whether detected microbes are likely causative of UTIs or are incidental findings. ObjectiveTo compare infection-associated biomarker levels against M-PCR and SUC results in symptomatic cases with a presumptive diagnosis of a UTI by a urologist. Design, setting, and participantsParticipants were ≥60 yr old and presented to urology clinics between January and April 2023 with symptoms of UTIs (n = 583). Urine microbial detection was by M-PCR and SUC. Three infection-associated biomarkers (neutrophil gelatinase-associated lipocalin, interleukin-8, and interleukin-1β) were measured by enzyme-linked immunosorbent assay. Symptomatic cases with elevated biomarkers, detection of uropathogens, and a specialist clinical diagnosis of a UTI were considered definitive UTI cases. Outcome measurements and statistical analysisDistributions were compared using two-sample Wilcoxon rank sum test, with two-tailed p values of <0.05 considered statistically significant. Results and limitationsIn cases with M-PCR–positive/SUC-negative results (n = 80), all median biomarker levels were significantly higher (p < 0.0001) than in cases with M-PCR–negative/SUC-negative results (n = 107). Two or more biomarkers were positive in 76% of M-PCR–positive/SUC-negative specimens. Limitation was an inability to examine associations between each individual organism and inflammation. ConclusionsA significant number of M-PCR–positive/SUC-negative cases had elevated levels of infection-related urinary biomarkers, especially when infection was caused by organisms other than Escherichia coli. This is a strong indication that microbes detected by M-PCR, which would be missed by SUC, are associated with UTIs. Patient summaryWe compared infection-associated biomarkers in patients diagnosed with urinary tract infections (UTIs) against the detection of microorganisms by standard urine culture (SUC) and multiplex polymerase chain reaction (M-PCR). We found that most patients with microorganisms detected by M-PCR, which were missed by SUC, had elevated markers of inflammation, indicating that these organisms were likely causative of UTIs.

Clinical Spectrum of Recurrent Urinary Tract Infections: A Single-Center Study

A retrospective observational study was undertaken to evaluate the clinical profile of recurrent urinary tract infections (UTIs) in a tertiary care hospital. Patients &lt;18 years, kidney-transplant recipients, those on immunosuppressive agents and pregnant patients were excluded. Patients with ≥2 episodes of culture positive UTIs were included. Demographic details, investigations and treatment were recorded. Out of total 48 patients, 18 were female and 30 male. The common manifestations were acute pyelonephritis (52%), emphysematous pyelonephritis (20%) and cystitis (25%). Extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli (48%) was the most frequent organism isolated followed by Klebsiella spp. (29%) and Pseudomonas spp. (23%). Recurrent episodes of UTI with same organisms were noted in 62% patients. Death occurred in 12.5% patients due to septic shock. Renal calculi (24%) and double J (DJ) stent placement (30%) were associated with recurrent UTIs, though this was not statistically significant. Resistance to higher antibiotics (colistin, carbapenems, piperacillin-tazobactam, cefoperazone-sulbactam, third-generation cephalosporins) (65.4%, r = 0.81), diabetes (62.5%, r = 0.79), urological procedure (39.5%, r = 0.68), prior hospitalization (75%, r = 0.84), history of UTI prior to the study period (44%, r = 0.72) and need for per urethral catheter (PUC) beyond 7 days (35%, r = 0.74) had significant correlation with recurrent UTIs.

Who needs an ultrasound? Using patient symptom questionnaire & UTI history to determine when to obtain an RBUS in children with non-neurogenic lower urinary tract dysfunction

Non-neurogenic lower urinary tract dysfunction (LUTD) is one of the most common reasons for presentation to a pediatric urologist, affecting up to 20% of children. Predicting who will benefit from RBUS as part of their work-up is challenging as the majority will have normal imaging. Our objective was to assess the utility of using the Dysfunctional Voiding and Incontinence Scoring System (DVISS) and urinary tract infection (UTI) history to predict which LUTD patients were most likely to have an abnormal RBUS as well as determine a DVISS cutoff to aid in making this prediction. We hypothesized that higher DVISS scores and a positive urinary tract infection (UTI) history would be associated with increased likelihood of RBUS abnormality. We retrospectively reviewed outpatients seen for LUTD from 5/2014-1/2016 who received an RBUS. Association between prior UTI, DVISS score, gender, and race and RBUS abnormality were evaluated using logistic regression analysis. Receiver operating characteristic (ROC) curves were created to evaluate the predictive model and a Youden index calculated to determine the optimal cutoff for DVISS score to predict abnormal RBUS. 15 of 333 patients (4.5%) had a clinically significant RBUS abnormality. Significantly more patients with abnormal RBUS had a positive UTI history and median DVISS was higher. UTI history and DVISS score were associated with RBUS abnormality whereas neither gender nor race were. A DVISS score cutoff of 12 was determined to be ideal for predicting abnormal imaging. Using DVISS≥12 and positive UTI history, patients with both risk factors were significantly more likely to have an abnormal RBUS than those with zero or one risk factor (Figure). To the best of our knowledge this is the first study to try to identify risk factors associated with RBUS abnormality in pediatric LUTD patients and create an evidence-based approach to imaging these patients. We found both DVISS cutoff ≥12 and positive UTI history to be useful to risk stratify LUTD patients' likelihood of abnormal RBUS. Limitations include the study's retrospective nature as well as the fact the population was drawn from a tertiary care pediatric hospital with a large referral population and the fact that the decision to order an RBUS was based on individual clinician preference and decision making. We found that DVISS score≥12 and UTI history are useful in guiding the decision to obtain RBUS in pediatric LUTD patients.

Evaluation of the diagnostic performance of the urine dipstick test for the detection of urinary tract infections in patients treated in Kenyan hospitals.

Culture is the gold-standard diagnosis for urinary tract infections (UTIs). However, most hospitals in low-resource countries lack adequately equipped laboratories and relevant expertise to perform culture and, therefore, rely heavily on dipstick tests for UTI diagnosis. In many Kenyan hospitals, routine evaluations are rarely done to assess the accuracy of popular screening tests such as the dipstick test. As such, there is a substantial risk of misdiagnosis emanating from inaccuracy in proxy screening tests. This may result in misuse, under-use or over-use of antimicrobials. The present study aimed to assess the accuracy of the urine dipstick test as a proxy for the diagnosis of UTIs in selected Kenyan hospitals. A hospital-based cross-sectional method was used. The utility of dipstick in the diagnosis of UTIs was assessed using midstream urine against culture as the gold standard. The dipstick test predicted 1416 positive UTIs, but only 1027 were confirmed positive by culture, translating to a prevalence of 54.1 %. The sensitivity of the dipstick test was better when leucocytes and nitrite tests were combined (63.1 %) than when the two tests were separate (62.6 and 50.7 %, respectively). Similarly, the two tests combined had a better positive predictive value (87.0 %) than either test alone. The nitrite test had the best specificity (89.8 %) and negative predictive value (97.4 %) than leucocytes esterase (L.E) or both tests combined. In addition, sensitivity in samples from inpatients (69.2 %) was higher than from outpatients (62.7 %). Furthermore, the dipstick test had a better sensitivity and positive predictive value among female (66.0 and 88.6 %) than male patients (44.3 and 73.9 %). Among the various patient age groups, the dipstick test's sensitivity and positive predictive value were exceptionally high in patients ≥75 years old (87.5 and 93.3 %). Discrepancies in prevalence from the urine dipstick test and culture, the gold standard, indicate dipstick test inadequacy for accurate UTI diagnosis. The finding also demonstrates the need for urine culture for accurate UTI diagnosis. However, considering it is not always possible to perform a culture, especially in low-resource settings, future studies are needed to combine specific UTI symptoms and dipstick results to assess possible increases in the test's sensitivity. There is also a need to develop readily available and affordable algorithms that can detect UTIs where culture is not available.

MP78-02 CRITICALLY EVALUATING THE ROLE FOR POSTOPERATIVE ANTIBIOTICS IN PATIENTS UNDERGOING URETHROPLASTY WITH BUCCAL MUCOSA GRAFT: A CLAIMS DATABASE ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023MP78-02 CRITICALLY EVALUATING THE ROLE FOR POSTOPERATIVE ANTIBIOTICS IN PATIENTS UNDERGOING URETHROPLASTY WITH BUCCAL MUCOSA GRAFT: A CLAIMS DATABASE ANALYSIS Logan Galansky, Andrew Gabrielson, and Andrew Cohen Logan GalanskyLogan Galansky More articles by this author , Andrew GabrielsonAndrew Gabrielson More articles by this author , and Andrew CohenAndrew Cohen More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003355.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Although many consider administration of antibiotics after urethroplasty dogma, there is lack of evidence regarding the benefit for postoperative antibiotics. We compare perioperative and post-surgical outcomes among patients undergoing first-time urethroplasty with use of buccal mucosa graft (BMG) who receive postoperative antibiotics versus those who do not. METHODS: A retrospective cohort study was conducted using TriNetX research network, a claims database of 110 million patient encounters between 2008-2022. Using applicable CPT, ICD10, and LOINC codes, patients>18 years old undergoing primary urethroplasty with use of BMG, who received perioperative intravenous antibiotics (IVAb), and either received an outpatient prescription for antibiotics between postoperative day 0-30 or did not were queried. Patients with positive pre-operative urine culture or urinary tract infection (UTI) within 30 days prior to urethroplasty were excluded. Surgical outcomes included 5-year revision rates and revision-free survival. Safety outcomes included new UTI within 30 days, surgical site infection (SSI) or clostridium difficile infection within 90 days of the procedure. RESULTS: We identified 645 patients (505 [78%] antibiotic cohort, 140 [22%] no-antibiotic cohort) that met inclusion criteria. There was no difference in mean age at time of urethroplasty, presence of suprapubic tube, or pre-operative rates of common medical comorbidities between cohorts (Table 1). There was no difference in type of IVAb between groups. There was no difference in 5-year rates and revision-free survival for all-cause revision (18.2% vs. 15.7%, log-rank p=0.15), endoscopic revision (10.3% vs. 12.1%, log-rank p=0.94), or surgical revision (11.1% vs. 8.6%, log-rank p=0.17) between groups. Rates of UTI within 30 days, SSI within 90 days, and clostridium difficile infection within 90 days were similar between groups. CONCLUSIONS: In this large retrospective cohort study of patients undergoing urethroplasty with use of BMG, we observed no significant benefit from the use of postoperative antibiotics on revision rates or infectious complications. Limitations of this analysis include inability to delineate between continuous versus short course prophylaxis. Source of Funding: NA © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1131 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Logan Galansky More articles by this author Andrew Gabrielson More articles by this author Andrew Cohen More articles by this author Expand All Advertisement PDF downloadLoading ...

Urine collection techniques in non-toilet trained children: Switzerland's paediatric office practices in 2022.

Urine collection techniques in non-toilet trained children: Switzerland's paediatric office practices in 2022.

Prevalence and Clinical Significance of Urinary Tract Infection among Neonates Presenting with Unexplained Hyperbilirubinemia in Lebanon: A Retrospective Study.

Neonatal jaundice is commonly seen in term and preterm newly born babies. It could be either physiologic or secondary to multiple underlying pathologies like urinary tract infection (UTI). Our main objective was to confirm the relationship between neonatal jaundice without apparent cause like hemolysis and the presence of UTI. We, retrospectively over a period extended from 2017 to 2020, included 496 babies admitted for elevated indirect hyperbilirubinemia for whom demographic, clinical, laboratory, and therapeutic data were collected through a detailed questionnaire. Our study included 496 neonates and showed a prevalence of UTI in 8.9% of neonates. The two most common microorganisms in urine culture were Escherichia coli (65.9%) and Klebsiella pneumoniae (25.0%). A multivariate logistic analysis showed that UTI was associated with male neonates (odds ratio [OR] = 2.366, 95% confidence interval [CI]: 1.173 - 4.774; P = 0.016), history of prenatal UTI (OR = 5.378, 95% CI: 2.369 - 12.209; P <0.001), poor feeding (OR = 3.687, 95% CI: 1.570 - 8.661; P = 0.003), and positive urine culture in catheter (OR = 2.704, 95% CI: 1.255 - 5.826; P = 0.011). The mean length of stay was higher in patients with positive UTI (Median = 216 hours) compared to patients with negative UTI (Median = 48 hours) (P <0.001). Neonatal sreening for UTI should be recommended whenever there is unexplaind early or prolonged hyperbilirubinemia with no evidence of alloimmune hemolysis or blood group incompatibility and to prevent the morbidity of urosepsis and congenital kidneys malformations.

Antibiotic resistance pattern in the bacterial strains of urinary tract infection in Tangail city, Bangladesh

Background: Antimicrobial resistance has become an alarming issue all over the world. Moreover, in the developing countries as well as in Bangladesh facing this badly due to lack of study. Antibiotic resistance is prevalent among the bacterial pathogens causing urinary tract infections. Urinary tract infections affect &gt;30% of people around the world. Worldwide, about 150 million people experience urinary tract infections each year. Antimicrobial treatment is often prescribed ‘empirically’ without antibiotic susceptibility testing to treat urinary tract infections (UTIs). Aims: The prevalence of antibiotic resistance is worsening, probably because of the increasing number of multidrug-resistant bacterial strains and the indiscriminate use of broad-spectrum antibiotics and empirical treatment. This study aims to determine the frequency and antibiotic resistance pattern of bacteria from suspected UTIs in Bangladeshi patients. Methods: In our study, about 200 samples of positive UTIs patients were analyzed with several parameters to see the antibiotic resistance rate. Result: After examining the patient’s sample of UTIs antibiotic resistance rate is alarming and the most causative bacteria is Escherichia coli which is about 61.8%. Among the 200 urine sample suspected UTI patients 66% and 30% are female and male, respectively. Conclusions: Empirical therapy should be guided to control the antibiotic resistance. Especially, developing country should accept the challenge with proper infrastructure to get the surveillance of resistance, as resistance varies from region to region. Appropriate antibiotics should be focused for the rational use of antibiotics to prevent antibiotics resistance through common infections.

Are we underestimating urinary retention following intravesical onabotulinumtoxinA in women with overactive bladder and a history of prior pelvic surgery?

This study's purpose is to review the rates of urinary retention requiring intermittent catheterization (IC) post intravesical OnabotulinumtoxinA (BTN/A) injection for idiopathic overactive bladder from a single practicing specialist urological surgeon. We performed a retrospective review of a single Australian urologist to identify the rate of intermittent catheterization in our clinical setting. Logistic regression was used to assess associations between requirement of IC and risk factors for urinary retention. Ninety-fourpatients were included after inclusion and exclusion criteria were applied and the average age was 69.7 years (SD 17.2) and all participants were female. Thirty-six percent (n = 34) of patients required IC. Of patients requiring IC, 32% had a prior urethral sling, 35% had prior vaginal prolapse surgery, and 29% had a preoperative urinary tract infection(UTI). There was strong evidence of univariate associations between IC and prior sling (odds ratio [OR]: 5.26, 95% confidence interval [CI]: 1.64-16.55, p = 0.005), preoperative UTI (OR: 4.25, 95%CI: 1.31-13.08, p = 0.016) and prior vaginal prolapse surgery (OR: 4.91, 95%CI: 1.64-14.72, p = 0.005). Evidence that prior sling patients were more likely to require IC remained strong in a multivariable model (OR: 7.35, 95% CI: 1.59-34.11, p = 0.011). Prior urethral sling surgery, prior vaginal prolapse surgery, and positive preoperative UTI, despite treatment, were found to be associated with a higher rate of initiation of intermittent catheterization. The rate of IC initiation of 36% was higher than reported in prior clinical trials.

Frequency of culture positive urinary tract infection in febrile children.

Objective: To determine prevalence, causative organisms and sensitivity patterns of urinary1tract infections in febrile children. Study Design: Cross Sectional study. Setting: National Institute of Child Health, Karachi. Period: Jan 2019 to July 2019. Material &amp; Methods: Patients from 3.0 to 14.0 years of age of either sex with complain of fever of &gt;37.5 C for less than 2.0 weeks were included. Patients who have life threatening conditions, chronically ill, received antibiotics within 48 hours or had structural abnormalities of urinary tract like posterior ureteral valves and children with renal failure were excluded from study. Urinary sample was collected following aseptic measures of febrile children ad was sent to lab for culture and sensitivity within one hour of its collection. Sensitivity pattern was measured in lab via disc diffusion method. Data was analyzed using SPSS version 22. Results: The mean age was 8.6±3.3 years out of which 115 (65.7%) were male and 60 (34.3%) were females, mean duration of illness was 8.7±3.1 days. The frequency of culture positive UTI in febrile children was 21 (12%) cases. The common pathogen isolated from the urine culture was E. coli found in 10 cases followed by Klebsiella oxytoca. Overall 70% of E. coli are sensitive to. gentamicin and amikacin, 50% were sensitive to third generation cephalosporin, 60% of Klebsiella are sensitive to third generation cephalosporin, 60% resistant to gentamicin and amikacin and 80% were resistant to ampicillin. Conclusion: It was concluded from this study that the frequency of culture positive urinary tract infections in febrile children was 12% and common pathogen was E.coli followed by klebsilla oxytoca.

PREVALENSI ESCHERICHIA COLI PADA SPESIMEN URIN PENDERITA INFEKSI SALURAN KEMIH DI RSUP SANGLAH TAHUN 2019

Introduction: Urinary tract infection is the second most common infectious disease in the world with high mortality and morbidity, including in Indonesia. Escherichia coli is one of the Gram negative bacteria which often causes urinary tract infections. Urinary tract infections risks will increases as a person ages. This study is intended to determine prevalence of Escherichia coli in urine specimens of urinary tract infections at Sanglah General Hospital in 2019.&#x0D; Methods: The design of this0study was a descriptive observational study with a cross-sectional design that was carried out at Sanglah General Hospital in October 2020. The sample of this study came from urine samples patients with urinary tract infections at Sanglah General Hospital for the period of January - December 2019. Where the data was taken retrospectively from the register of the Clinical Microbiology Installation of Sanglah Hospital. The prevalence of Escherichia coli in urine specimens of urinary tract infections is presented in tables and graphs.&#x0D; Results: Most of the patients with urinary tract infections were female (53.06%). The 40-59 years age group is the age group with the most incidence of urinary tract infections (36.7%). Based on the results of urine culture urinalysis, 49 patients (81.7%) had a result of 105 CFU / mL which indicated a positive urinary tract infection. According to the study results, the prevalence of Escherichia coli causing urinary tract infections was 67.3%.&#x0D; Conclusion: Based on the research that has been done, the conclusion is that the prevalence of Escherichia coli in urine specimens of urinary tract infections at Sanglah General Hospital in 2019 was 67.3%, dominated by female patients aged 40-59 years.