Recent Urinary Tract Infection Research Articles

Secretory leukocyte protease inhibitor protects against severe urinary tract infection in mice.

Millions suffer from urinary tract infections (UTIs) worldwide every year with women accounting for the majority of cases. Uropathogenic Escherichia coli (UPEC) causes most of these primary infections and leads to 25% becoming recurrent or chronic. To repel invading pathogens, the urinary tract mounts a vigorous innate immune response that includes the secretion of antimicrobial peptides (AMPs), rapid recruitment of phagocytes, and exfoliation of superficial umbrella cells. Here, we investigate secretory leukocyte protease inhibitor (SLPI), an AMP with antiprotease, antimicrobial, and immunomodulatory functions, known to play protective roles at other mucosal sites, but not well characterized in UTIs. Using a preclinical model of UPEC-caused UTI, we show that urine SLPI increases in infected mice and that SLPI is localized to bladder epithelial cells. UPEC-infected SLPI-deficient (Slpi-/-) mice suffer from higher urine bacterial burdens, prolonged bladder inflammation, and elevated urine neutrophil elastase (NE) levels compared to wild-type (Slpi+/+) controls. Combined with bulk bladder RNA sequencing, our data indicate that Slpi-/- mice have a dysregulated immune and tissue repair response following UTI. We also measure SLPI in urine samples from a small group of female subjects 18-49 years old and find that SLPI tends to be higher in the presence of a uropathogen, except in patients with a history of recent or recurrent UTI, suggesting a dysregulation of SLPI expression in these women. Taken together, our findings show SLPI promotes clearance of UPEC in mice and provides preliminary evidence that SLPI is likewise regulated in response to uropathogen exposure in women.IMPORTANCEAnnually, millions of people suffer from urinary tract infections (UTIs) and more than $3 billion are spent on work absences and treatment of these patients. While the early response to UTI is known to be important in combating urinary pathogens, knowledge of host factors that help curb infection is still limited. Here, we use a preclinical model of UTI to study secretory leukocyte protease inhibitor (SLPI), an antimicrobial protein, to determine how it protects the bladder against infection. We find that SLPI is increased during UTI, accelerates the clearance of bacteriuria, and upregulates genes and pathways needed to fight an infection while preventing prolonged bladder inflammation. In a small clinical study, we show SLPI is readily detectable in human urine and is associated with the presence of a uropathogen in patients without a previous history of UTI, suggesting SLPI may play an important role in protecting from bacterial cystitis.

P07 Impact of menopausal status and recurrent urinary tract infections (UTIs) on symptoms, severity, and daily life: findings from an online survey of women reporting a recent UTI

Abstract Background Current UKHSA urinary tract infection (UTI) guidance advises empirical antibiotics if two of the following symptoms are present: cloudy urine, dysuria, and new onset nocturia. Hormonal changes during menopause may affect UTI symptoms. Qualitative studies suggest women with recurrent UTIs may present with different UTI symptoms. This study aims to assess whether menopausal status and a history of recurrent UTIs affects UTI symptoms in women. Methods An e-survey was conducted between 13 March 2021 and 13 April 2021. Women aged 16 years or older with a history of a UTI in the past year were eligible for inclusion. We defined menopause as those aged 45–64 years; pre-menopause as those less than 45 years; and post-menopause as those 65 years and older. Recurrent UTIs were defined as three or more UTIs in the last year. Data were weighted to be representative of the UK population. Crude and adjusted ORs were estimated using logistic regression. Results A total of 1096 women reported a UTI in the last year. There were significant differences in UTI symptoms based on menopausal status and the presence of recurrent UTIs. Post-menopausal women were more likely to self-report new or worsening incontinence (OR 2.76, 95% CI 1.50, 5.09) with an acute UTI compared with pre-menopausal women. Menopausal women were also more likely to self-report new or worsening incontinence (OR 1.66, 95% CI 1.06, 2.62) and nocturia (OR 1.43, 95% CI 1.05, 1.96) with an acute UTI compared with pre-menopausal women. Women with recurrent UTIs were less likely to self-report dysuria with an acute UTI but reported more severe symptoms (OR 1.93 95% CI 1.37, 2.73) and a greater impact on daily life (OR 1.68, 95% CI 1.19, 2.37) compared with women without recurrent UTIs. Conclusions This survey provides evidence that acute UTIs present differently based on menopausal status and in women with recurrent UTIs. This has implications for the diagnosis and treatment of acute UTIs in these patient populations and suggests that a more tailored approach may be required that takes account of menopausal status and history of recurrent UTIs. It is important healthcare professionals are aware of these differences when assessing women presenting with an acute UTI.

Effectiveness of Platelet-Rich Plasma Injections as Prophylaxis for Recurrent Urinary Tract Infection in Women.

To investigate the therapeutic efficacy of intravesical platelet-rich plasma (PRP) injections as prophylaxis for adult women with recurrent urinary tract infection (rUTI). This proof-of-concept study enrolled 63 women with rUTI in PRP treatment and control groups after achieving control of the most recent urinary tract infection (UTI) episode. The treatment group included 34 women who received 4 monthly intravesical PRP injections. The control group was made up of 30 women who received continuous antibiotic treatment for 3 months. After the completion of PRP or antibiotic treatment, outpatient follow-up was continued for up to 12 months. Treatment was considered successful if ≤2 UTI episodes occurred during a period of 12 months or ≤1 UTI episode within 6 months; otherwise, the outcome was considered a treatment failure. The frequency of symptomatic UTI episodes before and after PRP treatment was compared with that of the controls. Regression analysis was used to determine the association between potential predictors for a failed treatment outcome. At the study endpoint, 33 PRP and 25 control group patients were available for analysis. After four PRP injections, the frequency of rUTI episodes per month was significantly decreased compared with baseline (0.46 ± 0.27 vs. 0.28 ± 0.30, p = 0.047). The PRP treatment success rate was 51.5% (17 of 33) for the PRP group versus 48% (12 of 25) for the control group. The PRP treatment success group had significantly higher voided volume, lower post-void residual volume, and higher voiding efficiency than the PRP treatment failure group. A higher baseline voiding efficacy ≥0.71 was significantly associated with a successful outcome (OR 16.56; p = 0.049). The study results revealed that repeat intravesical PRP injections decreased the recurrence rate of UTI within 1 year in women with rUTI. The treatment success rate with intravesical PRP injections for rUTI was about 51.5%, whereas for women with prolonged antibiotic treatment, it was 48.0%. A baseline VE ≥ 0.71 was associated with a better treatment outcome with PRP injections.

P.109 Meningioma with intraparenchymal abscess: a case report and review of the literaure

Background: Intracranial intratumoural abscesses are rare occurrences typically treated with antibiotics and possible surgical resection. This study describes a meningioma-associated abscess and a review of the literature. Methods: Medical records and investigations were reviewed. A literature search of PubMed was completed. Results: A 56-year-old male presented with septic shock and dysuria. Urine culture isolated E. Coli, and he was treated with Ertapenem prior to discharge. A CT scan was ordered during hospitalization for unrelenting headaches, revealing a meningioma. Conservative management with follow-up as an outpatient was decided. However, he returned within two weeks with a fever and progressive left-sided weakness. A right frontal craniotomy for tumour resection was performed, and culture of necrotic-appearing tissue within the tumour revealed E. Coli. He was treated with Meropenem for six weeks, and at follow-up, the patient was asymptomatic. Our scoping review illustrated that 18 meningioma-associated abscesses have been reported in the literature since the first report in 1994. Conclusions: This case highlights the hematogenous spread of a urinary infection, resulting in an intratumoural abscess. Review of the literature indicated that, similarly, 39% of cases had recent or concurrant urinary tract infections. Future studies should seek to determine conclusive guidelines for diagnosing intratumoural abscesses.

A unique complication: Iatrogenic renal pelvis perforation following accidental urinary catheterisation of an intramural ectopic ureter in a dog

AbstractA 5‐month‐old, female, entire golden retriever presented for investigation of urinary incontinence and recent urinary tract infection. While under general anaesthesia, a urinary catheter was placed to fill the bladder, aid accurate visualisation of the ureteral vesicular junction and facilitate a retrograde contrast study. The preliminary computed tomography was deemed unremarkable, and a computed tomography intravenous urethrogram was performed, followed by retrograde of contrast in an attempted vaginourethrogram. The post‐contrast retrograde study highlighted an unusually straight distal right ureter and contrast escaping into the right retroperitoneal space. Contrast‐enhanced ultrasonography supported haemorrhage into the perirenal space, and on retrospective analysis of preliminary pre‐contrast computed tomography sequences, the urinary catheter was identified in the right renal pelvis. Accidental catheterisation of the right intramural ectopic ureter and iatrogenic renal perforation was ultimately concluded. The dog made a full recovery with conservative management and to date has no chronic repercussions of the injury.

Re-examining advice to complete antibiotic courses: a qualitative study with clinicians and patients.

Antibiotic treatment duration may be longer than sometimes needed. Stopping antibiotics early, rather than completing pre-set antibiotic courses, may help reduce unnecessary exposure to antibiotics and antimicrobial resistance (AMR). To identify clinicians' and patients' views on stopping antibiotics when better (SAWB) for urinary tract infections (UTIs), and to explore comparisons with other acute infections. An exploratory qualitative study with general practice clinicians and patients in England. Primary care clinicians and patients who had recent UTI experience were recruited in England. Remote one-to-one interviews with clinicians and patients, and one focus group with patients, were conducted. Data were audiorecorded, transcribed, and analysed thematically. Eleven clinicians (seven GPs) and 19 patients (14 with experience of recurrent and/or chronic UTIs) were included. All participants considered SAWB unfamiliar and contradictory to well-known advice to complete antibiotic courses, but were interested in the evidence for risks and benefits of SAWB. Clinicians were amenable if evidence and guidelines supported it, whereas patients were more averse because of concerns about the risk of UTI recurrence and/or complications and AMR. Participants viewed SAWB as potentially more appropriate for longer antibiotic courses and other infections (with longer courses and lower risk of recurrence and/or complications). Participants stressed the need for unambiguous advice and SAWB as part of shared decision making and personalised advice. Patients were less accepting of SAWB, whereas clinicians were more amenable to it. Patients and clinicians require good evidence that this novel approach to self-determining antibiotic duration is safe and beneficial. If evidence based, SAWB should be offered with an explanation of why the advice differs from the 'complete the course' instruction, and a clear indication of when exactly to stop antibiotics should be given.

The impact of Technetium-99m dimercapto-succinic acid scintigraphy on DNA damage and oxidative stress in children.

Technetium-99m-dimercapto succinic acid (Tc-99m DMSA) scintigraphy is a commonly used imaging modality in children with urological abnormalities. The radiopharmaceuticals, which have the effects of ionising radiation, are used in this method. This study aimed to investigate the impact of the Tc-99m DMSA scan on renal oxidative stress and mononuclear leukocyte (MNL) DNA damage. Children, who were followed up by paediatric nephrology at Bezmialem Vakif University and underwent Tc-99m DMSA scintigraphy between April 2015 and January 2016 with the indication of detection of renal scars, were included in this study. The exclusion criteria were nephrolithiasis, history of premature birth and recent urinary tract infection 3months prior to scintigraphy or antibiotic use in the last 1month. 3mL heparinised blood samples were obtained just before, immediately after and 1week after the scintigraphy. MNL DNA damage, total antioxidant status (TAS) and total oxidant status (TOS) were measured in the blood samples. The oxidative stress index (OSI) was calculated. Spot urine samples were obtained from each patient before and within 3days after performing the scintigraphy. TAS/Creatinine (TAS/Cr), TOS/Creatinine (TOS/Cr) and N-acetyl-glucosaminidase/creatinine (NAG/Cr) levels were measured in the urine samples. Twenty-seven children were evaluated. The values between TAS, TOS and OSI levels in serum samples at baseline, immediately after and 1week after the scintigraphy (P=.105, P=.913, and P=.721, respectively) showed no statistically significant difference. The levels of TAS/Cr, TOS/Cr, NAG/Cr ratios and OSI, which were evaluated from urine samples before and within 3days after the scintigraphy scan were also similar (P=.391, P=.543, P=.819 and P=.179, respectively). The levels of DNA damage only increased following scintigraphy scan and decreased a week later (P<.05). The effect of Tc-99m DMSA scintigraphy is insufficient to create oxidative damage, but it can cause DNA damage via the direct impact of ionising radiation which can be repaired again in a short time.

Identification of Risk Factors for Invasive Extraintestinal Pathogenic Escherichia coli (ExPEC) Disease

Background: A pathogenic group of invasive extraintestinal pathogenic (ExPEC) Escherichia coli possess the ability to infect normally sterile body sites and cause severe invasive ExPEC disease (IED). ExPEC is a leading cause of bacteremia and sepsis worldwide and is associated with older age and multidrug-resistant infections. Janssen Vaccines &amp; Prevention is developing a novel multivalent glycoconjugate vaccine to prevent IED. We aimed to use an unbiased approach, with no prespecified potential risk factors, using machine-learning models, to screen for and identify IED risk factors for further validation. Methods: We used a patient-level prediction study design to model the probability of a patient developing IED within 14 days to 1 year from a given date based on their prior 2 years of health records. We used the Optum EHR database (~98 million subjects) in the common data model (CDM) format, with health features encoded in the following categories: conditions, procedures, drugs, healthcare visits, recent laboratory measurements, and age and gender. A gradient boosting model (XGBoost) was used with Shapley additive explanation (SHAP) values to identify which features were most important to the model’s decisions and to characterize precisely the relationship between features and outcomes (binary or continuous). Results: Study participants were aged ≥60 years at index with no previously recorded IED. Of ~6,500,000 cases included, ~8,000 had IED during the prediction window. We found that having ≥1 urinary tract infection (UTI) in the retrospective period increased the model’s probability of predicting IED for that patient, with more frequent or more recent UTIs increasing IED prediction chance (Figure 1). Higher age linearly increased the model’s likelihood of predicting that a patient would develop IED. The model also identified ≥1 inpatient or ER visit and laboratory values indicative of renal or immune dysfunction to be correlated with increased IED risk. This methodology is a generalizable approach to screening for potential risk factors for an outcome using EHR databases; it requires little to no prespecification of the health factors or precise relationship between the factors and outcome. Conclusions: Using a new, impartial methodology (with no prespecification), older age and a history of UTIs were key predictive features for IED, factors previously identified through traditional analysis, confirming the validity of the methodology. Novel features, including recent hospitalization, were shown to increase IED risk relative to existing criteria. Our findings may be used to inform the clinical development of preventive strategies.Funding: Janssen Research and DevelopmentDisclosures: None

Does a Recent Urinary Tract Infection Increase the Risk of Postprocedure Urinary Tract Infection After Onabotulinum Toxin A?

(Abstracted from Female Pelvic Med Reconstr Surg 2021;27(2):121–125) Onabotulinum toxin A (BTX-A) is commonly used as treatment for refractory overactive bladder (OAB) but is associated with postprocedural urinary tract infection (UTI) in up to 35% of cases despite antibiotic prophylaxis. In women with recent UTI, it is unclear whether there should be a prolonged waiting period prior to BTX-A.

Risk Factors for Urosepsis After Ureteroscopy for Stone Disease: A Systematic Review with Meta-Analysis.

Introduction: Urosepsis is a serious potential complication of ureteroscopic procedures for stone disease, yet the risk factors for this complication are not well characterized. The purpose of this systematic review with meta-analysis was to identify potential risk factors for urosepsis after ureteroscopy (URS) for stone disease. Materials and Methods: We performed systematic searches of Medline, Embase, and the Cochrane Central Register of Controlled Trials for studies reporting at least one prospectively defined risk factor for urosepsis after URS. Studies that only reported rates of isolated fever, urinary tract infection (UTI), or pooled infectious complications were excluded. The risk factors evaluated in this review were age, sex, body mass index, diabetes mellitus, ischemic heart disease, recent UTI, pyuria, hydronephrosis, stone history, stone size, preoperative stent placement, preoperative positive urine culture, and procedure time. A random effects meta-analysis model with inverse variance weighting was used where the statistic of interest was the odds ratio for dichotomous variables and the mean difference for continuous outcomes. Results: In 13 studies (5 prospective) with 5597 patients, the pooled incidence of postoperative urosepsis was 5.0% (95% confidence interval: 2.4-8.2). Six risk factors were statistically associated with increased postoperative urosepsis risk-preoperative stent placement (odds ratio = 3.94, p < 0.001, 6 studies), positive preoperative urine culture (odds ratio = 3.56, p < 0.001, 6 studies), ischemic heart disease (odds ratio = 2.49, p = 0.002, 2 studies), older age (mean difference = 2.7 years, p = 0.002, 6 studies), longer procedure time (mean difference = 9 minutes, p = 0.02, 1 study), and diabetes mellitus (odds ratio = 2.04, p = 0.04, 6 studies). Conclusions: Current evidence suggests that among patients undergoing URS for treatment of stone disease, the risk of postoperative urosepsis was 5.0%. Older age, diabetes mellitus, ischemic heart disease, preoperative stent placement, a positive urine culture, and longer procedure time were associated with increased postoperative urosepsis risk. These results will assist urologists with preoperative risk stratification before ureteroscopic procedures.

1694. Successful Gut Decolonization of Extended-Spectrum β-lactamase Producing Klebsiella pneumoniae Using Oral Lyophilized Fecal Microbiota Transplant (FMT) in a Woman with Recurrent Urinary Tract Infections

BackgroundIn patients with anatomic disruption or long-term indwelling catheters of the urinary tract, recurrent infections can be a problematic complication. Exposure to multiple antibiotics can set the stage for the acquisition of resistant organisms. Restoration of a healthy gut microbiota may help such patients develop colonization resistance and eliminate multi-drug resistant organisms. We report the successful use of an oral FMT to decolonize an ESBL-producing K. pneumoniae (Kpn) from a woman with an ileal conduit with urostomy and recurrent urinary tract infections (UTI).MethodsFMT was performed using PRIM-DJ2727, an oral encapsulated lyophilized stool product under investigation for treatment of Clostridioides difficile infection. Three doses of PRIM-DJ2727 (60 g total fecal matter lyophilized to 1g/dose) were given weekly under an Expanded Access Investigational New Drug Application protocol approved by the US Food and Drug Administration and the local Institutional Review Board. Urine and stool samples were collected prior to treatment, 1 week after the final FMT dose, at transplant day +70, and transplant day +180. Samples underwent nucleic acid extraction using the Qiagen DNeasy PowerSoli Kit and 16S rRNA sequencing on an Illumina MiSeq.ResultsA 50 year old woman with von Willebrand disease presented with recurrent UTIs after complications from a hysterectomy decades prior. She had an ileal conduit with urostomy, and for the prior 2 years had been colonized with an ESBL Kpn with recurrent episodes of pyelonephritis. In the preceding 6 months, she had 5 symptomatic UTIs (Fig 1). FMT was given 1 week after stopping antibiotics from the most recent UTI. In the 6 months subsequent to the FMT, she developed two symptomatic UTIs, with cultures positive for Achromobacter (Axyl), Stenotrophomonas (Steno), and Enterococcus spp. Axyl and Steno were not identified in the FMT product (Fig 2A). Stool α-diversity increased after the transplant, and recovered by 6 months despite oral fluoroquinolone therapy (Fig 2B). Interestingly, there was an inverse relationship between stool and urine α-diversity. ESBL Kpn was not recovered subsequent to the FMT.Figure 1 Figure 2 ConclusionOral FMT was used to successfully decolonize a woman with recurrent UTIs due to ESBL Kpn.Disclosures Zhi-Dong Jiang, MD, DrPH, UT School of Public Health (Other Financial or Material Support, Patent for PRIM-DJ2727) Herbert DuPont, MD, UT School of Public Health (Other Financial or Material Support, Patent for PRIM-DJ2727) Cesar A. Arias, MD, MSc, PhD, FIDSA, Entasis Therapeutics (Scientific Research Study Investigator)MeMed (Scientific Research Study Investigator)Merck (Grant/Research Support) William R. Miller, MD, Entasis Therapeutics (Scientific Research Study Investigator)Merck (Grant/Research Support)Shionogi (Advisor or Review Panel member)

Assessment of a Potential UTI–Using Videos to Analyze a Simulated Nursing Home Experience

In the past, urinary tract infections (UTIs) have been attributed to poor hygiene, the natural course of aging, an unfortunate corollary of nursing home (NH) residence, and a condition routinely treated empirically with antibiotics. Recent UTI management consensus statements foretell a very different future and support the need to consider all UTIs in the NH as complex infections. Improving assessment capabilities of the NH nurse workforce is essential for improving quality of care. This study aimed to determine how, using simulation, licensed vocational nurses (LVNs) integrated a mobile decision-support app (MDS-app) into assessment of a NH resident with a potential UTI. The MDS-app directed the LVN to examine or question the resident (mannequin) to identify signs and symptoms developed as part of a simulated clinical scenario. MDS-app items were based on UTI practice guidelines. A descriptive, participant observation design (video-taped) was used with ten practicing LVNs. An observation checklist was used to examine audiovisual recordings and included frequency of verbal interaction (17.9+/-7.2), and eye contact (10.6+/-4.1). Participants (47%) were “glued to” the MDS-app without making resident eye contact or touching residents during the assessment. 60% of participants deviated from the app to ascertain urine odor and color; irrelevant symptoms for UTI diagnosis. Assessments required 11.20 (+/-4.67) minutes to complete. The MDS-app provided LVNs with needed focus on data driven by guidelines and not individual LVN preferences. Training LVNs should focus on integration of communication, assessment skills, and MDS-app use for evidence-based data collection as a basis for UTI treatment decisions.

Association of dementia diagnosis with urinary tract infection in the emergency department.

ObjectivesOverdiagnosis of urinary tract infections (UTI) among people living with dementia is a nationally recognized problem associated with morbidity from antibiotics as well as multidrug‐resistant bacteria. However, whether this problem also exists in the emergency department (ED) is currently unknown.MethodsTo examine the association between dementia and UTI diagnosis in the ED we performed a retrospective analysis of Medicare beneficiaries older than 65 years old who presented to an ED in 2016. A diagnosis of UTI was present in 58,580 beneficiaries, and 321,479 beneficiaries without a diagnosis of UTI served as the comparison group. Our logistic regression model controlled for dementia, older age, female sex, Medicaid status, skilled nursing facility residence, history of prostate cancer, recent urinary catheter use, recurrent UTI, and multiple comorbidities.ResultsIn our model, people living with dementia had over twice the odds (odds ratio = 2.27, 95% confidence interval = 2.21, 2.33) of being diagnosed with a UTI in the ED compared to those without dementia despite their lower prevalence of symptoms and signs localizing to the genitourinary tract (3.8% vs 8.9%, respectively).ConclusionThis is the first study from a national database that examines the association of dementia with UTI diagnosis among older adults who visit the ED. Our study could not establish whether the UTI diagnoses in the ED were accurate but does imply a disproportionate burden of UTI diagnoses in people living with dementia despite their lower prevalence of clinical criterion. Antimicrobial stewardship in the ED should address the complexity of UTI diagnosis in dementia.

Diagnosis and Management of UTI in Primary Care Settings-A Qualitative Study to Inform a Diagnostic Quick Reference Tool for Women Under 65 Years.

Background: To inform interventions to improve antimicrobial use in urinary tract infections (UTIs) and contribute to a reduction in Escherichia coli bloodstream infection, we explored factors influencing the diagnosis and management of UTIs in primary care. Design: Semi-structured focus groups informed by the Theoretical Domains Framework. Setting: General practice (GP) surgeries in two English clinical commissioning groups (CCGs), June 2017 to March 2018. Participants: A total of 57 GP staff within 8 focus groups. Results: Staff were very aware of common UTI symptoms and nitrofurantoin as first-line treatment, but some were less aware about when to send a urine culture, second-line and non-antibiotic management, and did not probe for signs and symptoms to specifically exclude vaginal causes or pyelonephritis before prescribing. Many consultations were undertaken over the phone, many by nurse practitioners, and followed established protocols that often included urine dipsticks and receptionists. Patient expectations increased use of urine dipsticks, and immediate and 5 days courses of antibiotics. Management decisions were also influenced by patient co-morbidities. No participants had undertaken recent UTI audits. Patient discussions around antibiotic resistance and back-up antibiotics were uncommon compared to consultations for respiratory infections. Conclusions: Knowledge and skill gaps could be addressed with education and clear, accessible, UTI diagnostic and management guidance and protocols that are also appropriate for phone consultations. Public antibiotic campaigns and patient-facing information should cover UTIs, non-pharmaceutical recommendations for “self-care”, prevention and rationale for 3 days antibiotic courses. Practices should be encouraged to audit UTI management.

Asymptomatic Bacteriuria versus Symptom Underreporting in Older Emergency Department Patients with Suspected Urinary Tract Infection

Asymptomatic Bacteriuria versus Symptom Underreporting in Older Emergency Department Patients with Suspected Urinary Tract Infection

Office Cystoscopy Urinary Tract Infection Rate and Cost before and after Implementing New Handling and Storage Practices.

Based on 2010 American Urological Association recommendations our practice transitioned from sterile to high level disinfection flexible cystoscope reprocessing and from sterile to clean handling practices. We examined symptomatic urinary tract infection rate and cost before and after policy implementation. We retrospectively reviewed 30-day outcomes following 1,888 simple cystoscopy encounters that occurred from 2007 to 2010 (sterile, 905) and 2012 to 2015 (high level disinfection, 983) at the Malcom Randall Veterans Affairs Medical Center. We excluded veterans who had recent instrumentation, active or recent urinary tract infection, performed intermittent catheterization, or had complicated cystoscopy (dilation, biopsy etc). Patient/procedural factors and cost were collected and compared between groups. Both cohorts had similar age (mean 68 years), race (Caucasian, 82%), comorbidities (cancer history, 62%; diabetes mellitus, 36%; tobacco use, 24.5%), and cystoscopy procedural indications (cancer surveillance, 50%; hematuria, 34%). Urological complication rate was low between groups (1.43%) with no significant difference in symptomatic urinary tract infection events (0.99% sterile vs 0.51% high level disinfection, p=0.29) or unplanned clinic/emergency department visits (0.66% sterile vs 0.71% high level disinfection, p=0.91). Roughly 95% of the cohorts were given prophylactic antibiotics, most commonly fluoroquinolones (91%). High level disinfection was $82 cheaper per procedure than sterile with most cost disparity stemming from reprocessing. Total savings for our facility by switching to high level disinfection was more than $100,000 annually. In an older, morbid veteran population receiving centralized care and prophylactic antibiotics we found no difference in symptomatic urinary tract infection or unplanned visits between sterile or high level disinfection techniques. However, high level disinfection was associated with a sizable cost savings, improved clinic workflow, and reduced use of personal protective equipment.

Sodium glucose cotransporter 2 inhibitors and risk of genital mycotic and urinary tract infection: A population-based study of older women and men with diabetes.

The objective of the study was to quantify the association between SGLT2 inhibitors and genital mycotic infection and between SGLT2 inhibitors and urinary tract infection (UTI) within 30 days of drug initiation among older women and men. This was a retrospective cohort study using linked administrative databases of women and men with diabetes, aged 66 years or older, in Ontario, Canada. We compared the incidence of genital mycotic infection or UTI within 30 days between new users of an SGLT2 inhibitor and of a dipeptidyl-peptidase-4 (DPP4) inhibitor. We identified 21 444 incident users of SGLT2 inhibitor and 22 463 incident users of DPP4 inhibitor. Among SGLT2 inhibitor users, there were 8848 (41%) women and the mean age at index was 71.8 ± 5 (SD) years. After adjusting for propensity score, age, sex and recent UTI, there was a 2.47-fold increased risk of genital mycotic infection with incident use of SGLT2 inhibitors (adjusted hazard ratio (HR), 2.47; 95% confidence interval (CI), 2.08-2.92; P < 0.001) within 30 days compared to incident use of DPP4 inhibitors. For UTI, the adjusted HR was 0.89 (95% CI, 0.78-1.00; P = 0.05). Incident use of SGLT2 inhibitors among older women and men is associated with increased risk of genital mycotic infections within 30 days; there is no associated increased risk of UTI. These findings from a real-world setting provide evidence of the potential harms of SGLT2 inhibitors.

Does a Recent Urinary Tract Infection Increase the Risk of Postprocedure Urinary Tract Infection After Onabotulinum Toxin A?

The objective of this study was to evaluate the risk of postprocedure urinary tract infection (UTI) after injection of onabotulinum toxin A (BTX-A) in women who had a UTI within 30 days before procedure. This was a retrospective cohort study of women who underwent their first injection of BTX-A from 2010 to 2016. Two cohorts were identified: (1) recent UTI (within 30 days before injection) and (2) no recent UTI. Our primary outcome was UTI within 90 days after BTX-A. Continuous variables were analyzed using the Wilcoxon rank sum test, and categorical variables were analyzed using Fisher exact or χ2 tests. One hundred sixty-six women underwent their first BTX-A injection. Twenty-five (15%) had a recent UTI and 141 (85%) did not. Women with a recent UTI were more likely to have a subsequent infection (52% vs 26%, P < 0.01). However, in a logistic regression model, controlling for history of recurrent UTI, age, history of diabetes mellitus, periprocedural antibiotics, and urinary retention requiring catheterization, the association between having a recent UTI, and a subsequent UTI was no longer significant (adjusted odds ratio, 1.98; 95% confidence interval, 0.60-6.50; P = 0.26). Performing a first injection of BTX-A within 30 days of a UTI does not increase the odds of postprocedure UTI. Therefore, BTX-A therapy does not need to be delayed after a recent UTI.

Prospective Study on Several Urinary Biomarkers as Indicators of Renal Damage in Children with CAKUT.

The aim of the study was to investigate urinary levels of monocyte chemotactic protein-1 (MCP-1), epidermal growth factor (EGF), β-2-microglobulin (β2M), and FAS-ligand (FAS-L) in children with congenital anomalies of kidney and urinary tract (CAKUT) disease at risk of developing glomerular hyperfiltration syndrome. For this reason, we selected patients with multicystic kidney, renal agenesia and renal hypodysplasia, or underwent single nephrectomy. This prospective, multicentric study was conducted in collaboration between the Pediatric Surgery Unit in Foggia and the Pediatric Nephrology Unit in Bari, Italy. We enrolled 80 children with CAKUT (40 hypodysplasia, 22 agenetic; 10 multicystic; 8 nephrectomy) who underwent extensive urological and nephrological workup. Exclusion criteria were recent urinary tract infections or pyelonephritis, age > 14 years, presence of systemic disease, or hypertension. A single urine sample was collected in a noninvasive way and processed for measuring by enzyme-linked immunosorbent assay urine levels of MCP-1, EGF, β2M, and FAS-L. As control, urine samples were taken from 30 healthy children.Furthermore, we evaluated the urinary ratios uEGF/uMCP-1 (indicator of regenerative vs inflammatory response) and uEGF/uβ2M (indicator of regenerative response vs. tubular damage). These results suggest that urinary levels of MCP-1 are overexpressed in CAKUT patients. Furthermore, our findings clearly demonstrated that both uEGF/uMCP-1 and uEGF/uβ2M ratios were significantly downregulated in all patient groups when compared with the control group. These findings further support that CAKUT patients may, eventually, experience progressive renal damage and poor regenerative response. The increased urinary levels of MCP-1 in all groups of CAKUT patients suggested that the main factor responsible for the above effects is chronic renal inflammation mediated by local monocytes.

MP15-09 ALTERATIONS IN THE URETHRAL MICROBIOME IN PATIENTS WITH GENITOURINARY LICHEN SCLEROSIS

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia I1 Apr 2018MP15-09 ALTERATIONS IN THE URETHRAL MICROBIOME IN PATIENTS WITH GENITOURINARY LICHEN SCLEROSIS Thomas Gaither, Erick Castellanos, Kirkpatrick Fergus, Nima Baradaran, Alan Shindel, and Benjamin Breyer Thomas GaitherThomas Gaither More articles by this author , Erick CastellanosErick Castellanos More articles by this author , Kirkpatrick FergusKirkpatrick Fergus More articles by this author , Nima BaradaranNima Baradaran More articles by this author , Alan ShindelAlan Shindel More articles by this author , and Benjamin BreyerBenjamin Breyer More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.522AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Alterations in the urinary microbiome have been associated with urological disease, such as neurogenic bladder dysfunction and interstitial cystitis. Genitourinary lichen sclerosis (GU-LS) is a chronic, inflammatory condition of unknown etiology, and explorations in the urinary microbiome may shed light into the pathophysiology of this complex disease. METHODS We collected a mid-stream urine sample from men with GU-LS (cases) and men with urethral stricture disease (controls). Cases and controls were matched on age and IPSS score. Patients were excluded if they had recent genitourinary surgery/instrumentation (<2 months) or a recent urinary tract infection (<6 months). Samples were provided for DNA extraction, PCR amplification of the V4 hypervariable region of the 16s rRNA gene, and sequencing. Paired sequencing reads were quality filtered into operational taxonomic units (OTUs) using a 97% sequence similarity threshold. Alpha diversity was measured in richness (number of different OTUs), evenness (abundance of OTUs), and diversity (Shannon, Simpson, Inverse Simpson, and Faith’s phylogenetic diversity). Beta diversity was measured via principal coordinates analyses. RESULTS Successful amplifications occurred in 24/41 (59%) samples; 22 (92%) of amplified samples had quality filtered read numbers above the specified rarefied threshold. There were 5 cases and 17 controls with analyzable data. No differences were observed in median age (57 v. 50, p=0.55) or median IPSS score (16 v. 15, p=0.88). Alpha diversity significant factors included richness (p=0.02) and diversity (Faith’s phylogenetic diversity p=0.01, Simpson diversity p=0.05, and Inverse Simpson diversity p=0.05). Evenness and Shannon diversity did not reach statistical significance (p=0.41 and p=0.06, respectively). We found no differences in beta diversity. Compared to controls the microbiome of patients with GU-LS was enriched with Streptococcus taxa and depleted with respect to Enterobacteriaceae taxa. CONCLUSIONS Men with GU-LS had significantly higher microbiome diversity compared to control patients. However, the relative abundance of species within individual patients did not differ between controls and GU-LS patients. Further work will be required to elucidate the clinical relevance of these variations in the urinary microbiome. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e192 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Thomas Gaither More articles by this author Erick Castellanos More articles by this author Kirkpatrick Fergus More articles by this author Nima Baradaran More articles by this author Alan Shindel More articles by this author Benjamin Breyer More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...