Positive Urine Culture Research Articles

EndoSheath use in flexible cystoscopy: a prospective evaluation of >1000 cases.

To investigate patient tolerability and safety (using urinary tract infection (UTI) as a proxy measure) following EndoSheath-assisted flexible cystoscopy (eFC). EndoSheaths are single-use, disposable sheaths used in FC. They reduce cystoscope turnaround times as complicated, time-consuming and costly sterilisation is no longer necessary. This reduces patient waiting times as cystoscope idle time, the most common rate limiting step, is reduced. All adult patients undergoing eFC over a 26-month period at a single institution were evaluated prospectively. Post-eFC, participants rated discomfort on a visual analogue scale (discomfort 1 = none, 2-4 = mild, 5-7 = moderate, 8-10 = severe). The diagnosis of UTI was broad and based on any one of patient self-report, positive urine culture or antibiotic prescription within 30 days of eFC. Data were analysed using chi-squared testing (P < 0.05, two-tailed). Of the 1091 eFCs analysed, 33.2% and 48.2% of were ranked as causing no or mild discomfort, respectively, with just 3.1% ranked severe. Discomfort was greater in younger participants but similar between sexes. Overall, post-eFC UTI incidence was 13.3%, with rates higher in females (18.1%) than males (11.2%). Participants aged ≥65 years reported a higher UTI rate (15.4%) than those aged <65 years (8.8%). No participants developed urosepsis. This large, prospective, unselected, real-world study reports that eFC is well tolerated. UTI was higher in females than males, and in those aged ≥65 years, in line with other studies using the same broad based diagnostic criteria for UTI. The conclusion is that eFC is both well tolerated and safe.

Antimicrobial stewardship to reduce overtreatment of asymptomatic bacteriuria in critical access hospitals: measuring a quality improvement intervention.

Asymptomatic bacteriuria (ASB) treatment is a common form of antibiotic overuse and diagnostic error. Antibiotic stewardship using the inappropriate diagnosis of urinary tract infection (ID-UTI) measure has reduced ASB treatment in diverse hospitals. However, critical access hospitals (CAHs) have differing resources that could impede stewardship. We aimed to determine if stewardship including the ID-UTI measure could reduce ASB treatment in CAHs. From October 2022 to July 2023, ten CAHs participated in an Intensive Quality Improvement Cohort (IQIC) program including 3 interventions to reduce ASB treatment: 1) learning labs (ie, didactics with shared learning), 2) mentoring, and 3) data-driven performance reports including hospital peer comparison based on the ID-UTI measure. To assess effectiveness of the IQIC program, change in the ID-UTI measure (ie, percentage of patients treated for a UTI who had ASB) was compared to two non-equivalent control outcomes (antibiotic duration and unjustified fluoroquinolone use). Ten CAHs abstracted a total of 608 positive urine culture cases. Over the cohort period, the percentage of patients treated for a UTI who had ASB declined (aOR per month = 0.935, 95% CI: 0.873, 1.001, P = 0.055) from 28.4% (range across hospitals, 0%-63%) in the first to 18.6% (range, 0%-33%) in the final month. In contrast, antibiotic duration and unjustified fluoroquinolone use were unchanged (P = 0.768 and 0.567, respectively). The IQIC intervention, including learning labs, mentoring, and performance reports using the ID-UTI measure, was associated with a non-significant decrease in treatment of ASB, while control outcomes (duration and unjustified fluoroquinolone use) did not change.

Efficacy and safety of a polyherbal formulation in the management of Escherichia coli urinary tract infection.

Urinary tract infection (UTI) is one of the most frequent reasons for prescribing antibiotics. Escherichia coli implicated in 75-90 % cases of UTI is becoming increasingly resistant to antibiotics. Finding alternative therapeutic agent for this infection is critical, for which herbal drugs may be an option. In Unani medicine, urinary tract infection (Ṭa'diya Majra-i-Bawl) is treated with herbal drugs possessing Da'fe Ufoonat (antiseptic), Muhallilat (anti-inflammatory) and Mudirrat (diuretic) properties. Polyherbal formulations of such drugs are expected to be beneficial in treating Escherichia coli infection. The aim of the study was to assess the efficacy and safety of a Unani polyherbal formulation aimed to develop a safe and efficacious drug for the treatment of urinary tract infection (Ṭa'diya Majra-i-Bawl) caused by Escherichia coli. This open-label, single armed clinical study was conducted on patients with clinical signs and symptoms of UTI and positive urine culture for E. coli. Patients were treated with the polyherbal formulation consisting of 50 % hydro-alcoholic extracts of Khar Khasak (Tribulus terrestris), Bhui Amla (Phyllanthus niruri), Kabab Cheeni (Piper cubeba), Beekh -i-Kasni (Cichorium intybus), Beekh-i-Karafs (Apium graveolens), Asl-us-Soos (Glycyrrhiza glabra), and Giloy (Tinospora cordifolia) in a dose of one capsule (500 mg) thrice a day orally with plain water for 42 days. Maximum (83 %) urine cultures turned out negative for E. coli after the completion of therapy. Polyherbal Unani formulation was found to be very effective for the treatment of Urinary tract infection. Clinical and microbiological cure was achieved in maximum number of patients and drug was very well tolerated without any adverse/side effect.

Predictive Value of D-dimer in Children with Acute Pyelonephritis

Background: The diagnosis of acute febrile urinary tract infection (UTI) relies on various clinical and laboratory findings, which have shown conflicting results. Objectives: This study aimed to evaluate the utility of serum D-dimer in distinguishing acute pyelonephritis (APN) from other acute bacterial febrile infections. Methods: This cross-sectional study included 47 children with a confirmed UTI (verified by positive urine culture) and 47 children with other bacterial febrile infections. Serum D-dimer levels were measured in all patients before starting antibacterial treatment. Results: A total of 94 febrile children were evaluated, with females outnumbering males. Significant differences between the two groups were observed for microscopic hematuria (P = 0.044), bacteriuria (P ˂ 0.001), white blood cell (WBC) count (P = 0.047), and hemoglobin (Hgb) (P = 0.035), but not for serum D-dimer (P = 0.327). Binary logistic regression analysis revealed that Hgb (P = 0.019) had a significant predictive value in APN, whereas serum D-dimer did not. Serum D-dimer was found to be an unreliable biomarker for distinguishing febrile UTI from other bacterial febrile infections. Conclusions: Based on our findings, while D-dimer levels increase in various acute bacterial febrile infections, they are not effective in differentiating febrile UTI from other bacterial infections.

Flemish consensus statement on the prevention, diagnosis and treatment of urinary tract infections in older nursing home residents.

Urinary tract infections (UTIs) are one of the most commonly reported infections in Belgian nursing home residents. In older adults, UTI diagnosis and management is complex, often leading to over-diagnosis and irrational antimicrobial use, stressing the need for a guideline approach. A consensus statement on the prevention, diagnosis and treatment of UTIs in older adults residing in nursing homes was developed in a collaborative effort between the Flemish Hospital Outbreak Support Teams, the Flemish Agency for Care and Health, the Association of the Flemish Coordinating and Advising General Practitioners, the Belgian Association of Urology, the Belgian Society for Gerontology and Geriatrics and PhD researchers based on a combination of clinical expertise, (inter)national guidelines and peer-reviewed studies. Optimizing fluid intake, appropriate toilet behaviour and posture, mobilization and local estrogen therapy in women are of proven value in UTI prevention, whereas the use of cranberry and probiotics is not to be advocated. The importance of avoiding bladder catheterization is stressed. In older nursing home residents, the diagnosis of UTIs remains challenging, mostly due to atypical systemic symptoms. A consensus diagnostic algorithm for UTI among residents with and without a urinary catheter was developed, including the presence of suggestive clinical symptoms and a positive urine culture. Urine dipsticks have a high negative but a low positive predictive value. C-reactive protein point-of-care testing is not recommended. Asymptomatic bacteriuria should not be screened for, in order to avoid unnecessary triggers for treatment. In cystitis, nitrofurantoin is the primary choice for treatment, with fosfomycin as an alternative; in prostatitis and uncomplicated pyelonephritis a fluoroquinolone is the advocated empirical antimicrobial.

Urine Contamination Prevalence Using a Midstream Collection Device Compared with Clean Voided Collections in Dogs.

Collecting clean-caught voided urine samples is minimally invasive, but contamination occurs when urine passes through the nonsterile urethra and external genitalia. Discarding the initial urine stream may reduce these contaminants. This study hypothesized that using a midstream urine collection device would decrease bacterial and cellular contamination as compared with cleanly caught voided urine. This descriptive cross-sectional study collected urine from dogs using standard clean-caught (SCC), midstream collection device (MCD), and cystocentesis (CYS) techniques. Urinalysis and aerobic urine culture characteristics were recorded with each characteristic's prevalence described using percentages and 95% confidence intervals for each mode of collection. Positive urine culture prevalence did not differ between SCC and MCD (adjusted P value = .099); however, CYS had a lower prevalence compared with SCC and MCD (adjusted P values of <.001 [CYS versus SCC] and 0.009 [CYS versus MCD]). For other variables, there was no difference in prevalence when comparing SCC with MCD. There was no identified advantage to collecting urine using an MCD as compared with the SCC technique. Either option is a suitable alternative when CYS is not practical; however, clinicians need to interpret results cautiously because bacterial contamination is more common as compared with CYS.

Trends in Urinary Tract Infection Management in Women.

Urinary tract infections (UTIs) are a common cause of health care utilization in the United States. The coronavirus disease 2019 (COVID-19) pandemic accelerated virtual care for UTIs. This retrospective cohort study analyzes more than 1.2 million encounters for UTI based on diagnosis codes, examining temporal trends focusing on virtual compared with in-person encounters, antibiotic dispensation rates, and culture-confirmed UTIs. From 2015 to 2022, UTI encounters increased by 325.9%, with a majority occurring at virtual visits. The rate of UTI encounters per 1,000 adult female patients increased by 241.6%. Antibiotic dispensation rates increased, surpassing the rise in rate of positive urine cultures, suggesting increasing use of empiric antibiotics. Our findings underscore the importance of balancing telemedicine's accessibility with maintaining antibiotic stewardship and highlight the need for updated guidelines.

Mortality of patients with sepsis in intensive care units at tertiary hospitals in Jordan: Prospective cohort study.

The aim of this study was to describe the 30-day mortality rate of adult patients with sepsis and septic shock in 6 intensive care units of 2 tertiary hospitals in Jordan. A prospective cohort design was used. Patients with sepsis and septic shock admitted to the medical and surgical intensive care units at 2 tertiary hospitals were followed up during the period between February 2022 and June 2022 (N = 148). Data were analyzed using SPSS, version 23. Moreover, descriptive statistics, chi-square, and binary logistic regression were used. Notably, 52.7% of patients with sepsis and septic shock died within 30 days of diagnosis of sepsis and septic shock. Sequential Organ Failure Assessment score and the history of having solid tumors significantly predicted the 30-day mortality rate. Moreover, 43 (29.0%) patients with sepsis and septic shock had positive blood cultures, and 46 (31.0%) had positive urine cultures. Patients with sepsis and septic shock have a notable mortality rate that can be predicted from total Sequential Organ Failure Assessment scores and from the history of having solid tumors. Early assessment and initiation of treatment for sepsis essentially would reduce the likelihood of progression of sepsis to septic shock and would reduce associated patients' mortality.

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 &amp;lt;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 &amp;gt;104/mL or &amp;gt;107/L and &amp;gt;105/mL or &amp;gt;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 &amp;gt;105/mL or &amp;gt;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.

Predictive performance of urinalysis for urine culture results according to causative microorganisms: an integrated analysis with artificial intelligence.

Urinary tract infections (UTIs) are pervasive and prevalent in both community and hospital settings. Recent trends in the changes of the causative microorganisms in these infections could affect the effectiveness of urinalysis (UA). We aimed to evaluate the predictive performance of UA for urinary culture test results according to the causative microorganisms. In addition, UA results were integrated with artificial intelligence (AI) methods to improve the predictive power. A total of 360,376 suspected UTI patients were enrolled from two university hospitals and one commercial laboratory. To ensure broad model applicability, only a limited range of clinical data available from commercial laboratories was used in the analyses. Overall, 53,408 (14.8%) patients were identified as having a positive urine culture. Among the UA tests, the combination of leukocyte esterase and nitrite tests showed the highest area under the curve (AUROC, 0.766; 95% CI, 0.764-0.768) for predicting urine culture positivity but performed poorly for Gram-positive bacteriuria (0.642; 0.637-0.647). The application of an AI model improved the predictive power of the model for urine culture results to an AUROC of 0.872 (0.870-0.875), and the model showed superior performance metrics not only for Gram-negative bacteriuria (0.901; 0.899-0.902) but also for Gram-positive bacteriuria (0.745; 0.740-0.749) and funguria (0.872; 0.865-0.879). As the prevalence of non-Escherichia coli-caused UTIs increases, the performance of UA in predicting UTIs could be compromised. The addition of AI technologies has shown potential for improving the predictive performance of UA for urine culture results.IMPORTANCEUA had good performance in predicting urine culture results caused by Gram-negative bacteria, especially for Escherichia coli and Pseudomonas aeruginosa bacteriuria, but had limitations in predicting urine culture results caused by Gram-positive bacteria, including Streptococcus agalactiae and Enterococcus faecalis. We developed and externally validated an AI model incorporating minimal demographic information of patients (age and sex) and laboratory data for UA, complete blood count, and serum creatinine concentrations. The AI model exhibited improved performance in predicting urine culture results across all the causative microorganisms, including Gram-positive bacteria, Gram-negative bacteria, and fungi.

UROPOT: study protocol for a randomized, double-blind phase I/II trial for metabolism-based potentiation of antimicrobial prophylaxis in the urological tract

BackgroundUrinary tract catheters, including Double-J or ureteral stents, are prone to bacterial colonization forming biofilms and leading to asymptomatic bacteriuria. In the context of asymptomatic bacteriuria, endourological procedures causing mucosa-inducing lesions can lead to severe infections. Antibiotic prophylaxis is warranted, yet its efficacy is limited by biofilm formation on stents. Biofilms promote antibiotic tolerance, the capacity of genetically susceptible bacteria to survive a normally lethal dose of antimicrobial therapy. The UROPOT study evaluates the effectiveness of a first-in-type metabolism-based aminoglycoside potentiation for (i) preventing infectious complications of asymptomatic bacteriuria during mucosa lesion-inducing endourological procedures and (ii) assessing its anti-tolerance efficacy.MethodsThe UROPOT trial is a phase I/II single-center (Lausanne University Hospital (CHUV), Switzerland) randomized double-blinded trial. Over 2 years, patients with asymptomatic Escherichia coli and/or Klebsiella pneumoniae bacteriuria, undergoing endourological procedures, will be randomly allocated to one of three treatment arms (1:1:1 randomization ratio, 30 patients per group) to evaluate the efficacy of mannitol-potentiated low-dose amikacin compared to established standard treatments (ceftriaxone or amikacin standard dose). Patients will be recruited at the CHUV Urology Outpatient Clinic. The primary outcome is the comparative incidence of postoperative urinary tract infections (assessed at 48 h) between the investigational amikacin/mannitol therapy and standard (ceftriaxone or amikacin) antibiotic prophylaxis, defined by specific systemic symptoms and/or positive blood and/or urine culture. Secondary outcomes include assessing microbiological eradication through anti-biofilm activity, sustained microbiological eradication, and mannitol and antibiotics pharmacokinetics in blood and urine. Safety outcomes will evaluate the incidence of adverse events following amikacin/mannitol therapy and postoperative surgical complications at postoperative day 14.DiscussionUROPOT tests a novel antimicrobial strategy based on “metabolic potentiation” for prophylaxis enabling aminoglycoside dose reduction and targeting biofilm activity. The anti-biofilm effect may prove beneficial, particularly in patients who have a permanent stent in situ needing recurrent endourological manipulations strategies in preventing infections and achieving sustained microbiological eradication in pre-stented patients.Trial registrationThe protocol is approved by the local ethics committee (CER-VD, 2023–01369, protocole 2.0) and the Swiss Agency for Therapeutic Products (Swissmedic, 701,676) and is registered on the NIH’s ClinicalTrials.gov (trial registration number: NCT05761405). Registered on March 07, 2023.

Antimicrobial Resistance of Uropathogenic Escherichia coli in Outpatient Cases at Baeza Basic Hospital, Ecuador

Introduction: Bacterial resistance to antibiotics is one of the current major public health issues, as these compounds constitute a primary tool for controlling and treating bacterial infections. Objective: To determine the bacterial resistance of uropathogenic Escherichia coli in outpatient individuals attending the Microbiology Laboratory of Baeza Basic Hospital (BBH) during the period January-December 2023. Methodology: An observational, descriptive, and cross-sectional study was conducted to describe the antimicrobial resistance characteristics of uropathogenic Escherichia coli during the period January-December 2023. Results: We analyzed 169 positive urine culture results from outpatient individuals of both sexes, varying ages, with a diagnosis of urinary tract infection. The most frequently isolated microorganisms were Escherichia coli (80.1%), followed by Enterococcus faecalis (3.8%) and Proteus mirabilis (3.3%). Regarding antimicrobial resistance profiles expressed as a percentage for E. coli, they were as follows: ampicillin (70.8%), nalidixic acid (53.7%), amoxicillin + clavulanic acid (48.8%), trimethoprim + sulfamethoxazole (44.0%), and ciprofloxacin (34.3%). 12.4% of E. coli were extended-spectrum beta-lactamase (ESBL) producers. The sensitivity of E. coli to nitrofurantoin was 92.1%, ampicillin-sulbactam 90.4%, and fosfomycin 87.1%. Conclusions: The recommended empirical first-line treatment is nitrofurantoin, fosfomycin, and as second-line options, cephalexin and cefuroxime for uncomplicated urinary tract infections. Based on this information, it is proposed to develop a Clinical Guide for the treatment of uncomplicated urinary tract infections in the study areaarea.

Antimicrobial Resistance of Uropathogenic Escherichia coli in Outpatient Cases at Baeza Basic Hospital, Ecuador

Introduction: Bacterial resistance to antibiotics is one of the current major public health issues, as these compounds constitute a primary tool for controlling and treating bacterial infections. Objective: To determine the bacterial resistance of uropathogenic Escherichia coli in outpatient individuals attending the Microbiology Laboratory of Baeza Basic Hospital (BBH) during the period January-December 2023. Methodology: An observational, descriptive, and cross-sectional study was conducted to describe the antimicrobial resistance characteristics of uropathogenic Escherichia coli during the period January-December 2023. Results: We analyzed 169 positive urine culture results from outpatient individuals of both sexes, varying ages, with a diagnosis of urinary tract infection. The most frequently isolated microorganisms were Escherichia coli (80.1%), followed by Enterococcus faecalis (3.8%) and Proteus mirabilis (3.3%). Regarding antimicrobial resistance profiles expressed as a percentage for E. coli, they were as follows: ampicillin (70.8%), nalidixic acid (53.7%), amoxicillin + clavulanic acid (48.8%), trimethoprim + sulfamethoxazole (44.0%), and ciprofloxacin (34.3%). 12.4% of E. coli were extended-spectrum beta-lactamase (ESBL) producers. The sensitivity of E. coli to nitrofurantoin was 92.1%, ampicillin-sulbactam 90.4%, and fosfomycin 87.1%. Conclusions: The recommended empirical first-line treatment is nitrofurantoin, fosfomycin, and as second-line options, cephalexin and cefuroxime for uncomplicated urinary tract infections. Based on this information, it is proposed to develop a Clinical Guide for the treatment of uncomplicated urinary tract infections in the study areaarea.

Medical dissolution of presumptive upper urinary tract struvite uroliths in 6 dogs (2012-2018).

Minimally invasive approaches are the standard for treatment of upper urinary tract uroliths in humans. To describe the medical dissolution of upper urinary tract uroliths in a series of dogs and report clinical outcomes. 6 female dogs (9 kidneys). Retrospective case series. A review of medical records in dogs that underwent medical dissolution of upper urinary tract uroliths utilizing diet, administration of antibiotics, and double-pigtail ureteral stent(s) placement, when indicated, was performed. Medical management was generally continued for 4 weeks beyond urolith dissolution. Information on biochemical, microbiological, imaging, and clinical outcomes before and after dissolution were recorded. Six dogs (9 kidneys) were included with bilateral (3) or unilateral (3) nephrolithiasis, ureterolithiasis, or a combination. A ureteral stent(s) was placed endoscopically in 5/6 dogs (6/9 kidneys) for obstructive ureterolithiasis (n = 5) or a nonobstructive massive nephrolith (n = 1). All dogs had a positive urine culture of Staphylococcus pseudintermedius with a median urine pH of 7.25 (range, 6.5-8) and 4/5 had pyonephrosis. All dogs had initial evidence of urolith dissolution at a median of 1.1 months (range, 0.42-5.9), with complete dissolution of ureteroliths at a median of 3.9 months (range, 1.5-7.6), nephroliths at 5.3 months (range, 1.5-7.6), and lower urinary tract uroliths at 0.87 months (range, 0.42-5.9). Stents were removed in 3/6 once dissolution was documented. The median follow-up time was 519 days (range, 177-2492 days). Medical dissolution and decompression of upper urinary tract struvite uroliths should be considered a minimally invasive treatment for dogs before more invasive options.

Early diagnostic model of pyonephrosis with calculi based on radiomic features combined with clinical variables

ObjectiveThis retrospective aims to develop a comprehensive predictive model based on CT radiomic features and clinical parameters, facilitating early preoperative diagnosis of pyonephrosis.MethodsClinical and radiological data from 311 patients treated for upper urinary tract stones with obstructive pyelohydronephrosis, between January 2018 and May 2023, were retrospectively collected. Univariate and multivariate logistic regression analyses were conducted on clinical data to identify independent risk factors for pyonephrosis. A clinical model was developed using logistic regression. The 3D Slicer software was employed to manually delineate the region of interest (ROI) in the preoperative CT images, corresponding to the area of pyelohydronephrosis, for feature extraction. The optimal radiomic features were selected to construct radiomic models and calculate the radiomic score (Radscore). Subsequently, a combined clinical–radiomic model—the nomogram—was established by integrating the Radscore with independent risk factors.ResultsUnivariate and multivariate logistic regression analyses identified cystatin C, Hounsfield Unit (HU) of pyonephrosis, history of ipsilateral urological surgery, and positive urine culture as independent risk factors for pyonephrosis (P < 0.05). Fourteen optimal radiomic features were selected from CT images to construct four radiomic models, with the Naive Bayes model demonstrating the best predictive performance in both training and validation sets. In the training set, the AUCs for the clinical model, radiomic model, and nomogram were 0.902, 0.939, and 0.991, respectively; in the validation set, they were 0.843, 0.874, and 0.959. Both calibration and decision curves showed good agreement between the predicted probabilities of the nomogram and the actual occurrences.ConclusionThe nomogram, constructed from CT radiomic features and clinical variables, provides an effective non-invasive predictive tool for pyonephrosis, surpassing both clinical and radiomic models.

Positive preoperative cultures but not bacterial species predict postoperative urine culture results after holmium laser enucleation of the prostate

Purpose: The purpose of this study was to evaluate risk factors associated with positive urine cultures following holmium laser enucleation of the prostate (HoLEP). Materials and Methods: The data from a prospectively maintained database were analyzed to evaluate urine culture results following HoLEP and determine the contribution of predefined variables (age, prostate size, Charlson comorbidity score, surgical time [surrogate for case difficulty], the presence of a catheter preoperatively, postoperative urinary retention, and preoperative positive culture) on urine culture positivity at 60 days postoperatively. Statistical analyses included logistic regression and ANOVA. Results: The data from 136 subjects were included in the database and were evaluated at a median of 13.37 ± 6.72 months after their HoLEP. Postoperative positive cultures were noted in 23 subjects (16.91%). Preoperative positive cultures were found to predict positive postoperative urine cultures (odds ratio: 3.78, confidence interval: 1.18–12.78, P = 0.03). However, the preoperative and postoperative results were discordant in 9 of 14 subjects with both positive preoperative and postoperative cultures. Conclusions: Positive preoperative cultures were predictive of positive postoperative cultures. However, the pre- and postoperative results were often discordant. Host factors increasing susceptibility to bacteriuria may explain these findings.

The reused-disposable scope in flexible ureteroscopy for stones as a cost-conscious approach: Reporting the outcomes of a real-world practice multicenter study of 2183 patients by the team of worldwide endourological researchers group

ABSTRACT Introduction: We aimed to assess complications and stone-free rate of flexible ureteroscopy (FU) reusing disposable scopes (RDS) after repeated sterilization. Methods: Data from adults from 11 centers were retrospectively reviewed (January 2020–December 2022). Inclusion criteria were proximal ureteral/renal stone(s). All cases were performed using an RDS to save costs for patients who come from economically challenged environments. Residual fragments (RFs) were defined as single fragment ≥4 mm or multiple fragments of any size within 3 months. Continuous variables are presented as median and interquartile range. Results: Two thousand one hundred and eighty-three patients were included, of whom 67.0% were male. Median age was 48.0 (36–59) years. The median stone diameter was 10.2 (9–14) mm. Flash sterilization was used in 90.2% (plasma in 60.5%). Approximately, 88% had FU with an RDS used ≤2 times (12%: 3–5 times). RDS needed to be changed intraoperatively in 3.9% of cases due to its malfunction. Commonly, defects in RDS function were reported in upward (1.6%) and downward deflection (6.5%) and image quality on white balancing (4.7%). Fever &gt;38C was seen in 13.7% of cases, and sepsis in 0.5%. RFs were found in 31.4% of cases. Lower pole (odds ratio [OR] 5.63) or pelvis stone (OR 4.67), faulty scopes (OR 12.8), and total operation time (OR 1.05) were factors associated with higher odds of RFs. Stone size (OR 1.09), positive urine culture (OR 1.67), interpolar stone (OR 1.68), and prestenting (OR 1.37) were factors associated with higher odds of fever/sepsis. Conclusions: RDS was used as a cost-conscious approach with a low rate of serious infections but with a high rate of RFs.

A Machine Learning Predictive Model for Ureteroscopy Lasertripsy Outcomes in a Pediatric Population-Results from a Large Endourology Tertiary Center.

Introduction: We aimed to develop machine learning (ML) algorithms for the automated prediction of postoperative ureteroscopy outcomes for pediatric kidney stones based on preoperative characteristics. Materials and Methods: Data from pediatric patients who underwent ureteroscopy for stone treatment by a single experienced surgeon, between 2010 and 2023 in Southampton General Hospital, were retrospectively collected. Fifteen ML classification algorithms were used to investigate correlations between preoperative characteristics and postoperative outcomes: primary stone-free status (SFS, defined as stone fragments <2 mm at the end of the procedure confirmed endoscopically and no evidence of stone fragments >2 mm at Xray kidney-ureters-bladder (XR KUB) or ultrasound kidney-ureters-bladder (US KUB) at 3 months follow-up) and complications. For the task of complication and stone status, an ensemble model was made out of Bagging classifier, Extra Trees classifier, and linear discriminant analysis. Also, a multitask neural network was constructed for the simultaneous prediction of all postoperative characteristics. Finally, explainable artificial intelligence techniques were used to explain the prediction made by the best models. Results: The ensemble model produced the highest accuracy (90%) in predicting SFS, finding correlation with overall stone size (-0.205), presence of multiple stones (-0.127), and preoperative stenting (-0.102). Complications were predicted by Synthetic Minority Oversampling Technique (SMOTE) oversampled dataset (93.3% accuracy) with relation to preoperative positive urine culture (-0.060) a1nd SFS (0.003). Training ML for the multitask model, accuracies of 83.3% and 80% were respectively reached. Conclusion: ML has a great potential of assisting health care research, with possibilities to investigate dataset at a higher level. With the aid of this intelligent tool, urologists can implement their practice and develop new strategies for outcome prediction and patient counseling and informed shared decision-making. Our model reached an excellent accuracy in predicting SFS and complications in the pediatric population, leading the way to the validation of patient-specific predictive tools.

32 Machine Learning Prediction of Positive Urine Cultures in an Academic Pediatric Emergency Department

32 Machine Learning Prediction of Positive Urine Cultures in an Academic Pediatric Emergency Department

Antibiotic resistance in community-acquired urinary tract infections. Did the COVID-19 pandemic cause a change?

This study aimed to evaluate the antimicrobial resistance rates before and during the coronavirus disease 2019 (COVID-19) pandemic. 897 positive urine cultures collected from outpatients of all ages between January 1, 2017, and December 31, 2022, were analyzed. The antibiotic susceptibility tests (AST) were analyzed by using an automated VITEK 2 (Biomerieux, Marcy-l`Étoile, France) compact system. AST results were interpreted according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria. The significance of resistance rates was tested with the Pearson's Chi-squared test and risk factors of extended-spectrum beta-lactamases (ESBL) positiveness were identified with binary logistic regression. E. coli (n = 774) and K. pneumoniae (n = 123) were isolated in 86.3% and 13.7% of the patients, respectively. During this period of six years before and during pandemic, the highest resistance rate was found for cefuroxime axetil (49.8%) and the lowest for nitrofuratoin (6.0%). Statistically significant increases in resistance compared to the pre-pandemic period were only determined for cefixime (37.2 vs 46.0%) and ceftriaxone (37.6 vs 46.1%) (p = 0.010). ESBL positivity was the most important factor that statistically increased resistance for all antibiotics (p < 0.001 for all). Being male [OR (95% CI) 1.56 (1.13-2.15)] and presenting to the clinic after the pandemic period [1.4 (1.1-1.8)] were found to increase ESBL positiveness significantly. Ceftriaxone and Cefixime resistance rates and ESBL positivity among the uropathogens E. coli and K. pneumoniae increased during the pandemic compared with the pre-pandemic period. ESBL positivity was higher in males.