Prognosis Of Urinary Tract Infection Research Articles

Evolution of Urinary Tract Infection Understanding: From Ancient Insights to Contemporary Perspectives

This research delves into the historical understanding and evolutionary trajectory of urinary tract infections (UTIs) from ancient descriptions to modern comprehension. The study explores the historical perspectives from ancient Egyptian insights to Hippocratic beliefs and traces the evolution of management approaches until the discovery of microorganisms as causative agents. Advancements in antimicrobial therapy and the changing landscape of UTI treatment strategies are also outlined, considering the emergence of antibiotic resistance. Defining UTI, the research emphasizes the differentiation between asymptomatic bacteriuria and UTI, highlighting crucial aspects and clinical implications. The prevalence of UTIs across different demographics and regions, especially in children, is examined. Variations in prevalence rates and contributing factors are explored in detail, considering regional disparities, age groups, and gender differences. Moreover, the research identifies several risk factors contributing to UTI occurrence, including gender, age, uncircumcision in males, improper toilet training, vesicoureteral reflux, and other anatomical and behavioral aspects. It also delves into the pathophysiology of UTIs, elucidating the multifaceted factors involved, such as aetiologic agents, anatomical variations, immunological factors, and genetic influences affecting the location, course, and prognosis of UTIs. The clinical forms of UTIs, namely acute pyelonephritis and cystitis, are outlined, delineating the symptoms, diagnostic approaches, and clinical implications associated with each form. The research emphasizes the importance of accurate differentiation between these clinical forms for appropriate treatment and long-term consequences, particularly renal scarring and other complications associated with pyelonephritis. In summary, this comprehensive review consolidates historical insights, epidemiological trends, risk factors, pathophysiological mechanisms, and clinical manifestations to offer a holistic understanding of UTIs, providing valuable insights for effective management and future research directions. Keywords: Urinary tract infection, historical perspective, prevalence, risk factors, pathophysiology, clinical forms, antimicrobial therapy.

Risk Factors for Bacteremia and Its Clinical Impact on Complicated Community-Acquired Urinary Tract Infection.

Bacteremia has been associated with severity in some infections; however, its impact on the prognosis of urinary tract infections (UTIs) is still disputed. Our goal is to determine the risk factors for bacteremia and its clinical impact on hospitalized patients with complicated community-acquired urinary tract infections. We conducted a prospective observational study of patients admitted to the hospital with complicated community-acquired UTIs. Clinical variables and outcomes of patients with and without bacteremia were compared, and multivariate analysis was performed to identify risk factors for bacteremia and mortality. Of 279 patients with complicated community-acquired UTIs, 37.6% had positive blood cultures. Risk factors for bacteremia by multivariate analysis were temperature ≥ 38 °C (p = 0.006, OR 1.3 (95% CI 1.1-1.7)) and procalcitonin ≥ 0.5 ng/mL (p = 0.005, OR 8.5 (95% CI 2.2-39.4)). In-hospital and 30-day mortality were 9% and 13.6%, respectively. Quick SOFA (p = 0.030, OR 5.4 (95% CI 1.2-24.9)) and Barthel Index <40% (p = 0.020, OR 4.8 (95% CI 1.3-18.2)) were associated with 30-day mortality by multivariate analysis. However, bacteremia was not associated with 30-day mortality (p = 0.154, OR 2.7 (95% CI 0.7-10.3)). Our study found that febrile community-acquired UTIs and elevated procalcitonin were risk factors for bacteremia. The outcomes in patients with bacteremia were slightly worse, but without significant differences in mortality.

A Review of Urinary Tract Infections in Pediatric Patients

Urinary tract infections (UTIs) are a common and significant health concern in children. The etiology of UTIs in children can vary depending on various factors, including age, gender, and underlying conditions. This comprehensive review aims to explore the etiology, pathogens involved, etiological evaluation by age group, diagnosis, differential diagnosis, follow-up, treatment, and prognosis of UTIs in children. Introduction: Urinary tract infections (UTIs) are bacterial infections that affect the urinary system, comprising the kidneys, ureters, bladder, and urethra. In children, UTIs can cause substantial morbidity if not promptly diagnosed and treated. Understanding the etiology and appropriate management strategies is crucial for healthcare providers involved in the care of pediatric patients. Etiology of UTIs in Children: UTIs in children can have various etiological factors, with the most common cause being bacterial invasion of the urinary tract. The majority of UTIs are caused by Gram-negative bacteria, with Escherichia coli being the predominant pathogen. Other potential pathogens include Klebsiella pneumoniae, Proteus mirabilis, Enterococcus faecalis, and Staphylococcus saprophyticus. Viral and fungal infections can also contribute to UTIs in certain cases. Pathogens Involved in the Etiology of UTIs: A detailed examination of the pathogens involved in UTIs is essential for appropriate diagnosis and treatment. E. coli, which colonizes the gastrointestinal tract, is responsible for the majority of UTIs in children. Understanding the antibiotic resistance patterns of these pathogens is crucial in selecting appropriate antimicrobial therapy. Etiological Evaluation by Age Group: The etiological evaluation of UTIs in children varies according to age group. Infants, young children, and older children may exhibit different risk factors and underlying conditions that contribute to UTIs. An age-specific approach is necessary to identify the potential causes, such as urinary tract abnormalities, voiding dysfunction, or anatomical abnormalities. Diagnosis of UTIs in Children: Accurate and timely diagnosis of UTIs is crucial to prevent complications and recurrent infections. Various diagnostic tools, including urinalysis, urine culture, and imaging studies, aid in identifying UTIs and determining the severity of infection. Clinical symptoms, such as fever, dysuria, and urinary frequency, must also be considered in the diagnostic process. Differential Diagnosis: UTIs can present with symptoms similar to other conditions, leading to diagnostic challenges. Differential diagnoses may include conditions such as pyelonephritis, urinary tract stones, urethritis, and sexually transmitted Open Access Journal of Urology &amp; Nephrology 2 Parlak ME and Kucukkelepce O. A Review of Urinary Tract Infections in Pediatric Patients. J Urol Nephrol 2023, 8(3): 000238. Copyright© Parlak ME and Kucukkelepce O. infections. An understanding of these potential differentials is essential to avoid misdiagnosis and provide appropriate treatment. Follow-up and Monitoring: After initiating treatment for UTIs, regular follow-up and monitoring are necessary to ensure the resolution of infection, assess treatment response, and prevent complications. Monitoring urine culture results, renal function, and imaging studies play a vital role in evaluating the effectiveness of treatment and detecting any underlying conditions that require further management. Treatment of UTIs in Children: Treatment of UTIs in children involves antimicrobial therapy targeted at the identified pathogen. The choice of antibiotics should consider local resistance patterns, age of the child, and severity of infection. Adequate hydration, symptomatic relief, and addressing predisposing factors are also important in the overall management of UTIs. Prognosis: With timely diagnosis and appropriate treatment, the prognosis for UTIs in children is generally favorable. However, the presence of underlying conditions, delayed diagnosis, or recurrent infections can influence the long-term outcome. Identifying and managing risk factors and promoting good urinary hygiene can help prevent future UTIs and potential complications. Conclusion: Urinary tract infections in children present unique challenges in terms of etiology, diagnosis, and management. Understanding the etiological factors, pathogens involved, appropriate diagnostic approaches, and treatment strategies is crucial for healthcare providers. By implementing a comprehensive approach that considers age-specific evaluations, accurate diagnosis, and effective treatment, healthcare professionals can ensure optimal outcomes and reduce the burden of UTIs in children.

Effect of Health Education Program Based on Health Belief Model on Prognosis of Urinary Tract Infection in Pregnant Women

Background: Urinary tract infection is a common cause of morbidity in pregnant women. The success of any educational intervention rests on the proper application of health behavior theories and models. Aim of the study was to investigate the effect of a health education program based on Health Belief Model (HBM) on the prognosis of Urinary Tract infection (UTI) in pregnant women. The study hypothesis was that women’s knowledge and practices will be improved, and this will lead to improvements in UTI symptoms and urine culture. Subjects & methods: Research design: an open label controlled quasi-experimental study with pre-post assessment was used in this study. Setting: the antenatal care (ANC) clinics in the primary health care centers affiliated to the Ministry of Health in urban areas of Port-Said city. Subjects: consisted of 90 pregnant women in first and second trimesters diagnosed with UTI were recruited consecutively in the study sample, each woman was randomly assigned to either the intervention or the control group as 45 women per group.Tools of data collection: include; structure interview schedule and a lab sheet. Results: showed that majority were living in urban areas, with no formal education. More women had a history of previous UTI (53.3% versus 40.0%) for studied and control women respectively. no statistically significant differences in their baseline (pre-intervention) scores of symptoms, knowledge of UTI, related health behavior practices, or Health Belief Model (HBM). At the post-intervention phase, the scores of symptoms severity and bothersome were statistically significantly lower among the study group with median scores zero. The knowledge and health behavior practices scores were statistically significantly higher among the study group with knowledge medians 81.00 and 31.00 respectively (p < 0.001). The scores of HBM were statistically significantly higher among the study group (p < 0.001). The pus cells and the urine culture in urine were less among the study group both in the post and 3-month follow up samples (p < 0.001) (p=0.03), respectively. Conclusion: the study concluded that the study intervention was protective against the risk of having a positive urine culture at 3-months follow-up. Recommendations: the study recommended that the program and its booklet should be implemented in ANC settings.

Risk factors affecting the prognosis of urinary tract infection in Chinese pediatric patients: Single-center experience.

Urinary tract infection (UTI) is common in children. The purpose of this retrospective study was to determine the various risk factors that usually affect the prognosis of UTI in children diagnosed with the disease. In the present retrospective study, we enrolled all pediatric patients diagnosed with UTI and hospitalized between 1 January 2013 and 31 July 2016 at Nanjing Children's Hospital. We then collected all the relevant patient clinical demographics and characteristics. The study involved 2,092 pediatric patients diagnosed with UTI. On logistic regression analysis, factors that could affect the prognosis of pediatric UTI were complications, hospitalization, intensive care unit (ICU) admission, type of UTI, urine culture results, blood lymphocytes, urine nitrites (NIT) and antibiotics (unstandardized coefficients, 0.06, <0.001, -0.28, 0.32, <0.001, 0.01, -0.11, 0.01, respectively, all P < 0.001). Complications, hospitalization, type of UTI, urine culture results, blood lymphocytes, and antibiotics had a significant, positive association with UTI prognosis. Meanwhile, ICU admission and urine NIT had a negative association with prognosis.

Prognosis of urinary tract infection caused by KPC-producing Klebsiella pneumoniae: The impact of inappropriate empirical treatment

There is scarce information on the prognosis of urinary tract infections (UTI) caused by KPC carbapenemase-producing Klebsiella pneumoniae (KPC-Kp). To investigate the association between KPC-Kp aetiology and clinical failure and all cause mortality and to explore the impact of inappropriate empirical treatment. This is a retrospective observational study of hospitalized patients with UTI due to K. pneumoniae. We explored clinical failure at day 21 and 30-day all-cause mortality using different models of adjusted analysis. We analyzed 142 episodes of UTI; 46 episodes (32.4%) were due to KPC-Kp and 96 episodes (67.6%) were due to non-KPC-Kp strains (62 wild type and 34 EBSL producer). Clinical failure was more frequent in the KPC-Kp group (41.3% vs. 15.6%, p = 0.001). KPC-Kp aetiology and inappropriate empirical therapy were associated in the non-adjusted analysis with clinical failure. When analysed in separate adjusted models, both were found to be associated; inappropriate empirical treatment (OR 2.51; 95% CI, 1.03-6.12; p = 0.04) and KPC-Kp (OR 2.73; 95% CI, 1.03-7.22; p = 0.04) were associated with increased risk of failure. All-cause 30-day mortality was higher in patients with KPC-Kp UTI (39.1% vs. 15.6%, p = 0.002). Bacteraemia was more frequent in patients with KPC-Kp etiology (23.9% vs. 10.4%; p = 0.034). In both cases, the association was not confirmed in the adjusted analysis. KPC-Kp UTI is associated with higher clinical failure and may be due to an increase in inappropriate empirical treatment.

Smartphone-based, sensitive µPAD detection of urinary tract infection and gonorrhea.

The presence of bacteria in urine can be used to monitor the onset or prognosis of urinary tract infection (UTI) and some sexually-transmitted diseases (STDs), such as gonorrhea. Typically, bacteria's presence in urine is confirmed by culturing samples overnight on agar plates, followed by a microscopic examination. Additionally, the presence of Escherichia coli in a urine sample can be indirectly confirmed through assaying for nitrite (generated by reducing nitrate in urine), however this is not sufficiently specific and sensitive. Species/strains identification of bacteria in a urine sample provides insight to appropriate antibiotic treatment options. In this work, a microfluidic paper analytical device (µPAD) was designed and fabricated for evaluating UTI (E. coli) and STD (Neisseria gonorrhoeae) from human urine samples. Anti-E. coli or anti-N. gonorrhoeae antibodies were conjugated to submicron particles then pre-loaded and dried in the center of each paper microfluidic channel. Human urine samples (undiluted) spiked with E. coli or N. gonorrhoeae were incubated for 5 min with 1% Tween 80. The bacteria-spiked urine samples were then introduced to the inlet of paper microfluidic channel, which flowed through the channel by capillary force. Data confirms that proteins were not filtered by μPAD, which is essential for this assay. Urobilin, the component responsible for the yellow appearance of urine and green fluorescence emission, was filtered by μPAD, resulting in significantly minimized false-positive signals. This filtration was simultaneously made during the μPAD assay and no pretreatment/purification step was necessary. Antibody-conjugated particles were immunoagglutinated at the center of the paper channel. The extent of immunoagglutination was quantified by angle-specific Mie scatter under ambient lighting conditions, utilizing a smartphone camera as a detector. The total μPAD assay time was less than 30s. The detection limit was 10 CFU/mL for both E. coli and N. gonorrhoeae, while commercially available gonorrhea rapid kit showed a detection limit of 10(6) CFU/mL. A commercially available nitrite assay test strip also had a detection limit of 10(6) CFU/mL, but this method is not antibody-based and thus not sufficiently specific. By optimizing the particle concentration, we were also able to extend the linear range of the assay up to 10(7) CFU/mL. The proposed prototype will serve as a low-cost, point-of-care, sensitive urinalysis biosensor to monitor UTI and gonorrhea from human urine.

Pronóstico de las infecciones urinarias con tratamiento antibiótico discordante

Introduction This study aims to evaluate the prognosis of urinary tract infections (UTI) treated empirically with inadequate antibiotic treatment. Material and Methods Prospective cohort study of patients over 18 years of age, attended in the hospital emergency service between 01/02 and 31/05 of 2007, due to micturation symptoms, accompanied by pyuria (>10 leukocytes/mm 3 of uncentrifuged urine) or positive reactive strip for nitrites-leukocytes and urine culture with >10 3 colony forming units. It was considered that the antibiotic treatment prescribed empirically was adequate if the bacteria isolated was sensitive and had been prescribed for the correct time. It was considered that there was therapeutic failure when the symptoms persisted after 5 days of treatment. Age, gender, presence of indwelling bladder catheter, type of UTI, hospitalization in the previous 3 months, origin of the patient and associated diseases were recorded. Results A total of 177 bacteria were isolated in 168 patients. In 29 cases (17.3%), the microorganism isolated was resistant to the antibiotic prescribed. There was thereaputic failure in only 6 patients, although they did not required hospital admission. The patients who lived in a residential home for the elderly (13.7% vs 2.2%, P=0.015) or who had been hospitalized during the previous 3 months (20.6% vs 4.3%, p=0.039) had a greater risk of receiving inadequate treatment. Conclusions The prognosis of the patients attended in the emergency hospital service due to UTI with discordant antibiotic treatment is favorable in most of the cases. Performing urine culture in patients with greater risk of suffering UTI due to a resistant microorganism would be recommendable.

Influence of diabetes and hyperglycaemia on infectious disease hospitalisation and outcome

Diabetes mellitus is believed to increase susceptibility to infectious diseases. The effects of hyperglycaemia per se on infectious disease risk are unknown and the influence of diabetes on infectious disease outcome is controversial. We studied 10,063 individuals from the Danish general population, who were participants in The Copenhagen City Heart Study, over a follow-up period of 7 years. Risk of hospitalisation caused by any infectious disease, and subsequent risk of disease progression to death were estimated by Cox proportional hazards regression analysis. At baseline, 353 individuals reported having diabetes. During 71,509 person-years of follow-up, a total of 1,194 individuals were hospitalised because of an infection. The risk of pneumonia (adjusted hazard ratio [aHR] 1.75, 95% CI 1.23-2.48), urinary tract infection (aHR 3.03, 95% CI 2.04-4.49) and skin infection (aHR 2.43, 95% CI 1.49-3.95) was increased in subjects with diabetes compared with subjects without. Each 1 mmol/l increase in plasma glucose at baseline was associated with a 6-10% increased relative risk of pneumonia, urinary tract infection and skin infection after adjustment for other possible confounders. Among patients hospitalised for urinary tract infection, diabetic patients were at an increased risk of death at 28 days after admission compared with non-diabetic subjects (HR 3.90, 95% CI 1.20-12.66). In the Danish general population, diabetes and hyperglycaemia are strong and independent risk factors for hospitalisation as a result of pneumonia, urinary tract infection and skin infection. Further, diabetes has a negative impact on the prognosis of urinary tract infection.

The importance of the host nutritional and immune status on the prognosis of urinary tract infection in the elderly

This study was performed to evaluate the role of the nutritional and immune status on the prognosis of urinary tract infections (UTI) in the elderly. 192 patients among the 790 inpatients were diagnosed as UTI. Age-related increase in the prevalence of UTI was accompanied with poor prognosis in the patients with hypoalbuminemia (< 2.6 g/dl) and lymphocytopenia (< 700/mm3). To study the immunologic basis for susceptibility to UTI in the aged further, we compared the T-cell functions between outpatients without serious disease and inpatients with chronic UTI. The absolute numbers of lymphocyte, OKT3 (pan T-cell marker), OKT4 (Helper/Inducer marker) and Interleukin (IL)-2 as well as serum albumin concentration were decreased in the patients with UTI. A prospective study was done to confirm that these nutritional and immunological changes become risk factors in the prognosis of UTI with long-term and low-dose chemotherapy. In the patients continued with bacteriuria (Non-responders, n = 6), serum albumin concentration and IL-2 production were significantly lower than the patients who became free from bacteriuria (Responders, n = 7). These results suggest that poor nutrition-related immune dysfunction contributes to the vulnerability of elderly patients to UTI and becomes risks for he prognosis of UTI.

Review of the immunological aspects of the pathogenesis, diagnosis and prognosis of urinary tract infections.

SummaryDuring a urinary infection, antibodies are produced against a variety of antigens both host and bacterial. Some of the antibodies are protective in animal-models. This is the case with the anti-pili, anti-K and anti-O antibodies. Others, like the anti Tamm-Horsfall protein auto-antibodies, could be responsible for renal scarring. Antibodies production is generally more marked in pyelonephritis than in cystitis. In the serum, the antibodies are of the IgG and IgM types and in the urine of the IgA and IgG types. This qualitative difference is the basis of diagnostic tests for localizing the level of urinary tract infection. The antibody-coated-bacteria test seems to be the easiest routine test. The importance of this test for the diagnosis of urinary infection in the children as well as in adults (especially in pregnant women) is discussed. Furthermore, a negative test is an accurate predictor of therapeutic success using a single dose antibiotic regime. The measurement of antibody titres against the...

Urinary Tract Infection in Childhood

The physician interested in primary care must recognize his responsibility in correctly diagnosing and properly treating children with urinary tract infections (UTIs). Despite some recent reviews,1,3 physicians may be confused and unsure of themselves in this area. They have been told by pathologists that chronic pyelonephritis is not usually due to UTI,4 that screening for UTI in females is5 (is not6) valuable, that aggressive urologic evaluation is of questionable importance,7-9. that there is danger in overdiagnosis3 (underdiagnosis2), and that the prognosis of UTI is unknown.5 What can the clinician do to help (and not inadvertently harm) his patient in the face of such controversy? One possible approach is to present the areas of controversy and to allow each practitioner the opportunity to draw his own conclusions. The following review is intended as a discussion of the problems presented by children with UTI and a statement of one physician's principles of management. INCIDENCE The incidence of UTI varies with age. The only careful prospective studies that have been done have assessed the prevalence (number positive at one point in time) of asymptomatic bacteriuria (ABU). The frequency of symptomatic UTI is less than ABU at each age, but precise data are not available. Estimates are that as many as 50% of patients with ABU may have had previous symptomatic UTI.10 In premature newborns, the prevalence of ABU is approximately 3%11; in term infants, 1%11; in the age group 1 to 5 years, 1%12; and in the school-age child,1.5%.6.13-16 Except for the

On the prognosls of urinary tract infection in childhood.

On the prognosls of urinary tract infection in childhood.