Positive Urine Samples Research Articles

Serological and Molecular Evidence of Pathogenic Leptospira spp. in Stray Dogs and Cats of Sicily (South Italy), 2017–2021

Leptospirosis is a zoonosis of public health concern. Its prevalence in stray animals in the South of Italy is unknown. This study aimed to investigate Leptospira spp. prevalence in 1009 stray animals. Out of them, 749 were alive animals, including 358 dogs (316 from Palermo and 42 from Ragusa) and 391 cats (359 from Palermo and 32 from Ragusa), and 260 were corpses (216 dogs and 44 cats) randomly collected in Sicily. Dogs and cats underwent a serological screening by Microscopic Agglutination Test and a molecular investigation by Real-Time PCR targeting lipL32. Corpses were subjected to Real-Time PCR. Serological analyses showed a prevalence of 1.12% (4/358) for dogs and 0.26% (1/391) for cats, with the only positive cat coming from Palermo. Serogroup Icterohaemorrhagiae serovar Icterohaemorrhagiae or Copenhageni, followed by Canicola and Bratislava, were the most spread among dogs, while the serological positive cat reacted with Hardjo serogroup. Two urine (2/32, 6.25%) and one blood (1/391, 0.26%) samples of cats, all from Ragusa, were positive at Real-Time PCR for pathogenic Leptospira spp. Sequencing analyses showed the presence of L. interrogans serogroup Icterohaemorrhagiae serovar Icterohaemorrhagiae or Copenhageni in one of the positive urine samples and in the positive blood sample. Analyses on corpses showed a prevalence of 1.85% (4/216) in Sicilian dog kidney samples, while all corpses of cats resulted in negative. Genotyping analysis showed a genetic relatedness between cat and human isolates. Results show Leptospira spp. circulation among Sicilian stray animals. The genetic relatedness between cat and human isolates suggests a possible common infection source.

Susceptibility of urinary Enterobacteriaceae to selected antimicrobials in an out-patient setting in Wallonia-Belgium: retrospective analysis over 5 years period (2018-2022).

Increasing antimicrobial resistance in urinary tract infection is a major healthcare concern. In this study, we evaluate the patterns of resistance exhibited by the most implicated microorganisms in urine infections. This approach is a prerequisite for an appropriate and successful empiric therapy in ambulatory patients. A retrospective study was carried out from January 2018 to September 2022 in Synlab-Collard laboratory, Liège, Belgium; a total of 129,939 Enterobacteriaceae isolated from 120,616 positive urine sample were included. Sex ratio is 81.6% female and 18.4% male. E. coli is the most common urinary pathogen (70.4% of cases), followed by Klebsiella spp. (13.5%), Proteus spp. (8.5%), and Citrobacter spp. (2.5%). Ampicillin shows the highest resistance at 56%. Nitrofurantoin, the recommended antimicrobial treatment for cystitis in Belgium, expresses an overall resistance rate of 19% in females and 32% in males peaking at 43% in males over 80 years. Fosfomycin and ciprofloxacin display higher resistance rates in subjects over the age of 80 (18%, 24% in females, and 25%, 35% in males respectively). Trimethoprim shows 24% and 29% resistance rate in females and males over the age of 80 respectively. Even if empiric treatment of suspected UTIs may be of benefit in some cases, it is important for healthcare providers to carefully consider its limitations and evaluate its potential failure rate based on the resistance profiles of urinary Enterobacteriaceae. Susceptibility tests should be performed, and treatments adjusted especially in elderly populations.

Antibiotic resistance in elderly patients: Comparison of Enterobacterales causing urinary tract infections between community, nursing homes and hospital settings

ObjectiveThe objective was to compare the prevalence of antibiotic resistance of, Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae in elderly patients in, three sectors: community, nursing homes, and hospital settings. Material and methodsThis study was a retrospective observational study conducted in, Bourgogne Franche-Comté (France). We collected positive urine samples from, patients over 75 years of age from six private laboratories. ResultsAntibiotic resistance rate for E. coli in nursing homes was close to that of the, ommunity setting. Conversely, resistance of K. pneumoniae in nursing homes was, close to hospital settings. No difference in resistance of P. mirabilis was observed, between the three healthcare sectors. ConclusionsPatients living in nursing homes should not be considered more at risk of, infection by multi-drug resistant E. coli than patients living in community setting. Screening of multi-drug resistant K. pneumoniae could be of interest for nursing home, patients.

Status of Urinary shedders of Leptospires among cattle in Tamilnadu: Implications on zoonosis.

Bovine leptospirosis causes jaundice, mastitis, infertility, abortion, and death of the animal. This research aimed to study the status of urinary shedders of pathogenic Leptospira among the cattle population and identify the infecting serogroup circulating in this region. A total of 305 blood and 305 urine samples were collected from organized farms (n = 44), individually housed animals (n = 81) and animals from the slaughterhouse (n = 180). Microscopic agglutination test was carried out to detect anti‑leptospiral antibodies. Dark‑field microscopic examination and culture of urine were done to detect and isolate the Leptospira. The isolated Leptospira were identified by cross‑agglutination test and gene sequencing. PCR and real‑time PCR were carried out to detect leptospiral genomic DNA in urine samples to detect the shedders. The anti‑leptospiral antibodies were detected in 6.2% of animals. The Leptospira genomic DNA was detected in 9.2% (28 of 305) of urine samples. Of the 28 Leptospira positive urine samples, 39.2% were from animals with clinical signs suggestive of leptospirosis and 60.8% Leptospira positive samples were from slaughterhouse animals. The Leptospira isolated were identified as Leptospira interrogans serogroup Sejroe and Hebdomadis. The present study demonstrates the need to include leptospirosis in cattle health surveillance programmes to prevent leptospirosis by vaccination, preventing renal carriage.

Antibiogram of bacterial isolates from urine at Okhaldhunga Community Hospital: a rural setting in Nepal

Introduction: Infection of urinary tract is the second most common site of infection after respiratory tract worldwide. The objective of the study is to study the prevalence of positive urine samples and antibiotic susceptibility pattern of the bacterial isolates in Eastern part of Nepal.
 
 Method: A total of 210 Mid-Stream Urine (MSU) samples collected from both inpatient and outpatient departments of Okhaldhunga Community Hospital (OCH) were included in the study. Each urine samples were cultured and the antibiogram of isolates were determined as per CLSI guideline.
 
 Result: The prevalence of positive culture was found to be 40.9%. Out of which, 82.5% were identified bacteria. The age group with the greatest number of bacterial isolates was 20-30 years. Altogether five different bacteria were identified. Among these, E. coli was the most predominant isolate (76.1%), followed by S. aureus (16.9%) and K. pneumoniae (4.2%). Nitrofurantoin was found to be the most effective drug for the Gram-negative bacilli with a sensitivity of 86.3% while Amoxicillin was least effective showing 87.7% resistance. For Gram positive cocci, Chloramphenicol and Cloxacillin were the most effective and Penicillin was least effective drug showing 84.6% sensitivity and 92.3% resistance respectively.
 
 Conclusion: The prevalence of positive urine culture was 40.9%. The most effective antibiotic was Nitrofurantoin. Since the isolates showed high resistance towards Amoxicillin and Doxycycline, antibiotic susceptibility testing of the isolates should be performed time to time to monitor the resistance pattern of the bacteria.

Human phase-I metabolism and prevalence of two synthetic cannabinoids bearing an ethyl ester moiety: 5F-EDMB-PICA and EDMB-PINACA.

Around 2017, with the appearance of 5F-EDMB-PINACA, synthetic cannabinoids (SCs) carrying an ethyl ester moiety at the linked group started spreading on the market of new psychoactive substances (NPS). In 2020 and 2021, the indole analog of 5F-EDMB-PINACA (5F-EDMB-PICA) and the non-fluorinated analog of this compound (EDMB-PINACA) were analytically characterized. Here, we present suitable urinary markers to prove the consumption of these two ethyl analogs. Ten authentic urine samples for each compound were analyzed by liquid chromatography-quadrupole time-of-flight mass spectrometry (LC-qToF-MS). Anticipated phase-I metabolites detected in urine samples were confirmed in vitro by applying a pooled human liver microsomes (pHLM) assay. Prevalence data were obtained from urines collected for abstinence control and submitted to a screening method for SC metabolites. Ten phase-I metabolites of 5F-EDMB-PICA and 18 of EDMB-PINACA were detected by LC-qToF-MS analysis of authentic urine specimens. The main in-vivo metabolites were built by ester hydrolysis, often coupled to further metabolic processes. Investigation of phase-I biotransformation led to the identification of ester hydrolysis, monohydroxylation, and defluorination products as the most suitable urinary biomarkers for 5F-EDMB-PICA. Metabolites formed by ester hydrolysis coupled to ketone formation and by monohydroxylation are suggested for the detection of EDMB-PINACA. From October 1, 2020 to February 1, 2022, among positive urine samples, 5.4% and 10.1% tested positive 5F-EDMB-PICA and EDMB-PINACA, respectively. Due to common metabolites shared among structurally related SCs, the unequivocal detection of their consumption remains challenging for forensic laboratories and requires sensitive methods to monitor multiple metabolites, ideally including highly specific species.

Compliance or Abuse? Detectable hydromorphone in patients taking oxycodone

Abstract A middle-aged woman with recent cervical diskectomy with spinal fusion at C3-C4 suffered a mechanical fall with bilateral upper extremity paresthesia requiring admission but no surgical intervention. Patient was seen by orthopedic service and was recommended to continue using Aspen collar and oxycodone for pain. Following discharge, a drug urine screen test was performed, and showed positive for oxycodone by immunoassay. Confirmatory urine test by liquid chromatography-tandem mass spectrometry (LC-MS/MS) showed detectable oxycodone, oxymorphone and hydromorphone. In patients treated with opioid therapy for chronic pain, urine drug monitoring is an important tool to ensure that patients are adhering to the prescribed medication. Hydrocodone and hydromorphone are not metabolites of oxycodone. However, hydrocodone can be present in oxycodone preparations with an estimated impurity of <1%. Hydrocodone can be metabolized into hydromorphone, although, there is no literature reporting detectable hydromorphone in patients’ urine with prescribed oxycodone only. This case resulted in a quality improvement project where we evaluated the detection of hydrocodone and hydromorphone in positive oxycodone urine samples using LC-MS/MS. We analyzed 322 oxycodone positive urine samples. Twenty-one samples (6%) had detectable hydrocodone and/or hydromorphone below 100 ng/mL. Twelve out of the 21 were from patients taking no opioid medication other than oxycodone in the last week, with 33.3% showing detectable hydromorphone and 75% for hydrocodone below 100 ng/dL. The calculated hydrocodone/oxycodone (HC/OC) and hydromorphone/oxycodone (HM/OC) ratios were on average 0.26% HC/OC = 0.26% (0.05-0.69% SD 0.002; HM/OC = 0.26% (0.18-0.37% SD 0.001)] each (<1%). Patients taking oxycodone and other opioids had ratios >1% [HC/OC = 168% (3-563% SD 2.53; HM/OC = 699% (1.09-6585% SD 15.96)] and had higher detected levels (>100 ng/mL). Pain management can be very challenging; therefore, laboratory testing provides an objective assessment of drug exposure and adherence to treatment. Cut-off values for considering positive the detection of hydrocodone and hydromorphone may change the interpretation of the drug urine tests in patients with prescribed oxycodone. Using higher cutoff (100 ng/mL) and the ratios HC/OC and HM/OC (<1%) may be useful to determine that the detection of these components is due to impurity of oxycodone formulation.

Biological Monitoring via Urine Samples to Assess Healthcare Workers’ Exposure to Hazardous Drugs: A Scoping Review

Although biological monitoring is beneficial as it assesses all possible routes of exposure, urine sampling of healthcare workers exposed to hazardous drugs is currently not routine. Therefore, a scoping review was performed on this subject matter to understand what is known about exposure and identify knowledge gaps. A literature search was performed on three databases: ProQuest, Web of Science, and PubMed. Articles published between 2005 and 2020 and written in English were included. Overall, this review consisted of 39 full-text articles. The studies varied with respect to design, sample sizes, sample collection times, and drugs examined. Many articles found at least one sample had detectable levels of a hazardous drug. Studies reported urinary drug contamination despite controls being employed. Knowledge gaps included a lack of an exposure limit, lack of a standardized sampling method, and lack of correlation between health effects and urinary contamination levels. Due to differences in sample collection and analysis, a comparison between studies was not possible. Nevertheless, it appears that biological monitoring via urine sampling is meaningful to aid in understanding healthcare workers’ exposure to hazardous drugs. This is supported by the fact that most studies reported positive urine samples and that case-control studies had statistically significant findings.

An Unusual Case of High 6-Monoacetylmorphine and Low Morphine in Urine: Heroin Abuse or Analytical Error?

A 59-year-old male with a past medical history of chronic low back pain, opioid use disorder, and type 2 diabetes mellitus presented to an outpatient clinic for pain contract–related urine drug screen testing. Current medications included metformin, oxycodone, and Suboxone® (buprenorphine and naloxone combination). The patient stated that 5 days prior to the visit, he stopped taking Suboxone due to complaints of nausea and vomiting. Urine toxicology test results are summarized in Table 1. ... ... Suboxone is an opioid abuse management medication that is formulated with buprenorphine and naloxone. Naloxone has limited bioavailability when administered sublingually and should be barely detectable in urine. However, when Suboxone is taken parenterally, naloxone enters the blood stream and is largely excreted in urine. In this case, the presence of a high concentration of naloxone in urine with a high ratio to buprenorphine suggested parenteral administration (1). Heroin is readily metabolized into 6-MAM and then to morphine. Typically, the 6-MAM-to-morphine ratio is <0.26, so it is uncommon to see a high positive 6-MAM with very low morphine concentrations (2). The calculated 6-MAM-to-morphine ratio in this sample was 7.27. Conversion from morphine to 6-MAM due to contaminants in enzyme hydrolysis or acid hydrolysis used during sample preparation in urine samples with extremely high morphine (>100 000 μg/L) has been reported (3). In our case, morphine was very low, so this was unlikely, but to rule out any analytical cause, the positive urine sample was sent to a reference laboratory, which confirmed our findings. The fact that 2 laboratories using different mass spectrometry–based methods showed detectable 6-MAM supported heroin use, instead of a false positive due to an interference. The unusually low morphine result in some heroin users has been reported elsewhere and may be mostly attributed to inhibitors of carboxylesterases from the heroin synthesis process (2) or explained by polymorphism in the esterase enzymes metabolizing 6-MAM to morphine (4). The physician also requested serum fentanyl testing by mass spectrometry 5 days after the original urine sample collection (fentanyl was not part of our general urine drug screen), which came back positive for fentanyl and norfentanyl. In addition to the unexpected positive amphetamine result, all of this confirmed that this patient suffered from polysubstance abuse.

CURRENT TREND OF ANTIBIOGRAM OF ENTEROCOCCUS SPECIES ISOLATED FROM URINE SAMPLES OF PATIENTS ATTENDING TERTIARY CARE CENTER, POKHARA

Background: Enterococcus an important uropathogen has appeared to be of great therapeutic challenge globally due to its intrinsic and acquired resistance to multiple antibiotics. High level aminoglycoside and vancomycin resistant Enterococcus has narrowed the treatment options. Thus, the aim of this study was to detect the current antibiogram trend of Enterococcus species isolated from urine samples. Methods: A descriptive cross-sectional study was conducted in urine sample of patients attending Gandaki Medical College Teaching Hospital from September 2021 to May 2022. Ethical clearance was obtained from Institutional Review Committee. Enterococcus species was isolated and antibiotic susceptibility test was performed by Kirby-Bauer disc diffusion method. Simple random sampling was done and data was analyzed by Statistical Package for Social Science (SPSS) version 20. Results: A total of 61 (10.62 %) Enterococcus species were isolated from 574 culture positive urine samples. Enterococcus isolates were highly susceptible to linezolid 60 (98.4%), vancomycin 56 (91.8%) and nitrofurantoin 50 (82.0%) whereas less susceptible to ampicillin 16 (26.2%). Multidrug resistant Enterococcus was identified commonly from 25 (73.5%) in-patients. Nitrofurantoin was sensitive among 4 (80.0%) vancomycin resistant isolates. Only 4 (16.0%) Enterococcal isolates were sensitive to both ampicillin and high-level gentamicin. Conclusions: Emergence of multidrug resistant Enterococcus in our institution is worrisome. Nitrofurantoin remains a useful drug and shows high efficacy in vitro against emerging vancomycin resistant isolates. Combination of ampicillin and high-level gentamicin is used to treat complicated urinary tract infection; however, it seems less effective in our scenario.

Direct Urine Resistance Detection Using VITEK 2

Urinary tract infections (UTIs) are the most common infectious diseases in both communities and hospitals. With non-anatomical or functional abnormalities, UTIs are usually self-limiting, though women suffer more reinfections throughout their lives. Certainly, antibiotic treatment leads to a more rapid resolution of symptoms, but also it selects resistant uropathogens and adversely affects the gut and vaginal microbiota. As uropathogens are increasingly becoming resistant to currently available antibiotics, it could be time to explore alternative strategies for managing UTIs. Rapid identification and antimicrobial susceptibility testing (AST) allow fast and precise treatment. The objective of this study was to shorten the time of diagnosis of UTIs by combining pathogen screening through flow cytometry, microbial identification by matrix-assisted laser desorption ionisation time-of-flight mass spectrometry (MALDI-TOF MS), and the VITEK 2 system for the direct analysis of urine samples. First, we selected positive urine samples by flow cytometry using UF5000, establishing the cut-off for positive at 150 bacteria/mL. After confirming the identification using MALDI-TOF MS and filtering the urine samples for Escherichia coli, we directly tested the AST N388 card using VITEK 2. We tested a total of 211 E. coli from urine samples. Cefoxitin, ertapenem, imipenem, gentamicin, nalidixic acid, ciprofloxacin, fosfomycin, and nitrofurantoin had no major important errors (MIE), and ampicillin, cefuroxime, and tobramycin showed higher MIEs. Cefepime, imipenem, and tobramycin had no major errors (ME). Fosfomycin was the antibiotic with the most MEs. The antibiotic with the most minor errors (mE) was ceftazidime. The total categorical agreement (CA) was 97.4% with a 95% CI of (96.8–97.9)95%. The direct AST from the urine samples proposed here was shorter by one day, without significant loss of sensibility regarding the standard diagnosis. Therefore, we hypothesize that this method is more realistic and better suited to human antibiotic concentrations.

Infrequent detection of unintentional fentanyl use via urinalysis among people who regularly inject opioids in Sydney and Melbourne, Australia.

Background and aimThe current phase of the North American ‘opioid crisis’ is characterised by illicit fentanyl use; however, the presence of illicit fentanyl in Australia is unknown. This study aimed to monitor unintentional fentanyl consumption in Australia.DesignRapid urine drug screens (UDS) paired with surveys conducted within supervised injecting facilities (SIFs) and confirmatory laboratory testing.SettingSydney and Melbourne, Australia.ParticipantsClients who used heroin within the past 2 days (n = 911 tests, 2017–2021). Participants were demographically similar to the overall client base (median age 43, 72% male).MeasurementsUDS were conducted using BTNX Rapid Response fentanyl urine strip tests with cross‐reactivity to numerous fentanyl analogues. Positive urine samples were analysed using liquid chromatography coupled with tandem mass spectrometry. Surveys covered past 3 day drug use and lifetime report of fentanyl in heroin.FindingsTwo percent of participants reported intentional use of fentanyl, mostly through fentanyl patches. Of the 911 rapid UDS conducted, 17 (1.9%) yielded positive results. Eight of these (all from Melbourne) were not explained by survey‐reported fentanyl use in the past 3 days. Of these 8 unexplained positives, confirmatory laboratory analysis was conducted on 6, with 4 deemed to be false positives, and 2 confirmed for the presence of fentanyl. This represents the first confirmation of unintended use of fentanyl type substances in this population.ConclusionThere is limited evidence of unintentional fentanyl use among people in Sydney and Melbourne, Australia who regularly inject heroin, suggesting that, currently, there is very little illicit fentanyl in Australian drug markets accessed by supervised injecting facilities attendees. This study demonstrates the feasibility of quick onsite testing to cost‐effectively screen large samples for fentanyl; however, the high false positive rate emphasises the need for confirmation of positive tests through advanced analytical techniques.

Detection of DHCMT long-term metabolite glucuronides with LC-MSMS as an alternative approach to conventional GC-MSMS analysis

Dehydrochloromethyltestosterone (DHCMT) is one of the most detected illicit used anabolic–androgenic steroids in professional sports. Therefore, a fast and accurate analysis of this substance is of great importance for a constructive fight against doping abuse. The conventional method for the analysis of this drug, GC-MSMS, is very sensitive and selective but also very time- and resource-consuming. With the presented work, a new approach for simple detection with LC-HRMSMS without any sample preparation is introduced. The method is based on the direct analysis of two newly described phase-II metabolites of the DHCMT long-term metabolite 4-chloro-18-nor-17β-hydroxymethyl-17α-methyl-5β-androst-13-en-3α-ol (M3). LC-HRMSMS, GC-MSMS, fractionation and derivatization experiments are combined to identify and characterize for the first time two different glucuronide-acid conjugates of this metabolite in positive human urine samples. In addition, a third glucuronide metabolite was identified, however without isomeric structure determination. The detection of these metabolites is particularly interesting for confirmation analyses, as the method is rapid and requires little sample material.

Optimisation of Benzodiazepine Immunoassay Using &amp;lt;i&amp;gt;β&amp;lt;/i&amp;gt;-Glucuronidase Enzymatic Hydrolysis: A Comparison of Five Different &amp;lt;i&amp;gt;β&amp;lt;/i&amp;gt;-Glucuronidase Enzymes

Background: Hydrolysis improves the sensitivity of drug detection for drug classes such as opiates/opioids and benzodiazepines, which are highly metabolized by glucuronidation and sulfation and should be implemented in analytical procedures to convert conjugated metabolites into the free or unbound form. This study was aimed to compare different enzymes to make an informed decision. Methods: In this study, the CEDIA Benzodiazepine assay was compared with the LC-MS-MS method using 150 positive urine samples and 50 negative urine samples. The samples were analysed without adding any enzyme and then by adding different enzymes to compare their performance. Results: The Kura Escherichia coli enzyme performed better than the Roche Escherichia coli enzyme which had 20% false-positive results. Kura BG-100 enzyme performed well but Kura B-One enzyme performed better The Kura B-One enzyme had only 11.5% false-positive results. When double the volume of Kura B-One enzyme was used to test to see if it will have any impact on reducing the number of false negatives, it performed worse. Kura Turbo enzyme behaved similarly to Kura BG-100. Conclusions: The β-glucuronidase enzymes comparison allowed us to identify the Kura B-One enzyme as the enzyme of choice for our operation because it reduces the false positives from 20% to 11.5% when compared with the Roche enzyme. It also improved the detection of oxazepam. The Kura B-One enzyme has a short incubation time for hydrolysis when used with the LC-MS-MS method. As a result, we improved the overall turn-around time and reduced the number of false positives that needed confirmation.

First-line noninvasive management of cytomegalovirus primary infection in pregnancy.

To introduce a first-line noninvasive antenatal management of maternal cytomegalovirus (CMV) primary infection based on ultrasound (US) and magnetic resonance imaging (MRI). Amniocentesis (AC) is used as a second-line tool in cases of abnormalities compatible with fetal CMV infection on US and/or MRI screening. Between January 2011 and October 2018, pregnant women referred with a CMV primary infection on antibody screening were followed up by monthly US scans and a brain MRI at approximately 32weeks. In cases with US and/or MRI abnormalities compatible with congenital CMV infection, AC was performed to confirm the diagnosis. Ninety pregnant women with a primary CMV infection were included (89 singleton and one twin pregnancy). The first-line screening by US and/or MRI was normal for 72 of 91 fetuses (79%). At birth, 19 of these 72 neonates (26%) had a positive urine sample for CMV but were asymptomatic. US and/or MRI abnormalities were identified in 19 fetuses (21%). AC confirmed a fetal CMV infection in 16 fetuses (84%); 12 pregnancies were terminated, and four were continued, with three symptomatic neonates at birth and one poor neurodevelopmental outcome at postnatal follow-up. First-line noninvasive management of maternal CMV primary infection based on serial US scans and brain MRI can be offered to identify fetuses with severe symptomatic congenital CMV infection and reduce the number of ACs without compromising the fetal outcome.

Optimizing outpatient treatment outcomes among methamphetamine-using gay and bisexual men through a computerized depression intervention

Introduction: Depression is a common sequelae of frequent methamphetamine use, and may influence rates of engagement in sexual risk-taking among methamphetamine-using cisgender gay, bisexual, and other men who have sex with men (GBMSM). The study team hypothesized that layering a brief, computerized depression intervention (i.e., MoodGym; based on Cognitive Behavioral Therapy [CBT] and Interpersonal Therapy) on top of a long-running outpatient methamphetamine treatment program (based on CBT and Contingency Management) for GBMSM could optimize reductions in methamphetamine use and sexual risk-taking among program participants. Methods: This pilot study, which also included analysis of historical data, employed nearest-neighbor matching algorithms to match current pilot study participants (N = 39) to prior participants of an outpatient methamphetamine treatment program (N = 703) and employed treatment effects analyses to determine the observed effects of adding depression intervention content to GBMSM-specific methamphetamine treatment. Results: Pilot study participants who received the MoodGym intervention were significantly less likely to submit methamphetamine-metabolite positive urine samples (Adjusted Treatment Effect [ATE] = −0.72; p < 0.01), and evidenced significantly greater reductions in receptive condomless anal intercourse with non–primary partners in the past 30 days (ATE = −1.39; p < 0.05), relative to prior participants of the outpatient methamphetamine treatment program who did not receive depression intervention content. Conclusion: Preliminary results suggest layering a brief computerized depression intervention onto outpatient methamphetamine treatment for GBMSM may optimize reductions in methamphetamine use and/or sexual risk-taking.

Antimicrobial Resistance Trends of Escherichia coli Isolates from Outpatient and Inpatient Urinary Infections over a 20-Year Period

Antimicrobial resistance is a worldwide problem, and resistance in Enterobacteriaceae, particularly Escherichia coli and Klebsiella pneumoniae, is a critical threat to human health. Inappropriate and unnecessary use of antibiotics in human health care is the most common cause for the development and spread of antimicrobial resistance. In this work, we retrospectively analyzed the antimicrobial data of E. coli strains isolated from midstream urinary samples over a 20-year period (2000-2019). The aim was to provide useful information to clinicians to prescribe a more appropriate empirical antibiotic therapy. A total of 30,955 unique E. coli isolates from positive midstream urine samples of inpatients (1,198) and outpatients (29,757) were collected. Except for carbapenems, over time all the antibiotics tested showed increasing resistance rates in both groups (p < 0.0001). On the other hand, fosfomycin and nitrofurantoin presented significant decreasing trends in resistance rate (p < 0.05). There were significant increases in extended-spectrum β-lactamases- and multidrug resistance positive isolates starting in 2000 (p < 0.0001), with similar results in both groups. Ciprofloxacin, gentamicin, trimethoprim/sulfamethoxazole, and third-generation cephalosporin resistances significantly increased with increasing age (p < 0.0001). Collectively, E. coli resistance rates severely increased during the study period, except for fosfomycin and nitrofurantoin. The need of monitoring studies about antibiotic nonsusceptibilities at local and regional levels are necessary to enhance the focus on antimicrobial stewardship, to reduce antimicrobial consumption and to detect alarming resistance mechanisms.

Untargeted Metabolomics in Forensic Toxicology: A New Approach for the Detection of Fentanyl Intake in Urine Samples.

The misuse of fentanyl, and novel synthetic opioids (NSO) in general, has become a public health emergency, especially in the United States. The detection of NSO is often challenged by the limited diagnostic time frame allowed by urine sampling and the wide range of chemically modified analogues, continuously introduced to the recreational drug market. In this study, an untargeted metabolomics approach was developed to obtain a comprehensive “fingerprint” of any anomalous and specific metabolic pattern potentially related to fentanyl exposure. In recent years, in vitro models of drug metabolism have emerged as important tools to overcome the limited access to positive urine samples and uncertainties related to the substances actually taken, the possible combined drug intake, and the ingested dose. In this study, an in vivo experiment was designed by incubating HepG2 cell lines with either fentanyl or common drugs of abuse, creating a cohort of 96 samples. These samples, together with 81 urine samples including negative controls and positive samples obtained from recent users of either fentanyl or “traditional” drugs, were subjected to untargeted analysis using both UHPLC reverse phase and HILIC chromatography combined with QTOF mass spectrometry. Data independent acquisition was performed by SWATH in order to obtain a comprehensive profile of the urinary metabolome. After extensive processing, the resulting datasets were initially subjected to unsupervised exploration by principal component analysis (PCA), yielding clear separation of the fentanyl positive samples with respect to both controls and samples positive to other drugs. The urine datasets were then systematically investigated by supervised classification models based on soft independent modeling by class analogy (SIMCA) algorithms, with the end goal of identifying fentanyl users. A final single-class SIMCA model based on an RP dataset and five PCs yielded 96% sensitivity and 74% specificity. The distinguishable metabolic patterns produced by fentanyl in comparison to other opioids opens up new perspectives in the interpretation of the biological activity of fentanyl.

Risk factors in bacterial colonization of internal ureteral stent

A ureteral stent is most broadly used to manage upper urinary tract disorders such as obstruction and prevent post-endoscopic complications. However, the stent may become a niche for bacterial colonization. This study aimed to determine the rate of bacterial colonization and type of bacteria in internal ureteral stents and the risk factors associated with bacterial colonization. This prospective cross-sectional study included 100 consecutive adult patients who had temporary ureteral stenting as preparation for a secondary ureterorenoscopy at Al-Yarmook Hospital/ Baghdad. All included patients were negative for bacterial culture before stenting. Stent and urine culture were performed at the time of stent removal. The colonization rate and bacteriuria in patients with internal ureteral stent were 19% and 9%, respectively. The most common bacteria in-stent and urine were E. coli accounting for 31.58% and 33.33%. Pseudomonas aeruginosa was common in stent culture, representing 21.05%. Positive bacterial culture was confirmed in 19 stents and 9 urine samples. All cases with positive urine samples were also positive for culture. Thus, the sensitivity and specificity of urine culture for detection of stent colonization were 47.37% and 100%, respectively. Diabetes mellitus, chronic renal failure, and prolonged stenting were significantly associated with increased stent colonization. The ureteral stent could be a source of urinary tract infection. The most pathogenic bacteria associated with the ureter stent are E. coli and Pseudomonas aeruginosa. Risk factors associated with stent colonization are diabetes mellitus, chronic renal failure, and prolonged indwelling time.

Comparative Antibiogram of Escherichia Coli Isolated from the Urinary Tract Infection in Patients from Tertiary Care Hospital

Introduction: UTI occurs when bacteria that live inside intestine find their way into the urinary tract through the urethra. Women are familiar to be a lot of at risk of UTI than men, with a five hundredth probability of a UTI in their life.&#x0D; Aim: The aim of this study was to find the antibiotic resistance pattern in Escherichia coli isolated from urinary tract infection with commonly found antibiotics among different age and sex groups.&#x0D; Materials and Methods: All positive urine samples for Escherichia coli obtained from patients were included. On the basis of colony morphology and biochemical tests Isolates were identified. The antibiogram profile of the isolates was determined by commonly used antibiotics.&#x0D; Result: In this studied, total 250 patients with UTI of both sexes were included and divided into age group. Samples processed only 250 samples with the growth of E. coli were included in this studied. The isolated E.coli showed more resistant to some degree to all the antibiotics tested. The greatest resistance was shown against Amoxycillin (15.2% isolated were sensitive) and the least resistance was shown against Imipenem (96.4% isolated were sensitive).&#x0D; Conclusion: The pattern of antibiotic resistance varies from place to place, region to region, and country to country. Antimicrobial resistance should be monitored on a regular basis in both the community and hospital settings.