Pyelonephritis Patients Research Articles

The role of Monocyte Chemotactic Protein-3 (MCP3) in pyelonephritis patients in Al- Najaf Governorate, Iraq

Pyelonephritis is a serious disease that is widespread in Iraq and is mostly caused by Gram-negative bacteria, which are highly contagious and can spread from an infected person to others. The aim of this article was to evaluate the immunomodulatory role of Monocyte chemotactic protein-3 (MCP3) in the blood serum of patients with acute pyelonephritis and chronic pyelonephritis. A group of patients suspected of having nephritis were sampled in Najaf city, Iraq. Clinical and biochemical tests were performed to confirm their infection. Where 30 patients had acute pyelonephritis and 30 patients had chronic pyelonephritis, in addition to 29 healthy people who were considered control. MPC-3 was measured in the serum of the affected person using ELISA technology. MPC3 levels were significantly elevated (P < 0.05) in the group of patients with pyelonephritis compared with the control group. The chronic pyelonephritis group showed higher levels of MPC-3 in blood serum (P < 0.05) compared to the acute pyelonephritis group. This study showed that MPC-3 is related to pyelonephritis and can be used to help in diagnose the disease.

Bacteriological investigation of pyelonephritis in AL-Najaf Governorate, Iraq: a cross-Sectional study

Pyelonephritis is an inflammation caused by bacteria that primarily effects the interstitial area and the renal pelvis or, less often, the renal tubules. It is one of the most common renal diseases. The main objective of the study is to know and to compare the bacterial species that cause pyelonephritis in its three types, acute, chronic and emphysematous for patients in Iraq, specifically in the Al-Najaf Governorate. 663 (82.88%) samples gave a positive result for bacterial growth, and they belonged to patients with acute pyelonephritis 128 samples, chronic pyelonephritis patients had 288 samples and 247 samples for pyelonephritis emphysematous patients. The chronic pyelonephritis type had the most diverse bacterial species (11) bacterial species, the acute pyelonephritis (9) bacterial species, and the emphysematous pyelonephritis (6) species only. Escherichia coli bacteria was the most widespread of all types pyelonephritis, with a percentage of 34.41% (53/ 154) .For the acute type, percentage of 49.83% (152/305) was for the chronic type and a percentage of 56.07% (157/280) for the emphysematous type. 15 types of antibiotics were tested, and the antibiotics Imipenem and Amikacin were the best for most isolated bacterial species. In terms of gender, age and residence of the patients, females were the most susceptibility 341 (51.43%), and the age group (41-55) years is the most influential 211 (31.83%) and the percentage of residents of urban areas 379 (57.16%) gave the highest percentage of residents of rural areas.

Contrast-Enhanced Ultrasound Follow-Up for Acute Pyelonephritis Patients.

Contrast-enhanced ultrasound (CEUS) is increasingly used in clinical practice as the first diagnostic method in patients with suspected pyelonephritis rather than abdominal CT with contrast medium, especially in young subjects. We performed a retrospective analysis on patients in for whom a CEUS examination was utilized as a follow-up method after acute pyelonephritis as normal clinical practice. Through evaluating all patients, in terms duration between CEUS examination and normalization (healing) of the renal disease, we found that the mean duration is 25.9 days. Our ultrasound findings did not induce any therapeutic modifications, not even in the cases in which the examination was repeated several times. Therefore, setting up a CEUS follow-up examination after 25 days from the first diagnosis can reduce the number of repeated tests, benefitting patients and the healthcare system in terms of reducing costs.

Comparison of prognosis of five scoring systems in emphysematous pyelonephritis patients requiring intensive care

IntroductionOur study aimed to evaluate the performance of Quick Sepsis-related Organ Failure Assessment (qSOFA), Modified Early Warning Score (MEWS), National Early Warning Score (NEWS), Systemic Inflammatory Response Syndrome (SIRS), and Global Research in the Emphysematous Pyelonephritis group (GREMP) in predicting the need of admission in intensive care units (ICU) for emphysematous pyelonephritis (EPN) patient.Patients and methodsIn this retrospective study, we reviewed 70 patients admitted to our department from January 2008 to October 2022. Data on clinical presentation and EPN management were noted. The five scoring systems were calculated by one investigator. Univariate and multivariate analyses were used to assess predictive factors of severe sepsis and mortality. Statistical analysis was made using SPSS version 22.ResultsMean age was 61.83 years with 65.7% diabetes. As per Huang and Tseng classification, 41 patients had class I EPN, 7 had class II EPN, 8 had class IIIa, 6 class IIIB EPN, and 8 had class IV EPN. Seventeen patients (24.28%) were admitted to ICU with an 18.57 mortality rate. Univariate analysis showed that ICU admission was significantly associated with higher respiration rate and heart rate, lower systolic blood pressure, confusion, CRP, lactate and creatinine serum (p = 0.0001, p = 0.0001, p = 0.001, p = 0.007, p = 0.004, p = 0.001, p = 0.001, respectively). All five scores and Huang and Tseng classification were significantly predictive of admission to ICU. All five scores showed good results under the area curves to predict ICU entry with 0.915, 0.895, 0.968, 0.887, and 0.846 for qSOFA, MEWS score, NEWS score, SIRS, and GREMP score, respectively.ConclusionNEWS score seemed to be the best performing physiologic score among the five scoring systems studied and may help with biological and radiological findings to quickly identify EPN patients that need intensive care unit.

Comparative study of the effects of fresh and canned Naftussya bioactive water on neuro-endocrine-immune complex and metabolism in chronic pyelonephritis patients

Background. There are several patented methods of preservation of medicinal waters of the Naftussya type. The authors of the patents as evidence of the correctness of the methods cite the facts of preservation of the ability of canned water to enhance motility rat’s v. portae in vitro and/or increase diuresis. However, such tests are not attributive. The most characteristic manifestation of the biological activity of Naftussya water is the stimulation of phagocytosis through the mediation of the nervous and endocrine systems. Another "Method of preservation of hydrogen sulfide mineral waters" was recently patented. The purpose of this study is to compare the impact of fresh and canned by this method Naftussya water on its targets in patients with chronic pyelonephritis. Materials and Methods. The object of clinical-physiological observation were residents of the city of Truskavets’ (21 men aged 24-67 years and 8 women 33-76 years) with chronic pyelonephritis in remission. The subject of the study were the phagocytic function of neutrophils, excretory function of kidneys, leukocyturia and bacteriuria levels, components of microbiota of feces as well as HRV and endocrine parameters. Results. Weekly use of fresh Naftussya water causes an increase in the reduced content of probiotics in the microbiota and a decrease in the increased content of conditionally pathogenic microflora, which is accompanied by an increase in reduced bactericidal capacity of neutrophils against both E. coli and Staph. aureus, normal diuresis, phosphaturia, magnesiumuria, ureauria while reduction of bacteriuria and leveling of leukocyturia as well as decrease in concentration of uric acid in urine and creatinine and cholesterol in plasma. Favorable changes in neuro-endocrine regulation were revealed. The beneficial effect on the listed parameters of canned Naftussya water is less pronounced, but the differences are statistically insignificant. Conclusion. The obtained results confirm the effectiveness of the Dovzhenko© method for Naftusya water conservation and provide grounds for continuing research into the effects of canned Naftusya water on the body of urological patients.

Unusual surgical treatment option for an uncommon disease: Ureterocutaneostomy in an emphysemateous pyelonephritis patient.

Emphysematous pyelonephritis (EPN) is severe necrotising inflammation of renal parenchyma. Because of the devastating consequences of the pathology aggressive treatment can prevent permanent renal damage. Fifteen-year-old-girl patient without medical follow-up applied to emergency room with fever and vomiting. Computed Tomography (CT) revealed EPN. After diagnostic procedure minimal invasive procedures like double J catheter and nephrostomy tube insertion failed. While taking into account family’s treatment and medical follow-up compliance, also severe dilatation in both ureters made bilateral ureterocutaneostomy (UC) to be considered as a feasible option. UC creation can be thought as a safe and effective alternative surgical procedure. Pediatric neurogenic bladder (NB) population incompatible to treatment and follow-up are candidates for EPN development. We also believe that UC can be beneficial in terms of acute and long-term management of EPN in NB patients who the clinician thinks will not be compatible with complex surgical intervention, follow-up and treatment.

Pyonephrosis among Patients with Pyelonephritis Admitted in Department of Nephrology and Urology of a Tertiary Care Centre: A Descriptive Cross-sectional Study

Pyonephrosis is a severe complication of pyelonephritis leading to rapid progression to sepsis and loss of renal function resulting in nephrectomy. Early identification of pyonephrosis based on clinical or radiological characteristics amongst pyelonephritis is paramount. This study aimed to determine the prevalence of pyonephrosis among patients with pyelonephritis admitted to the Department of Nephrology and Urology of a tertiary care centre. This descriptive cross-sectional study was done in a tertiary care centre among patients with pyelonephritis from 1 July 2016 to 31 Jan 2021. Ethical approval was obtained from Institution Ethics Committee (Reference number: IEC/56/21). The available clinical, demographic and laboratory parameters were recorded from the hospital records in a predesigned proforma. A convenience sampling method was used. Point estimate and 95% Confidence Interval were calculated. Among 550 pyelonephritis patients, the prevalence of pyonephrosis was 60 (10.9%) (8.3-13.5, 95% Confidence Interval). The mean age was 54.62±12.14 years, and 41 (68.33%) were males. The most common clinical symptom was flank pain with or without fever in 46 (76.66%) patients. Escherichia coli was the most common offending organism in 20 (33.33%). Ultrasonography showed classical echogenic debris with floaters and internal echoes in 44 (73.33%) patients. Double J stenting was successfully done in 44 (73.33%) patients. Percutaneous nephrostomy was done in the remaining 16 (26.66%) patients. The prevalence of pyonephrosis in pyelonephritis is similar to previous studies done in similar settings. pyelonephritis; pyonephrosis; kidneys.

Clinical Profile of Children with Pyelonephritis and Cystitis in Dr. Soetomo General Academic Hospital, Surabaya

Highlights:1. In patients younger than one year old, cystitis was more frequent in boys. Meanwhile, in patients aged 1-5, girls were more frequent in pyelonephritis and cystitis.2. In pyelonephritis, all patients had fever, followed by diarrhea and lethargy.3. Urinary symptoms, such as dysuria and hematuria, were more frequent in cystitis than in pyelonephritis. AbstractIntroduction: Urinary tract infection (UTI) is a common infection in children. Prompt diagnosis and treatment of this infection are important to prevent further damage to the kidney. This study aimed to examine the clinical profile of children with pyelonephritis and cystitis in Dr. Soetomo General Academic Hospital, Surabaya.Methods: This was a descriptive study conducted in Dr. Soetomo General Academic Hospital, Surabaya, from June 2013 until December 2015, using secondary data and presented by percentage. Samples included in this study were children aged two months to five years old with UTI as a primary or secondary diagnosis of diarrhea and had urine culture results ≥ 105 CFU/ml.Results: There were 30 patients with pyelonephritis and 27 patients with cystitis. The prevalence of pyelonephritis was 0.285% and of cystitis was 0.247%. In pyelonephritis patients younger than one-year-old, boys and girls were equal. However, boys (60%) were more frequent in cystitis patients. In both pyelonephritis and cystitis patients aged 1-5, girls were more frequent (56.3%; 64.7%). In pyelonephritis patients, all patients were found with fever, followed by diarrhea (60%) and lethargy (56.7%) as the two most common symptoms. The two most common symptoms in cystitis patients were lethargy (44.4%) and irritability (33.3%). Urinary symptoms, such as dysuria and hematuria, were more frequent in cystitis (11.1%; 7.4%) patients than in pyelonephritis patients.Conclusion: Boys were more frequent to suffer urinary tract infections. Systemic symptoms were frequently found in pyelonephritis patients, while urinary symptoms were more frequent in cystitis patients.

Factors associated with urinary diversion and fatality of hospitalized acute pyelonephritis patients in France: a national cross-sectional study (FUrTIHF 2).

Acute pyelonephritis (AP) epidemiology has been sparsely described. This study aimed to describe the evolution of AP patients hospitalised in France and identify the factors associated with urinary diversion and fatality, in a cross-sectional study over the 2014-2019 period. Adult patients hospitalised for AP were selected by algorithms of ICD-10 codes (PPV 90.1%) and urinary diversion procedure codes (PPV 100%). 527,671 AP patients were included (76.5% female: mean age 66.1, 48.0% Escherichia coli), with 5.9% of hospital deaths. In 2019, the AP incidence was 19.2/10,000, slightly increasing over the period (17.3/10,000 in 2014). 69,313 urinary diversions (13.1%) were performed (fatality rate 6.7%), mainly in males, increasing over the period (11.7% to 14.9%). Urolithiasis (OR [95% CI] =33.1 [32.3-34.0]), sepsis (1.73 [1.69-1.77]) and a Charlson index ≥3 (1.32 [1.29-1.35]) were significantly associated with urinary diversion, whereas E. coli (0.75 [0.74-0.77]) was less likely associated. The same factors were significantly associated with fatality, plus old age and cancer (2.38 [2.32-2.45]). This nationwide study showed an increase in urolithiasis and identified, for the first time, factors associated with urinary diversion in AP along with death risk factors, which may aid urologists in clinical decision-making.

The role of nitric oxide synthase and cystatin C in the mechanisms of antimicrobial protection in children with urinary tract infections considering the etiological factor

The aim of the study was to investigate the main etiological factors of urinary tract infections in children, the role of nitric oxide synthase and cystatin C in the mechanisms of antimicrobial protection in children with acute and chronic urinary tract infections. Materials and methods. The study groups consisted of 84 children (mean age – 10.0 ± 1.3 years). The main group was divided into subgroups: the first subgroup – 17 children with acute pyelonephritis, the second subgroup – 21 patients with chronic pyelonephritis, the third subgroup – 16 patients with acute cystitis, the fourth subgroup – 10 patients with unspecified urinary tract infections. The control group consisted of 20 relatively healthy children. The levels of inducible NO-synthase (NOS2) and cystatin C were measured by enzyme-linked immunosorbent assay. The etiological pathogen was identified in the urine of 200 patients with urinary tract infections. Results. Escherichia coli was identified as the dominant pathogen in 46.7 % of cystitis patients and in 66.6 % of chronic pyelonephritis patients. The next most frequently detected etiological agent in children with acute (27.3 % of cases) and chronic (25.6 %) pyelonephritis and unspecified urinary tract infection (32.2 %) was Enterococcus faecium. Proteus mirabilis was found in 26.6 % of patients with cystitis. The level of NOS2 in all the studied subgroups was significantly higher than that in the control group (P < 0.01). A statistically significant increase in the level of cystatin C in the main group (P < 0.05) was determined. The cystatin C-to-NOS2 ratios in the studied subgroups were 1.5–2.0 times lower than those in the control group (P < 0.05). Conclusions. The change in the spectrum of pathogens has been determined, which was a premise of the need for constant bacteriological monitoring. The development of the primary inflammatory process in the urinary tract occurred amidst a certain dysfunction of the immune system, which was manifested in an insufficient quantitative response of cystatin C, as well as high serum levels of inducible NO-synthase in the patients.

Detection of Autotransporter Genes and Evaluation of the Relationship Between the Autotransporters and Biofilm Formation in Uropathogenic Escherichia Coli Isolated From Urinary Tract Infections

Background: Uropathogenic Escherichia coli (UPEC) are among the pathogens causing urinary tract infections (UTIs). UPEC strains utilize autotransporter (AT) proteins for pathogenesis, especially the development of biofilm in the urinary tract. Objective: There is no general data about the frequency of ATs among the UPECs, thus we decided to assess the frequency and AT patterns in patients with UPEC recovered from UTI, as well as to find the possible correlation between the ATs and biofilm. Materials and Methods: Totally, 200 Escherichia coli were recovered from the urine of outpatients and inpatients with UTIs in Iran. Biofilm production was assessed by a phenotypic method. Extraction of DNA was done using the boiling method, and the extracted products were used for polymerase chain reaction (PCR). Amplification of AT genes was done by PCR with an optimized program in a thermal cycler apparatus. Then, the amplified genes were evaluated by electrophoresis. Results: Among the UPEC isolates, 63.5% and 36.5% were isolated from cystitis and pyelonephritis patients, respectively. In addition, the majority of UPECs (66.5%) were associated with hospitalized patients. Totally, 92% of isolates produced biofilm, of which 53.5%, 21.5%, and 17% were weak, moderate, and strong biofilm producers, respectively. Among investigated ATs, the most frequent genes were upaH (89%), upaB (87%), upaG (79%), vat (78%), sat (69%), upaC (67%), and ag43 (37%). There were 37 AT patterns among UPECs, and pattern 1 with the presence of all AT genes was the most common. It was found that the prevalence of upaB and upaG was significantly higher among the cystitis isolates compared to pyelonephritis isolates. Further, no significant difference was observed between the AT genes, except for upaC (P=0.003), and the intensity of biofilm formation in UPEC isolates. Conclusion: According to the high prevalence of AT genes among UPECs isolated from inpatients and outpatients, these factors can be ideal vaccine candidates for designing effective vaccines against the isolates. Evaluation of the efficacy of these ATs against UPECs is under investigation.

Comparative Assessment of Original vs. Standard Surgery Techniques in Treatment for Purulent Pyelonephritis

Background. Modern minimally invasive surgical techniques reduce traumatism of operative interventions and aggressive anaesthesia, which accordingly shortens the patient’s hospital stay and rehabilitation period.Aim. An improvement of surgical outcomes in patients with purulent pyelonephritis via introduction of laparoscopic techniques.Materials and methods. Th e study included 80 purulent pyelonephritis patients operated at the Territorial Clinical Hospital during 2006—2018. Th e patients were divided between two cohorts. Cohort 1 included 40 (50 %) patients operated with standard techniques (ST), cohort 2 — 40 (50 %) patients having surgery by an original minimally invasive technique (OT). Kidney decapsulation was found to outcome in parenchymal decompression and blood circulation restore in cortical layer. Intraarterial infusion of alprostadil prevents further spread of purulent-destructive processes in kidney.Results and discussion. In patients with the minimally invasive technique, postoperative period proceeded at no complications. On day 1, the patients reported reduced pain syndrome in the surgical area. Contrasted renal MSCT before and aft er surgery showed the recovery of renal blood flow and significant diminishing of destruction foci in short term. Nephrectomy was not performed as no-indication.Conclusion. The treatment outcomes in 40 patients having the new surgical technique demonstrate its efficacy and applicability in clinical practice.

Prognostic Accuracy of the qSOFA Score for In-Hospital Mortality in Elderly Patients with Obstructive Acute Pyelonephritis: A Multi-Institutional Study.

Prognostic accuracy of the quick sequential organ failure assessment (qSOFA) score for mortality may be limited in elderly patients. Using our multi-institutional database, we classified obstructive acute pyelonephritis (OAPN) patients into young and elderly groups, and evaluated predictive performance of the qSOFA score for in-hospital mortality. qSOFA score ≥ 2 was an independent predictor for in-hospital mortality, as was higher age, and Charlson comorbidity index (CCI) ≥ 2. In young patients, the area under the curve (AUC) of the qSOFA score for in-hospital mortality was 0.85, whereas it was 0.61 in elderly patients. The sensitivity and specificity of qSOFA score ≥ 2 for in-hospital mortality was 80% and 80% in young patients, and 50% and 68% in elderly patients, respectively. For elderly patients, we developed the CCI-incorporated qSOFA score, which showed higher prognostic accuracy compared with the qSOFA score (AUC, 0.66 vs. 0.61, p < 0.001). Therefore, the prognostic accuracy of the qSOFA score for in-hospital mortality was high in young OAPN patients, but modest in elderly patients. Although it can work as a screening tool to determine therapeutic management in young patients, for elderly patients, the presence of comorbidities should be considered at the initial assessment.

Clinical efficacy of Tailin formulation combined with continuous low-dose antimicrobial therapy for recurrent urinary tract infection: study protocol for a multicenter, double-blind, randomized, controlled clinical trial

BackgroundGiven the increasing rates of antimicrobial resistance (AMR), recurrent urinary tract infection (rUTI) is becoming refractory more and more. Antibiotic prophylaxis including continuous low-dose antibiotic therapy (CLAT), is the common treatment for rUTI of the world. However, the presumably adverse reactions caused by CLAT alone should be paid more attention. Studies indicated that Chinese herbal medicine (CHM) might be an available treatment method for rUTI. Tailin formulation (TLF) is a herbal prescription developed for the treatment of rUTI in the 2000s in Shanghai Municipal Hospital of Traditional Chinese Medicine. Our previous studies have shown TLF could prevent urinary tract infection both in pyelonephritis (PN) rat model and in PN patients. Additionally, our published data demonstrated TLF is helpful to reduce the recurrence of rUTI and protect renal tubular function in clinic. In order to find a novel treating project for rUTI to increase the clinical curative effect, we thus try to combine TLF with CLAT to treat rUTI and design an optimized, pragmatically clinical trial to evaluate the efficacy and safety of this project.Methods/designThis is a multicenter, double-blind, randomized, controlled clinical trial. We will enroll 200 eligible patients diagnosed with uncomplicated rUTI and then divide them randomly into two groups with a 1:1 ratio: TLF + CLAT group and placebo + CLAT group. This trial consists of two stages, a 12-week period of treatment and a 12-week period of post-treatment follow-up, respectively. The primary outcome will be the recurrence rate at the 12th week of the follow-up period; the second outcomes will be the post-treatment changes in renal and liver function; furthermore, traditional Chinese medicine (TCM) symptoms, non-infection-related physical signs, and subjective symptoms will be scored, and the number of episodes of each subject will be also recorded; meanwhile, vital signs indicators and serious adverse events (SAEs) will be monitored throughout the trial.DiscussionThis study will provide convictive research-derived data to evaluate clinical efficacy and safety of TLF combined with CLAT for rUTI, and provide an evidence-based recommendation for clinicians. Moreover, post-treatment changes in non-infection-related physical signs and subjective symptoms were included in the efficacy evaluation, which is important and more significant for assessing the clinical benefits for those rUTI patients.Trial registrationChinese Clinical Trial Registry ChiCTR2100041914. Registered on 10 January 2021. Protocol date and version: September 12, 2020; version 1.

Differences of virulence factors, and antimicrobial susceptibility according to phylogenetic group in uropathogenic Escherichia coli strains isolated from Korean patients

BackgroundEscherichia coli is among the most common uropathogens. Increased antibiotic resistance in Gram negative bacilli is global concern. Alternative therapeutic options including vaccines against uropathogenic E. coli (UPEC) have been developed. In this study, we compared the genotypic characteristics and antimicrobial susceptibility of UPEC according to phylogenetic groups.MethodsWe retrospectively reviewed the medical records of pyelonephritis patients with UPEC between February 2015 and June 2018. The study was conducted at a medical center in Korea. We compared the clinical and genotypic characteristics of UPEC according to phylogenetic groups. The phylogenetic groups and 29 virulence factors were identified using multiplex polymerase chain reaction.ResultsPhylogenetic group analysis revealed that most uropathogenic E. coli belonged to groups B2 and D: B2 (276, 77.7%), D (62, 17.5%), B1 (12, 3.4%), and A (5, 1.4%). Among the virulence factors, fyuA, fimH, traT, iutA, papG allele II, and papC were the most frequently observed. Phylogenetic group B2 was more closely related to virulence factors, including fimH, sfa/focED, focG, hlyA, cnf1, fyuA, and PAI, than group D. Groups B2 and D showed similar clinical presentations and complications. Group B2 had mostly healthcare-associated infections and antimicrobial resistance. Group D mostly had community-acquired infections. The K1 serotype was prevalent in group B2, and K5 was the most prevalent in group D.ConclusionsPhylogenetic group B2 had more proportions and types of virulence factors than group D. Group B2 showed a high presentation of virulence factors related to adhesions and toxins. An increased presentation of antimicrobial resistance and healthcare-associated infections was also noted. Considering the genetic characteristics of UPEC, alternative therapeutic options targeting frequent virulence factors might be considered in addition to antibiotics.

384 What Proportion of Pyelonephritis Admissions Under Urology Care Have Surgical Pathology

Abstract Aim To identify the proportion of pyelonephritis patients admitted with true urological pathology Method Retrospective audit Results The majority of adults admitted with diagnosis of pyelonephritis (80%) remain under urology team from 1st day of admission Of the 80% only 9% had an underlying urological pathology confirmed by imaging AND requiring invasive intervention Conclusions High rate of inappropriate admission to surgical / urological ward with subsequent pressure on beds and inevitable cancellations on some occasions Acute pyelonephritis should not be routinely admitted under urology unless there is clear evidence of underlying obstructing pathology or no obvious improvement on antibiotics Consider imaging in terms of US/CT KUB in first instance before making any referral to urology

The utility of human neutrophil peptide (1–3) in upper and lower pediatric urinary tract infections in kerbala province

Human Neutrophil Peptide is important components of the innate defense mechanism in the urinary tract. This aim was investigated by comparing urinary HNP (1–3) peptide levels of upper and lower Urinary tract infections (UTIs) patients to those of controls. A case- control study was conducted in Kerbala teaching Hospital during the period from December 2020 to April 2021. Fifty patients with confirmed pyelonephritis or cystitis and 40 healthy controls without UTI. Urinary level of HNP (1–3) were determined using an Enzyme linked immunosorbent assay (ELISA) kit. The mean concentration of anti-microbial peptide HNP (1–3) ng/ml was 5.8988 ng/ml in pyelonephritis patients compared with cystitis patients 5.1203 ng/ml, while the concentration in patients generally was 5.385 ng/ml compared with heathy control where it was 0.9047.

PBI-017 - Differences of virulence factors, and antimicrobial susceptibility according to phylogenetic group in uropathogenic Escherichia coli strains isolated from Korean patients

Background Escherichia coli is among the most common uropathogens. Increased antibiotic resistance in Gram negative bacilli is global concern. Alternative therapeutic options including vaccines against uropathogenic E. coli (UPEC) have been developed. In this study, we compared the genotypic characteristics and antimicrobial susceptibility of UPEC according to phylogenetic groups. Methods We retrospectively reviewed the medical records of pyelonephritis patients with UPEC between February 2015 and June 2018. The study was conducted at a medical center in Korea. We compared the clinical and genotypic characteristics of UPEC according to phylogenetic groups. The phylogenetic groups and 29 virulence factors were identified using multiplex polymerase chain reaction. Results Phylogenetic group analysis revealed that most uropathogenic E. coli belonged to groups B2 and D: B2 (276, 77.7%), D (62, 17.5%), B1 (12, 3.4%), and A (5, 1.4%). Among the virulence factors, fyuA, fimH, traT, iutA, papG allele II, and papC were the most frequently observed. Phylogenetic group B2 was more closely related to virulence factors, including fimH, sfa/focED, focG, hlyA, cnf1, fyuA, and PAI, than group D. Groups B2 and D showed similar clinical presentations and complications. Group B2 had mostly healthcare-associated infections and antimicrobial resistance. Group D mostly had community-acquired infections. The K1 serotype was prevalent in group B2, and K5 was the most prevalent in group D. Conclusions Phylogenetic group B2 had more proportions and types of virulence factors than group D. Group B2 showed a high presentation of virulence factors related to adhesions and toxins. An increased presentation of antimicrobial resistance and healthcare-associated infections was also noted. Considering the genetic characteristics of UPEC, alternative therapeutic options targeting frequent virulence factors might be considered in addition to antibiotics.

Regulation of Expression of the TIR-Containing Protein C Gene of the Uropathogenic Escherichia coli Strain CFT073.

The uropathogenic Escherichia coli strain CFT073 causes kidney abscesses in mice Toll/interleukin-1 receptor domain-containing protein C (TcpC) dependently and the corresponding gene is present in around 40% of E. coli isolates of pyelonephritis patients. It impairs the Toll-like receptor (TLR) signaling chain and the NACHT leucin-rich repeat PYD protein 3 inflammasome (NLRP3) by binding to TLR4 and myeloid differentiation factor 88 as well as to NLRP3 and caspase-1, respectively. Overexpression of the tcpC gene stopped replication of CFT073. Overexpression of several tcpC-truncation constructs revealed a transmembrane region, while its TIR domain induced filamentous bacteria. Based on these observations, we hypothesized that tcpC expression is presumably tightly controlled. We tested two putative promoters designated P1 and P2 located at 5′ of the gene c2397 and 5′ of the tcpC gene (c2398), respectively, which may form an operon. High pH and increasing glucose concentrations stimulated a P2 reporter construct that was considerably stronger than a P1 reporter construct, while increasing FeSO4 concentrations suppressed their activity. Human urine activated P2, demonstrating that tcpC might be induced in the urinary tract of infected patients. We conclude that P2, consisting of a 240 bp region 5′ of the tcpC gene, represents the major regulator of tcpC expression.

Predictive factors for prolonged hospitalisation in acute pyelonephritis patients admitted to the emergency medicine ward

Background: Acute pyelonephritis is a bacterial infection of the upper urinary tract. Patients can be admitted to a variety of wards for treatment. However, at the Prince of Wales Hospital in Hong Kong, they are managed initially in the emergency medicine ward. The aim of the study is to identify the risk factors that are associated with a prolonged hospital length of stay. Methods: This was a retrospective cohort study conducted in Prince of Wales Hospital. The study recruited patients who were admitted to the emergency medicine ward between 1 January 2014 and 31 December 2017. These patients presented with clinical features of pyelonephritis, received antibiotic treatment and had a discharge diagnosis of pyelonephritis. The length of stay was measured and any length of stay over 72 h was considered to be prolonged. Results: There were 271 patients admitted to the emergency medicine ward, and 118 (44%) had a prolonged hospital length of stay. Univariate and multivariate analyses showed that the only statistically significant predictor of prolonged length of stay was a raised C-reactive protein (odds ratio 1.01; 95% confidence 1.01–1.02; p &lt; 0.0001). Out of 271 patients, 261 received antibiotics in the emergency department. All 10 patients (8.5%) who did not receive antibiotics in emergency department had a prolonged length of stay (p = 0.0002). Conclusion: In this series of acute pyelonephritis treated in the emergency medicine ward, raised C-reactive protein levels were predictive for prolonged length of stay. Patients who did not receive antibiotics in the emergency department prior to emergency medicine ward admission had prolonged length of stay.