Probability Of Urinary Tract Infection Research Articles

Accuracy of the Sysmex UF-5000 analyzer for urinary tract infection screening and pathogen classification.

The screening performance of urine flow cytometry parameters (e.g., white blood cell and bacteria) for urinary tract infection (UTI) has been widely recognized. The majority of previous studies, however, investigated the screening performance of Sysmex UF-1000i urine flow cytometer. This study aimed to investigate the screening performance of Sysmex UF-5000 analyzer, a third-generation urinary flow cytometer, for UTI and its novel parameter named Gram flag for discriminating gram-positive and negative pathogens. Urine specimens sent to the clinical microbiology laboratory of our hospital for bacterial culture between September 13, 2021, and November 15, 2021, were prospectively and consecutively collected. The Sysmex UF-5000 analyzer was used to determine urine white blood cell (WBC) and bacteria simultaneously. A chemical strip was used to assess urine nitrate. UTI was defined as positive urine bacterial culture > 104 CFU /ml. The receiver operating characteristics (ROC) curve, nomogram, decision tree, and decision curve were used to determine the screening performance of urine WBC, nitrate, and bacterial. A total of 246 UTIs and 425 non-UTIs were enrolled. The areas under the ROC curve (AUCs) for WBC and bacterial were 0.74 and 0.86, respectively. The decision curve showed that urine bacteria had a higher benefit than WBC. The nomogram indicated that urine bacterial had the largest effect on the probability of UTI. The sensitivity and specificity of the decision tree were 0.69 and 0.95, respectively. The flag of Gram-negative had a positive predictive value (PPV) of 0.93 in patients with urine bacteria > 1367 /μl. Therefore, we conclude that urine bacteria determined by the Sysmex UF-5000 had higher screening performance and greater benefit than WBC. The decision tree can be used to improve the screening performance of routine urinary parameters. The flag of Gram-negative is a reliable indicator to confirm gram-negative bacteria infection in UTI patients.

Clinical Utility and Accuracy of UTI Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children

Objective: To investigate the accuracy of the UTI Calculator (UTI Calc) in predicting UTI in children by comparing the results of urine culture sensitivity tests (C/S). Study Design: Cross-sectional/descriptive study Place and Duration: The study was conducted at Urology Ward of Saidu Group of Teaching Hospitals, Swat during the period from 1st June 2020 to 31st December 2020. Methods: A total of eighty five children having ages from 4 to 24-months were presented. Children with fever >38oC were included. Following informed written agreement from the authorities, the demographics of enrolled cases were documented. Efficacy of UTI calculator was assessed in terms of diagnosing urinary tract infection among children. SPSS 21.0 was used to analyze complete data. Results: Among 85 cases, majority were male 50 (58.8%) infants and 35 (41.2%) were females. The mean age of the children was 8.44±7.65 years. Frequency of UTI was found among 9 (10.6%) febrile infants. Among 85 patients clinical UTI was high in 45 (52.9%) cases and by urine examination UTI found among 10 (10.6%) cases. Frequency of sensitivity was 100% and specificity 96%. E. coli was the predominant bacterium in 10 (11.8%) and urine cultures positive in (7.1%). Conclusion: In children, just a few clinical signs and symptoms are helpful in diagnosing or ruling out a urinary tract infection. Clinical prediction rules may be more accurate, but they need be externally verified. Urine collection should not be limited to children who have an unexplained fever or other symptoms that imply a urinary tract infection.

Effect of Cluster Nursing in Preventing Urinary Tract Infection in Postoperative Patients with Indwelling Urinary Catheter

Objective: This paper expounds and analyzes the effect of cluster nursing in preventing urinary tract infection in postoperative patients with indwelling urinary catheter. Methods: A total of 400 postoperative patients with indwelling urinary catheter, treated in Yancheng No. 1 People’s Hospital in recent two years, were recruited as research subjects. The patients were equally divided into group A and group B, with 200 patients in each group, and all received routine anti-infectives. The patients in group A (200 cases) received routine nursing. On the basis of group A, cluster nursing was implemented for patients in group B (200 cases). Results: The indwelling time of urinary catheter, the disappearance time of bladder irritation symptoms, and the probability of urinary tract infection were compared between both groups, which showed that the nursing effect of group B was better than that of group A (P < 0.05). Conclusion: The implementation of cluster nursing in postoperative patients with indwelling urinary catheter can improve the deficiency of routine nursing, consolidate the treatment effect, and reduce the complication rate of urinary tract infection.

Comparison of Neural Network and Logistic Regression Analysis to Predict the Probability of Urinary Tract Infection Caused by Cystoscopy.

Purpose Urinary tract infections (UTIs) are the most common infections among hospitalized patients. Cystoscopy is a minimally invasive procedure to check bladder disease, among the patients receiving procedure, approximately 10% of patients may experience UTI. In this study, a neural network model with high accuracy, sensitivity, and specificity was developed to predict the probability of UTIs caused by cystoscopic procedures. To reduce antibiotic overuse during cystoscopic procedures, the model can provide clinicians with a rapid assessment of whether patients require prophylactic antibiotics. Materials and Methods Patients who underwent cystoscopic procedures at China Medical University Beigang Hospital from 2016 to 2019 were retrospectively reviewed. A total of 1647 patients were enrolled, and 147 cases of urinary tract infection occurred. An artificial neural network (ANN) and logistic regression analysis were used to develop the prediction models, and the two models were compared. Results The logistic regression analysis model had an accuracy of 91%, sensitivity of 2%, and specificity of 99%, indicating that the logistic regression model predicted that most patients had a low risk of infection. The neural network model had a high accuracy of 85%, sensitivity of 80%, and specificity of 88%. Conclusions Because the logistic regression model had low sensitivity and missed most cases of UTI, the logistic regression model is inappropriate for clinical application. The neural network model has superior predictive ability and can be considered a tool in clinical practice.

Role of antibiotic resistance in urinary tract infection management: a cost-effectiveness analysis

Urinary tract infections and recurrent urinary tract infections pose substantial burdens on patients and healthcare systems. Testing and treatment strategies are increasingly important in the age of antibiotic resistance and stewardship. This study aimed to evaluate the cost effectiveness of urinary tract infection testing and treatment strategies with a focus on antibiotic resistance. We designed a decision tree to model the following 4 strategies for managing urinary tract infections: (1) empirical antibiotics first, followed by culture-directed antibiotics if symptoms persist; (2) urine culture first, followed by culture-directed antibiotics; (3) urine culture at the same time as empirical antibiotics, followed by culture-directed antibiotics, if symptoms persist; and (4) symptomatic treatment first, followed by culture-directed antibiotics, if symptoms persist. To model both patient- and society-level concerns, we built 3 versions of this model with different outcome measures: quality-adjusted life-years, symptom-free days, and antibiotic courses given. Societal cost of antibiotic resistance was modeled for each course of antibiotics given. The probability of urinary tract infection and the level of antibiotic resistance were modeled from 0% to 100%. We also extended the model to account for patients requiring catheterization for urine specimen collection. In our model, the antibiotic resistance rate was based either on the local antibiotic resistance patterns for patients presenting with sporadic urinary tract infections or on rate of resistance from prior urine cultures for patients with recurrent urinary tract infections. With the base case assumption of 20% antibiotic resistance, urine culture at the same time as empirical antibiotics was the most cost-effective strategy and maximized symptom-free days. However, empirical antibiotics was the most cost-effective strategy when antibiotic resistance was below 6%, whereas symptomatic treatment was the most cost-effective strategy when antibiotic resistance was above 80%. To minimize antibiotic use, symptomatic treatment first was always the best strategy followed by urine culture first. Sensitivity analyses with other input parameters did not affect the cost-effectiveness results. When we extended the model to include an office visit for catheterized urine specimens, empirical antibiotics became the most cost-effective option. We developed models for urinary tract infection management strategies that can be interpreted for patients initially presenting with urinary tract infections or those with recurrent urinary tract infections. Our results suggest that, in most cases, urine culture at the same time as empirical antibiotics is the most cost-effective strategy and maximizes symptom-free days. Empirical antibiotics first should only be considered if the expected antibiotic resistance is very low. If antibiotic resistance is expected to be very high, symptomatic treatment is the best strategy and minimizes antibiotic use.

Association Between the Placement of a Double-J Catheter and the Risk of Urinary Tract Infection in Renal Transplantation Recipients: A Retrospective Cohort Study of 1038 Patients

The incidence of urinary complications in transplantation is 2% to 20%, which can be decreased with the use of a double-J catheter. The objective of this study was to determine the association between the use of the catheter and the probability of urinary tract infection (UTI). We studied a retrospective cohort of 1038 patients divided into 2 groups: those treated with vs without a double-J catheter. Perioperative factors related to catheter use were analyzed. Second, whether the use of the catheter was associated with fewer other urinary complications was analyzed. Of the whole sample, 72 patients were eliminated from the study, and 358 (37%) received a double-J catheter. UTIs occurred in 190 patients (19.6%), of whom a greater proportion received a catheter: 88 of 358 (24.6%) vs 102 of 608 (16.8%) (odds ratio, 1.61; 95% confidence interval, 1.17-2.22; P=.003). The placement of a double-J catheter during transplant is associated with a higher proportion of UTIs, increasing their severity and the cost of care, without having a clear effect on other types of urinary complications.

Biocomputational Prediction Approach Targeting FimH by Natural SGLT2 Inhibitors: A Possible Way to Overcome the Uropathogenic Effect of SGLT2 Inhibitor Drugs.

The Food and Drug Administration (FDA) approved a new class of anti-diabetic medication (a sodium–glucose co-transporter 2 (SGLT2) inhibitor) in 2013. However, SGLT2 inhibitor drugs are under evaluation due to their associative side effects, such as urinary tract and genital infection, urinary discomfort, diabetic ketosis, and kidney problems. Even clinicians have difficulty in recommending it to diabetic patients due to the increased probability of urinary tract infection. In our study, we selected natural SGLT2 inhibitors, namely acerogenin B, formononetin, (−)-kurarinone, (+)-pteryxin, and quinidine, to explore their potential against an emerging uropathogenic bacterial therapeutic target, i.e., FimH. FimH plays a critical role in the colonization of uropathogenic bacteria on the urinary tract surface. Thus, FimH antagonists show promising effects against uropathogenic bacterial strains via their targeting of FimH’s adherence mechanism with less chance of resistance. The molecular docking results showed that, among natural SGLT2 inhibitors, formononetin, (+)-pteryxin, and quinidine have a strong interaction with FimH proteins, with binding energy (∆G) and inhibition constant (ki) values of −5.65 kcal/mol and 71.95 µM, −5.50 kcal/mol and 92.97 µM, and −5.70 kcal/mol and 66.40 µM, respectively. These interactions were better than those of the positive control heptyl α-d-mannopyranoside and far better than those of the SGLT2 inhibitor drug canagliflozin. Furthermore, a 50 ns molecular dynamics simulation was conducted to optimize the interaction, and the resulting complexes were found to be stable. Physicochemical property assessments predicted little toxicity and good drug-likeness properties for these three compounds. Therefore, formononetin, (+)-pteryxin, and quinidine can be proposed as promising SGLT2 inhibitors drugs, with add-on FimH inhibition potential that might reduce the probability of uropathogenic side effects.

Predicting Urinary Tract Infections With Interval Likelihood Ratios.

Protocols for diagnosing urinary tract infection (UTI) often use arbitrary cutoff values of urinalysis components to guide management. Interval likelihood ratios (ILRs) of urinalysis results may improve the test's precision in predicting UTIs. We calculated the ILR of urinalysis components to estimate the posttest probabilities of UTIs in young children. Review of 2144 visits to the pediatric emergency department of an urban academic hospital from December 2011 to December 2019. Inclusion criteria were age <2 years and having a urinalysis and urine culture sent. ILR boundaries for hemoglobin, protein, and leukocyte esterase were "negative," "trace," "1+," "2+" and "3+." Nitrite was positive or negative. Red blood cells and white blood cells (WBCs) were 0 to 5, 5 to 10, 10 to 20, 20 to 50, 50 to 100, and 100 to 250. Bacteria counts ranged from negative to "loaded." ILRs for each component were calculated and posttest probabilities for UTI were estimated. The UTI prevalence was 9.2%, with the most common pathogen being Escherichia coli (75.2%). The ILR for leukocyte esterase ranged from 0.20 (negative) to 37.68 (3+) and WBCs ranged from 0.24 (0-5 WBCs) to 47.50 (100-250 WBCs). The ILRs for nitrites were 0.76 (negative) and 25.35 (positive). The ILR for negative bacteria on urinalysis was 0.26 and 14.04 for many bacteria. The probability of UTI in young children significantly increases with 3+ leukocyte esterase, positive nitrite results, 20 to 50 or higher WBCs, and/or many or greater bacteria on urinalysis. The probability of UTI only marginally increases with trace or 1+ leukocyte esterase or 5 to 20 WBCs. Our findings can be used to more accurately predict the probability of true UTI in children.

Comprehensive analysis of some risk factors in the formation of a recurrent course of urinary tract infection in children

The aim – to study the risk factors for the formation of recurrent urinary tract infection (UTI) in children with the determination of their prognostic value, both in single-factor and multifactorial impact.Materials and methods. A total of 2 235 children aged between 1 month to 18 years with nephrological diseases were examined. To assess the risk factors for recurrent UTI in the study population, the patients were divided into groups: with recurrent UTI – 1 (n = 447), without UTI– 0 (n = 1788). 14 traits were taken from the list of studied factors: age <1 year; female gender; ARVI ≥3 episodes over 6 months; undifferentiated connective tissue disease; kidney cystic formations; hydronephrosis and other abnormalities; vesico-ureteric reflux; neurogenic bladder, enuresis; synechia, phimosis; no deworming in the last 6 months; constipation or irritable bowel syndrome; crystalluria, accumulation of salts according to ultrasound; antibacterial therapy in the next 3 months; the presence of resistant urological strains.Results. The one-factor analysis allowed to remove statistically insignificant risk factors. As a result of multivariate analysis, a multiple logistic model was developed for the personalized prediction of a recurrent UTI in a child: odds = exp (0.712 × X1+ 3.808 × X2+ 6.982 × Х6 + 2.248×X7+ 0.165 × Х8+ 0.300 × X9+ 0.200 × X10+ 0.306 × X11+ 0.196 × X12+ 0.217 × X13+ 0.440 × X14 + (-3.489)), where Xn is a variable (or factor) which equals 1 in the case of a factor, and 0 – in the absence of a factor. The mathematical model of regression showed high statistical significance and informativeness based on the results of its testing, χ2 = 161.9; P < 0.001.Conclusions. Factors such as frequent ARVI, undifferentiated connective tissue disease, kidney cystic formations did not present a risk of recurrent UTI episodes. The dominating factors in UTI recurrences were the following: female sex increased the chance of UTI in a child almost 12 times (RR = 11.898 ± 0.252 [7.255; 19.514], P < 0.001); hydronephrosis – 11 times (RR = 10.968 ± 0.419 [4.825; 24.933], P < 0.001); vesico-ureteric reflux – 8 times (8.308 ± 0.221 [5.380; 12.804], P < 0.05); age <1 year – 4 times (RR = 3.73 ± 0.165 [2.702; 5.158], P < 0.05). Other factors influenced the development of UTI only in their combined effects and increased the probability of UTI by 1.2–1.6 times (P < 0.05).

The role of antibiotic prophylaxis in mild to moderate isolated hydronephrosis detected in antenatal screening.

PurposeTo determine whether continuous antibiotic prophylaxis (CAP) could prevent urinary tract infection (UTI) in mild to moderate antenatal isolated hydronephrosis (IH), characterized by hydronephrosis without ureter and bladder abnormalities, and anteroposterior renal pelvis diameter <16 mm and the Society for Fetal Urology grade <4, in neonatal renal ultrasound.Materials and MethodsEighty neonates aged 7 to 30 days, with antenatal hydronephrosis and mild to moderate IH on neonatal renal ultrasound, were recruited from August 2015 to December 2016. Neonates were randomly assigned to CAP until hydronephrosis resolution or aged 12 months (CAP group, n=40) or to watchful observation (control group, n=40). The primary outcome was UTI. The probability of UTI was compared between the randomized groups using the Kaplan–Meier method and the log-rank test.ResultsNonadherence occurred in 6/40 parents in the CAP arm (15.0%). Thus, only 34 patients received CAP. UTI occurred in 5/34 patients in the CAP group (14.7%) and in 4/40 controls (10.0%). The probability of UTI was increased in the CAP group (hazard ratio, 1.38; 95% confidence interval, 0.37–5.16; p=0.63). UTI caused by cotrimoxazole resistant bacteria was four times higher in the CAP group than in controls (relative risk, 4.0; 95% confidence interval, 1.2–13.5; p=0.02). The trial was prematurely terminated due to the negative impact of CAP on bacterial sensitivity.ConclusionsThe benefits of CAP in infants with mild to moderate IH were inconclusive. CAP conferred a high risk of resistant bacterial organisms when UTI occurs.

Association of Ambulatory Ability on Complications and Medical Costs in Patients with Traumatic Spinal Cord Injury: A Decision-analytic Model.

Purpose The objective of this study was to determine the independent association of ambulatory ability with complications and medical costs in patients with spinal cord injury (SCI).MethodsPatients with SCI between T1-T12 enrolled in the National Spinal Cord Injury Database (NSCID) provided a minimum one-year follow-up. Covariate-adjusted annual rates of important medical complications (pressure sore, urinary tract infection, hospitalization) and associated medical costs were determined over five years post-injury. ResultsA total of 1,753 patients provided data at one-year follow-up and 1,340 patients provided five-year data. At one-year post-injury, 82% of patients were non-ambulatory and 18% were ambulatory. After adjusting for important covariates, ambulatory status was associated with a lower annual probability of urinary tract infection (43% vs. 68%), pressure sore (12% vs. 35%), and hospitalization (23% vs. 34%). Covariate-adjusted base-case medical costs due to urinary tract infection, pressure sore, and hospitalization were 34% lower in ambulatory vs. non-ambulatory patients ($31,358 vs. $47,266) over five years. Probabilistic sensitivity analyses confirmed the base-case results.ConclusionIn spinal cord-injured individuals, the ability to ambulate is independently associated with lower complication risks and associated medical costs over the five-year period following injury. Long-term clinical benefit and cost savings may be realized with assisted or unassisted ambulation in spinal cord-injured patients.

Pre-test probability of urinary tract infection in dogs with clinical signs of lower urinary tract disease

Clinical signs of lower urinary tract disease in dogs are characteristic but non-specific for infection. It has been hypothesized that age, sex and neuter status influences the prevalence of urinary tract infection (UTI), but the predictive value of the combined clinical presentation has not been explored in dogs. The aim of the study was to assess clinical predictors (sex/neuter status, age, dysuria/stranguria, pollakiuria, macroscopic hematuria, malodorous urine and history of recurrent UTI) for bacterial cystitis, and to develop a clinical decision rule. Data was retrieved from medical records (retrospective cases) or from standardized recording sheets (prospective cases). Bacterial cystitis was defined as significant bacteriuria on quantitative bacterial culture in dogs with compatible clinical signs of urinary tract disease. Dogs of any breed, sex and age were included.A total of 1727 microbiology records were screened and 424 samples were included in the analysis. Bacterial cystitis was confirmed in 46% of the cases. Four variables predicted bacterial cystitis: sex/neuter status, age, pollakiuria and hematuria. A score was designated to each variable and a clinical rule was constructed. This rule attained an AUC of 0.75 and had sensitivity of 83% and specificity of 55% at its optimal cut-off (score ≥2.0). A score cut-off of ≥3.0 had a positive predictive value of 70%. Several factors predicted bacterial cystitis, but the clinical rule had only modest predictive value. Other variables or point-of-care test results should be included in future research to optimize overall precision.

Do You Prefer Aminoglycosides or Cephalosporins in Neonatal Infections?

Background: Infections include an important cause of neonatal death. The gold standard of diagnosis is a culture that should be obtained from suspected sites. The basis of treatment is antibiotic therapy. It should start as soon as possible for preventing any subsequent complications. Choosing the appropriate antibiotic for empirical treatment is important. Methods: In this study, patients who were admitted to the neonatal wards of a Children’s Hospital Medical Center for infections with positive blood, CSF, or urine culture were studied during a two-year period. Results: Ninety-two newborns that had positive cultures were included in the study. Concerning the site of infection, 27.9% of positive blood cultures and 54.1% of urinary tract infections were sensitive to aminoglycosides (P value = 0.026). However, there was no significant relationship between the infection site and sensitivity to cephalosporins. Based on the bacterial species, 76.1% of Gram-negative infections were sensitive to aminoglycosides but 40.4% to cephalosporins (P value = 0.052). Conclusions: According to the relationship found in the study, aminoglycosides can safely start in case of a higher probability of urinary tract infections and Gram-negative infections as empirical treatment.

Development and Validation of a Calculator for Estimating the Probability of Urinary Tract Infection in Young Febrile Children

Accurately estimating the probability of urinary tract infection (UTI) in febrile preverbal children is necessary to appropriately target testing and treatment. To develop and test a calculator (UTICalc) that can first estimate the probability of UTI based on clinical variables and then update that probability based on laboratory results. Review of electronic medical records of febrile children aged 2 to 23 months who were brought to the emergency department of Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania. An independent training database comprising 1686 patients brought to the emergency department between January 1, 2007, and April 30, 2013, and a validation database of 384 patients were created. Five multivariable logistic regression models for predicting risk of UTI were trained and tested. The clinical model included only clinical variables; the remaining models incorporated laboratory results. Data analysis was performed between June 18, 2013, and January 12, 2018. Documented temperature of 38°C or higher in children aged 2 months to less than 2 years. With the use of culture-confirmed UTI as the main outcome, cutoffs for high and low UTI risk were identified for each model. The resultant models were incorporated into a calculation tool, UTICalc, which was used to evaluate medical records. A total of 2070 children were included in the study. The training database comprised 1686 children, of whom 1216 (72.1%) were female and 1167 (69.2%) white. The validation database comprised 384 children, of whom 291 (75.8%) were female and 200 (52.1%) white. Compared with the American Academy of Pediatrics algorithm, the clinical model in UTICalc reduced testing by 8.1% (95% CI, 4.2%-12.0%) and decreased the number of UTIs that were missed from 3 cases to none. Compared with empirically treating all children with a leukocyte esterase test result of 1+ or higher, the dipstick model in UTICalc would have reduced the number of treatment delays by 10.6% (95% CI, 0.9%-20.4%). UTICalc estimates the probability of UTI by evaluating the risk factors present in the individual child. As a result, testing and treatment can be tailored, thereby improving outcomes for children with UTI.

Correlations between quality ratings of skilled nursing facilities and multidrug-resistant urinary tract infections.

The purpose of this study was to determine risk factors for the acquisition of urinary tract infections (UTIs) and multidrug-resistant organisms (MDROs) in residents of skilled nursing facilities (SNFs). Using the informational database provided by the Centers for Medicare and Medicaid Services (CMS), a retrospective logistic regression was performed on 1,523 urine cultures from 12 SNFs located in Long Island, New York. Of the 1,142 positive urine cultures, Escherichia coli was most prevalent. Additionally, 164 (14.4%) of the UTIs were attributed to an MDRO. In multivariate logistic regression, sex and overall quality rating predicted the occurrence of UTIs, whereas identification of MDROs was dependent on the level of nursing care received. The mean predicted probability of UTIs and receipt of contaminated samples was inversely dependent on the facility's rating, where the likelihood increased as overall quality ratings decreased. The CMS's quality rating system may provide some insight into the status of infection control practices in SNFs. The results of this study suggest that potential consumers should focus on the overall star ratings and the competency of the nursing staff in these facilities rather than on individual quality measures.

Bacteria Isolated from Urinary Tract Infection among Patients and Determination of the Antibiotic Susceptibility Patterns of the Gram Negative Bacteria in Iran

Background: Escherichia coli (E. coli) is the most frequent infecting organism in acute infection. So, knowledge about the frequency and distribution of urinary tract infection (UTI) is important to improve infection control measures. The aim of this research was to determine the prevalence of bacteria isolated from urinary tract infection (UTI) in patients and determination of the antibiotic susceptibility patterns of the gram negative bacteria. M aterials and Methods: This descriptive study was performed in Imam Reza hospital, Tabriz (northwest of Iran) during March 2012 to February 2013. We surveyed 8153 patients, who had clinical manifestations of UTI. 5093 (62.47%) of them were female and 3060 (37.53%) of them male. Urine specimens were cultured for isolation of the microbial agents of UTI. The isolated bacteria were identified using biochemical tests. Disk diffusion susceptibility test was used to determine antimicrobial susceptibility. R es ults: E. coli (55.38%) was the most common isolated pathogen, followed by Enterobacter spp. (29.61%), Pseudomonas spp. (4.9%), S. aureus (3.21%), Enterococcus spp. (2.3%), fungi (1.5%) and Klebsiell a (0.48%). The sensitivity rates of isolated gram negative bacteria were for Amikacin (95.7%), Nitrofurantoin (91.5%), Gentamicin (64.1%), Ceftizoxim (56.8%), Ciprofloxacin (37.6%), Cotrimoxazole (31.4%) and Nalidixic acid (23.5%). C onclusion: This study showed that the frequency of E. coli and Enterobacter spp . increases the probability of urinary tract infection. Also this survey indicates the emergence of antibiotic resistant infections in the studied hospital. So, there is a need to improve the effectiveness of integrated infection control programs to control and manage nosocomial infections caused by highly resistant organisms.

Probability of urinary tract infection in infants with ureteropelvic junction obstruction: is antibacterial prophylaxis really needed?

In infants with ureteropelvic junction obstruction (UPJO), the risk of urinary tract infection (UTI) is unknown, and there is a lack of prospective studies showing definitive evidence regarding the benefits and necessity of antibiotic prophylaxis. The aim of this study was to assess the risk of UTI in infants with UPJO and to determine whether the risk varies according to the degree of hydronephrosis. Infants with hydronephrosis detected prenatally or within the postnatal 28th day and who had no previous history of UTI were followed prospectively without antibacterial prophylaxis. Imaging studies were performed according to our Pediatric Uro-Nephrology Study Group protocol. Dimercaptosuccinate (DMSA) scintigraphy was performed in all infants at the end of 1 year of follow-up. Eighty-four infants (56 boys, 28 girls) were included in the study. The distribution of patients in each hydronephrosis grading group was incidentally similar. Within a median follow-up period of 18 (12-24) months, none of the patients had UTI. Furthermore, no pyelonephritic scar was found on DMSA scans in any patient. We conclude that prophylactic antibiotic usage is not indicated in infants with UPJO, regardless of the severity of hydronephrosis, as the risk of UTI is minimal in this population.

Research and Statistics: Likelihood Ratio in Diagnosis

1. Stephanie Crewe, MD* 2. Peter C. Rowe, MD† 1. *Assistant Professor, Division of Adolescent Medicine, VCU Health Systems, Richmond, VA. 2. †Professor of Pediatrics, Department of Pediatrics, Division of General and Adolescent Medicine, Johns Hopkins University School of Medicine, Baltimore, MD. You are evaluating an 18-year-old girl who has dysuria. Using your understanding of the epidemiology of urinary tract infections (UTIs) in adolescents, your knowledge of the signs and symptoms of UTI, and your clinical judgment of how ill she appears, you arrive at a pretest estimation that she has a 40% probability of having a UTI. You wonder how much the probability of UTI will change if the urinalysis shows white blood cells (WBCs) in the urine. Diagnostic tests are used in practice to enhance clinical decision making and especially to revise probabilities in individual patients. (1) A diagnostic test is often ordered to modify the practitioner's initial estimation of disease probability (pretest probability) and generates the probability of disease after the test (posttest probability). Practitioners and patients are most interested …

Urine cultures for kids

I thank Kolk for her request for clarification. Suppose you are seeing a 1-year-old infant who has had a fever for two days but whose results of physical examination are unremarkable. The pretest probability of urinary tract infection is about 20%. [1][1] My preference would be to obtain a catheter

Urine analysis and decision-making on cystitis in general practice

Decision-making on cystitis in general practice was studied by addressing 1171 general practitioners of whom 909 responded. A case history was supplied with a test-strip result where leucocyte esterase was 1+ and the nitrite field either positive or negative. The respondents' estimated probability of urinary tract infection from the history had a median at 50% (10 and 90 percentiles, 30% and 90%). The test-strip results changed the estimate to 90% (50% and 100%) in the nitrite-positive group and 50% (10% and 90%) in the nitrite-negative group. Likelihood ratio was calculated from each respondent's estimated pre- and post-test probability to express the test's assumed diagnostic power. The median likelihood ratios were 4.75 (10 and 90 percentiles, 1.00 and 35.70) in the nitrite-positive group and 1.00 (0.11 and 4.00) in the nitrite-negative group. The resulting actions taken by the respondents were: no action (14 respondents, corresponding median estimated post-test probability 27.5%), await further examination (482, 50%) and prescription of antibiotics (366, 90%). Further examination included urine microscopy (13%), bacteriologic culture (21%), or both (65%). Eight-two percent of respondents who decided to prescribe antibiotics would also perform further examinations. In routine urine analysis, 79% of respondents request only test strips, 2% perform microscopy and 19% do both. The estimated probability of urinary tract infection is significantly affected by test-strip results and is important for the choice of further actions. Microscopy is performed more often than recommended in other studies.