Repeat Urine Cultures Research Articles

Piperacillin-Tazobactam Versus Carbapenems for the Treatment of Nonbacteremic Urinary Tract Infections due to Extended-Spectrum Beta-Lactamase-Producing Enterobacteriaceae.

Background: Carbapenems are the drug of choice for treatment of infections due to extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. Current evidence regarding piperacillin-tazobactam (PTZ) as an effective treatment alternative remains controversial. The purpose of this study was to determine the efficacy of PTZ versus carbapenems for treatment of nonbacteremic urinary tract infections (UTIs) due to ESBL-producing Enterobacteriaceae. Methods: A retrospective cohort study of patients treated for ESBL-related UTIs was conducted at three medical centers in the greater Middle Tennessee area. Patients were included if they were ≥ 18 years old, had a positive urine culture with an ESBL-producing organism, and received ≥ 48 hours of treatment with PTZ or carbapenem. Patients with bacteremia as well as those with isolates resistant to the treatment regimen selected were excluded. The primary objective was to determine the difference in clinical response between PTZ and carbapenem for treatment of ESBL-related UTIs. Clinical response was defined as absence of all of the following: (1) repeat admission for UTI caused by the same organism within 6 months, (2) repeat urine culture within 6 months showing growth of the same organism, or (3) a change in antimicrobial regimen due to subjective failure as determined by the ordering provider. Results: A total of 180 patients were included in the analysis (PTZ = 39; carbapenem = 141). There was no difference in clinical response between patients receiving PTZ and carbapenem (74.4% versus 80.9%; P = .38). Conclusion: PTZ may be an effective alternative to carbapenems for treatment of nonbacteremic UTIs due to ESBL-producing Enterobacteriaceae.

61 Identifying Opportunities to Reduce Cost and Improve Patient Care in the Routine Processing of Urine Samples

There is a strong incentive to reduce the costs associated with processing urine specimens, since tests involving urine specimens are often the most frequently ordered culture studies. Multiple analyses have demonstrated that approximately two-thirds of urine specimens sent to culture yield a negative result. Using the laboratory records of urinalysis and urine culture results for one week (October 20–27, 2016), data were collected on the number of urinalysis and cultures ordered in total and the results of each test for 45 patients. A total of 345 urine cultures and 859 urinalysis tests were ordered in that time. Fifty urine cultures and those patients’ corresponding urinalysis were also analyzed. Of the 50 cultures performed, five were repeat urine cultures, making it a total of 45 patients included in the analyses. Of these, 64 urinalyses were performed. Urinalysis and urine culture were concurrently ordered tests in 40/45 patients (88%). It was found that 11 of 50 cultures resulted in a positive result (22%), making the majority of cultures negative (78%). Due to the high negative result of culture, and the immense cost to the laboratory to process these specimens, a way to reduce costs and to speed up result turnaround time was identified. One solution for our lab is the use an instrument that is already utilized for urinalysis, the IRIS iQ200, as a urine culture screening method to screen out negative urines unnecessarily sent for culture. This intervention aids clinicians by providing faster presumptive culture results, which can shorten empiric antibiotic treatment time with the added benefit of reducing costs to the laboratory and patients.

Preoperative urine culture is unnecessary in asymptomatic men prior to prostate needle biopsy.

To determine the clinical utility of preoperative urine cultures in asymptomatic men undergoing prostate needle biopsy (PNB). One hundred fifty asymptomatic men had urine cultures obtained 14-days prior to PNB. As per study protocol, positive cultures were not treated. Antibiotic prophylaxis prior to PNB included ciprofloxacin 500mg the night before and morning of the biopsy. Repeat urine cultures were obtained immediately prior to PNB with colony-forming units (CFUs) annotated. Infectious complications post-biopsy were recorded. Of the 150 men, six patients (4%) had evidence of asymptomatic bacteriuria with>10,000CFU/mL on office urine culture. Repeat urine cultures on morning of biopsy in all 150 patients noted a mean bacterial count of 55CFU/mL (range 0-1000). All six patients with positive office urine cultures had<100CFU/mL at time of PNB. Following biopsy, four patients (2.7%) developed an infectious complication including two with sepsis and two with culture-positive UTIs. The causative organism in all cases was quinolone-resistant E. coli. None of the six patients with preoperative positive urine cultures developed an infectious complication following PNB. In this prospective observational study, under 5% of asymptomatic men had positive office cultures prior to PNB. Furthermore, repeat urine culture on the morning of biopsy showed resolution in these patients, and none developed post-biopsy infectious complications. Routine office urine culture in the asymptomatic male prior to PNB was unnecessary.

Covert bacteriuria in schoolchildren

Covert bacteriuria is defined as significant bacteriuria detected during a screening program, This study was done as a pari of pilot program held by Medical School University of Indonesia namely Community Health Program. The screening was carried out at four Primary School al Cibubur Subdistrict Eastern Jakarta. The population target was focused on children at the third, four1h and fifth grade from each school. Screening urinalyses include examinatiOfl for the presence of glucose, protein, blood and bacteria. There were 460 children enrolled to this study, but only 449 cases were eligible for assessment comprising 217 males and 232 females aged ranged between 7.4-14.1 years. Covert bacteriuria were found in ten cases (2.22%), comprising five males and females consecutively. Antibiotics were not given. Repeated urine culture done two weeks later revealed that six cases cured spontaneously, four other cases still showing bacteriuria although all cases remain asymptomatic. We conclude that covert bacteriuria in schoolchildren is a benign condition, most of them are spontaneously cured without antibiotic treatment. This conclusion is in accordance with the opinion of most authors that screening for bacteriuria in healthy children does not have a place in any age group including schoolchildren.

Assessment of Fosfomycin for Complicated or Multidrug-Resistant Urinary Tract Infections: Patient Characteristics and Outcomes

Background: Bacterial resistance among uropathogens is on the rise and has led to a decreased effectiveness of oral therapies. Fosfomycin tromethamine (fosfomycin) is indicated for uncomplicated urinary tract infections (UTIs) and displays in vitro activity against multidrug-resistant (MDR) isolates; however, clinical data assessing fosfomycin for the treatment of complicated or MDR UTIs are limited. Methods: We conducted a retrospective evaluation of patients who received ≥1 dose of fosfomycin between January 2009 and September 2015 for treatment of a UTI. Patients were included if they had a positive urine culture and documented signs/symptoms of a UTI. Results: Fifty-seven patients were included; 44 (77.2%) had complicated UTIs, 36 (63.2%) had MDR UTIs, and a total of 23 (40.4%) patients had a UTI that was both complicated and MDR. The majority of patients were female (66.7%) and elderly (median age, 79 years). Overall, the most common pathogens isolated were Escherichia coli (n = 28), Enterococcus spp. (n = 22), and Pseudomonas aeruginosa (n = 8). Twenty-eight patients (49.1%) were clinically evaluable; the preponderance achieved clinical success (96.4%). Fifteen out of 20 (75%) patients with repeat urine cultures had a microbiological cure. Conclusions: This retrospective study adds to the limited literature exploring alternative therapies for complicated and MDR UTIs with results providing additional evidence that fosfomycin may be an effective oral option.

Success of a 3-Day Hard Stop on Repeat Urine Cultures for the Reduction of Reported National Healthcare Safety Network Catheter-Associated Urinary Tract Infections

Success of a 3-Day Hard Stop on Repeat Urine Cultures for the Reduction of Reported National Healthcare Safety Network Catheter-Associated Urinary Tract Infections

Pandrug Resistant Pseudomonus Aeruginosa Isolated From Urine Sample of a Patient of Bitid : A Case Report

A 80 years old diabetic, hypertensive with severe sleep apnoea syndrome male patient who is on BiPAP machine having history of repeated hospitalization in ICU for stroke, LVF,sleep apnoea and chronic urinary retension with repeated urinary catheterization with intake of different parenteral antibiotic therapy presented with burning micturation along with passage of cloudy urine for five days. His urine culture report revealed growth of Pseudomonus aeruginosa which was resistant to all antibiotics like Azithromycine, Cefixime, Ceftriaxone, Cefuroxime, Cotrimoxazole, Amoxyclav, Amikacin, Ceftazidime, Ciprofloxacin, Doxycyclin, Meropenem, Nitrofurantoin, Chloramphenicol, Cefipime, Tetracyclin, Cefpirome, Cefotaxime, Levofloxacin, Piperacilin+Tazobactam, Cefoperazone+Sulbatam, Tygicyclin, and Ticarcillin+Clamlanic acid except Colistin which was sensitive. Patient was given Inj. Colstin for seven days and then was stopped due to severe nephrotoxicity and microbiologically patient was cured. But two weeks after again growth of multidrug resistant pseudomonas occurred in his urine sample. Then patient was given a series of parenteral and oral antibiotics(Inj. Cefuroxime, Inj. Colistin, Inj. Ceftriaxone, Moxifloxacin, Levofloxacin, Azythromycin, Ciprofloxacin, cefixime, cotrimoxazole etc) to which the organism was resistant along with relieve of obstruction by urinary catheterization for last 12 months of study. At follow up after end of study patients well being was good though resistant organism remained in his urine sample proved by repeated urine culture where the colony count of the organism was not in pathological range.&#x0D; JCMCTA 2016 ; 27 (1) : 61 - 64

Pregnant women admitted with urinary tract infections to a public sector hospital in South Africa: Are there lessons to learn?

Background: Urinary tract infection (UTI) is associated with poor maternal and foetal outcomes. There is little information on UTI in pregnancy in South Africa. Objectives: To evaluate the frequency of UTI admissions of pregnant women admitted to a public health facility; and, to describe the outcomes of pregnancies complicated by UTI in our study population. Methods: A retrospective chart review of pregnant women admitted with the diagnosis of UTI during the period of 1 January 2012 to 31 December 2012 was conducted. A midstream urine sample of women admitted with symptoms suggestive of UTI was collected for culture. The diagnosis was confirmed if the culture was positive. The data was analysed using SPSS version 21 and descriptive statistics, viz. percentages, frequency and means were estimated. Results: Of 9,881 admissions, 494 (5%) had a diagnosis of UTI based on clinical features. Sixty had positive cultures and were confirmed as having UTI. Women with UTI had high rates of preterm ruptured membranes (n = 5, 8.3%), preterm deliveries (n = 19, 31.6%), anaemia (n = 26, 43.3%) and renal impairment (n = 4, 6.6%). Two cases of pyelonephritis required admission to an ICU because they developed acute respiratory distress syndrome. The most common pathogen isolated using cultures was Escherichia coli (n = 24, 40%). Only 10% had repeat urine cultures. Conclusion: UTI represents 5% of admissions at the study site. This study highlights the need to improve the quality of care of pregnant women with UTI.

MP36-05 IS PRE-OPERATIVE URINE CULTURE NECESSARY IN ASYMPTOMATIC MEN PRIOR TO TRANSRECTAL PROSTATE NEEDLE BIOPSY?

You have accessJournal of UrologyInfections/Inflammation/Cystic Disease of the Genitourinary Tract: Prostate & Genitalia II1 Apr 2016MP36-05 IS PRE-OPERATIVE URINE CULTURE NECESSARY IN ASYMPTOMATIC MEN PRIOR TO TRANSRECTAL PROSTATE NEEDLE BIOPSY? David Qi, Kathleen Lehman, Kalyan Dewan, Girish Kirimanjeswara, and Jay Raman David QiDavid Qi More articles by this author , Kathleen LehmanKathleen Lehman More articles by this author , Kalyan DewanKalyan Dewan More articles by this author , Girish KirimanjeswaraGirish Kirimanjeswara More articles by this author , and Jay RamanJay Raman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.1639AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Infectious complications following transrectal prostate needle biopsy (PNB) continue to rise. These infections are thought to occur from translocation of bacteria in the rectal vault into the highly vascular prostate. The contribution (if any) of pre-biopsy bacteriuria on infectious sequelae following the procedure remains unclear. We investigate the utility of pre-operative urine culture in a cohort of patients undergoing PNB. METHODS Between March 2013 and August 2015, 150 asymptomatic male patients were prospectively enrolled in an IRB approved study investigating infections following PNB. Routine office urine cultures were obtained 14-days prior to PNB with reports of 10,000 flora or greater recorded. Per study protocol, positive cultures were not treated. Antibiotic prophylaxis regimen prior to PNB included Ciprofloxacin 500mg the day before and morning of the biopsy. Urine cultures were obtained immediately prior to PNB with plating onto Mueller- Hinton agar plates with colony forming units (CFUs) determined after incubation at 37°C for 48 hours. Infectious complications post-biopsy were recorded. RESULTS 150 men with a mean PSA of 11.4 ng/mL were included. 64% were undergoing an initial biopsy and 19% had a history of antibiotic use within the previous 6 months. Six patients (4%) had evidence of asymptomatic bacteriuria on office urine culture including 2 with > 100,000 CFU/mL E.Coli, 1 with > 100,000 CFU/mL Klebsiella, 1 with 10,000 CFU/mL E.Coli, and 2 with 10,000 CFU/mL mixed flora. Just prior to PNB, repeat urine cultures in all 150 patients noted a mean bacterial count of 55 CFU/mL with the highest urine bacterial count being 1000 CFU/mL. All 6 patients with positive office urine cultures had < 100 CFU/mL just prior to PNB. Following PNB, 4 patients (2.7%) developed an infectious complication including 2 with sepsis and 2 with culture positive UTIs. The causative organism in all cases was quinolone resistant E. Coli. None of the 6 patients with pre-operative positive urine cultures developed an infectious complication following PNB. CONCLUSIONS In this prospective study of 150 patients, < 5% had positive office cultures prior to PNB. Repeat urine culture on the morning of biopsy showed resolution in these patients and none developed post-biopsy infectious complications. Routine office urine culture in the asymptomatic male prior to PNB is likely unnecessary © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e491 Advertisement Copyright & Permissions© 2016MetricsAuthor Information David Qi More articles by this author Kathleen Lehman More articles by this author Kalyan Dewan More articles by this author Girish Kirimanjeswara More articles by this author Jay Raman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Screening and treatment of maternal genitourinary tract infections in early pregnancy to prevent preterm birth in rural Sylhet, Bangladesh: a cluster randomized trial.

BackgroundApproximately half of preterm births are attributable to maternal infections, which are commonly undetected and untreated in low-income settings. Our primary aim is to determine the impact of early pregnancy screening and treatment of maternal genitourinary tract infections on the incidence of preterm live birth in Sylhet, Bangladesh. We will also assess the effect on other adverse pregnancy outcomes, including preterm birth (stillbirth and live birth), late miscarriage, maternal morbidity, and early onset neonatal sepsis.Methods/DesignWe are conducting a cluster randomized controlled trial that will enroll 10,000 pregnant women in Sylhet district in rural northeastern Bangladesh. Twenty-four clusters, each with ~4000 population (120 pregnant women/year) and served by a community health worker (CHW), are randomized to: 1) the control arm, which provides routine antenatal and postnatal home-based care, or 2) the intervention arm, which includes routine antenatal and postnatal home-based care plus screening and treatment of pregnant women between 13 and 19 weeks of gestation for abnormal vaginal flora (AVF) and urinary tract infection (UTI). CHWs conduct monthly pregnancy surveillance, make 2 antenatal and 4 postnatal home visits for all enrolled pregnant women and newborns, and refer mothers or newborns with symptoms of serious illness to the government sub-district hospital. In the intervention clusters, CHWs perform home-based screening of AVF and UTI. Self-collected vaginal swabs are plated on slides, which are Gram stained and Nugent scored. Women with AVF (Nugent score ≥4) are treated with oral clindamycin, rescreened and retreated, if needed, after 3 weeks. Urine culture is performed and UTI treated with nitrofurantoin. Repeat urine culture is performed after 1 week for test of cure. Gestational age is determined by maternal report of last menstrual period at study enrollment using prospectively completed study calendars, and in a subset by early (<20 week) ultrasound. CHWs prospectively collect data on all pregnancy outcomes, maternal and neonatal morbidity and mortality.Implications/DiscussionFindings will enhance our understanding of the burden of AVF and UTI in rural Bangladesh, the impact of a maternal screening-treatment program for genitourinary tract infections on perinatal health, and help formulate public health recommendations for infection screening in pregnancy in low-resource settings.Trial registrationThe study was registered on ClinicalTrials.gov:NCT01572532 on December 15, 2011. The study was funded by NICHD: R01HD066156.

Granulomatous Hepatitis as a Consequence of Disseminated Mycobacterium bovis (M. bovis)

A 77 year-old male with history of transitional bladder cell carcinoma diagnosed 12 years ago, presented for further evaluation of recurrent fever, night sweats and weight loss of 1-month duration. Previously he was treated with 3 transurethral tumor resections (TUR) over 7 years and 18 intravesicular Bacillus Calmette-Guerin (BCG) doses. His cancer recurred recently and he underwent a TUR 2 months prior to presentation followed by 2 intravesicular BCG doses, last dose 1 day prior to fever. An extensive infectious work up in the form of blood, urine, and radiographic evaluation was obtained and was negative. Blood and urine cultures were negative. He was empirically treated for BCG cystitis with an antimycobacterial (anti-TB) regimen consisting of isoniazid (INH), rifampin (R), ethambutol and vitamin B6 (B6). His fevers resolved on this regimen and he was discharged on this regimen. He was readmitted 10 days later with fevers. Repeat blood and urine cultures had no growth. In addition, he had mildly elevated transaminases, which were attributed to the R and was substituted with ciprofloxacin. With persistently elevated transaminases, a liver biopsy was done showing granulomatous hepatitis with non-necrotizing granulomas and negative acid-fast bacilli (AFB) stain. Due to BCG therapy, this histologic finding is most consistent with BCG-associated granulomatous hepatitis confirming the diagnosis of disseminated BCG. He was restarted on anti-TB therapy with INH, levofloxacin and B6. His fevers improved 5 days after initiation of therapy. He was discharged on these medications for a 6-month course. Surprisingly, 6 weeks later, initial blood and urine cultures grew M bovis. BCG is a live attenuated strain of M bovis. Intravesicular administration of BCG is commonly used as an adjuvant therapy in superficial bladder cancer. Disseminated BCG is a very rare complication following intravesicular BCG therapy. The prevalence of granulomatous hepatitis in disseminated BCG is 0.7%. Of patients with BCG-associated granulomatous hepatitis, only 10% of patients have tissue that test positive for AFB stains showing mycobacterial organisms. The mechanism by which BCG therapy can cause disseminated M bovis is not clearly understood. One thought is a Th1-mediated hypersensitivity reaction since a number of case reports demonstrated disseminated granulomas with negative AFB and no isolated organism. Our patient did have evidence of disseminated granulomas with negative AFB, but the organism was later isolated in his urine and blood, hence raising the hypothesis that the organism itself also can access the blood stream via uroepithelial cells and disseminate to other organs. In these cases, multi drug anti-TB therapy is recommended for three to six months with or without the addition of glucocorticoids.

Perceptions and behaviours of infectious diseases physicians when managing urinary tract infections due to MDR organisms.

The objective of this study was to attain a better understanding of infectious diseases (ID) physicians' experience with MDR organism (MDRO) urinary tract infections (UTIs) by means of a survey on disease perception, diagnostic management and treatment preferences. A nine-question survey was developed and distributed to members of the North American Emerging Infections Network (EIN) in September 2013. Seven hundred and fourteen out of 1461 EIN members responded to the survey (49%). The responses of 603 responders were studied. Most providers perceived an increase in the incidence of MDRO UTIs over the past 3 years (75% of adult ID responders and 63% of paediatric ID responders). One hundred and thirty-four (22%) responders prefer intravenous over oral administration of antimicrobials when both are available, 171 (28%) prefer longer durations of therapy when comparing an MDRO with a susceptible isolate of the same species and 142 (24%) order a repeat urine culture as 'proof of cure' after treating an MDRO UTI. Nevertheless, 530 (88%) responders perceived MDRO UTIs to be of similar severity as non-MDRO UTIs. Fifty-five percent of providers prescribed fosfomycin for MDRO UTI at least once; the most common prescribing pattern (among a wide spectrum of approaches) was a single dose (16%). Future studies on MDRO UTIs should clarify the role of resistance in patient outcomes and the comparative efficacy of different antimicrobials. Of particular interest is fosfomycin, which is unrelated to other antibiotic classes and may take a more prominent role in treating MDRO cystitis.

Genitourinary tuberculosis in North America: A rare clinical entity.

Although tuberculosis (TB) is the most common cause of mortality from infectious diseases worldwide, genitourinary TB in North America is rare. We review 3 cases of genitourinary TB diagnosed within the last 5 years. The first case is that of a 76-year-old African-Canadian woman who was referred for percutaneous nephrolithotomy of right lower pole renal stones. Although renal TB was suspected, her initial urinary TB culture was negative. On follow-up imaging, she developed bilateral ureteral thickening and ureteroscopic biopsy confirmed necrotizing granulomata. Repeat urine cultures were positive for M. tuberculosis. The second case is a 73-year-old Italian-Canadian woman who was referred for ureteroscopic biopsy of left thickened ureter to rule out urothelial carcinoma. Initial urine TB cultures were negative, despite biopsies confirming granulomatous inflammation. She was closely followed with urine cytologies and TB cultures. Repeat urine culture was positive for M. tuberculosis. Both patients were treated with a course of anti-tuberculous agents and indwelling ureteral stents to relieve ureteral obstruction. The third case is a 70-year-old Cree woman who was referred for percutaneous nephrolithotomy of a left "staghorn stone" in an atrophic left kidney. Thirty years earlier she had been treated for pulmonary TB in addition to ileocystoplasty for a "thimble" bladder. A computed tomography scan showed autonephrectomized left kidney. Her urine TB cultures were negative. She was placed on prophylactic antibiotics for her recurrent bacterial urinary tract infections. Genitourinary TB may present in various subtle ways, and the astute clinician must have a high index of suspicion for this disease in patients with atypical clinical and radiologic findings. In addition, TB urine cultures should be repeated when there is high index of suspicion.

Penicillin G-induced hemorrhagic cystitis: a case and review of the literature

Penicillin G-induced hemorrhagic cystitis: a case and review of the literature

Foul Smelling Urine in a 7-year-old Boy Caused by Aerococcus urinae

To the Editors: Aerococcus urinae is an infrequently reported Gram-positive coccus mostly associated with urinary tract infection in elderly females. Sporadically, the organism has been described as the cause of severe infections.1 We report a young boy who had malodorous urine as the only sign of colonization with A. urinae. This 7-year-old boy was seen at the outpatient clinic because he exuded a bad odor. He was in good health and his medical history was unremarkable. Urinating was not painful and he had no fever. His mother described that after the boy urinated the whole house smelled bad. The general practitioner had found no leucocyturia or nitrite in the urine. Because it was believed that the smell occurred from smegma from under the preputium, a circumcision had been performed but this had no effect on the odor. At physical examination, he was a healthy boy with normal weight and height. The examination, including the genitals, was normal. A metabolic screen was reported normal. Repeated urine cultures consistently revealed significant growth (105 colony forming units/mL) of alpha hemolytic colonies identified as A. urinae. A course of 7 days treatment with co-trimoxazole was given and the smell disappeared. A follow-up urine culture was negative. Echography of the urinary tract revealed no abnormalities. This boy had repeatedly A. urinae in his urine with a foul smell as the only sign. A single course of antibiotics totally resolved the problem of the malodor. A. urinae is reported in about 0.2–0.3% of urine specimens sent in for culture. More than 90% of the patients are females >65 years of age. Most patients have a local or systemic underlying condition, predisposing to urinary tract infection.1 There is no relation between odor and urinary tract infections in the elderly.2 In young patients, A. urinae is reported rarely; we found only 1 article reporting pyelonephritis in a 12-year-old boy who had a history of pyeloplasty for vesicoureteral reflux.3 Our patient had no signs of an underlying disease. Although co-trimoxazole resistance has been described as a key feature in the identification of A. urinae, it was found recently that this is an in vitro effect. Most strains are susceptible to co-trimoxazole.4 A foul smell in children can be a result of bad hygiene, certain food stuffs, undesired loss of urine or feces or even of a metabolic disease. Although some do believe that the malodor of urine is a sign of an urinary tract infection, it has been demonstrated that this is not always true.5 Tjalling W. de Vries, MD, PhD Department of Pediatrics Medical Centre Leeuwarden Leeuwarden, The Netherlands Afke H. Brandenburg, MD, PhD Izore, Centre for Infectious Diseases Leeuwarden, The Netherlands

Repeat urine cultures in children with urinary tract infection

Background Urinary tract infections (UTIs) are the secondleading cause of infection in children, following respiratorytract infections. Repeat urine cultures after antibiotic treatmentare routinely obtained in clinical practice to verify proof ofbacteriologic cure. The American Academy of Pediatrics doesnot recommended repeat cultures, due to increased cost anddiscomfort to patients.Objective To determine the frequency of positive repeat urinecultures after 3 days of antibiotics in children 'With UTIs.Methods We conducted a retrospective study on childrenwith UTIs who visited the Division of Pediatric Nephrology,Department of Child Health at Dr. Soetomo Hospital, Surabayafrom January 2006 to December 2011. Results of repeat urinecultures were obtained after 3 days of antibiotic treatment.Descriptive statistics were used to analyze the data.Results Of the 779 pediatric UTI cases, repeat urine cultureswere performed in 264 (33.9%) cases. Of the 264 patients whocomprised our study, there were similar numbers of girls and boys(50.4% vs. 49.6%, respectively). The mean age of patients was43.9 (SD 1.59) months and 35.5% of subjects were aged under 1year. In the initial urine cultures of our subjects, Escherichia coliwas the most common organism found, v,ith 92 cases (34.8%),compared to 58 cases (21.9%) of Klebsiella pneumoniae and 29cases (10.9%) of Pseudom.onas aeruginosa. Repeat urine culturesshowed no bacterial growth in 168 cases (63.6%).Conclusion Mostly negative repeat urine cultures v,ill probablyobviate the need of this test in daily routine practice. [PaediatrIndanes.2012,52:170·4].

Repeat urine cultures in children with urinary tract infection

Repeat urine cultures in children with urinary tract infection

Investigating prolonged jaundice in healthy breastfed infants- time to change current practice?

Aim To determine the yield of investigations routinely undertaken in healthy breastfed term infants with prolonged jaundice. Methods Retrospective review of medical records of infants with prolonged jaundice referred during a 12-month period from August 2009 to July 2010. Inclusion criteria were (1) ≥ 37 weeks gestation at birth, (2) ≥ 14 days postnatal age (3) normal urine and stool culture. Infants with other clinical concerns were excluded. Microsoft excel was used for data analysis. Results Forty-two infants were referred for prolonged jaundice. 37 met the study criteria; 5 infants were excluded (concerns with adequacy of feeding or weight gain in 4, type of milk feed not documented in 1). Conjugated bilirubin was normal in all infants. Full blood count was normal in 32 of 33 tested. In 1 infant spherocytosis was suspected but subsequently excluded. 34 had a normal Direct Coomb9s test. Thyroid function test (TFT) was normal in 24 of 31 tested. 7 (22.5%) had transiently elevated Thyroid stimulating hormone levels. All abnormal TFTs spontaneously normalised over subsequent weeks. The universal newborn screening thyroid function test was normal in all infants. Urine reducing substances was negative in all 37 infants. 14 of 37 infants had urine tested with dipstix alone and none showed evidence of urinary tract infection (i.e. no nitrites or leucocytes). Of the remaining 23 infants, 14 had normal urine microscopy and culture, 9 had bacterial growth but no evidence of pyuria. Repeat urine microscopy and culture was however normal in these 9 infants. Conclusions The yield of routinely undertaken laboratory investigations for prolonged jaundice was extremely low. If similar results can be demonstrated in a larger study, the threshold for investigations in these babies could be altered leading to reduced unnecessary investigations, whilst still not missing important diagnoses. This could also generate cost savings.

Bacteriuria and antibiotic resistance in catheter urine specimens following radical prostatectomy

ObjectiveThere are increasing reports of infectious complications following prostate biopsy due to fluoroquinolone resistance. To determine infectious complications at catheter removal following radical prostatectomy (RP), another setting in daily urological practice where fluoroquinolone prophylaxis is frequently used. Materials and methodsWe prospectively examined urine culture results collected from 334 RP patients immediately prior to catheter removal. Patients received prophylactic antibiotics 1 day before, the day of, and for 5 days after catheter removal. Culture results were reviewed for bacterial species and antimicrobial susceptibilities. Patients with positive urine cultures resistant to the prophylactic antibiotic were switched to culture-specific antibiotic therapy and underwent follow-up culture. The frequency of urinary tract infection (UTI), complications, additional antibiotic therapy, and repeat urine cultures was determined within 60 days. ResultsOf the 334 patients identified, 203 (61%) had cultures with no bacterial growth, and 48 (14%) had colony counts of <1,000 bacteria or Candida albicans and received no further antibiotics. The remaining 83 (25%) had positive culture results, of which 7% were resistant to ciprofloxacin. Twenty-four bacterial species were identified, with Pseudomonas aeruginosa (5%) Escherichia coli (4%), and Staphylococcus epidermidis (3%) being the most frequent. Only two (0.6%) men developed clinical symptoms consistent with UTI (i.e., suprapubic pain, fever) prior to catheter removal, and no serious complications occurred. ConclusionsA substantial proportion of RP patients have positive urine cultures at the time of catheter removal, despite the administration of prophylactic fluoroquinolone antibiotics. Potentially virulent organisms are commonly cultured, and ciprofloxacin resistance is frequent. However, outcomes are favorable when culture-specific oral antibiotic therapy is initiated.

Conduite à tenir en cas de colonisation d’une sonde à demeure par une bactérie multirésistante chez un futur opéré d’urologie : résumé du forum du CIAFU 2010

The management of an indwelling catheter colonized by a multidrug-resistant bacteria (MRB) in patients scheduled for transurethral resection of the prostate requires: to prevent cross-transmission by implementing additional contact precautions (CPC), to report to the operational team of hygiene, to treat with appropriate antibiotics at least 48 hours before surgery, to change the indwelling catheter 24 hours after initiation of treatment to remove biofilm, not to repeat urine cultures preoperatively to verify the effectiveness of treatment, to keep the same antibiotics until the removal of the probe and to discharge the patient as quickly as possible without urinalysis control.